bluuebunny/crossref_metadata_2025 huggingface dataset:
A Psychology of Growth
Authors: SPOCK BENJAMIN
Published: December 2021

This book is based on a series of lectures on psychology which the author has given to student nurses. The publisher recommends it for professional groups in child care and also for parents. It should be a good introductory text for nurses, physicians, teachers and other professionals. Part of it would be helpful to parents too. But other parts, which emphatically and no doubt justifiably blame parents for many behavior problems, would create only guilt and further confusion in the parents to whom it applied.

The author discusses such topics as normal emotional development, feeding, toilet training, companionship, discipline, intelligence, mental testing, schooling, fears, enuresis, stuttering, stealing.
THE EVALUATION OF CORD-BLOOD HEMOGLOBIN, RETICULOCYTE PERCENTAGE AND MATERNAL ANTIGLOBULIN TITER IN THE PROGNOSIS OF HEMOLYTIC DISEASE OF THE NEWBORN (ERYTHROBLASTOSIS FETALIS)
Authors: Kelsall G. A. , Vos G. H. , Kirk R. L. , Shield J. W.
Published: December 2021

An unselected series of 218 consecutive pregnant women in whom Rh antibodies were detected by means of a standardized antiglobulin test has been studied to evaluate the prognostic significance of values for cord-blood hemoglobin, reticulocyte percentage and maternal antibody titer at term. Twenty-four of the women gave birth to Rh-negative infants, 35 to stillborn infants, the majority of whom were severely macerated, and 159 to liveborn Rh-positive infants.

All but three of the Rh-positive liveborn infants who were not moribund at birth were exchange-transfused if the maternal titer at term was 1:128 or higher.

Of the 159 Rh-positive liveborn infants, 19 subsequently died, 5 of these being in the untreated group. The remainder were alive and well at least 1 month after birth.

The antibody titer of the maternal serum at term determined by the indirect antiglobulin technique is not quite such a good prognostic index of the chance of survival of liveborn Rh-positive infants as either values for cord-blood hemoglobin or reticulocyte percentage. Titration values of the maternal serum have the distinct advantage that they can be determined before birth, and so give guidance in the management of the case, including the early induction of labor.

A statistical comparison of the effectiveness of treatment showed that the lower neonatal death rate achieved in the present series was not significantly different from that in comparable series in England and America.

Comparison with results published for a comparable American series, where the prognostic significance of maternal antibody titer at term as determined by the plasma-albumin method was evaluated, suggests that the indirect antiglobulin technique for titrating the antibodies in the maternal serum is not only more sensitive than the plasma-albumin method, but it achieves a more clear-cut separation between mild and severe cases. In consequence the indirect antiglobulin technique gives titration values of greater prognostic significance.

Once the child is born, prognosis based on a combination of either maternal antibody titer with values for cord-blood hemoglobin or reticulocyte percentage is more accurate than one based on maternal antibody titer alone.
CONGENITAL ABSENCE OF THE SPLEEN
Authors: Murphy James W. , Mitchell William A.
Published: December 2021

A case is reported of congenital absence of the spleen in a 15-month-old Negro female infant. Her condition was uncomplicated by other congenital abnormalities, and represents the second such case in a child to appear in the literature. Most of the other reported instances of splenic agenesis are associated with congenital cardiac anomalies, partial situs inversus, accessory lobe of the left lung, and abnormal mesenteric attachments, forming a syndrome of anomalies. These probably arise from factors affecting the fetus at the 5-week stage of development. Some patients have hematologic findings similar to patients post splenectomy.

This child had a course marked by lack of resistance to infection, and leukocyte counts so high as to simulate leukemia. She finally expired, with pneumonia and Waterhouse-Friderichsen syndrome.
OBSERVATIONS ON THE ETIOLOGY OF DWARFISM IN CONGENITAL TELANGIECTATIC ERYTHEMA
Authors: Hillman D. A. , Crawford J. D. , Talbot N. B.
Published: December 2021

The case history of a boy with growth retardation, caloric undernutrition, telangiectatic skin lesions on the face and areas of altered skin pigmentation is presented. Administration of cortisone resulted in improvement of the appetite and significant weight gains. Following discontinuation of cortisone therapy, spurts in linear growth were observed which appeared to be limited and probably related to the utilization of fat deposits accumulated during an earlier period of cortisone administration.

It is concluded that the short stature observed in this patient was a function of caloric undernutrition.
MEASUREMENT OF FETAL HEMOGLOBIN IN NEWBORN INFANTS
Authors: Cook Charles D. , Brodie Hugh R. , Allen David W.
Published: December 2021

A relation between per cent of the hemoglobin that is of the fetal type at birth and gestational age has been demonstrated. Data are presented which show that, after 34 weeks gestation, the per cent fetal hemoglobin drops approximately 3 to 4% per week prenatally. This is similar to the postnatal weekly decrease reported by other authors.

