bluuebunny/crossref_metadata_2025 huggingface dataset:
CONGENITAL MYASTHENIA GRAVIS
Authors: LABRANCHE HERNANDEZ G. , JEFFERSON RONALD N.
Published: December 2021

A case of congenital myasthenia gravis has been presented. Familial and possible hereditary cases of this disease previously reported have been listed, and a short discussion of the disease presented.

No definite statement can be made that myasthenia gravis is hereditary or familial, but this case and those previously reported indicate familial and possible hereditary aspects.
OBSERVATIONS ON STAPHYLOCOCCAL INFECTIONS TREATED WITH AUREOMYCIN
Authors: CHANDLER CAROLINE A. , SCHOENBACH EMANUEL B. , BRYER MORTON S.
Published: December 2021

Five infants with staphylococcal infections who had shown no clinical response to penicillin and sulfadiazine were successfully treated with aureomycin in the summer of 1948. Marked improvement was noted in all patients within 48 hours. The sixth patient, who was critically ill with staphylococcal septicemia and had not responded to combined penicillin, streptomycin and sulfonamide therapy, had negative blood cultures after five days of aureomycin therapy and made a rapid, uneventful recovery. No toxic effects from the drug were apparent.
PENICILLIN THERAPY OF DIPHTHERIA CARRIERS
Authors: SHEN JEROME T. Y.
Published: December 2021

The diphtheria carrier problem and its importance in children is discussed. Non-penicillin therapy of diphtheria carriers is briefly reviewed and commented upon. Literature on penicillin therapy in the diphtheria carriers is reviewed.

An analysis of the results of 70 cases of diphtheria carriers treated by different forms of penicillin therapy is presented and commented upon, especially in regard to the correlation between the effectiveness of the therapy and the pathology of the nose and throat. Rational treatment of diphtheria carriers is suggested in the conclusion of the paper.
STUDIES IN PANCREATIC FIBROSIS
Authors: SHWACHMAN HARRY , PATTERSON PAUL R. , LAGUNA JOSÉ
Published: December 2021

A simple new test is described which estimates roughly the proteolytic activity of stools by determining their ability to liquefy gelatin. Fecal suspensions are placed upon gelatin film (unexposed and unfixed) and the extent of removal of the gelatin film noted.

Two groups of patients were studied: (a) 500 normal and sick individuals, and (b) 50 patients with pancreatic fibrosis.

In group (a), less than 5% of the infant group lacked this proteolytic power. As one advanced into the older age groups, this percentage increased. The administration of a laxative to some older children with absent tryptic activity resulted in stools possessing tryptic activity.

A total of 220 separate stool specimens were examined from patients in group (b). In 209 specimens, there was no tryptic activity. The remaining 11 specimens from seven patients showed definite tryptic activity. Three patients in this group had minimal tryptic activity in the duodenal fluid.

When oral pancreatin was given to patients with pancreatic fibrosis, the stools became positive for trypsin. When laxatives were given to a few patients with pancreatic fibrosis, the stool trypsin test remained negative.

The duodenal fluid was assayed in a number of infants with acute and chronic nutritional disturbances, and, when tryptic activity was demonstrated in the duodenal fluid, the stools showed the presence of trypsin.

The possibilities of bacterial or food origin of fecal tryptic activity have been considered and largely eliminated.

Three separate stool examinations by this test in infants are proposed as sufficient either to eliminate or to make probable the diagnosis of pancreatic insufficiency. Conclusions and interpretations based on a single examination is hazardous. At least three menspecimens should be studied and whenever doubt arises duodenal intubation is indicated.
BALANCE AND ELECTROCARDIOGRAPHIC STUDIES IN A CHILD WITH POTASSIUM DEFICIENCY
Authors: WALLACE WILLIAM M. , MOLL FREDERIC C.
Published: December 2021

An instance of potassium deficiency is described which was caused by excessive gastrointestinal loss, the parenteral administration of excessive NaCl and glucose and by lack of potassium intake.

The changes produced in the ECG are described.

Treatment with parenterally administered K was effective. Although a rise in the level of serum K accompanied the improvement, it returned to normal more slowly than the electrocardiogram and the clinical state.

The balances of Na, K, Cl and N during the recovery period are presented and discussed.
ACUTE PULMONARY ASPERGILLOSIS
Authors: HERTZOG A. J. , SMITH T. S. , GOBLIN M.
Published: December 2021

Two fatal cases of acute pulmonary aspergillosis in siblings aged five and seven years are reported. The details of an autopsy in one case are recorded. The fungus in this case proved to be Aspergillus fumigatus Fres.
PERITONEAL LAVAGE IN THE TREATMENT OF ANURIA IN CHILDREN
Authors: SWAN HENRY , GORDON HARRY H.
Published: December 2021

Three children with acute anuria treated by peritoneal lavage and two others from whom it was withheld are reported. Peritoneal lavage should be reserved for the treatment of a progressing uremic state associated with an acute yet probably reversible anuria of renal origin. The procedure, when suitably indicated, is effective for removal of nitrogenous waste products and may prove life-saving.

Technical aspects of the method are discussed, and the use of variation of the glucose concentration in the lavage fluid as a means of controlling water retention is demonstrated.

