bluuebunny/crossref_metadata_2025 huggingface dataset:
Liver-Spleen Scanning in Pediatrics
Authors: Rosenfield Nancy , Treves S.
Published: December 2021

Liver-spleen scans on 254 children were reviewed retrospectively with regard to accuracy and yield of the examination. The scan predicted abnormality correctly 95% of the time and normality correctly 86% of the time. Pitfalls in interpretation include the nonspecificity of abnormalities present on the scan, confusion of extrinsic with intrinsic defects, and normal anatomical variations with pathology. The technetium-99m-sulfur colloid scan was found to be most helpful in diagnosing splenic abnormalities, in working up abdominal masses, and in evaluating tumor patients after a baseline scan. It was found least useful in patients with fever of unknown origin, abdominal pain, diffuse liver disease, and most inflammatory conditions. Liver abscesses were not found in febrile, otherwise healthy children. The iodine-131-rose bengal liver scan was found to be useful to differentiate potentially curable lesions (e.g., choledochal cysts) from those not surgically treatable.
Dr. Jean Astruc on the Vicious Conformation of the Froenum Linguae, or Bridle of the Tongue (1746)
Authors: C. T. E.
Published: December 2021

In 1746 an English edition of lectures on diseases of children given by Jean Astruc (1684-1766) was published anonymously in London. Astruc, Regius Professor of Medicine at Paris, as well as Chief Physician to the King of France, had this to say about the management of the "tongue-tied" infant.

The tongue is naturally connected with the fund of the mouth by the help principally of the muscles, called Geniohyoidei, which are inserted on the fore part, under the point of the tongue, where we meet a duplicature of the skin which covers the mouth, forming the froenum linguae. This is sometimes so advanced under the tongue, that the point of this organ cannot be folded or turned back to perform it's necessary functions. Hence this is a disorder of vicious conformations. The midwives prudently anticipate the physicians or surgeon's advice in this case; for immediately after the child is born, whilst the ligament is still very soft and tender, they break its superfluous connection with the tongue by their nail; which if it be not timely done, or if the bridle is too rigid and hard to yield to this method, the nurse soon feels the inconveniency thereof, by the infant's manner of sucking; or it becomes manifest at last when he begins to speak, at which time as the bridle is harder, the operation or incision should be performed by the help of the knife, or, which will do better, by the scissars (sic), putting the patient in a proper and commodius (sic) situation.
Prediction of Hospitalization During Infancy: Scoring the Risk of Admission
Authors: Winter S. T. , Lilos Pearl
Published: December 2021

A cohort of 5,243 live newborn infants in Haifa was followed to determine hospital admissions during the first two years of life. Parameters of the family and the neonate, routinely available at birth, were collected and studied in order to select those which would identify co-host infants with an increased risk of hospitalization during infancy. A total of 767 cohort children (14.6%) were admitted to hospital.

Multivariate analysis showed that many group factors are interrelated and therefore inconsistent. Six single independent factors predisposing to hospital admission could be defined (in order of decreasing significance): increasing birth order, male sex, poor education (up to four years of schooling), birth weight less than 2,250 gm, Jewish mothers born in Asia or Africa, and maternal age up to 24 years.

Numerical risk coefficients allocated to each of the above six single (multivariate) factors enabled the calculation of a predicted risk coefficient scoring the risk of admission to hospital. The use of a score predicted 43.3% of the total initial hospitalizations affecting 23.3% of the total cohort.

The allocation of health resources might be improved by the use of such a method of scoring to select families in need of special services.
Factors Influencing Length at Birth and Height at Five Years
Authors: Wingerd John , Schoen Edgar J.
Published: December 2021

The net effects of various factors on length at birth and height at 5 years were determined in 3,707 single-born white California children. First-born children were significantly short at birth, but taller than average at 5 years. Children born to women with early menarche and children of older parents were average in birth length but taller than average at 5 years. Length and weight at birth showed significant correlations with height at 5 years. The child small at birth was most likely to catch up with his peers at age 5 if short gestation caused small birth size. Children of smoking mothers were short at birth and at 5 years.

Socioeconomic factors (income, education, and occupation) appeared to be of little importance as determinants of growth.

Of the total variation in height at age 5 years which is explained by the factors considered, parental height alone accounted for 88.6%; all other factors for 11.4%.
Pneumococcal Meningitis in Mother and Neonate
Authors: Tempest Bruce
Published: December 2021

Recent reports have stressed several features of meningitis in the newborn period: high mortality rates despite antibiotic therapy, the absence of symptoms and signs of meningeal irritation and the frequency with which enteric bacilli are the causative agent. The observation that obstetrical complications increase the incidence of neonatal meningitis and that the majority of these infants develop their disease before the sixth day of life suggest that the infection is acquired during parturition.

The following case is of interest because of the unusual occurrence in both mother and infant of meningitis due to pneumococci, an organism which is an infrequent cause of meningitis in the neonatal period.
To Tap or Not to Tap in Convulsion (Free Will vs Damnation)
Authors: Lewak Norman
Published: December 2021

Should all children with first febrile convulsions routinely receive lumbar punctures? This issue was raised by Dr. Kafa in a Letter to the Editor (October 1973) issue of Pediatrics. Dr. Menkes defended having such a rule by replying that "(clinical intuition) is not reserved for those physicians who have not yet acquired the ‘feel’ for a seriously ill child."

