bluuebunny/crossref_metadata_2025 huggingface dataset:
ADRENOCORTICAL FUNCTION IN THE NEWBORN INFANT AS MEASURED BY ADRENOCORTICOTROPIC HORMONE-EOSINOPHIL RESPONSE
Authors: KLEIN ROBERT , HANSON JAMES
Published: December 2021

ACTH was given to newborn infants and the changes in circulating eosinophils were measured. There was much less response in infants in the first week of life than there was in infants over 1 week of age. Nine out of 11 infants given lipoadrenal extract in the first 2 days of life showed adequate eosinophil falls.
677 CONGENITALLY MALFORMED INFANTS AND ASSOCIATED GESTATIONAL CHARACTERISTICS
Authors: WORCESTER JANE , STEVENSON STUART SHELTON , RICE ROBERT GERALD
Published: December 2021

The obstetric records of all mothers who gave birth to congenitally malformed infants live or stillborn in the Boston Lying-in Hospital during the years 1930 through 1941, together with the pediatric records of their live babies during the neonatal period, have been abstracted and analyzed. Statistical evaluation of data from such a source offers a means to study the etiology of congenital anomalies; and many factors have been found to be associated with pregnancies which result in the birth of defective infants. The statistical method presents several difficulties, however, and it must be used with careful regard for proper sampling and controls, if fallacious conclusions are to be avoided. It is suggested that in future studies from large maternity hospitals analysis of all neonatal deaths and stillbirths be made in conjunction with analysis of defective infants. Such analysis of current records both of malformed and of normal infants should serve eventually to clarify the relations between the factors and to indicate which are the causes and which the effects.
PERTUSSIS DUE TO BRUCELLA BRONCHOSEPTICA
Authors: MAN CHANG SHIH
Published: December 2021

A case clinically resembling pertussis due to Br. bronchoseptica is reported.
PERNICIOUS ANEMIA IN AN EIGHT YEAR OLD GIRL
Authors: ROSENZWEIG LEONARD , BRUTON OGDEN C.
Published: December 2021

A progress report on an 8 year old female diagnosed as "nutritional anemia" at 4 months of age is presented.

The patient's good response, both clinically and hematologically, to folic acid and vitamin B12 during relapse has been observed.

She now appears to fulfill all criteria for the diagnosis of pernicious anemia and because of its rare occurrence in childhood she is reported as an additional case of that disease.
USE OF DRUGS IN THE DIAGNOSIS AND TREATMENT OF PHEOCHROMOCYTOMA
Authors: MCCOY G. E. , BRIDGEMAN M. L.
Published: December 2021

A case of a pheochromocytoma in a 13 year old white male is presented. The preoperative and postoperative effects of benzodioxain, dibenamine®, sedation, cold and posture on blood pressure in such a patient are shown. An eight month follow-up study is reported. The fact is re-emphasized that hypertension caused by a solitary pheochromocytoma may persist for many weeks following its removal. It may also return to normal immediately and stay there.
PRECOCIOUS PUBERTY
Authors: LLOYD CHARLES W. , LOBOTSKY JULIA , MORLEY MURIEL
Published: December 2021

Five cases of probable hypophyseal precocious puberty of constitutional origin and one case of hypophyseal precocious puberty associated with a hypothalamic lesion are presented. The physiologic alterations involved are briefly discussed.
ERYTHROBLASTOSIS FETALIS
Authors: ALLEN FRED H. , DIAMOND LOUIS K. , VAUGHAN VICTOR C.
Published: December 2021

The prognosis of erythroblastosis fetalis has been studied in relation to maternal history, maternal titer of Rh antibody, and length of fetal gestation.

The outlook for recovery of the first Rh-positive infant born to a mother after sensitization to the Rh factor occurs is good. About 30% of such infants have no clinical disease. Few are stillborn.

Subsequent affected babies have a less favorable prognosis. Stillbirths become common (about 40%) and are related to the fact that the maternal titer is likely to be high throughout a large part of pregnancy. The authors have not seen a general tendency to increasing severity of erythroblastosis after the second affected baby.

The prognosis of erythroblastosis fetalis in live born infants is more closely related to maternal titer than to family history of affected infants, with high titers carrying increased risk of kernicterus.

Immaturity in a live born baby with erythroblastosis fetalis carries an increased risk of unfavorable outcome, particularly with respect to kernicterus.
POLIOMYELITIS
Authors: THELANDER HULDA E. , SEHRING MAXINE , SHAW EDWARD B.
Published: December 2021

There is presented an analysis of the cases of poliomyelitis admitted to Children's Hospital, San Francisco, during a six year period in an effort to correlate this material with certain deductions regarding course, nature and the factors which affect the outcome.

This series does not constitute a completely valid cross section of northern California epidemics because the admissions were modified by age, economic status, by a somewhat higher proportion of females, and by the fact that, in general, more severe cases were referred to this hospital from outlying districts.

In addition to the physical traumatic factors which are generally admitted to be important in precipitating paralytic poliomyelitis, some evidence is introduced that systemic infections of unrelated etiology may provide a traumatic factor of comparable significance.