Intrauterine hypoxia, particularly of the sort associated with postmaturity, was not found to be associated with an increase in per cent fetal hemoglobin and probably not associated with an increase in total hemoglobin in the body. On the basis of reticulocyte counts and clinical examination and in the absence of studies of blood volume, it is suggested that the increased total concentrations of hemoglobin observed in the postmature infant with prenatal hypoxia are possibly the result of hemoconcentration rather than erythropoietic response to lack of oxygen.
Sinusitis and Rheumatic Fever
Authors: BROWN EDWARD E.
Published: December 2021

Rheumatic fever interests every pediatrician. After reading two articles on rheumatic fever in the May, 1957 issue of Pediatrics, one by Diamond and the other by Galdston, as well as much of the recent literature on the subject, I would like to comment on the failure to discuss or consider the probable streptococcal focus for this disease, chronic sinusitis (Brown, E. E.: Cause of rheumatic fever—Chronic sinusitis. Arch. Pediat., 68:575, 1951).

Such theories of etiology as "heredity" (Diamond), "constitution of the victim" (Galdston), virus, diet, allergy, cortical hypoadrenia and others, cannot explain the varying seasonal and geographical incidence of rheumatic fever.
Helping Babies Survive: Lessons Learned From Global Trainers
Authors: Merali Hasan S. , Visick Michael K. , Amick Erick , Savich Renate D.
Published: December 2021

BACKGROUND:

The Helping Babies Survive (HBS) suite of programs was launched in 2010 as an evidence-based educational package to train health care workers in low- and middle-income countries in neonatal resuscitation, immediate newborn care, and complications of prematurity. To date, there has been no purposeful examination of lessons learned from HBS trainers. Our intent with this study is to gather that data from the field.

METHODS:

To estimate the total global reach of the HBS program, we obtained equipment distribution data from Laerdal and HBS material download data from the HBS Web site as of March 2020. To understand the lessons learned from HBS trainers, we examined comments from trainers who recorded their trainings on the HBS Web site, and other first-hand accounts.

RESULTS:

More than 1 million pieces of equipment (simulators, flip charts, provider guides, and action plans) have been distributed worldwide. HBS materials have been downloaded from the Web site >130 000 times and have now been translated into 27 languages. HBS equipment and training has reached an estimated 850 000 providers in 158 countries. Qualitative analysis revealed 3 major themes critical to building successful and sustainable HBS programs: support, planning and local context, and subthemes for each.

CONCLUSIONS:

Lessons learned from experienced trainers represent a vital distillation of first-hand experience into widely applicable knowledge to be used to reduce potential failures and achieve desired outcomes. Findings from this study offer further guidance on best practices for implementing and sustaining HBS programs and provide insight into challenges and successes experienced by HBS trainers.
Helping Babies Survive Programs as an Impetus for Quality Improvement
Authors: Ehret Danielle E.Y. , Patterson Jackie K. , KC Ashish , Worku Bogale , Kamath-Rayne Beena D. , Bose Carl L.
Published: December 2021

Achieving the ambitious reduction in global neonatal mortality targeted in the Sustainable Development Goals and Every Newborn Action Plan will require reducing geographic disparities in newborn deaths through targeted implementation of evidence-based practices. Helping Babies Survive, a suite of educational programs targeting the 3 leading causes of neonatal mortality, has been commonly used to educate providers in evidence-based practices in low-resource settings. Quality improvement (QI) can play a pivotal role in translating this education into improved care. Measurement of key process and outcome indicators, derived from the algorithms (“Action Plans”) central to these training programs, can assist health care providers in understanding the baseline quality of their care, identifying gaps, and assessing improvement. Helping Babies Survive has been the focus of QI programs in Kenya, Nepal, Honduras, and Ethiopia, with critical lessons learned regarding the challenge of measurement, necessity of facility-based QI mentorship and multidisciplinary teams, and importance of systemic commitment to improvement in promoting a culture of QI. Complementing education with QI strategies to identify and close remaining gaps in newborn care will be essential to achieving the Sustainable Development Goals and Every Newborn Action Plan targets in the coming decade.
URINARY EXCRETION OF COPROPORPHYRIN BY CHILDREN DURING AND AFTER ACUTE STREPTOCOCCAL INFECTIONS
Authors: Galambos John T.
Published: December 2021

The 24-hour urinary excretion of coproporphyrin was measured in three groups of children.

Group I consisted of 88 children with acute scarlet fever, hospitalized in Providence, Rhode Island, during an epidemic in the spring of 1957. Single 24-hour specimens of urine were obtained during the first or second week of illness.

Group II was composed of 54 children with sporadic streptococcal pharyngitis seen by private pediatricians in Atlanta, Georgia. Urinary excretions of coproporphyrin were measured during the acute illness and at weekly intervals thereafter.

Group III included 21 children with nonstreptococcal pharyngitis.

Acute streptococcal infection usually is not associated with a significantly increased rate of urinary excretion of coproporphyrin in children who do not develop subsequent acute rheumatic fever. A greater rate of urinary excretion of coproporphyrin by boys than by girls was significant at the 1% level of confidence.
THE CONCENTRATION OF LEAD IN PLASMA, WHOLE BLOOD AND ERYTHROCYTES OF INFANTS AND CHILDREN
Authors: Robinson Morton J. , Karpinski Felix E. , Brieger Heinrich
Published: December 2021

The concentration of lead in the blood of 103 infants and children without history of pica or lead poisoning, ranging in age from 5 hours to 13 years, was studied. The children were divided into three groups according to age: Group I, 5 hours to 6 months of age; Group II, 6.1 months to 4 years of age; Group III, older than 4 years.

