bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE IMPORTANCE OF REGULAR MEALS FOR CHILDREN, ACCORDING TO JAMES NELSON, APOTHECARY, WRITING IN 1756
Authors: C. T. E. 
Published: December 2021

In eighteenth century England, children were rarely fed at regular intervals and when fed little attention was paid to what they ate. Among the first to stress the benefits of eating meals regularly was the Apothecary, James Nelson (1710-1794), whose thoughtful and widely known book, An Essay on the Government of Children contained the following:
. . . Nothing is more conducive to Health than a Habit of eating meals regularly. Children accustomed to eat all Day long are seldom healthy; besides, that it makes them disorderly, and often throws a Family into Confusion to gratify all their little Humors. The proper Breakfast is ... milk and Water with Bread, or milk-porridge, or Rice-milk, their Dinner should be made of one Dish, only, unless by great chance a passing Taste of a second; they should either eat a great deal of Bread, or blend their Meat with Greens, Turnips, or other Garden Stuff; Pickles and all high sauces should not be touch'd by them; and their Meal should be washed down with Water or light Small Beer. Their Supper may, like their Breakfast, sometimes be varied, as to the Auxiliary; Bread is to be the Repast; yet a small portion of Butter, Cheese, Fruit, or Tart, may in their Turn accompany it: the Vehicle the same as the Dinner. But should a Child at intermediate Times, especially before Dinner, complain of Hunger, and fasting long might make it's Stomach ach (sic); in that Case nothing so good as a bit of Bread; and if used to it, it will eat it as eagerly as the greatest Dainty; but to see Children walk about a house with Tarts or Bread and Butter in their Hands, daubing every thing and every body they touch, is certainly wrong; being not only detrimental to their Health, but to their manners too, as it is inexpressibly vulgar.1
RULES FOR REARING CHILDREN IN 1860
Authors: C. T. E. 
Published: December 2021

The 12 rules for rearing children, listed below, and published more than a century ago, may appear rather severe to us. And yet, at the time they were published, these rules were considered by some to be too permissive.
Rearing Children
1. Children should not go to school until 6 years old.
2. Should not learn at home during that time more than the alphabet, religious teachings excepted.
3. Should be fed with plain substantial food, at regular intervals of not less than 4 hours.
4. Should not be allowed to eat any thing (sic) within 2 hours of bed-time.
5. Should have nothing for supper but a single cup of warm drink, such as very weak tea of some kind, or cambric tea or warm milk and water, with one slice of cold bread and butter–nothing else.
6. Should sleep in separate beds, on hair- mattresses, without caps, feet first well warmed by the fire or rubbed with the hands until perfectly dry; extra covering on the lower limbs, but little on the body.
7. Should be compelled to be out of doors for the greater part of daylight, from after breakfast until half an hour before sun-down, unless in damp, raw weather, when they should not be allowed to go outside the door.
8. Never limit a healthy child as to sleeping or eating, except at supper; but compel regularity as to both; it is of great importance.
9. Never compel a child to sit still, nor interfere with its joyment, as long as it is not actually injurious to person or property, or against good morals.
Prognosis of Vesticoureteral Reflux: A Dissenting View
Authors: Askin John A. 
Published: December 2021

I would like to discuss the article on vesicoureteral reflux in the November issue.1
My reaction to the radiologically well documented article of Drs. Bland and Girdany1 is that their findings resulted in conclusions contrary to those of many investigators. They are certainly quite different from mine, after 30 years of experience with this entity at the Johns Hopkins Hospital, Sinai Hospital of Baltimore, Variety Childrens Hospital of Miami, and Mount Sinai Hospital of Miami, during which time I had the unfortunate experience of observing a 5-year-old girl whose right kidney (normal when first seen with pyuria and reflux on the right) had to be removed a year later, completely destroyed by pyelonephritis, because of improper management.
Is the "Shoulder-Hand Syndrome" Ever Seen in Children?
Authors: Steinbrocker Otto 
Published: December 2021

