bluuebunny/crossref_metadata_2025 huggingface dataset:
PRESIDENT'S MESSAGE
Authors: Fischer Carl C.
Published: December 2021

IT WOULD SEEM most appropriate that if we in American pediatrics were to be given an opportunity, in the words of the immortal Robert Burns, "to see ourselves as others see us" that this be given by a fellow countryman of his! Such is the case in the most interesting article entitled "Pediatrics in America—Impressions of a Visit," the lead article in the July, 1962, issue of the American Journal of Diseases of Children, by Dr. John O. Forfar, Consultant Pediatrician at the Western General Hospital, Edinburg, and Senior Lecturer in Child Health at the University of Edinburgh. Dr. Forfar is kind enough to present us with his impressions of a visit lasting 3 months and including some 10 academic centers in 21 hospitals along the East Coast with some few in the Central and Western America, each visit taking from 1 to 14 days.

He starts by making some interesting comparisons between pediatrics in the United States and Great Britain. He notes that although in general there are definitely more physicians per unit of population in the United States than in the British Isles (e.g., USA 1:760, Great Britain 1:900), the percentage of specialists is considerably higher in our country than in his. He also notes that in the United States there are reported to be three general practitioners for five specialists, as compared with three general practitioners for one specialist in England. He further reports that the United States is said to have approximately 9,000 pediatricians, two-thirds of whom are certified, while all of Great Britain has only 250.
THE PEDIATRICIAN AND THE PSYCHIATRIST
Authors: BYERS RANDOLPH K.
Published: December 2021

OVER THE PAST DECADES psychiatrists have bemoaned the hostile or neglectful attitude of pediatricians toward psychiatric contributions to medical science. In large measure pediatricians defend their prejudices on the basis that medical advance has been made by the scientific method of objective observation in controlled situations, and that much of psychiatric literature has not adhered to such standards.

From the pediatric point of view psychiatric literature has displayed three major weaknesses. These are exemplified, first, by the anecdotal papers, in which individual cases illustrative of a point may be quoted as of generic value. Secondly, there are the authoritarian papers, in which a psychiatrist considers some such subject as reading difficulty or bed wetting by classification and discussion without the benefit of any objective data.
CONGENITAL PERICARDIAL DEFECTS WITH HERNIATION OF THE HEART INTO THE PLEURAL SPACE
Authors: Duffie Edward R. , Moss Arthur J. , Maloney James V.
Published: December 2021

A congenital defect in the pericardium with subsequent herniation of part or all of the heart into the pleural space is an unusual anomaly, the precise incidence of which is not known. A reported incidence of 3% at autopsy suggests that the lesion occurs more frequently than is generally suspected. It may be associated with serious complications and even death and so should be suspected in any patient with unusual shadows near the cardiac borders. Properly performed selective angiography will demonstrate this lesion in the majority of patients. If significant signs or symptoms are associated with it, surgical repair is recommended.
Behavior and Development from 5 to 12
Authors: WATSON E. H.
Published: December 2021

This very readable book attempts, rather successfully, to present the child's reactions to what is happening to him under the influence of home, peers, school, and all other cultural forces. It supplements texts on growth and development which are written by physicians, or by psychologists or psychiatrists, in which the "specialist" viewpoint predominates. At the same time there is no lack of references to good source material, so that the book is also a reference work.
Pediatrics
Authors: HILL LEE FORREST
Published: December 2021

The present revision marks the thirteenth for this standard textbook of pediatrics since the original text was written by the late L. Emmett Holt in 1869. John Howland, of Hopkins fame, was associated with the senior Holt in revisions from 1912 to 1926. L. Emmett Holt, Jr., and Rustin McIntosh took over in 1927, and for this last revision they have been joined by Henry L. Barnett.

How should one go about reviewing the present edition of this nearly 1,400-page book which has served so illustriously as a standard text for some 66 years, and now has as author-editors such eminent educators in the pediatric field as Holt Jr., McIntosh, and Barnett?
INFLUENCE OF FAMILY ENVIRONMENT ON GROWTH: THE SYNDROME OF "MATERNAL DEPRIVATION"
Authors: Patton Robert G. , Gardner Lytt I.
Published: December 2021

Clinical observations are presented which suggest that growth failure may, at times, be a truly psychosomatic disorder. It is suggested that investigation of the emotional and social environment may be fruitful in many cases of growth retardation of "undetermined etiology."
Ceruloplasmin Test for Wilson's Disease
Authors: SCHINBERG I. HERBERT
Published: December 2021

The point made in the article by Silverberg and Gellis (Pediatrics, 30:402, 1962) is excellent and important: "In childhood, chronic liver disease of unknown etiology should always be screened for Wilson's disease." But why wait until chronic liver disease has developed? The diagnosis can be made while the patient is still asymptomatic as the authors' own case material demonstrates.

