bluuebunny/crossref_metadata_2025 huggingface dataset:
Letters to the Editor
Authors: SMITH NATHAN J. , THATCHER L. GILBERT , DESPOSITO FRANKLIN T.
Published: December 2021

The essential data presented in the paper by Beal et al. (Pediatrics, 30:518, 1962) involves the determination of hemoglobin concentrations. It is regrettable that these determinations are impossible to interpret. The unusual method used is neither adequately described nor documented. The accuracy of the method and the authors' sampling techniques, especially as used over the span of many years, is a question of such critical importance to this study that full documentation of accuracy and reproducibility of the result would have to be presented before any significance could be attached to this study. The authors interpret as "normal," ranges of hemoglobin values greater than any published elsewhere, again without statistical analysis or documentation.
THE ADRENAL GLAND IN INFANCY
Authors: BONGIOVANNI ALFRED M.
Published: December 2021

THE adrenal gland comprises virtually two distinct organs of separate embryologic origin, secreting chemical substances of two different categories: steroids and catecholamines. The cortex arises from the Wolffian duct and the medulla from the anlagen of sympathetic ganglia. The extensive effects of these two classes of hormones upon so many biological mechanisms in numerous organs and tissues render these endocrine glands a fruitful quarter for clinical investigation. Certain tissues may rely upon adrenal secretions for their own optimal function or they (and others, not necessarily primarily dependent upon these hormones) may be profoundly affected by excessive production of these humoral agents. During the past 20 years, practicable techniques have been developed and improved into accurate tools for the assessment of the operation of these structures.
Clinical Diabetes Mellitus
Authors: GUEST GEORGE M.
Published: December 2021

In 34 chapters of this book the editors have assembled articles written by 43 contributors, distinguished experts in various fields of physiology and clinical medicine. The chapters constitute a splendid composite of theoretical background and clinical concepts including practical aspects of therapy and latest developments in basic research related to diabetes mellitus. In the past, this disease, perhaps more than any other, has engaged the interest of investigators who employed the technical skills of many different disciplines. Thus it is especially appropriate that this excellent new treatise should be written by numerous contributors, each reporting from specialized acquaintance with problems encountered in the pursuit of different but closely interrelated lines of inquiry.
CONGENITAL DILATATION OF THE PULMONARY LYMPHATICS
Authors: Javett S. N. , Webster I. , Braudo J. L.
Published: December 2021

A case of congenital dilation of the pulmonary lymphatics is described, the infant being still alive at the age of 9 months. The distinctive clinical features dating from the age of 3 days were marked distension of the thoracic cage, dyspnea with inspiratory recession, prolonged expiration without adventitious sounds, and the absence of cough. X-rays of the chest showed voluminous lungs which altered little on expiration. At thoracotomy, the lungs were found to have a peculiar sponge rubber consistency, deflating tardily to compression and leaving visible finger imprints. There were no cysts large enough to be seen with the naked eye. Biopsies of the lungs taken at an interval of 6 months showed persistent and unaltered gross dilatation of the subpleural, perivascular, and septal lymphatics. No other pathology was present in the lungs. Later the infant became subject to spontaneous attacks of wheezing, associated with cough. Despite the troubled course, the patient gained weight reasonably. The cushioning of the lungs by the dilated lymphatics is the probable factor responsible for the restricted movement and all other associated respiratory signs. Infection and cor pulmonale are the complications most to be feared.
MEASUREMENT OF THE EARLY UPTAKE OF RADIOACTIVE IODINE BY THE THYROID GLAND
Authors: Mosier H. David , Armstrong Marjorie K. , Schultz Marvin A.
Published: December 2021

The early thyroidal uptake of I131 was measured in children and adults after an intravenously administered tracer dose of 0.2 to 5.0 µC. The data show that one can distinguish during the first few minutes hyperthyroidism from euthyroid or hypothyroid states and that T-3 suppression tests can be satisfactorily performed during this period. Continuous recording of the uptake permits one to see the hyperthyroid quality of the curve during the first few seconds of the uptake. If sodium perchlorate is administered orally after the 11-minute count, the 24-hour uptake value can be limited to about 2% of the dose in euthyroid individuals. The technique described offers an opportunity to limit the irradiation of the thyroid in certain diagnostic studies. This is of particular interest in children in whom there is probably greater sensitivity to irradiation induced thyroid neoplasia than in adults.
ELECTROENCEPHALOGRAPHIC AND ETIOLOGIC FINDINGS IN MENTAL RETARDATION
Authors: LaVeck Gerald D. , de la Cruz Felix
Published: December 2021

A series of 578 institutionalized mentally retarded patients was evaluated by a multi-discipline approach in order to establish a presumptive etiologic diagnosis. Abnormal electroencephalographic findings were found to be related to the age of the patient, the severity of retardation, and the presence of seizures or motor dysfunction.

In this series 65.9% had abnormal tracings, and the most frequent abnormality was a focal change in 18.7%. However, focal abnormalities correlated with seizures and motor dysfunction so that no specific electroencephalographic aberration was characteristic of mental subnormality. Abnormal tracings were most frequent in nonseizure patients when subnormality was caused by intoxication, new growths, metabolic disorders, infectious processes, trauma, and encephalopathy of unknown cause in decreasing order of frequency. Abnormalities were seen in 36.4% of "cultural-familial" defectives and those whose intellectual defect was presumably due to psychologic factors.