I would appreciate an opportunity to inquire of your readers whether in their experience with children or adolescents any of them have encountered reflex dystrophy, or the shoulderhand syndrome, or an idiopathic frozen shoulder. My interest and observations in these disorders for many years have so far not included a patient under the age of 35 years.
I often am asked about the occurrence of these conditions in children and adolescents. I have seen no reference to such observations by others.
THE COSTS OF TRAINING AND THE INCOME GENERATION POTENTIAL OF PEDIATRIC NURSE PRACTITIONERS
Authors: Yankauer Alfred , Tripp Sally , Andrews Priscilla , Connelly John P. 
Published: December 2021

The costs of training and the dollar income generation yields have been calculated for 26 graduates of the Pediatric Nurse Practitioner Program of the Bunker Hill Health Center of the Massachusetts General Hospital employed in private practice settings. Training costs were estimated from the program experience. Income generated by the nurse was estimated from data reported by nurse and employer 6 months or more after graduation from the program.
Direct educational costs were estimated at $1,410 per nurse, institutional overhead at $346 per nurse, production losses (associated with the training time of 17 weeks) at $1,442 per nurse. Total cost of training was $3,197 per nurse.
The average annual salary paid 26 pediatric nurse practitioners in private practice settings was $9,100 per year and the average number of "nurseonly" face-to-face patient encounters of all types, projected for full-lime employment, was 65 per week. Net income generation potential over and above salary averaged $2,500 per nurse per year with 14 of the 26 nurses capable of generating more than $3,000 per year over and above their current net salaries. These estimates must be interpreted with caution, but they suggest that the private sector of medicine can defray training costs in full in cases where the paying demand for its services is greater than physicians can supply themselves.
Smallpox Vaccination
Authors: Shaw Edward B. 
Published: December 2021

The zero incidence of smallpox in the United States for so many years, and the significant morbidity and mortality from vaccination, has led to the acceptable and desirable recommendation that routine immunization against smallpox be discontinued. However appropriate this step may seem, it will pose a number of new problems which will involve the pediatrician especially.
(1) For many years, smallpox vaccination has been an almost sacred tenet, an immunologic gospel to the population, and has been credited with the conquest of this disease in this country—even though herd immunity could hardly be said to have existed here. Public reeducation is a hazardous matter.
Letter to the Editor
Authors: Egner Jane Packard 
Published: December 2021

In response to your request for comment on his letter, I think Dr. Pick could expect some bristling on the part of many pediatric nurse practitioners and a signfficant number of pediatricians, at the term "ghost pediatrics."
For years the professions of medicine and nursing have paid lip service to "cooperative effort" and "team approach," while in reality, relatively few nurses are legally able to practice to the capacity for which they were educated, and instead become atrophied from task performances of appalling misuse of their potential.
Letter to the Editor
Authors: Fried Ralph I. 
Published: December 2021

I gratefully accept your invitation to comment on the letter by Dr. Pick on allied health workers in the private practice of pediatrics. I support Dr. Pick in his statement that this would constitute a regression in the quality of care offered to our children.
Dr. Charles A. Janeway remarked in 1957 that during his career the practice of pediatrics had reversed itself from 80% life-saving and 20% routine care, to the opposite figures, so that pediatricians have had to deal increasingly with parental concerns about child behavior and emotional problems.
ANALYSIS OF FETAL AND NEONATAL DEATHS IN 4117 CONSECUTIVE BIRTHS
Authors: MILLER HERBERT C. 
Published: December 2021

