bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECT OF MEASLES, GAMMA GLOBULIN MODIFIED MEASLES, AND ATTENUATED MEASLES VACCINE ON THE COURSE OF TREATED TUBERCULOSIS IN CHILDREN
Authors: Starr Saul , Berkovich Sumner
Published: December 2021

1. Wild measles in our series of INH-treated children with tuberculosis exerted a deleterious effect on the course of the tuberculosis.

2. Gamma globulin modified measles had a similar effect on the course of tuberculosis.

3. The effect of measles on the tuberculosis appeared 2 weeks to 3 months after the measles, manifesting itself as an increased pulmonary infiltration or as an increased number of gastric washings positive for M. tuberculosis.

4. These relapses occurred at about the time or soon after the time when the depressed tuberculin reactivity returned to its original positive state.

5. Vaccine measles caused by live attenuated measles vaccine did not produce any evident deleterious effect on the course of childhood tuberculosis while under isoniazid therapy. The effect of vaccine measles on the course of untreated tuberculosis is not known.

6. Where feasible, children in high risk areas should be checked for tuberculosis before being given live attenuated measles vaccine. If tuberculosis is found, at least 4 months of isoniazid therapy is recommended after administration of live measles vaccine.
Juvenile Diabetes: Adjustment and Emotional Problems. Proceedings of a Workshop held at Princeton
Authors: FARQUHAR JAMES W.
Published: December 2021

Perhaps on no other single subject does such an enormous and complex literature exist as for Diabetes Mellitus. Yet in the past year the well-known and often highly distinguished members of a Workshop, sponsored by the United States Public Health Service and other bodies, frankly admitted their ignorance both of the etiology of this common illness and of the prevention and treatment in childhood of related problems of emotional upset and adjustment. When men of the stature of Mirsky say, "I do not know what the aetiology of diabetes is or what the pathogenic mechanism is," and others of the experience of Danowski express the hope that "we will generate approaches, techniques and specific plans to relieve our ignorance," we get an insight into the intricacy of the problem.
SPONGY DEGENERATION OF THE NERVOUS SYSTEM (CANAVAN'S DISEASE)
Authors: Hogan Gwendolyn R. , Richardson Edward P.
Published: December 2021

The clinical and pathological findings in a case of spongy degeneration of the nervous system (Canavan's disease) occurring in an Irish family are presented. The literature is reviewed and the clinical findings that would aid in diagnosis are discussed.
CONGENITAL DIFFUSE FIBROMATOSIS: A CASE REPORT
Authors: Levkoff Abner H. , Gonzalez Carlos G. , Neher John L.
Published: December 2021

A fatal case of congenital fibromatosis involving a large area of the neck and shoulder with phrenic nerve palsy is presented.
Congenital Anomalies of the Kidney in Association with Wilms's Tumor
Authors: JAGASIA K. H. , THURMAN WILLIAM C.
Published: December 2021

The association of Wilms's tumor with congenital anomalies of the upper genitourinary tract in a series of 116 children has been presented. The importance of pathological changes in an anomalous kidney after removal of the other kidney has been discussed. All children having nephrectomy for Wilms's tumor should be closely followed in order that symptomatic congenital lesions of the remaining upper urinary tract will be noted early enough to avoid irreparable damage.
Our Blind Children—Growing and Learning with Them
Authors: DAVENS EDWARD
Published: December 2021

In this second edition of a standard work first published in 1956 on the growth and education of the blind child, the information is brought up to date and a new chapter dealing with the blind adolescent is added.

Discussion of the impact on the parents of having a blind baby is handled in an understanding and constructive way and is followed by a clear and accurate presentation of the facts most parents want to know.
Goldberger on Pellagra
Authors: CONE THOMAS E.
Published: December 2021

Although we rarely encounter pellagra in current pediatric practice in this country, it was a serious scourge during the first third of this century. The unraveling of the etiology of pellagra is as fascinating as any mystery story. Looking back on the intriguing process that led to the understanding of the cause and prevention of this disease, one can only wonder why American epidemiologists revere Snow on Cholera as the classic demontration of epidemiologic method and neglect our own masterpiece, the work of Joseph Goldberger on pellagra.
Sex-Linked Imperforate Anus
Authors: WEINSTEIN E. DAVID
Published: December 2021

Three families with recurrent cases of imperforate anus are presented. The distribution of cases in these three families suggests a sex-linked recessive pattern of inheritance for this anomaly. It is speculated that the excess of males reported in the literature with this disease may be due in part to sex-linkage.
Handbook for the Young Diabetic
Authors: CONE THOMAS E.
Published: December 2021

This is just the type of practical, attractively designed small booklet the physician treating adolescents with diabetes could well use in his practice to help get across to the young diabetic the idea that they can grow up and live a normal life with diabetes.

