bluuebunny/crossref_metadata_2025 huggingface dataset:
SYSTEMIC LUPUS ERYTHEMATOSUS IN CHILDHOOD
Authors: Jacobs Jerry C.
Published: December 2021

The clinical features of 35 children with systemic lupus erythematosus seen at the Columbia-Presbyterian Medical Center between 1930 and 1961 have been summarized. Seven of the more recent 25 patients gave a history of seizures and treatment with anticonvulsant medicaments prior to the onset of lupus and are believed to represent cases of drug-induced disease. The mechanism whereby drugs induce this disorder in susceptible patients receiving anticonvulsant medicaments remains unknown. While there is little question that steroids have improved the prognosis in systemic lupus erythematosus, further controlled study of varying therapeutic regimens is needed.
Screw Caps for Baby Food Jars (Statement for Physicians)
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

In compliance with the American mother's demand for maximum convenience in feeding her infant, baby food manufacturers have introduced screw cap closures for jars containing infant foods. These caps permit easy opening and reclosure, which mothers like, but also present a potential health hazard.

Experience shows that some people, unaware of, or indifferent to, the dangers of bacterial contamination, open jars of baby food in the store, sometimes taste them, and return them to the shelves. Contaminated jars then present a hazard. Manufacturers have devised means of indicating whether or not a jar has been opened but safety can be achieved only if the consumer is aware of these and makes proper use of them.
EVIDENCE THAT THE ANTIDIURETIC SUBSTANCE IN THE PLASMA OF CHILDREN WITH NEPHROGENIC DIABETES INSIPIDUS IS ANTIDIURETIC HORMONE
Authors: Holliday Malcolm A. , Burstin Charles , Harrah Jean
Published: December 2021

The antidiuretic activity in the plasma of four children with nephrogenic diabetes insipidus was measured by a rat assay technique. The evidence presented to indicate that this activity was due to antidiuretic hormone (ADH) was as follows: (a) the activity was higher in jugular vein plasma than in femoral or antecubital vein plasma, (b) it was high when the children were thirsted and decreased when they drank water, (c) it was destroyed when the plasma was incubated with thioglycollate, and (d) it was ultrafilterable, and vasopressin (Pitressin), when injected, was distributed as though it was ultrafilterable.

When the children were given vasopressin, there was no change in urine flow or osmolality, but plasma antidiuretic activity was higher than it was when water deprivation led to a reduction in urine flow and an increase in urine osmolality. The inference of these findings is that ADH is secreted normally in children with nephrogenic diabetes insipidus, it is ultrafilterable, but it is not a factor in modifying urine flow in response to dehydration.
HYPOPLASTIC ENAMEL ASSOCIATED WITH THE NEPHROTIC SYNDROME
Authors: Oliver William J. , Owings Clyde L. , Brown William E. , Shapiro Barry A.
Published: December 2021

A high incidence of enamel hypoplasia in permanent teeth was found in children with the nephrotic syndrome. There was a correlation between the time of severe renal disease and the estimated time at which faulty enamel was formed. The absence of fluorescence of the defective teeth upon exposure to ultraviolet light suggests that tetracycline therapy was not a causative factor. Other possible causes of the defect include corticosteroid therapy and metabolic disturbances associated with the nephrotic syndrome. Final identification of the etiological factor remains uncertain.
TRANSFER OF BILIRUBIN-C14 ACROSS MONKEY PLACENTA
Authors: Lester Roger , Behrman Richard E. , Lucey Jerold F.
Published: December 2021

Transfer of bilirubin across the placenta was studied in two pregnant Rhesus monkeys. Bilirubin-C14 was infused into a peripheral fetal vein and subsequently recovered from maternal bile. Significant transfer of bilirubin-C14 occurred in each experiment. It is probable that the placenta is a major site of fetal bilirubin transfer in primates.
ACTIVE IMMUNIZATION: CURRENT CONSIDERATIONS
Authors: Smith Margaret H. D.
Published: December 2021

THE PRACTICAL ASPECTS of immunization have changed in the last few years, and are inevitably destined to change continuously. Not only does modern science keep producing newer and more potent vaccines, but the vaccines themselves alter the distribution of disease agents and thereby the epidemiologic pattern of disease. As Batson and Christie have expressed it: "Immunization procedure is a dynamic subject in need of constant evaluation."

DIPHTHERIA

Nowhere does this phenomenon seem more clearcut than in the case of diphtheria. Whereas 25 years ago a basic course of immunization against diphtheria was essential, repeated natural exposure could be relied upon to boost that immunity throughout later childhood and adolescence. Nowadays the disease itself has become so relatively uncommon in many areas that we need to be reminded by articles like that of Doege, Heath, and Sherman in a recent issue of Pediatrics that 900 cases of diphtheria do occur annually in the United States, and that these cases tend to be grouped in states where immunization programs lag. Because of the very scarcity, in most places, of opportunity for natural exposure, there is an appreciable number of adolescents and adults who, even though immunized in childhood, has again become fully susceptible to infection with Corynebacterium diphtheriae. This falling off of immunity with increasing age must account for small outbreaks of diphtheria among older people in institutions, and for cases in recent years among certain "skid row" groups. It is the reason behind the long schedule of diphtheria toxoid inoculations recommended in the so-called Red Book of the Academy of Pediatrics.
Nonalimentary Fructosuria
Authors: KHACHADURIAN AVEDIS K.
Published: December 2021

