bluuebunny/crossref_metadata_2025 huggingface dataset:
PICA—SYMPTOM OR VESTIGIAL INSTINCT?
Authors: Neumann Hans H.
Published: December 2021

Pica is found commonly in the United States, and universally in West Africa. From observations in West Africa, pica—particularly the chewing of pieces of wood—appears to be the expression of an instinctual need for something hard to chew on. This may favor the development and maintenance of sound primary and secondary dentitions. Excellent, decay-resistant teeth prevail wherever indulgence in this type of pica is permitted.

In "advanced" societies the urge to chew on hard non-edible materials is provisionally sanctioned during the time of "teething." The need for it seems to extend over years rather than oven the few weeks during which it is tolerated.

As the instinctual urge becomes vestigial or suppressed, other functionally inadequate materials may be employed by children.

The view that pica in children is generally an expression of a personality disturbance seems questionable.
ALCOHOL-INDUCED HYPOGLYCEMIA AND COMA CAUSED BY ALCOHOL SPONGING
Authors: Moss Malcolm H.
Published: December 2021

The inhalation of ethyl or isopropylalcohol vapor during sponge bathing may result in alcohol intoxication and coma. Ingestion of these alcohols may cause hypoglycemia in children or adults.

The present case is the first reported in which alcohol-induced hypoglycemia developed following inhalation of alcohol.

A six month-old male infant became comatose following sponge bathing with ethyl alcohol. He was found to have acute alcohol intoxication (blood alcohol 220 mg per 100 ml) and severe hypoglycemia (blood glucose 22 mg per 100 ml). The administration of 50% glucose in water intravenously resulted in prompt recovery.

Alcohol sponging to lower elevated temperature is rarely necessary. Cooling with tepid water is effective and considerably less hazardous; the addition of alcohol is not necessary.
CARE OF THE CRITICALLY ILL CHILD: INTRAVENOUS ALIMENTATION
Authors: Filler Robert M. , Eraklis Angelo J.
Published: December 2021

In the past, starvation has been the mode of death for many seriously ill children. Utilizing this new method of intravenous alimentation, these fatalities may often be prevented. In our series, two infants were unable to tolerate the infusate, and 40 of the 53 children are alive. Only one infant died because of a complication of the method. Other causes of death included extreme prematurity, pulmonary complications of cystic fibrosis, acute surgical complications, extensive burns, and immune deficiency disease. Despite its effectiveness, this life-saving method of feeding should be reserved for those patients in whom satisfactory nutrition is not otherwise possible.
Letter To The Editor
Authors: Corsa Leslie
Published: December 2021

We referred Dr. Pinto's letter to Dr. Leslie Corsa, Jr., of the Center for Population Planning, University of Michigan. His comments follow.

Thanks for the opportunity to comment on Dr. Pinto's letter. I hope the following is helpful.

Dr. Pinto's concern with important national and world problems affecting, but largely outside of his specialized professional area, is refreshing. His recognition that he personally can do something about the many problems arising from present levels of births and resultant population growth is crucial.
Adolescent Enuresis, A Critique
Authors: Fink H. William
Published: December 2021

The generation gap has been bridged at last! I realize that it has become increasingly difficult to distinguish the male from the female of the present day younger generation, but I never thought such sexual anonymity would invade the esteemed pages of Pediatrics. Although I searched assiduously through the article " Adolescent Enuresis" in the March 1970 issue1 there was not even a hint as to the sex of the patients. I would think that in discussing such nebulous (at least to a pediatrician) entities as "minimal" and "mild" urethral strictures, the authors would consider the sex of the involved person to be of some importance.
Galactosemia, compiled and edited by David Yi-Yung Hsia, M.D. Springfield, Illinois: Charles C Thomas (301-327 East Lawrence Avenue), 1969, 318 pp., $18.50
Authors: Wright Stanley W.
Published: December 2021

One of the primary reasons for holding this International Conference on Galactosemia was to avoid the problems that have occurred in the evaluation of another inborn error of metabolism, phenylketonuria (PKU). If a similar conference had been held on PKU, the issues discussed would have included genetic heterogeneity, evaluation of therapy, incidence, and methods for detection. As a result mass screening for PKU might have been avoided, or at the least answers to these issues would have been sought in carefully designed studies.
Human Genetics, ed. 2, Dr. Victor A. McKusick. Englewood Cliffs, New Jersey: Prentice-Hall, Inc., 1969, 221 pp., $3.95 (paper), $5.95 (cloth)
Authors: Gerald Park S.
Published: December 2021

If you are a medical student, house officer, or practicing physician, unversed in human genetics but wanting a quick orientation, then this may be the book for you. It is brief, inexpensive, and gratifyingly up-to-date.