The book is readable, devoid of scientific jargon and written in a manner which will not bother the adolescent; it is free from dictatorial overtones and overly rigid enforcement of dietary rules.
Diseases of Children
Authors: MACDONALD WILLIAM B.
Published: December 2021

This new British textbook of pediatrics is a "compact" despite having nearly 600 pages. It was written entirely by one author, Hugh Jolly, now physician in charge of The Children's Department at Charing Cross Hospital, University of London. Prior to this, Dr. Jolly practiced pediatrics in the West of England where he served as a consultant to urban and rural practitioners. His textbook gives evidence of this; it has been written essentially as a practical work for medical students and general practitioners, as the author informs his readers in the first sentence of the Preface.
THE ETIOLOGY OF GASTROENTERITIS IN INFANTS AND CHILDREN, WITH EMPHASIS ON THE OCCURRENCE OF SIMULTANEOUS MIXED VIRAL-BACTERIAL INFECTIONS
Authors: Cramblett Henry G. , Siewers C. M. F.
Published: December 2021

Over a 3-year period, 117 episodes of gastroenteritis occurring in 112 children in North Carolina were studied virologically and bacteriologically. A bacterial agent alone and a viral agent alone were isolated in 25% and 12% of cases, respectively. Simultaneous mixed viral-bacterial infections occurred in another 12%. These findings are in accord with data reported by other workers in North America and Europe.

There was a definite seasonal pattern: 82% of all viral isolations were in the summer months, and most of the cases of diarrhea without demonstrable pathogens occurred in winter. Bacterial pathogens, however, were isolated at a rather constant rate throughout the year.

The peripheral white blood count was not found to be helpful in predicting the etiologic agent involved.

A significantly greater excretion rate of all infectious agents was found in children 6 months old and younger (43 pathogens from the specimens of 51 patients) in comparison to that observed in the older age group (38 pathogens from the specimens of 66 patients). Also, twice as many simultaneous mixed viral-bacterial infections occurred in children under 6 months of age as in all other age groups together.

The need for repeat bacterial cultures and the examination of both throat and anal specimens for maximal recovery of viral agents in cases of gastroenteritis is apparent.
RHINOVIRUS INFECTION IN CHILDREN WITH ACUTE LOWER RESPIRATORY DISEASE: EVIDENCE AGAINST ETIOLOGICAL IMPORTANCE
Authors: Portnoy Bernard , Eckert Herbert L. , Salvatore Margaret A.
Published: December 2021

The clinical, clinical laboratory, and viral aspects of 16 cases of lower respiratory disease in infants and children associated with rhinovirus isolation have been described. Rhinovirus isolations appeared to be as frequent in children without lower respiratory disease. Although the presence of concomitant infection with other viral agents made interpretation difficult, there was no conclusive evidence that the rhinoviruses were significant etiologic agents in children with lower respiratory disease severe enough to require hospitalization.
CLINICAL OBSERVATIONS IN PHENYLKETONURIA
Authors: Kang Ellen Song , Kennedy Joseph L. , Gates Lorraine , Burwash Ida , McKinnon Ann
Published: December 2021

Clinical observations over a 36-month period on a group of patients with phenylketonuria are summarized.

Preliminary comparison of 9 phenylketonuric patients started on dietary treatment at a mean age of 3.6 weeks and treated for a mean duration of 13.5 months revealed significantly lower developmental achievement than in their 34 unaffected siblings. Attempts should be made to shorten the period between birth and exact diagnosis as much as possible in order to determine whether that will further increase the benefits of dietary therapy.

Maternal obstetrical histories were found to be significantly abnormal in approximately 46% of net pregnancies in heterozygotes. Consequently, careful evaluation of the role of perinatal factors is advised in the assessment of the results of dietary therapy in each patient.

Fasting serum phenylalanine levels of 16 untreated infants under a month of age were not significantly different from those in 20 older patients with PKU. Individual variations in the vulnerability of the nervous system to elevation of the blood phenylalanine level may be another important factor in the variability in intellectual defect.

One atypical patient is discussed.

Measurements of phenylalanine levels in blood and close observation of the clinical course of the patient, particularly his weight gain, rather than the presence or absence of abnormal metabolites of phenylalanine in the urine, should be used as guides to early diagnosis and to the dietary management of patients with phenylketonuria.
INTESTINAL GLYCOSIDASE ACTIVITIES IN THE HUMAN EMBRYO, FETUS, AND NEWBORN
Authors: Auricchio Salvatore , Rubino Armido , Mürset Gertrud
Published: December 2021

1. In 32 human embryos, fetuses, newborns, and infants α-glycosidase activities (maltase, sucrase, isomaltase, palatinase, trehalase, dextranase, and amylase) and β-glycosidase activities (lactase and cellobiase) of the small intestine were determined.

2. The enzyme activities are distributed uniformly throughout the small intestine except in duodenum and terminal ileum. Lower values were found in these areas except for trehalase which remained high in the terminal ileum.

3. All glycosidases are present by the third month of intrauterine life. Most of the α-glycosidase activities reach maximal values by the 6th to 8th fetal month. Levels of activity are independent of the period lapsed since birth and independent of previous food intake. Only amylase and maltase 1 activities are low at birth in the full-term newborn.

4.β-glycosidase activities reach maximum values only at the end of normal gestation. After premature birth development of β-glycosidase activity occurs rapidly.

5. The observed development of the intestinal disaccharidases in the human is apparently different from that known in animals (calves, rabbits, pigs, and rats), where the α-disaccharidases develop only after birth and where lactase activity develops earlier in fetal life and drops after birth.
STUDIES ON A BOY WITH XXYY CHROMOSOME CONSTITUTION
Authors: Schlegel Robert J. , Aspillaga Manuel J. , Neu Richard , Gardner Lytt I.
Published: December 2021

The twelfth instance in a human of an XXYY chromosome complement is described in a 16-year-old boy. One hundred thirty-five metaphase plates from two leucocyte cultures and ten from testis and skin had a modal number of 48 chromosomes. Karyotyping demonstrated 2X-chromosomes 2Y-chromosomes, and 44 autosomes. Sex chromatin bodies were present in 23-28% of buccal epithelial cells and in testicular cells, and there were 17 drumsticks in 500 neutrophiles.

