British Paediatric AssociationArchives ofDisease in Childhood, 1980, 55, 728-740 British Paediatric Association Proceedings ofthe Fifty-secondAnnualMeeting The Annual Meeting of the

Archives of Disease in Childhood, 1980, 55, 728-740

British Paediatric AssociationProceedings of the Fifty-second Annual Meeting

The Annual Meeting of the British PaediatricAssociation was held at York from 15-19 April1980. 501 members and 35 associate membersattended together with 4 Heinz Fellows, 18 repre-sentatives of the German Paediatric Society, and243 guests. The Windermere Lecture was givenby Prof. H Bickel (Universitats Kinderklinik,Heidelberg).

The Spring Scientific Meeting of the RoyalCollege of Psychiatrists, Child Psychiatry Section,was held at York on 15 April and a joint sessionwith the BPA was mounted on 16 April.

The Annual General Meeting of the BritishPaediatric Association was held on Thursday, 18April 1980. The President, Dr G M Komrower, wasin the chair. The minutes of the last meeting, whichhad been published in the Archives of Disease inChildhood, were received and approved.

ELECTION OF OFFICERS. The following will serve theAssociation for 1980-81.

PRESIDENT:HONORARY TREASURER:HONORARY SECRETARY:HONORARY ASSISTANTSECRETARIES:

Dr G M KomrowerDr A D M JacksonDr D R Harvey

Dr J D BaumDr D W FieldingDr C H Nourse

The following were elected:

MEMBERS OF COUNCIL 1980-1983: Dr W R Forbes,Dr G M Lewis, Dr B McNicholl, Dr M W Moncrieff,Dr G H Watson.

HONORARY MEMBERS: Sir Douglas Black, Dr BChown, Prof. 0 H Wolff.

MEMBERS: R S Ackroyd (Birmingham), P J Aggett(Aberdeen), Janet M Anderson (Wolverhampton),I A Auchterlonie (Aberdeen), M F M Bamford(Portsmouth), S M Basheer (Cork), J H Baumer(Bristol), A R J Bosley (Cardiff), I H Brown (Bristol),Judith M Brown (Nairobi), Susan M Brown (Bir-mingham), T Brown (Dundonald), A M Butterfill(London), R W I Cooke (Liverpool), J F Cosgrove

(Waterford), S Court (Nottingham), Colleen A Cox(Hounslow), Mary C Cummins (London), D ACurnock (Derby), Kathleen Dalzell (Wrexham),T J David (Manchester), B Davies (London),Elizabeth Dryburgh (Leeds), Lilly M S Dubowitz(London), D A Ducker (London), Eileen M CDuke (Glasgow), D B Dunger (London), H BEckstein (London), A N Evans (London), D I KEvans (Manchester), Dr G I Fiddler (Leeds), N CFraser (Edinburgh), Cynthia M Gabriel (St Albans,Welwyn Garden City), A R Gatrad (Oldham),Joan Gray (Aylesbury), J D M Gould (London),T Graham (Wegberg), R Greenham (Manchester),M J Harran (Leicester), I G Hill (Birmingham),Judith Hockaday (Oxford), P Hutchins (London),Audrey J Jones (Bromley), R W A Jones (London),Dorothy V Joss (London), C R Kershaw (South-ampton), A D Kindley (Liverpool), Iris G Knight(Braintree), Mary F Knight (St Helens), I Kovar(London), B D Lask (London), T Lee (Bristol,Exeter), W Lenney (Brighton), M J Lewins (Cardiff),Helen Lewis (Manchester), T Lissauer (Harrow),M F Lowry (Birmingham), R C McWilliam(Glasgow), Barbara S M Marshall (Leicester), A JMartin (Newcastle upon Tyne), T G Matthews(Dublin), Marion Miles (London), R A Minns(Edinburgh), Eileen Naughten (Oxford), R Newton(Manchester), Pauline A O'Connell (Dublin), A SPaynter (Newcastle upon Tyne), J L Pearce (Slough),M E Pembrey (London), Betty E Powe (London),M P Prendergast (Norwich), Constance R Pullan(Newcastle), Heather Richardson (Canterbury),R P A Rivers (London), D W Rogers (London),S Rom (London), S A W Salfield (Sheffleld), DSalisbury (London), M A A Siddiqi (Newport),N J Spencer (Sheffield), J A Spies (London),C Spratt (St Helier), C R Steer (Edinburgh), C MStern (London), N Tangney (Dublin), C J Taylor(Liverpool), C M Taylor (Birmingham), M ATettenborn (London), B Thalayasingam (Consett),Ruth B Thomson (Glasgow), R L Tozer (Richmond),R Tyler (London), Mary J Vaizey (Boston), M PWailoo (Southampton), Sheila M Wallis (Reading),A R Watson (Manchester), S Williamson (Ashford),R A Wilson (Manchester), Janet G Yassa (Sheffield).

ASSOCIATE MEMBERS: Winifred Bartindale (DudleyAHA), Mary Brayshaw (Calderdale AHA), Kathleen

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Campbell (Birmingham AHA), Margaret Carrie(Lothian Health Board), Lydia Cowan (GreaterGlasgow Health Board), S G A Dias (Kensington,Chelsea, and Westminster AHA), Isabelle Ellis (Cityand East London AHA), Margaret Ewart (Lambeth,Southwark, and Lewisham AHA), Mary Gallaher(Greater Glasgow Health Board), Doreen George(Dudley AHA), Doreen Gledhill (Bradford AHA),Eiwen Griffiths (Kent AHA), Ruth Graham-Yoll(Lothian Health Board), Jean Horne (GreaterGlasgow Health Board), Margaret Inglis (GreaterGlasgow Health Board), Angela Johnston (EssexAHA), Wendy Kemp (Lothian Health Board),Maria Kreppel (Lothian Health Board), GlenysLowdon (Newcastle upon Tyne AHA), PhilippaLudlam (Lothian Health Board), J McFadden(Greater Glasgow Health Board), SeethadeviMadadeva (Birmingham AHA), Joan Martin(Kensington, Chelsea, and Westminster AHA),Marjorie Masson (Lothian Health Board), RosemaryMeyers (Northern Ireland Eastern Health Social andServices Board), Meryn Pearce (Lothian HealthBoard), F S Rogers (Northumberland AHA),J W Tuke (Northumberland AHA), Sara Young(Humberside AHA).

