bluuebunny/crossref_metadata_2025 huggingface dataset:
AN AMERICAN LOOKS AT EUROPEAN CHILD HEALTH
Authors: Eliot Martha M.
Published: December 2021

In View of the ferment today in the United States in our search for new ways and means to organize the delivery of high quality, comprehensive health care to children and families on a community basis, Dr. Miller's report of a survey of "Health Services for Children in some Western European Countries: Their Significance for the United States," published elsewhere in this issue of Pediatrics1 is of timely interest. Pediatricians and others responsible for the delivery of maternity care and health care to children and families, and especially those involved in the planning and administration of programs (public or voluntary) through which combined and comprehensive preventive and curative services are delivered to families on a community basis, will find this report of more than passing interest and should also give their attention to the more detailed appendix material that will be available with reprints.
The Electroencephalogram in Minimal Cerebral Dysfunction
Authors: Copple Peggy J.
Published: December 2021

I noted with interest the article by Drs. Capute, Niedermeyer, and Richardson, "The Electroencephalogram in Children with Minimal Cerebral Dysfunction," (Pediatrics, 41:1104, 1968). However, I disagree with their conclusion, "the EEC is a valuable diagnostic tool in minimal cerebral dysfunction."

The authors rightly state that no specific findings can be expected from the EEC in large numbers of children with the minimal cerebral dysfunction syndrome, however vague and nonspecific the diagnostic criteria for this may be.
Letters to the Editor
Authors: Dull H. Bruce
Published: December 2021

Dr. Edward Mortimer sent me a copy of his reply to your question on the intradermal administration of influenza vaccine. I believe that he has very succinctly summarized the current attitudes on this procedure.

I would like to re-emphasize Dr. Mortimer's comment that to be satisfied with the technique, one would need the assurance of actual protection following intradermal influenza immunization, as well as antibody booster effect. Antibody response to influenza antigens is tremendously influenced by one's past experience with similar and related influenza viruses.
Doubts and Water Droplets in Mist Therapy
Authors: Baker Harry
Published: December 2021

One can have only high regard for the dedicated effort that Matthews and his group put forth to help children with cystic fibrosis. Yet with all this one cannot accept some of the thought which is embodied in this quotation from their recent paper.1 "For therapy, the nebulizer must provide a particle size which will result in deposition at the site of the pathologic lesion being treated. In disease of the trachea of larynx a nebulizer providing a very small particle-size mist is senseless, since 99% of the particles under 6µ in diameter will pass the involved area without depositing.
A NEW ARRANGEMENT FOR HOSPITAL SERVICES: THE PARENT-CARE PAVILION
Authors: Green Morris
Published: December 2021

At a time when institutionalized patterns are being vigorously questioned in many aspects of American life, health care is no exception. Although changes in the hospital care of children have been slow in evolving, possibly because of the lack of the potent goad of economic necessity, a number of alternatives to traditional practices are appearing, including sophisticated ambulatory facilities, traveling clinics, home care programs, day hospital care, and observation or temporary "hold" wards.

The motel-like facility described by James and Wheeler in this issue adds another dimension to health services for children in regional medical centers.
Gel Cysts—Unusual Foreign Bodies
Authors: Moore Ralph B. , Patterson Matthew C.
Published: December 2021

Three patients are presented who vomited cystic objects. It is believed that these cysts are formed by an interaction between ingested gel and gastric contents.
Treatment of Myelomeningocele: II
Authors: McCann B. Cairbre
Published: December 2021

Dr. Donald Matson Commentary on the surgical treatment of myelomeningocele, which was published in Pediatrics (42:255, 1968), stimulated these few reactions in one who is ininvolved largely in the long-term management of children with chronic handicaps. I hope that some of my feelings and opinions regarding management may be aired.

Dr. Matson makes a distinction between the indications for surgical treatment of myelomeningocele and the timing of such surgery. The point is stressed that, if surgery is to be done, it should be done as soon as possible, ideally within the first 24 hours of life. I believe that there would be little disagreement on this point.
Letter to the Editor
Authors: Skillito John
Published: December 2021

Dr. Matson is currently hospitalized himself and unable to reply to the comments of Dr. Seymour Bluestone and Dr. B. Cairbre McCann. Those of us who have worked closely with Dr. Matson can perhaps paraphrase some of his thoughts in reply to criticism of his Commentary.

Dr. Bluestone questioned the number of cases on which Dr. Matson's opinions were based. As will be mentioned in the second edition of Neurosurgery of Infancy and Childhood, which will be published by Charles C Thomas in the spring of 1969, Dr. Matson points out that there were 1,157 patients with myelomeningocele seen at the Children Hospital between 1930 and 1953, and between 1953 and 1966 there were 233 patients openated upon for this condition.
Atlas for Somatotyping Children, with a Scheme of Somatotypes in Children, by G. Petersen, M.D. Springfield, Illinois: Charles C Thomas, 1967, 244 pp., $63.00
Authors: Damon Albert
Published: December 2021

