bluuebunny/crossref_metadata_2025 huggingface dataset:
PARENT REACTION TO THE CONCEPT OF PEDIATRIC ASSISTANTS
Authors: Patterson Patricia K. , Bergman Abraham B. , Wedgwood Ralph J.
Published: December 2021

The attitudes of patient families must be considered in planning training programs for "pediatric assistants." Structured interviews of 145 mothers were conducted to determine reactions to the concept of delegation of tasks usually performed by pediatricians. Results indicate that all socioeconomic groups, including "affluent suburbia," will accept the concept of "pediatric assistants," depending on how the innovation is presented.
Milk Antibodies in Familial Dysautonomia
Authors: Drucker M. M. , Russell Alex , Kletter B. , Gery I. , Freier S. , Moses S. W.
Published: December 2021

Cow's milk antibodies in sera, hemagglutinins, and precipitins were studied in six children with familial dysautonomia and were found to be exceptionally high—indeed, higher than in Down's syndrome or cerebral palsy, and much higher than in normal children. It is suggested here that these high levels of milk antibodies in dysautonomia may be mainly related to recurrent episodes of milk aspiration.
Care by Parent: Further Advantages
Authors: Wessel Morris A. , Lacamera Robert G.
Published: December 2021

The article, "The Care by Parent Unit," by Vernon James and Warren Wheeler, and Morris Green's Editorial Comment on the "The Parent Care Pavilion" (Pediatrics 43:486, 1969) indicate a trend based on realistic resolution of some of the problems inherent in hospitalization of children. It seems to us appalling that children's hospitals should be so slow in recognizing the potential advantages, both economic and psychologic, of a "live-in" plan for parents.

Hospitalization and surgery in childhood always involves psychological stresses.
Psychological Needs of Hospitalized Children and Indexing of Letters
Authors: Thorpe Helene S.
Published: December 2021

The April and May 1969 issues of Pediatrics contain five significant articles on the psychological needs of the hospitalized child.

In the April issue, Dr. Morris Green's editorial comments that new parent care units cannot stand alone. They require an intimate relationship and integration with child development and rehabilitation services. The description of the University of Kentucky's Care by Parent Unit may offer encouragement for more units that will lessen the emotional trauma of hospitalization.
Letter to the Editor
Authors: Milby Thomas H.
Published: December 2021

Dr. Aase's question about the possibility that differences in exposure to light might have accounted for our observed differences in bilirubin levels is, of course, germane.

During the course of our study, we became aware of the reports which described the effect of light on degradation of bilirubin. However, we could determine no differences in light exposure between the two populations under study nor, because of the physical arrangements of the nurseries, did there appear to be any possibility that there would be seasonal variations in the amount of light exposure.
Letter to the Editor
Authors: Burke Frederic G.
Published: December 2021

There is little question that the per diem costs in an intermediate-stay children hospital, like those of several hospitals, are rising at an unprecedented rate in an inflationary economy. However, without the expenses of maintaining a large surgical facility, which accounts for a very significant part of high cost, rates for extended care beds are considerably lower. When all departments concerned with the multifaceted nature of chronic illness are brought to full strength, this cost difference will diminish, but cost should still be lower than for acute short-stay units.
SHOULD NURSERY ENVIRONMENTAL CONTROL MEASURES BE RE-EXAMINED?
Authors: Gezon Horace M.
Published: December 2021

Many nursery routines are based on the belief that newborn infants are exquisitely susceptible to certain infectious agents carried by personnel working in the nursery. Empirically, protective measures to minimize the possible transfer of these agents to infants have been employed. These include: exclusion of parents and visitors from the nursery, protective over-gowns or scrub dresses, hairnets or caps, masks and gloves for personnel, isolation incubators, frequent air changes of the room through forced ventilation, nasal antibioties cream for personnel, handwashing with hexachlorophene-containing detergents, protective antiseptics applied to the skin of infants as bathing solutions or skin lotions, and so forth.
URINARY TRACT INFECTION IN CHILDREN
Authors: Govan Duncan E. , Palmer John M.
Published: December 2021

To study the influence of successful ureterovesicoplasty on incidence of recurrent urinary infection, two groups of infected children were compared in this regard before and after urologic evaluation. Of 280 new pediatric urologic hospital admissions, 55.6% had urinary tract infections. Sixty-six of these 156 infected children had vesicoureteral reflux. Bacteriologic localization of infection site was performed in both children with and without reflux at the time of diagnostic cystoscopy. Both groups were specifically treated with short-term antibiotic therapy and empiric urethral dilation. Operative vesicoureteroplasty was carried out in 62 children with reflux, with an overall cure rate of 83.8%. Distal urethral stenosis was not a contributing factor in this population nor did urethral caliber relate to the incidence of reflux. Only 3 of 35 children without reflux were found to have bacteriologically proved upper urinary tract infection. Similarly, only 32% of these children without reflux had clinical histories suggestive of recurrent pyelonephritis. In the children with reflux undergoing bacteriologic localization while infected, no nonrefluxing ureters were found infected, and only one third of the refluxing ureters so studied had proved upper urinary tract infection. Historical evidence for clinical pyelonephritis was present in 79% of the population with reflux; but, after successful cure of reflux, only 7% of these children continued to have pyelonephritic episodes. The long-term incidence of recurrent urinary tract infection was virtually identical, however, in the children undergoing successful antireflux surgery and the children without reflux following ureteral dilation. This relationship indicates that reflux plays little role in the etiology of bacteriunia but has a profound influence on urinary tract infection morbidity in children.
TRACHEOBRONCHIOMEGALY AND ACQUIRED CUTIS LAXA IN A CHILD
Authors: Wanderer Alan A. , Ellis Elliot F. , Goltz Robert W. , Cotton Ernest K.
Published: December 2021