In the 5 years since the first edition of this small book, there have been many important developments in human genetics—the use of hybrid cells for genetic analysis, the discovery of multiple structural genes for the Y chain of Hgb F, appreciation of the frequency of the XYY syndrome, the use of amniocentesis for antenatal diagnosis, and so forth.
VITAMIN B12-DEPENDENT METHYLMALONICACIDURIA: AMINO ACID TOXICITY, LONG CHAIN KETONURIA, AND PROTECTIVE EFFECT OF VITAMIN B12
Authors: Hsia Y. Edward , Lilljeqvist Anne-Ch. , Rosenberg Leon E.
Published: December 2021

Methylmalonicaciduria is an inborn error of metabolism characterized by protein intolerance, neonatal or infantile ketoacidosis, long chain ketonuria, and by the accumulation of large amounts of methylmalonic acid (MMA) in blood and urine. The present study examines the metabolic basis for these features in a young boy with the vitamin B12-dependent variant of this disorder. A diet containing 5 gm of protein per kg body weight per day resulted in transient ketoacidosis, long chain ketonuria, and increased methylmalonicaciduria. Isoleucine, valine, methionine, and threonine, all known MMA precursors, were responsible for this protein intolerance. Oral loads of each of these amino acids resulted in equimolar 1,000 µg increases in urinary MMA. Valine and isoleucine also precipitated mild ketoacidosis and long chain ketonuria.

Injections of vitamin B12 (1000 µg per day) promptly lowered urine MMA by 70% and partially corrected the defect in propionate or methylmalonate oxidation found in the patient's leucocytes or platelets. While receiving vitamin B12, the clinical toxicity of a valine load was abolished and its biochemical effects significantly modified.

These findings demonstrate that the observed protein intolerance and ketoacidosis in patients with methylmalonicaciduria are direct results of the primary block in methylmalonate catabolism and that vitamin B12 acts by overcoming, in part, this metabolic block. These conclusions imply that children with this disorder should respond to dietary protein restriction and/or vitamin B12 supplementation, a regimen on which our patient has thrived for over 2 years.
EVALUATION OF A SCHOOL FOR YOUNG MOTHERS
Authors: Stine Oscar C. , H. P. , Kelley Elizabeth B.
Published: December 2021

Registration with a social agency, required attendance of prenatal care, a school lunch, supplemental milk, counseling, nutritional education, health education, group discussion, and selfgovernment are elements of a public school program for teen-age mothers.

To study the health impact of this program, we located the birth certificates of children born to mothers who were 16 years of age and under and who attended the program. We matched these certificates with certificates of children of the same race and sex born to mothers of the same age living in similar socioeconomic census tracts who did not attend the school but who gave birth during the same period of time.

This gave us a study and control group totaling 448 births to mothers 14, 15, and 16 years old. We defined low birth weight as under 2,501 gm and found 23.7% of the control group and 11.6% of the study group to be low birth weight infants. We defined gestation periods less than 37 weeks as premature and found 34.4% of the control group and 21.4% of the study group to be born prematurely. Both of these differences were statistically significant at the level of p smaller than .01. The slightly diminished frequency of prenatal care in the control group was not significantly associated with the differences in birth weight or gestational age. One infant died in the study group and eight infants died in the control group.

The differences between the study group and the control group were most pronounced among the 14-year-old mothers.
SIR WILLIAM WRITES ABOUT MASSIVE ABDOMINAL TUMORS IN CHILDREN
Authors: C. T. E.
Published: December 2021

Osler delivered a number of lectures on how to diagnose abdominal tumors to a postgraduate class at the Johns Hopkins Hospital in 1893. The comments to this class about abdominal tumors in childhood, cited below, give an idea of Osler's lecture style.

In children, massive tumors of the abdomen are not uncommon, and, as a rule, are either sarcomata of the kidney or of the retro-peritoneal glands. The kidney tumors are the most frequent. Both ultimately produce large, solid growths, which may occupy the greater portion of the abdominal cavity. In the differentiation of these two forms we rarely have any difficulty. Both develop painlessly, and the child may make no complaint whatever; the general health may not be seriously affected, even when the mass has attained a considerable size. Death, indeed, may occur, as in a remarkable case which I have reported of embolism of the heart (the transference of sarcomatous thrombi from the renal vein) , before there were any symptoms to attract attention. Progressive emaciation, with enlargement of the abdomen, usually painless . . . are the prominent characters, which are common, however, to both the renal and the retro-peritoneal growth. The two important points of differentiation are, first, the retro-peritoneal growth is more central in its origin, and, if seen early, it is found to occupy the umbilical region, not extending to the flanks; whereas, in the renal tumor, as in the case before us, the growth is lateral, and fills the entire flank, extending deeply behind.
Letter To The Editor
Authors: Presman David
Published: December 2021

I agree that in the vast majority of cases when a child has a fecal impaction and urinary retention, there is no neurogenic disease of the large bowel. However, since this combination of findings is unusual and since a barium enema is a relatively simple diagnostic procedure, it is well worthwhile to be certain of the absence of neurogenic disease by performing a barium enema.
Letter To The Editor
Authors: Forrest Jill M. , Menser Margaret A. , Harley J. D.
Published: December 2021

We were most interested to read of Plotkin and Kaye's two children with congenital rubella and diabetes mellitus. Since our original report of five cases referred to by those writers, we have found three further patients under 30 years of age with this combination of disorders.1 Each of these three patients had no evidence of diabetes mellitus on routine clinical examination and urinalysis in 1967. However, when reviewed this year all three patients had glucose tolerance tests indicative of diabetes.
Analyzing Chldren's Art, by Rhoda Kellogg. Palo Alto, California: The National Press, 1969, 308 pp., $8.95
Authors: Baker Harry
Published: December 2021

This book, based on a unique experience, gives us an insight into a facet of childhood development which we have not had before.

