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NEUROBLASTOMA is among the most frequent cancers of childhood; yet in contrast to leukemia, very little effort has been made to seek clues to its origins through epidemiologic research. The failure to assign neuroblastoma a single exclusive code number in the Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death , 1 has been a great handicap in studying its distribution nationally. By handsorting all death certificates for US children dying of cancer, 1960 to 1964, we have been able recently to separate deaths attributed to neuroblastoma and, in conjunction with information from 504 hospital charts of children with this neoplasm, to examine its patterns of occurrence for etiologic implications. Methods The mortality study was based on about 22,000 copies of childhood cancer death certificates provided by the National Vital Statistics Division, US Public Health Service. The certificates concerned all deaths from malignant neoplasms in children under 15

The Committee on Environmental Health of the Indiana Chapter of the American Academy of Pediatrics sought the assistance of the Academy's Committee on Environmental Hazards regarding a developing health risk to children in Indiana. A cattle feedlot was developed along the shores of a creek which empties into a lake where recreational use included an area specifically designated for swimming. The Environmental Protection Agency estimates that the wastes produced by farm animals in the United States are equivalent to the wastes of 2 billion people, more than half the world population of 3.7 billion people. It has further estimated that more than half of these wastes are produced in feedlots. Feedlots for livestock and poultry are a relatively new industry that has developed since World War II in various parts of the United States. Significant changes are occurring in the increased demand for meats and in the manner of feeding, processing, and marketing livestock. Feedlots are now being established closer to market areas throughout the nation. With the increasing number of animals and the increasing use of feedlots, it is necessary that some wastes management system be required to protect the human population from a number of infectious diseases. Animal wastes from feedlots are more infectious than wastes from grazing farm animals because of naturally occurring epizootics within such confined feeding facilities. Chemical pollution by animal wastes or chemical changes incident to microbiologic or chemical pollution are also a concern. In the interest of our domestic water supply and the safe use of recreational waters, both vital to the health of children, the Committee has approved the following statement

To the Editor .—The fascinating case report by Lynch and Green in the June issue of theJournal(115:723-727, 1968) stresses in the title and text the relationship between Wilms' tumor and congenital heart disease, for which there is little evidence. 1 There is a way, which was not discussed, for linking each of the disorders in the child to the mother's bilateral pheochromocytomas with solid (medullary) thyroid carcinoma and amyloid stroma, a well defined familial syndrome. 2-5 The possible role of multiple neurofibromatosis, which need not be clinically apparent, is of particular interest. Neurofibromatosis, inherited as an autosomal dominant trait, carries a high risk of pheochromocytoma 6 and has been reported with the neoplastic syndrome observed in the mother. 3-5 Pheochromocytoma, which itself may be familial, 7 apparently also occurs excessively in persons with congenital heart disease, including transposition of the great vessels, 8,9 the anomaly found in the

In its recent statement on iron,1 the Committee on Nutrition emphasized the value of iron-fortified, proprietary milk formulas for the prevention of iron-deficiency anemia of infancy. Despite this recommendation, the most recent marketing information available to the Committee shows that more than 70% of the proprietary formulas currently prescribed by physicians do not contain added iron. The reasons for continuing routine use of formulas not fortified with iron are not entirely clear. One reason may be that some physicians still believe iron additives increase the incidence of feeding problems or gastrointestinal disturbances. There is no documented evidence that this is a significant problem. The Committee strongly recommends when proprietary formulas are prescribed that iron-supplemented formulas be used routinely as the standard–that is, that this be the rule rather than the exception. There seems to be little justification for continued general use of proprietary formulas not fortified with iron. The Committee is fully aware that only a small percentage of American infants are fed proprietary formulas after 6 months of age. Fluid whole milk (available in bottle or carton ) or evaporated milk, both of which contain only trace amounts of iron, are substituted at the time of greatest iron need and highest prevalence of iron-deficiency anemia. The infant's diet is usually deficient in iron, unless other foods are carefully selected to insure adequate iron intake. Since the major dietary component during infancy is milk, two courses of action should be taken: (1) Pediatricians and other health professionals should engage in a program of public education to convince American mothers to provide their infants with a source of dietary iron.

