bluuebunny/crossref_metadata_2025 huggingface dataset:
TRANSMISSION OF POLIOVIRUSES
Authors: Wehrle Paul F. , Reichert Ralph , Carbonaro Ory
Published: December 2021

A partially immunized recreational school population in central New York has been studied during the course of an outbreak of poliovirus Type I infection. The data indicate that some increased resistance to poliovirus Type I infection occurred following immunization but that the effect was limited to extra-household contact and was not apparent within households where infection occurred regardless of the immunization status of either the presumptive source or contact.

Relatively poor antigenicity of the vaccine used seems the best explanation for the lack of demonstrable effect on prevalence of pharyngeal polioviruses among infected persons. The present study emphasizes the need for universal immunization if clinical poliomyelitis is to be effectively controlled with Salk-type poliomyelitis vaccine, and it further provides a base-line for studies with attenuated polioviruses in this population.
TRANSMISSION OF POLIOVIRUSES
Authors: Wehrle Paul F. , Carbonaro Ory , Day Paul A. , Whalen Joseph P. , Reichert Ralph , Portnoy Bernard
Published: December 2021

Isolation of polioviruses from pharyngeal secretions of previously immunized household contacts of persons with poliomyelitis is accomplished less frequently than among those not previously immunized. This is consistent with previous data indicating a greater influence of circulating antibody on poliovirus infection at that site. This is also consistent with antibody persistence or rapid recall upon infection following immunization with formol-inactivated vaccine.
MEASLES ENCEPHALITIS
Authors: Karelitz Samuel , Eisenberg Melvin
Published: December 2021

The histories of 42 patients with measles encephalitis were reviewed to evaluate the treatment, in particular to determine whether adrenal corticosteroids or adrenocorticotropin were helpful, beyond the results with usual supportive therapy.

There were no fatalities, but 13 patients had central nervous system sequelae on discharge; 9 of these had been treated with, and 4 without ACTH and/or corticosteroids.

Re-examination of 20 of the 42 cases 2 to 7 years after discharge from the hospital revealed that of 14 children treated during the acute phase of encephalitis with ACTH and/or corticosteroids, 12 had central nervous system sequelae, while only 6 of these 12 had manifested complications on discharge. Four of 6 untreated patients among the 20 followed-up had central nervous system sequelae, as compared to 4 of 22 at the time of discharge from the hospital.

The patient's condition on discharge from the hospital did not accurately indicate the future course; some sequelae became manifest later, others disappeared, some became milder and others worse.

Adrenal corticosteroids and ACTH administered to these patients did not prevent central nervous system complications.

The advisability of the use of these hormones in the management of measles encephalitis is questioned.

The survival of 42 consecutive patients indicates that some fatalities may be prevented by constant supervision and intensive supportive therapy.
EDUCATION
Authors: Badgley Robin F.
Published: December 2021

Three conclusions are deduced from the results presented.

First, attendance by patients at this pediatric clinic is highly selective by social class and racial backgrounds. Negroes and lower class whites are significantly over-represented. The ratio of Negroes attending the clinic to their expected representation is seven to one. One suspects Negroes may find this clinic more accessible than they do community practitioners. Although the patients attending the clinic are not representative of the community in which they reside, nevertheless they do provide the student with an excellent "testing ground" for future practice. Thus one of the main objectives of the clinic has been achieved.

The second conclusion focuses upon the types of diseases and the utilization of hospital services. Diseases, as would be expected, vary from one service to another. Two per cent of the pediatric ward patients and 4% of the emergency room patients were given diagnoses of psychobiological and psychoneurotic disturbances. In contrast, 25% of the pediatric clinic patients were in these categories.

Dr. Milton Senn believes that pediatric outpatient departments constitute a realistic testing ground for community practice. If this is so, and the prevalence of psychoneurotic disturbances in the community is but a fraction of the figure reported for the clinic, then this finding has broad implications for the treatment of such patients by pediatricians. Referring to the treatment of mentally ill children by pediatricians, Dr. Senn states:

The ordinary paediatric staff, even with some psychologic insight, is usually not trained well enough to cope with these children. In order to deal with them properly, psychiatric rather than paediatric hospital services are needed.
PRESIDENT'S MESSAGE
Authors: Wheatly George W.
Published: December 2021

Much thought is being given these days to the content of pediatric education for the future. Indeed, it has been under serious consideration for the past several years. Representatives of the American Board of Pediatrics, the American Pediatric Society, the Society for Pediatric Research, the Pediatric Section of the American Medical Association, and the American Academy of Pediatrics, constituting an ad hoc committee organized in mid-1960, have recommended the formation of a Joint Committee on Pediatric Education, Practice and Research, and have outlined a program to explore and study the various problems. Details of this report will be found in the report of our Committee on Medical Education, October, 1960. Your Executive Board has accepted this report and is prepared to do its full part in implementing the Committee's recommendations. This includes staff help, space at the Evanston headquarters, and sharing in the cost. I consider this a subject not only important but urgent.