Dr. Menkes hopes that by making a rule (all children having their first febrile seizure must have a lumbar puncture), better medicine will be practiced.
Glaucoma in Infants and Children, by Marvin L. Kwitko, B.A., M.D., F.A.A.O., F.A.C.S., F.I.C.S., F.R.C.S.(C). New York: Appleton-Century-Crofts, 1973, 651 pp., $28.50
Authors: Walton David S.
Published: December 2021

Less than 25 years ago the treatment of infantile glaucoma was considered hopeless. In the 1940s the goniotomy operation was established as a successful method of treatment for many patients. Since then the early recognition of congenital and infantile glaucoma to allow early treatment has become a pediatric diagnostic responsibility of great practical significance.

This book is the second textbook devoted to the pediatric glaucomas to be published within the last three years, and awareness of its arrival should at the least serve to remind pediatricians of the occurrence of these unusual disorders.
Infektionskrankheiten, vol. IV, edited by O. Gsell and W. Mohr. Berlin/Heidelberg/New York: Springer-Verlag, 1973, 705 pp., $77.70
Authors: Eichenwald Heinz F.
Published: December 2021

The present volume brings to a conclusion a massive series dealing with infectious diseases of man, the first survey of its kind undertaken in the German language in several decades. Some idea of the extent of this effort might be obtained from the fact that these ten-inch-high books occupy, in total, approximately seven inches of shelf space and contain more than twice the number of pages included in the classical volumes "Viral and Rickettsial Infections of Man" by Horsfall and Tamm and "Bacterial and Mycotic Infections of Man" by DuBos and Hirsch.
Pediatric Aspects: From the Embryo Through Adolescence: Special Susceptibility and Exposure
Authors: Lowe Charles U.
Published: December 2021

It is a very special responsibility to open a conference with a title and mission as specific and important as this one. I would like to congratulate both the Academy and the Committee on Environmental Hazards for assuming the responsibility of bringing together professionals from a variety of disciplines to discuss an issue which is clearly of great and increasing importance to the children of our country.

My presentation will emphasize several themes. Perhaps the most important, other than the need to protect infants and children, is the need for research. And it is a need for research which targets on specific vulnerable populations in our nation. I perceive that those with responsibility at the Federal and even the state level attempt to look at the environment as it impacts upon the population of our nation as if it were a homogenized whole. Those of us who deal with infants, children, and adolescents know that, in fact, this is far from the truth. So, my first theme will be research with respect to specific groups of children.

The second theme is the need for professionalism and a broad attack on the issues. I think the need for professionalism becomes less important as disciplines become well established; as yet, environmental studies hardly constitute a discipline. It is thus exceptionally important that we recruit into studies on environmental issues those with broad and competent professional backgrounds.

Our knowledge of age-related responses to a variety of chemical agents comes largely through study of drugs.
Environmental Aspects: Problems and Priorities
Authors: Kotin Paul
Published: December 2021

Man is increasingly creating most of his environment. In the process he has created significant hazards to his health. Some of the adverse effects are longstanding but related to rapid technologic change. There has been an accumulation of contaminants and waste products. Not only is population increasing, but there is also mounting per capita consumption. People continue to concentrate in urban centers. All these changes have greatly magnified the threats and complicated the problems of keeping adverse effects down to acceptable limits.

This Conference is specifically addressed to threats arising from chemical pollutants, with special emphasis on the susceptibility of the fetus and child. It would be misleading, however, to believe that discussions can be limited to these important segments of the population, inasmuch as adverse effects of chemical pollutants following exposure in utero and childhood may not become manifest until late in adult life.

Man's continued drive for material progress has produced many by-products and wastes, some of which are disadvantageous or clearly threatening to his health. A series of crises has resulted at a rapid rate from unforeseen consequences of environmental changes. Solution of these crises has been restricted by the traditional regard for the environment as a series of isolated compartments rather than as a highly integrated continuum of strongly interdependent factors. Multiple factors act singly or in combination, sequentially or simultaneously, in their threats to human health. Such threats occur, furthermore, through exposure to low concentrations of environmental agents over long periods of time and call for action on the basis of sound presumptive evidence well before overt disease is established.
Special Susceptibility of the Host to Chemical Agents: Endocrinologic Considerations
Authors: Gardner Lytt I.
Published: December 2021

THYROID

The thyroid offers a diagnostic advantage over other endocrine glands in that its enlargement can be detected clinically (that is also true of the testis which, however, enjoys somewhat less visibility). It is no doubt because of this visibility of the thyroid that observations on its enlargement in association with environmental events go back for centuries. In addition to endemic iodine deficiency (the classical explanation for endemic goiter and endemic cretinism), there may be additional factors acting as chemical pollutants implicated in thyroid disturbances. The 1972 Kroc Foundation Conference on Endemic Cretinism established that endemic goiter and endemic cretinism are worldwide diseases affecting thousands of persons in such remote geographical areas as the Andes, the Brazilian state of Goiaz, the Himalayas, the mountains of New Guinea, and two separate areas in the Congo.1 The syndrome varies from locale to locale, presumably due to interacting environmental factors.

