bluuebunny/crossref_metadata_2025 huggingface dataset:
DIAGNOSIS AND TREATMENT: RISKS OF OBTAINING. SAMPLES OF VENOUS BLOOD IN INFANTS
Authors: McKay R. James
Published: December 2021

THE PAPER by Asnes and Arendar, appearing elsewhere in this issue of Pediatrics, is a reminder that even one of the simplest and most frequently performed procedures of pediatric practice in the hospital may be a source of serious iatrogenic disease.

Unfortunately, no statistical data are available for an analysis of the relative safety of the various methods of venipuncture; complications are infrequent with any of them if the operator is careful, skilled, and familiar with the method he is using. On the other hand, since accidents on complications may also result from any method used, it is self-evident that those procedures in which the complications are relatively minor are preferable to those in which the complications threaten life or may result in permanent handicap. A specific method may carry an unacceptable risk for a particular patient, yet be the method of choice for most others. Under any circumstances the hazard of the procedure, be it great or small, must be weighed against what is to be gained from it, so that good judgment in its use is always an important factor in the safety on hazard of even so simple a procedure as venipuncture.

Although there are at least 14 possible sites from which to obtain venous blood from infants and children, only three (antecubital, external jugular, and femoral veins) are currently widely used in the United States. The internal jugular vein and superior sagittal sinus have been almost universally discontinued as routine sites because of the potentially fatal nature of complications when they occur.
Practicing Pediatrics in a Rather Special Underdeveloped Country
Authors: BOODISH WESLEY
Published: December 2021

As I near the end of a 12-month tour spent in a 400 bed civilian hospital in South Vietnam as a "pediatrician," I am of course quite interested in Dr. Eskes' letter on pediatrics in underdeveloped countries (Pediatrics, 37:851, 1966).

I head a 16 man Navy medical team situated in Quang Tri, working under a program called MILHAP (Military Provincial Hospital Assistance Program). There are now 21 of these military medical teams in South Vietnam—Army, Navy and Air Force—each consisting of three doctors, an administrative officer, and twelve corpsmen.
LATE EFFECTS OF LOW-DOSE WHOLE BODY X-IRRADIATION OF FOUR-DAY-OLD RATS
Authors: Billings Marta S. , Yamazaki James N. , Bennett Leslie R. , Lamson Baldwin G.
Published: December 2021

1. Four-day-old male and female Long-Evans x Sprague-Dawley F1 hybrid rats were exposed to a single total body x-ray dose of 125, 25, 5, and 0 r and then were observed during their entire lifespan for weight changes, signs of morbidity and age at death.

2. There was a 10% reduction of life span in the 125 r exposed female rats. None of the male groups showed significant shortening of longevity.

3. Mean body weights were consistently lower in both male and female groups exposed to 125 r total body irradiation.

4. Female rats exposed to 25 and 125 r attained their maximum weights at a younger age than their non-irradiated controls.

5. External tumors appeared earlier in female rats. Tumor incidence was not increased by irradiation in either sex.

6. Male parentage influenced the length of life span of progeny to a greater degree than the irradiation exposure at the employed dose-level. The influence of female parentage upon longevity cannot be evaluated in this study.

7. Low dose radiation life shortening can only be demonstrated in long-lived strains. Hereditary and radiation life shortening effects are not cumulative under conditions of this study.
DIAGNOSIS AND TREATMENT: APPENDICITIS IN CHILDHOOD
Authors: Rowe Marc I.
Published: December 2021

AS RECENTLY AS 1958, 258 children died in this country as a result of appendicitis. Most of these deaths occurred in young children with perforation. Correct early diagnosis of acute appendicitis and precise and vigorous management of children with advanced appendicitis can prevent these deaths. Particular attention should be paid to the pre-school child with abdominal pain. The historical and physical findings which are generally called classical are more common in older children. The intraluminal pressure of the obstructed appendix of the young child is built up to the same order as in the adult, but the intravascular pressure is lower and the bowel wall thinner. This results in the rapid development of necrosis. These two factors—difficulty in diagnosis and a fulminating course—lead to a high incidence of perforation in children. Combining the statistics of four large series of 551 children, age 4 years and under, with appendicitis, 429 or 77% were found to have perforated appendixes. This high incidence of perforation has not decreased over the years.

THE EARLY DIAGNOSIS OF APPENDICITIS

Abdominal pain is the prime symptom of appendicitis. Its character and location depend on the anatomic position of the inflamed appendix and the stage of development of the disease process. The young child is often not able to verbalize his complaint of abdominal pain or localize accurately the area of his abdominal discomfiture. Fretfulness, crying, disturbed sleep, and resistance to handling are often the first indications that something is wrong. Anorexia and vomiting are common accompaniments of many childhood illnesses. However, the presence of a good appetite casts some doubt on the diagnosis of appendicitis.
Nerves in the Skin of a Patient with Familial Dysautonomia (Riley-Day Syndrome)
Authors: WINKELMANN R. K. , BOURLOND ANDRÉ , SMITH ALFRED A.
Published: December 2021

The nerves in the skin of a patient with Riley-Day syndrome were studied by silver and cholinesterase techniques. Sensory nerve end-organs, nerve fibers, and autonomic nerve plexuses were found in normal distribution. Cholinesterase was observed in the sensory end-organs and the autonomic plexuses. It is proposed that the absence of axon flare in these patients, unlike patients with congenital analgesia, must rest on some pharmacologic abnormality, since the anatomy and histochemistry of the cutaneous nerves are normal.
ANNUAL SUMMARY OF VITAL STATISTICS—1965
Authors: Wegman Myron E.
Published: December 2021

A CONTINUED downward trend for births, slightly upward for marriages, and about the same rate as last year for deaths characterize the provisional vital statistics of the United States for 1965 (Table 1).

