bluuebunny/crossref_metadata_2025 huggingface dataset:
CLINICAL CONFERENCE
Authors: Miller Robert A.
Published: December 2021

In recent years there has been growing interest in pulmonary disease in infancy, especially in the newborn period. Therefore, it has become more important to try to differentiate primary pulmonary disease as a cause of cyanosis in the newborn period, from congenital heart disease as a cause of the same symptoms.

Since recognition of such clinical entities as hyaline membrane disease, plasma cell pneumonia and some types of interstitial fibrosis of the lung is occurring in younger and younger patients, one may get the impression from the literature that it is fairly easy to separate primary pulmonary disease from pulmonary disease secondary to congenital heart disease.

I woud like to show you two children, one of whom was considered to have congenital heart disease and was found at postmortem examination to have primary pulmonary disease. In the other case the child was considered to have primary pulmonary disease and then was found to have pulmonary disease secondary to heart disease.

The first case is that of a girl who was first seen in this hospital as an infant because of a mild degree of cyanosis. She had been getting along quite well, but had been noted to breathe a little harder than the other children.

Aside from the cyanosis there was no abnormality on examination of this baby except that the second heart sound was very loud. There was no distinct cardiac murmur during the period of infancy. However, as the child was followed, a systolic murmur became audible. This was a soft, Grade II to Grade III pansystolic murmur and was maximum in the third left interspace medial to the apex. The second sound was narrowly split, fixed and was quite sharp. The electrocardiogram showed right ventricular hypertrophy. The roentgenogram at the time showed that the heart was only slightly enlarged and that there was a prominence in the pulmonary artery area. This was a number of years ago, and at that time, the clinical diagnosis was Eisenmenger syndrome; that is, a ventricular septal defect with pulmonary vascular obstructive changes and high pulmonary artery pressure.

This child was followed for a number of years, and finally, at the age of 8 years, came to this hospital in extremis. She was quite cyanotic. She still had a faint systolic murmur, and a loud snapping second heart sound.

Roentgenograms showed that the heart was now quite large. The pulmonary artery was still quite prominent, and the major branches of the pulmonary artery also seemed to be somewhat enlarged. The vascular markings in the lung fields were essentially normal, and the most important clinical impression one got of this child was that she was in right heart failure and was cyanotic.
All About You
Authors: WINTER WILLIAM D.
Published: December 2021

Parents for years have been keeping personal record books of their children's progress from birth to maturity; the present publication is the first such book designed specifically for the adopted child, beginning with the day he enters his permanent home. All the elements of the usual "baby book" are present, but nowhere need a page be left blank just because the child did not enter the family until months or years after birth.

A most important feature is a removable booklet addressed to adoptive parents, stressing the need and the means of acquainting the child with his adopted status from the very beginning.
CONGENITAL DEFICIENCY OF FACTOR VII ASSOCIATED WITH HEMORRHAGIC DISEASE OF THE NEWBORN
Authors: Rabiner S. Frederick , Winick Myron , Smith Carl H.
Published: December 2021

Early diagnosis of congenital abnormalities of coagulation may be masked by the clotting defects associated with the newborn period and mistaken for hemorrhagic disease of the newborn. A case is presented which illustrates this problem.

To exclude a congenital defect, a careful family history should be obtained and a complete coagulation study performed on all infants with severe hemorrhagic manifestations. The diagnosis of hemorrhagic disease of the newborn should not be assumed in such cases. If there is evidence to support the diagnosis of a congenital abnormality, either from the family history or from the coagulation studies, or should there be a lack of response to vitamin K in an infant with severe bleeding, replacement therapy with plasma or serum should be instituted immediately. Repeated coagulation studies will eventually demonstrate the congenital abnormality and should be performed in suspected cases.
TRIMETHADIONE (TRIDIONE®) NEPHROSIS IN RATS
Authors: Heymann Walter , Hackel Donald B. , Hunter Janet L. P.
Published: December 2021

Doses of 38 to 57 mg of trimethadione (Tridione®) were given by stomach tube daily for 4 to 18 months to 22 rats. Eleven of these developed a nephrotic syndrome characterized by proteinuria (without hematuria), hypoproteinemia, hyperlipemia and histologic lesions in the kidneys.

The disease began usually 5 to 6 months after trimethadione administration was started. It was mild in 3 rats, moderately severe in 6, and marked in 2. Renal failure was noted in three animals after proteinuria had been noted for 4 to 9 months.

Spontaneous remissions after the administration of trimethadione had been discontinued were not noted. The administration of cortisone in two animals was without detectable beneficial effect.

Complement activity in sera of 13 animals was normal, and no agglutinating antibodies could be detected in 10 sera obtained at the time of death.

In 11 rats given trimethadione for 6 to 17 months without development of proteinuria, less marked, but definite, histologic alterations were noted. Four of these had some azotemia and in five, slight degrees of hyperlipemia were noted.

