bluuebunny/crossref_metadata_2025 huggingface dataset:
COMMITTEE ON NUTRITION
Authors: LOWE CHARLES U. , COURSIN DAVID BAIRD , HEALD FELIX P. , HOLLIDAY MALCOLM A. , O'BRIEN DONOUGH , OWEN GEORGE M. , PEARSON HOWARD A. , SCRIVER CHARLES R. , FILER L. J. , KLINE O. L.
Published: December 2021

"BABY FOODS" have been regarded as "Food for Special Dietary Uses" under federal Food, Drug, and Cosmetic Act regulations that have been in effect since 1942. The current revision of the FDA regulations proposes to continue this classification (Federal Register, December 14, 1966; 31 F.R. 15730).

A recent article in the New England Journal of Medicine objects to classifying infant foods as "Food for Special Dietary Uses" in the recently proposed revision of the federal Food and Drug regulations. The authors appear to be unaware that "baby foods" have been regarded as "Food for Special Dietary Uses" for a quarter of a century. The proposed revisions make no substantive changes in the current regulations affecting "baby foods."

In practical terms, this section of the regulations provides that if a food represented by the manufacturer for use by infants. specifically those less than 12 months of age, contains two or more ingredients, these shall be listed on the label. The label needs to indicate the specific plant or animal source of each ingredient and the common or usual name of each ingredient, including spices, flavorings, and colorings. This is important since typical "baby foods" may contain as many as 10 to 12 ingredients in addition to the principal one. They may combine a variety of additives, including flavoring agents, preservatives, antioxidants, emulsifiers, nutrients, and special fat ingredients.

Special feeding problems are of common occurrence in pediatric practice. It is impossible for the physician to identify the cause of food idiosyncrasy unless he has knowledge of the specific nature of all food consumed.
Hyperbilirubinemia, Streptomycin, and Hearing Loss
Authors: KRACKE A. D.
Published: December 2021

In the article, "Erythroblastosis Fetalis and Hyperbilirubinemia," I noticed several cases described of hearing loss which was ascribed to erythroblastosis or kernicterus of mild degree. I note that a number of these children had what would now be considered excessive doses of streptomycin. I would appreciate any comments that the authors might have on how they eliminated the possible effect of streptomycin and ascribed it all to that of hyperbilirubinemia.

They do make a comment, of course, that their controls had received similar doses of dihydrostreptomycin and/or streptomycin, etc., but this is difficult to know whether the actual levels were comparable from the information presented.
THE SCHOOL PHYSICIAN: A STUDY OF SATISFACTION WITH HIS ROLE
Authors: Wagner Marsden G. , Levin Lowell S. , Heller Marian H.
Published: December 2021

IN 1965 an in-depth study of school physicians in Los Angeles was undertaken The object of this study was to describe personal and professional characteristics of Los Angeles City School physicians and to relate these characteristics to various aspects of physician performance in the school health program. This report presents findings on a cluster of attitudes which, in association, may describe the school physician's satisfaction with his work.

Job satisfaction has to do with the environment which surrounds the doing of the job. The assumption is often given that poor job attitudes would serve to reduce the effectiveness of the physician or in some degree restrict his functions. While on the face of it this seems to be a plausible position, questions may be raised with regard to what a state of satisfaction obscures in a work setting. It is possible that there are situations where satisfaction is a totally inappropriate response. For example, satisfaction with brief routine health examinations may actually represent a measure of a physician's settling for less than effective case finding procedures. An analysis of job satisfaction data provides a basis for such speculation, which, in turn, is believed to have direct implications for policies related to pediatric education, the employment of school physicians, and utilization of school physicians.

STUDY SETTING

The Los Angeles City Unified School District, the second largest school district in the United States, served a population of 3,324,390 in 1965. The schools contained 364,657 elementary pupils and 254,311 secondary pupils (618,968 total kindergarten through twelfth grade).
"Small for Dates" Infants have Lower Average Serum Bilirubin Concentrations than Normal Low Birth Weight Infants of Similar Weight
Authors: LUCEY JEROLD F. , HEWITT JEAN , FERREIRO MARIO
Published: December 2021

Many factors are known to influence physiologic jaundice in premature infants. However no studies have been reported of the effect intra-uterine growth retardation or malnutrition has upon the average serum bilirubin concentrations in "small for dates" infants.

It has been a policy in the nurseries of the University of Vermont Hospitals to do serum bilirubins on all low birth weight infants (2,500 gm or less) on the fourth to sixth day of life. Any infant with a positive Coomb's test or clinical evidence of A.B.O. incompatibility was excluded from this review.
Fun Society
Authors: SCHOWALTER R. P.
Published: December 2021

In these days of "mixed up kids" who often become hippies and beatniks, I do believe that the paragraph entitled "Fun Society" at the bottom of page 4 in the Newsletter of August 1 deserves much attention.

Bakwin and Bakwin's conclusions about the factors that breed delinquency could be brought to the attention of the National Parent-Teacher Association.