Despite the falling birth rate almost 2,000,000 persons were added to the United States population through the excess of births over deaths. Births in 1965 were down about 7% from 1964, bringing the total number, estimated at 3,767,000, below 4,000,000 for the first time in 12 years. The number of births was the lowest since 1951, giving a crude birth rate of 19.4 births per 1,000 population and a fertility rate of 96.7.
On Terminal Sterilization of Formulas, and on Disaccharidase Deficiency and Sucrose Exclusion
Authors: LATHROP FRED
Published: December 2021

An error occurs on page 148, column 2, line 1, of a letter published in the July issue (Pediatrics 38:148, 1966). Dr. Bowman appears to have written "2 level scoops, etc." This should be reversed: "I level scoop for every 2 oz of water."

I appreciated the Review Article by Dr. R. R. W. Townley on disaccharidase deficiency, page 127 of the same issue. This could have been improved if the author had added a few words on more specific dietary management.
XXY CELLS IN A PREDOMINANTLY XX HUMAN MALE: EVIDENCE FOR CELL SELECTION
Authors: Hecht Frederick , Antonius John I. , McGuire Patricia , Hale C. Gordon
Published: December 2021

An 18-year-old phenotypic male who had been reported to have XX and no Y chromosome was further investigated. He had small (2.4 cm) testes and azoospermia. His testicular biopsy was markedly abnormal with dysplastic spermatic tubules and interstitial fibrosis.

Cytologic studies revealed drumsticks in neutrophils and sex chromatin bodies in skin and various testicular cells. Chromosomal studies disclosed a small proportion (3/270) of XXY cells in cultures of blood and testis and no XXY cells (0/39) in culture of skin. The predominant line of cells in all these tissues had 46 chromosomes with XX and no Y chromosome. Cells with a Y chromosome were thus scarce, although as a zygote the patient presumably possessed a Y.

Reference is made to the idea that sometimes selection may by unknown mechanisms work against the survival of a particular clone of cells after that clone has irrevocably influenced the course of embryonic development. The XXY cells in our patient would thus be a clone which selection has caused to nearly vanish.
PHENYLKETONURIA IN THE AMERICAN INDIAN
Authors: Wagner Marsden G. , Littman Bruce
Published: December 2021

THE geographic and racial distributions of phenylketonuria have been recorded in the literature for many years, beginning with Jervis in 1939. It has been reported to occur in the Scandinavian countries, Ireland, England the European continent, North and South America, and Japan. Racially it has apparently been recorded equally among all groups with the exception of Jews and Negroes, in whom its incidence is much lower. After a review of the literature, however, only three papers presented the possibility of phenylketonuria occurring in the American Indian or related racial groups (e.g., Mexican). These are summarized in Table I.

A study of the following family has therefore proven to be significant.

FAMILY HISTORY

Mr. Y, age 30, and Mrs. Y, age 20, were born and raised in a Cheyenne-Arapaho Indian community in Oklahoma. Both are in good health and are of normal intelligence. Mrs. Y has had four pregnancies; the first resulted in a spontaneous abortion at 2 months, but the next three were viable. These three children with their clinical status are, in order of birth: Je, diagnosed as phenylketonuric with mental retardation; Su, normal; and Ch, diagnosed as phenylketonuric.

Case 1

Je, age 3½ years, was born in the Oklahoma Indian community; he weighed 3,300 gm at birth; pregnancy and delivery were normal. He has no history of eczema or seizures, conditions frequently associated with phenylketonuria. Development has been as follows: held head at 4 months, sat with support at 5 months, sat without support at 8 months, smiled at 9 months, rolled over at 10 months.
STOKES-ADAMS ATTACKS IN A SMALL CHILD TREATED BY PROLONGED USE OF AN INDWELLING PACING CATHETER
Authors: Craenen Jo , Moore Douglas
Published: December 2021

Stokes-Adams attacks occurred in a 6-year-old boy weighing 18 kg with complete heart block. The arrhythmia persisted despite medical treatment. Internal pacing of the heart was instituted by the insertion of an indwelling pacing catheter into the right ventricle. The catheter pacing system was maintained in place for 3 weeks, and its use was not followed by any complication. The patient made an uneventful and apparently complete recovery.
ACCEPTANCE OF PRESIDENCY
Authors: Anderson William S.
Published: December 2021

Members of the Academy and guests: It is with a feeling of humble dedication that I assume the position of President of the American Academy of Pediatrics. I am grateful to you for the honor you have bestowed upon me and I am well aware of the responsibilities of the office. Following in the footsteps of our outgoing President, Jim Hughes, I shall endeavor to carry forward the progressive course he has so ably set during his term of office. Never before in the history of the Academy have we had such an opportunity for leadership as we have today. I am convinced that the Academy can and will meet every new challenge.