With progress in advanced countries against "environmental" diseases, largely infectious and nutritional, attention has returned to "host" diseases, long in eclipse. Constitution is a major host factor, and one aspect of constitution is body form. Petersen's is the first attempt to establish standards for rating children's body build according to Sheldon's "somatotype" system, introduced in 1940. Sheldon describes physique in terms of three "primary components" of build, endomorphy (softness and roundness, or fat), mesomorphy (bony, rugged muscularity), and ectomorphy (linear fragility).
Some Recent Advances in Inborn Errors of Metabolism, edited by K. S. Holt, M.D., M.R.C.P., D.C.H., and V. P. Coffey, L.R.C.P. and S.I., Ph.D., D.C.H. Edinburgh: E. and S. Livingstone Ltd., 1968, 167 pp., $6.50
Authors: Rosenberg Leon E.
Published: December 2021

This brief volume represents the proceedings of the Fourth Symposium of the Society for the Study of Inborn Errors of Metabolism held in Dublin, Ireland, in July 1966. The book consists of 12, well-written, separate papers by noted authorities from Europe and the United Kingdom, which vary greatly in length, scope, and subject matter. Several of the papers are embellished by lively discussions which allow the reader to share the broad experience of the participants.
THE TREATMENT OF ULCERATIVE COLITIS IN CHILDREN WITH ALTERNATE-DAY CORTICOSTEROIDS
Authors: Sadeghi-Nejad Abdollah , Senior Boris
Published: December 2021

Seven children, six with ulcerative colitis and one with granulomatous colitis, were treated with prednisone administered as a single dose on alternate days for periods of between 1 and 3½ years. All seven are attending school regularly and are growing and gaining at rates that approach normal. None show the features of Cushing's syndrome. Gastrointestinal symptoms have been slight, the bowel lesions have improved radiologically, and the findings on sigmoidoscopy and rectal biopsy have been equally satisfactory. A significant degree of therapeutic benefit has been achieved with little in the way of side effects, but one cannot yet predict whether the long-term risk of carcinoma has diminished.
Ben H. Nicholson
Authors: Riley Harris D.
Published: December 2021

The death of Ben H. Nicholson at age 64 on September 25, 1968, from a myocardial infarction removed from pediatrics a remarkable person. Few have made a greater contribution to the welfare of children or to medical education in this region.

Dr. Nicholson, an outstanding practicing pediatrician in Oklahoma City since 1931, was a graduate of Vanderbilt University, where he was a member of Phi Beta Kappa and Alpha Omega Alpha. He received his internship and residency training in Pediatrics at Vanderbilt University Hospital.
Letter to the Editor
Authors: Lucey Jerold F.
Published: December 2021

Very little experience has been reported on the use of fluorescent phototherapy in the Crigler-Najjar syndrome in older children. The only case report of which I am aware (Ann. Pediat., 43:829, 1967) indicates that, while some effect was apparent, pretty intense continuous exposure was necessary. I would think that a trial of this therapy durmg periods of exacerbation of jaundice, together with phenobarbital therapy, would be worthwhile in any future cases.
Human Embryology, ed. 3, by Bradley M. Patten, Ph.D. New York: McGraw-Hill Book Company, 1968, 651 pp., $17.50
Authors: Hay Elizabeth D.
Published: December 2021

This new edition of a standard, widely accepted textbook on human embryology resembles closely the 1953 edition in both format and coverage. The book begins with a discussion of the position of embryology in the medical curriculum and the value to the student of actual laboratory study. The student is referred to the available smaller textbooks on the embryology of the chick and pig as aids in laboratory study of this type. In this edition of his textbook, Dr. Patten has replaced the majority of illustrations of lower vertebrates with illustrations of human embryos.
NURSERY ILLUMINATION AS A FACTOR IN NEONATAL HYPERBILIRUBINEMIA
Authors: Lucey Jerold F.
Published: December 2021

The present recommended lighting conditions for newborn nurseries were selected on the basis of what was the best combination of lights to enable nurses and physicians visually to judge cyanosis and jaundice. The possibility that environmental lighting conditions could have any effect on newborn infants has not previously received serious consideration. The article by Giunta and Rath in this issue clearly demonstrates that a very moderate increase in environmental lighting intensity does have an effect on the degree of hyperbilirubinemia of prematurity. The practical application of this observation seems simple and obvious. We should reexamine our attitude towards light, not from our own adultocentric viewpoint, but from the standpoint of what might be best for the newborn infant.
COMPROMISED CONVALESCENCE FROM HYALINE MEMBRANE DISEASE
Authors: Nelson Nicholas M.
Published: December 2021

Those unfamiliar with the technique and manipulation of blood gas analysis as so artfully employed by T. M. Adamson and colleagues in this issue may appreciate some exposition of this important work. The commentator hopes briefly to orient the reader sufficiently to perceive the method and message of what Adamson, et al. have done.

If the reader be one of those medical students of all ages fortunate enough to have browsed (or plowed) through Comroe's The Lung, he will instantly recognize that the hypoxemic (but not always cyanotic) patient can have only a limited differential diagnosis of functional impairment. Barring such side issues as methemoglobinemia, the hemoglobinopathies, and the hypoxia of altitude as causes of low (usually less than 75 to 80 mm Hg) arterial oxygen pressure, the possibilities for cardiopulmonary derangements of physiology are four in number: (1) simple hypoventilation, (2) diffusion barriers to gas exchange across the alveolar membrane, and the effective venous admixture produced either by (3) ventilation/perfusion imbalance in the lung or by true anatomic (4) venoarterial shunting.
DELIVERY OF PEDIATRIC HEALTH SERVICES IN A RURAL HEALTH CENTER
Authors: Brown Roy E.
Published: December 2021

The Division of Health Affairs of the Office of Economic Opportunity is currently supporting a number of Neighborhood Health Centers throughout the country. One such "Poverty Program" center is described along with the presentation of the efforts made to provide a comprehensive health action program which directly relates to a poor rural community in Mississippi.