Peritoneal lavage is a complex, expensive, yet effective method of partially simulating the kidney glomerulus. The absence of tubular function in anuric patients who are receiving peritoneal lavage makes management of their acid-base balance a difficult problem.
INTRAPULMONARY SHUNTS IN CYSTIC FIBROSIS
Authors: Moss Arthur J. , Desilets Donald T. , Higashino Stanley M. , Ruttenberg Herbert D. , Marcano Bertrand A. , Dooley Richard R.
Published: December 2021

Eight children with cystic fibrosis were studied for intrapulmonary shunts. Evidence of right-to-left shunt was found in seven. Five of these also had left-to-right shunt at the precapillary level. The latter were demonstrated by cineangiography and by indicator dilution (indocyanine green dye) methods.
Infectious Mononucleosis with Thrombocytopenic Purpura
Authors: Chen Julia J. , Anand Sudhir K. , Porter Philip J.
Published: December 2021

A patient with infectious mononucleosis who presented with a purpuric rash is reported. Although extremely rare, infectious mononucleosis must be added to the differential diagnosis of a febrile child who presents with a purpuric rash.
The Micro-methemoglobin Reduction Screening Test for G6PD Deficiency in Childhood
Authors: Miller Denis R. , Kotok David
Published: December 2021

A microscreening test for G6PD deficiency, based on methemoglobin reduction was studied in 219 Negro children and was found to be simple, reliable, and inexpensive. Heterozygotes were also detected by this method.
THE BRUTAL TREATMENT OF YOUNG CHILDREN EMPLOYED IN THE MINES AND COLLIERIES OF THE UNITED KINGDOM A LITTLE MORE THAN A CENTURY AGO
Authors: C. T. E.
Published: December 2021

If an age is judged by its treatment of the weak and helpless, the nineteenth century deserves condemnation. The callous indifference in that century toward the employment of young children in the mines and collieries of the United Kingdom was never more vividly described than by Anthony Ashley Cooper, Seventh Earl of Shaftesbury (1801-1885) in his speech to the House of Commons in 1842. By his persistent agitation in Parliament, covering several decades, Shaftesbury eventually forced society's recognition that all children, regardless of social class, deserve the same humane treatment. Some of the cruelties inflicted by the early industrial community on these filthy and ignorant children of the poor are described by the Earl of Shaftesbury in these passages from his speech:

With respect to the age at which children are worked in mines and collieries in South Staffordshire, it is common to begin at 7 years old; in Shropshire some begin as early as 6 years of age; in Warwickshire the same... In Derbyshire many begin at 5... Near Oldham children are worked as low as 4 years old, and in the small collieries towards the hills some are so young that they are brought to work in their bedgowns....

It must be borne in mind that the regular hours of a full day's labour are 14, and occasionally 16; and the children have to walk a mile or two at night without changing their clothes... In Oldham the mountain seams are wrought in a very rude manner. There is very insufficient drainage.
Liver Biopsy
Authors: Brent Robert L.
Published: December 2021

In the December issue of Pediatrics, Dr. Lucey discussed the usefulness of liver biopsy in the management of children with undiagnosed or complicated liver disease. He coneludes that in the proper hands liver biopsy can be a safe and helpful procedure. This is probably true. Any physician interested in acquiring this skill could, presumably, do so in a short period of time whether he is at a medical center or small community hospital.

There is one aspect of liver biopsy that Dr. Lucey alluded to but did not clarify.
INTESTINAL IgA NEUTRALIZING ANTIBODIES IN NEWBORN INFANTS FOLLOWING POLIOVIRUS IMMUNIZATION
Authors: Keller Robert , Dwyer Julia E. , Oh William , D'Amodio Mabel
Published: December 2021

The development of poliovirus neutralizing coproantibodies was studied in 14 newborn infants following a single immunization with either live oral trivalent or parenterally administered inactivated poliovirus vaccine. Poliovirus coproantibodies, predominantly directed against poliovirus type 2, appeared in stool specimens of all orally immunized infants within 2 to 3 weeks. Oral reimmunization of one infant 47 days after the primary dose resulted in the production of coproantibody to all three types of poliovirus. In contrast, parental immunization of five infants did not stimulate fecal antibody production.

IgA was the predominant, and sometimes the only, immunoglobulin detected in fecal extracts. Although stools of newborn infants usually did not contain IgA, the infants secreted fecal IgA at the time of the appearance of polio coproantibodies. Furthermore, alimentary IgA was demonstrable in the control group of older infants, even in the absence of detectable serum IgA.

Our results indicate that local intestinal antigenic stimulation is a necessary requirement for the production of polio antibodies by the secretory IgA immunoglobulin system of the alimentary tract. These findings are presented as a mechanism for the alimentary immunity to homotypic poliovirus reinfection which follows oral polio immunization of natural infection.
ACUTE OTITIS MEDIA: TREATMENT RESULTS IN RELATION TO BACTERIAL ETIOLOGY
Authors: Nilson B. W. , Poland Ronald L. , Thompson Robert S. , Morehead David , Baghdassarian Alice , Carver David H.
Published: December 2021