The values obtained in Group I were significantly lower than those obtained in Groups II and III. Groups II and III showed approximately the same content of lead in whole blood and erythrocytes. The median values in Group I were 0.015 mg/ 100 ml of whole blood and 0.034 mg/100 ml of erythrocytes. In the combined Groups II and III median values in whole blood were 0.027 mg/100 ml, and in erythrocytes 0.065 mg/100 ml. The range in Group I was 0.005-0.031 mg/100 ml of whole blood and 0.010-0.090 mg/100 ml of erythrocytes. In the two groups more than 6 months of age, the range for whole blood was found to be 0.003-0.054 mg/100 ml, and for erythrocytes 0.003-0.144 mg/100 ml; 90% of the values were between 0.015 and 0.040 mg/100 ml (whole blood), and between 0.028 and 0.103 mg/100 ml (erythrocytes).

Significant amounts of bead were found in the whole blood (0.007-0.028 mg/100 ml), and erythrocytes (0.010-0.044 mg/100 ml) of newborn infants.
IMMUNOLOGIC DISEASE
Authors: Raffel Sidney
Published: December 2021

IMMUNOLOGIC diseases are those in which some kind of immunologic sequence of events in the body is of prime importance in initiation and progression. Underlying this there may be an infectious or toxic process, or simply exposure to an antigenic substance or cell. The list of such diseases is fairly lengthy, and they are often all spoken of as diseases of allergy or hypersensitivity. The main purpose of this paper is to categorize these diseases, as well as facts and speculation permit, on the basis of underlying immunologic mechanisms; the intention is to dispel the notion that these are all necessarily products of those changes which the term "hypersensitivity" denotes.

It is worth while to bring precision to our semantics because otherwise we may easily be trapped into an assumption of knowledge which we do not have, and into a corollary tendency to stop delving into that which we think we already know. The term "hypersensitivity" implies certain fairly well-understood immunologic processes which account for some of the diseases to be mentioned, but from the mechanistic standpoint these processes do not explain other disorders which may nonetheless be of immunologic origin.

The roster of these diseases includes such unequivocally allergic conditions as asthma, hay fever, serum sickness, and anaphylaxis, as well as the so-called delayed allergic reactivities which accompany infection or follow contact with various plant and chemical substances. To this list are added the so-called "collagen" diseases: periarteritis nodosa, disseminated lupus erythematosus, rheumatic fever, rheumatoid arthritis and dermatomyositis; glomerulonephritis, demyelinating encephalomyelitis, and sympathetic ophthalmia; the disorders in which two individuals are concerned, including tissue grafting and transplantation, transfusion reactions, erythroblastosis fetalis and possibly reactions occasioned by platelet and leukocyte group factors; and finally those hematologic disorders, including anemia, thrombocytopenic purpura and agranulocytosis, in which a transfer of cellular or tissue elements between two individuals is not involved.
Les Malformations Congénitales du Poumon
Authors: WARKANY JOSEF
Published: December 2021

With the improvement of diagnostic methods and surgical procedures for recognition and alleviation of congenital malformations, the interest of physicians in morphologic deviations of development has increased in recent years. A monograph on congenital malformations of the lungs will be welcomed by many clinical students of this field.

In the introduction the authors review the classifications of pulmonary malformations established by other writers and then offer a classification of their own. The first chapter deals with the embryology of the respiratory apparatus and the changes occurring at and after birth.
CHLOROTHIAZIDE
Authors: CRAWFORD JOHN D.
Published: December 2021

CHLOROTHIAZIDE is a new, orally effective diuretic agent chemically related to acetazolamide. Curiously, it is a considerably less potent carbonic anhydrase inhibitor, at least in vitro and, in vivo, its effect has been found additive to that of acetazolamide as it is to the action of the mercurials. Laragh's observations suggest that chlorothiazide inhibits the process of solute reabsorption which normally gives rise to "free" water in the urine. Thus, it may well have a locus of action in the kidney different from that of its chemical cousin or the mercury derivities. There have been optimistic reports of its efficacy in a variety of edema states including nephrosis, cirrhosis of the liver, congestive heart failure, acute hemorrhagic nephritis and chronic renal insufficiency.
Frenectomy
Authors: COLE ARTHUR R. C.
Published: December 2021

Not too many years ago articles appeared in pediatric journals regarding the attachment of the frenulum of the upper lip to the gum and the relationship of this attachment to the separation of the upper central incisors.

I would like to know if there is any further more conclusive work on this subject.