Fructosuria in an 18-month-old boy suffering from sickle-cell thalassemia is reported. The fructosuria persisted after the patient was placed on a fructose-free diet. Oral and intravenous tolerance tests were normal. The fructosuria had diminished by the age of 3½ years. The mechanism of the fructosuria is uncertain. A delay in enzyme maturation is suggested.
Let Us Give the Russians Their Due
Authors: HOLT L. EMMETT
Published: December 2021

A current report by an Academy committee (Pediatrics, 31:512, 1963) credits Sir Edward Mellanby in 1920 with the discovery of the antirachitic potency of cod liver oil. While in no way deprecating Mellanby's excellent work, it should be pointed out that the value of cod liver oil was firmly established more than a decade before Mellanby's report. There was clinical testimony to support its use during the latter part of the nineteenth century, but it was the Russian pediatrician J. A. Schabad of St. Petersburg who gave the first convincing demonstration of its efficacy.
Sterility and Exchange Transfusions
Authors: BROWNLEE ALBERT W. , KRAMER JOHN C.
Published: December 2021

During the process of performing exchange transfusions on babies with hyper-bilirubinemia, we have come across some information we feel is of vital importance for all physicians who are doing these procedures.

It is common practice of this hospital to perform the procedure under sterile operative conditions within the surgical rooms of the hospital. The procedure used is that of inserting a feeding tube into the umbilical vein for the injection and withdrawal of the blood. In July of 1962, we had reports of two of our infants, who had these exchange transfusions within two weeks of each other, developed staphylococcal septicemia, one of which was fatal. In reviewing the techniques used in the procedure, we came across the following information:
ECHO II VIRUS INFECTIONS ASSOCIATED WITH EXANTHEMS
Authors: Cherry James D. , Lerner A. Martin , Klein Jerome O. , Finland Maxwell
Published: December 2021

Seven cases of ECHO 11 virus infection with exanthem are described. The etiologic relation of the rashes to the viruses is suggestive but not statistically validated. Evidence is presented that at least two antigenic variants were related to the cases reported and neither was closely related antigenically to the prototype strain. The data also suggested that HI test is more sensitive but less specific than the neutralization test in identifying infections with ECHO 11 viruses. A case with a chronic, recurrent vesicular rash was described in which an ECHO 11 virus was isolated from a lesion, but no corresponding antibody could be demonstrated in the patient's serum.
CARDIAC COMPLICATIONS OF DIPHTHERIA
Authors: Morgan Beverly C.
Published: December 2021

Ninety-eight cases of diphtheria were observed in a 5½ year period, and the cardiac findings were evaluated. There were nine deaths. Three patients were dead on arrival

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at the hospital (without postmortem evidence of myocarditis) while three died of diphtheritic myocarditis and three as a result of respiratory complications. No child who succumbed had been immunized against diphtheria. Four patients developed electrocardiographic and clinical evidence of myocarditis, and three died. In addition, 27 children showed minor electrocardiographic abnormalities of questionable significance. No patient had clinical or pathological evidence of myocarditis in the absence of electrocardiographic abnormalities. Although transient nonspecific electrocardiorgaphic abnormalities are frequent, their significance remains unclear. Marked electrocardiographic abnormalities such as bundle-branch block, A-V dissociation, and complete heart block are diagnostic of myocarditis in patients with diphtheria.
CARCINOMA OF THE COLON IN CHILDREN
Authors: Middelkamp J. Neal , Haffner Heinz
Published: December 2021

Two cases of primary adenocarcinoma of the colon are presented. Patient C.P. had a highly undifferentiated, signet ring type of adenocarcinoma and survived only 3 months. Patient P.G. had a well-differentiated adenocarcinoma with early, adequate resection of the lesion and has survived 8 years with no evidence of recurrence.

The literature on carcinoma of the colon in children under 17 years of age is reviewed. There are twice as many boys with this disease as girls. Abdominal pain, vomiting, constipation, weight loss, blood in the stool, abdominal distension, and anorexia were common symptoms. The most common physical findings were the presence of an abdominal mass, abdominal distension and tenderness, anemia, and dehydration. These signs and symptoms are similar to those seen in adults with this disease.

Approximately 50% of these children had a highly invasive, signet ring type of adenocarcinoma on microscopic examination. This type of carcinoma is rare in adults. Those patients with a signet ring type of adenocarcinoma have a very poor prognosis. However, the remaining 50% had well-dif-ferentiated adenocarcinoma where early diagnosis and adequate surgical resection could reduce the mortality.
RECOMMENDATIONS ON FORMULA SUPPLY IN THE HOSPITAL
Authors:   Committee on Fetus and Newborn
Published: December 2021

In the process of preparing a new revision of the manual, Standards and Recommendations for Hospital Care of Newborn Infants, the Committee on Fetus and Newborn established a new set of standards concerning preparation and handling of formula supply in the hospital.

Because of the current interest in formula supply, brought about by recent technological changes, the Committee decided to issue the standards as a separate statement. It will later appear as a section in the revised edition of Standards and Recommendations of Hospital Care of Newborn Infants.

Responsibility for the policies regarding feeding of infants in nurseries must be assigned to designated members of the medical staff. They make all decisions about prescription, acceptability, preparation, and distribution of formula. They also set up control and review procedures.