Progress in understanding host defenses and infectious agents has been so rapid that it is difficult to keep up with recent developments. In this book, an all-star cast of contributors attempts to fill this gap. They cover an immense scope; viruses, be they "helper," "hybrid," ECHO, oncogenic, picorna-, or myxoviruses; bacteria, of which the least familiar are perhaps the mycoplasmas; and various body defenses, including chapters on interferon and the pathogenesis of fever. The introductory essay on virus diseases by Sir Christopher H. Andrewes is a masterpiece of medical writing. Also outstanding is the overview of the newer immunology by Sir Macfarlane Burnet, and an up-to-date account by Robert Good and his associates of human immunological protection against infection and malignancy, as revealed by errors of nature—rare inborn immunological disorders, as Wiskott-Aldrich syndrome, ataxiatelangiectasia and agammaglobulinemia. Many of the chapters begin with fascinating historical reviews, sometimes including personal experiences not

There has been increasing concern by several groups about the plight of children whose lives are harmed by their housing environment, which results in an increased risk of accidents, infectious diseases, and in particular, lead poisoning. The Committee on Environmental Hazards has also been vitally concerned with these problems, and several of its members have served as expert witnesses in congressional hearings on related bills. However, efforts up to the present have been insufficient to alleviate illnesses which, though ill-defined, are clearly preventable. The Committee on Environmental Hazards recommends that the Academy encourage national and local governments to support, at the economic and law enforcement levels (including health departments), those measures necessary to alleviate the problems of childhood lead poisoning. Deteriorated housing is an essential feature of lead poisoning, and it is related to the increased risk of accidents and the incidence of infectious diseases. Action is needed to urge landlords, by whatever means possible, to improve those housing conditions which are a danger to the health of children. It may be economically unfeasible for landlords of deteriorated housing in inner cities to improve their buildings, and both legislative action and financial commitment from government may be necessary to bring about required action.

RECENTLY interest has quickened in the use of human population study centers as sources of data for medical research. The idea is not new. An early example of population studies was the series of investigations in Hagerstown, Mid., initiated by the Public Health Service in 1921 (1). Other such studies have been supported in part by National Institutes of Health research grants. The Framingham, Mass., survey of heart disease (2) and the Veterans Administration-National Cancer Institute study of smoking and health (3) were National Institutes of Health intramural activities. To assess their role in the support of human population study centers the NIH Division of Research Grants Study Sections concerned with grant applications sponsored the Conference on Health Studies of Human Populations at the University of Pittsburgh School of Public Health in November 1960 (4). The question now is what steps the National Cancer Institute should take in the further development of human population study centers. Any review and appraisal of human population study centers is conditioned not only by events past but by the expectation of things to come and so must be regarded as speculative judgments not unlike those involved in predicting the future course of business and market activities. Humane and ethical considerations deprive investigators of the distribution of disease in man of many advantages conferred by experimental work with pedigreed animals, such as precise control of environmental and related factors, detailed and sophisticated comparative measurements in experimental and control animals, and the relatively large numbers of subjects available for experiments. Studies of disease in man must rely heavily on observations and on the substitution of statistical for experimental control. Situations, then, must be sought which improve the power of the observational method, usually through resort to more detailed cross-classifications of data and more elaborate determinations of the sequence of events, in order to extend the range of inferences permitted by the observational associations. Many investigators look upon human population study center studies as a specialized activity which has its own techniques and discipline. In a statistical context, this distinction arises from recognition that statistical methods suitable for analysis of experimental data are often not appropriate for handling observational data. The "human population study center" label has been applied to a number of different concepts so that it is difficult to obtain general agreement on all features of these centers. At the outset it would be well to distinguish between "populations for continuing study" and community-based "population center facilities." Mr. Haenszel is chief of the Biometry Branch and Dr. Miller is chief of the Epidemiology Branch, National Can7cer Institute, National Institutes of Health, Public Health Service.' This paper was prepared for presentation at a meeting of the Consultant Panel on Biometry and Epidemiology of the National Cancer Institute on November 5-6, 1961. While the present text benefits from the comments of panel members and other reviewers, the authors assume responsibility for the views expressed.