Three hundred and six children less than 3 years of age with acute otitis media were randomly distributed among three oral treatment regimens: penicillin V, penicillin V plus sulfonamide, and ampicillin. Treatment groups were comparable when analyzed for the number of patients with fever at onset and the proportion shown to be taking the antibiotic by blood assay. Response was determined in a double blind manner and correlated with the organism isolated from the middle ear aspirate. Results both for pneumococcal otitis and for all otitis regardless of culture were not significantly different with the three regimens. However, the groups with H. influenzae otitis treated with either penicillin plus sulfonamide or ampicillin had a better therapeutic response than those treated with penicillin V alone. Patients receiving ampicillin generally achieved a bacteriostatic serum level for strains of H. influenzae isolated by tympanocentesis while patients receiving penicillin V generally did not achieve such a level.
Further Doubts about the Value of the EEG in Minimal Cerebral Dysfunction
Authors: VanPelt John C.
Published: December 2021

I would like to rise in denfese of an author of a letter appearing in the letters section of the November issue of Pediatrics. Dr. Peggy J. Copple1 therein criticized the article by Drs. Capute, Neidermeyer, and Richardson on the EEG in minimal cerebral dysfunction.2 Her conclusions were that the parent of a child so afflicated would be well advised to spend the price of an EEG on something of more tangible value, such as a new hat.
Letter to the Editor
Authors: Smith Clement A.
Published: December 2021

Letter to the Editor are often the most interesting thing in the daily mail. When they concern a teaching and patient-care program in a hospital so long and affectionately known to the recipient, he may perhaps be allowed to offer an answer.

We would first thank Dr. Brazleton for writing. Then we would remark that the Editor finds much of the spirit—if not all the letter (in Biblical sense)—reminiscent of earlier and simpler times. Outstanding memories of houseofficership in the thirties are the participation of Miss Amy Greene as Head of Social Service on many of Dr. Blackfan's regular rounds, the regular attendance of the Nursing Supervisor, and the frequent, highly personal, assistance of Dr. Crothers (a pediatrician in search of mental hygiene) often with Miss Elizabeth Lord, his associate in psychology.
A STUDY OF THE NEED FOR ALTERNATIVE TYPES OF HEALTH CARE FOR CHILDREN IN HOSPITAL
Authors: Shah Chandrakant P. , Papageorgis Demetrios , Robinson Geoffrey C. , Kinnis Claire , Israels Sydney
Published: December 2021

In a population of hospitalized children, 45% of the 611 parents whose children qualified for day care stated they would have preferred day care if such an alternative had been available at the time and if the choice of type of care had been left to them.

Factors which seemed related to the parents' choice of care were the child's age, the distance from home to hospital, the parents' education, the parents' perception of the degree of safety afforded by hospitalization, and the ability to make the necessary arrangements to care for the child at home following day care. No relationship was found between parental choice of care and such variables as type of day care recommended (medical or surgical), sex of child, number of employed family members, occupational class, and family income.
INFANTS OF DIABETIC MOTHERS: ATTENUATED GLUCOSE UPTAKE WITHOUT HYPERINSULINEMIA DURING CONTINUOUS GLUCOSE INFUSION
Authors: King Katherine C. , Adam Peter A. J. , Clemente Geronima A. , Schwartz Robert
Published: December 2021

Blood glucose, plasma insulin, and free fatty acid interrelationships were examined in newborn infants during and after continuous hourly glucose infusions at rates varying from 4 to 24 mg/kg/minute. Normal newborn infants disposed of glucose efficiently until glucose was infused at rates greater than 6 mg/kg/minute. Plasma insulin levels rose gradually during glucose infusion. When large loads of glucose infusion were initiated (12 mg/kg/minute), however, there was a delay in plasma insulin rise.

At the slow rates of glucose infusion, the infants of gestational or insulin-dependent diabetic mothers disposed of the exogenous glucose more slowly than the normal newborns. Plasma insulin levels in the infants of gestational diabetic mothers were similar to those in the normal infants. These observations suggest that, with comparable glucose stimulus by continuous infusion, the infants of diabetic mothers do not have excessive insulin output.
MULTIPLE MALFORMATIONS STUDIED WITH A NATIONAL REGISTER OF MALFORMATIONS
Authors: Källén Bengt , Winberg Jan
Published: December 2021

An analysis was performed of 120 children, born with multiple malformations and reported to the Swedish national register of congenital malformations. The simultaneous occurrence of two or more specific malformations may be random or due to the presence of a specific syndrome. A statistical analysis demonstrates that specific associations do occur between certain malformations, and one "new" syndrome was found, consisting of closure defects of the central nervous system, an- or microphthalmia, cleft lip and/or cleft palate, and reduction malformations of the limbs, not related to the amelia-phocomelia group. Children with this constellation of malformations were especially common during the first half of 1965. Its cause is unknown. The method of analysis presented may be useful for an early detection of a new, drug-induced malformation syndrome.
MULTIPLE SACCULAR CONGENITAL ANEURYSMS OF THE ATRIA CAUSING PERSISTENT ATRIAL TACHYARRHYTHMIA IN AN INFANT
Authors: Varghese P. J. , Simon Allan L. , Rosenquist Glenn C. , Berger Martin , Rowe Richard D. , Bender Harvey W.
Published: December 2021