When we ask the 17-year-old boy in the office what his purpose in life is, he gives such naive answers.
GOITER
Authors: BONGIOVANNI ALFRED M.
Published: December 2021

ENDEMIC GOITER remains one of the most widespread nutritional diseases in the world today. The major cause is iodine deficiency. The World Health Organization reports a high incidence of goiter in Thailand (where a program of iodine supplementation was instituted), in the mountains of Western Pakistan, Lebanon, Basutoland, and Kenya. The incidence of goiter in iodine-deficient regions may be as high as 50%. Of three goitrous zones in the Himalayas, two were selected for iodine supplementation and one was reserved as a control. There was a striking reduction of goiter in the zones provided with the iodine supplement but not in the third.
PULMONARY FUNCTION, DEDUCED FROM URINARY NITROGEN TENSIONS
Authors: A. M. E.
Published: December 2021

THE elegant studies reported by Led-better, Homma, and Farhi in this issue are entitled `'Readjustment in Distribution of Alveolar Ventilation and Lung Perfusion in the Newborn." It must come as a great surprise to the reader to discover that the only measurement actually made was the partial pressure of nitrogen in the infants' urine. How could one conclude that there were significant imbalances between the distribution of alveolar ventilation and pulmonary blood flow (VA/Q) in the first days of life in normal infants from a urine sample? It is all the more astounding in the light of previous (and seemingly more direct) studies of alveolar-arterial oxygen and carbon dioxide differences which led others to consider the differences largely explained by anatomical right-to-left shunts.
THE EXCESSIVE PROPORTION OF MALE OVER FEMALE DEATHS UNDER THE AGE OF PUBERTY IN PHILADELPHIA BETWEEN 1821 AND 1830
Authors: C. T. E.
Published: December 2021

Ever since John Graunt (1620-1674) established the statistical science of epidemiology, physicians have been aware of the greater vulnerability of the male to disease than the female. Graunt also called attention to the excess of males over females at birth; he further commented on the greater mortality rate of the male throughout his life. The following observations upon the mortality of infants and children in Philadelphia were probably the first published in this country to support Graunt's observations:

Of the children born in Philadelphia during the ten years included between 1821 and 1830, amounting according to the returns made to the Board of Health, to 66,642; there were 2,496 more males than females. But notwithstanding the males at birth thus exceed the females about 7½ per cent, a reference to the census of 1830, shows that by the fifth year of childhood, the male excesss is reduced to about 5 per cent; and at ten years to only 1 per cent; and that the reduction still going on, the females between the ages of ten and fifteen, exceed the males about 8 per cent; and between fifteen and twenty, 7.3 per cent.

Here then we find, that during the early stages of life, there are agencies operating to reduce unduly the proportion of the male sex, and to trace out and identify these, forms a highly interesting subject of inquiry.

It has commonly been supposed that the greater exposure of males to accidents furnished a sufficient explanation of their greater mortality. But our inquiry (in 1830) shows the fallacy of this reasoning, the deaths reported under the head of casualties consisting but a small proportion of the whole mortality, in which when burns and scalds are included, the female deaths are found to exceed the male. The truth is that with very few exceptions, all the morbid influences to which the early periods of life are exposed, operate with peculiar fatality among the males, showing unequivocally that the true cause of the disparity resides in some physiological peculiarity.
RESPONSE OF INFANTS TO TRIVALENT POLIOVIRUS VACCINE (SABIN STRAINS)
Authors: Murphy William
Published: December 2021

An initial dose of live, oral, trivalent poliovirus vaccine was fed to 137 infants at the age of 6 to 8 weeks. Eight weeks later they were given a second dose. They received a third dose at the age of 1 year and a fourth dose 8 weeks later.

Efficacy was judged by antibody levels in serum samples.

Results showed that general sero-immunity was conferred by this program.

Analysis of the data revealed that a significant response followed the first two doses but that antibody levels for type 1 were not maintained at the age of 1 year. Response to the third dose was prompt and significant for type 1. The fourth dose apparently was unnecessary.

There was some evidence of interference by maternal antibodies. However, their presence, even in high concentrations, did not preclude effective immunization.
CONTAMINATION OF SOFT TISSUES OF INFANTS AND CHILDREN WITH RADIOACTIVE FALLOUT AS EXEMPLIFIED BY Cs137 AND I131
Authors: Hanson Wayne C.
Published: December 2021

Fallout iodine131 in children's thyroid glands has resulted from local fallout associated with nuclear weapons tests and the Windscale reactor accident. Milk is recognized as the principal means of transport into human populations, and very young children are considered to be the critical age group as far as exposure hazards are concerned. Environmental factors influence the deposition of the iodine131 and the subsequent rate of transfer to dairy cattle and into humans. Maximum exposures within the continental United States have generally occurred among Utah children. During the period 1952-1962, some 40,000 to 50,000 children in Utah were estimated to have received doses to the thyroid glands of a few rads of iodine131 on several occasions; and, during 1953 about 700 infants at St. George, Utah, received an estimated dose of 84 rads. This was about five times the maximum dose received by English children immediately following the Windscale accident and about one-tenth the iodine131 dose estimated to have resulted in thyroid nodules in a few Marshallese children several years after exposure.

