bluuebunny/crossref_metadata_2025 huggingface dataset:
HUMAN IMMUNOGLOBULINS—A GUIDE TO NOMENCLATURE AND CLINICAL APPLICATION
Authors: Smith Richard T.
Published: December 2021

THE MULTIFOLD character of the human immune response has been recognized for many years by the variety of antibodies which result from infection or immunization. Until recently, the basis for such discrimination has been limited to the electrophoretic mobility or biologic effects of antibody in vitro. Biophysical tools which permit the isolation and structural investigation of proteins and other macromolecules have been applied to antibody molecules with such effectiveness that it is now possible to describe the heterogeneity of the human immune response in exquisite detail. These major advances in knowledge require and justify an updated nomenclature.

THE NOMENCLATURE

A group of leaders in this field met in 1964 at Geneva under the auspices of WHO and recommended international adoption of the terms shown in Table I A-1.

The preexisting confusion over nomenclature appears to have been resolved by nearly unanimous adoption of their recommendations by workers in the field with the result that it is standard in most current technical literature on the subject. Popular usage to date appears to favor the notation employing the Greek letter gamma: γG, γM, γA, and γD for the major classes of immunoglobulins, rather than the equally acceptable, but phonetically clumsy Ig-G, Ig-M, Ig-A, and Ig-D notation. Because the data involved, as well as the nomenclature, are too new to have appeared in textbooks or review journals usually read by those interested in child health, it is appropriate to review briefly the structure and functions of the immunoglobulin molecules as currently understood, and to suggest some actual and potentially important applications of this information in diagnosis and therapy.
Reflections on Practicing Pediatrics in Underdeveloped Countries:
Authors: ESKES PHILIP W. H.
Published: December 2021

In May 1962, Dr. Louis K. Diamond made a plea in this journal for pediatricians to become actively involved in giving their services to underdeveloped countries. To my knowledge, little response was received. Recently in a nationally distributed paramedical journal some remarks were made about the future of the pediatrician, either disgruntled because his disease-oriented residency training did not prepare him for the reality of pediatric practice, or accepting the role of URI treater and preventive medicine distributor.
Recognition of the Clinical Teacher
Authors: PRYLES CHARLES V.
Published: December 2021

For some time others as well as I have been concerned with the fact that there are no rewards for excellence in teaching and that in order to achieve advancement in academic medicine one must do basic laboratory research, and perhaps the more basic the research, the better the chances for recognition and promotion.

A recent Special Article by Dr. Samuel Proger in the September 9, 1965, issue of the New England Journal of Medicine and an editorial in the November 1 issue of the New York Times deplore the emphasis on research to the neglect of teaching, both in undergraduate and postgraduate years.
Department of Deteriorating Relations to the North
Authors: COODIN FISCHEL J.
Published: December 2021

I am provoked to write this letter after perusing the recently-arrived January 1966 number of Pediatrics. Just because you Americans were plunged into blackness as the result of a minor electrical switch failure NORTH of Niagara Falls is no reason to darken Canadian-American relations as well as the affairs of the American Academy of Pediatrics.

Quebec is the largest province of Canada, covering an area of 594,860 square miles (larger than a combination of Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York, New Jersey, Pennsylvania, Ohio, Indiana, Illinois, Maryland, Delaware, Virginia, West Virginia, North Carolina, South Carolina, Georgia, and Florida, with the District of Columbia thrown in for good measure).
Pediatricians, Society, and Battered Children
Authors: BLOCH HARRY
Published: December 2021

The "battered child" is the subject of justifiable and increasing concern. It is unfortunate that the training of the pediatrician tends to direct his thought and interest principally to the individual child. In rare instances do we take up the cudgels for "battered children," the uncountable numbers outraged by society. Victims of slums, poverty, inadequate educational facilities, discrimination, war; the millions of starving children; the tens of thousands murdered by the Nazi Germans in their crematoria and concentration camps; the thousands injured and killed in automobile tragedies; and the many criminally ruined by drug addiction.
Toxicity of Hexachiorophene (Phisohex) Taken Internally
Authors: Stotzer Don A.
Published: December 2021

Much to my surprise (and thankfully not thru personal experience), I recently found out that Phisohex is poisonous. After surveying our hospital staff, I am sure this fact is not generally known and I feel it should be called to the attention of all physicians. In our hospital and presumably others, we use individual 150 cc. bottles of Phisohex to bathe each newborn and the unused portion is sent home with the mother.
"Society" or "Genetic Inferiority"
Authors: Mason Alfred B.
Published: December 2021

I found both your February articles on "Reading Retardation" quite interesting. However, this letter is a mild protest against some of the sentiments in Dr. Eisenberg's article.

I've followed public controversies for a number of decades in my life, long enough to recognize the rise and fall of "fads" in public opinion. When I was in my teens, there was a growing self-consciousness in the United States about race, as there had always been about sex.
Blood Lactate in Newborn Infants
Authors: Oliver Thomas K.
Published: December 2021

The interesting paper by Graven, et al. on changes in serum lactate with activity in neonates1 is confusing in one respect. The authors indicate that measurements of pCO2 and pH were performed on the umbilical venous blood samples and yet no data are presented. This is of more than passing interest because it has been shown that blood lactate may rise quite rapidly as a consequence of hyperventilation.2 Furthermore, we have shown that the response to arousal as measured by changes' in oxygen tension in the descending aorta below the ductus arteriosus is quite variable and must be due to a varying response of ventilation as well as to changes in shunting through the foramen ovale or the ductus arteriosus.3
LACTATE AND PYRUVATE AS AN INDEX OF PRENATAL OXYGEN DEPRIVATION
Authors: Daniel Salha S. , Adamsons Karlis , James L. Stanley
Published: December 2021

The concentrations of lactate and hydrogen ions in maternal and fetal blood indicate that their net movement is from fetus to mother. Since these ions can cross the placenta in either direction, maternal acidosis will be reflected in the fetus.