A 5-month-old infant presented with persistent tachyarrhythmia, cardiomegaly, and an abdominal mass. Cardiac catheterization and cineangiocardiograms revealed multiple aneurysms of the atria. These were removed successfully at surgery, whereupon normal sinus rhythm returned. The abdominal mass proved to be a hamartoma of the liver.
Diabetes Mellitus and Congenital Rubella
Authors: Forrest Jill M. , Menser Margaret A. , Harley J. D.
Published: December 2021

Five patients with congenital rubella and diabetes mellitus are reported. The possibility that the two disorders may be causally related is discussed.
Letter to the Editor
Authors: Frazier Robert G.
Published: December 2021

The Academy's decision to request the resignation of Dr. Mendelsohn, as Director of the Medical Consultation Service for Project Head Start, was made in spite of our past and present conviction that "the vigorous implementation of this program has been due to the experience, sensitivity and enthusiasm of Dr. Robert Mendelsohn." Continuing disagreements with Dr. Mendelsohn in regard to policies and administrative procedures made the discontinuation of his responsibilities necessary.

The Academy's record demonstrates its commitment to speak as an advocate of the child on health and health-related issues.
Education of the Cerebral Palsied
Authors: Nader Philip R. , Allmond Bayard
Published: December 2021

Dr. Berenberg's commentary is timely for pediatricians and other physicians having contact with school children and educators. We believe, however, that the physician must reinterpret the school referral "which asks, ‘Does he have minimal brain damage?’ "

Dr. Berenberg states, "It should stimulate the physician to a more detailed examination of the ‘softer’ neurologic signs which might answer the question posed to him." We raise the following two questions in response to Dr. Benenberg:

Does the presence of "softer" neurologic signs answer the question?
SYMPATHOMIMETIC DRUGS IN ACUTE VIRAL BRONCHIOLITIS
Authors: Phelan P. D. , Williams H. E.
Published: December 2021

Mean pulmonary resistance and inspiratory and expiratory pulmonary resistance were measured in 10 infants with acute viral bronchiolitis before and after the administration of isoprenaline or orciprenaline by aerosol. No consistent change in any measurement of pulmonary resistance was recorded following the administration of the drugs.
THE MORALS OF YOUTH IN 1805 AS DESCRIBED IN AN EDITORIAL IN ONE OF OUR MOST RESPECTED NEWSPAPERS
Authors: C. T. E.
Published: December 2021

Since newspapers were first published in this country, editorial writers have never seemed to tire of writing about the moral deficiencies of our young people. The quotation below, from an editorial published in a well-known newspaper in 1805, could have appeared (in a less ornate style) in the paper we read this morning.

To a person of reflection and sensibility, there cannot be a subject of more painful thought, than that which the morals of our youth present. In many of them, we observe the brightest colours of the human character almost totally eclipsed by the foulest immoralities. We see them triumphing in vice as a proof of distinguished spirit and refinement, and permitting their passions to shoot wild in all the dreadful luxuriance of folly and guilt.

Let us limit our remarks within a narrow sphere, and select from the cluster of youthful lusts, one which is more fashionable and perhaps more detrimental to them, in every point of view, than any other with which the present age is scourged: I mean the illicit indulgence of that passion which was given to us for the preservation of the human species. Considered merely with reference to this life, I know not a more deadly antidote to bliss than this lawless tyrant over man. How often does it dig the grave for genius and character! How are all the energies of the mind unstrung by its excess; all the affections of the heart deadened or empoisoned; every virtuous propensity put to flight, and all the charms of chaste society lost and forgotten.
GENERALIZED REACTION TO INSECT BITES
Authors: Torsney Philip J.
Published: December 2021

The Insect Committee of the American Academy of Allergy is interested in obtaining information concerning reactions to biting insects. The Committee is not interested now in purely local reactions, but rather it wishes data on patients who have had constitutional symptoms following insect bites (e.g., fever, arthralgia, hives, dyspnea, and so forth). At this time, we do not request information on patients suffering abnormal reactions to bee, wasp, hornet, or yellow jacket sting.

Stable fly, horse fly, deer fly, black fly, sand fly, biting midge, chigger mite, ticks, scorpion, wheel bug, kissing bug, and spider are reported to cause constitutional symptoms after a bite. We request information from any physician who has seen or treated a patient who has sustained an unusual reaction to such bite. This information should include age, sex of patient, insect causing reaction, site of insect bite, size of local reaction, was there previous unusual reaction to insect bite, description of associated symptoms, duration of such symptoms, was symptomatic treatment necessary, results of desensitization treatment if instituted, results of any diagnostic tests, and presence of other allergic problems in the patient.

We ask any physician who has seen or treated such case to submit the above information to Claude A. Frazier, M.D., 4-C Doctors Park, Asheville, North Carolina 28801.
Teratology of the Central Nervous System, by Harold Kalter. Chicago: The University of Chicago Press, 1968, 483 pp., $17.50
Authors: Gilles Floyd H.
Published: December 2021

Kalter monograph is a compendium of congenital malformations of the central nervous system organized by agent or method (Part 1) or by animal (Part 2). As such, it is a valuable source of teratological information up to the year 1967. While largely a résumé of literature, it includes a reserved presentation of the author contribution to teratology.
Anatomy of the Newborn: An Atlas, by Edmund S. Crelin, Ph.D. Philadelphia: Lea and Febiger (600 Washington Square, Philadelphia, Pennsylvania 19106), 1969, 270 pp., $24.00
Authors: Avery Gordon B.
Published: December 2021

