bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE MORALS OF YOUTH IN 1805 AS DESCRIBED IN AN EDITORIAL IN ONE OF OUR MOST RESPECTED NEWSPAPERS
Authors: C. T. E. 
Published: December 2021

Since newspapers were first published in this country, editorial writers have never seemed to tire of writing about the moral deficiencies of our young people. The quotation below, from an editorial published in a well-known newspaper in 1805, could have appeared (in a less ornate style) in the paper we read this morning.
To a person of reflection and sensibility, there cannot be a subject of more painful thought, than that which the morals of our youth present. In many of them, we observe the brightest colours of the human character almost totally eclipsed by the foulest immoralities. We see them triumphing in vice as a proof of distinguished spirit and refinement, and permitting their passions to shoot wild in all the dreadful luxuriance of folly and guilt.
Let us limit our remarks within a narrow sphere, and select from the cluster of youthful lusts, one which is more fashionable and perhaps more detrimental to them, in every point of view, than any other with which the present age is scourged: I mean the illicit indulgence of that passion which was given to us for the preservation of the human species. Considered merely with reference to this life, I know not a more deadly antidote to bliss than this lawless tyrant over man. How often does it dig the grave for genius and character! How are all the energies of the mind unstrung by its excess; all the affections of the heart deadened or empoisoned; every virtuous propensity put to flight, and all the charms of chaste society lost and forgotten.
GENERALIZED REACTION TO INSECT BITES
Authors: Torsney Philip J. 
Published: December 2021

The Insect Committee of the American Academy of Allergy is interested in obtaining information concerning reactions to biting insects. The Committee is not interested now in purely local reactions, but rather it wishes data on patients who have had constitutional symptoms following insect bites (e.g., fever, arthralgia, hives, dyspnea, and so forth). At this time, we do not request information on patients suffering abnormal reactions to bee, wasp, hornet, or yellow jacket sting.
Stable fly, horse fly, deer fly, black fly, sand fly, biting midge, chigger mite, ticks, scorpion, wheel bug, kissing bug, and spider are reported to cause constitutional symptoms after a bite. We request information from any physician who has seen or treated a patient who has sustained an unusual reaction to such bite. This information should include age, sex of patient, insect causing reaction, site of insect bite, size of local reaction, was there previous unusual reaction to insect bite, description of associated symptoms, duration of such symptoms, was symptomatic treatment necessary, results of desensitization treatment if instituted, results of any diagnostic tests, and presence of other allergic problems in the patient.
We ask any physician who has seen or treated such case to submit the above information to Claude A. Frazier, M.D., 4-C Doctors Park, Asheville, North Carolina 28801.
THE MANAGEMENT OF THE CRITICALLY ILL CHILD WITH DEHYDRATION SECONDARY TO DIARRHEA
Authors: Finberg Laurence 
Published: December 2021

Diarrhea and vomiting, which so frequently complicate diarrheal diseases, occur in a variety of disorders affecting infants. Although enteric infections cause these symptoms more often than all other diseases combined, noninfectious causes may occasionally also occur. While each cause may have specific other effects, the discussion here will deliberately be limited to the management of the physiologic disturbances that accompany excessive loss of water and salts from tile gastrointestinal tract. Etiologic considerations, however important they may be, will not be further pursued. This emphasis is appropriate since survival following critical dehydration depends far more upon the correction of the physiologic disturbance than upon the removal of the cause.
A critical stage in diarrheal disease may be defined as occurring when a volume of fluid equal in mass to about 10% of the body weight has been lost over a period of a day or two. Clinically, this usually occurs shortly after anorexia or vomiting has precluded oral intake. At this stage of illness, parenteral fluid therapy should be employed. Oral intake should be curtailed during the early hours of therapy. The use of milk or other foods high in calories and solute complicates management by markedly increasing stool water losses. Even if severe undernutrition coexists with tile diarrhea, the first 6 to 8 hours should be a period of brief starvation; the parenteral glucose will provide emergency calories.
Although such routes of administration as intragastric drip and subcutaneous infusion have been employed successfully, their usage should be restricted to places where a deficiency of supplies or trained personnel interdicts the preferred parenteral route—continuous intravenous infusion.
Letter To The Editor
Authors: Dews Peter B. 
Published: December 2021