An analysis of the significant causes of death in 4117 consecutive births was made; there were 66 fetal deaths and 85 neonatal deaths. A significant cause of death was determined in 51 fetuses and 56 live-born infants.
Eighty-five per cent of the live-born infants who weighed over 1000 gm. at birth and had postmortem examinations had causes of death which were considered to be significant. Almost half of the live-born premature infants with birth weights between 1000 and 2500 gm. were considered to have had more than one significant cause of death.
The so-called significant causes of death among live-born infants differed from those determined for fetuses dying before birth. Among the former, pathologic conditions in the infants were determined four times more frequently than in those dying before birth and, in the latter, maternal complications of pregnancy and labor were diagnosed as significant causes of death five times more frequently than in infants dying in the neonatal period.
Hyaline-like material in the lung was considered to be the most frequent significant cause of death in live-born premature infants; congenital malformation and anoxia resulting from complications of labor were the most frequently determined significant causes of death in live-born full term infants. No differences were found in the significant causes of death in premature and full term fetuses. Anoxia resulting from accidental and unexpected interruption of the blood flow in the placenta and umbilical cord and from dystocia was the most frequently determined significant cause of death in both groups.
A plea has been made for the adoption by obstetricians, pathologists and pediatricians of a formal uniform plan of classifying the causes of fetal and neonatal death which would divest current efforts to determine the cause of death of as much vague terminology and arbitrary opinion as possible.
EVALUATION OF THE MUMPS SKIN TEST
Authors: FLORMAN ALFRED L. , FISCHER ALFRED E. , MOLOSHOK RALPH E. 
Published: December 2021

An intradermal test with formalin-inactivated egg-grown mumps virus was done on 109 household contacts of 42 cases of epidemic parotitis. Sixty of these individuals were skin-test positive and 49 negative. There were 12 contact cases of epidemic parotitis and 11 of them occurred among the nonreactors. There were 27 children who gave negative skin tests and they furnished 10 of the contact cases. The possible significance of this has been discussed.
The various types of reactions encountered have been described and the frequent occurrence of relatively faint reactions in children noted. The validity of the test was supported by an obvious correlation with the incidence of secondary cases, past history and the fact that patients who were originally skin-test negative were positive several months later.
It is concluded that the test is of value in determining susceptibility to epidemic parotitis. In view of the large number of clinically inapparent cases, the skin test should prove most useful in practice in removing unnecessary concern for infection by parents who do not recall having had the disease.
CHRONIC POISONING DUE TO EXCESS OF VITAMIN A
Authors: CAFFEY JOHN 
Published: December 2021

The clinical manifestations, the roentgenographic changes in the skeleton and the elevation of blood vitamin A are reported in a group of seven infants and younger children poisoned by ingestion of excessive quantities of vitamin concentrates A and D over periods of several months.
The differential features of vitamin A poisoning and infantile cortical hyperostosis are discussed.
Three types of vitamin concentrate A and D, commonly used in routine pediatric prophylaxis, were found to be toxic when ingested in sufficiently large quantities over sufficiently long periods. The minimal preclinical latent period of vitamin A poisoning was about six months and the minimal toxic daily dose was about 75,000 units.
Excessive dosage was due to overenthusiasm for vitamins and ignorance of the dangers of high vitamin intake.
The hazards of vitamin A poisoning from the routine prophylactic feeding of vitamin concentrates A and D to healthy infants and children on good diets are considerably greater than the hazards of vitamin A deficiency in healthy infants and children not fed vitamin concentrates.
SERUM IRON AND IRON-BINDING CAPACITY OF THE SERUM IN CHILDREN WITH SEVERE MEDITERRANEAN (COOLEY'S) ANEMIA
Authors: SMITH CARL H. , SISSON THOMAS R. C. , FLOYD WILLIAM H. , SIEGAL SHIRLEY 
Published: December 2021

