50 studies every pediatrician should

know First Edition Ashaunta T.

Anderson
Visit to download the full and correct content document:
https://textbookfull.com/product/50-studies-every-pediatrician-should-know-first-editio
n-ashaunta-t-anderson/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

50 studies every neurologist should know First Edition

David Y. Hwang

https://textbookfull.com/product/50-studies-every-neurologist-
should-know-first-edition-david-y-hwang/

50 Studies Every Ophthalmologist Should Know Alan

Penman

https://textbookfull.com/product/50-studies-every-
ophthalmologist-should-know-alan-penman/

50 Studies Every Palliative Care Doctor Should Know

Fifty Studies Every Doctor Should Know May 16 2018 1st
Edition Hui

https://textbookfull.com/product/50-studies-every-palliative-
care-doctor-should-know-fifty-studies-every-doctor-should-know-
may-16-2018-1st-edition-hui/

50 imaging studies every doctor should know 1st Edition

Christoph I. Lee

https://textbookfull.com/product/50-imaging-studies-every-doctor-
should-know-1st-edition-christoph-i-lee/
50 Landmark Papers Every Spine Surgeon Should Know
Alexander R. Vaccaro

https://textbookfull.com/product/50-landmark-papers-every-spine-
surgeon-should-know-alexander-r-vaccaro/

50 Landmark Papers every Trauma Surgeon Should Know 1st

Edition Stephen M Cohn (Editor)

https://textbookfull.com/product/50-landmark-papers-every-trauma-
surgeon-should-know-1st-edition-stephen-m-cohn-editor/

50 Landmark Papers Every Vascular and Endovascular

Surgeon Should Know 1st Edition Juan Carlos Jimenez
(Editor)

https://textbookfull.com/product/50-landmark-papers-every-
vascular-and-endovascular-surgeon-should-know-1st-edition-juan-
carlos-jimenez-editor/

Vinod Pottayil What Every Indian Should Know Before

Investing First Edition Vinod Pottayil

https://textbookfull.com/product/vinod-pottayil-what-every-
indian-should-know-before-investing-first-edition-vinod-pottayil/

What Every Science Student Should Know Justin Bauer

https://textbookfull.com/product/what-every-science-student-
should-know-justin-bauer/
50 Studies Every Pediatrician Should Know
50 STUDIES EVERY DOCTOR SHOULD KNOW

Published and Forthcoming Books in the 50 Studies Every Doctor

Should Know Series
50 Studies Every Doctor Should Know: The Key Studies that Form
the Foundation of Evidence Based Medicine, Revised Edition
Michael E. Hochman
50 Studies Every Internist Should Know
Edited by Kristopher Swiger, Joshua R. Thomas, Michael E. Hochman,
and Steven D. Hochman
50 Studies Every Neurologist Should Know
Edited by David Y. Hwang and David M. Greer
50 Studies Every Surgeon Should Know
Edited by SreyRam Kuy and Rachel J. Kwon
50 Studies Every Pediatrician Should Know
Edited by Ashaunta T. Anderson, Nina L. Shapiro, Stephen C. Aronoff,
Jeremiah Davis and Michael Levy
50 Imaging Studies Every Doctor Should Know
Christoph Lee
50 Studies Every Anesthesiologist Should Know
Anita Gupta
50 Studies Every Intensivist Should Know
Edward Bittner
50 Studies Every Psychiatrist Should Know
Vinod Srihari, Ish Bhalla, and Rajesh Tampi
50 Studies Every Pediatrician
Should Know
A shaunta T. A nderson, MD, MPH, MSHS
Assistant Professor of Pediatrics
University of California Riverside School of Medicine
Riverside, California
Health Policy Researcher
RAND Corporation
Santa Monica, California

Nina L. Shapiro, MD
Director of Pediatric Otolaryngology
Professor of Head and Neck Surgery
David Geffen School of Medicine
University of California Los Angeles
Los Angeles, California

Stephen C. A ronoff, MD, MBA

Waldo E. Nelson Professor and
Chairperson, Department of Pediatrics
Lewis Katz School of Medicine
Temple University
Philadelphia, Pennsylvania

Jeremiah C. Davis, MD, MPH

Community Pediatrician
Mosaic Medical
Bend, Oregon

M ichael L evy, MD
Assistant Professor of Pediatrics and Communicable Diseases
University of Michigan
C.S. Mott Children’s Hospital
Ann Arbor, Michigan

SERIES EDITOR:
M ichael E. Hochman, MD, MPH
Assistant Professor of Clinical Medicine
Keck School of Medicine
University of Southern California
Los Angeles, California

1
1
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
© Oxford University Press 2016
First Edition published in 2016
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-​i n-​P ublication Data
Names: Anderson, Ashaunta T., editor. | Shapiro, Nina L., editor. | Aronoff,
Stephen C., editor. | Davis, Jeremiah, editor. | Levy, Michael, editor.
Title: 50 studies every pediatrician should know /​[edited by] Ashaunta T. Anderson,
Nina L. Shapiro, Stephen C. Aronoff, Jeremiah Davis, and Michael Levy.
Other titles: Fifty studies every pediatrician should know | 50 studies every
doctor should know (Series)
Description: Oxford ; New York : Oxford University Press, [2016] | Series: 50
studies every doctor should know | Includes bibliographical references.
Identifiers: LCCN 2015039268 | ISBN 9780190204037 (alk. paper)
Subjects: | MESH: Pediatrics—​methods. | Clinical Trials as Topic. |
Evidence-​Based Medicine.
Classification: LCC RJ48 | NLM WS 200 | DDC 618.92—​dc23
LC record available at http://​lccn.loc.gov/​2 015039268
9 8 7 6 5 4 3 2 1
Printed by Webcom, Canada

This material is not intended to be, and should not be considered, a substitute for medical or other pro-
fessional advice. Treatment for the conditions described in this material is highly dependent on the indi-
vidual circumstances. And, while this material is designed to offer accurate information with respect to
the subject matter covered and to be current as of the time it was written, research and knowledge about
medical and health issues is constantly evolving and dose schedules for medications are being revised
continually, with new side effects recognized and accounted for regularly. Readers must therefore always
check the product information and clinical procedures with the most up-​to-​date published product infor-
mation and data sheets provided by the manufacturers and the most recent codes of conduct and safety
regulation. The publisher and the authors make no representations or warranties to readers, express or
implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher
and the authors make no representations or warranties as to the accuracy or efficacy of the drug dosages
mentioned in the material. The authors and the publisher do not accept, and expressly disclaim, any
responsibility for any liability, loss, or risk that may be claimed or incurred as a consequence of the use
and/​or application of any of the contents of this material.
For my son, Avery, and all the children we serve. I loved you before you were.
For my mother, Ingrid, and husband, Anton, who taught me
the power of words and of love.
—Ashaunta Anderson
For my family. And for my patients, who always teach me something.
—Nina Shapiro
To the patients who allowed me to treat them and, in the end,
proved to be my best teachers.
—Stephen Aronoff
To the patients I’ve yet to treat—may the knowledge herein help me
rise to the task.
—Jeremiah Davis
For Jen and Dad, the best pediatricians I know.
—Michael Levy
CONTENTS

Preface xiii
Acknowledgments xvii

SECTION 1 Allergy/​Immunology and Rheumatology

1. Efficacy of Immunoglobulin Plus Prednisolone in Prevention of Coronary
Artery Abnormalities in Kawasaki Disease (RAISE Study) 3
Nina Shapiro

SECTION 2 Behavioral
2. Measles, Mumps, and Rubella Vaccination and Autism 11
Michael Hochman, revised by Jeremiah Davis
3. Treatment for Adolescents with Depression Study (TADS) 17
Jeremiah Davis
4. The Multimodal Treatment Study of Children with Attention Deficit/​
Hyperactivity Disorder (MTA) 25
Michael Hochman, revised by Michael Levy

SECTION 3 Cardiology
5. Pharmacologic Closure of a Patent Ductus Arteriosus
in Premature Infants 35
Michael Levy
viii Contents

6. The Relation of Overweight to Cardiovascular Risk Factors among

Children and Adolescents: The Bogalusa Heart Study 39
Jeremiah Davis

SECTION 4 Dermatology
7. Propranolol versus Prednisolone for Symptomatic Proliferating
Infantile Hemangiomas: A Randomized Clinical Trial 47
Nina Shapiro

