bluuebunny/crossref_metadata_2025 huggingface dataset:
BRONCHOGRAPHY IN INFANTS AND CHILDREN
Authors: Waring William W. , Killelea Donald E.
Published: December 2021

Bronchography in infants and young children requires a procedure different from that generally employed in adults. A safe and reliable technique has been reviewed which eliminates the need for fluoroscopic control of the madiopaque medium.

Under general anesthesia the contrast material is fractionally instilled through an endotracheal tube and guided sequentially by gravity to all segmental bronchi of the lung. The patient's color and respiration can be observed continuously throughout the procedure.

Conventional roentgenograms are taken, and the medium is then removed by gravity and suction. If desired, the contralateral lung may next be visualized by analogous maneuvers. Bronchography by this method requires a team of two operators, anesthesiologist, radiology technician, and probably a surgeon. The team can be effectively integrated by a pediatrician interested in chest disease who serves as one of the operators.

Fifty-eight bronchograms have been performed by this method in 52 children between the ages of 2 months and 13 years.

Criteria are outlined for determination of the adequacy of bronchograms. These criteria have been applied to this series on a segmental basis with totals tabulated for lobes and lungs. Bronchograms of adequate or better diagnostic quality were obtained in approximately 85% of the 53 bronchograms available for review. Failure to visualize a segment may be due to disease of that segment or to several technical factors. These latter include either extreme of anesthetic depth, failure to position the patient properly, excessively caudal placement of the endotracheal tube, delivery of medium into the endotracheal tube rather than just distal to it, and procedural delays due to any cause.

No deaths ascribable to the method have occurred. Complications in this series, however, have included cardiac arrest (one patient); bradycardia (one patient); and acute, transitory lobar atelectasis (three patients). These complications seem best related to airway obstruction by viscous contrast material.
INCONTINENTIA PIGMENTI: A REPORT OF THREE CASES IN ONE FAMILY
Authors: Jackson Robert , Nigam Sueh
Published: December 2021

Three cases of incontinentia pigmenti occurring in one family (mother and two daughters) have been reported. Photographs of the various stages of the cutaneous manifestations of this disease have been included. No other congenital abnormalities were found. A striking histologic feature in the biopsies of the three cases was the presence of dyskeratotic cells in the stratum corneum; more in the late pigmentary stage, less in the early vesiculo-bullous stage.
Letters to the Editor
Authors: MACKEITH RONALD
Published: December 2021

It is good that a paediatric journal carries discussion on breast feeding (Pediatrics, 29:332, 1030, 1962). In this country (and I suspect in parts of the U.S.A. too) it is, among mothers in the professional classes, coming into fashion again. It is possible that in 20 years it will again be much more widely fashionable. Paediatricians, obstetricians, family doctors, and nurses have a duty to be informed of recent progress in knowledge about lactation and about the management of breast feeding and ways of promoting successful breast feeding.
POSSIBILITIES FOR A PREVENTIVE PSYCHIATRY
Authors: Eisenberg Leon
Published: December 2021

WHEN A SPEAKER is invited to address a medical society, it may safely be assumed that its members (or at least the less jaundiced among them) anticipate enlightenment or entertainment or, mirabile dictu, both. How often these expectations are rewarded is quite another matter, upon which each of us will hold his own opinion. But it would seem to require some word of justification when a speaker arrives, as I do this evening, not to offer help but to seek it.

This is all the more unusual in view of the frequency with which psychiatrists are asked to advise pediatricians, and the relative rarity of the converse. A curious state of affairs, indeed, unless one were to assume that the psychiatrist knows all that the pediatrician does, plus something more—or that what the pediatrician knows is of no consequence for the psychiatrist. No one would seriously maintain the former statement, and the latter is no less patently absurd.

How this relationship between the two specialties has come to be is an interesting historical question, but not our present concern. However, its existence is to the detriment of both the psychiatrist and the pediatrician. It is with the hope that you will enter the lists in the struggle for the advancement of psychiatric knowledge that I propose to review what is known of preventive psychiatry. You will discern that a substantial part of it is pediatrics, has been contributed by pediatricians along with other specialists, and very much concerns pediatric practice.
Home Care of Mongoloid Children
Authors: HERSHER LEONARD
Published: December 2021

A recent article in Pediatrics by Birch and Belmont has challenged the methodology, results and conclusions of an earlier article, by Centerwall and Centerwall, on home versus foster-home rearing of mongoloid infants.

The Centerwalls studied 64 mongoloid children one-half of whom had been placed in foster homes in the neonatal period, the other half having been reared in their own homes until at least 2½ years of age. All children were eventually institutionalized. At the time of admission to the institution, and approximately 4 years later, the home-reared group were found to be superior to the foster-placement group in intelligence, motor function, and social responsiveness. The investigators concluded that "the average baby with mongolism has a better chance of being a happy, easily cared for, somewhat productive person, if a reasonable adjustment can be made to having him remain in his own home during the first years of life (p. 685).
PARATHYROID FUNCTION IN VITAMIN D DEFICIENCY RICKETS
Authors: Taitz L. S. , de Lacy C. D.
Published: December 2021