Micro-orchidism and azoospermia were present. Testicular biopsy revealed diminution of germinal cells and hyalinization of seminiferous tubules, together with clumping of the Leydig cells.

A small brain case (20.8 in. occipitofrontal circumference) and mental retardation (Stanford-Binet I. Q. 62) were found. He also had slight facial prognathism, webbing of the neck, and congenital infundibular pulmonary stenosis.

There were no chromosomal abnormalities found in studies performed on his parents. Both the patient and many members of his immediate family had unusual dermatoglyphic findings, including low ridge counts and a high number of arches on the fingers.
URINARY VITAMIN B6 AND 4-PYRIDOXIC ACID IN HEALTH AND IN VITAMIN B6 DEPENDENCY
Authors: Scriver Charles R. , Cullen Andrea M.
Published: December 2021

The urinary excretion of vitamin B6 and 4-pyridoxic acid was studied in normal children and adults and in children with the vitamin B6dependency syndrome. There were no differences in the relative proportions of free and hydrolyzable vitamin B6 and of 4-PDA excreted by normal and by vitamin B6-dependent subjects.
Letters to the Editor
Authors: CORIELL LEWIS L.
Published: December 2021

All Physicians share Dr. Musiker's concern for the deaths, permanent CNS damage, and pyogenic complications caused by measles each year. Unfortunately, little could be done about it up until the very recent months. Experimental vaccines have been in the process of development since 1960 but were first endorsed for general use by the Ad Hoc Advisory Committee to the Surgeon General on Measles Control on February 25, 1963. Use of the vaccine was promptly endorsed by the American Academy of Pediatrics, the American Medical Association and other public health agencies.
Dr. Montessori's Own Handbook
Authors: PITTELLI A. L.
Published: December 2021

At the turn of the century, Dr. Maria Montessori was evolving a remarkably effective and entirely new method of education. This method was based on several premises—the freedom of the child seemingly to educate himself and to go at his own speed, the basic belief that a child will be carried forward by his excitement over the discovery of new skills and knowledge; and the concept of exercising and educating all of the senses so that the child's perceptual abilities will be heightened and the basic academic skills such as reading and arithmetic will be a natural outgrowth of former "sensory education" games.
IMMUNIZATION WITH INACTIVATED MEASLES VIRUS VACCINE: EFFECT OF BOOSTER DOSE AND RESPONSE TO NATURAL CHALLENGE
Authors: Karzon David T. , Rush David , Winkelstein Warren
Published: December 2021

A group of 40 kindergarten and first-grade school children were immunized with three doses of inactivated measles virus vaccine, or an equivalent placebo, at 0, 1, and 4 weeks as part of a larger controlled field trial. A booster dose of vaccine was administered at 8 months. A sharp outbreak of measles challenged the study group at 21 months. The serological response was followed by measuring neutralizing hemagglutination-inhibiting, and complement-fixing antibodies. Following challenge with wild measles virus, the serological and clinical evidences of viral replication were documented.

After three doses of inactivated measles vaccine, 11 seronegative children developed antibody, as measured by all three serologic techniques. The titers were approximately one-half to one-third those observed after natural infection. By 8 months, antibody had fallen to low or non-measurable levels. A booster dose at this time gave rise to an accelerated or secondary-type response, and resulted in titers which averaged twofold higher than the primary response. Following the booster dose the titers appeared to fall more slowly, and at 21 months following the primary series, all children retained significant levels.

Of 12 seronegative children receiving placebo, challenge with natural measles infection at 21 months resulted in 11 cases of regular measles and 1 case of mild measles. Of the 11 seronegative children receiving vaccine, 7 developed a highly atypical illness, and 4 suffered no illness. The atypical illness was characterized by minimal respiratory complaints and a sparse rash. Ten of the vaccinated group demonstrated unequivocal serological evidence of measles viral replication; the eleventh who had no known exposure to measles showed no antibody rise and may have had an unrelated exanthematous infection.

It was shown that measles virus infection can occur in the presence of a modest to high circulating antibody titer which had been induced by immunization with inactivated vaccine. Evidence was reviewed which indicates that antibody resulting from inactivated measles vaccine may be qualitatively different from that produced following natural infection.
BODY WATER COMPOSITION IN KWASHIORKOR BEFORE AND AFTER LOSS OF EDEMA
Authors: Brinkman Gail Lynn , Bowie Malcolm David , Friis-Hansen Bent , Hansen John Derek Lindsell
Published: December 2021

1. Total body water (TBW) estimated by tritium and extracellular water (ECW) estimated by sodium thiosulfate has been measured in 19 cases of kwashiorkor before and immediately after loss of edema.