The opportunity to see and correct this abnormality early is the pediatrician's and should be done if the correction is of definite value in reducing or eliminating orthodontic procedures at a later time.
Oral Feeding in Diarrhea and Hypertonic Dehydration
Authors: HOLT L. EMMETT
Published: December 2021

In Pediatrics, July, 1958 (22:5), Colle, Ayoub and Raille reported data on a group of infantile diarrheas which suggested strongly that the liberal administration of electrolytes with inadequate amounts of water during the course of the diarrhea, and possibly before its onset, had been responsible for an unusually high incidence of hypertonic dehydration. Their painstaking and thoughtful analysis deserves commendation and should provide a timely corrective to overenthusiastic and uncritical electrolyte therapy. In commenting upon their paper Finberg (Pediatrics, 22:2, July, 1958) went considerably beyond the data and conclusions of the authors, indulging in a broad condemnation of early feeding in acute diarrhea.
Care of the Premature Infant
Authors: PARKE PRISCILLA
Published: December 2021

This revised edition based on The Premature Infant by Miss Lundeen and Dr. Hess gives a most comprehensive report of the nursing methods and techniques used at the Premature Infant Station of Sarah Morris Hospital, Chicago. The book was composed to be of interest to both doctors and nurses in this field. In addition to nursing techniques, the book, perhaps unwisely, undertook some discussion of the physiologic aspects of the premature infant, the environmental needs, pathologic conditions and their management, and home and follow-up care.
ASSAY OF PROTEOLYTIC ACTIVITY IN THE DIAGNOSIS OF PANCREATIC FUNCTION
Authors: Frazier Robert G.
Published: December 2021

Difficulties in the proper use of the gelatin-viscosity test for assay of proteolytic activity have been discussed. It is the author's opinion that for routine clinical diagnostic studies the Andersen-Early test is sufficiently accurate and much simpler.

The considerations presented regarding measurement of pancreatic function and interpretation of data justify a critical attitude toward accepting some of the published data regarding normal and partial or progressive loss of pancreatic function. That such possibilities may exist is not denied, but the actual incidence must be determined by proper application and interpretation of results from sound methods for assay of pancreatic enzymes in duodenal fluid.
The Ureterovesical Junction
Authors: ZINSSER HANS H.
Published: December 2021

This little book contains an excellent summary of many aspects of the problem of neurogenic bladder with particular emphasis on the author's operation for returning competence to decompensated ureterovesical junctions. The initial section describing the clinical course of the patient with a traumatic neurogenic bladder is excellent both in detail and in tone. The book is profusely illustrated both with roentgenograms of excellent quality, drawings and microscopic sections.
SURVEY OF POISON CONTROL CENTERS
Authors: Cann Howard M. , Verhulst Henry L. , Neyman Dorothy S.
Published: December 2021

As of April, 1958, there were 124 poison control centers in 40 states and territories. The results of a study of the operations of 102 of these centers are presented. Coordination of activities of poison control centers is desirable, especially where more than one center serve the same area. The American Academy of Pediatrics has led the way in establishing centers all over the country. Increasing numbers of state and local departments of health and medical schools are participating in control of poisonings and strengthening the movement for development of poison control centers.

Poison control centers give information concerning toxicity of a variety of products and substances. Many also maintain facilities for treatment of poisoning, but emergency rooms of all hospitals should be equipped to give proper treatment for poisoning.

Prevention of accidental poisoning is the best "treatment" for this "disease." Followup studies of patients will uncover significant causal factors and enable effective preventive measures to be instituted.

All physicians are encouraged to learn the location and utilize the services of the nearest poison control center.
DETERMINATION AND SIGNIFICANCE OF A DIETARY ALLOWANCE OF PROTEIN FOR INFANTS
Authors: May Charles D.
Published: December 2021

PROBABLY the greatest contributions to successful artificial feeding of infants that will ever be witnessed have already been made, namely: the discovery of the importance of bacterial contamination; the recognition of the role of vitamins; and the realization that fresh cow's milk produces large curds in the infant's stomach and must be treated by heat or other means to improve its digestibility.

Elimination of these major handicaps of artificial feeding permitted attention to be focused on determination of precise figures for the amounts of individual nutrients which should be supplied by the diet to foster sound nutrition. Especial interest was attracted by the question of the relative adequacy of the protein in cow's milk and human milk. This called for refinement in methods of appraising the state of nutrition and clarification of the ultimate goal in infant feeding—the most desirable state of nutrition.

Premature or excessive emphasis on selection of a figure for the dietary allowance of a nutrient is liable to arouse emotional controversy and distract nutritionists from the fundamental issues involved in judging nutritional status. Progress in the science of nutrition could easily be hampered by satisfaction with the sort of pseudosophistication so readily conveyed by plain numbers.

If a figure for an allowance is proposed, there is a great temptation to exploit such a handy value by matching the composition of food products against this kind of "standard." The clamor of conflicting claims in the market place threatens to obscure the deficiencies in the fundamental knowledge upon which a meaningful figure for the allowance of protein or any other nutrient must be based.

The Food and Nutrition Board of the National Research Council has now wisely recognized these considerations by not including a figure for protein allowance in infancy in the 1958 revision of their Recommended Dietary Allowances which states: "Breast-feeding is the best and desired procedure for meeting the nutrient requirements in the first months of life."