Tracheohronchiomegaly and acquired cutis laxa are described in a 14-year-old boy. Marked dilatation of the tracheobronchial tree associated with recurrent lower respiratory tract infections has been reported chiefly in the adult medical literature as the Mounier-Kuhn syndrome. Cutis laxa is a rare elastic tissue disorder that involves the skin and other systems. While the etiology of tracheobronchiomegaly is unknown, the coexistence of two rare conditions in the same patient suggtsts a common fundamental elastic tissue defect.

The investigative studies revealed abnormal elastic fibers in the skin, increased thoracic gas volumes, abnormal pulmonary elastic recoil, and a normal immunologic status except for increased serum and parotid IgA levels.
Responsibility for School Problems: An Objection to "Pediatric Globalism"
Authors: Schmitt Barton D.
Published: December 2021

At a time when our country is reviewing the question of foreign overcommitment, overextension, and priorities it may be relevant to look at a similar problem in pediatrics.

The pediatrician is being asked to become an expert in school problems. If not the final expert, he is at least expected to be the coordinator of the team that diagnoses and treats the school problem. Parents want this. The schools want this.

The pediatrician who doesn't attempt to provide these services might well feel madequate.
Letter to the Editor
Authors: Juberg Richard C. , Jewson Douglas V. , Taylor Mary Belle
Published: December 2021

The writer gives us the opportunity to discuss further the etiology of abnormalities of the external genitalia. There is apparently a continuum beginning with a simple anomaly in an otherwise phenotypically normal male, e.g., glandular hypospadias, extending to ambiguity of the external genitalia in persons with testes, to variable external genitalia in bisexual persons, to ambiguity of the external genitalia in persons with ovaries, and finally to a simple anomaly in an otherwise phenotypically normal female, e.g., enlargement of the clitoris.
Stilts, Somersaults, and Headstands: Game Poems Based on a Painting of Peter Brueghel, by Kathleen Fraser. New York: Atheneum, 37 pp., 1968, $3.75
Authors: Cone Thomas E.
Published: December 2021

When Peter Brueghel, the Elder (1525/30-1569), finished his painting of Children's Games in 1560, I am certain he never thought that Kathleen Fraser in 1968 would use his painting as the subject of a book. Although the book would be classified as a children's book, any adult interested in children, or still young enough to remember his youth, will find it irresistible.

Brueghel's painting, measuring 118 x 161 cm, which now hangs in the Kunsthistorisches Museum in Vienna, vividly depicts nearly 100 games and pastimes played and enjoyed 400 years ago by children in the Low Countries.
Genetische Familienberatung: Ein Leitfaden für den Arzt, by Walter Fuhrmann and Friedrich Vogel. Berlin/Heidelberg/New York: Springer-Verlag, 1968, 98 pp., $2.20. In German
Authors: Zellweger Hans
Published: December 2021

This small paperback appeared as Volume 42 in the series Heidelberg Pocket Books (a translation of L. S. Penrose's Introduction to Human Genetics is Volume 4 of the same series). The authors, both directors of an institute for human genetics in Germany, wrote this syllabus to familiarize the genetically uninformed physician with the common and practical aspects of medical genetics and genetic counseling. They advise the reader to consult a professional geneticist for more complicated genetic problems.
Proceedings of the International Conference on Leukemia-Lymphoma, edited by Chris J. D. Zarafonetis, M.D. Philadelphia: Lea & Febiger, 1968, 519 pp., $15.00
Authors: Murphy M. Lois
Published: December 2021

If one believes, as Dameshek writes in the summary of these Proceedings, that the final "breakthrough" to cure leukemia or lymphoma-so beloved by newswriters-is questionable and that the advances in the control of these malignant diseases will come about only from the slow, steady investigations now being made in hundreds of laboratories throughout the world, he will find this book rewarding. No original material is presented but what is given in the 50 odd chapters has previously been subjected to editorial review in specialty journals and at other meetings and does bring together the findings of the multiple disciplines currently involved in the study of different aspects of lymphoma-leukemia.
TRAFFIC ACCIDENTS INVOLVING CHILD PEDESTRIANS: A PROGRAM FOR THEIR PREVENTION
Authors: Read John H.
Published: December 2021

The two papers that follow report the results of painstaking epidemiological work on pedestrian accidents involving children. Because these papers relate the age of the child to specific behavior patterns that result in accidents and to specific injury patterns that result from such accidents, they would appear to offer a sound empirical base for the development of a variety of countermeasures, whether such countermeasures are intended to reduce accidents or to limit the severity of the resulting injuries.