Whenever a question as fundamental as the education involved in a specialty is raised, many points of view must be considered. In a democratic society, this is as it should be. It is essential that those most concerned, namely, those who must do the teaching and those who apply this education by direct service to the public, be heard. For this reason I have proposed that the regional meetings of our Medical Education Committee deal with the question and invite practitioners, as well as heads of pediatric departments, to these sessions. Too often the voice of the practitioner is not raised or perhaps not heard or heeded when professional education is under consideration. I hope that these meetings will get under way this year under the aegis of our Committee on Medical Education.

One of the points of view on the nature and future of our specialty which has been publicized, and thus perhaps over-emphasized, is that pediatrics has become debased by over-production of pediatricians and the simplicity of the service involved in taking care of children. To preserve the value of our specialty, it has been proposed that pediatricians should turn over "routine office care" to physicians less highly trained in child care, leaving "problem cases" to the true specialist. Aside from the fact that "routine office care" often presents an opportunity to the pediatrician to turn up incipient difficulties of many kinds, this concept is unrealistic, defeatist and unimaginative. It is unrealistic because medical practice in a free society, so long as the public has free choice of physician, will be determined by what the public wants and is willing to pay for.
FEMINIZING ADRENAL ADENOMA IN A 7-YEAR-OLD BOY
Authors: Mosier H. David , Goodwin Willard E.
Published: December 2021

Clinical findings in a case of feminizing adrenal tumor in a 7-year-old boy included gynecomastia, development of sexual hair and cryptorchidism on the left. The total excretion of estrogens in urine was 4 µg/24 hr, and of 17-ketosteroids, 9.1 mg/24 hr. The left testis was found to be normal on palpation after having been forced into the inguinal canal. By means of retroperitoneal pneumography a mass in the left adrenal was visualized. Removal of the tumor with the host adrenal was followed by a prompt return of steroid excretion to normal and gradual recession of the sexual hair and abnormally developed glandular tissue of the breast. The tumor appeared histologically to be a benign adrenal cortical adenoma. A 2-year period of observation has revealed no recurrences. Problems relating to the diagnosis of feminizing adrenal tumor in children are discussed.
STATUS OF SULFONAMIDES IN THERAPY OF INFECTIONS
Authors: Daeschner C. W. , Yow E. M.
Published: December 2021

MANY physicians will recall clearly the great enthusiasm that greeted the introduction of the sulfonamides into clinical medicine in 1935. For the first time the physician carried to the bedside a broadly effective chemotherapeutic agent for the management of bacterial infections. As new sulfonamide derivatives appeared, the pneumococcus, staphylococcus and streptococcus could be inhibited, and the common childhood infections—pneumonia, impetigo, otitis media, and tonsillitis—were managed effectively. Problems of urosepsis, bacterial meningitis and bacterial arthritis were often dramatically improved. Though drug toxicities were encountered, these were readily accepted by a grateful profession as a small price to pay for such an effective approach to the control of infectious diseases.

During the next 10 years sulfonamides of greater efficacy and lower toxicity continued to appear and rapidly expanded the clinical use of chemotherapy. With the introduction and widespread use of sulfadiazine in 1941-1942, sulfonamides reached a peak of popularity. This same period saw the introduction of the first antibiotic.
Procedures in Vascular Surgery
Authors: VOOREES ARTHUR B.
Published: December 2021

In the preface the author outlines the origin of this excellent, useful book. Starting as a guidance outline for residents at the Peter Bent Brigham and West Roxbury Veterans Administration Hospitals, it has had, since its inception, the advantage of constant critical review.

The text contains a remarkable amount of crisp information of a technical and practical nature, which is of considerable value to the student of vascular surgery at any level. Since no attempt is made by the author to cover cardiac surgery, the book is of somewhat limited pediatric interest.

The author has avoided encrusting his outline text with discussions of controversial practices.
CAUSES OF DEATH IN INFANTS WITH HEMOLYTIC DISEASE OF THE NEWBORN (ERYTHROBLASTOSIS FETALIS)
Authors: Van Praagh Richard
Published: December 2021

In a series of 882 infants with hemolytic disease, there were 82 fatalities, for which 74 necropsies were performed. In general, death resulted from severity of hemolytic disease in 59%, from delay in treatment leading to kernicterus in 18%, from profound late anemia in 3%, and from conditions unrelated to hemolytic disease in 20% of the cases in which necropsy was performed. Significant clinical and pathologic findings in the 74 infants were: anemia in 70%; aspiration of amniotic sac content in 55%; pulmonary hemorrhage in 54%; heart failure in 51%; with anascarca in 42%; death during or soon after the exchange transfusion in 32%; pneumonia in 19%; kernicterus in 18%; pulmonary hyaline membranes in 12%; rupture of the spleen in 5%; and cerebral intraventricular hemorrhage in 4%.