E.M. was examined carefully in 1952 at 8 years of age, when she was asymptomatic, because her sister M.M., then 15 years old, had Wilson's disease.
BILATERAL CONGENITAL LOBAR EMPHYSEMA SURGICALLY CORRECTED
Authors: Floyd Frederick W. , Repici Anthony J. , Gibson Edgar T. , McGeorge Chauncey K.
Published: December 2021

A case of bilateral congenital lobar emphysema, documented by serial roentgenograms, required two separate lobectomies. Most authors believe the etiology to be probably valvular obstruction of the main lobar bronchus. Rarely is medical management sufficient; most patients with this disorder require lobectomy of the affected lobe.
INTRAVENOUS GLUCOSE TOLERANCE IN THE NORMAL NEWBORN INFANT: THE EFFECTS OF A DOUBLE DOSE OF GLUCOSE AND INSULIN
Authors: Bowie Malcolm D. , Mulligan Paula B. , Schwartz Robert
Published: December 2021

The intravenous glucose tolerance test in normal vaginally delivered neonates, 3 to 6 hours old, is abnormal by adult standards. There is an initial slow rate of glucose disappearance from the blood comparable to that found in adult diabetics. After 60 to 70 minutes the rate increases. No rebound phenomenon is noted by 120 minutes after injection. Double glucose tolerance tests show that the rate of glucose disappearance in the initial phase is more rapid in the second test than in the first. It is comparable to the increased rate occurring 60-70 minutes after the first injection. Combined glucose-insulin tolerance tests show a rate of glucose disappearance in the first 60 minutes comparable to that found in normal adults after the injection of glucose alone. Intravenous glucose tolerance tests done on the third day of life show an increased rate of glucose disappearance as compared to the first hours of life, but this is still diminished as compared to the normal adult. On the basis of this data it is suggested that there is a diminished response of pancreatic insulin output to the stimulus of hyperglycemia during the early period of extra-uterine life and that this mechanism slowly improves over the first few days of life. A hypothesis is presented to explain the alterations in blood sugar observed in the newborn infant.
THE HAND-MOUTH REFLEX OF BABKIN IN PREMATURE INFANTS
Authors: Parmelee Arthur H.
Published: December 2021

The hand-mouth reflex of Babkin consisting of head flexion and rotation with opening of the mouth in response to pressure on the palms of both hands was studied in 57 newborn infants. All but eight of these infants were premature, weighing less than 2,500 gm at birth. Only two infants did not respond at any time. One hundred seventy-nine tests were done, with 153 (85.4%) positive. Of the latter, 105 (68%) showed head flexion, 81 (53%) head rotation, and 106 (68.6%) mouth opening.

The responses seemed to be more easily obtained in the smaller premature infants, but the intensity was greater in the larger infants. Since there was also some indication that the test is state-dependent, especially in the larger infants, it is proposed that possibly the smaller premature infants have a narrower range of state from sleep to alertness. Thus the smaller infants might be expected to always give some degree of response regardless of state, whereas the large infants would only respond if in a somewhat aroused state, including light sleep.

The reflex seems to be very primitive in nature, since it was obtained in one very premature infant of 26 weeks gestation weighing 580 gm as well as in all but two of the other premature infants. No definite correlation of the absence of response or degree of response could be made with lesser degrees of neurological disorders in the newborn period. However, babies who were critically ill or in coma did not respond, or only responded weakly. The hand-mouth reflex of Babkin is still another of several primitive reflexes relating the hand and mouth in a sensory motor relationship. These are discussed.
THE EFFECT OF MONTHLY GAMMA-GLOBULIN ADMINISTRATION ON MORBIDITY AND MORTALITY FROM INFECTION IN PREMATURE INFANTS DURING THE FIRST YEAR OF LIFE
Authors: Amer Jules , Ott Esther , Ibbott Frank A. , O'Brien Donough , Kempe C. Henry
Published: December 2021

A double-blind controlled study to determine the effect on infections of repeated administration of large doses of gamma-globulin to premature infants revealed that significantly more of these infants had no infections and fewer had mild infections during the first year of life. The data also suggests that gamma-globulin afforded some amelioration of serious but nonfatal infections. Deaths from infection showed a similar trend in favor of the gamma-globulin group, but this difference on its own was not significant.
MATERNAL RUBELLA AND PULMONARY ARTERY STENOSES
Authors: Rowe Richard D.
Published: December 2021

Eleven patients with pulmonary artery stenosis associated with a history of maternal rubella in the early months of the pregnancy are described. Seven were infants whose mothers had contracted rubella at the time of an epidemic in New Zealand in 1959. Eight patients suffered from either deafness or cataracts. All had associated simple cardiovascular anomalies, chiefly pulmonary valve stenosis or patent ductus arteriosus, but in four instances the additional anomalies were mild. The major physical sign permitting clinical diagnosis—transmission of the murmur to the lateral chest wall—is emphasized. It is suggested that rubella may be an important etiologic agent in pulmonary artery stenosis and that specific auscultatory measures should be taken during physical examination of infants born with a history of maternal rubella to establish whether or not this additional arterial anomaly exists. While progressive symptoms during childhood are rare, the late prognosis may be unfavorable.
CONTINUOUS INTRAVENOUS INFUSION OF CALCIUM IN VITAMIN D DEFICIENT RICKETS
Authors: Cassimos Christos , Tsenghi Christine , Michael Sophia , Liaromati Argyro , Metaxotou Katerina
Published: December 2021