This is a favorable setting in which to survey the principles which should govern the determination of the dietary allowance of protein for infants and to dwell upon the significance to be attached to any value proposed.
The Nursing of Mental Defectives
Authors: YANNET HERMAN
Published: December 2021

In England and Scotland, unlike the situation in this country, one of the nursing specialities is known as "mental deficiency nursing." The training for this is professionally supervised, and when completed, leads to official registration or certification, following a suitable examination. This book, written by a registered nurse, teaching the course in one of the official hospitals for mental defectives, is designed to serve as a textbook to fill a longstanding need, to assist these nursing students in their studies, and is also suggested as helpful reading for parents and others who may be caring for these children.
STUDIES ON CONGENITAL HEMOLYTIC SYNDROMES
Authors: Erlandson Marion E. , Schulman Irving , Smith Carl H.
Published: December 2021

Four adult patients were studied in whom classic congenital spherocytic anemia was evident clinically and by laboratory examination. Anemia, as determined by total volume of erythrocytes, was marked although concentrations of hemoglobin were only slightly low. Rates of destruction and production of erythrocytes were markedly accelerated.

Six pediatric patients with minimal clinical manifestations but definite laboratory evidence of congenital spherocytosis were evaluated. Anemia, in terms of total volume of erythrocytes, was present in all patients despite normal concentrations of hemoglobin in some patients. A potential for future severe clinical manifestations was shown to be present in five of six children by the demonstration of marked hemolytic defects equivalent to the hemolytic defects present in adult patients with classic congenital spherocytic anemia.

In the present series of patients with congenital spherocytosis in whom concentrations of hemoglobin were normal or slightly low, values for the total volume of erythrocytes and the compensation index were similar to values in patients with intermediate (homozygous) thalassemia and in many patients with sickle cell anemia.

Abnormally low values for total volume of erythrocytes and compensation index were present in four patients in whom the rate of destruction of erythrocytes was less than six times normal. Rates of production of erythrocytes were less than six times normal in the majority of patients studied. This is contrary to a previous concept of the capacity for erythropoietic compensation in such patients. These values imply that some factor(s) which has not as yet been identified regulates the rate of erythropoiesis in these patients.

Studies of four family groups of patients with congenital spherocytosis demonstrated the absence of any specific familial pattern of manifestations of the disease.

It has been suggested that management of children with minimal symptoms resulting from the presence of this disease consists of careful observation, splenectomy being deferred until late in childhood to avoid a maximal risk of infection after splenectomy. It has also been suggested that splenectomy be performed before the age of 10 years in order to avoid the complication of gallstones, and that splenectomy be performed at an even earlier age if persistent severe symptoms are present.

The existence of a truly mild hemolytic defect was demonstrated in only 1 of the 10 patients studied. It would seem that splenectomy is not indicated in this unusual patient.
PHENOTHIAZINE TRANQUILIZERS AS A CAUSE OF SEVERE SEIZURES
Authors: Shaw Edward B. , Dermott Robert V. , Lee Raymond , Burbridge T. N.
Published: December 2021

The phenothiazine tranquilizer drugs should not be used indiscriminately for symptomatic treatment without due appreciation of the alarming and potentially serious side effects which may follow relatively small doses, especially in childhood. Minimal dosage, due warning to parents of possible symptoms, and careful observation are essential precautions for physicians who use these agents.
CHILD REARING
Authors: MAY CHARLES D.
Published: December 2021

MUCH of the practical concern of pediatricians with mental hygiene involves concepts of child rearing. The way parents seek to influence the development of their children is determined by many factors, not the least of which are the prevalent attitudes of the "experts." Parents expect the pediatrician to be among the "experts" or at least be familiar with current authoritative opinions on the "best" ways to rear children.

This means that we should occasionally take stock of the present notions about rearing children and try to discern the direction the currents of opinion may be carrying us. It requires rare ability to gain the perspective needed to set forth the essential issues in so complex a problem and to see the paths being taken to reach the goals. This has been done with great skill in an article by Dorothy Barclay, reprinted in this issue of Pediatrics (Education).
EDUCATION
Authors: Barclay Dorothy
Published: December 2021

AS WE OBSERVED the family scene over the year just past, it seemed to us that public talk about the family, about what it is and what it should be, was taking a definite turn for the wiser. By this we mean that discussions of this sort seemed to become more logical and realistic—more "common-sense," if you will. In 1958 we saw a general easing up on parents, a tapering off of the blame-them-beat-them type of criticism that had flourished in recent years.

The experts—and we include under this heading speechmakers from a wide range of fields who make pronouncements on "the right way" to live—continue to recognize parents as the single greatest influence on children's lives. But they recognize that there are other influences at work, too. Some are totally beyond parental control. They include hereditary or constitutional factors affecting the individual child, neighborhood conditions, the quality of community schools and services and, indeed, the whole state of the world.
PEDIATRIC OPHTHALMOLOGY
Authors: Miller James E.
Published: December 2021

THE ROUND TABLE covered two principal topics: first, external diseases of the eye, especially in relation to infection and to lid and conjunctival lesions; and, second, growth and development of the eye with stress upon eye movements, refractive errors, and strabismus.