Dr. Dews writes:
Dr. Milman, in her first paragraph on the dangers of marijuana, shows the dangers of jargon. "Acute toxicity" in the trade implies killing, usually within 24 hours. Large amounts of tetrahydrocannabinols are required to kill mice and other laboratory animals, hence "the acute toxicity is vanishingly small," a statement which says more in English than it should. My apologies.
Dr. Milman in her penultimate paragraph quotes King and Cowen for the statement that following intravenous injection of marijuana, "the histopathology is real."
Factors Affecting Reports of Neonatal Deaths in United States and Elsewhere
Authors: Nickey Laurance N. 
Published: December 2021

Again, I have read that the United States' infant mortality rate is "a disgrace and totally unacceptable," that the Nation's infant mortality rate is 21.7 per 1000 live births, and that there are 12 countries which have lower infant mortality rates than the United States.
I would very much like to challenge the Editorial Board of Pediatrics and the American Academy of Pediatrics to help clarify this somewhat mysterious but often quoted figure.
I would like to see in print an authoritative report outlining the criteria for neonatal death as used in this country and its several states, and also the countries that are commonly listed in the forefront, in so far as infant mortality rates are concerned.
EVALUATION OF THE ROUTINE PHYSICAL EXAMINATION OF INFANTS IN THE FIRST YEAR OF LIFE
Authors: Anderson Frederic P. 
Published: December 2021

Because of the critical shortage of professional manpower to deliver child health care in the United States, new programs are being developed involving paramedical personnel for the provision of much of the routine health appraisal services traditionally accomplished by the physician. It is difficult to anticipate the effect of such programs Upon the health care of children without knowing what contribution is presently made by the existing system.
In an effort to assess the role of the routine physical examination in the health care of the infant under the age of 12 months, the results of 6,668 such examinations by 83 private pediatricians were evaluated in a prospective study. One hundred and thirty significant physical abnormalities (1.9%) were discovered, many of which probably could have been detected by a specially trained nurse or physician's assistant because of their inherent visibility or susceptibility to identification by simple screening procedures.
It is concluded that more effective use of the physician's time could be accomplished by the relegation of a major portion of the routine infant physical examination to a paramedical person.
BENZEDRINE® AND DEXEDRINE® IN THE TREATMENT OF CHILDREN'S BEHAVIOR DISORDERS
Authors: BRADLEY CHARLES 
Published: December 2021

The effect of benzedrine® (dl-amphetamine) and dexedrine® (d-amphetamine) sulfates upon the behavior of maladjusted children was studied in the somewhat controlled setting of a children's psychiatric hospital. Twelve years' experience with these drugs is reported involving observations upon 275 children who received benzedrine®, 113 who received dexedrine® and 82 who received both preparations.
The most frequent optimal daily dose was 20 mg. of benzedrine® and 10 mg. of dexedrine®.
Specific behavior responses to both drugs approximated one another both in quality and frequency, with 50 to 60% of the children becoming more subdued, 15 to 25% showing no change, 20% showing increased activity and 5% showing an acceleration of school progress only. Clinically these reactions indicated 60 to 75% symptomatic improvement, 15 to 25% no change and 10 to 15% unfavorable responses. Children with a variety of clinical diagnoses were benefited with no evidence of tolerance or addiction following prolonged administration.
Occasional undesirable physiologic side effects were noted with both preparations, most frequently during the first few days of treatment only. Approximately equal numbers of children responded more favorably to one drug in contrast to the other. In general benzedrine® was found to produce the more dramatic results, except with individual children in whom its side effects were more pronounced, in which cases dexedrine® proved more advantageous.
The conclusion is drawn that these drugs influence children's behavior by altering their emotional reactions to distressing situations. Both offer the practitioner readily available and easily controlled pharmacologic approaches to the symptomatic treatment of children's behavior disorders.
CLINICAL NOTE ON STUTTERING AND CLUTTERING IN YOUNG CHILDREN
Authors: HIRSCH KATRINA DE , LANGFORD WILLIAM S. 
Published: December 2021