Dr. Crelin is Professor of Anatomy at Yale, where, as a young instructor, he was consulted by a surgeon about a proposed operation on a baby. The operation failed, in part because of the special features of the anatomy of the newborn, at that time unfamiliar to him. This frustrating experience, and the realization that no adequate text of neonatal human anatomy existed, eventually led Dr. Crelin to the massive work embodied in this atlas.
THE MANAGEMENT OF THE CRITICALLY ILL CHILD WITH DEHYDRATION SECONDARY TO DIARRHEA
Authors: Finberg Laurence
Published: December 2021

Diarrhea and vomiting, which so frequently complicate diarrheal diseases, occur in a variety of disorders affecting infants. Although enteric infections cause these symptoms more often than all other diseases combined, noninfectious causes may occasionally also occur. While each cause may have specific other effects, the discussion here will deliberately be limited to the management of the physiologic disturbances that accompany excessive loss of water and salts from tile gastrointestinal tract. Etiologic considerations, however important they may be, will not be further pursued. This emphasis is appropriate since survival following critical dehydration depends far more upon the correction of the physiologic disturbance than upon the removal of the cause.

A critical stage in diarrheal disease may be defined as occurring when a volume of fluid equal in mass to about 10% of the body weight has been lost over a period of a day or two. Clinically, this usually occurs shortly after anorexia or vomiting has precluded oral intake. At this stage of illness, parenteral fluid therapy should be employed. Oral intake should be curtailed during the early hours of therapy. The use of milk or other foods high in calories and solute complicates management by markedly increasing stool water losses. Even if severe undernutrition coexists with tile diarrhea, the first 6 to 8 hours should be a period of brief starvation; the parenteral glucose will provide emergency calories.

Although such routes of administration as intragastric drip and subcutaneous infusion have been employed successfully, their usage should be restricted to places where a deficiency of supplies or trained personnel interdicts the preferred parenteral route—continuous intravenous infusion.
Letter To The Editor
Authors: Dews Peter B.
Published: December 2021

Dr. Dews writes:

Dr. Milman, in her first paragraph on the dangers of marijuana, shows the dangers of jargon. "Acute toxicity" in the trade implies killing, usually within 24 hours. Large amounts of tetrahydrocannabinols are required to kill mice and other laboratory animals, hence "the acute toxicity is vanishingly small," a statement which says more in English than it should. My apologies.

Dr. Milman in her penultimate paragraph quotes King and Cowen for the statement that following intravenous injection of marijuana, "the histopathology is real."
Letter To The Editor
Authors: Schlossman Charles M.
Published: December 2021

I wish to protest the recent change of the format of the first page of Pediatrics, from the traditional heading of the journal with the seal of the American Academy of Pediatrics, to the present format which I find esthetically quite disturbing and unappealing. I wish to request that the title page be changed back to its previous format.
Factors Affecting Reports of Neonatal Deaths in United States and Elsewhere
Authors: Nickey Laurance N.
Published: December 2021

Again, I have read that the United States' infant mortality rate is "a disgrace and totally unacceptable," that the Nation's infant mortality rate is 21.7 per 1000 live births, and that there are 12 countries which have lower infant mortality rates than the United States.

I would very much like to challenge the Editorial Board of Pediatrics and the American Academy of Pediatrics to help clarify this somewhat mysterious but often quoted figure.

I would like to see in print an authoritative report outlining the criteria for neonatal death as used in this country and its several states, and also the countries that are commonly listed in the forefront, in so far as infant mortality rates are concerned.
KERNICTERUS: HIGH INCIDENCE IN PREMATURE INFANTS WITH LOW SERUM BILIRUBIN CONCENTRATIONS
Authors: Gartner Lawrence M. , Snyder Richard N. , Chabon Robert S. , Bernstein Jay
Published: December 2021

During a 2-year period, 1966 and 1967, 485 low birth weight infants were admitted to the special care unit. Sixteen of these infants expired during the third to sixth days of life, and fourteen of them were examined postmortem. Nine of the fourteen infants (64%) were found to have pathologic evidence of kernicterus characterized by yellow staining of one or more areas of the brain with necrosis of brain cells in the stained areas. None had clinical signs of kernicterus. Peak total serum bilirubin concentrations ranged from 9.4 to 15.6 mg/100 ml in the kernicteric group and from 8.8 to 17.2 mg/100 ml in the group without kernicterus. These infants were of extremely low birth weight and short gestational period, and they had very low Apgar scores and the respiratory distress syndrome. Pathologically the infants demonstrated pulmonary atelectasis, hyaline membranes, and pneumonia as their major findings. Extraneural lesions of hyperbilirubinemia were observed in four infants with kernicterus but not in any of the infants without kernicterus. Neuropathological examination revealed a high frequency of intracranial hemorrhage in the kernicteric group in addition to yellow staining and cell necrosis.
EVALUATION OF THE ROUTINE PHYSICAL EXAMINATION OF INFANTS IN THE FIRST YEAR OF LIFE
Authors: Anderson Frederic P.
Published: December 2021

Because of the critical shortage of professional manpower to deliver child health care in the United States, new programs are being developed involving paramedical personnel for the provision of much of the routine health appraisal services traditionally accomplished by the physician. It is difficult to anticipate the effect of such programs Upon the health care of children without knowing what contribution is presently made by the existing system.