In the biphasic febrile course of poliomyelitis the initial period of fever is rarely a matter of hospital observation and proof is usually completely lacking that this initial fever is certainly due to poliomyelitis virus. This preliminary rise in temperature may very well be due to other infectious agents which serve to precipitate the onset of poliomyelitis.

There is much to indicate the considerable ubiquity of poliomyelitis virus among a population during an epidemic. In the absence of great exposure dosage, entrance of the virus into the body may frequently produce inapparent and completely latent infection which may be converted into active disease only by a variety of factors, including unrelated infections, which increase momentarily the susceptibility of the central nervous system of the host.

The value of pooled irradiated human plasma in therapy is admittedly not very great but seems to have a certain value. Statistical demonstration in support of this is almost impossible because of the fact that a weakly effective agent is applied in the treatment of an infection which has an extremely variable outcome.

This measure of treatment may displace the spectrum of outcome favorably without there being a great contrast in the statistical comparison of paralytic or nonparalytic outcome.

Nonparalytic poliomyelitis is generally believed to be of frequent occurrence. Unquestionably this is more frequent with the inclusion of patients in which the diagnosis is based on minimal and unconvincing evidence. If the diagnosis is restricted to those cases with very definite clinical and laboratory findings, only a small proportion will completely escape paralysis though this paralysis may be minimal, may be detected only by careful and repeated examination, and may disappear entirely before the end of the two week period of hospitalization.
ANESTHETIC MANAGEMENT OF INFANTS AND CHILDREN DURING ENDOSCOPY
Authors: HELRICH MARTIN , DALY JOHN F. , ROVENSTINE E. A.
Published: December 2021

The accepted technics for anesthesia during bronchoscopy in children have been reviewed. A technic using a new thiobarbiturate, sodium 5-allyl-5 (1-methylbutyl)-2-thiobarbiturate (sodium surital®, rectally, is described. Advantages and complications of this method are discussed.
CANDIDA KRUSEI AS A PATHOGEN
Authors: ROOK GEORGE D. , BRAND DAVID
Published: December 2021

A case of an infection of the tonsils due to C. Krusei is presented. A review of the literature reveals this type of infection as extremely rare.

Almost all the reported successful medical remedies for the treatment of Candidiasis were tried without results. Permanent cure was obtained finally by surgery.
ERYTHROBLASTOSIS FETALIS
Authors: VAUGHAN VICTOR C. , ALLEN FRED H. , DIAMOND LOUIS K.
Published: December 2021

The clinical syndrome of kernicterus in erythroblastosis fetalis is reviewed.

Data are presented which indicate that there is a tendency for the familial occurrence of kernicterus in siblings. Kernicterus is shown to be directly related to the intensity of maternal sensitization, and to the degree of immaturity of the infant. It is more common in male infants than in female.

Evidence is presented that the occurrence of kernicterus in a baby with erythroblastosis fetalis cannot be accurately predicted on the basis of degree of clinical illness at birth, nor on the basis of laboratory examination of the baby's blood at birth.

The possible relationship of kernicterus to hyperbilirubinemia and to other predisposing factors in erythroblastosis fetalis is discussed.
STUDY OF ADOLESCENT CHILDREN INOCULATED WITH BCG IN EARLY INFANCY
Authors: LEVINE MILTON I.
Published: December 2021

This study consists of a follow-up of 1165 adolescent children of whom 601 had been vaccinated with BCG during infancy. The remainder, 564, had been followed from infancy as controls.

Approximately 550 of these cases received roentgenographic examinations which were compared with RGs taken during the first 5 years of life.

As was to have been expected, roentgenographic evidence of healed lesions of primary pulmonary tuberculosis was found much more frequently in the control group than those in the group vaccinated by BCG.

Of the 298 vaccinated cases which received RGs there were three with evidence of a healed pulmonary primary complex. There were also two cases with re-infection tuberculosis of the lungs. Of the 286 controls, there were 27 showing evidence of healed pulmonary primary complex. There were no cases of re-infection tuberculosis in the control group.

A study of the three vaccinated cases which developed evidence of a healed primary pulmonary complex suggests that in two of the cases the BCG vaccine was weak or inadequate while in the third case the child has been exposed and was probably vaccinated in the pre-allergic phase of a human tuberculosis infection. Of the two vaccinated cases that developed signs of a re-infection tuberculosis in adolescence, it is evident in the first case that the allergy following a weak BCG inoculation subsided and the child received a subsequent exposure to open tuberculosis, later with the development of the re-infection tuberculosis. The second case with re-infection tuberculosis showed evidence of having lost the tuberculin allergy approximately three years after inoculation.

As yet no evidence is forthcoming on the ability of BCG vaccine given in infancy to diminish the tuberculosis mortality rate among adolescents and young adults. There were no tuberculosis deaths in either group.

It is evident that the BCG inoculation has the ability to prevent a pulmonary primary tuberculosis, at least during the period of postvaccination tuberculin allergy.

There is no evidence to indicate that BCG given in infancy is capable of preventing reinfection tuberculosis in adolescence. It is yet to be demonstrated that if the post-BCG tuberculin allergy is maintained the re-infection type of tuberculosis will be avoided.

It would appear from this study that there is great difficulty in determining the efficacy of BCG unless some method of maintaining the potency be devised and a standard accurate means of inoculation be used.

