bluuebunny/crossref_metadata_2025 huggingface dataset:
Questions About Dipstick Screening
Authors: Wolman Irving J.
Published: December 2021

Many EPSDT protocols either suggest or specify that testing for bacteriuria be part of the complete screening examination. Hence those of us active in the nationwide EPSDT program tend to dissect all reports on childhood screening in order to see which offer lessons applicable for local usage. When doing this with the report by Kunin et al., "Detection of Urinary Tract Infections in 3- to 5-Year-Old Girls by Mothers Using a Nitrite Indicator Strip" (Pediatrics 57:829, June 1976), it was disappointing to find the presentation of the data not in conformity with the expectations raised by the title.
Clarification
Authors: Barness Lewis A. ,   Committee on Nutrition
Published: December 2021

The statement on iron supplementation for infants indicates that breast-fed infants are to some degree protected against iron deficiency, but it then does not proceed to make separate recommendations for this group. This apparent conservatism of the Committee was based on the fact that data are still too scant to warrant the elimination of the recommendation for iron supplementation of all full-term breast-fed infants.

The available information indicates that preterm infants who are fed breast milk require iron supplementation.
A Different Position on Postural Drainage
Authors: Kravath Richard E.
Published: December 2021

Law and Kosloske reported in the September 1976 issue (Pediatrics 58:362, 1976) on the use of postural drainage in the management of tracheobronchial foreign bodies. Their results were not as good as those previously reported. They state that they placed the involved portion of the lung in a "dependent" position for postural drainage. It is hard to understand the theoretical background for this particular practice unless, for example, one is dealing with foreign bodies that are lighter than air.
Simulated Patients
Authors: Bloom Henry R.
Published: December 2021

I was interested to read the article "The Use of Paraprofessionals to Teach Interviewing Skills" by Stillman et al (Pediatrics 57:769, May 1976). Indeed, the use of "Programmed" or "simulated" patients has proven to be an important part of the birth of medical education as a science and a discipline, rather than its traditional place in the medical school, as a by-product of research and patient care.

Those interested in this area, such as Dr. Stillman et al., should know, however, that for over ten years1,2 there has existed extensive experience, development, and literature on the use of simulated patients.
In Reply: Are We Being Too Cautious?
Authors: Brunell Philip A.
Published: December 2021

I am delighted that Dr. San has seen fit to express his feelings about a varicella vaccine. I would hope that as many practitioners as possible are heard. We are sorely lacking a dialogue between the practitioners and the so-called experts.

It is essential in making decisions about new drugs, vaccines, or modes of therapy to weigh the advantages against the disadvantages. The temporal perspective in making these judgments is critical. In expressing my personal opinion, I feel it would be better to wait until we have a greater understanding about the nature of virus latency before commiting ourselves to an expensive and potentially hazardous program.
In Reply: A Question on Failure-to-Thrive Study?
Authors: Oates R. K. , Hufton I. W.
Published: December 2021

We appreciate Dr. Kramer's concern to know whether the cognitive, emotional, and social dysfunctions seen in these children and their families on follow-up are a result of the earlier failure to thrive, the psychosocial dysfunction initially present in these families, or a combination of these factors.

Many practicing pediatricians would agree that failure to thrive alone does not cause the abnormalities that were seen on follow-up in this group. Our initial follow-up study of nonorganic failure to thrive1 included a group of children admitted to the hospital during the same period with failure to thrive due to organic causes.
The Blood Pressure Cuff Controversy
Authors: Cohen Myron L. , Alexander Harold , Steinfeld Leonard
Published: December 2021

In a letter (Pediatrics 59:138, January 1977) Bailie noted that the sizes of cuffs normally available for the measurement of blood pressure in infants and children are inadequate to insure that measuremnents will accurately reflect the true arterial blood pressure. In general the use of an improperly sized cuff will lead to an overestimation of the arterial blood pressure. In recent studies,1,2 we have shown that several criteria must be fulfilled in the design of an occlusive cuff in order to insure that the indirect pressure accurately reflects the arterial pressure.
Pelvic Osteomyelitis in Children
Authors: Edwards Morven S. , Baker Carol J. , Granberry W. Malcolm , Barrett Fred F.
Published: December 2021

Six children (7 to 16 years of age) with pelvic osteomyelitis are described. Sites of involvement included the pubis in three patients, the ilium in two patients, and the ischium in one patient. All were right-sided. Each patient presented with a history of fever and an abnormal gait. In four, the point tenderness indicated the site of bony involvement. All patients had pain on abduction but free passive range of motion of the hip. Soft tissue swelling was present on admission pelvic roentgenograms in five patients. Intravenous pyelogram revealed deviation of the bladder toward the midline in each of four patients studied. Roentgenographic changes typical of osteomyelitis developed in four patients ten days to ten weeks after onset of symptoms. In four patients in whom an organism was identified, Staphylococcus aureus was isolated from blood and/or bone. All isolates were methicillin-sensitive and two were penicillin-sensitive. Purulent material was drained from three of the five patients who underwent surgical exploration of the pelvis. All patients received parenteral antistaphylococcal therapy for 3 to 5½ weeks (mean, 4 weeks). Oral antibiotics were given to five patients for an additional 3 to 14 weeks. All patients recovered completely.
Nafcillin-Induced Neutropenia in Children
Authors: Greene Gerald R. , Cohen Eddie
Published: December 2021

