bluuebunny/crossref_metadata_2025 huggingface dataset:
Letters to the Editor
Authors: BIRCH HERBERT C.
Published: December 2021

One can only agree with Dr. Hersher that "carefully controlled research on mental retardation is relatively rare and that given the support it deserves will contribute to our understanding of retarded children, serve as a stimulus for further research, and help the clinician make judgments on the basis of fact rather than feeling." It is unfortunate that despite such mutuality of interest we cannot agree that the research on the foster-placement of mongoloid infants by Centerwall and Centerwall is carefully controlled and establishes a basis for the making of judgments on "fact rather than feeling." Moreover, we note with regret that Dr. Hersher's comments introduce additional features of methodologic confusion which, if accepted, can only contribute negatively to the development of effective methodology for retrospective research in the area of mental retardation. For these reasons, we take this opportunity to reply to Dr. Hersher's letter.
Diagnostic Tests for Lead Poisoning
Authors: DINMAN B. D.
Published: December 2021

The report of Whitaker, Austin, and Nelson, "Edathamil Calcium Disodium (Versenate) Diagnostic Test for Lead Poisoning" (Pediatrics 29:384, 1962), comments upon the use of this agent and its mechanism of action in a manner which may lead to misapprehension concerning the potentialities of this agent. The authors state that this test is based upon the principle that "edathamil chelates lead in body stores, as well as circulating lead...." In view of our present knowledge concerning these sites of action of edathamil calcium disodium, it would appear that this is an overstatement of the efficacy of this agent in producing mobilization and subsquent excretion of the body burden of lead.
PREVENTION OF VIRAL DISEASES
Authors: Warren Robert J. , Robbins Frederick C.
Published: December 2021

Although the control of infectious hepatitis leaves much to be desired, certain measures can be taken. When a specific source of infection can be identified, such as shellfish, or the parenteral introduction of infected serum or blood, epidemiologic control can be effective in eliminating the source of infection and the use of gammaglobulin may protect those already exposed. When transmission occurs by intimate contact, such as within the family or where sanitary measures cannot be employed, passive immunization should be initiated. There are no immediate prospects for active immunization.
THE EFFECTS OF PROLONGED NEONATAL HYPOXEMIA ON THE PULMONARY VASCULAR BED AND HEART
Authors: Naeye Richard L. , Letts Harry W.
Published: December 2021

Changes in the blood vessels and heart were assessed in infants chronically hypoxemic during the neonatal period. The hypoxemia appears to arrest the relative involution of smooth muscle about the pulmonary arterial bed. This change is presumably related to persistent pulmonary arterial hypertension, as evidenced by a relative hypertrophy of the right ventricle in the hypoxemic infants. The small pulmonary arteries are identified as a possible site of hypoxemia-induced vasoconstriction. No abnormalities were found in the veins or capillaries of the pulmonary circulation or in any vessels of the systemic circulation.
The Consumers Union Report on Family Planning
Authors: RYAN KENNETH J.
Published: December 2021

This short publication covers the subject of family planning with regard to both the use of contraceptive methods for preventing pregnancy and the infertility evaluation for those who cannot conceive. A short introductory chapter is devoted to a discussion of the physiology of ovulation and fertilization. The material is well organized and reasonably comprehensive for the lay reader. In addition, it is a fair and accurate summary of our present state of knowledge. The book has a pleasing format and is executed with taste.

While this material is suitable for the educated layman, there is, as yet, no completely satisfactory source book for the physician.
AN INEXPENSIVE PROPHYLAXIS FOR AMMONIACAL DERMATITIS
Authors: Ross Lawrence S.
Published: December 2021

Ammonia in the morning diaper has been demonstrated to be the breakdown product of urea in the presence of Bacterium ammoniagenes. Most methods of treatment of ammoniacal dermatitis have been aimed at inhibiting the growth of the causative bacteria. Neutralization of the ammonia as it is produced has effectively been achieved by rinsing diapers in dilute vinegar. It is suggested that this simple procedure be added to the usual routine in the elimination of ammoniacal dermatitis.
Neonatal Hyperphosphatemia
Authors: RAPKIN RICHARD H.
Published: December 2021

Connelly et al., in their recent article on neonatal hyperphosphatemia (Pediatrics, 30:425, 1962), came to the conclusion that "an effect of the hormone was evident on day three, the clearance of the treated infants being significantly greater than that of the controls. . . ." They go on to say: "The increase in approximately four liters in filtration attributable to hormone effect is quite adequate . . . to explain the entire difference . . . between the phosphate excretion of the treated and control infants. . . ."

I believe that these conclusions cannot be justifiably made from the available data. The creatinine clearance of control infants on day three varies from 6.48 to 30.09 liters/24hours/ 1.73m2, a fivefold variation.
Letters to the Editor
Authors: EICHENWALD HEINZ F.
Published: December 2021

I have been informed that some objections have been voiced to the recommended space allowance in newborn nurseries of 30 square feet per infant. Since I feel very strongly that 30 square feet represents in fact the minimum safe and efficient space requirement, I believe it might be worthwhile to review the evidence which has led us to this recommendation.