It is believed that electroencephalography is a valuable diagnostic aid in the evaluation of mentally retarded children.
CONCENTRATIONS OF CALCIUM AND INORGANIC PHOSPHORUS IN SERUM OF NORMAL INFANTS RECEIVING VARIOUS FEEDINGS
Authors: Owen George M. , Garry Philip , Fomon Samuel J.
Published: December 2021

Sera of normal full-term infants, 2 weeks to 5 months of age, were analyzed for concentrations of calcium and inorganic phosphorus. Concentrations of calcium were not found to be significantly influenced by age, sex or type of feeding, the mean value being 9.6 mg/100 ml. Concentrations of inorganic phosphorus in sera of groups of infants receiving a variety of feedings were not well correlated with phosphorus content of the feedings. The mean concentration of inorganic phosphorus in sera of infants 2 weeks to 2 months of age was 7.0 mg/100 ml, approximately two-thirds of the values falling between 6.0 and 8.0 mg/100 ml. The mean concentration of inorganic phosphorus in sera of infants 2 to 5 months of age was 6.5 mg/100 ml, approximately two-thirds of the values falling between 5.8 and 7.4 mg/100 ml. Mean concentration of inorganic phosphorus in sera of boys was significantly greater than in sera of girls, particularly during the first two months of life. The importance of this observation is uncertain.
PRESIDENT'S MESSAGE
Authors: Webb Clarence H.
Published: December 2021

THE PREVIOUS Message (Pediatrics, January, 1963) presented the role of the pediatrician as a clinical specialist; the other side of this professional coin is his role as family counsellor. For the child is not complete without his family, and the family—man's oldest institution—is unfulfilled without the child.

The background of this series was outlined in the first article as the concept of the author, enhanced by the shared thoughts and experiences of 20 pediatricians of his approximate vintage who practice in various parts of this country and in cities and towns of diverse size.

Some questions which have been posed or may arise should be answered. First, this series is a positive approach, and no attempt shall be made to catalog the disadvantages or occupational discomforts; they have been discussed by others. The challenge of pediatrics and the love of children make possible a full, satisfying life for the every-growing number of pediatricians.

Secondly, the emphasis herein on pediatric practice rather than total pediatrics reflects no lack of respect or affection for pediatric teachers, researchers, and other kinds of pediatricians. I have known many and worked with a number; they are imbued with the same ideals and purposes about which I write. A great strength of pediatrics and of the American Academy of Pediatrics is the cohesive force of service to children, which enables academicians and practitioners to work together exceptionally well. But I would feel awkward in attempting to describe those pediatric fields which are outside of my major experience; I must write of those things which I have known.
Cold Formulas and Adaptability
Authors: MCCLELLAN MARVIN
Published: December 2021

On October 22, 1962, an article appeared in the Medical Tribune entitled "Warming formula seen unnecessary in baby feeding." Subsequently, in another article on October 29, 1962, in the same publication, there was another article entitled "Cold-bottle school likely to prevail, experts feel."

Both of these articles are comments about the feeding of cold formulas instead of those traditionally heated to body temperatures. The first work done in this direction was by Dr. John P. Gibson of Abilene, Texas. In the winter of 1958-9, Dr. L. Emmet Holt, Jr., Professor of Pediatrics, New York University School of Medicine, and Dr. Saul Krugman, Director of Pediatrics at the Bellevue Hospital, conducted a study, comparing the feeding of warm and cold formulas.
THE METABOLISM OF MAGNESIUM AND OTHER INORGANIC CATIONS AND OF NITROGEN IN ACUTE KWASHIORKOR
Authors: Linder Geoffry C. , Hansen John D. L. , Karabus Cyril D.
Published: December 2021

Continuous balance measurements of magnesium, nitrogen, potassium, sodium, calcium, and phosphorus have been made in the first 21 days of treatment of acute kwashiorkor, with particular attention to magnesium. In the next 30 days, isolated 5-day or 6-day balance determinations were made. Thirteen children, aged 10 months to 2 years, were studied. Five of them took a supplement of magnesium hydroxide throughout. In all but one, the balance of magnesium was strongly positive, much more so when the supplement was given. The retentions of magnesium and potassium were greater than was expected from the nitrogen balance, and that of phosphorus was greater than expected from the nitrogen and calcium balances. This reflects the deficient state of cell protoplasm in these ions, which others have reported. The magnesium content in urine was always very low on admission, but in a third of the children the magnesium concentration in serum was within normal limits. No symptoms referable to magnesium deprivation were observed in this series, but reasons are given for recommending that a magnesium supplement be used routinely in treatment.
Benign Carotenemia of Infancy
Authors: O'NEIL RICHARD R.
Published: December 2021

In the past 2 years I have noted a fair number of children with a yellow discoloration to their skin but with normal color to their sclerae. On the early cases I performed liver function studies, checked the youngsters for diabetes and hypothyroidism, and in all instances found these to be within normal limits. The only positive laboratory finding was a consistently elevated blood carotene. In no instance was any significant illness noted in these youngsters.
The Relationship of Acute Bronchiolitis to Bronchial Asthma—A 4-to-14-year Follow-up
Authors: EISEN A. H. , BACAL HARRY L.
Published: December 2021