Originating in Tufts University School of Medicine 1,500 miles away in Boston, the multidisciplinary team members work both in the field and in the health center itself to involve members of the community within a defined area in the provision of what must be considered to be more than basic medical services. The social, educational, cultural, and psychological factors which are relevant to and influence the health of individuals and groups in the target area are inspected and analyzed.

Despite free and accessible medical facilities, various barriers are present which interfere with the delivery of services. Members of the health team must determine both their own priorities and those of the local community in the combined participation of local health councils within the overall program. The possibilities of a teaching exposure for all levels of health personnel in a rural health center must be emphasized along with the vast potential for basic research.
HUMAN FETAL INSULIN RESPONSE AFTER ACUTE MATERNAL GLUCOSE ADMINISTRATION DURING LABOR
Authors: Tobin Jordan D. , Roux Jacques F. , Soeldner J. Stuart
Published: December 2021

The effects of an intravenous injection of glucose (0.5 gm/kg) on the concentration of maternal and fetal serum glucose, insulin, and free fatty acids (FFA) were determined in six women in labor. The maternal hyperglycemia was accompanied by a rapid increase in maternal serum insulin concentration and a fall in maternal FFA levels. Fetal serum insulin and FFA values showed either no changes or a markedly attenuated response despite fetal hyperglycemia. These results are consistent with a diminished responsiveness of the human fetal pancreas to alterations in glucose concentrations in the hour prior to birth.
LONG-TERM PLASMA INFUSIONS IN A PATIENT WITH ATAXIA-TELANGIECTASIA AND DEFICIENT IGA AND IGE
Authors: Ammann A. J. , Good R. A. , Bier D. , Fudenberg H. H.
Published: December 2021

A patient with ataxia-telangiectasia and deficient IgA and IgE has been treated with long-term plasma infusions from a single donor over a 3-year period. No significant deleterious effects could be demonstrated. Despite the presence of anti-IgA antibodies, plasma infusions did not result in transfusion reactions. The IgA levels achieved following plasma infusion were similar to that of the donor. IgE could be detected in the skin of thee patient 5 days following plasma infusion, but no IgA was demonstrated in the saliva. Some evidence of a beneficial effect is suggested a significant control of recurrent sinopulmonary infection in a patient with deficient IgA, IgE, and abnormal cellular immunity.

Currently plasma infusion is the only readily available method of replacing adequate amounts of deficient IgA and IgE. Bone marrow transplantation was considered in this patient, but lack of a suitable donor has made this form of treatment temporarily unavailable.
CHILD HEALTH AND COMMUNITY HEALTH CENTERS IN THE AMERICAS
Authors: Christopherson E. H. , Grulee Clifford G. , Hamburger Robert N. , Harrison Gunyon , Kagan Benjamin M. , Logan George B. , Metcoff Jack , Ordway Nelson K. , Smith Nathan J. , Snyder C. Harrison , Yankauer Alfred , Bain Katherine , Wheatley George M. , de Andrade Carvalho Azarias , Gamba Jorge Camacho , Meneghello R. Julio
Published: December 2021

In the North, Middle, and South Americas, excessive and avoidable child death and disability continue to occur. Lack of knowledge about how to plan and execute programs for the health care of children and how to train personnel to function within such programs stands in the way of effective action. Throughout the hemisphere, there are requirements for simple survey and research methods to define health problems and suggest solutions to them within the context of their cultural and social milieu; there are pressures for more health resources and better utilization of those which exist; there are opportunities for training programs to prepare professional personnel and community aides to staff the health services; and there are needs for methods of evaluation which will feed back information needed to perfect the entire operation.

Reduction of high infant mortality is an important goal toward which all national programs in the Americas should be directed. It is the goal most relevant to the needs of both developing countries and the poverty pockets of the United States. Pediatrics and pediatricians have a special and unique contribution to make toward the achievement of this goal.

The present statement proposes the selection or establishment throughout the Americas of several community health centers to serve as resources for training and for developing and testing programs oriented toward the goal of reducing infant mortality. These centers would be related through a system of intercommunication, including the exchange of personnel. The developing countries of Latin America, faced with enormous health problems and limited health resources, have been forced to use efficient and ingenious ways of marshalling and distributing their scarce resources. The goals to which they have addressed themselves are improved child nutrition, promotion of family planning, and reduction of high infant mortality rates.
HUMAN GROWTH HORMONE: CURRENT STATUS OF AVAILABILITY AND USEFULNESS
Authors: Yaffe Sumner J. , Weiss Charles F. , Avery Mary Ellen , Cann Howard M. , Gold Arnold P. , Kenny Frederic M. , Riley Harris D. , Schafer Irwin , Stern Leo , Shirkey Harry C. , Lockhart Jean D. , Bishop Jeffrey , Farchione Louis , Sawchuk Steven
Published: December 2021

About 10% of short patients referred for endocrine consultation have hypopituitarism. This may be in the form of growth hormone deficiency in association with the loss of other pituitary trophic hormones or isolated growth hormone deficiency. For treatment of these patients, pediatricians inquire whether human growth hormone (HGH) is available and what growth response will result from its administration.