In an effort to assess the role of the routine physical examination in the health care of the infant under the age of 12 months, the results of 6,668 such examinations by 83 private pediatricians were evaluated in a prospective study. One hundred and thirty significant physical abnormalities (1.9%) were discovered, many of which probably could have been detected by a specially trained nurse or physician's assistant because of their inherent visibility or susceptibility to identification by simple screening procedures.

It is concluded that more effective use of the physician's time could be accomplished by the relegation of a major portion of the routine infant physical examination to a paramedical person.
BENZEDRINE® AND DEXEDRINE® IN THE TREATMENT OF CHILDREN'S BEHAVIOR DISORDERS
Authors: BRADLEY CHARLES
Published: December 2021

The effect of benzedrine® (dl-amphetamine) and dexedrine® (d-amphetamine) sulfates upon the behavior of maladjusted children was studied in the somewhat controlled setting of a children's psychiatric hospital. Twelve years' experience with these drugs is reported involving observations upon 275 children who received benzedrine®, 113 who received dexedrine® and 82 who received both preparations.

The most frequent optimal daily dose was 20 mg. of benzedrine® and 10 mg. of dexedrine®.

Specific behavior responses to both drugs approximated one another both in quality and frequency, with 50 to 60% of the children becoming more subdued, 15 to 25% showing no change, 20% showing increased activity and 5% showing an acceleration of school progress only. Clinically these reactions indicated 60 to 75% symptomatic improvement, 15 to 25% no change and 10 to 15% unfavorable responses. Children with a variety of clinical diagnoses were benefited with no evidence of tolerance or addiction following prolonged administration.

Occasional undesirable physiologic side effects were noted with both preparations, most frequently during the first few days of treatment only. Approximately equal numbers of children responded more favorably to one drug in contrast to the other. In general benzedrine® was found to produce the more dramatic results, except with individual children in whom its side effects were more pronounced, in which cases dexedrine® proved more advantageous.

The conclusion is drawn that these drugs influence children's behavior by altering their emotional reactions to distressing situations. Both offer the practitioner readily available and easily controlled pharmacologic approaches to the symptomatic treatment of children's behavior disorders.
PASSIVE INTRAPERITONEAL MOUSE PROTECTION TEST IN A STUDY OF IMMUNE RESPONSE TO H. PERTUSSIS VACCINATION
Authors: MCGOVERN JOHN P.
Published: December 2021

A passive mouse protection test and its use in testing sera from infants given a course of phase I pertussis vaccine is described. Infants 3 to 6 months of age consistently developed mouse protective antibodies following immunization with a phase I H. pertussis vaccine. Agglutinating antibodies did not develop consistently in these infants and the agglutinin titer did not closely parallel the values obtained by the mouse protection test.
CLINICAL NOTE ON STUTTERING AND CLUTTERING IN YOUNG CHILDREN
Authors: HIRSCH KATRINA DE , LANGFORD WILLIAM S.
Published: December 2021

The early clonic iterations of the child between 20 and 40 months are a part of the normal speech patterns of growing children. As a rule reassurance of the parents and withdrawal of attention and concern from speech are all that is necessary.

There is a group of children who start speaking late and whose familial background shows evidence of difficulty in the language area and delay in establishing a functional superiority of one side over the other. Many of these children have trouble with the enunciation of specific sounds, with vocabulary and with sentence construction. In spite of at least average intelligence these children handle speech poorly. They often show a great number of clonic iterations at an age when most children have already discarded them. Their handling of speech closely resembles the cluttering of older children and adults. Such children frequently need technical help with sounds, vocabulary and grammatical construction. Smoother production of speech and slowing up of speed will often bring about a reduction in the original iterations. The pediatrician should be aware of the fact that emotional tensions and conflicts tend to become fixed to a speech mechanism which is none too stable in these children. The cluttering child may easily turn into a stutterer.

There is a larger group of children who show no familial difficulty in the language area, who talk early and quite well and who abruptly develop stuttering at some time during childhood. Some of these children display other symptoms of emotional disorder; others seem to function effectively in most areas but express their emotional conflicts principally in stuttering. These children should be referred for psychiatric help early.

In older children who stutter, a careful differential diagnosis is necessary as to the relative importance of specific language and emotional factors in pathogenesis. If existing emotional difficulties seem to be the result rather than the cause of the stuttering, a more specifically technical therapy is favored; in cases where emotional factors are outstanding a psychiatric approach is to be preferred.

Speech is a means of expression of the personality as well as a means of communication; severe dysfunctions in speech then may reflect a personality disorder or a disorder of interpersonal relationships or both. In the child, however, speech is also a tool which he masters as it develops. A speech difficulty in the growing child must be evaluated from both points of view.
FEMALE PSEUDOHERMAPHRODITISM WITH HYPOADRENIA
Authors: PANOS THEODORE C.
Published: December 2021

Two infants presenting the syndrome of true female pseudohermaphroditism and associated hypoadrenia have been described. The essentially identical clinical features encountered in these infants may be summarized as follows:

1. Characteristic history with (a) anorexia, noted shortly after birth; (b) weakness; (c) vomiting, repeated and frequently projectile, beginning at about 3 weeks of age; (d) frequent attacks of diarrhea; (e) progressive loss of weight; (f) emaciation; severe dehydration and shock at about the age of 3 to 4 months.