Three principal methods for providing formula to nursery infants are currently available in the United States. Their relative efficacies cannot be evaluated at this time, but all should meet basic standardized requirements.

The three methods are: (1) preparation of the formula entirely in the hospital formula room; (2) final preparation of formula in the hospital from components, pre-sterilized, packaged, and delivered by an ourside source; (3) use of individually packaged pre-steriuized formula delivered by an outside source.

In providing formula for infants, attention must be given to the following:

Facilities

Personnel and their responsibilities

Formula preparation

Safety standards and quality control

A. Facilities

Facilities necessary for the preparation of formula depend on the method used in providing the formula.

1. Formula Room
MENTAL DISORDERS: A Guide to Control Methods, prepared and published by the American Public Health Association, Inc. 1962, 132 pp., $1.25
Authors: Byers Randolph K.
Published: December 2021

I have read with interest the brochure on Mental Disorders, A Guide to Control Methods, published by the American Public Health Association, Inc. This book is prepared from the pragmatic point of view, both in relation to the care of people already afflicted with various types of mental disturbance and to attempts at prophylaxis of mental disturbances. There is, finally, a thoroughgoing summary of project organization through which one might make useful inquiries into causes of mental defects.
EXERCISING TESTING IN ADULT NORMAL SUBJECTS AND CARDIAC PATIENTS
Authors: Bruce R. A. , Blackmon J. R. , Jones J. W. , Strait G.
Published: December 2021

1. Several approaches to assessment of physical work capacity in the upright posture in normal adults and cardiac patients have been reviewed critically.

2. Preliminary experience has been presented with a new multistage treadmill test of maximal exercise which permits appraisal of either a physically trained normal subject or an impaired but ambulatory cardiac patient.

3. The most effective means of differentiating cardiacs from normals has been an estimate of the total oxygen intake/Kg of body weight.

4. The need for monitoring the circulation with respect to arrhythmias, ischemia and/or hypotension has been emphasized.

The authors wish to acknowledge their appreciation of many physicians, particularly Dr. Robert M. Levenson of the Seattle Cardiac Work Evaluation Clinic, and medical and graduate students who have assisted in the testing of patients and normals. The assistance of Mrs. Gladys Pettet is gratefully acknowledged also.
CARDIAC ARREST DURING STRENUOUS EXERCISE IN A PATIENT WITH CONGENITAL HEART DISEASE
Authors: Kattus Albert A.
Published: December 2021

THE FOLLOWING CASE is presented in order to introduce a note of caution into consideration of the advisability of recommending unmonitored exercise for patients with heart disease.

The patient is a 24 year old third year medical student who had been known to have a heart murmur since birth. He had lived a vigorously active life and had participated in high school football as well as snow skiing in more recent years. At the age of 19 he underwent a detailed cardiac work-up including right heart catheterization at another hospital. The findings at that time included a normal examination except for a grade III/VI blowing pansystolic murmur at the 4th left intercostal space. The chest x-ray disclosed a normal cardiac silhouette with normal pulmonary vascularity. The electrocardiogram disclosed right bundle branch block and left axis deviation.

Cardiac catheterization disclosed systolic pressure of 30 mm. Hg. in the right ventricle and 23 in the pulmonary artery. There was O2 saturation of 78 per cent in the superior vena cava and 75 per cent in the inferior vena cava. In the high and mid right atrium O2 saturations ranged from 76 per cent to 80 per cent. Low in the atrium, just above the tricuspid valve, there was a small step-up of O2 saturation to 83 per cent and similar saturations were found in the right ventricle and pulmonary artery. The findings suggested a small shunt from left ventricle to right atrium of the type seen in the transitional form of atrio-ventricular communis.

During the two weeks prior to the present event the patient and his roommate who was also a third year medical student, had undertaken to improve their physical conditioning by performing the Canadian Air Force series of calisthenic exercises.
THE EFFECT OF HYPOXIA ON NEWBORN ANIMALS, WITH REFERENCE TO HYALINE MEMBRANE DISEASE
Authors: Avery Gordon B.
Published: December 2021

Various lines of clinical evidence point to an association between perinatal hypoxia and the genesis of hyaline membrane disease in human infants. The question of whether hyaline membranes can be caused by hypoxia alone was investigated in experimental animals. Newborn guinea pigs, rabbits, rats, and mice were placed in a chamber where they breathed a mixture of oxygen-nitrogen or oxygen-nitrogen-carbon dioxide for a period of up to several days. Their reactions were noted, the period of their survival recorded, and their lungs were examined histologically and compared with controls. All species showed a remarkable tolerance to hypoxia as newborns: most animals were able to survive for hours in mixtures ranging down to 3% or 4% oxygen. For each species there appeared to be a critical oxygen pressure needed for survival. Below this level all individuals promptly died. Carbon dioxide in the gas mixture was found to protect against initial hypoxic convulsions, prolong the period of hyperventilation, and prolong survival at the same level of oxygen tension. In no instance did the severe and prolonged hypoxia to which the newborns were subjected result in the histological picture of hyaline membrane disease: diffuse atelectasis, hyaline membranes, and vascular congestion. This is taken as evidence that, for these species at least, hypoxia alone is not sufficient to reproduce the respiratory distress syndrome of human infants.
GIANT-CELL ARTERITIS WITH ANEURYSM FORMATION IN CHILDREN
Authors: Wagenvoort C. A. , Harris Lloyd E. , Brown Arnold L. , Veeneklaas G. M. H.
Published: December 2021

