bluuebunny/crossref_metadata_2025 huggingface dataset:
How Environmental Effects on Child Health Are Recognized
Authors: Miller Robert W.
Published: December 2021

There is no doubt that the fetus and child have special susceptibility to the harmful effects of chemical pollutants.

EPIDEMIOLOGIC CASE REPORTS

Example 1

"Strange incidents occurred in villages along Minamata Bay in [the] Kyushu district in Japan, in which many cats went mad and died. These incidents were the prelude to [an] epidemic of a mysterious disease in human beings."1 In this way Japanese scientists began their account of the link between the ailment, now known as Minamata disease, and pollution of water with methylmercury.

Initially, a degenerative neurological disease was observed only in older children and adults. Apparently no one thought of possible fetal effects. In consequence, they went unnoticed for several years before it was realized that an epidemic of cerebral palsy had paralleled the illness in adults and older children. This was the first evidence that a chemical pollutant could harm the human fetus.

Methylmercury was identified as the cause of the epidemic by looking back into the histories of affected persons. The frequency and seriousness of the effect was greatest in the families of fishermen. It had been noted that fish in the Bay swam erratically. Fishermen sold their best catch and used the sickest looking fish as food for their families. Twenty-three children developed cerebral palsy after intrauterine exposure. Six percent of births during the interval were affected, as compared with 0.5% elsewhere in Japan. Although brain damage in the children was severe, only one of their mothers showed signs of the disease.

The methylmercury came from waste flushed into the Bay by a factory that made vinyl plastic.
Problems in Applying Teratologic Observations in Animals to Man
Authors: Warkany Josef
Published: December 2021

In teratology you will have to deal with the question of the relation between animal experiments and legislative regulation. As one who has long been interested in human malformations and who has been in experimental teratology for 35 years, I will tell you about the application of animal experiments to human situations. Thirty-five years ago it was discovered that vitamin deficiencies were reliable teratogenic procedures, yet I have not seen any comparable effects in human beings. In 1959 we found that salicylates are excellent teratogens in rats. I still have not seen a child who was deformed by salicylates. With thalidomide, the situation is the other way around; its teratogenicity was first discovered in man and then one had to find susceptible animals. These experiences exemplify how cautious one must be in applying animal observations to man. I do not say that the animal studies were in vain. They gave us important concepts about general principles of teratogenesis, but one cannot simply apply observations in mice, rats, or monkeys to man. Yet, it is done all the time.

We have also learned from experimentation about the variability of response in different species, and even within species there are strain differences in susceptibility. Furthermore, we have learned that a combination of genetic and environmental factors play an important role in the production of congenital malformations, as has been well demonstrated in mice in which cleft palate was produced by cortisone in certain but not all strains. Those who have been in the field for a long time are most hesitant in applying animal results to man.
Environmental Exposures and Biologic Considerations of the Adolescent in Relation to Chemical Pollutants
Authors: Cohen Michael I.
Published: December 2021

The somewhat dissimilar biologic processes occurring within the adolescent and his often unique environmental subculture place him at different and, at times, greater risk than his older or younger relalives. These potential differences and a current American census of approximately 35 to 40 million adolescents form the basis of the following discussion.

Essential to any thoughtful exploration of chemical pollutants and adolescence is a clear appreciation of the unique physiologic features1 of the teen-ager and his unusual societo-environmental subcultures. After initially viewing the adolescent as biologically in an active stage of physiologic growth, as well as being a fragile social phenomenon in the development of modern man in a rapidly changing milieu, one must next address the issue of the adolescent as a patient.2,3 Inherent in the latter concept are the features of health maintenance and disease specific to this group and the environment in which they exist. For the purposes of this discussion, only the areas of adolescent health or the adolescent environment which may predispose to attack by chemical pollutants will be pursued.

Definitions of the adolescent individual most often applied clinically deal with a chronological age coupled with the onset and termination of puberty (endocrine age); the onset of specific and obvious psychosexual behaviors and their resolution (psychological age); or the change in certain restricted anthropometric parameters (bone age, height age, weight age). Clinicians could just as easily include additional observations of dental age; legal age; intellectual age; vocational or educational age; a host of other anthropometric ages; alterations in body composition and body image; and, with the continued accumulation of more data, "ages" as defined by study of other biological processes and their maturation.
Some Pediatric Aphorisms From Hippocrates
Authors: C. T. E.
Published: December 2021

Hippocrates, generaly regarded as the "Father of Medicine," was probably born in 480 B.C. on the Island of Cos. Some of his aphorisms of interest to pediatricians are these:

Old persons endure fasting most easily; next, adults; young persons not nearly so well; and most especially infants, of them such as are of a particularly lively spirit.

A humid regimen is bifitting in all febrile diseases, and particularly in children, and others accustomed to live on such a diet.

Epilepsy in young persons is most frequently removed by changes of air, of country, and of modes of life.

With regard to the seasons, in spring and in the commencement of summer, children and those next to them in age are most comfortable, and enjoy best health; in summer and during a certain portion of autumn, old people; during the remainder of the autumn and in winter, those of the intermediate ages.

