bluuebunny/crossref_metadata_2025 huggingface dataset:
Radionuclide Pericardial Scan. Is It Outmoded by Echocardiography?
Authors: Meyer Richard A. , Kaplan Samuel
Published: December 2021

In the November 1971 issue of Pediatrics, the review article on the use of radionuclide examinations in children refers to pericardial scanning to diagnose pericardial effusion and to differentiate pericardial disease from cardiac enlargement. This technique has been supplanted by the simple noninvasive method of echocardiography which is highly accurate and without risk. Therefore, radionuclide need not be used in the differential diagnosis of pericardial disease.

The review also omits the significant applications of the use of radionuclides in the differential diagnosis of congenital heart disease.
Letter to the Editor
Authors: Chabot André
Published: December 2021

Thank you very much for giving me the opportunity to answer Dr. Gilbert's comments.

I agree whole heartedly with Dr. Gilbert that many other factors influence the health status of a community besides health services. However, I still believe that notwithstanding this, the quality, quantity, availability, accessibility, and acceptability of health services has an influence on the health status of the community.
Pulmonary Hyaline Membranes: Killer or Protector
Authors: Fujikura Toshio
Published: December 2021

It is unfortunate that the clinical significance of hyaline membranes has been overempha-sized in the respiratory distress syndrome. Membranes are confirmed always in neonatal deaths at postmortem examination and there is very little information regarding the membranes among surviving infants who have suffered from the syndrome. Although some investigators have tried to dissolve the membranes with fibrinolytic enzymes, there is no definite evidence that the membranes are responsible for the direct cause of death and the syndrome.
ST. AUGUSTINE ON HIS CHILDHOOD
Authors: C. T. E.
Published: December 2021

Gradually I came to know where I was, and I tried to express my wants to those who could gratify them, yet could not, because my wants were inside me, and they were outside, nor had they any power of getting into my soul. And so I made movements and sounds, signs like my wants, the few I could, the best I could, for they were not really like my meaning. And when I was not obeyed, because people did not understand me, or because they would not do me harm, I was angry, because elders did not submit to me, because freemen would not slave for me and I avenged myself on them by tears.1
THE IMPORTANCE OF REGULAR MEALS FOR CHILDREN, ACCORDING TO JAMES NELSON, APOTHECARY, WRITING IN 1756
Authors: C. T. E.
Published: December 2021

In eighteenth century England, children were rarely fed at regular intervals and when fed little attention was paid to what they ate. Among the first to stress the benefits of eating meals regularly was the Apothecary, James Nelson (1710-1794), whose thoughtful and widely known book, An Essay on the Government of Children contained the following:

. . . Nothing is more conducive to Health than a Habit of eating meals regularly. Children accustomed to eat all Day long are seldom healthy; besides, that it makes them disorderly, and often throws a Family into Confusion to gratify all their little Humors. The proper Breakfast is ... milk and Water with Bread, or milk-porridge, or Rice-milk, their Dinner should be made of one Dish, only, unless by great chance a passing Taste of a second; they should either eat a great deal of Bread, or blend their Meat with Greens, Turnips, or other Garden Stuff; Pickles and all high sauces should not be touch'd by them; and their Meal should be washed down with Water or light Small Beer. Their Supper may, like their Breakfast, sometimes be varied, as to the Auxiliary; Bread is to be the Repast; yet a small portion of Butter, Cheese, Fruit, or Tart, may in their Turn accompany it: the Vehicle the same as the Dinner. But should a Child at intermediate Times, especially before Dinner, complain of Hunger, and fasting long might make it's Stomach ach (sic); in that Case nothing so good as a bit of Bread; and if used to it, it will eat it as eagerly as the greatest Dainty; but to see Children walk about a house with Tarts or Bread and Butter in their Hands, daubing every thing and every body they touch, is certainly wrong; being not only detrimental to their Health, but to their manners too, as it is inexpressibly vulgar.1
SYMPOSIUM: BEHAVIOR MODIFICATION BY DRUGS
Authors: Baldessarini Ross J.
Published: December 2021

The pharmacology of the amphetamines has been studied for several decades. There is now a great deal of information about their tissue distribution and catabolism, largely by enzymatic oxidative processes. The most clearly characterized actions of the amphetamines occur at catecholamineconaining nerve terminals and tend to enhance the availability of the transmitter to post-synaptic receptors. The actions of the drugs in the CNS include stimulation of the ascending reticular formation of the brainstem, and probably enhancement of the activity of a behavior reinforcement system mediated by the median forebrain bundle. Toxic effects of amphetamine include apparent interactions at the basal ganglia to produce stereotyped behaviors in animals and man. All of these actions might involve catecholaminergic synaptic transmission systems. Under careful, controlled medical supervision the amphetamines are remarkably safe, although in excessive doses they can produce severe toxic, sympathomimetic and psychotic effects and can be lethal. They are subject to gross abuses, and to habituation. Tolerance develops to some of their actions, but usually not to their legitimate and rational uses in narcolepsy and hyperkinesis. Withdrawal symptoms are relatively minor.
RULES FOR REARING CHILDREN IN 1860
Authors: C. T. E.
Published: December 2021

The 12 rules for rearing children, listed below, and published more than a century ago, may appear rather severe to us. And yet, at the time they were published, these rules were considered by some to be too permissive.