In two children who had multiple aneurysms in the aorta and systemic arteries, and who subsequently died, the histopathologic findings were those of giant-cell arteritis. We have designated this condition as infantile giant-cell arteritis. The etiology is unknown.
FAMILIAL ERYTHROPHAGOCYTIC LYMPHOHISTIOCYTOSIS
Authors: MacMahon H. Edward , Bedizel Metin , Ellis Charles A.
Published: December 2021

The clinical records and gross and histological findings are described in the case of two siblings who died at different times and at slightly different ages of an unusual, but apparently similar, disease complex. Letterer-Siwe's disease was suspected clinically, but the autopsy findings characterized by hyperplasia of histiocytic cells, erythrophagocytosis, and an infiltration of lymphocytes and histiocytes into almost every organ in the body, including, in one of the children, the central nervous system, were distinctly different from the disease described by Letterer. Neither the etiology nor the nature of the disease is understood. Little or nothing is known about therapy though splenectomy in one of the two infants led to a temporary relief. Its similarity to other familial diseases of infancy designated by such terms as familial haemophagocytic reticulosis, familial nonlipid reticuloendotheliosis, familial generalized lympho-histiocytic infiltration, and possibly, Chédiak-Higashi syndrome, is so striking as to suggest that these exceptional diseases may themselves comprise a distinct clinical and anatomical category. Until more is known about this group, the descriptive term "familial erythrophagocytic lympho-histiocytosis" is suggested.
Neonatal Death from Congestive Heart Failure Associated with Large Cutaneous Cavernous Hemangioma
Authors: COHEN MICHAEL I. , SINCLAIR JOHN C.
Published: December 2021

A newborn infant with a large cutaneous cavernous hemangioma who died from congestive heart failure in the first day of life has been described. A plea is made for careful observation of the hemodynamic status of newborn infants with similar lesions.
THE PRENATAL PEDIATRIC VISIT
Authors: Wessel Morris A.
Published: December 2021

Various topics of discussion which occur between expectant couples and a pediatrician have been presented. The subject matter in the interview varies in individual circumstances. The relationship which can be established prenatally with the pediatrician offers a valuable supporting force as expectant couples approach parenthood. The pediatrician finds it easier to provide professional service after the birth of the baby when the relationship between physician and parents is well established during the pregnancy.
Letters to the Editor
Authors: WHEATLEY GEORGE M.
Published: December 2021

Dr. Siebenthal's letter points up an important practical problem of which our Committee on International Child Health has been much aware ever since we began to function. There is a need for pediatricians to help in many foreign countries and in a variety of conditions including short-term assignments.

The organization sponsoring short-term medical assignments with which I am most familiar is MEDICO. They have been quite successful in enlisting orthopods and gynecologists for one-month assignments, notably in Jordan and South Vietnam.
COMPARISON OF INNOCENT CARDIAC MURMURS OF CHILDHOOD WITH CARDIAC MURMURS IN HIGH OUTPUT STATES
Authors: Harris T. N. , Friedman Sidney , Tuncali Mustafa Tahsin , Hallidie-Smith Katherine A.
Published: December 2021

Cardiac murmurs have been recorded in patients in a number of clinical states which give rise to systolic cardiac murmurs, in which no abnormalities of the intracardiac pathway or direction of blood flow are known to exist: uncomplicated congenital heart block, chronic anemia, pregnancy, arteriovenous fistula, and hyperthyroidism. These recordings have been examined in the cathode-ray oscillograph and sound spectrograph. The oscillograms of murmurs of each of these groups have been found to be of the same general category, a basic wave of relatively low frequency (90-130 c.p.s.) with a variable amount of distortion by higher-frequency transient vibrations. The spectrograms of the murmurs of each of these groups have again been found to have the same general pattern: a relatively dense spectrogram limited to a fairly well-defined area, largely below the 250-c.p.s. level. Thus both the oscillograms and spectrograms of these murmurs showed the characteristics found in earlier studies of the innocent cardiac murmurs of childhood in contrast to the characteristics which have been found in murmurs of a number of lesions of rheumatic and congenital heart disease. Since the clinical states included in the present study have in common an increased stroke volume, this has been taken as supporting evidence of the thesis that the common innocent murmurs of childhood are caused by the vibration, at its natural period, of some structure in the cardiac wall or great vessels, arising from the ejection of an unusual volume of blood from the heart in systole or the greater velocity of ejected blood under these circumstances.
Letters to the Editor
Authors: PRYLES CHARLES V.
Published: December 2021

Several points occur to us in regard to Dr. K. G. Johnson's letter questioning you in detail about our article of April, 1963.

We would like to point out that the article contains a plethora of statistical information; however, retrospective cross table data analysis of this sort does not necessarily result in statistically valid disclosures.

