bluuebunny/crossref_metadata_2025 huggingface dataset:
STUDIES OF RESPIRATORY PHYSIOLOGY IN CHILDREN
Authors: Cook Charles D. , Bucci Giovanni
Published: December 2021

The results of follow-up pulmonary function studies of nine previously lobectomized children without residual lung disease and one pneumonectomized and seven lobectomized children with residual disease are presented. From the studies of patients with remaining normal lung tissue, it appeared that there was little or no tendency to compensatory increase in volume or number of remaining lung units or compensatory changes in the pulmonary capillary bed. The discrepancy between these conclusions and those of others who have shown overdistention may be based on the lack of residual disease in this group of patients and/ or the less extensive removal of lung tissue.

In the patients with residual disease, there was evidence of obstructive emphysema and an indication of slight increase in diffusion and pulmonary capillary blood volume. The poor results with penumonectomy when there is chronic obstructive dissease in the remaining lung are illustrated by the presentation of a case.
RESPIRATORY RATE, TIDAL VOLUME AND VENTILATION OF NEWBORN INFANTS IN THE PRONE AND SUPINE POSITIONS
Authors: Bruns W. T. , Loken K. O. , Siebens A. A.
Published: December 2021

The respiratory rate, tidal volume and ventilation were measured in newborn infants with a body plethysmograph. A continuous recording revealed that, with one exception, no significant change occurred in these parameters when seven mature infants were turned from supine to prone position or vice versa. Two mature infants with periodic breathing, one of whom had congenital heart disease, exhibited periods of apnea when placed from the supine into the prone position.
Letters to the Editor
Authors:   COMMITTEE ON CONTROL OF INFECTIOUS DISEASES
Published: December 2021

The dosage of gamma-globulin recommended for adults for the prevention of hepatitis with jaundice in the 1961 edition of the "Redbook" of the American Academy of Pediatrics has been questioned by Drs. Gellis and McComb in the preceding communication. The Committee on Control of Infectious Diseases, which is charged with the revision of the "Redbook," realizes that the optimum dose of gamma-globulin for adults is not known. Although there is good evidence based on well-controlled studies that 0.01 ml/lb is effective in preventing jaundice in children, comparable evidence is lacking for adults.
ASSOCIATION OF COXSACKIE VIRUSES WITH ILLNESSES RESEMBLING MILD PARALYTIC POLIOMYELITIS
Authors: Magoffin Robert L. , Lennette Edwin H. , Schmidt Nathalie J.
Published: December 2021

Viral diagnostic studies were done in 1,210 cases clinically diagnosed as poliomyelitis or aseptic meningitis. Fairly severe paresis was observed in one instance among 182 patients whose stools yielded a Coxsackie virus; 24 others were clinically regarded as having paralytic poliomyelitis on the basis of mild to moderate paresis of one or more muscle groups, accompanied in some instances by muscle pain and back pain, and appearing in the course of an acute meningitic syndrome. These 25 patients comprised 5% of the 497 clinically classified as having paralytic poliomyelitis, for whom viral studies were done. The types of Coxsackie virus recovered included A9 (3 cases), B2 (6 cases), B3 (1 case), B4 (8 cases), B5 (6 cases), and in one instance both B4 and B5.

Serologic studies in 16 of the 25 patients revealed equivocal evidence of poliomyelitis in two cases, but in the remainder it appeared unlikely from the antibody pattern that poliovirus infection could have been associated with the present illness. There was no occurrence of paralytic poliomyelitis in members of the family of any of these patients, but in two families siblings of the patient experienced a milder febrile illness and also excreted the same type of Coxsackie virus as recovered from the patient. The laboratory diagnosis of Coxsackie virus infection was further supported by significant titer rises (4 cases) or elevated titers (1:32 or greater, 10 cases) of homotypic neutralizing antibody to the type of Coxsackie virus recovered in 14 of 15 patients whose serums were tested. Serologic tests for mumps and Western equine and St. Louis encephalitis were negative. Nearly half of the 25 paralytic illnesses associated with Coxsackie virus infection were in children aged 5 to 9 years, and only three patients were more than 12 years of age, viz., ages 16, 37 and 64.
STATEMENT ON THE USE OF DIAGNOSTIC X-RAY
Authors:   COMMITTEE ON RADIATION HAZARDS AND EPIDEMIOLOGY OF MALFORMATIONS
Published: December 2021

THERE is no longer any disagreement on the harmful nature of the biologic effects of ionizing radiations. The fact that responsible physicians continue to employ this form of energy for medical purposes is an indication of its great value in modern medical care. Properly controlled ionizing radiations, and x-rays in particular, provide benefits that greatly outweigh the potential hazards. Nevertheless, considerable emphasis is still being given to the reduction of exposure to ionizing radiations to the lowest level consistent with acceptable standards for good medical care.