External diseases of the eye are often primary, but pathology in this area frequently is found to reflect systemic illness.

LID

Various glands of the lid were defined and the pathology of each reviewed. In the fibrous tarsal portion of the lid lies the Meibomian gland, the sebaceous secretion of which prevents the spillage of tears and protects the lid margin. The acute inflammation is usually staphylococcal, and tends to persist to produce a granuloma surrounded by fibrous tissue. A chronic chalazion consists of round, epithelial and giant cells without acid-fast organisms. Heat may be useful initially in the acute stage; however resolution is slow and usually terminates in a hard, persistent nodule. The removal of the chronic chalazion is by curettage.

The glands of Zeiss are the sebaceous glands for the lash follicles. By contrast, infection of these results in a self-limited disease, hordeolum or stye, which drains itself spontaneously or may require local incision. Rarely are there complications following a hordeolum. Some individuals are more susceptible to repeated infections, and prevention remains an unsolved problem.

The sweat glands of the lid, or glands of Moll, may form simple cysts on the lid margins which rupture easily.

The lacrimal glands in the upper part of the lid are seldom involved in an inflammatory process, except occasionally in mumps or sarcoid.
Letters to the Editor
Authors: WATERS WILLIAM J.
Published: December 2021

I have read with great interest and delight your recent editorial in Pediatrics, "Can The New Pediatrics Be Practiced?" Nowhere have I seen the issues so clearly defined, and it was particularly refreshing to see one who is not in "full time practice" focussing attention on the problem. Your admonition to the "conscientious practicing pediatrician" is very apropos but I firmly believe that every individual interested in the field of pediatrics, regardless of the affiliation, had best put his shoulder to the wheel.
Letters to the Editor
Authors: BROOKE WILLIAMS R. D.
Published: December 2021

I am writing regarding the editorial in the February issue of Pediatrics concerning discontent with the practice of pediatrics, and would suggest several factors that may be contributory.

Many pediatricians, whether of the old original school or of a more recent vintage, have taken up the practice of pediatrics because of the inspiration and satisfaction they have obtained from working with the fine group of men who run the pediatric departments in the medical schools, and often because they enjoy a close relationship with parents and children.
Letters to the Editor
Authors: TOMPKINS CHARLES A.
Published: December 2021

Your excellent editorial in the February issue of Pediatrics should be provocative of additional constructive thinking on the problems of the practice of pediatrics.

I believe the new pediatrics can be practiced, but not in old frameworks. This is new wine and cannot be contained in old wine skins.

Comprehensive care means a new focus. The focus shifts from "shot and formula" and "diseases," to the whole child in whole families. The approach is longterm. Philosophically the concern is with the child and his family's total fulfillment, emotional and physical. The concern is not merely with illnesses as such, but with the child with an illness, whether it be emotional or physical and how it effects the fulfillment of his potential destiny in the family and social milieu.
Test to Aid in Diagnosis of Phenothiazine Intoxication
Authors: NELLHAUS GERHARD
Published: December 2021

In connection with the recent article by Shaw and coworkers (Pediatrics, 23:485, March, 1959) on the possibility of neurologic complications following the use of phenothiazine tranquilizers, attention is called to a simple laboratory test, first pointed out by Fellman (J. Nerv. & Ment. Dis., 123:575, 1956) and later popularized by the Forrests (Am. J. Psych., 113:931, 1957) which—especially in the absence of a good history—may help to establish the diagnosis.

A few drops of the urine of a patient who has taken one of the phenothiazides will give a red to purple color when mixed with ferric chloride solution (usually stocked as a 10% solution). A similar color reaction is obtained with Phenistix®, a paper strip impregnated with ferric chloride ions, marketed by the Ames Company, Inc. for the testing of urines to detect phenylketonuria.
ERYTHROPOIETINE
Authors: STOHLMAN FREDERICK
Published: December 2021

ERYTHROPOIETINE is a protein, capable of stimulating erythrocyte production, which is found in the plasma of animals subjected to hypoxia or following the administration of cobalt. Sufficient data have been accumulated in the more common hematologic disorders to draw some tentative conclusions about its etiologic and therapeutic significance in clinical medicine.

The highest concentrations of erythropoietine have been observed in diseases associated with erythroid aplasia. Substantial levels have been observed in congenital hypoplastic anemia, aplastic anemia, marrow aplasia due to chloramphenicol, and acute lymphocytic leukemia.

In diseases associated with hemolysis and erythroid hyperplasia, such as Cooley's erythroblastic anemia and sickle cell disease, concentrations of erythropoietine in the plasma are not as high as in patients with similar hemoglobin levels due to aplasia.
INTRACARDIAC PHONOCARDIOGRAPHY IN THE DIAGNOSIS OF CONGENITAL HEART DISEASE
Authors: Lewis David H. , Ertugrul Ali , Deitz George W. , Wallace John D. , Brown James R. , Moghadam Abdol-Nabi
Published: December 2021

Intracardiac phonocardiography, the recording of sounds from within the heart, has been carried out with 63 patients with congenital heart disease. Studies have also been done with 11 patients in the pediatric age range who did not have heart disease. This new technique of recording heart sounds has been shown to provide a degree of localization of heart sounds and murmurs not heretofore obtainable. It is by virtue of this property that intracardiac phonocardiography has an important place in the diagnosis of congenital heart disease. Records from several lesions are shown to illustrate this point.