As you know, we were able in the past several years to construct a series of experimental nursery units in which it was possible to conduct controlled observations while the units were in regular use.
Dissatisfaction with Pediatrics
Authors: HUDSON PHOEBE
Published: December 2021

I cannot resist a letter to you concerning the booklet "Careers in Pediatrics" which was published in The New Physician and sent to members of the Academy.

I am compelled to take issue with the article by Dr. McKay entitled Dissatisfactions With Pediatrics. First of all, I feel the selection of Dr. McKay (a fine fellow and excellent doctor) is wrong. His subject deals with the practice of pediatrics in which he is not engaged—much as he might wish to have us think so. It's always the same.
EXPERIENCES IN THE DETECTION AND TREATMENT OF PHENYLKETONURIA
Authors: Hudson F. P. , Dickinson R. A. , Ireland J. T.
Published: December 2021

Collected experiences in the detection and treatment of phenylketonuria in a large children's hospital during the past 5 years have been described. Thirty cases of phenylketonuria have been confirmed. Early examination revealed phenylketonuria in three siblings of known cases. One case showing atypical features has been discussed in more detail. Four patients reported "positive to Phenistix" were found to be excreting phydroxy-phenylpyruvic acid. Two other false-positives were shown to be due to histidine derivatives. In an appendix, details are given of a simple routine method for the determination of plasma phenylalanine.
Reading Disability: Progress and Research Needs in Dyslexia
Authors: WOODBURY CHARLES B.
Published: December 2021

This book contains the 12 original papers from a conference on "Research Needs and Prospects in Dyslexia and Related Aphasic Disorders," which was held at Johns Hopkins in November, 1961, under the auspices of the Departments of Pediatrics, Psychiatry, and Ophthalmology. These contributions are augmented by an overview chapter prepared by the editor, which also covers the conference discussions, and by an introduction by Leon Eisenberg, the chairman. The list of participants is a distinguished one, representing pediatric psychiatry, otolaryngology, clinical and educational psychology, neurology, and experimental and developmental-comparative psychology.
GROWTH RETARDATION: USE OF SULFATION FACTOR AS A BIOASSAY FOR GROWTH HORMONE
Authors: Kogut Maurice D. , Kaplan S. A. , Shimizu C. S. N.
Published: December 2021

A bioassay for measurement of human growth hormone based upon the observation that normal human serum, in vitro, will favor the incorporation of S-35 into immature rat cartilage is described. The factor in serum is called "sulfation factor." Sulfation factor determinations were performed on 27 normal children, 15 with hypopituitarism, 26 dwarfs without demonstrable endocrine or other diseases, 11 children with a variety of non-pituitary diseases causing dwarfism, and 1 adult with acromegaly.

The mean activity (± S. E.) of sulfation factor was 0.84 ± 0.057 S. F. units in the normal children, 0.45 ± 0.024 S. F. units in idiopathic hypopituitary patients (p < 0.01), 0.95 ± 0.054 S. F. units in dwarfs without evidence of endocrine or other recognizable diseases, 0.82 ± 0.057 S. F. units in dwarfs with well recognized nonpituitary disease, and 2.2 S. F. units in one adult with acromegaly.

There was an excellent correlation between sulfation factor and other laboratory determinations of pituitary function. Hypophysectomized rats receiving bovine growth hormone showed substantial increase of sulfation factor as compared to control hypophysectomized rats. Sulfation factor activity appears to be a valid and useful indicator of growth hormone activity in serum.
A Philosophy of Infant Feeding
Authors: BARNESS LEWIS A.
Published: December 2021

This is a delightful book.

In the author's introduction it is stated: "There are so many books on the feeding of infants. Whatever its faults, at least this little book is different." This book is especially different in that infant feeding is covered in a very painless fashion with a minimum of tables and figures. The writing is excellent, and one hardly realizes that he is reading a textbook of fact.

The author uses a paleocentric approach to infant feeding. In his evolutionary study he finds for example, "In modern cultures it is no longer a case of survival of the breast fittest." In addition to many bon mots the book is replete with helpful practical advice.
INTRAVENOUS METHOTREXATE (AMETHOPTERIN) THERAPY IN THE TREATMENT OF ACUTE LEUKEMIA
Authors: Perrin Jane C. S. , Mauer Alvin M. , Sterling Theodor D.
Published: December 2021

Fourteen children with acute leukemia were treated with bi-weekly intravenous injections of methotrexate (amethopterin) after relapse during oral chemotherapy. Twelve of these children obtained a remission from the therapy with an average duration of 4.4 months for the 14 patients. The median survival time was 19.5 months for the group, with six patients still living. A statistical method based on regression analysis was used to determine the significance of the difference in the results obtained in the study group and in a control group of 36 patients treated at this hospital between 1955 and 1959. It was concluded that intravenous methotrexate therapy prolonged the survival of these patients and was a useful therapeutic adjunct.
THE CEREBROSPINAL FLUID OF LEUKEMIC CHILDREN WITHOUT CENTRAL NERVOUS SYSTEM MANIFESTATIONS
Authors: Evans Audrey E.
Published: December 2021