It is suggested by this study that the BCG tuberculin sensitivity be maintained by revaccination whenever the skin reaction becomes negative.
DIAGNOSIS OF TRICUSPID ATRESIA OR STENOSIS IN INFANTS
Authors: GASUL BENJAMIN M. , FELL EGBERT H. , MAVRELIS WILLIAM , CASAS RAUL
Published: December 2021

Ten cases of tricuspid atresia or stenosis in infants are discussed. A classification of these cases into Type I, amenable to surgery, and Type II, not amenable to surgery, is presented. The clinical, fluoroscopic, roentgenologic, angiocardiographic and electrocardiographic findings in these types are discussed. The differential diagnosis is given briefly.
STUDIES ON PREMATURITY
Authors: STEINER MORRIS , POMERANCE WILLIAM
Published: December 2021

The fatality rate of 791 liveborn premature infants delivered at the Jewish Hospital of Brooklyn during the five year period from 1941 to 1945 was investigated. The data were analyzed to determine the significance of fetal maturity and of magnitude of birth weight as factors influencing survival.

It was found that for a given weight group, the fatality rate varied inversely with the length of the gestation period. In other words, the outlook for the infant improved in proportion to the degree of its maturity. This was especially striking in the case of infants weighing less than 1500 gm., a result which served to emphasize the importance of length of gestation period as well as birth weight in predicting the chance of survival.

Premature infants born of multiple births had a lower over-all fatality rate than those born of single births. This was directly attributable to the greater maturity of babies born of multiple births.
VITAMIN E LEVELS IN TERM AND PREMATURE NEWBORN INFANTS
Authors: MOYER WINFIELD T.
Published: December 2021

Evidence has been presented to show that:

1. The average vitamin E level in plasma or serum at birth is .23 mg./100 cc. with wide variations in both term and premature infants regardless of birth weight.

2. The average level of vitamin E in cord blood is equal to the average level of the infant's blood taken within the first 24 hours, although in any one case they may vary as much as 50% to 75%.

3. The vitamin E level in term infants appears to be higher after five days, averaging .36 mg./100 cc.

4. The vitamin E level in premature infants does not increase for two months. Between three and six months of age it increased to an average of .50 mg./100 cc.
Mucosal Enterokinase Activity in Pancreatic Insufficiency and Celiac Disease
Authors: Morin Claude L. , van Caillie Micheline , Roy Claude C. , Lasalle Roger
Published: December 2021

Enterokinase (enteropeptidase, E.C. 3,4,4,8) converts trypsinogen into active trypsin and is a key enzyme in the digestion of dietary proteins. Its absence results in gross protein malabsorption.1

In the present study, jejunal biopsy specimens were obtained from children with cystic fibrosis (CF), celiac disease (CD), or congenital exocrine pancreatic hypoplasia (CEPH) and from control subjects. Sections were examined histologically and homogenates were used for measurement of enterokinase and sucrase activities.

This work was undertaken because enterokinase is considered a brush border enzyme,2,3 the release of which into the intestinal lumen is influenced by pancreatic enzymes,4,5 and also because we have recently shown a small bowel mucosal dysfunction in patients with CF.6
The oral examination of the American Board of Pediatrics
Authors:   American Board Of Pediatrics, Inc.
Published: December 2021

This review of the oral examination of the American Board of Pediatrics is presented in the hope that it will help candidates to prepare effectively for the procedure and with some familiarity to feel more comfortable during the process. The purpose of the oral examination is not to focus upon minutiae of factual knowledge, but to examine with the candidate his or her approach to clinical problems, including problem-solving techniques. It goes without saying that the more the candidate knows, the more comfortable he or she may be with the material to be presented. This knowledge is born out of experience in the devoted and skillful care of patients, in training programs which have adequate breadth and depth of content, and competent supervision.
Continuing education or indoctrination?
Authors:   Student
Published: December 2021

Every mail brings new glossy brochures describing postgraduate courses of instruction, in subjects ranging from acanthocytosis to zoonoses, which are convened in exotic vacation spots or famed universities throughout the world. "Continuing education" has become a thriving growth industry which obviously benefits someone—but whom? It is not hard to see that name recognition, prestige, travel opportunities, and money accrue to educators, but what evidence is there to support the opinion that learners are advanced by exposure to the proclamations of authorities? Is it possible that the authoritative-lecture format is converting American physicians into passive consumers of predigested pap, stifling skepticism and usurping time which may be spent in self-actuated learning?
Dr. Gold Replies
Authors: Gold Arnold P.
Published: December 2021

I certainly concur with the corrections noted by Drs. Soyka, Curless, and Walson. The original letter unfortunately gave the levels with percent signs, i.e., µg/ml%, and this was subsequently published as micrograms per 100 ml. Unfortunately, this error was not corrected prior to publication.

As correctly stated by Drs. Soyka, Curless, and Walson, the level should be micrograms per milliliter or milligrams per liter.