SECTION 5 Endocrinology
8. Risk Factors for Cerebral Edema in Children with Diabetic
Ketoacidosis 55
Jeremiah Davis

SECTION 6 ENT
9. A Trial of Early Ear Tube Placement in Children with Persistent
Otitis Media 63
Michael Hochman, revised by Nina Shapiro

SECTION 7 General Pediatrics

10. Maintenance IV Fluid Requirements 71
Michael Levy
11. Predischarge Serum Bilirubin to Predict Significant
Hyperbilirubinemia in Newborns 77
Michael Levy
12. Sudden Infant Death Syndrome Risk Factors: The Chicago
Infant Mortality Study 83
Michael Levy
13. Treatment of Acute Otitis Media in Children 87
Michael Hochman, revised by Nina Shapiro
14. The Human Papillomavirus Vaccine: The Future II Trial 93
Michael Hochman, revised by Nina Shapiro
15. Evidence of Decrease in Vaccine-​Type Human Papillomavirus (HPV)
and Herd Protection in Adolescents and Young Women 99
Nina Shapiro
Contents ix

16. Effects of Lead Exposure in Childhood 105

Ashaunta Anderson

SECTION 8 Hematology
17. Iron Supplementation for Breastfed Infants 113
Ashaunta Anderson
18. Transfusion Strategies for Patients in Pediatric Intensive Care Units 119
Jeremiah Davis
19. Prophylactic Penicillin in Sickle Cell Anemia 125
Ashaunta Anderson

SECTION 9 Infectious Disease

20. Empiric Antimicrobial Therapy for Skin and Soft-​Tissue Infections 133
Michael Levy
21. Infants at Low Risk for Serious Bacterial Infection 137
Ashaunta Anderson
22. Outpatient Treatment of Febrile Infants at Low Risk for Serious
Bacterial Infection 143
Ashaunta Anderson
23. Outpatient Treatment of Selected Febrile Infants without
Antibiotics 151
Ashaunta Anderson
24. Neonatal Fever without a Source 159
Ashaunta Anderson
25. Serious Bacterial Infections and Viral Infections in Febrile Infants 165
Ashaunta Anderson
26. Chest Radiograph and Lower Respiratory Tract Infection 171
Ashaunta Anderson
27. Vidarabine Therapy of Neonatal Herpes Simplex Virus Infection 177
Jeremiah Davis
28. Early Reversal of Pediatric and Neonatal Septic Shock 183
Michael Levy
29. Reduction of Vertical Transmission of Human
Immunodeficiency Virus 189
Jeremiah Davis
x Contents

30. Palivizumab Prophylaxis against Respiratory Syncytial Virus

in High-​R isk Infants 195
Jeremiah Davis
31. The Spectrum of Bronchiolitis 201
Jeremiah Davis
32. Preventing Early-​Onset Neonatal Group B Streptococcal Disease 207
Michael Levy

SECTION 10 Neonatology
33. Apgar Scoring of Infants at Delivery 215
Michael Levy
34. Prophylactic Treatment with Human Surfactant in Extremely
Preterm Infants 219
Michael Levy

SECTION 11 Nephrology
35. Oral versus Initial Intravenous Antibiotics for Urinary Tract
Infection in Young Febrile Children 225
Michael Levy
36. Identifying Children with Minimal Change Disease 231
Jeremiah Davis
37. Chronic Renal Disease Following Poststreptococcal
Glomerulonephritis 237
Jeremiah Davis

SECTION 12 Neurology
38. Antipyretic Agents for Preventing Febrile Seizure Recurrence 245
Nina Shapiro
39. Febrile Seizures and Risk for Epilepsy 251
Ashaunta Anderson
40. Seizure Recurrence after First Unprovoked Afebrile Seizure 257
Ashaunta Anderson
41. Mortality and Childhood-​Onset Epilepsy 263
Ashaunta Anderson
Contents xi

42. Identifying Children with Low-​R isk Head Injuries Who Do Not
Require Computed Tomography 269
Michael Hochman, revised by Ashaunta Anderson

SECTION 13 Oncology
43. Health-​Related Quality of Life among Children with Acute
Lymphoblastic Leukemia 277
Nina Shapiro

SECTION 14 Ophthalmology
44. Treatment of Acute Conjunctivitis in Children 285
Nina Shapiro
45. Screening for Amblyopia 291
Nina Shapiro

SECTION 15 Orthopedics
46. Differentiation between Septic Arthritis and Transient Synovitis
of the Hip in Children 299
Michael Levy

SECTION 16 Pulmonary
47. Steroids for the Treatment of Croup 307
Michael Hochman, revised by Nina Shapiro
48. Inhaled Corticosteroids for Mild Persistent Asthma:
The START Trial 311
Michael Hochman, revised by Nina Shapiro
49. Inhaled Salbutamol (Albuterol) versus Injected Epinephrine
in Acute Asthma 317
Nina Shapiro
50. Long-​term Inhaled Hypertonic Saline for Cystic Fibrosis 323
Jeremiah Davis

Index 329
PREFACE

At the turn of the last century, William Osler, the father of modern medicine
and pediatrics, noted that the practice of medicine is “an art based on science.”
The science, in the late 1890s and early twentieth century, consisted mostly
of anatomy, histology, pathology, and rudimentary microbiology. The medi-
cal literature of the day consisted of anecdotal observations and logical, well-​
reasoned treatises. Much of the knowledge of medicine was passed from master
to apprentice and was largely dogmatic in nature.
Beginning in the late 1940s, medical evidence, as we have come to know it,
was born. Beginning with the early trials of streptomycin therapy for tuber-
culosis and the Framingham Heart Study in the 1940s, the observations of
Rammelcamp and Jones linking streptococcal pharyngitis and rheumatic
fever, and the Salk polio vaccine trials in the 1950s, the amount of usable, sci-
entifically based, medical evidence has grown at logarithmic rates. If Osler
were alive today, he would probably state that the science of modern medi-
cine, while inherently uncertain, is empiric and based on evidence generated
by well-​defined, rigorous methodologies. Unlike the generations of physicians
who have gone before, today’s medical practitioners have a wealth of evidence
to use as touchstones in all aspects of medical decision-​making, enabling all of
us to practice a higher quality of medicine and to ensure that, above all else, we
do no harm.
This book and the other volumes in the Oxford University Press series, 50
Studies Every Doctor Should Know, represent the cumulative “canon” that many
physicians have created individually and together to try to better understand
the evidence behind our practice. With the rapid increase in scientific litera-
ture publishing over the past two decades, selecting only 50 titles to include
may seem unnecessarily restrictive. Our goal with this first edition was to
uncover the original studies that inform key areas of pediatric medical decision
making, recognizing that this evidence is imperfect and inherently uncertain.
xiv Preface

Nevertheless, the studies presented in this volume are, as best we can deter-
mine, the controlling evidence at this point in time.
The process of identifying the studies included: (1) recruitment of authors
around the United States in both academic and community settings, in gen-
eral pediatrics and subspecialty pediatrics; and (2) the development of a pre-
liminary list of those studies we felt were most important to how pediatrics is
currently practiced. This list was shared with national experts in pediatrics in
an effort to include the most pivotal studies available. The final list of candidate
articles was divided among team members and each article was summarized;
these summaries were shared with original authors whenever possible for feed-
back, comment, and correction. When original authors were unavailable, mem-
bers of their research teams were solicited, and, if needed, national experts in
the appropriate subspecialties were consulted. We are incredibly fortunate to
have had so many original authors discuss their work with us and, through this
collaboration, make our summaries more accurate and reflective of the original
works’ intention.
Perhaps more than any other area of medicine, pediatrics struggles to amass
a sufficient evidence base for many of our interventions. Studies involving
children are inherently more circumspect with regard to consent, risk, and
determining long-​term benefit. Many pediatric illnesses are rare, making sig-
nificant conclusions difficult to come by at single centers. Whenever possible,
we tried to seek “gold standard” study designs such as randomized, placebo-​
controlled, double-​blind investigations. Admittedly, there are a fair number of
studies included in this volume that fall short of what is today considered the
gold standard for medical evidence. Our team made a conscious decision to
include many of these trials simply because they continue to underpin pediatric
medicine. It is our hope that an in-​depth examination of these classic articles
will provide the reader with a better understanding of the uncertainty and lim-
itations of the evidence commonly used in medical decision making, allowing
the reader to make more informed choices for their own patients. To help this
effort, each article summary includes discussion of related articles—​many of
which are more current and often explain how our thinking as pediatricians
has changed with better-​designed studies in more recent publications. We also
include a relevant case presentation at the conclusion of each chapter, to better
illustrate the clinical relevance of each article.
Preface xv