Two important factors govern the benefits received from a given exposure to x-rays: the indications for the exposure, and the manner in which it is done. The indications are a matter of judgment on the part of the responsible physician and reflect, among other things, his experience with the method. It follows that a physician regularly engaged in the practice of radiology is usually in a better position to evaluate the relative merits of various types of examinations than is the physician who uses the techniques only infrequently. It is clear also that "routines" cannot substitute for judgment. The manner of employment of x-rays involves, in addition to the skill and experience of the operator, consideration of types of equipment. Leak-free tube housing, appropriate filtration, rectangular coning, shielding, modern films, screens and processing techniques are available to the occasional user of radiography as well as to the professional radiologist, and permit appreciable reduction in radiation doses.
CLINICAL CONFERENCE
Authors: Kunstadter Ralph H. , Tanman Faik
Published: December 2021

History: This 13-year-old white male was admitted to Sarah Morris Hospital on April 17, 1960, for re-evaluation of diabetes insipidus.

The patient was first seen at another hospital in June, 1957, because of small penis and shortness of stature. Laboratory studies revealed 17-ketosteroids, 2.9 mg/24 hr, and follicle-stimulating hormone in urine, 13.6 units/24 hr. The bone age was 8 3/12 years, and roentgenograms of the skull revealed normal findings. The specific gravity of urine was 1.002; otherwise, findings were negative.

In August, 1958, he was readmitted with complaints of growth failure, polyuria and polydypsia. His weight on the first admission was 71.5 lb (32.4 kg), and on the second, 82.0 lb (37.2 kg), but his height was the same. Water load and pitressin test were diagnostic for diabetes insipidus. An intravenous pyelogram was normal. He developed a short period of hypernatremia, which was corrected with intravenous fluids. The protein-bound iodine value was 6.8µg; fasting blood sugar, 115 mg/100 ml; and nonprotein nitrogen, 35 mg/100 ml. On October 15, 1958, the specific gravity of urine varied between 1.016 and 1.027 following administration of vasopressin (Pitressin) tannate. Vasopressin was administered in doses of 0.5 to 1.0 cc daily, and the patient responded well.

He did well until the summer of 1959 when he developed almost constant sleepiness. He had been a grade A student, but his work deteriorated. He also became a difficult person to get along with because of uncontrollable emotional outbursts and a definite personality change. His weight had increased considerably but his linear growth remained stationary.

Physical Findings: Physical examination revealed a small obese boy in no acute distress. His height was 130 cm (3rd percentile for 10 years of age) and his weight, 50.2 kg (75th percentile for 13 years of age).
Letters to the Editor
Authors: MATHER ALAN
Published: December 2021

Dr. Reinhold's views are always worthy of careful attention and merit a detailed reply. Most of his objections to the use of the Soret band for correction of absorbance at the bilirubin maximum are quite valid, and in fact I'm afraid they apply quite generally to spectrophotometric estimation of bilirubin; it is not immediately apparent, however, that correction at 575 mµ will solve all the difficulties cited. Turbidities, for example, are a serious problem and can contribute appreciable error. Since fine protein turbidities show greater absorbence in the blue than at longer wave lengths, and since the Soret band is much nearer the bilirubin maximum than is the 575 mµ peak, turbidities are also undercorrected by the procedure of White, Abu Haidar and Reinhold—up to about 50%, as best one can judge from globulin turbidities produced by aqueous dilution.
EFFECT OF SODIUM GLUTAMATE ON LEUCINE-INDUCED HYPOGLYCEMIA: CLINICAL AND ELECTROENCEPHALOGRAPHIC STUDY
Authors: Gomez Manuel R. , Gotham James E. , Meyer John S.
Published: December 2021

The clinical and electroencephalographic signs of leucine-induced hypoglycemia in the infant can be alleviated with oral or intravenous administration of sodium glutamate. The improvement occurs in spite of low glucose levels in plasma after intravenous administration; this supports the view that glutamic acid is rapidly metabolized by the brain during hypoglycemia.
Indications for and Risks of Replacement Transfusion
Authors: Newman Arthur J. , Gross Samuel
Published: December 2021

We would like to offer several comments about the article by Wishingrad and Elegant concerning replacement transfusions (Pediatrics, 28:331, 1961).

The authors consider a positive Coombs test sufficient indication for an exchange transfusion in an erythroblastotic infant born into a family in which previously affected siblings have required exchange transfusions. A positive Coombs test does not of itself serve as adequate indication for an exchange transfusion. There must exist the same criteria for an exchange transfusion in any affected patient, particularly when one considers the fact that this procedure is not totally benign.
Circumcision and the Tribe
Authors: Swafford T. D.
Published: December 2021

In regard to child care, I have come across two amusing quotations.

1. "Father Buget points out that the uncircumcised, kehee, has no rights of possession. He cannot build a homestead of his own. In the days of tribal war he could not go to the battlefield; he could only stay at home with the women and defend the homestead. He cannot boast or brag or even appear to do so. He is not allowed to wear the long hair of the mwanake, circumcised youth; it is taboo for him to have sexual intercourse with circumcised egirls.
Positive Schick Test after Diphtheria Immunization, as Evidence of Hypogammaglobulinemia
Authors: Mofenson Howard C.
Published: December 2021

The report of the Committee on the Control of Infectious Disease of the American Academy of Pediatrics in the 1961 edition states on the subject of Schick tests:

"If immunization practices, including periodic recall injections, are carried out as outlined in this report, the routine use of the Schick test to determine individual susceptibility to diphtheria is unnecessary."

