bluuebunny/crossref_metadata_2025 huggingface dataset:
SEXUAL PROBLEMS IN CHILDREN AND ADOLESCENTS
Authors:   COMMITTEE ON YOUTH
Published: December 2021

ACCURATE DATA on teenage sexual behavior is difficult to obtain. Only a small proportion of the problem behavior comes to the attention of the juvenile courts, and schools usually prefer to direct little attention to sexual behavior among students. To equip professionals in the health fields to cope with contemporary problems of American youth, more attention should be directed toward studying deviant sexual behavior, especially homosexuality, drugs, use of contraceptives, sex education, and venereal disease in teenagers. Since most teenage problems related to identification and sexual behavior have their genesis in early childhood, the family physician plays an important role in promoting optimum childrearing practices and identifying potentially problematic behavior.

THE NEED FOR RESEARCH

There is a limited amount of valid scientific knowledge regarding the sexual behavior of adolescents. Although this subject receives considerable attention from the lay press, few good studies have been published. Information which is available is often based on folklore, prejudiced moral judgments, and retrospective anecdotal reporting. The pediatrician usually has limited knowledge on which to base the counseling and advice he is frequently called on to give regarding these problems. The Committee on Youth recommends that this subject be investigated thoroughly and encourages the development of studies to increase our meager knowledge and provide a basis on which to judge contemporary standards of normal and deviant behavior.

SEX EDUCATION

Any program of sex education is made more complicated by three recent developments: (1) Conception can now be readily controlled by oral medication. (2) There is an increasing interest in, and detailed understanding of, the physiology of the sexual response in both sexes.
COMPETITIVE ATHLETICS FOR CHILDREN OF ELEMENTARY SCHOOL AGE
Authors:   Committee on Accident Prevention
Published: December 2021

COMPETITIVE SPORTS organized by school or other community agencies are now played so universally in all parts of the country by children 13 years of age and younger that the above organizations wish to suggest positive and realistic guidelines to govern participation.

Children of this age are not miniature adults; they are boys and girls in the process of maturation into adults. They seek and can profit from suitable play opportunities, but the benefits are not automatic. High quality supervision and a broad range of physical education activities, including sports adapted to the needs and capacities of growing children, are required for full realization of benefits.

A variety of competitive sports, appropriately a part of a sound physical education program, has the advantage of directing funds, facilities, instruction, and leadership toward all children in the school system or community. Such a program avoids providing a narrow sports experience for children or one directed only to the physically gifted, the well developed, the skillful, or the precocious child.

The problems involved are sufficiently significant and variable to warrant each community's having a local committee representing education, recreational, and medical specialists. Decisions about all school or community athletic programs may then be made in terms of local interest and needs, adequate supervision, and assurance of proper safeguards. Such decisions about athletic programs for children of elementary school age should embody local consideration of the following:

1. Proper physical conditioning.

2. Conduct of the sport: (a) competent teaching and supervision with regard for the relative hazards of each particular sport; (b) modification of rules, game equipment and facilities to suit the maturity level of the participants; (c) qualified officials.
Dangers of Hyperbilirubinemia
Authors: Sterne George G.
Published: December 2021

In the April 1968 issue of Pediatrics, Drs. Weldon and Odell propose to deal with the question of the relative risks of hyperbilirubi nemia due to causes other than Rh incompati bility and the risks inherent in the procedure of exchange transfusions.

Their short-term results are certainly impressive and they acknowledge the possibility of late sequellae such as portal vein hypertension and homologous serum jaundice.

Once again the case for the low risk of care fully done exchange transfusions has been made; but, to quote the authors, "In the final analysis the risk of development of bilirubin encephalopathy must be weighed against the morbidity and mortality risks inherent in the procedure itself."
In Reply: Indications of Operations in Craniostenosis
Authors: Shillito John , Matson Donald D.
Published: December 2021

Dr. Freeman's principal objection is that the morbidity rate of 14% is too high for a purely cosmetic operation.

We would like to redirect attention to Table III on page 834, where the complications are tabulated so that their significance may be fully appreciated. May we again emphasize that of all 519 patients, 2 have died as the result of their surgery, and only 3 have anything undesirable to show as a complication of the surgery.
An Epidemic Unchecked
Authors: North A. Frederick
Published: December 2021

A serious and largely unrecognized health problem stalks our land. Each year it kills nearly 300 children, permanently cripples an unknown number, and subjects nearly a million to hospitalization and surgery. The problem costs the nation at least $150,000,000 in direct medical costs alone.

This epidemic is not caused by a microorganism, by an environmental contaminant, nor by a genetic defect. It is caused by the failure of the medical profession to apply rational standards of safety and efficacy to one of its own well established habits.
Gas Leak Syndrome
Authors: Sherman Bennett R. , Harris Ellis H.
Published: December 2021

In a period of approximately 20 years of pediatric practice, we have seen six cases and probably a few more that have slipped from our memory, of what we have labeled "gas leak syndrome." Recently, another such case occurred; and, as we thought about it and browsed through the literature (very little written on this subject), we decided to avail ourselves of your Letters to the Editor section.