2. The TBW as a percentage of body weight was increased but changed relatively little as edema was lost (70%-69%).

3. The ECW (thiosulfate space) showed a significant decrease with loss of edema (33%-26%).

4. The intracellular water (TBW-ECW) increased markedly (37%-43%).

5. These results suggest that the edema of kwashiorkor is a phenomenon of mal-distribution of the excess body water between the body compartments and not only an excess accumulation of body water per se.
POSSIBLE TRANSPLACENTAL TRANSMISSION OF HERPES SIMPLEX INFECTION
Authors: Witzleben Camillus L. , Driscoll Shirley G.
Published: December 2021

Transplacental dissemination of herpes simplex has never been demonstrated, although one instance of congenital herpes infection has been described, which was followed by an unusually "benign" disease in the newborn. [SEE TABLE I IN SOURCE PDF]

The present case report presents persuasive evidence that the disseminated fulminant form of the herpes simplex infection may begin before birth: (1) the suggestive maternal illness, (2) the unexplained fetal distress, (3) the delivery by caesarean section, without traverse of the genital tract, (4) the unusual placental lesions, characteristic of hematogenous dissemination of infection and histologically similar to the visceral lesions in the infected infant, and (5) the separation of the infant from the parents following delivery. However, intrauterine transmission was not proved unequivocally, since virus was not cultured from the placenta and only suggestive inclusion bodies were found in the placenta. It is possible that the virus entered the fetus via an ascending infection following rupture of the membranes, although this seems unlikely in view of the absence of pulmonary lesions, the short period between rupture of the membranes and delivery, and the presence and character of the villous placental lesions.

The preservation and examination of placentas in suspected and proven cases of neonatal viral infection, and the study of maternal and fetal sera in these cases are valuable but neglected aids in diagnosing disease and elucidating its pathogenesis. Maternal history and/or physical examination in the immediate pre- or postpartum period are frequently abnormal. Such abnormalities should alert the physician to the possibility of disseminated herpes simplex infection in the severely ill neonate without demonstrable bacterial infection.
HEREDITARY CHARACTERISTICS OF FAMILIAL TEMPORAL-CENTRAL FOCAL EPILEPSY
Authors: Bray Patrick F. , Wiser W. C.
Published: December 2021

Focal "temporal lobe" epilepsy of genetic etiology is apparently transmitted by a single, autosomal dominant gene. The overall penetrance of this trait is low and is highly age-dependent. It approximates 50% between 5 and 15 years of age and then drops again to a low over-all incidence after 20 years of age. The low penetrance is evident from the fact only 12% of the affected individuals develop seizures, and the risk-of-recurrence rate for clinical seizures in this small group of 12 affected families is approximately 1 in 8. Persistence of genetically determined focal "temporal lobe" epilepsy into adult life, usually with refractory psychomotor seizures, occurred in 13% of affected close relatives in time study and should be considered carefully in any patient who is a potential candidate for temporal lobectomy. Evidence for a genetic etiology has been uncovered in only 30% of the 40 families. In the remaining 70% of families an acquired structural lesion is probably etiologic in some cases.

The application of these data to any single patient with epilepsy must be carried out with extreme caution because of the non-specific nature of all EEC abnormalities and the variable nature of the associated clinical seizure. Hence, the physician must remember that he is obligated to study each patient with great care before invoking a genetic explanation for a focal electroclinical seizure. The conclusions proposed in this report have resulted from a controlled study of whole families whose brain-wave patterns were sampled both in cross section and longitudinally. The authors still make no presumptions about their ability to identify accurately an hereditary brain-wave disorder without a thorough clinical and laboratory study of the individual case.
Respiratory Distress Syndrome and Hypoperfusion
Authors: NORMAND I. C. S. , REYNOLDS E. O. R. , STRANG L. B.
Published: December 2021

We have read the article of Drs. Chu, Clements, Cotton, Klaus, Sweet, Thomas, and Tooley (Pediatrics, 35:733, 1965) with interest but some dismay.

Investigation of the pathogenesis of the respiratory distress syndrome has been hampered by confusion concerning terminology and we cannot help feeling that the introduction of yet another title for the illness is bound to add to this confusion, particularly when the evidence that pulmonary hypoperfusion is the "central issue" in the etiology of the disease seems somewhat tenuous on the data presented.
THE PIERRE ROBIN SYNDROME
Authors: Dennison Wallace M.
Published: December 2021

The whole object of the medical and nursing care of infants with the Pierre Robin syndrome is to keep them alive and thriving in their perilous passage through the early months of life until the failure of mandibular development in utero is subsequently rectified by nature.

From my limited experience of this condition I suggest that surgery has little to offer in the treatment of the Pierre Robin syndrome. Cap suspension, tube feeding, and skilled nursing are more important than any surgical procedures.
ENVIRONMENTAL TEMPERATURE, OXYGEN CONSUMPTION, AND CATECHOLAMINE EXCRETION IN NEWBORN INFANTS
Authors: Stern Leo , Lees Martin H. , Leduc Jean
Published: December 2021

In seven studies of normal newborn infants lowering the evironmental temperature below the neutral range resulted in an increase in metabolism as measured by increased oxygen consumption. Simultaneous with this an increase in urinary noradrenalin excretion was found in all cases.