The early clonic iterations of the child between 20 and 40 months are a part of the normal speech patterns of growing children. As a rule reassurance of the parents and withdrawal of attention and concern from speech are all that is necessary.
There is a group of children who start speaking late and whose familial background shows evidence of difficulty in the language area and delay in establishing a functional superiority of one side over the other. Many of these children have trouble with the enunciation of specific sounds, with vocabulary and with sentence construction. In spite of at least average intelligence these children handle speech poorly. They often show a great number of clonic iterations at an age when most children have already discarded them. Their handling of speech closely resembles the cluttering of older children and adults. Such children frequently need technical help with sounds, vocabulary and grammatical construction. Smoother production of speech and slowing up of speed will often bring about a reduction in the original iterations. The pediatrician should be aware of the fact that emotional tensions and conflicts tend to become fixed to a speech mechanism which is none too stable in these children. The cluttering child may easily turn into a stutterer.
There is a larger group of children who show no familial difficulty in the language area, who talk early and quite well and who abruptly develop stuttering at some time during childhood. Some of these children display other symptoms of emotional disorder; others seem to function effectively in most areas but express their emotional conflicts principally in stuttering. These children should be referred for psychiatric help early.
In older children who stutter, a careful differential diagnosis is necessary as to the relative importance of specific language and emotional factors in pathogenesis. If existing emotional difficulties seem to be the result rather than the cause of the stuttering, a more specifically technical therapy is favored; in cases where emotional factors are outstanding a psychiatric approach is to be preferred.
Speech is a means of expression of the personality as well as a means of communication; severe dysfunctions in speech then may reflect a personality disorder or a disorder of interpersonal relationships or both. In the child, however, speech is also a tool which he masters as it develops. A speech difficulty in the growing child must be evaluated from both points of view.
FEMALE PSEUDOHERMAPHRODITISM WITH HYPOADRENIA
Authors: PANOS THEODORE C. 
Published: December 2021

Two infants presenting the syndrome of true female pseudohermaphroditism and associated hypoadrenia have been described. The essentially identical clinical features encountered in these infants may be summarized as follows:
1. Characteristic history with (a) anorexia, noted shortly after birth; (b) weakness; (c) vomiting, repeated and frequently projectile, beginning at about 3 weeks of age; (d) frequent attacks of diarrhea; (e) progressive loss of weight; (f) emaciation; severe dehydration and shock at about the age of 3 to 4 months.
2. Abnormalities of the external genitalia: (a) a greatly enlarged clitoris simulating a penis as to size, shape, ventral bowing and preputial covering; (b) a "urinary meatus" situated along the under surface of the clitoris or the perineum; (c) a "scrotal sac," bifid or united in the midline with a median raphe, with typical corrugations and exhibiting the dartos effect.
3. Occurrence of crises associated with decrease in the sodium and chloride and elevation of the potassium of the serum.
4. Elevated urinary excretion of 17-ketosteroids.
5. Special urologic studies: (a) urethrocystoscopy which revealed the presence of a urogenital sinus, bladder trigone of the female type, "prostatic urethra" which contains a flattened veru montanum and an elongated utricle; (b) retrograde injection of radiopaque dye through the utricular slit resulted in definite colpohysterosalpingograms with free dye spilled out into the peritoneal cavity.
6. Exploratory laparotomy disclosed the presence of normal female internal genitalia and the absence of male gonadal tissue.
7. Biopsy of the ovaries disclosed primordial follicles.
8. Satisfactory response to the management of the adrenocortical insufficiency by the administration of sodium chloride alone or in combination with desoxycorticosterone acetate.
The advisability of surgical resection of the adrenals in order to diminish the production of androgens is discussed. In the event there are no signs of adrenocortical insufficiency, it is suggested that excision of adrenocortical tissue be performed even though the improvement effected may be small and of a temporary nature. On the other hand, where hypoadrenia is a part of the clinical picture such surgery would be distinctly hazardous and would therefore seem contraindicated. The importance of safeguarding the healthy psychologic development of these patients is emphasized.
THIAMINE-RESPONSIVE LACTIC ACIDOSIS IN A PATIENT WITH DEFICIENT LOW-KM PYRUVATE CARBOXYLASE ACTIVITY IN LIVER
Authors: Brunette Michèle G. , Delvin Edgard , Hazel Bernard , Scriver Charles R. 
Published: December 2021