During the next few years, we will see many changes in the practice of pediatrics. Problems of private practice have become more and more complicated. Having been in the private solo practice of pediatrics for over 30 years, I am proud to be in that, almost extinct, group of pediatricians who still make house calls. I am well aware of these problems and, as one of you, I am honored to serve as your representative in the office of President.

A year ago a telegram from Surgeon General William Stewart welcomed consultation with the American Academy of Pediatrics. Since that time there has been an "open line" of communication between the Academy and governmental health agencies. During the coming year these lines of communications will be kept open to insure that the highest standards of pediatric care be established and maintained, to preserve the identification of the pediatrician in private practice, and to guarantee that he will receive proper remuneration for services rendered.
AN OFFER TO PAY 5 GUINEAS TO THE PATIENT IF VACCINATION FAILED TO PREVENT SMALLPOX
Authors: C. T. E.
Published: December 2021

For a number of years after Jenner's brilliant report of the efficacy of vaccination, several institutions in the United Kingdom tried to foster interest in this procedure by guaranteeing a handsome sum to be paid to the patient if the vaccination should prove unsuccessful in preventing smallpox. A good example of this may be found in the following resolutions put forth by the Vaccine Pock Institution of Edinburgh in 1805.

VACCINE POCK INSTITUTION, BROAD-STREET, GOLDEN-SQUARE, EDINBURGH

General Quarterly Court, November 5:-Resolved, That, according to the experience of the medical establishment of this institution, it appears that the inoculation for the cow-pock affords security against the small-pox equally with variolus inoculation, and that the new practice possesses all the advantages already stated to the public.

Resolved, That, in order to give a further proof to the public, and to afford an inducement for information adverse to the new practice, the following proposal be made public, viz.

That, in future, every patient who shall be vaccinated at this institution, on discharge, shall receive a certificate, stating, that such patient has gone through the cow-pock, and engaging, that if hereafter the said patient shall take the smallpox, he or she shall be entitled to the sum of five guineas, to be paid from the funds of this institution, at the first general court, after the proofs have been given, according to the rules of the medical establishment.
SERUM LEVELS OF METHICILLIN AND AMPICILLIN IN NEWBORN AND PREMATURE INFANTS IN RELATION TO POSTNATAL AGE
Authors: Boe Roger W. , Williams Christopher P. S. , Bennett John V. , Oliver Thomas K.
Published: December 2021

Serum levels of methicillin and ampicillin are reported in 82 term and premature infants in groups of increasing postnatal age. During the first day of life, term infants showed high and sustained serum levels following a single injection of either agent. When methicillin was given to groups of term infants beyond the first day of life, rapid changes in excretion rate occurred with increasing postnatal age. Premature infants showed similar changes in excretion rate with age, with higher levels at any given age than the term infants. These findings are discussed in relation to neonatal renal and hepatic function and suggestions are made regarding clinical use of these drugs. A brief description is given of a highly accurate bio-assay method for the penicillins which can be adapted for most antibiotics and is suitable for investigational and clinical use in small infants.
COEXISTENT MEGACOLON AND MEGAURETER
Authors: Winkelman James
Published: December 2021

A case of coexistent megacolon and bilateral megaureter is reported. Adequate histopathologic study revealed aganglionic rectum and colon and normal autonomic innervation to the bladder. These findings are discussed in relation to the hypothesis that a common etiology is responsible for both lesions. The agenesis of the peripheral autonomic ganglia that characterizes megacolon was not the cause of megaureter in this case.
DIAGNOSIS AND TREATMENT: PSYCHOSOCIAL ASPECTS OF WELL CHILD CARE
Authors: Bolian George C.
Published: December 2021

The practical importance and frequency of well child care in both pediatric and general medical practice has been well established. Employing a model of the child as a bio-psycho-social organism, the author has attempted to outline an approach to this phase of practice, particularly the psycho-social elements. Five goals are discussed: (1) assessment of development; (2) prevention of potential disorder; (3) treatment of early disorder, including six suggested techniques; (4) referral of gross disturbance; and (5) establishment of a meaningful relationship with the child and his family, including several general approaches.
Informed Consent
Authors: MOSIER H. DAVID
Published: December 2021

It is difficult to imagine a physician investigator who does not also at the same time play the role of "physician-friend" in the sense of Dr. Silverman's proposal (Pediatrics, 38:373, 1966). Any physician responsible for the subjects of clinical investigation must perform his role guided by the same ethical considerations that guide other physicians in the care of their patients. Were it otherwise, the subjects would be placed at some jeopardy as to their welfare and the preservation of their dignity.
Renal Tubular Dysfunction
Authors: FELLERS FRANCIS X.
Published: December 2021

Professor Woolf has attempted to put together in this book a diverse group of 20 clinical syndromes which have in common some change in concentration of substances normally present in the urine. Each of these abnormalities is then identified, according to the compound present, as a specific renal dysfunction. This classification, convenient for historical description, was derived from a review of some 387 references from the English, French, and American literature. Very clear accounts are presented of cystinuria, galactosemia, Wilson's disease, hepatorenal syndrome, and renal hypoelectrolytemia (Bartter's syndrome).
ROLE OF CAROTID CHEMORECEPTORS IN THE INITIATION OF EFFECTIVE BREATHING OF THE LAMB AT TERM
Authors: Harned Herbert S. , Griffin Clarence A. , Berryhill William S. , MacKinney Loren G. , Sugioka Kenneth
Published: December 2021

Respiratory patterns after deliberate cord occlusion of four fetal lambs with bilaterally divided carotid sinus nerves were compared with those of four control lambs subjected to similar surgery without actual division of the nerves.

