bluuebunny/crossref_metadata_2025 huggingface dataset:
AUDITORY EVOKED RESPONSES OBTAINED FROM THE SCALP ELECTROENCEPHALOGRAM OF THE FULL-TERM HUMAN NEONATE DURING SLEEP
Authors: Weitzman Elliot D. , Fishbein William , Graziani Leonard
Published: December 2021

1. Two distinct stages of sleep were identified in sixteen newborn infants, 1½ hours to 15 days old, by behavioral observations and electroencephalographic, electromyographic, and rapid eye-movement recordings.

2. Evoked responses to an auditory stimulus were obtained from the scalp in all sixteen infants. The responses of eight were analyzed for differences during the two sleep stages by three-way analysis of variance.

3. The amplitudes and latencies of the response components are smaller during the active stage, characterized by a low-voltage EEG and rapid eye movements, than in the quiescent stage with a characteristic high-voltage EEG.

4. The results demonstrate that the nervous system of the human neonate can respond to a simple auditory signal with a complex pattern of electrical activity, and that the pattern of the response changes in amplitude and latency with changes in the states of sleep.
THE ROLE OF CHROMOSOME TRANSLOCATION IN THE RECURRENCE RISK OF DOWN'S SYNDROME
Authors: Petersen C. David , Luzzatti Luigi
Published: December 2021

Increasing knowledge of the chromosomal pattern of patients with Down's syndrome has helped in elucidating the possible hereditary factors present in this condition. The pattern of transmission of the translocation type from a parental carrier to the offspring is fairly well defined. There is still a question concerning possible hereditary factors in the transmission of the more usual type, characterized by simple trisomy of chromosome No. 21. While the over-all incidence of Down's syndrome increases with maternal age, the chance for a second affected child is greater in the younger maternal age group.

The present study has been undertaken to evaluate: (1) the frequency of inherited translocation among affected children born to younger mothers, and (2) the significance of translocation in the increased recurrence risk of the young mother. A total of 227 index patients with Down's syndrome, born to mothers age 15 to 29 years, was collected. Of these, 42 were studied in our laboratory and the others collected from the literature. In this group, the incidence of the usual type of trisomy 21 was 92.1% and the incidence of the translocation type 7.9%. In 1.8% of the patients the mother carried a D/21 translocation. On the basis of the frequency of maternal D/21 translocation in this group and the expected ratio of affected offspring born in the general population a recurrence risk has been calculated for all mothers with an affected child purely on the chance they may carry a D/21 translocation. This calculated recurrence risk decreases with increasing maternal age and never approaches the figures of the observed total recurrence risk available in the literature. After age 35, data in this study concur with those in the literature, failing to demonstate an increased recurrence risk over the general population.

Though the data are by necessity small, the figures in this study tend to suggest that only a part of the increased recurrence risk of the young mother is due to the possibility she may carry a translocation. There are undoubtedly other still ill-defined factors that may predispose to a recurrence of affected children in these mothers. These factors are discussed but more data are necessary for accurate genetic counseling.
THE PARENTAL DILEMMA
Authors: Rule John T.
Published: December 2021

WHEN I was a Dean of Students I became increasingly fascinated by the tremendous complexity and subtlety of the dynamics of student-parent relationships. I grew more and more convinced that the important forces at work between the participants were dominantly subjective and emotional, inhibiting mutual objective understanding. Above all I learned the extent of human oblivion to personal motivation in any such highly emotional situation.

The parental tie is one of the strongest of all emotional ties. It is, however, one that should and must be broken, or at least rewoven in a looser mesh, if young people are to achieve independence and personality fulfilment. As a Dean, I most frequently saw parents when, regardless of the surface details of their immediate question, the true issue was the son's struggle to break one of the threads of the tie. This is not an unusual nor a new struggle; all of us have been aware of it in our own lives, but it has relatively unexplored aspects that I should like to examine in the hope of presenting a fresh viewpoint in a unified and perhaps illuminating way.

The young person has the problem of growing away from his parent toward himself, the parent that of timing his permission for him to do so, that of determining the rate of thread cutting that will achieve a new and satisfactory relationship on a mutually mature basis.

Most parents intellectually want their children to become separate individuals but emotionally and subconsciously they, in general, wish to hold them and control them.
Letters to the Editor
Authors: SNYDER W. H.
Published: December 2021

The case reported by Dr. Ekelund adds another to the increasing number of recognized late intestinal obstructions due to inspissated feces in fibrocystic disease. It will help to alert the profession to this aspect of this many faceted disease.

It is of added interest that no further obstructive episodes occurred in this patient during the ensuing 4 years although no special diet or treatment with pancreatic enzyme was given.
SWADDLING, A CHILD CARE PRACTICE: HISTORICAL, CULTURAL, AND EXPERIMENTAL OBSERVATIONS
Authors: Lipton Earle L. , Steinschneider Alfred , Richmond Julius B.
Published: December 2021

INFANT care practices are deeply rooted in culture and represent the end results of generations of experience and conviction. It is understandable that few systematic studies of specific aspects of infant care have been undertaken; for each practice (whether feeding, fondling, toileting, etc.) is characterized by a complex process of interaction and methods of evaluation are difficult to define. Yet with progress in the study of physiologic, psychologic, and socio-cultural processes, it should become possible to study the physiologic and developmental consequences of specific infant care practices.