Cesium137 is most important in arctic regions, where whole-body burdens are several orders of magnitude greater than those of temperate North America and Europe. This results from ecologic factors which facilitate the effective transfer of cesium137 through the lichen to caribou (reindeer) to man food web. The distribution of cesium137 body burdens within Alaskan native populations showed important influences of ethnic background and cultural practices of the people. Maximum values were consistently found in those persons who consumed the greatest amounts of caribou flesh and reflected the seasonal cycle of cesium137 concentrations in caribou flesh. Adults had the greatest cesium137 whole-body burdens and concentrations, minors (15-20 years old) contained median amounts and children (less than 15 years old) contained the least. Comparison of male and female cesium137 body burdens at times of the seasonal maximum indicated there was no difference between the sexes until about the age of 20, males then consistently had more cesium137 than females; maximum difference occurred at about the age of 40, and then the difference decreased with advancing age.

Whole-body radiation dosage to the Anaktuvuk Pass people from cesium body burdens during 1964, the period of maximum values, were calculated to be about 30% of the amount suggested as a radiation protection guide for that population group.
HYPERURICEMIA IN NEOPLASTIC DISEASE IN CHILDREN: PREVENTION WITH ALLOPURINOL, A XANTHINE OXIDASE INHIBITOR
Authors: Krakoff Irwin H. , Murphy M. Lois
Published: December 2021

Allopurinol [4-hydroxypyrazolo (3,4-d)-pyrimidine] was used in the treatment or prevention of hyperuricemia in 21 children with various neoplastic diseases in whom there was severe hyperuricemia or in whom it might have been expected as a result of the anti-neoplastic therapy to be employed. Allopurinol was effective in reducing hyperuricemia and in preventing the hazard of uric acid nephropathy in each patient. Previous experience with such patients had been characterized by the frequent occurrence of hyperuricemia and uric acid nephropathy. Allopurinol has produced no toxicity, except for the occasional occurrence of a mild skin rash. It is considered a useful agent in the treatment or prevention of uric acid nephropathy in children with leukemia and lymphoma.
NEPHROLITHIASIS AND NEPHROCALCINOSIS IN CHILDREN
Authors: Wenzl James E. , Burke Edmund C. , Stickler Gunnar B. , Utz David C.
Published: December 2021

A survey of the case records of children seen at the Mayo Clinic from 1935 to 1965 revealed that 77 had nephro-ureterolithiasis and 6 had nephrocalcinosis. Calculous disease occurred twice as frequently in boys as in girls; the incidence did not change with age between the ages of 1 and 15 years. Urologic lesions, urinary infections, or both were present in 49 children and cystinuria was present in 5. In 8 children, renal stones were considered causally related to hypercalciuria, whereas in 14 children no etiologic associations could be found. Chemical analysis of calculi, which was performed in 36 cases, revealed that most stones consisted of calcium oxalate or phosphate; no uric acid stones were found.
Clinical Observations on Ketonurias
Authors: Noguchi Takeshi
Published: December 2021

It is a common observation that pediatric patients often present with ketonuria not accompanied by vomiting, and that some adults may show ketonuria and vomiting together, or either of them separately and without discoverable cause. The present letter deals with such cases encountered by the writer.

An analysis of the symptoms of 46 children with ketonuria has revealed that 23 (50%) may be diagnosed as recurrent vomiting, whereas the remaining 23 cases (50%) are not accompanied by vomiting.
The Hospitalized Child and His Family, edited by J. Alex Haller, Jr. Baltimore: The Johns Hopkins Press, 1967, 121 pp., $5.95
Authors: Green Morris
Published: December 2021

This is an important book because it expresses in print the thoughtful concern of a group of distinguished pediatricians and surgeons for the total care of children in hospitals, and because it describes a working program designed to achieve this. Although both the developmental needs of children (mothering, play, physical activity, education, preparation for procedures) and the adverse effects of hospitalization (sleep disturbances, regressive behavior, withdrawal) have been known for a long time, there have been but few innovations in hospital programs which provide for the former or prevent the latter.
OBSTRUCTIVE DISEASE OF THE AIRWAYS IN CYSTIC FIBROSIS
Authors: Mellins Robert B. , Levine O. Robert , Ingram Roland H. , Fishman Alfred P.
Published: December 2021

A study of the interrelationships of instantaneous air flow, lung volume, and transpulmonary pressure over the range of the vital capacity has demonstrated striking differences in the determinants of maximum expiratory flow in cystic fibrosis and asthma. At high lung volumes, maximum expiratory flow rates in asthma are limited by the mechanical characteristics of the lungs and airways, whereas in cystic fibrosis and in the normal they are dependent on effort. At lower lung volumes, maximum expiratory flow rates are relatively more reduced in cystic fibrosis than in asthma and pressures in excess of those required to produce maximum flow actually depress flow. Also, forced expiration is associated with a transient reversal in the slope of the single breath nitrogen curve in cystic fibrosis and not in asthma.

From these studies it is concluded that: (1) airway obstruction is less uniform and involves larger airways in cystic fibrosis than in asthma, and (2) increased expiratory pressure is associated with collapse of some of the larger airways over most of the range of the vital capacity in cystic fibrosis.