A study which might be taken as a model is that of DeLange and Ermans in Idjwi Island in the Congo.2 They found that the presence of excessive dietary intake of thiocyanate as a chemical pollutant interacted with dietary iodine lack to produce an unusual and severe form of endemic goiter and endemic cretinism. They found no goiter in their most severe cases of cretinism; the fetal thyroid had been totally destroyed in utero with early brain damage. Figure 1 depicts the two forms of cretinism found on Idjwi Island. This is a classic example of how a dietary lack (iodine) may set the stage for special susceptibility of the host to a chemical pollutant (thiocyanate).
Special Susceptibility of the Fetal and Neonatal Hematopoietic System to Chemical Pollutants Including Drugs Administered to the Mother
Authors: Brown Audrey K.
Published: December 2021

Because of the anemia or bleeding that may herald the adverse impact of any agent upon the hematopoietic system, the capacity of drugs, insecticides, lead, and other agents to cause malfunction of this system has long been recognized. As a matter of fact, the major therapeutic step in the management of recognized aplastic anemia is to separate the child from his environment even before the offending agent has been identified. There is, however, no good evidence to date that the child or neonate is singularly susceptible to aplastic anemia or neutropenia from such agents. In response to other agents, there is a special susceptibility of the hematopoietic system in the fetus and newborn.

One special feature of the fetus affecting susceptibility to environmental agents is that, in a sense, he is trapped in his environment; and, we cannot extract him early enough from exposures via the mother and placenta. The smoking mother, the heroin addict, and the mother exposed to industrial pollutants are the conduits through whom poisons may reach the fetus. The special features of fetal physiology, the stage of organ development, and the phase of physiologic maturity dictate the uniqueness of response at a particular time in gestation or immediately after delivery.

CHEMICAL EFFECTS ON RED CELLS OR PLATELETS

In the last trimester women take an average of 8.7 drug agents or vitamins and 80% of these agents are taken without medical supervision. The impact of these agents on red cells, white cells, platelets, the fetal coagulation system, and on the appearance of pigments formed during red cell destruction are in some instances predictable because of the growing fund of information concerning the unique physiology of these cells and systems in the fetus and newborn.
Metabolic Studies of Environmental Effects
Authors: Dorfman Albert
Published: December 2021

Perhaps some of the comments already made here about developing a theoretical basis for predictive purposes were in disagreement because opportunities vary greatly with the model under discussion. Certainly the general lesson of molecular biology and biochemistry in the last two decades has been surprisingly opposite to that of toxicology in that metabolic pathways are remarkably similar in range, not merely from mouse to man but even from bacteria to man. It is at times hard to accept the claim that animal models are not too useful for studying teratogenesis.

Some principles that have been reviewed today are worth summarizing, because if one thinks of certain parameters, such as the final toxic substance (frequently a metabolite of the original pollutant) there is probably not much difference among various species or organisms. At least so it seems from study of enzyme systems. If one considers simpler situations, such as mercury pollution, he can realize the validity of this concept.

THREE PARAMETERS OF TOXICITY

One could possibly look at the situation as follows: at various stages of the developmental process, starting from the fertilized ovum and progressing to the mature organism or even the aged organism, there are enzymological differences which have become of interest in developmental biology. In particular, in pediatrics we know about programmed processes that go forward inevitably, and others which are subject to control by hormonal influences, by administration of certain substances, or by induction. In the interpretation of any kind of toxic effect, we must consider if our developmental parameter will or will not be toxic at certain stages of development, as I will ifiustrate later.
Effects of Air Pollution on Children
Authors: Holland Walter W.
Published: December 2021

Unfortunately we do not know, at this point in time, which components of air pollution are really the causative agents associated with respiratory symptoms or respiratory diseases, whether it be in the adult or in the child. All that we can say is that air pollution is bad for health, and I would like to emphasize that it is not only air pollution but also other factors that are related to symptoms or disease in both the child and the adult.

ACUTE EFFECTS

When we consider the effects of air pollution, we ought to consider two major types. First, the acute (smog) episode: in London, 1952, we had one of the severest episodes that has ever occurred in the world. There were about 3,000 excess deaths in men and women aged 45 years and over. There were about eight excess deaths in children aged less than 1 year. We could not find any evidence of excess mortality in children older than 1 and below 24 years of age.1 More recently Lawther and my own group have followed up approximately 1,000 children born just before the 1952 smog; that is to say, who were exposed in this smog episode at less than 1 year of age. We contrasted them with a control group, and have not been able to identify any harmful effects in terms of symptoms or lung function among the survivors. However, it is quite clear that air pollution in the first year of life does have an effect on mortality from respiratory disease and other conditions,2 but we cannot show an effect in later periods.
Behavioral Implications of Prenatal and Early Postnatal Exposure to Chemical Pollutants
Authors: Weiss Bernard , Spyker Joan M.
Published: December 2021

Although this Conference focuses on the fetus and child, it should not deflect us from the larger issue-effects over the total lifespan. Early developmental stages are important less in themselves than in what they portend.