I have been doing Shick test prior to vaccination for smallpox for several years as a means to determine the patient's gamma-globulin level by this indirect means.
Progress in Meeting Protein Needs of Infants and Preschool Children, Publication 843, Washington, D.C., National Academy of Sciences-National Research Council, 1961, 569 pp. $5.00
Authors: Wegman Myron E.
Published: December 2021

This book represents an interesting and very useful compilation of the proceedings of an international conference on the subject, held in Washington, August 21-24, 1960, under the auspices of the Committee on Protein Malnutrition of the Food and Nutrition Board and the Nutrition Study Section of the National Institutes of Health. The book contains all the original papers presented as well as the discussion following each presentation. Participants were those co-operating in the world-wide program conducted by the Committee on Protein Malnutrition in order to develop protein products from indigenous sources, which could be inexpensive and meet the needs of infants.
VACCINATION AS PRIMARY CONTACT WITH INFLUENZA A AND B VIRUSES
Authors: NICHOLAS RAE V. , HENLE WERNER
Published: December 2021

A single dose of 0.5 ml. of commercially available influenzal virus vaccine injected into children from seven weeks to three years of age produced antibodies in about 70%. Resulting antibody levels in the children, most of whom were born after the last widespread epidemics of influenza A and B, were distinctly lower than those observed in older individuals who, in all likelihood, had experienced previous contacts with influenzal antigens. Two injections at a week's interval failed to result in a better antibody response in these children in agreement with the experience gained in adults. Increase in the dose of vaccine appears unwarranted now, since the incidence of febrile reactions—all of short duration—exceeded 40%.

This inferior antibody response may be the result of several factors: (a) the smaller dose of vaccine which can be safely administered to such children; (b) the possible inferior immune response of the younger individual; and (c) the absence of a basic immunity to the antigens present in most older individuals as a result of previous contacts with influenzal viruses.

Although it is impossible to decide among these factors, the booster effect of restimulation with small doses of antigen is a well known phenomenon in protective measures against other infectious agents. It is felt that such a mechanism may well be the explanation for the discrepancies between young children and older individuals in their response to vaccination against influenza.
TRENDS IN HEALTH LEGISLATION AND ADMINISTRATION
Authors: WALL JOSEPH S.
Published: December 2021

A MONTH ago in this column we indicated briefly the attitude of the administration as it may influence health legislation in the 81st Congress. In particular, we pointed out that we may anticipate a reintroduction of the School Health Services Bill and a new bill for the creation of a National Child Health Research Institute.

These latter two measures a "re of real concern to all those interested in the health and welfare of children and have a very direct bearing upon the general field of pediatrics. Therefore, we present here drafts of these two bills as they now stand (December 20, 1948).

It will be noted that the School Health Services Bill is now in the form of an amendment to the Social Security Act of 1935, rather than a separate bill as in the case of S.1290—The School Health Services Bill—introduced in the 80th Congress by Senator Saltonstall, which never got further than committee hearings. In essence, this new proposed legislation would increase the appropriation made to the Children's Bureau for Maternal and Child Health Services and for Crippled Children's Services from $18,500,000 where it now stands to $37,000,000. Particular attention should be given to the sections in italic which are proposed as amendments in place of words and passages which have been lined out (i.e. shown in parentheses). It should be noted also that under section 501 (b) and (c) and under section 511 (b) and (c) provision is made for grants paid through state agencies for the training of personnel for Maternal and Child Health Services and for Crippled Children's Services.
SPECIAL REPORT FROM THE COMMITTEE FOR THE STUDY OF CONGENITAL MALFORMATIONS OF THE AMERICAN ACADEMY OF PEDIATRICS
Authors: MILLER HERBERT C. , CLIFFORD STEWART H. , SMITH CLEMENT A. , WARKANY JOSEF , WILSON JAMES L. , YANNET HERMAN
Published: December 2021

1. The data on 199 cases of maternal rubella have been presented according to the method by which the maternal infection was diagnosed and according to the period of gestation in which it occurred. The difficulties in timing the maternal infection in retrospect from a history have been pointed out. The incidence and types of defects that occurred in the 199 children have been discussed.

2. Evidence is presented to indicate that sharp peaks of prevalance of rubella occur simultaneously in many parts of the United States in the spring of the year.

3. Replies were received on 14 children with the so-called rubella syndrome whose mothers were considered to have had no infection during pregnancy, indicating either that the mothers had rubella but did not know it or that the rubella syndrome has more than one etiology.

4. The difficulties involved in planning an investigation which will give more accurate information concerning the incidence of congenital defects subsequent to maternal rubella have been discussed.

5. Evidence obtained from a survey of Kansas physicians is in agreement with previously reported data and indicates that perhaps 5% of congenital defects are associated with maternal rubella.