The risk of death during or soon after the exchange transfusion was 2% per patient and per procedure, if infants with hydrops or fatal lesions are excluded. The total risk was 4% per patient and 3% per exchange transfusion. Approximately one-third of all fatalities occurred during or soon following exchange transfusion. In approximately one-third of infants who died at this time, no adequate cause of death was found pathologically. Pulmonary hemorrhage did not differ significantly in incidence or in degree between kernicteric infants, nonkernicteric infants with hemolytic disease, and a control series. Rupture of the spleen occurred significantly more frequently in infants with severe hemolytic disease than in the control series. The important problems of death during or soon following exchange transfusion, and of hemorrhage in infants with hemolytic disease, merit further study.
Recent Advances in Human Genetics
Authors: MIGEON BARBARA
Published: December 2021

Recent developments in special techniques and their application to the study of heredity in man have led to exciting advances in a field that has always been of interest to pediatricians. Dr. Penrose has attempted to bring together in this small volume enough advances to "whet the readers' appetite for descriptions of other parts of the subject elsewhere." By design, a consideration of developments in human biochemical genetics, with exception of the hemoglobins, has been omitted. Included in eight chapters are discussions, by six distinguished contributors in addition to the editor, that are concerned not only with new knowledge in the areas of chromosomes, hemoglobins and linkage, but also with the elucidation of the cytologic, biochemical and statistical techniques that have made these advances possible.
CHONDROECTODERMAL DYSPLASIA (ELLIS—VAN CREVELD SYNDROME) WITH A COMPLEX CARDIAC MALFORMATION
Authors: Husson George S. , Parkman Paul
Published: December 2021

A 4-month-old girl with chondroectodermal dysplasia (dwarfism, bimanual polydactyly and ectodermal dysplasia) (Ellisvan Creveld syndrome) and congenital heart disease, consisting of anamalous pulmonary venous return, single atrium and a persistent left superior vena cava, is described. A review of the literature concerning chondroectodermal dysplasia reveals an incidence of congenital heart disease in more than 50% of patients.
IMPORTANCE OF AGE, SEX AND BODY HABITUS IN THE DIAGNOSIS OF LEFT VENTRICULAR HYPERTROPHY FROM THE PRECORDIAL ELECTROCARDIOGRAM IN CHILDHOOD AND ADOLESCENCE
Authors: Walker Colin H. M. , Rose Raymond L.
Published: December 2021

The electrocardiographic records of 849 normal individuals between the age of 1 and 16 years were studied, and the arithmetic sum of the voltages SV2 and RV5 were calculated. Values considerably in excess of those usually quoted were found to exist in this age group, the mean being 38.0 mm ± 9.7 and the range 15 mm to 65 mm. A new set of means and standard deviations for this index have been prepared.

Variations in these values are evident with advancing age, and these appear to be related to sex. Whereas there is no difference in voltages between the sexes in children under the age of 11 years, over this age the females present values which become progressively smaller with the advance of puberty (both in relation to their previous values and to the values found in males), reaching a mean level 17 mm lower than that of the males by the age of 16 years. The males show no significant difference in voltage after and before the age of 11 years, while the females do. The possible causes for these trends have been briefly discussed.

As a result of this study and in contradistinction to adult experience it is considered unwise to rely on precordial voltage alone as an index of left ventricular hypertrophy unless the SV2 + RV5 value is greater than 60 mm in children less than 11 years of age, or greater than 55 mm in females and 65 mm in males past 11 years of age.
THE PEDIATRIC IMPLICATIONS OF BLADDER NECK OBSTRUCTIONS
Authors: Berman Leonard B. , Crotty John J. , Tina Leticia U.
Published: December 2021

Forty-seven cases of bladder neck obstruction in children ranging from the age of 6 months to 9 years are analyzed in detail. A great preponderance of females and a scarcity of Negro children is noted in the study. From the data it appears that a large number of cases of undiagnosed bladden neck obstruction exist in pediatric practice. The most frequent clinical manifestations are related to infection of the urinary tract, which complicates the obstruction. The diagnosis should be suspected automatically in the presence of infection or a disordered pattern of urination. Careful attention should be given to the presence of pyuria and to the post-voiding urogram. Cystoscopy is usually definitive. Relief of the obstruction is considered essential, but this may not always have an immediate effect on the course of the urinary tract infection.
PLATELET ENUMERATION IN THE NEONATAL PERIOD
Authors: Ablin Arthur R. , Kushner Joseph H. , Murphy Arlene , Zippin C.
Published: December 2021

Two hundred four platelet counts for 105 infants between birth and 4 days of life were determined by phase microscopy. Resuits were analyzed for sex, race, weight and age, without any significant difference in counts being found. No significant trend (increase or decrease of the platelet count) during the period of study was demonstrated. The platelet count as determined by phase microscopy for the normal neonate during the first 4 days of life is 200,000 ± 100,000/mm3.
CLINICAL CONFERENCE
Authors: Rozenfeld Irving H.
Published: December 2021

WE HAVE recently seen two youngsters whose presenting complaints were highly suggestive of spinal cord disease but whose lesions were far removed from this area. We believe this deserves emphasis.

CASE REPORTS

Case 1

The first patient was seen initially when he was 14½ years old, complaining of vague pains in his night knee and thigh. This pain was intermittent, slightly worse at night, but did not interfere with the patient's activities. Physical examination was entirely negative. There was no local tenderness, limitation of motion or limp. Roentgenograms of the knee, thigh and hip were interpreted as negative, and the patient was advised to limit activity temporarily.