2. Abnormalities of the external genitalia: (a) a greatly enlarged clitoris simulating a penis as to size, shape, ventral bowing and preputial covering; (b) a "urinary meatus" situated along the under surface of the clitoris or the perineum; (c) a "scrotal sac," bifid or united in the midline with a median raphe, with typical corrugations and exhibiting the dartos effect.

3. Occurrence of crises associated with decrease in the sodium and chloride and elevation of the potassium of the serum.

4. Elevated urinary excretion of 17-ketosteroids.

5. Special urologic studies: (a) urethrocystoscopy which revealed the presence of a urogenital sinus, bladder trigone of the female type, "prostatic urethra" which contains a flattened veru montanum and an elongated utricle; (b) retrograde injection of radiopaque dye through the utricular slit resulted in definite colpohysterosalpingograms with free dye spilled out into the peritoneal cavity.

6. Exploratory laparotomy disclosed the presence of normal female internal genitalia and the absence of male gonadal tissue.

7. Biopsy of the ovaries disclosed primordial follicles.

8. Satisfactory response to the management of the adrenocortical insufficiency by the administration of sodium chloride alone or in combination with desoxycorticosterone acetate.

The advisability of surgical resection of the adrenals in order to diminish the production of androgens is discussed. In the event there are no signs of adrenocortical insufficiency, it is suggested that excision of adrenocortical tissue be performed even though the improvement effected may be small and of a temporary nature. On the other hand, where hypoadrenia is a part of the clinical picture such surgery would be distinctly hazardous and would therefore seem contraindicated. The importance of safeguarding the healthy psychologic development of these patients is emphasized.
THIAMINE-RESPONSIVE LACTIC ACIDOSIS IN A PATIENT WITH DEFICIENT LOW-KM PYRUVATE CARBOXYLASE ACTIVITY IN LIVER
Authors: Brunette Michèle G. , Delvin Edgard , Hazel Bernard , Scriver Charles R.
Published: December 2021

The cause of severe intermittent lactic acidosis was investigated in a female infant with profound psychomotor retardation. Hypoglycemia, hyperpyruvic acidemia, and hyperalaninemia were identified in the newborn period. A triad of lactate, pyruvate, and alanine accumulation persisted throughout infancy, and ACTH, anorexia, and high carbohydrate feeding further provoked their accumulation. Careful dietary control or thiamine-HCl supplementation (5 to 20 mg/day) ameliorated the metabolic abnormality.

Pyruvate dehydrogenase activity (which is thiamine-dependent) was normal in leukocytes and cultured skin fibroblasts. Hepatic pyruvate carboxylase activity (which is biotin-dependent) was found to comprise more than one component. There was a partial deficiency of total hepatic pyruvate carboxylase activity in the patient. The loss of activity was confined to the low-Km component of the enzyme which serves pvruvate metabolism in the physiological range.

A defect in glucogenesis causing hypoglycemia, pyruvate accumulation with lactic acidosis, and aberrant amino acid metabolism can be attributed to the abnormality of pyruvate carboxylase. The response to thiamine in our patients may reflect activation of a normal "shunt" mechanism for pyruvate disposal via pyruvate dehydrogenase.
RETROLENTAL FIBROPLASIA IN A CYANOTIC INFANT
Authors: Kalina Robert E. , Hodson W. Alan , Morgan Beverly C.
Published: December 2021

Proliferative retrolental fibroplasia was documented by ophthalmoscopy and histopathological study in a 940-gm birth weight infant with severe cyanotic congenital heart disease who died at the age of 11 weeks. Arterial oxygen tensions usually considered to be pathologic were not noted in this infant and would appear to have been possible in view of the cardiac anomalies found during life and at autopsy. These observations indicate that retrolental fibroplasia may occur in immature infants in the absence of oxygen abuse.
ELECTROPHYSIOLOGICAL RESPONSE OF THE RABBIT BRAIN TO CHRONIC HYPERNATREMIC DEHYDRATION AND REHYDRATION
Authors: Hogan Gwendolyn R. , Dodge Philip R. , Gill Sheila R. , Scholl Mary Louise , Master Susan
Published: December 2021

In thirty-two rabbits epidural electrodes were placed and in ten of these animals concentric depth electrodes were placed stereotactically.

All animals with both epidural and stereotactically placed electrode; were rehydrated with intravenous 2.5% dextrove in water over a four-hour period. Animals with just epidural electrodes had normal tonicity restored by intravenous 2.5% dextrose administered over six or eight hours or by the ad libitum oral intake of tap water. The electrical cortical activity was monitored at 15 minute intervals throughout rehydration and for an additional four-hour observation period. In animals rehydrated over a four-hour period seizures were most prominent during the third and fourth hour of rehydration and the first hour of the observation period. Slowing of the electrical actisity and development of spikes occurred during this same period of time in some animals without as well is some with clinical seizures.
Serum 5’-Nucleotidase in Neonatal Hepatitis and Biliary Atresia: Preliminary Observations
Authors: YEUNG C. Y.
Published: December 2021