Hypocalcemic tetany does not occur in South African Bantu infants with very gross bone changes of rickets. Rachitic children with hypocalcemic tetany have significantly lower phosphorus excretion indices than those with normal or moderately decreased calcium levels. Tetany appears to occur in a specific group of subjects with moderately severe bone changes, decreased phosphorus clearance, and relatively high plasma phosphorus levels. It is suggested that this group represents either failure of the compensatory parathyroid response or secondary "pseudo-hypoparathyroidism." Certain cases of idiopathic infantile tetany may be the result of premature failure of the compensatory parathyroid response to deficiency of vitamin D.
THREE EPISODES OF SPONTANEOUS THYROID STORM OCCURRING IN A NINE-YEAR-OLD CHILD
Authors: Darby Charles P.
Published: December 2021

A case of a 9-year-old girl with apathetic hyperthyroidism, with three episodes of thyroid storm, is described. Each storm responded dramatically to corticosteroids and potassium iodide. The signs and symptoms of hyperthyroidism failed to show any response to methimazole, but a satisfactory response to propylthiouracil was obtained.
MISSION AND MANPOWER
Authors: STEIGMAN ALEX J.
Published: December 2021

THE SPECIAL ARTICLE by Stewart and Pennell, "Pediatric Manpower in the United States and Its Implications," is interesting and timely. It will be viewed differently by various readers, by some as seen from their personal perch, by others in terms of the broad reaches past and present of pediatrics as a discipline.

The purposes of the Special Article are to highlight the manpower situation and to point out long-term trends and implications in the light of the growing responsibility of pediatrics. The authors say that one requires a "delineation of the role of the specialty of pediatrics in child health care," and "while this role may be shared by other types of physicians, the responsibility for the development, maintenance, and improvement of child health services was clearly assumed by pediatrics when, as a specialty, it adopted as its objectives the protection and promotion of the health of children."
METABOLIC ACIDOSIS IN CHILDREN WITH SEVERE CYANOTIC CONGENITAL HEART DISEASE
Authors: Gootman Norman L. , Scarpelli Emile M. , Rudolph Abraham M.
Published: December 2021

Four children with severe cyanotic congenital heart disease and markedly reduced effective pulmonary blood flow were studied by cardiac catheterization. All children were severely hypoxic and acidotic, while the sytemic arterial pCO2 was relatively normal. These factors tended to maintain respiratory activity at a high level. However, due to the decreased pulmonary flow, respiratory compensation for the acidosis was ineffective. The chronic, uncompensated metabolic acidosis and hypoxemia suggested that (1) anaerobic tissue metabolism is significant, and (2) renal function may be compromised, in children with severe cyanotic congenital heart disease.
Tumors of the Eye and Adnexa in Infancy and Childhood
Authors: COGAN DAVID G.
Published: December 2021

Three books have appeared in the past few years bearing "tumors of the eye and adnexa" in their titles. The other two—one written by A. Reese and the other edited by L. Zimmerman—have been comprehensive texts emphasizing pathology. By contrast the present book by Iliff and Ossofsky is limited to tumors of childhood and has a strong clinical orientation. It represents the combined efforts of an ophthalmologist and pediatrician who have had extensive experience in radiology, surgery, and case material. The book is well organized, abundantly illustrated, and smoothly readable. It is one of the few contemporary books which can be read through in one sitting or shelved for intermittent reference reading.
Artificial Respiration: Theory and Applications
Authors: DRIPPS ROBERT D.
Published: December 2021

This volume is uneven in its impact. A few good chapters, e.g., that by John Clements on respiratory mechanics in resuscitation, are combined with some very poor presentations. Thirty-six pages are devoted to expired air methods without accessory apparatus, and these are immediately followed by 42 more pages on insufflation methods with simple equipment. There just is not enough "meat" to justify this length. The reviewer would suggest elimination of the 12 pages of case reports in Chapter 7 as one way of reducing the size of the book. A shorter, less-contrived offering would educate more readers; the present volume is too detailed, too heavy, and too long to capture one's imagination.
Letters to the Editor
Authors: PINCUS JOSEPH B. , GITTLEMAN ISAAC F.
Published: December 2021

In our article we referred to the publications of Barness et al. and Omans et al. in three areas dealing with weight gain and with the effect of diets on serum protein levels. Barness et al. in the American Journal of Diseases of Children (94:480, 1957) state: "Rate of weight gain was slightly more rapid in infants fed the higher protein formula." Again, Omans et al. in the Journal of Pediatrics (59:955, 1961), state: "In the present study the babies who were fed less than 2.5 gm/kg/day gained poorly, while those who were fed 3 to 8 gm/ kg/day gained equally well."These conclusions would lead one to believe that infants gain better on diets higher in protein.
Cerebral Dominance and Its Relation To Psychological Function
Authors: BYERS RANDOLPH K.
Published: December 2021

This little book is a review of and contribution to the subject of language and its relationship to cerebral dominance. In general it emphasizes that in right-handed people language function is nearly regularly and fairly strictly localized to the left hemisphere. In left-handed and clearly ambidextrous people there is still a tendency for language to be localized in the left hemisphere, but its localization is not as complete, and various language functions may escape in injury to one hemisphere. Recovery tends to be more complete following acute lesions of the left hemisphere in predominantly left-handed individuals.
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

Despite inadequacies in information concerning the minimum prophylactic requirement of vitamin D for all age groups beyond infancy, there is no doubt that a total intake of 400 I.U. per day is adequate to prevent vitamin D deficiency in substantially all normal children from birth through adolescence.