Report of the Council 1979-80

1. OBITUARIESThe Association has suffered the loss of Dr J DAllan, Dr A C Blandy, Prof. Guido Fanconi (Hono-rary Member), Dr I R S Gordon, Dr A P M Page,Dr R R Struthers, Prof. Jack Tizard (HonoraryMember) and Prof. H L Wallace (HonoraryMember).

2. COUNCILMembership. The following members of the Asso-ciation have served on Council during 1979-80: DrG M Komrower (President), Dr D P Addy, Dr J DAndrew, Dr E H Back, Dr R D H Boyd (HonoraryAssistant Secretary), Prof. F Cockburn, Dr A FConchie, Dr W Davies, Prof. E E Doyle, Dr J PHarper, Dr D R Harvey (Honorary Secretary), DrA D M Jackson (Honorary Treasurer), Dr B WLewis, Dr M M Liberman (Honorary AssistantSecretary), Dr J M Littlewood, Dr D Morris,Dr C H Nourse (Honorary Assistant Secretary),Dr Aileen Redmond, Dr L Rosenbloom, Dr N JRoyston, Dr M J Simpkiss, Dr H Simpson, DrP E Walker, Dr S G F Wilson, Dr B Wolman,Dr H B Valman, Dr M H Bellman (Junior Repre-sentative), Prof. D Hull (Chairman of the AcademicBoard).

Observers. The Association is grateful to the follow-ing for assistance and advice both at Council and

in many other ways: Prof. F S W Brimblecombe(Member of the Central Health Services Council),Mr A Jolleys (President of the British Associationof Paediatric Surgeons), Prof. R G Mitchell (Asso-ciation of Clinical Professors and Heads of Depart-ments of Paediatrics), Prof. T E Oppe (Adviser inChild Health, DHSS), Dr Marie Richards (WelshOffice), Dr Mary Tate (Department of Health andSocial Security).

Meetings. Council met on three occasions: 12 Mayand 13 October 1979, and 9 February 1980.

3. MATTERS CONCERNING THE ADMINISTRATION OFTHE ASSOCIATION

The Association's staff comprises an ExecutiveSecretary and four Assistant Secretaries. It has beennecessary to increase the number of AssistantSecretaries from three to four in order to cover theextra work load created by the new category ofAssociate Membership and extra representation onoutside bodies. A temporary secretary was againtaken on for 2 months before the 1980 AnnualMeeting to process the booking forms.The Association would like to record its continuing

debt of gratitude to the Institute of Child Healthfor portering and mailing services, duplicatingfacilities, and the use of rooms for meetings.Membership. Council noted that the membershipat 9 February 1980 was as follows: Members-962;Honorary Members-I 10; Associate Members-220.Academic Board. The 14th Annual Report of theBoard has been received by Council.

4. AWARDS OF THE ASSOCIATION

James Spence Medal-Prof. J M Tanner.

Guthrie Medal-Dr M A Preece.

Heinz Fellowships of the BPA-Dr M V Joseph andDr A M Kiango (Fellowship A); Dr P D Manueland Dr Jean E Shoreland (Fellowship C). In additiona special supplementary award has been made to DrE W Swaby. The Association remains indebtedto the Nuffield Foundation for their advice andadministrative help.

5. FINANCE AND ALLIED MATTERSThe Directors of Unigate have again generouslydonated their annual travel grant of £225 and havesupplied the programme and stationery for the 1980Annual Meeting.A contribution of £100 has been made by Wyeth

Laboratories towards the President's travellingexpenses.



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730 British Paediatric Association

A bequest of £500 has been gratefully received bythe Association from the late DrWW Payne towardsthe promotion of the objects of the Associationand in particular to help younger members.The BPA continues to benefit by a share of the

profits from the sale of the Archives of Disease inChildhood.

6. MEETINGS OF THE ASSOCIATIONThe 51st Annual Meeting of the Association washeld at York in March 1979 and 631 members andguests attended. Council wishes to record itsappreciation to the Academic Board in organisingthe scientific programme for these meetings and tothank the many members and guests who submittedpapers. Council also wishes to thank the convenersand members of specialty groups (13 of whichheld sessions during the meeting) for their contri-butions.The next Annual Meeting of the Association

will be held from 7 to 11 April 1981.

7. STANDING COMMITTEES AND WORKING PARTIES OFTHE ASSOCIATION

Reports have been received by Council, and com-ments have been submitted to government depart-ments and other bodies on many important issues.

Council is deeply grateful to the members whohave served on committees and working parties,and also to those who have represented the Associa-tion on both statutory and voluntary bodies. Manyindividual members have helped the Associationby their advice, suggestions, and criticisms.

A major change for the Association this year hasbeen the admittance of Associate Members inaccordance with the wishes of the Annual GeneralMeeting. Applications were invited and of the 280who applied 220 were accepted into membershipin January 1980. A further 29 were elected at theAnnual General Meeting. Two Associate Memberswere elected at the Annual Meeting to serve onCouncil.

Council wishes to record its thanks to DouglasGairdner who retired this year from the Committeeof the Archives of Disease in Childhood. He hadbeen Editor for 16 years and had always served theAssociation very well. Prof. Roy Meadow joinsProf. Roger Robinson in editing the Archives.

The Association is now being represented on manymore bodies either in its own right or through itsmembership of the Joint Paediatric Committeeof the Royal Colleges of Physicians UK and the

BPA. There are now paediatric representatives on allthree Councils for Postgraduate Medical Educationand we are fortunate that the President has beennominated by the Royal College of Physicians(London) to sit on the Joint Consultants Committee.The Association is being consulted more and moreabout important matters and there has been theopportunity for the Association to be representedat many more meetings. The Association is parti-cularly pleased at the number of times it has beenconsulted by the DHSS.

Other agenda items

l. The Honorary Treasurer's verbal report and theaccounts for 1979 were accepted. The meetingnoted that it would be necessary to increase themembership subscription rates from 1 June 1981in order to keep pace with inflation.

2. The meeting approved the revised rules of theAssociation circulated to members in December1979.

3. Dr James Taylor announced that the FirstWorld Congress of Paediatric Cardiology wouldtake place from 2 to 6 June 1980 in London.

4. The Honorary Secretary reminded members thatin 1982 the Annual Meeting would take theform of a joint meeting with the ScottishPaediatric Society. It would be held in Aviemorefrom 20 to 24 April. The cost of attendance at themeeting would be greater than at present ashotel accommodation would have to be used.