Low absolute values for lactate in both umbilical vein and artery of vigorous infants at birth indicate that under optimal conditions the fetus derives only a small proportion of energy from anaerobic glycolysis.

Infants born following prolonged or complicated labors during which oxygen supply to the fetus is likely to be impaired are more acidotic and have significantly higher lactate levels.

The concentration of pyruvate at birth shows no consistent relationship to the clinical condition of the infant, and neither the ratio of lactate to pyruvate nor excess lactate appears to be a better index of prenatal oxygen deprivation than the concentration of lactate.

The acid-based components of amniotic fluid do not correlate either with the lactate concentration in fetal blood nor with the clinical condition of the infant at birth. In the minutes following birth, there is a further fall in blood pH, presumably due to a delayed influx of hydrogen ion from tissues. Thus, the composition of cord blood does not fully reflect the degree of fetal asphyxia during labor and delivery.
THE FORCES OF SOCIAL CHANGE
Authors: YANKAUER A.
Published: December 2021

"A nation's greatness is measured by its concern for the health and welfare of its people. Throughout our democracy this commitment has grown and deepened. . . . With these programs and those I am recommending today, we can move closer to attainment of our goals: to bring every child the care he needs to develop his capacity to the fullest; to reduce infant mortality, concentrating particularly on those minority groups whose death rate is highest." These are words that the President of the United States addressed to the Eighty-ninth Congress in March 1966. They reflect the forces of social change whose spirit and legislative expression have shaken the domestic order to a greater degree than at any time since the early days of the New Deal.
Letters to the Editor
Authors: LOWE CHARLES U.
Published: December 2021

A letter from Dr. Harry Bowman addressed to the Editor of Pediatrics was forwarded to me as Chairman of the Committee on Nutrition of the American Academy of Pediatrics for reply. The issue raised by Dr. Bowman concerning sterilization of formulas was discussed in some detail at a recent meeting of the Committee on Nutrition and below follows a summary of the position taken:

Dr. Bowman questions the necessity for terminal sterilization of formulas prepared in the home and asks whether current practices which utilize cleanliness rather than heat treatment for home formula preparation are safe.
Small Intestinal Biopsies
Authors: SCHUBERT WILLIAM K.
Published: December 2021

We wish to comment on the last two paragraphs of R. R. Townley's excellent article, "Quantitative Assay of Disaccharidase Activities of Small Intestinal Mucosal Biopsy Specimens in Infancy and Childhood."

Although our experience with the biopsy procedure is somewhat less (176 biopsies) than that of Dr. Townley and his associates in Victoria and Boston, it has been collected entirely with the Crosby-Kugler capsule. We believe we are correct that many, if not the majority, of the 500 biopsies composing the composite series mentioned in Dr. Townley's paper were obtained with the Rubin biopsy tube, since that is the instrument most extensively used in Victoria and in Boston until relatively recently.
Breast Feeding, Doctors, and Social Class
Authors: ROBERTSON W. O.
Published: December 2021

Once again Boston's uniqueness is documented! On this occasion Salber and Einleib's survey1 on breast-feeding practices provided the evidence. But a proper Bostonian living in "a town that accepts modestly the acclaim that comes to it as the hub of the universe"2 would hardly point with pride to the results–the overall rate of breast feeding being barely 1/5 that determined for other regions of the country. One is particularly struck by the contention that higher social class mothers (especially students' wives) nurse significantly more frequently and allegedly longer than those from the lower social class.
Endocardial Fibroelastosis and Mumps
Authors: GUNTHEROTH WARREN G.
Published: December 2021

I had begun to despair that endocardial fibroelastosis was a different disease on the West Coast, or possibly even in the Northwest, and I was considerably reassured by the report by Gersony, Katz, and Nadas (Pediatrics, 37:430, 1966). We are in complete agreement with them that there seems to be no consistent correlation between endocardial fibroelastosis and reaction to mumps antigen in our patients, several of whom have been autopsied and the diagnosis confirmed by tissue techniques.
Physiologic Jaundice in Premature Gypsy Newborns
Authors: SZABÓ LAJOS , KOVÁCS ZOLTÁN
Published: December 2021

Two articles published in your Journal have stated that the physiologic icterus of premature American Negro newborns is milder (Holman, G. H.: Pediatrics, 22:115, 1958), and the jaundice in full-term healthy Chinese and Malay infants is more severe than in premature and full-term healthy infants of the white population living in the same geographic area (Brown, W. R., and Wong Hock Boon: Pediatrics, 36:745, 1965). The authors suppose that ethnic differences observed in the physiologic icterus can be first of all explained by genetic and racial factors.
Endocardial Fibroelastosis Mumps Skin Tests, and Cross Reactivity
Authors: FULGINITI V. A. , SIEBER O. F. , JOHN T. J.
Published: December 2021