In the different ages the following complaints occur: to little and newborn children, aphthae, vomiting, coughs, sleeplessness, frights, inflammation of the navel, watery discharges from the ears.

At the approach of dentition, pruritus of the gums, fevers, convulsions, diarrhea, especially when cutting canine teeth, and in those who are particularly fat, and have constipated bowels.

To persons somewhat older, affections of the tonsils, incurvation of the spine at the vertebra next the occiput, asthma, calculus, round worms, ascarides, acrochordon, satyriasmus, struma, and other tubercles (phymata), but especially the aforesaid.

If in a person affected with fever, without any swelling in the fauces, be seized with a sense of suffocation suddenly, it is a mortal symptom.
George Bernard Shaw on the Institution of the Family
Authors: C. T. E.
Published: December 2021

Shaw tells us that "no man is bad enough to tell the truth about himself during his life time, involving, as it must, the truth about his family and his friends and colleagues." One wonders how near the truth Shaw was when he wrote as follows about his family.

The institution of the family, which is the centre of reverence for carefully brought-up children, was just the opposite for me. In a large family there are always a few skeletons in the cupboard; and in my father's clan there were many uncles and aunts and cousins, consequently many cupboards, consequently some skeletons. Our own particular skeleton was my father's drunkenness. It was combined with a harmlessness and humaneness which made him the least formidable of men; so that it was impossible for him to impress his children in the manner that makes awe and dread almost an instinct with some children. It is much to his credit that he was incapable of deliberately practising any such impressiveness, drunk or sober; but unfortunately the drunkeness was so humiliating that It would have been unendurable if we had not taken refuge in laughter. It had to be either a family tragedy or a family joke; and it was on the whole a healthy instinct that decided us to get what ribald fun was possible out of it, which, however, was very little Indeed. If Noah had made a habit of drinking, his sons would soon have worn out the pious solicitude which they display on the occasion of his single lapse from sobriety.
Noncompliance Contributing to Apparent Drug Failure in Status Epilepticus
Authors: Wilson John T.
Published: December 2021

The case to be described illustrates apparent drug failure because of noncompliance in the drug delivery system, and the sequelae of this mishap. In connection with investigation of this case further occurrences of noncompliance were found. This incident also brings into focus the importance of plasma drug level determinations for effective application of therapy.

CASE REPORT

A 7-year-old, 26-kg, black girl was admitted with a 16-month history of nonprogressive neurologic disease accompanied by clinical and EEG evidence of petit mal and grand mal epilepsy which responded to diphenylhydantoin (DPH), phenobarbital or ethosuximide (Zarontin) treatment. Generalized convulsions had been infrequent for four months, but, before the present admission, a marked increase in grand mal seizures was noted. On the day of admission (day 1), recurrent generalized seizure activity progressed to status epilepticus within six hours. Intravenous diazepam (Valium [0.18/mg/kg]) controlled the seizures. Primidone (Mysoline), 250 mg tid, and ethosuximide, 500 mg tid were prescribed as maintenance anticonvulsants in an attempt to allay further progression to status epilepticus.

For the next several days her seizures could be controlled only with paraldehyde (0.36 mg/kg intravenously), although administration of other drugs was continued. Assays of drug plasma levels did not become available until day 6. They disclosed that plasma levels of diazepam and demethyldiazepam were high (289 and 50 ng/ml, respectively) one hour after dosing with 0.18 mg/kg. This indicated that diazepam was not effective for continuous control of seizures, but this information was not acted upon immediately. The most striking finding was that primidone was not detected in plasma, although the prescibed dosage was 250 mg tid.
Pneumopericardium in the Newborn: Diagnosis and Pathogenesis
Authors: Varano L. A. , Maisels M. Jeffrey
Published: December 2021

Pneumopericardium is a rare complication of pulmonary disease in the newborn period. Its radiographic appearance on anteroposterior films of the supine infant may be confused with pneumomediastinum or pneumothorax so that knowledge of the relevant fascial layers is necessary for an understanding of the pathophysiology and allows proper radiographic diagnosis and appropriate treatment. The management of pneumopericardium depends on whether or not cardiac tamponade is present and the monitoring of aortic blood pressure allows this diagnosis to be made. In the absence of a fall in blood pressure, a conservative approach is probably indicated.
Rheumatoid Factor (Anti-Gamma-Globulins) in Children With Focal Scleroderma
Authors: Hanson Virgil , Drexler Elizabeth , Kornreich Helen
Published: December 2021

Seven of 21 children with focal scleroderma were found to have RF (anti-gamma-globulins) in their serum compared with none of 23 control children. Two of the RF-positive children had suggestive evidence of arthritis associated with focal scleroderma. The highest titers of rheumatoid factor were associated with the most severe lesions suggesting a possible relationship of RF to severity of disease.
Indian Health Service—By One Who Provides It
Authors: Sondheimer Henry M.
Published: December 2021

As one of the "young, highly idealistic physicians, just out of internship or residency . . ." and currently in the Indian Health Service, I read the Commentaries of Drs. Mortimer and Kemberling with great interest. Although it is unfair to extrapolate from my experiences at one hospital to the entire Indian Health Service, I believe a practicing pediatrician in the field may comment.

