bluuebunny/crossref_metadata_2025 huggingface dataset:
Letter To The Editor
Authors: Orlowski James P. , Clough John D.
Published: December 2021

We appreciate the opportunity to respond to the letter of Drs. Moorthy and Chesney. They raise some very legitimate questions about the optimum therapeutic approach to rare diseases such as Wegener's granulomatosis (WG). Obviously, no single institution can accumulate a sufficient number of cases of WG to have statistically significant results in various therapeutic trials, as evidenced by the fact that our six patients with WG represent the largest single experience in the literature with this disease in children1 and our institution has one of the largest experiences with this syndrome.2,3
CURE FOR COMMON SPECTATOR: ADULT PLAY AREAS
Authors: Margolis Joseph
Published: December 2021

In recent years, taxpayers throughout the country have been asked to spend millions of dollars in support of the construction and refurbishing of stadiums and arenas, which are used primarily by a relative handful of highly paid professional athletes. . . .

Why are we spending so much on projects that can only benefit us indirectly? Have our values become inverted?

The answer is this: We are a nation of spectators, not participants. We don't seem to have the time, or the place . . . to engage in physical activity.
Multifocal Myocardial Necrosis and Fibrosis in Pancreatic Diseases of Children
Authors: Nezelof Christian , LeSec Guy
Published: December 2021

From a review of 2,000 autopsies of children, 16 cases of extensive necrosis and scarring fibrosis of the myocardium were found. These lesions involved mainly the left ventricle and spared the endocardium, the pericardium, and the coronary vessels. These necrotic or fibrotic heart lesions were found to be closely associated with various pancreatic diseases: cystic fibrosis (11 cases), pancreatic lipomatosis (2 cases), extensive small bowel resection (3 cases, 2 of which were associated with acute interstitial pancreatitis). To explain these unexpected associations, two hypotheses can be put forth: (1) The lack of absorption of some presently undetermined substances indispensable for the correct trophicity of the myocardium, and (2) the release in the blood of proteolytic enzymes with consecutive activation of phlogistic substances such as kinins.
MODERN INFANTICIDE
Authors: Piers Maria W.
Published: December 2021

The careless neglect of the nation's urban poor children is a contemporary version of the age-old practice of infanticide, of the industrialists' treatment of the "throwaway" children of the nineteenth century. . . . What they have in common with their earlier counterparts is that they are conceived of as insignificant. They are expendable. And, as long as we are able to pin the blame for so many violent misfits on some scapegoat institution, be it the media or the schools, we do not need to feel guilty about nor responsible for the beatings children receive. Like the cinquecento burghers, like the French government in the eighteenth century, we can wash our hands of the chain reaction of violence.
Assessing Immunization Services at a Neighborhood Health Center
Authors: Minear Ralph E. , Guyer Bernerd
Published: December 2021

American children are not adequately immunized. The 1976 US Immunization Survey found that among children 1 to 4 years of age, more than 33% had never received measles or rubella vaccine, 40% had not received three doses of polio vaccine, and 30% had not received three or more doses of diphtheria-pertussis-tetanus (DPT) vaccine.1 For any of these vaccines, immunization levels were lower for children living in the central cities than for those living in suburban areas.1 Surveys in Massachusetts confirmed these national findings, with pockets of low immunization found in the inner city areas of Boston.2

Recognizing the risks inherent in these low immunization levels, the US Department of Health, Education and Welfare (DHEW) announced an "immunization initiative" designed to achieve 90% coverage among two-year-olds by October 1979.3
Zinc Mistake
Authors: Smith Douglas
Published: December 2021

The Committee on Nutrition's review of zinc (Pediatrics 62:408, September 1978) was informative and timely. We have recently switched to zinc acetate after experiencing some vomiting problems with a zinc sulfate preparation. I would, however, appreciate clarification of the statement that refers to an oral zinc acetate preparation of 13 mg per milliliter yielding approximately 1 mg of zinc.

Zinc acetate USP is available in the dihydrate form with a molecular weight of 219.5.1 Zinc, having a molecular weight of 65.37, represents 29.8% of the total molecular weight of zinc acetate dihydrate.
Letter To The Editor
Authors: Barness Lewis A.
Published: December 2021

You are absolutely right. The statement on zinc by the Committee on Nutrition should have read ". . . 3 mg of zinc acetate (approximately 1 mg of zinc) per milliliter." Three milligrams is approximately correct. I think the absolutely correct figure is about 2.8 mg. We also use the dihydrate form.
Ganglioneuroblastoma and Fetal Hydantoin-Alcohol Syndromes
Authors: Seeler Ruth Andrea , Israel Jeannette N. , Royal Joyce E. , Kaye Celia I. , Rao Sita , Abulaban Mohammed
Published: December 2021

A ganglioneuroblastoma developed in a 35-month-old boy with both the fetal hydantoin and fetal alcohol syndromes. Our case, plus two recent reports in the literature, would very likely establish the relationship between fetal hydantoin syndrome and the development of neural crest tumors. Infants exposed in utero to hydantoins should be closely observed for the development of these tumors.
THE VALUE OF A SALT PORK COMPRESS IN THE TREATMENT OF A CHILD WITH SORE THROAT
Authors: Hale Amie M. , C. T. E.
Published: December 2021

Amie M. Hale, M.D., in 1880 wrote a popular book for American mothers entitled The Management of Children in Sickness and in Health.1 She treated sore throat as follows:

External applications [for sore throat] do great good oftentimes. An old-fashioned but an excellent remedy is a slice of fat pork, cut very thin, stitched to a bit of muslin, and applied by means of a flannel bandage. It may first be sprinkled with salt or powdered camphor to make it act more quickly.