The typical case is as follows: the patient is usually ill with some minor illness which forces confinement for a 3- or 4-day period.
In Reply: Follow-up of Infectious Lymphocytosis Cases
Authors: Clement David H.
Published: December 2021

The quantitative data supplied by Drs. Oleinick and Glass are greatly appreciated. In view of the small size of the study sample reported by Putnam, Moore, and Mitchell,1 it is true that a significant increase in leukemia or lymphoma could still exist undetected. Infectious lymphocytosis has often been characterized by an extra-ordinary proliferation of cells to levels tenfold or more above normal. Such a phenomenon might be followed in later years by increased risk of malignancy 130 times normal or above.
Trends In Illegitimacy: United States, 1940-1965, by Mrs. Alice J. Claque and Mrs. Stephanie J. Ventura. Washington, D.C.: Government Printing Office (PHS Publication Number 1000, Series 21, No. 15 of National Center for Health Statistics), 1968, 90 pp., $0.55 (Available through the Superintendent of Documents, U.S. Government Printing Office. Washington, D.C. 20402)
Authors: Ventura Stephanie J.
Published: December 2021

This recent report from the National Center for Health Statistics describes trends and differentials in illegitimacy in the United States. These statistics are based on information required on birth certificates in 34 States and the District of Columbia, and deal principally with the illegitimacy rate, or number of births per 1,000 unmarried women 15-44 years of age.

The illegitimacy rate increased from 7.1 in 1940 to 23.5 in 1965. The nonwhite rate declined from 12 times higher than the white rate in 1950 to slightly over 8 times as high in 1965.
Atlas of Infant Surgery, by Dr. J. Eugene Lewis, Jr. St. Louis: The C. V. Mosby Company, 1967, 258 pp., $21.00
Authors: Hendren W. Hardy
Published: December 2021

This book describes most of the more common general surgical conditions seen in infants. Each entity is described in general terms, followed by artist's drawings depicting the major steps of the operative procedure. The author's stated purpose in this book is to "assist physicians and surgeons who encounter and who must help solve surgical problems of early infancy." The book does outline the essential steps of correction of many of these congenital malformations, but some of the procedures seem unduly simplified.
DIAGNOSIS AND TREATMENT: SHOULD ORAL HYPOGLYCEMIC AGENTS BE USED IN PEDIATRIC AND PREGNANT PATIENTS?
Authors: Adam Peter A. J. , Schwartz Robert
Published: December 2021

Two Groups of hypoglycemic agents– the sulfonylureas and biguanides* – have achieved widespread acceptance over the past 10 years as therapeutic tools in selected cases of ketosis-resistant diabetes beginning in maturity. From experimental evidence concerning their modes of action and their successful clinical maintenance of normoglycemia in these patients, some investigators have proposed using oral hypoglycemic agents either alone in prediabetes or to supplement insulin in labile diabetes with onset during growth.

The use of sulfonylureas and biguanides in diabetes beginning in maturity was originally based on two principal actions of these drugs:

1. The sulfonylureas have a beta-cytotropic effect, which refers to their stimulation of insulin output from islet cells.

2. Both the sulfonylureas and the biguanides enhance insulin action, but by different mechanisms.

The enhancement by tolbutamide is not completely understood, but in vivo depends upon the presence of either infused insulin or secreting pancreatic beta-cells.2 In contrast to the sulfonylureas, the biguanides have no effect upon insulin secretion2 but also enhance the hypoglycemic effect of insulin. This action of the biguanides, which manifests itself only in fasting or diabetic man, appears to be caused by both inhibition of hepatic gluconeogenesis and by enhanced glycolysis leading to increased systemic glucose uptake.3 If therapeutic success in diabetes is measured by the maintenance of normal blood sugar rather than by a favorable effect upon vascular disease, these drugs will maintain normoglycemia in appropriate adult patients provided the islet beta-cells are responsive to either pharmacological or physiological stimuli. Since the two classes of drugs have different modes of action, they also have been used to supplement each other in oral therapy.4
Pediatric Plastic Surgery, Volume I– Trauma, by Francis X. Paletta, M.D., F.A.C.S. St. Louis: The C. V. Mosby Company, 1967, 245 pp., $27.50
Authors: Murray Joseph E.
Published: December 2021

Pediatric Plastic Surgery, Volume I–Trauma, by Francis X. Paletta of the St. Louis University School of Medicine, is a welcome addition to the growing literature of plastic surgery. This book of 245 pages is well illustrated, well indexed, and covers emergency room care, tetanus, tracheostomy, local anesthesia, major soft tissue injuries, facial fractures, hand injuries, wringer injuries, bites, and burns in the pediatric age group. The bibliography is well arranged and complete. This volume is, in some respects, a "how-to-do-it" book with treatment outlined by-the-numbers.
Amino Acid Metabolism and Genetic Variation, edited by William L. Nyhan, M.D., Ph.D. New York: McGraw-Hill, Blakiston Division, 1968, 495 pp., $22.50
Authors: Marks James F.
Published: December 2021

This book, the product of a symposium held March 1967 at Freeport, Grand Bahama Island, was sponsored jointly by the Department of Pediatrics, University of Miami School of Medicine, and the Johnson and Johnson Institute for Pediatric Service. Fifty-three experts contributed recent information, some of it unpublished, on a group of diverse yet related diseases.