The blood of children with severe Mediterranean anemia was found to have a high serum iron and an absence of a latent or unbound iron capacity of the serum. Whereas serum iron levels comprise approximately one third of the total iron-binding capacity in normal children and adults, the two values are equal in the severe form of Mediterranean anemia. The iron-binding capacity of the serum in this condition is therefore fully saturated and quantitatively lower than in normal children.
The absence of a measurable latent iron-binding capacity does not depend entirely on the liberation of iron from exogenously administered blood. Comparable changes were also noted in two nonanemic adult carriers possessing the trait of the disease, in two children with the mild form not requiring transfusions, and in one severely anemic child with Mediterranean anemia who had never been transfused. Similar changes occurred in three patients with spherocytic anemia and in five children with sickle cell anemia, one of whom had never been transfused.
In every instance therefore of the advanced form of Mediterranean anemia and in some of the nonanemic and mildly anemic forms of this disease, a fully saturated metal-binding protein is present in total amounts usually less than those found in normal children. In contrast, children with iron deficiency anemia manifest a reduction in percentage saturation of iron-binding protein, an increased level of unbound latent iron-binding capacity and a markedly elevated total iron-binding capacity.
The failure to demonstrate a latent iron-binding capacity of the serum in asymptomatic persons adds another criterion to those already established for the identification of carriers of the trait of Mediterranean anemia who constitute the source of its transmission.
The presence of bilirubin in increased concentrations in the serum of patients with severe Mediterranean anemia does not interfere with its capacity to combine with iron. The capacity for binding iron was restored when Fraction IV-7 was added to samples of icteric sera of patients in whom no capacity had previously been demonstrated.
The high serum iron and absence of latent iron-binding capacity observed in children with severe Mediterranean anemia receiving multiple transfusions correspond to the changes regarded as diagnostic of transfusion hemosiderosis and hemochromatosis. While these changes remain unaltered in Mediterranean anemia, their reversibility has been demonstrated in two children with hemophilia who received weekly transfusions of small amounts of blood. Following cessation of this form of therapy a decrease of serum iron and a gradual restoration of iron-binding capacity were noted.
ENDOCRINE HOMEOSTASIS IN CLINICAL PEDIATRICS
Authors: TALBOT NATHAN B. 
Published: December 2021

SIX MONTHS or a year ago it might have been appropriate to introduce these remarks with comments on the fact that endocrinology encompasses much more than the diagnosis and therapy of such primary endocrinopathies as pituitary gigantism, thyrotoxicosis, sex precocity and the like. The remarkable current reports on the therapeutic actions of adrenal cortical hormones and of pituitary adrenocorticotropic hormone (ACTH) already have shown that there may be as much or more endocrinology in a patient with rheumatoid arthritis, ruptured appendix, pneumonia, status asthmaticus or thermal burn as in the pituitary dwarf or eunuch. In fact it appears safe to say that there is hardly an organ or structure in the body that is not influenced directly or indirectly by endocrine forces or a clinical condition that is not accompanied by functional or homeostatic alterations on the activity of some endocrine gland.
These homeostatic reactions constitute to a major extent, as Walter Cannon once put it, "the Wisdom of the Body." Most of the time they work so efficiently that we forget that they exist and are playing an important role in bodily defense and recovery reactions. This thought may be worthy of illustration by a few arbitrarily selected situations. In presenting these illustrations I wish to emphasize that they represent the cumulative researches of many investigators working in many laboratories over a considerable period of time.
Figure 1 presents observations on a child with psychogenic polydipsia who was subjected to water restriction. This restriction was accomplished by omitting all fluids except those contained in solid foods. It is seen that such a physiologically normal individual is able quite effectively to conserve body H2O (weight) and to prevent hemoconcentration (elevation in blood hemoglobin) by increasing urine solute concentration (specific gravity).
Round Table Discussion
Authors: SEELYE WALTER B. , BILLINGTON SHEROD M. , TIMMONS ELMER LEE , GROB OTTO 
Published: December 2021

Chairman Seelye: No subject lies closer to the heart of the pediatrician than that of the newborn infant. Pediatrics has always been deeply concerned with the management of the infant during that trying period immediately following birth, when certain anatomic and physiologic adjustments must be quickly and smoothly made if the child is to survive. Here indeed is the supreme challenge to the physician who must promptly and efficiently recognize, correct and treat the defects, deficiencies and diseases which may handicap the infant.
Certain aspects of the newborn infant are of such magnitude that they lend themselves to separate panels and round tables. Among these are: the premature infant, hemolytic disease of the newborn, anemias of the newborn, epidemic diarrhea of the newborn—all of which have been presented at recent meetings of the Academy. These will be omitted from our discussion today, which will be directed toward consideration of the following topics:
1. Accidents and Trauma Incident to Birth
2. Infections
3. Feeding. The Psychologic Aspects of Mother-Infant Relationships
1. Accidents and Trauma Incident to Birth
Much has been recently added to our knowledge of the effects of interference with the supply of oxygen to the tissues of the fetus before and during birth, and to the infant after delivery. Clifford has clearly shown that injury resulting from anoxia is widespread, involving physiologic and pathologic changes throughout the entire body. These have been summarized as "congestion, edema, hemorrhage and death of tissue."
Intrauterine anoxia is presumably due principally to pathologic conditions of the placenta which result in the majority of instances, in premature separation of this organ.
DIASTEMATOMYELIA (CONGENITAL CLEFTS OF THE SPINAL CORD)
Authors: MATSON DONALD D. , WOODS ROBERT P. , CAMPBELL JAMES B. , INGRAHAM FRANC D. 
Published: December 2021