Although he was subsequently seen for minor respiratory infections, there was no further mention of pain. Eighteen months later, the patient's mother called to say that she had just noticed that the right leg was thinner than the left.

When seen, however, the patient, now 16 years old, reported that pain in the leg had continued during the 18-month period. There was no specific localization of the pain; it was worse at night and responded to heat, massage and aspirin. He had pain occasionally during the day and had limped for the preceding several months. This however did not stop him from playing football and baseball. He reported further that he first became aware of the thinness of the right leg about 4 months previously but had not told anyone. Furthermore, he reported an 11-lb weight loss during this 4-month period.

On examination, there was marked atrophy of the entire right leg, as shown in Figure 1.
On Feeding at the Breasts
Authors: JONES WILLIAM O.
Published: December 2021

To the Editor:

A decreasing percentage of new mothers and their newborn babies are experiencing the pleasurable opportunity of breast feeding. It seems apparent that this once-universal method of furnishing our young with their nutritional and sucking needs will become less common as time moves on. It is my conviction that the mother who is interested in breast feeding her nextborn child should be given proper encouragement as well as the best advice in the implementation of the desire.
Gamma-globulin in Prevention of Hepatitis
Authors: STOKES JOSEPH
Published: December 2021

To the Editor:

In Pediatrics, 28:514-515, 1961 are a letter from Sydney S. Gellis, M.D., and James A. McComb, D.V.M., and a reply from the Committee on the Control of Infectious Diseases, which appear to be contradictory, concerning previous recommendations in earlier studies on the control of epidemic hepatitis. I should agree with the major points made by Gellis and McComb: "We firmly believe that 10 years experience should not be abruptly discarded on the basis of a single clinical trial."
A CHILD-ORIENTED APPROACH TO TOILET TRAINING
Authors: Brazelton T. Berry
Published: December 2021

Results of toilet training obtained from the records of 1,170 children in pediatric practice over a 10-year period are summarized. The suggested method stressed the child's interest and compliance in developing autonomous control. This was instituted at about 2 years of age and depended on his physiologic and psychologic readiness.

Initial success was achieved simultaneously in both bowel and urinary control in 79.5% of the cases, 12.3% in bowel control alone, and 8.2% in urinary control. This first accomplishment was reached at an average age of 27.7 months. Daytime training was completed between 2 and 2½ years of age in 80.7% of this group. The average age for day training was 28.5 months; males and females showed no significant difference; first children were 1.2 months slower than their siblings. Night training was accomplished by 3 years in 80.3% of cases. The average age for completion of all training was 33.3 months. Males took 2.46 months longer for complete training. First children were delayed 1.7 months in complete training in relation to their siblings.

Of the children who had chronic difficulties in this area, 76 (6.5%) were untrained at 4 years, and 16 (1.4%) were failures by the age of 5 years. The value of such a child-oriented program in preventing residual symptoms is stressed.
FOOD HYPERSENSITIVENESS?
Authors: Morishima Akira , Kessler Walter R.
Published: December 2021

Two cases of presumed food allergy are presented in infants who showed acute constitutional reactions following ingestion of commonly used foods; squash in one and sweet potatoes in the other. The manifestations of the reaction were delayed, taking place approximately 90 minutes after ingestion of the offending foods. Skin tests by the passive transfer method failed to reveal any sensitizing antibody in the patients' circulating blood. It is pointed out that a more reliable method to demonstrate antigen-antibody mechanism is needed in the study of food allergy.
THE ACADEMY 1960-61
Authors: Wheatley George M.
Published: December 2021

This will be a brief report about some important national programs and actions since our annual business meeting a year ago. While they help demonstrate the Academy's influence and breadth of interest in child health affairs, these developments also are a challenge to our leadership. How to keep pace with this broadening public interest and also maintain a private practice is the dilemma of most pediatricians. It can be done, it must be done, and it will be done, if each of our members takes seriously the obligation of Fellowship.

As an organization we continue to grow at an impressive rate. In the past 10 years our membership in the United States has more than doubled. Altogether there are slightly more than 7,000 members in the Academy. Of these, more than 5,700 are in the United States, 231 in Canada and 940 in Latin America. With greater size comes a greater problem in communication. The annual business meeting—though it serves an important purpose in this respect—is not enough. Our News Letter is becoming increasingly useful as a means of reaching all our members. The brochure "An Introduction to the American Academy of Pediatrics," published this year, fills the need for a brief description of the purpose, organization and program of the Academy. A new publication, Careers in Pediatrics, soon to be issued will give young people some better understanding of pediatrics and show them that as a specialty it has many inviting possibilities. This all helps.

But for the Academy of fulfill its purpose to improve the health of all children, it must mobilize the ideas and efforts of all its members.
CHOLECYSTITIS AND CHOLELITHIASIS IN CHILDREN
Authors: Sorge Dominick V.
Published: December 2021

Four cases of gallbladder disease in a young age group are presented. Etiologic factors are discussed. Although gallbladder disease in children is uncommon, it should be ruled out in patients who present with abdominal complaints, especially with symptoms consistent with gallbladder disease.