The book is divided into 11 parts. Roughly one fifth of the book is devoted to problems relating to phenylalanine and tyrosine metabolism.
Inter-Illness Prophylaxis in Febrile Convulsions
Authors: Curran John P.
Published: December 2021

In his review of Febrile Conculsions by Dr. J . Gordon Millichap, in the August 1968 issue of Pediatrics, Dr. Randolph K. Byers briefly deals with the question of continuous or "inter-illness" prophylaxis versus the intermittent administration of anti-convulsant medication at the onset of a febrile illness. This is certainly one of the most difficult decisions facing the pediatrician confronted with a child who has experienced one or more "febrile" seizures. Too often, it seems to me, this subject generates heated polemics, highlighted by the expression of extreme views of equal rigidity, leaving the busy practitioner draped over a therapeutic barrel.
Footprinting for Identification of Infants
Authors: Gleason Doris
Published: December 2021

Newspaper reports of the finding and return to its parents of a newborn baby kidnapped August 28, 1968, from a Port Arthur, Texas, hospital point out clearly the part footprints taken at time of baby's birth played in positively identifying the baby found 2 days later as the baby kidnapped. Footprinting of newborn infants in the delivery room is a routine procedure in this hospital and thus imprints were available when the need arose.

Fortunately for all concerned, the administrator and physicians of this hospital realized that the conclusion reached by the authors performing the study of footprinting reported in the January 1966 issue of Pediatrics1 was due entirely to the use of improper footprinting techniques.
The Battered Child, edited by Ray E. Helfer, M.D., and C. Henry Kempe, M.D. Chicago: The University of Chicago Press, 1968, 268 pp., $12.50
Authors: Haggerty Robert J.
Published: December 2021

It is but a short 8 years since Kempe and colleagues coined the term "the battered child syndrome." This was a major advance, for it captured both professional and lay attention and led within a remarkably short time to the implementation of reporting laws within all 50 states. Hardly any other piece of research can be said to have influenced social policy so effectively in such a short period of time. We are now presented in this edited book with an upto- date picture of the problem.
THE EFFECT OF ADRENERGIC STIMULATION UPON SWEATING IN NORMAL CHILDREN AND CYSTIC FIBROSIS PATIENTS
Authors: Gibson Lewis E.
Published: December 2021

The cover title and running head of the article by Lewis E. Gibson (Pediatrics, 42:458, 1968) should have read Adrenergic Sweating and Cystic Fibrosis instead of Adrenergic Sweating in Polycystic Disease.
ANTENATAL DETECTION OF HEREDITARY DISORDERS
Authors: Nadler Henry L.
Published: December 2021

Amniotic fluid cells obtained by transabdominal amniocentesis at various stages of pregnancy were successfully cultivated. The intra-uterine detection of Down's syndrome, galactosemia, and mucopolysaccharidosis was established utilizing the cultivated amniotic fluid cells. The use of this procedure increases the precision of genetic counseling and should stimulate the development of new approaches for the intra-uterine management of genetic defects. However, until considerably more experience is gained with these techniques, these procedures should be considered experimental in nature.
TUBERCULOUS MENINGITIS DUE TO PRIMARY DRUGRESISTANT MYCOBACTERIUM TUBERCULOSIS HOMINIS
Authors: Bonforte Richard J. , Karpas Charles M. , Gribetz Irwin , Shanzer Stefan
Published: December 2021

Fatal drug-resistant tuberculous meningitis developed in a 6-year-old boy who had received measles vaccine. The infecting organism was Mycobacterium tuberculosis hominis resistant to isoniazid, streptomycin, para-amino-salicylic acid, and ethionamide. Clinically, the course of disease in children infected with INH-resistant strains of tubercle bacilli does not differ appreciably from the course in children harboring INH-sensitive organisms. Therefore, potentially fatal complications such as miliary disease and meningitis can develop in both instances. Up to now, however, such complications have been uncommonly associated with drug-resistant tuberculosis. The therapeutic and epidemiologic importance of determining the pattern of drug sensitivity of the tubercle bacillus, especially a strain resistant to multiple drugs, is discussed in the light of this case report. Speculation is also made as to the relation of the child's illness to his prior inoculation with measles vaccine.
MALNUTRITION IN THE WORLD'S CHILDREN
Authors: Wheatley George M. , Diamond Louis K. , Gardner Lytt I. , Grulee Clifford G. , Hamburger Robert N. , Holt L. Emmett , Hughes James G. , Kagan Benjamin M. , Metcoff Jack , Schmidt William M. , Wegman Myron E. , Yankauer Alfred , Bain Katherine , Christopherson E. H. , M.D. Alvaro Aguiar , Gamba Jorge Camacho , Julio Meneghello R.
Published: December 2021

Protein-Calorie malnutrition coupled with infection is the greatest killer of infants and young children and the major cause of retarded child growth and development in today world. It has been estimated that by 1968 there would be 276,000,000 child victims of serious malnutrition in 29 developing countries. Its greatest toll is during the weaning period and in children below the age of 2 years. Some of these young children will die. Others, who survive severe disease, may sustain brain damage which impairs learning, limits achievement, and condemns them to the fate of their parents, thus perpetuating a cycle which interferes with national development itself.