Rearing Children

1. Children should not go to school until 6 years old.

2. Should not learn at home during that time more than the alphabet, religious teachings excepted.

3. Should be fed with plain substantial food, at regular intervals of not less than 4 hours.

4. Should not be allowed to eat any thing (sic) within 2 hours of bed-time.

5. Should have nothing for supper but a single cup of warm drink, such as very weak tea of some kind, or cambric tea or warm milk and water, with one slice of cold bread and butter–nothing else.

6. Should sleep in separate beds, on hair- mattresses, without caps, feet first well warmed by the fire or rubbed with the hands until perfectly dry; extra covering on the lower limbs, but little on the body.

7. Should be compelled to be out of doors for the greater part of daylight, from after breakfast until half an hour before sun-down, unless in damp, raw weather, when they should not be allowed to go outside the door.

8. Never limit a healthy child as to sleeping or eating, except at supper; but compel regularity as to both; it is of great importance.

9. Never compel a child to sit still, nor interfere with its joyment, as long as it is not actually injurious to person or property, or against good morals.
Is There a Correlation between Allergy and Infantile Pyloric Stenosis?
Authors: Collicott Paul E. , Chappell John S. , Bill Alexander H.
Published: December 2021

A study was carried out to determine whether a correlation exists between a high incidence of allergy and infantile pyloric stenosis, The incidence of allergy diagnosed by a physician among 20 post-pyloromyotomy patients was determined, and was compared with the incidence of allergy among their siblings and among a matched group of 20 post-hemiorrhaphy patients. The results show no significant difference in the incidence of allergy among the small groups studied.
In Reply: Evaluating Effectiveness of Care: Some Questions
Authors: Gordis Leon , Markowitz Milton
Published: December 2021

In our paper we specifically discussed the points raised by Drs. Sommers and Sussman regarding the problems of population size, duration of follow-up, and measures of effectiveness used. In regard to measures of effectiveness, we proceeded on the assumption that when a new program for delivering health services is developed to meet unmet health needs it should be possible to demonstrate measurable changes in the health of the target population if the program is indeed effective.
Erythromycin in the Middle Ear: Further Information
Authors: Meland Mary
Published: December 2021

In response to Bass's article "Erythromycin Concentrations in Middle Ear Exudates"1 in the September issue, we would like to clarify the apparent disparity between in vivo effects of various types of erythromycin. It is known, but not mentioned in the article, that both erythromycin ethylsuccinate and estolate are absorbed in their bacteriologically inactive ester forms2 and must be hydrolyzed to active erythromycin base. Bioassay levels measure the total of both ester and base and do not correlate well with antibacterial activity.
Prognosis of Vesticoureteral Reflux: A Dissenting View
Authors: Askin John A.
Published: December 2021

I would like to discuss the article on vesicoureteral reflux in the November issue.1

My reaction to the radiologically well documented article of Drs. Bland and Girdany1 is that their findings resulted in conclusions contrary to those of many investigators. They are certainly quite different from mine, after 30 years of experience with this entity at the Johns Hopkins Hospital, Sinai Hospital of Baltimore, Variety Childrens Hospital of Miami, and Mount Sinai Hospital of Miami, during which time I had the unfortunate experience of observing a 5-year-old girl whose right kidney (normal when first seen with pyuria and reflux on the right) had to be removed a year later, completely destroyed by pyelonephritis, because of improper management.
Hypoglycemia and Leukemia
Authors: Collipp P. J.
Published: December 2021

I read with interest the report1 by Drs. Jaffe and Kim regarding hypoglycemia in a child with acute myelogenous leukemia. I should like to call to your attention our reports2,3 describing reduced liver-glucose-6-phosphatase in children with leukemia. At the time of our reports relatively little information regarding hypoglycemia associated with leukemia had been reported and since that time the literature has added a few pertinent articles. I should like to point out that elevations in lactic acid, uric acid, plasma lipids and reductions in liver glycose-6-phosphatase have been reported in both leukemia and glycogen storage disease.
Accidents from Gates: Hidden Dangers of Safeguards
Authors: Harper John J.
Published: December 2021

I would like to call your readers' attention to a potentially serious problem involving the use of "toddler tension gates." Recently, a 9-month-old infant patient of mine was found with his head wedged through the slats of such a gate. The infant was gasping for breath and had slumped against the gate. The child's father was finally able to free the infant's head from the gate by using heavy wire cutters on the wooden slats.
Is the "Shoulder-Hand Syndrome" Ever Seen in Children?
Authors: Steinbrocker Otto
Published: December 2021

I would appreciate an opportunity to inquire of your readers whether in their experience with children or adolescents any of them have encountered reflex dystrophy, or the shoulderhand syndrome, or an idiopathic frozen shoulder. My interest and observations in these disorders for many years have so far not included a patient under the age of 35 years.