These findings make it imperative to evaluate the renal status of human patients receiving dione derivatives as long-term treatment for petit mal seizures.
THERAPY OF CYSTIC FIBROSIS OF THE PANCREAS
Authors: Shwachman Harry
Published: December 2021

GENERAL CONSIDERATIONS

I SHOULD like to open my remarks concerning therapy of cystic fibrosis of the pancreas by pointing out that some of the things we do are based on sound physiologic principles, such as salt and pancreatic enzyme replacement. Other therapeutic measures are based on prevention, e.g., the use of water-miscible vitamin A to prevent vitamin A deficiency, the use of vitamin K to prevent prothrombin deficiency, or the use of gamma-globulin to prevent measles in the exposed patient. A number of therapeutic measures have been employed in the management of patients with cystic fibrosis that require further evaluation, as unfortunately the effects produced in many instances are based on the judgment of anxious parents and enthusiastic physicians. Examples of this kind may include the use of trypsin by intramuscular or aerosol routes or the use of adrenal steroids. It is important to keep a proper perspective. We must not discard any form of therapy that offers relief, and on the other hand, we must avoid the use of harmful agents and needless operative procedures.

The first point I should like to make is the importance of being certain of the diagnosis. In the case of equivocal laboratory findings with a clinical picture that is consistent with the disease, I believe therapy should be instituted and the laboratory tests repeated, until the diagnosis can be established or discarded. Figure 1 shows a 9-week-old baby who was first seen about 10 years ago. He had the typical pulmonary picture of cystic fibrosis, yet the duodenal fluid contained adequate proteolytic activity and showed increased viscosity.
Letters to the Editor
Authors: HURST PETER L.
Published: December 2021

In their letter to the editor Talbot and Richie are attempting to demonstrate two independent equations. The first concerns the relationship between fluid requirements and the two-thirds power of weight. The second concerns the relationship between surface area and the two-thirds power of weight. Whereas, according to their Figure 1, there can be no controversy over the first relationship, controversy over the second relationship continues and is not clarified by the authors. Since their aim to calculate fluid requirements for all ages in a uniform manner is accomplished by expressing it as a function of the two-thirds power of weight, the additional concept of surface area is unnecessary and confusing.
Letters to the Editor
Authors: TALBOT NATHAN B. , RICHIE ROBERT H. , CRAWFORD JOHN D.
Published: December 2021

We note with interest that Drs. Hurst and Darrow agree that body fluid requirements of patients of differing sizes bear a simpler relation to weight raised to the two-thirds power than to weight directly.

"Surface area" is directly proportional to the two-thirds power of weight, being closely equal to weight in kg⅔ X 0.1. We have used "surface area" thus defined as a basis for describing limits of tolerance and related physiologic data and for expressing dosages simply because this familiar body dimension has been found empirically to give reasonably satisfactory results.
TRANSPLACENTAL TRANSMISSION OF BUSULFAN (MYLERAN®) IN A MOTHER WITH LEUKEMIA
Authors: Diamond Israel , Anderson Mary M. , McCreadie Samuel R.
Published: December 2021

A female infant, born of a mother with leukemia who received 6-mercaptopurine and x-ray therapy early in the pregnancy and Myleran® throughout most of the pregnancy, showed severe stunting of growth, congenital anomalies of the eyes, palate and ovaries, and cytomegaly involving most of the organs and tissues of the body.

Evidence is cited to implicate Myleran® as the agent responsible for the defects and cytomegaly.
PERNICIOUS ANEMIA IN CHILDHOOD
Authors: Leikin Sanford L.
Published: December 2021

In two children with pernicious anemia specific studies showed that gastric function and structure were normal. There was a specific inability to absorb vitamin B12 from the gastrointestinal tract. These findings add evidence to the hypothesis that the gastric manifestations of pernicious anemia are not an intrinsic part of the disease, but are secondary to chronic deficiency of vitamin B12.
THE COPPER CONTENT OF INFANT FOODS
Authors: Hughes Gertrude , Kelly Vincent J. , Stewart Robert A.
Published: December 2021

A method of measuring the copper content of processed baby foods is described. More than 2,600 randomly selected samples of 86 baby food items packed at four widely separated areas were assayed for copper content. Strained beef liver and the cereals, particularly high-protein cereal, showed the highest levels, followed by fruits and vegetables. In general, the values were found to be consistent with other published data. With very few exceptions the copper content did not differ significantly in products packed in widely separated areas.

It is concluded that the copper intake provided by "average" diets containing processed baby foods meets or exceeds the estimated daily requirement of 0.05 mg/kg of body weight/day. The conditions under which an inadequate copper intake might obtain have been discussed.
CONCENTRATIONS OF I7-HYDROXYCORTICOSTEROIDS IN THE BLOOD OF DIABETIC MOTHERS AND IN BLOOD FROM THE UMBILICAL CORDS OF THEIR OFFSPRING AT THE TIME OF DELIVERY
Authors: Migeon Claude J. , Nicolopoulos Demetrios , Cornblath Marvin
Published: December 2021

Concentrations of 17-hydroxycorticosteroids were determined in plasma from maternal venous blood of 13 diabetic mothers and in cord venous blood of their infants at the time of elective cesarean section.

No significant differences were found between plasma levels of 17-hydroxycorticosteroids when compared with normal controls.