Neutropenia developed in three pediatric patients treated intravenously with nafcillin. This association has not been, to our knowledge, previously reported in children. One of the patients is the youngest reported who had neutropenia associated with any penicillin; another patient had a prolonged recovery. The literature pertaining to marrow suppression by all penicillins is reviewed. This usually occurs 10 to 25 days after the inception of high-dose intravenous therapy and resolves when the penicillin therapy is discontinued. An absolute neutrophil count of less than 1,000/ml is an indication to change to an antibiotic other than a penicillin. Children receiving intravenous penicillins should have WBC counts with differential analysis two to three times a week.
Electroretinography in Neonates Treated With Phototherapy
Authors: Bhupathy Kalavathi , Sethupathy Ramasamy , Pildes Rosita S. , Constantaras Alexander A. , Fournier John H.
Published: December 2021

Electroretinographic (ERG) studies were performed in 22 normal control newborns and 28 neonates who had had phototherapy during the first few days of life. Mean age at ERG testing was 16.8 ± 2.9 days in the phototherapy group and 16.4 ± 3.7 days in the control group. Results of routine funduscopy were normal in both groups. Amplitudes of a and b waves under dark- and light-adapted states were similar in both groups. Phototherapy did not appear to have deleterious effects on photopic and scotopic retinal function in infants whose eyes were adequately shielded.
Obstetric, Neonatal, and Psychosocial Outcome of Pregnant Adolescents
Authors: McAnarney Elizabeth R. , Roghmann Klaus J. , Adams Barbara N. , Tatelbaum Robert C. , Kash Claire , Coulter Molly , Plume Marguerite , Charney Evan
Published: December 2021

Obstetric, neonatal, and psychosocial outcomes were compared for 82 matched adolescents who had been pregnant, been delivered of an infant, and received health care in three sites in Rochester, New York. There were no major differences in obstetric and neonatal outcome of adolescents and their babies according to health site. Differences in outcome were expected in the psychosocial area where a specialized maternity project (Rochester Adolescent Maternity Project [RAMP]) offered more services. On follow-up two years later, school attendance and reliance on full or partial assistance were similar. Repeated pregnancy and postpartum use of contraception favored RAMP.
Chest Physiotherapy in the Neonate: A Controlled Study
Authors: Finer N. N. , Boyd J.
Published: December 2021

The effect of postural drainage alone was compared to postural drainage with chest percussions on the arterial blood gases of 20 neonates with respiratory distress. There was no significant alteration in the arterial PO2 following postural drainage alone, with a significant increase (14.5 mm Hg) following postural drainage with chest percussions. The PO2 midway through postural drainage with percussions showed a small (5 mm Hg) but nonsignificant rise in the PO2, suggesting a gradual improvement throughout the use of this form of therapy. There was no significant change in the pH or PCO2 with either procedure. Appropriately performed chest percussions will result in an improvement in oxygenation in neonates with respiratory distress.
A BLACK HOLE
Authors: Lawson I. R. ,   Student
Published: December 2021

. . I [do] not infer . . . that the choice is between a humane caring for the chronically ill and disabled on the one hand and public-health interventions on the other. Neither are doing well at present (in the United States 18 million children are not protected from poliomyelitis) and there is no need to worsen their case by implying that they are competitive. The voracious competitor to them both is high-cost technology, centered on the doctor-hospital complex. Even in developed countries, it is losing touch with the real biology of need. By reason of its intramural psychology, its control on education, and its autonomous costing, it curbs the invention and development of the medium and low cost technology services which are required to support the well-being of communities and the personal care of their large, needy minorities, whether they be rural villagers or urban elderly. Given infinite time and money, the doctor-hospital complex will never of its own extend outwards towards them. For it is a kind of black hole in the medicosocial sky: more resources only make it denser.
Gonadotropin Excretion and Body Composition
Authors: Penny Robert , Goldstein Irwin P. , Frasier S. Douglas
Published: December 2021

Urinary follicle stimulating hormone (FSH) and luteinizing hormone (LH) excretion was correlated with calculated total body water (TBW) and body fat (BF) in 140 normal girls and 142 normal boys, ages 3 to 16 years.

In girls, there was a significant increase in gonadotropin excretion at the time of a significant increase in BF as a percent of body weight and decrease in TBW as a percent of body weight. Pubertal changes in body composition were seen in girls at the same chronological age and stage of puberty as increased gonadotropin excretion.

Similar findings were observed in boys. Pubertal changes in body composition (an increase in TBW as a percent of body weight and decrease of BF as a percent of body weight) accompanied significantly increased gonadotropin excretion. Both developmental changes were seen at the same chronological age and stage of puberty.

Our findings are consistent with the hypothesis that characteristic changes in body composition as well as the other hallmarks of puberty, including menarche in girls, result from increased gonadotropin and gonadal steroid secretion. They do not support the hypothesis that changes of body composition trigger increased hypothalamic function and hormone secretion leading to the subsequent events of puberty.
THE AGE OF MENARCHE IN LONDON IN 1870
Authors: C. T. E.
Published: December 2021

The following statistics were obtained from women who appeared at the University College Hospital (in 1870) to be attended in their confinement.

In 2,696 cases menstruation occurred for the first time-

From these cases it would appear most common at 14 years of age, then 15, 16, 13, 17, 12, 18, 19, 20, 10.