Fifty lumbar punctures were performed on each of three groups of leukemic children. The three categories studied were (1) those with central nervous system manifestations, (2) those free of symptoms following effective treatment, and (3) those not yet having developed central nervous system symptoms. The patients in Group I all had abnormal cerebrospinal fluid. Those examined before or between episodes referable to the central nervous system had normal findings, with rare exceptions. Positive results in the patients without symptoms almost always indicated the early recurrence of central nervous system symptoms.
THE EFFECT OF EXTRACORPOREAL CIRCULATION UPON THE TISSUE CONCENTRATION OF DIGOXIN-H3
Authors: Hernandez Antonio , Kouchoukos Nicholas , Burton, Robert Main , Goldring David
Published: December 2021

The effect of extracorporeal circulation upon the radioactivity from tritium-labeled digoxin and/or its metabolites in heart muscle and other tissues of patients who underwent open heart surgery with the aid of extracorporeal circulation was studied. These experiments demonstrate that the digoxin concentration of the heart muscle was not significantly altered by extracorporeal circulation as measured by the radioactivity in the heart tissue and that no significant radioactivity was detected in the blood from the heart-lung pump. It should be emphasized that patients who are digitalized preoperatively and who undergo open heart surgery with the aid of extracorporeal circulation still have an appreciable amount of the digoxin in the myocardium and other tissues after cardiopulmonary by-pass. Since the concentration of digoxin in heart muscle which would produce maximal cardiotonic effect is not known, the postoperative administration of digoxin and other cardiac glycosides must be approached with caution.
LEUKEMIC INFILTRATION OF MENINGES AND SPINAL NERVE ROOTS
Authors: Sullivan Margaret P.
Published: December 2021

Three of 32 children with leukemic infiltration of the central nervous system have shown symptoms caused by involvement of the spinal meninges and nerve roots. The case reports demonstrate the use of radiation and intrathecal chemotherapy in combination and in sequence in management of this complication of leukemia. Intrathecal Methotrexate was used for the meningeal infiltrations and radiation therapy was employed for the infiltrations of the nerve roots and nerves which would be contacted poorly or not at all by intrathecally administered medication. Two of the children showed relief of symptoms caused by involvement of spinal structures. The central nervous system infiltrations of the third child were resistant to therapy.

The incidence of infiltration of spinal meninges and nerve roots is probably higher than indicated by this report. This type of involvement should be suspected in the child who complains of pain in the legs and ceases walking, particularly if there is a previous history of leukemic involvement of the nervous system.
PEDIATRIC APPLICATION OF THE RADIOIODINE (1-131) ROSE BENGAL METHOD IN HEPATIC AND BILIARY SYSTEM DISEASE
Authors: White William E. , Welsh John S. , Darrow Daniel C. , Holder Thomas M.
Published: December 2021

Rose bengal tagged with radioiodine (I-131) injected in the vein of a normal subject is rapidly cleared from the blood by the liver and conveyed by the biliary ducts to the intestine. By counting the radioactivity over the heart, liver, and intestine, the liver function (rate of clearing the blood of activity and rate of liver uptake) and patency of the biliary ducts (appearance of activity in the intestines) can be assessed. Patients with hepatitis clear the blood of dye slowly and exhibit a slow liver uptake. Intestinal activity appears somewhat slower than normal but in normal amount. In patients with biliary atresia, the blood is cleared of activity somewhat more slowly than normal. Liver activity, though rising slowly, continues to increase for a much longer period of time than in the normal subject. No activity reaches the intestine. Sixty-five nose bengal studies were carried out in 50 pediatric patients. The test is of most value in evaluating the jaundiced neonate. More experience with it will be necessary to evaluate fully the usefulness of this test.
CERVICAL MASSES IN INFANTS AND CHILDREN
Authors: Moussatos George H. , Baffes Thomas G.
Published: December 2021

Two hundred sixty-seven patients with tumors in the neck, observed at the Children's Memorial Hospital, have been reviewed. Forty-seven of these patients had malignancy. The most common malignancy was lymphosancoma or Hodgkin's disease (20 cases). The highest incidence of malignant degeneration in tumors of a specific organ occurred in the thyroid (50%). The over-all malignancy rate in neck tumors in this series was 15.7%.

This study was undertaken primarily to evaluate clinical patterns and diagnostic methods. It was of great interest to find that tumors of the neck are not as deadly as one might suppose. At least 84% of the lesions were benign and responded well when accepted methods for their treatment were carried out. Moreover, it was fascinating to find that, aside from certain organspecific carcinomas (e.g., thyroid and parotid glands), most cervical neoplasms arose from mesodermal tissues and, when malignant, offered a very poor prognosis. Yet, most lesions arising in the neck manifested themselves before metastasizing beyond the region, so that, if they were localized, surgical excision offered excellent opportunity for adequate containment. Certainly, the backbone of treatment of neck tumors, regardless of type, was surgical ablation, wherever possible.

A few neck tumors were metastatic in nature, but adequate study and evaluation of the patient usually demonstrated the distal primary before operation was undertaken.