The value of these simple remedies depends largely upon skill in preparing and employing them. After the bandage is ready, the pork being nicely stitched upon it, warm it slowly until it becomes soft, flexible, and oily on the surface. Then, if the soreness is high up under the angle of the jaw, the ends of the bandage should be brought up on the head and carefully pinned, not so tightly as to be uncomfortable, but so as to keep the slice of pork in close contact with the skin. If the soreness is lower down, the bandage may be simply fastened around the neck. This must be kept on for some time. After twenty-four hours, a slight eruption will appear under the bandage, when it may be left off for a little while and afterwards reapplied. But in twenty-four hours we should expect a simple sore-throat to be very much improved.
A DAILY TRIP ACROSS THE HUDSON RECOMMENDED FOR TEETHING INFANTS
Authors: Mott Valentine , C. T. E.
Published: December 2021

Dr. Valentine Mott (1785-1865), one of the foremost American surgeons of his day, in a supplement to Infant Treatment,1 by Mrs. Louisa Mary Barwell (1800-1885), had this to say about the value of pure air for infants suffering from teething:

When a child, pent up in the confined and impure atmosphere of our cities, has become emaciated by teething, and perhaps brought to death's door by cholera infantum, it is surprising to see with what rapidity he is restored, on removal to the pure air of the country. This seems to be a specific for nearly all the disorders, which arise from teething; and, accordingly, all our writers on diseases of children, recommend this as an indispensable, and the only remedy, almost, which is needed. We have been in the habit, for the last twenty years, of recommending to those who dwell in the city of New York, a daily trip, across the river to Hoboken, during the summer months, for children undergoing the process of teething, and we have found, where this has been practiced, that dentition has, in a very large majority of cases, been attended with little or no inconvenience.
Effect of Heparinization of Fluids Infused Through an Umbilical Artery Catheter on Catheter Patency and Frequency of Complications
Authors: Rajani Krishna , Goetzman Boyd W. , Wennberg Richard P. , M.D. Ernest Turner , Abildgaard Charles
Published: December 2021

Heparinization of fluids (1 unit/ml) infused through an unibilical artery catheter (UAC) was efficacious in prolonging catheter patency in a double-blind, randomized, controlled clinical study. On the basis of life-table analysis, the half-life of catheter function was seven days in the heparinized group as compared with just over two days in the nonheparinized group (P < .01). UAC occlusion occurred imi 4 of 32 patients in the heparinized and in 19 of 30 in the nonheparinized group (x2 = 17.6, P < .01). Blood transfusions, number of arterial blood gases drawn through the UACs, and fluid infusion rates were not related to catheter occlusion. Heparinization of the UAC infusion did not alter the partial thromboplastin time or the incidence of catheter-related thromboembolic pheniomena in the extremities. Heparinization of fluids infused through a UAC appears to be useful in the care of critically ill neonates.
Society vs the Wheelchair
Authors: MacElman Rose Marie
Published: December 2021

Rose Marie became a patient of mine at the age of 2½, just one month after I began practicing pediatrics in July of 1962. She had typical childhood illnesses and seemed otherwise normal until March of 1965, when on her preschool physical exam I picked up mild ataxia and a positive Romberg's sign. This showed slow but steady progression, so a year later I referred her to a neurologist. He felt she had a progressive degenerative cerebellar disease of unknown etiology. At that time, her only problems were an unsteady gait and "shaky" handwriting. In 1971 her sister, five years younger, was noted to have an identical disability.

By 1972, Rose Marie had ECG abnormalities consistent with Friedreich's ataxia. By that time she was confined to a wheelchair, had slurred speech, and a progressive scoliosis. In five more years she had developed diabetes mellitus (felt to be unrelated), occasional choking spells, and marked weakness and ataxia of her upper as well as lower limbs, distally more than proximally. She has absent deep tendon reflexes and loss of position and vibratory sensation in the lower limbs.

Despite her problems, Rose Marie is a B student and a very personable young lady. In the spring of 1978, a few months before she was to graduate from high school, I was sent a form from the state vocational rehabilitation director regarding her potential and prognosis. Although I felt I knew Rose Marie as well as any of my patients, my immediate reaction was, "Rehabilitation?
CHAUVINISM IN MEDICINE
Authors: Osler William
Published: December 2021

The doctor's intellectual independence may keep the practitioner out of the clutches of the arch-enemy of his professional independence—the pernicious literature of our camp-followers, a literature increasing in bulk, in meretricious attractiveness, and in inpudent audacity. To modern pharmacy we owe much . . . but the profession has no more insidious foe than the large pharmaceutical houses. We all know only too well the bastard literature which floods the mail, every page of which illustrates the truth of the axiom, the greater the ignorance the greater the dogmatism. Much of it is advertisements of nostrums foisted on the profession by men who trade on the innocent credulity of the regular physician. . . . No class of men with which we have to deal illustrates more fully that greatest of ignorance which is the conceit that a man knows what he does not know.
WHY DO YOU WRITE?
Authors: Healy J. B.
Published: December 2021