The mean age in these cases is 14.96 years nearly.
Ischemic Colitis and Stricture After Hemolytic-Uremic Syndrome
Authors: Sawaf Hadi , Sharp Marcia J. , Youn Kum J. , Jewell Patrick A. , Rabbani Ali
Published: December 2021

The hemolytic-uremic syndrome (HUS) was first described by Von Gasser et al.1 in 1955 as a syndrome of acute renal failure, hemolytic anemia, and thrombocytopenia in children. Follow-up studies on HUS have emphasized hypertension and uremia as late complications.2,3 A review of the literature has revealed no previously reported cases of persistent colitis and bowel stenosis after HUS. We present a child who continued to have intermittent intestinal obstruction and diarrhea until surgical removal of a segment of colon almost seven months after the onset of HUS.

CASE REPORT

A 26-month-old white boy who had no history of gastrointestinal disturbance had sudden onset of diarrhea with blood and mucus in the stool.
Hyperkinesis revisited
Authors: Eisenberg Leon
Published: December 2021

Four decades after Bradley's introduction of amphetamines for the treatment of childhood behavior disorders1 and two decades after the confirmation of his clinical observations by placebo-controlled trials, there is an ongoing debate about the effectiveness of stimulants, the indications for their use, whether hyperkinetic behavior disorder is a syndrome, and what inferences can be made about its cause. The paradigm of the double-blind trial was correct as far as it went, but it has become evident that it did not go far enough; that is, there is no reason to doubt the repeated demonstration of symptomatic benefit in the four to eight weeks of experimental studies, but investigators were slow to appreciate the long-term nature of the clinical problem.
Early Pancreatectomy in Neonatal Hyperinsulinism
Authors: Aynsley-Green A.
Published: December 2021

I would like to endorse the recommendation by Crowder et al. (Pediatrics 57:897, June 1976) that early pancreatectomy is indicated in neonates with severe hypoglycemia due to hyperinsulinism from pancreatic β-cell abnormalities by briefly reporting our experience in managing such an infant (a full report is in preparation for publication).

A boy born at term and weighing 4.38 kg was transferred to our hospital at the age of 24 hours having suffered a convulsion associated with a nonrecording Dextrostix.
Early Diagnosis of GBS Pneumonia Using Tracheal Aspirates
Authors: Rajani K. B. , Goetzman B. W. , Wennberg Richard P.
Published: December 2021

The association between hyaline membrane disease (HMD) and group B streptococcus (GBS) was once again highlighted in the article by Lilien et al. (Pediatrics 60:360, September 1977). We routinely perform tracheal aspirates on all newborns with respiratory distress as part of their initial evaluation. It has been our experience that GBS pneumonia as evidenced by clinical features and proved by culture-positive tracheal aspirates is not necessarily correlated with positive cultures of blood and CSF. During the past year (July 1, 1976, through June 30, 1977) we have had ten infants with HMD in whom GBS was isolated from the tracheal aspirates, seven of ten from blood, and only four of ten from CSF.
Letter to the Editor
Authors: Silverman Frederic N.
Published: December 2021

There are several reasons for a roentgenographic examination of the suspected child abuse victim, including radiographic confirmation and evaluation of obvious trauma for purposes of medical management as well as diagnosis; screening to identify clinically silent, recent injury or evidence of prior injury; and to provide a baseline for comparison with follow-up films. Under no circumstances should a radiographic examination be a substitute for a careful physical examination.

Assuming that all areas of the child's body where clinical signs can be found have been examined, what constitutes a necessary and sufficient roentgenographic examination to complement the medically indicated examination or to identify occult evidence of skeletal injury where clinical signs are lacking?
Drs. Greenwood and Nadas Reply
Authors: Greenwood Ronald D. , Nadas Alexander S.
Published: December 2021

Speed of referral for cardiac evaluation, accuracy of diagnosis, and parental and physician attitudes have changed in the last few years, resulting in more aggressive intervention in the infant with congenital heart disease and Down's syndrome. The study reported in Pediatrics reviews the "clinical course" at a major cardiac referral center, which during the years noted neither denied care nor aggressively intervened in babies with multiple anomalies. Many children in the review were not operated on and at the time of entry into the center should not have been.
Dr. Blumenthal Replies
Authors: Blumenthal Sidney
Published: December 2021

I am responding to the letter from Dr. Berenson and his colleagues at the request of the members of the Task Force on Blood Pressure Control in Children. Their comments and reactions to the letter are incorporated into this response.

The members of the Task Force would like to express their appreciation for the very thoughtful comments in the Berenson letter. It is encouraging to note that internists have become involved in the problems and challenges of blood pressure control in children.
THREE 18th CENTURY PRESCRIPTIONS FOR THE TREATMENT OF WORMS IN CHILDREN
Authors: C. T. E.
Published: December 2021

Worm infestations must have been extremely common in colonial American children because of the prominence given its cure in books, almanacs, and even newspapers of the period.

The three prescriptions below were taken from publications well known to 18th century American parents.