This letter is a comment on the somewhat contradictory reports of Shone, et al. and Gersony, et al. concerning the pathogenesis of endocardial fibroelastosis. The former suggests a relationship between "positivity" of mumps skin tests and the clinical diagnosis of E.F.E. and the latter denies it. Both suggest that cross-reactivity with other myxoviruses must be considered. Also, Gotoff in commenting on a similar presentation by St. Geme, et al. asked if skin tests with parainfluenza viruses had been carried out.
Commentary
Authors: JOHNSON LOIS , BOGGS THOMAS R.
Published: December 2021

Dr. Diamond has presented important in vivo evidence reaffirming the thesis of Dr. Odell that unbound bilirubin is the toxin causing kernicterus. Unfortunately, we have not yet learned how to apply this knowledge to the management of the jaundiced newborn infant. For example, we are still left with the problem of deciding which jaundiced infant needs treatment. Recent electron microscopic studies in the Gunn rat emphasize this point. At birth, in homozygous (jj) rats born to heterozygous (Jj) mothers, no staining of the tissues is present and there are no cellular abnormalities to be found in the brain. By 4 to 8 hours of life, jj animals display slight clinical jaundice and their brains, after perfusion with saline or formalin to wash out capillary blood, exhibit equivocal localized staining.
THE APPLICABILITY OF THE FRANK LEAD SYSTEM TO INFANTS AND CHILDREN
Authors: Gamboa Raul , Gersony Welton M.
Published: December 2021

The accuracy of the Frank corrected lead system has been investigated in experimental two-and three-dimensional models of newborn, 5-year-old child, and adult sizes. Analysis of results indicates that the system is relatively orthogonal and uniform throughout the "normal" heart area in the adult and 5-year-old child torsos, but significant peripheral distortions due to electrode proximity effects occurs in the presence of a "large" heart as well as in the "newborn," who normally has a greater heart-size/chest-size ratio.

The Frank system was found to display practically equal lead voltage response for each model, but an inverse relationship was demonstrated between surface potentials and chest circumference. The application of proportionality factors to compensate for body size variations has been suggested.

Finally, this study emphasizes that the reliability of results when using this system depends critically on correct lead placement, and this is of particular significance in infants and children.
III. OPENING ADDRESS TO THE INSTITUTE ON PEDIATRIC RESIDENCY TRAINING
Authors: Mclntosh Rustin
Published: December 2021

MY EXCUSE for being here is the simple fact that Dick Day invited me. Not all acts of a benevolent dictatorship are self-explanatory. My contacts with the Board as an operating agency have in the past been minimal, even though I have known personally most of the Board members quite well. Being already a battlescarred veteran in 1936, I was privileged to be certified under the grandfather clause and never had the honor of being grilled in Board examinations. On one occasion, when oral exams were being held in New York, I served briefly as an invited examiner. This momentary exposure to the inner workings of the Board evidently disclosed that I lacked that little spark of sadism which, when properly compounded with benevolence and encyclopedic knowledge, marks the effective defender of the pediatric citadel; for I was never asked again. In my recurrent efforts to steer former residents along the course that leads to certification, to quell their jitters before they went up for the third degree, and to join them in their celebration after they had been told they had made it, I guess I must have felt much as the average college undergraduate feels when he stands around, watching the big shots being tapped for initiation into the secret Senior societies, and meditating on the fact that something vital is taking place with which he himself will never have direct experience. With this introduction I arrive at the obvious conclusion that my qualifications for telling the Board just what they ought to do remain shrouded in mystery.
DAILY COST PER CHILD AT THE CHILDREN'S HOSPITAL, PHILADELPHIA IN 1877
Authors: C. T. E.
Published: December 2021

1. Cost of a Child pen day, including food, wages, fuel, and medicines........... 38c

2. Cost of a Child per day, food only ........................................... 26c

3. Cost of a Child per day, including all expenditures (includes cost of operating a large dispensary, dispensing free advice and medicines for about 8,000 visits annually) ...................................................................54c
PUPILLARY DYSFUNCTION AS A CONCOMITANT OF CYSTIC FIBROSIS
Authors: Rubin Leonard S. , Barbero Giulio J. , Chernick Warren
Published: December 2021

This study extends previous observations on pupillary reactivity in patients with cystic fibrosis by carrying out measurements of pupillary dilatation and constriction under conditions of rest, stress, and after termination of a painful stimulus (homeostatic recovery) on 9 well children and 11 children with cystic fibrosis. At rest a significantly diminished rate and absolute level of dilatation was confirmed in the cystic fibrosis group with no difference in the two groups in pupillary constriction. During stress, the cystic fibrosis group showed a significantly smaller increase in pupillary dilatation and decrease in pupillary constriction than the normal group. During homeostatic recovery, the cystic fibrosis group showed a much slower response of the stress, darkadapted pupil diameter requiring 12 minutes before returning to the rest level while the normal group fell below the rest level within 1 minute. With respect to pupillary constriction, the normal children showed significantly smaller pupil diameters through the period of homeostatic recovery.