Of 63 patients suffering a single attack of acute bronchiolitis in infancy, 16 (25.4%) were found to have bronchial asthma on follow-up 4 to 14 years later. The familial incidence of allergic manifestations was high (62%) in this group. Thirteen patients (20.6%) continued to have attacks of wheezing associated with respiratory infections. This tendency to wheeze gradually subsided after an average period of five years. The ultimate prognosis of these children is not known. The presence of a positive immediate family history of allergy in an infant with bronchiolitis considerably alters the usually excellent prognosis. The first attack of bronchiolitis may be a form of respiratory allergic manifestation in an already potentially asthmatic infant.
COMMITTEE ON FETUS AND NEWBORN
Authors:   COMMITTEE ON FETUS AND NEWBORN,   SUBCOMMITTEE ON BILIRUBIN STANDARDS
Published: December 2021

FOR THE past several years exchange transfusion has been generally accepted as the best preventive measure available against the hazard of kernicterus in hyperbilirubinemia in the newborn. During this period the Committee on Fetus and Newborn has repeatedly discussed the advisability of making a recommendation concerning the concentration of bilirubin in the serum above which an exchange transfusion would be indicated in the immediate neonatal period of life.

The Committee to date has not felt that sufficient evidence existed to justify a specific recommendation of this sort, because the ultimate clinical decision rests on the relative risks of kernicterus and serious complications of death associated with the exchange transfusion procedure. While knowledge and experience are accumulating which improve the effectiveness of, and confidence in, exchange transfusion, the Committee recognized that several areas existed where greater application could be made of existing knowledge with obvious benefit.

In 1961 the Committee attempted to stimulate Academy State Chapters to initiate or conduct educational programs on the subject of neonatal jaundice at the state and local level. At the same time, the Committee established a Subcommittee under the chairmanship of Dr. David Hsia to work with other interested groups and experts to draw up recommendations on a uniform bilirubin standard. Surveys using unknown standard bilirubin solution had emphasized what was widely suspected, that laboratories determining bilirubin were using standards prepared in several different ways, and different analytic methods, which resulted in a considerable range of answers on any single specimen.
Biliary Atresia: Possibility of a Prosthesis
Authors: HAYS DANIEL M.
Published: December 2021

A significant advance in the treatment of biliary atresia would command the immediate attention of all pediatricians and pediatric surgeons.

In a recent report (Sterling, J. A., and Lowenburg, H.: Observation of Infants with Hepatic Duct Atresia and Use of Artificial Duct Prosthesis. Pediat. Clin. N. Amer., 9:485, 1962.) an operative procedure employing multiple metal tubes connecting the hepatic parenchyma with the gastrointestinal tract is described. Analysis of the results of therapy using these prosthetic devices includes the following statements or inferences: (a) the usual survival in untreated biliary atresia is less than 8 months and (b) the length of survival following the surgical procedure described may be significantly increased.
Radiography of Infants and Children
Authors: SILVERMAN FREDERIC N.
Published: December 2021

A volume on methodology in any field properly includes a description of the equipment used, explanation for the selection of the equipment and accessories, appropriate precautions in their use, adequate illustrations of their use, and examples of the results to be obtained. Dr. Darling's volume covers this sequence admirably. The actual photographs of patients in the various positions described helps immeasurably in placing a child in the proper position to obtain a desired film. The format, which relates the films obtained to the "clinical photographs" makes for ease in utilization of the volume.
Sweat Electrolytes in Glycogen Storage Disease, Type I
Authors: HARRIS RUTH C. , COHEN HERBERT I.
Published: December 2021

The cause of high concentration of electrolytes in sweat in a small group of patients with glycogen storage disease has interested us. Sodium and chloride concentration in sweat of three boys with glucose-6-phosphatase deficiency has been found in a range comparable to that seen in patients with cystic fibrosis of the pancreas. These children seem to have a preference for salty food and also have frequent periods of hypoglycemia. While such factors have been known to influence the sweat test, heretofore such association in patients with glycogen storage has not been recorded.

Table I presents data on five children with glycogen storage disease type I. Significantly high electrolyte concentrations in sweat were found in one male, moderately high concentrations in two males, and normal concentrations in the two females. Two males with phosphorylase defect had normal electrolyte concentrations.

Sweat tests by pilocarpine iontophoresis were done by the method of Gibson and Cooke on 484 children between the ages of 4 weeks and 5 years. Collections were made on the left forearm, usually for less than 60 minutes. As shown in Table II, 73 of the tests were on children with cystic fibrosis (CF) and eight on children with glycogen storage disease. The remaining 403 tests included 84 on CF siblings and other relatives of children with CF. Since no difference was discernible between results of tests on these relatives and other normal individuals, they were grouped together as controls. Among normal individuals, sodium, and chloride values in sweat were below 30 meq/1 in 96%. A few patients with cystic fibrosis or glycogen storage disease had values in the borderline range of 40-49 meq/l. All the males with glucose-6-phosphatase deficiency had values above 50 meq/l.
THE PHYSICALLY ABUSED CHILD
Authors: BAIN KATHERINE
Published: December 2021