6. A total of 26 cases of maternal measles, mumps, chicken pox, infectious mononucleosis and poliomyelitis are reported in the present study. Seventy-seven cases of the above infections that occurred in the first four months of pregnancy have been collected from the literature, including those from the present study. The number is to small to draw any definite conclusions concerning any specific disease. The high incidence of defects following maternal infectious mononucleosis deserves especial attention.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HARPER PAUL
Published: December 2021

DR. W. MONTAGUE COBB, who prepared the article which follows, is the professor of anatomy at Howard University School of Medicine, Washington, D.C., and is recognized as one of the foremost Negro educators in this country. He is chairman of the Council on Medical Education and Hospitals of the National Medical Association and a member of the National Medical Committee of the National Association for the Advancement of Colored People. His article describes the difficulties and obstacles encountered by Negroes in this country in obtaining medical education and shows the paucity of Negro physicians and the dearth of facilities for medical care of our 14,000,000 Negro people.

It is generally admitted that the greatest difficulty in our current medical care structure is the appalling lack of personnel and facilities for the care of the Negro. The Negro and white races are so intermingled in their working and living arrangements that the health of one race is profoundly influenced by the state of health of the other. Sickness in the Negro undoubtedly takes its toll among the white race. But the real reason why good medical education and good medical care should be provided for the Negro race is not this, but because they need it for their own happiness and welfare; as citizens of this country they are entitled to equal opportunity to obtain good medical care.

If the editors of the column may be permitted to express their own personal views, it is that qualified Negroes should be admitted to our medical schools and should subsequently be given the necessary opportunities to obtain working experience in our hospitals and clinics.
How to Help Your Child Grow Up
Authors: MCCULLOCH HUGH
Published: December 2021

It is a pleasure to receive and recommend this book and to know that the short chapters published as syndicated articles in the daily press have been made available in permanent form. The use of these short chapters, repeated frequently in small doses, is one of the effective methods of bringing home to parents good advice on child behavior and the approach to the problems and questions related thereto. There are many who would like to have a permanent record of the press articles.

The book is a continuation of several books under varied titles, made up of the same subject matter. The text is made up of seven parts—The Child Himself—The Baby—The Child at Home— The Child at School—Growing into Youth—and Suggestions for Special Problems. Each part is subdivided into chapters, made up of an introductory statement, then an arrangement of short topics, each with a special note. There are no illustrations and none are needed for this book. There is a good index.
ANALYSIS OF A BILIRUBIN SURVEY
Authors: Westphal Milton , Viergiver Ellenmae , Roth Robert
Published: December 2021

Unknown specimens containing bilirubin in concentrations of 0.5 to 1.0, 5.2, 10, 15, and 20 mg/100 ml were tested in 13 laboratories. Analysis of the data suggests that bilirubin results reported from these laboratories will vary as much as ± 3.6 mg/100 ml from the true values. The means from the individual institutions differed widely from the true values, but the scatter of values about these individual means was small. When the data were pooled, the means were close to the true concentrations of the samples analyzed, but the variances were large. The hypothesis that incorrect bilirubin standardization was a significant cause of inaccurate results is presented.
Intramuscular Injections in Infants and Small Children: A Preferred Site Selection
Authors: HOLOWACH JEAN
Published: December 2021

The safety of intramuscular injection into the gluteal region of infants and children has recently been challenged (Combes, M. A., et al.: J.A.M.A., 173:1336, 1960; and News-Letter, American Academy of Pediatrics, Vol. II, No. 10, Dec. 1960). In adult medicine the relatively large surface area and bulk of the gluteal muscles make this the preferred site for intramuscular injection. The co-operation of the patient permits accurate identification of landmarks with injection well beyond the course of the sciatic nerve.
STUDIES IN EXPERIMENTAL HYPERTONICITY
Authors: Sotos Juan F. , Dodge Philip R. , Talbot Nathan B.
Published: December 2021

Hypertonicity of body fluids was induced in 23 rabbits by the intravenous injection of solutions of sodium chloride, sodium chloride and bicarbonate, sucrose, or urea at concentrations of about 2,000 mOsm/l. The results obtained suggest that (1) hypertonicity of body fluids can cause disturbances in cellular metabolism, resulting in the formation and release of large quantities of hydrogen ion and the development of severe extracellular metabolic acidosis; (2) with restoration of osmolality toward normal by rehydration, the acidosis is improved; and (3) there is no correlation between the values for plasma pH and the values for sodium and chlorides in plasma, total body water, extracellular and intracellular water, and blood volume.
Health Services for Mothers and Children
Authors: SCHMIDT WILLIAM M.
Published: December 2021

During the past 50 years an organized public effort has been made to bring available resources into action for the protection of health of mothers and children. Every state in the union has been helped with federal funds to develop units of their state health departments under medical direction, and to strengthen and support such services. The generic term covering this effort is "maternal and child health." Yet today one may still occasionally hear even pediatric and obstetric residents ask what maternal and child health—or colloquially, MCH –means.
Letters to the Editor
Authors: HOROWTTZ LEON
Published: December 2021

I cannot help commenting on Dr. Spock's article "Should Not Physicians' Families Be Allowed the Comfort of Paying for Medical Care?" (Pediatrics, 30:109, 1962).