It is proposed that noradrenalin is the mediator of chemical thermogenesis in the newborn, and that the ability and degree of noradrenalin response at cool environmental temperatures is tile governing factor in the development and maintenance of temperature stability in the newborn infant.
CURRENT CONCEPTS IN DIAGNOSIS AND MANAGEMENT OF CONGENITAL CUTANEOUS HEMANGIOMAS
Authors: Margileth A. M. , Museles M.
Published: December 2021

SPONTANEOUS involution of hemangiomas in children was reported nearly 80 years ago and was further emphasized by Lister in 1938. However, among physicians considerable diversity of opinion still prevails regarding management of these lesions. Recent articles and texts continue to advocate or discuss therapy (surgery, radiation, dry ice, or injections of sclerosing agents) even though these authors mention that many hemangiomas will spontaneously subside. Our experience has shown that very few hemangiomas require any type of active therapy and that children in whom these lesions were treated had more complications than those managed conservatively.

Our current approach to management is based on a seven-year experience with over 200 children who had 340 hemangiomas. The seven common types encountered are listed (Table 1) in the practical classification used by most authors. Since the outcome of the tumorous types (strawberry, cavernous, and mixed) and erythema nuchae is one of gradual regression and involution whereas the course of many spider nevi and most port wine stains is lack of regression, a brief description of each type follows to facilitate diagnosis.

The common strawberry hemangioma or hemangioma simplex (Fig. 1) is a capillary hemangioma, usually bright red or purlish red with well-defined margins. It consists of myriads of tiny capillaries protruding above the skin surface. The strawberry [SEE TABLE I., FIG. 1A. and FIG. 1B. IN SOURCE PDF.] lesion blanches incompletely with pressure, and on palpation is a firm rubbery mass which compresses minimally if at all.

The cavernous hemangioma (Fig. 2) usually has poorly defined borders arising underneath the skin surface (hypodermal) or it may be well circumscribed and elevated above the surface (dermal). [SEE FIG. 2A. IN SOURCE PDF]
A COMMUNITY-WIDE PEDIATRIC PROGRAM: A BEGINNING AND A BLUEPRINT FOR THE FUTURE
Authors: Schaffer Alexander J.
Published: December 2021

IN DECEMBER OF 1963 a communication by Robert M. Sigmond, Director of the Hospital Council of Western Pennsylvania, appeared in Pediatrics. It examined in detail the existing facts concerning the quality of pediatric care and residency training in the community hospitals of Pittsburgh and its environs and came to some definite conclusions. Excerpts of these conclusions follow:

"Planning for children's inpatient services should encourage grouping of small segregated pediatric units in which most children receive care today. . . . Small units interfere with provision of high quality, comprehensive care and are wasteful of scarce personnel and dollars. . . . 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. . . . Failure of children's medical centers to develop such affiliations may have dire consequences in the long run."

By the time this article appeared Drs. Robert E. Cooke (Professor of Pediatrics), Russell A. Nelson (President of The Johns Hopkins Hospital), Thomas B. Turner (Dean of The Johns Hopkins University School of Medicine), and I were deep in discussions about this very topic. For many years, while I had been heavily engaged in the problems of the pediatric department of the Sinai Hospital and the nursery service of the Hospital for the Women of Maryland, the manifest deficiencies of these services as they were then constituted, and the difficulty of overcoming them had been much on my mind. Chief of these was our inability to develop a training program which would attract the house staff so necessary in modern times to provide ideal patient care.
Letters to the Editor
Authors: CLEMENTS JOHN A. , KLAUS MARSHALL H. , TOOLEY WILLIAM H.
Published: December 2021

Dr. Ivanhoe suggests the interesting possibility that pulmonary venoconstriction may be an important feature of the idiopathic respiratory distress syndrome. While our physiological studies are consistent with pulmonary vascular obstruction on either the pre-or postcapillary side, there is evidence that the major obstruction is precapillary. The small pulmonary arterioles in lungs of infants dying with respiratory distress have thick walls and small lumina. When we perfused these lungs in vitro with blood or plasma, very low flows were observed unless pressures in excess of 200 cm of water were applied.
VISCERAL LARVA MIGRANS SYNDROME: CLINICAL CHARACTERISTICS AND IMMUNOLOGIC STUDIES IN 51 PATIENTS
Authors: Huntley Carolyn C. , Costas Margarita C. , Lyerly Anne
Published: December 2021

Fifty-one preschool children with hypereosinophilia and signs of visceral involvement were studied. The most common symptoms were pica (90%), pulmonary symptoms (86%), and fever (80%). Fourteen patients (28%) had convulsions. Hepatomegaly (encountered in 65%) was the most prominent physical finding. Anemia was present in almost half of the patients. Albumin concentrations were decreased and globulin concentrations increased in the patient group. Total gamma-globulins and gamma1 M globulins were significantly elevated. Precipitating antibody to A and B blood group substances and/or helminth antigens was found in one-half of the patients. Isohemagglutinin titers were elevated (above 1:256) in two-thirds of the patients. Sheep cell agglutination titers were slightly elevated in the patient group, and heat stable antiglobulins were found in 14 of 29 patients tested. The significance of the hypergammaglobulinemia, anemia, and central nervous system symptoms was discussed.
BEHAVIOR CHANGES IN SICK CHILDREN NURSED AT HOME
Authors: Shrand H.
Published: December 2021

A study of children nursed at home without being separated from their mothers and without the stress of hospitalization showed that although more severe reactions were avoided, some behavioral changes still occurred, which could be attributed to the stress of the illness itself.
HEMOLYSIS AND JAUNDICE IN THE NEWBORN FOLLOWING MATERNAL TREATMENT WITH SULFAMETHOXYPYRIDAZINE (KYNEX)
Authors: Brown Audrey K. , Cevik Namik
Published: December 2021

Two cases of neonatal hemolysis and jaundice are reported in Negro male infants. Both infants were born to mothers who had been given sulfamethoxypyridazine (Kynex) prior to delivery. Both infants were deficient in erythrocyte G-6-PD.