I must compliment those who picked up this error so rapidly; I have also received numerous personal communications regarding the problem.
Terbutaline and Ephedrine in Asthmatic Children
Authors: Blumberg Michael Z. , Tinkelman David G. , Ginchansky Elliot J. , Blumberg Barbara S. , Taylor John C. , Avner Sanford E.
Published: December 2021

The effects of terbutaline, ephedrine, and placebo on the cardiovascular and pulmonary systems have been compared in 24 asthmatic children. Ephedrine and terbutaline were both found to be effective bronchodilators, with onset of action within 30 minutes. The bronchodilator effect of ephedrine was maintained for three hours, while terbutaline was active for five hours. Terbutaline caused significantly greater improvement in pulmonary functions than did ephedrine. Both terbutaline and ephedrine were associated with clinically insignificant changes in blood pressure and pulse rate. The only significant side effect observed was hand tremor in children receiving terbutaline and this appeared only early in the course of drug treatment. There was no evidence of tolerance to the bronchodilator effect of ephedrine or terbutaline after eight weeks of therapy.
Measles Pneumonia in Childhood Leukemia
Authors: Siegel Michael M. , Walter Thomas K. , Ablin Arthur R.
Published: December 2021

Fatal measles pneumonia developed in a 7-year-old boy who was in complete remission from acute lymphoblastic leukemia. There was no detectable antibody titer in two specimens taken eight days apart. Measles virus was grown from a lung biopsy taken shortly after hospital admission. Classical measles had been diagnosed in the patient and his siblings nine months previously. Immunosuppressed children who do not develop an antibody rise after a measles infection are at risk of later development of measles giant cell pneumonia. Suggestions are offered for the prevention of this often fatal complication.
THE MODERN CHILD AS VIEWED IN 1898
Authors: C. T. E.
Published: December 2021

The editorial1 below, written in 1898, might well have been written today, although we would have to add the influence of television on the modern child of 1977.

To the student of sociology, one of the most notable features of the past few decades is the growing attention bestowed upon children. The thought now devoted to them would amaze our ancestors of three generations ago. Child-study has become one of great importance. Thousands of men and women are being trained in scores of normal schools for the one purpose of instructing young, for the work of a teacher is now believed to be one demanding extensive and peculiar education. Volumes are written annually for children and of children, while journals and magazines of the same character have increased a hundred-fold. The children are apparently considered a far more important factor in every household than they were fifty years ago. It is at least a fact that they receive more attention and are brought into much greater prominence. The average child of to-day has a score of toys where his grandfather had one. Many children are overburdened with them, and are less happy than they would be with a smaller number. The most contented and quiet children that the physician sees in his rounds are certainly not those with the most playthings.

We are far from criticising the general tendency to bestow more attention upon children and more thought upon their education and training, but it cannot be denied that the matter in many families is carried to a very injudicious extreme.
Ambiguous Genitalia in XX Male Children: Report of Two Infants
Authors: Roe Thomas F. , Alfi Omar S.
Published: December 2021

Two infants with ambiguous genitalia were recognized to have the XX male syndrome. Although most xx males have normal penile development, a review of the reported cases showed that eight of the 14 affected children, diagnosed before age 15 years, had penile abnormalities, most commonly hypospadias and/or chordee. This syndrome should be considered in children with incomplete genital differentiation. The available indirect evidence suggests that deficient testosterone production by the fetal testes accounts for the genital ambiguity. Although no explanation has been established for the presence of testes in the apparent absence of the Y chromosome, studies of the X-linked Xg blood group in XX males demonstrate a high frequency of unusual inheritance patterns. This implies that the abnormality in the transmission of maleness in affected families may also be X-related rather than autosomal.
WHAT WILL BE THE END OF THE AMERICAN REPUBLIC IF AMERICAN WOMEN REFUSE TO BECOME MOTHERS?-AS VIEWED IN 1912
Authors: C. T. E.
Published: December 2021

The editorial1 below appeared in the April 1912 issue of Pediatrics (N.Y.). Both the florid style in which it is written and the sentiments it expresses will seem antediluvian to most modern readers.

The majority of American women of today look upon maternity as undignified and a menace to a wife's liberty. They consider it an unwelcome invocation of duty and responsibility. So strong is this unhealthy sentiment prevalent in the rural districts, as well as in the Metropolitan centers that the gynecologist is eagerly sought and urged to do an operation which makes maternity impossible. If conception has occurred then these women seek a physician, devoid of moral obligation, and urge him to perform an operation which will rid her of the responsibility of motherhood.

The individual women is autocrat of her own decisions, but when she takes the vows of the marriage law, however broad or simple its words, there goes with this vow an injunction of motherhood. The woman who unites herself in marriage to a man and then refuses to be mother of his children unless there are moral, physical or hereditary laws-which cannot in justice to the unborn be propogated in the human race, has obtained a husband, a man to pay her bills, and to support and protect her through the subterfuge and methods of a common cheat. The man and woman unwilling to be father and mother to children are both unworthy of a place in Society and should not marry. Let their taints, whether of blood, or body or morals die with their own soul's death.
MEDICAL FALLIBILITY
Authors: Gorovitz  , MacIntyre  ,   Student
Published: December 2021

At present, the typical patient is systematically encouraged to believe that his physician will not make a mistake, even though what the physician does may not achieve the desired medical objectives, and even though it cannot be denied that some physicians do make mistakes. The encouragement of this inflated belief in the competence of the physician is of course reinforced by the practice of not keeping systematic and accessible records of medical error. Yet everyone knows that this is a false confidence . . . the current high incidence of iatrogenic illness constitutes a medical problem of enormous proportions, well recognized within government agencies and segments of the medical profession, but only dimly suspected by the public at large. There is still a relatively high probability of a patient suffering from medical error.