Hopefully this collection of pediatric articles adds new insight into your
practice, reveals some publications that may not have been part of your own
canon, and fosters discussions of what evidence we all should be using as pedi-
atricians in the future.
Thank you for your interest,
Ashaunta T. Anderson, MD, MPH, MSHS
Nina L. Shapiro, MD
Stephen C. Aronoff, MD, MBA
Jeremiah C. Davis, MD, MPH
Michael Levy, MD
ACKNOWLEDGMENTS

As with other books in this series, we sought to gain insights from study authors.
We contacted as many study authors as we could, for them to have the opportu-
nity to review our chapters and make any valuable suggestions to our work. We
were able to communicate with 41 study authors. We are ultimately responsible
for the content of the book, but greatly appreciate and acknowledge here the
original study authors’ time, effort, and comments regarding our summaries of
their excellent studies.
We would like to thank:

• M. Douglas Baker, MD, first author: Outpatient management

without antibiotics of fever in selected infants. N Engl J Med.
1993;329(20):1437–​1441; and Unpredictability of serious bacterial
illness in febrile infants from birth to 1 month of age. Arch Pediatr
Adolesc Med. 1999;153:508–​511.
• Marc N. Baskin, MD, first author: Outpatient treatment of febrile
infants 28 to 89 days of age with intramuscular administration of
ceftriaxone. J Pediatr. 1992;120:22–​27.
• Nancy Bauman, MD, Dept. of Otolaryngology, Children’s
National Medical Center, first author: Propranolol vs prednisolone
for symptomatic proliferating infantile hemangiomas: a
randomized clinical trial. JAMA Otolaryngol Head Neck Surg.
2014;140(4):323–​330.
• Allan Becker, MD, Department of Pediatrics, University of
Manitoba, first author: Inhaled salbutamol (albuterol) vs injected
epinephrine in the treatment of acute asthma in children. J Pediatr.
1983;102(3):465–​4 69.
• Gerald S. Berenson, MD, Director, Tulane Center for Cardiovascular
Health, Tulane University, senior author: The relation of overweight
xviii Acknowledgments

to cardiovascular risk factors among children and adolescents: the

Bogalusa heart study. Pediatrics. 1999;103(6):1175–​1182.
• Carrie L. Byington, MD, first author: Serious bacterial infections
in febrile infants 1 to 90 days old with and without viral infections.
Pediatrics. 2004;113:1662–​1666.
• Joseph Carcillo, MD, corresponding author: Early reversal of
pediatric-​neonatal septic shock by community physicians is associated
with improved outcome. Pediatrics. 2003;112(4):793–​799.
• Brian Casey, MD, chapter reviewer for: A proposal for a new
method of evaluation of the newborn infant. Curr Res Anesth Analg.
1953;32(4):260–​267.
• Robert W. Coombs, MD, PhD, Vice-​Chair for Research,
Department of Laboratory Medicine, University of Washington,
participant in: Reduction of maternal-​infant transmission of
human immunodeficiency virus by zidovudine. N Engl J Med.
1994;331(118):1173–​1180.
• Ron Dagan, MD, first author: Identification of infants unlikely to have
serious bacterial infection although hospitalized for suspected sepsis.
J Pediatr. 1985;107:855–​860.
• Mark R. Elkins, MHSc, Clinical Associate Professor of
Medicine, Central Clinical School, The University of Sydney, first
author: A controlled trial of long-​term inhaled hypertonic saline in
patients with cystic fibrosis. N Engl J Med. 2006;345(3):229–​2 40.
• Daniel Elliott, MD, MSCE, first author: Empiric antimicrobial
therapy for pediatric skin and soft-​tissue infections in the
era of methicillin-​resistant Staphylococcus aureus. Pediatrics.
2009;123(6):e959–​966.
• Joseph T. Flynn, MD, MS, Chief, Division of Nephrology, Seattle
Children’s Hospital, reviewer for: Primary nephrotic syndrome in
children. Identification of patients with minimal change disease
from initial response to prednisone. J Pediatr. 1981;98(4):561–​564.
Dr. Flynn also graciously reviewed: Potter EV, et al. Clinical healing
two to six years after poststreptococcal glomerulonephritis in
Trinidad. N Engl J Med. 1978;298:767–​772.
• James K. Friel, PhD, MSc, first author: A double-​masked, randomized
control trial of iron supplementation in early infancy in healthy term
breast-​fed infants. J Pediatr. 2003;143:582–​586.
• William Furlong, MSc, McMaster University, first author: Health-​
related quality of life among children with acute lymphoblastic
leukemia. Pediatr Blood Cancer. 2012;59(4):717–​724.
Acknowledgments xix

• Marilyn H. Gaston, MD, first author: Prophylaxis with oral

penicillin in children with sickle cell anemia. N Engl J Med.
1986;314:1593–​1599.
• Francis Gigliotti, MD, Depts. of Pediatrics and Immunology,
University of Rochester School of Medicine, senior author: A single-​
blinded clinical trial comparing polymyxin B-​trimethoprim and
moxifloxacin for treatment of acute conjunctivitis in children.
J Pediatr. 2013;162(4):857–​861.
• Nicole S. Glaser, MD, Professor of Pediatric Endocrinology,
University of California at Davis, first author: Risk factors for
cerebral edema in children with diabetic ketoacidosis. N Engl J Med.
2001;344(4):264–​269.
• Fern Hauck, MD, Spencer P. Bass, MD, Twenty-​First Century
Professor of Family Medicine Professor of Public Health Sciences
Director, International Family Medicine Clinic, first author: Sleep
environment and the risk of sudden infant death syndrome in an
urban population: the Chicago Infant Mortality Study. Pediatrics.
2003;111(5 Pt 2):1207–​1214.
• Frederick W. Henderson, MD, Professor, Department of Pediatrics,
University of North Carolina, first author: The etiologic and
epidemiologic spectrum of bronchiolitis in pediatric practice.
J Pediatr. 1979;95(2):183–​190.
• Alejandro Hoberman, MD, first author: Treatment of acute otitis media
in children under 2 years of age. N Engl J Med. 2011;364(2):105–​115;
and Oral versus initial intravenous therapy for urinary tract infections
in young febrile children. Pediatrics. 1999;104(1 Pt 1):79–​86.
• Jessica Kahn, MD, Division of Adolescent Medicine, Cincinnati
Children’s Hospital, first author: Vaccine-​t ype human papillomavirus
and evidence of herd protection after vaccine introduction. Pediatrics.
2012;130(2);e249–​e256.
• Tohru Kobayashi, MD, Department of Pediatrics, Gumma
University Graduate School of Medicine, first author: Efficacy of
immunoglobulin plus prednisolone for prevention of coronary
artery abnormalities in severe Kawasaki disease (RAISE
Study): a randomised, open-​label, blinded-​endpoints trial. Lancet.
2013;379(9826):1613–​1620.
• Mininder Kocher, MD, MPH, first author: Validation of a clinical
prediction rule for the differentiation between septic arthritis and
transient synovitis of the hip in children. J Bone Joint Surg Am.
2004;86-​A(8):1629–​1635.
xx Acknowledgments