The occurrence of protein-calorie malnutrition is not limited to developing countries, particular ethnic groups, or tropical climates. This affliction is found in the United States, although less frequently and rarely in extreme degree when compared to developing countries. More accurate information about its prevalence in the United States will soon be available.

The causes of protein-calorie malnutrition can be described within a variety of different conceptual frameworks: political, economic, educational, socio-cultural, agricultural, industrial, and medical-nutritional. The interrelation of the size of the world population and its food supply is so vital a factor that inadequate programs of family planning increase the likelihood of malnutrition. Programs to eliminate malnutrition must be delineated within these different frameworks, and each must be brought into appropriate collaboration with the others.

Obviously, no statement of ours can cover this multiplicity of factors completely. We can speak only as pediatricians to whom any degree of malnutrition is unacceptable.
More on Poisoning
Authors: Coleman Allan B.
Published: December 2021

Concerning chewable tablets and their relationship to the broad picture of the drug ingestion problem, I cannot allow Dr. Cohen letter (Pediatrics, 42:548, 1968) to pass without one more word, as well as to submit for publication a few pertinent extracts from correspondence between Dr. Wolf (Pediatrics, 41: 1009, 1968) and myself.

I repeat that I do not necessarily disagree with the point of view of Drs. Cohen and Wolf. I simply believe they are oversimplifying a complex problem.
Even More on Poisoning
Authors: Marder Gerard
Published: December 2021

It is hard for me to believe that Dr. Cohen1 has solved all his aspirin poisoning problems. In our practice by far the number of serious salicylate intoxications have occurred because the mother (iatrogenically or on her own) has been overdosing with aspirin for a few days or the children have eaten a good number of regular, 5 grain aspirin tablets (not candied of course) that have been carelessly left around. We are always amazed by how many distasteful things an infant will ingest.
Infant Care: The United States Government Guide, Supplements and Annotations, by Frederick W. Goodrich, Jr., M.D. Englewood Cliffs, New Jersey: Prentice-Hall, Inc., 1968, 230 pp., $4.50
Authors: Alpert Joel J.
Published: December 2021

Infant Care, with 50 million copies distributed, rivals the Bible and Dr. Spock as a bestseller and is a "significant and up-to-date aid for parents eager to start their baby on a healthy, happy life." It is written well and easy to read. It can be reassuring to a parent. It is so good that those areas where the authors have not found the middle ground stand out sharply. For example, if the intent is to relax the parent, it is disappointing to see the suggestion made "to pop the baby on the scales every day or so."
The Know-how of Infant Care, by Sylvia Close, S.A.N.C. Bristol, England: John Wright and Sons, Ltd., 1967, 49 pp., $3.50. (The Williams and Wilkins Co., Baltimore, exclusive U.S. agents)
Authors: Bergman Abraham B.
Published: December 2021

The less physician time spent on routine well child care, the better. The growing demand for child health services without concomitant addition of manpower is forcing pediatricians to focus on tasks which require their unique talents and delegate those which do not to others. Surely medical school and house officer training do not (and should not) prepare one to serve as arbiter of what brand of shoes to purchase, the technique of rinsing diapers, or the correct temperature of bath water.
ADMINISTRATION OF SINGLE DOSES OF AHF (FACTOR VIII) CONCENTRATES IN THE TREATMENT OF HEMOPHILIC HEMARTHROSES
Authors: Honig George R. , Forman Edwin N. , Johnston Christine A. , Seeler Ruth A. , Abildgaard Charles F. , Schulman Irving
Published: December 2021

In the treatment of acute hemarthroses in AHF (factor VIII)-deficient patients it has been our practice to administer repeated infusions of plasma in order to maintain hemostatic levels of AHF over a 48-hour period. In the present study AHF concentrates were administered so as to provide the entire therapeutic AHF replacement in a single infusion. Fifty-one episodes of acute hemarthrosis in 14 boys with AHF deficiency were treated with plasma cryoprecipitate, glycine-precipitated factor VIII (Hyland), or a new higher potency AHF concentrate (Hyland Method 4). Single doses of 20 to 30 units of AHF activity per kilogram were given; this was sufficient to produce a post-infusion AHF level of 40 to 50%. In 47 of the 51 episodes treated, satisfactory resolution of the hemarthroses occurred without need for further AHF therapy. These results appeared at least as satisfactory as those using repeated plasma infusions. Advantages of therapy using single infusions of AHF concentrates include fewer venipunctures, ease of administration, less need for hospitalization, and greater patient acceptance. Studies of Hyland Method 4 AHF concentrate indicated that the dose-response relationship and survival of AHF activity in vivo are similar to that seen with other therapeutic forms of AHF.
Letter to the Editor
Authors: Matthews LeRoy W. , Doershuk Carl F.
Published: December 2021

Dr. Baker in his letter to the editor derives a number of corollaries which are strictly his own and based more on bias than on either the article in question or the relevant literature to which the article refers. Possibly his corollaries suffer from the same problem we encountered namely, the necessity of being concise and avoiding a great deal of qualifying verbiage. Our manuscript as originally submitted qualified many of the statements he criticizes but was considered too long and had to be cut.
Childhood Ecology and Child Development—As Training for Pediatric Practice
Authors: Thelander H. E.
Published: December 2021

At the meeting of the Child Development Section of the Academy of Pediatrics in October 1968, one of the physicians asked why medical schools and pediatric departments failed to prepare pediatricians for the private practice of their specialty. When I was chief of the department of Children's Hospital in San Francisco, two special exercises were introduced to remedy this deficiency.