From the limited data available, no correlation between concentrations of blood sugar, 17-hydroxycorticosteroids, clinical course or outcome was apparent.
BRONCHIAL OBSTRUCTION IN CYSTIC FIBROSIS: RHEOLOGICAL FACTORS
Authors: Denton Robert
Published: December 2021

Rheological studies of the respiratory secretions from patients with cystic fibrosis and from controls are presented. The apparent viscosities of mucous secretions were obtained in five patients with cystic fibrosis and in seven control subjects. The viscosity values for cystic fibrosis mucus after shearing were found to be about 5 times that of controls.

The structure of the mucous molecule is discussed, and the various factors affecting its viscosity and flow characteristics are described.

The effect of 0.5 molar NaCl solution in dispersing cystic fibrosis mucus is presented. This effect suggests the theory that the high viscosity of mucus in cystic fibrosis is due to a decreased concentration of sodium ions in the structure of the mucous molecule. A link between the high concentration of salt in the sweat and the high viscosity of mucus of patients with cystic fibrosis could thereby be provided.
HYPERBILIRUBINEMIA OF PREMATURITY
Authors: Lucey Jerold F.
Published: December 2021

The general subject of hyperbilirubinemia of prematurity has been reviewed. Several factors which are now known to affect the concentration of bilirubin in the serum in the neonatal period have been discussed. These are divided into pre- and postnatal factors.

It is suggested that the term hyperbilirubinemia should be used in preference to "physiologic jaundice" when referring to infants with concentrations of serum bilirubin of over 10 to 15 mg/100 ml. This roughly separates a group of infants who are potentially endangered and for whose jaundice some specific etiology can frequently be found.

Data have been presented which indicate that the incidence of hyperbilirubinemia and kernicterus may vary considerably from one premature nursery to another and within the same unit from time to time. The hypothesis has been offered that this variation may be due to iatrogenic factors. It seems justified to suggest that any premature unit encountering a high incidence of hyperbilirubinemia or kernicterus should carefully examine some of its routine policies.

The results of a survey by the author indicate that there is a wide divergence of opinion as to whether hyperbilirubinemia of prematurity should be treated. Considerable variation in the criteria used to select infants for treatment also exist. The only proven effective means of therapy at the present time is exchange transfusion. This has been demonstrated not to be excessively dangerous for premature infants, and available evidence suggests that it is effective in preventing brain damage. Fully realizing the many deficiencies inherent in the concept of a "critical level" of serum bilirubin, the author recommends choosing a concentration of serum bilirubin between 18 and 25 mg/100 ml as the main criterion for the selection of patients for treatment. Some of the newer methods aimed at controlling hyperbilirubinemia are reviewed. These are still in the highly experimental stage and cannot as yet be adequately evaluated.
Calculation of Surface Area of the Body
Authors: KROVETZ L. JEROME
Published: December 2021

Several recent commentaries have been concerned primarily with the use of surface area of the body as a means of computing parenteral fluid dosages. Since there is, fortunately, a reasonably wide latitude of bodily homeostatic mechanisms, it becomes largely a matter of personal preference whether one utilizes surface area to estimate initial dosages or some other scheme to apply a corrective factor to weight-age relationships.

There exists another more profound facet to this issue, namely the relationship, if any, of surface area of the body to such physiologic variables as cardiac output, oxygen consumption, renal functioin, etc. It seems logical to separate three areas for discussion.
THE RADIOACTIVE "FALL-OUT" PROBLEM
Authors: FORBES GILBERT B.
Published: December 2021

THE ADVENT of the atomic bomb as a military weapon has added a new group of constituents to the environment of man. These are the various radioactive fission products produced in the bomb explosion. In addition, the released neutrons serve to transmute a small quantity of atmospheric nitrogen to radiocarbon. By "local" fall-out is meant the deposition of fisson products in the area adjacent to the site of bomb detonation. Large quantities are also blown into the stratosphere, there to circulate for variable periods of time before returning to the earth as "distant" fall- out. Extensive studies by the Atomic Energy Commission and other governmental agencies (current expenditures for fall-out sampling exceed $12,000,000 yearly), as well as by foreign governments, have already provided a large body of observational data on fall-out and radiocarbon accumulation.
Fundamentals of Modern Allergy
Authors: DEAMER WILLIAM C.
Published: December 2021

Although the title suggests a general text-book on allergy, this volume is something quite different. It consists of 63 separate articles in the field of allergy written by 59 authors, each covering a particular phase of the subject. All but two of these appeared in recent years in a series on allergy for the New York State Journal of Medicine, of which Dr. Prigal is Associate Editor. The work was sponsored by the New York Allergy Society, of which almost all the authors are members.
THE NEPHROTIC SYNDROME IN THE FIRST YEAR OF LIFE
Authors: Parker R. A. , Piel Carolyn F.
Published: December 2021

The clinical course of nephrosis in five infants with onset of disease before 7 months of age is presented, together with evaluation of renal lesions seen at necropsy.

The problems of the management of nephrosis susceptibility to infection and water and electrolyte imbalance were found to be exaggerated by the young age of the patients.

The renal pathology observed in these five infants consisted of persistence of immature glomeruli and dilatation of the tubules in the cortical area. Later, the immature glomeruli and associated tubules appear to atrophy and the remaining glomeruli to hypertrophy.