In six patients with vitamin D deficient rickets, aged 4 to 12 months, calcium was administered by continuous intravenous infusion. The total amount of calcium delivered over a period of 9 to 38 days ranged from 2.4 to 13.6 gm. As a result of the infusion, radiologic healing of rickets appeared promptly in the mild cases, but was much delayed in the more severe. The influence of the calcium infusion on calcium, phosphorus, and alkaline phosphatase in the serum, and on calcium and phosphorus in the urine has been discussed.
MILK ALLERGY
Authors: Goldman A. S. , Sellars W. A. , Halpern S. R. , Anderson D. W. , Furlow T. E. , Johnson C. H. , Bean G. W. , Cook T. E. , Crook W. G. , Fein B. T. , Fruthaler G. J. , Harrison W. , Kamin P. B. , Kniker W. T. , McElhenney T. R. , McLaughlin L. A. , Rabinowitz H. I. , Saperstein S. , Thannisch G. E.
Published: December 2021

Skin testing separately and with equal concentrations of the purified milk proteins, casein, alpha-lactalbumin, beta-lactoglobulin, and BSA was done in 85 milk allergic children. For control purposes, intradermal tests with the same antigens were done in 102 normal children and 31 children allergic to non-milk substances.

Six per cent of the normal children had weakly positive reactions. However, positive skin tests occurred in 68% of the children allergic, but not to milk, and in 59% of the children allergic to milk. In the milk allergic children, the incidence of positive reactions to each milk protein was similar. The incidence of positive skin tests in milk allergic children was higher than previously apprised. Positive skin tests in the milk allergic child were obtained long after the dietary elimination of milk antigens and after the disappearance of circulating milk antibodies as detected by a variety of techniques.

In contrast to the control groups, strongly positive skin tests occurred only in milk allergic patients. Although no correlation was found between the results of all skin tests and the results of oral challenges with the same milk protein, a close correlation was found between the results of strongly positive skin tests and the results of oral challenge with the same milk protein. It appears that weakly positive skin tests with purified milk proteins have a little diagnostic value, but strongly positive skin tests have diagnostic significance.
Hazards of Radioactive Fallout
Authors:   Committee on Environmental Hazards, Farr Lee E. , Bradley Charles , Clifford Stewart H. , Lis Edward F. , Silverman Frederic , Wheatley George M. , Yamazaki James N.
Published: December 2021

The Committee on Environmental Hazards, in its efforts to acquaint members of the Academy with the real hazards of radioactive fallout, has been encouraged by actions of important groups and individuals qualified in that field. For example, the USPHS, charged with the responsibility of the welfare of our population, has requested and received copies of the Committee's first report for further distribution. The Committee recognizes that exception to its report has been taken by some individuals and groups who are equally interested in the problem.
SPONTANEOUS ALVEOLAR RUPTURE AT BIRTH
Authors: Chernick Victor , Avery Mary Ellen
Published: December 2021

Spontaneous pneumothorax in the newborn period was recognized in fifteen infants over a 6-year period.

Seven of the 15 infants were symptomatic in the delivery room, which suggests that lung rupture occurred with the first few breaths. Three of the seven were meconium stained. The remaining eight infants were symptomatic within the first 24 hours.

The unique features of the first breath of the newborn infant, namely, the serial opening of ventilatory units and high applied pressures, suggest that any foreign material in the airway would make rupture of opened units likely. Studies on the inflation of airless lungs demonstrate the opening phenomenon.

Four of the 15 infants died, 2 from their pneumothoraces. This bad experience led us to examine principles of treatment of spontaneous pneumothorax with the recommendation that oxygen breathing in some term infants, and prompt aspiration in others would be useful. The majority, however, can be expected to resolve spontaneously.

Measurements of the rate of absorption of air in the pleural cavity in the rabbit show a six-fold increase with 100% O2 breathing.
THE PROBLEM OF HOSPITAL ACCIDENTS TO CHILDREN
Authors: Lowrey George H.
Published: December 2021

Accidents do occur with an alarming frequency to children who are in the hospital. Fortunately, the majority of such accidents do not result in any serious injury to the child. Nevertheless, many of them are potentially serious in nature. The medicolegal implications are of considerable importance to the hospital, physician, nurses, and other personnel. A very high percentage of the accidents can be traced directly or indirectly to errors on the part of these hospital personnel. The material presented in this survey is not complete but leads to certain conclusions.

1. There could be greater uniformity in accident reporting with an attempt to define an accident more specifically. It is felt that the actual number of accidents that occur in pediatric wards is probably much higher than indicated by this paper, but many accidents are not reported, since they do no actual injury to a patient.

2. Orientation toward accident prevention should be carried out and repeated at regular intervals for all hospital personnel. This should be designed to stress all potential dangers and to give all staff working in pediatric areas greater knowledge in this field.

3. The prevention of medication errors might be reduced by a number of factors. These include the preparation of medicaments in a more isolated area so that there is less opportunity for distraction. The orders required for any medicaments should be very specific. This is particularly true when parenteral fluids are administered, and this should include quantity, duration of administration, and the type of fluids or medicaments to be used. Finally, the stocking of pediatric dosages of commonly used medicines is to be encouraged.