The results of these studies suggest that the generalized derangement of exocrine glands in cystic fibrosis may be concomitant with a dysfunction of the autonomic nervous system.
BENIGN LYMPHOID POLYPOSIS OF THE COLON
Authors: Collins Joseph O. , Falk Maurice , Guibone Roy
Published: December 2021

A 3½-year-old child with benign lymphoid polyposis of the colon is reported with a brief review of the literature. The similarity of the lesion to benign lymphoid hyperplasia of the rectum and other organs is pointed out. The difficulty of differential diagnosis is alluded to and the desirability of conservative handling is suggested.
The Association of Indirect Inguinal Hernia with Congenital Cytomegalic Inclusion Disease
Authors: LANG DAVID J.
Published: December 2021

In 1956 and 1957 the isolation of agents responsible for cytomegalic inclusion disease (CID) in man was accomplished almost simultaneously in three laboratories. This group of viruses apparently consists of several related, although serologically distinct, agents. Information has now accumulated with regard to their properties as well as their relationship to clinical disease.

In 1964 Medearis described characteristics of congenital infections induced by cytomegaloviruses in eight children. Seven of the eight cases discussed in that report exhibited symptoms on the first day of life, and, of these congenitally infected infants, all the males manifested inguinal hernias in infancy.
Endocardial Fibroelastosis Occurring in a Mother and Son
Authors: MOLLER JAMES H. , FISCH ROBERT O , FROM ARTHUR H. L. , EDWARDS JESSE E.
Published: December 2021

Endocardial fibroelastosis occurring in a mother and her infant son is reported. The relationship between the cardiac disease in the mother and that in the infant is uncertain, although two etiologic factors are possible. The first of these is a genetic predisposition to the disease. The second is a viral infection with myocarditis in the mother and with secondary viral infection of the infant.
The Electrocardiogram and Vectorcardiogram in Congenital Heart Disease
Authors: GERSONY WELTON M.
Published: December 2021

This small volume, by members of the Department of Medicine at the School of Medicine University of Puerto Rico, attempts to present the electrocardiographic and vectorcardiographic findings in congenital heart disease for "the student and practitioner of medicine." The authors derive their discussion of this discipline from experience with their own case material, with additional references to other workers. Unfortunately, however, the authors' experience with many of the defects is extremely limited.
Neonatal Anaesthesia
Authors: SMITH ROBERT M.
Published: December 2021

Due to differences not only in size but also in bodily proportions, reaction to anesthetic agents and their general physiological response to operative procedures, the anesthetic management of infants differs markedly from that of adults. Consequently, detailed information on this subject is much needed.

This volume is a practical guide to neonatal anesthesia and offers an abundance of information on apparatus and techniques that are in common use today. In their presentation the authors have taken pains to describe a wide variety of methods and rarely dictate personal rules for choice of agent or case management.
TEMPORARY IDIOPATHIC NEONATAL HYPERGLYCEMIA
Authors: Geefhuysen J.
Published: December 2021

The first case of temporary idiopathic neonatal hyperglycemia in an African infant from South Africa is reported. The condition presented with glycosuria, hyperglycemia, and acetonuria in a dysmature infant with a respiratory infection. The hyperglycemia disappeared by some 20 days later, without the use of insulin and in spite of recurrent pulmonary infections.

The presence of dysmaturity and acetonuria, or the insulin requirement, do not differentiate between true diabetes mellitus and temporary hyperglycemia. The etiology of temporary hyperglycemia may be related to the normal postnatal involution of pancreatic islet cell tissue.

The indications for insulin administration in the newborn with high blood sugar levels are failure to thrive, failure to maintain hydration, and persistent acidosis. Insulin should be given intravenously.
Recognition of Maltreatment and Prevention of the Battered Child Syndrome
Authors: FONTANA VINCENT J.
Published: December 2021

The letters in Pediatrics by Dr. Harry Bloch (Pediatrics, 37:856, 1966) and Dr. Isaacson (Pediatrics, 38:523, 1966) certainly express the feelings of many physicians, particularly pediatricians who have been interested in the problem of child abuse and neglect.

The term "battered child," as coined by Kempe (J.A.M.A., 181:17, 1962), has surely served its purpose by bringing this all-important disease entity to the attention of the physician. Prior to his report the medical literature failed to give proper attention and recognition to the fact that children were being maltreated and battered by their own parents.
Erythema Multiforme in a Premature Infant Associated with Sepsis Due to Pseudomonas
Authors: WASHINGTON JUAN L. , FOWLER RICHARD E. L. , GUARINO GUY J.
Published: December 2021

A case of erythema multiforme associated with septicemia due to pseudomonas in a premature infant is reported. A review of the recent literature indicates that rare cases of neonatal sepsis have been encountered in which erythema multiforme was associated with streptococcal, staphylococcal, and pseudomonas infections. It is, therefore, concluded that the appearance of this lesion in the newborn or premature infant should be considered a danger signal of possible sepsis.
Hazards of Swings—and Other Unsuspected Articles
Authors: FRIEND WILLIAM K.
Published: December 2021

This letter is written to call attention to a common potential hazard to small children. The usual swing set found in playgrounds and in backyard play areas is a metal frame support with chains holding the swing seat. The chains are frequently attached to the swing seat by means of an "S" hook. Children will often climb the metal frame and slide down the chain. If the "S" hook is not closed completely it offers a dangerous hazard to the falling child.
EARLY SURGICAL CORRECTION OF LARGE VENTRICULAR SEPTAL DEFECTS
Authors: Sigmann Joan M. , Stern Aaron M. , Sloan Herbert E.
Published: December 2021

A significant number of babies born with large ventricular septal defects present early in life as problems in management of congestive heart failure, severe pulmonary hypertension, marked growth retardation, and recurrent pulmonary infections. Review of patients born since December 1954 with ventricular septal defects and followed at our institution allowed for comparison between infants treated surgically and those patients treated either medically or requiring no specific therapy.