The Golden Gate Kindergarten Association, founded in San Francisco in 1878, now conducts a Nursery School and Child Art Classes. The Nursery School directed by Rhoda Kellogg since 1945 is singular because it admits children as young as 24 months for day care. Some of the activities provided for these children are scribbling, drawing, easel painting and finger painting; for the past 20 years, the author has collected, dated, and named these scribblings, drawings, and paintings. This accumulation contains a complete spectrum of material from the child's earliest attempts at scribbling to the pictorial efforts of children aged 24 to 60 months.
FECAL FAT AND NITROGEN IN HEALTHY CHILDREN AND IN CHILDREN WITH MALABSORPTION OR MALDIGESTION
Authors: Shmerling D. H. , Forrer J. C. W. , Prader A.
Published: December 2021

The daily excretion of total fatty acids and nitrogen in stool was assessed in 3 or 5 days' collection periods in 71 control patients and in 71 patients with different forms of malabsorption and maldigestion. Control infants have higher normal values for fecal fat (range 1.1 to 3.6 gm/day, upper limit, calculated as mean ± S.D. = 4.3 gm/day) than older children (range 0.2 to 2.2 gm/day, mean + 2 S.D. = 3.02 for children aged 1 to 4 years, and range 0.8 to 3.2 gm/day, mean + 2 S.D. = 3.11 gm/day for children aged 4 to 10 years). The upper limit of fecal nitrogen was found to be 1 gm in infants and 1.2 gm/day in children.

Patients with exocrine pancreatic insufficiency excreted significantly higher amounts of both fat and nitrogen than those of camparable age with untreated Celiac disease. These findings can be of diagnostic value in this age group.
In Reply: Diabetes Insipidus, Chlorpropamide, and Hypoglycemia
Authors: Ehrlich Robert M.
Published: December 2021

I would like to make several comments on the letter of Drs. Pinto and Stoppoloni. First of all, the dose of chlorpropamide given to this child was extremely large compared to the amounts that we have used. This child was only 3 years and 8 months of age and was receiving 500 milligrams per day. The largest dose that we have used in any child was 400 milligrams and this was in a teenager. We have found that children under the age of 5 years are much more sensitive to this drug and more liable to have hypoglycemia.
THE FAMILY IN CLASSICAL GREECE, by W. K. Lacey. London: Thames and Hudson, 1969, 342 pp., 63s ($7.50)
Authors: Cone Thomas E.
Published: December 2021

From ancient times until today the strongest force in Greek life has always been the family. Indeed, as the author–University Lecturer in Classics at St. Catherine's College, Cambridge–points out, classical Greek history, literature, and art cannot be properly understood without a knowledge of the family. And yet, there is no previous book on the subject–at least in English. For this reason Mr. Lacey's book in itself is destined to become a classic.

Aristotle began his work on Politics by contending that the Greek states could not be understood unless they were broken down into their smallest parts; the smallest being the family or oikos made up of three elements, the male, the female, and the servant.
STUDIES IN CLINICAL ENZYMOLOGY, by D.P. Mullan. St. Louis: The C. V. Mosby Company, 1969, 238 pp., $12.00
Authors: Coffey Victoria P.
Published: December 2021

This little book of about 230 pages is noteworthy on two counts. First, it contains an excellent up-to-date summary of recent advances in clinical enzymology; and second, the author succeeds in making the book easy to read, despite the complexity of the subject. To do so is quite an achievement, requiring the unusual talent of making understandable a topic most physicians would find recondite.

There are eleven chapters each of which deals with a particular application of enzymology, such as cardiac infarction, African heart disease, pregnancy, inherited metabolic abnormalities, and so forth.
COLOR ATLAS AND TEXTBOOK OF HEMATOLOGY, edited by William R. Platt, M.D., F.C.A.P., F.A.C.P. Philadelphia: J. B. Lippincott, 1969, 445 pp., 135 illustrations, 73 color plates, $27.00
Authors: Nathan David G.
Published: December 2021

Dr. Platt's book attempts to be a laboratory manual, a text on pathophysiology, and a collection of photomicrographs. This reviewer is unable to recommend it over other much less expensive laboratory manuals. The color photomicrographs do not approach the quality present in the Atlas compiled by McDonald, Dodds, and Cruickshank; the pathophysiology sections are too brief, and incompletely referenced. The chapters on technique including special staining and chromosome morphology are among the more useful sections.
VITAMIN D DEPENDENCY: AN INHERITED POSTNATAL SYNDROME WITH SECONDARY HYPERPARATHYROIDISM
Authors: Arnaud C. , Maijer R. , Reade T. , Scriver C. R. , Whelan D. T.
Published: December 2021

Three French-Canadian children in a large inbred pedigree each developed hypocalcemic, hypophosphatemic rickets in the latter half of their first year of life; there were also manifestations of generalized renal tubular dysfunction. These abnormalities, which mimic advanced Vitamin D deficiency, disappeared only when Vitamin D2 or D3 was given at about 100 times the recommended daily allowance; this indicated the diagnosis of Vitamin D dependency.

Enamel hypoplasia was a prominent clinical finding; only those teeth which calcify postnatally were affected, indicating that the condition found does not affect Vitamin D-dependent nutrition in utero.