4. The preparation of a detailed accident report by the person involved in each of the accidents, whether it is his fault or not, should be a required hospital procedure. One of the aims of such a report is to further education in this field, and secondly, to bring about solution to the repeated occurrence of a similar type of accident.

5. The formation of an accident committee to review data from accident reports and to inspect the pediatric areas in a hospital at regular intervals is highly recommended.
Observations on Blood Cultures with Exchange Transfusion of the Newborn Infant
Authors: JOHNSTON RICHARD B. , SELL SARAH H.
Published: December 2021

Two hundred seventy-one blood cultures taken with exchange transfusions of 80 newborn infants were studied. It was found that 13.4% of the pre-exchange and 3.6% of the post-exchange cultures were positive. Fifteen patients had positive cultures; thirteen of these patients were referred from other hospitals. Most of the bacteria isolated are common inhabitants of the gastrointestinal tract. The possibility is discussed that contamination from the umbilical cord can be reduced by discarding the first blood withdrawn. Further studies are needed to determine the significance of blood cultures which are positive at the time of exchange transfusion.
A Simple Device and Technique for Removing Ear Wax
Authors: HARTMAN B. H.
Published: December 2021

A simple device and technique for the rapid removal of ear wax are described. The device consists of a modification of the ordinary ear speculum in which a spoonlike projection is molded smoothly into the distal end. By its use, the removal of wax is accomplished quickly under direct vision. Since all necessary manipulations are easily performed with one hand, the other hand is free to hold the patient's ear and head. Thus, no more than one unskilled assistant is required even with the most unco-operative patients. The device is most useful in the many cases in which soft or sticky wax partially occludes the ear canal. It has particular merit in infants and small, unco-operative children.
IMMUNOLOGICAL COMPETENCE OF THE NEWBORN INFANT
Authors: ROSEN FRED S. , JANEWAY CHARLES A.
Published: December 2021

IMMUNOLOGISTS have long been fascinated with the apparent immunologic incompetence of the mammalian neonate. At the turn of the century comparisons of various antibody titers in the blood of the mother and her offspring led Ehrlich and others to the firm conviction that the newborn mammal was dependent on a dowry of maternal antibodies for protection against the microbial insults of the extrauterine environment. Yet subsequent comparisons of human maternal and cord serum for their antibody content against a wide variety of antigens yielded a seemingly senseless patchwork of results. It became evident that certain antibodies such as those against viruses, Gram positive pathogens, bacterial toxins, and so-called blocking antibodies induced by the injection of allergens were efficiently transferred to the fetus, whereas atopic reagins and antibodies to the Gram negative enteric commensals and pathogens, the blood group substances, and the Wassermann and heterophile antigens were in the main barred from the fetal circulation.
THE DEVELOPMENT OF THE IMMUNE RESPONSE
Authors: Smith R. T. , Eitzman D. V.
Published: December 2021

Immunization of newborn infants with Salmonella vaccines results in agglutinin formation to the flagellar antigen as early as 7 days of life, and in 80% of infants by 14 days. This agglutinin is a gamma-l macroglobulin with a sedimentation rate of approximately 17 to 20S, and is susceptible to reductive cleavage. Production of a 7S sedimenting gamma-2 globulin agglutinin occurred by the 30th or 40th day after immunization in some infants.

In the adult, macroglobulin agglutinins against the flagellar antigen appeared 4 to 5 days after immunization, followed by appearance of 7S agglutinins 3 or 4 days later. Both the macroglobulin and the slower sedimenting gamma-2 globulin agglutinin were thus qualitatively similar in the adult and infant and differed only in the timing of their appearance. Transplacentally acquired agglutinins specifically inhibited the response to the homologous flagellar antigen.

Evidence was found for an agglutinin of intermediate sedimentation rate which had the electrophoretic mobility of gamma-l globulin, and was susceptible to reductive cleavage. This type agglutinin appeared after the macroglobin and before the 7S agglutinin.

These studies support the concept that immunity, like all developmental processes, must not be measured to adult norms. At each stage of ontogeny, the mechanisms which have evolved should be judged by their appropriateness in dealing with the threats to survival peculiar to the epoch rather than those of full maturity.
Fatal Neonatal Illness Associated with ECHO 9 (Coxsackie A-23) Virus
Authors: RAWLS WILLIAM E. , SHORTER ROY G. , HERRMANN ERNEST C.
Published: December 2021

A case is reported of fatal illness in a newborn infant associated with ECHO 9 (Coxsackie A-23) virus which was isolated from lung, brain, and spinal fluid. There was an unexpected lack of histologic abnormalities on postmortem examination.
CHROMOSOME ANALYSES IN A CHILDREN'S HOSPITAL
Authors: Warkany Josef , Weinstein E. David , Soukup Shirley W. , Rubinstein Jack H. , Curless Mary C.
Published: December 2021