The role of sulfamethoxypyridazine in the production of neonatal jaundice is discussed.
Letters to the Editor
Authors: DENNISON W. M.
Published: December 2021

Thank you for giving me an opportunity to reply to Dr. Ward's letter to you on the treatment of the Pierre Robin syndrome.

We abandoned the "method" of Dr. Oeconomopoulos in 1953 as we found that in patients with true glossoptosis the heavy silk suture through the base of the tongue and through the alveolus cut through the tongue within a week. We then created an artificial tongue tie as recommended by Du Hamel and others—raised the under surface of the tongue and attached it to the floor of the mouth, the lower alveolus, and the inner aspect of the lower lip.
THE INFLUENCE OF ALBUMIN ON THE DISTRIBUTION AND EXCRETION OF BILIRUBIN IN JAUNDICED RATS
Authors: Natzschka Jürgen C. , Odell Gerard B.
Published: December 2021

Infusion experiments were performed in adult rats with two different loads of bilirubin.

The maximal biliary excretion was found to be 65± σ 12 µgm bil./100 gm body weight/min.

A single intravenous injection of human albumin caused an increase of the serum concentration of bilirubin. The changes in blood hematocrit and total serum protein concentration indicated that the administered albumin remained within the intravascular space for the duration of the experiments.

The intravenous administration of PVP was followed by a fall of the serum concentration of bilirubin. This was due to a hemodilution caused by the PVP as indicated by the simultaneous decrease of hematocrit and serum protein concentration. The intravascular bilirubin content remained unchanged after the injection of PVP.

The hepatic excretion rate of bilirubin and the bilirubin concentration of the adipose tissue were not significantly altered by the injection of either human albumin or PVP. The results demonstrate that albumin may prevent bilirubin from concentrating in extravascular tissues, and it can also effect a back diffusion of bilirubin already within non-adipose extravascular tissues.
GROWTH HORMONE AND GROWTH
Authors: GRUMBACH MELVIN M.
Published: December 2021

THE RECENT cascade of knowledge of the chemistry and physiology of the protein and polypeptide hormones of the pituitary gland has been a consequence of steady progress over the past 20 years in methods of isolation, purification, and assay of these hormones. These development, while providing new insights into old problems, have raised a host of challenging and unanticipated questions. Of especial interest to students of growth is the considerable new information on growth hormone, the subject of a recent and perceptive review by Allen Root.

New analytical technique utilizing immunochemical methods and radioiodinated hormone have provided specific, sensitive, and precise redioimmunoassay procedures for the measurement of the minute quanitity of human growth hormone in blood.
PARTIAL 18 MONOSOMY IN THE CYCLOPS MALFORMATION
Authors: Nitowsky H. M. , Sindhvananda N. , Konigsberg U. R. , Weinberg T.
Published: December 2021

The morphologic and cytologic findings have been described in a newborn infant with cyclops but without malformation involving other systems. A cytologic abnormality was found consisting of a deletion of the short arms of one of the E chromosomes, which on the basis of size and radioautographic studies has been identified as a number 18 chromosome. These findings resemble those of another patient with cyclops malformation and suggest the presence of a characteristic chromosomal defect in this unusual teratism. On the other hand, the different abnormalities in other cases of partial monosomy 18 illustrates the phenotypic variability which can be observed in association with apparently similar chromosomal aberrations.
SERUM C-REACTIVE PROTEIN IN INFECTIONS DURING THE FIRST SIX MONTHS OF LIFE
Authors: Felix Natalie S. , Nakajima Hironori , Kagan B. M.
Published: December 2021

Serum C-reactive protein determinations were done on 66 cord blood specimens and on capillary blood specimens of 669 apparently normal infants and 266 infants ill with known or suspected infection during the first 6 months of life.

All but one of the cord blood specimens were negative for C-reactive protein. The incidence of positive reactors increased soon after birth with 50% of the normal newborns having positive reactions during the first week of life. This rapidly decreased after this period so that by 1 month to 6 months of age the incidence was only 2%. The intensity of the positive reaction in the majority was only up to 1 mm.

Two-thirds of the infants with infection had positive reactions. The more severe the infection the greater the intensity of the positive reaction.

C-reactive protein was also present in a variety of conditions besides infections.

Serum C-reactive protein determination can be a valuable diagnostic aid in infections during the first 6 months of life when the usual laboratory criteria for infections are often not helpful. However, it has its limitations. Like any other single laboratory test, it must be used in conjunction with critical clinical judgment.
ABNORMAL CAPILLARY MORPHOLOGY IN CONGENITAL HEART DISEASE
Authors: Kontras Stella B. , Bodenbender JoAnn G.
Published: December 2021

Capillary morphology has been studied in 111 normal children. In 98% of these cases, straight hairpin forms make up over 80% of the capillaries examined.

Thirty children with congenital heart disease showed 80% abnormal capillary patterns consisting of dilated, tortuous, and branched loops. These were most marked in cyanotic tetralogy of Fallot and ventricular septal defect with pulmonary hypertension. These cases also were associated with microscopic hemorrhages, increased capillary fragility and actual postoperative hemorrhagic complications. Definitive surgery in two cases, though improving the patient, did not result in changes in the abnormal capillary patterns.