Dr. Mortimer may be surprised to hear that sick newborn infants at our hospital are cared for not by aides but by physicians in close contact with the Arizona Newborn Transit System in Phoenix (250 miles away), and that seriously ill newborns are transferred to one of the two neonatal intensive care units in Phoenix under the auspices of this system.
Committee on Drugs Attacked
Authors: Oettinger Leon
Published: December 2021

I note Doctor Livingston's comments on the use of amphetamines in epilepsy and the Committee's reply. I would like to support Doctor Livingston's endorsement of the use of amphetamines in epilepsy.

He and his colleagues wrote an article in the fifties on their use in petit mal. Laufer and Denhoff also indicated an increase in the convulsive threshold using a metrazol activation in hyperkinetic children.

Although the Committee may not be aware of the literature concerning this, many of us who have had extensive clinical experience with epilepsy feel that the amphetamines are of value.
The Development of the Infant and Young Child: Normal and Abnormal, ed. 5, by R. S. Illingworth, M.D. Leads, F.R.C.P., D.P.H., D.C.H. Baltimore: The Williams & Wilkins Company, 1972, 377 pp., $16.75
Authors: Brazelton T. Berry
Published: December 2021

This is an updating of Illingworth's original and highly successful textbook which was first published in 1960—and almost triennially since then. To bring a successful textbook up to date is a difficult job and the new edition is indeed an enlargement on the original text of 305 pages. I found the same delight as before in rereading Dr. Illingworth's comprehensive approach to development. He has been a leader in the field of pediatrics pressing for child development as an important part of a pediatrician's tools.
Radiation Exposure to Personnel in a Neonatal Nursery
Authors: Poznanski Andrew K. , Kanellitsas Christos , Roloff Dietrich W. , Borer Robert C.
Published: December 2021

Radiation dose to personnel in a neonatal nursery from scattered irradiation from mobile radiographs can be kept at a level below background if certain simple precautions are observed. These consist of staying one foot or more away from the baby that is being radiographed and avoiding the direct beam when lateral cross table films are obtained.
Calcium and Fat Absorption From Infant Formulas With Different Fat Blends
Authors: Barnes Lewis A. , Morrow Grant , Silverio John , Finnegan Loretta P. , Heitman Sandra E.
Published: December 2021

Three formulas with different fat blends were fed to 29 infants from the fourth to the tenth days of life. Absorption and retention of fat, calcium, and phosphorus were measured by a metabolic balance technique. The following observations were made:

1. Absorption of oleate and linoleate was best with the formula that had a linoleate:oleate ratio similar to that of human milk. Absorption of palmitate was similar with all three formulas. Stearate absorption was low in the formula with the lowest stearate content.

2. Calcium absorption was 36 mg/kg/day or 38% of intake with the formula which had a linoleate:stearate ratio similar to that of human milk; this was significantly greater than with the other two formulas which both had much higher linoleate:oleate ratios.

3. Phosphorus absorption was approximately 90% of intake with all three formulas, equivalent to 47 to 79 mg/kg/day. Retention varied from 27 to 53 mg/kg/day.
Intellectual Elitism Attacked
Authors: Pyeritz Reed E.
Published: December 2021

There is today universal agreement on the existence of a health care crisis in this country, and total lack of agreement on how to improve the situation. Dr. David Nathan in his commentary1 proposes no solutions, but rather suggests people whom he feels are best qualified to effect a cure, and, by implication, the manner by which solutions should be sought. Beginning with the trenchant observation of Dr. David Rogers2 (not found, incidently, in the reference cited by Dr. Nathan3) that academic medical centers are partly to blame for the present health care mess and that they should aid society in correcting the situation, Dr. Nathan calls for established, research-oriented medical faculty to switch interests, "retrain themselves" where necessary, and solve the problems of health care by scientific investigation.
Dr. Nathan's Assumptions Attacked
Authors: Katcher Ayrum L.
Published: December 2021

David G. Nathan's commentary (Pediatrics, 52:768, 1973) on problems of delivery of health care suggests that the rational application of scientific methods which have been so successful in the biomedical research area to the problems of the delivery of health services to our population, will produce comparable achievements in this new arena.

Nathan may well be correct in his faith in the research process. However, he also seems to believe that persons engaged in research possess talent ("the cream") which is equipotential in all areas.
Viewpoint From the Division of Community Child Health
Authors: Bass Joel , Johnson Dorothea , Kirby Jacqueline , Lamb George A. , Levy Janice C. , McCarthy Paul L. , Robins Carol , Ross Cynthia
Published: December 2021

We read with interest Dr. Nathan's comments on primary medical care (Pediatrics, 52:768, 1973), but feel compelled to add another viewpoint.

One of the striking changes occurring today in teaching hospitals and medical schools is an increased awareness of and interest in primary care. Some institutions, including our own, have created residencies and fellowships in ambulatory pediatrics as a response to house staff interests and also in response to the needs of the surrounding community.
Dr. Nathan's Reply to His Critics
Authors: Nathan David G.
Published: December 2021

Though the tone of some of the responses to my commentary is a bit more strident than I would hope to hear in a discussion among colleagues, I must admit that some of the criticisms are well taken.