The level of parathyroid hormone was elevated in serum before treatment; it fell to normal either after treatment with Vitamin D, or during intravenous infusion with a calcium solution sufficient to produce hypercalcemia.

Vitamin D dependency appeared to be inherited as an autosomal recessive trait in this pedigree, but we could observe no phenotypic signs in presumably obligate heterozygotes. One of the three cases in the pedigree arose from outbreeding, suggesting that the mutant allele is probably not particularly rare in the population under our surveillance.
Nosogenic Prehension of the Nasus by a Neonate: A Resumption of Fetal Posture
Authors: Conner Garris K. , Levkoff Abner H.
Published: December 2021

Occlusion of the nares by the same hand on three occasions, producing respiratory obstruction and cyanosis in a newborn infant in the immediate post-delivery period is described. It is presumed that this unusual behavior represented a temporary resumption of the fetal posture.
Letter To The Editor
Authors: Askin John A.
Published: December 2021

I would like to comment upon the leading article in Pediatrics for May 1970, "Recurrent Abdominal Pain in Childhood," by Robert F. Stone and Giulio J. Barbero.

In the attempt by the authors to define the "Symptom Complex Of The Irritable Bowel Complex Syndrome" they have not given sufficient consideration to the possibility of anomaly of the excretory tract being the cause of the recurrent abdominal pain.

I think that every one with any experience in taking care of children will agree that recurrent abdominal pain in childhood is a very common problem.
Cortical Blindness, Fever, and Convulsions—A Misinterpretation
Authors: McEnery John T.
Published: December 2021

I must protest the article in the July issue of Pediatrics (46:102) by Oyin Olurin, titled "Cortical Blindness after Convulsions and Fever." This misleading title only seems to perpetuate the canard, firmly entrenched in the layman's medical knowledge, that high fevers are dangerous.1

Parents, unconcerned with temperatures of 101 or 102, suddenly panic when their child's fever rises two points to 103 or 104. Brain damage seldom results from fever alone. Four of the reported cases in the above article had cerebral malaria according to the author's own evaluation.
A Sex Difference in Immunologic Responsiveness
Authors: Michaels Richard H. , Rogers Kenneth D.
Published: December 2021

Serum levels of E. coli hemagglutinins were found to be slightly higher in females in tests of 120 hospitalized infants age 6 to 14 months. The female antibody response to rubella vaccine was also found to slightly exceed the male response in each of 10 field trials, involving a total of over 15,000 children.
Rapidly Administered Hypertonic Solutions
Authors: Harris Robert L.
Published: December 2021

The article "Clinically Significant Physiological Changes from Rapidly Administered Hypertonic Solutions: Acute Osmol Poisoning" (Pediatrics, 46:267, 1970) by Kravath, et al. is a valuable addition to the pediatric literature. In a series of interesting experiments the authors again document the potential dangers of rapid intravenous infusions of hypertonic solutions. However, the implication that the experiments so performed are necessarily applicable inthe human organism need some clarification.

In considering the effects of an intravenous infusion in the human, three factors should be considered: (1) osmoiality, (2) volume, and (3) total dose.
Neonatal Suppurative Parotitis
Authors: Tow Abraham
Published: December 2021

The report on neonatal suppurative parotitis by Leake and Leake (Pediatrics, 46:203, 1970) is an interesting one. May I take the liberty of adding some opinions based on experiences at the New York Polyclinic Hospital where I was active on the newborn service from 1925 to 1959.

This condition is much more common than the above authors would lead us to believe. I followed over a dozen cases. All were premature infants and all recovered. Before the advent of antibiotics, the prognosis was guarded.
EVIDENCE FOR INDEPENDENT REGULATORS OF ORGAN MATURATION IN FETAL RABBITS
Authors: Kotas Robert V. , Fletcher Barry D. , Torday John , Avery Mary Ellen
Published: December 2021

The degree of organ development bears a relationship to gestational age, but in a given infant not all organs need be at the same stage of development. The range of variation of organ maturation can be best studied in an animal with a large litter, such as the rabbit, in which gestation can be precisely timed.

Body weight, ossification centers, and lung "maturity," defined as distensibility and stability on deflation, were all measured. Marked variations within a litter allowed study of the relationships between them. Body weight and the number of ossification centers were closely correlated at the same gestational age (R = 0.88, p 001). Ossification centers were less well correlated with gestational age. Lung "age," on the other hand, was more closely related to gestational age than body weight.

A single injection of the fetus with 9-fluoroprednisolone, a glucocorticoid, at 24 days resulted in an acceleration of lung maturation, defined in terms of distensibility and the presence of surfactant by 26 to 27 days. No increase in lung weight took place. Similarly, the glucocorticoid had no effect on body size or the number of ossification centers, suggesting that regulators of maturation of these organs are independent.
ON CATS AND CRIB DEATH
Authors: C. T. E.
Published: December 2021

Crib death or the Sudden Infant Death syndrome (SIDS) continues to be a major cause of death of young babies and yet there is no known common pathogenic mechanism for this syndrome. Of all the proposed hypotheses to explain the syndrome's etiology, that of mechanical suffocation by a cat is not even mentioned.1 But almost all grandmothers -whether they be ailurophiles or ailurophobes -are convinced that cats may mechanically suffocate an infant while he sleeps in his crib. The annotation below written in 1905 for a leading pediatric journal supports the widely held belief that cats should be banished from the nursery.2