• Nathan Kuppermann, MD, MPH, first author: Identification of

children at very low risk of clinically-​important brain injuries after
head trauma: a prospective cohort study. Lancet. 2009;374:1160–​1170.
• Jacques Lacroix, MD, Professor, Department of Pediatrics, Université
de Montréal, first author: Transfusion strategies for patients in
pediatric intensive care units. N Engl J Med. 2007;356(16):1609–​1619.
• Kreesten Meldgaard Madsen, MD, first author of: A population-​based
study of measles, mumps, and rubella vaccination and autism. N Engl J
Med. 2002;347(19):1477–​1482.
• John March, MD, Professor of Psychiatry and Chief of Child and
Adolescent Psychiatry, Duke University, first author: Fluoxetine,
cognitive-​behavioral therapy, and their combination for adolescents
with depression: Treatment for Adolescents With Depression Study
(TADS) randomized controlled trial. JAMA. 2004;292(7):807–​820.
• Dennis Mayock, MD, Department of Pediatrics, Division of
Neonatology, participant in: Null D, Bimle C, Weisman L, Johnson
K, Steichen J, Singh S, et al. Palivizumab, a humanized respiratory
syncytial virus monoclonal antibody, reduces hospitalization from
respiratory syncytial virus infection in high-​r isk infants. Pediatrics.
1998;102(3):531–​537.
• T. Allen Merritt, MD, MHA, first author: Prophylactic treatment
of very premature infants with human surfactant. N Engl J Med.
1986;315(13):785–​790.
• Michael Moritz, MD, chapter reviewer for: The maintenance need for
water in parenteral fluid therapy. Pediatrics. 1957;19(5):823–​832.
• Karin B. Nelson, MD, and Jonas H. Ellenberg, PhD, first and last
authors: Predictors of epilepsy in children who have experienced
febrile seizures. N Engl J Med. 1976;295:1029–​1033.
• Paul O’Byrne, MD, co-​author: Early intervention with budesonide
in mild persistent asthma: a randomized, double-​blind trial. Lancet.
2003;361:1071–​1076.
• Jack Paradise, MD, first author: Effect of early or delayed
insertion of tympanostomy tubes for persistent otitis media on
developmental outcomes at the age of three years. N Engl J Med.
2001;344(16):1179–​1187.
• Morton Printz, PhD, co-​author: Pharmacologic closure of
patent ductus arteriosus in the premature infant. N Engl J Med.
1976;295(10):526–​529.
• Heikki Rantala, MD, Dept. of Pediatrics, University of Oulu, senior
author: Antipyretic agents for preventing recurrences of febrile
Acknowledgments xxi

seizures: randomized controlled trial. Arch Pediatr Adolesc Med.

2009;163(9):799–​804.
• Shlomo Shinnar, MD, PhD, first author: The risk of seizure recurrence
after a first unprovoked afebrile seizure in childhood: an extended
follow-​up. Pediatrics. 1996;98:216–​225; and last author, Long-​term
mortality in childhood-​onset epilepsy. NEJM. 2010;363:2522–​2529.
• George H. Swingler, MBChB, PhD, first author: Randomised
controlled trial of clinical outcome after chest radiograph in
ambulatory acute lower-​respiratory infection in children. Lancet.
1998;351:404–​4 08.
• Richard J. Whitley, MD, Distinguished Professor of Pediatrics,
Professor of Microbiology, Medicine and Neurosurgery, University of
Alabama, first author: Vidarabine therapy of neonatal herpes simplex
infections. Pediatrics. 1980;66(4):495–​501.
• Cathy Williams, FRCOphth, Dept. of Ophthalmology, Bristol
Eye Hospital, first author: Screening for amblyopia in preschool
children: results of a population-​based, randomised controlled trial.
ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and
Childhood. Ophthalmic Epidemiol. 2001;8(5):279–​295.

We would also like to thank Rachel Mandelbaum, BA (UCLA School of

Medicine MD Candidate 2017) for her meticulous help in several of the chap-
ter preparations.
SECTION 1

Allergy/​I mmunology
and Rheumatology
1

Efficacy of Immunoglobulin Plus

Prednisolone in Prevention of Coronary
Artery Abnormalities in Kawasaki Disease
The RAISE Study
N I NA SH A PI RO

Findings from our randomized study show that combination treatment

with intravenous immunoglobulin plus prednisolone is better than that with
intravenous immunoglobulin alone in prevention of coronary artery abnor-
malities, reducing the need for additional rescue treatment, and rapid reso-
lution of fever and inflammatory markers in Japanese patients with severe
Kawasaki disease.
—​K obayashi et al.1

Research Question: Does addition of prednisolone to conventional treatment

with intravenous immunoglobulin (IVIG) and aspirin reduce the incidence of
coronary artery abnormalities in patients with severe Kawasaki disease?

Funding: Japanese Ministry of Health, Labour, and Welfare.

Year Study Began: 2008

Year Study Published: 2012

4 A ll e r g y / I mm u n o l o g y a n d Rh e u ma t o l o g y

Study Location: 74 hospitals in Japan.

Who Was Studied: Children with severe Kawasaki disease, who received a
Kobayashi risk score3 of 5 points or higher (see Boxes 1.1 and 1.2), indicating a
high risk of nonresponse to immunoglobulin therapy and subsequent coronary
artery involvement.

Box 1.1 JAPANESE GUIDELINES FOR DIAGNOSIS

OF KAWASAKI DISEASE

Infants and children under the age of 5 should satisfy either 5 of the principal
symptoms of Kawasaki disease or 4 of the principal symptoms plus coronary
aneurysm or dilatation.2

Principal Symptoms:
1. Fever persisting ≥5 days
2. Fever for ≤4 days shortened by early intravenous immunoglobulin
therapy
3. Bilateral conjunctival congestion
4. Changes of lips and oral cavity (reddening of lips, strawberry tongue, dif-
fuse injection of oral and pharyngeal mucosa)
5. Polymorphous exanthema
6. Changes of peripheral extremities (initial stage: reddening of palms and
soles, indurative edema; convalescent stage: membranous desquamation
from fingertips)
7. Acute nonpurulent cervical lymphadenopathy

Box 1.2 KOBAYASHI RISK SCORES WERE CALCULATED

USING THE FOLLOWING CRITERIA

• 2 points each for:

• Serum sodium concentration ≤133 mmol/​L
• Illness of ≤4 days at diagnosis
• Aspartate aminotransferase concentration of ≥100 U/​L
• % neutrophils ≥80%
• 1 point each for:
• Platelet count ≤30Å~10 4/​μ L
• C-​reactive protein concentration of ≥100 mg/​L
• Age ≤12 months
Efficacy of Immunoglobulin Plus Prednisolone 5

Who Was Excluded: Children with a prior history of Kawasaki disease or cor-
onary artery disease before study enrollment, those who were diagnosed with
Kawasaki disease 9 or more days after onset of illness, those who were afebrile
before study enrollment, those who received steroids or IVIG within 30 days
or 180 days respectively, and those with coexisting severe medical disorders or
suspected infectious disease were excluded from the study.

How Many Patients: 248

Study Overview: See Figure 1.1 for a summary of the study design.

Children with severe Kawasaki Disease

Randomized

IV immunoglobulin, aspirin, and

IV immunoglobulin and aspirin only
prednisolone

Figure 1.1 Summary of Study Design.

Study Intervention: Children diagnosed with severe Kawasaki disease were

randomly assigned to receive either:

1. Conventional treatment with intravenous immunoglobulin (2 g/​kg

for 24 h) and aspirin (30 mg/​kg per day until afebrile and then 3-​5mg/​
day for at least 28 days after fever onset) or
2. The same regimen of intravenous immunoglobulin and aspirin just
described plus prednisolone (2 mg/​kg per day over 15 days) and
famotidine (0.5 mg/​kg per day), a histamine receptor antagonist, for
gastric protection.

Follow-​Up: Two-​d imensional echocardiograms and laboratory data were

obtained at baseline and at week 1 (6–​8 days after study enrollment), week
2 (12–​16 days after study enrollment), and week 4 (24–​32 days after study
enrollment).

Endpoints: The primary endpoint was the incidence of coronary artery abnor-
malities on two-​
d imensional echocardiography during the study period.
6 A ll e r g y / I mm u n o l o g y a n d Rh e u ma t o l o g y

Secondary endpoints included coronary artery abnormalities at week 4 after

study enrollment, need for additional rescue treatment, duration of fever after
enrollment, serum concentrations of C-​reactive protein at 1 and 2 weeks after
enrollment, and serious adverse events.