Excellent responses in augmenting somatic growth and controlling hypoglycemia in the treatment of growth hormone deficiency have been obtained with intramuscular injections of HGH. Growth rates increase to supranormal levels, permitting "catch up" growth in amounts as much as 15 cm per year during therapy. It is frequently necessary to treat with HGH for several years, since the hypopituitary patient is usually well below the 3rd percentile in height at the time of diagnosis. The minimum amount of HGH required would at present seem to be of the order of 3 units per week. Since most HGH preparations have a potency of the order of 1 unit or less per milligram, and the human pituitaries from which HGH is extracted yield from 3 to 5 mg (depending on the extraction procedure), many pituitaries are required to treat each patient.

The increasing availability of growth hormone immunoassay has made it possible to diagnose growth hormone deficiency relatively easily; therefore, the number of children who need therapy has increased considerably. However, the supply of growth hormone is still entirely dependent on the collection and extraction of human pituitaries. This laborious procedure has not been able to keep up with the increasing demand for the hormone.
CHILDREN IN TRAFFIC ACCIDENTS
Authors: Ryan G. Anthony
Published: December 2021

The part that children play in traffic accidents has been studied by numerous workers from differing points of view. Slätis,1 in a study of 5,291 persons injured in traffic accidents and receiving medical treatment in Sweden, found that 16.3% were less than 15 years of age. An examination by Mackay2 of a series of 250 accidents investigated at the scene in Birmingham, England, found that children less than 16 years of age formed 6.2% of the 464 persons involved. In Brisbane, Australia, Jamieson and Tait3 found that children less than 15 years old formed 10.9% of a group of 1,000 admissions or deaths from traffic accidents. Gädeke4 in Germany, found children less than 15 years old were injured more often in rural accidents, that traffic accidents formed 35 to 40% of all fatal accidents in children, and that injuries to the head and lower limb were most common. In Sweden, Ekström, et al.5 found that the majority of children involved in accidents they studied were pedestrians or pedal cyclists, and 40% were between 5 and 9 years old. Moore and Lilienfeld6 reported on 31,001 occupants of known age in 14,520 automobiles involved in injury-producing accidents on rural highways in the United States. They found that children less than 12 years of age formed 9%, adolescents age 12 to 18 years formed 16%, and adults of more than 18 years formed 75%. They found that children received fewer and less severe injuries than adolescents or adults, in each seating position. Front seat passengers in each age group were injured more often and more severely than rear seat passengers.
THE ASTHMATIC CHILD AND HIS PARTICIPATION IN SPORTS AND PHYSICAL EDUCATION
Authors: Kugel Robert B. , Barbero Giulio J. , Bartram John Bowman , Bost Roger B. , Dickinson David G. , Garrard Sterling D. , McMahon Jean L. , Scott Roland B. , Sharp Austin R. , Weil William B. , Green William T. , Kennedy Charles , Koch Richard , Browder J. Albert , Gallagher James J. , Halpern Daniel
Published: December 2021

Bronchial Asthma is a chronic pulmonary disorder, frequently allergic in nature, and characterized by paroxysms of dyspnea, wheezing, tightness in the chest, and bronchospasm. Asthmatic attacks may be minor and short in duration with little discomfort, or they may be very severe and of long duration, producing the characteristic picture of intractability. During symptomatic periods, it is usually possible to demonstrate changes in certain aspects of pulmonary function. With mild symptoms or between the episodes of severe asthma, the individual may be at little or no disadvantage in any or all activities. However, when the symptoms of pulmonary distress become severe or prolonged, this may lead to interruption of the child's daily routine, including school attendance. Occasionally, such children may become home or hospital bound for long periods of time.

Between the two extremes of no symptoms and severe asthma, there is a spectrum of respiratory or pulmonary disability—the nature and severity of which requires that each child receive individual consideration and evaluation in the matter of his daily activity. The outlook for the control of asthma in children has been improving during the past several decades. However, with the increase in population, there is an increasing number of children who require medical management for this disorder. It is a leading medical cause for school absenteeism and probably contributes to inefficient school work because of chronic fatigue, irritability, decreased attention span, and secondary emotional disorders.

There is general agreement among physicians that most children with bronchial asthma should attend regular school since, when under proper control and with no residual pulmonary defect, the child needs no special facilities.
CLINICAL AND BIOCHEMICAL OBSERVATIONS OF PATIENTS WITH ATYPICAL PHENYLKETONURIA
Authors: Kang Ellen Song , Kaufman Seymour , Gerald Park S.
Published: December 2021

Patients with hyperphenylalaninemia appear to represent a heterogeneous group. The enzyme phenylalanine hydroxylase may be implicated, either by indirect measurement of activity (phenylalanine loading studies) or through direct enzyme assays in the patients studied. When phenylalanine tolerance tests were used, the measurement of phenylalanine levels alone did not distinguish the subject with classical phenylketonuria from the atypical subject. Rise in plasma tyrosine levels as well as the excretion of breakdown products of phenylalanine and tyrosine better distinguished the two types of subjects. A significant rise in plasma tyrosine level was demonstrable in the atypical subject in sharp contrast to the classical homozygous subject with phenylketonuria.
THE TERRIBLE MORTALITY RATE OF LONDON CHILDREN UNDER 5 YEARS OF AGE—ABOUT 1790
Authors: C. T. E.
Published: December 2021