There are one or two points that require closer examination. First, it is not fair to blame the overgrowth of specialty and research medicine on the department chairmen of the 50s. The facts are that organized medicine made certain that no funds would be available to develop new primary care programs aside from traditional residency training programs.
School Problems and Their Causes
Authors: Wender Esther H.
Published: December 2021

In most respects Dr. Marcel Kinsbourne's discussion of school problems was excellent1, but he makes some statements which I feel should be reviewed critically.

His opening statement that "the great bulk of illiteracy in this country derives from socioeconomic adversity and cultural alienation that presents a primarily political rather than a medical challenge" (emphasis mine), though often made, confuses correlation and causation. Although illiteracy can be correlated with low socioeconomic class, that does not necessarily mean that a poor socioeconomic status causes illiteracy (cf the arguments regarding intelligence and social class).
Letter to the Editor
Authors: Mutti Margaret , Sterling Harold M.
Published: December 2021

Marcel Kinsbourne's paper (Pediatrics, 52:697, 1973) is timely and practical. Unfortunately, however, the volume of children with school problems approaches the unmanageable, and we need reliable and effective ways of screening which will enable us to give appropriate professional attention to the "problems".

In 1969 we began to develop an instrument that would select school children having distinct neurologic handicaps from a large group experiencing learning problems. Our brief screening can be administered in approximately 20 minutes by medical or nonmedical professional qualified personnel.
A New Infantile Acute Febrile Mucocutaneous Lymph Node Syndrome (MLNS) Prevailing in Japan
Authors: Kawasaki Tomisaku , Kosaki Fumio , Okawa Sumio , Shigematsu Itsuzo , Yanagawa Hiroshi
Published: December 2021

What may be a new disease has been afflicting infants and young children in Japan since 1960. It is an acute, febrile, mucocutaneous condition accompanied by swelling of cervical lymph nodes (tentatively called mucocutaneous lymph node syndrome [MLNS]). It may be misdiagnosed as scarlet fever, the Stevens-Johnson syndrome, or infantile periarteritis nodosa. The disease is now known to be widely occurring all over Japan with an increasing incidence each year. More than 6,000 cases have been reported as of 1973. One to two percent of the patients reported have died suddenly of cardiac failure. All the autopsies showed infantile periarteritis nodosa-like arteritis accompanied by coronary thrombosis and aneurysm. Some of the surviving cases have been shown to have similar changes. These findings lead us to believe that this clinical picture is a new clinical entity. Recently, rickettsia-like bodies were found by electron microscopy in biopsy specimens from the skin and lymph nodes of the patients. The bodies were isolated by yolk sac culture and their pathogenicity is now under investigation.
Intellectual Development After Severe Malnutrition in Infancy
Authors: Lloyd-Still John D. , Hurwitz Irving , Wolff Peter H. , Shwachman Harry
Published: December 2021

Intellectual performance, sensory motor abilities and social adaptation were studied in 41 subjects (2 to 21 years of age) who had severe malnutrition in infancy. A control group consisted of 41 siblings. The mean IQ of 31 parents was 108 (S.D. $$Word$$ 11.3). Socioeconomic deprivation was not present. The results of the Merrill-Palmer test for the malnourished group and the controls revealed significant differences in favor of the controls. No differences were found in the older population for whom the WISC and WAIS were used. The Lincoln-Oseretsky test of motor development and the Vineland scale of social maturity showed no significant differences. These results are consistent with the hypothesis that malnutrition in infancy can affect intellectual development in the first five years of life. Beyond this age, given adequate socioeconomic support, no significant differencces were observed.
An Account of the Successful Outcome of a Compound Skull Fracture in a Six-year-old Boy-Reported in 1763
Authors: C. T. E.
Published: December 2021

The case history below attests to the vis mediatrix naturae because the patient survived a serious head injury without any of the supportive therapeutic aids which would be considered routine today.

Thomas Walker, a child about six years of age, living at Caton, being asleep near the fire, a stone about half a hundred-weight fell from the top of the chimney upon the side of his head, and fractured his skull in a most terrible manner. The poor lad lay as dead for several hours; but his parents being persuaded to carry him to Dr. Brachen of Lancaster, they immediately followed the advice. The doctor made a proper incision, in order to clear the skull from the pericranium, and discover the fracture; when he found the parietal bone fractured in twenty pieces (some as large as a shilling piece) with their sharp points sticking down in the brain, the dura and the pia being both destroyed, and a considerable effusion of blood from the vessels of the brain.