Another interesting point, not entirely foolproof but fairly reliable, is the observation that malignant tumors generally were located in the posterior cervical triangle. This applied almost universally, except for lesions in the thyroid gland. Although biopsy is the only way to be certain, it is comforting to have some assurance preoperatively that a solitary mass in the anterior cervical triangle probably is benign. The probability that a cervical tumor is malignant increases in the following order: (1) multiple tumors located in the anterior triangle of the neck; (2) tumors, single or multiple, located in the posterior cervical triangle; (3) multiple tumors located both in the anterior and posterior cervical triangles. Tumors of the thyroid gland represent a class unto themselves. When they are present the malignancy rate is very high, and in this series represented approximately 50%.
Resistance of Bacteria to the Penicillins. Ciba Foundation Study Group No. 13
Authors: SMITH MARGARET H. D.
Published: December 2021

This slender volume reports in lively form a 1962 Symposium concerned with the theoretical aspects of resistance of staphylococci to penicillin, and recent attempts to find new penicillins which would obviate this problem of resistance. Although it has been possible in the laboratory to render staphylococci penicillin-resistant without their producing penicillinase, nevertheless all naturally occurring penicillin-resistant strains of staphylococci are, without exception , penicillinase-producers. Small structural changes in the penicillin molecule might therefore be expected to alter markedly the affinity of the enzyme penicillinase for its substrate; recognition of this fact led several groups of organic chemists to systematically attempt to modify the benzyl penicillin (= penicillin G) molecule.
CIRCULATORY CHANGES IN THE LUNGS DURING EXERCISE
Authors: Shepherd John T.
Published: December 2021

During exercise the normal pulmonary vessels can accommodate a three to fourfold increase in flow with about a 50 per cent increase in perfusion pressure. There is about a 10 per cent increase in the total volume of blood in the lungs, which may be accounted for mainly by an increase in capillary blood volume. The diffusion capacity is increased, the concentration of red blood cells is increased, and a relatively uniform ventilation-perfusion ratio is achieved throughout the lung.
TEMPERATURE REGULATION IN EXERCISE
Authors: Robinson Sid
Published: December 2021

The central body temperature of a man rises gradually during the first half hour of a period of work to a higher level and this level is precisely maintained until the work is stopped; body temperature then slowly declines to the usual resting level. During prolonged work the temperature regulatory center in the hypothalamus appears to be reset at a level which is proportional to the intensity of the work and this setting is independent of environmental temperature changes ranging from cold to moderately warm. In hot environments the resistance to heat loss may be so great that all of the increased metabolic heat of work cannot be dissipated and the man's central temperature will rise above the thermostatic setting. If this condition of imbalance is continued long enough heat stroke will ensue. We have found that in a 3 mile race lasting only 14 minutes on a hot summer day a runner's rectal temperature may rise to 41.1°C., with heat stroke imminent. The physiological regulation of body temperature of men in warm environments and during the increased metabolic heat production of work is dependent on sweating to provide evaporative cooling of the skin, and on adjustments of cutaneous blood flow which determine the conductance of heat from the deeper tissues to the skin. The mechanisms of regulating these responses during work are complex and not entirely understood. Recent experiments carried out in this laboratory indicate that during work, sweating may be regulated by reflexes originating from thermal receptors in the veins draining warm blood from the muscles, summated with reflexes from the cutaneous thermal receptors, both acting through the hypothalamic center, the activity of which is increased in proportion to its own temperature. At the beginning of work the demand for blood flow to the muscles results in reflex vasoconstriction in the skin. As the body temperature rises the thermal demand predominates and the cutaneous vessels dilate, increasing heat conductance to the skin. Large increments in cardiac output and compensatory vasoconstriction in the abdominal viscera make these vascular adjustments in work possible without circulatory embarrassment.
VALUE OF LONGITUDINAL STUDIES OF EXERCISE FITNESS TESTS
Authors: Sexton Alan W.
Published: December 2021

THE TERM "longitudinal study" implies observation or experimentation over a considerable period of time. Just what this period of time will be depends upon the phenomenon and the organism being studied. If, for example, one is interested in the growth rates of long bones in mice, a few months is sufficient. In human beings fifteen to twenty years would not be out of line since, wanting to know how the individual arrives at his ultimate length, one must measure him periodically during his entire growing period. To be worthwhile, therefore, the longitudinal study must be designed to answer questions which cross-sectional data cannot answer.

In order to discuss intelligently the value of longitudinal studies of exercise fitness tests, one must at the outset define what the objectives are in such studies. Consider the following questions:

1. What are the effects of growth, of sex, and of aging on the fitness of the individual?

2. In the absence of conditioning programs, is the level of fitness of an individual a rapidly-changing measurement, or does it demonstrate relative constancy?

3. When conditioning programs are considered, what is the effect of their onset, duration, and cessation on the individual level of fitness?

4. What are the immediate and longterm results of illness on the individual level of fitness?

5. What, if anything, can one say about the effect of fitness levels on the longevity of the individual?

The answers to these and related questions are the principle goals of longitudinal fitness studies. How successfully, then, have such longitudinal studies been carried out?
LOW BIRTH WEIGHT
Authors: SILVERMAN WILLIAM A.
Published: December 2021

SINCE THE First World Health Assembly in 1948, the international definition of prematurity based on birth weight (≤ 2500 gm) has been used widely and successfully for purposes of vital statistics concerning newborn infants. This definition is objective and subject to standardization in contrast to a classification based on estimates of gestational age which are dependent upon the mother's memory and menstrual regularity. On the other hand the taxonomic advantage of the birth weight criterion has tended to obscure the fact that fetal growth may be influenced by a number of factors; thus, size at birth is always an uncertain measure of the duration of gestation.
EFFECT OF AMNIOTIC FLUID ASPIRATION ON THE LUNG AND CIRCULATION
Authors: Colebatch H. J. H. , Halmagyi D. F. J. , Starzecki B.
Published: December 2021

The administration of 1-2 ml/kg body weight of human amniotic fluid into the trachea of anesthetized sheep caused a gross fall in lung compliance, an increase in resistance to air flow and severe hypoxemia, but only a slight rise in pulmonary arterial pressure. The changes in lung mechanics, and the hypoxemia, were not affected by forced inflation of the lungs; but after atropine sulphate, adrenaline, or aerosol isoproterenol, forced inflation produced marked improvement.