So that you do not conclude, to our immense embarrassment, that we are about to envelop you in a Freudian mist, let us immediately brace these statements with some quantitative perspectives.

Assume that exposure to an environmental contaminant takes place over a lifetime-a contaminant that, like methylmercury, can destroy brain tissue (although we don't know whether a threshold for damage exists for methylmercury). What are the implications for central nervous system function and performance? Figure 1 represents extrapolations from a function postulated by Kety,1 on the basis of the then existing literature, to represent aging of the brain. It shows a decline in neuronal cell density (paralleled by declines in oxygen consumption and blood circulation) of about 20% to 25% between age 25 and 75. There is substantial evidence that the central nervous system undergoes a continuous loss of cells throughout postnatal life, that a large proportion of cells die during morphogenesis, and that numerous structural and chemical changes take place both in the developing and the aging brain. An important, in fact a key, concurrent process is the decline with advancing age in a wide range of behavioral performance measures.

Weiss and Simon2 calculated the additional decrease that would be imposed by enhancing the rate of loss calculated by Kety. Even as minute an increment as 0.1% represents a significant acceleration in terms of equivalent brain age.
Antimicrobial Agents for Bacterial Meningitis
Authors: Lindenbaum Jeffrey
Published: December 2021

I was a little disturbed by a sentence in the otherwise informative article, "Bacterial Meningitis: A Symposium," by Smith et al. (Pediatrics, 32:586, 1973). In part 5 on the treatment of bacterial meningitis, it is mentioned that ampicillin is the current agent of choice in bacterial meningitis. This might leave the false impression that ampicillin is the agent of choice for the entire treatment course when in fact this is probably incorrect. Ampicillin appears to be the initial agent of choice pending results of culture and sensitivity and may be the agent of choice in Hemophilus influenzae meningitis.
Medical Care of Newborn Babies: Clinics in Developmental Medicine Nos. 44/45, by Pamela A, Davies, R. J. Robinson, J. W. Scopes, J. P. M. Tizard, and J. S. Wigglesworth, Spastics International Medical Publications. London: William Heinemann Medical Books, Ltd., Philadelphia: J. B. Lippincott Company, 1972, $22.50
Authors: Smith Clement A.
Published: December 2021

Five Senior Members of the Hammersmith Hospital (London) Neonatal Research Unit have here produced an excellent and unusual book. They say it originated as the instructions for the unit's resident staff—"revised when too heavily amended by entries in the departmental diary or when superseded by departmental folklore handed down from resident to resident." (What better winnowing of the clinical wheat from the academic chaff?) While offering details necessary for use in a maternity department with a well-staffed and equipped intensive care unit, the practical viewpoint and clear style of the five authors will render their advice immediately useful to any physician, with or without a blood gas analyzer or a thermistor, when faced with a prenatal, perinatal, or neonatal problem.
Orbital Tumors, by John W. Henderson, M.A. (Anatomy), M.D., M.S. (Ophthalmology). Philadelphia/London/Toronto: W. B. Saunders Company, 1973, 705 pp., $40.00
Authors: Walton David S.
Published: December 2021

The interpretation and appropriate management of orbital tumors in children is an important segment of pediatric ophthalmology. Such lesions are usually first manifested by the onset of proptosis. It is important that the practicing pediatrician be aware of the potential significance of these signs. A review of Dr. Henderson's textbook would quickly familiarize the reader with the potential tumors that can occur within the orbit and put into appropriate perspective his own concern in regard to the occurrence of proptosis in children.
Congenital Tuberculosis: Report of a Case
Authors: Reisinger Keith S. , Evans Palmer , Yost Gerald , Rogers Kenneth D.
Published: December 2021

This report describes an infant with congenital tuberculosis. The rarity of congenital acquisition of tuberculosis makes this case unusual. The infant presented with a problem of pulmonary infiltrates unresponsive to antibiotics. Only after the patient died at 8 weeks of age was the diagnosis confirmed by isolation of M. tuberculosis. The mother was febrile at delivery and in the postpartum period. She had a negative PPD skin test reaction and chest x-ray after delivery but left the hospital before the etiology of her febrile illness was determined. She died 3½ months after delivery despite eight weeks of chemotherapy for tuberculosis. Postmortem examination of the mother revealed miliary tuberculosis with marked involvement of the pelvic organs. Progressive primary tuberculous infection of the mother appears likely. The mode of fetal infection could not be determined, but hematogenous transmission via the umbilical vein or through fetal aspiration of infected amniotic fluid is likely.
The Problem With the Replacement of Copper Pennies by Aluminum Pennies
Authors: Heller Richard M. , Reichelderfer Thomas E. , Dorst John P. , Sang Oh Kook
Published: December 2021