Sir: The number of medical papers published is monstrously large. How much has one really learned from last year's erratic efforts to read journals? And think of all the work involved in producing the published and the unpublished papers, the millions of blood samples, and the laboratory tests, and of all the assistants, medical and paramedical, who had to be employed; and think of all the people who were measured and tested as controls. Was the primary object of all this to improve the treatment of disease or to publish papers? If the former, then publishing is only a secondary object—that of letting other doctors know something that may be of use to them. But if publication is the primary object, then one naturally suspects that the work is being done for advancement and benefit of the author(s); it is scarcely being done for the benefit of other practitioners.

It seems to me that we should, for an experimental period of a year, declare a moratorium on the appending of authors' names and the names of hospitals to articles in medical journals. Just print the article.

If the dissemination of information is the reason why papers are submitted for publication, there will be no falling-off in the numbers offered. If the honest search for better treatment is the object of trials, there will be no lessening of the amount of tests and measurements performed in hospitals. But if there is a big saving in costs in the Health Service and far less material is offered to the journals, we shall have unmasked ourselves.
Physician Extenders and the Cost of Medical Care, January 1979
Authors: Davidson Stephen M. , Connelly John P.
Published: December 2021

The existing evidence does not support increasing the number of physician extenders as a reliable cost-containing measure. More research is needed on the conditions under which they can limit costs and those under which they may increase costs.

There may be other reasons for use of physician extenders, however, such as to maintain existing levels of productivity and allow the physician to work shorter and better scheduled hours; to replace foreign medical graduates as hospital staff; and to increase comprehensiveness of cane and maintain continuity.
THE SOCIALIZATION OF THE NEW PROFESSIONAL
Authors: Larson M. L.
Published: December 2021

For most recognized professions, an orderly career begins with training in professional schools or universities. The authoritative and authoritatian framework of relations between teachers and students is a fundamental element of institutionalized professional socialization. The hierarchy of excellence and prestige by means of which a profession legitimizes its internal stratification is produced in the university; professional recruits internalize it, first, in that context. The student's inevitable subordination and acceptance of his teachers' supervision are immediately and tacitly justified in terms of the teachers' greater expertise. The interrelations between the context of training and the contexts of practice are personalized; the teaching elites of a profession are often elite practitioners in the field. In any case, their personal sponsorship guarantees the proper socialization of the students to the professional world outside the school. As Friedson and Rhea remark: "Successful completion of a professional education in an objective measure of . . . technical and normative socialization, but its inadequacy seems to be implied by the characteristic tendency of professionals to rely on personal testimonials and recommendations."

These personalized warrants do more than simply insure the adequate socialization of the new professional, guaranteeing that his "compliance and consent" will not be too difficult to obtain; they reinforce the control by an elite and the latter's legitimacy. Prestige filters down, from the "great men" in a field to those who study or work under them, through ideological mechanisms; the formation of cults and the vicarious enjoyment of the great man's prestige by his underlings are characteristic of the training situation, but they also extend to the world of work.
Food Intake and Growth of Children Between 30 and 48 Months of Age in Jerusalem
Authors: Palti Hava , Reshef Avraham , Adler Bela
Published: December 2021

The food intake and body size of a sample of children from a western neighborhood of Jerusalem were determined at 30, 36, and 48 months of age. The mean caloric intake was below the 100% of the Recommended dietary allowance (RDA). The percentage of children receiving less than 100% of the RDA increased slightly with age. Less than 20% of the children had intakes below 60% of the RDA. The mean protein intake was 200% of the RDA. Iron intake met the World Health Organization recommendations. The heme component of the iron intake decreased with age. The mean protein and caloric intake increased as the mother's educational level increased. The weight and height distribution of this population does not differ significantly from the US reference population. At 48 months of age, the children are heavy for their height. Some difficulties of dietary intake studies and the association between food intake and growth are discussed.
Fetal and Neonatal Ventricular Arrhythmia
Authors: Stevens Dennis C. , Schreiner Richard L. , Hurwitz Roger A. , Gresham Edwin L.
Published: December 2021

Ventricular arrhythmia in the perinatal period is observed with greater frequency than reported in the literature. Four cases from the authors' experience and an analysis of the literature are presented. Of the total of 45 cases, nine were detected in utero, three persisted beyond the neonatal period, and two resulted in death with associated disorders. Twenty-four percent of the entire group had serious medical disorders associated with arrhythmia; however, 43% of the group with ventricular tachycardia had major associated disease.
THE DISPENSABLE CHILDREN
Authors: O'Gorman Ned
Published: December 2021

The children who come to me are children who exist in a colonial "outpost" of the American empire. I have been eleven years in Harlem, eleven full years: I have watched a place on this earth decay while the nation in which that place exists grows in power and wealth. It is an if Harlem, like Biafra or the gutters of Calcutta, had become a dispensable part of the fabric of national life. Nothing has happened in eleven years to make one jot of difference in the lives of the children conceived during that time or in the lives of the children who came to my nursery since 1966.
Do Low-Calorie, High-Protein Diets Lead to Obesity?
Authors: Barness Lewis A.
Published: December 2021

Nutritional surveys of wide interest are rare. They usually are not applicable except to populations under study, and are frequently skipped by the reader unless he or she is a member of or closely involved with that population.