The cause of severe intermittent lactic acidosis was investigated in a female infant with profound psychomotor retardation. Hypoglycemia, hyperpyruvic acidemia, and hyperalaninemia were identified in the newborn period. A triad of lactate, pyruvate, and alanine accumulation persisted throughout infancy, and ACTH, anorexia, and high carbohydrate feeding further provoked their accumulation. Careful dietary control or thiamine-HCl supplementation (5 to 20 mg/day) ameliorated the metabolic abnormality.
Pyruvate dehydrogenase activity (which is thiamine-dependent) was normal in leukocytes and cultured skin fibroblasts. Hepatic pyruvate carboxylase activity (which is biotin-dependent) was found to comprise more than one component. There was a partial deficiency of total hepatic pyruvate carboxylase activity in the patient. The loss of activity was confined to the low-Km component of the enzyme which serves pvruvate metabolism in the physiological range.
A defect in glucogenesis causing hypoglycemia, pyruvate accumulation with lactic acidosis, and aberrant amino acid metabolism can be attributed to the abnormality of pyruvate carboxylase. The response to thiamine in our patients may reflect activation of a normal "shunt" mechanism for pyruvate disposal via pyruvate dehydrogenase.
ELECTROPHYSIOLOGICAL RESPONSE OF THE RABBIT BRAIN TO CHRONIC HYPERNATREMIC DEHYDRATION AND REHYDRATION
Authors: Hogan Gwendolyn R. , Dodge Philip R. , Gill Sheila R. , Scholl Mary Louise , Master Susan 
Published: December 2021

In thirty-two rabbits epidural electrodes were placed and in ten of these animals concentric depth electrodes were placed stereotactically.
All animals with both epidural and stereotactically placed electrode; were rehydrated with intravenous 2.5% dextrove in water over a four-hour period. Animals with just epidural electrodes had normal tonicity restored by intravenous 2.5% dextrose administered over six or eight hours or by the ad libitum oral intake of tap water. The electrical cortical activity was monitored at 15 minute intervals throughout rehydration and for an additional four-hour observation period. In animals rehydrated over a four-hour period seizures were most prominent during the third and fourth hour of rehydration and the first hour of the observation period. Slowing of the electrical actisity and development of spikes occurred during this same period of time in some animals without as well is some with clinical seizures.
Infant Mortality, Breast-Feeding, and Improved Health Surveillance
Authors: Cunningham Allan S. 
Published: December 2021

In light of Dr. Wegman's comments on infant mortality in his review of vital statistics I thought it would be of interest to recall two morbidity-mortality studies of infants born between 1910 and 1930.
Grulee et al. studied 20,000 welfare infants in Chicago. Nearly 10,000 of them were breast-fed exclusively for ten months and had a mortality rate less than 1.6 per thousand. Mortality in otherwise comparable groups of partly breast-fed and exclusively bottle-fed infants were 6.9 and 84 per thousand, respectively.
Chemicals in Human Teratogenesis and Transplacental Carcinogenesis
Authors: Fraumeni Joseph F. 
Published: December 2021