His first question can be answered simply. Thirty-four infants received antibiotics. Six infants received antibiotics because of other indications, i.e., they did not show clinical sepsis. None of these became ill or died. Twenty-nine infants showed clinical symptoms and signs of sepsis. Twenty-eight were treated with antibiotics and one was not. Five of these died, including the one who received no antibiotics.
Letters to the Editor
Authors: KRIEGER INGEBORG
Published: December 2021

Dr. Robbins' comments in his letter to the editor offer certainly an attractive explanation for the phenomena observed in bronchiolitis, although Engel's opinion concerning the functional significance of the bronchiolar muscles is not shared by all investigators.

The fact that bronchiolitis occurs in this form, severity and rapidity only in infants may not be fully explained by the smaller size of the bronchioles in infancy, since they are in terms of ultimate size relatively large.
RESPONSE OF DUCTUS ARTERIOSUS AND PULMONARY AND SYSTEMIC ARTERIAL PRESSURE TO CHANGES IN OXYGEN ENVIRONMENT IN NEWBORN INFANTS
Authors: Moss Arthur J. , Emmanouilides George C. , Adams Forrest H. , Chuang Katok
Published: December 2021

Hemodynamic studies were performed through the umbilical arteries in 15 normal unanesthetized full-term newborn infants breathing air, 13% oxygen in nitrogen, and 100% oxygen. The investigation was aimed at studying the effect of changes in oxygen environment on shunts through the ductus arteriosus and on pressures in the pulmonic and systemic circuits. Left-to-right shunts disappeared with administration of 100% oxygen and recurred with 13% oxygen. This response was most pronounced during the first 3 hours but diminished noticeably or disappeared completely thereafter. During the first few hours there was a tendency for the ductus to reopen spontaneously after closure was effected with 100% oxygen. Hypoxia consistently caused a rise in pulmonary arterial pressure whereas inhalation of 100% oxygen caused a fall. The data support the concept that oxygen environment of the ductus arteriosus may be one of the factors which determines its closure.
Otitis Media in the Premature Infant: A Report of Two Cases
Authors: FEIGIN RALPH D. , INGALL DAVID , KLEIN JEROME O.
Published: December 2021

Two cases of otitis media in the premature infant have been presented. Otitis media was associated with B. pyocyaneous infection in one case and with a Coxsackie B3 virus infection in the other. The need for including careful otologic examination in the evaluation of neonatal sepsis has been stressed.
Letters to the Editor
Authors: PRESS EDWARD
Published: December 2021

This suggestion has been made several times in the past and our Committee on Accidental Poisoning, together with one of the major manufacturers have explored it in some detail. The manufacturer concluded (perhaps erroneously) that the increased cost and repeated shopping excursions involved would tend to make many families either buy two or three bottles at a time or to use a half or a third of the adult aspirins instead.

I still think, like you, it is a good idea but we have been unable to convince the industry. I doubt that it is legally likely that we could prohibit packaging in sizes exceeding 25 tablets for household use. This could not be done under the existing laws and it would require a revision to the Federal Food and Drug legislation.
Medicine and the State
Authors: PETERSON OSLER L.
Published: December 2021

This book reminds one of French waiters who err in adding the bill. This is not remarkable, but the fact that the errors are always in their own favor is, however, unusual. Medical care everywhere is plagued by certain problems—loss of practitioners from rural areas, augmented demands for care, rising costs, and increasing specialization, and fewer family doctors to name but a few. Using mainly data from European countries, the authors seek to prove that most of these problems of modern medicine are a consequence of "planning" and state intervention.
ATTENTION: Pediatricians
Authors: CORNELY DONALD A.
Published: December 2021

The Joint Committee studying Pediatric Research, Education, and Practice (PREP) composed of representatives from and under the jurisdiction of the American Academy of Pediatrics, American Board of Pediatrics, American Pediatric Society, American Society for Pediatric Research, and Pediatric Section of the A.M.A. is working actively to collect information considered essential to further the care of children in this country and to strengthen the role of pediatricians and pediatrics as the specialty for child care.

During this current year (1964), efforts are being directed toward assembling opinions and data needed by the American Board of Pediatrics in its continuing appraisal of the appropriateness of pediatric residency training programs. THE JUDGMENTS OF PHYSICIANS ACTIVELY ENGAGED IN PEDIATRICS REPRESENT THE SINGLE MOST IMPORTANT SOURCE OF INFORMATION THAT WILL BE COLLECTED. To this end, plans are being completed to query all pediatricians in the United States so we may have the benefit of their knowledge and recommendations.

From time to time you may receive questionnaires developed by commercial establishments that purport to answer various questions before the pediatric community. Please appreciate the PREP Committee's intention to seek your opinions this year and that the future of Pediatrics is dependent on your sincere participation in our study. Use your good judgment in deciding whether or not to contribute to enterprises whose commercial purposes are remote from that of this official Pediatric Research, Education, and Practice Committee. To assure success, your wholehearted support of the work of the Pediatric survey committee is required.
Medical Embryology. Human Development—Normal and Abnormal
Authors: WARKANY JOSEF
Published: December 2021

This concise volume was written for medical students giving in broad outlines a description of human prenatal development. A general part deals with gameto-genesis, fertilization, and embryonic and fetal stages. One chapter of 18 pages deals with congenital malformations and their causes. The special part describes the development of the various organ systems. Each chapter ends with a list of selected references. The text is illustrated entirely by good schematic drawings.
REACTIONS TO THE THREATENED LOSS OF A CHILD: A VULNERABLE CHILD SYNDROME
Authors: Green Morris , Solnit Albert J.
Published: December 2021

1. A group of clinical features constituting a vulnerable child syndrome is reported and described in 25 children with a history of an illness or accident from which they recovered although the parents were expecting a fatal outcome.