How few children survived their fifth year of life in the 1790's was forcefully shown in these words of Dr. Michael Underwood.1

The average of births annually, within the bills of mortality, for ten successive years, as taken a few years ago (c. 1790), was 16,238; out of which were buried under five years of age 10,145, and from amongst these 7,987 were under two years. So that almost two thirds of the children born in London and its environs, become lost to society, and more than three fourths of these die under two years of age.—This proves how hazardous a period that of infancy is, in this country; and I am sorry there is so much reason to be persuaded that the want of air, exercise, and a proper diet, has added unnecessarily to its dangers; there being no such mortality in barbarous nations, whose inhabitants live in a state of nature; nor in any part of the known world, amongst other young animals.
NEUROLOGICAL EVALUATION OF ADOLESCENT ENURETICS
Authors: Murphy Solbritt , Nickols Jackson , Hammar Sherrel
Published: December 2021

The relationship between neurological dysfunction and enuresis was explored as part of a comprehensive study of etiological factors in chronic enuresis. Twenty-seven enuretic adolescents without known neurological defects were compared to 22 nonenuretic clinic patients. Some comparisons were also made with a group of 25 community controls.

There were no significant differences between the groups in incidence of prenatal, neonatal, or childhood health problems often associated with central nervous system damage. No evidence for significant neurological impairment among enuretics was found by physical examination, EEG studies, or psychological test indices.

Thus, if children with obvious neurological defects are excluded, there is no evidence for a subtle neurological factor in chronic enuresis.
Use and Dosage of Hydrocortisone in Endotoxic Shock
Authors: Sonnenschein Harry , Joos Howard A.
Published: December 2021

We enjoyed reading Dr. Hodes's excellent article on endotoxin shock.1 It was particularly interesting to us to note that the Shwartzman reaction could be discounted in these children, and that large doses of intravenous hydrocortisone should be administered promptly on admission to the hospital, or as soon as the diagnosis is made.

Dr. Hodes presented several important reasons for using hydrocortisone in endotoxin shock, to which we should like to add another. It has been well documented2 that bacteria possess enzyme systems that can modify and degrade steroids, both partially and completely to carbon dioxide and water.
Letter To The Editor
Authors: Goldman Herbert I.
Published: December 2021

Dr. Goldman commented as follows:

The letter of Drs. Burgio and Vaccaro presents additional evidence that dietary vitamin K deficiency may occur during the course of diarrhea and/or the use of antimicrobials. We are continuing to study this matter in an attempt to define the vitamin K requirement under these circumstances.
A BRIEF HISTORY OF IPECAC (IPECACUANHA)
Authors: C. T. E.
Published: December 2021

Ipecac, the shortened form of ipecacuanha, was first brought to Europe from Brazil in 1649 by Piso, a Dutch physician; the dried root, reached Paris about 1658 and was then taken up by Helvetius, a quack physician, who prepared a secret preparation from it for the treatment of dysentery. Helvetius' preparation was called to the attention of Louis XIV of France, because his son, the Dauphin, was seriously ill with intractable dysentery which none of the physicians of the Court could cure.

Legend has it that Helvetius' secret preparation-known as Radix Antidysenterica-promptly cured the Dauphin. Some time later Louis XIV paid Helvetius a large sum of money for the secret of the medication which had cured his son.

The formula obtained from Helvetius proved to be a complex mixture of drugs, but Ipecac was the only ingredient which was later found to be of any medicinal value.1

(Ipecac is a native Brazilian word which in Guarani means ipé, small; kaa, plont; quanà, causing vomiting.2)
POVERTY, ILLNESS, AND THE NEGRO CHILD
Authors: Seham Max
Published: December 2021

In the midst of a rising prosperity enjoyed by a majority of American citizens, there are 39,000,000 of the nation's poor who belong to families with total annual incomes that fall below the recognized subsistence level of $3,000 for a family of four. Of these, six million are children below the age of 6 years, and about nine million are between 6 and 17 years. As of 1966, more than a fifth of the nation's youth, and in some areas one-third, are growing up in dire poverty.

The children who, through no fault of their own, are compelled to grow up under these circumstances are known to suffer from the so-called "deprivation syndrome," a complex disorder which is often the consequence of severe social pathology. It interferes with normal growth and development of the child in the physical, mental, and emotional spheres. It may result in intellectual retardation, personality disorders, social maladjustment, and even brain damage. Overwhelming evidence shows that poverty accounts for higher rates of morbidity and mortality among youth as well as among other age groups.