Unfortunately, however, the ability to generalize such data is extremely limited. A given pattern of child-pedestrian behavior is the result of a highly complex set of variables: the social class and ethnicity of the child, the ecological characteristics of the neighborhood and the broader community, the characteristics of the traffic pattern and the types and density of the vehicles that make it up, the current enforcement policy, climatic conditions, road and highway characteristics, and a host of other conditions that combine and interact in various ways. Consequently, few localities are sufficiently similar to justify the application of data from one to another. The injury patterns described by Ryan, for example, are those produced by Australian vehicles on children walking, playing, and cycling in a specific Australian city. It seems quite unlikely that the injury patterns produced in an American urban environment would resemble those that Ryan reports. Indeed, data from another Australian city might show striking differences.

For the same reasons, such data as Read presents cannot be used reliably as a before-and-after measure to assess the effectiveness of a specific countermeasure. Any significant changes in the data after the introduction of a countermeasure might well be attributable not to the countermeasure itself but to changes in traffic patterns, ecology, the weather, or other events which operated to reinforce or counteract the countermeasure in question.

The overwhelming obstacle to systematic research in vehicular accidents and on the assessment of countermeasure effectiveness is the investigator's inability to control the numerous variables that affect both the incidence and the consequences of accidents. The present papers, despite their inherently interesting data, are seriously limited by this problem.
THE ROLE OF THE PEDIATRIC HOSPITAL IN INJURY CONTROL
Authors: Hoekstra Lilly D.
Published: December 2021

The role of the children's hospital as a community center is widely recognized, yet its potential as a base of operations for injury control is seldom utilized. While hospital beds continue to be filled with many children having burns, poisonings, broken bones, and other residuals of injury, an active preventive program to counteract this toll is rarely demonstrated. Miss Hoekstra has emphasized the important trilogy of training, research, and service in childhood injury which should be carried on in pediatric centers. Recent studies have clearly indicated that even in the hospital children are in danger from falls, mismatched medications and other traumatic experience. It seems evident that children's medical institutions must assume a more significant leadership role with injury control.
CHILDHOOD INJURY AND PEDIATRIC EDUCATION: A CRITIQUE
Authors: Meyer Roger J.
Published: December 2021

The medical school, the school of engineering, the liberal arts college, and the high school all share a common problem today: the exponential growth of knowledge and the increasing complexity of contemporary society have caused numerous demands for further crowding their already crowded curriculums. Thus, there are those who believe that high school students "must" get driver education, that engineering students "must" learn something about the social sciences, that liberal-arts students "must" have a course in computer technology. Often these needs are "felt" by their proponents rather than demonstrated objectively, and often the proponents seem unaware that the subject matter they advocate might be acquired with equal or greater effectiveness outside a formal curriculum.

The paper that follows, however, distinguishes itself in several ways from the hortatory pleadings characteristic of special-interest groups. To begin with, it demonstrates the cost-benefits of sound injury-control teaching in departments of pediatrics. Secondly, it points out that much needs to be done in the development of materials and methods before a demonstrably sound program can be proposed. (In both these respects the author provides a sharp contrast with the proponents of driver education, who have successfully lobbied into the American high school curriculum a program whose methods and materials have never been subjected to systematic evaluation and whose outcomes have been questioned by responsible research.) Lastly, the paper does not propose that the departments of pediatrics is the "ideal" or "inevitable" site for the teaching of injury control; rather, the responsibility for the program is seen as shared among many community institutions and agencies.

The paper does not, unfortunately, address itself to the question of the role of the pediatrician in injury control, although this question needs to be answered before adequate materials and methods can be fully developed. Should the pediatrician's role be a purely preventive one? And, if so, should he focus his efforts on the patient and his family or on environmental hazards in the community as a whole or on the broad social, cultural, and technological factors found to be related to accidental injury in children? Should he be sufficiently trained in research methodology to carry on his own investigations or should he be taught to work with other specialists in an interdisciplinary context? A number of papers in this volume demonstrate the methodological inadequacies of even the most dedicated pediatrician. On the other hand, interdisciplinary research, despite the lip service which it constantly receives, is beset with problems and has produced few findings that can be incorporated into action programs or that offer clear guidelines for the teaching of injury control-in medical schools or elsewhere.

As the paper makes clear, the student in a medical school today learns little to make him effective in reducing childhood injury. But, what, when, and how he is to be taught remain unanswered questions.
ANNUAL SUMMARY OF VITAL STATISTICS—1968
Authors: Wegman Myron E.
Published: December 2021

Infant mortality declined again in 1968, for the third successive year, and there is some evidence of a more rapidly downward trend in the unacceptably higher infant death rates which have existed among some population groups. The birth rate also declined again, but the marriage rate showed rather a sharp rise ( Table I ). With an excess of births over deaths of 1.55 million persons, the rate of natural increase was 7.8 per 1,000 population.