The United States Mint may begin producing an aluminum alloy one-cent coin. Aluminum, unlike copper, is not radiodense and an ingested aluminum coin is difficult to distinguish on radiographs. Since children often swallow coins, this is of particular interest to pediatricians. Should the proposed aluminum coin be minted, pediatricians and radiologists will have to exercise special care in assessing children who may have swallowed such a coin.
Neurotoxicity of Hexachlorophene in the Human: I. A Clinicopathologic Study of 248 Children
Authors: Shuman Robert M. , Leech Richard W. , Alvord Ellsworth C.
Published: December 2021

To assess the susceptibility of human beings to the neurotoxic effects of hexachlorophene demonstrated in experimental animals, a blind clinicopathologic analysis was made of 248 children coming to autopsy over a 7.5-year period in the two Seattle institutions to which practically all premature or sick children are referred. Repeated whole-body bathing of premature newborn infants in 3% hexachlorophene-bearing soap (undiluted pHisoHex) is associated with a vacuolar encephalopathy of the brainstem reticular formation. The prevalence of the vacuolar encephalopathy appears to be related to the number of exposures to hexachlorophene, to the concentration of hexachiorophene, to the birth weight (gestational age), to the length of survival and to the thoroughness of rinsing. From these observations we conclude that hexachlorophene should not be used on neonates under 1,400 gm birth weight and should be used only sparingly in full-term neonates with thorough rinsing.
Who Invented the Ice Cream Sundae?
Authors: Dickson Paul
Published: December 2021

The ice cream sundae emerged in the late 1890s and became extremely popular around the turn of the century. This popularity was substantially aided by laws prohibiting the sale of sodas on Sunday, and for this reason the concoction was first known as the "Sunday" or the "Soda-less Soda." The more elegant -ae ending probably came about when those who orated from the pulpit on the sinful soda went to work on the sacrilegious use of the name of the Sabbath for its stand-in.

As for the specific birthplace of the dish, two possibilities emerge as the most likely among many contenders. Neither place can offer conclusive dates, so one can pick between "Heavenston" (favored by the National Dairy Council, among others) and Two Rivers (championed by such diverse sources as the old Ice Cream Review and H. L. Mencken in his American Language).

The first claim goes back to the 1890s in Evanston, Illinois (then widely known as "Chicago's Heaven" or "Heavenston"), where civic piety had reached such a state that it became the first "Sunday Soda Menace." This prompted confectioners to create Sundays so that they could do business on the Sabbath. Ironically the soda was later given a strong boost from this community when the Evanston-based Women's Christian Temperance Union (WCTU) championed it as a pleasant alternative to alcoholic drinks.

The Two Rivers, Wisconsin, claim goes back to the same era and, so the story goes, was created when a youth named George Hallauer went into Ed Berner's soda fountain for a dish of ice cream.
Dr. J. Marion Sims Wonders How To Treat a Child With Cholera Infantum (1835)
Authors: C. T. E.
Published: December 2021

The major limitation of formal American medical education in the early 1800's was the absence of any practical clinical and laboratory training.1

J. Marion Sims (1803-1883), probably the most eminent gynecologist and surgeon of his day, wrote as follows about his first case as a newly graduated physician—an infant suffering from gastroenteritis (then called cholera infantum).

. . . I examined the child minutely from head to foot. I looked at its gums, and, as I always carried a lancet with me and had surgical propensities, as soon as I saw some swelling of the gums I at once took out my lancet and cut the gums down to the teeth. This was good so far as it went. But, when it came to making up a prescription, I had no more idea of what ailed the child, or what to do for it, than if I never studied medicine. I was at a perfect loss what to do....

I hurried back to my office, and took out one of my seven volumes of Eberle, which comprised my library, and found his treatise on the "Diseases of Children." I hastily took it down, turned quickly to the subject of "Cholera Infantum," and read it through, over and over again, to the end most carefully. I knew no more what to prescribe for the sick babe than if I hadn't read it at all. But it was my only resource. I had nobody else to consult but Eberle....
Pediatric Education—For What?
Authors: Bergman Abraham B.
Published: December 2021

I am at the midpoint of my medical career; about ten years getting trained to be a pediatrician, and about ten years supposedly training others to be pediatricians. And though the worm's eye perspective is probably the worst, I would like to examine the past 20 years of medical education, and then try to take a look at where we're heading. I will speak mostly of pediatric education because it is what I know best.

I entered pediatrics when the subspecialties were bursting forth into full bloom. The diagnostic and therapeutic tools used by the cardiologists, hematologists, endocrinologists and others have profoundly improved the care of sick children. Where the unique talent of all pediatricians used to be applied to care of the newborn, now few of us "generalists" dare enter the sanctum of flashing lights, clicking machines, and hissing vapors. By the time I entered pediatrics, at least lip service was paid to the notion that children had minds and souls as well as bodies, and that they came from families and communities. Pioneers like Ben Spock, Milton Senn, and a few others in this country had fought hard to establish psychosocial pediatrics; physicians of my generation, if not families, reap the fruits of their efforts.

