bluuebunny/crossref_metadata_2025 huggingface dataset:
LENGTH AND CROSS-SECTION GROWTH PATTERNS IN THE HUMAN TRACHEA
Authors: Butz Ralph O.
Published: December 2021

Twenty-four tracheas taken from autopsies of children ranging in age from premature to 14 years and in weight from 1½ pounds to 155 pounds, were studied. Details of the growth patterns in length and cross section are discussed. Length and cross-section area are found to have different growth curves. "Flattening" of the trachea is also found to be age related. Application of the data to the selection of proper endotracheal tubes for anesthesia is made in this study, including special attention to length in the newborn infant.
POSTNATAL CHANGE OF HEMOGLOBINS F AND A2 IN INFANTS WITH DOWN'S SYNDROME (G TRISOMY)
Authors: Wilson Miriam G. , Schroeder W. A. , Graves Doris A. , Kach Victor D.
Published: December 2021

Hemoglobins F (fetal hemoglobin) and A2 were determined by column chromatography in 12 infants with Down's syndrome (G trisomy). Comparison data were obtained from 48 normal term infants, of which 13 were followed throughout early infancy. None of the infants were significantly premature or postmature; and none possessed S or C hemoglobins. With one exception, infants with Down's syndrome were found to have low hemoglobin F throughout the first several months of life and relatively elevated hemoglobin A2 for this duration of time. These findings are the direct opposite of the hemoglobin changes in D trisomy syndrome.
Scalding Water
Authors: Scanlon John
Published: December 2021

As a resident in pediatrics at a large teaching hospital I have had the unfortunate opportunity to help care for five children in the past 11 months who have sustained second and third degree body burns due to scalding water taken directly from the hot water tap. These burns ranged from 15% to 60% of total body surface and occasioned horrifying morbidity.

Four of the burns were entirely accidental in that the child inadvertently came in contact with the hot tap water either being used for bathing (three cases) or for floor cleaning (one case).
Letters to the Editor
Authors: Stickler Gunnar B.
Published: December 2021

We agree with the comments by Dr. Jacobs reminding us of the shortcomings of our study. Indeed, there was a difference in the time periods in which these two groups of patients were observed, with an overlap of 4 years. While this time difference may be a factor that influences survival, this is doubtful in view of the fact that no other change in treatment has occurred.

Indeed, Dr. Jacobs and our group may differ in the definition of renal disease, but I agree that we would not consider grade 1 proteinuria and 2 to 4 red blood cells in a casual urine sample as evidence of renal disease.
The Drifters: Children of Disorganized Lower-Class Families, edited by Eleanor Pavenstedt. Boston: Little, Brown and Company, 1967, 345 pp., $10.50
Authors: Coles Robert
Published: December 2021

This book and the study it describes has to be considered a landmark. Extremely poor families in a Boston slum were approached by a group of child psychiatrists, sociologists, social workers, and educators who wanted to understand, but also to help, to cure, to change things, to do what they could to bring order and coherence to lives riddled with confusion and suspicion. For years the middle-class observers persisted–learning, reaching out, seeing the lives of incredibly hard-pressed parents and children unfold day by day.
INFANTS OF TUBERCULOUS MOTHERS: FURTHER THOUGHTS
Authors:   Committee on Drugs,   Amerucan Academy of Pediatrics
Published: December 2021

Elsewhere in this issue, Avery and Wolfsdorf1 present a well balanced review of the choices open to the pediatrician in the management of an infant horn to a tubercubus mother. If the baby is infected at birth, immunization (BCG) cannot be used and chemotherapy (INH) is mandatory. Controversy does exist as to what constitutes optimal management for those infants not infected at birth but at high risk of contacting tuberculosis because of active or quiescent disease in members of their households. Management by chemoprophylaxis with INH, immunization with BCG, or observation with frequent tuberculin tests as reviewed by Avery, would constitute accepted practice for most infants who are born to responsible, well motivated parents.
HEREDITARY OROTIC ACIDURIA
Authors: Rogers Lon E. , Warford Lloyd R. , Patterson Richard B. , Porter F. Stanley
Published: December 2021

A new case of hereditary orotic aciduria is reported. Clinical manifestations included growth retardation, orotic acid crystalluria, and a megaloblastic anemia. Uridine therapy produced a prompt hematologic response and a rapid acceleration of growth. Orotic acid excretion on treatment ranged from 0.96 gm to 3.89 gm orotic acid per gram creatinine, and no decrease in excretion was observed when the uridine dosage was increased from 0.75 to 2.0 gm per day. Studies of the patient's erythrocytes revealed a virtual absence of the activity of orotidylic pyrophosphorylase and orotidylic decarboxylase. Previously undescribed studies of liver revealed the enzymatic deficiency in this tissue as well.