THE SYMPOSIUM, "The Battered Child Syndrome," held at the American Academy of Pediatrics meeting in Chicago in October, 1961, brought into focus the increasing professional recognition of a new significance to an old problem. The phrase "the battered child" was, of course, arresting and accounted in part for the large audience. The interest shown, however, was not simply a response to the sensational but rather an expression of the need to clarify a vague and ill-defined area that had long troubled many physicians. The presentation recalled to the memories of many of the participants cases never fully solved to their satisfaction, and defined an entity into which many of these would fit.
STUDIES WITH A FURTHER ATTENUATED LIVE MEASLES-VIRUS VACCINE
Authors: Krugman Saul , Giles Joan P. , Jacobs A. Milton , Friedman Harriet
Published: December 2021

A "further attenuated" live measles-virus vaccine was administered to more than 2,000 infants and children in the New York City area. The clinical and immunologic effects of further attenuated and Edmonston "B" vaccines were compared. Observations were made on the protective effect of live measles-virus vaccine. The febrile reaction rate following further attenuated measles-virus vaccine without gamma-globulin was 15%, a rate essentially the same as that following Edmonston "B" vaccine with gamma-globulin, 0.01-0.02 ml/lb body weight. The percentage incidence of fever in infants less than 2 years of age was 35%, a rate significantly higher than the 15% febrile reaction rate observed in older children. Modification of further attenuated vaccine by an additional inoculation of 0.2 ml of gamma-globulin eliminated febrile reactions almost completely; the "corrected" incidence of fever was 1%.

A comparison of the relative incidence of febrile reactions following live measles, smallpox, and inactivated polyvalent influenza vaccines revealed no significant differences. Systemic reactions were most severe following influenza vaccine, minimal or absent following live measles vaccine, and moderately severe following smallpox vaccine. The following decreasing incidence of rash was observed when Edmontson "B" vaccine was modified by the addition of gamma-globulin and by further attenuation: Edmonston "B" vaccine, 50%; Edmonston "B" plus gamma-globulin, 12%; further attenuated vaccine, 5%; and further attenuated vaccine plus gamma globulin, 3%. The immunologic response following further attenuated vaccine without or with gamma-globulin (0.2 ml) exceeded 97%.

A rapid immunogenic and protective effect of live measles-virus vaccine was observed in children from five families in which a case of measles had occurred. Vaccination performed on the day of exposure and 1, 5, and 6 days before exposure was followed by no illness and a significant antibody response. Children vaccinated 3 to 10 days after exposure acquired measles after the appropriate incubation period.

The protective effect of live attenuated measles-virus vaccine was observed at the Willowbrook State School. Since the last "measles year" in 1960, 600 susceptible children were admitted to the institution; of this group, 550 were vaccinated. During the 1962 "measles year" only 32 cases of measles occurred in the entire institution—all in unvaccinated children.
HEARING LOSS IN INFANTS AND PRESCHOOL CHILDREN
Authors: Robinson Geoffrey C. , Kendall David C. , Cambon Kenneth G.
Published: December 2021

This paper reviews the development of a provincial program to evaluate and train preschool children with hearing impairment of a degree sufficient to interfere with language and speech development. Problems relating to delay in diagnostic assessment and hence to early initiation of training are described, and some suggestions for overcoming them are made. It is suggested that physicians, and particularly pediatricians, have an important role in the resolution of these problems.
Preventive Pediatrics: Child Health and Development
Authors: SHAWK EDWARD B.
Published: December 2021

This book serves very well to fulfill the author's avowed purpose "to bring together in one place as much as possible the information and research which are pertinent to the health supervision of growing children and to describe the health services which are or should be available to them."

Perhaps the chief charm of this book is that it has been written by a single author who has deliberately attempted to improve his own knowledge in every area which he discusses and to present it in an evenly paced and understandable manner. The encyclopedic scope of this volume could readily have been expanded beyond its 800 pages; abbreviation of some sections and omission of some subjects is understandable for this reason.
Child Development & Personality, 2nd Edition
Authors: ILLINGWORTH R. S.
Published: December 2021

The authors set out with a laudable object of tracing a child's development chronologically, in order to give a sense of continuity, and to discuss various aspects of growth, physical, intellectual, social and emotional, at each age period, so as not to consider them as unrelated phenomena. They attempt to integrate data on child development with general behaviour theories, notably those of Piaget. They try to say why the child is what he is, and why he behaves in a particular way.
ELECTROENCEPHALOGRAPHIC AND CLINICAL ASPECTS OF CEREBRAL PALSY
Authors: Gibbs Frederic A. , Gibbs Erna L. , Perlstein Meyer A. , Rich Catherine L.
Published: December 2021

The motor defects of cerebral palsy, and the mental retardation that so commonly accompanies it, are chiefly clue to destruction of cerebral neurons. Such disorder is not as clearly indicated in the electroencephalogram as nondestructive, nonlethal, irritative injuries. Certain nonparoxysmal forms of electroencephalographic abnormality, for example, focal slowing, asymmetry, and altered sleep patterns, correlate fairly well with the structural damage and with the specific motor defects of cerebral palsy.

The electroencephalogram is a sensitive indicator of less than lethal injury in damaged but surviving neurons, whose function is not abolished but is unstabilized. Such disorder commonly manifests itself in epileptic seizures. Although cerebral dysrhythmia and epilepsy are not the main problems in cerebral palsy, they should not be overlooked. They are related to the motor and intellectual manifestations and they are part of the total problem.