Long-term adrenocorticosteroid therapy seems to be contraindicated, not only on the basis of the pathologic changes, but because it greatly exaggerates the problems of management and does not effect a remission of the disease.
SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Cook Charles D. , Wedgwood Ralph J. P. , Craig John M. , Hartmann John R. , Janeway Charles A.
Published: December 2021

An analysis of 37 cases of systemic lupus erythematosus in children is reported in order to demonstrate the course of this disease and its pathology. In this series 92% of the children were girls.

Necropsies of 14 cases of the present series revealed characteristic renal findings in all, even when clinical evidence of renal disease had been absent. Generalized arteriolitis as well as evidence of cardiac involvement was usually present. Renal failure was the most frequent cause of death.

Of the 37 children, 10 were alive at the time of this report; 8 of these surviving patients have been followed for more than 2 years. Steroid therapy was associated with partial or complete disappearance of urinary abnormalities in six children. Endocrine therapy was used in 32 of the children with symptomatic improvement in most cases.

Until more specific drugs are available, an intensive and prolonged course of therapy with adrenal corticosteroids offers the best, though limited, chance of slowing or halting this disease process.
A PEDIATRIC VIEW OF GENERAL EDUCATION
Authors: Richmond Julius B.
Published: December 2021

Pediatricians, because of their interest ". . . in all aspects of the work for the welfare of children,"° have reason to be concerned with the current controversy concerning education in general. Although it is evident that there is no simple solution, it is important that as a professional group concerned with child development, we keep informed on the problems facing us in education in order that we may lend support to constructive efforts as these develop. It is in this spirit that this communication is offered.

While the launching of Sputnik I by the Russians set off public anxiety concerning education in this country, it is well to note that educators and thoughtful citizens generally were concerned about the quality of our educational programs for a considerably longer period of time.1,2
CONFLICTS AND REBELLION DURING ADOLESCENCE
Authors: Glaser Kurt
Published: December 2021

During the years from 10 to 18 the youngster is confronted with a series of problems for which he has to find solutions suitable and acceptable to himself, to his parents, and to society. He can find the solutions and adjust his life pattern either in a gradual, smooth and comfortable way or in stormy forward bouts and retreats: this will determine his life during adolescence. The nature and suitability of the solutions and his acceptance of them as his way of life will determine his integration into adult society.

Advancement to high school requires adjustment from one teacher to several, from a prearranged curriculum to some choice of subject, from day to day assignments to projects extending over weeks, requiring responsibility for planning that are now to be assumed by the student rather than the teacher. The youngster becomes concerned about his career and begins to understand the connection between his present schooling and future life plans.

His thoughts about his choice of profession still vacillate between an immature wish for gratification of immediate desires (he wants to be a taxi driver because he likes to ride in cars) and a more mature ability to postpone gratification and engage in long-range planning. He learns to consider his interests, abilities, opportunities, and ultimate returns from his work and begins to favor them over the immediate returns. His plans and his ability to carry them out will depend upon his emotional maturity. He is in need of guidance to assist him with his decisions, and to supplement his partially matured conscience, self-control and super-ego.
ABNORMALITIES OF SEX DIFFERENTIATION
Authors: Wilkins Lawson
Published: December 2021

There are many discordances between the anatomic development of the external and internal sex organs, the chromosomal patterns, the gonadal morphology and the secondary sexual development. The psychosexual orientation is not predetermined by any of these, but depends largely upon the gender role assigned to a child in early life. It is, therefore, most important to select in early life the sex to which the child can best adapt.

The abnormalities of sex differentiation are: 1) Gonadal dysgenesis, in which there are various widely differing defects in the embryonic development of the gonads. These conditions are often due to chromosomal aberrations. There is a low familial incidence. 2) Male pseudohermaphroditism, in which testes are morphologically fairly well developed, but have defective secretion of "male organizing substance." 3) Female pseudohermaphroditism, in which masculinization of the external genitalia of females is due to androgens of the fetal adrenals or transmitted from the mothers during pregnancy.

Ambiguity of the external genitalia is usually the finding which arouses a suspicion of an abnormality of sex differentiation. However, the finding of firm masses in the groins or labia of apparent females or the absence of gonads in apparent males are also indications for more extensive diagnostic studies.

The study of the nuclear chromatin pattern of cells in smears of the buccal mucosa is the most important diagnostic screening test. A chromatin-positive pattern indicates that the patient is either a female pseudohermaphrodite, a true hermaphrodite or a case of "testicular dysgenesis." In chromatin-positive cases the urinary excretion of 17-ketosteroids should be measured to determine whether or not the patient has virilizing adrenal hyperplasia. Patients with a chromatin-negative pattern have either male pseudohermaphroditism, true hermaphroditism or some form of gonadal dysgenesis. Exploratory laparotomy with gonadal biopsies is necessary to establish the diagnosis. When the diagnosis is made in early infancy, all types of female pseudohermaphrodites should be reared as females. In male pseudohermaphroditism the assignment of the gender role depends largely upon the degree of phallic development. In true hermaphroditism one must take into consideration both the anatomy of the external genitalia and the type of development of the gonads. The explanations to be given to the parents and the hazards of changing the gender role in later life are discussed.