A good medical, economic and family-racial history is, as always, very important. There may be a female preponderance for cholelithiasis, even in children. A higher index of suspicion in the differential diagnosis of abdominal complaints may lead to a higher percentage of pre-operative diagnoses.
CYTOMEGALIC INCLUSION DISEASE ASSOCIATED WITH HYPOPARATHYROIDISM
Authors: Curtis John C. , Dodge Warren F. , Daeschner C. Wm.
Published: December 2021

The presence of both cytomegalic inclusion body disease and hypoparathyroidism seems well established in the case reported here. Symptoms of the former antedate the onset of symptoms characteristic of the latter. A more definite causal relationship could be established only by surgical exploration of the neck and the finding of cytomegalic inclusions in the parathyroid tissue. The latter procedure could not be justified under the circumstances, so the possible etiologic relationship must rest upon circumstantial evidence.
VACCINATION AGAINST VIRUS DISEASES
Authors: Hodes Horace L.
Published: December 2021

Great advances in the science of virology have raised the reasonable hope that all serious virus diseases which affect large portions of mankind will eventually be brought under control by the use of virus vaccines. It has been apparent for some time to virologists that a number of specific problems must be solved before the safest and most effective method of vaccination against each virus disease can be determined. This is readily understood with vaccines in the field trial stage, such as measles virus vaccine. However, to a lesser extent the statement is true even for virus vaccines of proven efficiency, such as the poliomyelitis and influenza virus vaccines.
PROTRACTED JAUNDICE ASSOCIATED WITH HYPERTROPHIC PYLORIC STENOSIS
Authors: Nakai Hisayo , Margaretten William
Published: December 2021

Five patients with hypertrophic pyloric stenosis are described, in whom protracted jaundice could not be attributed to any other disease. Their course was characterized by indirect hyperbilirubinemia, similar to that in three previously reported cases. It seems reasonable that, in those patients with early onset of jaundice, factors such as physiologic hyperbilirubinemia may account for the early phase, but prolonged or second-phase hyperbilirubinemia may be caused by under-perfusion of the liver as a result of increased intra-abdominal pressure due to the gastric dilatation of pyloric stenosis. Pyloric stenosis should be considered in infants with unexplained protracted or cyclic indirect hyperbilirubinemia.
SYNDROME OF HEMOLYSIS, THROMBOPENIA AND NEPHROPATHY IN INFANCY
Authors: Javett S. N. , Senior B.
Published: December 2021

Five cases of a syndrome occurring in infancy, characterized by acute hemolysis, thrombopenia and nephropathy are described. In each case the illness was preceded by a mild diarrhea, the main onslaught following after a symptom-free period of 1 to 10 days. Azotemia and oliguria were the most serious features of the disease. The convulsions exhibited by two of the patients in the introductory phase of the illness were probably due to hypertensive encephalopathy. The infants were treated with intravenously given fluids, blood transfusion and steroids. All recovered completely, though in all likelihood this was determined less by the treatment than by the extent of the renal damage present. Results of bacterial and viral studies of blood, urine, stool, throat and cerebrospinal fluid were negative in all cases. Despite the failure to identify a pathogen, the possibility that the disease was excited by an infection best fits the facts of the described cases. It is suggested that the mechanism may be an allergic response to a viral infection.
EFFECTS OF BODY-TILTING ON THE RESTING END-EXPIRATORY POSITION OF NEWBORN INFANTS
Authors: Avery Mary Ellen , O'Doherty Neil
Published: December 2021

Previous studies of changes in lung volume with position in adults demonstrate the efficacy of gravity methods of artificial respiration. In the present study the ventilation was measured that could be achieved by changes in body position of normal new-born infants. In no instance was the volume of air moved equal to a tidal volume. The failure of this method to achieve ventilation in infants may be due to their shorter abdominal length and more compliant rib cage.
ANOMALOUS ORIGIN OF THE LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY (ADULT TYPE)
Authors: Agustsson M. H. , Gasul B. M. , Lundquist R.
Published: December 2021

The case of a 7-year-old white female with an anomalous left coronary artery from the pulmonary artery is presented. The clinical findings of an asymptomatic patient with a continuous murmur at the left lower strenal border, with left ventricular hypertrophy by roentgenography and electrocardiography raised the suspicion of an aortic fistula, which was then investigated by retrograde aortography. The aortogram demonstrated the anomalous origin of the left coronary artery with retrograde flow into the pulmonary artery. The age and circumstances of death in previously reported cases indicate that the so-called adult type is not a benign disease. The diagnosis of an anomalous coronary artery from the pulmonary artery is at any age an indication for consideration of surgical intervention.
ACCIDENTAL CARDIAC PUNCTUREDURING RIGHT HEART CATHETERIZATION
Authors: Lurie Paul R. , Grajo Maria Z.
Published: December 2021