Dr. Spock gives the best argument against his own case in the introductory two paragraphs of his communication. The tradition is honorable and does demonstrate some of the noble attributes of man—generosity, loyalty, pride in service, and devotion to an ideal, not to mention devotion to our history and principles. to render medical service to his family.
STUDIES OF CARBOHYDRATE METABOLISM IN THE NEWBORN INFANT
Authors: Oh William , Baens Gloria S. , Migeon Claude J. , Wybregt Susan H. , Cornblath Marvin
Published: December 2021

Cortisol administered to the mother prior to elective repeat cesarean section resulted in an increased level of this hormone in both the mother and the infant's blood at the time of delivery. Cortisol given either to the mother prior to delivery or to the infant directly augmented the infant's hyperglycemic response to 30 µg/kg of glucagon. Some implications of these findings are discussed.
Hazards of Radioactive Fallout
Authors: CHARLES SEYMOUR , FINKELSTEIN ABE S. , WILLNER MILTON , LILIEN BERNARD B.
Published: December 2021

Very properly, the American Academy of Pediatrics has appointed a Committee on Environmental Hazards to consider the "problems posed for pediatricians by fallout of radioactive materials in this country." We in practice had looked forward to the reports of this Committee because the pediatric literature had been singularly free of relevant material. Since its appointment the Committee has met only occasionally and issued a few brief superficial statements, which have served as "pacifiers" for the profession and the public.
Letters to the Editor
Authors: CENTERWALL SIEGRIED A. , CENTERWALL WILLIARD R.
Published: December 2021

Thank you for your invitation to comment on the discussions of our study of children with mongolism. We are glad that so much sincere interest has been shown in this subject. It bodes well for further studies and for better care for retarded children and better guidance for their parents.

Hersher has expressed many of the views we have about Birch and Belmont's paper, and we thank him particularly for his insight into the problem of clinical studies of this type.
THE CHLORIDE SPACE, ARITHMETIC AND DEFICIT THERAPY
Authors: Gamble James L.
Published: December 2021

On the basis of currently available information, it appears that the significant volume of distribution of extracellular electroytes in pediatric patients is closer to 30 to 33% of body weight (chloride space, infants) than 18 to 20% (inulin space, adults). Theoretical deficits of chloride, calculated with use of the larger figure, have been found to agree closely with values obtained from balance data. The problem with respect to sodium is more complex due to transfers to and from the cells, and the calculated predictions must be modified in the individual case in accordance with clinical experience.
THE ASSOCIATED OCCURRENCE OF THE NEPHROTIC SYNDROME AND CONGENITAL HEART DISEASE
Authors: Drummond Keith N. , Vernier Robert L. , Worthen Howard G. , Good Robert A.
Published: December 2021

Two patients with congenital heart disease who developed the nephrotic syndrome are discussed. Neither had evidence of heart failure or increased venous pressure. The possible pathophysiologic mechanisms leading to the nephrotic syndrome are discussed. The interesting possibility is raised that the associated occurrence of congenital heart disease and the nephrotic syndrome in such patients may represent different expressions of an inherited or developmental abnormality.
TEACHING ABOUT MENTAL SUBNORMALITY TO THE MEDICAL STUDENT AND PHYSICIAN: A CONFERENCE REPORT
Authors: Knobloch Hilda
Published: December 2021

MENTAL SUBNORMALITY is defined officially by the World Health Onganization as incomplete or insufficient general development of the mental capacities. It has two components: mental deficiency and mental retardation. Mental retardation is present when the social and educational performance is lower than that expected from a knowledge of intellectual abilities. Mental deficiency is diminution of the mental capacities themselves as a result of pathological processes. Individuals with organic disease of the brain may have additional impairment of intellectual functioning as the result of adverse environmental circumstances.

It seems clean that advances in medical care have resulted in increasing survival of infants with brain damage, and more attention is being paid to the problem of subnormal mental functioning as well as to other neuropsychiatric disabilities. The American Academy of Pediatrics has reflected this increased interest by organizing a Section on Child Development and appointing a group to study formation of a separate Committee on Mental Retardation. The forthcoming report of the President's Panel on Mental Retardation will undoubtedly include consideration of the role of the official pediatric organizations as well as that of the individual pediatrician.

In 1957 a conference on Teaching Mental Retardation in Medical Education was held. As its name implies, it was restricted to the problems of physician education. However, the relationship between physicians and other professionals concerned with providing services to the mentally subnormal was not considered. The report represents the consensus of members of the conference as to the most fruitful approach to engaging the interest of the physician, from the time he starts as a medical student, and mobilizing it in the most constructive fashion.
PRESIDENT'S MESSAGE
Authors: Webb Clarence H.
Published: December 2021

THE ROLE of the pediatrician in the totality of medical practice in this country undergoes close scrutiny; panels and papers have dealt with it. Pediatric educators are vitally concerned that their teaching programs be tailored to future needs; official interest of the American Academy of Pediatrics has been expressed through its Committee on Medical Education and Subcommittee on Postgraduate Education. Now the Academy, jointly with the American Pediatric Society, the Society for Pediatric Research, the American Board of Pediatrics, and the Pediatric Section of the A.M.A., cosponsors a study of Pediatric Research, Education and Practice (PREP) under the direction of Dr. Alex Steigman.