I often am asked about the occurrence of these conditions in children and adolescents. I have seen no reference to such observations by others.
Breast Feeding without Pregnancy
Authors: Perlman Everett C.
Published: December 2021

Just a facetious thought which struck me as I read your Associate's reply to Dr. Cohen's letter on "Breast Feeding without Pregnancy."1

Should not Oliver Wendell Holmes' statement read "Man has his will–but woman has her whey?"
THE COSTS OF TRAINING AND THE INCOME GENERATION POTENTIAL OF PEDIATRIC NURSE PRACTITIONERS
Authors: Yankauer Alfred , Tripp Sally , Andrews Priscilla , Connelly John P.
Published: December 2021

The costs of training and the dollar income generation yields have been calculated for 26 graduates of the Pediatric Nurse Practitioner Program of the Bunker Hill Health Center of the Massachusetts General Hospital employed in private practice settings. Training costs were estimated from the program experience. Income generated by the nurse was estimated from data reported by nurse and employer 6 months or more after graduation from the program.

Direct educational costs were estimated at $1,410 per nurse, institutional overhead at $346 per nurse, production losses (associated with the training time of 17 weeks) at $1,442 per nurse. Total cost of training was $3,197 per nurse.

The average annual salary paid 26 pediatric nurse practitioners in private practice settings was $9,100 per year and the average number of "nurseonly" face-to-face patient encounters of all types, projected for full-lime employment, was 65 per week. Net income generation potential over and above salary averaged $2,500 per nurse per year with 14 of the 26 nurses capable of generating more than $3,000 per year over and above their current net salaries. These estimates must be interpreted with caution, but they suggest that the private sector of medicine can defray training costs in full in cases where the paying demand for its services is greater than physicians can supply themselves.
Smallpox Vaccination
Authors: Shaw Edward B.
Published: December 2021

The zero incidence of smallpox in the United States for so many years, and the significant morbidity and mortality from vaccination, has led to the acceptable and desirable recommendation that routine immunization against smallpox be discontinued. However appropriate this step may seem, it will pose a number of new problems which will involve the pediatrician especially.

(1) For many years, smallpox vaccination has been an almost sacred tenet, an immunologic gospel to the population, and has been credited with the conquest of this disease in this country—even though herd immunity could hardly be said to have existed here. Public reeducation is a hazardous matter.
Letter to the Editor
Authors: Egner Jane Packard
Published: December 2021

In response to your request for comment on his letter, I think Dr. Pick could expect some bristling on the part of many pediatric nurse practitioners and a signfficant number of pediatricians, at the term "ghost pediatrics."

For years the professions of medicine and nursing have paid lip service to "cooperative effort" and "team approach," while in reality, relatively few nurses are legally able to practice to the capacity for which they were educated, and instead become atrophied from task performances of appalling misuse of their potential.
Letter to the Editor
Authors: Fried Ralph I.
Published: December 2021

I gratefully accept your invitation to comment on the letter by Dr. Pick on allied health workers in the private practice of pediatrics. I support Dr. Pick in his statement that this would constitute a regression in the quality of care offered to our children.

Dr. Charles A. Janeway remarked in 1957 that during his career the practice of pediatrics had reversed itself from 80% life-saving and 20% routine care, to the opposite figures, so that pediatricians have had to deal increasingly with parental concerns about child behavior and emotional problems.
Immunologic Incompetence, edited by Benjamin M. Kagan, M.D., and E. Richard Stiehm, M.D. Chicago: Year Book Medical Publishers, 1971, 396 pp., $22.00
Authors: Johnston Richard B.
Published: December 2021

Prospective readers of this book should be informed at the outset that it is not a textbook and it is not, by and large, about immunologic incompetence. Rather it is a compilation of presentations given at a conference in 1970 by established investigators, most of them pediatricians, on that aspect of immunology about which they were particularly knowledgeable. Moreover, the book's contents encompass much more than its title implies, in that many disease states not generally ascribed to incompetence are included, and fortunately for those who seek a genuine understanding of immunology and diseases involving immune mechanisms, there is as much discussion of the basic physiology of immunity as of illness.
ANALYSIS OF FETAL AND NEONATAL DEATHS IN 4117 CONSECUTIVE BIRTHS
Authors: MILLER HERBERT C.
Published: December 2021

An analysis of the significant causes of death in 4117 consecutive births was made; there were 66 fetal deaths and 85 neonatal deaths. A significant cause of death was determined in 51 fetuses and 56 live-born infants.

Eighty-five per cent of the live-born infants who weighed over 1000 gm. at birth and had postmortem examinations had causes of death which were considered to be significant. Almost half of the live-born premature infants with birth weights between 1000 and 2500 gm. were considered to have had more than one significant cause of death.

The so-called significant causes of death among live-born infants differed from those determined for fetuses dying before birth. Among the former, pathologic conditions in the infants were determined four times more frequently than in those dying before birth and, in the latter, maternal complications of pregnancy and labor were diagnosed as significant causes of death five times more frequently than in infants dying in the neonatal period.