This study is in agreement with the observation that the serum 5’ nucleotidase level is related to the degree of bile duct proliferation in hepatobiliary disease. In infants with congenital extrahepatic biliary atresia, where ductal proliferation is a feature, the enzyme levels are markedly raised and are significantly different from those with neonatal hepatitis. Such finding is of diagnostic value in differentiating between the two conditions.
Letter to the Editor
Authors: S. C. A.
Published: December 2021

Not even this excellent letter could include mention of everything for which the Washburns were memorable. One would like to note a single omission: Al's delight in Nature, and the reflections of that delight which illuminated his Annual Reports on the work of his Child Research Council. These writings were composed on special outings into the mountains, where he always seemed to find perfect mornings for observation and reflection. Increasingly he shared these reports with a widening circle of appreciative friends.
Infant Mortality, Breast-Feeding, and Improved Health Surveillance
Authors: Cunningham Allan S.
Published: December 2021

In light of Dr. Wegman's comments on infant mortality in his review of vital statistics I thought it would be of interest to recall two morbidity-mortality studies of infants born between 1910 and 1930.

Grulee et al. studied 20,000 welfare infants in Chicago. Nearly 10,000 of them were breast-fed exclusively for ten months and had a mortality rate less than 1.6 per thousand. Mortality in otherwise comparable groups of partly breast-fed and exclusively bottle-fed infants were 6.9 and 84 per thousand, respectively.
Severe Respiratory Disease in Infants With Cystic Fibrosis
Authors: Lloyd-Still John D. , Khaw Kon-Taik , Shwachman Harry
Published: December 2021

The diagnosis, management and prognosis of 17 infants with cystic fibrosis (CF) and severe respiratory disease were reviewed for the period 1968 to 1972. The clinical course of these infants was characterized by a bronchiolitis-like syndrome with failure to thrive and malnutrition. Arterial blood gases demonstrated marked hypoxemia (mean Pao2, 37.5 mm Hg). Tracheal cultures showed a predominance of gram-negative microorganisms with Pseudomonas aeruginosa, Kiebsiella pneumoniae and Escherichia coli predominating. Corticosteroids were used in all patients. Despite vigorous therapy including antibiotics there was a 60% mortality. A delay in the diagnosis of CF from the onset if respiratory symptoms with a mean of six weeks was considered an important factor affecting survival. This data supports the need for developing a reliable screening test for CF at birth.
Timing of Neurological Development in Rural Guatemalan Children
Authors: Dayton Delbert H. , Blanco Ricardo A.
Published: December 2021

This is a cross-sectional study of the anthropometric measurements and neurological evaluation of 559 children under 36 months of age (286 boys and 273 girls) from a rural area of Guatemala. Height and weight were compared with values from well-nourished Central American children which do not differ from North American standards. Head circumference was compared to standards from 14 different studies compiled from the world literature. The analysis of the data showed that the study population was far behind these standards in its physical growth characteristics. Results are presented for the timing of neuromotor skill development by calculation of the 16th, 50th and 84th percentiles for individual neurological functions by the probit method. Comparable data from other populations using the probit method of analysis are generally not available. One exception is the age of walking, which appeared to be delayed approximately four months in the rural Guatemalan children when compared to previous studies analyzed in this manner. These results should not be taken as patterns or norms but rather as a baseline for future studies.
Reye's Syndrome and Its Treatment
Authors: Mendoza Stanley A. , Schneider Jerry A.
Published: December 2021

The recent commentary by Brown et al. contains a number of important warnings about possible dangers in the treatment of Reye's syndrome. There is, however, one additional warning which must be added. The authors speak of Reye's snydrome as a disease rather than as a syndrome. This may seem to be a minor point, but it has significant implications. A disease is an entity with a specific cause, natural history, etc. A syndrome is a group of symptoms and signs with diverse causes, natural histories, etc.
Chemicals in Human Teratogenesis and Transplacental Carcinogenesis
Authors: Fraumeni Joseph F.
Published: December 2021

It is estimated that about 2% to 3% of all congenital malformations in man can be attributed to drugs or other chemicals in the environment.1 Cancers may also result from chemical exposures prenatally, since stilbestrol therapy in pregnant women has been linked recently to the development of vaginal cancer in their daughters.2 This paper briefly reviews the current evidence in man implicating chemical agents in teratogenesis and transplacental carcinogenesis.

TERATOGENS

Generally, the chemicals that have been implicated as teratogens in man have been drugs, except for pollutants such as organic mercury and polychlorinated biphenyls. Some agents are clearly teratogenic on clinical or epidemiologic grounds, while others show only a preliminary indication of hazard. Table I lists the agents which are or may be teratogenic, according to their apparent effects on the fetus.3 The precise mechanisms for most agents remain to be clarified, but some agents seem to produce direct fetal toxicity, while others interfere with fetal metabolism. In animal models, some compounds are teratogenic by actions on the placenta or on the mother or father, but such mechanisms have not been identified in man. Table I also records the particular defects associated with each agent, in view of the tendency for teratogens to produce characteristic patterns of malformation.

Well-Documented Teratogens

Thalidomide, first identified as a teratogen in the early 1960s, is believed to be responsible for the deformities of 6,000 to 8,000 children.4 The malformations characteristically involved the extremities, face, and ether organs. Particularly striking were cases of phocomelia (seal limbs), usually a rare condition, in which hands are attached directly to the shoulders.