Evidence derived from the study of idiopathic hypercalcemia suggests that certain infants excessively sensitive to the toxic action of vitamin D may, on rare occasions, be adversely affected by daily intakes of 3,000 to 4,000 I.U. and sometimes considerably less. Because of the prevalent practice of food fortification in the United States and Canada, there is now a definite possibility that the individual, even the young infant, may ingest considerably more than the recommended vitamin D allowance, and intakes of 2,000 to 3,500 I.U. per day are possible, particularly beyond infancy. Although there has been no specific evidence that intakes of this order produce deleterious effects beyond infancy, it is pointed out that the long-term consequences of this new nutritional situation on older children or adults are entirely unknown.

In view of these considerations the Committee on Nutrition recommends that efforts be taken to ensure a total vitamin D intake of 400 I.U. per day by all infants and children. At the same time, an attempt should be made to restrict the intake from all sources to an amount not greatly in excess of this figure.

The value of carefully planned enrichment of commercial milk supplies with vitamin D has been clearly demonstrated. However, the present practice of enriching foods other than milk and infant formula products is not justified, and discontinuation of this practice is to be recommended. Under the present circumstances, cognizance should be taken of the amount of vitamin D acquired by the individual from food sources before prescribing a vitamin D supplement.

In keeping with present concepts regarding vitamin D requirement, commercial vitamin D supplements should be adjusted to contain not more than 400 I.U. per dose.
RESPIRATORY DISTRESS SYNDROME OF NEWBORN INFANTS
Authors: Miller Herbert C.
Published: December 2021

Sex did not appear to affect survival of newborn infants who had respiratory distress syndrome (RDS) in severe form. Male premature infants with birth weights over 1,500 gm were three times more likely to have severe RDS than female infants. Race did not appear to alter the fatality rate among infants with severe RDS. The effect of birth weight on survival in RDS depended on how the scope of RDS was defined. When infants with the mild form of the syndrome were excluded, no significant decrease in fatality rates was observed as the birth weight increased from 1,251 to 2,250 gm. When the infants with both severe and mild forms of the syndrome were included, there was a very significant decrease in fatality rates as birth weight increased. This inverse relationship was related to fact that the ratio of mild to severe cases increased with the birth weight. Fatality rates were significantly higher among infants with severe RDS if self-sustaining, spontaneous breathing was delayed more than one minute after birth.
RENAL HYPERTENSION: A REVIEW
Authors: Guntheroth Warren G. , Howry Cherie L. , Ansell Julian S.
Published: December 2021

Renal hypertension is divided into two categories: renoprival (excretory failure) and renovascular. The diagnostic and therapeutic implications of this classification are presented. Two cases of unilateral renal disease are discussed, emphasizing radiologic diagnosis and pharmacologic testing with tetraethyl ammonium chloride. Indications and expectations for nephrectomy are presented. Antihypertensive drugs are reviewed, their relative usefulness and probable mechanism of action are suggested. Two opportunities for preventing renal hypertension are offered: chronic pyelonephritis and radiation nephritis.
THE HISTIDINE REQUIREMENT OF THE INFANT
Authors: Snyderman Selma E. , Boyer Audrey , Roitman Ellen , Holt L. Emmett , Prose Philip H.
Published: December 2021

Histidine appears to be an essential amino acid for the young infant. Its omission from the diets of young infants gives rise to a depression of weight gain and of nitrogen retention. It also resulted in a dermatitis clinically and pathologically similar to infantile eczema, except for the absence of pruritus and atrophic changes in the sebaceous glands.

Under the conditions of this study, the histidine requirement was less than 35 mg/kg/day in all six infants tested with this intake. Five infants were given a trial of 22 mg/kg/day; in three this figure was satisfactory, but in the remaining two there was some evidence of inadequacy. An intake of 16.6 mg/kg/day appeared to be adequate for one infant.
INFECTION HAZARDS IN SWIMMING POOLS
Authors: McLean Donald M.
Published: December 2021

Adequate inactivation of potentially pathogenic human viruses and bacteria in swimming pool waters has been attained by maintenance of free residual chlorine levels of 0.2 to 0.5 ppm at pH between 7 and 8. Similar residuals of free bromine or free iodine have inactivated six common enteroviruses and parainfluenza-1, and although they have inactivated enteric bacteria satisfactory in swimming pools, further tests are required to determine their viricidal efficiency. The virtual absence of enteric bacteria from swimming pools or wading pools with detectable free chlorine residuals contrasts sharply with the relatively frequent occurrence of high bacterial counts in unchlorinated lake waters or wading pools. However, chemical evidence of pollution, on the basis of concentrations of ammonia nitrogen, organic nitrogen, and chloride, was greatest in recirculating swimming pools, less in overflow-refill swimming pools, and least in freshwater lakes.
LATERAL SINUS OBSTRUCTION AND MASTOIDITIS
Authors: Greer Melvin , Berk Marvin S.
Published: December 2021

The clinical picture resulting from mastoiditis and lateral sinus obstruction is dependent upon the variation of the pathways for intracranial venous drainage. Two children, in whom this pathological process existed, presented with markedly different neurological signs and symptoms. The right lateral sinus was obstructed in one instance and the left in the other. It was assumed that an incompetent torcular Herophili and a right-sided predominance for intracranial venous blood flow existed in both to account for the marked disparity in neurological findings. The evidence for this interpretation is indirect and is based on the clinical and roentgenographic findings.
Retroperitoneal Xanthogranuloma; Priority of Case Reports
Authors: KRUGLY MELVIN S.
Published: December 2021