Four generations of the patient's family were evaluated with erythrocyte enzyme assays and with a urinary screening test developed during the course of these studies. A subject apparently unrelated to the propositus was unexpectedly found to be a carrier of the disorder. Investigation of his family revealed other heterozygous individuals. With the pedigrees of these families, an autosomal, recessive mode of inheritance was demonstrated.
HEREDITARY OROTIC ACIDURIA
Authors: Rogers Lon E. , Porter F. Stanley
Published: December 2021

A urinary screening test for hereditary orotic aciduria is described. The test is based upon the conversion of orotic acid to barbituric acid by the action of saturated bromine water and subsequent reduction by ascorbic acid. Barbituric acid reacts with p-dimethylaminobenzaldehyde (Ehrlich's Reagent) to form a colored product with a maximal absorption at wave-length 480 mµ. The screening test may be used to detect subjects either homozygous or heterozygous for hereditary orotic aciduria. Quantitation of urinary orotic acid is possible only when the concentration is high, as is found in the urine of the homozygote. The test requires a small aliquot of a random urine specimen, it is easy to perform, and many samples may be determined simultaneously.
CARBONIC ANHYDRASE IN THE PREMATURE
Authors: Poblete E. , Thibeault D. W. , Auld P. A. M.
Published: December 2021

Carbonic anhydrase activity was measured in the blood of premature and full-term infants to determine if the arterial-alveolar carbon dioxide gradient was related to low levels of carbonic anhydrase. The time at which levels in these infants approached the adult was studied as well. The study demonstrates that CO2 gradients do not correlate with blood carbonic anhydrase activity, and minimal or no activity can be associated with a small gradient. An increase in the carbonic anhydrase activity-produced by transfusion did not significantly change the CO2 gradient. Premature infants approach adult levels of activity in 6 to 7 months.
THE CHILD DEVELOPMENT TRAVELING CLINIC PROJECT IN SOUTHERN CALIFORNIA
Authors: Koch Richard , Baerwald Ann , McDonald Joan , Fishler Karol , Boyle David
Published: December 2021

This report is the result of a demonstration project illustrating how to develop diagnostic services to young retarded children. The techniques and methods utilized in this project are described.

The practicality of a multidisciplinary approach to the problem of mental retardation using the local district public health nurse as the case coordinator is demonstrated. The project suggests that this model of cooperation between a specialized pediatric center and a local health department could be utilized to serve other groups of handicapped children. Furthermore, it appeared that the participation of local professionals in the decision-making process concerning a course of action for the retarded child committed them to greater effort to implement and facilitate such care. In each county served, the clinic appeared to mobilize pediatric and other professional interest in the problems faced by parents of retarded children.
MEASUREMENT OF SKINFOLD THICKNESS IN CHILDHOOD
Authors: Lowe Charles U. , Coursin David Baird , Heald Felix P. , Holliday Malcolm A. , O'Brien Donough , Owen George M. , Pearson Howard A. , Scriver Charles R. , Filer L. J. , Kline O. L.
Published: December 2021

Standardized techniques for caliper measurement of skinfold thickness have been established during the past decade and investigators are accumulating data. The skinfold thickness appears to serve as an indicator of relative fatness in adults in whom correlations between this and other methods which estimate body fat have been obtained. Even in adults insufficient data are available to judge the precision of the method. Uncontrolled variables such as skin compressibility and the normal flux in subcutaneous fat thickness characteristic of growing subjects may reduce the significance of measurements in early life. Although this technique may ultimately provide a practical clinical tool for assessing adiposity of individual children, basic reference data must be accumulated before either the precision or the usefulness of the method can be established.
Urine of Abnormal Color
Authors: Fleisher Daniel S.
Published: December 2021

In the March issue of Pediatrics, Dr. Thomas E. Cone, Jr., presents an excellent summary of some syndromes, diseases, and conditions associated with abnormal coloration of the urinary diaper. I should like to suggest an additional consideration for the clinician faced with a urine of abnormal color. Perhaps the best way to do this is to briefly cite a ne cent experience which led me to this suggestion.

A 10-year-old boy was referred to me recently by a urologist with a statement that the boy passed orange-pink urine.
The Self-Curing Poison
Authors: Nussbaum Arnold H.
Published: December 2021

I have read with interest every suggestion made to prevent accidental poisoning in children. I also incorporate into my practice every practical idea that is advanced by our colleagues and drug firms. It appears, however, that, in spite of our best efforts, some children manage to obtain pills and other medications and do harm to themselves.

Recently I made a suggestion to one of the detail men of a drug firm but he could not do much about it.
Sporotrichosis in Childhood
Authors: Carpenter Carlton L. , Jolly Henry W.
Published: December 2021

Sporotrichosis, a world-wide disease caused by Sporotrichium schenckii, occurs as a subacute or chronic infection, usually of the skin and subcutaneous tissues, but may on rare occasions undergo extracutaneous dissemination. Sex and race may be less important than age in its genesis. Children are rarely attacked. The organism occurs as a saprophyte on various plants and has been isolated from the soil.