In this issue of Pediatrics (p 713), Palti et al report on a nutritional survey of young children in Jerusalem. Their data collection suffers from the error most frequently made in nutritional surveys, namely, that the data were obtained by means of a 24-hour recall, which is well known to be fraught with errors. Anthropologists have mdicated that the only proper way of learning what a population consumes is to live day-by-day in the household.
Neonatal Thyroid Screening Programs: Caution
Authors: Green Orville C. , Winter Robert J. , Wise Joyce E.
Published: December 2021

Two recent publications by authoritative groups1.2 have pointed out the value of thyroxine screening of all newborn infants in an effort to diagnose hypothyroidism early. Both statements advised caution in undertaking mass screening programs without an advisory committee and supporting services; in spite of these cautions, many hospitals with delivery services have now begun screening programs without such ancillary services. As a result, the aim of utilizing screening for the detection of hypothyroidism has been obscured because physicians and laboratories performing these assays have never established an upper limit of normal for thyroxine assays in neonates by the various methodologies in use.
Adolescent Pregnancy—Where Is the Unwed Teenage Father?
Authors: Elster Arthur B. , Panzarine Susan
Published: December 2021

As discussed by McAnarney et al (Pediatrics 61:199, February 1978), a comnprehensive teenage maternity program can have an effect on reducing the psychosocial risk of repeat pregnancy. School attendamice figures and reliance on government financial assistance, however, did not differ between the groups they studied. Perhaps the missing key to reducing the psychosocial risks of teenage pregnancy may be found by including the girl's partner in the activities offered by maternity programs.

Since the work of Pannor et al1 in 1969, there has been a paucity of literature addressing the subject of the unmarried teenage father, and health care providers show little interest in encouraging these teenage boys to share in the responsibility of the pregnancy.
Munchausen Syndrome by Proxy: Definition of Factitious Bleeding in An Infant by 51Cr Labeling of Erythrocytes
Authors: Kurlandsky Lawrence , Lukoff Jonathan V. , Zinkham William H. , Brody Judith P. , Kessler Richard W.
Published: December 2021

In the article, "Munchausen Syndrome by Proxy: Definition of Factitious Bleeding in An Infant by 51Cr Labeling of Erythrocytes" by Kurlandsky et al (Pediatrics 63: 228-231, February 1979) "vocal chords" (p 229, col 1) should be spelled "vocal cords."
Food Intake and Growth of Children Between 30 and 48 Months of Age in Jerusalem
Authors: Palti Hava , Reshef Avraham , Adler Bela
Published: December 2021

In the article "Food Intake and Growth of Children Between 30 and 48 Months of Age in Jerusalem" by Palti et at (Pediatrics 63: 713-718, May 1979), the phrase "protein and caloric malnutrition" (p 718, cot 1) should read "protein energy malnutrition."
Nonoperative Management of Distal Fingertip Amputations in Children
Authors: Rosenthal Laurie J. , Reiner Mark A. , Bleicher Michael A.
Published: December 2021

Success with the uncommonly recognized technique of nonoperative management of fingertip amputations in children has prompted presentation of four cases so treated in our institution. Previously, fingertips amputated distal to the distal interphalangeal joint have been observed to regenerate in children under 12 years of age.1,2

MATERIAL

Our patients were 1, 2, 4, and 9 years old. They had injured the thumb, middle, index, and small fingers, respectively. The levels of amputation are seen in Fig 1. Three injuries transsected the distal bone. All cases were evaluated for extent of injury and chosen for nonoperative therapy (Fig 2). The wounds were cleansed with antiseptic solution and dressed with fine mesh absorbent gauze impregnated with bismuth tribromophenate 3% in petrolatum blend (Xeroform) and sterile gauze bandage. To encourage mobility, no splints were used. Dressings were changed one week after injury and bi-weekly thereafter. All children were free of pain within 24 hours after treatment. Healing began at three weeks and was completed 12 weeks after injury. Good cosmetic and functional result with regeneration of the fingertip including nail was observed in each case (Fig 3).

DISCUSSION

Douglas1 and Illingworth2 were among the early proponents of the nonsurgical management of children's fingertip injuries. Despite their well-documented success with this treatment, it is not widely practiced. Many3-5 continue to advocate reimplantation of the amputated tip, suture closure, or skin graft and flap application to the amputated stump. However, these techniques should be reserved for injuries to the proximal two phalanges or for disarticulation injuries where regeneration is not seen.
Pediatrics Editorial: Obstruction of CSF Shunts
Authors: Freeman John M. , D'Souza Bernard
Published: December 2021

The development of improved shunting devices has allowed most children with hydrocephalus to survive, lead normal lives, and be of normal intelligence.1-3 Many different devices incorporating different ventricular ends, different types of one-way valves, and different distal ends all have one common purpose—to divert cerebrospinal (CSF) fluid from within the head into the blood stream or the peritoneal cavity where absorption can take place.