It is estimated that about 2% to 3% of all congenital malformations in man can be attributed to drugs or other chemicals in the environment.1 Cancers may also result from chemical exposures prenatally, since stilbestrol therapy in pregnant women has been linked recently to the development of vaginal cancer in their daughters.2 This paper briefly reviews the current evidence in man implicating chemical agents in teratogenesis and transplacental carcinogenesis.
TERATOGENS
Generally, the chemicals that have been implicated as teratogens in man have been drugs, except for pollutants such as organic mercury and polychlorinated biphenyls. Some agents are clearly teratogenic on clinical or epidemiologic grounds, while others show only a preliminary indication of hazard. Table I lists the agents which are or may be teratogenic, according to their apparent effects on the fetus.3 The precise mechanisms for most agents remain to be clarified, but some agents seem to produce direct fetal toxicity, while others interfere with fetal metabolism. In animal models, some compounds are teratogenic by actions on the placenta or on the mother or father, but such mechanisms have not been identified in man. Table I also records the particular defects associated with each agent, in view of the tendency for teratogens to produce characteristic patterns of malformation.
Well-Documented Teratogens
Thalidomide, first identified as a teratogen in the early 1960s, is believed to be responsible for the deformities of 6,000 to 8,000 children.4 The malformations characteristically involved the extremities, face, and ether organs. Particularly striking were cases of phocomelia (seal limbs), usually a rare condition, in which hands are attached directly to the shoulders.
Animal Tests to Screen for Human Teratogens
Authors: Sullivan Frank M. 
Published: December 2021

Despite Dr. Brent's statement earlier that animal models are not good for teratologic testing, they are all that we have at the moment. It is not reasonable to use new compounds without some preliminary experimental teratology, and it is not reasonable to think we can use human beings for toxicological screening of new compounds. Therefore, I should like to describe briefly, especially for the clinicians present, several aspects of teratologic testing in animals. First the question, "Is a given drug teratogenic?" To my mind that is the same type of question as, "Is a given drug toxic?" because teratogenesis is just one aspect of toxicology. For almost any compound someone could devise a system to show that it is teratogenic.
When a drug or chemical is administered to a pregnant animal, it can affect either the mother first or the fetus first. If the fetus is more sensitive, low doses may produce malformations. At higher doses more severe effects occur, namely lethality. At still higher doses, the mothers themselves become ill.
If the mother is more sensitive, no effects are observed on the fetus until the mother receives near-lethal doses, at which time one begins to see abnormal or defective fetuses. We have found that, generally, drugs which are teratogenic for the fetus at almost toxic levels for the mother are rather safe. Drugs that are teratogenic at doses much lower than the toxic levels for the mother are, on the whole, unsafe. The judgment is made without regard to the therapeutic dose of the drug.
Industrial and Agricultural Chemicals
Authors: Sandifer S. Hope 
Published: December 2021

The alert practitioner should know the types of pollution created by agriculture and industry in his area. In agriculture, two important pollutants are nitrates and pesticides (which include insecticides, herbicides, fungicides, rodenticides, and defoliants). Pediatricians are well aware of methemoglobmnemia due to excessive nitrates in water. Nitrates in water supplies are of increasing concern because of runoff from feed lots and incremental use of fertilizers. Tolerance levels of nitrate in municipal water supplies are established, and pediatricians should insist that these standards be enforced in their community.
With regard to pesticides, the Environmental Protection Agency has funded 13 community studies throughout the United States. The purpose is to monitor the health of pesticide workers compared with suitable controls. To date no significant health effects have been demonstrated. Most studies have been made on adult males because of their occupational exposure to pesticides. The groups under surveillance include workers who manufacture pesticides, pest-control operators who spray daily, and farmers who have intermittent exposure to high concentrations of pesticides. We are seeking the effects, if any, in the most heavily exposed persons before trying to determine the effects of smaller doses. This approach suffers the problem of small sample size (several thousand instead of hundreds of thousands of exposed persons).
Our studies and those of others have shown that DDT in the sera of blacks is about two to three times that of whites.1-3 We had assumed that this difference was due to environmental exposure, but recent studies in Charleston, South Carolina, have suggested a genetic factor.