Direct person-to-person transmission probably does not occur, although infection has followed the handling of bandages from clinical lesions,1 and from animals.2

The majority of the cases of sporotrichosis are of the localized lymphangitic type. There is usually a history of minor trauma (i.e., scratch, prick, or insect bite) followed within 1 to 4 weeks by the appearance of a small, painless papule or pustule.
Glycogen Storage in a Hepatoma: Dephosphophosphorylase Kinase Defect
Authors: Christiansen Robert O. , Page Lyman A. , Greenberg Robert E.
Published: December 2021

Formation of active hepatic phosphorylase is the consequence of a complex series of enzymatic reactions.1 The activation of dephospho-phosphorylase to phosphorylase is catalyzed by a kinase which, in turn, requires activation involving cyclic-3',5'-AMP. The synthesis of this nucleotide is hormonally regulated. In 1959 Hers described three patients with hepatic glycogen storage disease in whom there was diminished phosphorylase activity.2 Activity of phosphorylase was unaffected by either ATP and Mg++ or cyclic-3',5'-AMP. Whether defects in the phosphorylase system can be responsible for glycogen storage remains unresolved.3 Recently, Hug, et al4. described a patient with hepatic glycogen storage disease in whom reduced activity of phosphorylase was demonstrated.
In Reply: Follow-up of Infectious Lymphocytosis Cases
Authors: Putnam Samuel M. , Moore Gordon T. , Mitchell Donald W.
Published: December 2021

We agree with the conclusions of Dr. Oleinick and Dr. Glass. Their letter points out the problems of using a small group of patients to study questions related to an illness of low incidence, such as leukemia.

We were careful to state the limitations of our study and said that we hoped that this report would stimulate others to study this question in greater detail. As Drs. Oleinick and Glass state, more patients will need to be studied before any association of lymphocytosis and malignancy can be statistically ruled out.
Teratologic Monitoring through Embryo and Fetus Collecting
Authors: Shepard Thomas H. , Hollingsworth Ralph R.
Published: December 2021

The article by Källén and Winberg1 regarding a Swedish register of congenital malformations described a system of early reporting and tabulation of anomalies in the newborn. Another approach to the same problem is the systematic collection and examination of human abortuses. The advantages to this program which should, of course, only augment newborn monitoring are: (1) The onset of an epidemic of malformations following introduction of a new teratogen could appear in the aborted fetus many months before delivery of affected full-term infants.
Biological Factors in Temporal Lobe Epilepsy, by Christopher Ounsted, Janet Lindsay, and Ronald Norman. London: Published by the Spastics Society Medical Education and Information Unit in association with William Heinemann Medical Books Ltd. (Clinics in Developmental Medicine No. 22), 1966, 135 pp., $3.00
Authors: Gibbs Frederic A.
Published: December 2021

In Gilbert Glaser's "Foreword" to this book, the term "temporal lobe seizures" is taken to mean "psychomotor seizures." The authors also apparently consider these terms synonymous, for on page 2 they cite a case which meets their criteria for the diagnosis of temporal lobe epilepsy. The patient had an aura of abdominal discomfort, a succession of autonomic signs, semi-purposeful psychomotor movements, visual hallucinations, and a spike focus in the anterior temporal area. By considering temporal lobe epilepsy and anterior temporal lobe or psychomotor epilepsy as identical, they follow a usage that is almost universal in Europe and one that is also common in the United States.
HEREDITARY SPLENIC HYPOPLASIA
Authors: Kevy Sherwin V. , Tefft Melvin , Vawter Gordon F. , Rosen Fred S.
Published: December 2021

The hazard of overwhelming infection following splenectomy has been the subject of controversy and the physiologic role of the spleen in childhood remains unclear. We studied five siblings who are the offspring of a consanguineous marriage. One of two boys and two of three girls had severe hypoplasia of the spleen, presumably on an hereditary basis, and no other anatomic abnormality. Immunologic competence in the affected children was intact, except for their inability to form antibody to intravenously injected sheep red cells. One child died of overwhelming Haemophilus influenzae sepsis and the other two had repeated episodes of pneumococcal meningitis and H. influenzae sepsis. This isolated, presumably hereditary, abnormality may help define the spleen's role in resistance to infection.
Rheumatic Nodules Wanted
Authors: Wedum Bernice G.
Published: December 2021

In the course of tissue culture studies on the pathogenesis of rheumatic fever, we are in need of rheumatic nodules which have recently formed in the course of rheumatic carditis. These structures have become rare due to the recent decrease in the prevalence and severity of acute rheumatic fever and the widespread use of steroids.

The nodule should be situated on the extremities, be readily accessible to biopsy, and, preferably, be just in the process of forming, although nodules of any age would be welcome.
ANNUAL SUMMARY OF VITAL STATISTICS—1967
Authors: Wegman Myron E.
Published: December 2021

0nmany occasions previously this annual article has included serious criticism of the record of the United States as to infant mortality. It is satisfying, therefore, to report that 1967 marked a second year of a downward trend and that early tentative reports for 1968 are encouraging that the trend has continued. Nevertheless, as will be seen later, there is still a long way to go, and there are too many unacceptably high rates in particular population groups.

Each year at this time a report is presented of the national situation in respect of the most significant vital rates, that is live births and infant deaths.
Simpler Test for the Diagnosis of Choanal Atresia in the Newborn
Authors: Danufsky Philip G.
Published: December 2021

I was interested to read of Dr. Reisner's test for choanal atresia in the July issue of Pediatrics (42:216, 1968). My newborn examinations include listening to airflow through each naris with the edge of the stethoscope bell pressed against the columella to exclude sound from the other side. This requires no additional equipment and little time; however, I question if my method, or Dr. Reisner's, would detect choanal stenosis as described by Van Leeuwen and Glenn (Pediatrics, 41: 147, 1968).
Medical Aspects of Fitness to Drive Vehicles: A Guide for Medical Practitioners, edited by Leslie G. Norman. (Report by the Medical Commission on Accident Prevention). London : Royal College of Surgeons, 50 Brompton Road, London, S.W. 7, 1968, 48 pp. 5 shillings ($0.10)
Authors: Coleman Allan B.
Published: December 2021