A major clinical implication of these studies is that the effectiveness of cough is impaired by large airway collapse in cystic fibrosis.
INFECTIOUS LYMPHOCYTOSIS: LONG-TERM FOLLOW-UP OF AN EPIDEMIC
Authors: Putnam Samuel M. , Moore Gordon T. , Mitchell Donald W.
Published: December 2021

The authors attempted to locate and examine 31 individuals who had infectious lymphocytosis 19 years earlier. The purpose of the follow-up of this epidemic was to determine if a disease with some similar characteristics, such as leukemia, might be a long-term sequela of infectious lymphocytosis. Twenty-five persons were located, and no significant after effects could be associated with their childhood illness.
DIAGNOSIS AND TREATMENT: SOME SYNDROMES, DISEASES, AND CONDITIONS ASSOCIATED WITH ABNORMAL COLORATION OF THE URINE OR DIAPER
Authors: Cone Thomas E.
Published: December 2021

This Abbreviated Quotation from the writings of Hippocrates is evidence that he shared with the modern physician an awareness of and concern for the color of the urine. Parents often seek professional advice because of their anxiety about the color of their child's urine or diaper. The physician often finds himself wondering whether the parents' description of what they believe is an abnormally colored urine represents either an inconsequential finding or one manifestation of a serious illness.

Uroscopy by both parents and physicians has led to the discovery of a number of commonly, as well as rarely, encountered diseases of childhood. It was Sir Archibald Garrod's2 interest in the color changes in the urine of patients with alcaptonuria that led him to develop his whole concept of inheritable metabolic diseases. More recenfly, the finding of a bluish discoloration of the diapers in two male siblings led to the description of a new and rare familial disease known as thee "blue diaper syndrome."3

Before discussing syndromes associated with abnormally colored urine, a brief description of the normal color of children's urine seems appropriate.

Normal Color of Urine and Causes for it Being Unduly Pale or Dark

The normal amber color of urine is due to the pigment urochrome, the excretion of which is roughly correlated with basal metabolism.1 The normal amber or yellow color may be diminished, increased, or altered in character.

Unduly Pale Urine

Urine may he unduly pale due to a temporary diuresis resulting from (1) a large fluid intake or or (2) a sudden absorption of edema fluid (e.g., children receiving treatment for nephrosis, congestive heart failure, acute glornerulonephritis, or chronic nephritis), or to either (3) diabetes insipidus or (4) mellitus.
A Foster Grandchild Program
Authors: Mendelsohn Robert S. , Gold Jacob C.
Published: December 2021

In his continuing efforts to promote optimum child growth and development, the peditrician often finds social action to be one of his most effective tools. The "foster grandparent" program properly falls in this category. The purpose of this communication is to describe another such social action program that the pediatrician can initiate and help develop. We have called this the "foster grandchild program."

Serving as a consultant to the foster grandparent program at Dixon State School (for the inception and development of which the Illinois State Department of Mental Health and others deserve great praise), one of us (R.S.M.) participated in the successful creation of artificial families.
Letters to the Editor
Authors: Wegman Myron E.
Published: December 2021

Dr. Thomas is, of course, quite correct in noting that various reporting countries use different definitions of live births, a problem which does complicate the matter of precise comparisons. On the other hand, the report from which Dr. Thomas quotes, International Comparison of Perinatal and Infant Mortality, goes on to analyze several instances in which quantitative data on definitions are available. The major problem, of course, has to do with definition of a live birth; for example, the Swedish definition of a live birth was not the same as that in the United States until 1959.
Letters to the Editor
Authors: S. C. A.
Published: December 2021

Thanks to Mr. Beatty for a correction arising from more than one aspect of The Crisis in Communication.
Pediatrics at a Crossroad (Continued)
Authors: Steigman Alex J.
Published: December 2021

There was published recently a Commentary in Pediatrics1 which addressed itself to some general aspects of the present state of our specialty ("Pediatrics at a Crossroad"). The publication will by now have had the critical attentive reading and reflection it deserves.

The Commentary may have conveyed an erroneous impression. It was based on very general statements unsupported by pertinent available facts. It avoided taking into account historical perspective appropriate to the subject under discussion.

Sweeping statements are seldom illuminating.
Letters to the Editor
Authors: Van Leeuwen G.
Published: December 2021

We appreciate the further attention given to the incidence of choanal stenosis by Dr. Marcus. His comments are helpful and were omitted from our discussion in the interest of space. We hesitate to attempt to perforate a membranous atresia because we never know what dangers lurk behind closed doors. Certainly, immediate diagnosis of choanal stenosis and/or atresia is of clinical assistance in excluding non-pulmonary respiratory distress, eliminating the need for many studies, and enabling therapy to be instituted immediately if indicated.
Infant Nutrition, by Samuel J. Fomon, M.D. Philadelphia: W. B. Saunders Company, 1967, 299 pp., $10.50
Authors: Lowe Charles U.
Published: December 2021

The last half century has witnessed changes in child care which are dramatic and in some instances revolutionary. This has been particularly apparent in those three aspects of pediatrics which 50 years ago caused the preponderance of deaths during the first year of life: respiratory disease, diarrhea, and nutritional failure. The first of these is now effectively controlled by antimicrobial agents. The second has been largely eliminated by improvements in sanitation and food handling and, when present, is no longer life threatening since the advent of modern parenteral fluid techniques.
CONGENITAL SUBLUXATION OF THE HIP
Authors: Dickerson Robert C.
Published: December 2021

A late follow-up analysis was carried out on 34 children with congenital subluxation of the hip treated in one consistent manner. The late end results in these patients confirm that abduction splinting was the only treatment necessary in 10 of every 11 patients and that the congenitally subluxed hip which is detected and treated under the age of 8 months should ultimately become a normal hip.
DIAGNOSIS AND TREATMENT: SOME DISEASES, SYNDROMES, AND CONDITIONS ASSOCIATED WITH AN UNUSUAL ODOR
Authors: Cone Thomas E.
Published: December 2021

This Quotation from the writings of one of the founders of ancient Hindu or Ayurvedic medicine, is evidence that Suśruta was aware of the diagnostic significance of odors in many diseases.