Diastematomyelia associated with the presence of a bony spicule arising from the posterior aspect of a vertebral body and transfixing the spinal cord or cauda equina has been encountered in 11 operative cases. In the last nine of these the diagnosis was made previous to operation.
It seems apparent that progressive neurologic impairment of the lower extremities and of the rectal and vesical sphincters may result from increasing distortion of the neural axis as a result of fixation produced by these bony spicules during the growth period.
The diagnosis is suspected in the presence of cutaneous midline defects, muscular imbalance in the lower extremities, gait disturbances, deformities of the feet, urinary or fecal incontinence or increasing enuresis. The diagnosis is confirmed on roentgen examination by the presence of a midline opacity usually in the region of a spina bifida or other vertebral anomaly or by visualization of two separate subarachnoid channels on myelography.
Operative treatment consists in laminectomy with extradural removal of the bony spicule insofar as possible, followed by opening the dura with excision of its reflections adjacent to the spicule, excision of the remaining bony prominence down to the anterior dura, and division of all adhesions to the bifid cord or cauda equina until the latter is freely movable within a single dural canal.
In all these cases there appeared to be complete division of the cord or cauda equina into separate parts rather than reduplication of the cord. Each half of the neural axis was invested with its own meninges.
The operative findings in the 11 cases reported here, together with the brief follow-up observations noted to date, have convinced the authors that it constitutes good preventive medicine to carry out surgical treatment of diastematomyelia associated with spina bifida occulta at any time the diagnosis is made during infancy and early childhood.
PENICILLIN AND ITS EFFECT IN PRODUCING A PREDOMINANT GRAM-NEGATIVE BACILLARY FLORA IN UPPER RESPIRATORY TRACT OF CHILDREN
Authors: HAFFNER FREDERICK D. , NETER ERWIN , RUBIN MITCHELL I. 
Published: December 2021

A study was carried out on 90 children to determine whether conversion to a gram-nagative bacillary flora of the nasopharynx and throat takes place during therapy with penicillin, either alone or in conjunction with sulfonamides, and to evaluate the influence of such a conversion on the course of the infection.
Following the demonstration of "conversion" in 22 selected cases, a change to a gram-negative bacillary flora was observed in an additional 30 out of 68 unselected children. The gram-negative bacilli encountered in this conversion group included members of the E. coli-A. aerogenes group, Ps. aeruginosa, A. fecalis and K. pneumoniae; these organisms became predominant in 23 out of the 30 cases of the unselected group. In 22 cases in this latter group the gram-negative bacillary flora was present prior to commencement of specific therapy; however, there was an increase in the number of these organisms in 13 instances. Conversion did not take place in 16 cases.
Vomiting per se was not responsible for the conversion since it occurred more frequently in the nonconverted group and vomiting was not a prominent feature of the converted patients.
Of 10 patients receiving penicillin as "aerosol," nine converted to a predominantly gram-negative bacillary flora.
The administration of sulfonamides in conjunction with penicillin did not materially lower the incidence of conversion.
Clinical evaluation of the patients showed that, on the average, the children who had "converted" had a more severe illness and one of longer duration than those of the nonconverted group.
Five patients of this group, all under 2 years of age, succumbed. Autopsy was performed in four and revealed the presence of gram-negative bacilli in the lung tissue of three of them.
The significance of these data is discussed.