This little paperback of about 50 pages contains valuable and difficult to locate information to help the physician whose advice is sought about a person's fitness to operate a motor vehicle. There are seven chapters dealing with important problems which may adversely affect an individual's fitness to drive. These are: cardiac conditions, diabetes, epilepsy, the nervous system, drugs, vision, ageing, locomotor disabilities, and fatigue and boredom resulting from long uninterrupted penods sitting behind the steering wheel.
Paediatric Anaesthesia, by Harold T. Davenport, M.B., R.F.A.R.C.S. Philadelphia: Lea and Febiger, 1968, 181 pp., $650
Authors: Smith Robert M.
Published: December 2021

In the field of pediatric anesthesia, a coliection of references is gradually being constructed; the small volume by Dr. Davenport is a welcome and valuable addition because it is a concise personalized view by an intelligent and experienced clinician. This book is designed to fit both the pocket and pocketbook and in its relatively small size lie both its advantages and its shortcomings.

The British background of tile author is obvious in phrase, brevity, and content.
SOME ASPECTS OF THE CURRENT DRUG SCENE
Authors: Louria Donald B.
Published: December 2021

Since antiquity man, both civilized and primitive, has utilized a confused collection of drugs for a variety of purposes, including escapism, pleasure, divination, magic, prophesy, warfare, rituals, and orgies. It is clear that no one drug has a single, entirely predictable effect; rather, the effects are largely dependent on the expectations and underlying personality pattern of the user and on the setting in which the drug is taken. This is well illustrated by the following three quotations.

1. They (the Otomac Indians) have another dreadful way of getting drunk through the nose, using malignant powders called yupa which drive them completely out of their minds so that, beside themselves, they seize any weapon to hand and if the women were not clever enough to stop them and tie them up, they would wreak cruel havoc every day. The Saliva Indians and other tribes also take yupa; but as they are gentle, harmless and cowardly people they do not become infuriated like the Otomacs who . . . get fighting mad with yupa, wound themselves and full of blood and fury go out to fight like raging tigers.1

2. After they had eaten (the mushrooms) and drunk they foregathered on the plain and danced and sang for joy all through the night and day, this on the first day. The following day they all wept a great deal and they said that they cleaned and washed their faces and eyes with their tears (an effect of hallucinogenic mushrooms on Chichimec Indians of Latin America).
Ambulatory Pediatrics, edited by Morris Green, M.D., and Robert J. Haggerty, M.D. Philadelphia: W.B. Saunders Company, 1968, 970 pp., $22.50
Authors: Fraad Lewis M.
Published: December 2021

Even 10 years ago, a stunning volume on ambulatory pediatrics such as this would have been impossible. This volume mirrors the increased interest in the ambulatory patient and his problems. In spite of many difficulties in space, funds, prestige, and so forth in out-patient pediatric divisions, a volume such as this is evidence that ambulatory pediatrics "has come of age." From the enthusiastic introduction by Dr. Janeway to the index, this volume is beautifully assembled and edited.
A SIMPLE SCREENING TEST FOR HISTIDINURIA
Authors: Gerber Marcia G. , Gerber Donald A.
Published: December 2021

Histidinemia, a childhood disease associated with mental retardation, can be identified by the presence of histidinuria. A rapid and simple screening test for histidinuria has been developed by the authors and is based on the inhibition by histidine of the blue color formed by the reaction of cupric ion and bis-cyclohexanone oxaldihydra-zone. The formation of a colorless solution in this test should identify all urine specimens in which the concentration of histidine is greater than 60 mg/l00 ml and most specimens in which the concentration of histidine is greater than 20 mg/100 ml. By appropriate dilution of a urine sample, the screening test may be used to estimate, semi-quantitatively, the concentration of histidine in urine.
UNIFORMITY OF VENTILATION IN THE NEWBORN INFANT: DIRECT ASSESSMENT OF THE ARTERIAL-ALVEOLAR N2 DIFFERENCE
Authors: Nourse C. H. , Nelson N. M.
Published: December 2021

The arterial-alveolar pressure difference for nitrogen (aADN2) was directly measured during the first 4 hours after birth in nine clinically normal infants. Transient gross elevations of the aADN2 were seen in most babies, indicating early maldistribution of ventilation.

However, by 4 hours of age, the aADN2 had subsided to 6 ± 22 mm Hg, a value characteristic of normal older infants and children. These findings are in conflict with previous indirect assessments of aADN2 by analyses of urinary nitrogen pressure. It is concluded that normal infants achieve excellent uniformity of pulmonary distribution of gas and blood soon after birth.
EARLY INTRAVENOUS FEEDING OF THE LOW BIRTH WEIGHT NEONATE
Authors: Mamunes Peter , Baden Melvin , Bass James W. , Nelson James
Published: December 2021

In 100 low birth weight neonates, the effect of early intravenous feeding on several biochemical and clinical parameters was evaluated by comparing this regimen to one with oral feedings after a 24-hour fast.

Blood glucose determinations obtained on 11 occasions during their first 5 days of life revealed a statistically significant higher mean value for the intravenous group through the first 60 hours of life. An unexpectedly high percentage (21%) of infants from both of the groups had glucose values below 30 mg/100 ml within 1 to 2 hours after their birth.