The fondness many children display in taking cherished toys to bed with them is proverbial, and frequently these favourite bedfellows take the form of animal representations in the shape of rabbits, monkeys, and so on, the fur of which is usually much the worse for wear, and requires frequent stitching to prevent the shedding of the interior and for the preservation of the original outline. The more disreputable the appearance of the toy the better it is liked. Some children show a partiality for live animals, and of these cats are not unpopular. Cats, unlike dogs, evince a partiality for lying on the children's chests in close proximity to their faces, and when that is the case there is a real danger of a fatal termination by suffocation. An inquiry was recently held at Battersea into the circumstances of the death of a 1-month-old infant. A relative of the deceased stated that the infant was put to bed at mid-day, and half an hour later, when she went into the room, she found the cat curled up on the child's face.
TETRACYCLINES AND PERMANENT TEETH: THE RELATION BETWEEN DOSE AND TOOTH COLOR
Authors: Grossman Elmer R. , Walchek Alexander , Freedman Helen , Flanagan Cynthia
Published: December 2021

A quantitative estimation of the darkening effect of tetracyclines on permanent incisors was made by correlating tooth colors with the recorded history of tetracycline exposure in 160 children under our care since infancy. The average darkening caused by one 6-day course of oral tetracycline or demethylchlortetracycline during the years of permanent incisor formation was 0.3 of a shade on a 14 shade dental scale. Children with five such courses of tetracycline therapy during the first 4½ to 5 years of life had permanent incisors averaging about two shades darker than children with no tetracycline exposure, a nearly imperceptible and cosmetically negligible difference; however, 3 of these 14 children had moderately darkened teeth.

With greater frequency of tetracycline exposure, the risk increases; four of our six patients with eight or more courses had noticeably dark teeth. After age 6 for girls and 7 for boys the risk of tetracycline staining can be ignored since the cosmetically important anterior teeth have all formed. When tetracycline therapy is indicated during the first 6 to 7 years, the use of oxytetracycline (or possibly doxycycline) may diminish tooth darkening.
THE INTERRELATIONSHIP BETWEEN THE PATIENT, HIS FAMILY, THE REFERRING PHYSICIAN, AND THE PEDIATRIC ALLERGIST
Authors: Heimlich Ernest M. , Ellis Elliot F. , Frick Oscar , Ghory Joseph E. , Lecks Harold I. , Strem Edward L. , Halpern Salmon
Published: December 2021

The magnitude of the problem of allergic disease in children was brought out by the U.S. National Health Survey,1 which showed that 32.8% of children less than 17 years of age with chronic illness had an allergic disease. The purpose of this statement is to discuss the relationship between the child's primary physician and the pediatric allergist to help bring adequate care to the child with allergies.

Children may be referred to or consult an allergist for various reasons:

(1) An allergic survey may be necessary because earlier efforts failed to control allergic symptoms or because an allergy may be involved in recurring otitis, sinusitis, bronchitis, pneumonia, or other infections.

(2) The child's physician may feel that desensitization is necessary, but he may not have the time, expertise, or the inclination to treat the child.

(3) The parents may recognize what they believe to be an allergic problem or they may feel that prior management has not brought satisfactory relief; therefore, they may seek advice and therapy on their own.

The goal of treatment of the child with allergy is to provide effective relief of symptoms and prevent the development of complications. An early comprehensive study of a child with allergy can be a prophylactic measure. Children should never be expected to "outgrow" their allergic symptoms. Some children appear to outgrow them; but, chronic sinusitis, bronchitis, or emphysema may develop later. Buffum urged, "When asthma begins, get it under control quickly. Patients treated early do better."2 Not every child with allergy needs to be seen by an allergist.
Reporting of Neonatal Deaths (Continued)
Authors: Nichols M. M.
Published: December 2021

The concern of the practicing physician to provide the best possible care for his patients is not a new one belonging to the "now" generation or even Nader's Raiders.1 It has been passed from yesterday's family doctor to today's general practitioner and specialist and is exemplified by Dr. Laurance Nickey's letter to the Editor2 in which he asks if the data are reliable which show that 12 countries report lower infant mortality rates than the United States.
Action for Children's Television: How Pediatricians Can Help the ACT
Authors: Feinbloom Richard I.
Published: December 2021

I should like to call to the attention of the members of the American Academy of Pediatrics the organization Action for Children's Television (ACT) which was founded in 1968 by concerned mothers. ACT's stated purposes are: (1) to persuade TV networks, stations, and advertisers that children are special human beings and not simply miniature consumers; (2) to encourage and support good entertaining programming for children of all ages; (3) to eliminate commercialism from children's programs and to require a reasonable amount of programming each week designed for children of different ages; and (4) to substitute a new system of financial support for children's programs by commercial underwriting and public service funding, in the belief that this system would look toward the benefits to children rather than the profit to the advertisers.
The Chromosome Disorders: An Introduction for Clinicians, ed. 2, by G. H. Valentine, M.B., Ch.B. (Bristol), M.R.C.P., D.C.H., F.R.C.P.(C), Philadelphia: J. B. Lippincott, 1969, 172 pp., no price given
Authors: Gerald Park S.
Published: December 2021