One of these was a weekly seminar in childhood ecology. It started in July of each year with discussion of fetology, perinatal problems, and the newborn; from there on we "grew up," as it were, with the child during the year, and by June we were discussing the adolescents.
THE CARE-BY-PARENT UNIT
Authors: James Vernon L. , Wheeler Warren E.
Published: December 2021

A preliminary report was made of 2 years' experience with hospitalization of children in the Care-By-Parent Unit. A surprising number of mothers can, with supervision, take complete care of their ill children in an area of the hospital designed for this, releasing registered nurses to work elsewhere. The authors are convinced that this plan lessens the emotional trauma of hospitalization to the child. Most importantly, it greatly improves the learning experience for mothers who are interested in their child's illness and its management at home. The learning experience of medical students and house staff is enhanced. Certainly, hospitalization in this manner is economical as far as personnel and money are concerned. In spite of lower costs, the authors feel that patients on this unit receive superior care.
RESISTANCE OF THE TOTAL RESPIRATORY SYSTEM IN HEALTHY INFANTS AND INFANTS WITH BRONCHIOLITIS
Authors: Wohl Mary Ellen B. , Stigol Luisa C. , Mead Jere
Published: December 2021

We have applied the forced oscillatory technique of DuBois to measure the resistance of the respiratory system in infants from the newborn period to the age of 15 months. We have compiled normal data in this age group and related conductance to body length. Twenty infants with bronchiolitis were studied during the acute phase of their disease, and 10 were followed for periods up to 11 months. We found both inspiratory and expiratory resistance to be elevated. In all infants we found expiratory resistance to be greater than inspiratory resistance and suggest that this may be due to dynamic narrowing of the airways on expiration. Follow-up studies revealed that three patients had evidence of airway obstruction even when "well."
ONE OF THE EARLIEST CLINICAL AND POSTMORTEM DESCRIPTIONS OF CYANOTIC CONGENITAL HEART DISEASE REPORTED IN THE UNITED STATES
Authors: C. T. E.
Published: December 2021

The first volume of the New England Journal of Medicine and Surgery, which appeared in 1812, contained this succinct description of congenital cyanotic heart disease in a young girl:

S.R. when born was for a considerable time supposed to be dead-did not cry, or evince any living actions. The lungs were artificially inflated for several minutes and life at length appeared, but very feebly.-A livid countenance, with frequent syncope took place.-With great maternal care the infant was kept alive, and as she grew became remarkably sprightly and active. When two years old (she) was unusually intelligent and fond of exercise.-As she advanced in age her fondness for violent exercise in playing often exposed her danger, as these efforts never failed to produce syncope and a kind of convulsion, laughing, crying, any emotion of mind, also brought on the syncope, from which after falling into a horizontal position, she generally soon recovered.-Her countenance, all times blueish and livid, was in these fits extremely extremely so. Her nails were always of the colour of litmus, or perhaps a little nearer to violet.

After death the thorax was examined-it was of an unusual shape, being more cylindrical than common, and the lungs having less the form of a cloven hoof, when inflated, than they usually assume.-The heart was very small. In place of a right auricle was observed a small appendage like the edge of that portion of the heart, not capable of containing more than one fourth its usual contents.
RED HAIR AND RHEUMATIC FEVER
Authors: C. T. E.
Published: December 2021

A widely held popular belief in this country and in England until recently was that children with red hair were especially prone to develop rheumatic fever. Physicians as distinguished as Sir George Frederic Still (1868-1941) also shared this view as is shown in the following quotation which is taken from his famous textbook, Common Dlsorders and Diseases of Children.

There is one further phenomenon which is noteworthy in rheumatic children and which is perhaps worth mentioning here, although it is necessarily noticeable also in adults-the association of red hair with rheumatism and rheumatic heredity. The following observation may serve to illustrate it. In four days there were amongst my out-patients eleven children with red hair. Of these, two were attending with articular rheumatism; one had occasional pain and swelling in the knees, his mother had red hair and frequent pain in the limbs, and her brother and sister had "rheumatic fever;" one had "pains in the knees" and his mother had "rheumatism;" three others showed a history of "rheumatic fever" in the mother or father; one was attending with chorea; one had a brother attending with articular rheumatism; only two out of the eleven showed no rheumatism or chorea in themselves or their families.