Births Once more there was a decline in annual number of births, although a smaller one than last year. Nevertheless, with a rising population the birth rate fell to 17.4, the lowest ever recorded in the United States.
Drug Abuse in Adolescence
Authors: Tapper Theodore S.
Published: December 2021

The report of the Committee on Youth concerning "Drug Abuse in Adolescence" (PEDIATRICS, 44: 131, 1969) has many valid points to make. However, there are several issues which the report raises which concern me.

Virtually no mention at all is made of the two prime offenders among the abused drugs:alcohol and tobacco. Simply because their use is legal and their deleterious effects are more of a chronic nature is no reason to ignore them. Far more deaths and chronic, debilitating illness, as well as acute trauma in auto accidents, are caused by these agents than by those mentioned in the report.
The Middle-Aged Pediatrician Syndrome; Its Recognition and Treatment
Authors: Bruser David
Published: December 2021

Hindsight suggests that the early years of practice are the best time for the pediatrician to begin immunizing himself (if that is possible) against the later onset of what might be called the Middle-Aged Pediatrician Syndrome (MAPS) . A treacherous feature of this condition is the well-known fact that, while the pathognomonic signs are known to all and readily observed in others, the victim may for some time be unaware of them in himself. Therefore, as an aid to estimating individual susceptibility, the following equation is suggested, where CF represents Constitutional Factor, EF Economic Factor, YP Years in Practice, QUART Quality and Amount of Residency Training, SMC Separation from Medical Center then, the tendency to develop MAPS is predictable, and proportional to CF+EF+YP/QUART x SMC3.
Currents in American Medicine: A Developmental View of Medical Care and Education, by Julius B. Richmond, M.D., with a foreword by Ward Darley, M.D. Cambridge, Massachusetts: Harvard University Press, 1969. 138 pp., $5.50
Authors: Cone Thomas E.
Published: December 2021

In only 138 pages, the author, a distinguished pediatrician, as well as the Dean of one of our major medical schools, offers a succinct historical review of the turbulent changes in American medicine since 1940. No period in our history has seen more dramatic transitions; in fact, the tempo and thrust of events since this century began have drastically altered every facet of medicine.

All medical schools are in a Sisyphean struggle to make their curriculum "relevant" and in keeping with the pace of social change.
Observing Children Who Are Severely Subnormal: An Approach to Their Education, by Mildred Stevens, M.Ed. London: Edward Arnold, 1968, 94 pp., $5.50. (The Williams and Wilkins Company, Baltimore, exclusive U.S. agents)
Authors: Pueschel Siegfried M.
Published: December 2021

This book is primarily addressed to the teacher of intellectually subnormal children; the author's purpose is to offer a methodical approach of teaching the mentally handicapped. As emphasized in the title, "observing" is the key word throughout the book, reflecting one of the author's principal educational concepts. Through skillful observation, one can recognize both the limitations of the mentally retarded as well as his strengths, which then permits one to understand the child and his handicap.
CONDITIONING CHILDREN WHEN REFUSAL OF ORAL MEDICATION IS LIFE THREATENING
Authors: Wright Logan , Woodcock James M. , Scott Robert
Published: December 2021

Two 18- to 24-month-old girls who refused oral medication were subjected to a conditioning program designed to elicit their cooperation. Both patients had a disease which would be life threatening in the absence of medication. Their refusal to take medicine was further complicated by regurgitation of any substance placed in their stomachs by means of gavage. One patient responded promptly and completely to conditioning and thereafter accepted the necessary oral medication. The other child required the use of successive approximations or shaping, which resulted in her acceptance of the medicine when offered in candy. The conditioning techniques employed by the experimenters were successfully transferred to hospital staff and eventually to the parents in both cases. The techniques for conditioning and shaping are described.
The Young Male Prostitute
Authors: Hick John F.
Published: December 2021

After reading Deisher's article, "The Young Male Prostitute" (Pediatrics,43:936, 1969) and the companion editorial by Solnit, "Bisexuality Gone Astray," many a subscriber must have mused over the prospect of a sequel editorial taking "Pediatrics Gone Astray" for its title.

The only distinction Deisher claims for his study is that it is the first sociologic investigation of the professional male deviant. No other distinction is in sight, yet Solnit strains with sometimes meaningless grandiloquence to reach for a profound implication arising from the study.
DEVELOPMENTAL AND PSYCHOLOGICAL TEST SCORES IN CHILDREN OF LOW BIRTH WEIGHT
Authors: Eaves Linda C. , Nuttall J. C. , Klonoff H. , Dunn H. G.
Published: December 2021