In 45 infants direct surgical closure of the ventricular defect was undertaken when supportive medical management alone appeared to be inadequate to insure survival or a normal life potential. There was an 80% survival with surgery. All 9 deaths occurred in patients having severe pulmonary hypertension; in some instances additional factors were believed to have contributed to the death of the infant. Nonetheless, surgical mortality appeared to be lower in the infants having severe pulmonary hypertension than among children with a comparable degree of hypertension who were operated on over the age of 2 years. Postmortem examination revealed pathologic changes of advanced pulmonary vascular obstructive disease at as early an age as 8 months.

Direct surgical closure of the ventricular septal defect was chosen in preference to the pulmonary artery handing procedure because it not only offers an immediate means of helping the sick infant but also should obviate the necessity of a second major surgical procedure when the patient is older. It is further anticipated that early correction of the septal defect will prove effective in many instances in preventing the serious consequences of pulmonary hypertension.
MOSAICISM OF AN ABNORMALLY LONG B CHROMOSOME IN A BOY WITH PHYSICAL AND MENTAL RETARDATION
Authors: Hsu Lillian Y. F. , Nemhauser Iris , Bettmann Hilda K. , Sobel Edna H.
Published: December 2021

An 11-year-old boy with short stature, mental retardation, low-set ears, simian creases, unusual dermatoglyphic patterns, and bilateral dysplastic mid-phalanges of the fifth fingers was found to have mosaicism in both leukocyte and fibroblast (skin) cultures. The normal cell-line predominated and the second cell-line contained an abnormally long chromosome B. The autoradiographic studies suggest that the abnormally long chromosome may involve a No. 5 which contains a translocated on inserted segment of an unknown donor autosome. The possible mechanism for the occurrence of this abnormality is discussed. Nine other instances of abnormally long B chromosomes (with lengthened long arm due to translocation) are reviewed and compared.
ERYTHROBLASTOSIS FETALIS AND HYPERBILIRUBINEMIA
Authors: Johnston W. H. , Angara Violetta , Baumal Ruth , Hawke W. A. , Johnson Robert H. , Keet Sylvia , Wood Margaret
Published: December 2021

One hundred and twenty-nine children who had indirect serum bilirubin levels over 20 mg/100 ml during the neonatal period were examined at approximately 5 years of age. Only seven children showed sequelae. All had sensorineural hearing impairment, associated in three with aphasia, and in one with mental retardation. Three were mildly athetotic, three had hearing loss alone.

Our study would suggest that multiple exchange transfusions are effective in preventing long-term sequaelae due to hyperbilirubinemia.
Skin Dimples and Rubella
Authors: HAMMOND KEITH
Published: December 2021

Apparently no one has reported a peculiar discrete, deep dimpling of the skin over the patella and certain bony prominences as a physical finding of early infancy. Consequently, the following patients and circumstances are described for the consideration of other physicians who might encounter, or have encountered, these peculiar dimples.

K.T. was born in 1963 and her physical findings at that time included some very striking dimples of the skin. These were present over each patella, over the radial styloid process and the lower end of the ulna at each wrist, over the bony medial and lateral epicondyles at each elbow, and one over each superior and inferior posterior iliac spine, neatly demarcating the sacral portion of the pelvic girdle.
CASE OF A REMARKABLY SMALL INFANT
Authors: C. T. E.
Published: December 2021

A. G., a healthy woman, aged thirty-four years; has had five children; her youngest now two years old; pregnant, and expected to be confined some time in the early part of the month of January. She laboured under great anxiety of mind for the last four months, and was seized with labour-pains on the 8th instant. On the 10th, after forty-six hours of severe labour, she was delivered of a female child, of so very small a size, that it did not appear to have attained the sixth month, agreeing in this particular with the woman's calculation as to the time she should be confined. Not expecting it could survive more than an hour or so, it was rolled in a piece of fine flannel, and laid in a warm place. Contrary to all expectation, she survived, sucked vigorously, and was healthy in every respect. The ossification of the bones of the head was very imperfect; the sutures were broad enough to admit of the middle finger being laid between the bone; the fontanelles were of a correspondingly large size; and she has inguinal hernia on the left side. On the 14th [of November], she being then four days old, I weighed her accurately; the actual weight of the child was two pounds thirteen ounces.

Dec. 14, she being 34 days old, weighed 3 lb. 7 oz.

Dec. 27, she being 47 days old, weighed 4 lb, 4 oz.

Jan. 10, she being 61 days old, weighed 5 lb, 4 oz.

Jan. 25, she being 76 days old, weighed 5 lb, 12 oz.

March 4, she being 114 days old, weighed 8 lb, 8 oz.