RESULTS
The incidence of coronary artery abnormalities during the study period was
significantly lower in the IVIG plus prednisolone group (3%) compared with
the group receiving only IVIG (23%, P < 0.0001). At week 4 after study enroll-
ment, patients in the IVIG plus prednisolone group also had significantly fewer
coronary artery abnormalities, although the difference was less than that seen
during the study period. Additionally, patients in the IVIG plus prednisolone
group had more rapid fever resolution, lower incidence of rescue treatments,
higher white blood cell counts and percentage neutrophils, lower aspartate
aminotransferase concentration, higher serum sodium, higher total choles-
terol, and lower concentrations of C-​reactive protein.

Criticisms and Limitations: The RAISE study did not evaluate for many of
the adverse effects of corticosteroids, though the study did identify an increase
in the incidence of leukocytosis and high serum cholesterol in the group receiv-
ing prednisolone.
All study participants were of Japanese origin, and thus the results may not be
generalizable to a more heterogeneous population. For example, the Kobayashi
risk score was used to identify Japanese infants and children with severe
Kawasaki disease that might be unresponsive to standard IVIG therapy, putting
them at higher risk for coronary artery abnormalities. Yet, while this system pre-
dicted immunoglobulin nonresponse in Japanese patients, this scoring system
has been found to have a low sensitivity for other populations, such as North
Americans.4 Further study is required to address the efficacy of the RAISE treat-
ment regimen in non-​Japanese patients with severe Kawasaki disease. 5

Other Relevant Studies and Information:

• The Pediatric Heart Network (PHN) study, “Randomized Trial of

Pulsed Corticosteroid Therapy for Primary Treatment of Kawasaki
Disease,” found no benefit of addition of pulsed high-​dose intravenous
methylprednisolone before conventional therapy with intravenous
immunoglobulin with respect to coronary artery outcomes,
reduction in adverse events, treatment time, or fever duration.6
Another random document with
no related content on Scribd:
 THE STONE FLEET.

Notwithstanding all the activity and watchfulness of the

blockading vessels off the Southern coast, many instances were
exultingly heralded by the Southern press, as well as in Europe, of
the successful running of the blockade by vessels bound both
outward and inward. The logic of these occurrences was very simple
on the part of the secessionists and their sympathizers. The frequent
evasion of the blockade proved that it was “inefficient” on the part of
the Federal government, and therefore not only to be disregarded,
but officially declared by foreign governments to be incomplete, and
practically null and void. This declaration was expected to be
sufficient to warrant the free movements of commerce, and any
attempt to interfere on the part of the United States would be a
challenge for the intervention of England and France.
The repeated instances of vessels escaping rendered it an
imperative necessity for the government to adopt some measure that
would, if possible, prevent their recurrence at the principal ports of
the South. For this purpose it was determined to close several of the
harbors by placing obstructions in the channels. Most of the harbors
of the Southern coast, in consequence of the deltas, and numerous
islands at their entrances, have several channels, through which
vessels of light draft may pass, while those of the heaviest draft are
confined to one principal channel. This is the case in the approach to
both Charleston and Savannah. The obstructing of these two
principal channels was therefore assigned for the month of
December.
For this purpose a number of old whaling vessels were purchased
at New Bedford and New London, freighted with granite from the
Bay State, and taken to Port Royal as a rendezvous, whence they
were to be convoyed to their destination. The people of Savannah,
after the capture of Port Royal and Beaufort, anticipating the
approach of the Federal fleet, volunteered the work on their own
behalf and blockaded their own port by similar means. The fleet was
therefore at liberty to repair to Charleston, and within sight of the
walls of Sumter, to shut out the rebellious people of that city from the
ocean.
The “Stone Fleet” sailed from Port Royal on the 18th of December,
accompanied by the steamers Cahawba, Philadelphia and Ericsson,
to tow and assist, the whole convoyed by the Mohican, Captain
Gordon, the Ottawa, Captain Stevens, and Pocahontas, Captain
Balch.
The fleet arrived off Charleston harbor the next day and
preparations were made for sinking them in their places. Each of the
weather-beaten and storm-tossed old vessels that had so long borne
the stars and stripes in every latitude, were now to make a stubborn
protest against treason by keeping watch at the very door of its birth-
place. They were furnished with ingenious contrivances and plugs,
the withdrawal of which would allow the water to flow in and sink
them on the floor of the channel.
The sinking of the fleet was intrusted to Captain Charles H. Davis,
formerly on the Coast Survey, and ever since more or less intimately
connected with it. It is remarkable that when, in 1851, an
appropriation was made by the Federal Government for the
improvement of Charleston harbor, and, at the request of South
Carolina, a commission of army and navy officers was appointed to
superintend the work, Captain Davis was one of the commission, and
for three or four years was engaged in these operations. The present
attempt was of somewhat different character. The entrance by the
main ship channel runs from the bar to Fort Sumter, six miles, nearly
south and north. The city is three miles beyond, bearing about N. W.
The other channels are Sanford’s, Swash, the North, and Maffit’s, or
Sullivan’s Island, which need not to be particularly described. Only
the latter is practicable for vessels of any draught, but all serve more
or less to empty the waters discharged by the Ashley and Cooper
rivers. Over the bar, at the entrance of the main ship channel, is a
narrow passage, through which vessels may carry eleven feet at low
water; about seventeen at high water. The plan of Captain Davis for
closing the harbor proceeded on the following principles:
 The obstructions were to be placed on both sides of the crest of the
bar, so that the same forces which created the bar might be relied on
to keep them in their places.
The bar was not to be obstructed entirely; for natural forces would
soon open a new passage, since the rivers must discharge themselves
by some outlet; but to be only partially obstructed, so that, while this
channel was ruined, no old one, like Swash or Sanford, should be
improved, or a new one formed.
The vessels were so placed that on the channel course it would be
difficult to draw a line through any part of it that would not be
intercepted by one of them. A ship, therefore, endeavoring to make
her way out or in could not, by taking the bearings of any point of
departure, as she could not sail on any straight line.
The vessels were placed checkerwise, at some distance from each
other, so as to create an artificial unevenness of the bottom, remotely
resembling Hell Gate and Holmes’s Hole, which unevenness would
give rise to eddies, counter-currents and whirlpools, adding so
seriously to the difficulties of navigation that it could only be
practicable by steamers, or with a very commanding breeze.
The execution of this plan was begun by buoying out the channel
and circumscribing within four points the space where the vessels
were all to be sunk, as follows:
*
S. W. * THE BAR. * N. E.
*

The distance between the points from S. W. to N. E. is about an

eighth of a mile; the breadth perhaps half as much. It was no part of
the plan to build a wall of ships across, but to drop them at a little
distance from each other, on the principles above stated, closing the
channel to navigation, but leaving it open to the water.
Work was resumed on Friday morning, the 20th, the Ottawa and
Pocahontas bringing the ships to their stations. The placing of them
was an operation of considerable nicety, especially as some of the
vessels were so deep as to be with difficulty dragged on the bar,
except at high water. A graver hindrance to their exact location was
found in the imperfection of the arrangement for sinking, several of
the ships remaining afloat so long after the plug was knocked out,
that they swung out of position. They were, nevertheless, finally
placed very nearly according to the plan. Great credit was earned by
Mr. Bradbury and Mr. Godfrey for the successful execution of so
difficult an undertaking. The last ship, the Archer, closed the only
remaining gap, and the manner in which Mr. Bradbury took her in
with the Pocahontas and then extricated the latter from her perilous
position, filled the fleet with admiration for his skillful seamanship
and cool daring. By half-past ten the last plug was drawn, and every
ship of the sixteen was either sunk or sinking.
One of the vessels, the Robin Hood, with upright masts, stood
erect, in water too shallow to submerge her. As evening drew near
she was set on fire, and in a little time the evening sky was lighted up
with the pyrotechnic display, while the inhabitants of Charleston, the
garrison of Fort Moultrie, and the surroundings, were compelled to
look on and see the temporary completion of the blockade they had
so long derided and defied.
This event provoked loud and vindictive complaints and assaults
in France and England, and the measure was denounced as an
outrage on civilization, and a sufficient warrant for interference in
the war. But an examination of the historical precedents afforded by
British practice closed the mouths of the declaimers in Parliament as
well as through the press, and once more American practice was
permitted to pass, justified by the verdict of opinion as well as of
illustrious example.
 BATTLE OF CAMP ALLEGHANY, W.
VIRGINIA.

December 13, 1861.

On Thursday morning, December 12th, Brigadier-General R. H.