What patients and the public have to learn is to recognize, accept, and respond reasonably to the necessary fallibility of the individual physician. The physician-patient relationship has to be redefined as one in which necessarily mistakes will be made, sometimes culpably, sometimes because of the state of development of the particular medical sciences at issue, and sometimes, inevitably, because of the inherent limitations in the predictive powers of an enterprise that is concerned essentially with the flourishing of particulars, of individuals. The patient and the public therefore must also understand that medical science is committed to the patient's prospering and flourishing, and that the treatment of the patient is itself a part of that science and not a mere application of it.
Questions Conclusions
Authors: Jacob Jack
Published: December 2021

All too often, conclusions drawn from studies are not justified from the data that is presented. Such is the case in the article by Goetzman et al. on the thrombotic complications of umbilical artery catheters (56:374, September 1975). One of the conclusions reached by the authors was that "positioning of the catheter tip below the mesenteric and renal arteries may be safer for the patient." Preceding this conclusion is the statement that catheters were only positioned at the level of the diaphragm.
Velocities of Growth in Vegetarian Preschool Children
Authors: Shull Margaret W. , Reed Robert B. , Valadian Isabelle , Palombo Ruth , Thorne Halorie , Dwyer Johanna T.
Published: December 2021

The growth velocities (weight and length) of vegetarian preschool children were compared to norms established from the Harvard growth study. At first measurement vegetarian subjects weighed less and were shorter than expected from Harvard standards. Growth velocities of children under 2 years of age were depressed, while among those over the age of 2 growth velocities were generally comparable to Harvard norms. Vegetarian boys over age 2 exhibited a higher mean weight velocity. Macrobiotics' mean weight and length velocities were not significantly different from those of nonmacrobiotics before age 2. However, the mean weight velocity of macrobiotics over age 2 was significantly greater than the mean weight velocity of nonmacrobiotics over 2 years. Low growth velocities of vegetarian children are more apparent in infants under the age of 2. When breast-feeding, possibly inadequate supplemental feeding may be present past 6 months of age. Since it is then that the velocities are more likely to be depressed, this may be the most appropriate time for surveillance and possible intervention.
Effects of Imipramine on Enuretic Frequency and Sleep Stages
Authors: Kales Anthony , Kales Joyce D. , Jacobson Allan , Humphrey Frederick J. , Soldatos Constantin R.
Published: December 2021

Four children with a history of primary enuresis were evaluated in both the sleep laboratory and at home in a 68 consecutive-night protocol with successive conditions of 10 placebo-baseline nights, 27 drug (imipramine) nights, and 31 placebo-withdrawal nights. On the placebo conditions, two thirds of the enuretic events occurred during the first third of the night. Enuretic events occurred out of each sleep stage in approximate proportion to the time spent in that sleep stage for each third of the night. Thus, primary enuresis was found to be chiefly related to time of night and not any specific sleep stage such as stage 3 or 4 (slow wave) sleep.

Administration of imipramine in a manner simulating clinical use of the drug resulted in a marked decrease in overall enuretic frequency. The reduction of enuretic frequency was not related to the effects of imipramine on sleep stages. There was a reduction of enuretic events in the first two thirds of the night with an increase in enuretic events in the last third of the night. Also, with long-term drug administration, there was a significant increase in wakefulness in the last third of the night. These findings suggest that early in the night when sleep is deepest, imipramine decreases bladder excitability and/or increases the child's bladder capacity. This allows the child to continue to sleep without micturition and, later in the night when sleep is lighter, to be more aware of the stimuli from the bladder. Immediately following withdrawal of imipramine, enuretic frequency approximated baseline levels.

Administration of imipramine resulted in a moderate degree of rapid eye movement (REM) suppression. With long-term administration, there was a dimunition of the REM suppressant effect. Initial withdrawal of imipramine produced a marked REM rebound.
Prolonged Retention of Foreign Bodies in the Stomach
Authors: Mandell Gerald A. , Rosenberg Henrietta K. , Schnaufer Louise
Published: December 2021

Two patients had prolonged retention of small round foreign bodies in the stomach. Both patients had a history of a pyloromyotomy. Radiographic examination revealed a prepyloric web in one patient and a deformed pylorus in the other. These findings were confirmed by surgery.
Classes of pediatric care
Authors: ROSS MAURICE
Published: December 2021

Dr. Robert A. Hoekelman's commentary entitled “Primary Care: We Need All the Help We Can Get!” (Pediatrics 59:315, March 1977)raises some very important questions about the practice of pediatrics as a medical specialty.

Whether we like it or not, we must admit that there are different classes of pediatric care even in the health supervision of apparently well children. We are all familiar with well-child care as practiced by the qualified pediatrician. If we were to deny that the pediatrician who devotes his career to the care and study of children and adolescents cannot do this work better than
Comment on Intracranial Bleeding in Infants
Authors: SAMUELS DAVID , GRASSY RICHARD , ZACHMAN RICHARD D.
Published: December 2021

To the Editor:

We read with interest the article by Deonna et al. entitled “Neonatal Intracranial Hemorrhage in Premature Infants,” reporting on 11 cases(Pediatrics 56:1056, December 1975). We have recently summarized the data on six similar infants in the neonatal intensive care unit at Madison, Wisconsin,and feel it is important to supplement the article of Deonna et al.