It is a measure of the importance of chromosome disorders in clinical medicine and of the rate at which information has been added that this primer appears in second edition only 3 years after its initial publication. In part, this also reflects the literary quality of the text. A reviewer of the first edition of this little book reportedly described it as information disguised as entertainment. I can do no better than concur with this judgment and apply it equally to the present edition.
Recognizable Patterns of Human Malformation, in the Series–Major Problems in Clinical Pediatrics, vol. VII, by David W. Smith, M.D. Philadelphia: W. B. Saunders Company, 1970, 368 pp., $16.00
Authors: Gerald Park S.
Published: December 2021

Dr. David Smith is well known for his clinical descriptions of malformation syndromes. He was one of the team of clinicians and investigators that first described the D1 trisomy syndrome. To this clinical expertise he has more recently added a year of study in embryology under Dr. Gian Töndury of Zurich. The present volume is the summation of these experiences and represents one of the few attempts by a clinician to integrate the embryologic with the clinical approach to malformations.
ADJUSTMENT OF VENTILATION AND PERFUSION IN THE FULL-TERM NORMAL AND DISTRESSED NEONATE AS DETERMINED BY URINARY ALVEOLAR NITROGEN GRADIENTS
Authors: Krauss A. N. , Soodalter J. A. , Auld P. A. M.
Published: December 2021

The urinary alveolar nitrogen gradient was measured serially in 20 normal and six distressed full-term newborn infants. When the gradient is small (less than 10 mm Hg) ventilation is evenly distributed throughout the lung. When a large gradient is determined this is a reflection of numbers of alveoli with low ventilation-perfusion (VA/Q) ratios. In healthy adults used as a control for the method, a gradient of less than 10 mm Hg was recorded. Healthy, nondistressed newborn infants were almost all within the normal range from the first day of life.

Infants found to have distress due to meconium aspiration or transient neonatal tachypnea had large gradients throughout the first week of life. The studies indicate that the healthy, full-term infant rapidly achieves a normal distribution of pulmonary ventilation, whereas serious maldistribution of ventilation occurs in meconium aspiration pneumonia.
The Effectiveness of Methylphenidate Hydrochloride (Ritalin) on Learning and Behavior in Public School Educable Mentally Retarded Children
Authors: Blacklidge Virginia Y. , Ekblad Robert L.
Published: December 2021

Three classes of public school children in EMR classes were administered methylphenidate hydrochloride (Ritalin) and a placebo in a double-blind study, with each child acting as his own control, to evaluate the effects of this medication on classroom behavior, academic performance, and home behavior. Pupils were rated on the Burks Behavior Rating Scale by teachers and parents; and the Gray's Oral Reading Paragraphs, the arithmetic section of the Wide Range Achievement Test, and the Porteus Mazes were administered.

Only the teachers' ratings of classroom behavior showed a statistical difference in response to methylphenidate hydrochloride. Neither the parents' ratings of behavior nor the children's performance on the academic measures showed a statistically significant difference in response to treatment.

Additional studies are needed to clarify the teachers' impression of improved academic performance and to study the effects of medication on the classroom environment as a whole. This additional study might need to be conducted over a longer period of time and different measures of academic improvement might be used. If behavior at home is to be studied, the medication should be given just before the pupil leaves for home.
BOOK OF ACCIDENTS (1830)
Authors: Cone Thomas E.
Published: December 2021

In nineteenth century America, falls from horses must have been a common cause of accidental death of children because so many parents' manuals of the period contained warnings to keep children away from horses. The lesson below, written for children in 1830, vividly describes what may happen to a little boy who tries to ride his father's horse.1

An amusing proverb occasionally included in these warnings was: "It is a good horse that never stumbles and a good wife that never grumbles."2
Audio-Visual Unit
Authors: Wharton B. A.
Published: December 2021

We have recently set up a small audio-visual teaching unit at this hospital, for use by our residents, postgraduates, and undergraduates.

Slide and cassette sets have been purchased from the "Teaching Aids at Low Cost" unit (TALC) of the Institute of Child Health, London, and from the Medical Recording Service Foundation, of the Royal College of General Practitioners. We hope that some of our own staff members will make their own sets for us.
Allergy and Urinary Infections: Is There an Association?
Authors: Harrison Anne
Published: December 2021

Noting in my small general pediatric practide that the same families kept returning for urine checks following infections as well as for allergy shots, I decided to review all of the current charts to determine the incidence of both problems. "Allergy" includes hay fever, asthma, allergic cough, eczema, bee and other stings, and reaction to foods or drugs severe enough to warrant avoidance, medication, or allergic workup. "G-U infection" includes typical symptoms of bladder irritation with or without pyuria and bacteriuria, acute pyelonephritis diagnosed by the usual symptomatology and laboratory work, and subacute or chronic infections with the children presenting often with more subtle symptoms (tired, cranky, low-grade fever, and off-and-on abdominal pain being the most common complaints) and with a "clean-catch" urine culture of at least 20,000 colonies of one organism.
A SPEECH SCREENING PROCEDURE WITH THREE-YEAR-OLD CHILDREN
Authors: Fiedler Miriam F. , Lenneberg Eric H. , Rolfe Ursula T. , Drorbaugh James E.
Published: December 2021