SCIENTIFIC PROCEEDINGS

WINDERMERE LECTURE. The lecture was delivered byProf. H Bickel of the Universitats Kinderklinik,Heidelberg, on 'Inborn errors of metabolism:prevention and treatment'.

Schizoid personality in childhood. S Wolff andJ Chick (Edinburgh).In the treatment of disturbed children and theirparents it is important to be accurate in one'saetiological assumptions and to be realistic about achild's capacity for change. Neither child nor parentscan be helped if constitutionally based behaviourdifficulties are attributed to family pathology orif expectations for conformity remain high in



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the face of a child's inherently limited capacity foradaptive behaviour.

Relief and improved behaviour often followwhen the psychiatric disorder is correctly inter-preted as a result of the child's personality make-up,and allowances are made for him both at home andat school.One type of personality disorder recognisable

in middle childhood is schizoid personality (des-cribed by Asperger as schizoid psychopathy ofchildhood).

This contribution will report on the validation ofthe syndrome by means of a follow-up study by anindependent psychiatrist of 22 schizoid childrenand 22 controls some 10 years after their originalreferral to a child psychiatric clinic. At follow-up,the diagnosis of the independent psychiatrist agreedvery well with that made in childhood and mostof the core features postulated as characteristic ofschizoid personality differentiated significantly bet-ween the probands and the controls.

A psychiatrist in a paediatric diabetic clinic. MLindsay, J D Baum, and A L Kinmonth (Oxford).

The incidence of psychiatric disturbance and psycho-social problems in a population of diabetic childrenis no different from normal children. However it isimportant to detect and assist with emotional prob-lems in diabetic children because distress directlyaffects glucose homeostasis in addition to disturbingthe child's ability to adapt to his lifelong condition.An analysis has been made of cases seen by a

child psychiatrist attending a weekly paediatricdiabetic clinic for a year when 142 families were seen.The presence of a psychiatrist enabled staff todevelop a more perceptive and broader therapeuticapproach. Specifically the psychiatrist's involvementin clinical consultation was subdivided as follows:36 families: joint consultation in clinic concerningproblems brought by the family or identified bystaff: e.g. not eating prescribed food, reflectingfamily tensions unrelated to diabetes.11 families: separate consultations in clinic follow-ing identification of serious problems: e.g. twopotential suicides (aged 8 and 18).S families: problems requiring discussions with staffafter clinic; e.g. father obsessionally involved withdaughter's diabetes.2 families: problems were so profound that unlesscontinuous emotional support was assumed, it wasfelt better not to initiate discussions unless instigatedby the family: e.g. father diabetic, blind, and dyingfrom diabetic nephropathy.88 families: no indication for psychiatric contribu-tion.

Sexually-abused children-are they seen by pae-diatricians and child psychiatrists? A Bentovim,P Beezley-Mrazek, and M Lynch (London andDenver, USA).

Sexual mistreatment of children is gradually beingrecognised as a form of child abuse. We hoped tofind out who was providing help for these childrenand their families. Samples of relevant professionalgroups were circulated with questionnaires toinvestigate this, providing a categorisation of sexualabuse-such as the battered child with injuries in thegenital area, incest, sexual assault, and involvementin pornography.As one would expect, a comparatively large number

of children were being seen by police surgeons.Possibly reflecting society's preoccupation with theperpetrator, few of them were referred for special-ised help. Those children seen by paediatricians andchild psychiatrists were far more likely to be referredby other routes, and often the initial reason forreferral was for a medical or behavioural problem.A wide range of age and type of abuse was seen

affecting boys and girls. Paediatricians only referred11 % of their cases to child psychiatrists.Throughout our survey there was a trend towards

seeing the problem as a 'police matter', rather thanas a family disorder. All available evidence points tothere being a far larger number of sexually abusedchildren than is officially recognised. As profes-sionals are becoming more willing to identify theproblem, a co-ordinated strategy for dealing withthese cases is needed.

Munchausen syndrome by proxy. R Meadow(Leeds).Two families in which parents, by falsification,caused their children innumerable harmful hospitalprocedures were described in 1977. Since then Ihave encountered 2 further cases. Paediatricianshave informed me of 8 other families. Details of the15 children and their families have been studied toidentify common features which may improverecognition and management.The children have an unusually long and per-

plexing clinical syndrome requiring much investi-gation in hospitals. Despite active managementsymptoms persist or recur e.g. recurrent haematuria,hypernatraemia, anaemia, faecal or blood-stainedvomiting.The offender is the mother. Commonly she has:

(1) Demanded (and enjoyed) coming into hospitalwith her child and appeared a happy addict ofgood living-in facilities for parents.

(2) Worked in hospital or with children beforemarriage.



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(3) A history of similar physical illness to that whichshe has projected on her child, her own symp-toms having been rather cursorily investigated.

(4) A previous history of hysterical illness orfabrication by her of investigations and findingswhen she herself was ill.

(5) A particularly poor intellectual and emotionalrelationship with her husband.

Six of the families are from Yorkshire, but it islikely that the syndrome is widespread and oftenunrecognised. It is a dangerous condition with anappreciable mortality. Early experience suggests thatpositive management can prevent further problems.

Children with special needs. Review of placementfor adoption of 37 children. A N Jepson (London).The specialist adoption agency, Parents for Children,was set up two years ago to find families for childrenwith special needs, i.e. older children, sibling groups,and handicapped. 37 children have been placed withadoptive families. There were 9 children in siblinggroups, 10 Down's children, 2 severely subnormalmultiply-handicapped children placed from longstay subnormality hospitals, 3 children with emo-tional/behaviour disturbance of such a degreethat they were categorised as maladjusted; amongthe other children placed were some with con-ditions-such as cerebral palsy, Noonan's syndrome,adrenal hyperplasia, and achondroplasia. There were5 disruptions of placement. The majority of thechildren referred to the agency had been in care formost of their lives, and many of them had hadinadequate medical care, damagingly so in the caseof 7 children. The majority of these children withspecial needs experienced particular problems afterplacement in their adoptive families and exhibitedemotional symptoms for which their familiesrequired continuing social work support from theplacing agency, and on occasion medical advice. Itis particularly important that children with handi-capping conditions are assessed before placement,that the adoptive parents are aware of these needs,and that after placement there will be the necessaryservices available, particularly if special schoolingis required and specialist medical care.