For better comparison with results of other newborn units, it would have been helpful if
Shouldn't SIDS Be Recognized?
Authors: BORGENICHT LOUIS
Published: December 2021

To the Editor:

Dr. Wegman's article “Annual Summary of Vital Statistics-1974”(Pediatrics 56:960, December 1975) provides some valuable and interesting information.

There is, however, some disconcerting information in Table III,“Infant Mortality Rates by Age and Selective Causes for the United States, 1964 and 1974.” There is no specific listing for the major cause of infant mortality between 1 and 12 months of age: sudden infant death syndrome (SIDS). As Dr. Wegman suggests, “To be
Ms. Clow and Dr. Scriver Reply
Authors: SCRIVER CHARLES R. , CLOW CAROL
Published: December 2021

Dr. Kuhr can cite the “bad” aspects of our Tay-Sachs screening program among adolescents; others may choose to cite the “good.”Both facets are presented in our report. The open-minded reader will find Dr. Kuhr's selective quotations less than the whole story. For example, he will learn that later attitudes among Tay-Sachs screenees, after initial worry has been dispelled, are largely benign and very similar in screened carriers and noncarriers. Moreover, 88.4% of carriers say
Comment on Parent Education
Authors: KASH IRWIN J.
Published: December 2021

To the Editor:

I congratulate Dr. Tomlinson on having educated his private patients so well, but I feel that his conclusions are unfairly biased against the inner-city patient (Pediatrics 56:1009, December 1975). If he would have chosen his private patient group from the practices of randomly selected physicians in his geographic area, the patients might not have been so accurately informed. It has been my experience that numerous physicians misguide patients with myths about tonsils,
Diet and Growth in Congenital Heart Disease
Authors: STEIER MOSHE , LOPEZ RAFAEL , COOPERMAN JACK M.
Published: December 2021

To the Editor:

We read with considerable interest the article by Strangway and her colleagues (Pediatrics 57:75, January 1976). The authors concluded that “nutrient intake is not an important factor limiting the growth of children with congenital heart disease.” Children and infants with growth failure associated with congenital heart disease are not a homogeneous population. We feel that the foregoing conclusion does not apply to the child with more severe heart disease. The studies on
Dr. Hamilton Replies
Authors: HAMILTON J. R.
Published: December 2021

By choosing to study an unselected group of ambulatory patients, we have,as Dr. Steier et al. suggest, a preponderance of mildlv affected patients. We agree that the findings may differ in very young, very severely affected patients, and we are presently assessing this group. No doubt there are individual patients with serious congenital heart disease who are not eating adequately and not growing adequately. We did take eyanosis and cardiac enlargement as measured by
Challenges “Fact” Cited in Committee Report
Authors: AINBENDER EUGENE , BROWN EDWIN G. , SWEET AVRON Y.
Published: December 2021

To the Editor:

The report of the American Academy of Pediatrics Committee on Nutrition that appeared in the February 1976 issue (Pediatrics 57:278, 1976)contains a statement that is not factual and may be misleading. The Committee states, “There is some clinical evidence suggesting that [the immune globulins of colostrum and early breast milk] provide protection from necrotizing enterocolitis.” They base that statement on a publication of Santulli et al.1 who presented no clinical findings
Nothing New Under the Sun
Authors: HURD ARTHUR H.
Published: December 2021

To the Editor:

The interesting report by Dr. Lee et al. (Pediatrics 57:259,February 1976) truly confirms the adage that there is “nothing new under the sun.” It is of interest that the earliest of their ten references to congenital neuropathy with absence of pain sensation was the article of D. Denny Brown written in 1951.

I am enclosing a copy of Dr. H. L. Heyl's intern's summary of two admissions to the Infant's Hospital
Distribution of HLA-B27 in Patients With Juvenile Rheumatoid Arthritis
Authors: MITSUI HIROSHI , JUJI TAKEO , SONOZAKI HIDEKICHI , WATANABE NOBUO
Published: December 2021

To the Editor:

Lately there has been extensive searching for an association between histocompatibility antigen (HLA) and specific disease. Rachelefsky et al. demonstrated that HLA-B27 was found in 42% of all juvenile rheumatoid arthritis patients examined.1 Gibson et al. showed the frequency of this1 phenotype was 16%.2 These reports stimulated us to examine whether a similar relationship could be demonstrated in Japanese patients.

Twenty-four HLA antigens were examined in 181 normal Japanese controls and in
Intractable Diarrhea and the Colon
Authors: MICHEL MARIO VILLA , MARTUSCELLI ALFONSO
Published: December 2021

To the Editor:

Dr. Lebenthal et al. (Pediatrics 56:585, October 1975) establish enterokinase deficiency and reduced intraluminal trypsin as a contributing factor to intractable diarrhea. The concomitant decrease in disaccharidase activity in the presence of blood in the stools, however, strongly suggests pathology in the colon.