Fasted infants under 1,500 gm had significantly lower glucose levels than the entire fasted group through most of the first 33½ days of life. Only fasted infants (10%) developed consecutive glucose values below 30 mg/100 ml, all were males, and four-fifths were below the 20th percentile for weight for their gestational age.

Sudden cessation of the intravenous infusion was at times associated with a precipitous drop in the blood glucose, especially in the infants under 1,500 gm. Rate of weight loss or subsequent gain, mean maximum bilirubin levels, incidence of respiratory distress syndrome, and mortality were not altered by the intravenous fluid, but a slight hemodilution did occur.
CRITERIA FOR GUIDANCE IN THE DIAGNOSIS OF TUBERCULOSIS
Authors: Stegen Guillermo , Jones Kenneth , Kaplan Patricio
Published: December 2021

In countries with a high incidence of tuberculosis and where BCG vaccination at birth is a routine procedure, the diagnosis of tuberculosis in infants and young children may be exceedingly difficult.

A point system is proposed in order to evaluate all the available data when tuberculosis is suspected. This approach offers the advantages of a uniform criterion for diagnosis and treatment and a useful guide for completing diagnostic procedures. This point system carried out on each individual case gives four possible answers: (1) tuberculosis unlikely; (2) tuberculosis possible, requires further investigation; (3) tuberculosis probable, may justify therapy; (4) tuberculosis appears unquestionable.

It is a great help in clarifying a dubious diagnosis of tuberculosis based on vague x-ray shadows and positive tuberculin tests of doubtful interpretation in the absence of positive sputum or gastric washings. This point system has the limitations of all rigid point systems of evaluation. However, if priority is given to clinical experience, it is an additional tool in a difficult diagnosis.
Unscientific Treatment
Authors: Rapkin Richard H.
Published: December 2021

Dr. North raises a most interesting question as to the status of treatments which have not been subjected to scientific scrutiny. There are many common pediatric problems which are being dealt with in an "experimental" fashion, there being no controlled studies to define the ideal therapy, if any. Among these are the child with frequent sore throats, colds, or ear infections; the child with flat feet, pronation, tibial torsion or intoeing; the child with bed-wetting, meatal "structure," labial synechiae, and so forth.
Transverse Nail Ridging, Or the Dangers of Putting Faith in Prominent Neonatologists
Authors: Turano Andrew F.
Published: December 2021

In the May 1968 issue of Pediatrics you published an observation on transverse nail ridging in early infancy that I felt was original. However, subsequent correspondence, revealed that Dr. Bela Schick first described these ridges in 1908 (Jahrb. Kinderh., 67:146). This fact was kindly brought to my attention by Dr. Maarten S. Sibinga, who published observations on growth of fingernails in Pediatrics (24:225, 1959). It is obvious, therefore, that this observation was known to some neonatologists and careful observers for some time.
Foetal and Neonatal Physiology: A Comparative Study of the Changes at Birth, by Geoffrey S. Dawes, D.M. Chicago: Year Book Medical Publishers, Inc., 1968, 247 pp., $11.00
Authors: Smith Clement A.
Published: December 2021

It is difficult to review Geoffrey Dawes's book without looking back to another volume, Barcroft's Researches on Perinatal Life, published in 1946. Seen in this perspective, the recent growth of fetal and neonatal physiology is particularly striking. In much of that growth, Dr. Dawes has been concerned, either as Director of the Nuffield Institute for Medical Research (and thus leader of a major investigating team), or-less directly-as a source of stimulation to a multitude of investigators elsewhere.
Handbuch der Kinderheilkunde, Vol. IX: Paediatrische Grenzgebiete, Augen, Ohren, Zahne, Haut, edited by H. Opitz and F. Schmid. Berlin-Heidelberg-New York: Springer-Verlag, 1968, 968 pp., $96.25 (by subscription $77.00)
Authors: Eichenwald Heinz F.
Published: December 2021

This book represents Volume IX of the monumental Handbuch der Kinderheilkunde; only Volume I (Growth and Development) and VIII (Neurology-Psychiatry; Tumors) still remain to be published.

Volume IX is devoted to those areas which the editors consider to be "Grenzgebiete" (literally, "border areas") of pediatrics, a term perhaps not quite appropriate since the contents deal with ophthalmology, otolaryngology, dermatology, and dentistry. Actually, this volume consists of four concise textbooks covering different areas of vital interest to pediatricians.
Guide to Steroid Therapy, by Picton Thomas, M.D., M.R.C.P. Philadelphia: J. B. Lippincott Company, 1968, 223 pp., $8.25
Authors: Migeon Claude J.
Published: December 2021

The author has attempted the ambitious project of outlining the various uses of steroid therapy in the full range of human diseases. In this process, he has also described succinctly the diseases to be treated with steroid. In addition, Part I of the book discusses the structure and synthesis of steroids, their physiology, the methods for their measurement, and tests of steroid function. It is evident that, covering all this material within the limits of a 200 page book, is a difficult and probably impossible task. In any event, the present attempt cannot be considered as a full success.
THE PHYSICIAN'S RESPONSIBILITY IN THE EDUCATION OF THE CEREBRAL PALSIED CHILD
Authors: Berenberg William
Published: December 2021