The animals with divided carotid sinus nerves did not develop sustained rhythmic respiration and showed fall in Po2, which persisted, and progressive fall in pH and rise in Pco2 during the 10-minute period of observation after cord occlusion. The mock-operated animals developed sustained rhythmic respirations and showed rise in Po2, fall in Pco2 and less fall in pH than the animals with divided carotid sinus nerves.

This striking inability of the lambs deprived of carotid chemoreceptor function to initiate effective respiration indicates that this mechanism has an important role in the initiation of breathing under these conditions.
TRANSUMBILICAL AORTOGRAPHY AND SELECTIVE ARTERIOGRAPHY IN NEWBORN INFANTS
Authors: Emmanouilides George C. , Hoy Raymond C.
Published: December 2021

Transumbilical retrograde aortography and selective arteriography were performed in seven newborn infants from 2 to 10 days1 of age. In three infants abdominal aortograms were obtained for evaluation of abdominal masses and in one of these a clinically unsuspected, severe abdominal coarctation was discovered. In one infant an aortic arch study was done because of suspected vascular ring. In the remaining three infants cerebral arteriograms were obtained because of suspected intracranial lesions, and in one of them a massive subdural hematoma was found. Description of the technic and its advantages and limitations have been presented.
THERAPEUTIC VALUE OF ALCOHOL IN CHILDREN
Authors: C. T. E.
Published: December 2021

Doctor Abraham Jacobi's influence upon American pediatrics was greater than any other physician's of the present or past. It may surprise the younger pediatrician to read the following two quotations from Jacobi's writings concerning the esteem in which he held alcohol as a therapeutic agent for children.

But practical observation shows us that there is at the present time no antiseptic which can be administered internally of equal value with alcoholic beverages. The worst forms of typhoid infection die without them; the septic forms of diphtheria which are inaccessible to antitoxin may still be reached by whiskey or brandy. In this seemingly hopeless condition it may be life-saving. Theoretical objections, ethical opposition should not count. A child of three or four years may be saved by 100 or 200 ccm. of whiskey given daily, if by nothing else and escape the undertaker.

There is no better antiseptic than alcohol beverages. I claim as one of the most meritorious facts in my professional life, if there be any, to have proclaimed long before the time of most of you the necessity of giving large doses of alcoholic dilutions in the grave forms of diphtheria; indeed every case may be or become grave. There is almost no dose that is not well tolerated. What I have observed, and written these forty years, still holds good. Septic cases, with high fevers (also others so septic as to exhibit collapse), that will not improve after 100 or 200 centimetres of whiskey daily, are apt to do well with two or three times the dose, which, however, will cease to be tolerated as soon as the septic fever has passed by. Indeed I have seen such septic children of three or four years take 500.0 [ccm.] of whiskey a day, which had no bad influence on the brain while the sepsis lasted, but would cause alcoholic delirium as soon as convalescence began.

For a marked antipyretic effect rather large doses of alcohol are required; that is why it should not be given except in sepsis when the reduction of temperature—while necessary—can be obtained in other ways. There is no reason, for instance, why the first stages of pneumonia should be treated with alcohol. At that time inanition is not threatening, and therefore the indication fulfilled by alcohol in moderate doses, viz., to avoid the disintegration of albuminoids and of fat, does not yet exist. It is only in later stages, and in chronic diseases, when starvation is threatening, that diluted alcohol, which is readily absorbed in the stomach and therefore quicker in its action, is of the greatest value.
THE EFFECT OF SEVERE PROTEIN CALORIE MALNUTRITION ON THE RENAL FUNCTION OF JAMAICAN CHILDREN
Authors: Alleyne G. A. O.
Published: December 2021

The renal function of 32 malnourished Jamaican children was investigated by serial tests from admission until recovery. It has been established that in the malnourished as compared to the recovered children there are several functional renal lesions.

There is a reduction in G.F.R. and R.P.F., and evidence of impaired tubular function as shown by aminoaciduria, occasional renal phosphaturia, impaired urinary concentration, and inability to excrete an acid load.

There is no demonstrable difference in G.F.R. or R.P.F. between the edematous and non-edematous malnourished children. With recovery there was steady improvement in renal function. The etiology of these lesions may be related to the deficiencies of magnesium and potassium which are known to occur in malnourished children.
Immaturity, the Blood-Brain Barrier, Bilirubinemia, and Kernicterus
Authors: BELTER LESTER F.
Published: December 2021

Your invitation for comments and questions on the article, "Kernicterus: Revised Concepts of Pathogenesis and Management," appearing in the October, 1966 issue of Pediatrics (38:539, 1966) is accepted.