Four instances of accidental puncture of the heart during venous cardiac catheterization are described. Two of these punctures were of right auricular appendages, and two were of thick hypertrophied right ventricles. All instances were in infants less than 4 months old. In two cases death occurred as the direct result of the accident, in one the accident was the precipitating cause, while in the fourth case there was no recognition of the episode and the evidence was discovered accidentally at surgery several weeks later. Some possible causal factors were subjected to experimental study. It is concluded that persistence in catheter manipulation plays a considerable role and must be tempered by judgment of the patient's needs. Excessive stiffness of the catheter must be avoided in selection and sterilization. The small infant especially presents the risk of catheter puncture because of the short distance between the point of application of force and its point of contact with the heart. The infant also has a very narrow "venous sleeve" through which the catheter is passed, thereby producing more rigidity by extrinsic support. Thus the possibility of cardiac puncture is an important reason for deferring catheterization at least beyond the age of 6 months if possible. If it must be performed early, it should be with concern and preparation for this eventuality. If puncture is recognized, the catheter tip should be left in the pericardial sac until the wound is surgically closed.
Hyaline Membranes in Lebanon
Authors: Younozai M. K.
Published: December 2021

Because of recent interest in the geographical incidence of hyaline membrane formation in the lungs of infants dying in the newborn period, the following observations are reported.

Between July 1, 1948, and June 30, 1958, there were 7,131 live births at the American University Hospital in Beirut, Lebanon. There were 117 known deaths during the first month of life. Autopsies were performed on 91 infants (78%). With use of the criteria of Potter,1 sections of the lungs of the 63 infants who died during the first 3 days of life were reviewed.
Full-term and Low Birth Weight
Authors: Gruenwald Peter
Published: December 2021

It has been customary to determine prematurity by birth weight alone, even though the shortcomings of this practice have been pointed out convincingly, for instance, by McKeown and Gibson.1 The World Health Organization has recently taken cognizance of this problem, realizing that its previous recommendation of a birth weight limit of 2,500 gm is but a temporary expedient while no better method is available to define, study, and manage prematurity. The new, brief report2 points out the numerical magnitude of the problem by stating that among infants of healthy, young primigravidae receiving good obstetrical care, only two-thirds of those weighing less than 2,500 gm are born before the thirty-eighth week.
IATROGENÉSIS PEDIÁTRICA
Authors: Byers Randolph K. , Childs Barton , Gordon Harry H. , Hodes Horace L. , Kretchmer Norman , McKay R. J. , Ordway Nelson K. , Schulman Irving , Wallace William McL. , Wegman Myron E. , Wishik Samuel M. , Smith Clement A.
Published: December 2021

Under this title a distinguished Latin American member of the Academy, Dr. Alfredo Ceballos Carrión, Professor of Pediatrics in the University of Guayaquil, Ecuador, has written an interesting article,1 reviewing for his colleagues the many ways in which activities of a physician may provoke or enhance disease in a child, during the course of zealous efforts to cure and heal. Among other factors to which Dr. Ceballos refers is that of unwise, ill chosen, or unnecessary medication. Certainly the vastly increased armamentarium of effective drugs at the disposition of modern physicians has opened enormous possibilities for them to benefit patients.
CONGENITAL DEFECTS OF THE CENTRAL NERVOUS SYSTEM ASSOCIATED WITH HYPERENDEMIC GOITER IN A NEOLITHIC HIGHLAND SOCIETY OF NETHERLANDS NEW GUINEA
Authors: Gajdusek D. Carleton
Published: December 2021

A recently discovered, isolated, and still neolithic population in the interior Highlands of Netherlands New Guinea has been studied, in which most, and perhaps all, of the members suffer from varying degrees of congenital central nervous system damage. This damage ranges from subtle degrees of mental subnormality to severe feeble-mindedness often associated with deafness or deaf-mutism. In this region about one-fourth of the males and two-thirds of the females are found to have goiter. In some hamlets the incidence reaches 100% among the adult females. Many of these goiters are among the largest reported in world literature.

The extreme isolation and the high incidence of this congenital goitrous cretinism of varying degrees of severity make this region ideally suited for studies of both the genetic and environmental factors which determine the defects in this population. Similarly, they offer an unprecedented opportunity to investigate the etiology and pathogenesis of central nervous system defect associated with endemic goiter. The possibility that an unusual use of sweet potato leaves as a dietary staple in a region wherein the total nutritional balance is marginally adequate may play a role in the medical situation is under investigation. Metabolic and biochemical studies will be reported in subsequent papers in this series. Other medical problems of the area are briefly discussed and the distribution of goitrous areas in New Guinea is reviewed.
AN EPIDEMIC OF ASEPTIC MENINGITIS SYNDROME DUE TO ECHO VIRUS TYPE 6
Authors: King Dudley L. , Karzon David T.
Published: December 2021

Ninety-three patients with aseptic meningitis syndrome due to ECHO virus type 6 were evaluated 3 years following their acute infection to determine the extent of neuromuscular residua. In addition, 9 patients with aseptic meningitis due to other enteroviruses and 19 patients with paralytic poliomyelitis were similarly evaluated. Forty-four individuals with no history of central nervous system disease were studied for comparison.