It is suggested that the role of the capillary structure in rheology of blood in the microvasculature has largely been ignored and that abnormalities in this vascular compartment may affect perfusion of tissues. The association of abnormalities in coagulation studies, hemorrhage, and thrombosis with congenital heart disease may in part be related to the morphologic vascular abnormalities. The abnormal capillary findings may be due to maturational arrest or dysmaturity of this portion of the cardiovascular system or may be the result of chronic hypoxia.
READING RETARDATION: I. PSYCHIATRIC AND SOCIOLOGIC ASPECTS
Authors: Eisenberg Leon
Published: December 2021

THE modern species of the genus Homo has been christened variously: sapiens, the wise; faber, the tool-maker; loquens, the speaker; but man's most extraordinary accomplishment warrants the epithet: Homo scribens et legens, man the writer and reader. Contemporary man, wherever he has been found and whatever his state of culture, has possessed a spoken language; every language thus far encountered has been complex and sophisticated. The origins of the faculty of speech are lost in antiquity. It can be deduced confidently that Cro-Magnon man, who lived from 25,000 to 10,000 years ago, possessed language; his fabrication of tools, his ceremonial burials, and, most of all, his cave paintings, all bespeak the necesary level of conceptulization. It seems not unreasonable to suppose that Neanderthal man, the maker of stone tools and of fire, knowledgeable enough to cook his food, a man with a cranial capacity in no wise inferior to our own and with endocranial markings indicative of frontal and parietal lobe differentiation, may have possessed the gift of tongues as long as 50,000 years ago. The invention of writing, on the other hand, dates no earlier than the fourth millenium before Christ.

Consider the exponential rate of development of society in the 5,000 years since written language as against the limited progress in the 50,000 years of spoken language that preceded it. True, technological advances other than literacy have been catalysts of this revolutionary transformation but few are the advances that have not been mediated by written symbols. The magnificence of this accomplishment transcends the creature comforts it has enabled man to attain.
Letters to the Editor
Authors: S. C. A.
Published: December 2021

The translator will be informed and a note calling attention to this error inserted in the earliest possible "Resúmenes en Español. "We are delighted to find Pediatrics in this new educational role (see p. 398, infra).
Recent Advances in Paediatrics
Authors: GERRARD J. W.
Published: December 2021

This third edition in an excellent series of recent advances, contains contributions on the circulation, respiration, and metabolism of the newborn by Dawes, on the adaptation of the newborn to its postnatal environment by Karlberg and Celander, together with chapters on obstetrical hazards to the newborn by Drillien, a very lucid appraisal of modern concepts of the etiology and management of the respiratory distress syndrome by Gairdner, and idiopathic hypoglycaemia in the newborn by Neligan.
THE MUMPS ANTIGEN SKIN TEST IN ENDOCARDIAL FIBROELASTOSIS
Authors: Shone John D. , Armas Simon Muñoz , Manning James A. , Keith John D.
Published: December 2021

Skin testing with mumps virus antigen solution was performed in 50 children with clinically diagnosed primary E.F.E. (Group I), and in 202 children who served as a control group (Group II). A further group of children with congenital mitral insufficiency (Group III) were similarly skin tested.

Approximately 91% of the children with clinical E.F.E. under the age of 2 years in Group I showed a "positive" reaction to the intradermal inoculation of mumps skin-test antigen solution. In contrast, approximately 91% of the children in a control series under the age of 2 years in Group II showed a negative skin reaction.

Confirmatory evidence of E.F.E. was obtained by left atrial biopsy in 2 children in Group I and in three children with congenital mitral insufficiency (Group III). E.F.E. was confirmed at autopsy in a fourth child with clinically diagnosed congenital mitral insufficiency who had shown a "positive" skin reaction.

Hematologic studies for determination of mumps serum antibody titer (M.S.A.T.) were performed on 24 children in Group I, 29 children in Group II, and 6 children in Group III. It was apparent from our study that "positivity" of the skin reaction in E.F.E. was not correlated with an elevated M.S.A.T.

Isolated congenital mitral insufficiency is, almost invariably, associated with E.F.E. The high incidence of "positive" reactors in this group suggests that both conditions arise in utero at the same period of gestation and due to an identical etiologic agent (possibly viral) and associated with fetal immunologic deficiency.

"Positivity" of the skin reaction in E.F.E. to mumps antigen solution may, therefore, represent either: (1) a non-specific hypersensitivity; or (2) "cross-reactivity" to viruses other than mumps virus, for example, Coxsackie B viruses or myxoviruses other than mumps virus; or (3) evidence of preexisting mumps viral infection in utero or during infancy, despite the absence of an elevated M.S.A.T. This is explicable on the basis of a partial immunologic deficiency whereby the fetus or infant is incapable of developing specific mumps antibodies, but remains capable of exhibiting a delayed cutaneous hypersensitivity response to mumps antigen. Such an immunologic deficiency could also explain the familial occurrence of E.F.E.