Despite these advances, complications of shunting procedures remain4 (see also Neuren and Ellison in this issue, (p 90). The prompt recognition and management of these complications should eliminate the mortality and markedly decrease the morbidity associated with shunts.
Paregoric Should Be Banned
Authors: Shaw Edward B.
Published: December 2021

I was surprised to find that camphorated oil and spirits of camphor were common causes of poisoning in children, for I did not realize that these products were often present in most households or that they were used for folklore therapy by parents any more. I wish the author (Pediatrics 62:404, 1978) had gone one step further to speak about the impropriety of using paregoric as a mild opiate for children, often in combination with absorbent agents expected to remove intestinal toxins during diarrhea.
Which One Is Best?
Authors: DeNicola Lucian K.
Published: December 2021

Goldsberg, Berne, and Oski's report of CT scanning for orbital cellulitis (Pediatrics 12:1000, 1978) brought to mind a patient whom I cared for during my residency who had three recurrences of unilateral orbital cellulitis within a two-month period, each of which resolved easily on antibiotics. An echo scan investigation revealed a solid orbital tumor.

Would Drs. Goldsberg et al or perhaps other editors comment on this less expensive, more available technique to evaluate the infections discussed in this article?
Dirtfall
Authors: Powers Richard J.
Published: December 2021

The article concerning the EPA's establishment of the air lead standard (Pediatrics 62:1070, 1978) deserves further comment. The importance of sources for lead poisoning other than paint has emerged in the past 10 years with studies incriminating the automobile, lead smelting industries, etc.1,2 The culmination of this data lies in the dirtfall theory, in which the final step in the pathway of lead absorption is the ingestion of contaminated dust and soil through hand-mouth activity, normal behavior for infants and toddlers.
Short Stature and Diagnostic Studies
Authors: Schmitt Barton D.
Published: December 2021

Horner, Thorsson, and Hintz1 have recently reviewed their experience with constitutional short stature (CSS) as defined by short stature, a delayed bone age, no family history of short stature, and no pathologic etiology. Their coverage of this specific condition is excellent, but it raises several questions about short stature in general.

First, whatever happened to the children with familial short stature (FSS)? FSS can be defined as a child with short stature, a normal bone age, and a family history positive for short stature.
Letters to the Editor
Authors: Horner James M. , Thorsson Arni V. , Hintz Raymond L.
Published: December 2021

Dr. Schmitt makes some interesting points in his comments about our article. First of all, he finds it remarkable that our clinic has had experiences with 149 children with constitutional short stature (CSS) and none with familial short stature (FSS). If that were true, it would indeed be remarkable. There seems to be a semantic problem arising over our definitions of CSS and FSS. We defined our children as having CSS if they had heights greater than 2 SD below the mean, any retardation in skeletal maturation, no family history of abnormal short stature, and no pathologic etiology for the short stature.
The "In-Training Examination" of the American Board of Pediatrics: Does It Test for "New" or "Old" Information?
Authors: Hoffer Fredric A. , Oski Frank A.
Published: December 2021

The American Board of Pediatrics In-Training Examination or "Pre-Test" is now in widespread use as a means of evaluating the cognitive knowledge and problem-solving skills of house officers. The examination is modeled after the certifying examination of the American Board of Pediatrics. The 1977 Pre-Test was analyzed in an attempt to determine whether awareness of recent medical knowledge was required to pass this examination. The 7th through 10th editions of the Nelson Textbook of Pediatrics were used as a reference source. These editions represent information that is from 5 to at least 20 years of age. Analysis of the 190 items revealed that the correct answer was known for 148 or 78% of the questions at least 20 years ago. These results suggest that the Pre-Test, and presumably the American Board of Pediatrics certifying exam, measures the candidates' knowledge of long-standing core information.
THOMAS PERCIVAL, MD WRITES TO HIS CHILDREN ABOUT CRUELTY TO INSECTS
Authors: C. T. E.
Published: December 2021

Thomas Percival (1740-1804) is best known for his Medical Ethics (1794). The British and American medical professions have adopted much of "Percival" in their ethical codes.1

He was also the author of a delightful book of tales, fables, and reflections written for the instruction of his children.

This is how Percival taught his children about cruelty to insects.2

Mr. Melmoth, in one of his elegant letters, informs his friend, that the snails have had more than their share of his peaches and nectarines this season; but that he deems it a sort of cruelty to suffer them to be destroyed. It seems to be his opinion that it is no less inhuman to crush to death a harmless insect, whose only offence is that he eats the food which nature has provided for his sustenance, than it would be to kill a more bulky creature for the same reason. For the sensations of many insects are at least as exquisite as those of animals of more enlarged dimensions. The Millepedes rolls itself round upon the slightest touch; and the snail draws in her horns upon the least approach of the hand. Such instances of sensibility certainly confirm the observation of our inimitable Shakespeare, who teaches us that

—The poor beetle which we trated upon,

In corporal sufferance feels a pang as great

As when a giant dies.