For most contemporary physicians an awareness of the importance of the sense of smell in clinical medicine was rekindled largely by the discovery of phenylketonuria by Følling ill 1934.2 He, as has almost every other student of this disease, called attention to a distinctive odor of patients with PKU.

With the burgeoning of our knowledge of inborn errors of metabolism during the last decade, we are now aware of at least five additional conditions in which the patient's odor is unusual; these conditions include disorders of amino acid as well as fatty acid metabolism.

ODORS IN CLINICAL MEDICINE

The quality or character of odors described ill clinical medicine for the same disease varies from author to author. Although an odor may be defined as a volatile emanation that is perceived by the sense of smell, the precise description of a particular odor is extremely difficult. This may be because most of us, unlike almost all other mammals, pay little attention to the odors around us. It is not that we are anosmic but rather that our faculty for discniminating smell in clinical practice has atrophied from disuse.

Sources of Patients' Odors

Odors arise chiefly from the secreta and excreta of the body: sweat, sebum from the skin; secreta from the nose, mouth, throat, bronchi, and lungs; urine, stool and vaginal discharges; wound suppuration; and from necrotic tissue.
HYPERBILIRUBINEMIA AND KERNICTERUS IN GLUCOSE-6-PHOSPHATE DEHYDROGENASE-DEFICIENT INFANTS IN SINGAPORE
Authors: Brown William R. , Boon Wong Hock
Published: December 2021

Hyperbilirubinemia among glucose-6-phosphate dehydrogenase-deficient infants in Singapore is a common and serious problem. Sixty-nine G-6-PD-deficient newborns were studied throughout the neonatal period. A total of seven infants (10%) required exchange transfusions or developed kernicterus. Kernicterus occurred in two infants. The incidence of similarly severe hyperbilirubinemia in G-6-PD-normal newborns of Singapore is probably less than 0.3%. Hyperbilirubinemia in G-6-PD-deficient Chinese infants appears to result from slightly excessive hemolysis superimposed upon a moderately severe hyperbilirubinemia of a nonhemolytic type. In the average infant excessive hemolysis contributes relatively little to the total bilirubinemia. Exposure to exogenous agents occasionally may be important.

Neonatal hyperbilirubinemia may vary considerably among ethnic groups, and it is suggested that the incidence of severe hyperbilirubinemia in G-6-PD-deficient members of an ethnic group may be influenced by their "baseline" or "physiologic" hyperbilirubinemia.

Early-detection of G-6-PD deficiency and close surveillance of affected newborns has substantially reduced the incidence of kernicterus associated with G-6-PD deficiency in Singapore.
Improving the Manual on Standards of Child Health Care
Authors: Christy Raymond A.
Published: December 2021

It has been one year since the American Academy of Pediatrics published Standards of Child Health Care. During this time, 16,000 copies of this manual have been distributed. The recipients have varied from individual pediatricians to federal government agencies, state departments of health and welfare, and insurance companies.

The Subcommittee on Standards of the Council on Pediatric Practice has begun preliminary considerations for revision of the manual. We are eager to learn of the uses to which it has been put as well as comments and criticisms which may be helpful in the revision process.
Prevention of Smoking
Authors: Staub Henry P.
Published: December 2021

In the Newsletter of January 1, 1968, the American Academy of Pediatrics reported that the executive board strongly endorsed time American Cancer Society's anti-smoking resolution.

Personally, I cannot agree with the approach of the resolution to the public health hazard of smoking. If the American Academy of Pediatrics (or for that matter, the American Cancer Society) wanted to back effective measures, an entirely different type of resolution would have been adopted, one that would have put the emphasis On reaciling the younger generation.
Toys and Learning
Authors: Feinbloom Richard I. , Wolff Peter
Published: December 2021

In a current advertising campaign, a wellknown toy manufacturer (Creative Playthings, Inc.) seeks to enlist the cooperation of the pediatric profession in promoting its product by asking that its catalogues be exhibited in the doctor's office.

The alleged superiority of these toys, implied if not actually stated by the advertisement, is based on a deliberate effort to exploit the inherent potential of each infant and young child during certain critical periods of development. The advertisement further implies that the loss resulting from a failure to stimulate children maximally during these critical periods (presumably by such toys) cannot be fully redeemed by subsequent experience; in other words, what is lost (or never attained) is lost forever.
Sex and Morals, by C. H. Whiteley and Winifred M. Whiteley. New York: Basic Books, Inc., 1967, 135 pp., $3.95
Authors: Doyle Brian B.
Published: December 2021

Few subjects command as much intrinsic interest as does sex. Few controversies rage more actively than that over morality, particularly now when effective contraception heralds increased sexual freedom. Those concerned with attitudes of children toward sex, be they parents, pediatricians, or the children themselves, will find this book useful. Sex and Morals addresses itself forthrightly to the subjects of its title.