Take Myrrh and Aloes of each alike, finely powdered; and with a few drops of Chymical Oyl of Wormwood, or Savin, with a little Turpentine, mix them and make them up for a Plaister for the Child's Navel.1

Boil a handful of rue and wormwood in water; forment the belly with the decoction, and apply the boiled herbs as a poultice; repeat the application night and morning. This frequently brings away worms from children who will take no internal medicine.2

There is not a faster or surer Remedy to kill worms in children than to take 6, 8, or 10 red Earth-Worms, and let them purge in Bay Salt, then slit them open and wash them in fair Water, then dry them in an Earthern Dish and beat them to a Powder, and give them to the Child in the morning fasting, for 3 or 4 Mornings, but let them eat nothing for an hour after.—Poor Tom's Almanac, 1950.3
THERAPEUTIC NIHILISM
Authors: Starr P.
Published: December 2021

The recent debate over medicine has failed to address a central issue. Is it the purpose of national medical policy to maximize the health of the country, or is it to underwrite the services that individual physicians believe are warranted for their individual patients? The two are very different. If we continue to follow the second policy, we should not try to measure it by the standard of the first. It will always be found wanting.

The therapeutic nihilism of the nineteenth century had its justification in objective fact. We now know that it was correct: most medical treatment of the day was absolutely useless. Much of it—the bleeding, blistering, and purging of patients—was lethal. By helping to rid medicine of such techniques, therapeutic nihilism contributed to the liberation of medicine from the dead hand of the past. Today, medical institutions are often as ineffective as specific treatments were then. Let us hope that the new therapeutic nihilism, which questions the medical system in its totality, will have the same liberating effect.
Sinus Node Dysfunction in Children, Adolescents, and Young Adults
Authors: Yabek Steven M. , Jarmakani Jay M.
Published: December 2021

Thirty children and young adults with electrocardiographic and clinical evidence of sinus node dysfunction (SND) are described. Ages ranged from 3 days to 25 years. Of these, 10 patients had inappropriate sinus bradycardia, 16 had periods of sinus arrest, and 9 had sinoatrial exit block. A total of 22 patients had significant heart disease and SND developed in 13 after cardiac surgery. Eight patients with SND had no obvious heart disease. Seven patients were symptomatic, having either syncopal (three) or nearsyncopal episodes (four). The three with syncope have received permanent demand pacemakers. Although significant SND occurs most frequently in children with congenital heart disease, particularly following corrective cardiac surgery, it may occur in otherwise normal individuals.
FAILURE OF PREVENTIVE MEDICINE
Authors: Gray J. A. Muir ,   Student
Published: December 2021

I suggest that the main reason why people choose to act in a way that puts them at risk is because their concept of the future is different from that of those who give them advice. We ask people to desist from behaviour which is immediately rewarding, offering as an alternative a reduction in the probability that they will become unwell in the future, the future being a decade or more from the point at which the decision must be made....

Although this hypothesis is difficult to test, the change in the way in which the consequences of cigarette smoking are presented (the fact emphasised is that cigarettes make one unattractive to kiss now rather than that they cause illness in ten or twenty years) shows that it has already been adopted by some health educators. I do not know whether it is possible to give an air of immediacy to the reasons for preventive medicine. I do say, however, that our inability to persuade people to adopt the means by which they can decrease the probability of illness, pain, and premature death requires a new approach to postpone immediate gratification for the offer of a possible reward in an inconceivable future.
Successful Transplantation of the Thymus in Nezelof's Syndrome
Authors: Shearer William T. , Wedner H. James , Strominger Donald B. , Kissane John , Hong Richard
Published: December 2021

A 6-month-old girl with congenital thymic dysplasia or Nezelof's syndrome (lack of T cell function and normal levels of immunoglobulins) was given a transplant of a human thymus gland from a 14-week-old fetus and is surviving 36 months after transplant. Her clinical condition is the principal index of the success of the transplant since most in vitro and in vivo data indicate a full immunologic restoration has not been achieved. However, the number of E-rosettes in the peripheral blood has increased, the number of surface immunoglobulin-bearing cells has decreased, but there is little improvement in mitogen responsitivity. Immunoglobulin levels have increased with age, but there is no demonstrable specific antibody activity. Nevertheless, she remains free of infection, living in an unprotected environment.
THE LAND OF MACHINES
Authors: Smith Michele Lynn
Published: December 2021

Sitting here in the land of machines Holding the hands of the ones we love A beeper sounds, a red light flashes, And fear runs away with our hearts.

Those strange incomprehensible machines Made up of buttons and switches and flashing lights And buzzers beeping to every tune Telling us how strongly our loved ones live.

To sit there and watch helplessly As the blood flows red As the heart stops beating As the lungs stop breathing Is worse than any death.

To hold the hands of the ones we love As the veins and arteries deteriorate As the sores grow worse As the eyes grow blind and the bones grow weak Is worse than any fate.

We cry and pray and try to be strong And we put on an act for the world While inside we are filled with pain As we sit there holding the hands of the ones we love While fear runs away with our hearts Sitting in that land of machines.
JOHN LOCKE IN 1684 DESCRIBES THE REMARKABLE RECOVERY OF A 6-YEAR-OLD DUTCH GIRL FROM A DREADFUL BURN OF THE SCALP
Authors: C. T. E.
Published: December 2021

While visiting the medical school at Leyden in 1684, John Locke (1632-1704), the celebrated English physician and philosopher, met Dr. Lucas Schacht (1634-1689) who showed him the remarkable case of a 6-year-old girl who had recovered after having lost about one third of her skull from a frightful burn.