In a number of couples who applied to the agencyas adoptive parents, one or other partner sufferedfrom a potentially serious condition. The importanceof medical assessment and interpretation of suchinformation is discussed.

Supporting bereaved parents after perinatal death.G Forrest and R Claridge (Oxford).It is thought important to offer emotional support

to parents bereaved in the perinatal period. Toevaluate this, a study has been planned in whichbereaved parents are randomly allocated to acontrol (C) group, or a supported (S) group, andtheir emotional state assessed 6 and 12 months later.

Currently 14 C and 15 S families have enteredthe studyand 4 C and 4 S were assessed at 6 months.Areport will be presented of hospital routine in groupC and extra support given in group S with pre-liminary results of the 6-month follow-up.A tangible result of the study so far has been

identification of complicated and emotionally-charged administrative procedures which affectparents shortly after bereavement. These includesimultaneous registration of birth and death;collection and delivery of the certificate of burial orcremation; choosing the funeral arrangements,particularly given the uncertainties of hospitalfunerals; can the parents attend? how many babiesin one grave? is a coffin used? is a funeral serviceheld? can the grave be found afterwards?

Clarification of these points is important for allthe staff in a maternity hospital and has enabled thechild psychiatrist to give practical help to group Sand thus be placed in a position to offer moregeneral emotional support.

GUEST LECTURE. A guest lecture was delivered by DrC Ounsted of the Park Hospital for Children,Oxford, on 'The development of temporal lobeepilepsy in childhood'.

Hypertrophic pyloric stenosis and the urinary tract.J D Atwell and P Levick (Southampton).

Observations have been made over the last 10years of congenital anomalies of the urinary tractassociated with hypertrophic pyloric stenosis. Nopreviously recorded observations existed of urinarytract anomalies and hypertrophic pyloric stenosis.This investigation started as a result of operatingon two infants with pyloric stenosis one of whomhad bilateral megaureters and the other pelviuretericjunctional hydronephrosis, thus linking together acommon smooth muscle disorder.The patients studied can be subdivided into three

main groups:(1) Prospective study. 68 patients underwent pyloro-

myotomy during the 3-year period 1970-2. 64 ofthese patients had a limited IVP performed todetermine the incidence of associated anomaliesof the urinary tract; 13 of these were abnormalan incidence of 19%.

(2) Retrospective study. 276 patients were operated



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on for pyloric stenosis over the 10-year period1960-9. The incidence of anomalies with a geneticbasis was determined in this group and includedinguinal hernia, undescended testes, hypospadias,and urinary tract anomalies.

(3) Otber observations. This group included a follow-up of patients seen in the prospective study andother examples of the association of urinary tractanomalies with pyloric stenosis.

The findings suggest a genetic basis for theassociation of congenital anomalies of the urinarytract and pyloric stenosis.

A systematic method for examination of the neonatalbrain by real-time ultrasound. M I Levene, V Dubo-witz, and J S Wigglesworth (London).

The poorly mineralised neonatal skull allows goodvisualisation of intracranial structures by means ofreal-time ultrasound, and permits diagnosis ofsubependymal and intraventricular haemorrhage aswell as structural abnormalities of the brain. Inaddition real-time ultrasound has been shown tobe of value in following the course of hydrocephalusin neonates.The three systems which produce a real-time

image are linear array, phased array, and mechanicalsector scanners. As a preliminary part of ourinvestigation we examined the merits and dis-advantages of each system. The linear array allowsbetter visualisation over the tempero-parietal area ofscalp, whereas the phased array and mechanicalsector scanners permit good views through thefontanelle.A study has been undertaken to correlate the

appearance of the ultrasound scan with anatomicalsections of neonatal brain. We have devised a methodfor systematic examination of the brain in a mannerlikely to give most information with least handlingof the baby. Five 'cuts' of the brain are taken,three through the tempero-parietal area givinginformation on brain stem, pons, aqueduct ofsylvius, third and lateral ventricles. Views throughthe fontanelle show the configuration of the ven-tricular system and offer clear images of the caudatenucleus, allowing diagnosis of germinal layerhaemorrhage.We conclude that the use of ultrasound is a

reliable and safe method of examination of theneonatal brain. The information given by the scancorrelates well with anatomical findings and allowsaccurate diagnosis ofhaemorrhage or hydrocephalus.

Oral prostaglandin E2 for palliation of cyanoticcongenital heart disease in neonates. E D Silove,J Y Coe, M D Mitchell, A J F Page, and S P Singh(Birmingham).E-type prostaglandins (PGE) infused into the aortaor intravenously have become the initial line ofemergency treatment in neonates whose pulmonarycirculation depends on patency of the ductusarteriosus. We have evaluated the effectiveness oforal PGE2 given for periods of 6 days to 5 months to11 neonates with right ventricular outflow obstruc-tion (RVOO) and 2 with interrupted aortic arch(IAA). Nine infants with RVOO were studied atintervals to determine the influence of oral PGE2on arterial oxygen saturation (Sao2) or tension(Pao2) and on plasma PGE2 concentration.

Within 20 minutes of a dose of PGE2, Sao2 orPao2 rose by a mean of 41 % of the pre-dose value(P 0001) and plasma PGE2 on concentrationreached dose-related peak levels. The ductusarteriosus remained PGE2-dependent for months.Infants with IAA improved, pulses becomingpalpable and blood pressure rising to normal valueswithin hours of starting treatment. Infants withRVOO all grew; four underwent repeat angiographywhich showed pulmonary arterial growth.

Oral administration of PGE2 was at least aseffective as intravenous and had practical advantagesfor both short- and long-term purposes. Medicalpalliation and elective surgery may be a betteralternative to emergency surgery.