The bones were removed with great care and dexterity, for as their points went so far into the brain, the nicety consisted in removing them so that the instrument might not pass too far into the substance of the brain, and consequently destroy the patient. In time the boy recovered beyond expectations, and is now entirely well, though it is three months since he received the hurt. Therefore, the said Dr. Brachan inserts this for the information of those who are bigoted to an opinion, that if the brain was wounded till the lobe or particular part of the brain was rotted or consumed away, the case would be desperate.
Hydrocarbon Pneumonitis
Authors: Eade Norman R. , Taussig Lynn M. , Marks Melvin I.
Published: December 2021

Small children, particularly those aged 1 to 5, often drink liquid hydrocarbons when these substances are left accessible to them by careless adults. The hydrocanbons most commonly ingested include petroleum solvents, dry cleaning fluids and spot removers, kerosene, lighten fluids, gasoline, and "mineral seal oil" which is found in many liquid polishes and waxes. For statistical purposes many surveys also include ingestions of turpentine, oil paints, stains and a variety of hydrocarbon-based preservatives. In 1972, petroleum products accounted for 4.6% (4,571 of 105,018 poisonings reported) of accidental ingestions in the United States among children under 5 years of age.1 This figure has remained virtually unchanged since 1969. In a hospital based study published by Deeths and Bneeden2 in 1971, ingestion of hydrocarbons was reported to be the second most common cause of admission to hospital for accidental poisoning in each of the years from 1962 to 1968. In the United States from 1951 through 1958, 763 people died following accidental ingestion of petroleum distillate and children under 5 years of age accounted for about 90% (680 of 760) of these deaths.3 However, statistics reveal a decreased mortality rate, with only nine hydrocarbon fatalities reported in 1972 for this same age group.1

Although a wide variety of hydrocarbons are involved in the accidental poisonings reported, most related publications have dealt with kerosene intoxication. The incidence rate and the mortality rate from kenosene ingestion is decreasing, although it continues to be a major problem in the United States. For children less than 5 years of age in 1972, there were 579 reported cases of kerosene ingestion of which two were fatal.1
ADVICE FROM AN OLD DOCTOR TO A YOUNG DOCTOR ON "KEEPING UP"
Authors: Hailey A.
Published: December 2021

"You're young, you're full of spice and vinegar—that's good. You know your stuff too. You're up-todate—you know things that I never did and never will now. Take my advice and try to keep it that way. It'll be tough to do; make no mistake about it." He waved toward the desk he had just vacated. "You'll sit in that chair and the phone will ring, and it'll be the administrator—talking about budgets. Next mmute one of the lab staff will want to quit; and you'll have to smooth that out. And the doctors will come in, and they'll want this bit of information and that." The old man smiled thinly. "Then you'll get the salesman—the man with the unbreakable test tube and the burner that never goes out. And when you're through seeing him there'll be another and another and another. Until at the end of a day you'll wonder what happened to it and what you've accomplished, what you've achieved."

"That's the way the next day can go, and the next, and the one after that. Until you find a year has slipped by, and another, and another. And while you're doing all this you'll send other people on courses to hear about the new things in medicine—because you can't take time out to go yourself. And you'll quit investigation and research; and because you work so hard, you'll be tired at night, and you won't feel like reading textbooks. And then suddenly, one day, you'll find everything you knew is out of date.
Why Circumcision?
Authors: Burger Robert , Guthrie Thomas H.
Published: December 2021

Since the subject of this presentation is a query, let us follow with other questions. Why has controversy developed among educated peoples when discussing a procedure which has been performed for centuries? Why has circumcision become a "hot issue"? One reason, we know, is that health insurance carriers have asked the American Academy of Pediatrics, the American Urologic Association and, we are sure, other concerned groups or associations to determine whether or not neonatal circumcisions should be covered. They have proposed an economic question; and we, as concerned physicians, must review the procedure from its inception and offer reasonable recommendations.
Pseudohermaphroditism, Nephron Disorder and Wilms' Tumor: A Unifying Concept
Authors: Barakat Amin Y. , Papadopoulou Zoe L. , Chandra Roma S. , Hollerman Charles E. , Calcagno Philip L.
Published: December 2021

We have observed three infants and learned of two other previously unreported cases presenting with various combinations of pseudohermaphroditism, Wilms' tumor and nephron disorders including nephrotic syndrome. The concurrence of these disorders, as described in our cases and others from the literature, indicates that they may have teratogenic origins in common and that all of them originate when pseudohermaphroditism does; namely, during embryogenesis.
Blindness and Neuropathy From Diiodohydroxyquin-Like Drugs
Authors: Yaffe Sumner J. , Bierman C. Warren , Cann Howard M. , Cohen Sanford , Freeman John , Segal Sydney , Soyka Lester F. , Weiss Charles F. , Oakley Godfrey P.
Published: December 2021

The halogenated hydroxyquinolines can cause serious, permanent neuropathy. Optic atrophy, causing permanent blindness, is the most commonly reported neuropathy in children. In young children, the onset of neuropathy is insidious and hard to diagnose. We, therefore, recommend that these drugs not be used in children, with two possible exceptions: the treatment of the asymptomatic cyst passer of E. histolytica in a person not living in an endemic area and the treatment of acrodermatitis enteropathica. If used, parents should be informed of the possible toxicity. Parents, child, and physician should diligently search for the first indication of neuropathy. These drugs are contraindicated in the treatment of nonspecific, chronic diarrhea, and "traveler's diarrhea."
Immunization Action Month, October 1974
Authors: Katz Samuel L.
Published: December 2021

The Executive Board of the American Academy of Pediatrics, in a recent session, unanimously approved a resolution supporting Immunization Action Month, October 1974, in order to stimulate a more widespread immunization of American children against poliomyelitis, diphtheria, rubella, mumps, pertussis and tetanus. It is completely appropriate, therefore, that the Academy take an active role in a nationwide effort to make October 1974 a month for emphasis and promotion of childhood immunization. Joining with the Academy in this effort are the American Medical Association, American Academy of Family Physicians, National Medical Association, American Osteopathic Association, American Nurses Association, American League of Nursing, five major service organizations and five manufacturers of biologics.