The relative incidence of the various types of abnormalities of sex differentiation are shown. It is pointed out that among 242 patients of all types, there were only 20 cases in which the assignment of a male role would have been preferred.
Pathogenesis of Hyposthenuria in Sickle Cell Anemia
Authors: Morgan Clarence L.
Published: December 2021

Schlitt and Keitel report (Pediatrics, 26: 249, 1960) complete reversibility of hyposthenuria in a 6-month-old subject with sickle cell disease following transfusion over a 4-day period of 290 ml of blood with a rise in maximal urine osmolality from 700 to 1100 mosmol/l. They cite this as evidence against an independent genetic defect being causal in the etiology of hyposthenuria in sickle cell disease.

It is well known that the concentrating capacity of the normal kidney increases as the ratio of urea to other solutes in the urine approaches 0.35, and the approximate range of improvement may be from 650 to 1100 mosmol/l.1
A TRIBUTE TO JAMES L. GAMBLE, M.D
Authors: Gamble James L.
Published: December 2021

The first six articles in this issue of Pediatrics are new contributions from from the laboratories of former associates of James L. Gamble and are dedicated to his memory. At the request of the Editor two friends of Dr. Gamble and members of the Editorial Board, Dr. Charles Janeway and Dr. William Waallace, located papers ready for publication and persuaded the authors to submit them to Pediatrics a collection in honor of their great teacher. This sort of enterprise requires more thought and effort than is generally realized and so constitutes a substantial and fitting tribute. The Editor wishes to express appreciation to all who have aided our purpose, especially to William Wallace, who was the guiding hand.

Pediatrics is proud to sponsor this tribute, not only to a unique and distinguished pediatric investigator, but also in recognition of the continuing vigor of basic research in pediatric laboratories. The aim of this tribute is to commemorate the man by reviewing his deeds and offering a sample of the work stimulated by his immortal influence.

A brief chronology of pivotal points in Dr. Gamble's career may serve to place the ensuing accounts of his timeless thoughts and work in familiar temporal perspective. He was born in Millersburg, Kentucky on July 18, 1883. Dr. Gamble's early education was accomplished in private schools in that small town. In 1901 the family moved to Pasadena, California, and he entered Stanford University and enrolled in the premedical course, graduating in 1906. In 1910 he received his M.D. degree, cum laude, from Harvard.
A COMPARATIVE STUDY OF BACTERIAL CULTURES AND COLONY COUNTS IN PAIRED SPECIMENS OF URINE OBTAINED BY CATHETER VERSUS VOIDING FROM NORMAL INFANTS AND INFANTS WITH URINARY TRACT INFECTION
Authors: Pryles Charles V. , Lüders Dieter , Alkan Mustafa K.
Published: December 2021

Bacteriologic studies, including cultures and colony counts, of catheterized and voided specimens of urine from infants (all under 2 years of age) were carried out in three groups: Group I, paired specimens (catheter and clean-voided); Group II, random non-clean-voided specimens; Group III, clean-voided and catheter specimens in a group of infants with clinical evidence of urinary tract infection.

In 70% of the Group I patients there was complete "diagnostic" correlation between catheter and clean-voided specimens if one accepts the figure of 1,000 colonies/ml of urine as the dividing line between a true bacteriuria and contamination, as established in this clinic for those over 2 years of age. While a 96% "diagnostic" correlation between clean-voided and catheter specimens is observed if the line between "contamination" and "infection" is placed at 10,000 colonies/ml, and this figure corresponds to the 98% correlation figure found in the group over 2 years of age, it is our feeling that the critical count should remain at 1,000 colonies/ml of urine for both infants and children. Repeat examination of clean-voided or catheter specimens should resolve all equivocal findings.

Proper "strapping" of boy and girl infants after careful cleansing of perineum, vulva or prepuce and glans will provide satisfactory samples of urine for bacteriologic study. Where doubtful results are obtained, the study of more than one specimen of urine is absolutely necessary. Catheterization, under certain circumstances, may be necessary to clarify doubtful findings, but this should be carried out with the full realization of the risk of introducing infection.
Newer Virus Diseases: Clinical Differentiation of Acute Respiratory Infections
Authors: KARZON DAVID T.
Published: December 2021

Acute respiratory diseases, especially those of viral etiology, occupy a goodly proportion of the attention of the pediatrician in his daily practice. In this small volume, Dr. Adams attempts to bring together the rapidly appearing information regarding recent discoveries and innovations in virology and correlate them with clinical aspects of respiratory infection. Sections are devoted to introducing basic concepts in virology and to anatomic and physiologic aspects of the respiratory system in relation to infection.
EVIDENCE FOR FAMILIAL ALLERGY
Authors: Critz George T.
Published: December 2021

A study of parents of 50 allergic children has been presented. A history of personal or family allergy was elicited in 20 mothers and 23 fathers, but bilateral histories were found in only 11. Scratch tests were performed on these parents and on a group of 44 adults free of allergy.

The children themselves were scratch-positive in 46 (92%) of the cases. The parents were scratch-positive in 70% (mothers) and 72% (fathers) of the cases. The presumably nonallergic comparison group of adults was positive in one (2.2%) case.

Of the parents as individuals, both history and scratch test indicated allergy in 56 (56%) of the cases (36 allergic subjects were positive and 20 "nonallergic" subjects were negative). Disagreement occurred in 44 cases, of which 37 were scratch-positive although clinically "nonallergic." In the remaining seven, verification of clinical allergy was lacking. This 7% compares favorably with the 8% of children known to be allergic in whom verification by scratch test was not demonstrated.