Locke wrote the following (his spelling has been retained):

Frid. Nov. 17 [1684]. I was Sarah Vander Speck a girle about 6½ years old a great part of whose scul I had seen yesterday by Dr. Schafte [Schacht] who is professor magnificus, viz. 2 of occipitis and a great part of the 2 ossa bregmatis which togeather could not I think be lesse then ½ of the scull.

The story in short is this. This girle when she was about 1½ old being left alone by the fire in her standing stoole fell down on the hearth and was found lying with her head neare the moderately smal turf fire at her mothers returne quite senselesse. She had lain there soe long that not only her head clothes and haire were burnt but the flesh of her head also and the bones of her scul which were afterwards taken out were burnt black on the out side, and retaine that colour still, the fire seemeing also by the appearance it has still to have penetrated the inside of the scul but not soe as to make it blak. The uper part also of one (I thinke her right) eare was burnt away. This accident happend on the 6th December.
Please Report Kawasaki Disease
Authors: Morens David M. , Nelson David B.
Published: December 2021

In a letter to the editor in the July 1977 issue of Pediatrics (60:133), Drs. John and Wilson drew attention to the geographic prevalence of Kawasaki disease (mucocutaneous lymph node syndrome). Kawasaki disease has been reported not only from Japan, Korea, Canada, Greece, Hawaii, and the continental United States, but also Australia,1 Belgium,2 the Netherlands,3 Italy,4 West Germany,5 Sweden,6 England,7 Scotland,8 and Turkey,9 as well as Spain, Mexico, Taiwan province, and the Philippines (Center for Disease Control [CDC], unpublished data).
More About the Photodistribution Viral Exanthems
Authors: Uhari Matti
Published: December 2021

Dr. Cupoli reported photodistribution of viral exanthems (Pediatrics 59:484, March 1977) just as Gilchrest and Baden had done earlier.1 Their conclusions are obviously right, but I would like to remind the reader of another disease, swimmer's itch, which may occur like the exanthems Cupoli reported.2 The lesions in Figure 1 of Cupoli's report resemble very much real swimmer's itch (accompanying Figure). It is caused by a worm, cercaria ocellata, and is acquired by swimming in infected water.3
Comments on Nutrition Committee Statement
Authors: Silverio John
Published: December 2021

This is a comment on the statement on the nutritional needs of low-birth-weight infants, made by the Committee on Nutrition of the American Academy of Pediatrics (Pediatrics 60:519, October 1977).

1. In the section on water requirements (p. 519), the document states that "preterm infants excrete sodium well." This statement is backed tip by two references.1,2 Although the two quoted references are reliable, it is also true that other published data have shown that premature babies do not excrete sodium well, with subsequent retention of water.3
Polyarteritis and Streptococcal Infection
Authors: Fink Chester W.
Published: December 2021

The clinical and laboratory findings reported by Blau et al. (Pediatrics 60:227, August 1977) of polyarteritis nodosa (PAN) in older children are similar to those found in seven older children with PAN in Dallas.1 Six of these seven children had a preceding throat or ear infection. Antistreptolysin-O titers were obtained in five and all were elevated to a minimum of 500 Todd units. Thus in these two series all 14 patients who were tested had elevated antistreptococcal antibodies.
Xeroderma Pigmentosum and Cockayne Syndrome
Authors: Dupuy J. M. , Lafforet D.
Published: December 2021

In the August 1977 issue of Pediatrics (60:135, 1977), R. D. Schmickel et al. demonstrated an increased ultraviolet (UV) light sensitivity and normal DNA repair by Cockayne cells.

In 1974 we published the case of a 10-year-old girl who presented clinical manifestations of both Cockayne syndrome and xeroderma pigmentosum.1 Since the cells of this patient were DNA repair-deficient, we postulated that the various clinical profiles observed in xeroderma pigmen-Ultraviolet (UV) light-induced tritiated thymidine incorporation into 106 lymphocytes from normal donors and patients during five hours of incubation after UV light irradiation (30 and 300 ergs/sq mm).

See image in the PDF file
THE SIZE OF CITIES
Authors: Sale Kirkpatrick ,   Student
Published: December 2021

. . . records of urban populations suggest that for most of human history cities did not generally grow beyond the 50,000 to 100,000 range. For most of its celebrated life the city of Athens hovered around 50,000 people, though at periods of particular power the surrounding state may have grown to 150,000 or 200,000. The Italian cities that nurtured the Renaissance were no larger than 80,000, and most of them held closer to 50,000—the Rome of Michelangelo had perhaps 55,000 people, the Florence of Leonardo 50,000, and Venice, Padua, and Bologna at their height probably 50,000 to 80,000. Boston and Philadelphia at the time of the Revolution did not have more than 30,000 people, New York had even fewer. In fact, it seems that only rarely did historical cities go much beyond 100,000, and then only temporarily when serving as the capitals of empires. . . . The very existence of giant cities is so recent as to be a mere eye-blink in recorded history. It was not until 1800 that any city grew to more than one million people—that was industrialized London—and by 1900 there were only ten others of that size.