But whilst we encourage these amiable feelings of the heart, we must not forget that humanity itself may be earned to an unreasonable, and even ridiculous extreme.
THE POET COLERIDGE RECALLS HIS CHILDHOOD
Authors: C. T. E.
Published: December 2021

Samuel Taylor Coleridge (1772-1834) described himself as a precocious and imaginative child. Reading his recollection of himself as a child, one sees the emerging poet who was to become one of the most important and influential figures in the English Romantic movement.1

My father's sister kept an every-thing shop at Crediton—and there I read through all the gilt-cover little books that could be had at that time, and likewise all the uncovered tales of Tom Hickathrift, Jack the Giant-killer, etc. and etc. etc. etc.—and I used to lie by the wall, and mope—and my spirits used to come upon me suddenly, and in a flood—and then I was accumstomed to run up and down the church-yard, and act over all I had been reading on the docks, the nettles, and the rank-grass. At six years old I remember to have read Belisarius, Robinson Crusoe, and Philip Quarll—and then I found the Arabian Nights' entertainments—one tale of which (the tale of a man who was compelled to seek for a pure virgin) made so deep an impression on me (I had read it in the evening while my mother was mending stockings) that I was haunted by spectres whenever I was in the dark—and I distinctly remember the anxious and fearful eagerness with which I used to watch the window in which the books lay—and whenever the sun lay upon them, I would seize it, carry it by the wall, and bask, and read.

My father found out the effect which these books had produced—and burnt them.
The Effect of Head Position and Angle of Tracheal Bifurcation on Bronchus Catheterization in the Intubated Neonate
Authors: Fewell James , Arrington Robert , Seibert Joanna
Published: December 2021

The effect of head position and angle of tracheal bifurcation on bronchus catheterization was studied in newborn infants. Frequency of bronchus catheterization following appropriate head positioning was evaluated radiographically after passage of a No. 5 French feeding tube in eight intubated neonates within 30 minutes post mortem. Positioning the infants head to the right in preparation for a suctioning procedure may facilitate but not assure catheterization of the left main stem bronchus (LMSB). Positioning the infant's head straight or rotating to the left appears to be equally effective in catheterization of the right main stem bronchus (RMSB). The predominance of RMSB catheterization in infants with their head in the straight position may be explained by the different angles of mainstem bronchi divergence which we determined using radiographs. The angles of divergence of the LMSB and the RMSB from the trachea averaged 44.4° and 24.1°, respectively.
THE PREVENTION OF ADOLESCENT PROBLEMS
Authors: Huessy Hans
Published: December 2021

Most child rearing advice is built around the small, nuclear family. The family that plays, prays, camps together, stays together. Not long ago, families were much larger, frequently with many relatives living near and including maids and nannies.

Today's small family and great mobility have created special problems for adolescents. Many teenagers on their road to independence, go through a stage when their parents seem hopelessly out-dated and stupid. During this period, no parental advice is acceptable. In years past, other members of the extended family could substitute for the parents. Now teenagers are thrown on their peers for advice, peers trying to cope with the very same problems.

Parents should be told in the child's early years to help the child to develop lasting relationships with other adults to prepare for those adolescent years. When the time comes, these adults can give the very same advice which is unacceptable when it comes from the parents.

Well-to-do families use summer camps and boarding school to help ease them through this sometimes difficult period. Often these adolescents get along well at school and in other homes. Their own home is where things go badly. Rather than waiting until the problem gradually spreads, I would suggest placing the child in another home, perhaps exchanging adolescents, for a vacation period or a whole year. Successful programs, like the "Experiment in International Living," "Schoolboys Abroad," and the American Field Service have made this kind of experience available to well-to-do or gifted children who usually need it least.
The Process of Selecting Interns: From the Unknown to the Unknown
Authors: Korsch Barbara M. , Werner Edwenna R. , Adler Robert
Published: December 2021

Each autumn program directors begin anew the task of recruiting and selecting housestaff. Tradition and common sense are the main guides of this process, there being little data regarding the most useful information to collect about applicants or the best method of ranking candidates. It is difficult for selection committees to evaluate their work since internship performance itself is difficult to assess and since the relationship between internship and later performance in pediatrics is unknown. Thus, selection decisions, presumed to be important to both pediatric programs and their housestaff, are based on uncertainty at every step.

A literature review and a recent survey of directors of 61 moderate-sized and large pediatric training programs has highlighted several problems in the current situation:
Additional Uses for Immune Globulin
Authors: Spence David A.
Published: December 2021

Dr. Stiehm's review article in Pediatrics (63:301, 1979) is excellent in its comprehensive treatment of the use of immune serum globulin. However, the portion on Rh immune globulin (RhIG) has two omissions regarding current management of the Rh-negative woman: (1) Amniocentesis is an indication for considering the use of RhIG in the Rh-negative pregnant woman, and (2) evidence of massive fetal-maternal hemorrhage (placenta abruptio, placenta previa, or neonatal anemia) in the Rh-negative woman should be cause for an attempt to determine the magnitude of that bleed and gauge the dose of RhIG to the volume of that bleed.
Modern Management of Tetanus Neonatorum
Authors: Adams James M. , Kenny John D. , Rudolph Arnold J.
Published: December 2021