I received a letter from Dr. Walton M. Edwards, requesting us to acknowledge his report of an xanthogranuloma in the retroperitoneal space as the second case in the pediatric literature. Since our paper, "Retroperitoneal Xanthogranuloma"(Pediatrics, 30:608, 1962) was submitted for publication this paper by Captain Douglas H. Sandberg, M.C., and Colonel Walton M. Edwards, M.C., appeared in the British Journal of Urology, 34:47, 1962, reporting a case of xanthogranuloma of the retroperitoneal space in a 3-year-old male child. Our case is therefore the third to be reported in the pediatric age group and not the second as we reported.
FURTHER INVESTIGATIONS ON THE ENZYMES IN HUMAN MILK
Authors: Heyndrickx G. V.
Published: December 2021

Different enzymes have been determined in 10 samples of human colostrum and 10 samples of human normal milk. From the results, it appears that the activity of pyrophosphatase, protease, trypsin inhibitor, catalase, and peroxydase is greater in colostrum than in normal milk, while the reverse is true for adenosinetriphosphatase and pseudocholinesterase. Furthermore, it appears that the activity of adenosinetriphosphatase is 23 times greater in human normal milk than in normal cow milk, catalase 10 times, pseudocholinesterase 9 times, and protease 3 times, while trypsin inhibitor is the same in the two milks. The activity of the pyrophosphatase and especially of peroxydase is lower in human than in cow milk. Finally, different correlations have been established between some enzymes, and a micro-method for protein determination in human milk with amido black has been established.
Ankyloglossia Superior (Palato-glossal Adhesion in the Newborn Infant)
Authors: WILSON REGINALD A. , KLIMAN MURRAY R. , HARDYMENT A. F.
Published: December 2021

A case of "ankyloglossa superior" is described. The operative treatment of this lesion is illustrated. The association between the tongue lesion and digital anomalies is discussed. An acquired etiology is suggested.
Payment for Care of Physician's Children
Authors: STANLEY-BROWN EDWARD G.
Published: December 2021

Whenever a doctor or a nurse asks me to provide surgical care for their own child I am flattered and much humbled. Having grown up watching the doctors in my own family giving such help cheerfully and with pride, I frankly resent the degrading discussions of this time honored privilege.
HEARING LOSS IN INFANTS AND PRESCHOOL CHILDREN
Authors: Robinson Geoffrey C. , Brummitt John R. , Miller James R.
Published: December 2021

The various etiologies of hearing impairment in 200 preschool children are described. The implications of these findings insofar as they affect the pediatrician are discussed.
ELECTRICAL CONDUCTIVITY OF SWEAT
Authors: Shwachman H. , Dunham R. , Phillips W. R.
Published: December 2021

A practical and simple method for measuring conductivity of sweat has been described. A close correlation was found between the results from 367 patients tested by the routine Pilocarpine iontophoresis method with chemical determinations of the chloride, sodium, and potassium in sweat eluted from pads and by the described conductivity method. The high conductivity values noted in 40 patients with cystic fibrosis serve to distinguish these patients from all others. Only one patient given a diagnosis of cystic fibrosis gave a conductitvity scale reading of less than 100. Although this is a semi-quantitative method, it could serve a useful purpose in the small laboratory where technicians experienced in the performance of the quantitative sweat tests are not available. Standardization of equipment is essential, as is constant checking by using standard test solutions. When borderline values are encountered by the conductivity method with values between 80 and 100 scale units, quantitative electrolyte determinations may also yield borderline concentrations and are the determinations we recommend. Age is a factor in interpretation of the conductivity of sweat, as the values increase with age in parallel with the sweat electrolyte concentration. In small infants, especially those malnourished or dehydrated, one may encounter some difficulty in obtaining an adequate sweat specimen.
BLOOD PRESSURE AND VASOMOTOR REFLEXES IN THE NEWBORN INFANT
Authors: Moss Arthur J. , Duffie Edward R. , Emmanouilides George
Published: December 2021

The aortic pressure was measured via an umbilical artery in 74 normal full-term and 26 premature infants. The ages ranged from 1 to 77 hours and the weights from 1.2 to 4.5 kg. The pressure was lower in the premature than in the full-term group and there was a positive correlation with age in both groups and with weight in the premature group.

Vasomotor reactivity was appraised by use of the cold pressor test and postural tilting. The results indicate that the vasomotor regulatory mechanisms are present and functional at birth in premature as well as in full-term infants.
Osteochondromata following Irradiation in Children
Authors: COLE A. R. C. , DARTE J. M. M.
Published: December 2021

Eight patients successfully treated by operation and irradiation developed osteochondromata within or adjacent to the irradiated area. We believe this demonstrates a benign effect of roentgen therapy infrequently reported.
Unusual Responses to Smallpox Vaccinations in Two Children
Authors: HYATT HERMAN W.
Published: December 2021

Since it appears that no case of lymphatic transfer of smallpox vaccine to new areas with resultant primary takes or of excessive hair growth around the periphery of a recently healed smallpox scar has been described in the medical literature, it seems important to report one infant with the former, and another with the latter, condition.