The effects of amniotic fluid aspiration resemble some of the features of the respiratory distress syndrome of the newborn. However, whether sheep amniotic fluid introduced into newborn lamb lungs would have an entirely similar effect remains to be proven.
Pulmonary Hyaline Membranes and Vascular Anomalies of the Lung
Authors: BOZIC C.
Published: December 2021

We have described an infant who died on the third day of life with typical hyaline membrane disease in all portions of the lung perfused by the pulmonary artery. The inferior portion of the left lower lobe, which was separately perfused by three aberrant vessels from the aorta, was emphysematous and had no hyaline membranes. It seems likely that the inequalities in oxygenation of the lung played a role in the localization of the disease.
Common Bullous Lesions—Presumably Self-Inflicted—Occurring in Utero in the Newborn Infant
Authors: MURPHY WILLIAM F. , LANGLEY A. LOUISE
Published: December 2021

A relatively common bullous lesion of the skin of the newborn infant has been described. It is presumed that these lesions are self-inflicted in utero as a consequence of vigorous sucking reflex in otherwise normal newborns.
AN ELECTRON MICROSCOPE STUDY OF THE FETAL DEVELOPMENT OF HUMAN LUNG
Authors: Campiche M. A. , Gautier A. , Hernandez E. I. , Reymond A.
Published: December 2021

Results of a study of lung ultrastructure in 13 human fetuses of about 1 to 6 months of gestation are reported. Light microscope controls were obtained in all cases. The columnar epithelial cells of young fetuses contained large deposits of glycogen which tended to become less abundant between the fourth and the sixth month. The fine structure of epithelial glycogen is described. A gradual transition between the columnar or cuboidal epithelium and the attenuated cytoplasmic lining of fully developed alveoli started during the fifth month, when the first contacts between capillaries and epithelium were established. Further differentiation of the epithelial cells in two morphologically different types, as observed in adult lung, took place during the sixth month. Both types appeared to have the same endodermal origin. Lamellar inclusions were first observed during the sixth month. Their significance is discussed in the light of recent work on alveolar surface activity.
LAWSON WILKINS 1894-1963
Authors: SCHAFFER ALEXANDER J.
Published: December 2021

IN THE death of Lawson Wilkins world Pediatrics has lost an outstanding leader. But this is only half the story. Pediatric endocrinology has lost its Dean and one of the builders of its foundations. Pediatric endocrinologists have lost their chief, their adviser, their teacher, and their constant friend. Pediatric practitioners have lost a delightful companion, as well as one who spared no pains to translate for them the complicated language of endocrinology into intelligible and usable clinical information.

Lawson was a scientist, to be sure, but he lived in no ivory tower. He was first and last a warm physician.
TWO YEARS, TEN MONTHS, AND TWO DAYS OF ACCOMPLISHMENT ON BEHALF OF THE HANDICAPPED
Authors: Cooke Robert E.
Published: December 2021

TODAY I speak with great personal sadness and humility concerning two years, ten months, and two days of accomplishment for the handicapped. Yesterday I called Dr. Denhoff and told him that because of my friendship with the President's family and my acquaintance with the President I did not feel I could or should speak today. A few hours later I changed my mind—I am glad I did so, because I am given an opportunity to say things I could not say at any other time. Though I am totally inadequate to eulogize President Kennedy, I probably know as well as anyone what he has contributed to the handicapped. Many tributes will be paid to many aspects of his life—his interests, his beliefs, his accomplishments.
TEMPERATURE REGULATION IN PREMATURE INFANTS
Authors: Adams Forrest H. , Fujiwara Tetsuro , Spears Robert , Hodgman Joan
Published: December 2021

Sixteen serial observations of oxygen consumption, carbon dioxide production, R.Q., respiratory rate, rectal temperature, and skin blood flow were made on six premature infants ranging in age from 3 hours to 12 days and weighing from 1.14 to 1.94 kg, utilizing a specially designed climatized chamber at neutral (32-34°C), low (21-23°C), and high (36-38°C) ambient temperatures. Ten premature infants ranging in age from 2½ hours to 18 days were studied at high (36-38°C) ambient temperature.

At low ambient temperature, there was a mean increase of 63% in oxygen consumption even in infants under 24 hours of age. At the end of the rewarming period, rectal temperature, which had been lowered during a 20-minute exposure to 21-23°C, nearly recovered to the original level in infants in both of the age groups of 0 to 24 hours and 2 to 5 days, whereas in the 6 to 12 day old group, it returned faster than the former two and it was increased by 0.32 to 1.9°C (mean 0.9°C).