Another change that I witnessed was the growth of full-time faculties to teach clinical medicine—basic science teachers had, of course, come in long before. Where previously the bulk of clinical teaching was performed by practitioners who had to make a living seeing private patients, I was trained mostly by physicians who were paid to do so—or so I thought.
Recurrent Idiopathic Thrombocytopenia Purpura With "Accessory" Splenic Tissue
Authors: Aspnes Gregg T. , Pearson Howard A. , Spencer Richard P. , Pickett Lawrence K.
Published: December 2021

Idiopathic thrombocytopenic purpura (ITP) of childhood has a relatively good prognosis with only 5% to 10% of patients manifesting chronic disease. Chronic idiopathic thrombocytopenic purpura is one of the disorders often benefited by splenectomy,1 but recurrences of thrombocytopenia at various time intervals following removal of the spleen may occasionally occur. Recurrences are probably due to exacerbations of indolent chronic disease; rarely, other causes may be operative. We present here a report of recurrence of ITP in a previously splenectomized patient in whom accessory splenic tissue was documented by radioisotopic scanning. Removal of the small accessory spleen was followed by return of the platelet count to normal levels.
WHO INVENTED THE ICE CREAM CONE?
Authors: Dickson Paul
Published: December 2021

On April 28, 1954, the pooh-bahs of the cone and ice cream industries assembled in St. Louis to celebrate the golden anniversary of the ice cream cone. Under the sponsorship of the International Association of Ice Cream Manufactuners IAICM), the two-day celebration/convention was held at the Chase Hotel, built atop the very spot where the Association had determined that the first cone had been made.

It was a festive affair honoring the late Ernest A. Hamwi, a Syrian who had come to St. Louis from Damascus in 1903. Based on the IAICM's investigations, the birth of the cone goes like this.
Newborn Screening for Duchenne Muscular Dystrophy
Authors: Zellweger Hans , Antonik Alan
Published: December 2021

Duchenne muscular dystrophy (DMD) occurs in about 1 of 3,000 to 4,000 boys. Laboratory evidence of the disease, notably elevated creatinephosphokinase (CPK), is present already in the newborn infant. Unspecific CPK elevation occurs in the newborn as well, yet disappears shortly thereafter, while in DMD patients the CPK remains high throughout infancy.

A new method to reliably determine CPK in a drop of dried blood is described. The method fulfills the criteria given for a suitable screening method in the newborn infant. Although DMD is an incurable disease, early diagnosis has benefits. The latter include early beginning of supportive treatment and particularly recognition of heterozygous carriers of the mutant gene before other affected children are born in a stricken family. It is proposed to adopt the method as a new screening procedure for male newborn infants. (Received January 15; revision accepted for publication March 27, 1974.)
Cystic Fibrosis Detection by Means of a Test-Strip
Authors: Stephan U. , Busch E.-W. , Kollberg H. , Hellsing K.
Published: December 2021

The effectiveness of meconium screening for albumin as an indication of cystic fibrosis is examined. BM-Test Meconium was applied to 69,000 investigations. In 60 positive tests, cystic fibrosis was confirmed later. No increased albumin content was observed in four cases of (Received May 24; revision accepted for publication August 21, 1974.)
WHO INVENTED THE GOOD HUMOR BAR?
Authors: Dickson Paul
Published: December 2021

One of those who heard of Nelson's original 1919 discovery that melted chocolate could be made to adhere to ice cream was Harry Burt, a confectioner and ice cream parlor operator in Youngstown, Ohio. Burt, who had successfully marketed a lollipop called the Good Humor Sucker, was always looking for new ideas, so in 1920 he decided to try to replicate Nelson's feat. After a series of failures, late one night Burt emerged from his hardening room and presented his new ice cream bar to the family to taste. His daughter approved but thought the bar "too messy" and asked why he did not put it on a stick like his famous lollipop. Father Burt went back to the hardening room and tried a new prototype model with a stick in it. A bond was formed by ice crystals interlocking with the wooden handle and it stuck. He immediately applied for a patent on the Good Humor Ice Cream Sucker. Burt liked the name "Good Humor" because it expressed his belief that the humors of the mind were regulated by those of the palate.

After three years of waiting, the Good Humor patent had still not come through, so Burt's son, Harry, Jr., was sent to Washington with a five-gallon can of Good Humors which he carried to the Patent Office. Young Harry literally forced his evidence into the mouths of patent officials, who then agreed that it was an original idea and granted the patent.
Idiopathic Thrombocytopenic Purpura in Children: Diagnosis and Management
Authors: McClure P. D.
Published: December 2021

In children, the term idiopathic thrombocytopenic purpura (ITP) has been loosely applied to at least four conditions; postviral thrombocytopenia, "true" idiopathic thrombocytopenia in which no precipitating factor or associated illness can be found, thrombocytopenia associated with other autoimmune syndromes and drug-induced immune thrombocytopenia. Patients initially thought to have "true" ITP may later develop lupus erythematosus or hemolytic anemia and hence move from one category to another.