Case 1

F.S., a 3-week-old white male infant, received a smallpox vaccination on the right deltoid area, June 3, 1956 at Kern County Health Department, Bakersfield, California.

On June 15, an enlarged lymph node (about 1.5 cm in diameter) appeared in the right axilla. Although somewhat tender on June 15 and 16, the swollen node was barely palpable on June 17.

On June 16, an elevated erythematous "ridge" extended from the right deltoid vaccination site to the elbow. On June 17, the erythematous area had extended to the dorsum of the hand, about 1 cm below the wrist. Immediately below the termination of the "ridge" a small yellow vesicle had formed, after which the entire erythematous area disappeared. Subsequently, an elevated erythematous area extended from the vesicle to the end of the distal phalanx of the third right finger. On June 19, a yellow vesicle formed on the indicated finger immediately below the termination of the erythematous area. Shortly after the formation of the second vesicle, the erythematous "ridge" spontaneously disappeared.

The vesicles underwent desiccation, umbilication, and scab formation. The scabs thereafter separated, leaving the typical pitted smallpox scar. (Except for the tiny needle pricks related to the original inoculation, there was no change in the deltoid vaccination site.)
A SIMPLE PHENYLALANINE METHOD FOR DETECTING PHENYLKETONURIA IN LARGE POPULATIONS OF NEWBORN INFANTS
Authors: Guthrie Robert , Susi Ada
Published: December 2021

A new method is described for rapid and economical screening of large numbers of hospital nursery infants for elevation in blood phenylalanine associated with phenylketonuria. Results are presented for 682 infants, 96% of whom were 4 days of age. None of the blood phenylalanine values were found to be as high as 4 mg/100 ml, and only 8% were above 2 mg/100 ml. These values appear to be in agreement with values obtained by other methods, and indicate that a very low rate of "false-positives" will be encountered during screening of the 10,000 or more infants that may be necessary to detect a case of phenylketonuria. It is recommended that any result of 6 mg/100 ml or above be considered positive, and require confirmation by phenylalanine determination of a second blood specimen.
GASTROINTESTINAL MALABSORPTION ASSOCIATED WITH CYSTINURIA
Authors: Fleming William H. , Avery, Gordon B. , Morgan R. Irvin , Cone Thomas E.
Published: December 2021

A case of cystinuria occurring in a 14-year-old Negro male is presented. The hereditary nature of the aminoaciduria was demonstrated, and the genetic implications are pointed out. Associated with the cystinuria was a severe idiopathic steatorrhea and extreme vitamin D refractory rickets. Suggestive evidence for a depressed absorption of L-lysine from the gut is presented. A satisfactory explanation for the steatorrhea and vitamin D resistant rickets is not apparent.
MEGALOBLASTIC ANEMIA ASSOCIATED WITH THE INGESTION OF PHENOBARBITAL AND PRIMIDONE
Authors: Kahn Sigmund Benham , Lischner Harold , Baker Lester , Williams William J.
Published: December 2021

A new case of megaloblastic anemia which occurred in a 6-year-old girl receiving anticonvulsant therapy with primidone and phenobarbital is described. Low serum folic acid activity was found on admission. A prompt clinical and hematological remission occurred following the administration of 500 µg of folic acid per day, associated with a rise in serum folic acid activity to normal. Anticonvulsant therapy with phenobarbital was continued without supplemental folic acid, and 12 months following the correction of the anemia the serum folic acid level was again found to be low. This is further evidence for a relationship between folic acid deficiency and anticonvulsant drug therapy.
ANTIBODY DEFICIENCY SYNDROME WITH INCREASED GAMMA1 M (B2 M) GLOBULINS AND ABSENT GAMMA1 A (B2 A) GLOBULINS AND GAMMA2 (G) GLOBULINS
Authors: Huntley Carolyn C. , Lafferty John W. , Lyerly Anne
Published: December 2021

A case of absent gamma1 A and gamma2 globulins and increased gamma1 M globulins is presented. The name "antibody deficiency syndrome" Type III is suggested for this entity until its relationship to other antibody deficiency syndromes, particularly the Bruton type, is clarified.
CONGENITAL GLAUCOMA
Authors: Bettman Jerome W. , Cleasby Gilbert W.
Published: December 2021

Certain important points concerning congenital glaucoma should be remembered. The pediatrician should be suspicious of irritation of the eyes in an infant. Photophobia, lacrimation, and/or haziness of the cornea should make one suspect congenital glaucoma and call for competent ophthalmological examination. These findings indicate congenital glaucoma until proven otherwise. Medical therapy should not be attempted except as a supplement to surgery. Goniotomy is the operation of choice for congenital glaucoma.
MILK ALLERGY
Authors: Goldman A. S. , Anderson D. W. , Sellers W. A. , Saperstein S. , Kniker W. T. , Halpern S. R.
Published: December 2021

The diagnosis of milk allergy was confirmed in 89 children by oral challenge with milk and/or purified milk proteins. Most of these patients were diagnosed as allergic during the first 2 years of life. The symptoms of milk allergy usually began during the first few months of life. Eighteen of the total patients experienced spontaneous remission of milk hypersensitivity. Multiple symptoms were produced by oral milk challenge in 77% of the patients. Vomiting, diarrhea, abdominal pain, asthma, rhinitis, and atopic dermatitis were frequently presenting and challenge symptoms. Several patients had central nervous system symptoms, urticaria, or anaphylactic reactions following milk challenge. Seventy-eight per cent of the presenting symptoms were reproduced by oral milk challenges. Challenge feedings produced symptoms not found in the history in 18% of the patients. No consistent patterns of symptom combinations were found.