Immuno-osseous dysplasia-a new hereditary dis-order. J Spranger, H Schulte-Wisserman, and EStraub (Mainz).Son and daughter of nonconsanguineous parentsshowed an unusual combination of cellular immunedeficiency, skeletal dysplasia, and progressive renalfailure. Clinically, the patients had a peculiarphenotype with facial dysmorphism, dwarfism, andnumerous pigmented nevi of the skin. Radiographicstudies showed a spondyloepiphyseal dysplasia.Histologically, the cartilage cells were distended withlack of column formation. Studies of the immunesystem showed a numerical and functional T-celldeficiency, as shown by depressed E-rosette forma-tion and negative skin tests to PPD, candidin,streptococcus antigen, and mumps. The girl died atage 6 years from renal failure. The clinical findingswere those of a nephrotic syndrome, the histologicalfindings those of an immune complex nephritis withmesangioproliferative histological changes. Thepathogenesis is unknown. No abnormalities of theaminoacid, glycosaminoglycan, purine, or pyrimidine



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metabolism were found. The apparently autosomalrecessive multisystem disease is differentiated fromother osteochondrodysplasia with immunodeficiencysuch as adenosine deaminase deficiency or car-tilage-hair hypoplasia.

Is overheating a factor in some cot deaths? A NStanton, M A P S Downham, and D J Scott(Newcastle upon Tyne).

Clinical and pathological evidence of overheatingwas sought in a consecutive series of infants dyingin Newcastle and Gateshead. Eight of 33 unexpected,unexplained deaths (cot deaths) were found to havehistological changes in the small intestine of thekind described in association with heatstroke.Five of these had overwhelming clinical evidence ofoverheating, a sixth had major terminal symptoms,and the histories of the other two were unreliable.Small intestinal changes were not found in any of12 deaths from chronic or congenital conditions andin only one of eight acute explained deaths-a babywho died with necrotising enterocolitis.

Seven of 34 cot death families interviewed hadfound their baby hotter than usual at death, andfour other babies had a terminal pyrexia; 13 morebabies had evidence of a terminal infection withoutobserved fever. None had gastroenteritis. 15 of thecot death babies were excessively dressed or coveredat the time of death.The ability to generate heat increases rapidly

with age in infancy, while sweating capacity remainsrelatively constant. Warming neonates excessivelyincreases the incidence of apnoea. Overheatingyoung animals experimentally or babies in incubatorsaccidentally may cause sudden silent death.The possibility that overheating contributes to

some cot deaths has important implications forhealth education.

Investigation of children when Crohn's disease issuspected. C A Campbell, C Bartram, J Douglas, andJ A Walker-Smith (London).

Despite reports that Crohn's disease is increasingin frequency in childhood in recent years, it stillremains an uncommon disease in this age group.However, it is not uncommon for Crohn's diseaseto be considered as a possible diagnosis in childrenwith a wide variety of symptoms and signs, and atan early stage it is still a difficult diagnosis to makeparticularly when recurrent abdominal pain is themain presenting symptom.We have critically reviewed the early clinical

features and initial investigations performed in 26

children with established Crohn's disease, diagnosedsince 1975. We wish to emphasise the early symp-toms and signs which were found to be particularlyassociated with Crohn's disease, and also the impor-tant role of well performed and appropriate radio-logy in making the diagnosis.From our personal experience of these children

and others referred with similar symptoms wepropose a plan of investigation for suspected casesinvolving detailed questioning, followed by radiologyand/or endoscopy as appropriate for the individualchild. Such an approach minimises both the timeand trauma to which the child is subjected.

Possible prevention of neural tube defects by peri-conceptional vitamin supplementation. R W Smithells,D W Fielding, R Harris, N C Nevin, A P Read,C J Schorah, M J Seller, and S Sheppard (Leeds andLiverpool).

Circumstantial evidence has previously been pre-sented to the BPA suggesting that nutritionaldeficiencies, specifically minor deficiencies of folicacid, ascorbic acid, and possibly other vitamins, maycontribute to the causation of neural tube defects.A prospective, multicentre trial of periconceptionalvitamin supplementation in high-risk mothersprovides further evidence compatible with thishypothesis.

Mothers given Controlpericonceptional mothersvitaminsupplementation

Infant or fetus 1 12with neural tubedefectInfant without 140 192neural tube defectNormal amniotic 26 38alpha fetoproteinTotal 167 242

P (Fisher's exact test) <0-01.

National food policy and child growth. P C Elwoodand 0 P Gray (Cardiff).

The Welfare Food Act 1940 gave entitlement to amilk supplement for pregnant mothers, infantsunder 5 years of age, and all schoolchildren. The pro-visions of this Act were substantially reduced in 1971and further restrictions appear to be imminent.



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In 1972 two randomised controlled trials were setup, both designed to mimic situations created by the1940 Welfare Food Act.One trial was initially based on a representative

sample of 1200 pregnant women. Half of these weresupplied with milk tokens entitling them to half apint of milk free per day. There was no evidence ofany effect of the entitlement on the pregnancy, judgedby the birthweights of their infants. Their infantswere then followed to age 5 years and half of themwere supplied with milk tokens. Again there was noevidence consistent with benefit on the growth of thechildren.The other trial was based on 581 schoolchildren

aged 7 and 8 years. All were from families with atleast 4 children, and of social class III manual, IV,or V. One-third of a pint of milk was supplied eachschool day for two years and this led to an increasedgrowth of about 1-5 cm per year (P<0-05).The relevance of these findings to our national

food policy will be discussed.

The BFM therapy study 1970/79 in childhood acutelymphoblastic leukaemia (ALL). H Riehm, G Henze,and C Schellong (Berlin).

The co-operative ALL study group BFM (Berlin/Frankfurt/Munich) enrolled between October 1970and March 1979 in sequence 355 children andadolescents being treated according to the BerlinALL protocol. The study started in Berlin andafter 4 years was extended to Frankfurt and Munich(study I, standard programme, 1970-6, n=141).Between October 1976 and March 1979 8further paediatric departments within the FederalRepublic of Germany participated in study IL(standard programme, for 'low risk' patients, n= 137,intensified standard programme for 'high risk'patients in two randomised modifications, n=77). Indiscriminating the two risk groups a risk index wasused. The results up to 1 January 1980 are asfollows:Study I: 76/141 patients are virtually in completecontinuous remission (CCR) with a median durationof 5 years. The therapy failure group (nonresponders,disease-unrelated deaths, relapses) comprises 65patients (1/15/49). Out of 126 evaluable patientsthe 'cure' expectancy is calculated to be 58 %.Study 11 171/214 patients in CCR, median duration17 months, failure group 43 patients (3/14/26).Out of 200 evaluable patients the calculated pro-portion in CCR ('cure' expectancy) is 78 % for boththe 'low risk' and the 'high risk' therapy group.The results indicate that the Berlin ALL pro-

gramme in its standard version has improved theoutcome of childhood leukaemia by the impact of

intensified and prolonged induction therapy. By theuse of the same principle (intensification of thestandard programme) the prognosis for patients withrisk factors is equal to that of the 'low risk' groups,thus underlining the value of early intensificationtherapy in childhood leukaemia.