Hyaline-like material in the lung was considered to be the most frequent significant cause of death in live-born premature infants; congenital malformation and anoxia resulting from complications of labor were the most frequently determined significant causes of death in live-born full term infants. No differences were found in the significant causes of death in premature and full term fetuses. Anoxia resulting from accidental and unexpected interruption of the blood flow in the placenta and umbilical cord and from dystocia was the most frequently determined significant cause of death in both groups.

A plea has been made for the adoption by obstetricians, pathologists and pediatricians of a formal uniform plan of classifying the causes of fetal and neonatal death which would divest current efforts to determine the cause of death of as much vague terminology and arbitrary opinion as possible.
EVALUATION OF THE MUMPS SKIN TEST
Authors: FLORMAN ALFRED L. , FISCHER ALFRED E. , MOLOSHOK RALPH E.
Published: December 2021

An intradermal test with formalin-inactivated egg-grown mumps virus was done on 109 household contacts of 42 cases of epidemic parotitis. Sixty of these individuals were skin-test positive and 49 negative. There were 12 contact cases of epidemic parotitis and 11 of them occurred among the nonreactors. There were 27 children who gave negative skin tests and they furnished 10 of the contact cases. The possible significance of this has been discussed.

The various types of reactions encountered have been described and the frequent occurrence of relatively faint reactions in children noted. The validity of the test was supported by an obvious correlation with the incidence of secondary cases, past history and the fact that patients who were originally skin-test negative were positive several months later.

It is concluded that the test is of value in determining susceptibility to epidemic parotitis. In view of the large number of clinically inapparent cases, the skin test should prove most useful in practice in removing unnecessary concern for infection by parents who do not recall having had the disease.
CHRONIC POISONING DUE TO EXCESS OF VITAMIN A
Authors: CAFFEY JOHN
Published: December 2021

The clinical manifestations, the roentgenographic changes in the skeleton and the elevation of blood vitamin A are reported in a group of seven infants and younger children poisoned by ingestion of excessive quantities of vitamin concentrates A and D over periods of several months.

The differential features of vitamin A poisoning and infantile cortical hyperostosis are discussed.

Three types of vitamin concentrate A and D, commonly used in routine pediatric prophylaxis, were found to be toxic when ingested in sufficiently large quantities over sufficiently long periods. The minimal preclinical latent period of vitamin A poisoning was about six months and the minimal toxic daily dose was about 75,000 units.

Excessive dosage was due to overenthusiasm for vitamins and ignorance of the dangers of high vitamin intake.

The hazards of vitamin A poisoning from the routine prophylactic feeding of vitamin concentrates A and D to healthy infants and children on good diets are considerably greater than the hazards of vitamin A deficiency in healthy infants and children not fed vitamin concentrates.
RELATION OF THE LET-DOWN REFLEX TO THE ABILITY TO BREAST FEED
Authors: NEWTON NILES RUMELY , NEWTON MICHAEL
Published: December 2021

The existence and function of the let-down reflex was studied in 103 mothers who fed their babies at the breast while in hospital after delivery. Successful breast feeders reported a significantly higher incidence of symptoms of let-down than unsuccessful breast feeders. Successful breast feeders made a significantly higher proportion of their milk available to the baby and the breast pump before let-down was artificially induced with Pitocin. The let-down reflex functioned more erratically in the unsuccessful breast feeders. Methods by which the let-down reflex might be helped to function more adequately are discussed.
AUREOMYCIN IN THE TREATMENT OF RESISTANT BACILLURIA
Authors: LOPRESTI JOSEPH M. , ROSS SIDNEY , RUBIN MILTON B.
Published: December 2021

Ten children with urinary tract infections (eight of which were due to Esch, coli and two with a mixed infection caused by Esch. coli and Staph. aureus) were treated with aureomycin. The dosage ranged from 30 to 60 mg./kg./day in a four hour divided dosage schedule. The urine culture in 9 of the 10 patients became sterile within 48 hours while the 10th became negative in four days. There was a concomitant disappearance of pyuria and a subsidence of symptoms after initiation of therapy. Three of the patients, one of whom had a bladder neck obstruction, relapsed following discontinuation of aureomycin.
SIMPLIFICATION OF DRUG DOSAGE CALCULATION BY APPLICATION OF THE SURFACE AREA PRINCIPLE
Authors: CRAWFORD JOHN D. , TERRY MARY E. , ROURKE G. MARGARET
Published: December 2021

Observations on the relationship of administered dosage per unit of body surface area and blood concentration achieved when different amounts of sulfadiazine and acetylsalicylic acid were given patients varying widely in size indicate that a direct proportionality exists for these two drugs regardless of patient size. On the basis of this finding body surface area was used as the common denominator in the calculation of dosages of a large variety of drugs for a period of more than one year on a service dealing with patients ranging from small prematures to young adults. The clinical results suggest that this method of dosage calculation offers the advantages of simplification and greater accuracy over calculations based on a unit of body mass or on the patient's age.
SERUM IRON AND IRON-BINDING CAPACITY OF THE SERUM IN CHILDREN WITH SEVERE MEDITERRANEAN (COOLEY'S) ANEMIA
Authors: SMITH CARL H. , SISSON THOMAS R. C. , FLOYD WILLIAM H. , SIEGAL SHIRLEY
Published: December 2021

The blood of children with severe Mediterranean anemia was found to have a high serum iron and an absence of a latent or unbound iron capacity of the serum. Whereas serum iron levels comprise approximately one third of the total iron-binding capacity in normal children and adults, the two values are equal in the severe form of Mediterranean anemia. The iron-binding capacity of the serum in this condition is therefore fully saturated and quantitatively lower than in normal children.