The onset time of oral challenge reactions was usually within the first 12 to 24 hours. Some reactions occurred within a few minutes while others required 2 days or more before they were discernible. The duration of challenge reactions was usually between 12 to 24 hours. Allergic symptoms appeared much sooner after oral challenge in the patients who required less milk to elicit an allergic reaction.

Forty-five patients were challenged with amounts of the purified milk proteins, casein, alpha-lactalbumin, beta-lactoglobulin, and bovine serum albumin, present in the challenge doses of 100 ml skim milk. Every patient had an allergic reaction to one or more milk proteins. The frequencies of reactions were casein, 57%; BSA, 51%; beta-lactoglobulin, 66%; and alpha-lactalbumin, 54%. The reactions from oral challenge to skim milk or purified milk protein in a given patient were very similar. No correlation was found between the symptoms produced and the specific protein which produced these reactions.

By oral challenge tests few patients (13%) were allergic solely to the heat labile protein, BSA. Only two of these patients could be actually managed on a processed milk in which BSA was inactive by laboratory tests.
PRESIDENT'S MESSAGE
Authors: Webb Clarence H.
Published: December 2021

QUESTIONS are asked, sometimes hesitantly, sometimes stridently: Shall the American Academy of Pediatrics continue its traditional role in the framework of American medicine? Or should it alter the purposes expressed by the founders, to which it has held consistently through the years? Should it become partisan on behalf of the pediatrician's welfare, a political-action organization, active also in medical economics?

Those who have concern for the ultimate future of pediatrics and the path which the Academy travels must take a thoughtful, searching look at these questions and arrive at a concert of opinion.

Why do these questions arise?

They represent one expression of growing pains in our specialty. All surveys and reports indicate that pediatrics is flourishing, one of the fastest growing of the specialties. Increasing numbers of American and foreign graduates are in pediatric residency training and apply to the American Board of Pediatrics for certification. Many foreign trainees remain in the Americas and seek citizenship. The present body of pediatricians, in practice, teaching, and research, has neither the post-training experience nor the cohesiveness of purpose of the Academy founders and members during its formative years; many lack the reassurance of established solidity.

Paralleling this development, the Academy grows in size, significance, and comprehensiveness of program. Now 8,000 in membership, it is the largest pediatric organization in the world. Its voice on behalf of children becomes increasingly persuasive; its programs of training, of research into special problems, of committee activities in many spheres of child health and welfare, its reports and publications, have an expanding influence.
The Disgruntled Pediatrician Syndrome
Authors: VANDERSALL THORNTON A.
Published: December 2021

One year ago, after 3 years of practice, I left Pediatrics and began a 3-year fellowship in Psychiatry. In the belief that my thoughts about leaving have more than purely personal validity, I am submitting them here.

I began with the stark realization that I did not like practice. Having reveled in hospital Pediatrics, I was surprised. I first complained that the work of practice was not essential (compared to "sick child" care in hospitals). Any mother who picks up the phone to call a pediatrician can point out the error in that argument.
ADENOVIRUS COMPLEMENT-FIXING ANTIBODY TITERS FROM BIRTH THROUGH THE FIRST YEAR OF LIFE
Authors: Nemir Rosa Lee , O'Hare Donna , Goldstein Stanley , Hilton Charles B.
Published: December 2021

Complement fixing antibody titers to the adenoviruses were determined in 251 newborn infants, using cord blood. Approximately 95% of these were found to have CF titers of 1:16 or over, the majority (75%) were 1:32 or more. Material from the pharyngeal and rectal swabs of these infants on tissue culture studies (542) on HeLa and amnion cells showed no cytopathic effect in oven 96% of these infants.

A longitudinal study of 114 of these infants was made at 3 months intervals; 67 have been observed for one year. At 3 months, only 12% still showed CF antibody titers, and these were chiefly at a low level, 1:16. At the subsequent 3-month interval observations, a gradual rise in CF antibodies were found. At one year of age, approximately 37% had titers of 1:32 on over.

The findings of this report support the statement that CF antibodies to adenovirus pass the placental barrier. There is a gradual increase in the percentage of infants with positive CF antibodies after 3 months.
RELATION OF 7S AND 19S STAPHYLOCOCCAL HEMAG-GLUTINATING ANTIBODY TO AGE OF INDIVIDUAL
Authors: Florman Alfred L. , Lambertson Gertrude H. , Zepp Helen , Ainbender Eugene , Hodes Horace L.
Published: December 2021