Using history and scratch tests as criteria for the presence of allergy, the results indicate that in 50 allergic children, 66% possessed evidence for familial allergy in both parents, 28% in one parent, and 6% in neither parent.
THE FLUORESCENT ANTITOXIN TEST FOR THE IMMEDIATE DIAGNOSIS OF DIPHTHERIA
Authors: Whitaker Jo Anne , Nelson John D. , Fink Chester W.
Published: December 2021

The recent increase in the incidence of diphtheria in our area stimulated the search for a reliable laboratory test for the immediate differential diagnosis of diphtheritic and non-diphtheritic membranous tonsillitis. Fluorescein-conjugated diphtheria antitoxin proved to be highly specific for staining toxigenic C. diphtheriae. Eight of nine patients with proved diphtheria had fluorescent organisms on a smear of exudate. The failure in the one case is attributed to the poor quality of the specimen obtained. An early case of diphtheria was detected by examination of family contacts of one of the patients in this series.

The conjugated antitoxin does not result in fluorescent staining of nontoxigenic diphtheria bacilli on of other bacteria commonly found in the nasopharyngeal tract. Fluorescent staining of cultures suggests that only a small proportion of the potentially toxigenic diphtheria organisms are actually producing toxin at a given moment.

The fluorescent antitoxin test can be performed within 1 hour. A positive result of the test is an absolute indication for antitoxin therapy. With a negative result the physician must still rely on his clinical judgment and cultural and virulence tests.
THE PASSIVE TRANSFER OF ANTIBODIES TO ESCHERICHIA COLI 0111:B4 FROM MOTHER TO OFFSPRING
Authors: Sussman Sidney
Published: December 2021

Esch. coli antibody titers in 27 mothers and their respective offspring were studied by the trypsinated and nontrypsinated hemagglutination technic.

All of the maternal sera and colostra contained Esch. coli 0111-B4 antibody. In 19 cases the antibody titer in the specimens of colostrum on the first day was higher than that of the corresponding sera. The antibody titer in the colstrum fell rapidly during the next 3 to 4 days.

Five cord sera had a low antibody titer to Esch. coli 0111:B4 when tested by the trypsinated hemagglutination method. By contrast, only two cord sera were positive for Esch. coli 0111:B4 antibody when tested by the untrypsinated hemagglutination technic.

With the trypsinated method, two infants showed a 2-tube rise and one infant had a 1-tube rise in titer at the end of the third colostrum day; one infant demonstrated a 1-tube rise in titer when tested by the untrypsinated hemagglutination technic.

In general, there was a 1-to-3-tube difference between the trypsinated and untrypsinated hemagglutination procedures.
Human Toxoplasmosis: Proceedings of the Conference on Clinical Aspects and Diagnostic Problems of Toxoplamosis in Pediatrics at the VIII International Congress of Paediatrics, Copenhagen
Authors: FELDMAN HARRY A.
Published: December 2021

This Conference, organized by the editor and participated in by representatives from 12 countries, was the largest meeting ever to be concerned with this subject. Although the Conference was held in 1956, the material presented was revised by the contributors in 1959. Thus, the monograph probably represents the greatest amount of information available on the subject of toxoplasmosis in a single volume.

Following some prefatory remarks by Prof. P. Plum, there is an introductory discussion, by Dr. Albert B. Sabin, of the status of problems posed by toxoplasmosis in pediatrics. There then follow six sections, each made up of contributions by participants from various countries.
STUDIES OF CARBOHYDRATE METABOLISM IN THE NEWBORN INFANT
Authors: Cornblath Marvin , Ganzon Angelita F. , Nicolopoulos Demetrios , Baens Gloria S. , Hollander Richard J. , Gordon Mordecai H. , Gordon Harry H.
Published: December 2021

Sugars in capillary blood were measured during the first hours of life in full-term infants delivered vaginally and by cesarean section. Pretreatment with dextrose solution for mothers delivered vaginally did not affect the course of the sugar in blood significantly Pretreatment with dextrose or saline solution for mothers delivered by cesarean section produced significant differences in the course of the infants' sugar in blood when compared to each other.

Full-term infants delivered vaginally who were more than 6 hours old had a greater hyperglycemic response to glucagon, 30 µg/kg, than infants less than 3 hours of age.

Full-term infants delivered by elective cesarean section without previous labor responded to 30 µg/kg of glucagon with a diminished hyperglycemia as compared to infants delivered vaginally.

An exposure to labor influenced the neonates' response to glucagon, whereas neither pretreatment of the mother nor the course of sugar in blood were associated with this response.

With large doses of glucagon, 300 µg/kg, the response differences associated with mode of delivery and maturity were not found to be significant.
PEDIATRICIANS' APPRAISALS OF PATIENTS' INTELLIGENCE
Authors: Korsch Barbara , Cobb Katharine , Ashe Barbara
Published: December 2021

Four hundred seventy-seven estimates by pediatricians of developmental level and intelligence of 242 patients from 1 through 9 years of age were compared with results of standard psychologic tests. Approximately a half of the pediatricians' appraisals were accurate within 10 points of the psychologic test results, and about a third deviated more than 15 points.