It is believed that intracardiac phonocardiography should be made a part of the routine studies done at the time of cardiac catheterization.

The prospects for intracardiac phonocardiography are discussed.
ESTIMATION OF SEVERITY OF THE NEPHROTIC SYNDROME IN CHILDHOOD AS A GUIDE TO THERAPY AND PROGNOSIS
Authors: McCrory W. W. , Rapoport M. , Fleisher D. S.
Published: December 2021

The degree of clinical and biochemical improvement observed in 20 children with the nephrotic syndrome who received a similar course of adrenocortical steroid therapy has been correlated with the severity of the existing renal glomerular damage.

It appears that the clinical response of children with nephrosis to hormone therapy and their behavior shortly thereafter can provide the physician with information of prognostic value at an earlier period in the course of the disease than has been possible heretofore. This was especially true in the case of patients destined to have a favorable outcome.

The immediate and long-term therapeutic benefits obtained in a small group of patients with nephrosis, who received sufficient adrenocortical hormone therapy to induce and maintain maximal improvement in all measurable abnormalities, are superior to the results obtained by therapy aimed only at control of edema.
EXUDATIVE ENTEROPATHY
Authors: ULSTROM ROBERT A.
Published: December 2021

Loss of plasma protein into the gastrointestinal tract in the absence of actual bleeding has recently been demonstrated as a cause of "idiopathic hypoproteinemia." The euphonious name, "exudative enteropathy," has been used by Gordon to describe a group of nine patients, including a 2-year-old boy, whose common finding was hypoproteinemia due to loss of plasma protein into the gastrointestinal tract. A concomitant report by Schwartz and Jarnum confirms the association of these events in four additional patients. Although the first such patient reported had quantities of plasma protein present in the gastric juice sufficient to allow their demonstration by electrophoresis, the rapid digestion of the proteins by the enzymes normally present in the gastrointestinal tract has required the use of less direct methods in most of the subsequent cases.

Using a preparation of I131-labelled polyvinyl pyrrolidone (a plasma substitute with average molecular weight the same as serum albumin) Gordon has devised a test that avoids the problems created by the gastrointestinal digestion of protein.
DIENCEPHALIC SYNDROME OF EARLY INFANCY ASSOCIATED WITH BRAIN TUMOR
Authors: Braun Frederick C. , Forney William R.
Published: December 2021

A case of a diencephalic syndrome in early infancy is presented along with a review of nine previously reported cases.

This patient, as well as previously reported cases, had a glioma of the third ventricle. Massive hemorrhage secondary to a duodenal ulcer was a heretofore unreported complication.

The syndrome is characterized primarily by alertness and euphoria in the presence of marked emaciation.
A GUIDE FOR INTRODUCING CATHETERS WHEN CANNULATING SMALL VESSELS
Authors: Hohn Arno R. , Vlad Peter
Published: December 2021

THE INTRODUCTION of a catheter into a vein or artery in the pediatric age group is often difficult because of the small size of the vessels. A guide is herein described which greatly facilitates the insertion of a catheter. This instrument both dilates the vessel and guides the placement.

The guide is a curved probe tapering to a point, with a groove on its underside and a phlange on one end to facilitate its manipulation (Fig. 1, A). It is fashioned from 23 gauge. #316 stainless steel. Several sizes are made for the various sized catheters. The inside diameters of the guide vary from ⅛ to 3/64 of an inch and the length is 1½ inches. The phlange measures 1 by ¾ inches.

The technique of catheter introduction is as follows: a small longitudinal incision is made in a previously isolated vessel, the pointed end of the guide is then inserted and threaded up the vessel for a distance of two to eight millimeters. With one hand holding the guide in place, the catheter is slipped along the groove in the underside of the guide and into the vessel (Fig. 1, B). Once the catheter is in place, the guide is withdrawn.

Advantages of the guide are its structural simplicity and the speed with which [SEE FIG I IN SOURCE PDF] catheters can be inserted or replaced. No forceps or hemostats are needed. Catheters can now be readily inserted into small vessels. There is little trauma to the vessel aside from the initial incision. The latter becomes important when vessels are repaired following catheterization. Such is the case for all retrograde arterial catheterizations.

In addition to its use during cardiac catheterization, the guide should make easy the insertion of plastic tubing for exchange transfusion and in exposure of veins for intravenous therapy, especially in infants.
Prevention of Poisoning
Authors: DRESCHER ALEXANDER N.
Published: December 2021

The education of parents to the danger of accidental poisoning is an important aspect of office and clinic pediatrics. Since this preventive instruction can be time-consuming and incomplete in the usual medical interview, attention is called to the simple device of a display cabinet in the waiting room. In the display used in our clinic, the upper shelf shows common items actually ingested by our patients; the middle shelf contains those responsible for fatalities; the lower shelf demonstrates some of the discomforting elements of treatment.