The Whiteleys' opening discussion of the reasons for a sexual morality shows clearly their tempered, pragmatic approach.
CHILD ABUSE: EARLY CASE FINDING IN THE EMERGENCY DEPARTMENT
Authors: Holter Joan C. , Friedman Stanford B.
Published: December 2021

In a 2-week survey of all children under 6 years of age seen in an emergency department for accidents, 7 of 69 cases were suspected of having injuries due to maltreatment. These judgments were made by the investigators systematically reviewing the medical records of these children and their parents. In a second 2-week survey conducted 6 months later, a similar incidence (7 of 87) of abuse was suspected by the investigators. These latter families also were evaluated by a home visit, and an additional 3 accidents were judged to reflect abuse and 10 further cases were thought to reflect gross neglect. Empirically, certain types of injuries were found to be most commonly associated with childhood abuse. These findings are discussed in terms of the preventive function and role of an emergency department.
ELEVATION OF SERUM COPPER FOLLOWING COPPER SULFATE AS AN EMETIC
Authors: Holtzman Neil A. , Haslam Robert H. A.
Published: December 2021

Copper sulfate in a dose equivalent to 100 mg of copper was administered orally to six young children who came to the outpatient department because of ingestion of substances in toxic amounts. As a control, six other children presenting with the same complaint received 10 to 15 ml of syrup of ipecac. Although vomiting occurred within 5 minutes after administering the copper sulfate, significant elevations of serum copper occurred in each child. Only one of the children receiving ipecac had any rise in serum copper concentration.

Because of hazards associated with copper sulfate, its use as an emetic appears questionable.
Joint Council of National Pediatric Societies
Authors: Wedgwood Ralph J.
Published: December 2021

The Joint Council of National Pediatric Societies was formed in April 1967 to provide liaison and to facilitate efforts towards common goals. The stated purpose of the Council is to "coordinate and express common policies of its constituent societies in matters related to national issues affecting child health." The constituent societies are: American Academy of Pediatrics, ,Association of Medical School Pediatric Department Chairmen, American Pediatric Society, Association of Teachers of Maternal and Child Health, and Society for Pediatric Research.
Morbilliform Rashes Appearing in the Terminal Phase of the Epidemic Viral Respiratory Illnesses in December 1967 and January 1968
Authors: Wolf I. J.
Published: December 2021

We have been having an epidemic of respiratory infections in this area for the past 2 months, considered to be viral in character. In the past 25 days I have seen 9 girls of the following ages who developed morbilliform rashes at the terminal stages of their respiratory illnesses: 7 months, 4 years (2), 7 years, 8 years, 9 years, 11 years, 12 years, and 18 years. At the time the rashes appeared the patients had no fever and were not acutely ill.
Letters to the Editor
Authors: Cherry James D.
Published: December 2021

The exanthems noted by Dr. Wolf during the terminal stages of respiratory illnesses in nine patients are of interest. These could all be a manifestation of one infectious agent, but it seems more probable, due to the age spread of the patients and the lack of a more specific syndrome, that multiple etiologic agents are involved. However, the apparent occurrence only in girls is intriguing.

The majority of "newer viral exanthems" have been associated with enteroviruses which, with the exception of certain Coxsackie B and ECHO 11 strains, are not usually noted for respiratory symptomatology.1-3
Ampicillin Dosage
Authors: Nespole A. J.
Published: December 2021

In the February issue, Young, et al.1 presented a case of Hemophilus influenzae meningitis with apparent relapse following 14 days of ampicillin therapy. The ampicillin, in a dose of 200 mg/kg. day, was given intravenously at 6-hour intervals for 3 days and then the administration was changed to the intramuscular route. The question arises as to whether this case was an example of suppressed continuing infection.

In the first major article published in this country on the use of ampicillin in the treatment of acute suppurative meningitis, Barrett, et al.2 treated 16 patients with meningitis caused by H. influenzae.
"FETAL PKU:" THE EFFECT OF MATERNAL HYPER-PHENYLALANINEMIA DURING PREGNANCY IN THE RHESUS MONKEY (MACACA MULATTA)
Authors: Kerr George R. , Chamove Arnold S. , Harlow Harry F. , Waisman Harry A.
Published: December 2021

Maternal hyperphenylalaninemia was induced by feeding excess L-phenylalanine to pregnant rhesus monkeys. Animals which received the phenylalanine supplement throughout the entire pregnancy gave birth to infants with low birth weight. Marked elevations of phenylalanine and tyrosine were consistently observed in maternal sera; the levels of phenylalanine and tyrosine in umbilical cord sera were greater than the corresponding maternal value in eight of nine pregnancies. Maternal and umbilical cord levels of serine were slightly elevated and maternal levels of 3-CH3-histidine were reduced in all pregnancies. Values for the other amino acids, and the cord: maternal ratios for all amino acids, including phenylalanine and tyrosine, were within the control range. Infant monkeys born to mothers with hyperphenylalaninemia demonstrated a significant reduction in learning behavior. This experiment indicates that not only is maternal hyperaminoacidemia reflected in the free amino acids of fetal blood, but an added insult is also produced by a normal placental process which functions to maintain higher levels of each of the free amino acids in the fetus than in the maternal organism.
A VICTORIAN CHILD READS ABOUT DEATH
Authors: C. T. E.
Published: December 2021

One of the most popular books written for children in Victorian England was The Peep of Day.1 As with so many other children's books of this period, it contained many religious instructions which were considered to be at the level the child's mind would be capable of receiving and understanding them.