Staphylococcal hemagglutinating antibodies are present in both 7S and 19S fractions of serum. Newly born infants receive only 7S hemagglutinins from their mothers, and this passively acquired antibody soon disappears from the circulation. Infants under 4 months of age fail to respond to severe staphylococcal infections with hemagglutinin production. Infants over 4 months of age do make hemagglutinins, but these antibodies are mostly in the 19S class. Infants and children over 4 months of age may have high titers of hemagglutinins even without a history of staphylococcal infections. Most adults have significant staphylococcal hemagglutinin titers. The distribution of staphylococcal hemagglutinating antibodies between 7S and 195 is consistent. Under the age of 16 years, most of the actively acquired hemagglutinin is in the 19S class. After 16, 7S hemagglutinins may dominate. Thus, under the conditions of natural exposure to staphylococci, age of the individual is a significant determinant of the class of his staphylococcal hemaglutinating antibodies. Although it is clear from this and other reported studies that individuals react to different antigenic stimuli by making different classes of antibodies, the biological and clinical significance of these observations are not yet completely understood.
THE USE OF THE WORKING CAPACITY TEST IN THE EVALUATION OF CHILDREN WITH CONGENITAL HEART DISEASE
Authors: Duffie Edward R. , Adams Forrest H.
Published: December 2021

A safe, simple and effective method of objectively measuring the functional capacity of children with congenital heart disease is now available. This study shows that as a group, these children have a decreased working capacity. The reduction is most marked in those patients with severe obstructive lesions, pulmonary hypertension or cyanosis. A comparison of pre- and post-operative working capacities in a small group of children shows that the majority improved following corrective surgery. There are apparently other factors involved than anatomic repair of the defects, however. The working capacity test provides a means whereby objective evidence of the functional results of surgery can be evaluated.
Letters to the Editor
Authors: WEBB CLARENCE H.
Published: December 2021

I suspect that the great majority of pediatricians are much too busy—and interested—with their daily jobs to indulge seriously in the kind of self-pity reflected in the article which Dr. Hudson extols. A skilfully written compendium of the kind of occupational grumbling which every professional man uses as a form of self-catharsis, it falls into the commonplace error of confusing the fringe with the core of a subject, of presenting the unusual as though it were the regular.
ORGANIC ACIDS IN FETAL BLOOD AND AMNIOTIC FLUID
Authors: Räiha Niels C. R.
Published: December 2021

The acid-base balance and the concentrations of lactate, pyruvate, citrate, alphaketoglutarate and total acetone bodies have been studied in human amniotic fluid and in cord blood. Lactate and citrate concentrations are elevated in amniotic fluid, the other acids being present in a concentration similar to that in blood.

Lactate accounts for only a part of the total metabolic acidosis in cord blood. The concentration of the other organic acids studied does not explain this difference.

The lactate and pyruvate concentrations are significantly correlated with the degree of metabolic acidosis in cord blood expressed as negative base excess, the other acids showing no correlation with the degree of acidosis and asphyxia.
FAMILIAL OCCURRENCE OF LETTERER-SIWE DISEASE
Authors: Schoeck Volker W. , Peterson Raymond D. A. , Good Robert A.
Published: December 2021

The cause of acute disseminated histiocytosis X is still unknown. This review indicates that the involvement of hereditary factors is likely; however, further evidence, such as the observation of the disease in two or more generations of the same family, is needed. There is also sufficient evidence for a communicable agent to warrant a further search for such an agent.
An Atlas of Congenital Heart Disease
Authors: SISSMAN NORMAN J.
Published: December 2021

Despite the vast experience accumulated during the past decade with all aspects of the lives and deaths of patients with congenital heart disease, there is still room for the clarification and direction that careful, informed, imaginative analysis of the results of pathological examination of postmortem material can give to the clinical management of these patients. Dr. Sherman has made a notable contribution in this area with the present volume.

The atlas was compiled from 503 specimens collected in the Museum of Congenital Heart Disease at the Children's Hospital in Pittsburgh since 1954.
COMMUNITY-WIDE PLANNING FOR CHILDREN'S HOSPITAL SERVICE IN A METROPOLITAN AREA
Authors: Sigmond Robert M.
Published: December 2021

Community-wide planning of hospitals and related facilities in a metropolitan area helps to translate the miracles of modern medical science into high quality service for all at reasonable cost. Community-wide planning for children's inpatient services should encourage grouping of small segregated pediatric units in which most children receive care today. These small units interfere with provision of high quality, comprehensive care and are wasteful of scarce personnel and dollars. Experts should agree upon the minimum size unit in which effective care can be provided; this minimum would obviously be much larger than most units in existence today. To achieve this minimum, most general hospitals should affiliate with major general hospitals or children's medical centers at which their pediatric inpatient facilities could be grouped into a few large units. The children's medical centers should take leadership in exploring the feasibility and nature of such affiliations of which the key element is the medical staff relationship. Such affiliations are consistent with and conducive to valid objectives of children's medical centers: leadership in promotion of child health, child care, education and research. Failure of children's medical centers to develop such affiliations may have dire consequences in the long run.
A COMMUNITY EPIDEMIC OF ENTEROPATHOGENIC ESCHERICHIA COLI O126:B16:NM GASTROENTERITIS ASSOCIATED WITH ASYMPTOMATIC RESPIRATORY INFECTION
Authors: Boris Marvin , Thomason Berenice M. , Hines Virginia D. , Montague Tom S. , Sellers Thomas F.
Published: December 2021

A 15-month surveillance was conducted at a metropolitan hospital for detection of enteropathogenic Escherichia coli (EEC). Of the 383 admissions, 151 cases of gastroenteritis (39.6%) were due to EEC as determined by the fluorescent antibody (FA) method. During the late summer of 1962, the O126:B16:NM strain was unusually prevalent, having been detected in 39 of the 82 cases (47.5%) of EEC enteritis. Epidemiologically, the outbreak was localized in three geographically distinct areas. Age and race specific rates for infants hospitalized with O126:B16:NM enteritis from these areas were 73.2, 54.5, and 118.2 per 1,000 population.