The absence of a measurable latent iron-binding capacity does not depend entirely on the liberation of iron from exogenously administered blood. Comparable changes were also noted in two nonanemic adult carriers possessing the trait of the disease, in two children with the mild form not requiring transfusions, and in one severely anemic child with Mediterranean anemia who had never been transfused. Similar changes occurred in three patients with spherocytic anemia and in five children with sickle cell anemia, one of whom had never been transfused.

In every instance therefore of the advanced form of Mediterranean anemia and in some of the nonanemic and mildly anemic forms of this disease, a fully saturated metal-binding protein is present in total amounts usually less than those found in normal children. In contrast, children with iron deficiency anemia manifest a reduction in percentage saturation of iron-binding protein, an increased level of unbound latent iron-binding capacity and a markedly elevated total iron-binding capacity.

The failure to demonstrate a latent iron-binding capacity of the serum in asymptomatic persons adds another criterion to those already established for the identification of carriers of the trait of Mediterranean anemia who constitute the source of its transmission.

The presence of bilirubin in increased concentrations in the serum of patients with severe Mediterranean anemia does not interfere with its capacity to combine with iron. The capacity for binding iron was restored when Fraction IV-7 was added to samples of icteric sera of patients in whom no capacity had previously been demonstrated.

The high serum iron and absence of latent iron-binding capacity observed in children with severe Mediterranean anemia receiving multiple transfusions correspond to the changes regarded as diagnostic of transfusion hemosiderosis and hemochromatosis. While these changes remain unaltered in Mediterranean anemia, their reversibility has been demonstrated in two children with hemophilia who received weekly transfusions of small amounts of blood. Following cessation of this form of therapy a decrease of serum iron and a gradual restoration of iron-binding capacity were noted.
ENDOCRINE HOMEOSTASIS IN CLINICAL PEDIATRICS
Authors: TALBOT NATHAN B.
Published: December 2021

SIX MONTHS or a year ago it might have been appropriate to introduce these remarks with comments on the fact that endocrinology encompasses much more than the diagnosis and therapy of such primary endocrinopathies as pituitary gigantism, thyrotoxicosis, sex precocity and the like. The remarkable current reports on the therapeutic actions of adrenal cortical hormones and of pituitary adrenocorticotropic hormone (ACTH) already have shown that there may be as much or more endocrinology in a patient with rheumatoid arthritis, ruptured appendix, pneumonia, status asthmaticus or thermal burn as in the pituitary dwarf or eunuch. In fact it appears safe to say that there is hardly an organ or structure in the body that is not influenced directly or indirectly by endocrine forces or a clinical condition that is not accompanied by functional or homeostatic alterations on the activity of some endocrine gland.

These homeostatic reactions constitute to a major extent, as Walter Cannon once put it, "the Wisdom of the Body." Most of the time they work so efficiently that we forget that they exist and are playing an important role in bodily defense and recovery reactions. This thought may be worthy of illustration by a few arbitrarily selected situations. In presenting these illustrations I wish to emphasize that they represent the cumulative researches of many investigators working in many laboratories over a considerable period of time.

Figure 1 presents observations on a child with psychogenic polydipsia who was subjected to water restriction. This restriction was accomplished by omitting all fluids except those contained in solid foods. It is seen that such a physiologically normal individual is able quite effectively to conserve body H2O (weight) and to prevent hemoconcentration (elevation in blood hemoglobin) by increasing urine solute concentration (specific gravity).
Round Table Discussion
Authors: SEELYE WALTER B. , BILLINGTON SHEROD M. , TIMMONS ELMER LEE , GROB OTTO
Published: December 2021

Chairman Seelye: No subject lies closer to the heart of the pediatrician than that of the newborn infant. Pediatrics has always been deeply concerned with the management of the infant during that trying period immediately following birth, when certain anatomic and physiologic adjustments must be quickly and smoothly made if the child is to survive. Here indeed is the supreme challenge to the physician who must promptly and efficiently recognize, correct and treat the defects, deficiencies and diseases which may handicap the infant.

Certain aspects of the newborn infant are of such magnitude that they lend themselves to separate panels and round tables. Among these are: the premature infant, hemolytic disease of the newborn, anemias of the newborn, epidemic diarrhea of the newborn—all of which have been presented at recent meetings of the Academy. These will be omitted from our discussion today, which will be directed toward consideration of the following topics:

1. Accidents and Trauma Incident to Birth

2. Infections

3. Feeding. The Psychologic Aspects of Mother-Infant Relationships

1. Accidents and Trauma Incident to Birth

Much has been recently added to our knowledge of the effects of interference with the supply of oxygen to the tissues of the fetus before and during birth, and to the infant after delivery. Clifford has clearly shown that injury resulting from anoxia is widespread, involving physiologic and pathologic changes throughout the entire body. These have been summarized as "congestion, edema, hemorrhage and death of tissue."