Electroencephalography adds another dimension to our view of cerebral palsy. In combination with other parameters of evaluation is useful for diagnosis and prognosis and as a guide to treatment.
Pediatric Surgery
Authors: KOOP C. EVERETT
Published: December 2021

As Dr. Swenson says in his preface, the major change carried out in this second edition of his textbook consists of an expanded section on heart surgery. There is a considerable dissertation on complete transposition of the great vessels, remarkably well illustrated, and a concise resume of malformations of the heart which may be corrected by surgical procedures. Although it is undoubtedly true that this expanded section contributes something to the second edition, it is not an exhaustive coverage of the field of cardiovascular surgery in children.
AUTOSOMAL DISORDERS
Authors: Lejeune Jerome
Published: December 2021

THE RAPID GROWTH of human cytogenetics imposes, as a corollary, the progressive restriction of the scope of a talk on this subject. Two years ago, a quarter of an hour was sufficient for a general survey; today, a whole hour is filled with one topic only. Without being a prophet, it can be seriously foreseen that some day, a Blackfan Lecture restricted to "the genic content of the short arm of chromosome 22" will be considered a very brief summary of the current knowledge.

I would like to discuss the general implications of the available data on autosomal disorders. Chromosomes are divided into sex chromosomes and non-sex chromosomes, which are generally called autosomes. My subject can be considered under three points of view: the recognition of autosomal disorders, the mechanism of their production and, finally, the practical or heuristic use of this knowledge, as it enables more to be learned.

SYNDROMES DETERMINED BY AUTOSOMAL DISORDERS

The Numerical Abnormalities

The numerical abnormalities are no longer limited to classic mongolism, with its 47 chromosomes and its trisomy for No. 21.1-3

The trisomy for chromosome 17, in which there occurs a typical deformity of the head, a small mandible, low set ears, other nonspecific malformations of heart, hands and feet, and severe mental retardation, is also quite classic. Possibly more than 25 different patients suffering from this disease are now known.

The 13-15 trisomy with eyeball defects, polydactyly, cardiopathy, and mental defect, together with deformities of lips, palate, skin, and ears is also well established.
CITRULLINURIA
Authors: McMurray W. C. , Rathbun J. C. , Mohyuddin F. , Koegler S. J.
Published: December 2021

A heretofore undescribed disorder manifested by mental retardation, citrullinuria, hypercitrullinemia, and hyperammonemia is reported. Dietary studies show a direct relationship between protein intake and urinary citrulline excretion. Citrulline excretion occurs as an overflow mechanism with plasma citrulline being maintained at about 25 mg/100 ml. Loading studies suggest that the ornithine urea cycle is functioning; high post-absorptive blood ammonia levels indicate that little reserve capacity for urea formation is present.
Tuberculosis in Children
Authors: COOK CHARLES D.
Published: December 2021

It seems appropriate that Dr. Lincoln, who has devoted her professional life to the care of children with tuberculosis (and the critical evaluation of such care) has, with Dr. Sewell's assistance, recorded her unique experiences. This volume represents an important and very useful contribution; it will certainly provide pediatricians with up-to-date and authoritative information on the management of tuberculosis in infants and children. The authors have drawn on their very large experience, which fortunately antedates the era of anti-tuberculous drugs and hence gives them an unusually good perspective for evaluating present trends in treatment.
CHANGES IN RED CELL ENZYME ACTIVITY IN RELATION TO RED CELL SURVIVAL IN INFANCY
Authors: Kaplan Eugene , Tildon J. Tyson
Published: December 2021

The change in activity of red cell G6PDH and AChE in normal full term infants forms a pattern which parallels that of Cr51 red cell life span in the first months of life. These two phenomena, one relating to erythrocyte biochemistry and the other to erythrocyte function, are in keeping with the hypothesis that reduced erythropoiesis after birth results in an older red cell population.
Folic Acid Content of Cow's Milk
Authors: NAIMAN J. LAWRENCE , OSKI FRANK A.
Published: December 2021

In the report of the Committee on Nutrition concerning the nutritional adequacy of cow's milk substitutes (Pediatrics, 31:329, 1963) we noted that the folic acid content of cow's milk was stated to be 2.2 µg per quart.

This figure was obtained by microbiologic assay with Streptococcus fecalis1; no added ascorbic acid was used in the incubation medium to protect labile folates from oxidative destruction.
Letters to the Editor
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

The Committee on Nutrition has reviewed the interesting letter from Drs. Naiman and Oski regarding the Committee Report, "Appraisal of Nutritional Adequacy of Infant Formulas Used as Cow Milk Substitutes." In this letter they call attention to a discrepancy between their own values for folic acid (60 µg/qt) and those mentioned in the Committee report (2 µg/qt). The Committee is aware that the S. fecalis assay is quite low in comparison to the L. casei assay, whereas bioassay values are intermediate. The complexity of the problem is obvious from the following letter by Drs. Luhby and Cooperman.
Folic Acid Content of Milk and Milk Substitutes
Authors: LUHBY A. LEONARD , COOPERMAN JACK M.
Published: December 2021

The "folic acid" content of cow's milk, as listed in the report of the Committee on Nutrition (Pediatrics, 31:329, 1963) is probably too low, as pointed out by Drs. Naiman and Oski. We would agree that these figures should be withdrawn until a more accurate assessment can be made.