Amongst 80 children with red hair (including the 11 already mentioned) 24 were attending with definite manifestations of acute rheumatism, articulan or cardiac or chorea; 6 had pains in the limb which were almost certainly rheumatic, and of the remaining 50 cases 17 showed a family history of acute rheumatism (including chorea) in parents or brothers or sisters; so that there was rheumatism either in the child or the family in 47 out of 80; i.e. in 58 percent.
DIAGNOSIS AND TREATMENT: CHILDREN WITH FEVERS
Authors: Cone Thomas E.
Published: December 2021

In the article, "Diagnosis and Treatment: Children with Fevers," by Thomas E. Cone, Jr., M.D. (Pediatrics 43:290, 1969), the symbol before 102°F at the bottom of the second column on page 292 should read (L 102°F).
Coma Produced by Topical Application of Isopropanol
Authors: McFadden Samuel Wilton , Haddow James Edward
Published: December 2021

The topical use of isopropyl alcohol to reduce fever in children is a common procedure in pediatric practice. Deep coma has been reported in two children, presumably from inhalation of the alcohol during sponging procedures in poorly ventilated areas.1,2 Absorption through the skin has not been reported to be a significant portal of entry.3 The toxic effects of ingested isopropanol in humans are reported to be similar to those of ethanol, but they occur at lower blood concentrations.4 The lethal dose for adults of ingested 70% isopropyl alcohol has been estimated to be 240 ml.5 The following case is reported as an example of coma in an infant following injudicious topical application of isopropanol for the relief of fever.
Re-warming following Surgical Hypothermia
Authors: Wolfson Sidney K.
Published: December 2021

In their article entitled "Metabolic Aspects of Deep Surgical Hypothermia in Infancy,"1 Dr. Baum and associates reported changes in carbohydrate and lipid metabolism observed in infants undergoing cardiac surgery with deep hypothermia (20°C) and circulatory arrest. Because they observed a failure to metabolize infused glucose as well as an increase in the ratio of plasma glycerol to free fatty acids, they concluded that the lowered temperature impairs hepatic function. This is certainly not a surprising finding and the authors have cited several references in support of this concept.
Diseases of Children, ed. 2, by Hugh Jolly, M.A., M.D., F.R.C.P., D.C.H. Philadelphia: F. A. Davis Company, 1968, 752 pp., $11.50
Authors: Cone Thomas E.
Published: December 2021

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

Dr. Jolly wrote his book entirely by himself, drawing on his long and varied clinical expenience in both England and West Africa. This in itself is a tremendous accomplishment because there are few pediatricians left in any country whose professional experience is broad enough for them to be able to write single-handedly a text of pediatrics in the classical tradition.
Genetics in Medical Pracfice, edited by Mihály Bartalos, M.D. Philadelphia: J. B. Lippincott Company, 1968, 244 pp., $10.75
Authors: Littlefield John W.
Published: December 2021

This book consists of a series of seminars given by different people at Howard University College of Medicine, Washington, D.C., in January 1967, plus five new chapters intended to connect and fill in the gaps, so the book may serve as an introductory text in medical genetics. However, because of the multiple authorship, the book is unevenly written, poorly coordinated, and frequently repetitive.

The first third of the text (eight chapters) is intended to convey basic concepts to "the physician who has had little or no previous exposure to medical genetics."
Handbook of Pediatric Medical Emergencies, ed. 4, edited by Charles Varga, M.D., and 13 contributors. Saint Louis: The C. V. Mosby Company, 1968, 654 pp., $19.75
Authors: Levine Melvin D.
Published: December 2021

In the fourth edition of the Handbook of Pediatric Medical Emergencies, Dr. Charles Varga succeeds in assembling a useful, easy to read, and practical volume, and at the same time one containing recommendations that are easy to locate when the physician needs on-the-spot guidance in treating a pediatric medical emergency.

With this edition Dr. Varga takes over as sole editor, following the death of his former, long-time collaborator, Dr. Adolph DeSanctis. This edition is considerably expanded and rewritten; the chapters on pediatric procedures and inhalation therapy are drastically revised, and the toxicology section has also been completely reorganized.
STUDIES IN CYSTIC FIBROSIS: DETERMINATION OF SWEAT ELECTROLYTES IN SITU WITH DIRECT READING ELECTRODES
Authors: Kopito Louis , Shwachman Harry
Published: December 2021

An evaluation is made of newly developed specific-ion electrodes for determining sodium and chloride on the skin surface following the stimulation of the sweat glands by pilocarpine iontophoresis.

This procedure offers a rapid (5 to 6 minutes), convenient, and safe means for large-scale cystic fibrosis screening programs for screening infants and children.

Caution is urged in the evaluation of the reading since a failure to sweat may result in a misleading value.
A SCHEMATIC APPROACH TO ACID-BASE THERAPY IN THE NEWBORN
Authors: Nelson N. M. , Riegel K. P.
Published: December 2021

The overriding purpose of therapy for acid-base imbalance is to assist the body in its defense of pH. Outside of fairly narrow biologic limits of hydrogen ion activity, various critical enzyme systems may break down at the cellular level. At higher levels of integration, whole tissues and organ systems can become deranged when homeostatic limits are exceeded. Just as hemoglobin concentration and hematocrit express the state of balance between hematopoiesis, hemolysis, and blood volume, so also is pH an index of the state of balance between acid production, its neutralization by retention of base, and the body water spaces where such ions are distributed. The bicarbonate buffer system, operated upon by renal and pulmonary mechanisms, is the chief indicator and final mediator of the state of whole body buffer systems. Since the quantitative contributions of these other buffer systems are difficult to assess, especially at the bedside, any scheme of acid-base management based on measurements of the bicarbonate buffer system alone is necessarily imperfect. Hence, there will never be an adequate substitute for close monitoring of blood pH. However, pH measurements alone will never distinguish between the respiratory and inetabolic components of any acid-base disorders.