Intrauterine anoxia is presumably due principally to pathologic conditions of the placenta which result in the majority of instances, in premature separation of this organ.
RECOVERY FROM INFLUENZAL MENINGITIS WITHOUT INTRATHECAL THERAPY IN A FOUR DAY OLD INFANT
Authors: SEGAL JACK , HILL FONTAINE S.
Published: December 2021

A case of H. influenzae meningitis in a 4 day old infant is reported in which recovery was obtained without intrathecal medication. Treatment consisted of parenteral streptomycin, sodium sulfadiazine and penicillin.
DIASTEMATOMYELIA (CONGENITAL CLEFTS OF THE SPINAL CORD)
Authors: MATSON DONALD D. , WOODS ROBERT P. , CAMPBELL JAMES B. , INGRAHAM FRANC D.
Published: December 2021

Diastematomyelia associated with the presence of a bony spicule arising from the posterior aspect of a vertebral body and transfixing the spinal cord or cauda equina has been encountered in 11 operative cases. In the last nine of these the diagnosis was made previous to operation.

It seems apparent that progressive neurologic impairment of the lower extremities and of the rectal and vesical sphincters may result from increasing distortion of the neural axis as a result of fixation produced by these bony spicules during the growth period.

The diagnosis is suspected in the presence of cutaneous midline defects, muscular imbalance in the lower extremities, gait disturbances, deformities of the feet, urinary or fecal incontinence or increasing enuresis. The diagnosis is confirmed on roentgen examination by the presence of a midline opacity usually in the region of a spina bifida or other vertebral anomaly or by visualization of two separate subarachnoid channels on myelography.

Operative treatment consists in laminectomy with extradural removal of the bony spicule insofar as possible, followed by opening the dura with excision of its reflections adjacent to the spicule, excision of the remaining bony prominence down to the anterior dura, and division of all adhesions to the bifid cord or cauda equina until the latter is freely movable within a single dural canal.

In all these cases there appeared to be complete division of the cord or cauda equina into separate parts rather than reduplication of the cord. Each half of the neural axis was invested with its own meninges.

The operative findings in the 11 cases reported here, together with the brief follow-up observations noted to date, have convinced the authors that it constitutes good preventive medicine to carry out surgical treatment of diastematomyelia associated with spina bifida occulta at any time the diagnosis is made during infancy and early childhood.
CLOSING OF THE ANTERIOR FONTANELLE
Authors: AISENSON MILTON R.
Published: December 2021

The age at which the anterior fontanelle closed in 1677 infants varied between 4 and 26 months, with 90% between 7 and 19 months. In the first year, 41.6% closed, of which 2.7% occurred by 6 months and 13.5% by 9 months. Compared to data in older textbooks, this suggests a trend towards earlier closure of the fontanelle.
PENICILLIN AND ITS EFFECT IN PRODUCING A PREDOMINANT GRAM-NEGATIVE BACILLARY FLORA IN UPPER RESPIRATORY TRACT OF CHILDREN
Authors: HAFFNER FREDERICK D. , NETER ERWIN , RUBIN MITCHELL I.
Published: December 2021

A study was carried out on 90 children to determine whether conversion to a gram-nagative bacillary flora of the nasopharynx and throat takes place during therapy with penicillin, either alone or in conjunction with sulfonamides, and to evaluate the influence of such a conversion on the course of the infection.

Following the demonstration of "conversion" in 22 selected cases, a change to a gram-negative bacillary flora was observed in an additional 30 out of 68 unselected children. The gram-negative bacilli encountered in this conversion group included members of the E. coli-A. aerogenes group, Ps. aeruginosa, A. fecalis and K. pneumoniae; these organisms became predominant in 23 out of the 30 cases of the unselected group. In 22 cases in this latter group the gram-negative bacillary flora was present prior to commencement of specific therapy; however, there was an increase in the number of these organisms in 13 instances. Conversion did not take place in 16 cases.

Vomiting per se was not responsible for the conversion since it occurred more frequently in the nonconverted group and vomiting was not a prominent feature of the converted patients.

Of 10 patients receiving penicillin as "aerosol," nine converted to a predominantly gram-negative bacillary flora.

The administration of sulfonamides in conjunction with penicillin did not materially lower the incidence of conversion.

Clinical evaluation of the patients showed that, on the average, the children who had "converted" had a more severe illness and one of longer duration than those of the nonconverted group.

Five patients of this group, all under 2 years of age, succumbed. Autopsy was performed in four and revealed the presence of gram-negative bacilli in the lung tissue of three of them.