SINCE 1956 the chromosome number of man has been 2 and it has become possible to classify human chromosomes according to size and position of the centromere. Physicians became interested in chromosome analyses when it was found in 1959 that patients with mongolism or Down's syndrome, with Klinefelter's syndrome and with Turner's syndrome showed specific chromosomal abnormalities. These could be demonstrated in cells derived from fascia, skin, or bone marrow after their culture and exposure to colchicine and hypotonic saline. When it became possible to make chromosome preparations of leukocytes cultured from human peripheral blood, many areas of medicine could more readily be investigated with chromosome studies. It was soon found that the number of human beings with chromosomal abnormalities was larger than at first suspected. Moreover, chromosomal aberrations were found not only in patients with pathologic states but also occasionally in phenotypically normal persons. Many sciences and medical specialities have become interested in human chromosome analyses Which already have changed theoretical concepts and practical approaches in many fields. Pediatrics, with its own interests and problems, has also been considerably influenced by these new developments. Findings in children have been recorded in numerous case reports which are often published in journals not regularly read by pediatricians. Although good general reviews on chromosomes in normal and abnormal human beings are available, it may be of interest to pediatricians to learn of the results of chromosome analyses in a children's hospital and affiliated institutions where patients were chosen from a pediatric point of view and where so-called negative results (i.e., normal chromosomal patterns) are as important as positive ones.
Dangers of Toys
Authors: RAPKIN RICHARD H.
Published: December 2021

In the short article by Wolf relating to plastic toy injury (Pediatrics, 32:594) the conclusion is reached: "the pediatrician . . . should warn parents against their purchase." This conclusion is unwarranted from the evidence presented of one child's injury. Shall we condemn forks, pencils, bikes, bats, plastic or otherwise, because of careless injury? Parents should be warned to teach care in the handling of toys to their children. It is the child's carelessness rather than the toy, plastic or otherwise, that causes injury.
Letters to the Editor
Authors: VANDERSALL THORNTON A.
Published: December 2021

The major points of my letter appear to have been accepted by the Drs. Randall, i.e., that there are differences between the residency and the community experience, that residency programs need constant re-evaluation and that most pediatricians could use a much wider experience in Psychiatry.

The idea that pediatricians are the most dissatisfied specialists has been well documented elsewhere. My suggestion was that, in other cases as well as my own, it was not economic factors or professional ambition that led to dissatisfaction.
Dangers of Vaccination in Lymphopenic Infants
Authors: ROSEN FRED S. , JANEWAY CHARLES A.
Published: December 2021

During the past decade at least a dozen case reports have appeared in the literature describing death in infants from progressive vaccinia associated with agammaglobulinemia. Until recently we were rather puzzled by these reports, because Dr. Robert Good and his group at the University of Minnesota and our group in Boston have vaccinated over 40 children with congenital agammaglobulinemia. In no instance has there been any untoward reaction following such vaccination, and both normal primary takes and accelerated reactions have been observed in these children.
Dangers of Extra Oxygen in Apnea
Authors: MILLER HERBERT C.
Published: December 2021

In discussing respiratory difficulty of central origin in newborn infants, Smith recently suggested that "there may be some justification for constantly providing less than 40% oxygen in nitrogen (from a cylinder so prepared) to occasional very immature infants with frequent apnea" (Pediatrics, 33:111 , 1964). However, his next statement was disquieting, since it recorded the occurrence of retinal vascular changes among infants so managed. It would be helpful to know whether or not these vascular changes were reversible or led to permanent changes.
SURVIVAL RATES IN RH SENSITIZATIONS:
Authors: Boggs Thomas R.
Published: December 2021

The comparative results achieved in 140 interrupted and 141 uninterrupted pregnancies associated with an Rh sensitization are presented. The data are interpreted as indicating that early termination of selected pregnancies has merit. A program of selection based on maternal history is presented.
Early Gastrostomy in Feeding Prematures
Authors: STEIGMAN ALEX J.
Published: December 2021

The good results of Berg et al. reported as "The Use of Gastrostomy in Feeding Premature Infants" will encourage others to explore this technique.

There has long been a reluctance to consider surgery for a so-called medical condition. In 1837, W. Stokes (in connection with tracheostomy in diphtheria) wrote: "There is always that kind of feeling connected with a surgical operation in acute diseases, which prevents its being proposed, assented to, or performed, unless under nearly desperate circumstances and when all other means have failed."
Letters to the Editor
Authors: RAWLS WILLIAM E. , SHORTER ROY G. , HERRMANN E. C.
Published: December 2021

The letter by Dr. David W. Van Gelder raises an interesting point. The excretion of enteroviruses in the stools of apparently healthy individuals has been reported in a number of studies; however, we know of no reports of enteroviruses having been isolated from tissues such as the brain from apparently healthy individuals who might have died from accidental causes. It is our contention that the isolation of such viruses from tissues is a significant finding.
Letters to the Editor
Authors: BABSON S. GORHAM , KANGAS JOHN , YOUNG NORTON , BRAMHALL JAMES L.
Published: December 2021

We appreciate Dr. Pick's interest in our paper on dissimilar sized twins. It may be as Dr. Pick suggests that some infants of small birth weight for their gestational age grow and develop "normally." Our study has demonstrated the failure of the undersized member of twin pairs to achieve a comparable level of growth and development to that of the co-twin at the time of the study examination. The reasons for this continued disproportion in size are not clear. Further studies are necessary to relate all possible factors concerned in intrauterine growth retardation with the subsequent development of the child.
The Diagnosis and Treatment of Speech and Reading Problems
Authors: KENNEDY CHARLES
Published: December 2021