Underdiagnosis and undertreatment of asthma inchildren of primary school age. A N P Speight,E N Hey, and D A Lee (Newcastle upon Tyne).

All the 2700 7-year-old children in North Tyne-side were screened using a school-based question-naire. Children with symptoms were seen for furtherstudy. Preliminary analysis of the results showedthat approximately 13 % of the children had wheezedsince starting school. An attempt was made toassess the degree of disability suffered by thesechildren and to review previous diagnosis andmanagement.Only 14% of the wheezy children had previously

been labelled as asthmatic. All of these childrenlabelled asthmatic had received some bronchodilatortreatment. In contrast, of all the other wheezychildren who had been given some other diagnosticlabel by their doctor (e.g. wheezy bronchitis,bronchitis, chest infection), only 11% had everreceived bronchodilator treatment. Overall, two-thirds of the symptomatic children had never receivedbronchodilator treatment. The degree of disabilitysuffered by these children appears to be considerable,as measured by time lost from school. One-quarterof the symptomatic children had lost more than halfa year of schooling as a result of their asthma sincestarting school.

Children who had significant current symptomswere offered treatment for their asthma at a specialclinic. Many appeared to benefit greatly though onlylonger follow-up will allow this to be assessed fully.

Oxford cerebral palsy survey: a review of 160 latewalking children. J Hardie and J A Macfarlane(Oxford).

Children in Oxfordshire born after 1 July 1976and not walking by 18 months are referred byhealth visitors for neurological and developmentalassessment by a paediatrician at home, in an attemptto pick up undiagnosed cases of cerebral palsy atan early age. This survey, in conjunction with aprospective follow-up of certain categories of 'atrisk' babies from the special care baby unit and adocumentation of known cases of cerebral palsy,aims to determine as fully as possible the incidenceand aetiology of cerebral palsy in this area. Of thefirst 160 late walkers assessed, 6 (3 8 %) cases of



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cerebral palsy and 4 (2 5 %) cases of neurologicalabnormality were newly diagnosed. A further 16children had previously diagnosed conditions (notcerebral palsy) likely to have delayed their develop-ment. Patterns of early locomotion, family history,social background, and developmental assessmentscores on the remaining 134 'idiopathic' late walkersare discussed. The incidence of newly diagnosedcerebral palsy among late walkers born in 1977 forexample makes a significant difference to the pre-viously known overall incidence (2:1000) for thatyear in Oxfordshire. This survey helps to explain thedifficulties in the accurate determination of theincidence of cerebral palsy.

Home monitoring of blood glucose in diabetic children.S Court and D Johnston (Nottingham).

Home monitoring was performed in 40 childrenage range 3-15 years, using Glucochek devices. Acomposite blood glucose profile was constructedduring one week for each of three consecutivemonths, a maximum of four samples being collectedin one day. The child and family participated ininterpreting the profile and adjusting the therapeuticregimen. Control was also assessed by 24-hour urineglucose and haemoglobin A1 measurement. Anxietyprovoked by monitoring was assessed by standardisedpsychological questionnaires. 36 were able tocomplete monitoring, and none found the samplingunacceptable. Patient selection was biased towardsthose with unsatisfactory control.

In contrast to studies in adults, there was nomarked variation in sequential profiles for individualchildren. In 12, previously unrecognised hypo-glycaemia was identified, and in 8 this was recurrentand prolonged. Persistent marked hyperglycaemiawas confirmed in others but could not always becorrected. Only three families provided inadequatedata.Of 21 children who have completed three months'

monitoring, the change in diabetic control as judgedby HbA, and mean fasting,blood glucose (MFBG)is shown.

Improved Unchanged Worse

HbA1 8 9 4MFBG 7 6 8

POSTER PRESENTATIONS

Monitoring of phenobarbitone and phenytoin con-centrations in small children by saliva assay. C JBacon, D Henderson, A Heirons, J C Mucklow,M D Rawlins, and J K G Webb.

Biochemical evidence for genetic heterogeneity inmannosidosis. P F Benson, L R Button, A H Fensom,and C B S Wood.

Pitfalls in the diagnosis of coeliac disease in a non-specialised unit. D S K Brookfield, P G Isaacson, andC J Rolles.

A simplified method for the estimation of plasma bileacids in children. P T Clayton, D P R Muller, andO H Wolff.

Amniotic fluid acetylcholinesterase and the diagnosisof open tube neural defects. G Dale.

Medical audit in neonatal care. D P Davies andT Williams.

Suppressor cell activity in dermatomyositis. R F Eife.

An auxological study of six patients with cerebralgigantism (Soto's syndrome). C C Forsyth, P J Smail,and J A Young.

Nitrazepam baby. S K M Jivani.

Cyclosporin A treatment of a child with T-cellleukaemia. J E Kingston, N D Barnes, and V ABroadbent.

2-D-echocardiographic diagnosis of the hypo-plastic left heart syndrome. L Lange, H D Allen,S J Goldberg, and D J Sahn.

24-hour blood glucose monitoring in diabetes mellitus.B M Laurance, A M Long, M 0 Savage, and MTucker.

Free drug level monitoring-two years' experiencewith carbamazepine and phenytoin. T A Morelandand G W Rylance.

Propanolol and cold thermogenesis in the newbornbaby. A I Mukhtar, KW Cross, and J K Stothers.

Complementary breast-fed infants. A Nicoll, RGinsberg, and J Tripp.

Chemical and histological investigations followinginfusions of fat emulsions during parenteral feedingof neonates. F Pohlandt, H U Klor, W Mohr, andU Tollner.

Ethnic differences in perinatal mortality-a challenge.M J Robinson, S R Palmer, and R W Taylor.

Home blood glucose monitoring is well toleratedbut there are difficulties in interpretation. It ispotentially useful in children with deterioratingcontrol or where urine analysis is unreliable.



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Relationship between drug metabolism and livervolume in children. G W Rylance, M D Cowan,E Guy, and T A Moreland.

Osteogenesis imperfecta in a family with an auto-somol recessively inherited defect in collagen syn-thesis. H Schloon, A C Nicholls, M Pope, andW R F Weigel.