Age and race specific attack per 1,000 population for all gastroenteritis in the clinic population and hospitalized patients were 177.2 and 30.3, respectively, with 31.7% due to EEC. In the nonwhite population, 0-3 months of age, 13% of the infants were hospitalized for gastroenteritis of which 53% was caused by EEC.

In three selected hospital populations, 6 of 270 surveyed infants were asymptomatically infected with EEC, an incidence of 2.2%.

In a community investigation, 50% of index households had one or more asymptomatic pharyngeal carriers of strain O126:B16:NM, while next-door neighbor households and distant community control households had pharyngeal carrier rates of 33 and 0% respectively. Intestinal carriage rates in these three groups were 18%, 3%, and 0%, respectively. Follow-up studies in pharyngeally infected neighbor households in which no members were intestinal carriers of EEC revealed on subsequent examinations six previously uninfected individuals became infected in four of five households examined. This implies a respiratory transmission of EEC.
MENTAL RETARDATION AND THE MATERNAL AND CHILD HEALTH AMENDMENTS OF 1963
Authors: LESSER ARTHUR J.
Published: December 2021

IT IS A little over a year since a Panel appointed by the President published its report entitled "A Proposed Program for National Action to Combat Mental Retardation." In preparation for the report, members of the Panel discussed mental retardation in its broadest aspects with thousands of people in this country and abroad. Over 90 recommendations for action were made including recommendations for federal legislation.

The enactment in October, 1963, of Public Law 88-156, "The Maternal and Child Health and Mental Retardation Planning Amendments of 1963" will make it possible for the Children's Bureau to carry out some of the major recommendations of the President's Panel.
WHY ARE TWINS DISSIMILAR?
Authors: DRISCOLL SHIRLEY G.
Published: December 2021

TWINNING has captured the imaginations of artist, story-teller, and scientist throughout recorded history. Many studies of the intrapair likenesses and differences of twins have been directed toward elucidation of the interplay between nature and nurture. Yet the dissimilarities which occur within twin pairs may not be recognized and the mechanisms which underlie these differences often are not understood. Indeed, clinical observation of discordance between cotwins seems to evoke surprise, especially when such dissimilarities are evident at birth and in monozygous twins. In terms of the health and survival of the twins, these phenomena may be of critical importance.

How do these differences arise? Dissimilarities between dizygous twins are to be expected, reflecting the individual genetic heritage of two siblings, as they evolve contemporaneously.
ACUTE TUBULAR NEPHROSIS IN THE NEWBORN INFANT, A MANIFESTATION OF ANOXIA
Authors: Kwittken John , Reiner Leopold
Published: December 2021

The presence of cellular renal casts in the newborn infant is considered evidence of renal tubular injury. A cause-and-effect relationship between anoxia and these renal lesions is suggested by this study. The histopathologic manifestations of tubular disease best demonstrated in sections stained for fat and with the periodic acid-Schiff routine are dependent not only upon the severity and duration of anoxia, but also upon the length of survival after injury. In this regard, the finding of urinary cellular casts in the newborn infant may suggest to the clinician an early and vigorous approach against the pathologic effects of anoxia.
DIAGNOSIS AND TREATMENT: MANAGEMENT OF THE CHILD WHO HAS HAD ONE CONVULSION
Authors: Carter Sidney
Published: December 2021

FOR MOST PARENTS their child's first convulsion is a dramatic, frightening event which demands immediate medical attention. The physician, on the other hand, may see the patient after recovery from the attack and may tend to minimize the severity of the situation and assume a wait-and-see attitude before investigation and treatment are initiated.

The convulsion is a symptom that indicates a disturbance of cerebral neurones. This disturbance may be the result of underlying organic disease of the brain, either fixed or progressive, or it may be an indication of a functional disturbance related to a circulatory or metabolic disorder. The first attack may be so mild that the child is unaffected but subsequent attacks may be prolonged, or result in status epilepicus, and produce a mild or severe degree of mental impairment. There is considerable evidence to indicate that anoxia associated with convulsions can cause brain damage and for this reason every child who has had a convulsion should be investigated and, with rare exception, placed on prophylactic daily anticonvulsant medication when no specific treatable condition is discovered.

EVALUATION

The first step in the study of a child who has a convulsion is to document its occurrence. Anxious parents are, as a rule, poor witnesses. Despite this, every effort should be made to obtain a description of the seizure, particularly premonitory symptoms, loss of consciousness, convulsive movements, duration of the attack, and the state of the patient following the attack. In infants breath-holding spells may simulate convulsive seizures. In breath-holding spells there is always a precipitating factor, usually a slight injury or some emotional disturbance which results in violent crying, ending suddenly in respiratory apnea. The cyanosis in such attacks appears before the loss of consciousness and convulsive movements.
Taste Discrimination in Familial Dysautonomia
Authors: SMITH ALFRED A. , DANCIS JOSEPH
Published: December 2021

Taste perception and discrimination is deficient in patients with familial dysautonomia. No deficiency was evident in parents of children with dysautonomia.