At 36-38°C, ambient temperature, the mean oxygen consumption increased 18% in infants ages 2½ to 7½ hours, whereas there was no significant increase in infants ages 10 to 18 days. Sweating and significant vasodilatation generally did not occur even in the older infants. The respiratory rate was increased in most infants. It is suggested that heat loss through the respiratory tract might be important to the premature infant who has a lack of evaporative means at high ambient temperature.
CEREBRAL SPASTIC PARAPLEGIA AND PREMATURITY
Authors: Berenberg William , Ong Beale H.
Published: December 2021

Cerebral spastic paraplegia (cerebral diplegia) merits special consideration by those concerned with the care of young infants because of its diagnostic and prognostic pitfalls. The striking incidence of antecedent premature birth in this group, together with major delay in motor development and evidence of spasticity of the lower extremities, often erroneously suggest a poor prognosis at an early age. These features, combined with infrequent mental retardation, uninvolved speech, and a low incidence of convulsive seizures in an infant with striking disparity between upper and lower extremity involvement, emphasize the need for identification of this particular group within the general framework of cerebral palsy.
PHENYLALANINE HYDROXYLASE ACTIVITY IN NEWBORN INFANTS
Authors: Allen Richard J. , Heffelfinger John C. , Masotti Ronald E. , Tsau Makepeace U
Published: December 2021

One of the techniques that may be employed to expedite the diagnosis of phenylketonuria in the newborn infant is the phenylalanine load test. However, this is probably an impractical method for a routine examination but in the suspected sibling may permit rapid differentiation of an affected infant from one entirely normal. Also, carriers may simulate phenylketonuric infants so that the diagnosis must still rest on the appearance of abnormal metabolites in the urine.

Of 15 suspected infants, three proved to have typical phenylketonuria very early while four others demonstrated elevated phenylalanine levels in load tests in the newborn period and on serial follow-up, which might otherwise suggest the disease. Studies of these infants showed that they did not have phenylketonuria and that they were in all probability carriers. The carrier state which has been extensively studied in adults may therefore occur in the neonate and may be confused in the clinical diagnosis with the phenylketonuric infant. The proven phenylketonuric infants developed abnormal metabolites in the urine within the first few days of life so that the diagnosis could be corroborated by the simple ferric chloride test in addition to chromatographic methods which detected o-HPA and phenylalanine.

Also ten infants with phenylketonuria diagnosed at less than two months of age are included in this report. They consist of four infants who were "first cases" in the family and six infants diagnosed as the result of a known older sibling. Three infants were recognized by our study of 15 suspected newborns horn into 13 different families where phenylketonuria was known to be present. Positive urine ferric chloride tests appeared as early as two days of age and indicated that ferric chloride testing is useful in the newborn. If, however, the diagnosis is established by elevated serum phenylalanine levels the child should probably not be treated for phenylketonuria until other typical metabolites are identified.
THE ROLE OF ANTIBODY TO COW'S MILK PROTEINS IN THE SUDDEN DEATH SYNDROME
Authors: Gold Eli , Adelson Lester
Published: December 2021

The titers of antibody to cow's milk proteins were measured in four groups of children: (a) infants dead of known causes, (b) infants who died from the sudden death syndrome, (c) well babies fed cow's milk formulas exclusively, and (d) well babies fed both cow's and human's milk. No significant differences in mean antibody titer to cow's milk existed between the well, bottle-fed, and the sudden death groups. Sera with hemagglutinating antibody to cow's milk proteins induced a positive PCA reaction, indicating that the measured antibody was probably of the 7S type and capable of provoking the anaphylactic reaction in humans. No evidence was obtained to support the hypothesis that hypersensitivity to milk was causally related to the sudden death syndrome.
OXYGEN CONSUMPTION IN INFANT MALNUTRITION
Authors: Mönckeberg Fernando , Beas Francisco , Horwitz Isidoro , Dabancens Alfredo , González Margarita
Published: December 2021

Oxygen consumption was determined with a closed circuit apparatus in 52 normal infants and 22 marasmatic infants.

Oxygen consumption in marasmatic infants was similar to that of the normal ones when expressed in relation to the actual weight, but was significantly lower if expressed in regard to height.

The lower values were observed in marasmatic infants before recovery started (Group B), while those marasmatics that had started recovery (Group A), showed intermediate values between that of the normal infants and Group B.

The significance of these results has been discussed.
SEVERE RHEUMATIC MITRAL INSUFFICIENCY IN CHILDHOOD AMENABLE TO SURGERY
Authors: Yuan Shang-Hsien , Doyle Eugenie F. , Pisacano John C. , Reed George E.
Published: December 2021

A case of severe rheumatic mitral insufficiency in a 12-year-old boy invalided by chronic congestive heart failure and atrial fibrillation who was strikingly improved by mitral annuloplasty is described. The clinical course and cardiac catheterization findings before and after operation are outlined.