This short text is an articulate presentation of a group of hypotheses which serve as the basis for treatment of such varied disabilities as stuttering, difficulty in learning to read, failure in speech development, strabismus, and behavioral problems. The essence of these is that unless an infant is allowed to proceed within the confines of a certain timetable of rigidly defined motor and special sense activities he runs the serious risk of impairing his mature cerebral function.
ECHO 9 Virus Infection or Galactosemia
Authors: VAN GELDER DAVID W.
Published: December 2021

The brief case report titled "Fatal Neonatal Illness Associated with ECHO 9 (Coxsackie A-23) Virus" by Rawls et al. which appeared in Pediatrics, 33:278, may have given an erroneous interpretation of the cause of death. At nine days of age the infant was noted to be lethargic, anorexic, and irritable with jaundice and hepatomegaly. Certainly these are all signs compatible with severe galactosemia. In addition the authors demonstrated galactosuria both by yeast fermentation and paper chromatography.

Because of the lack of family history of galactosemia plus the isolation of ECHO 9 virus from tissues at necropsy the authors concluded the fatal illness was associated with an ECHO 9 virus infection.
LEAN BODY MASS AND FAT IN OBESE CHILDREN
Authors: Forbes Gilbert B.
Published: December 2021

Measurements of total body potassium in obese children were made in the whole body scintillation counter, and from this value lean body mass was calculated, and then fat by difference. A series of normal children was available for comparison.

There was a good correlation between total body fat and relative body weight, abdominal circumference, and buttocks circumference, and a fair correlation with triceps skin-fold thickness.

Although the series is a small one, it suggests that there are two types of obesity in childhood. The first is characterized by increased LBM in addition to fat, by a tendency to tallness and advanced bone age, and to have been overweight since infancy. The second group shows no increase in LBM; these subjects tend to have a normal bone age, to be of average height, and the majority have become obese during the childhood years.
Organ Composition in Newborn Parabiotic Twins with Speculation Regarding Neonatal Hypoglycemia
Authors: NAEYE RICHARD L.
Published: December 2021

Donor twins in the monovular placental transfusion syndrome have organs which are significantly different than those found in their better nourished recipient partners. The malnourished donors have disproportionate reductions in the size of liver, pancreas, and fetal adrenal cortex. Liver and adrenal abnormalities are due to a reduced mass of cytoplasm of individual parenchymal cells. The mass of pancreatic islet tissue was as great as that found in well nourished neonates of the same gestational age. All of these anatomic changes have possible implications for neonatal carbohydrate metabolism.
Accidental Multiple Drug Poisoning
Authors: HARVEY NORMAN A.
Published: December 2021

Certain problems arise in cases of multiple drug accidental poisoning which are not encountered with single drug ingestion.

An illustrative case was a 3-year-old male who ingested 6 anorexigenic ("obesity") tablets of the sustained action variety, each containing 15 mg methamphetamine and 60 mg phenobarbital. Gastric lavage was performed 3 hours later and some pink material removed.

At this time the child exhibited hyperexcitability and hyperkinesia indicating a predominance of amphetamine effect. He was given 0.1 gm sodium phenobarbital s.c. (a short-acting barbiturate would have been a better choice), quieted, and went to sleep in 20 minutes. An intravenous infusion of 500 ml 10% dextrose in water was then started and the child made a subsequent uneventful recovery.
The Child Who Has Had One Convulsion
Authors: MEDLINSKY H. LESTER
Published: December 2021

In spite of my professional respect for Dr. Livingston, I disagree emphatically on both humane and medical grounds with the point of view expressed by him in Pediatrics, 33:1001, 1964 (Letter to the Editor). I believe strongly that the first simple febrile convulsion should be treated with anti-epileptic drugs. (My personal preference is for continuous or daily medication until age 4, or for 2 seizurefree years whichever is later, followed by intermittent treatment—for fever only—until the child is 6 years old.)
THE TREATMENT OF MYOCLONIC SEIZURES OF INFANCY AND CHILDHOOD WITH LA-I
Authors: Markham Charles H.
Published: December 2021

Seventeen children with massive myoclonic seizures and minor motor seizures in infancy and childhood have been treated with a chlordiazepoxide hydrochloride (Librium) analogue, LA-I. A 60-100% reduction in number and severity of seizures occurred in 15 cases in trials from 2 to 30 months. Benefit was seen in both the infantile spasms and seizures accompanying them and also in seizures in later childhood in those patients who had had infantile spasms in infancy. The drug was relatively ineffective in 29 adults and children with other seizure disorders. No serious side effects were seen.
Letters to the Editor
Authors: KAGAN B. M.
Published: December 2021

I appreciate the opportunity to comment on the letter of Dr. Howard Setleis.