The conclusion of the great Greek city planner Constantine Doxiades, who spent his life categorizing such things, seems on the mark: "If we look back into history . . . we find that, throughout the long evolution of human settlements, people in all parts of the world have tended to create urban settlements which reached an optimum size of 50,000 people."
Presidential Address—1977: Pediatrics—Changes and Opportunities
Authors: Van Gelder David W.
Published: December 2021

This past year has been a most gratifying one for me, not because of any personal accomplishments, but because I have had the opportunity to witness the ways in which so many people have contributed to the Academy's goal of improved health for the nation's children. Everywhere I have gone—to meetings of national committees and medical groups, to discussions with government officials—I have found able pediatricians engaged in a variety of activities. All of these men and women seemed genuinely interested in their chosen role, whether it involved practice, research, administration, education, or community service. They expressed personal satisfaction in their work, and displayed a great dedication to the well-being of children. Meeting so many exceptional people has been the personal highlight of my term as president.

I have been greatly impressed with the amount of dedication and goodwill within the pediatric community. Yet, I have also detected a certain uneasiness among pediatricians, indeed among physicians in general. There is a feeling that medicine is entering a crucial period, and difficult choices about future directions must be made. Not knowing which choices should be made lies at the heart of medicine's restlessness. After all, the light at the end of the tunnel could be the headlight of an onrushing train. As the poet W. H. Auden said, "It takes little talent to see clearly what lies under one's nose, a good deal of it to know in which direction to point that organ."

One thing, though, is becoming increasingly clear.
USEFUL PRODUCT LIFE
Authors: Papanek Victor , H. R. J.
Published: December 2021

See table in the PDF file

". . . the correlation between the ‘primary useful product life’ and the actual use works to the disadvantage of the have-nots of the world. . . ."
Persistent Müllerian Duct Syndrome in Male Identical Twins
Authors: Weiss Edra B. , Kiefer Joseph H. , Rowlatt Ursula F. , Rosenthal Ira M.
Published: December 2021

Male pseudohermaphroditism, characterized by the persistence of Müllerian duct structures with otherwise normal differentiation, is a rare disorder that appears to be caused by an abnormality in the activity of Müllerian inhibiting factor.1 Patients with this syndrome are phenotypically normal males who usually present with inguinal hernia and cryptorchidism. This condition has also been called hernia uteri inguinalis, persistent Müllerian duct syndrome, and male internal pseudohermaphroditism. It has recently been suggested that hysterectomy may not be indicated in most of these patients because of possible injury to the vas deferens.2

The condition appears to be genetic, since familial incidence occurs. Brook et al.3 reported four affected pairs of brothers in unrelated families.
Edith B. Jackson, M. D
Authors: Kempe C. Henry
Published: December 2021

Edith Jackson, one of the true pioneers in the fields of behavioral pediatrics and child psychiatry, died at the age of 82 on June 5, 1977, in Denver, in her sleep. She had been thoroughly active and well until her death.

Edith Jackson was born in 1895, and received her B.A. from Vassar in 1916 and an M.D. from Johns Hopkins University in 1921. After a two-year internship, first in medicine and then in pediatrics, she was prominent with Dr. Martha Eliot in developing the New Haven rickets study for the U.S. Children's Bureau between 1923 and 1928 while she held the rank of an instructor in pediatrics at the Yale University School of Medicine.
Perspectives on chronic nonspecific diarrhea: Dietary management
Authors: Cohen Stanley , Lake Alan M. , Mathis Richard K. , Walker W. Allan
Published: December 2021

Chronic nonspecific diarrhea (CNSD) of childhood, originally thought to be part of the celiac syndrome, was described as a separate clinical entity by Cohian1 in 1956. In the ensuing years, CNSD has been appreciated to represent one of the most common causes of prolonged diarrhea in the infant and toddler. Yet confusion remains regarding its cause and treatment.

Drs. Davidson and Wasserman2 have described consistent diagnostic criteria further characterizing CNSD as a recognizable syndrome. The onset of symptoms occurs classically between 6 and 30 months of age with the development of three to six loose and often mucousy stools per day.
Tap Water Scald Burns in Children
Authors: Feldman Kenneth W. , Schaller Robert T. , Feldman Jane A. , McMillon Mollie
Published: December 2021

Tap water scald burns account for 7% to 17% of all childhood scald burns that require hospitalization. Often the burns are severe and disabling. Toddlers and preschool children are the most frequent victims. In 45% of the injuries, the unsupervised victim or a peer turned on the tap water; in 28% the cause was abuse. Eighty percent of the homes tested had unsafe bathtub water temperatures of 54 C (130 F) or greater, exposing the occupants to the risk of full-thickness scalds with 30-second exposure to hot water. Such burns may be prevented passively by limiting household water temperatures to less than 52 C (125 F). New water heaters could be preset at this temperature and families could be taught to turn down the temperature on existing units.
Neonatal Death: Reflections for Parents
Authors: Elliott Barbara A.
Published: December 2021

We have something in common. My baby died, too. In fact, two of my babies died. You and I know how hard life is when that happens. That is why I am writing this—to share with you what each of us has to feel, think, and talk about before time finally numbs the emptiness. Many of my feelings are hard to write about, but I know they are normal. I want you to know that too.

It takes a long time before these feelings are no longer a part of every day or even every hour. But life eventually regains its meaning. I hope that telling you my story will help you understand your feelings and perhaps make things easier for you.