The issue at hand is not whether the physician should assume a responsible role in the education of a cerebral palsied child but rather how he might most effectively contribute. Any doctor who has ever identified himself with the care of normal children is totally familiar with the common questions relating to education, posed to him by their parents. Shall I enter him in school a year early? Should he repeat a grade? Does he need a small private school? Multiply these out to infinity and you approximate a fraction of the meaningful questions directed to the doctor in the instance of any handicapped child.
INFLUENCE OF THE INFANT'S FOOD ON HIS CHARACTER ACCORDING TO DR. JOSEPH SIMMS WRITING IN 1891
Authors: C. T. E.
Published: December 2021

Until almost the beginning of this century, a commonly and widely accepted belief was that an infant imbibes with the breast milk the character of the nurse. Even as late as the 1890's there were physicians who vigorously supported this hypothesis. None was more convinced of this erroneous concept than Dr. Joseph Simms, who in 1891 wrote:

The child that sucks the milk of the mother who bore it will naturally take on the mother's moral characteristics; while the orphan, compelled to take in the milk of an animal, will reveal in its character some of those idiosyncracies peculiar to that animal. This is not a visionary statement; it is founded on fact, and can be testified to by those who have paid any attention to the subject. An illustration of what we mean was found in 1870 in the family of Captain P. M. Choutea, of Kansas City, Mo. In the captain's family there was a little girl, five years of age, who had been deprived of a mother's milk and nursed on the milk of a goat, and when she grew up and was able to run about, she gave unmistakable evidence of the truth of that law for which we contend. She had a strong and very unusual desire for climbing. She would mount rocks, fences, and go to the tops of houses, and, in fact, jump about in every respect like the animal whose milk she had sucked. Nor when in her climbing moods did she manifest any tokens of fear; and these peculiarities became apparent in her climbing moods did she had sucked.
Letter to the Editor
Authors: Adam Peter A. J. , Schwartz Robert
Published: December 2021

In his letter to the Editor Robert C. Tibbs, criticizes our suggestion that inadequate information has been published to establish that phenformin is a beneficial adjunct to insulin therapy of diabetes mellitus in children. He cites his personal experience which confirms the impressions of several authors—that combined insulin-biguanide therapy plus the increased supervision such treatment entails has been associated with lowering of insulin dosage, stabilization of blood sugar, and reduction of the tendency to acidosis in a few "brittle" diabetic patients.
Incidence of the Salt-Losing Form of Congenital Adrenal Hyperplasia
Authors: Marks James F. , Fink Chester W.
Published: December 2021

We have been impressed by the high mcidence of the salt-losing form of congenital adrenal hyperplasia (CAH) in the patients seen at the Children Medical Center in Dallas when compared to the quoted figures in the literature. The latest published figures from Johns Hopkins1 show 45 salt losers in a total of 131 patients, on 34%. Prader and co-workers2 reported 64 salt losers in 163 patients and affected siblings (39%), and Raiti and Newns3 report 28 salt losers in 58, or 48%. Two other series do not list numbers but give estimates of "as high as 30%" and "approximately one-half" for the incidence of the salt-losing form.
Kinderheilkunde, edited by Professor G.-A. von Harnack. Berlin/Heidelberg/New York: Springer-Verlag, 1968, 451 pp., $9.50
Authors: Cone Thomas E.
Published: December 2021

Both of these books, one English the other German, will satisfy the needs of the reader who wants something more than a synopsis yet less than a detailed textbook of pediatrics. Each accomplishes this goal, but in a different way.

Dr. Jolly wrote his book entirely by himself, drawing on his long and varied clinical expenience in both England and West Africa. This in itself is a tremendous accomplishment because there are few pediatricians left in any country whose professional experience is broad enough for them to be able to write single-handedly a text of pediatrics in the classical tradition.
PLACENTAL TRANSFER OF GROUP A TYPE-SPECIFIC STREPTOCOCCAL ANTIBODY
Authors: Zimmerman R. A. , Hill Harry R.
Published: December 2021

Group A streptococcal infections and their nonsuppurative complications are rare in infancy in spite of the fact that there is ample opportunity for streptococcal acquisitions. In an attempt to define the long-recognized contribution of trans-placental antibody to this epidemiological phenomena, the present study of 107 maternalcord paired sera was undertaken. Seventy-eight percent of the maternal specimens contained antibody to at least one of the four M-types common in the area, and 62% had antibody to two or more of the serotypes.

The high prevalence of type-specific antibody (TSA) in maternal sera, along with the fact that both TSA and bactericidal activity cross the placental barrier and persist in the newborn infant, suggest that passively acquired immunity might be partially responsible for the low incidence of streptococcal acquisitions which occurs during the newborn period.