Such has been our experience in over 30 children who had prolonged diarrhea which consistently showed mucus and blood in the stools.1Rectosigmoidoscopic examination revealed small bleeding ulcers, petechiae,
Dr. Lebenthal Replies
Authors: LEBENTHAL EMANUEL
Published: December 2021

The comment by Drs. Villa Michel and Martuscelli is a referral to their experience with colitis. We think this speculation on the origin of colitis is interesting, but until it is proven, it is an assumption only.
Outpatient Pediatric Surgery in a Developing Country
Authors: El-Shafie Mohamed , Shapiro Robert P.
Published: December 2021

A total of 5,522 outpatient surgical procedures were performed at the Children's Hospital in Kingston, Jamaica, West Indies, between 1968 and 1973. This included 2,662 general surgical procedures. There were no deaths or major complications. Parents participated actively in the preoperative and postoperative care.

Outpatient surgery can be a safe, inexpensive, and effective means of health care delivery. It is of special value in developing countries with limited facilities for inpatient care.
Recurrent Adolescent Suicidal Behavior
Authors: McIntire Matilda S. , Angle Carol R. , Wikoff Richard L. , Schlicht Marilyn L.
Published: December 2021

Suicide is the third leading cause of death among people in the age group 15 to 25 years.1 Self-destructive behavior in children and adolescents is a continuum that ranges from drug intoxications to gestures of low lethality to suicide attempts with high lethality of intent. In our survey of 1,100 self-poisonings in people aged 6 to 18 who were seen at poison control centers we found an incidence of 220 self-poisonings for every fatality.2 This is higher but comparable to other estimates of 50 to 150 suicide gestures for every reported death from suicide in the adolescent.3-6 Suicide attempts may account for 12% of all emergency room visits.7 This represents a public health problem of the first magnitude.

It is ironically tragic that many of the adolescent suicide deaths are unintentioned-the victim did not really intend to die. In our collaborative poison study, for example, none of the six deaths could be called intended. The adolescents were not victims of suicide but of pharmacologic roulette.

The single best correlate of suicidal risk appears to be lethality of intent. A diagnosis of suicide attempt, as contrasted to a gesture, implies both a lethality of intent coupled with a mature concept of death as an irreversible state. Lethality is defined by Shneidman8 as the probability of an individual's killing himself in the immediate future. In classifying all deaths as intentioned, subintentioned, and unintentioned as contrasted to the traditional classifications of natural, accidental, suicidal, and homicidal he has used the dimension of lethality to cut across the terms attempted, threatened, and completed suicide.
Child Psychiatry and Pediatrics: The State of the Relationship
Authors: Anders Thomas F.
Published: December 2021

A great deal of attention has been focused on the notion that child psychiatry and pediatrics should develop strong ties. Yet, a review of the literature suggests that, in spite of exhortations to the contrary, little true collaboration has developed between the two disciplines.

This study surveys the major pediatric teaching and training centers throughout the country in an attempt to assess the current state of the relationship between child psychiatry and pediatrics. Of the 82 centers surveyed, 68% responded. Although enthusiasm and desire for closer collaboration were expressed repeatedly, actual successful efforts remain minimal. Psychiatric consultations on pediatric inpatient units continue to be the predominant child psychiatry service provided. A method for achieving closer relationships between the two disciplines is proposed.
Child psychiatry and pediatrics
Authors: Rothenberg Michael B.
Published: December 2021

Anders' survey, the report of which appears in this issue of Pediatrics (p. 616), was much needed, and I am grateful to him for it. The data that he presents certainly reflect my own experience in three major training centers during the last 25 years.

I have some trouble with his contention that "the source of the difficulty stems from the fact that neither child psychiatrists nor behavioral pediatricians have defined their areas of collaborative responsibility and effectiveness sufficiently." Also, I am not comfortable with his recommended solution to this problem.

The American tendency to stand in awe of the "scientific," especially on a molecular level, leaves many pediatric faculty members with a conscious or unconscious feeling that they would somehow lose prestige and status were they to focus their teaching efforts in the behavioral pediatrics arena.1
"We Won't Leave You"
Authors: Schowalter John E.
Published: December 2021

Few things compare in sluggishness to institutional inertia. Changing hospital procedures to better care for the physical and emotional needs of children is more often advocated than done. A recently released film, "We Won't Leave You,"1 produced by Dr. Edward Mason at the Massachusetts General Hospital, raises in a positive but provocative way a number of important issues in this regard.

Briefly, in cinema verité technique the 17-minute film follows a 5-year-old girl from two days before her outpatient surgery for bilateral hernias through her eight-hour stay in the hospital to her recollection of the experience that same evening. The girl's mother, a nurse, is adamant about wanting to be with her child as much as possible during the ordeal, and this leads her to agree to the daughter's one-day surgery.
Electrophysiologic Study of the Conduction System in Normal Children
Authors: Roberts Nigel K. , Gillette Paul C.
Published: December 2021