Residua following aseptic meningitis were minimal and fell into two categories: 1. Approximately 20% gave a history of minor changes in behavior, easy fatigability, headaches or pain, stiffness or subjective weakness of the back or legs, the onsets of which were associated with the acute illness. 2. On examination approximately 25% revealed subtle neuromuscular changes such as altered reflexes, minor weaknesses in anterior neck or trunk muscles, or slight skeletal abnormalities, particularly scoliosis. The group with no history of central nervous system disease demonstrated an appreciable, but somewhat lesser, incidence of minor neuromuscular changes, further tending to minimize the specific significance of the findings in the study group.
COMMENT ON METABOLIC BALANCE STUDIES AS A METHOD OF ESTIMATING BODY COMPOSITION OF INFANTS
Authors: Fomon Samuel J. , Owen George M.
Published: December 2021

It seems probable that several factors must be considered jointly in explaining the falsely high body content of protein calculated on the basis of nitrogen balance studies. Of these, the most important are probably cumulative errors in balance techniques, nitrogen loss in sweat and desquamated epithelium, and differences in retention of nitrogen during balance studies and in intervals between balance studies. Confirmation or refutation of the conclusion based on metabolic balance studies—that feeding of high-protein diets results in accumulation of relatively large amounts of protein in the body—must certainly come from assessments of body composition of normal infants made with techniques other than metabolic balance studies.

Similar errors are inherent in calculating body content of calcium, phosphorus, sodium, and other minerals from results of metabolic balance studies. However, in these instances the systematic procedural error will be relatively greater because a smaller percentage of the intake is retained. With some substances, e.g., sodium and potassium, failure to measure losses from skin will introduce a much greater error than is the case with nitrogen.

The unsuitability of metabolic balance studies as a means for estimation of body content of a substance indicates that the absolute values obtained with the methods are not precise. The methods are nevertheless useful when only relative results are sought, as in the nutritional evaluation of two foods fed to comparable groups of infants at similar intakes of nitrogen or in comparison of performance of normal subjects with subjects having certain metabolic abnormalities. The usefulness of balance technique is also obvious in the study of patients in whom large retention or losses are to be anticipated.
PROTRACTED JAUNDICE ASSOCIATED WITH HYPERTROPHIC PYLORIC STENOSIS
Authors: Nakai Hisayo , Margaretten William
Published: December 2021

In the Article entitled "Protracted Jaundice Associated with Hydpertrophic Pyloric Stenosis," by Nakai and Margaretten, in PEDIATRICS(29:198, 1962) an error appeared. On page 200, second column, third line from the bottom, the word "appear" should have been "disappear."
GLUCOSE-6-PHOSPHATASE DEFICIENCY GLYCOGEN STORAGE DISEASE
Authors: Howell R. Rodney , Ashton Doris M. , Wyngaarden James B.
Published: December 2021

Three siblings with glycogen storage disease have been studied. These children demonstrated the classic physical findings of von Gierke's disease. Liver enzyme assays on one sibling revealed very low glucose 6-phosphatase activity. Hepatic phosphoglucomutase, phosphorylase, glucose 6-phosphate dehydrogenase, and fructose 1,6-diphosphatase activities were within normal limits. Erythrocyte glucose 6-phosphate dehydrogenase activity was also normal.

Incubation of liver slices with glucose 1-C14 and glucose 6-C14 revealed an initial rate of C14O2 production at which CO2 from C-1 was three times that from C-6. This is strong evidence for the active operation of the phosphogluconate oxidation pathway in this patient, and taken with the normal assay value of hepatic glucose-6-phosphate dehydrogenase, constitutes a negation of the concept of a dual enzyme defect recently proposed for von Gierke's disease.

Striking elevations of free fatty acids in serum, triglycerides, phospholipids, cholesterol, and blood ketones were noted. Potential mechanisms for these elevations have been discussed.

Marked hyperuricemia was a persistent finding and was associated with a somewhat low renal clearance of urate in the one patient studied. All three had striking elevations of lactic acid in blood, which is known to interfere with renal urate excretion. Thus renal factors may have contributed to the hyperuricemia, previously considered solely a consequence of enhanced nucleoprotein catabolism secondary to persistent hypoglycemia.

Long-term intramuscular administration of glucagon did not produce significant clinical or laboratory improvement in the one patient in whom it was employed.
TEMPORAL LOBE SYNDROME IN CHILDREN
Authors: Bray Patrick F.
Published: December 2021

Twenty children with a well-defined temporal lobe electroencephalographic focus were studied for a period averaging 7 years. A careful search was conducted for etiologic factors, and correlation of psychological patterns with electroencephalographic findings was carried out. In addition neurologic deficit, psychometric findings and social adjustment were studied.

A genetic etiology was suspected in half of the patients on the basis of a clear history of epilepsy, a severe psychiatric disturbance, or the presence of a temporal lobe focus in a close relative, although a familial incidence was well documented in only 3 of the 10 patients. Hippocampal sclerosis secondary to herniation of the temporal lobe uncus and compromise of its circulation was thought to be etiologic in two small premature infants who experienced marked neonatal asphyxia, and in one child who suffered a severe head injury. A cystic astrocytoma had caused focal motor seizures in one patient for a 7-year period prior to its total removal.