The effectiveness of this exhibit has been attested to by a decreased incidence of poisonings and continued parental interest in the information presented.
Letters to the Editor
Authors: COHEN MELVIN I.
Published: December 2021

I fully appreciate and understand the nature of Dr. Bates' request. The many patients seeking treatment at our clinics make me uncomfortably aware of the problem. I wish I were able to give a more satisfactory answer.

Many of the orthodontic problems, especially the severe ones, are best explained on a genetic basis. Therefore, prevention, except for a rather indelicate perusal of the family albums prior to the nuptial vows, is often not possible. In specific instances where the environment is unfavorable, such as crossbite and late thumbsuckers, the orthodontists and pedodontists can and are eliminating more extensive treatment by instituting preventive measures. However, these constituite a minority of the cases.
Myleran and Malformations
Authors: Sherman Jacques L.
Published: December 2021

Diamond and co-workers (Pediatrics, 25:85, 1960) make the statement that "strong circumstantial evidence implicates Myleran transmitted through the placenta as the direct cause of the stunting, congenital anomalies and cytomegaly found in the infant described here." I believe that several comments are in order.

Can Myleran be implicated? One of the bits of evidence cited by the authors is: "There is no known published experience in humans to exonerate this drug as there is with 6-mercaptopurine."
IS THIS TRUE?
Authors: Cowie Valerie
Published: December 2021

"First, it is reasonable to suppose that significant numbers of profoundly handicapped children, dragging out their existence in a limbo, which is inconceivable to us, are alive owing to possibly over-zealous care and the use of sophisticated techniques in the neonatal period. Secondly, much more undergraduate and postgraduate teaching should be carried out in the wards of hospitals for the mentally subnormal where these unfortunates live, and where they pass from the view of those who have saved them. Very many doctors, some of whom are especially responsible for the care of the new-born, go the whole of their professional lives without setting foot in the places where the profoundly handicapped live on into adult years and even old age."
BIOFEEDBACK TRAINING: A REVIEW OF EVIDENCE
Authors: Blanchard E. B. , Young L. D.
Published: December 2021

The wonders of biofeedback training for treatment of many psychosomatic disorders such as hypertension, migraine headaches, cardiac arrhythmias, and epilepsy have appeared in Playboy, National Observer, and Medical World News, as well as in professionally edited journals. Alpha wave control by EEG feedback has become a popular executive creativity induction method. In a careful review of the published papers with good controls clinical effectiveness has been established only for EMG feedback training to eliminate subvocal speech during reading, in muscle retraining of paralytics, and in treatment of tension headaches. The therapeutic value of EEC biofeedback on alpha rhythms has not been demonstrated. Substantial reduction of blood pressure and cardiac arrhythmias has been achieved but convincing control data are not available. Modification of gastric acidity or migraine has not been demonstrated.

It would seem premature to hail biofeedback training as a panacea for psychosomatic and other disorders, but the evidence is interesting and highly provocative.
Occult Spinal Dysraphism: A Series of 73 Cases
Authors: Anderson Frank M.
Published: December 2021

The subject of occult spinal dysraphism or myelodysplasia is reviewed from standpoints of embryology, clinical manifestations, and treatment, and the management of 73 cases summarized. In general, these concealed lesions arise from developmental variants in the most distal part of the neural tube, a situation which may cause distortion or partial absence of neural tissues and also lead to damage from compression or traction. Lipomyelomeningocele and congenital dermal sinus are two examples of the many types of such lesions, but some are more complicated, and borderline myelomeningocele-like forms occur. Incontinence, deformity or weakness of the feet, impaired gait, and other difficulties may appear late and increase with growth. Surgical treatment is advised to reduce chances of delayed or progressive loss of function.
Why Such High Serum Levels of Vitamin A?
Authors: Garry Philip J.
Published: December 2021

The article by Glueck et at.1 dealing with the effect of cholestyramine and of diet therapy on the level of plasma vitamin A in familial type II hyperlipoproteinemia patients is somewhat disturbing because of the reported high levels of vitamin A found in the plasma of both normal and type II children.

In Table I of the article the vitamin A levels are reported in µmol/liter. Converting these values to the more familiar notation, µg/dl, one obtains the results shown in Table I.
Critical Comments on Lattimer et al's Article
Authors: Guyda H.
Published: December 2021

The recent article "The Optimum Time to Operate for Cryptorchidism" by Lattimer et al. is an upsetting and curious mixture of urologic and psychologic opinion. Certainly the need to diagnose and treat true bilateral cryptorchid testes is well documented. However, several highly important and serious proposals of theirs are completely unsubstantiated by documented scientific evidence to my knowledge and in the report by these authors themselves. The authors advocate the use of chorionic gonadotropins for both true cryptorchid (unilateral as well as bilateral) and migratory testes between the 4th and 5th birthdays, following which surgery must be embarked upon forthwith to preserve body image.