In a prospective survey, 420 out of 502 infants of low birth weight (≶ 2,041 gm, or 4½ lb) and all but one of 207 control children of full birth weight (> 2,500 gm, or 5½ lb) have survived for more than 3 years. One hundred fifty of the low birth weight (LBW) group have passed the age of 6 years. Developmental and psychological tests have given the following results: (1) Control children performed better than LBW infants on the Griffiths Developmental Scale up to the age of 18 months; among the LBW infants mean Griffiths Scores in 250 gm birth weight groups mosty differed significantly in direct relation to the weight. (2) LBW girls scored higher than boys after the first year on the hearing-speech subscale and, to a lesser extent, on the personal-social and performance subscales of the Griffiths test and also on the Stanford-Binet and Graham-Ernhart tests at 4 years of age. (3) Whereas the effect of birth weight on I.Q. became less distinct at 2½ to 4 years, the effect of socioeconomic status only became definite at that age. (4) In general, "small-for-dates" (SFD) children, including those born before term, scored higher than "true prematures" up to the age of 12 months and slightly lower at 2½ to 6½ years, but the differences were only significant in a few weight groups. When the SFD children were subdivided into those born at less than 37 weeks' gestation and those born later, the latter scored significantly better than the former only at 3 and 6 months. (5) Isolated Griffiths infant test scores at 6 months per se have little predictive value for I.Q. scores of children at 4 years of age, even at the extremes of intelligence.
FOREWORD
Authors: Low Merritt B.
Published: December 2021

This paper Presents a strong argument in an exemplary area long considered central in our attacks on the problem of accidents. Here we have an opportunity for the implementation of combined educational, engineering, and legislative efforts. One likes to think a new, positive, safetyimage is being born, and that it will be one to be admired in an era of living dangerously. Bombardments of statistics and appeals through facts and reason are not enough; built-in safety and built-out hazards must be added. Some of the problems in pupil transportation are already being met, but the further message is clear and the recommendations sound and sensible. Automobile restraining devices for children remain in the investigative stage, with extrapolation from adult studies not yet entirely warranted or valid. There is nevertheless much available knowledge and methodology ready for daily application in our practices. The pediatrician has obligations to become involved and encourage involvement. This can be done through study and knowledge of current federal and local laws, and work with local school boards and other organizations. Individual community strengths and weaknesses can he better understood and the latter eliminated through participation in "local lobbying." Precept and participation are strong partners in the advocation of desirable devices.
MODERN CONCEPTS OF LOWER URINARY TRACT OBSTRUCTION IN PEDIATRIC PATIENTS
Authors: Shopfner Charles E.
Published: December 2021

Awidely recognized concept in pediatric uroradiology is that urinary tract infection is usually secondary. A consultation request commonly suggests, "urinary tract infection—rule out obstruction." Vesicoureteral reflux and hydronephrosis are the abnormalities most often found by the radiologist. The conclusion that the infection is secondary comes from old concepts that reflux and hydronephrosis are always secondary to obstruction, and, therefore, that the infection itself is also thus produced.

The bladder neck, the meatus, and the distal urethra are widely recognized as sites of obstruction, because the reflux and hydronephrosis are usually bilateral and require an obstruction that causes symmetrical back pressure.
THE FIRST DETAILED DESCRIPTION OF MUMPS BY ROBERT HAMILTON, M.D. (1721-1793), PUBLISHED IN 1790
Authors: C. T. E.
Published: December 2021

Although Hippocrates mentioned orchitis as a complication of mumps, a full description of this disease did not appear in print until 1790 when Dr. Robert Hamilton described the clinical course of mumps as follows:

A lassitude, a heaviness, a general restless uneasiness not easily described are perceived several days before the swelling which characterizes the disease begins to appear. These disagreeable feelings are attended with . . . some degree of fever, which being slight is commonly disregarded. Then a stiffness with obtuse pain, is felt in one or both sides of the articulation of the lower jaw, impending its motion and of course mastication: which symptoms increasing, a swelling appears upon the parts the following day, and quickly extends to the parotid glands, the neighbouring skin, and cellular membrane. Here in some it stops without discolouring the skin . . . the tumor becomes more diffuse and sometimes increases so suddenly in size that on the third day from its first appearance it occupies the salivary glands and surrounding cellular membrane on the side; and if both sides are affected, the parts are so much swelled and the tumor descends so low, that the countenance is rendered of a frightful enormous magnitude; and now deglutition becomes more or less impeded. All this is frequently without much pain; but . . . commonly there is . . . a considerable degree of fever. In many subjects here it ends . . . And it seems probable from the natural resolution of the disease, which now immediately follows, that the tumor has attained its greatest magnitude and the distemper it came from about the morning of the fourth day from the first appearance of the swelling.
Guillain-Barré Syndrome Associated with ECHO Virus Type 7 Infections
Authors: Urano Takashi , Kawase Takao , Kodaira Kinjiro , Takeuchi Yoshinao , Kikuchi Tatsuo , Kimura Mikio
Published: December 2021

The cause and pathogenesis of this syndrome remain unknown. The recovery of ECHO virus type 7 from the cerebrospinal fluid and stool of a patient with the Guillain-Barré syndrome during its acute stages and the demonstration of a concomitant increase in antibody titer establish that the syndrome and the infection were concurrent. This is apparently the third ECHO virus to be associated with this kind of illness.
Pruritis Associated with the Rash of Juvenile Rheumatoid Arthritis
Authors: Schaller Jane , Wedgwood Ralph J.
Published: December 2021