Milroy started from his headquarters on Cheat Mountain Summit,
with fifteen hundred men, with the design of attacking a rebel camp
on the Alleghany mountains, twenty-five miles distant. The column
started at eight o’clock, and after a fatiguing day’s march arrived, at
eight P. M., at the old Camp Bartow, on the Greenbrier river, the
scene of General Reynolds’ rencontre on the 3d of October previous.
Here the troops rested until eleven P. M., when the General divided
his force into two columns, with the intention of reaching the
enemy’s camp on the summit of the mountain, about eight and a half
miles distant, from two opposite points, at four o’clock, A. M., of the
13th.
The first division, consisting of detachments from the Ninth
Indiana, Colonel Moody, and Second Virginia, Major Owens, about
one thousand strong, took up its march on the old Greenbank road to
attack the enemy on the left.
The second division consisted of detachments from the Thirteenth
Indiana, Twenty-fifth and Thirty-second Ohio, and Bracken Cavalry,
under Major Dobbs, Colonel J. A. Jones, Captain Hamilton and
Captain Bracken. Brigadier-General Reynolds and his staff
conducted this division, numerically about the same as the first
division. This column took the Staunton pike, and marched
cautiously until they came in sight of the enemy’s camp, where, after
throwing out more skirmishers, the division left the road and
commenced to ascend the mountain to the enemy’s right. After
driving in some of the hostile pickets they reached the summit in
good order. The enemy were fully prepared to receive them. The fight
on the enemy’s right commenced about twenty minutes after
daylight.
Lieutenant McDonald, of General Reynolds’ staff, with one
company of the Thirteenth Indiana, formed the line of battle, placing
the Twenty-fifth Ohio on his left, part of the Thirteenth Indiana on
their left, and part of the Thirty-second Ohio on their left. The enemy
immediately advanced to attack the Federal troops, but after a few
rounds retreated in great confusion, leaving their dead and wounded.
Colonel Moody’s division not appearing to attack the enemy on the
left, the rebels seeing the inferior force opposed to them, were again
encouraged to advance toward their assailants, which they did with a
far superior force, pouring in their fire with vigor. Some of the
Federals now commenced falling to the rear, all along the line; but
Captains Charlesworth and Crowe, of the Twenty-fifth Ohio,
Lieutenant McDonald, Captains Myers and Newland, of the
Thirteenth Indiana, and Hamilton, of the Thirty-second Ohio, rallied
them, and brought them into line in a few moments. The enemy
again fell back and attempted to turn their right flank, but was
immediately met and repulsed. The fortunes of the day appeared to
alternate between the respective armies for three hours, the Federals
holding out bravely against the superior numbers of the enemy, who
were enabled to concentrate their entire army of two thousand men
and four or five pieces of artillery against this comparatively small
force.
Colonel Moody’s force not having then been heard from, Colonel
Jones, who had charge of the division now in action, after exhausting
his ammunition, withdrew his men from the field.
Almost at this juncture, Colonel Moody’s command, which had
been detained by obstructions placed in the road over which they
were compelled to pass, arrived, and attacked the enemy vigorously
on his left, and in turn maintained an obstinate contest, unaided,
against the entire rebel command, which they did with much courage
and skill, until three o’clock, P. M., when they too were compelled to
retire before the superior force of their opponents.
Though thwarted in his plan of attack by the unexpected
obstructions which Colonel Moody’s division had to encounter,
General Milroy was far from being disconcerted by the result. The
men had evinced a high order of courage, and the divisions had
alternately maintained an obstinate fight against an army of nearly
three times their number.
The official report of the casualties on the Federal side gives the
number of killed, twenty; wounded, one hundred and seven; missing,
ten. The rebel loss is acknowledged by the Richmond Enquirer to
have been about the same.
 BATTLE AT MUNFORDSVILLE, KY.

December 17, 1861.

Colonel Willich, with the Thirty-second Indiana, a regiment

composed of Germans, occupying an advance post of General
McCook’s division of the Federal army in Kentucky, was attacked on
the 17th of December, by three regiments of Arkansas infantry,
Colonel Terry’s Texan Rangers, and Major Phifer’s cavalry, and also
an artillery company, with four pieces, the whole under the
command of General T. C. Hindman.
Colonel Willich’s regiment was guarding a new bridge built by the
Federal troops over Green river, at Rowlett’s Station, on the
Louisville and Nashville railroad, a temporary substitute for the
handsome iron structure which had been destroyed by the rebels, in
front of Mumfordsville. A picket guard of two companies had been
thrown across the river on the south side, occupying a wide area of
cleared ground, which was skirted by forests, from whence the rebels
attempted to surprise and capture them.
The second company, Captain Glass, was acting in detached
squads as pickets in the woods on the right flank, and were attacked
in detail by the enemy’s skirmishers. The pickets made a gallant
defence, and fell back slowly and in good order on their supports.
The alarm in the mean time having been given to the other
companies on the north side of the river, they started in “double-
quick” over the bridge, crossed the hill on the opposite side, and
rushed with fierce haste into the woods whence the firing proceeded,
led on by Lieutenant-Colonel Treba, Colonel Willich at the time
being necessarily at headquarters. A portion of the third company,
under Lieutenant Sachs, occupied a covered position on the left
flank, where they were now attacked by the advancing enemy.
Unable to restrain the ardor of his men, the Lieutenant boldly left his
sheltered position and attacked the rebels in the open field; but fierce
as his onset was, the disparity of numbers proved too greatly against
him, and his little band would have inevitably been cut to pieces but
for the timely arrival of Lieutenant-Colonel Treba, with the main
body of the regiment. He sent the sixth, seventh and tenth companies
to support the second company on the right, and the first, fifth,
eighth and ninth companies to support the third company on the left
flank. At the very first rush of the skirmishers, the enemy were
thrown into confusion, and driven back at all points.
Then the most severe and bloody part of the battle commenced.
With terrible ferocity Colonel Terry’s regiment of Texas Rangers
poured in black masses of cavalry upon the Union skirmishers along
the whole line. They rode up within fifteen or twenty yards, some
even in the very midst of the men, and commenced a terrible fire
from their carbines and revolvers. At their first onset, it seemed as if
every one of the men would be destroyed. But here it was that the
veteran coolness and bravery of the Union troops shone forth. They
allowed the enemy to come almost as near as he chose, and then
poured a deadly fire upon him, which shook the entire line. Upon the
right flank of the third company’s position, by order of Adjutant
Schmidt, the eighth company was led forth by Lieutenants Kappel
and Levy; upon the left, Lieutenant-Colonel Treba advanced with the
ninth company; both attacked the enemy in close skirmishers’ line,
drove him back, and rescued the rest of the heroic little band under
Lieutenant Sachs. He himself and a number of his men were,
however, already killed, though they had made the enemy pay dearly
for their lives.
Now the artillery of the enemy was brought to bear upon the
Union men. Their fire, balls and shrapnell, was well directed, but
fortunately not very fatal. Only a few of the men were wounded by
splinters of balls.
While this was going on upon the left wing, the conflict on the
right was no less severe. The second, sixth and tenth companies were
scattered as skirmishers, while the seventh was drawn up in
company column for their support. The sixth company had taken
position behind a fence. The Rangers galloped up to them in close
line, and commenced firing from rifles and revolvers. Their fire was
steadily returned by the sixth, which held them in check till a part of
them got behind the fence, when the skirmishers fell back behind the
seventh, drawn up in a square. Now a fearful conflict ensued. A
whole battalion of Rangers, fully two hundred strong, bore down
upon the little band of not more than fifty. Upon the front and left
flank of the square they rushed, with a fierce attempt to trample
down the squad before them.
Captain Welschbellich allowed them to come within a distance of
seventy yards, then fired a volley, which staggered and sent them
back. But immediately afterward they reformed and again rushed
fiercely upon the front and both flanks of the square. They seemed
frantic with rage over the successful resistance offered to them, and
this time many of their band rode up to the points of the bayonets.
But another well-aimed volley emptied a number of saddles, and sent
back the whole mass which a moment before had threatened certain
destruction to Captain Welschbellich’s company. A few bayonet
thrusts and scattering shots brought down those who had ventured
to the front. This second repulse had a marked effect. Yet a third
attack was made, much less determined and fierce than the two first,
though it was more disastrous to the enemy. During this third attack
it was that Colonel Terry, the commander of the Rangers, was killed.
Upon his fall, the whole column broke and fled in wild dismay.
But in place of the Rangers, a whole regiment of infantry,
accompanied by their band of music, now marched against the
“invincible square.” Before this overpowering force Captain
Welschbellich deemed it prudent to retire, and united with the
second, sixth and tenth companies again.
About this time it was that Colonel Willich, with his battle horse in
a foam, arrived upon the field. He saw the right wing retiring, and
the entire infantry of the enemy, two regiments, coming on, thus
endangering the retreat of the left wing. He therefore ordered the
signal for “retiring slowly” to be given, and collected the companies.
The second company, under Captain Glass, and the seventh, under
Captain Welschbellich, were the first who took their places in the line
of battle of the regiment.
About this time a manœuvre was executed by the first company,
under Captain Erdemeyer, which decided the day. When the battle
commenced, and the impression prevailed that the Unionists were
fighting cavalry alone, Lieutenant-Colonel Treba had detached this
company to take a position and attack the flank of the enemy. When
the first company arrived at the place of destination, Captain
Erdemeyer found that the enemy had likewise a large force of
infantry and artillery, to attack which would have been certain
destruction to his company. He therefore kept his covered position
until the time mentioned. Then, finding the larger part of the
infantry drawn to another part of the field, he ordered an advance.
His appearance was the signal of a general retreat of the enemy. The
rest of the cavalry fled, the artillery retired in haste, and the infantry
followed as quickly.
The Union loss was eleven killed, twenty wounded, and five
missing. The enemy left a large number of killed on the field, and
among their dead was the body of Colonel Terry. The rebel loss was
thirty-three killed and sixty wounded.
 CAPTURE OF REBEL RECRUITS AT
MILFORD, MO.