I do not question the validity of the first two sentences of the first paragraph of page 541; however, the third, "Thus, newborn and adult animals did not differ fundamentally in the functional characteristics of the blood-brain barrier for bilirubin," is misleading and probably provides little or no evidence against the concept of "immaturity" of the blood-brain barrier.
Letters to the Editor
Authors: DIAMOND IVAN
Published: December 2021

It is, of course, well-known that the newborn guinea pig has a relatively mature central nervous system but this may have little to do with the functional characteristics of the blood-brain barrier for bilirubin and other organic compounds. For example, although the maturing brain of guinea pigs, mice, rats, cats, and humans shows marked metabolic differences, in these mammals a number of substances are regularly excluded from the brain at all stages of development. Thus, despite species differences and "the changing metabolic pattern of a given specie" the blood-brain barrier for certain compounds is functionally intact in the fetus, newborn, and adult.
Subject Matter of Pediatrics
Authors: NORTON R. A.
Published: December 2021

I find the articles in Pediatrics so completely esoteric as to be almost useless to a man in private practice. There is never more than one article in any issue that is more than passing interest. I would like to keep my membership in the Academy but am increasingly unhappy about what appears to be a wasteful luxury—paying for the journal. I feel sure you must have had similar complaints before. If you print this as a Letter to the Editor, I daresay you'll receive many more.
The Acute Abdomen
Authors: RANDOLPH JUDSON G.
Published: December 2021

Although there are other books dealing with the acute abdomen, this volume will be welcomed because it represents the experience of a major American general hospital widely known for its accident and emergency facilities. The Acute Abdomen is dedicated by the medical staff of the Wayne County General Hospital to the memory of Dr. Wayne W. Glas and contains much of the surgical thinking of the Department of Surgery which Dr. Glas directed for many years.
Dynamics of Development: Euthenic Pediatrics
Authors: MCLENDON P. A.
Published: December 2021

In recent years much discussion has developed in pediatric circles relative to the pediatrician's role in the broad field of child health. There is a consenses that pediatricians should be broadly educated in the development of later behavioristic problems, even into the adolescent years—in truth a position of eminence in the family constellation. With therapeutics of infectious diseases well documented and immunization procedures well stabilized, his abilities can be directed to the broad area of normal and abnormal sociomedical problems.
NATURE AND NURTURE
Authors: Y. A.
Published: December 2021

THOSE American pediatricians who are socially oriented may be more familiar with the beautifully expressed observations of 1,000 children born in Newcastle-upon-Tyne, than with the emerging findings of a somewhat less ambitious but comparable attempt to follow the course of 670 children born on an island in the youngest state of their own country. The two studies have in common the fact that they set out to probe the mysteries of nature and nurture by observing children (and families) drawn from a whole community at large rather than groups selected because of condition at birth (such as prematurity) or place of birth (such as a teaching hospital).
SELECTIVE IMMUNOGLOBULIN DEFICIENCY ASSOCIATED WITH THYMIC ALYMPHOPLASIA
Authors: Buckley Rebecca H. , Bradford William D. , Butcher Suzanne R.
Published: December 2021

Serum immunoglobulin, fluorescent antibody and pathological studies were performed on tissues from a 9-month-old infant who died of Pneumocystis carinii pneumonia.

The serum levels of IgG and IgA were found to be greatly diminished, whereas IgM and IgD were present in normal amounts. In addition, a moderate number of immunoglobulin-M-containing-cells were demonstrated in the spleen by fluorescence microscopy. Rare cells were seen which contained IgA or IgG.

The thymus was poorly developed, contained no Hassall's corpuscles and few lymphocytes. Peripheral lymphoid tissue was scant; only two lymph nodes and no tonsils were found at postmortem examination. The largest peripheral aggregation of small lymphocytes appeared in the appendix. During life the child manifested varying degrees of lymphopenia.
CARBOHYDRATE AND ENERGY METABOLISM IN THE NEWBORN—AN INTERNATIONAL EXPLORATION
Authors: Cornblath Marvin
Published: December 2021

Dr. Smith (Chairman): To start the evening, I might remind you that 6 years ago a similar group took advantage of their presence at the International Congress in Montreal to gather together informally for the exchange of ideas about hyaline membrane disease. The one major result of that discussion was the agreement that, whatever hyaline membrane disease is, it should thereafter always be called the idiopathic respiratory distress syndrome. As you may know, the syndrome is now referred to more firmly than ever as hyaline membrane disease; nevertheless, something of value was accomplished in the exchange of ideas and in the focusing of international attention upon central rather than peripheral aspects of a previously ill-defined problem.

In organizing tonight's meeting, I know Dr. Cornblath hopes something of a similar nature can occur with regard to problems of carbohydrate and fat metabolism in newborn infants. Some of us, I am afraid, would have said 6 years ago that newborn infants actually had no problems of this sort. It was largely through Marvin Cornblath's alertness and continued investigations that we now know the subject as one of great importance and interest. Yet, I think one of the reasons we are here is not only to discuss how these matters look to all the rest of us, but to find out if anyone else sees quite as many infants with significant hypoglycemia as seem to be encountered in Chicago. What it is that we are missing in other cities, or what Dr. Cornblath is doing that we are not, are aspects which, I hope, can come out in the discussion tonight.
The Battered Child
Authors: BLOCH HARRY
Published: December 2021

Dr. Vincent J. Fontana in a letter (Pediatrics, 38:1078, 1966) expresses the urgency of early recognition of the "maltreatment syndrome." However, he continues to isolate the "battered child" from the children battered by society.