We are, however, less certain than they appear to be, that the L. casei assay, ascorbate-protected, will provide the information desired, i.e., the true total folate content of foodstuff biologically available to the human. For an understanding of the present situation, it is necessary to review briefly certain pertinent developments in this field.
Family Medical Care: A Report on The Family Health Maintenance Demonstration
Authors: VINCENT MARC
Published: December 2021

Dr. Silver has condensed in a book rich with facts amid details the origins, developments and results of this "Family Health Demonstration." The demonstration was set up in an attempt to find a way of giving to the patient the personal attention that he expects to receive from an individual practitioner and the higher level of technical excellence that might be possible in group practice.

The author outlines the main characteristics of the present day life of the urban American family and shows what can be the role of the physician in regard to these facts.
THE PEDIATRICIAN AND THE HANDLING OF TERMINAL ILLNESS
Authors: Lourie Reginald S.
Published: December 2021

There is little in our medical training which prepares us as pediatricians to deal with the problems attending the death of our patients. Our emphasis has rightly been on the maintenance of life and growth. While over-all pediatric mortality decreases, there is an increasing segment of the patient population with chronic illness such as leukemia, cancer, and cystic fibrosis that can be expected to be terminal. Inevitably, the handling of the terminal phases becomes the responsibility of the physician who is most knowledgeable about the disease, usually the pediatrician, who has had no preparation for dealing with the delicate interpersonal problems and processes involved.
THE THYMUS AND OTHER LYMPHOID TISSUES IN CONGENITAL AGAMMAGLOBULINEMIA
Authors: Gitlin David , Craig John M.
Published: December 2021

Patients with congenital agammaglobulinemia may be separated clinically and pathologically into two groups. One group manifests a persistent lymphopenia and is characterized clinically by an unremitting course marked by pneumonia, moniliasis, and other infections usually beginning in the first three months of life and, thus far, terminating fatally during the patient's infancy. These patients have thymic alymphoplasia and lymphocytic hypoplasia of their tissues: the thymus is rudimentary, and the other lymphoid structures contain only sparse populations of small lymphocytes. The thymic alymphoplasia and general deficiency in small lymphocytes appear to be inherited characteristics and the evidence suggests that the primary defect is thymic alymphoplasia which results in generalized lymphocytic hypoplasia including lymphopenia.

The second group of patients often has a later onset and a more intermittent course of bacterial infections, a variable leukocyte response marked only occasionally by transitory lymphopenia; their lymphoid organs including the thymus contain more nearly normal numbers of lymphocytes.

Plasma cells and germinal follicles are absent from the tissues of both groups of patients, but the marked generalized paucity of small lymphocytes in these patients with thymic alymphoplasia results in an increased susceptibility to infection beyond that seen in nonlymphopenic agammaglobu-linemia. Whatever the exact contribution of the small lymphocyte to resistance to infection, it appears to be significant and its loss is not replaced by γ-globulin therapy.
PASSIVE IMMUNIZATION
Authors: Edsall Geoffrey
Published: December 2021

Passive immunization has existed for over 70 years, ever since Von Behring and Kitasato demonstrated its effectiveness in neutralizing diphtheria toxin. In fact, at first glance one might think that there was little new to say on this subject. However, the very fact that its concepts and practices have been so long accepted and–in the minds of many–have fallen into the pattern of purely routine procedures, is in itself sufficient justification to re-examine the subject. In addition, moreover, there have been a number of changes in the range of diseases for which passive immunization may be employed, the type of antiserum used, and the guiding principles for use of such preparations. Therefore, it may be timely to deal with some of the present considerations that apply to passive immunization, its prospects, its scope, and its limitations.

At the risk of repeating old and familiar cliches it appears desirable to summarize, at first, the guiding principles which apply to the effectiveness (or ineffectiveness) of passive immunization. First of all, it is well established that some techniques of passive immunization are highly effective–e.g., diphtheria prophylaxis with antitoxin; some are very useful but fall short of the ideal of routine success with the purpose intended–e.g., the use of gamma-globulin for the modification of measles; whereas others are of relatively uncertain value so that their usefulness in medical practice still continues to be debated–e.g., gas gangrene antitoxin. The reasons for such great disparity in the efficacy of different antisera cannot easily be put into generalizations, but surely the varied pathogenesis of the diseases in question must be a major factor, as well as the fact that high antibody titers can readily be obtained for some such sera, whereas they are difficult or impossible to achieve with others.
THE ACADEMY—1962-1963
Authors: Webb Clarence H.
Published: December 2021

I am grateful to you, the fellows of the Academy, for entrusting me–a simple practitioner of pediatrics from a small city in a small state–with this highest office in the world of pediatrics. You had the promise, one year ago, of my undivided attention and best efforts in meeting this responsibility. But only as time passed did the realization come, as it must to every president, of the golden gift which I had received and for which I shall be forever thankful: the vision from the portals of my office of the far-flung activities and influence of the Academy. It touches the lives of children on isolated farms and in the great cities; its voice is heard in governmental councils, in public health and child welfare activities; it counsels with other great medical and nonmedical organizations; we glimpsed something of its international role in Lisbon last year, and we saw its expanding influence in other American countries when we went to South America and the Pan-American Pediatric Congress this year.