Other investigators have reported higher levels of antistreptococcal antibodies in cord sera than in the corresponding maternal specimen. Five cord specimens in the present study were found to have higher TSA titers as well as higher antistreptolysin and/or antihyaluronidase levels than found in the maternal sera. Cord macroglobulins were elevated in each case; however, treatment with 2 mercaptoethanol did not significantly decrease the type-specific titers in these sera. The reason for the higher levels of antistreptococcal antibodies in cord sera warrants further investigation.
A SENSITIVE ELECTROCARDIOGRAPHIC SIGN IN MYOCARDITIS ASSOCIATED WITH VIRAL INFECTION
Authors: Rodriguez-Torres Ramon , Lin Jer-Shoung , Berkovich Sumner
Published: December 2021

The electrocardiographic signs used to diagnose myocardial disease are nonspecific. Therefore, it would seem to be of significance, that, in nine myocarditis children with proved viral infections (6 under 1 year of age), there was a constant electrical abnormality. Eight of the nine had abnormally wide spatial QRS-T angles. Recordings were made before onset of therapy and were repeated frequently during both the acute and convalescent phases of the illnesses. It was found that the return to a normal angle coincided with the disappearance of cardiac disease. Other findings were variable. The regularity with which an abnormal spatial QRS-T angle was detected in our children with viral myocarditis made this finding a valuable and dependable tool for detection and evaluation of their disease.
THE XYY CONDITION IN CHILDHOOD: CLINICAL OBSERVATIONS
Authors: Daly Richard F. , Chun Raymond W. M. , Ewanowski Stanley , Osborne Richard H.
Published: December 2021

The 47,XYY chromosome complement was found in the lymphocytes of a 6-year-old white boy of average intelligence. He seems well adjusted to home and school environments. He is extremely tall for his age, has an articulation problem, impaired coordination, and muscular and skeletal anomalies. Although he has had a hydrocoele repaired, his genitalia are otherwise normal. Mental retardation and genital maldevelopment have been quite common in the few reported cases of the XYY condition in children, but this may be partially due to sampling methods. It is apparent that the mental and physical characteristics of the average XYY boy are yet to be determined.
True Hermaphroditism Unassociated with a Common Urogenital Sinus
Authors: Hefelfinger David C. , Tyson Kenneth R. T. , Assor Dieter , Bryan George T.
Published: December 2021

A child with true hermaphroditism, Group II variety (ovotestis:ovotestis) with separate vaginal and urethral openings has been reported. The cause of this unusual anatomical presetitation remains unknown.
Mist Therapy Reconsidered Twice More
Authors: Matthews LeRoy W. , Doershuk Carl F.
Published: December 2021

Drs. Wolfsdorf, Swift, and Avery1 have carried out an interesting study of the delivery and distribution of aerosolized water in the respiratory tract of adult humans. We do not doubt the validity of their data with the experimental design utilized. It is unfortunate that their design does not reproduce either the usual clinical setup for direct inhalation from a nebulizer or for inhalation from a mist tent.

The usual mist tent is not air-tight. The fact that diffusion of air into and of oxygen out of such a tent occurs very rapidly is apparent to anyone who has attempted to raise the oxygen concentration above 50% by adding oxygen.
Down's Syndrome and Cystic Fibrosis
Authors: Vetrella M. , Barthelmai W. , Matsuda H.
Published: December 2021

The association of Down syndrome with cystic fibrosis (CF) is a very interesting problem. Recently Dr. Milunsky reported three cases; one was confitmed by karyograni as trisomy 21.

We have studied a newborn with trisomy 21 and cystic fibrosis who showed an unusual hematologic picture with hypoplastic thrombocytopenia at the same time. Diagnosis was confirmed by: sweat-test (81 mEq Na I, 141 mEq Cl/1), absence of pancreatic enzymes in duodenal juice, delayed meconium passage, pneumonia, and intestinal problems. The infant died at 49 days of age with severe diarrhea, anemia, leukopenia (WBC 3500/mm, with 520 neutrophiles) and a platelet count of 2000/mm.
Letter to the Editor
Authors: Milunsky Aubrey
Published: December 2021

The patient reported in the foregoing letter is of particular interest in view of the recent observations on patients with tnisomy 21 and cystic fibrosis. The multiple possibilities that could explain the clinical presentation have no doubt been considered by the authors. However, the description of "hypoplastic thrombocytopenia" and later pancytopenia in this patient, associated with pancreatic insufficiency, leads to the serious consideration of Shwachman's syndrome (pancreatic insufficiency and bone marrow dysfunction). The wide discrepancy between the sodium and chloride concentrations in the sweat reported in their letter indicates that evaporation of water may have occurred from the sweat sample, leading to an apparently higher sodium and chloride concentration.
DO INFANTS CRY IN THE WOMB?
Authors: C. T. E.
Published: December 2021

In the Ladies Dictionary,1 printed in London in 1694, one finds the following answer to the question above:

Infants crying in the Wombs of their Mothers, have occasioned various discourses among the Learned, as to its Signification, but in this they differ; however, it is a thing very unusual, and therefore strange; Sorrow indeed is incident to mankind, and we begin it with Weeping before we know what it means but that is very rare, till we come to breath in the open Air; now whether such untimely Cryings may signify something extraordinary in the Course of Life; or that Provident Nature would have them Practice in the dark Cell of Generation, what they shall afterwards seldom want so long as they enjoy the Light, viz; Sorrow and Affliction we undertake not to determine; but such Relations of those little Prisoners that have been heard to cry in those close Apartments [sic] take as we find them in credible Histories. In Holland, a Woman had a Child cryed [sic] and bemoaned it self [sic] in her Womb with little intermission for the space of fifteen days. In Leyden, a gentlewoman being in Bed with her husband on a suddain [sic] hearing the Child cry in her Womb was greatly terrified, so that in two days after she fell in labour, though she expected to go a great while longer. In Rathstadt, a town in the Norwick Alps, a Child was heard to cry in his mothers [sic] Womb fourteen days before it was born.
TREATMENT OF THE CRITICALLY ILL CHILD: HEMORRHAGIC SHOCK
Authors: Replogle Robert L.
Published: December 2021

Shock in the child is nearly always caused by blood (or fluid) loss, burns, or infection. The goal of the physician is to recognize which of these are causing shock in his patient, and to treat both the underlying disorder and the shock as quickly as possible. This review will touch only on the clinical management of the patient in hemorrhagic shock.