2. This paper describes a study of this group based on the hypothesis that children who are expected by their parents to die prematurely often react with a disturbance in psychosocial development and in the parent-child relationship.

3. Outstanding clinical features include difficulty with separation, infantile behavior, bodily overconcerns, and school underachievement.

4. Predisposing factors and determinants of the symptomatology are discussed along with suggestions for management and prevention.
FECAL RETENTION IN CHILDREN WITH CYSTIC FIBROSIS
Authors: Snyder William H. , Gwinn John L. , Landing Benjamin H. , Asay Lyal D.
Published: December 2021

Three older children, ages 7, 11, and 18 years old with cystic fibrosis who developed fecal retention requiring operation are reported. One had an asymptomatic right lower quadrant mass which suggested a cecal tumor both by barium enema and at the time of operation. In this patient, a right colon resection was performed. The other two showed signs of acute intestinal obstruction requiring laparotomy. In one, the retained fecal material was so firm and tenacious that it could not be removed through an enterotomy incision and a bowel resection was performed. Six months later the patient again developed intestinal obstruction due to retained fecal material. At this time, an enterostomy allowed removal of the obstructing feces. In the other patient, the acute obstruction could be relieved by "milking" the inspissated feces through the ileo-cecal valve.

A review of the literature reveals that now 19 cases of this entity have been reported. Retained impacted fecal material requiring surgical intervention in older children with cystic fibrosis has been documented. It is important for the pediatrician, roentgenologist, and the surgeon to be aware of this complication. It is probable, although not yet proved, that the regular administration of adequate amounts of pancreatin will be helpful in avoiding the occurrence and recurrence of this condition. The use of a laxative diet, lubricative cathartics, and enemas as necessary is advised.
GYNAECOLOGICAL DISORDERS OF INFANTS AND CHILDREN, Christopher J. Dewhurst. Philadelphia: F. A. Davis Company, 1963, 164 pp., $9.00
Authors: Schauffler Goodrich C.
Published: December 2021

There are numerous reasons why Dewhurst's text is a valuable contribution to the literature of our specialty. In the first place there seems to be only one other text in the same field–and this we understand will not be revised after the expiration of its 5th edition. So there is a need for a new book and especially for a book as authoritative and up-to-date as this of Dewhurst's.

And it is a very good book all the way through, but it is just the least bit lumpy in spots.
DIAGNOSIS AND TREATMENT: MANAGEMENT OF VENTRICULAR SEPTAL DEFECT
Authors: Nadas Alexander S.
Published: December 2021

Intelligent management of a ventricular septal defect necessitates full analysis of the size of the defect, the shunt across it and the status of the pulmonary vasculature. Only patients with moderate or large defects with appreciably increased pulmonary blood flow deserve surgery. Those with small left-to-right shunts, with or without pulmonary vascular disease, should be managed medically.
Keeping Pediatricians in Practice (continued)
Authors: Troy Jack M.
Published: December 2021

After reading Dr. Gould's letter in the May issue (Pediatrics, 33:789), in which he cited the reasons for leaving the private practice of general pediatrics, I would like to enumerate the reasons which make it possible for my associate and myself to practice the new pediatrics with satisfaction.

1. We practice in an area that needs pediatricians. There are about 500,000 people and 2,000 hospital beds in our immediate area, and about 12 pediatricians. I and my associate are 2 of 3 pediatricians in a 500-bed hospital.
COPROLITHS IN CHILDREN: RECOGNITION AND SIGNIFICANCE
Authors: Williams Hugh J.
Published: December 2021

1. Coproliths are sufficiently common in children and of such significance that the pediatrician should be "coprolith cognizant."

2. Eleven children with coproliths are reported including 2 under 2 years of age, the youngest recorded cases to date.

3. An abdominal roentgenogram in any child with unusual abdominal symptoms or pain is recommended since only by this step can a coprolith be detected and proper treatment implemented.

4. Immediate appendectomy is indicated in the child with abdominal pain and a demonstrable coprolith, even though the signs and symptoms are atypical for appendicitis. In 50% of such cases, rupture has already occurred.

5. Prophylactic appendectomy in the asymptomatic child in whom a coprolith is incidentally discovered is justified because of the frequent subsequent development of acute appendicitis.
A Reappraisal of Extraction Methods for Bilirubin Assay and of the Role of Bilirubin Monoglucuronide in Neonatal Hyperbilirubinemia
Authors: IBBOTT FRANK A. , O'BRIEN DONOUGH
Published: December 2021

Recent studies of bilirubin and its two glucuronides in the serum of newborn infants suggested that the monoglucuronide was an important intermediate in the conjugation process and that its ratios to bilirubin itself and to the diglucuronide might be a helpful index of the need for exchange transfusion.

The studies reported here suggest that these conclusions may be unfounded and that there are certain important intrinsic errors in conventional extraction procedures.