Values for cardiac conduction intervals obtained from normal children are reported so that the data will be available for comparison with patients who are suspected of having abnormalities. Sinus node recovery time correlated linearly with the resting PP interval. The mean intra-atnal conduction was considerably shorter in children (< 25 msec) than in adults (42 msec). The atrioventricular node had similar electrophysiologic properties in the child and adult. With aging, the His bundle to Purkinje fiber time increased significantly (P < .01).
THE THERAPEUTIC VALUE OF BLOODLETTING IN A CHILD SUFFERING FROM SEVERE COMPLICATIONS OF POSTSCARLATINA GLOMERULONEPHRITIS IN 1897: THE FALLACY OF POST HOC, ERGO PROPTER HOC REASONING
Authors: C. T. E.
Published: December 2021

Bloodletting until as late as the end of the 19th century was falsely considered by many physicians to have a curative effect on poststreptococcal glomerulonephritis in children because few, if any, i9th century physicians were aware that this form of acute glomerulonephritis has a very favorable prognosis, irrespective of its initial severity. An excellent example of the fallacy of post hoc, ergo propter hoc reasoning is the following case history, published in 1897.

A boy, 8 years old, well developed, was affected with a mild form of scarlatina. The disease had about abated when a grave nephritis supervened. The eyelids were edematous; the urine contained about 1 per cent albumin and showed, microscopically, white and red blood-cells, renal epithelia and numerous granular casts. The heart was normal, the pulse 96 per minute; the general condition, which was fair at the onset, became worse. Without somnolence or other distinct premonitory symptoms uremia supervened suddenly, with four rapidly succeeding convulsive attacks, one of which lasted about half an hour and affected particularly the right half of the body. Chloroform inhalations caused momentary relief but did not prevent repetition of the convulsive attacks, which ensued with greater frequency and intensity. The child was apparently moribund. As the pulse was still strong, however, venesection was resorted to, though very little hope was held out for recovery. About 100 cc. of blood were withdrawn from the right median cephalic vein. The result was more striking than any the observer had ever noticed following therapeutic intervention.
Increased Incidence of Gram-Negative Neonatal Sepsis With Intramuscular Iron Administration
Authors: Barry D. M. J. , Reeve A. W.
Published: December 2021

During a five-year period the incidence of neonatal sepsis was 20 times higher in Polynesian newborns compared with European newborns (11 per 1,000 vs. 0.6 per 1,000 total births). This high incidence in Polynesians was confined to a period when the infants were being given intramuscular iron dextran. When the iron administration was stopped the incidence of disease in Polynesians decreased from 17 per 1,000 to 2.7 per 1,000 total births.

An analysis of the Polynesian iron-treated and non-iron-treated groups showed a statistically significant difference in the incidence of sepsis, the type of causative organism, and mortality.

The data suggest that the iron dextran injections have impaired the immunity of the treated infants, making them more susceptible to Escherichia coli sepsis.
Did They Ignore Genetics?
Authors: Hsia Y. Edward , Kidd Kenneth K.
Published: December 2021

The epidemiologic article by Hennekens et al. (Pediatrics 58:211, August 1976) ignores the strong clinical and biochemical evidence for genetic heterogeneity in the hyperlipidemias.1-3 This report obscures important heterogeneity because no attempt was made to analyze the children according to the cholesterol level of the father, even though these data were collected. This failure to consider genetics and possible genetic heterogeneity is surprising since these recognized authorities have already noted: "Not every infant or child with an elevated cholesterol level has [familial hypercholesterolemia] nor do all adults suffering from premature [coronary artery disease] have familial hypercholesterolemia."4
Dr. Hennekens et al. Reply
Authors: Hennekens Charles H. , Jesse Mary Jane , Blumenthal Sidney , Klein Barbara E. , Gourley Janet E.
Published: December 2021

Both of these letters concern the general issue of the influence of genetic determinants on elevated cholesterol levels. A general comment relevant to the concerns of both letters is that our findings reflect those of a descriptive, not an analytic study. Our purpose does not include etiologic considerations (i.e., relative roles of genetics and environment in elevated childhood cholesterol level).

Dr. Williams first suggests the possibility that our findings of higher mean levels of cholesterol among children of affected men compared with children of healthy men may be attributable to our failure to exclude kindreds with hypercholesterolemia.
MORAL JUDGMENT
Authors: Mills C. Wright ,   Student
Published: December 2021

What a man calls moral judgment is merely his desire to generalize, and so make available for others, those values he has come to choose.
Infections and Other Maternal Factors as Risk Indicators for Congenital Malformations: A Case-Control Study With Paired Serum Samples
Authors: Koskimies Olli , Lapinleimu Kaisa , Saxén Lauri
Published: December 2021

An obstetric population of 48,000 individuals was prospectively followed up for evidence of possible teratogenic factors that might be associated with congenital malformations. Serum samples from 274 mothers of defective children and from paired controls were collected during early pregnancy and approximately one month after delivery and tested for antibodies against ten different viruses, Mycoplasma pneumoniae, and Toxoplasma. These data were supplemented with clinical information on infections, other diseases, drug intake, and other potentially teratogenic factors during pregnancy. Mothers of defective children had more seroconversions (fourfold or greater increase in titer) than the controls, 123 vs. 86. This difference was mainly due to an increase in herpes simplex viruses 1 and 2, cytomegalovirus, varicella-zoster virus, and Toxoplasma titers. In addition, the number of reported diseases during the pregnancy, the intake of drugs (especially analgesics and hormones), and the number of earlier abortions were greater in the mothers of the defective children than in the controls.