Indications for surgical relief of mitral insufficiency in the pediatric patient have been suggested. The problem of optimum timing of surgery after subsidence of acute rheumatic carditis is unsolved. Each case must be carefully evaluated. The case presented was less than two years from overt rheumatic activity at the time of surgery. We hope this case stimulates surgical consideration for the child with severe rheumatic mitral insufficiency since earlier operation in appropriate instances may prevent the onset of atrial fibrillation and progressively diminishing myocardial reserve.
Do We Need a Registry for PKU?
Authors: CUTTER RICHARD D.
Published: December 2021

Some years ago I wrote to the Secretary of the American Academy of Pediatrics suggesting that there might be merit in establishing a National Registry of Phenylketonuria. My suggestion was met with polite but not very enthusiastic interest. Subsequently, I discussed the matter with a distinguished academic pediatric biochemist, who suggested that what there was to be known about phenylketonuria was already pretty well known by the pediatric biochemists and that a carefully controlled statistical evaluation of the clinical aspects of the subject (that was what I had in mind in suggesting a national registry) would be a waste of time.
Clinical Toxicology of Commercial Products—Acute Poisoning (Home and Farm)
Authors: PRESS EDWARD
Published: December 2021

This book is an unusually detailed and comprehensive revision of an encyclopedic reference source on the composition of thousands of chemicals and a correlated practical guide to the first-aid and medical treatment of poisonings. It is an extremely useful resource for hospitals and physicians in the handling of accidental and intentional poisonings.

A new (8th) section has been added to the book based on the 1961 edition of Standard Nomenclature of Diseases and Operations and this should promote uniform classification of poisonings thus facilitating research and distribution of clinical data and experience in this area.
Pediatric Cardiology
Authors: LAMBERT EDWARD C.
Published: December 2021

In spite of the fact that he has made extensive changes from his first edition and has expanded it by 200 pages, Dr. Nadas has fortunately continued to express himself in a familiar, readable style, frankly basing most of his opinions largely on his own extensive experience and stating his prejudices in a Johnsonian fashion. Like Thoreau, he does not believe in omitting the I, or first person. This continues to be a text in the great tradition of those written by Sir Thomas Lewis, Paul Wood, and Samuel Levine—medical writing which has delighted students, house officers, practitioners, and cardiologists of our era because it makes available, in highly readable form, the personal opinions regarding the various aspects of cardiology by men who are both outstanding clinicians and teachers with great experience and who are able to express themselves clearly, vigorously, and colorfully.
MANIFESTATIONS AND TREATMENT OF CONGESTIVE HEART FAILURE IN YOUNG PATIENTS WITH RHEUMATIC HEART DISEASE
Authors: Feinstein Alvan R. , Arevalo Aida C.
Published: December 2021

This report analyzes the manifestations and treatment of 90 episodes of congestive heart failure in 40 children and adolescents with rheumatic heart disease. By use of specific clinical criteria, 34 episodes could be designated as part of "active" rheumatic inflammation, and 56 as "inactive."

The most common signs in "active" and "inactive" groups were hepatic enlargement or tenderness, tachycardia, distention of neck veins, peripheral edema, and weight gain. The most common symptom was dyspnea, but it often was absent and, when present, was usually unaccompanied by rales. Three symptoms uncommon in the congestive failure of adults were frequently noted: cough, nausea, and a right upper quadrant abdominal ache. The latter finding was due to hepatic tenderness, demonstrated by a positive "liver slap" test, that often preceded palpable hepatomegaly and was sometimes the first evidence of decompensation.

The "active" and "inactive" distinctions were therapeutically useful in that "active" episodes sometimes responded well to anti-inflammatory agents alone. Digitalis seemed to have equal occurrences of effectiveness or toxicity in "active" or "inactive" patients, and showed no major advantages over diuretics except when ventricular rates were rapid. In "active" patients, anti-inflammatory therapy seemed preferable and most beneficial only in the early untreated stages of the rheumatic attack. Although usually less effective than steroids for this purpose, salicylates were occasionally successful. Decompensation occurring as part of post-therapeutic rebounds in "active" patients could often be managed by digitalis or diuretics, without need for resumption of anti-inflammatory agents and their attendant risk of another post-therapeutic rebound. Except in the specific "active" and "inactive" instances cited above, we believe diuretics are a preferable first choice in the pharmaceutical treatment of the decompensated young rheumatic heart. Success with diuretics obviates not only the hazards of digitalis toxicity, but also the risk of inflammatory recrudescence after steroids.
ARE THERE "PYELOPATHOGENIC" E. COLI?
Authors: WHEELER WARREN E.
Published: December 2021

THE CAREFUL STUDY of urinary infections in a nursery by Sweet and Wolinsky in this issue raises the question: Are there "pyelopathogenic" strains of E. coli? Various workers have hinted that there are specific strains of this organism which cause pyelonephritis just as E. coli 0111:B4 causes infantile diarrhea. Vahlne, Ewing and Davis Rantz, Kunin and Halmagyi, and Turck et al. all found that the majority of urinary infections in older children and adults were caused by a few serotypes: O groups 1, 2, 3, 4, 6, 7, and 75 were found by most of these workers to be common urinary isolates.
SERUM MAGNESIUM LEVELS IN THE NEWBORN
Authors: Anast Constantine S.
Published: December 2021