The pathophysiology of hemorrhagic shock is characterized by a decrease in cardiac output resulting in inadequate tissue perfusion, tissue hypoxia, and acidosis; and, it is caused by an inadequate circulating blood volume.

The patient often arrives in the emergency room with multiple injuries, being hypotensive, tachycardic, tachypneic, and obtunded. First priority is given to establishing an adequate airway, stopping massive hemorrhage (application of manual pressure or tourniquets) , and splinting unstable fractures. Since many resuscitative measures should be undertaken simultaneously, even the most experienced physician should call for assistance as soon as he recognizes the seriousness of a patient's condition. The nurse should start a chart on the patient, recording at frequent intervals vital signs, pupil size and reaction, and fluids and medications given. As quickly as possible, one or more routes for the rapid infusion of fluid should be established. In the child this is best accomplished by cutdown of the greater saphenous vein at the ankle and insertion of a large bore catheter.1 (Efforts at introducing a needle or catheter percutaneously into a collapsed peripheral vein will usually waste valuable time.)
Letters to the Editor (As a Mixed Bag)
Authors: Fields John P.
Published: December 2021

Thank you for your kind words about "several" original articles in the March issue of Pediatrics. Thank you also for evidence that the Letters pages are-as we hope they will be-controversial.

May I briefly consider your specific comments in order?

Dr. Bumbalo's letter was sent to the author of the original article for comment on September 23, 1968. The inquiry was repeated December 10, 1968. Having received no answer to either letter, we decided upon publication of that from Dr. Bumbalo without further delay, in the hope that a response would result.
Activity, Caloric Intake, and Energy Balance of Infants
Authors: Krieger Ingeborg
Published: December 2021

I am writing in response to a paper on the energy balance of infants, by H. E. Rose and J. Mayer, in the January 1968 issue of Pediatrics. The authors' findings were very interesting and are significant where data are from actual measurements, i.e., muscular activity and skinfold thickness. I am surprised, however, that estimates of the caloric intake and predicted values for "extra" calories were considered admissible in a multiple regression analysis. The results of this analysis have led the authors to make conclusions which are currently favored theory but not supported by the data.
Letter to the Editor
Authors: Rose Hedwig E.
Published: December 2021

We agree that muscular activity and weight gain are both related to calorie intake. It was not suggested that this is not so but simply that the activity factor was the greater determinant of calorie intake. Its variability and influence on calorie intake are, in fact, so great that they mask the correlation between weight gain and calorie intake; and "make any attempt at correlating (these factors) futile," unless activity is held constant, as in the equation, "Total calories: 5 mo weight A activity."
Dangers from Talcum Powder
Authors: Moss Malcolm H.
Published: December 2021

Most pediatricians are aware of the adverse effects of talcum powder aspiration which may result in acute or chronic lung disease. At least three fatalities have been reported following the aspiration of talcum powder by infants. Verbal communication with the New York Poison Control Center reveals that approximately 50 cases of talcum powder aspiration are reported to that center annually.

Despite the potential dangers of talc aspiration, little has been done to publicize these dangers to the general public.
BISEXUALITY GONE AWRY—THE CHILD IS FATHER TO THE MAN
Authors: Solnit Albert J.
Published: December 2021

Pediatrics has persisted in retaining its interest in all children and in not limiting its concern to certain kinds of children or to one set of influential factors in the development of children. Although his biological training is crucial, the pediatrician, as a generalist, has a critical interest in psychological aspects of child development and in the social-economic conditions that have a bearing on child and family life.

Deisher, Eisner, and Sulzbacher's article, "The Young Male Prostitute" (page 936 in this issue), demonstrates the pediatrician's scientific and humanitarian concern about a group of homosexual boys. This study, an excellent model of exploratory social science research, touches upon an extreme outcome of childhood psychopathology, lesser degrees of which are more frequently seen in the pediatrician's office.
THE YOUNG MALE PROSTITUTE
Authors: Deisher Robert W. , Eisner Victor , Sulzbacher Stephen I.
Published: December 2021

Interviews with 63 male prostitutes were carried out in San Francisco and Seattle. Information is presented regarding background and present mode of operation within the two cities. Data presented are derived solely from interviews conducted in the natural setting of the street corner, bar, or automobile.

An attempt is made to describe this group of young males as thoroughly as possible in order to suggest some methods of rehabilitation. Some of the more outstanding characteristics of the group were their limited education, high mobility, unstable home environment, and lack of social and vocational skills. Although most were unemployed when interviewed, they expressed interest in finding work, and a number were given assistance in obtaining employment. While the authors feel justified in presenting this information on the 63 boys interviewed, extensive generalization to a larger population would be unwarranted and further research is indicated to confirm findings of this preliminary study.