It will be perceived that, in the first thirty days, she gained but ten ounces; in the thirteen that followed she gained thirteen ounces, averaging one ounce per diem. About the 1st of January she suffered a good deal from the hernia, and continued ill for four weeks, during which time she acquired only twenty-four ounces additional weight. From the 25th of January to the 4th of March, the period at which I weighed her last, her health had been very good, and during that time (thirty-eight days), she acquired forty-four ounces of additional weight, something more than an ounce in the day. She left this part of the country about the date of my last observation.—Cavan, April 18th, 1846. (From Dublin Quarterly Journal of Medical Science, 1:562, May 1846.)
THYMIC ALYMPHOPLASIA, LYMPHOMA, AND DYS-γ-GLOBULINEMIA. HYPER-γA-, NORMO-γM-, HYPO-γG, A-γD-, AND γE-GLOBULINEMIA, PLASMACYTOSIS, NORMAL DELAYED HYPERSENSITIVITY, SEVERE ALLERGIC REACTIONS, AND COOMBS' POSITIVE ANEMIA
Authors: Goldman Armond S. , Haggard Mary E. , McFadden John , Ritzmann Stephan E. , Houston Elsie W. , Bratcher Raymond L. , Weiss Kurt G. , Box Edith M. , Szekrenyes Julius W.
Published: December 2021

A male infant is described with thymic alymphoplasia; lymphocytopenia; lymphoid tissue hypoplasia; plasmacytosis of lymph nodes and marrow; dys-γ-globulinemia characterized by hyper-γA-, normo-γM-, hypo-γG-, and a-γD- and γE-globulinemia and decreased K- and λ-light chains with an increased K/λ light chain ratio; deficient formation of certain hemagglutinin, precipitin and neutralizing antibodies; the presence of skin-sensitizing, heat-labile reaginic antibodies and severe allergic reactions; normal delayed hypersensitivity; and a Coombs' positive anemia. Subsequently, a lymphoma involving bones, liver, spleen, lung, and kidney developed and terminally Pneumocystis carinii pneumonia appeared.

A male sibling who died at age 11 months manifested thymic aplasia, lymphoid tissue hypoplasia, pancytopenia and hypo-γ-globulinemia. The frequency of allergic disorders was increased in family members of these children.
CYTOGENETICS OF FETAL ABORTIONS
Authors: Waxman S. H. , Arakaki D. T. , Smith J. B.
Published: December 2021

Eighty-five specimens (56%) of 149 samples of spontaneous fetal abortions grew initially in tissue culture. Sixty were cultivated with only minimal growth and were subsequently lost in attempted chromosomal preparations. Of the remaining 25 cultures, 10 had abnormal karyotypes. These consisted of one monosomy-3, three trisomy-16, one mosaic trisomy-16, one trisomy-F (19-20), an XO, two polyploid, and an unusually long unidentified translocation chromosome karotypes. The remaining 15 cultures had normal karyotypes.

The sex ratio as determined by sex chromatin was: males, 13 and females, 15. Eleven were confirmed chromosomally to be XY males and 13 to be XX females. Two of the trisomy-16, the mosiac trisomy, and the polyploid fetuses were males; the other four fetuses with abnormal karyotypes were females. The sex of the XO specimen could not be ascertained.
Elongated Patent Ductus Arteriosus with Intermittent Shunting
Authors: KOHLER COLETTE M. , MCNAMARA DAN G.
Published: December 2021

The presence of patent ductus arteriosus without a typical continuous murmur has long been recognized, especially in the presence of pulmonary hypertension, or a small ductus, or with associated cardiac defects; however, there are only a few reports of documented, intermittently disappearing murmurs occurring in individuals over 6 months of age with a substantial shunt in the absence of pulmonary hypertension or associated defects. Danilowicz, et al. have recently reported delayed closure of the ductus anteriosus up to 6 months of age in some premature infants.

We present this case report of a 2½-year-old boy with patent ductus arteriosus with cardiac catheterizations during the disappearance and subsequent reappearance of a continuous murmur with documentation of absence of shunting when the murmur was absent and substantial shunting if the murmur was present.
Letters to the Editor
Authors: WINTERBAUER RICHARD H. , FORTUINE ROBERT , EICKHOFF THEODORE C.
Published: December 2021

We appreciate Dr. Nogen's concern with the diagnosis of purulent meningitis in the face of a normal spinal fluid protein and glucose. A careful review of the records of the second patient indicates that the spinal fluid protein of 24.5 mg/100 cc and glucose of 79 mg/100 cc are indeed correct. Further, the child did not receive intravenous glucose prior to the lumbar puncture. Nevertheless, one can never completely rule out the possibility of human error in recording of laboratory data.
Factors Affecting McCaman-Robins Method of Screening for PKU
Authors: HILL JOHN B.
Published: December 2021

A recent publication in your journal points out that the blood and serum levels of phenylalanine as analyzed by the method of McCaman and Robins rise as the sample ages unless the samples are kept in the frozen state. The use of refrigerated trucks in sample transportation is described as a means of dealing with the problem, which is an extremely important one in view of the many large scale screening programs for phenylketonuria now in progress. A one sentence reference is made to the use of filter paper for storage and transport of blood samples but the reader is given no clue as to what the merits of this approach are.
Letters to the Editor
Authors: KLEINMAN DAVID S. , DAY ROBERT W.
Published: December 2021

Dr. Hill calls attention to the important problem of the effects of transport and storage of specimens for PKU testing, but otherwise misses the point of our article. Its purpose was to explore the pattern of PKU test results on normal newborns, considering their age in days and type of feeding and accounting for the effects of specimen age and handling, and laboratory differences. We felt that our series was large enough to be of value. Hopefully, our findings will be useful in stimulating the development, demonstration, and use of better specimen transport and holding techniques.
WHAT THE NEGRO WANTS FOR HIS CHILDREN
Authors: BATES TALCOTT
Published: December 2021

Johnie Scott, a 20-year-old who was born in a women's prison and raised in the slum of Watts, heard by chance of the Scholastic Aptitude Tests, took them, attended Harvard, and is now back in Watts. He writes of Watts as he knows it. His vivid first person description ends with a statement of the Negroes' "demands."