I speak now for the practicing pediatrician. The experiences and philosophy acquired from a third-century devoted to pediatric practice, spanning the lifetime of the Academy, may be of value to those concerned with the future of the specialty. Not content to rely on an individual judgment, I have submitted the outline of my thought to 20 friends of my generation for their opinions of its validity, their experiences and ideas. Their responses, enthusiastic and often detailed, enhance and embellish my observations.

The composition of this group is important, since my thesis relies on their approval and added experiences. They practice in 17 states from New England and Florida to California and Hawaii; they live in cities and towns from the size of New York and Chicago to as small as 25,000 on 35,000 population. All are long-time members of the Academy; many, but not all, have held office or served on committees of this organization. All have been primarily involved in practice, but many have had part-time teaching experience in university or hospital; a few are known for clinical research and published articles.
Academy Recommendations and Public Health Regulations
Authors: BOGGS THOMAS R.
Published: December 2021

Dr. Fred Harvie's expressed concern (Pediatrics, 27:838, 1961) over the possibility that a well-intentioned but perhaps naive city government might translate the American Academy of Pediatrics recommendations for nursery space requirements into law was not without foundation. The City of Philadelphia has moved so far in this direction that these recommendations will become law in a matter of weeks unless the city government chooses to change its mind. Unfortunately, the proposed law, in this instance, is to apply to existing, not new, facilities; consequently considerable pressure is being exerted to influence the city to refrain from passing the law.

There were 48,775 recorded live births in the City of Philadelphia in 1961; 32,502 were white and 16,723 were non-white.
Letters to the Editor
Authors: SILVERMAN WILLIAM A.
Published: December 2021

Dr. Boggs' letter of reproof continues the dialogue begun in 1961 (Pediatrics, 27:838, 1961) on the Academy's recommendations for the design of newborn nurseries, and little would be gained by repeating these arguments. However it seems to me that he has raised two issues that call for an additional reply by the Committee on Fetus and Newborn.

The first question concerns the information at hand on which the space recommendation was made. As Dr. Irving Schulman noted in 1961, the recommendation of 30 square feet per infant was based upon experimental evideuce on the transmission of airborne infection from infant to infant which was presented to the Committee on Fetus and Newborn and its consultants.
Potentialities of Pediatrics
Authors: THELANDER H. E.
Published: December 2021

The medical journals continue to transmit a feeling of ambivalence and uncertainty regarding the future of pediatrics as a specialty. From the vantage point of 30 years in pediatric practice, this appears due largely to the fact that pediatric departments are still being patterned after the other clinical departments in the medical school, especially after internal medicine. Primary orientation is toward systems, disease entities, and laboratory research. From a clinical viewpoint, on the other hand, pediatrics, as a specialty, has the potential to take the leadership in a tremendous new role for all of medicine.
Iron Intake, Hemoglobin, and Growth
Authors: DIAMOND LOUIS K.
Published: December 2021

The article on "Iron Intake, Hemoglobin, and Physical Growth" (Pediatrics, 30:518, 1962) merits special comment. Although this represents years of careful observation of healthy infants and children, the hematologic data offered on them are meager. They do not clearly support the authors' contention that iron intake does not appear to be directly reflected in hemoglobin levels at 2 years of age. At 1 year this relationship certainly does not hold true from an analysis of their own data. As a matter of fact, 1 year of age is a more critical time to evaluate the relationship of iron to hemoglobin, because during the first year, growth is more rapid and dietary inadequacies are more likely to occur.
COXSACKIE B5 INFECTIONS WITH EXANTHEMS
Authors: Cherry James D. , Lerner A Martin , Klein Jerome O. , Finland Maxwell
Published: December 2021

Seven cases of Coxsackie B5 virus infection with exanthem observed at the Boston City Hospital during the late summer of 1961, are reported. The virus was isolated from six of the patients and a fourfold or greater rise in titer of hemagglutinin-inhibiting antibodies (HIA) to this virus was demonstrated in five of these six cases. In the seventh patient there was a significant rise in HIA titer, but attempts to isolate the virus were unsuccessful. The illness in these patients was characterized by a moderate fever, usually of 2 to 3 days duration with the fine, erythematous maculopapular eruption involving mostly the face and trunk, appearing toward the end of the febrile period, and somewhat resembling exanthem subitum. There was also some cervical and occipital lymph node enlargement. In 49 pairs of bloods obtained from mothers and infants (umbilical cord) at the time of delivery, the titers of HIA to Coxsackie B5 virus in the maternal sera were usually fourfold to eightfold greater than in the sera of corresponding umbilical cord blood. HIA titers of 1:80 or higher against Coxsackie B5 virus were demonstrated in 65% of these maternal sera, but only in 2 of 75 sera (2.7%) obtained from infants and children who did not have a rash during the summer of 1961.
SHOULD OUR CHILDREN PAY FOR THE CIGARETTE COMMERCIALS?
Authors: WISHIK SAMUEL M.
Published: December 2021

The evidence that continues to pile up concerning the unfavorable health effects of cigarette smoking is most striking when a person has been a fairly heavy smoker over a long period of years. Obviously, this points to the seriousness of persons starting to smoke early in life.