The principle of the extraction method described by Eberlein is that when bilirubin in serum is diluted in a pH 5 phosphate buffer and extracted with ethyl acetate, unconjugated bilirubin is quantitatively extracted into the organic solvent.
Preliminary Observations on the Prenatal Administration of Demethylchlortetracycline HCI
Authors: MACAULAY JOHN C. , LEISTYNA JOSEPH A.
Published: December 2021

Prenatal administration of tetracycline has previously been reported to cause staining of the infants' teeth. Demethylchlortetracycline has not previously been implicated. Five cases are presented in which demethylchlortetracycline was administered prenatally. In each case, there was staining of those teeth that were undergoing mineralization at the time the drug was administered.
Acute Intermittent Porphyria in a Child with a Note on the Glycine Loading Test
Authors: BARLTROP DONALD
Published: December 2021

A case of acute intermittent porphyria in a 6-year-old boy is described. Screening of urine specimens from his family showed elevated ALA and PBG levels in a 12-year-old brother. Administration of glycine (0.4 gm/kg) to the patient resulted in increased urinary output of ALA and PBG.

Coproporphyrin appeared in the urine of the patient and one brother after glycine. Normal results were obtained in another brother and two control children.
The In Vitro Sensitivities of 70 Strains of Shigella
Authors: DONALD WILLIAM D.
Published: December 2021

In vitro sensitivities of 70 shigella strains isolated over a recent 18-month period are reported. The high degree of sulfadiazine resistance casts some doubt on the selection of this agent as the drug of choice in the treatment of shigellosis, at least in this community. Some of the other agents, although inhibiting the growth of the organisms in vitro, have disadvantages such as toxicity or failure of absorption from the gastrointestinal tract. Tetracycline resistance was found in only 7% of the organisms tested, but from this and other reports we may anticipate the occurrence of more organisms resistant to this agent. The results of the sensitivities to ampicillin are encouraging and further studies including clinical trials of this agent are in order.
Cystic Fibrosis and Family Functioning
Authors: DERBES CHRISTINE M.
Published: December 2021

In the July issue, Juanita Turk's article "Impact of Cystic Fibrosis on Family Functioning" (Pediatrics, 34:67, 1964) provided an interesting example of how the distress experienced by families varies with the resources available for coping with the stress.

Working with many low-income families in a cystic fibrosis center, I have seen a different population of families from the white collar and professional parents of the NIH group. The emotional response of parents to a child's having a potentially fatal condition need not be elaborated.
A History of the Care and Study of the Mentally Retarded
Authors: BIRCH HERBERT G.
Published: December 2021

The rapid growth over the last decade of interest, service, and knowledge in the area of mental subnormality has created a real need for historical perspectives upon which to base current and future work and planning. The appearance at this time of a history of the subject by so eminent a student of abnormal behavioral development as Dr. Kanner is a noteworthy occurrence.

Within the compass of the small volume, the author deals with a wide range of issues including the development of humanitarian concern for the mentally subnormal, the emergence of institutional care in Europe and America, the origins of differential diagnosis and nosology, the rise of the eugenics movement, the development of evaluative techniques, the evolution of treatment, educational and training services, the growth of organizations and periodicals concerned with mental subnormality, and the new opportunities for prevention, treatment, and research which derive from recent genetic and metabolic studies.
MEASLES IMMUNIZATION INCORPORATED IN THE ROUTINE SCHEDULE FOR INFANTS: EFFICACY OF A COMBINED INACTIVATED-LIVE VACCINATION REGIMEN
Authors: Krugman Saul , Stone Shirley , Hu Rose , Friedman Harriet
Published: December 2021

1. Live attenuated measles virus vaccine without gamma globulin was extremely well tolerated by infants 12 to 14 months of age if they received 3 doses of inactivated vaccine at about 2, 3, and 4 months of age. This phenomenon was observed in spite of no detectable antibody after inactivated vaccine and a consistent antibody response after live vaccine.

2. Three inoculations of inactivated vaccine appeared to have an attenuating effect on measles infection acquired within 9 months by 17 infants; at least 70% of these infants were proved to have a subclinical disease by serologic studies.

3. The failure to detect antibody following three inoculations of killed vaccine probably reflects the lack of sensitivity of the HI antibody test which was employed in this study. The attenuating effect of the killed vaccine on the natural disease and on the measles vaccine-virus disease provides indirect evidence of antibody formation.

4. If killed measles vaccine can be successfully incorporated with diphtheriapertussis-tetanus toxoid it should be a useful preparation for primary immunization during the first 6 months of life. However, it would be most important to complete the immunization with an inoculation of live attenuated measles-virus vaccine at 12 to 14 months of age.
ESSENTIAL FAMILIAL HYPERLIPIDEMIA IN CHILDHOOD
Authors: Jakovcic Smilja , Fuhrmann Walter , Hsia David Yi-Yung
Published: December 2021

The present paper describes in detail the biochemical studies undertaken in a previously reported hyperlipemic family where 3 of 13 children are affected. The parents of these children are second cousins.

The children were first placed on a high-carbohydrate diet containing 15% protein, 10% fat, amid 75% carbohydrate. During this period, the triglycerides increased in one patient from 1,670 to 2,700 mg/100 ml and in the other patient from 1,620 to 2,300 mg/100 ml; lipoprotein lipase remained low with levels of 0.07-0.13 µEq/ml/min. They were then placed on a high-fat diet containing 15% protein, 40% fat (half poly unsaturated and half saturated fat), and 45% carbohydrate. During this period, the triglycerides decreased from 2,700 to 1,300 mg/100 ml in one patient and from 2,300 to 605 mg/100 ml in the other patient. The lipoprotein lipase reverted to normal levels of 0.22-0.33 µEq/ml/min. After the intravenous administration of tolbutamide the glucose level shows a drop of only 80% and 70% respectively at 20 minutes and fails to rise at 60-minute interval. These data indicate that the children had hyperlipemia of the carbohydrate-induced variety and not of the fat-induced type.