The primary disorders of acid-base balance are, of course, metabolic and respiratory acidosis as well as metabolic and respiratory alkalosis. If the primary disorder is metabolic in origin, the ideal correction is also metabolic; but, lacking this capability, the secondary compensation of the body is respiratory (e.g., Kussrnaul respiration in diabetic acidosis). diabetic acidosis). Similarly, if the Primary disturbance is respiratory, the ideal correction is respiratory (e.g., intermittent positive pressure therapy in emphysema); but, lacking this capability, the secondary compensation of the body is metabolic (e.g., the renal adaptation to chronic hypercapnea by retention of bicarbonate).
A RATIONAL APPROACH TO ACID-BASE THERAPY IN THE NEWBORN: A COMMENTARY
Authors: Kildeberg Poul , Engel Knud
Published: December 2021

Although the phenomenon of severe acidosis in the depressed neonate is now widely appreciated, our understanding of both pathogenesis and clinical significance of this disturbance is still incomplete. The fall in blood pH under such circumstances is usually due to accumulation of both carbon dioxide and titratable non-volatile acid; the latter feature is explained in part by bicarbonate redistribution in response to hypercapnia and in part by addition to the blood of organic acid in response to hypoxia. In the hypoxic infant, elevations of the blood lactate level often fall short of the change in the concentration of blood titratable acid as reflected by the blood "base excess;"1,2 and, in recent experimental studies on this problem we found that, in (constantly) normocapnic dogs, acute severe hypoxia leads to a rapid fall in blood "base excess" before any appreciable rise in lactate levels occurs. Because conventional "physiological-type" acid-base terminological systems do not allow for the presence of secondary noncompensatory variables, the "high Pco2-low base excess" type of acidosis so characteristic of the asphyxiated newborn is not easily classifled in terms of conventional acid-base diagnostic categories. Far from representing a "misinterpretation of negative "base excess values," as stated by Nelson and Riegel, classification of this particular disturbance as a "mixed acidosis" appears reasonable in view of the evidence described in the foregoing; actually, the identical diagnostic attitude is implicit in Nelson and Riegel paper. On the other hand, we wish to emphasize that both bicarbonate redistribution and accumulation of organic acids are secondary to the primary pulmonary insufficiency, and that both are rapidly reversible upon restoration of adequate pulmonary function.
FAMILIAL PITUITARY DWARFISM ASSOCIATED WITH AN ABNORMAL SELLA TURCICA
Authors: Ferrier Pierre E. , Stone E. Franklin
Published: December 2021

Two non-twin sisters issued from healthy non-consanguineous parents of normal stature demonstrated severe growth failure, hypoglycemia, and evidence of deficiency of growth hormone, thyroid stimulating hormone (TSH), and adrenocorticotropic hormone (ACTH); in addition, they both had a very small sella turcica located in a sphenoid bone of abnormal morphology. This form of familial pituitary dwarfism is different from the genetic forms previously described.
THE PEDIATRIC CONVALESCENCE HOSPITAL
Authors: Burke Frederic Gerard
Published: December 2021

There are several compelling reasons to re-evaluate programs for hospitalized children. These derive from the varied behavioral and biologic requirements that assume importance based on the length of time necessary for a child to be in a hospital. There is a need to focus multidisciplinary staff attention on the child who requires 30 to 90 days, or more, extended care. The philosophy and programs of most acute, short-stay pediatric hospitals give little attention to these special needs because they are primarily concerned with immediate life-threatening situations.

The intermediate-stay convalescent hospital has as its primary focus the needs of chronically sick children. Another important factor is the reduced cost of such care, usually running about one-third to one-half the per diem cost of the acute, short stay. Also, the opportunities for conducting teaching and research programs with convalescent children are greatly expanded. Too many pediatric training programs today provide candidates with depth exposure to other than the initial effects of illness. Too often, the effects of prolonged illness on the child, his family, and community are ignored, leaving large gaps of knowledge in the preparation of the pediatricians of the future.

The Hospital for Sick Children in Washington, D.C., draws its patients from several acute, shortstay hospitals, and is a proposed model for this type of programming.
Letter to the Editor
Authors: Swift D. L. , Wolfsdorf J. , Avery M. E.
Published: December 2021

Several of the points raised by Drs. Matthews and Doershuk deserve further comment.

The experimental model used for our experiments was designed to prevent the dispersion of a radioactive aerosol, and as such did not permit convective back mixing with dry room air. The degree of mixing described by Drs. Matthews and Doershuk in the clinical situation situation would be almost completely convective; thus, the different diffusion co-efficients of oxygen and water vapor would be of almost no significance, we believe.
Letter to the Editor
Authors: Smith Margaret H. D.
Published: December 2021

Thank you for your thoughtful letter about mumps virus vaccine. We have had several letters over the past year from individuals and groups who, like yourselves, have been perturbed about the recommendations for the use of mumps vaccine. Let me first point out that the recommendations for the use of mumps vaccine, which seem to you confused and which others have referred to as "wishywashy," are not those alone of the Committee on Control of Infectious Disease, but that they concur very closely with those of the Advisory Committee on Immunization Practice of the Surgeon General.
Cinematographic Records of Growth and Development
Authors: Bolduan Nils W.
Published: December 2021

Using the movie camera to record and study the development of the infant and child was initially done by Gesell and the Yale group in the 1930. During the following 3 decades, many investigators, like Myrtle McGraw, Gajdusek, and others, provided a wealth of observational material in this field. However, the technical exigencies constrained them to a laboratory-type setting, or to such elaborate production facilities as to restrict the usefulness of this exceedingly valuable recording and research tool.
WHAT THE SCHOOL DAY WAS LIKE IN 1645 FOR THE YOUNG CHILD LIVING IN BOSTON
Authors: C. T. E.
Published: December 2021

The routine of our early colonial schools as described by Clifton Johnson in his delightful Old-Time Schools and School-Books1 makes one wonder how our colonial children tolerated such long hours in school. Also, one wonders, after reading passages like the following, how these children reacted to their master's harshness.