I had twin boys, and each died at 1 week of age. When my first son died, I was numb and full of hope for the other. Then the second baby died too. I was shocked at what was happening to me and was left feeling totally empty. I wanted my babies. Every time I closed my eyes, I relived the experiences in the nursery. I could see each of them and wanted them. Nothing else in my life mattered.

I felt very alone and was not able to care about other people. I ate only because food was put in front of me, and I did not sleep well. Every minute hurt as it dragged by. I wondered if I could stand it. I wanted time to go faster so the pain would not be so bad.
Gastric Retention in Neonates
Authors: Gupta Madan , Brans Yves W.
Published: December 2021

Forty-seven healthy neonates were fed by nasogastric tube 10 to 20 ml/kg of 5-gm/dl glucose in water containing 0.24 mg/dl of phenol red as a marker. The proportion of test meal remaining in the stomach 30 minutes after feeding was measured. Gestational ages ranged from 34 to 44 weeks and birth weights ranged from 1,300 to 4,680 gm. Thirteen of 29 term neonates were appropriate for gestational age (AGA), six were small for gestational age (SGA), and nine were large for gestational age (LGA). Of the 18 preterm neonates, 6 were AGA and 12 were SGA. Each baby was studied three times: at 4 to 12 hours after birth, before any other feeding, at 22 to 36 hours, and at 46 to 60 hours. Preterm AGA babies retained more than term AGA neonates at both 4 to 12 hours and 22 to 36 hours. Preterm SGA neonates retained more than their term peers at 4 to 12 hours only. In both term and preterm neonates, 30 minute gastric retention decreased significantly from the 4- to 12-hour period to the 22- to 36-hour period, but it was similar at 22 to 36 hours and 46 to 60 hours. At no time were there significant differences in retention between AGA, SGA, and LGA babies-except at 22 to 36 hours when preterm SGA neonates retained less than their AGA peers. Thus 30-minute gastric retention was affected mainly by gestational maturity and postnatal age rather than by the quality of intrauterine growth.
Amniotic Fluid Lecithin/Sphingomyelin Ratio: Comparison Between an African and a North American Community
Authors: Olowe Samuel A. , Akinkugbe Ajibayo
Published: December 2021

One hundred nineteen samples of amniotic fluid obtained from healthy pregnant Nigerian women were analyzed for their lecithin/sphingomyelin (L/S) ratio. There was a gradual increase in the L/S ratio with increasing maturity from week 23 to week 42 when values of 0.69 and 5.73, respectively, were obtained. Compared with the ratios reported from San Diego, our ratios were significantly higher where numbers were adequate for statistical tests. The higher L/S ratio probably shows that pulmonary maturity occurs earlier in the African babies and might partly explain the low incidence of respiratory distress syndrome in our premature babies.
Antibody to Hepatitis A and B in Children in New York
Authors: Cherubin Charles E. , Dienstag Jules L. , Szmuness Wolf L.
Published: December 2021

The article "Antibody to Hepatitis A and B in Children in New York City" by Cherubin et al. (Pediatrics 61:781, May 1978) should have included an acknowledgment of the services provided by Drs. Ramesh Jhaveri and Sophie Pierog.
PROFESSIONAL REMUNERATION
Authors: Hackett E.
Published: December 2021

. . . To me it now seems a simple anthropological fact of our culture that ever wider obvious fee-chasing reduces our status and consequently our autonomy and liberty of action in real social terms. The remedy is simple enough, to receive more of our remuneration by the displaced-in-time device of salary or session payment or capitation grant in various forms. Now I know that it is argued by many that this could not increase our liberty but would reduce it by making us dependent on some potentially ill-disposed paymaster. There is no good evidence to support that view. One has only to look at the liberty of action and freedom from interference enjoyed by the judiciary, and also by academics, politicians and clergy, to realise that a salary is compatible with great professional freedom.
Tuberculosis among children in the United States: 1978
Authors: Kendig Edwin L.
Published: December 2021

Tuberculosis mortality in the United States has declined sharply during the past three quarters of a century, from 200 per 100,000 population in 1900 to 1.8 per 100,000 population in 1974.1 The number of persons infected with tuberculosis has decreased proportionately. Whereas even 40 years ago the rate of tuberculin sensitivity among youths of high school age (15 to 19 years) was approximately 32%, a 1958 to 1969 survey of more than a million Navy recruits 17 to 21 years of age showed that only slightly more than 5% were reactors.2

From these statistics it would appear that eradication of tuberculosis in the United States is imminent.
Enterobacter aerogenes Primary Bacteremia in Pediatric Patients
Authors: Edwards Kathryn E. , Allen James R. , Miller Marilyn J. , Yogev Ram , Hoffman Philip C. , Klotz Roger , Marubio Sandra , Burkholder Ernest , Williams Thomas , Davis A Todd
Published: December 2021

Enterobacter aerogenes bacteremia associated with the infusion of contaminated admixed intravenous (IV) fluid occurred in seven patients in a pediatric hospital over a five-day period. Clinical illness was characterized by spiking fever in all patients. The temporal clustering of cases allowed for rapid recognition of the problem. The primary control measure was the prompt replacement of the IV fluids, although IV antibiotics were also administered. Hospital pharmacy practices for admixing IV solutions should follow published recommendations to minimize this source of potential contamination of fluids.
Sodium Concentration of Homemade Baby Foods
Authors: Kerr Clark M. , Reisinger Keith S. , Plankey F. W.
Published: December 2021