No matter how carefully a book—or even an article, for that matter—is prepared or edited, there is always the possibility of an error either of commission or omission. Dr. Setleis' recommendation that a complete mailing list of physicians be maintained is possible for those who subscribe to journals. Such corrections as are needed are often published in subsequent issues of the same journal, which is usually distributed to a subscriber list. Dr. Setleis' suggestion that a list of the purchasers of all medical books be maintained is likewise worthy of consideration.
Need for More Medical Attention to Accident Prevention Program
Authors: SOUTHARD SAMUEL C.
Published: December 2021

The Committee on Accident Prevention of the American Academy of Pediatrics recently surveyed a group of pediatricians and general practitioners in New York State to learn more about the role played by the medical practitioner, and especially the pediatrician, in accident prevention.

The survey, reported in the August, 1964, News Letter of the Academy, verified the opinion of some committee members that the practicing physician generally neglected to include accident prevention as part of his purpose in patient care and that he lacked a missionary zeal in combating the number one killer and disabler of children.
Neurosis in the Family and Patterns of Psychological Defense: A Study of Psychiatric Epidemiology
Authors: STOCKING MYRON
Published: December 2021

The embattled general pediatrician, harried by the anxious demands of neurotic mothers and confronted by the frequency of emotional disorder and psychosomatic illness in childhood, could scarcely afford to overlook any book that shed real light on the problems of neurotic interaction within the structure of the family. Dr. Ehrenwald's title might suggest that this is just such a book. Unhappily, it is not.

Dr. Ehrenwald, a psychoanalyst with an eclectic orientation, has tried to fill a gap that has existed in the field of the study of the family.
PEDIATRICIANS' ASSESSMENTS OF THE INTELLIGENCE OF TWO-YEAR-OLDS AND THEIR MENTAL TEST SCORES
Authors: Bierman Jessie M. , Connor Angie , Vaage Marilyn , Honzik Marjorie P.
Published: December 2021

We have explored the agreement between pediatricians' appraisals of intelligence and the mental test scores of a group of 681 two-year-olds born during a specified time period on the Island of Kauai. Only a modest agreement was found between the two types of appraisals but a detailed consideration of the later school performance of children assessed as below normal by either or both methods indicates that (a) the prognosis is poor for children assessed as below normal by both methods; (b) low test scores at two years are somewhat what predictive and should not be entirely discounted and (c) most important, the test scores would appear to be valuable to the pediatrician who does not want to err in the direction of giving a poor prognosis for a child who may later prove capable of adequate if not superior academic performance; (d) predictions for boys should be somewhat more guarded than for girls at this age period.
A SIMPLE BEHAVIOR QUESTIONNAIRE FOR PRESCHOOL CHILDREN
Authors: Willoughby John A. , Haggerty Robert J.
Published: December 2021

A simple questionnaire was developed to help mothers express concerns about their child's behavior. In the 195 cases studied, the mean number of maternal concerns was 3.5 per child (SD ± 3.2, r = 0 to 17).

The questionnaire was simple to administer, easily understood, and required approximately 4 minutes for mothers to answer. It was useful in helping mothers focus on their concerns, for 12 times the number of concerns were revealed over those listed on a blank sheet.

Play observations and repeat questionnaires demonstrated mothers' concerns to be justified and consistent.

When the questionnaire was not available, physicians failed to discuss 55% of mothers' concerns in a usual Child Health Clinic. However, when mothers' questionnaires were available this figure was significantly lowered to 18%. It took the physician on an average only 1.4 minutes longer for the visit with the questionnaire than without. Seventy-three percent of pediatricians found the maternal questionnaire useful, especially when mothers had an average or higher number of concerns.

Such a simple, single-sheet behavior questionnaire is useful for mothers and physicians in the Child Health Clinic, is helpful as a screening device separating those mothers who may need further attention from those who do not, and could make the Child Health Clinic more efficient and perhaps more effective.

The questionnaire might also be useful in a private pediatricians's office by enabling a more complete discussion of mothers' concerns to be carried out. This would show mothers that the physician was interested in all aspects of their child's health and in the initial visits could prove helpful in establishing a better mother- doctor relationship.
PULMONARY ARTERY THROMBOSIS
Authors: Gootman Norman , Gross Joseph , Mensch Arthur
Published: December 2021

Pulmonary artery thrombosis occurring in 2 nephrotic patients treated with chlorothiazide and prednisone is reported. The implications of these observations and possible mechanisms of significance in the pathogenesis of this unusual complication are discussed.
ANNUAL SUMMARY OF VITAL STATISTICS—1963
Authors: Wegman Myron E.
Published: December 2021

FOR A great many years there have been presented under this heading certain basic vital statistics data for the United States, drawn from the provisional report published by the National Center for Health Statistics. This year's provisional report, published July 31, 1964, as Vol. 12, No. 13, of the Monthly Vital Statistics Report, was shortly followed, through an innovation of processing final data more rapidly, by Advance Final Natality Data, Vol. 13, No. 6, September 14, 1964, and, just as this manuscript was being submitted, by Advance Final Mortality Data, Vol. 13, No. 8, November 2, 1964. Thus, for the first time, the present report may be made without the reservations relative to later correction.
Gastrostomy Feedings for Prematures
Authors: KEITEL HANS G.
Published: December 2021

The editor of Pediatrics kindly responded to my previous letter which questioned the safety of gastrostomy for facilitating the feeding of "low intake" premature infants without surgical disease. We agree with his judgment that the use of general premature mortality statistics may not be appropriate for a "select" group of "low intake" premature infants but hasten to add that the higher mortality rate of the gastrostomized premature infants may have been related to the surgical procedure.
I. LUNG VOLUMES
Authors: DeMuth George R. , Howatt William F. , Hill Bruce M.
Published: December 2021

A three-year longitudinal study of a variety of lung function tests in 147 normal children has been carried out to permit better separation of growth effects (by covariance analysis) from individual variation, to supply information not previously available, and to permit study of the interrelationships of the tests in normal subjects.