The significance of these data is discussed.
CONGENITAL HEART DISEASE
Authors: GIBSON STANLEY
Published: December 2021

A short while ago, I asked a busy pediatrician of long experience how many "blue babies" he had seen in the course of his practice. He thought for a moment, then replied, "Four." Since that time I have made several other inquiries among my pediatric associates and have been surprised to find how small a number of cases of congenital heart disease they have had in their private practice. Yet if some stranger from another planet should visit Dr. Taussig's clinic, he might well conclude that congenital heart disease is as frequent as measles. The concentration of cases in a few medical centers throughout the country has doubtless given a false impression of the frequency and importance of congenital malformations of the heart. If then the problem represents so small a portion of general pediatric practice, one may fairly ask whether the already overworked children's specialist should undertake an additional burden. He is apt, too, to be discouraged when he contemplates some of the special technics and gadgets which have become popular in cardiac diagnosis. Let me hasten to assure him that his feeling of frustration is no more acute than that of many of us of the older generation when some of our chemical pediatricians begin to toss their atomic weights around and overwhelm us with millimols and milliequivalents.

I wish, however, to emphasize the fact that it requires very little time and effort to have a good working knowledge of the diagnosis of most of the congenital cardiovascular anomalies which lend themselves to correction or improvement by surgical means.
RESULTS OF THERAPY IN 265 CASES OF TUBERCULOUS MENINGITIS
Authors: FLORI ARRIGO GALEOTTI
Published: December 2021

The technic of streptomycin and sulfone treatment followed at the Pediatric Hospital of the University of Florence has been outlined. Successive improvements in the technic of therapy are reflected in the increasing percentage of recoveries with the passage of time. The results of therapy in 265 cases of tuberculous meningitis seen since December 1946 are reported. The over-all mortality in the year 1948 for treated cases was 26%. Some patients have been entirely well for over 2½ years.
GROWTH AND DEVELOPMENT OF NEGRO INFANTS
Authors: SCOTT ROLAND B. , JENKINS MELVIN E. , CRAWFORD ROBERT P.
Published: December 2021

This analysis comprises 11,818 Negro newborn infants delivered at Freedmen's Hospital during the period 1939 to 1947. There were 10,692 full term infants and 1126 premature babies. The incidence of prematurity was 9.5%. The average birth weight for full term female infants was 3269 gm. and for males 3378 gm. The combined average for full term infants was 3337 gm.

The relatively higher birth weights for Negro infants observed in this series is attributed in a large measure to more favorable economic conditions during the period of observation.
SITUS INVERSUS, BRONCHIECTASIS AND SINUSITIS
Authors: BERGSTROM W. H. , COOK C. D. , SCANNELL J. , BERENBERG WILLIAM
Published: December 2021

A family is reported in which there occurred two cases of Kartagener's triad and two of bronchiectasis without situs inversus among six siblings. Eighty cases of Kartagener's triad previously reported are tabulated. The relation of this syndrome to the question of the etiology of bronchiectasis is discussed.
CHOICE OF ROOMING-IN OR NEWBORN NURSERY
Authors: KLATSKIN ETHELYN H. , LETHIN ANTON N. , JACKSON EDITH B.
Published: December 2021

From July 1, 1947 to July 1, 1949, 1251 mothers attending the obstetric clinic of the University Service of the Grace-New Haven Community Hospital were "screened" through interview to determine their preference in hospital accommodation and to obtain basic identification data. Patients were grouped according to preference for Rooming-In, preference for Nursery, and Undecided. The significance of the relationship between accommodation preference and patient's feeding preference, parity, age, education, descent, religion, race and occupation of patient's husband was then statistically determined. It was found that inclusion of the Undecided group with the Nursery group did not alter the statistical significance of any of the obtained relationships, and[SEE CHART 2 IN SOURCE PDF] consequently only the Rooming-In and Nursery groups will be contrasted in the following summary:

1. A highly significant relationship was found between accommodation preference and feeding preference. The majority of the Rooming-In group preferred breast feeding, the majority of the Nursery group preferred bottle feeding.

2. A highly significant relationship was found between accommodation preference and patient's parity. On the whole, the Rooming-In group members have lower parities than the Nursery group members.

3. No relationship was found between accommodation preference and patient's age.

4. A highly significant relationship was found between accommodation preference and occupation of patient's husband. The preponderance of patients in upper occupational classifications (student, professional, small business) occurred in the Rooming-In group. If the student classification is not included, the groups approach similarity.

5. A highly significant relationship was found between accommodation preference and patient's education. The preponderance of patients in higher educational classifications (college and above) occurred in the Rooming-In group.

6. No statistically significant relationship was found between accommodation preference and patient's descent, though a trend approaching significance was noted for the Rooming-In group to be chosen more often by patients of United States, British Isles, and Northwest European descent, and Nursery by patients of Southern European descent.

7. No relationship was found between accommodation preference and patient's religion.

8. A highly significant relationship was found between accommodation preference and patient's race. The Rooming-In group contained fewer Negro mothers in proportion to white mothers than did the Nursery group.