Amid the affluence of modern life, crumbling tenements, inadequate sanitary facilities, es, malnutrition, and disease mark the spread of poverty. Public action has been inadequate in meeting even the most pressing needs of families submerged in economic struggle. While poverty claims its victims from among all racial groups, it has undoubtedly wrought its greatest damage upon the impoverished Negro child. No case better illustrates the wreckage left by poverty and discrimination than that presented before the Senate Committee on Labor and Public Welfare by Dr. Robert Coles of Harvard on June 15, 1967.
Letter To The Editor
Authors: Liebman Jerome
Published: December 2021

Dr. Liebman writes as follows:

Dr. Guntheroth's excellent comments are worth noting. Obviously, there are no data from our paper or anybody else's that give evidence that the renin-angiotensin system did not begin the chain of events ending in hypertension. Furthermore, the control theory-feedback mechanism concept for hypertension as expressed by Dr. Guyton indicate that renin levels should be normal at this time. However, other than the fact that it makes sense that the renin-angiotensin system started it all, what evidence is there that it did indeed start it all.
Antinauseant Drugs in Treatment of Epidemic or Virus Gastritis?
Authors: Anderson O. William
Published: December 2021

The parents of a teenage girl called in obvious panic, too excited to give a reliable story and description of a child apparently in some type of seizure. On arrival in the hospital emergency room the child was conscious, and therefore not convulsing, but rigid with carpopedal spasm and much grimacing, but without hyperventilation.

On quizzing the parents it was learned that the child had been vomiting presumably because of a virus gastritis. The grandmother, a registered nurse, had medicated the child with prochlorperazine (Compazine) suppositories which she had in her possession.
CASE STUDIES OF SIBLINGS WITH JUXTAGLOMERULAR HYPERPLASIA AND SECONDARY ALDOSTERONISM ASSOCIATED WITH SEVERE AZOTEMIA AND RENAL RICKETS—BARTTER'S SYNDROME OR DISEASE?
Authors: Arant B. S. , Brackett N. C. , Young R. B. , Still W. J. S.
Published: December 2021

In 1962 two cases of juxtaglomerular (J-G) hyperplasia and secondary aldosteronism without hypertension with otherwise near normal renal function were presented. We have followed, since birth, two male siblings (F.T., age 6; J.T., age 3), with many features of "Bartter's syndrome," but who progressed to severe renal failure (F.T. and J.T.) and in one child (F.T.) overt renal rickets. Metabolic alkalosis, high levels of plasma renin activity (PRA) not suppressed by Na loading were found, but renal biopsy (J.T.) and autopsy (F.T.) revealed a severe glomerular and interstitial nephritis with mild J-G hyperplasia (not the typical "invasive" J-G cell hyperplasia seen in Bartter's cases). Balance studies demonstrated renal sodium wasting in both J.T. and F.T. PRA and aldosterone excretion rates were inappropriately high for sodium intake.

Severe bone disease present in F.T. was associated with an increase in the total hydroxyproline (HP): Cr ratio to 1.77 (N = .13). Free HP excretion was increased in J.T. in whom bones appeared normal. It is suggested that either the typical cases with "invasive" J-G hyperplasia and near normal renal function represent a distinct entity (?Bartter's disease) or that "Bartter's syndrome" must be extended to include uremia and renal osteodystrophy.
WHOOPING COUGH IS FIRST DESCRIBED AS A DISEASE SUI GENERIS BY BAILLOU IN 1640
Authors: C. T. E.
Published: December 2021

Guillaume de Baillou (1536—1616), often called "the Sydenham of France," gave the first detailed description in his Epidemiorum et Ephemeridum Libri (duo) of an epidemic of whooping cough which occurred in 1578:

Fevers attacked children of four months, ten months, and a little older, and carried off an enormous number. Especially that common cough which is popularly called Quinta or Quintana, of which mention has been made before. The symptoms of this are severe. The lung is so irritated that in its struggle to drive out by utmost effort the cause of irritation, it can neither inspire, nor with any ease expire. The patient seems to swell up, and as if on the verge of suffocation with his breathing obstructed in midthroat. Why it is popularly called Quinta, is not altogether clear. Some think the word is a made-up term of onomatopoeic origin, from the sound and noise which they make when they cough like this. Others do not derive it from this source, but think the cough is called in Latin ‘Quintana,’ because it repeats at certain hours: and experience shows this is true, for they are free from this distress of coughing sometimes for an interval of four or five hours, then the paroxysm of coughing repeats, sometimes so distressing that blood is driven out by its violence, through nose and mouth. Very frequently the stomach empties it contents. I have never yet read any author who gives any account of this cough.1
Rabies Prophylaxis
Authors: Johnson George M.
Published: December 2021

Considering that the article "Rabies: Rare Disease, Serious Problem" in the May 1970 Pediatrics1 was published under "Diagnosis and Treatment," it was disappointing that the importance of passive immunization or use of antirabies horse serum was mentioned only briefly in passing. The Sixth Technical Report of the World Health Organization emphasizes the importance of antirabies horse serum for potential human exposure to wildlife rabies, particularly involving bats and carnivorous animals. Personal experience pertaining to treatment of children bitten by wild animals and participation in the care of the child who died following a skunk bite2 have convinced me that the use of antirabies horse serum is not well understood or even known to many.
HYBRID COMPUTER STUDIES OF VENTILATORY DISTRIBUTION AND LUNG VOLUME
Authors: Hanson John S. , Shinozaki Tamotsu
Published: December 2021

The applicability of a computerized, on-line, breath-by-breath nitrogen washout technique to respiratory studies in newborn infants is described. Reproducibility and accuracy of the system are entirely comparable to standards previously established in adult studies.

Methodology allows simple, rapid, and direct assessment of a newborn infant's functional residual capacity, the uniformity of inspired gas distribution, and longitudinal time changes in these parameters.