The early schools in . . . Dorchester [Boston] . . . of 1645, provided that for seven months in the warmer part of the year the master should every day begin to teach at seven o'clock in the morning and dismiss the scholars at five in the afternoon, while in the colder and darker months of the remainder of the year he was to begin at eight and close at four. There was to be a midday intermission from eleven to one, except on Monday, when the master shall call his scholars together between twelve and one of the clock to examine them what they have learned, at which time also he shall take notice of any misdemeanor or outrage that any of his scholars shall have committed on the Sabbath, to the end that at some convenient time due admonition and correction may be administered.

He shall diligently instruct both in humane and good literature, and likewise in point of good manners and dutiful behavior towards all, especially their superiors. Every day of the week at two of the clock in the afternoon, he shall catechise his scholars in the principles of the Christian religion.

He shall faithfully do his best to benefit his scholars, and not remain away from school unless necessary.
Letter to the Editor
Authors: Lovejoy Frederick H. , Hollister J. Roger , McInerny Thomas K.
Published: December 2021

As senior residents at the Boston Children's Hospital Medical Center, we are glad to give our views of Patient Care Rounds for the interest of Dr. Fields. Unfortunately, but true, today's busy house officer rarely has enough time to consider the environmental, social, and psychological factors attendant to the child's hospitalization. That the traumatic effects of hospitalization, the psychological aspects of hospital care, and the total welfare of the child are important is indisputable. That the organically oriented house officer needs to be reminded of the total needs of the patient is also indisputable.
Prognosis of Childhood Leukemia
Authors: Stein Richard C. , Ablin Arthur R. , Kushner Joseph H. , Zoger Seymour
Published: December 2021

We have been troubled by what we judge to be inaccurate assessments of the current prognosis of acute leukemia in childhood. These assessments have appeared in the lay press: Saturday Evening Post, June 1, 1968, "It is quite possible . . . that median survival of patients now starting treatment will be between 4 and 5 years;" Time, March 4, 1969, "now . . . the average survival time is about 5 years in major medical centers" and in such medical journals as J.A.M.A., Medical Tribune, Cancer Research, and so forth, where in a number of artides in the last 2 years median survivals of 3 years or longer are stated as current or shortly to be obtained.
Systemic Mycoses (Ciba Foundation Symposium), edited by G. E. W. Wolstenholme and Ruth Porter. Boston: Little, Brown and Company, 1968, 287 pp., $12.00
Authors: Tynes Bayard
Published: December 2021

Twenty-three experts from around the world present an easily read symposium on deep fungus infections in man. "Organ Distribution and Pathogenesis in the Deep Mycoses," by Dr. Roger Baker, "Recent Application of Immunological Techniques in the Diagnosis of the Deep Mycoses," by H. P. R. Seeliger, and the "Ecology and Epidemiology of the Deep Mycoses," by Dr. Libero Ajello, are clinically oriented and well referenced. Other contributors discuss fungi found mostly in Africa, e.g., mycetoma, phycomycosis, rhino-entomophthoromycosis, chromomycosis, and African histoplasmosis.
Proceedings of the First Congress of the International Association for the Scientific Study of Mental Deficiency (held in Montpellier, France, September 12-20, 1967), edited by B. W. Richards. Surrey, England: Michael Jackson Publishing Co., Ltd., 1968, 982 pp., $20.00
Authors: Crocker Allen C.
Published: December 2021

This volume represents a formidable editorial and publishing feat, being the record of 450 papers from the First Congress of the International Association for the Scientific Study of Mental Deficiency, held September 12-20, 1967 in Montpellier, France. Many of the papers are published in their entirety, some as symposium notes, others as abstracts, and a few only by title. As could have been anticipated, all this makes for quite heavy going (4½ lb, paperbound); and, with the permissiveness characteristic of a fledgling organization, the proceedings include marked repetition and unevenness in its 982 pages.
The Hippie Trip, by Lewis Jablonsky. New York: Pegasus, 1968, $6.95
Authors: Farnsworth Dana L.
Published: December 2021

During the past year three books about the hippies have appeared, all remarkably similar in their method of investigation, their content, and the impression they give of their subjects. The other two are: Louis Wolf's Voice from the Love Generation, Little, Brown, and Company, Boston; and Nicholas von Hoffman's We're the People Our Parents Warned Us Against, Quadrangle Books, Chicago. That by Jablonsky is the best organized and most complete and saves reading the others, though perusing one or both of these will serve to confirm one's concern about the hippie movement.