A screening examination for use by nonprofessional interviewers in the home situation for evaluation of speech and language development of 3-year-old children was developed. The perinatal histories and developmental data for the first year of life were examined for 46 children who failed this screening examination and for 92 control subjects, matches for age, sex, and time of examination, who passed the screening examination. Significant differences were found between the groups in incidence of complications of pregnancy and labor, prematurity and in various aspects of development during the first year of life. Follow-up psychological examinations at 4 years of age and psychological and neurological examinations at 7 years of age found marked differences between the groups still present, with the speech failure group presenting a significantly higher incidence of a Variety of psychological and neurological deviations from the normal.
Infantile Xanthomatous Cardiomyopathy
Authors: MacMahon H. Edward
Published: December 2021

This report deals with a most unusual disease of the heart that was characterized clinically by irreversible atrial tachycardia and recurrent ventricular fibrillation. This led to the death of a 13-month-old female infant. Anatomically, xanthomatous clusters of closely packed lipid-containing cells displaced segments of the myocardium. Neither the etiology nor pathogenesis of this disease is known. This is the seventh such case to be recorded.
Utilization of Allied Health Workers: Does It Solve the Basic Problem?
Authors: Baren Martin , Bell Leo S. , Misbach William D. , McKay R. J.
Published: December 2021

I have recently received a questionnaire from the Academy concerning my feelings on the training and subsequent utilization of allied health workers, especially the pediatric nurse associate. I feel the time has come to face the fact that we as pediatricians are trying to solve the solution-not the basic problem-when we talk about the utilization of the various assistants.

For the past 10 years or so, pediatricians have been talking about the "New Pediatrics" and other such "changes" in our approach to child care, but as with so many other ideas, the practice continues to rule.
Spot Test for Lead in Paint (Continued)
Authors: Sayre James W.
Published: December 2021

Questions asked by several people about our sodium sulfide testing of paint for lead1 make us feel we might wisely add several words of caution about the stability of the prepared solution.

Sodium sulfide solutions deteriorate fairly rapidly with age, especially on exposure to air. For this reason, it is suggested that people using the procedure check the odor of the sodium sulfide solution tlley are using, to make sure the odor of hydrogen sulfide is detectable.
Patient, Family, Referring Physician, and Pediatric Allergist (Continued)
Authors: Speer Frederic
Published: December 2021

The recommendations of the Section Committee on Allergy that appeared in the March issue1 are well thought out and very much to the point. I would, however, like to dissent on one point: we have found that patients who live near enough to do so get along much better if they come to our clinics for allergic care, including hyposensitization. Patients who cannot do this are far more difficult to handle. This is not meant to be an adverse comment on this excellent report but an alternate approach to allergic management.
Phototherapy—A Note of Caution
Authors: Lanzkowsky Philip , Salemi Mozafar , Gootman Norman
Published: December 2021

A newborn infant with Rh hemolytic disease developed profound anemia following phototherapy. The potential danger of the use of phototherapy in hemolytic disease of the newborn is discussed. Since the development of late anemia following erythroblastosis fetalis occasionally occurs, the need for frequent repeated hemoglobin levels in infants with hemolytic disease of the newborn is stressed.
ACCEPTANCE OF THE PRESIDENCY
Authors: Arena Jay M.
Published: December 2021

June 12-13, 1931, in Atlantic City at the first regular meeting of the American ademy of Pediatrics, Dr. Isaac A. Abt, the first president, defined the purpose of this new society. There was no need, he claimed, for another scientific society, but "it has been our desire to build an association so that every qualified pediatrician could seek membership . . . We must perfect our department of medicine where imperfections exist." He went on to say that the Academy should be an organization for action in behalf of the health and welfare of all children.

Forty years later, the Academy has become just that–an "organization of action." This is clearly demonstrated by its 35 national committees, many of which are truly outstanding and have made innumerable contributions over the years to child health and the delivery of health care (Committee on Infectious Disease, Accident Prevention, Fetus and Newborn, Nutrition, and the Council on Pediatric Practice, to mention a few).

There are many challenges that confront us today, but the most serious in my opinion is the grave manpower shortage and maldistribution in the delivery of primary health care to all of our children. We have the "chiefs but not the Indians." In most instances we have ample numbers, talented and productive in most subspecialties. In a few, we many even have too many. But as for the hard-working, dedicated "local pediatrician," with the constant challenge of a private practice and its physical and emotional demands, there is a woeful scarcity and a great need.
HAZARDS OF LAUNDRY PRODUCTS USED IN THE NEWBORN NURSERY
Authors: Yaffe Sumner J. , Bierman Charles W. , Cann Howard M. , Gold Arnold P. , Kenney Frederic M. , Riley Harris D. , Schafer Irwin , Stern Leo , Weiss Charles F. , Shirkey Hary C. , Ballin John C. , Bishop Jeffrey , Farchione Louis , Lockhart Jean D. , Sawchuk Steven
Published: December 2021