Studies in 40 normal infants > 2 to 128 hours of age have confirmed some previously published findings, but do not support the concept of very early establishment of optimal ventilatory distribution.

Coupled with hemodynamic and blood gas studies, results obtained by this technique can provide a thorough evaluation of an infant's cardiopulmonary status. It is anticipated that such studies will provide valuable help in guiding and assessing results of ventilatory assistance and pharmacologic interventions in the respiratory distress syndrome.
Storm Door Hazards
Authors: Feinberg Sheldon N.
Published: December 2021

Six children in this pediatric practice have suffered accidental glass door injury during the last 18 months. Five of these accidents involved the familiar aluminum frame storm doors and four accidents occurred at play. The experience in this practice and throughout the country indicates a significant increase in the number of such injuries. The problem is thus defined as a distinct hazard of childhood.

It is necessary to alert both pediatrician and parent to the danger of storm and other glass doors and to the possibility of replacing easily broken glass, in whole or part, with a safety material. In addition, there is a distinct need for legislation that will eventually eliminate unsafe glass in doors.
Modified Hearing Screening Method
Authors: Callas James G. , Callas Evelyn R.
Published: December 2021

The subject of this communication is a modifled technique for hearing screening in young children that is quick, easy to use, and appears to be effective. In the original method described by Hardy, et al.,1 based on earlier work by Ewing and Ewing,2 the child sits on his mother's lap, facing another adult who attracts the child's attention with a toy. A third adult crouches behind the child, out of sight, and operates a variety of noise makers. The hearing child usually responds by turning his head toward the sound. This technique is most suitable for the 9-month to 18-month age group when the patient is too old for newborn screening techniques and too young for conventional audiometry and when deafness may not yet be suspected from failure of normal language development.
Black Tongue Moniliasis
Authors: Wolf I. J.
Published: December 2021

The usual description of oral moniliasis is, "Superficial, streaklike lesions which become confluent and form pearly-white, elevated patches which resemble milk curds."1 I have recently seen a strikingly different form.

Case Report: The patient was a 5-year-old Negro boy who became sick November 11, 1969, complaining of abdominal pain and next day of throat and ear pain. His tongue was getting dark. He was seen November 13th by an ear, nose, and throat specialist, who said the child had an abscess of his tonsil for which he prescribed Declomycin syrup, 1 teaspoon four times a day for 3 days.
EXCRETION OF KYNURENIC ACID AND XANTHURENIC ACID DURING INFECTION
Authors: Shaw Richard C. , Feigin Ralph D.
Published: December 2021

Urinary excretion of diazotizable amines in acute febrile disease was demonstrated 90 years ago. These substances were subsequently identified as metabolites of tryptophan via the kynurenine pathway and the hepatic enzyme tryptophan pyrrolase (TP) was established as a regulator of this pathway. Animal studies have previously shown that TP has a circadian periodicity of activity and can be induced by gram-negative infections in the intact animal. Steroid administration also can enhance TP activity whereas endotoxin inhibits TP. This study measured urinary excretion of kynurenic acid (KA) and xanthurenic acid (XA), two tryptophan metabolites via the kynurenine pathway, in 26 hospitalized children with a variety of febrile disorders and 10 age-matched control subjects. Increased excretion of these metabolites was noted in the febrile patients and was unrelated to etiology of the fever. Circadian periodicity in the excretion of these metabolites was observed in both normal and febrile individuals. Significant group periodicity was not noted for minimal and maximal excretory values did not occur synchronously in patients within any group. Two patients with endotoxic shock failed to exhibit an increased excretion of kynuremic acid and xanthurenic acid presumably because of inhibition of TP. A biochemical basis for the therapeutic use of exogenous corticosteroids in endotoxic shock is postulated.
INTRA-UTERINE GROWTH OF NORTH INDIAN BABIES
Authors: Ghosh Shanti , Bhargava S. K. , Madhavan Shantha , Taskar A. D. , Bhargava Vijaya , Nigam S. K.
Published: December 2021

Intra-uterine growth has been studied in 5,031 consecutive, single, live born babies born over a period of 1 year. The growth curves have been compared with some of the earlier studies. The deviation in the curves is seen to occur in the latter part of the third trimester.
The LaBrosse Spot Test: A Practical Aid in the Diagnosis and Management of Children with Neuroblastoma
Authors: Evans Audrey E. , Blore Judith , Hadley Richard , Tanindi Sakir
Published: December 2021

Measurement of vanillylmandelic acid (4-hydroxy-3 methoxy-mandelic acid or VMA) in the urine of patients with neuroblastoma has become part of the routine work up, since its presence was described by Voorhess and Gardner in 1960.1 When quantitative measurements of this catecholamine metabolite are performed, the patient must be placed on a strict diet for 2 to 3 days to eliminate substances whose breakdown products appear in the urine and give false positive results. The numerous items which must be excluded are beverages such as tea, colas, and Kcol-Aid, desserts and pastries flavored with chocolate and vanilla, and a variety of fruits including oranges, bananas, grapes, and tomatoes.
Pediatric Practice: Whose Mood Are We Altering?
Authors: Olsen Ralph
Published: December 2021

Like most pediatricians in private practice, I receive one or two calls a week about the first or second grade boy who is not sitting still in school, who is disturbing the other children, and whose parent or teacher or guidance counselor feels that my putting him on methylphenidate hydrochlorid (Ritalin) or dextroamyphetamine sulfate (Dexedrine) would be of value.