A wide pattern of psychologic diagnosis was noted, ranging from four normal to six psychotic, four hyperactive, four neurotic and two retarded children. All psychotic children had either a unilateral midtemporal spike focus or spike foci arising independently in both temporal lobes. Three of the four patients with bilateral abnormalities were psychotic, a finding that might be related to the bizarre behavioral changes in animals which have undergone bilateral temporal lobectomy. Neurologic abnormalities were restricted to mild speech disorders in two patients with normal intellect, a finding possibly related to the expressive language functions centered in the temporal lobe.

Eighteen of the 20 patients were functioning in the normal intellectual range, 2 were mentally deficient and the other 3, although functioning in the subnormal range, had normal intellectual potential.

Social maladjustment, resulting from serious behavioral and psychologic disturbances and incomplete control of psychomotor seizures, affected 15 of the 20 patients in the early phase of the study. Follow-up examinations revealed improvement in six of the socially handicapped patients. This improvement occurred with all types of temporal lobe electroencephalographic abnormality, excluding those with anterior temporal spike activity.

All 11 patients who had psychomotor seizures were incompletely controlled after vigorous, prolonged attempts at medical management. Grand mal attacks were seen in 15 of the patients and were easily controlled. Surgery for the relief of seizures was performed in three patients and benefited only the one whose tumor was removed. The other two patients, who underwent limited subpial resections, showed no improvement.
Unsterile Formulas
Authors: Grossman Elmer R.
Published: December 2021

As a pediatrician who has taught unsterile formula preparation for several years, I was unconvinced by the Report of the Committee on Fetus and Newborn on this topic in Pediatrics (28:674, 1961).

It seemed to me that the weakness of their position was exemplified by the last paragraph of the report which recommended that formulas be sterilized "until the age of the infant, the care and co-operation of the parents, and the initial cleanliness and safety of the milk and supply of water would offer reasonable assurance that the sterilization of the preparation could be stopped."
The Resident in the Non-university Hospital
Authors: Fink H. William
Published: December 2021

I write with concern for the future of good community hospitals with qualified attending pediatricians and plenty of patient material but no residents. In the ever-increasing competition for residents, such hospitals are slowly being strangled by the more fortunate university hospitals with their access to medical students and interns. I fear that the ultimate consequences will be the downgrading of pediatric practice throughout the county in those areas where there is not a medical school.
EDATHAMIL CALCIUM DISODIUM (VERSENATE) DIAGNOSTIC TEST FOR LEAD POISONING
Authors: Whitaker Jo Anne , Austin Wm. , Nelson John D.
Published: December 2021

In the article entitled "Edathamil Calcium Disodium (Versenate) Diagnostic Test for Lead Poisoning," by Doctors Whitaker, Austin, and Nelson, in Pediatrics, 29:384, March, 1962, a decimal point has been omitted. On page 385, the first line of the text should be corrected to read "procaine to make 1.5% procaine solution."
INBORN ERROR OF HISTIDINE METABOLISM
Authors: Ghadimi H. , Partington M. W. , Hunter A.
Published: December 2021

A 3-year-old girl with fair hair and blue eyes came under observation because of speech retardation. The patient was given a phenylalanine-free diet, since persistently positive urine tests with ferric chloride and reagent strips (Phenistix) were strongly suggestive of phenylketonuria. On further investigation she was found to be suffering from a totally different and not heretofore recognized condition, the salient features of which were an abnormally high concentration of histidine in the blood and an excessive output of histidine in the urine. The child's sister, one year older, presented the same metabolic anomaly. In each case both the concentration of histidine in plasma and the daily output were directly related to the amount of protein in the diet; but even at their lowest levels they greatly exceeded those of normal children of the same age. An oral load of histidine was followed by an increase of histidine in plasma much higher and more prolonged than that observed in controls, and by the excretion of a much larger fraction of the ingested dose.

The urine of each sister contained not only excessive amounts of histidine but also notable quantities of imidazole-pyruvic, imidazole-acetic, and imidazole-lactic acid, histidine derivatives of which normal urine contains only traces. It is concluded that in the two sisters the normally predominant pathway of histidine catabolism, which leads through urocanic acid to glutamic acid, was partially or completely blocked. Since, even after histidine loading, the urines never contained detectable amounts of urocanic acid, the block must precede the formation of that substance. The condition presented is therefore due primarily to a deficiency or total lack of histidine-alpha-deaminase; the enzyme which converts histidine to urocanic acid. As a result of this defect histidine is forced to take the alternative but less efficient pathway which begins with its transamination to imidazole-pyruvic acid. This substance is the one responsible for positive reactions in the ferric chloride and Phenistix tests.

All urine specimens examined, whether from the patient or from normal controls, contained considerable quantities of an unidentifiable imidazole compound ("X"), which does not appear to have been previously reported. The existence of this substance may call for some modification of current concepts of histidine metabolism in man.
AN EVALUATION OF THE ICTEROMETER
Authors: Morrison R. T. , Wilkinson D.
Published: December 2021

The icterometer does not appear to be very reliable as a means of estimating concentrations of bilirubin in serum, or as a screening device to decide when bilirubin determinations should be done by the laboratory. At present, except for those infants known to have blood group incompatibilities, we continue to measure bilirubin concentrations on all newborn infants who appear jaundiced within 24 hours of birth, or who subsequently become severely jaundiced, rather than to depend upon the icterometer.