In 1951 Harrington demonstrated an antiplatelet factor in the serum of patients with ITP. Later this factor was proven to be an antibody of the IgG class and to be present in the blood of all four types of patients. Platelets lightly coated with antibody are sequestered and removed by the reticuloendothelial system in the spleen while more heavily coated platelets may be removed in the liver.2-4 The spleen further contributes to the thrombocytopenia by producing platelet antibodies.5-7 Recently Wybran and others8-10 have shown that cell-mediated immunity to autologous platelets may also be a factor in the pathogenesis of some cases of ITP. In view of the obvious association of ITP and altered immune mechanisms some authors have suggested the term ITP be changed to immunological or immunogenic thrombocytopenic purpura.11, 12 Karpatkin, Garg and Siskind recommend that if a platelet antibody can be demonstrated in the absence of associated disease, the term autoimmune thrombocytopenic purpura (ATP) be applied.13 Since not all patients have demonstrably altered immunity and since the cause of autoantibody production is unclear, we think the term idiopathic thrombocytopenic purpura should be retained at least for those cases in which the precipitating cause (virus or drug) cannot be identified.
Expenditures for child health care
Authors: Haggerty Robert J.
Published: December 2021

Costs for medical care, new financing schemes, and methods to curtail rising costs have become a paramount concern in many minds in recent years. Most of us, as physicians, find this emphasis somewhat disturbing, for we have operated on the assumption that anything we could do that might result in more good than harm for the individual patient should be done, no matter how marginal the gain in health. Now we must operate on a more fixed total health-care budget and use this for the greatest good. There are and will be unsettled ethical or philosophical issues as to how far we should push utilitarianism—the greatest good for the greatest number—for there are other human values of equal or higher importance.
Yersinia enterocolitica Arthritis
Authors: Jacobs Jerry C.
Published: December 2021

Human infections with Yersinia were first recognized and reported in upper New York State almost 40 years ago. Recently, there have been increasing numbers of reports from Scandinavia of episodes of polyarthritis associated with Yersinia infections.

A 6-month-old girl from upstate New York had a fever of 40 C for two weeks and green watery diarrhea, and irritability was noted when she was handled. An evanescent rash was most apparent at times of temperature elevations. Her mother and father had had diarrhea during the month preceding the child's illness.

Stool cultures were grown in an effort to identify Yersinia enterocolitica if it was present, and the organism was found. A rise in serum agglutination titer against polyvalent Y. enterocolitica was demonstrated from zero to 1:256 dilutions.

Y. enterocolitica is probably a cause of arthritis, mesenteric adenitis, and erythema nodosum in the United States.
THE LIMITS OF MEDICAL CARE
Authors: Illick Ivan
Published: December 2021

Overpopulation makes more people dependent on limited resources. Affluence compels each person to use more energy. Faulty technology degrades energy in an inefficient way.

Honesty requires that we each recognize the need to limit procreation, consumption and waste, but equally we must radically reduce our expectations that machines will do our work for us or that therapists can make us learned or healthy.
PHYSICIAN'S ASSISTANTS
Authors: Bicknell W. J.
Published: December 2021

The U.S. primary-care assistant seems lost in a vicious circle: problems in the American health-care system (high cost and hospital orientation, lack of satisfaction for patient and provider with primary-health-care services, and the related maldistribution of physicians)—problems which might be mitigated by utilising physicians' assistants and nurse practitioners—themselves militate against effective use of such assistants. Financial incentives, educational systems, and traditional patterns of behavior and expectation all work in the opposite direction; all favour decisions which virtually preclude good primary care—maximum hospital usage, short physician visits, minimal delegation to non-physicians. There will have to be a substantial change in the U.S. system before physicians' assistants and nurse practitioners can begin to function well, and can hope to contribute to the quality, accessibility, and cost-effectiveness of primary care.
PEOPLE OR PERSONNEL
Authors: Goodman Paul
Published: December 2021

There is the realization . . . . that urban anomie and the hopelessness of rural areas that have lost their economies cannot be manipulated away by simply imparting social and medical services, or even money.

The new wisdom is that the neighborhood(or community) must "participate" in its own reconstruction. . . . The best means of creating community is to delegate power.

Throughout society the centralizing style of organization has been pushed so far as to become inefficient, economically wasteful, humanly stultifying and ruinous to democracy . . . .the only remedy is a strong admixture of decentralism.
Metric Blood Levels of Diphenylhydantoin
Authors: Preiser Gary
Published: December 2021

Since completing my residency at Pittsburgh Childrens Hospital, I have been practicing pediatrics for one year in Walton, New York, a rural town of 4,000. I rely largely on the pediatric journals to update the quality of my practice. The series of articles about epilepsy in the April 1974 issue of Pediatrics was very informative. As recommended, I use drug blood levels obtained at nearby Wilson Memorial Hospital in Johnson City, New York, as an adjunct for seizure control in my epileptic patients.
Lettrt To The Editor
Authors: Menkes John H.
Published: December 2021

Dr. Preiser has found us out in an error which should be rectified. The optimal therapeutic blood levels of diphenylhydantoin for the treatment of psychomotor disorder seizures1 are 1 to 2 mg/100 ml or 10µg to 20µg per milliliter.
Lettrt To The Editor
Authors: Fleisher David R.
Published: December 2021

I would state that in the past six years, during which my practice has been confined to pediatric gastroenterology, I have not had the opportunity to treat a single patient with acrodermatitis enteropathica. I agree that the halogenated hydroxyquinolines are the drug of choice for this condition. It may be of interest that approximately 15% of all my new referrals are infants or school-age children with irritable colon syndrome as described by Murray Davidson and others.
Measles Immunization Status in 1972 Among First- and Second-Grade School Children in Danbury, Connecticut
Authors: Lepow Martha L. , Steele Frances M. , Ross Martin R. , Randolph Martin F.
Published: December 2021