Five infants with neonatal tetanus were managed with neuromuscular blockade and positive pressure ventilation. All survived. Tetanus was frequently confused with neonatal seizures at time of presentation. All infants were delivered at home. Mean age of onset of symptoms of poor suck, hypertonicity, and generalized spasms was 5.4 days with hospital admission at 6.4 days. Mean duration of mechanical ventilation was 34 days. Although hospital management of tetanus neonatorum may be expected to have a satisfactory outcome, it represents a costly and complex approach to a preventable disease.
Granulopoiesis in Shwachman's Syndrome (Pancreatic Insufficiency and Bone Marrow Dysfunction)
Authors: Saunders E. Fred , Gall Grant , Freedman Melvin H.
Published: December 2021

Granulopoiesis was studied in 10 children with Shwachman's syndrome (chronic neutropenia and exocrine pancreatic insufficiency). Marrow proliferative activity assessed by determination of mitotic indices and tritiated thymidine uptake into granulocytic cells was normal. Assay of bone marrow granulocyte colony-forming cells (CFU-C) in a methylcellulose tissue culture system demonstrated normal CFU-C numbers in four patients and reduced numbers in five. The granulocyte colonies formed were indistinguishable from normal colonies morphologically. Production of colony-stimulating activity (CSA) from patients' peripheral blood leukocytes appeared normal when tested on control marrow. No serum inhibitors against CFU-C or CSA could be demonstrated using both control and autologous marrow, and co-culture of patients' peripheral blood lymphocytes with control marrow did not inhibit CFU-C growth. We conclude that in Shwachman's syndrome committed granulocytic stem cells are present, and the numbers detected in vitro vary widely as does the clinical neutropenia. The proliferative activity of recognizable granulocytic cells is normal and neither a deficiency of humoral stimulators nor the presence of serum or cellular inhibitors of granulopoiesis can be demonstrated.
A "Retreat" for Pediatric Interns
Authors: Bergman Abraham B. , Rothenberg Michael B. , Telzrow Robert W.
Published: December 2021

For the past two years, pediatric interns at the University of Washington have been relieved of their clinical duties for five days to participate in a "retreat". Their places were taken by pediatric practitioners as a continuing education experience. The chief benefit of the retreat was the coming together of the intern group and the subsequent support they were able to give to each other. The educational content was deemed less important than the fact that the retreat occurred.
Lactobezoars
Authors: Babson S. Gorham , Reynolds John W.
Published: December 2021

The two articles1,2 on lactobezoar in the April issue of Pediatrics presented the case histories of nine preterm infants with this complication. Other centers have apparently had similar experiences suggesting that occurrence of lactobezoar is on the increase.

An analysis of their articles indicates that seven of nine infants on the day of diagnosis of lactobezoar were receiving formula at the rate of 187 to 253 ml/kg/day on the basis of birth weight. Of the remainder, one received 133 mg/kg/day on the fifth day of life and the other received only 60 ml/kg/day on day 9.
ON THE FATHER ASSUMING PARTIAL RESPONSIBILITY IN THE REARING OF CHILDREN—AS VIEWED BY WILLIAM POTTS DEWEES IN 1825
Authors: C. T. E.
Published: December 2021

Dr William Potts Dewees (1768-1841), the author of the first American work to deal with children’s health and disease in a scientific manner, had this to say about the failure of American fathers to assist their wives in rearing young children.1

Is it not both unfortunate, and unjust, that the responsibility and care of early education should so exclusively devolve on the mother? For it is every way sufficiently severe upon the female, to superintend the concerns of her establishment, if it be an object that these shall be well and economically managed, without the burden and perplexity of educating her children.

It is time then, that some changes should be made, which would tend to the relief of the over burdened mother; and this can be most profitably done, by the father partaking in this arduous and interesting duty. This would not only contribute to her relief, but would command a conformity from the child, which would be highly useful, to its future welfare.

Besides, the father from his education, and studies, is for the most part better qualified to direct and enforce, a proper system of physical education. But unfortunately at present, every thing connected with the nursery and education, "is voted a bore," by the modern fine gentleman; and the physical treatment of his children, is a duty he would feel almost disgraced to perform. Not so felt a Cato, an Augustus, a Henry the 4th, or a Montaigne: they felt it worthy of their most serious regard.
Infectious Mononucleosis and Encephalitis: Recovery of EB Virus from Spinal Fluid
Authors: Halsted Crystie C. , Chang R. Shihman
Published: December 2021

In the article "Infectious Mononucleosis and Encephalitis: Recovery of EB Virus from Spinal Fluid" by Halsted and Chang (Pediatrics 64:257-258, 1979), reference 9 should be added as follows: Rocchi F, de Felici A, Ragona G, et al: Quantitative evaluation of Epstein-Barr-virus-infected mononuclear peripheral blood leukocytes in infectious mononucleosis. N Engl J Med 296:132, 1977. On page 258, first column, 12 lines from bottom, reference 5 should read reference 9.
Letters to the Editor
Authors: Wilkie Ormond L.
Published: December 2021

The article by Dr Russell D. Snyder entitled "The Right Not To Read" (Pediatrics 63:791, 1979) and the accompanying editorial comment by Dr Melvin Levine (p 817), struck me as having completely missed the major problem in childhood education in America today. Dr Levine, in listing the sub-groups of children with reading failure, significantly lists " socioeconomic and cultural factors" as six in a list of seven sub-groups.