Recently a mother called me with this typical case history. I explained to her that during the child's recent complete physical examination I had detected no neurological abnormalities.
THE EVIL EFFECTS OF SCHOOLING AND THE "MODERN WAYS" OF 1873 ON AMERICAN GIRLS
Authors: C. T. E.
Published: December 2021

Too many hours of schooling, particularly for girls, was thought by many well-known 19th century physicians to be a pernicious practice and a major source of ill health in young women. Edward H. Clarke of Boston in 1873 wrote as follows:

"The sick chamber not the school room; the physician's private consultation, not the committee's public examination; the hospital, not the college, the workshop or the parlor–disclose the sad results which modern ways . . . have entailed on women. Examples of them may be found in every walk of life. On the luxurious couches of Beacon Street [Boston]; in the palaces of Fifth Avenue [New York City]; among the classes of our private, common and normal schools; among the female graduates of our colleges; behind the counters of Washington Street [Boston] and Broadway [New York City], may be found numberless pale, weak, neuralgic, dyspeptic, hysterical, menorrhagic, dysmenorrheic girls . . . improper methods of study, and a disregard of the reproductive apparatus and its functions, during the educational life of girls . . . are (not) the sole causes of female diseases . . . But it is asserted that the number of these female graduates (from our schools and colleges) who have been permanently disabled to a greater or less degree by these causes is so great, as to excite the gravest alarm, and to demand the serious attention of the community, if these causes should continue for the next half-century, and increase in the same ratio as they have for the past fifty years, it requires no prophet to foretell that the wives who are to be mothers in our republic must be drawn from transatlantic homes.
Accidental Childhood Poisoning
Authors: Scherz Robert G. , Margolis James A.
Published: December 2021

The accidental poisoning of a child is an uncommon and usually not repeated event in the life of the individual child, which represents the culmination of complex intertwined factors related to the agent, the host, and the environment. To emphasize the importance of one set of factors with the exclusion of others defies logic. In his article, "Psychosocial Study of Childhood Poisoning: A Five-year Follow-up," Dr. Margolis suggests that the environmental hazard is not a significant variable.1
Iron Fortification of Milk (Continued)
Authors: Friedman Gerald D.
Published: December 2021

I am obliged to take issue with the recommendation of the Committee on Nutrition that all babies be fed iron fortified milk throughout the first year. I refer you to the Committee Report published in Pediatrics,1 in which a more reasonable policy is outlined. The Committee recommends and I quote directly, "The most effective way to prevent iron deficiency on a large scale is by an iron fortified dietary staple which can be begun by 6 weeks of age for infant consumption.
DRUG ABUSE LEGISLATION FOR THE 1970'S
Authors: Yaffe Sumner J. , Bierman Chables W. , Cann Howard M. , Gold Arthur P. , Kenny Frederic M. , Riley Harris D. , Schafer Irwin , Stern Leo , Weiss Charles F. , Shirkey Harry C. , Bishop Jeffrey , Farchione Louis , Hayes Thomas H. , Lockhart Jean D. , Sawchuk Steven
Published: December 2021

The frequent use of marijuana by American youth has compelled the Committee on Drugs to explore the present methods of and recommendations for controlling marijuana.

On October 15, 1970, the Executive Board of the American Academy of Pediatrics endorsed in principle a statement on marijuana which was prepared by the Massachusetts Chapter of the Academy and published in the Academy's Newsletter.1 This statement called for considering possession of marijuana as a misdemeanor rather than a felony, but it was against legalizing use of marijuana at the present time. On October 27, 1970, President Nixon signed into law the Comprehensive Drug Abuse, Prevention and Control Act of 1970 (P.L. 91-513). This law became effective May 1, 1971; it is the Federal Government's attempt to control drug abuse by scientific and medical measures (under control of the Department of Health, Education, and Welfare) and by law enforcement activities (Department of Justice). The new Federal law has stopped short of legalizing marijuana, but it does allow a judge the discrelion to withhold criminal charges for the first offense of possession.

The Massachusetts Chapter notes2 that marijuana is not a narcotic and does not produce addiction. Short-term physical effects are innocuous. However, impaired performance on simple intellectual and psychomotor tests is seen after individuals have smoked marijuana for the first time; but, such effects are not seen in regular users. There is no evidence to substantiate the common misconceptions that use of marijuana leads to crime or addiction to opiates. But, so little scientific information is available on the long-term use of marijuana that it should be considered a potentially harmful drug.
Joseph Stokes, Jr
Authors: Bongiovanni Alfred M.
Published: December 2021

Dr. Joseph Stokes, Jr., Emeritus Physician-in-Chief of the Children's Hospital of Philadelphia and Professor and Chairman Emeritus of the Department of Pediatrics at the University of Pennsylvania, died suddenly on the evening of March 9, 1972. He was 76 years of age.

He was a brilliant Chairman of Pediatrics who introduced the first diagnostic virus laboratory into any clinical department in these United States shortly after his appointment to his academic post in 1939. With his retirement in 1963 he became active at the Henry Phipps Institute of the University of Pennsylvania where he was Professor Emeritus of Pediatrics in Community Medicine.