"The slum Negro will ask, for his children, parks (and in Watts there is but one); efficient care of those who need relief and medical care (and at present both the Bureau of Public Assistance and the Los Angeles County General Hospital are under fire for their inordinately slow treatment and processing of poor people); jobs that will reach the majority of the community's skills (there is no trade school in Watts, and there is but one in the entire city of Los Angeles); increased contact with social workers; a rapport with politician and policeman; good schools with space for growth as the community itself grows; and, most of all, communication with the outside world on a level other than that of fear."
An Unusual Complication of Retrograde Pyelography: Neuromuscular Blockade
Authors: PERCY ALAN K. , SAEF EDWARD C.
Published: December 2021

This report describes the onset of respiratory paralysis 2 hours after retrograde pyelography with a contrast material containing 2.5% neomycin. Although calcium has been described as more effective in treatment of neomycininduced neuromuscular blockade, the condition responded promptly to intravenous neostigmine and positive-pressure respiration.
Letters to the Editor
Authors: SUSSMAN SIDNEY J. , MAGOFFIN ROBERT L. , LENNETTE EDWIN H. , SCHIEBLE JACK
Published: December 2021

The results of our investigation based upon bacteriologic and virologic findings were, indeed, in keeping with the conclusion that Dr. Macaulay drew from clinical observations. Since 1951, however, many authors have expressed the contrary conclusion that a rise in titer of cold agglutinins is virtually diagnostic of Mycoplasma pneumoniae (Eaton agent) infection. Our observations were considered to be of interest because they failed to support the latter view.
PATHOLOGIC VARIANTS OF CONGENITAL HYPOGAMMAGLOBULINEMIA: AN ANALYSIS OF 3 PATIENTS DYING OF MEASLES
Authors: Lipsey Allen I. , Kahn Myra J. , Bolande Robert P.
Published: December 2021

Three patients with abnormal thymus glands characterized principally by the absence of Hassall's corpuscles were presented. These patients do not clinically fall into either the ataxia-telangiectasia syndrome or the Swiss-type of agammaglobulinemia. This suggests that hypoplasia of the epithelial thymus, i.e., absence of Hassall's corpuscles, may be associated with a spectrum of lymphoid tissue histopatholgy and immunologic derangement, perhaps dependent on an additional lympho-immune primer. The immunologic disorders appear to have resulted in bizarre, widely disseminated lethal measles infections in each case.
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA IN CHILDHOOD AND ADOLESCENCE
Authors: Miller Denis R. , Baehner Robert L. , Diamond Louis K.
Published: December 2021

Two cases of PNH in adolescence and childhood are reported. The first presented at age 7½ years with aplastic anemia and improved after splenectomy performed at age 14. The second, a 15-year-old girl, presented with a Coombs-positive hemolytic anemia and has had a course complicated by multiple peripheral thromboses. The clinical and laboratory manifestations, complications, and certain therapeutic aspects of PNH are discussed. Anticoagulant therapy appears indicated in the presence of multiple thrombotic episodes.

Erythrocyte metabolic studies revealed normal glycolysis, ATP stability, and GSH content in the cells of a child with a normal reticulocyte count. Mild elevations of glycolysis, noted in the child with a reticulocytosis, was ascribed to a younger mean red cell population since further elevations found in the "top" reticulocyte-rich layer after centrifugation. Heparin, the anticoagulant used in these studies, had no adverse effect on glycolysis but did inhibit hemolysis and minimize ATP instability when compared to cells suspended in defibrinated serum.

Erythrocytes fractionated by centrifugation revealed increased glycolytic enzyme activities of hexokinase, G3PD, PGK, TPI, PK, LDH, G6PD, and 6PGD in the reticulocyte-rich layer. Normal, rather than increased activity of aldolase, a membrane enzyme, may reflect damage to the red cell membrane. PFK, known to be decreased in the erythrocyte of neonates, showed normal activity, but it was lowest in the reticulocyte-rich layer. Fetal hemoglobin was elevated in this layer.

AChE deficiency and increased suceptibility to hydrogen perioxide and acid hemolysis confirmed previous reports and were most marked in the young cell layer. The level of increased glycolytic rates and enzyme activity, AChE deficiency, acid hemolysis and peroxide hemolysis were related to the clinical severity of the disease.
Encephalopathy and Fatty Degeneration of the Viscera Associated with Chickenpox
Authors: JENKINS RAMON , DVORAK ANN , PATRICK JAMES
Published: December 2021

A case of encephalopathy and fatty degeneration of the viscera associated with chickenpox is described. Evidence is adduced from reported necropsies on patients with chickenpox supporting the view that these two conditions are more commonly associated than has been previously believed.