On the eighteenth of December, Brigadier-General Pope,

commanding the Federal troops in the central district of Missouri,
made a brilliant and successful movement, which resulted in the
capture of a considerable number of the enemy.

It will be recollected that the withdrawal of the Federal troops

from Springfield and the leading points of both central and southern
Missouri, had given free scope to the action of the enemy. Seditious
proclamations had been issued by Ex-Governor Jackson and General
Price, and had been thoroughly circulated. Enlisting agents, also, had
been very active, and some two thousand recruits, mostly drawn
from the northern counties, were proceeding by slow stages
southward, to unite with the main body under General Price.
A well laid plan was matured by Generals Halleck and Pope to
capture these reinforcements; and two brigades of General Pope’s
division were dispatched without exciting any suspicion as to their
destination, to intercept the enemy on their march. The brigades
were constituted as follows:
First Brigade, Acting Brigadier-General Steele.—Twenty-seventh
regiment Ohio Volunteers, Colonel Kennett; Twenty-second
regiment Indiana Volunteers, Colonel Hendricks; First regiment
Kansas Volunteers, Colonel Thayer; one battery First Missouri
Volunteers, Lieutenant Marr; four companies regular cavalry,
Colonel Amory.
Second Brigade, Acting Brigadier-General Jeff. C. Davis.—
Eighteenth regiment Indiana Volunteers, Colonel Patterson; Eighth
regiment Indiana Volunteers, Colonel Benton; Twenty-fourth
regiment Indiana Volunteers, Lieutenant ——; one battery First
Missouri Artillery, Lieutenant Klaus; one squadron First Iowa
Cavalry, Major Torrence.
The whole was under the immediate command of General Pope.
The four companies of regular cavalry were the fragments of the
original companies, B, C, D, and E, and numbered but a little over a
hundred men. They were under the command of Captain Crittenden,
of the regular army, son of Hon. John J. Crittenden.
The command started from Sedalia on Sunday, the 15th, and
encamped at night eleven miles distant on the road to Clinton. The
next day they marched twenty-six miles, and at sunset arrived at
Shawnee Mound, in Henry county. Here reports of various
companies of rebels began to come in from residents and from Union
scouts. One company of near five hundred was heard of at a point
about twelve miles north-west, and several smaller bodies directly
south, from Clinton to Butler. General Pope then dispatched his
whole available force of cavalry, nearly seven hundred, before they
had secured three hours’ rest, after the five hundred near
Morristown. The cavalry under Lieutenant-Colonel Brown, of the
Seventh Missouri Volunteers, pushed on all night, and arriving at the
rebel camp they found it vacated. The enemy had received warning
and fled precipitately, leaving numerous evidences of haste. The
cavalry, notwithstanding their forty miles’ continuous march, pushed
on after the fleeing rebels till they reached Rose Hill, picking up
some twenty or thirty stragglers on the road. At Rose Hill the rebels
separated into several squads, some taking the road west, others
taking the south route to Butler, and Colonel Brown had no other
alternative than to rest his exhausted horses, and finally to make his
way back to the main column next day, near Warrensburg. He
brought in nearly one hundred prisoners.
General Pope in the meantime kept advancing in a direction west
of north to Chilhowee, a most important point, being the centre of
numerous cross-roads. This was near the site of the rebel camp just
referred to, and here the pickets brought in some few straggling men
who were bound for Price’s army. At Chilhowee they heard of a rebel
force of 1,800 from the north, and of the scouring of the country
south of Clinton by Major Hubbard, of the First Missouri Cavalry.
The direction of the Union forces was at once east, toward
Warrenburg. That night (Wednesday) they encamped two and a half
miles west of Warrenburg. The reports were confirmed by a loyal
man, who was on his way to give the information. He gave their
location as at Kilpatrick’s mill, on the Clear fork of Blackwater Creek.
(Milford is the post-office name.) Early on Thursday morning they
started in the direction of Knob Noster, being directly south of the
enemy. Colonel Merrill’s Horse was ordered to take the direct road
running parallel with the course of the Blackwater, so as to intercept
them in case they took a western course.
The brigade of Colonel Davis was placed in the advance, with
orders to keep well up to the cavalry, a section of artillery being ready
to support the cavalry upon a minute’s warning. General Pope, with
the main body, kept due west for Knob Noster, ready to come up if
necessary. Colonel Davis, finding that the enemy was still in camp at
Milford, diverged to the left, and put the regular cavalry, under
Lieutenant Amory, in the advance, the four companies of the First
Iowa Cavalry, under Major Torrence, being next. On approaching the
mill, the men discovered that the rebels were posted on the opposite
side of the bridge, across the dam. Finding that it would be
dangerous to charge the bridge mounted, Lieutenant Amory ordered
the men to dismount and skirmish with pistols and sabres, as
infantry, the fourth man holding the horses of the other three. This
they instantly did, and advanced under the lead of Lieutenant
Gordon, of Company D. Some ineffectual skirmishing took place
between the regulars, who were sheltered behind a barn on the south
of the creek, and the rebels, who were on the north side. During this
interval the Iowa Cavalry filed off to the left, in the attempt to cross
the stream higher up, but after vainly traversing its steep sides and
muddy bottom for a mile, returned to find Lieutenant Amory
charging across the bridge, the rebels having deserted it upon seeing
Colonel Davis, with the artillery advancing. Lieutenant Amory
followed the road, thinking that the rebels might flee to the north.
Lieutenant Gordon immediately dashed after some of the scattering
fugitives through the wood, and after penetrating a few rods,
received a volley from the enemy, whom he just then discovered
formed in line. He instantly formed in line, and ordered his men to
fire.
The cavalry, under Major Torrence, and the regulars, under
Lieutenant Amory, had in the mean time reached the flank and rear
of another body of the enemy, who was thus enclosed on one side by
a long marsh, on the other by a deep and muddy mill-pond, and on
the third by our cavalry. Colonel Davis had by this time come up in
the rear. A white flag was displayed, and Colonel Alexander, a young
man, came forward and asked if thirty minutes would be allowed
them for consultation. Colonel Davis’s answer was “that as night was
closing in, that was too long.” Colonel A. then asked if he would be
allowed to go to headquarters and bring back the answer of the
commander of the corps, Colonel Robinson. Permission being
granted, he returned in about five minutes, with the response that
“they would be obliged to surrender as prisoners of war.” The arms
were stacked, and the men formed in line and marched between two
files of infantry, the Eighteenth and Twenty-fourth Illinois, with all
the honors of war. Colonel Davis immediately sent dispatches to
General Pope announcing his success, and as night was closing
around, the arms were hastily stowed in wagons, and the Federal
troops commenced the march for camp. One thousand guns of all
kinds were captured, with a full supply of clothing and provision.
One of the enemy was killed, and several wounded. Two Federals
were killed and eight wounded.
Dispatches were received Thursday evening from General Halleck
ordering the Union troops to fall back to Sedalia. General Pope,
therefore, accompanied with the victors as an escort, and the
wounded men, started and made the journey (twenty miles) by two
o’clock.
Following close upon them was the brigade of Colonel Hovey, of
the Twenty-fourth Indiana, who had been dispatched with two
regiments, a battery, and two squadrons of the First Missouri
Cavalry, on the Clinton road some twelve miles from Sedalia, where
the cavalry, under Major Hubbard, some two hundred and fifty in
number, made a reconnoissance of the country extending westward
and southward, as far as the Grand river, beyond Clinton. Here they
came upon the pickets of General Rains, who, with an advanced
cavalry force was guarding the Grand river. The pickets were driven
in, one shot, about sixty prisoners taken within the lines of General
Rains, and a mill near Clinton burned.
The detachment of cavalry under Lieutenant-Colonel Brown also
burned a mill near Johnstown, on the borders of Bates county. His
force travelled two hundred and fifty miles in six days.
Colonel Hovey, of the Twenty-fourth Indiana, effected a successful
ruse, whereby he succeeded in making a capture of six prisoners and
two hundred bushels of corn meal. He was ordered by General
Turner to reconnoitre with about a hundred men on the road to
Clinton. He left on Monday morning, taking Fairview and Siseonville
on his route. Learning on Tuesday that a party of the enemy was
encamped at a mill near Chapel Hill, he adopted a scheme for
capturing the whole of them next day.
He ordered his men into the wagons, and had them drawn, with
the exception of a small guard, resembling a provision train. As they
approached Hall’s store the rebels appeared in the brush ready to
seize the train. One of his officers rode around a hill to see the
whereabouts of the party, when he encountered a mounted rebel,
who raised his shot-gun, when he was brought to the ground by a
revolver. Colonel Hovey then ordered his men to emerge from their
concealment, and a search was made for the enemy. One of them was
wounded in the fray, and one killed, two balls lodging in his neck. A
few horses and mules were captured, some of which were branded U.
S. The mill was afterward burned, and the meal put in Hovey’s
wagons.
The total number of prisoners taken exceeded sixteen hundred.
The march was accomplished in exceeding cold weather, and many
of the troops suffered severely.
 BATTLE OF DRANESVILLE, VA.