The entire campaign is initiated and coordinated by the Center for Disease Control. The aims of this national effort are twofold: (1) "to motivate parents to check the immunization status of their children with their family doctor"; and (2) "to create receptivity on the part of the physician to these parental inquiries and encourage him and his office nurse to conduct an ongoing office audit of the immunization record of every child he sees." A third goal should be to make every effort to reach those indigent and other disadvantaged groups who do not receive consistent health care.

Why is such a campaign necessary? The striking reductions in the numbers of reported cases of diphtheria, tetanus, pentussis, poliomyelitis, and measles attest to the remarkable efficacy of the vaccines in the prevention of these diseases. Disquieting information has arisen from two sources: (1) the surveillance reports of infectious diseases; and (2) the surveys of the immunization levels of preschoolers and those children at the time of school entry.1
Is a Temperature Higher Than 104 F per se Damaging?
Authors: Sullivan Cary E.
Published: December 2021

One recent text1 (and less clearly a second2) refers to the possibility of brain damage in children from fever over 104 F. Though not specifically stated, the inference is that these are children with general pediatric infectious diseases.

I have considered this notion to be anecdotal and perpetuated by tradition. However, it is widely held by parents and is the cause of much anxiety.

Excepting, of course, children with predisposition to febrile seizures, those with primary disease of the nervous system, those with incipient hypernatremia or other qualifying conditions, have instances, in fact, been reliably documented of CNS damage from fever per se?
Check Umbilical Catheter Position
Authors: Szold Philip D.
Published: December 2021

On reading the brief recording, "Gangrene of the Buttock: A Complication of Umbilical Artery Catheterization,"1 I was convinced that because the contribution was included in Experience and Reason, the conclusion would be to always obtain an adequate x-ray after catheterization to verify proper positioning. Such an x-ray was not obtained until more than 30 hours postcatheterization in the above-mentioned case report. However, I reached the end of the article with no mention of the importance of these x-ray studies.
Letter to the Editor
Authors: Lee Henry F.
Published: December 2021

It was with dismay that I recently found Pediatrics policy changed to permit advertising to be inserted into the body of the scientific content. We join the Readers Digest.

I read Dr. Frazier's commentary (Pediatrics, 52:767, 1973) and I recognize the forces at work.

I would rather see the number of issues reduced or the price raised to cover costs than to see a fine professional publication so demeaned. Rest assured it is a demeaning move!
Reye's Syndrome—Study
Authors: Haller Jerome S.
Published: December 2021

Because of the variety of therapies employed in Reye's syndrome, Dr. Peter Huttenlocher of Yale University School of Medicine and I have drawn up a protocol designed to evaluate the effectiveness of frequently used regimens. The study has been devised on a multi-hospital basis with the following hospitals already participating: Harbor General Hospital (Dr. Marvin Weil); Children's Hospital of Buffalo (Dr. M. Cohen); Emory University School of Medicine (Dr. J. Schwartz); Children's Hospital of Michigan (Dr. J. Finnegan); and Centre Hospitalier Universitaire, Université de Sherbrooke, Sherbrooke, Quebec (Dr. B. Lemieux).
Sustained Hyperoxemia Without Cicatricial Retrolental Fibroplasia
Authors: Aranda Jacob V. , Sweet Avron Y.
Published: December 2021

Twenty infants weighing between 890 and 1,750 gm at birth who survived the respiratory distress syndrome had sustained aortic Po2 values >150 mm Hg for 10 to 43 hours; 16 of the 20 had sustained aortic Po2 values >200 mm Hg for 4 to 40 hours; 11 had sustained aortic Po2 values >300 mm Hg for 1 to 21 hours. At 5 months of age or beyond, 19 had no evidence of cicatricial retrolental fibroplasia, while one who died at 6 weeks of age had no eye abnormalities two weeks earlier. These findings suggest there may be one or more factors other than oxygen operative in the etiology of cicatricial retrolental fibroplasia.
Phocomelia, Flexion Deformities and Absent Thumbs: A New Hereditary Upper Limb Malformation
Authors: Holmes Lewis B. , Borden Spencer
Published: December 2021

Absence or hypoplasia of the radii and thumbs usually occurs as an isolated and presumably nonhereditary malformation.1,2 Among those for which a genetic basis has been proven, there are at least three different types of hereditary absence of radii1 as well as several disorders with absence or hypoplasia of the radii a feature of a hereditary syndrome of multiple malformations.3-15 We have evaluated a boy who appears to have a previously unreported pattern of upper limb deformities and minor craniofacial anomalies. The fact that his mother has milder, but similar deformities, suggests the disorder is hereditary.