It is hoped that this report will stimulate further studies in (1) the value of the mumps skin-test antigen solution as an ancillary aid in the diagnosis of E.F.E. and (2) the possible role of viral infection(s) in the etiology of E.F.E.
OBSCURE AND UNUSUAL EDEMA
Authors: Fisher D. A.
Published: December 2021

Primary lymphedema, orthostatic edema with increased ADH or aldosterone secretion, inappropriate ADH secretion associated with central nervous system, and/or thoracic pathology, congenital analbuminemia, severe nutritional deficiency with hypoproteinemia, protein-losing gastroenteropathies and hereditary angioneurotic edema have been discussed in the context of unusual and obscure clinical syndromes associated with edema. The pathogenetic mechanisms are not established in all cases, but major advances have been made in our understanding and clinical characterization of these entities. Consideration of these syndromes with documentation by appropriate laboratory studies can provide definitive diagnosis in many instances of clinically obscure edema.
Pets, Parasites, and Pediatrics
Authors: HOROWITZ LEON
Published: December 2021

In his editorial in the October issue, "Pets, Parasites, and Pediatrics" (Pediatrics 36:521, 1965), Dr. Webb mentioned some of the bacterial, viral, fungal, and helminthic diseases which children may get from animals and which may, at times, pass the other way.

He might also have mentioned the one-way group: the allergic diseases that children suffer from sharing the environment with animal pets. The variety of respiratory and cutaneous problems which may result from this contact is well-known.
THE INFLUENCE OF AN EARLY CALORIC INTAKE WITH I-V GLUCOSE ON CATABOLISM OF PREMATURE INFANTS
Authors: Auld Peter A. M. , Bhangananda P. , Mehta S.
Published: December 2021

Protein catabolism was studied in a group of premature infants some of whom were provided with a caloric intake soon after birth. The group given calories had a considerably decreased catabolism compared to the starved infants. Infants with respiratory distress were given calories as well and their catabolism was reduced below that of the starved group. The effects of catabolism and, particularly, of hyperkalemia on the heart of the infant suggest that it should be avoided. The conclusion from the study is that early caloric feeding of the premature is desirable.
SERUM LEVELS OF IMMUNE GLOBULINS IN HEALTH AND DISEASE: A SURVEY
Authors: Stiehm E. Richard , Fudenberg H. Hugh
Published: December 2021

Immune globulins in sera of normal persons of various ages were quantitated by a radial diffusion technique; the levels changed considerably with age, especially during early infancy. Adult levels (γG 1158 ± 305, γM 99 ± 27, and γA 200 ± 61 mg/100 ml) generally were attained by 16 years of age. In all specimens of umbilical cord serum the level of γG was similar to that of adult serum and a trace quantity of γM (mean 10 mg/100 ml) was present; in one-third there was a trace amount of γA-globulin. The level of γM increased rapidly after birth but synthesis of γG and, especially, γA was delayed. Because of these normal alterations, it is recommended that specimens of serum be compared with those of age-matched control subjects for optimal evaluation.

There was significant elevation of levels of γG-, γA-, and total γ-globulins, and diminution of that of γM in the serum of mongols over 10 years of age. The diminution of γM may be implicated in the poor response of mongols to immunizing antigens and the increased susceptibility of such patients to infections. Mongols may have a genetic instability of immune globulin synthesis analogous to their abnormality of leukopoiesis.

Patients with sex chromosome abnormalities or trisomy 18 syndrome had normal levels of immune globulins, whereas those with neutropenia had elevated levels of all immune globulins. Abnormal levels determined in 12 cases of antibody deficiency diseases are presented.
SEXUAL MATURATION OF CHINESE BOYS IN HONG KONG
Authors: Francis Chang K. S. , Ng P. H. , Lee Marjorie M. M. C. , Chan S. J.
Published: December 2021

Sexual maturation of 3,658 Chinese school boys from 6 to 18 years of age was assessed by investigating four attributes associated with puberty, namely, growth of genitalia (penis), pubic hair, axillary hair, and change of voice. The first two attributes were rated on a 5-point scale (5 stages), and the last two attributes were just noted as having occurred or not. The children were divided into three socioeconomic groups based on multiple criteria comprising family educational level, occupation, income, and housing conditions. The probit method of biological assay with weighting scheme was employed to estimate the 30%, 50% (median age), and 70% end points and fiducial limits of the onset of development of the above-mentioned four attributes of boys in the three socioeconomic groups and of the total sample. In the case of genitalia and pubic hair, the same was done for the completion of development. The median ages (50% end point) of onset of development for genitalia, pubic hair, voice, and axillary hair of the total sample were 13.19 ± 0.19, 13.31 ± 0.21, 13.67 ± 0.43, and 14.57 ± 0.10 respectively. The median ages (50% end point) for the completion of genitalia and pubic hair development were the same, 16.47 ± 0.10.

The estimated duration between the successive developmental stages of genitalia and pubic hair show the period between Stages 2 and 3 to be the shortest (genitalia, 0.55 year, pubic hair, 0.39), and longest in the period between Stage 4 and 5 (genitalia and pubic hair, 1.87). The estimated whole duration of pubescence from onset to completion was about 3.28 years.

In temporal sequence of maturation, the development of genitalia and pubic hair was the first and practically simultaneous, followed by the change of voice (0.48 year after genitalia), and the last to develop was the axillary hair (0.9 year after change of voice).

The effect of socioeconomic background was shown to be evident, the boys from well-circumstanced homes being significantly more advanced in development than those from poor homes.

Comparison of our results with those of similar cross-sectional investigations on American and British boys show little difference in spite of race and clime.