In this, the first of a series of papers, we have presented the results of the study of lung volumes. Height is the best single indicator of physical size for predicting normality. Comparison of residual variances indicates that the use of multiple independent variables offers little advantage.

Although there is reason to believe that the lung volumes do not increase in a simple exponential relationship to height after birth, after 5 years of age the lung volumes do increase as approximately the cube of height. When the values of the exponents obtained from regression analyses of the lung volumes on different independent variables are adjusted by the dimensional relationships of the variables, several points become evident. Among them are: (1) the various independent variables (except sitting height) are all reflecting the same general body growth; (2) the exponents for the FRC in girls are less than those for vital capacity in boys or girls and less than the FRC in boys; (3) there is a difference between boys and girls in the exponent for age. The latter only reflects the relatively smaller body growth of girls for each age increment.

Analyses of covariance made possible by the longitudinal studies indicate that about three-fourths of the residual variance obtained from the ordinary regression of log vital capacity on log height (and one-half of that of log FRC on log height) is due to a quality inherent in the individual. Knowledge of this factor permits future estimates of a person's lung volume with greater precision.
CONGESTIVE HEART FAILURE IN INFANCY
Authors: Talner Norman S. , Sanyal S. K. , Halloran Katherine H. , Gardner Thomas H. , Ordway Nelson K.
Published: December 2021

Studies of arterial blood gases and acid-base equilibrium in twenty infants in congestive heart failure have revealed the following alterations: (1) elevation of arterial Pco2, (2) diminution of arterial Po2, (3) lowered pH. These findings demonstrate the presence of respiratory insufficiency in infants with pulmonary congestion and cardiac decompensation. Studies of serum electrolytes have shown in some infants a hyponatremia and hypochloremia present prior to the use of therapeutic agents and these alterations may influence response to digitalis and diuretic agents.
MYOTONIC DYSTROPHY IN INFANCY AND CHILDHOOD
Authors: Dodge Philip R. , Gamstorp Ingrid , Byers Randolph K. , Russell Patricia
Published: December 2021

Myotonic dystrophy is more often symptomatic in infancy and early childhood than previously supposed, seven definite and two possible cases having come to our attention during a single year. In all but one case the disease was present, though unrecognized, in one or more members of preceding generations. At least three patterns of expression of the disease are suggested.

(1) The most common clinical syndrome (five cases) begins at birth or in early infancy with difficulty in nursing, attributable to bilateral facial weakness. Generalized myopathic weakness and hypotonia and variable degrees of retarded motor development are encountered during infancy. In one case there was no difficulty with bulbar musculature and only the limb muscles were involved. No evidence of a progressive loss of motor function has been observed during early childhood, but the pattern of greater proximal than distal weakness of extremities appears to become reversed gradually until the tyical adult distribution of weakness and atrophy is seen. The less common clinical syndromes, which include the two possible cases of myotonic dystrophy, are: (2) almost pure myotonia, symptomatic from early infancy (one case) or evident only on electromyography (one case) and (3) isolated congenital ptosis (one case).

Percussion myotonia or myotonia of grasp or both is usually present if looked for. Electromyographic evidence of myotonia has been found in every case and was of great help in establishing the diagnosis. Myopathic changes were identified in three of the five available muscle biopsies. Mental defect was an associated finding in onethird of the cases in the present series.
SEX DIFFERENCES IN SUSCEPTIBILITY TO INFECTIONS
Authors: Washburn Thomas C. , Medearis Donald N. , Childs Barton
Published: December 2021

Sex differences in vulnerability to infectious diseases have been defined by a search of the world's literature and a study of the Johns Hopkins Hospital case records covering the period from 1930 to 1963. Special attention has been focused on bacterial meningitis at all ages and bacterial septicemia in children less than 15 years of age. A significant male preponderance is seen in all the data, but it is most marked in infancy. This is also the period in which infections by Gram-negative enteric bacilli outnumber those by Gram-positive organisms and this difference affects males more than females. The advent of antibiotics and related therapy has been associated with an increased sex ratio in incidence of infectious diseases, even as death rates from these diseases decreased.

The sex differences in susceptibility to the infections cited in this paper are consistent with the expectations of a genetic hypothesis that concerns a gene locus on the X chromosome of human beings, which is involved with synthesis of immunoglobulins. In general one might expect greater resistance to infectious diseases in that sex for which heterozygosity is possible. More direct evidence for the hypothesis must come from comparative studies of the immune mechanism in the two sexes.