Five children with typical systemic juvenile rheumatoid arthritis have had pruritis associated with rheumatoid rash. This rash is not always nonpruritic. The clinician should not overlook the possibility of juvenile rheumatoid arthritis simply because the patient is scratching his rash.
CELLULAR GROWTH, NUTRITION AND DEVELOPMENT
Authors: Cheek Donald B. , Graystone Joan E. , Read Merrill S.
Published: December 2021

Traditionally, the biological sciences have focused their attention on the whole organism, on organs as functional units, or on individual tissues in the quest for knowledge of mechanisms controlling development. Alternatively, the biochemist and endocrinologist have explored enzymes and metabolic pathways seeking the same goals. Improved methodologies now permit convergence of these approaches in the study of cells as fundamental units of structure and function. As this review has emphasized, the preliminary results are encouraging and exciting.

The concept of critical periods in development has been repeatedly emphasized. Systematic exploration of the effects of imposed nutritional variables on cell ploidy, the appearance or disappearance of enzyme systems, and the production and/or functional expression of hormones will shed light on imprinting effects of early deficiencies on the growing organism. Sex and age differences in these parameters are most thought provoking, as is the potential application of cell methods to diagnosis or monitoring progress of childhood diseases. Particularly exciting are the studies seeking to explain the consequences of malnutrition on nerve cell development, an understanding of which may perhaps identify a biological basis for subsequent behavioral abnormalities. A potentially fruitful area for study is the aging process, with emphasis on improved understanding of cellular changes associated with maturation and decline in cellular function.

Acceleration of progress in this field will depend on refinements in methods for counting cells and estimating cell size or functionality. Special attention needs to be given to DNA as the index for cell function in the light of recent questions concerning the nature and location of DNA in different cells. More direct measures of cell function are needed inasmuch as large cells may not in fact be more functional cells.

Comparability of findings from experimental animals to developmental processes in subhuman primates and humans need clarification. The need for new experimental models (including invertebrates) for research on cellular aging is particularly pressing. The adaptation of cell culture techniques to nutritional problems is another promising area for expanding research.

The cellular approach to nutrition promises new explanations for nutritional influences on development. The data presently available partly explain why nutritional insults at a given time have permanent repercussions throughout life. These and future findings will be significant beyond the laboratory setting, having impact upon clinical diagnosis as well as on the design and implementation of improved nutrition service programs.
Low Birth Weight and Subsequent Development
Authors: Illingworth R. S.
Published: December 2021

I was most interested to read the paper by Eaves, et al. They have helped to remedy the defects of most earlier papers on the prognosis of "prematurity" by carefully distinguishing small-for-dates babies from true premature babies.

They found that Griffith's infant test scores correlated badly with test scores at 4 years. I would not expect them to have a high predictive value, apart from the effect of environmental variables in the intervening period, because several of the Griffiths tests have no bearing on intelligence, and the method does not allow one to take into consideration the factors which may have affected the score and which are unrelated to intelligence.
Letter To The Editor
Authors: Urschel Harold C.
Published: December 2021

Dr. Urschel comments as follows:

We were not aware of Mr. Carré's contributions, and we wish to apologize for not including his work in the background material.

Our thinking has been influenced by Mr. Ronald Belsey, who in 1952 first made reference to gastroesophageal reflux with or without hiatal hernia producing pulmonary symptoms in adults, children, and infants.

We agree with Mr. Carré on most points although his experience with infants and smaller children is far greater than ours, which has been with older children and approximately 2,000 adults.
THE TREATMENT OF CHRONIC UREMIA IN CHILDHOOD I. TRANSPLANTATION
Authors: Potter Donald , Belzer Folkert O. , Rames Linda , Holliday Malcolm A. , Kountz Samuel L. , Najarian John S.
Published: December 2021

Twenty-seven renal allotransplants were performed in 25 children less than 17 years of age between April 1964 and September 1969. Sixteen were from living, related donors, and 11 were from cadaver donors. There was one death and one rejection in the living donor group, and five deaths and one rejection in the cadaver donor group. Ten recipients weighed less than 20 kg, and all but two received adult kidneys. Four children received transplants because of bilateral Wilms' tumor.

Complications included infection, immunologic rejection, pulmonary disease, recurrence of glomerulonephritis, and aseptic necrosis of bone. Growth retardation occurred in 7 of 10 children and sexual development was delayed in 2 of 3 children following transplantation. These factors were best correlated with steroid administration. Rehabilitation was generally good, however; and the results of transplantation in children equalled or surpassed those in adults.
Chronic Urinary Tract Infections in Children: A Double-Blind Study of Medical Management
Authors: RAY C. George , Ching Yi-Chuan , Shurtleff David B. , Hill Margaret L. , Ansell Julian S. , Wedgwood Ralph J.
Published: December 2021

Nine children with nonobstructive urinary tract infections, 10 children with neurogenic bladders secondary to meningomyeloceles, and 2 children with ileal bladders have been studied in a double-blind program of medical management for recurrent urinary tract infections.