CASE HISTORIES

The propositus (A.B.) was born in 1966. His birth weight was 2.6 kg and length 46 cm. Because her two previous pregnancies had ended in spontaneous abortions at four and six weeks' gestation, his mother was given four intramuscular injections of hormone preparations. The medication was hydroxyprogestrone caproate (Delalutin), 250 mg, which was given 47,61,76 and 90 days after her last menstrual period. In addition, she took a medication (Bonadoxin, each tablet containing 25 mg of meclizine hydrochloride and 50 mg of pyridoxine htydrochloride) for nausea for three weeks and a multivitamin preparation throughout the pregnancy. At birth the propositus was noted to have no thumbs, three fingers on his left hand and four on his right hand, flexion deformities and ulnar deviation of his fingers and by radiography shortening of both radii without radial deviation of each forearm. Full-body radiographs revealed no other abnormalities. At four years he underwent surgical removal of the distal portion of his right index finger because of the severe flexion contracture and ulnar deviation which interfered with the function of the adjacent finger.
Parental Expectations vs Outcome in Toilet Training
Authors: Stephens James A. , Silber David L.
Published: December 2021

Sixty-nine follow-up questionnaires were mailed to parents who had completed an earlier questionnaire on toilet training expectations. This follow-up questionnaire examined the reported experiences of parents in training a first-born child. Analysis of these data support the following conclusions:

1. Most children (70%) were not completely toilet trained by age 2.

2. There were no relationships between age of initiating toilet training and subsequent soiling or constipation problems.

3. One third of the parents were planning to change the training techniques with their subsequent children.

4. One third of the parents felt that training their oldest child was begun to early, and planned a later and more relaxed child-centered approach in training their subsequent children.

5. Since most parents do not seek professional advice in this area, the physician or his aide should initiate discussions in this area during the child's visits for the first two to three years of life.
Growth Charts for Children 0 to 18 Years of Age
Authors: Duncan Burris , Lubchenco Lula O. , Hansman Charlotte
Published: December 2021

The purpose of this communication is to present growth grids which incorporate many of the recommendations set forth by the Committee on Growth and Development of the American Academy of Pediatrics and the Maternal, Child Health Service of the Department of Health, Education and Welfare.1

The percentile curves depicted on these grids are based on longitudinal data collected by the Child Research Council of Denver2 which represent optimal values for whites living in this area. The charts have been in use at the University of Colorado Medical Center for over one year and have proven to be quite satisfactory.

CLINICAL MATERIAL AND METHODS FOR THE GROWTH CURVES
Prenatal Diagnosis of Methylmalonic Aciduria
Authors: Gompertz D. , Goodey Patricia A. , Saudubray J. M. , Charpentier Christiane , Chignolle Agnes , Girard Sylvie
Published: December 2021

The abnormal accumulation of small molecular weight metabolites in amniotic fluid in inborn errors of metabolism is unusual and prenatal diagnosis usually requires amniotic cell culture and specific enzyme assay. However, Morrow et al.1 reported raised concentrations of methylmalonic acid in the amniotic fluid of a pregnancy at risk from methylmalonic aciduria and confirmed the diagnosis in the postnatal period. More recently Mahoney et al.2 have reported an abnormal methylmalonic acid concentration in the amniotic fluid of one of two pregnancies at risk. They confirmed that the fetus in this case was affected by showing an impaired oxidation of methylmalonic acid in cultured amniotic cells.
Other Causes of Petechiae
Authors: Wald Ellen R.
Published: December 2021

Sahler and Wilfert1 report a case of a 10-year-old boy hospitalized because of onset of a petechial rash in association with a febrile illness. The petechial eruption appeared following approximately a 24-hour period marked by pernicious vomiting and was distributed over left forehead, right lower cheek and to a lesser extent on neck and upper thorax. The notable absence of petechiae on the distal extremities, the more classic locations for rash in the older child with meningococcemia in association with a history of repeated vomiting, leads me to interpret the vascular lesions as secondary to mechanical causes.
Letter to the Editor
Authors: Tamer M. Akram , SANDBERG Douglas H.
Published: December 2021

According to Webster's New Collegiate Dictionary, the term "intractable" means "not easily relieved or cured." "Intractable diarrhea" as defined by Avery1 refers to persistence of diarrhea for more than two weeks, with a minimum of three stool cultures negative for bacterial pathogens and three negative examinations for ova and parasites. That study was limited to infants under 3 months of age. Only one of our patients (case 2) had diarrhea for less than two weeks' duration.
Comment on Prevention of Diabetic Atherosclerosis
Authors: Hicks William M.
Published: December 2021

The prevention of diabetic atherosclerosis may not be as easy as exerting good control over one's diabetes.1 Preliminary studies of the activity of pyrophosphatase in bone cells show that pre-incubation with human insulin in physiologic concentrations resulted in a three-fold increase in the activity of pyrophosphatase. Pyrophosphates (P-Pi) are liberated in the process of breaking high energy phosphate bonds. P-Pi are in the serum and in the aorta in concentrations large enough to prevent or inhibit calcification.2
On the Hospitalization of Children: An Historical Approach
Authors: Hunt Andrew D.
Published: December 2021

Societal interest in infants' and children's welfare in the English-speaking world appears to have originated in London in the mid-l8th century, at which time the evidence suggests a general lack of concern for the life of a child. Mortality within the first five years of life was upward of 75%. "Children were regarded as a necessary evil and except in time of alarming and grave illness were little considered. Evidence of neglect, cruelty and infanticide is so abundant that we are forced to believe that at times children were not even considered necessary."1 Although artificial feeding usually resulted in infants' deaths, women of wealth and social stature rarely nursed their babies, but rather sent them away to be cared for by wet nurses who, in turn, frequently had to sacrifice their own infants in order that they might feed those of their employers. The "dropping" of infants, either on doorsteps of wealthy families, or onto dung heaps to starve or freeze to death, was a common practice and rarely noticed.