Two hundred and thirty-eight determinations of serum magnesium levels during the first 4 days of life were carried out on 78 infants. No statistically significant differences were found when these values were compared to those determined in 111 older children and adults. Differences in mean values between any of the first 5 days were not statistically significant nor were any significant differences found when the values of each day were compared with the mean value of older children and adults or the mean value of the cord bloods. The mean values on days 3, 4, and 5 were higher in breast-fed infants than in infants fed evaporated milk. Higher values in breast-fed infants and lower values in evaporated-milk-fed infants on days 3 and 4 when compared to day 1 in the same infant were found in a significant number of cases. The possibility that the observed differences in these two groups of infants may be related to the difference in phosphate to magnesium ratio in cow's milk as compared to human milk is discussed. Further investigation of this problem is needed before definite conclusions can be drawn.
An Increased Incidence of Spina Bifida in Vermont in 1962
Authors: LUCEY JEROLD F. , MANN ROBERT W. , SIMMONS G. MILLARD , FRIEDMAN EDWARD
Published: December 2021

An increased incidence of spina bifida among live-born infants in Vermont during 1962 has been observed and documented. The average incidence for this congenital anomaly during the period 1952-1961 was 99 per 100,000 live births; in 1962 it increased to 232 per 100,000 live births. This is the second report of such an occurrence in the United States during 1962.

Epidemiologic studies failed to reveal any clues as to a possible teratologic agent.
CONGENITAL ISOLATED VENTRICULAR SEPTAL DEFECT, Erik Sande. Munksgaard, Copenhagen: Scandinavian University Books, 1963, pp. 219, $8.40
Authors: Talner Norman S.
Published: December 2021

This study of 87 patients with isolated ventricular septal defects aims to extend and coordinate current knowledge of the pathophysiology of this anomaly. Unfortunately the study is confined to the course of the disease after the age of 2 years and important information on the natural history of the defect in the first year is entirely lacking except for references to data obtained by other investigators and case histories of patients in the author's series. Repeat cardiac catheterizations, when performed, were carried out primarily in the 5-9-year age group, a period of stability as suggested by previous authors.
COPPER DEFICIENCY IN INFANCY
Authors: Cordano Angel , Baertl Juan M. , Graham George G.
Published: December 2021

In four severely malnourished infants who were rehabilitated on high-calorie, low-Cu diets, we have observed the appearance of severe anemia, marked neutropenia, scurvy-like bone changes, and hypocupremia. In 2 cases there was a prompt and dramatic response to Cu supplementation. In the other 2, slower but good responses were obtained with vitamin B12; supplemental Cu produced further responses. The Cu requirement of rapidly growing infants with poor stores is estimated at between 42 and 135 µg/kg/day.
EFFECTS OF OSMOTIC GRADIENTS ACROSS THE PRIMATE PLACENTAL UPON FETAL AND PLACENTAL WATER CONTENTS
Authors: Bruns Paul D. , Hellegers Andre E. , Seeds A. Elmore , Behrman Richard E. , Battaglia Frederick C.
Published: December 2021

Infusions of 2.7 g/100 ml sodium chloride or 30 g/100 ml disaccharide solutions into the maternal circulation of pregnant rhesus monkeys produced a significant reduction in fetal and placental total water content. At the same time large transplacental total solute concentration gradients were produced.

The injection of sucrose into the amniotic fluid of pregnant rhesus monkeys produced a reduction in fetal total body water alone. The significance of these differences is discussed.
DIAGNOSIS AND TREATMENT OF INGUINAL HERNIA
Authors: Swenson Orvar
Published: December 2021

INGUINAL HERNIA has always been of concern to the pediatrician as the commonest surgical condition to confront him in practice and one always carrying the hazards of incarceration. It has been estimated that a problem associated with inguinal hernia will arise at sometime or other in 20 out of every 1,000 of the population. In the more precise studies done in England, the Newcastle statistics indicate that about 10 out of every 1,000 children up to the age of 12 years have an inguinal hernia. It is my impression that this lesion is more hazardous to life than is appendicitis, for during the past 10 years I have seen two deaths in infants with incarcerated hernia and intestinal obstruction but observed no deaths from appendicitis. The diagnosis of inguinal hernia presents few difficulties. Usually, the mother notes in the infant a swelling, characteristically intermittent, in the groin or the scrotum. In older children a swelling present at the end of the day but obscure in the morning constitutes prime evidence for a hernia; swelling which disappears on pressure or when the patient is recumbent is pathognomonic. Examination for such a swelling should be performed each time the pediatrician examines a child. Although a hernia may not be apparent, if by rolling the cord structures over the pubic spine the examiner finds a thickened cord, this, in addition to a reliable history, is sufficient to establish the diagnosis and to warrant embarking on surgical treatment of the lesion. The vast majority of groin hernias are indirect inguinal hernias, in which the hernial sac traverses the internal ring, with the deep epigastric vessels lying inferior and medial to the sac.
GENETIC IMPLICATIONS OF RARE DISEASES
Authors: CHILDS BARTON
Published: December 2021

ELSEWHERE in this number of Pediatrics appears a splendid paper by Snyderman and others on the dietary treatment of "Maple Syrup Disease." This news of a successful treatment for so distressing a disorder will be greeted by cheers from all, but there will be also an obligato of groans from the many to whom the biochemistry and the means of measurement of amino acids and of their keto derivatives are formidable and alien. It is the lot and fate of all of us who are away from medical school for more than a few years to lose touch with some or many of the most rapidly changing aspects of the study of human biology, and because we are busy with our own work, we wish to have these advances laid out for us in comprehensive and comprehensible reviews, rather than to persist in the unequal struggle to read and to understand all the original work.