Observations indicate that some patients with nonobstructive recurrent UTI's may benefit from long-term chemoprophylaxis; however, the effective drug may vary from patient to patient. Furthermore, not all patients need continuous therapy, although initial clinical differentiation is not currently possible. In all patients, the essence of management consists of frequent, careful evaluation, with periodic assessment of anatomic and functional status of the urinary tract.

Among children with anatomic and physiologic abnormalities of the urinary tract, neither continuous chemotherapy nor therapy of asymptomatic bacteriuria appears beneficial.
Valium in Management of Status Epilepticus: A Correction
Authors: Carter Sidney , Gold Arnold
Published: December 2021

In relation to our article, "Care of the Critically Ill Child: Management of Status Epilepticus" (Pediatrics, 44:732, 1969), it has been brought to our attention that the addition of diazepam (Valium) to sterile water results in a cloudy mixture. Since diazepam is insoluble in water and might result in an unequal dispersion of the compound, the manufacturer recommends that injectable diazepam not be diluted.

For this reason, we wish that Pediatrics would modify our recommendation by stating that injectable diazepam should only be administered in the undiluted form.
THE FIRST DESCRIPTION OF CHICKENPOX AS A DISEASE, BY WILLIAM HEBERDEN THE ELDER (1710-1801) IN 1767
Authors: C. T. E.
Published: December 2021

Both Rosén von Rosenstein (1706-1773)1 and François Boissier de Sauvages (1706-1767)2 came close to differentiating varicella from variola. But, it was left to William Heberden3 to give the first detailed description of chickenpox as a disease sui generis in 1767 as follows:

These pocks break out on many without any illness or previous sign: in others they are preceded by a little degree of chillness, lassitude, cough, broken sleep, wandering pains, loss of appetite and feverishness for three days. In some patients I have observed them to make their first appearance on the back, but this perhaps is not constant. Most of them are of the common size of the smallpox but some are less. I never saw them confluent nor very numerous. The greatest number which I ever observed was about twelve in the face, and two hundred over the rest of the body.

On the first day of the eruption they are reddish: on the second day there is at the top of most of them a very small bladder about the size of a millet seed. This is sometimes full of a watery and colourless, sometimes of a yellowish, liquor contained between the cuticle and the skin.

On the second or at the farthest on the third day from the beginning of the eruption as many of the pocks as are not broken seem arrived at their full maturity, and those which are fullest of that yellow liquor very much resemble what the genuine smallpox are on the fifth or sixth day especially where there happens to be a larger space than ordinary occupied by the extravasated serum.
INTRAVENOUS GLUCOSE TOLERANCE IN OVERWEIGHT NEWBORN INFANTS AND THEIR MOTHERS
Authors: Persson B. , Sterky G. , Strandvik B.
Published: December 2021

Mothers of infants with birth weights above 4,500 gm are classified as potential diabetics. However, only a few develop diabetes. An attempt has been made to diagnose the woman at risk by performing intravenous glucose tolerance test on the overweight newborn infant. Out of 129 such babies, 26 (20.9%) had a rapid glucose disapperance rate similar to newborn infants of mothers with overt or gestational diabetes. A thorough investigation of factors in mother and baby did not show any significant differences between the two groups divided according to kg of the infant. However, in the total material the maternal weight gain during pregnancy and height were greater than in normal patients. Fasting blood glucose values among overweight infants were lower than in infants of normal birth weight.
JUVENILE MIGRAINE, PRESENTING AS AN ACUTE CONFUSIONAL STATE
Authors: Gascon Generoso , Barlow Charles
Published: December 2021

In the literature, complicated migraine usually connotes paroxysmal unilateral headache and vomiting associated with neurological signs, such as hemiplegia, hemianopsia, aphasia, ophthalmoplegia, or syncope. A not uncommon form of complicated migraine in childhood is the presentation with an acute confusional state. Four cases are described. Emphasis is placed on the initial presentation with disturbed sensorium and consciousness, with varying degrees of agitation, and the difficulty for the clinician in distinguishing from other causes of acute mental disturbance, such as toxic-metabolic psychoses due to drug ingestion or known metabolic disease, encephalitis, acute toxic encephalopathy, and epilepsy, particularly petit mal status and postictal confusion. The diagnosis of migraine was made only after the acute episode, when the usual clinical criteria for making a diagnosis of migraine was established in retrospect or by subsequent course. In all cases the episodes of confusion were single ones, with no repetition of similar attacks, although the classic or common types of migraine often reoccurred.
CONGENITAL SENSORY NEUROPATHY IN SIBLINGS
Authors: Haddow J. E. , Shapiro S. R. , Gall D. G.
Published: December 2021

