bluuebunny/crossref_metadata_2025_split huggingface dataset:
PROLONGED APNEA AND THE SUDDEN INFANT DEATH SYNDROME: CLINICAL AND LABORATORY OBSERVATIONS
Authors: Steinschneider Alfred 
Published: December 2021

Little is known of the final physiologic mechanism(s) resulting in SIDS. Five infants participated in this study, three of whom were referred at about 1 month of age because of cyanotic episodes of undetermined etiology. Respirations and eye movements were recorded during several sleep sessions on each patient. In addition, patients were observed on an apnea monitor and a record was kept of the incidence of prolonged apneic episodes (≥ 15 seconds).
The laboratory sleep studies revealed frequent periods of apnea (≥ 2 seconds) which (1) decreased in amount after a certain age and (2) were most frequent during REM sleep. All infants had a number of prolonged apneic and cyanotic episodes during sleep, some requiring vigorous resuscitative efforts. Prolonged apnea most often occurred in conjunction with an upper-respiratory tract infection or when frequent apnea was noted in the laboratory. Two of the infants subsequently died of SIDS.
These data support the hypothesis that prolonged apnea, a physiological component of sleep, is part of the final pathway resulting in sudden death. It is suggested also, that infants at risk might be identified prior to the final tragic event.
Vaccinia Virus and Tuberculin Reactivity
Authors: Smithwick Elizabeth M. , Steiner Morris , Quick Jacquelin D. 
Published: December 2021

In the January issue of Pediatrics (p. 118), Drs. Cooper and Martin described a child with probable scotochromogen (M. scrofulaceum) infection, whose signs and symptoms became evident after a primary smallpox vaccination. We studied the tuberculin skin test and the in vitro lymphocyte response in two children vaccinated during therapy for primary tuberculosis, with results which may be of interest to the authors and to other readers.
All skin tests were done with freshly prepared PPD-S; the induration was recorded after 48 hours.
PATIENT CARE AND STUDENT LEARNING IN A PEDIATRIC CLINIC
Authors: Haggerty Robert J. 
Published: December 2021

Every pediatrician who has taught or worked in university pediatric outpatient departments recognizes the syndrome presented by Duff et al. in this issue of Pediatrics. The diagnosis is clear: effective student teaching is not occurring. The etiology of this problem is complex and not so clear. Some of the causes are inappropriate patient selection for beginning students, lack of effective administrative organization to achieve even limited teaching objectives, and lack of appropriate techniques to diagnose and manage the complex sociomedical problems presented. As a result, student, faculty, and patient dissatisfaction is very high. Effective management of the syndrome is even less clear.
As with most complex problems, a clearer definition of the goals is the first step to a solution. What do we want the student to learn?
How to gather information from families with such complex social and medical difficulties? Skills in diagnosis and management of common or rare health problems? Change of attitudes? Until each ambulatory program defines its teaching objectives more clearly in behaviorally measurable terms, effective management of the disease "poor patient care and teaching" will continue to elude us. I would, however, suggest the following considerations:
1. The first direct patient experiences which students have in ambulatory settings should be with patients who present considerably less complex problems than those available in most of our outpatient departments, and there should be a wider social class selection for the student's initial experience. To achieve this will require either a different patient recruitment procedure or the use of different settings for such education.
LATE ADOLESCENT GROWTH IN STATURE
Authors: Roche Alex F. , Davila Gail H. 
Published: December 2021

Information is lacking concerning the ages at which children cease to grow in stature and the increment in stature after particular chronological ages or maturational events. This information would assist the management of children receiving therapy that may alter potentials for growth in stature and would be useful in developing new methods for estimating adult stature from childhood parameters.
The data were obtained from 194 children measured serially from birth to at least 22 years of age. Piecewise regressions provided estimates of the ages at which adult statures were reached and of adult stature levels. Growth in stature ceased at median ages of 21.2 years (boys) and 17.3 years (girls). The median stature increments, from 18 years to the cessation of growth in stature, were very small in the girls but were about 1.0 cm in the boys. The median stature increments after the femur or the tibia became mature, until growth in stature ceased, were close to 1.0 cm in each sex.
These results demonstrate the variability of growth in children. Some retain considerable potentials for growth in stature after 18 years of age, after the femur or tibia has become mature or after intervals of one or two years during which stature increments are small.
PROLACTIN ACTIVITY IN JUVENILE HYPOTHYROIDISM AND PRECOCIOUS PUBERTY
Authors: Costin Gertrude , Kershnar Ann K. , Kogut Maurice D. , Turkington Roger W. 
Published: December 2021

Two 8-year-old girls, one of whom had Down's syndrome, presented with myxedema and precocious sexual development. Elevated circulating thyrotrophin (TSH), luteinizing hormone (LH), follicle-stimulating hormone (FSH) levels, and prolactin activities were documented. Following treatment with thyroid extract, the abnormal clinical findings and the elevated levels of pituitary hormones returned to normal. The results of studies in our patients suggest a derangement in hypothalamic pituitary regulatory mechanisms.
It is postulated that low circulating thyroxine may increase the hypothalamic content of thyroid-releasing hormone (TRH) and the sensitivity of the pituitary to TRH stimulation resulting in increased release of TSH and prolactin. The elevated plasma gonadotrophins may result from a nonspecific stimulation of the hypothalamic gonadotrophin-releasing hormone (LH-FSH-RH) or from a direct stimulation by prolactin of the LH-FSH-RH.
Warning: The Use of Lomotil in Children
Authors: Rosenstein Gladys , Freeman Martha , Standard Anna L. , Weston Nathan 
Published: December 2021

Recently a father wrote the Food and Drug Administration (FDA) concerning the death of his child from accidental ingestion of Lomotil tablets. He bore the blame for leaving the "pills" where the child had been able to reach them. He had thought they were a harmless medication for diarrhea.
On December 3, 1969, the New York Times1 carried a column entitled "Children Periled by an Adult Drug," commenting on a paper delivered at the American Medical Association's clinical session. The article stated that "children who accidentally swallow a few tablets of a commonly prescribed antidiarrheal drug can get severe breathing difficulty, lose consciousness and sometimes die. . ."
RADIATION PROTECTION IN DIAGNOSTIC RADIOGRAPHY OF CHILDREN
Authors: Grossman Herman , Altman Donald H. , Baker David H. , Gwinn John L. , Kirkpatrick John A. , Shopfner Charles E. , Swischuck Leonard , Tefft Mekvin , White Harvey , Wilkinson Robert H. 
Published: December 2021

As is readily apparent, the problem of reducing radiation exposure to the pediatric patient encompasses many areas. In the past, more attention has been devoted to the concrete aspects such as refined radiographic equipment and gonadal shielding. Less attention has been devoted to the abstract aspects which involve the general philosophy and disposition of the referring physician and his radiologic consultant. In this regard, it cannot be overstated that close communication with the radiologist is mandatory. The (pediatric) radiologist is constantly aware of the aspects of radiation safety and utilizes this information when he obtains radiographic examinations.
There is a tendency to treat radiographic examinations in the same context as clinical and chemical laboratory investigations. Perhaps this attitude stems from the fact that radiographs are often ordered at the same time as these laboratory tests. Such an orientation is dangerous, and it behooves the referring physician and the radiologist to work in cooperation to remedy this situation. Indeed, it is simple to improve radiographic equipment and not too difficult to shield the child; but, it is difficult to formulate a proper attitude regarding radiographic examinations and their potential hazard to the pediatric population.
The Committee on Radiology plans to prepare additional recommendations on radiographic examinations to provide more detailed and technical information which should be helpful to pediatricians and other physicians providing care for children.
Medical Evaluation for Reading Disability— Last Time Around
Authors: Gregory Warren C. 
Published: December 2021

I agree with Kenny et al.1 on only one thing: the history, neurologic exam, and electroencephalogram have little to contribute to the evaluation of dyslexia.
Medical evaluation is all important in early identification of dyslexic children, and the unmasking of school failures who come to their physician with psychosomatic, physical, or emotional complaints, or as school failures. The physician who handles such a problem should not only have expert knowledge of the reasons for school failure but he should have an approach to the evaluation that will identify the strengths and weaknesses of the visual and auditory systems as relate to language functioning.
UTILIZATION OF CHILD HEALTH ASSOCIATES BY A PRACTICING PEDIATRICIAN
Authors: Greeb Charles A. 
Published: December 2021

In the preceding article, Drs. Silver and Ott have described the program for the new child health associate. However, the success or failure of any such program lies with its practical application. How does the child health associate perform in a clinical setting? How does he or she perform when dealing with private patients in a busy office?
I am a solo pediatrician in Lamar, a community of approximately 8,000 people in southeast Colorado. My practice is probably no different from that of most pediatricians except that I am the only one within a radius of at least 125 miles. On a typical office day, I see 25 to 40 patients depending on the time of year and the particular epidemic making the rounds of the community. I also serve as consultant to the local Migrant Council Health Program set up to deliver health care during the harvest season to migrant laborers and their families. It was through the Migrant Council Health Program that I had my first contact with a child health associate.
A child health associate student who had finished the first year of the course of study in Denver was sent to Lamar during the summer of 1971 to work under my supervision in delivering health care to migrant children. Initially, she spent approximately three weeks with me in my office developing greater skill in performing a physical examination and managing the more common pediatric conditions which she would be seeing in the migrant workers setting. She then took over the first-line health care at the migrant center and the day care center which was providing supervision for the children of families working in the fields.
Removal of Coins From the Esophagus: Nothing New Under the Sun
Authors: Chang Jack H. T. , Burrington John D. 
Published: December 2021

In the recent literature there appears to be a revival of interest in the use of Foley catheters in removing foreign objects from both orifices of the alimentary canal.1-3
During the peak of the Byzantine period, foreign bodies were extracted from the esophagus by having the patient swallow a small, dry sponge on a string, allowing it to expand in the stomach and then withdrawing the sponge. Paulus Aegineta (seventh century) wrote in Book Six of his Epitome of Medicine:
PEDIATRICS AND THE ADOLESCENT
Authors: Gallagher J. Roswell 
Published: December 2021

Thank you, Dr. Janeway; and thank you Dr. Work. And thank you all, very much. Deserving or not, it is very pleasant to know that you feel that I should have this award. However, I want to be sure that you all know that a large share of the award belongs to the trustees and the staff of the Children's Hospital. They wanted to establish a medical service for adolescents, and they supported it enthusiastically. My debt is very great to the late James Wells Farley, then President of the Board of Trustees, and to Dr. Janeway and others on the Senior Staff.
By nature, I have followed Satchel Paige's sage advice: "Never look back– something might be gaining on you." But today it is more appropriate to remember Jung's suggestion that the first part of life should be concerned with doing, and then the later years be given over to examining what had been done, and why. So I have chosen to review some of my thoughts about general, medical programs for adolescents.
Today, on all sides there is concern about providing health care. Surely this is long overdue; but there is so much that needs to be done, and done now, for adolescents, that I hope that the major share of effort will go into providing service, teaching, and research in these young people's behalf, and only a minor share diverted into discussing who is to do it and how it is to be done. When those important questions are tackled, I trust all will keep in mind the fundamental reasons these general programs–these clinics or units, call them what you will-began to develop here and abroad in the 1950s.
PEDIATRIC PERCEPTIONS
Authors: Goldring David 
Published: December 2021

William Withering, an English physician, learned of a secret recipe for the treatment of dropsy from a woman of Shropshire in 1775. The medication was a concoction of more than 20 herbs, but Withering, who was a competent botanist, as well as an excellent physician, determined that it was the foxglove which contained See Table in the PDF file the active ingredient, digitalis, and he decided to use the leaves of the plant, not the whole recipe, on his patients.1 After ten years of clinical trials, he published his classical book, "An Account of the Foxglove and Some of its Medical Uses; With Practical Remarks on Dropsy and Other Diseases."2
Withering, however, was not the first physician to use and write about digitalis. The drug is mentioned by medical writers as being used for various diseases such as epilepsy, anasarca, wounds and ulcers, and was taken both internally and applied externably, during the 13th through the 15th centuries. Gerrarde (1597) and Parkinson (1640) mention the drug being used as an expectorant and emetic.3 Although it is highly probable that children, as well as adults, were treated in those times, it was Withering who first recorded the use of digitalis in children.
Withering reported the use of digitalis in 12 children with a variety of diseases, and the results are abstracted in Table I. His comments are noted as quotations to retain the flavor of his original accounts. There is also a general statement about the drug's use in children at the end of the table, and this, too, is reproduced in its original language.
Excerpt IX: The Hermit
Authors: Cone Thomas E. 
Published: December 2021

The moral of the fable below1–if accepted–must have been a source of strength to children of a bygone age when misfortune struck.
The moral was reinforced by this stanza written by John Milton and found in the same book as the fable:
Let us with a gladsome mind Praise the Lord, for he is kind, For his mercies ay endure, Ever faithful, ever sure.
THOMAS JEFFERSON WRITES TO HIS 11-YEAR OLD DAUGHTER
Authors: C. T. E. 
Published: December 2021

In the British Royal Family's collection of holograph letters, that of Thomas Jefferson's dated November 28, 1783, to his daughter, Martha, (Patsy as he called her), shows Jefferson to be as dedicated a father as he was a statesman.
After telling Patsy of the sorrow he felt in seeing her leave for school, Jefferson wrote as follows:
The acquirements which I hope you will make under the tuition I have provided for you will render you more worthy of my love, and if they cannot increase it, they will prevent its diminution.
With respect to the distribution of your time, the following is what I would approve:
From 8 to 10 practice music.
From 10 to 1 dance one day and draw another.
From 1 to 2 draw on the day you dance and write a letter next day.
From 3 to 4 read French.
From 4 to 5 exercise yourself in music.
From then till bedtime read English, write, etc.
Take care that you never spell a word wrong. Always before you write a word consider how it is spelled, and if you do not remember it turn to the dictionary. It produces great praise to a lady to spell well.
If ever you are about to say anything amiss or do anything wrong, consider beforehand and you will feel something within you which will tell you it is wrong and ought not to be said or done. This is your conscience and be sure and obey it. Our Maker has given us this faithful internal monitor, and if you always obey it, you will always be prepared for the end of the world....
Letters to the Editor
Authors: Slater Philip 
Published: December 2021

We rarely receive correspondence about what is known in the trade as a "white-space filler," though these are selected with considerable care. We so heartily agree with Dr. Gruenwald's thoughtful comment that we repeat the paragraph from Philip Slater's book below. Some readers of Dr. Gruenwald's letter may have missed either the book or page 701 of the December Pediatrics.
We behave toward our cities like an irascible farmer who never feeds his cow and then kicks hen when she fails to give enough milk.
Increased Intracranial Pressure in Children (vol. VIII in the series, Major Problems in Clinical Pediatrics), by William E. Bell, M.D., and William F. McCormick, M.D. Philadelphia/London/Toronto: W. B. Saunders, 1972, 260 pp
Authors: Welch Keasley 
Published: December 2021

Dr. Bell, a pediatric neurologist, and Dr. McCormick, a neuropathologist, have combined their talents in writing an account of increased intracranial pressure from the points of view of their disciplines. They have organized the work into three parts: increased intracranial pressure in childhood, its causes, and intracranial tumors, the latter making up some 40% of the whole.
In the first and more general part there are five chapters including a long one on headache in children and one which describes the essential features of tentorial and foraminal herniation.
A PRACTICAL APPROACH TO THE PROTECTION OF THE ABUSED CHILD AND REHABILITATION OF THE ABUSING PARENT
Authors: Kempe C. Henry 
Published: December 2021

Many judges and social workers feel that anyone can turn on to mothering. The fact is that some parents frankly do not like their children. They hate them. We don't find it socially acceptable to let them say so. It is tragic that we don't.
We have faced the problem of parents not getting along and we call that divorce.
We must acknowledge as a socially acceptable situation that a parent can admit she cannot mother her child for one reason or another. Allowing a mother or father to say in a socially acceptable way that try as they may, they cannot tolerate this child, will help us on the way to giving protection to all children.
I would like to now propose the thought that the quality of mothering is a continuum of from none of it to a lot of it. By mothering, I mean not only the female term but a quality of caring for a defenseless young child, giving without limit if you please, to a tiny child, which fathers have in great abundance as well. This quality saves many lives and can be had by maiden aunts and spinsters and people who have never had a baby. For practical purposes we have to face the fact that very few of us, fathers or mothers, have it in us to be "that kind of a mother" 24 hours a day, seven days a week, all year long.
If we have money we can arrange to supplement mothering for pay.
REDUCING THE LITERAL AND HUMAN COST OF CHILD ABUSE: IMPACT OF A NEW HOSPITAL MANAGEMENT SYSTEM
Authors: Newberger Eli H. , Hagenbuch John J. , Ebeling Nancy B. , Colligan Elizabeth Pivchik , Sheehan Jane S. , McVeigh Susan H. 
Published: December 2021

Social service personnel from one public and two voluntary agencies were integrated into a consultation group in an academic pediatric hospital, leading to a reduction in the actual cost of medical services and the risk of reinjury subsequent to the diagnosis of child abuse. In the 1969-1970 hospital year, 62 cases of child abuse were seen, of which 39 were hospitalized. The average hospital stay was 29 days; the average hospital cost $3,000. Total hospital costs for the 39 cases were $123,000, of which bed costs made up $95,000. There were at least three subsequent incidents of child abuse in these 39 cases, and there was one subsequent death; the reinjury rate was 10% for hospitalized cases.
In September 1970 the Trauma X Group, an interdisciplinary, interagency consultation unit based in the hospital, was formed. With formal consultation and continued surveillance after discharge by the Trauma X Group, the following data were obtained from the 1970-1971 hospital year. Of 86 cases, 60 were hospitalized. The average hospital stay was 17 days; the average hospital cost $2,500. Total hospital costs for the 60 cases was $150,000, of which bed costs made up $101,000. There was one incident of reinjury and no deaths subsequent to diagnosis in these 60 cases; the reinjury rate was 1.7%. The risk of reinjury calculated from a modified life table was reduced from 8% in the year previous to the formation of the group to 7% and 2%, respectively, in the subsequent year and six-month periods, supporting the dollar-cost impression of effectiveness. Foster placement, furthermore, was infrequent and does not explain the differential impact of the Trauma X Group in the intervals under study.
PEDIATRIC NEPHROLOGY E. Mead Johnson Award Address 1972
Authors: Edelmann C. M. 
Published: December 2021

The first printed book devoted to pediatrics was entitled The Little Book of the Diseases of Children, written by an Italian, and published in 1472. However, it was not until the 20th century that pediatrics formally emerged as a discipline. The impact of this modern development on the health and welfare of children is reflected in the change in morbidity and mortality statistics of the past 50 years, notably in the areas of infectious diseases and nutritional disturbances.
Now, 500 years after the appearance of The Little Book of the Diseases of Children, advances in our understanding of the biologic base upon which pediatrics is built have made further specialization and subspecialization imperative. No longer is a division into surgical and medical practice adequate. No longer does the separation into pediatric and adult medicine serve to keep the field totally within the grasp of one specialist. As pediatrics was born of internal medicine and obstetrics, so now pediatrics has given birth to new specialties. These offspring, based on organ systems, at first developed parthenogenetically. More recently it has been recognized that fertilization of pediatrics by internal medicine may lead to more viable progeny. Thus, when we speak of the pediatric subspecialties we must recognize that they cannot be exclusively pediatric if they are to be truly system based and take advantage of all the scientific advances within that system. In our own division of pediatric nephrology, we welcome the input of our colleagues from internal medicine, recognizing that they have much to offer to the nephrology half of our title, and much to learn from the pediatric half!