May I attempt to partially repay this debt by unfolding a panorama of your service to childhood and humanity through this organization? For the Academy is the extension of the personality and idealism of each of its members. Each of you seeks from it the ability to give better care to the children whom you serve; each of you contributes to it a part of your unselfish desire to improve the lot of all children. The effort, the aspirations of a single memher would amount to little; like a few drops of rain, they would be lost in the vast desert of child needs.
MECHANISMS OF ADAPTATION OF THE LEFT VENTRICLE TO MUSCULAR EXERCISE
Authors: Mitchell Jere H.
Published: December 2021

THE mechanisms of adaptation of the left ventricle to the demands of muscular exercise have intrigued cardiovascular physiologists for many years. Although highly complex, these adaptive mechanisms are more and more susceptible to analysis and quantification. In this presentation I will attempt to identify some of the individual factors which appear to be important in the response of the left ventricle to exercise, beginning with data obtained from experiments on conscious normal male subjects and proceeding to experiments performed on dog preparations in which individual factors were controlled and analyzed.

The changes in oxygen intake, cardiac output, estimated arteriovenous oxygen difference, pulse rate and estimated mean stroke volume were determined in 15 normal male subjects during rest in the standing position and during treadmill exercise at the maximal oxygen intake level. Oxygen intake was obtained from the volume and composition of expired air, cardiac output by the dye dilution technique, and pulse rate from the electrocardiogram. Estimated arteriovenous oxygen difference was obtained by dividing the oxygen intake by the cardiac output (Fick principle) and estimated mean stroke volume by dividing the cardiac output by the heart rate. The data are shown in Figure 1. Oxygen intake increased from a mean value of 0.34 at rest to a maximal value of 3.22 L./min. The corresponding mean values for cardiac output were 5.4 and 23.4 L./min. and for arteriovenous oxygen difference were 6.5 and 14.3 ml./100 ml. Thus, as oxygen intake increased 9.5 times, the cardiac output increased 4.3 times and the arterio venous oxygen difference 2.2 times.
EXERCISE STUDIES IN PATIENTS WITH CONGENITAL HEART DISEASE
Authors: Hugenholtz Paul G. , Nadas Alexander S.
Published: December 2021

The data collected during exercise at cardiac catheterization, in the supine position, show that the limit of exercise in patients with left to right shunts may well be determined by the degree of pulmonary flow that can be handled, and in patients with ventricular outflow obstruction by the absolute level of peak pressures a ventricle can generate. Thus baseline resting studies extrapolated for a given flow (based on an assumed need of approximately 700 cc. blood to move 100 cc oxygen to the periphery), may, in cases of a significantly disturbed hemodynamic state, well be sufficient to answer the question as to how much a patient with a single congenital heart lesion may be permitted to exercise.
THE JUXTAGLOMERULAR CELLS OF THE KIDNEY AND THE ZONA GLOMERULOSA OF THE ADRENAL CORTEX IN THE SODIUM-LOSING AND THE HYPERTENSIVE FORMS OF VIRILIZING ADRENAL HYPERPLASIA
Authors: Cara José , Gardner Lytt I.
Published: December 2021

Pathological and biochemical observations are presented in two cases of virilizing adrenal hyperplasia: one of the sodium-losing type and the other of the hypertensive type. Examination of the kidneys revealed hypertrophy of the juxtaglomerular cells in the case exhibiting excessive sodium loss. The adrenal cortex showed hypertrophy of the zona glomerulosa. It is hypothesized that the chronic state of sodium loss caused changes in the intravascular compartment which led to compensatory activity of the juxtaglomerular cells with resultant stimulation of the zona glomerulosa.

Examination of the hypertensive case (known to involve a different enzyme deficit) showed hypertrophy of the zona glomerulosa without hypertrophy of the juxtaglomerular cells. The intrinsic overproduction of sodium-retaining steroids associated with the genetic defect in this clinical form could account for both the hypertension and the absence of hypertrophy of the juxtaglomerular apparatus.
PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM
Authors: Kiely Brian , Morales Francisco , Rosenblum David
Published: December 2021

When the pulmonary valve is atretic and the ventricular septum intact, the right ventricle usually consists of a small chamber with a very thick wall capable of developing high pressure. This pathologic picture is associated with clinical findings similar to those in tricuspid atresia—cyanosis, decreased pulmonary flow, left ventricular preponderance on the electrocardiogram, and early death. The diagnosis may be confirmed by heart catheterization and selective angiocardiography with injection into the right ventricle, but the risk is great. Surgery has never been successful in the past; but because of the equally hopeless prognosis on medical treatment, attempts should continue to be made. Anastomosis of the superior vena cava to the right pulmonary artery appears to offer hope of success in the future.
Methodology in Human Genetics
Authors: FRASER F. C.
Published: December 2021