An increased incidence of rubeola among first-grade Danbury school children in 1973 led to a study of seroimmunity to rubeola in a random sample of 60% of the first- and second-grade school children (299) from whom blood samples had been obtained in October 1972 during a voluntary meningococcal vaccination program. Immunization histories derived from physicians' statements on school entry were obtained from school health department records and included date of immunization. Seventy-five percent of the study group had received measles vaccine. Of those immunized prior to 11 months of age only half had an hemagglutinating inhibiting titer (HAI) of ≥5 five to seven years later. This antibody level correlates with immunity. Eighty-five to ninety percent of those immunized during or after the 11th month had an antibody titer of ≥5. Seventy-one percent of those never immunized also had an HAI titer of ≥5 indicating natural infection had occurred. As a result of this investigation, a community-wide program was initiated to vaccinate those who were more than 1 year old as well as reimmunize those who had been vaccinated before the 11th month in accord with current U.S. Public Health Service recommendations for measles immunization.
Are Physicians Really Needed?
Authors: Eskes Philip W. H.
Published: December 2021

Dr. Mortimer’s commentary on the letter of David Turbeville on Indian health deserves discussion, or more specifically, his statistics on the Indian Health Service. He states that as of July 1974 only 408 physicians will be available in the I.H.S. for some 523 funded positions (66% of those believed needed, 78% of those funded), and the situation will be worse after July 1, 1975.

Apparently reflecting these figures, an announcement appeared in the July issue of News and Comments asking for short-term volunteers for the I.H.S. on the Navajo reservation.
Vaccination against herpesviruses
Authors: Brunell Philip
Published: December 2021

The elimination of infectious diseases in the United States during this century has been a truly remarkable achievement. Mortality from diphtheria, smallpox, pertussis, poliomyelitis, and tetanus have been reduced dramatically. Consequently, attention turned to the conquest of diseases such as measles, rubella, and even mumps. As the expertise which was acquired in these efforts is applied to elimination of infectious diseases that produce relatively less morbidity, the wisdom of pursuing these goals is critically evaluated.

Skepticism stems not only from bureaucratic considerations of cost-benefit ratios, but also from the fear that vaccines are not themselves without risks. We have been sensitized, if you will excuse the pun, by a number of sobering experiences such as the use of killed measles vaccines.
Postnatal Development of Obstruction in Coarctation of the Aorta: Role of the Ductus Arteriosus
Authors: Talner Norman S. , Berman Michael A.
Published: December 2021

The sequence of events leading to the development of acute obstruction in two infants with coarctation has been defined by clinical, hemodynamic, and angiographic studies. One infant had normally related great arteries and an isolated coarctation, while the other infant had transposition with a hypoplastic right ventricle, a ventricular septal defect, narrowing of the aortic isthmus, and a localized site of coarctation. In each instance, a posterior aortic shelf-the basic pathologic lesion in coarctation-could be observed angiographically. Signs of aortic obstruction were absent, however, as long as the ductus arteriosus was widely patent. Following ductal obliteration, femoral pulsations diminished, a peak systolic pressure difference was recorded between the ascending and descending aorta, and a discrete area of juxtaductal coarctation was seen. The basic malformation (posterior aortic curtain) would appear to exist in utero, possibly as an aortic branch point. This lesion is nonobstructive as long as blood can traverse the aortic isthmus through the aortic end of the ductus into the descending aorta. Postnatally, as the ductus arteriosus undergoes goes constriction at its aortic insertion, signs of acute aortic obstruction may become apparent. Normal femoral arterial pulsations during the newborn examination do not definitively exclude coarctation. Pediatricians should recheck at 2 weeks of age if the infant is asymptomatic or sooner if there are signs of cardiac failure to establish the presence or absence of this defect.
Hydranencephaly
Authors: Philip Alistair G.S.
Published: December 2021

The article by Koffler and colleagues presented an interesting hypothesis attributing hydranencephaly to elevated hematocrit levels in a newborn. The hypothesis is quite reasonable, but appears to be based on shaky clinical evidence.

The authors make it clear that their determinations of hematocrit levels were made on capillary blood, but do not make it clear how they were obtained. Their statements about polycythemia and hyperviscosity relate to venous blood. Since no studies of viscosity were performed, it may not be justifiable to assume that because the capillary hematocrit was greatly elevated, hyperviscosity was present.
Drs. Greensher and Mofenson Reply
Authors: Greensher Joseph , Mofenson Howard C.
Published: December 2021

Drs. Kaemmer and Johnson have rightfully pointed out that the patient in question had a single lead level of 64µg/100 ml and X-rays of the wrists and knees demonstrating lead lines as the only evidence of systemic lead absorption.

The authors recognized that treatment with BAL and calcium EDTA was started too hastily but felt that a discussion of treatment was not germane to the reporting of the unusual source of the lead poisoning in this article.