During the two year period, screening interviews were obtained on 280 private patients. As this group was a biased sample, the data were not analyzed statistically. Compared with clinic patients preferring rooming-in, the private patients more consistently preferred breast feeding, represented a different cultural and economic group, but were similar to the clinic group in age and parity.
Transitory Cataracts in Children With Diabetes Mellitus
Authors: Bilginturan A. Nihat , Jackson Robert L. , Ide Carl H.
Published: December 2021

One of the most common visual complaints seen ill diabetes is transitory refractive changes. This abnormality affects all age groups equally1 and has been reported in 6% to 34% of patients.2,3 Diabetic myopia is associated with marked hyperglycemia, whereas hyperopia usually develops as the blood sugar level returns to normal in response to therapy.4 The "true" diabetic cataract is now a rare cause of blurred vision in children and young adults with diabetes.5 Very few instances of transitory cataracts, however, have been documented, and those observed are found primarily in the ophthalmological literature. For these reasons, we are reporting in the pediatric literature two new cases of transitory cataracts.
Relactation: An Overview
Authors: Brown Roy E.
Published: December 2021

Relactation refers to the physiological process whereby human lactation is initiated at a time unrelated to the postpartum production of milk. This phenomenon has also been referred to as induced lactation or, in some instances, interrupted lactation in women who have weaned their infants and wish to resume breast-feeding. The relactation process can also be used to promote an increase in the milk supply of women who are already lactating.

Although relactation is an accepted fact in many cultures, even well-trained pediatricians in both the developed and developing countries may be unaware of the potential relactation has in good infant care.
PROBLEMS OF MEDICAL AFFLUENCE
Authors: Mahler H. ,   Student
Published: December 2021

Health development is essentially a political and social process that should start off with the acceptance of the social function of health and should ensure that health technology is developed and applied in harmony with this social function. It is not synonymous with the development of increasingly sophisticated services in medical institutions. In many countries the value of these expensive institutions can be seriously questioned if measured in terms of their impact on improving the health status of the populations. No country can afford to provide every citizen with every possible form of medical technology, nor would this necessarily be good for the health of the individual and of society. On the contrary, quite apart from possible adverse side effects and iatrogenic diseases, it would tend to make people overdependent on a medical "aristotechnocracy." Paradoxically, though medical care is often justified on the grounds that it reduces work-absenteeism, quite the contrary seems to be happening in many situations. In many countries, the so-called "health" industry is already consuming a high proportion of the national manpower pool and is approaching the upper limit, beyond which it could be seriously questioned whether medical care, as currently practised, is not becoming detrimental to further economic development. Other social sectors are in the same position, making it imperative to join forces in common planning and coordination of all the social services. Such planning requires clear definition of social policy, of which health policy forms an integral part.
Letter to the Editor
Authors: Curless Richard C. , Walson Philip D.
Published: December 2021

Dr. Gold's response to a letter to the editor that appeared in Pediatrics includes a correction of an error in diphenylhydantoin (Dilantin) and phenobarbital units that is, in itself, a mistake. Dr. Gold notes that the article referred to diphenylhydantoin and phenobarbital in which the therapeutic levels of each drug are given in milligrams per 100 ml. He suggested a unit correction of micrograms per 100 ml. In fact, the unit for the levels given should be micrograms per milliliter or the equivalent milligrams per liter.
New Ways of Looking at Ears
Authors: Gluckman Richard J.
Published: December 2021

Two articles in Pediatrics complement each other very nicely: "Acute Suppurative Otitis Media" by Rowe (56:285, August 1975) and "The Application of Acoustic Impedance Measurements to Pediatric Clinical Practice" by Ehrlich and Tait (55:666, May 1975). The former article expresses indirectly what I have always felt, that is, that a doctor who calls acute otitis media a "red ear" is either using a colloquialism or doesn't know what he is talking about. The second article provides a method for teaching residents and interns how to diagnose not only the acute otitis but also the serous otitis media and "glue ear" that are so frequently missed by the untrained observer.
Posthitis
Authors: Kaplan George W.
Published: December 2021

Although it may seem somewhat pedantic, I feel compelled to comment on the report of the Ad Hoc Task Force on Circumcision (56:610, October 1975). I do indeed agree with the information as presented, and the conclusions. Unfortunately, there is one error of fact. "Balanitis" in the article is defined as infection of the foreskin. "Balanitis" derives from the Greek word balanos (acorn) and is defined as inflammation of the glans penis. The proper term for inflammation of the prepuce is "posthitis," derived from the Greek posthe (foreskin).
Acute Hemiplegia and Cortical Blindness Due to Moya Moya Disease: Report of a Case in a Child With Down's Syndrome
Authors: Schrager Gloria O. , Cohen Solomon J. , Vigman Melvin P.
Published: December 2021

We are reporting what we believe to be the first case of moya moya disease (hemiplegia associated with supraclinoid carotid stenosis and multiple cerebral telangiectasia) in a child with Down's syndrome. On cerebral angiography, multiple collateral vessels and rete mirabile (anastomosis of meningeal vessels with internal cerebral vessels) were noted, in addition to the supraclinoid carotid stenosis. Computerized tomography revealed nonobstructive hydrocephalus and findings consistent with multiple vascular insults or infarcts. It is not clear whether moya moya disease represents a true disease entity (congenital arterial dysplasia) or is a syndrome caused by nonspecific vascular reaction. Since abnormal vascular morphology has previously been described in children with trisomy 21, we suggest that the presence of these two disease entities may not be coincidental. It may represent a genetic predisposition in Down's syndrome toward vascular abnormalities, with variable expressivity which manifested itself in this case by abnormalities in the cerebral circulation.