None of the attributes of the pediatricians or the conditions under which they made their appraisals were related to accuracy. However, not all estimates were made equally well. The greatest accuracy was shown in the estimates for children within the normal range of intelligence. The two groups most consistently misjudged by the pediatricians were the physically ill and the mentally retarded. Levels of development were most frequently underestimated in physically ill children and grossly overestimated in mentally retarded children.

Implications of the findings for pediatric practice and education are presented.
Infections in Splenectomized Children
Authors: FINLAND MAXWELL
Published: December 2021

The Commentary in the May issue (Pediatrics, 27:689, 1961) mentioned that only two cases of serious infections had been recorded following splenectomy for traumatic rupture. Both of those cases were reported by Smith et al. (Amer. J. Med., 92:507, 1956) and were also included in the analysis of Broberger et al. (Acta Paediat., 49:679, 1960), to which reference was made in the Commentary. The older age incidence of the post-traumatic cases, and the absence of underlying systemic disease for which splenectomy is indicated, are usually noted to explain the lower incidence of serious infection in cases where the spleen was removed because of traumatic rupture.
Handbook of Research Methods in Child Development
Authors: RICHMOND JULIUS B.
Published: December 2021

This is a book that pediatricians—and pediatric investigators particularly—will welcome, for it provides unusual insights into a related field of investigation. Although the avowed motivation of the editors for producing this handbook stems from their perception of an impoverished state of affairs in child development research, the contents of this excellent volume indicate that child psychology, in spite of its neglected condition, has succeeded in developing many ingenious and profitable methods to study the behavior of children.
PEDIATRIC HISTORY
Authors: Cone Thomas E.
Published: December 2021

It appears that a biologic measurement so mundane as the birth weight of the newly born infant was of little interest to physicians throughout almost the entire history of western medicine. Roederer, in 1753, slightly more than 200 years ago, published the first accurate value for an infant's weight at birth. In reviewing the course of obtaining so elementary a statistic as a newborn infants birth weight, two findings still remain enigmatic. The first is why so many distinguished physicians of the past lacked the curiosity to weigh a newborn accurately; the second, and perhaps, the more disturbing, is why such celebrated physicians were content to copy servilely the erroneous values of others.
Letters to the Editor
Authors: STEIGMAN ALEX J.
Published: December 2021

In response to Doctor Kozinn's thoughtful letter, may I say at once that his latter point is entirely well taken; nystatin is considered specific rather than "nonspecific," a typographical error which should be rectified in future editions.

As to the source of Candida, the Report states that p. 55) "yeastlike fungi are frequently found in intestinal tract, vagina, and skin of normal individuals." The skin ought not be singled out. In any of these three anatomic sites Candida may result in symptoms and signs. It was not intended to dismiss C. albicans as a common saprophyte.

The Committee appreciates comments and criticism of its brief Report.
STUDIES OF CARBOHYDRATE METABOLISM IN THE NEWBORN INFANT
Authors: Cornblath Marvin , Nicolopoulos Demetrios , Ganzon Angelita F. , Levin Ephraim Y. , Gordon Mordecai H. , Gordon Harry H.
Published: December 2021

Glucagon in varying doses was given to 40 infants born to diabetic mothers, and the blood sugar concentrations were determined at intervals thereafter. Glucagon (30 µg/kg) produced a hyperglycemia in vaginally delivered infants but not in those delivered by cesarean section. Glucagon (300 µg/kg) produced a hyperglycemia in infants delivered by cesarean section. Distressed infants seemed to respond less well than those who had an uneventful course. The data are interpreted as indicating the desirability of avoiding generalizations concerning all infants of diabetic mothers.
GASTROINTESTINAL POLYPOSIS WITH MUCOCUTANEOUS PIGMENTATION IN CHILDREN (PEUTZ-JEGHERS SYNDROME)
Authors: Wenzl James E. , Bartholomew Lloyd G. , Hallenbeck George A. , Stickler Gunnar B.
Published: December 2021

A case is reported in which a child had gastrointestinal polyposis associated with mucocutaneous pigmentations (the Peutz-Jeghers syndrome). He experienced severe recurrent abdominal pain caused by intermittent intussusception. Removal of the grossly palpable polyps from the small intestine and stomach controlled his symptoms. On the basis of a review of the literature it has become apparent that this disease may first become manifest during childhood. The symptoms are primarily those of recurrent abdominal pain and gastrointestinal bleeding in the presence of mucocutaneous pigmentation. The prognosis associated with this disease is excellent, and the risk of malignant change, if it really exists, is minimal. For this reason, it is urged that surgical treatment be conservative rather than radical, to avoid unnecessary loss of intestine.
Letters to the Editor
Authors: FINKEL K. C.
Published: December 2021

I am grateful to Dr. Cannon Eley for his criticisms on my paper, because I would not wish anyone to feel that the problem of varicella in patients receiving adrenocorticosteroids can be dismissed lightly.

In the cases referred to by Dr. Eley, adrenocorticosteroids were being administered in full therapeutic doses not only during the period of viremia, but also when clinical disease was apparent.