This volume contains the proceedings of a Conference sponsored by the National Institutes of Health and the University of Utah and held at Salt Lake City in 1960. It is, in the words of the Editor, "Not quite a complete compendium for experts nor a treatise for beginners . . . ," yet it will provide useful material both for the professional human geneticists and the novice. Sixteen presentations dealing with the methodology of various areas of human genetics are interspersed with discussions from others of the forty-five participants.
PHENYLKETONURIA IN YEMENITE JEWS
Authors: Cohen Bernard E. , Szeinberg Arieh , Boichis Hayim , Bodonyi Eva
Published: December 2021

Details are given of four phenylketonuric patients of Yemenite Jewish background. With one exception, their clinical and biochemical findings were identical to findings in phenylketonuric patients of other nationalities. None of the children was blond or blue-eyed, and there was only minor dilution of pigment of hair, skin, and iris.
Albumin in the Meconium of Infants with Cystic Fibrosis: A Preliminary Report
Authors: WISER WILMER C. , BEIER FRANCES R.
Published: December 2021

Meconium samples were collected from 5 newborn infants, who had a known family history of cystic fibrosis of the pancreas but who did not present with meconium ileus, and 11 normal newborn infants. Extracts of the meconium samples were examined for the presence of serum proteins by paper and immunoelectrophoresis.

Three of the infants who had a family history of cystic fibrosis of the pancreas showed protein in their meconium, and this was identified by immunoelectrophoresis as consisting mainly of albumin; each of these babies subsequently developed classic symptoms of cystic fibrosis of the pancreas. The two remaining infants had no albumin in the meconium and did not develop signs of cystic fibrosis. None of the meconium samples of the control group of infants contained detectable amounts of albumin.

Possible sources of the abnormal protein content of meconium are discussed, and the suggestion that the finding of albumin in meconium of newborn infants may prove to constitute a valuable diagnostic procedure for screening newborn infants for cystic fibrosis of the pancreas is advanced.
EVIDENCE FOR THE NUCLEIC ACID COMPOSITION OF MEASLES VIRUS
Authors: St. Geme Joseph W.
Published: December 2021

The in vitro interaction of cultural cells and viruses in the presence of 5-bromodeoxyuridine (5-BDU) provides a simple indirect assessment of viral nucleic acid composition. The 5-BDU, a thymidine analogue which inhibits cell deoxyribonucleic acid (DNA) synthesis, interferes with the replication of DNA-containing vaccinia virus but not ribonucleic acid (RNA)-containing poliovirus. The observation that measles virus escapes inhibition by 5-BDU suggests that it is composed of RNA, not DNA. Other characteristics also suggest a close taxonomic relationship with the myxovirus group. Since chemotherapeutic agents may selectively disrupt either DNA on RNA synthesis, knowledge of the nucleic acid composition of a virus seems essential in predicting which agents may be promising for clinical trial.

Note Added in Proff: Since this manuscript was submitted for publication there have appeared two other reports on the failure of halogenated deoxyuridines to inhibit either the in vitro cytopathology or multiplication of measles virus.
GASEOUS METABOLISM IN PREMATURE INFANTS AT 32-34°C AMBIENT TEMPERATURE
Authors: Adams Forrest H. , Fujiwara Tetsuro , Spears Robert , Hodgman Joan
Published: December 2021

Thirty-four measurements of oxygen consumption, carbon dioxide production, respiratory quotient, and rectal temperature were made on 22 premature infants with ages ranging from 2½ hours to 18 days. The studies were conducted at 32-34°C utilizing an open circuit apparatus and a specially designed climatized chamber. Oxygen consumption and carbon dioxide production were lowest in the first 12 hours and increased thereafter. The rate of increase in O2 consumption was greater than that of CO2 production, with a consequent fall in respiratory quotient during the first 76 hours of life. A reverse relation of O2 consumption and CO2 production was found following the 4th day of life with a consequent rise in respiratory quotient.

There was a close correlation between O2 consumption and rectal temperature regardless of age.

A respiratory quotient below the value of 0.707 for fat metabolism was observed in 7 premature infants with ages ranging from 24 to 76 hours.
A COMPARISON OF ATRIO-VENTRICULAR CONDUCTION IN NORMAL CHILDREN AND IN PATIENTS WITH RHEUMATIC FEVER, GLOMERULONEPHRITIS, AND ACUTE FEBRILE ILLNESSES
Authors: Mirowski M. , Rosenstein Beryl J. , Markowitz Milton
Published: December 2021

1. Atrio-ventricular conduction was studied in 50 normal children, 25 children with acute febrile illnesses, 50 patients with an initial episode of active rheumatic carditis, 46 patients with acute rheumatic fever without clinical evidence of carditis, and 39 children with acute post-streptococcal glomerulonephritis.

2. Quantitative measurements of A-V conduction were obtained by calculating the P-R index, the ratio between the recorded P-R interval (numerator) and the upper limit of normal for the age and heart rate as given in standard tables (denominator).

3. The mean P-R indices were similar in patients with acute rheumatic fever without clinical evidence of myocardial involvement and in children with overt carditis, and were significantly higher than in normal children, children with acute febrile illnesses of patients with acute glomerulonephritis.

4. The frequency with which high P-R indices were found in patients with acute rheumatic fever suggests that disturbances in A-V conduction are even more common than has been previously recognized from conventional P-R interval determinations.

5. The data suggest also that A-V conduction abnormalities in acute rheumatic fever occur independent of other signs of myocardial involvement and are not related to the ultimate prognosis.