In my letter (Pediatrics, 38:856, 1966) I suggested that we take up the cudgels for the uncountable numbers of children outraged by society. The victims of slums, poverty, inadequate educational facilities, discrimination; the millions of starving children; the many criminally ruined by drug addiction; the thousands of children injured and killed in accidents; the tragic black child emotionally, physically, and mentally battered; the burned and broken children, victims of war, napalm, and chemicals; the more than one million children murdered in Nazi cremaoria and concentration campus.
Cold Agglutinins and Eaton Agent Infections
Authors: MACAULAY DUNCAN
Published: December 2021

I read with interest the article, "Cold Agglutinins, Eaton Agent and Respiratory Infections of Children," by Dr. Sussman and his colleagues, (Pediatrics, 38:571, 1966). The authors state, "Experience with cold agglutinins has been derived principally from adults." May I draw their attention to a paper published in 1951 in which I reported the results of an investigation into this phenomenon in 114 infants and children?

That work was done at a time when virological studies were impracticable, and the only correlations that could be attempted were with clinical findings.
Letters to the Editor
Authors: STRAUSS JOSÉ
Published: December 2021

Without any qualification one must agree with Dr. Nottingham's statement that "adequate alveolar aeration" is the primary problem in any type of respiratory acidosis, including status asthmaticus. However, there are times when aeration cannot be returned to normal by use of steroids, bronchodilators, and usual fluids. We must even add that, as stated in the review by a group in which one of us (J.S.) is a co-author, all of these are desirable, general measures which will help many patients; but, for other patients these measures by themselves are insufficient to induce recovery. As shown by workers like Holmdahl, et al. and Matell, even addition of mechanical control of respiration may be insufficient to induce recovery and alkalinizing agents will need to be added.
Quellen zur Geschichte der Kinderheilkunde
Authors: RADBILL SAMUEL X.
Published: December 2021

In spite of celebrating his seventy-fifth birthday two years ago, the eminent German pediatric historian, Albrecht Peiper, continues his work with youthful vigor. Last year he published the fourth edition of his classic Chronik der Kinderheilkunde and now comes this little historical gem. After a brief introduction summarizing his reasons for selecting certain of the most important basic works in pediatrics, he begins with the Egyptian Incantations for Mother and Child, a pediatric text of the sixteenth century B.C. as translated by Erman in 1901.
PROBLEMS IN SIZING
Authors: A. M. E.
Published: December 2021

SURELY the pediatrician who looks over a group of newborn infants is increasingly aware of their heterogeneity, recently emphasized by Sinclair in a commentary in Pediatrics. Those of like size may be dissimilar in gestational age; the distribution of water and electrolytes differ on day 3 of postnatal life from day 1, after the obligatory loss of water and electrolytes; and body composition changes markedly during gestation. Widdowson, in a summary of many of the compositional changes in fetal life noted that at 1 kg weight the body is 86 to 90% water, at 2 kg it is 72 to 80% water, and at 3 kg it is nearer 75% water.
The Prophylactic Use of Folic Acid in Neonatal Hypertyrosinemia
Authors: PARTINGTON M. W. , MATHEWS J.
Published: December 2021

Thirteen small birth weight babies were studied; six were given folic acid by mouth (5 mg twice a day from the third to the twenty-first day of life) and seven were given a placebo mixture. The babies' behavior was rated in terms of activity or lethargy by the nurses and the plasma tyrosine levels were measured chromatographically. The administration of folic acid failed to prevent the occurrence of hypertyrosinemia and no association was found between the babies' activity and the plasma tyrosine level.

This work was supported by a Public Health Grant (No. 605-7-280) of the National Health Grants Programme and the Queen Elizabeth II Canadian Research Fund.
Pulmonary Hyaline Membranes and Vascular Anomalies of the Lung: The "Lausanne Baby"
Authors: ADAMS FORREST H. , EL-SALAWY ADEL
Published: December 2021

A very interesting brief case report, entitled "Pulmonary Hyaline Membranes and Vascular Anomalies of the Lung," was published in Pediatrics by Bozic. This case is commonly referred to as the "Lausanne baby" and is used by many to support the hypothesis that hyaline membrane disease is primarily related to reduced pulmonary blood flow. Although there are good reasons from observations in both man and animal to implicate reduced pulmonary blood flow as an important factor in the pathophysiology of hyaline membrane disease, we do not believe the "Lausanne baby" can be used to support this hypothesis.
Sudden and Unexpected Death
Authors: BRINGS ELIZABETH G.
Published: December 2021

With the greatest interest I read the Review Article, Sudden And Unexpected Death in Infancy (S.U.D.I.), and Sudden Unexpected Death in Infancy: With Special Reference to the Parathyroids in the January 1967 issue of Pediatrics which summarize the different aspects and present the latest attempts to explain this subject.

I would like to bring to consideration two factors which might be of importance in some cases, which I have never seen mentioned in any of the discussions dealing with the mystifying event of S.U.D.I.
Letters to the Editor
Authors: NADAS ALEXANDER S.
Published: December 2021

It is a particular pleasure to have a former trainee comment on one's views. When reading Dr. Guntheroth's previous, and supporting, commentary in regard to the mumps-fibroelastosis controversy, I was beginning to worry lest middle age and creeping conformity are catching up with him. The present letter of disagreement, reassuringly, redresses the balance.