Two siblings with congenital sensory neuropathy are discussed whose inheritance appears to be autosomal recessive, an unusual pattern for this disorder. Low cerebrospinal fluid protein was demonstrated in both children early in life, and at present one continues to have low cerebrospinal fluid total protein, while the other has an unusual spinal fluid electrophoretic pattern with very low albumin concentration. Both children suffered from chronic, unexplained diarrhea in their early years. The children's problems are reviewed, and the importance of classifying the various sensory disorders is stressed.
RESEARCH ISSUES IN CHILD HEALTH. II. SOME MEDICAL AND ECONOMIC ISSUES
Authors: Haggerty Robert J.
Published: December 2021

I have in this discussion advanced the notion that we should combine our humanitarian principles with our critical research questions and carry out the bold medical care experiment characteristic of Head Start's educational goals. We should ensure that children receive a basic comprehensive medical care program and then combine it with controlled experiments to answer some of the high priority questions about which we have so little data, such as manpower innovations, medical needs, screening tests, attitudes, utilization, prevalence data, and costs.

The solution, as in so much of life, is not a rigid adherence to a limited, parsimonious program or a totally uncritical and wasteful approach, but a middle ground. The middle is always hard to find and even more difficult to maintain. A comprehensive care program with certain guidelines, requirements of quality, and restrictions on unnecessary procedures is my middle ground with simultaneous stimulation through incentives to carry out specific research projects on top of this.
Tuberculous Meningitis During Chemotherapy for Pulmonary Tuberculosis
Authors: Steiner Morris , Steiner Phillip
Published: December 2021

The report of a case of tuberculous meningitis developing during the course of chemotherapy for pulmonary tuberculosis, by Lintermans and Seyhnaeve,1 illustrates the importance of drug susceptibility testing of the infecting organism. Initial cultures isolated from the gastric washings in this case were not tested for drug susceptibility, but subsequent cultures isolated from the spinal fluid after 33½ months of therapy proved to be isoniazid resistant.

The authors state that "this complication (meningitis) developed despite specific chemotherapy and corticosteroids for active pulmonary tuberculosis."
Letter To The Editor
Authors: Lintermans John P. , Seyhnaeve Victorine
Published: December 2021

Drs. Lintermans and Seyhnaeve commented as follows:

We agree with Drs. Morris and Phillis Steiner that the use of corticosteroids on our reported case1 might have contributed to the development of tuberculous meningitis 3½ months after the initiation of specific therapy for pulmonary tuberculosis. The fact that the infecting organism was isoniazid resistant seems to substantiate this possibility.

On the other hand, documented cases of tuberculous meningitis, due to isoniazid susceptible organisms, developing during the course of chemotherapy (including isoniazid) for pulmonary tuberculosis have been described.2-4
Child Health and Community Health Centers in the Americas
Authors: Elbualy M. S.
Published: December 2021

Those of us interested in the health (health in its widest sense) of the masses, especially those masses which are underprivileged, are delighted with the appearance of more and more articles in medical journals related to this subject.

However, it pains me to see the Committee on International Child Health1 propose and recommend more studies in order to delineate the most effective elements of community comprehensive child care. It seems we keep doing studies and then either never apply what was found or recommend further study of the study.
CONTINUING MEDICAL EDUCATION THROUGH SELF-EVALUATION
Authors: Daeschner C. W. , Hughes Gerald E.
Published: December 2021

In the late spring of 1970 the American Academy of Pediatrics will offer to its Fellows (and to interested nonmembers) a new continuing educational opportunity. Similar programs have been developed by other specialty societies for their members (American College of Physicians, American Psychiatric Association, and American Society of Anesthesiologists). Parenthetically, it should be explained that the more familiar term, postgraduate education, is now generally reserved for house staff-oriented, hospital-based programs, while continuing medical education is the preferred term for educational offerings directed to the practitioner.

Behind a broad resurgence of interest in the continuing education of the practitioner lies a growing body of criticism from professional and lay groups.
Reye's Syndrome Treated by Peritoneal Dialysis
Authors: Pross Diane C. , Bradford William D. , Krueger Ronald P.
Published: December 2021

A 9-month-old Caucasian male with hyperammonemia, hypoglycemia, and metabolic acidosis was treated by peritoneal dialysis. Our favorable experience with this form of therapy suggests that further trials are indicated to evaluate the efficiency of dialysis in the treatment of Reye's syndrome.
Decreased Nitroblue Tetrazolium Dye Reduction in the Phagocytes of Patients Receiving Prednisone
Authors: Miller Denis R. , Kaplan Henry G.
Published: December 2021

Nitroblue tetrazolium (NBT) dye reduction by leukocytes of 21 patients receiving prednisone was significantly decreased. Nineteen percent of the patients had values similar to those found in children with chronic granulomatous disease, and 57% had heterozygous-range NBT dye reduction. A qualitative NBT dye reduction "slide test" correlated well with the quantitative assay. The uptake of particles by the phagocytes of steroid-treated patients appeared normal.

The exact mechanism of corticosteroid action remains unknown. The decreased dye reduction observed in vitro suggests an induced defect of intracellular metabolism which may be related to known alterations of host defenses which occur in patients receiving these hormones.