Death of children was a favorite topic in these books and was usually presented to the child in sentimental pietistic terms such as in this passage:

When a little child, who loves God, falls sick, and is going to die, God says to the angels, "Go and fetch that little child's soul up to heaven." Then the angels fly down, the little darling shuts its eye, it lays its head on its mother's bosom, its breath stops;–the child is dead. Where is its soul? The angels are carrying it up to heaven.

How happy the child is now! Its pain is over; it is grown quite good; it is bright like an angel. It holds a harp in its hand, and begins to sing a sweet song of praise to God. Its little body is put into a grave, and turns into dust. One day God will make its body alive again.

Dear children, will you pray to God to send his angels to fetch your souls when you die?
PRIMARY FAMILIAL XANTHOMATOSIS WITH ADRENAL INVOLVEMENT (WOLMAN'S DISEASE)
Authors: Kahana David , Berant Moshe , Wolman Moshe
Published: December 2021

An apparently sporadic case of primary familial xanthomatosis with adrenal involvement (Wolman's disease) in a Jewish Israeli infant who died at the age of 3 months is described. Clinically, malabsorption and ileus were prominent. Pathological findings included the usual lipid storage process in the intestines, liver, lungs, spleen, and adrenals; storage in interstitial cells in other organs (heart, aorta, etc.); and evidence of lipid storage in the central and peripheral nervous system.

The histochemical findings are believed to suggest that derangement of triglyceride metabolism might be the main feature of the disease.
Islet Cell Adenoma in Newborn
Authors: Ehrlich Robert M.
Published: December 2021

The article by Salinas, et al., "Functioning Islet Cell Adenoma in the Newborn," in the March issue of Pediatrics (41:646, 1968) raises a number of questions.

If the adenoma was the cause of the hypoglycemia, I am at a loss to explain the mechanism. There was no increase in peripheral venous insulin, as well as no increase in portal vein insulin. Did the authors stain the adenoma for beta cells or insulin granules? Was the tumor extracted for insulin or insulin-like activity?
The Pregnant Diabetic and her Newborn: Problems and Management, by Jørgen Pedersen. Baltimore: The Williams and Wilkins Company, 1967, 219 pp., $11.50
Authors: Farquhar J. W.
Published: December 2021

Diabetic pregnancy and its effect on the developing fetus represent a research field of such diversity that those who stay with it over a long period of time are most likely to make a worthwhile contribution free from the errors made by the opportunists who touch on it but briefly. The collection of large numbers of cases alone is no guarantee against the fallacies implicit in small series; but, when wide and deep experience is matched with honesty, perceptiveness and lucid expression it can result in authority.
THE DISAPPEARANCE OF THE GENERAL PRACTITIONER: TWO SIMILAR VIEWS—1872 and 1968
Authors: C. T. E.
Published: December 2021

In 1968 Doctor Helen M. Wallace in writing about the decrease in the number of general practitioners cites the following facts:

It is clear from the existing data on medical manpower that although the total number of all physicians and of all pediatricians is increasing, the ratio of general practitioners to population is decreasing markedly. . . . For example, the ratio of general practitioners to the childhood population under fifteen years of age fell from 345 pen 100,000 in 1940 to a ratio of 135 in 1961.1

About a hundred years earlier Doctor J. B. Fonssagrives was similarly bothered by the disappearance of the family (general) practitioner. In a book widely read by mothers in the 1870's he wrote:

In former times there was such a person as the family physician; he exists no longer, except in a few small towns where old-time customs are still kept up, and in which free thus far from the cosmopolitan mania, the various generations of a family quietly succeed each other under the same roof.

But how vastly different (1872) is the ordinary course of events! The placid home life is becoming the exception; the house is giving place to the tent; we are born in one town reared in another, married in a third, and we shall die, God knows where. Thus situated–encamped as it were–we do not dream of providing ourselves with a physician. There comes an emergency, and we go from door to door in quest of the first one we may meet.
ABSENCE OF TRANSIENT SUPPRESSION OF SEX CHROMATIN IN FEMALE PREMATURE NEWBORNS
Authors: Homma Takemi , Kajii Tadashi
Published: December 2021