An article on the tobacco industry in the January, 1963, issue of Fortune magazine documents the tremendous recent increase in cigarette smoking by young people. As one looks around to see 18 and 19 year old boys and girls smoking, one is impressed with the number of them who have already become heavy smokers. It is not a matter of an occasional cigarette.
Presenting Symptoms in Childhood
Authors: MITCHELL Ross G.
Published: December 2021

The medical care of children in Great Britain is largely in the hands of the family doctor. A monograph on symptoms in childhood as encountered in family practice could therefore be of great value. Dr. Fry has tried to produce such a volume but unfortunately falls short of his aim, for his book unhappily combines a synopsis of rare diseases, inappropriate in a book of this kind, with a rather more useful treatise on diagnosis. It imparts some sound advice but contains much unnecessary and misleading detail. In its emphasis, the book has a curiously old-fashioned flavor, in spite of interpolated fragments of information on "recent advances." Neither in tone nor in matter does it reflect the thinking and practice of British pediatricians.
The Urinary Excretion of 3-Methoxy-4-Hydroxy-Mandelic Acid (VMA) in Newborn Infants with the Respiratory Distress Syndrome
Authors: BOEHM JOHN J. , O'BRIEN DONOUGH
Published: December 2021

Urinary excretion coefficients (µg/kg/24 hr) for 3-methoxy-4-hydroymandelic acid (VMA) have been measured for the first third, and fifth days of life in 6 infants with the respiratory distress syndrome and in 20 normal control infants. No significant differences could be detected between the two groups. Present understanding of pressor amine metabolism in this condition is discussed.
Letters to the Editor
Authors: BRADFORD WILLIAM L.
Published: December 2021

Dr. Hellerstein's letter is important, for it calls attention to one of the many conditions with symptoms similar to those of ordinary infantile colic. While we did not list the numerous conditions to be differentiated from colic, I hope we implied, by our references, that many different causes have been proposed obviously unrelated to progesterone. Perhaps we should have stated that each infant in our study had, at least, one thorough physical examination; and, in each case, the urine was examined routinely as well as for calcium (Sulkowitch Reagent) before it was subjected to chromatographic study. To our knowledge, no infant with any type of infection was included in our series.
The Well Child's Problem—Management in the First Six Years
Authors: ILLINGWORTH R. S.
Published: December 2021

The author has set out to provide a compendium to guide the practicing physician in the management of children's everyday problems. The book discusses physical growth and development, the health supervision of the well infant, feeding and nutrition, and common behavior problems.

I have no doubt that the writer has provided a great deal of useful information which will prove to be of much value to the physician. His sections on toilet-training, sleep, and toys are particularly good.
CONTRIBUTIONS OF A CHILDREN'S DIAGNOSTIC CLINIC TO CHILD WELFARE: SERVICES IN RELATION TO ADOPTION
Authors: Green Morris , Godfrey Carolyn
Published: December 2021

A study was designed to determine the nature of the contributions that a children's clinic can make to child welfare, specifically in relation to adoption. Data were collected on 40 children referred to a pediatric diagnostic clinic and who presented some problem relevant to adoption. In 12 of 40 cases it was judged that previous utilization of professional services by the agency or independent agent had been inadequate. Previous professional advice was judged to have been inadequate in 20% of cases. The data also help define a new role for an outpatient department in relation to (1) diagnostic services, (2) preventive services, (3) professional education, (4) research, and (5) social action.
Records for Hyperbilirubinemia
Authors: MILLER ALVIN A. , FUERTH JOHN H.
Published: December 2021

The problem of jaundice is frequent in a large nursery service. In a hospital delivering 400 to 500 babies per month, our "exchange team" commonly sees 15 to 20 babies each month. Most of these are subjected to diagnostic hematologic and bilirubin studies; some require exchange transfusion. We have devised the forms reprinted herein to be used as part of the newborn infant's record.

The "Graphic Data Sheet—Newborn Jaundice" (Fig. 1) has been useful in the following way. 1. All laboratory work is recorded on this form. 2. An over-all numerical record of the rate of rise and the degree of bilirubinemia is immediately apparent. 3. The need to search through many laboratory slips to relate age to level of bilirubin is avoided. 4. After discharge this sheet is removed and kept for future evaluation of our experience with neonatal jaundice in regard to etiology, frequency, course, and management. 5. We have also used this record for newborn infants with mild clinical icterus, if any work-up is done, to give more accuracy to statistical studies.

The "Exchange Transfusion Record—Newborn Jaundice" (Fig. 2) is used for all exchange transfusions of newborn infants. All occurrences and medications during exchange are recorded. Changes in the infant's condition, venous pressure, pulse rate, calcium infusions, exchange volume, and duration for procedure are documented. Morbidity and mortality statistics on exchange transfusions may then be readily accumulated.

These records and their analyses have facilitated our management of hyperbilirubinemia from known hemolytic disease, as well as bilirubinemia of undiscovered origin (called B.U.O. in our nursery). Perhaps other pediatricians would find these forms an aid to their care and study of newborn infants with jaundice.