The objective of this report is to present the results of our efforts to study one infant care practice—that of swaddling. Interest in this practice grew out of our long-term studies of the development of autonomic nervous system function in infancy. These studies of swaddling and early neurophysiologic capacity complement each other in many ways, as will be shown later.

An earlier study of motor restraint by means of swaddling was designed primarily to observe the relationships between autonomic and musculo-skeletal reactivity to stimulation. As the experiment progressed, however, it appeared clear that the process of restraining the infant, per se, often produced a tranquil, "co-operative" state which greatly facilitated the studies of physiologic reactivity.

As it became increasingly apparent that pacification was produced in most newborn infants, we considered with heightened curiosity what implications these findings held for clinical pediatrics and, more broadly, for evaluating the cultural practice of infant bundling or swaddling. We began to wonder whether there was not some more pervasive reason for this previously ubiquitous infant care practice, apart from the common anthropologic interpretations which will be described later in this paper.
AMNIOTIC FLUID SPECTROPHOTOMETRY AND EARLY DELIVERY IN THE MANAGEMENT OF ERYTHROBLASTOSIS FETALIS
Authors: Bowman John M. , Pollock Janet M.
Published: December 2021

Accuracy of prediction of intrauterine death in erythroblastosis fetalis, using history of disease and antibody titer alone, is limited (62% accuracy in a series of 121 perinatal deaths and babies who survived only because they were delivered early). Chief sources of error are in first sensitized pregnancies and in isoimmunized pregnancies where the mother has a bad history and a heterozygous husband. Spectrophotometric examination of amniotic fluid obtained transabdominally as early as 24 weeks' gestation has increased our accuracy of prediction of severity of disease to 96.8% in a series of 252 Rh negative isoimmunized pregnancies from whom 402 suitable fluids were obtained and examined. Only one of the eight inaccuracies was of such a degree that the infant's life was threatened. In 32 pregnancies with histories of severe disease on high titers and heterozygous husbands, accuracy of prediction of the Rh status of the fetus was 100 per cent. The procedure carries no risk to the mother, but if the placenta is traversed, her antibody titer may rise and the severity of the disease in the fetus may be increased. Liquor examination allows more accurate timing of induction in threatened intrauterine death and saves less severely affected babies from the hazards of prematurity. It has also proven of value in determining the fetus so severely affected that survival is only possible through intraperitoneal fetal transfusions.
Pediatric Procedures
Authors: DELEMOS ROBERT
Published: December 2021

All too often it has been assumed that children are in reality small adults and, hence, that pediatric procedures are merely adult techniques with smaller equipment. This, as has been discovered by countless students and house officers, is obviously not the case.

Hughes, in a clear and concise manner, and with obvious concern for the welfare of the patient, offers a blueprint for the performance of most of the standard pediatric procedures. The directions are easily understood and both advantages and disadvantages are discussed for each technique.
TINEA NIGRA PALMARIS
Authors: Merwin Charles F.
Published: December 2021

Tinea nigra palmaris is a distinctive benign superficial mycosis involving the palms of children and young adults that has not been sufficiently stressed in pediatric texts and literature. This disease is of no importance to the good health of the patient but its recognition by pediatricians and surgeons is important in that an unnecessary surgical procedure may be avoided. The United States literature is reviewed and summarized, a representative case is reported, and the details of the clinical and laboratory diagnosis outlined. An analysis of 60 reported cases reveals a striking sex preference for females over males of 3.6:1; all except 4 cases are under age 20 years; the disease is limited almost exclusively to the palms; and all of the cases have resided in coastal states. A plea is made for a high index of suspicion for this disease when dark skin lesions of the hand are seen in the young and for the more frequent use of the simple KOH microscopic examination of skin scrapings in all such lesions before excisional biopsy is carried out.
PROTECTION OF THE INFANT DIET: GOVERNMENT AND INDUSTR
Authors: Lowe Charles U. , Coursin David B. , Donnell George N. , Heald Felix P. , Kaye Robert , Owen George M. , Scriver Charles R. , Sweeney Michale J.
Published: December 2021

Only a very small percentage of American and Canadian families produce all their own food. Under the circumstances, over 200 million people and close to 5 milion infants are dependent, to a greater or lesser extent, upon codes, ordinances, and laws enacted to insure that produce in the market place is sound, wholesome, and free of noxious or toxic contaminants. In most instances, neither the consuming public nor the medical profession is aware of the complex and comprehensive nature of the regulatory network which controls the quality of the food supply.

Various governmental agencies, federal, state, provincial in Canada, and municipal, provide minimum standards of quality for food and nutritional products and promulgate codes governing manufacturing procedures. