bluuebunny/crossref_metadata_2025_split huggingface dataset:
A tale of two doctors
Authors: Fisher Julian H. 
Published: December 2021

The recent shift of funding emphasis on the part of the World Health Organization, turning from research orientation to provision of practical delivery systems, highlights the divergence of goals which must be established for the medical "haves" and "have-nots"—the developed and the developing world countries.
The same orientation applies as well to schema for medical education in these two worlds, and the implications were impressed upon me last year in what I would somewhat facetiously label a tale of two doctors, reviewing experiences I had with two American-trained native physicians in a Latin country.
Having reflected at length on a year away from familiar North American medicine, weighing the new experiences in the light of the old, I find that these two professional pathways illustrate the developed world's gifts of foreign medical aid (educational assistance) and the developing world's utilization of those grants.
Nonvenereal Transmission of Gonococcal Vaginitis
Authors: Ris Hania W. 
Published: December 2021

I read with great interest the timely article by Drs. Auman and Waldenberg, "Gonococcal Periappendicitis and Salpingitis in a Prepubertal Girl" (Pediatrics 58:287, August 1976), which deals with the important problem of Neisseria gonorrhoeae as an etiological factor of vaginitis and its complications in a 5-year-old girl. Vaginal discharge and penile discharge in young children, irrespective of age, should be cultured in appropriate media for N. gonorrhoeae in addition to those for other organisms.
According to Kotcher et al.,1 the gonococcus was the only significant bacterial etiological agent in 57 cases of vulvovaginitis in prepubertal girls.
Questions on Serum Levels of Theophylline
Authors: Tinkelman David G. 
Published: December 2021

In commenting on the article by Ellis et al.1 on the pharmacokinetics of theophylline, Dr. Bierman advocated that in patients receiving theophylline, "serial measurement of theophylline concentrations must be obtained during one dosing interval to determine the child's theophylline dosage and the proper interval between doses" (Pediatrics 58:623, October 1976). While an important commentary, it contains certain oversimplifications which give the clinician a false sense of security in the treatment of his asthmatic patients.
Dr. Bierman initially states that with theophylline there is a "narrow therapeutic range of 10 and 20 µg/ml," and thus implies we should keep all of our patients who are receiving theophylline within this range.
Comparative Study: Ampicillin and Cephalexin in Otitis Media
Authors: Mclinn Samuel E. 
Published: December 2021

The conclusion of Stechenberg et al. in their article "Cephalexin Compared to Ampicillin Treatment of Otitis Media" (Pediatrics 58:532, October 1976), that cephalexin is not warranted in the treatment of otitis, is questionable for several reasons.
The dose of 50 mg/kg/day of cephalexin has been unsuccessful in our experience and in that of others. That is why the recommended dose for treatment of Haemophilus influenzae is 100 mg/kg/day. The mean cephalexin level in the treatment of middle ear effusion is about 5 mg/ml.
Clarification
Authors: Barness Lewis A. ,   Committee on Nutrition
Published: December 2021

The statement on iron supplementation for infants indicates that breast-fed infants are to some degree protected against iron deficiency, but it then does not proceed to make separate recommendations for this group. This apparent conservatism of the Committee was based on the fact that data are still too scant to warrant the elimination of the recommendation for iron supplementation of all full-term breast-fed infants.
The available information indicates that preterm infants who are fed breast milk require iron supplementation.
Simulated Patients
Authors: Bloom Henry R. 
Published: December 2021

I was interested to read the article "The Use of Paraprofessionals to Teach Interviewing Skills" by Stillman et al (Pediatrics 57:769, May 1976). Indeed, the use of "Programmed" or "simulated" patients has proven to be an important part of the birth of medical education as a science and a discipline, rather than its traditional place in the medical school, as a by-product of research and patient care.
Those interested in this area, such as Dr. Stillman et al., should know, however, that for over ten years1,2 there has existed extensive experience, development, and literature on the use of simulated patients.
In Reply: Are We Being Too Cautious?
Authors: Brunell Philip A. 
Published: December 2021

I am delighted that Dr. San has seen fit to express his feelings about a varicella vaccine. I would hope that as many practitioners as possible are heard. We are sorely lacking a dialogue between the practitioners and the so-called experts.
It is essential in making decisions about new drugs, vaccines, or modes of therapy to weigh the advantages against the disadvantages. The temporal perspective in making these judgments is critical. In expressing my personal opinion, I feel it would be better to wait until we have a greater understanding about the nature of virus latency before commiting ourselves to an expensive and potentially hazardous program.
In Reply: A Question on Failure-to-Thrive Study?
Authors: Oates R. K. , Hufton I. W. 
Published: December 2021

We appreciate Dr. Kramer's concern to know whether the cognitive, emotional, and social dysfunctions seen in these children and their families on follow-up are a result of the earlier failure to thrive, the psychosocial dysfunction initially present in these families, or a combination of these factors.
Many practicing pediatricians would agree that failure to thrive alone does not cause the abnormalities that were seen on follow-up in this group. Our initial follow-up study of nonorganic failure to thrive1 included a group of children admitted to the hospital during the same period with failure to thrive due to organic causes.
Gonadotropin Excretion and Body Composition
Authors: Penny Robert , Goldstein Irwin P. , Frasier S. Douglas 
Published: December 2021

Urinary follicle stimulating hormone (FSH) and luteinizing hormone (LH) excretion was correlated with calculated total body water (TBW) and body fat (BF) in 140 normal girls and 142 normal boys, ages 3 to 16 years.
In girls, there was a significant increase in gonadotropin excretion at the time of a significant increase in BF as a percent of body weight and decrease in TBW as a percent of body weight. Pubertal changes in body composition were seen in girls at the same chronological age and stage of puberty as increased gonadotropin excretion.
Similar findings were observed in boys. Pubertal changes in body composition (an increase in TBW as a percent of body weight and decrease of BF as a percent of body weight) accompanied significantly increased gonadotropin excretion. Both developmental changes were seen at the same chronological age and stage of puberty.
Our findings are consistent with the hypothesis that characteristic changes in body composition as well as the other hallmarks of puberty, including menarche in girls, result from increased gonadotropin and gonadal steroid secretion. They do not support the hypothesis that changes of body composition trigger increased hypothalamic function and hormone secretion leading to the subsequent events of puberty.
THE AGE OF MENARCHE IN LONDON IN 1870
Authors: C. T. E. 
Published: December 2021

The following statistics were obtained from women who appeared at the University College Hospital (in 1870) to be attended in their confinement.
In 2,696 cases menstruation occurred for the first time-
From these cases it would appear most common at 14 years of age, then 15, 16, 13, 17, 12, 18, 19, 20, 10.
The mean age in these cases is 14.96 years nearly.
Ischemic Colitis and Stricture After Hemolytic-Uremic Syndrome
Authors: Sawaf Hadi , Sharp Marcia J. , Youn Kum J. , Jewell Patrick A. , Rabbani Ali 
Published: December 2021

The hemolytic-uremic syndrome (HUS) was first described by Von Gasser et al.1 in 1955 as a syndrome of acute renal failure, hemolytic anemia, and thrombocytopenia in children. Follow-up studies on HUS have emphasized hypertension and uremia as late complications.2,3 A review of the literature has revealed no previously reported cases of persistent colitis and bowel stenosis after HUS. We present a child who continued to have intermittent intestinal obstruction and diarrhea until surgical removal of a segment of colon almost seven months after the onset of HUS.
CASE REPORT
A 26-month-old white boy who had no history of gastrointestinal disturbance had sudden onset of diarrhea with blood and mucus in the stool.
Early Pancreatectomy in Neonatal Hyperinsulinism
Authors: Aynsley-Green A. 
Published: December 2021

I would like to endorse the recommendation by Crowder et al. (Pediatrics 57:897, June 1976) that early pancreatectomy is indicated in neonates with severe hypoglycemia due to hyperinsulinism from pancreatic β-cell abnormalities by briefly reporting our experience in managing such an infant (a full report is in preparation for publication).
A boy born at term and weighing 4.38 kg was transferred to our hospital at the age of 24 hours having suffered a convulsion associated with a nonrecording Dextrostix.
Letter to the Editor
Authors: Silverman Frederic N. 
Published: December 2021

There are several reasons for a roentgenographic examination of the suspected child abuse victim, including radiographic confirmation and evaluation of obvious trauma for purposes of medical management as well as diagnosis; screening to identify clinically silent, recent injury or evidence of prior injury; and to provide a baseline for comparison with follow-up films. Under no circumstances should a radiographic examination be a substitute for a careful physical examination.
Assuming that all areas of the child's body where clinical signs can be found have been examined, what constitutes a necessary and sufficient roentgenographic examination to complement the medically indicated examination or to identify occult evidence of skeletal injury where clinical signs are lacking?
Dr. Blumenthal Replies
Authors: Blumenthal Sidney 
Published: December 2021

I am responding to the letter from Dr. Berenson and his colleagues at the request of the members of the Task Force on Blood Pressure Control in Children. Their comments and reactions to the letter are incorporated into this response.
The members of the Task Force would like to express their appreciation for the very thoughtful comments in the Berenson letter. It is encouraging to note that internists have become involved in the problems and challenges of blood pressure control in children.
THREE 18th CENTURY PRESCRIPTIONS FOR THE TREATMENT OF WORMS IN CHILDREN
Authors: C. T. E. 
Published: December 2021

Worm infestations must have been extremely common in colonial American children because of the prominence given its cure in books, almanacs, and even newspapers of the period.
The three prescriptions below were taken from publications well known to 18th century American parents.
Take Myrrh and Aloes of each alike, finely powdered; and with a few drops of Chymical Oyl of Wormwood, or Savin, with a little Turpentine, mix them and make them up for a Plaister for the Child's Navel.1
Boil a handful of rue and wormwood in water; forment the belly with the decoction, and apply the boiled herbs as a poultice; repeat the application night and morning. This frequently brings away worms from children who will take no internal medicine.2
There is not a faster or surer Remedy to kill worms in children than to take 6, 8, or 10 red Earth-Worms, and let them purge in Bay Salt, then slit them open and wash them in fair Water, then dry them in an Earthern Dish and beat them to a Powder, and give them to the Child in the morning fasting, for 3 or 4 Mornings, but let them eat nothing for an hour after.—Poor Tom's Almanac, 1950.3
THERAPEUTIC NIHILISM
Authors: Starr P. 
Published: December 2021

The recent debate over medicine has failed to address a central issue. Is it the purpose of national medical policy to maximize the health of the country, or is it to underwrite the services that individual physicians believe are warranted for their individual patients? The two are very different. If we continue to follow the second policy, we should not try to measure it by the standard of the first. It will always be found wanting.
The therapeutic nihilism of the nineteenth century had its justification in objective fact. We now know that it was correct: most medical treatment of the day was absolutely useless. Much of it—the bleeding, blistering, and purging of patients—was lethal. By helping to rid medicine of such techniques, therapeutic nihilism contributed to the liberation of medicine from the dead hand of the past. Today, medical institutions are often as ineffective as specific treatments were then. Let us hope that the new therapeutic nihilism, which questions the medical system in its totality, will have the same liberating effect.
FAILURE OF PREVENTIVE MEDICINE
Authors: Gray J. A. Muir ,   Student
Published: December 2021

I suggest that the main reason why people choose to act in a way that puts them at risk is because their concept of the future is different from that of those who give them advice. We ask people to desist from behaviour which is immediately rewarding, offering as an alternative a reduction in the probability that they will become unwell in the future, the future being a decade or more from the point at which the decision must be made....
Although this hypothesis is difficult to test, the change in the way in which the consequences of cigarette smoking are presented (the fact emphasised is that cigarettes make one unattractive to kiss now rather than that they cause illness in ten or twenty years) shows that it has already been adopted by some health educators. I do not know whether it is possible to give an air of immediacy to the reasons for preventive medicine. I do say, however, that our inability to persuade people to adopt the means by which they can decrease the probability of illness, pain, and premature death requires a new approach to postpone immediate gratification for the offer of a possible reward in an inconceivable future.
THE LAND OF MACHINES
Authors: Smith Michele Lynn 
Published: December 2021

Sitting here in the land of machines Holding the hands of the ones we love A beeper sounds, a red light flashes, And fear runs away with our hearts.
Those strange incomprehensible machines Made up of buttons and switches and flashing lights And buzzers beeping to every tune Telling us how strongly our loved ones live.
To sit there and watch helplessly As the blood flows red As the heart stops beating As the lungs stop breathing Is worse than any death.
To hold the hands of the ones we love As the veins and arteries deteriorate As the sores grow worse As the eyes grow blind and the bones grow weak Is worse than any fate.
We cry and pray and try to be strong And we put on an act for the world While inside we are filled with pain As we sit there holding the hands of the ones we love While fear runs away with our hearts Sitting in that land of machines.
JOHN LOCKE IN 1684 DESCRIBES THE REMARKABLE RECOVERY OF A 6-YEAR-OLD DUTCH GIRL FROM A DREADFUL BURN OF THE SCALP
Authors: C. T. E. 
Published: December 2021

While visiting the medical school at Leyden in 1684, John Locke (1632-1704), the celebrated English physician and philosopher, met Dr. Lucas Schacht (1634-1689) who showed him the remarkable case of a 6-year-old girl who had recovered after having lost about one third of her skull from a frightful burn.
Locke wrote the following (his spelling has been retained):
Frid. Nov. 17 [1684]. I was Sarah Vander Speck a girle about 6½ years old a great part of whose scul I had seen yesterday by Dr. Schafte [Schacht] who is professor magnificus, viz. 2 of occipitis and a great part of the 2 ossa bregmatis which togeather could not I think be lesse then ½ of the scull.
The story in short is this. This girle when she was about 1½ old being left alone by the fire in her standing stoole fell down on the hearth and was found lying with her head neare the moderately smal turf fire at her mothers returne quite senselesse. She had lain there soe long that not only her head clothes and haire were burnt but the flesh of her head also and the bones of her scul which were afterwards taken out were burnt black on the out side, and retaine that colour still, the fire seemeing also by the appearance it has still to have penetrated the inside of the scul but not soe as to make it blak. The uper part also of one (I thinke her right) eare was burnt away. This accident happend on the 6th December.
Comments on Nutrition Committee Statement
Authors: Silverio John 
Published: December 2021

This is a comment on the statement on the nutritional needs of low-birth-weight infants, made by the Committee on Nutrition of the American Academy of Pediatrics (Pediatrics 60:519, October 1977).
1. In the section on water requirements (p. 519), the document states that "preterm infants excrete sodium well." This statement is backed tip by two references.1,2 Although the two quoted references are reliable, it is also true that other published data have shown that premature babies do not excrete sodium well, with subsequent retention of water.3
Xeroderma Pigmentosum and Cockayne Syndrome
Authors: Dupuy J. M. , Lafforet D. 
Published: December 2021

In the August 1977 issue of Pediatrics (60:135, 1977), R. D. Schmickel et al. demonstrated an increased ultraviolet (UV) light sensitivity and normal DNA repair by Cockayne cells.
In 1974 we published the case of a 10-year-old girl who presented clinical manifestations of both Cockayne syndrome and xeroderma pigmentosum.1 Since the cells of this patient were DNA repair-deficient, we postulated that the various clinical profiles observed in xeroderma pigmen-Ultraviolet (UV) light-induced tritiated thymidine incorporation into 106 lymphocytes from normal donors and patients during five hours of incubation after UV light irradiation (30 and 300 ergs/sq mm).
See image in the PDF file
THE SIZE OF CITIES
Authors: Sale Kirkpatrick ,   Student
Published: December 2021

. . . records of urban populations suggest that for most of human history cities did not generally grow beyond the 50,000 to 100,000 range. For most of its celebrated life the city of Athens hovered around 50,000 people, though at periods of particular power the surrounding state may have grown to 150,000 or 200,000. The Italian cities that nurtured the Renaissance were no larger than 80,000, and most of them held closer to 50,000—the Rome of Michelangelo had perhaps 55,000 people, the Florence of Leonardo 50,000, and Venice, Padua, and Bologna at their height probably 50,000 to 80,000. Boston and Philadelphia at the time of the Revolution did not have more than 30,000 people, New York had even fewer. In fact, it seems that only rarely did historical cities go much beyond 100,000, and then only temporarily when serving as the capitals of empires. . . . The very existence of giant cities is so recent as to be a mere eye-blink in recorded history. It was not until 1800 that any city grew to more than one million people—that was industrialized London—and by 1900 there were only ten others of that size.
The conclusion of the great Greek city planner Constantine Doxiades, who spent his life categorizing such things, seems on the mark: "If we look back into history . . . we find that, throughout the long evolution of human settlements, people in all parts of the world have tended to create urban settlements which reached an optimum size of 50,000 people."
Presidential Address—1977: Pediatrics—Changes and Opportunities
Authors: Van Gelder David W. 
Published: December 2021

This past year has been a most gratifying one for me, not because of any personal accomplishments, but because I have had the opportunity to witness the ways in which so many people have contributed to the Academy's goal of improved health for the nation's children. Everywhere I have gone—to meetings of national committees and medical groups, to discussions with government officials—I have found able pediatricians engaged in a variety of activities. All of these men and women seemed genuinely interested in their chosen role, whether it involved practice, research, administration, education, or community service. They expressed personal satisfaction in their work, and displayed a great dedication to the well-being of children. Meeting so many exceptional people has been the personal highlight of my term as president.
I have been greatly impressed with the amount of dedication and goodwill within the pediatric community. Yet, I have also detected a certain uneasiness among pediatricians, indeed among physicians in general. There is a feeling that medicine is entering a crucial period, and difficult choices about future directions must be made. Not knowing which choices should be made lies at the heart of medicine's restlessness. After all, the light at the end of the tunnel could be the headlight of an onrushing train. As the poet W. H. Auden said, "It takes little talent to see clearly what lies under one's nose, a good deal of it to know in which direction to point that organ."
One thing, though, is becoming increasingly clear.
Persistent Müllerian Duct Syndrome in Male Identical Twins
Authors: Weiss Edra B. , Kiefer Joseph H. , Rowlatt Ursula F. , Rosenthal Ira M. 
Published: December 2021

Male pseudohermaphroditism, characterized by the persistence of Müllerian duct structures with otherwise normal differentiation, is a rare disorder that appears to be caused by an abnormality in the activity of Müllerian inhibiting factor.1 Patients with this syndrome are phenotypically normal males who usually present with inguinal hernia and cryptorchidism. This condition has also been called hernia uteri inguinalis, persistent Müllerian duct syndrome, and male internal pseudohermaphroditism. It has recently been suggested that hysterectomy may not be indicated in most of these patients because of possible injury to the vas deferens.2
The condition appears to be genetic, since familial incidence occurs. Brook et al.3 reported four affected pairs of brothers in unrelated families.
Edith B. Jackson, M. D
Authors: Kempe C. Henry 
Published: December 2021

Edith Jackson, one of the true pioneers in the fields of behavioral pediatrics and child psychiatry, died at the age of 82 on June 5, 1977, in Denver, in her sleep. She had been thoroughly active and well until her death.
Edith Jackson was born in 1895, and received her B.A. from Vassar in 1916 and an M.D. from Johns Hopkins University in 1921. After a two-year internship, first in medicine and then in pediatrics, she was prominent with Dr. Martha Eliot in developing the New Haven rickets study for the U.S. Children's Bureau between 1923 and 1928 while she held the rank of an instructor in pediatrics at the Yale University School of Medicine.
Perspectives on chronic nonspecific diarrhea: Dietary management
Authors: Cohen Stanley , Lake Alan M. , Mathis Richard K. , Walker W. Allan 
Published: December 2021

Chronic nonspecific diarrhea (CNSD) of childhood, originally thought to be part of the celiac syndrome, was described as a separate clinical entity by Cohian1 in 1956. In the ensuing years, CNSD has been appreciated to represent one of the most common causes of prolonged diarrhea in the infant and toddler. Yet confusion remains regarding its cause and treatment.
Drs. Davidson and Wasserman2 have described consistent diagnostic criteria further characterizing CNSD as a recognizable syndrome. The onset of symptoms occurs classically between 6 and 30 months of age with the development of three to six loose and often mucousy stools per day.