The frequency of sex chromatin-positive nuclei during the first 7 days of life was determined in oral mucosa smears stained with lactic acetic orcein in three groups of newborn female infants: 28 cases of full-term newborns, 17 cases of infants with low birth weight (less than 2,000 gm) and high gestational age (more than 32 weeks), and 11 cases of infants with low birth weight and low gestational age (32 weeks or less). A transient suppression of sex chromatin frequency was observed for the first 3 days of life in the full-term females, as has been reported by previous workers. The infants with low birth weight and high gestational age likewise showed transient suppression. The infants with low birth weight and low gestational age, on the other hand, exhibited no comparable suppression of sex chromatin. The findings suggest that the mechanism responsible for sex chromatin suppression is related to a physiologic process that develops in the last 8 weeks of gestation.
SKIN TESTING WITH LIQUID OLD TUBERCULIN WITH A MULTIPLE PUNCTURE TECHNIQUE
Authors: Kravitz Harvey , Burg Fredric , Lawson Robert B.
Published: December 2021

An improved multiple puncture technique (MPT) for tuberculin testing is applied with a nine-pointed plastic ring covered by a tube containing a specially concentrated liquid tuberculin. A high degree of positive and negative agreement was obtained with this test when compared to the Mantoux test (PPD, 5 TU). The reactions from the multiple puncture technique are discrete, single, and circular, and they are easy to read and measure.

Erythema and induration from this test are smaller than from the Mantoux test (PPD, 5 TU). Children appear to show less fear and felt less pain with the multiple point test than with the Mantoux test. "Wet" tuberculin on multiple points eliminates two possible variables associated with "dry" tuberculin on the points–the length of time that the tines are held in the skin and the moisture content of the skin.
CYSTIC FIBROSIS AND DOWN'S SYNDROME
Authors: Milunsky Aubrey
Published: December 2021

The association of cystic fibrosis and Down's syndrome has been documented for the first time in three cases. While the association may be considered as purely fortuitous, features common to both indicate a contrary possibility. Similar shared features include increased sodium content of parotid saliva, abnormal morphology of nailbed capillaries, autonomic dysfunction, an increased frequency of diabetes mellitus, and intestinal atresia.

Cystic fibrosis probably occurs more frequently in children with mongolism than heretofore suspected. A sweat test is mandatory in a child, albeit a mongol, having recurrent pneumonia.
Septicemia and Enterocolitis Due To Shigella sonnei in a Newborn Infant
Authors: Kraybill Ernest N. , Controni Guido
Published: December 2021

Shigellosis has been considered an infection usually limited to the mucosa and lumen of the large bowel with occasional involvement of regional lymph nodes. This is undoubtedly true in most cases, but well documented instances of bacteremia associated with severe systemic illnessl-5 suggest that significant blood stream invasion can occur. In the majority of cases the bacteremia was due to Shigella fiexneri or Shigella dysenteriae.

Three cases of Shigella sonnei septicemia in children6-8 and one case in an adult9 have been reported. Recently, the first case report of meningitis and septicemia due to this organism in a newborn infant was published.10
Hattie Alexander
Authors: McIntosh Rustin
Published: December 2021

The death of Hattie Alexander, on June 24 last, took from pediatrics one of its most loyal and effective participants. Her skill as a clinician and as an investigator of communicable disease won her wide recognition which need not be detailed here, except to recall that she was the first woman to be elected president of the American Pediatric Society.

Two striking aspects of her personality should he mentioned, however, for they have been overlooked by the obituary notices I have seen thus far, including the admirable tribute published in the New York Times of June 25. One is her scientific objectivity, the other, her courage.
Letters to the Editor
Authors: Coleman Allan B.
Published: December 2021

The idea of incorporating an emetic into aspirin tablets is neither "whacky" nor new. Of course, the concept of the self-correcting poison appeals.

Previous attempts at such combinations have been poorly accepted and seem impractical. Those of us old enough to remember the symptomatic treatment of pertussis with syrup of ipecac in drop doses for infants, remember the rather individual dose-juggling required to stay at a "subemetic" nauseant expectorant level. I seem to recall a self-antidoting sedative plus analeptic tablet a few years ago which has faded into the limbo of useless drugs.
SOCIAL, PSYCHOLOGICAL, AND NEUROLOGICAL FACTORS ASSOCIATED WITH NOCTURNAL ENURESIS
Authors: Oppel Wallace C. , Harper Paul A. , Rider Rowland V.
Published: December 2021

Data on 859 children, who have been followed longitudinally from birth through 12 years, display associations of nocturnal enuresis with neurological, social, and psychological factors. To study these associations, various groups were formed, taking into account age of attaining ness and presence or absence of relapse. Most comparisons were of enuretic status at 6 to 8 years versus other measures at 6 to 10 years, as specified. Six-year-old children are at increased risk of having never been dry when they have neurological abnormalities on clinical examination, are middle children in birth order, or when their mothers have an unfavorable evaluation of them, a poor marital adjustment, or a low rating on a social contact scale. Other maternal attitudes are more likely to be associated with the never dry status of girls than of boys. Never dry 7 year olds are more sensitive, more likely to suppress feelings, more with-drawn, less ambitious, and have less fear of failure than the permanently dry group.

Relapsers at 6 to 7½ years are more likely to be of low socioeconomic status, have a large number of siblings and display the following personality traits: decreased fear of failure, decreased anxiety and tension, and increased impulsivity when compared to non-relapsers.

Low birth weight carries an increased risk of both prolonged bedwetting (never dry) and relapsing when it is associated with low I.Q. or poor performance on reading tests. Poor performance on Bender-Gestalt tests also is associated with increased risk of relapsing in children who are of low birth weight.