Fatty degeneration of the liver may be the cause of hypoglycemia occurring during the course of chickenpox.
Acute Phenothiazine Toxicity in Childhood: A Five-Year Survey
Authors: GUPTA J. M. , LOVEJOY F. H.
Published: December 2021

Twenty patients with phenothiazine toxicity admitted to the Children's Hospital Medical Center have been reviewed. In any patient presenting with bizarre neurological symptoms, phenothiazine toxicity should be borne in mind.

Diphenhydramine (Benadryl) was found to be useful in both diagnosis and treatment. The use of phenothiazines in the treatment of acute nausea and vomiting in childhood is questioned.
Letters to the Editor
Authors: SISSMAN NORMAN J.
Published: December 2021

The "controversy" over treatment of infants with ventricular septal defects published in the January 1967 issue of Pediatrics prompts me to comment on one general factor, vital in decisions between alternative methods of treatment of congenital heart disease, which has received little attention in the literature—namely, the experiences and capabilities of individual surgical teams. That Dr. Nadas takes this into account is reflected in his statements, ". . . our surgeons have been able to accomplish [banding of the pulmonary artery] at a mortality rate of 10% or less . . ." and ". . . the pediatrician unless he has surgeons with exceptional ability at his disposal, will do better to . . . proceed conservatively."
ANGIOCARDIOGRAPHIC STUDIES ON THE HUMAN FOETAL CIRCULATION
Authors: LIND JOHN , WEGELIUS CARL
Published: December 2021

Direct radiographic angiocardiography with 10 exposures per second on human foetuses in legal abortions is described. The technical solution combines the advantages of a high picture quality with a possibility of assessing the dynamic course in the heart and the circulation in both the arterial and the venous circulatory system. The foetal communications in the circulation of the human foetus are distinctly visualized as well as the various conditions in the cardiac chambers during the cardiac cycle and also its relationship to the circulation in the efferent vessels of the foetus.
Subject Matter of PEDIATRICS
Authors: ROGERS W. B.
Published: December 2021

Huzzas to Dr. R. A. Norton and his letter to you in the March issue of Pediatrics! As a practicing pediatrician, and a member of the American Academy of Pediatrics, I agree that our official publication is valueless to me.

Your "Commentaries" and "Review Article" are good. The other "Articles," and even your "Experience and Reason," are worthless to me.

I have read the references you quote in answer to Dr. Norton's letter. I understand your rationalizing what you are trying to do. But you are not helping me practice good pediatrics!
Letters to the Editor
Authors: THELANDER H. E.
Published: December 2021

The Letter to the Editor by Dr. R. A. Norton in the March issue of Pediatrics must express the sentiments of many pediatricians in private practice.

The American Academy of Pediatrics was started by and for the practicing pediatricians. Prior to its organization, the only society was the American Pediatric Society, which for many years limited its membership to 100. The purpose of the Academy was to give all qualified, practicing pediatricians an organization in which they would have an opportunity to exchange ideas.
Sudden Death in Infancy
Authors: FRASER G. R. , FROGGATT P.
Published: December 2021

We were much interested to see the excellent review article on sudden and unexpected death in infancy in the January issue of Pediatrics (39:123, 1967).

We have been working for some years on the condition of congenital deafness with abnormalities of the electrocardiogram, and we feel that this and other genetically determined disorders of cardiac conduction must play a definite though possibly numerically minor role in the causation of sudden and unexpected death in infancy.
The Battered Child
Authors: HALPERN SALMON R.
Published: December 2021

I am terribly disturbed by the Editor's reply to Dr. Harry Bloch's letter concerning "The Battered Child" which appeared in the April issue of Pediatrics (39:625, 1967).

As I understand, Dr. Bloch is greatly concerned about the battered child in the fullest implication of this term. "The victims of slums, poverty, inadequate educational facilities, discrimination; the millions of starving children; the many criminally ruined by drug addiction; the thousands of children injured and killed in accidents, the tragic black child emotionally, physically, and mentally battered; the burned and broken children, victims of war, napalm, and chemicals; the more than one million children murdered in Nazi crematoria and concentration camps.
Disorders of Carbohydrate Metabolism in Infancy
Authors: MARKS JAMES F.
Published: December 2021

Both authors of this text have extensive experience in the area about which they are writing. They skillfully blend their own experience with pertinent studies in the medical literature to make an interesting, informative, and readable book.

The book is divided into five major portions. Part I, or introduction, considers carbohydrate metabolism, metabolic adjustments in pregnancy, and carbohydrate homeostasis of the neonate. Part II relates to problems of the neonate with specific headings including infant of the diabetic mother, transient symptomatic hypoglycemia in the neonate, and transient diabetes mellitus in early infancy.
"WHEN SHOULD ONE LIGATE THE UMBILICAL CORD?"
Authors: S. C. A.
Published: December 2021

THE WORDS ABOVE, freely translated from the French, repeat the title of an article published in 1875 and referred to in this month's Review Article. Ninety-two years and at least 90 published papers later, the question is still unanswered today. It is worthwhile to ask: Why?

The appearance of this useful Review Article and of the investigation by Oh, Wallgren, Hanson, and Lind in the same issue suggested that Professor Lind himself be asked for a Commentary containing his own recommendation on when to ligate. Despite much evidence of his interest in placental transfusion, he was politely (as always) unwilling to commit himself in the hoped-for Commentary, or even in a personal letter.