Plasma from the affected children were separated by ultracentrifugation into the chylomicrons (< 1.006), the low density lipoproteins (< 1.019 and 1.019-1.063), and the high density lipoproteins > 1.063. Each of the fractions were analyzed for triglycerides, phospholipids, and cholesterol. In two of the children, the lipoproteins are mainly localized in the fractions < 1.006 and < 1.019 and there is a decreased amount of lipoproteins with a density of 1.019-1.063. In the latter fractions, the cholesterol to phospholipid ratio is decreased. This pattern corresponds to that seen in familial hyperlipemia. The other child and a maternal grandmother had lipoproteins concentrated mainly in densities < 1.019 and 1.019-1.063 with a normal cholesterol-phospholipid ratio. This pattern differs from that seen in familial hypercholesterolemia in that it is accompanied by markedly elevated triglycerides.

By gas chromatography, the triglyceride fraction showed an increase of myristic acid (14:0) and palmitic acid (16:0), while linoleic acid (18:2) and arachidonic acid (20:4) showed a definite decrease.

Finally, studies were carried out on parents and unaffected siblings. While all showed lipoprotein lipase within the normal range, some delay in clearing of triglycerides up to 24-48 hours after a 90-gm fat meal was found in both parents.
PROGNOSIS OF CHILDREN HAVING ASTHMA
Authors: Barr Lowell W. , Logan George B.
Published: December 2021

Follow-up letters were received from 336 asthmatic patients who had been examined at the Mayo Clinic 17 to 27 years previously. There was a ratio of two male patients to one female. The age of onset of asthma was less than 5 years in 65% of patients. Forty-eight per cent of patients reported that they had wheezing at the time of follow-up. There was essentially no difference between those who had an early onset of asthma and those who had a later onset. Of patients who had had associated eczema, 54% reported wheezing in the preceding year in contrast to 42% of those who had had no associated allergic disease. Of the group having had allergic rhinitis, 48% reported wheezing at the time of follow-up; this also was the average for the total group. When patients were divided into groups according to present age, a tendency was revealed for male patients to improve with age. This was not true of female patients.
The Use of Fibrinolysin in the Treatment of Respiratory Distress Syndrome
Authors: GOMEZ MANUEL F. , GRAVEN STANLEY N.
Published: December 2021

Eleven infants with RDS, 6 treated with intravenous fluids and 5 treated with intravenous fluids plus SKA fibrinolysin, are presented. The mortality rates were 17% (1/6) in the group receiving only intravenous fluids and 100% (5/5) in the group receiving intravenous fluids and intravenous SKA fibrinolysin. Combining the 8 infants treated with intravenous SKA fibrinolysin reported by Ambrus et al. with the present series, a mortality rate of 87% (11/13) was obtained. The intravenous administration of SKA fibrinolysin would appear to be contraindicated in the treatment of RDS in premature infants since its use has been associated with a significantly increased mortality rate—a mortality rate which makes the risk of further trials highly prohibitive.
PRESIDENT'S ADDRESS
Authors: Douglass Frank H.
Published: December 2021

UPON ASSUMING this office one year ago I stated that the founders and officers of the Academy who had served before me had set the purpose of the voyage of the Good Ship American Academy of pediatrics; the Executive Board of the Academy continually reviews our problems and charts our course, the Executive Director and Central Office staff arrange the cargo, but you, the stockholders, must work the cargo if our voyage is to be successful.

Our 1963-64 voyage is completed. I have brought the good ship back to the home port and she is again ready to sail under Captain Harry Towsley.

I am happy to tell you that you have worked the cargo well in every port of call. Our committees have been dedicated and active as their reports show. This next year the committee reports will be published in a special booklet as heretofore. I urge every one of you to read these reports so you may better understand what you are getting from your membership.

The Executive Board has not wavered one bit from the original purpose of our voyage, though I am sure there are some among us who would have them do so. The Board, your Officers, and even the Academy itself cannot be all things to all people, but we have tried hard to please as many as possible. I can assure you that every effort is made to comply with the wishes of the majority and to carry out the original precepts that made us the largest and most influential organization interested in children in all the world.
SPONTANEOUS PERFORATION OF BILE DUCTS IN EARLY INFANCY
Authors: Hyde George A.
Published: December 2021

A neonate with spontaneous perforation of the common bile duct is reported; the baby had a fulminating two-day illness with abdominal distention, vomiting, and progressive toxicity. A review of nineteen previously reported cases revealed that the condition is more commonly characterized by jaundice, abdominal distention due to bilious ascites, and failure to thrive for a month or more. Nearly all patients had unobstructed biliary trees. Laparotomy and drainage of the perforation led to spontaneous sealing and symptom-free survival. Babies who were not operated on died. It is suggested that these perforations may be caused by portal bacteremia localizing in the venous plexus surrounding the luminal diverticula and glands of the normal bile duct.