I do not wish to reopen the "numbers game." I would only like to draw Dr. Guntheroth's attention to a couple of facts he may have overlooked in the frenzy of his sabbatical year.
Flame-resistant Fabrics
Authors: LOW MERRITT B.
Published: December 2021

On December 2-3, 1966, I attended a Conference on Burns and Flame-Retardant Fabrics at the New York Academy of Medicine, to represent the American Academy of Pediatrics. The General Chairman of this conference was Dr. Paul Joliet, Chief, Division of Accident Prevention, United States Public Health Service with whose group we are in official liaison. Other sponsors were the American College of Surgeons, the New York and Brooklyn Trauma Committee, the National Fire Protection Association, the Section on Plastic Surgery of the New York Academy of Medicine, in cooperation with the National Safety Council, the American Public Health Association, and the American Academy of Pediatrics.
Lessons from Childhood: Some Aspects of the Early Life of Unusual Men and Women
Authors: CONE THOMAS E.
Published: December 2021

A question often asked is, "What factors in the child's formative years are most important in helping him to grow into an effective adult?" We wonder about the importance of such things as his home, his parents, his health, the type of school he attends, and his intellectual curiosity as either a help or a hindrance to his development. Seeking those factors whose presence or absence in the child's early years may lead to fame or to infamy, the Illingworths have read biographies of and autobiographies about 450 men and women described in their book, whose lives spanned the centuries from Socrates to Heinrich Himmler.
PSEUDOHYPOPARATHYROIDISM
Authors: PETERMAN M. G. , GARVEY J. L.
Published: December 2021

THIS case is presented because the circumstances provided an unusual opportunity to review and study a rare condition. The child concerned had been diagnosed as having a case of hypothyroidism and epilepsy and the parents had been advised to place her in an institution. The child was referred to the authors in a further effort to obtain relief or advice.

CASE HISTORY

A 12 yr. old girl was examined because of "incessant talking in a silly, immature fashion; excessive greed for food and salt; lethargy, fatigue, over-affection and clumsiness, awkwardness, inability to skate or ride a bicycle."

A year before admission she began to scream in her sleep once or twice every night. Six months later she began to scream during the day. The attacks of screaming occurred suddenly without warning. She abruptly stopped what she was doing, stared ahead and screamed in a loud, hoarse voice for several seconds. Immediately afterward, she was embarrassed and tried to withdraw from the scene. Treatment elsewhere with adequate doses of phenobarbital, tridione, benzedrine, thyroid and pituitary extract had been ineffective.

Report of a previous examination at a university clinic was "moderately plump girl with a round face and lethargic appearance. There was narrowing of the right palpebral fissure and mild ataxia of the lower extremities. The physical examination was otherwise unimportant. The IQ was 80."

Examination later at a hospital-clinic was reported as "revealing obesity and cretinism in spite of a basal metabolic rate of minus 6 and minus 7."

Mother and father are intelligent and the 4 siblings are normal and well-adjusted. There is no history of convulsive disorders or mental disease.
PEDIATRICS IN SOUTH VIETNAM
Authors: Hallett George W.
Published: December 2021

SOUTH VIETNAM is a country of 18 million people and approximately 1,000 native physicians, most of whom are in the military service. Civilian needs are met by 350 physicians, giving a doctor: population ratio of approximately 1:50,000. This figure is even more shocking in view of the inherent disease problems, augmented by wartime conditions. To help alleviate this shortage, a number of nations have sent paid medical or surgical units to assist the Vietnamese in their own provincial hospitals. England and Switzerland have sent small teams, and West Germany has sent a hospital ship. Iran, Japan, South Korea, the Philippines, New Zealand, and Australia have also participated. The United States has many Army and Air Force medical teams who assist in civilian care, and, through the United States Agency for International Development (U.S.A.I.D.), has financed a volunteer program which is administered by the American Medical Association. Transportation and living expenses are provided by the program. During the past 2 years, 24 to 32 United States volunteer physicians have been kept in the country at all times, serving in different provincial hospitals for 60-day periods.

The author was stationed at Long Xuyen Hospital, a 500-bed installation, serving the half million people of An Giang Province in the Mekong Delta. In addition to 10 Vietnamese physicians, this hospital has been staffed by an Australian surgical team during the past 2 years. These teams rotate every 90 days and usually consist of four or five doctors, four to five nurses, and laboratory and x-ray technicians.
Letters to the Editor
Authors: MARQUIS HENRIETTA L.
Published: December 2021

I would like to comment on a letter of Dr. R. A. Norton, published in the March 1967 issue of Pediatrics, wherein he states that he finds Pediatrics almost useless to a man in private practice.

My training is such that I am not "board eligible," but I have been active in pediatrics since 1940. I know there are many physicians in the same situation. I practice in a state that suffers from insufficient pediatric manpower, and I am associated with a hospital that has one of the few approved pediatric resident training programs in our state. Successful clinical practice is based on the thorough knowledge of the basic sciences.
Minimal Brain Damage
Authors: SCHWALB EUGENE
Published: December 2021

I would like to make several observations on "Minimal Brain Damage: 25 Year Follow-up" published in the March issue of Pediatrics, (39:393, 1967).

The 18 patients studied by Menkes, et al. ranged from 4.7 to 15.6 years old. We find that brain dysfunction in a 5 year old is not the same in a 15 year old. Hyperactivity, for instance, is common in the former and psychological stresses engendered by school, home, failure, and frustration take dominance in the latter.
Early Diagnosis of Shigellosis
Authors: NANCE FRANCIS D.
Published: December 2021

I have read with interest Doctor Suchada Poh's communication in your January 1967 issue entitled "Shigellosis: Clue to Early Diagnosis." An even more specific clue to the diagnosis is available, but frequently not used. I refer to microscopic examination of stained smears of the mucoid portion of stools in these patients.