Ingestion of excess salt may be an important factor in the development of hypertension in individuals who are predisposed to this disease genetically or through environmental factors. Some physicians and consumer groups have encouraged mothers to prepare their own baby foods, in part because of their concern that the physiologically unnecessary salt that is added by some commercial baby food manufacturers may lead to hypertension in adult life. This study presents data on the sodium concentration in 70 samples of homemade baby foods prepared by 36 mothers. The mean estimated amount of added salt was 0.41%/ weight—64% higher than the maximum recommended by the Food and Nutrition Board of the National Academy of Sciences. Home-prepared foods had a sodium concentration 1,005% higher than similar baby food products made by Heinz and Beech-Nut and 24% higher than products made by Gerber. The data suggest that advice to parents to prepare their own baby food or to feed their infant food from the table should be tempered with the knowledge that these foods may contain higher salt concentrations than the commercial baby foods.
DR. ARTHUR WENTWORTH AND THE FIRST LUMBAR PUNCTURE AT THE BOSTON CHILDREN'S HOSPITAL IN 1895
Authors: C. T. E.
Published: December 2021

In August 1895 Dr. Arthur Wentworth performed the first lumbar puncture ever done at the Children's Hospital in Boston. The patient was a 2-year-old girl with a doubtful case of tuberculous meningitis. The experience proved a harrowing one for Wentworth, as is evident from his description of it.

We punctured the spinal canal, using for the purpose the needle from an antitoxin syringe, and withdrew six cubic centimetres of a clear fluid which looked like distilled water. No tubercle bacilli were found....

Immediately after tapping the canal the child became restless, throwing herself about the bed, clutching at her hair and giving vent to short cries. The pulse rose to over 250 in the minute, the respiration was superficial, and the skin was cool and slightly livid. Subcutaneous injections of brandy and ether were given, heaters applied, and the foot of the bed raised. This condition persisted about the same for three-quarters of an hour, and then the child became quieter.1

During the attack I felt considerable uneasiness because I was unprepared for such a result and did not know but that it would terminate fatally. I now believe that the symptoms were due to headache, caused by the removal of fluid, and that her life was not endangered.2
Congenital Cystic Adenomatoid Malformation of the Lung Associated With Abdominal Musculature Deficiency (Prune Belly)
Authors: Wilson Stephen K. , Moore C. William , Hutchins Grover M.
Published: December 2021

"Prune belly"—a deficiency of abdominal niusculature usually associated with urinary tract anomalies and cryptorchidism—has been explained by numerous theories. Some postulate a primary defect of abdominal musculature, producing renal dysfunction1; others suggest the reverse2; other proposals include a sex-linked inherited trait3, and an intrauterine insult (between six and ten weeks of gestation).4

Congenital cystic adenomatoid malformation of the lung (CCAM) is a distinct morphological entity, characterized by a proliferation of cysts lined by bronchiolar-like epithelium and a lack of cartilage and seromucous glands.5 CCAM has been postulated to be a harnartoma,6 a focal type of pulmonary dysplasia,7 or a development anomaly.8
TV update
Authors: Feinbloom Richard I.
Published: December 2021

The public debate over television and its impact on children is heating up. Two highly visible skirmishes of 1978 are the investigation into television advertising to children by the Federal Trade Commission (FTC) and the trial in California of a bizarre rape claimed to have been perpetrated in imitation of a crime which appeared on a television drama.

The FTC has scheduled nile-making hearings in the fall of 1978 to consider whether television advertising to young children is inherently "unfair and deceptive" and whether restrictions should be placed specifically on the advertising to children of sugared products. Entering into these deliberations will be research and anecdotal evidence and authoritative opinions about the developmental capacity of children to make discerning judgments regarding advertising; the relation between sugar intake and dental caries and obesity; and the potentially disruptive effects of TV commercials on family life.
Letter To The Editor
Authors: Wegman Myron E.
Published: December 2021

Dr. Talbot is quite right that social and demographic factors have considerable influence on the neonatal death rate, as for almost any specific rate. As I stated, improved neonatal care seemed to me a factor because the neonatal rate had dropped much more rapidly than the postneonatal rate. I may well have given too much weight to this observation.

On the other hand, I fear that, while Dr. Talbot's proposed case fatality rate could be useful and worth doing to analyze a particular hospital's experience, it would lead to more uncertainty than precision about the community.
Human Milk and Iron Absorption
Authors: Brock J. H.
Published: December 2021

In their study of iron absorption from human milk, simulated human milk, and proprietary formulas, McMillan et al. (Pediatrics 60:896, December 1977) reported that absorption was less efficient from the simulated human milk than from human milk, despite their "similar content of protein, lactose, fat, calcium, phosphorus, and ascorbic acid." However, the reported phosphorus content of the simulated human milk (23 mEq/liter) was in fact 64% higher than that given for human milk (14 mEq/liter).
Urinary Tract Infection Presenting With Jaundice
Authors: Naveh Yehezkel , Friedman Abraham
Published: December 2021

Jaundice was the presenting feature in an 8-year-old girl suffering from urinary tract infection (UTI) due to Escherichia coli. The jaundice cleared with the cure of the infection. The mechanisms of jaundice complicating UTI are discussed, and the importance of urine culture in infants and children with jaundice is stressed.