We have submitted these records to the Academy's Committee on Fetus and Newborn for consideration as part of the "Standards and Recommendations for Hospital Care of Newborn Infants."
BICYCLE ERGOMETER STUDIES IN CHILDREN
Authors: Cumming Gordon R. , Danzinger R.
Published: December 2021

The working capacities of children tested on a bicycle ergometer in the spring and again in the fall showed no significant differences. The pulse rate method of determining working capacity in children has been validated by additional oxygen consumption studies. Oxygen consumption is proportional to the work load even with pulse rates from 170 to 215 beats per minute. The physical working capacity as determined by the pulse rate method shows a direct relationship to maximal oxygen consumption or oxygen pulse ratio. The determination of oxygen consumption would appear to offer no particular advantages, and physical working capacity of children may be determined with confidence by simply determining the pulse rate at known work loads. The working capacity of those in poor condition may be slightly underestimated when pulse rate methods are used.
Aids to the Diagnosis and Treatment of Diseases of Children
Authors: WRIGHT F. HOWELL
Published: December 2021

This is the eleventh edition of a pocket-sized compendium which offers tightly written synopses of the main areas of clinical pediatrics. It is clearly directed at the neophyte, whether medical student or paramedical professional worker, avoiding the theoretical and technical aspects of the field. To such individuals it can be recommended as a readable quick introduction, but it will hardly serve as a source book for those interested in more than a superficial consideration of the disorders of children.
Intestinal Biopsy, Ciba Foundation Study Group No. 14
Authors: CRAIG JOHN M.
Published: December 2021

This is one of the group of Ciba Foundation's well-known Symposia. In contrast to the Conferences, which last 3 to 4 days and appear in book form, the Study Groups cover a more limited aspect of an area of new knowledge and are published in booklets with hard covers but with the usual attention to typographic and reproductive excellence given to their larger counterparts.

The 21 participants in this conference gave six individual papers at the one-day meeting in Madrid. These covered the important areas in this relatively new field dating from 1956 when the first intestinal biopsies were carried out by Crosby and Doniach.
Letters to the Editor
Authors: AMBRUS CLARA M.
Published: December 2021

As all relatively new fields of investigation, the study of the fibrinolysin system is going through the growing pains of the development and interpretation of methodology. It is quite true that most of the fibrinolytic assays have been done by using as substrate bovine fibrinogen (Astrup, T., Müllertz, S., Arch. Biochem. 40:346, 1952), various synthetic esters (Troll, W., Sherry, S., Wachman, J., J. Biol. Chem. 208:85, 1954) or casein (Müllertz, S., Biochem. J. 61:424, 1955).
VARIATIONS IN GLUCAGON RESPONSE AMONG JUVENILE DIABETICS
Authors: Etzwiler Donnell D.
Published: December 2021

Glucagon or a placebo preparation was administered to 65 juvenile diabetics on 74 separate occasions. When the initial blood glucose of these children showed them to be in reasonably good control, glucagon produced a hyperglycemic effect. However, when the blood glucose levels were markedly elevated, the effect of glucagon was less predictable. The depletion of liver glycogen stores and the possible effect of contaminating insulin in glucagon preparations are discussed.
ANNUAL SUMMARY OF VITAL STATISTICS—1962
Authors: Wegman Myron E.
Published: December 2021

FOR A number of years there have been included in the pages of Pediatrics digests of the annual summary of provisional vital statistics published by the National Vital Statistics Division of the National Center for Health Statistics in the Public Health Service. This year the data have been presented in slightly different form, with a more detailed summary than usually available, as Volume 11, No. 13, of the Monthly Vital Statistics Report. The data, although provisional, are considered to reflect very closely the true state of affairs. Methods of making the estimates and the basis for confidence in their reliability have been explained in detail in previous reports.
PRIMATES, DRUGS AND FETAL SAFETY
Authors: LUCEY J. F.
Published: December 2021

IT WAS WELL KNOWN to teratologists at least, prior to the thalidomide disaster, that congenital anomalies could be produced in animals by a wide variety of therapeutically useful substances (thyroxine, vitamin A, caffein, salicylates, cortisone, insulin, penicillin, and streptomycin). Very little public attention was paid to these data. The teratologists remained quiet and well aware of the many pitfalls involved in interpreting such studies.

When the thalidomide disaster struck there was an understandable stampede back to the study of the teratogenic effects of drugs in animals. We now find ourselves in an apparently bottomless pit confronted with studies indicating that in some animals, at some time, under certain conditions, any drug with pharmacologic action is capable of causing anomalies.
ACCEPTANCE OF PRESIDENCY
Authors: Douglass Frank H.
Published: December 2021

THIRTY-THREE men have held this office before me—thirty-three of the greatest names in Pediatrics. With such a heritage I feel very grateful and humble.

It has been my good fortune to have known most of these men personally, and to the following three, I am particularly indebted: Dr. J. B. Bilderback, who was my teacher; Dr. Henry Dietrich, under whom I had my residency; and Dr. Jay I. Durand who was the first to interest me in our Academy and who was always an inspiration to me.

The founders and officers of the Academy who have served before me have set the purpose of the voyage of the Good Ship American Academy of Pediatrics; the Executive Board of the Academy continually reviews our problems and charts our course; the Execcutive Director and Central Office staff arrange the cargo, but you—the stock holders—must work the cargo if our voyage is to be successful. I will try to the best of my ability to run a happy and efficient ship— and hold her steady as she goes.