Genetic studies in children with aniridia and Wilms'stumour. R S Shannon, D G Harper, E Harper, andJ R Mann.

Congenital rubella and the 1978/79 rubella epidemic.S Sheppard, J A Dudgeon, R W Smithells, andO Stark.

An AHA confidential enquiry into child death.Y Sherman.

Phosphate treatment in X-linked hypophosphataemia.T E Stacey and D P Brenton.

Chronic active hepatitis in childhood: a review of 23cases. A Vegnente, V F Larcher, and A P Mowat.

Neonatal arterial occlusion. K P Ward and C RRayner.

GROUP SESSIONS

Child Psychiatry Section Workshop

Elective mute children: psychological developmentand background factors. I Kolvin.Can you tell in infancy what a child with Down'ssyndrome will be like at eight? Ann Gath.The role of stressful life events in childhood recurrentabdominal pain. Jennie Monaghan.Day wetting associated with bed wetting. I Berg.Training of paediatric registrars in child psychiatry.H G Morton.Communication in paediatrics: The Cardiff Coretraining course. P Pinkerton.Psychological aspects of diabetes in childhood andadolescence. Elspeth Earle.Psychiatric aspects of mutilating surgery in children.Anne Bolton.

British Paediatric Cardiology Section

Significant congenital heart disease in a maternityhospital. E Naughten.The outcome of infants referred to a regionalcardiac centre. B R Keeton.Williams's syndrome-what happened to idiopathichypercalcaemia. C R Kershaw.Tolazoline in the management of life threatening

pulmonary vasoconstrictive episodes after paediatriccardiac surgery. Use of indwelling pulmonary arterylines. 0 D H Jones.Echocardiographic assessment of pulmonary arterypressure following pulmonary artery banding.A Houston.Late effects on the left arm of subclavian flapaortoplasty. P J Todd.Sub-xiphoid echocardiography-a new approachto the diagnosis and differentitiation of atrio-ventricular defects. G R Sutherland.Ligation of the left pulmonary artery in the newbornpig; how the lung is perfused and grows. Sheila GHowarth.

The British Association for Paediatric Nephrology

Review lecture: A new look at the haemolyticuraemic syndrome. K N Drummond.Severe haemolytic uraemic syndrome associated withunmasking of Thomsen-Friedenreich antigen andtreated with plasminogen and streptokinase infusion.C M Taylor.The effect of indomethacin on renal function inchildren with cystinosis. G B Haycock.The echonephrogram. C Metreweli.Upper tract urodynamics: gamma camera studiesin duplex and refluxing systems. S T Meller.Renal osteodystrophy in young children: a doubleblind trial of I X hydroxycholecalciferol. S P ARigden.Review lecture: Twenty years of percutaneous renalbiopsy in children. R H R White.Nonfamilial haematuria in children. N Yoshikawa.Steroid-sensitive nephrotic syndrome and IgA/IgGnephropathy: an unusual association. M H Winter-born.High-density lipoprotein cholesterol levels inchildren with the nephrotic syndrome: a possiblerisk factor for premature cardiovascular disease.V J Wass.Urine production in early infancy. A Evans.

British Paediatric Nutrition, Metabolism, and Phar-macology Group

Maternal phenylketonuria treated by diet beforeconception. D P Brenton.Molecular differentiation in phenylketonuria andhyperphenylalaninaemia. K Bartholome.Tryptophanaemia observations on 4 cases. J BSardharwalla.Homocystinuria. Results of treatment in latediagnosed patients. H Groebe.Hypermethioninaemia-differential diagnostic con-siderations. H Przyrembel.



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The value of the glucagon test in glycogen storagedisease. J V Leonard.Rickets due to an inborn error in the biosynthesis ofvitamin D-hormone: deficiency of 25-OH-vitaminD3-a-hydroxylase. H K A Visser.Isn't it time we took lead out of petrol? F WAlexander.Nutritional growth restriction and catch-up. JDobbing.Dose dependent enzyme induction in anticonvulsanttreated children. H Bartels.The influence of dose and time of administration ontransplacentally acquired pethidine in the newborn.T A Moreland.Should we reduce the acid lead of cows' milk basedformulae for infant feeding? F Manz.Infant feeding: mothers' antenatal attitudes andsubsequent practices. J L Smart.

British Paediatric Tropical Child Health Group

Hospital admissions in children with sickle cellanaemia. Lily N Murtaza.Aetiological factors in chronic diarrhoea aftermeasles in malnourished children. J F B Dossetor.Plasma prolactin levels in undernourished lactatingmothers. P Lunn.A school-based approach as the second front incommunity health-care-the Kangazha experiment.M V Joseph.The use of oral glucose electrolyte solution pre-pared with untreated well water in acute non-specific childhood diarrhoea. M Watkinson.Hydrops fetalis in South Korea. Elizabeth Bryan.Growth and social class in urban Nigerian children.Margaret D Janes.

Community Paediatric GroupThe effects of personal health during pregnancy onfetal outcome

The strength and weaknesses of epidemiologicalapproaches to the problem. Jean Golding.What is the relationship between fetal nutrition,adverse birth factors, and subsequent development?J S Wigglesworth.Drug and alcohol teratology. R W Smithells.Why pregnant women don't do what we tell them.Hilary Graham.

British Paediatric Immunology Group

Clinical manifestations of allergy in an infantpopulation. D W Hide.

Successful marrow transplant for reticular dys-genesis. Karin Tiedemann.Disturbance of functional activity of the alternativepathway of complement in sickle cell anaemia-more than one defect? V F Larcher.Islet-cell antibodies in children with mumps infection.A Otten.Suppressor T-cells in asthmatic children. DA Hughes.Is breast feeding enough to prevent atopic disease insusceptible children? D Stratton.Immunological studies on allergic children andbeekeepers. R Urbanek.Polymorphonuclear leucocyte iodination responseas an estimate of defective yeast opsonisation.D M Roberton.

British Paediatric Perinatal Group

Neurological development of the preterm infant.Penelope Palmer.Isoimmune neonatal thrombocytopenic purpura.P Galea.A controlled trial of intravenous aminophyllineand face mask continuous positive airways pressurein apnoea of prematurity. Rosamund A K Jones.The benefit of silver swaddlers. J K Stothers.