December 20, 1861.

In the month of December, the Pennsylvania reserve regiments,

under the command of Major-General McCall, constituted the right
wing of the great Potomac army. The division occupied an extensive
range of country, beyond Langley’s church and tavern, the
encampments stretching toward Lewinsville. Beyond this, north-
westwardly, an open country extended, in the direction of Leesburg,
some twelve or fifteen miles, unoccupied by hostile forces. Midway
was the village of Dranesville, a small town, almost deserted.
It having been determined to send a foraging party to take
possession of a quantity of hay, oats and provender known to be in
this neighborhood, the brigade of General E. O. C. Ord, the third of
McCall’s division, was assigned to the duty.
The force consisted of the Sixth regiment, Colonel W. W. Rickets;
Ninth, Colonel C. F. Jackson; Tenth, Colonel John S. McCalmont;
Twelfth, Colonel John H. Taggart. The regiment of riflemen known
as the Bucktails, Lieutenant-Colonel Thomas L. Kane; a battery of
two twenty-four-pounders and two twelve-pounders, commanded by
Captain Easton, and a detachment of cavalry from Colonel Bayard’s
regiment, also accompanied the expedition. Each regiment was
strongly represented, and there were about four thousand men in the
expedition. The order for march was received on Thursday evening,
the men being directed to take with them one day’s rations. The
morning was clear, and rather cold, with a slight mist around the
sun, and a thin layer of frost whitening the road and coating the
grass. The Bucktails were assigned the advance of the infantry
column, the cavalry preceding as scouts, and battery being in reserve.
Colonel Taggart’s regiment brought up the rear. A number of teams
were also in company. Each regiment had two companies of flankers
thrown out, on either side of the column, to scour the woods, search
the thickets, and prevent the column from falling into an ambuscade.
They halted at Difficult Creek, a narrow stream, with a heavy stone
bridge. The stream is fordable, the average width being thirty feet.
The march continued. The day became warm, the sky soft and
clear, as the soldiers approached Dranesville. About noon the
flanking companies of the Twelfth regiment came in and reported
that a large body of rebels could be seen from a neighboring hill. At
another part of the line shots were exchanged between the hidden
enemy and the Union flanking companies. Instantly a line of battle
was formed, but no enemy appeared, and the firing ceased.
The delay was that of a few minutes. The Union men were anxious,
expectant, and enthusiastic. Suddenly a fire was opened upon our
line from a wood or thicket nearly a mile distant. The enemy’s
battery contained six guns, and was placed in a road skirting the
wood, and sheltered by it. Their guns were of large calibre, and they
fired shells. At first they passed over the column and exploded
beyond. The rebel artillerymen discovered this, altered their range,
and their shells fell short. In the mean time, Easton’s battery was
brought into position on the side of an elevation in front of the
Twelfth regiment, which was in line of battle. General Ord himself
sighted the guns, and a sharp fire was opened upon the enemy.
The Union infantry laid down on their arms, awaiting the orders of
their superior officers. At length the fire of the enemy began to be
irregular and uncertain, proving that they either intended to retreat
or change position. At this time Colonel Kane, who was on the right
of the column, discovered the infantry of the enemy passing through
an open clearing near the wood, evidently intending a flank
movement, or designing to occupy a brick house within a hundred
yards of his regiment. He sent a detachment of twenty men, under
command of Lieutenant Rice, to take the house, which they did, and,
under shelter of its walls, opened fire upon the advancing regiments.
Having bestowed the family found in this house safely in the cellar,
the small garrison demolished the windows and attacked the enemy,
which was afterwards discovered to be an Alabama regiment, under
command of Colonel John H. Forney; a Kentucky regiment,
commanded by Colonel Tom Taylor; and a South Carolina regiment.
They took the shelter of underbrush, and, under the supposition that
the house was filled by Union troops, opened a heavy fire upon it,
supported by two small guns, which threw shot and shell upon it.
They advanced nearer and nearer every volley, the brave Union
riflemen firing rapidly and with great effect. Colonel Kane was
among them all the time, inspiring them with his example. They fell
on the ground, they loaded their pieces, rising suddenly, taking
deliberate aim, and lying down to load again. The burden of the
enemy’s fire was directed at the house, and it was shattered and
pierced, the roof being broken, and some of the walls giving way.
The Federal fire was so terrific that the enemy fell back from the
advanced position they had assumed, abandoned their flanking
manœuvre, and retreated to the woods under cover of their battery,
which kept up an irregular and uncertain fire. The Bucktails
advanced in pursuit. As they rose to follow, Colonel Kane, who was
leading them, was wounded. He fell, but instantly arose, and
continued to advance. In the mean time General Ord ordered the line
to charge and take the battery. The order was given to the Twelfth
regiment, Colonel John H. Taggart commanding. It was received
with a cheer by the men, and they advanced in the direction of the
unseen battery. They proceeded to the edge of the wood and entered,
keeping the line as straight and precise as on dress parade. The wood
was dense, and so impenetrable that the men found it difficult to
proceed. Colonel Taggart threw his scabbard away and preceded his
men with his drawn sword in one hand and his pistol in the other.
They came into an open clearing, only to find that the rebels had
retreated in the most precipitate manner. While the Union troops
were crowding through the woods, the enemy had started along the
Leesburg road, taking their cannon, but leaving their dead and
wounded, and large quantities of arms and ammunition. A single
caisson remained. Their magazine had been struck by a shell, and
exploded with appalling effect. Around it the dead and dying were
heaped in masses—fifteen men and five horses being killed. The
Union men were wild with the enthusiasm of victory, and having
placed the wounded in the houses near by, and chopped the gun-
carriages to splinters, they started in pursuit of the retreating foe.