I would stress that my recommendations concern patients exposed to varicella and not individuals who have received steroids in full dosage throughout the incubation period.
THE BACTERIOLOGY OF THE URINE IN INFANTS AND CHILDREN WITH GASTROENTERITIS
Authors: Pryles Charles V. , Lüders Dieter
Published: December 2021

A bacteriologic study of samples of urine from 41 patients (27 infants and 14 children) with acute gastroenteritis and with diarrhea as a symptom was carried out.

Clean-voided urine samples from 22 of the 27 infants (less than 2 years of age) with diarrhea contained fewer than 10,000 organisms per milliliter; in 2 cases in which the counts were between 9,000 and 10,000, catheter samples obtained simultaneously were sterile. Three of the five infants with more than 10,000 organisms/ml of cleanvoided urine had fewer than 140 organisms/ml in catheter samples obtained at the same time; the remaining two had more than 100,000 organisms/ml and were presumed to have infection of the urinary tract.

Of the 14 children (over 2 years of age), 13 had fewer than 1,000 organisms/ml of clean-voided urine. The remaining one had more than one-million organisms/ml from both a clean-voided and catheter sample and was presumed to have infection of the urinary tract. Of the 41 patients with diarrhea, 3 (7%) had a significant bacteriuria (i.e., more than 10,000 organisms/ml of urine in infants, and more than 1,000 organisms/ml of urine in children), and were considered to have an infection of the urinary tract. It is of interest that each of these three patients had specffic gastroenteritis; one had a gastroenteritis due to Shigella sonnei, and two had an infection due to pathogenic enteric strains of Escherichia coli (055 and 0111); all three were girls, 1 month, 12 months and 7 years of age. Thus, 3 of 16 patients (19%) with specific gastroenteritis had bacteriologic evidence of infection of the urinary tract. Urine cultures for the three girls revealed organisms other than those isolated from cultures of stools.

The significance of the finding that only those patients with specific gastroenteritis were found to have a true bacteriuria and then only in girls, and that urine cultures in those patients with a true bacteriuria revealed organisms other than those isolated from the stool specimens is not clear and deserves further study.

The relationship of acute gastroenteritis to the pathogenesis of renal infection is discussed briefly, and consideration is given to the possible role disturbance in acid-base equilibrium may play in the pathogenesis of renal infection.
SEVERE REACTIONS TO LONG-ACTING SULFONAMIDES
Authors: Rallison Marvin L. , O'Brien John , Good Robert A.
Published: December 2021

Long-acting sulfonamides, represented by sulfamethoxypyridazine and sulfadimethoxine, appear to share toxic potential with other sulfonamide derivatives. Serious, often life-threatening, reactions have been reported in 35 patients receiving sulfamethoxypyridazine, with six deaths.

Erythema multiforme exudativum was observed in one child receiving sulfamethoxypyridazine and one receiving sulfadimethoxine. A disease resembling lupus erythematosus was observed in a girl treated for a long period with sulfamethoxypyridazine. Evidence of lupus disappeared when the drug was withdrawn.

The reversible nature of the observed case of lupus erythematosus supports the postulate that lupus is a disease resulting from an abnormal reactivity of a constitutionally abnormal reticuloendothelial system to the challenge of various environmental agents.
THE PHYSICAL DEVELOPMENT OF CHILDREN
Authors: Falkner Frank
Published: December 2021

In the title of this essay the traditional partner of development—growth—is missing. We have been taught that growth refers to the multiplication of cells and size changes, while development concerns the maturation of such structures and their concomitant functions. Today we realize that the whole process—call it what you will—is extremely complex and a mass of processes interacting upon each other. Because, in addition, there is no dividing line between the two terms, it seems desirable to drop an unnecessary and rather false division and use but one of the two good words.

PART I. A GUIDE TO THE INTERPRETATION OF GROWTH-CHARTS AND DEVELOPMENT ASSESSMENTS

The pediatrician is confronted today with many aspects of development. Are babies who are fed two different regimens growing comparably? Is a patient receiving steroids being stunted? Or does an anabolic hormone hasten epiphysial closure to the extent that it causes premature arrest of growth? Before interest can be taken in such questions, and in the problems of identifying true disturbances in developmental patterns, the basic principles of human development, of present methods, and the resources available must be critically reviewed.

The pediatrician and his ancillary colleagues may well be overwhelmed by the quantity of data, charts and grids concerning growth that have appeared in the last 20 years. This is not surprising and not the fault of physicians. It is perhaps an irritating fact that development and its allied problems cannot be discussed without a basic, simple knowledge of biometiy. The reader can be assured that the knowledge he requires is not complicated and will stand him in good stead in many branches of his scientific art.
Body Composition of Newborn Infants of Diabetic Mothers, Mogens Osler, Copenhagen F, Denmark, Osler, 1961, 79 pp
Authors: Cornblath Marvin
Published: December 2021

Dr. Osler, in his monograph, merely reiterates and summarizes work he has done in studying the height, weight, urinary excretion, and compartmental body water in babies of diabetic mothers. In the monograph, he presents the data in a fashion that makes it impossible to analyze and has added nothing new except that the diabetic baby is the proper length for its weight. In addition, he has made a sketchy, uncritical review of the literature pertaining to these babies and presents the data, again, in a summary fashion.