Willmore and Shearman, in 1919, as a result of investigations during an epidemic of shigellosis among British troops on the Island of Malta, first reported the diagnostic specificity of the cell picture in this disease.
Removal of Ear Wax
Authors: KEITEIR W. E.
Published: December 2021

Since publication of my Letter to the Editor (Pediatrics, 39:313, 1967) I have had numerous inquiries about the technique of using the Water Pik. If I may be allowed the space I would like to add the following description of how to use the Water Pik for this purpose.

The fine pulsating jet stream of the Water Pik is perfect for loosening impacted wax from the ear canal. I hold the nozzle about 1 cm from the external orifice of the canal and direct the stream into the canal. Immediately a great outflow of fine debris drains into a small emesis basin held under the ear, against the neck.
Pathogenesis of Retardation in Errors of Amino Acid Metabolism
Authors: DANCIS J. , BALIS M. E.
Published: December 2021

Menkes in his review of the pathogenesis of mental retardation in phenylketonuria (Pediatrics, 39:297, 1967) questions the significance of the in vitro demonstration that phenylalanine inhibits tyrosinase in providing an explanation for the deficient pigmentation commonly seen in phenylketonuria, on the grounds that the phenylalanine levels used in the experiments exceeded those found in patients with phenylketonuria. In the original contribution on this subject, it was pointed out that the phenylalanine levels used to demonstrate inhibition of plant tyrosinase were well above those observed clinically in phenylketonuria.
Letters to the Editor
Authors: ROSE ARTHUR L. , MATSON DONALD D.
Published: December 2021

Eight of our patients (Cases 1 to 8) developed the syndrome of benign intracranial hypertension following an infection other than otitis media. None of these patients had been treated with tetracycline or chlortetracycline. Two patients (Cases 2 and 4) were given penicillin 3 days and 7 weeks, respectively, before the onset of their neurological symptoms. One child (Case 5) was treated with penicillin and a sulphonamide for a streptococcal pharyngitis 5 weeks prior to the onset of symptoms.
Cutaneous Nerves in Dysautonomia
Authors: BROWN J. COLIN , BRUNT PETER W. , JOHNS RICHARD J.
Published: December 2021

We were interested to read the communication in your December 1966 issue from Drs. Winkelmann, Bourlond, and Smith (Pediatrics, 38:1060) in which they described normal nerve endings in a patient with familial dysautonomia. They stated that nerve conduction studies would be interesting but had not so far been done in dysautonomia.

During the last 18 months we have had the opportunity to study 13 children with this syndrome performing nerve conduction studies in 10 and, in two instances, skin biopsies.
HYPOPROTEINEMIA IN INTESTINAL LYMPHANGIECTASIA
Authors: Herskovic T. , Winawer S. J. , Goldsmith R. , Klein R. , Zamcheck N.
Published: December 2021

A 15-year-old boy with congenital lymphedema, ascites, hypoproteinemia, and a jejunal biopsy diagnostic of intestinal lymphangiectasia was studied. I131 albumin survival was evaluated by differential counting of the radioactivity in the lymphedematous and in the normal arm.

When a diet containing 150 gm of fat was fed daily, the I131 albumin half-life was 3.7 days in the normal arm and 22 days in the lymphedematous arm. Substitution of 75 gm MCT for 75 gm dietary fat increased the half-life in the normal arm to 5.1 days. Reduction of dietary fat to 25 gm per day further increased the half-life to 6.5 days in the normal arm. The I131 albumin half-life in the lymphedematous arm was not significantly affected by these dietary changes.

Although approximately 50% of the injected dose of labeled albumin had disappeared from the normal arm within 4 days, fecal and urinary losses accounted for only 15% of the injected dose. The high level of radioactivity remaining in the lymphedematous arm suggested significant "trapping" of the radioactive albumin. Albumin, cleared more slowly from the lymphedema because of inadequate lymphatic drainage, becomes unavailable to the metabolic pool. The observed rapid albumin half-life in intestinal lymphangiectasia is, thus, partly due to this "trapping" in addition to the known enteric losses of plasma proteins.
HIPPOCRATES DESCRIBES MUMPS FOLLOWED BY ORCHITIS
Authors: C. T. E.
Published: December 2021

In the first book of the Epidemics Hippocrates gave this excellent description of mumps complicated by orchitis:

Swellings appeared about the ears, in many on either side, and in the greatest number on both sides, being unaccompanied by fever so as to confine the patient to bed; in all cases they disappeared without giving trouble, neither did any of them come to suppuration, as is common in swellings from other causes. They were of a lax, large, diffused character, without inflammation or pain, and they went away without any critical sign. They seized children, adults, and mostly those who were engaged in the exercises of the palestra and gymnasium, but seldom attacked women. Many had dry coughs without expectoration, and accompanied with hoarseness of voice. In some instances earlier, and in others later, inflammations with pain seized sometimes one of the testicles, and sometimes both; some of these were accompanied with fever and some not; the greater part of these were attended with much suffering. In other respects they were free of disease, so as not to require medical assistance.