It is of interest that leadership to alter this situation was taken, not by a physician, but by a shipwright named Thomas Coram (1668-1751). He spent much of his life in Taunton, Massachusetts, to which he gave a valuable parish library. He retired from sea service in 1719 and, after having acted as a trustee for the embryonic Oglethorpe Colony in Georgia, returned to England where he was appalled by the condition of infants and children, and took a practical interest.
The Developing Field of Craniofacial Surgery
Authors: Whitaker Linton A. , Randall Peter
Published: December 2021

The abnormal facial structural deformities present in a variety of major birth defects including the craniofacial dysostoses; orbital hypertelorism, and mandibulofacial dysostoses can now be, to a large extent, surgically corrected. Correction utilizes extensive planning involving perhaps a larger number of specialties than any other in medicine, and ultimately a radical surgical approach. The greatest benefits derived from this surgery are the changing of sometimes grotesquely abnormal facies to normal or near normal ones. With this there is exceptional potential for psychologic gain. Two other areas of potential benefit are visual and dental occlusal abnormalities.
JOHN WINTHROP, JR., ON THE TREATMENT OF A PALSIED (?) CHILD
Authors: C. T. E.
Published: December 2021

Governor John Winthrop, Jr. (1606-1676), the first Governor of Connecticut, was famous throughout New England for his medical ability. He was often consulted by letter for medical advice about the management of sick children. The type of medicine he practiced can be gained from his letter below written in 1652 to the father of a sick child. The letter also shows that orthography –as we know it–had not yet been decided upon.

I received your letter about 2 daies since wherin you desire directions concerning your child, wch indeed is very uncertaine to doe in the absence of the pty, it being difficult to find out the true cause & seat of the originall of such disease by the most diligent & curious observation, when the patient is dayly present: for though by your description I iudge it to be a palsy, yet the cause of that diseas is often very differing for in Some it is through too much drinesse in some too much moisture in some the cause is in the Nerves of the third coniugation of the braine sometymes in other nerves, in others it hath its originall in ye marrow of the back bone: This seems to be that kind wch we call Hemiplegia where one halfe of the spinall marrow is affected or (wch is often in others, and makes me doubt it may be so in this child, by reason of the suddainnesse wherewth she was stroken) it may come fro a light apoplexye (a stronger Apoplexye is comoly present death) This lighter kind of Apoplexy strikes suddainly & leaves comoly one side wthout sence or motion, and after continueth it wholy paraliticall: it may also come fro some thick flegme stopping the influence and distribution of ye vitall spiritts in the nerves, wch may also cause that suddaine apoplecticall stupor.
Clinical Uses of the Brazelton Neonatal Scale
Authors: Soule A. Bradley , Standley Kay , Copans Stuart A. , Davis Miryam
Published: December 2021

The clinical usefulness of the Brazelton Neonatal Assessment Scale was explored in examination of infants born to heroin-addicted mothers taking methadone. Scale scores differentiated these babies in drug withdrawal from data of a normal sample and provided important information on courses of illness. Systematic observation of newborn behaviors can be a significant adjunct in diagnosis and management.
Intra-uterine Methylmercury Poisoning in Iraq
Authors: Amin-Zaki Laman , Elhassani Sami , Majeed Mohamed A. , Clarkson Thomas W. , Doherty Richard A. , Greenwood Michael
Published: December 2021

A disastrous epidemic of methylmercury poisoning occurred in rural Iraq early in 1972, due to the ingestion of home-made bread prepared from wheat treated with a methylmercury fungicide. We report the clinical and laboratory evaluation of 15 infant-mother pairs exposed to methylmercury during pregnancy, including mercury determinations in blood samples of mothers and infants, and in milk samples from mothers, during the first seven months following the epidemic.

In all cases except one, the infants' blood mercury levels were higher than their mothers' during the first four months after birth. Our results indicate that methylmercury passes readily from mother to fetus and that neonatal blood mercury levels are maintained through ingestion of mercury in mothers' milk.

Clinical manifestations of methylmercury poisoning were evident in six of 15 mothers and in at least six of 15 infants. In five severely affected infants there was gross impairment of motor and mental development. However, in only one infant-mother pair was the infant affected and the mother free of signs and symptoms–a marked contrast to the reports of Japanese mother-infant pairs from Minamata.

Careful follow-up studies of these and other Iraqi infants will determined where signs and symptoms of methylmercury poisoning will appear as these children continue to develop. Studies of these and additional infant-mother pairs may allow determination of the prenatal period of greatest fetal sensitivity to methylmercury poisoning.