Published reports and unpublished communications to the Committee on Drugs of the American Academy of Pediatrics indicate that substances potentially hazardous to the premature and full-term newborn infant continue to be used in the laundering of clothing, diapers, and bedding for hospital nurseries. In 1962 the Subcommittee on Accidental Poisoning called attention to occurrences of methemoglobinemia in premature and full-term newborn infants whose diapers were autoclaved after a final laundry rinse with the bacteriostatic agent, 3-4-4' trichlorocarbanilide (TCC).1 Subsequent reports in the pediatric literature confirmed and added to these "epidemics" of neonatal methemoglobinemia2-4 and suggested that aniline–a wellknown cause of methemoglobinemia5–resulting from the break-down of TCC during autoclaving, was absorbed from diapers and other nursery clothing through the skin of the infants. Although direct proof of the etiologic role of TCC is lacking, the association is of sufficient concern that the forthcoming Academy manual, Standards and Recommendations for Hospital Care of Newborn Infants, Second Edition, makes reference to the hazards of using TCC. Although a limited and informal survey of hospital nurseries in the United States and Canada indicates that most hospital laundry procedures have abandoned TCC in treating clothing and bed linens of newborn infants, sporadic instances of neonatal methemoglobinemia associated with exposure to this substance still come to the attention of local, state, and national health agencies, manufacturers, and the Committee on Drugs.

In 1967, deaths and severe illness occurred in epidemic form in the newborn nursery of a small Midwestern maternity hospital.6 Investigation revealed that the sodium salt of pentachlorophenol (PCP)— which was present in the antimicrobial neutralizer product used in the final rinse of the laundry process for diapers, infant undershirts, and crib linens for the nursery–intoxicated babies by percutaneous absorption.7
Allergy and Urinary Infections: Is There an Association?
Authors: Gerrard J. W. , Jones Betty , Shokier M. K. , Zaleski Anne
Published: December 2021

We were very interested in the letter1 from Dr. Harrison1 in which she commented both on the high incidence of genitourinary infections families in which there was a high incidence of allergic problems, and also on the frequency with which genitourinary and allergic problems appeared to be concentrated in families. She asked if there was any explanation. We think there is.

We ourselves have recently studied a group of 89 girls with recurrent urinary infections, and expect soon to publish our results.
Allied Health Workers in Pediatrics
Authors: Pick Walter
Published: December 2021

I would like to present my point of view regarding the use of allied health workers in pediatrics.

The Colorado plan under Dr. H. Silver, as well as the Feldshen experience in the Soviet Union, are excellent ways to bring pediatric help into areas that would otherwise go without. However, to make a virtue out of such necessity and to convince pediatricians that this is the preferred way to practice pediatrics swings the pendulum backwards.
SPECIAL ARTICLE: SHEDDING LIGHT ON THE USE OF LIGHT
Authors: Klein Richard M.
Published: December 2021

Radiation from the sun or from artificial sources is part of the basic environment impinging on all organisms. Its causal role in health and disease of man is seen daily by the clinician. Within the past decades, however, radiation has become important as a clinical and research tool. The generation, control, and measurement of radiation requires some application of photobiological and photophysical principles, not only to satisfy the editor of a periodical, but also to allow other investigators and clinicians to evaluate the results and conclusions, to permit confirmation and extension of reports, and to use radiation effectively in research and in practice. Although this brief resume of some of the perils and pleasures of photobiology is not comprehensive, it may provide a base for studies and reports in which radiation is a parameter.

You will note that the term radiation has been used, rather than the more common term, light. Actually, there are two systems of nomenclature, one dealing with radiation as a physical entity, the other with what is called the photometric or psychophysical system. Light is a people-word, referring to that small segment of the electromagnetic spectrum that stimulates the optic nerve. If a mosquito were the dominant and articulate life form, the word light would be restricted to wavelengths below those perceived by man; the region we call the ultraviolet. Since much of radiation research does not involve the human eye, photometric terminology has little meaning and, as we shall see, may provide information that is very misleading.
The Intermittent Endotracheal Intubation Technique for the Treatment of Recurrent Atelectasis
Authors: Ehrlich Robert , Arnon Rica G.
Published: December 2021

Thirty-five out of a total of 36 episodes of significant atelectasis in six patients were successfully treated using an intermittent endotracheal intubation technique (IIT). No complications were encountered even though the procedure was repeated as frequently as every 12 hours for days. This technique is most advantageous in treating recurrent atelectasis in infants with certain known predisposing factors, and thus obviates the use of bronchoscopy and the complications of prolonged endotracheal intubation and tracheostomy.
Non-Puerperal Induced Lactation
Authors: Jelliffe Derrick B. , Jelliffe E. F. Patrice
Published: December 2021

The December 1971 issue of Pediatrics has just become available here and we are writing to amplify the letter by Dr. Robert Cohen (p. 997) "Breast Feeding Without Pregnancy," and the note by the Associate Editor.

Briefly, the phenomenon sometimes termed "non-puerperal induced lactation" has been, and, in some areas, still is, a well-recognized, culturally accepted emergency method of feeding young babies whose mothers have died in childbirth. There is considerable literature in anthropological and historical records1,2 and the writers have personally observed induced lactation in various parts of the world, including the Yoruba community of Nigeria, when samples of breast milk from such women were found to show a low normal protein content.3
A Grimm Affair
Authors: Eisenberg Leon
Published: December 2021

I was so disarmed by Ronald MacKeith's comparison of me with the fabled Emperor (Pediatrics 49:325, 1972) that I haven't the backbone to object to his noting my lack of clothes. He invites a rejoinder; how can I appear in public, now that he knows my condition? Then, who is right? Let the reader decide. In the meantime, I am going to have a word with those new clothiers....