In 26 years of pediatric practice, including 17 years in the area of developmental disabilities, it seems rather obvious that American society, including the medical profession, stands culpable in witnessing the irreversible loss of cognitive ability in hundreds of thousands of children of the poor and of disadvantaged ethnic groups yearly due to "socioeconomic and cultural factors," placing our national priority instead on disorders that affect the upper class in relatively few numbers.
Letters to the Editor
Authors: Levine M. D.
Published: December 2021

I admire and concur with Dr Cobrinik's earnest commitment to nonreading children. My commentary was in no way intended to promote the underserving of such youngsters. I must hold, however, that the term or concept of "dyslexia" is of no value. Dr Cobrinik's exclusionary definition vividly illustrates its hazards. To "qualify" for having dyslexia you must evince no sign of neurologic trouble. By his definition, no child can have both seizures and dyslexia. I presume that minor neurologic findings would also lead to expulsion from this elite handicap group.
Brief Intubation Is Best
Authors: Weber Michel L.
Published: December 2021

The article by Faden (Pediatrics 63:402, 1979) confirms once again very nicely that brief intubation and parenteral antimicrobial therapy can achieve excellent results in the treatment of acute epiglottitis.

Since we described our early experience,1,2 our group has now accumulated more than 100 cases (including one of my daughters), due to the high incidence ofthis disease in Montreal, particularly during the summer months. While we were gaining more experience, we have been able to reduce further the length of intubation, parenteral therapy, and hospitalization.
Morning Plasma Cortisol Levels in Infants Treated with Topical Fluorinated Glucocorticosteroids
Authors: Weston William L. , Sams W. Mitchell , Morris Helen G. , Arthur James M. , Blakeman Gordon J. , Andresen Mary
Published: December 2021

The plasma cortisol levels of 17 infants of mean age 12.1 months taken at 8 AM were measured before and after application of a topical fluorinated glucocorticosteroid. There was a statistically significant depression of plasma cortisol value in 11 infants at days 3, 7, and 14 after therapy. All of the plasma cortisol levels returned to normal. For the entire group of 17 infants, however, there was no significant depression of plasma cortisol levels. Even in the usual office use of topical glucocorticosteroids, one must be aware of the possibility of percutaneous absorption.
THE CAUSES OF AN OFFENSIVE BREATH IN CHILDREN, ACCORDING TO LOUIS STARR, A FOUNDER OF THE AMERICAN PEDIATRIC SOCIETY
Authors: C. T. E.
Published: December 2021

In his ambitious An American Text-Book of Diseases by American Teachers (1894), Louis Starr (1849-1925), of Philadelphia, called attention to the importance of smelling the child's breath. In the 1890s, the paucity of what we now consider routine laboratory tests made the physician far more dependent on the use of the sense of smell when confronted with a sick child than is the case nowadays.

Starr1 wrote:

The breath may become sour, catarrhal, foetic, gangrenous, ammoniacal, and stercoraceous. Sour breath is present, in infants more especially, when there is gastric fermentation. Catarrhal breath has numerous shades of difference. In chronic catarrh of the pharynx there is a "heavy" odor, not noticeable far from the patient's face. It is always most marked during and after sleep. Should there be associated follicular tonsillitis, the breath, while still heavy, becomes extremely offensive, with a scent somewhat like that of decaying cheese, and is very penetrating. This odor, too, is worse after sleeping. At the onset of acute catarrh of the stomach the breath has a vinous odor, at other times it is sweetish, and again it has the same quality as after an inhalation of ether. Later in the attack it becomes sour or has the odor of sulphuretted hydrogen. What is known as a "feverish breath," has a heavy, sweetish smell. It is met with in diseases of high temperature; thus, it is very marked and rapid in appearance in scarlatina.

Foetor of the breath is observed in its mildest form in such affections as aphthae and ulcerative stomatitis. It is better developed in ozaena and necrosis of the maxillary bones.
Necrosis of the Forearm Following Radial Artery Catheterization in a Patient with Reye's Syndrome
Authors: Mayer Thom , Matlak Michael E. , Thompson Joel A.
Published: December 2021

The use of indwelling arterial catheters has become increasingly widespread in pediatric patients in recent years. As experience has expanded so has awareness of the complications that their use may entail. We report a case of a 9-month-old patient with Reye's syndrome who suffered diffuse microvascular compromise, which resulted in partial loss of an extremity following radial artery catheterization.

CASE REPORT

A 9-month-old male infant, previously in excellent health, was seen with a three-day history of rhinorrhea and cough, a one-day history of vomiting, and a 12-hour history of lethargy. When seen at a local hospital he had status left-sided focal seizures and a serum glucose of 17 mg/100 ml.
Child Abuse Intervention
Authors: Dunning Russell K.
Published: December 2021

In Child Abuse Intervention: Conflicts In Current Practice and Legal Theory, the author has included inaccurate references to Lynch et al vs King et al, US District Court for Massachusetts, CA 78-2152-K (filed sub nom Lynch et al vs. Dukakis et al). Because of the potentially serious ramifications of such inaccuracies and of consequent misconceptions of the case, a response is merited.

By way of preface, let me disclaim adherence to the construct of a "privacy model" and a "medicolegal model" and to the proposition that the tenants of each are in conflict.