The role of neonatal intensive care in the preventionof death and handicap

The benefits of neonatal intensive care. M L Chis-wick.The hazards of neonatal intensive care. N R CR oberton.An overview of neonatal intensive care. J P MTizard.

British Paediatric Radiology Group

Calcareous degeneration in discs in children. P PFranklyn.Acromesomelic dwarfism. D J Wilkinson.Bone scanning in childhood trauma. Helen Carty.Unusual sites of acute osteomyelitis in childhood.K J Shah.Skeletal maturation at the hand and wrist in normalchildren in Nottingham. P Small.The 'air block' phenomenon in neonates. G M AHendry.Respiratory difficulty in infancy due to intrathoracicmass lesions. P S Thomas.Echographic diagnosis of hydronephrosis pitfallsand difficulties. C Metreweli.Radiology in the diagnosis of meconium ileusequivalent. D W Pilling.



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British Society of Paediatric Endocrinology

B-cell development in human pancreas. P KWirdnam.A study of the remission period in juvenile diabetesmellitus. 0 Hensey.What are the medium term benefits of mono-component insulins? M Webster.What do diabetic children eat? Ann-Louise Kin-month.

Assessment of diabetic control

(1) An excursion into self-monitoring of bloodglucose in diabetic children. P G F Swift.(2) Home blood glucose monitoring in diabeticchildren. Valerie A Broadbent.(3) Filter-paper capillary blood glucose profiles inthe assessment of diabetic control. A D Edelsten.Melatonin and human puberty. M A Preece.Variation in the patterns of female precociouspuberty. D B Grant.Growth pattern and gonadotrophin secretion inboys with delayed growth and adolescence. M 0Savage.Acute endocrine and metabolic effects of hGH(UK). A Aynsley-Green.Circulating levels of DHA in growth hormone-deficient children. M B Ranke.Salivary cortisol levels during provocation tests inchildren. D A Price.Thyroxine dosages in congenital hypothyroidism.J A Hulse.

British Paediatric Gastroenterology Group

Short stature as a primary manifestation of coeliacdisease: a feature in need of emphasis. A Groll.Childhood coeliac disease in the Asian immigrantcommunity. M J Brueton.Disaccharidase activity in patchy enteropathy inchildren. C A Campbell.Loperamide inhibits cholera toxin induced secretion.Bhupinder Sandhu.Adhesion characteristics of strains of E. coli isolatedfrom children during an outbreak of acute diarrhoea:isolation of a colonisation factor II producing strain.D C A Candy.Quantitive analysis of small intestinal mucosa incows' milk protein intolerance. A D Phillips.Pitfalls in the investigation of carbohydrate mal-absorption in the neonate may be lessened by com-bined investigations. M J Harran.A new method for the detection of breath hydrogen.E J Eastham.Small intestinal absorption of neutral amino-acidsand glycyl-1-phenylanine in cystic fibrosis. P J Milla.

Studies on the pathogenesis of faecal bile salt lossesin cystic fibrosis. Anne Kilby.Extrahepatic portal hypertension in childhood.E R Howard.Intracellular localisation of copper by energydispersive microanalysis in Indian childhood cir-rhosis. M S Tanner.Liver disease in children with cystic fibrosis. H TPsacharopoulos.

British Paediatric Oncology and Haematology Group

Guest lecture: The histiocytic disorders. M Nesbit(University of Minnesota).Erythroid progenitor culture in the investigation ofpure red cell aplasia. C Sieff.The fall and rise of haemoglobin in the low birthweight infant. D Stevens.Sickle cell anaemia in Birmingham children. JillianMann.Acute splenic sequestration in SS disease in the lastfive years. Janet M Topley.Pit counts and infections in childhood sickle cellanaemia. D W Rogers.Effect of treatment on inhibitor levels in boys withhaemophilia A and B with inhibitors. G H Hill.An evaluation of cefuroxine and gentamicin infebrile neutropenic children. D Stratton.Ewing's sarcoma treatment with high dosageradiation and adjuvant chemotherapy. Ann Gold-man.Nephroblastoma-25 years of cases with specialreference to those under one year. Patricia H MorrisJones.Comparison of cyclophosphamide and vincristinewith cyclophosphamide, vincristine, and adriamycinin advanced neuroblastoma. J Ninane.

British Paediatric Respiratory GroupA survey of asthma in 7-year-old children in NorthTyneside. D A Lee.A comparative assessment of slow release tbeo-phylline, ketotifen, and placebo in young asthmatics.D Stratton.Ketotifen in childhood asthma. R C Groggins.Review lecture: Hyposensitisation in childhoodasthma. J 0 Warner.The effects of anti-mite measures on children withmite-sensitive asthma-a controlled trial. E RVerrier Jones.Nebuliser medication: how much leaves the bottle?S A Ibrahim.Review lecture: RS virus infections in infancy. E NHey.



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Respiratory patterns during sleep in bronchiolitis.F Silva.Severity of illness in children with whooping cough.D J Matthew.Bronchial hypersecretion in preterm babies. C Wong.

British Paediatric Neurology AssociationMulticystic encephalomalacia due to fetal viralencephalitis. S Lingham.A family study of hydrocephalus due to aqueductstenosis. Frances Howard.Peripheral nerve conduction velocity and fetalnutrition. R 0 Robinson.Multiple familial constriction rings with entrapmentneuropathics. N Marlow.

Factors associated with periventricular haemorrhagein the very low birthweight infant. R W I Cooke.Neuraminidase deficiencies. J Spranger.Congenital myopathy in Lowe's syndrome. FHanefeld.Fears of death in febrile convulsions are normal.J H Baumer.

Clinical aspects of neonatal neurology

Facts and fancies in the neurological examinationof the newborn. J K Brown.The floppy infant. D Gardner-Medwin.What can be learned from neonatal behaviour?J A Macfarlane.

Richard Heyworth DobbsWe record with regret the death of Dr RichardDobbs on 21 August. Among his many distinguishedcontributions to paediatrics, he was Editor of theArchives from 1954 to 1969-the second longestserving editor of the journal-and President of theBPA 1970-71. He took a keen interest in the Archivesafter his retirement and was a frequent and friendlyvisitor to the editorial office.



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Documents

British Paediatric AssociationArchives ofDisease in Childhood, 1980, 55, 728-740 British Paediatric Association Proceedings ofthe Fifty-secondAnnualMeeting The Annual Meeting of the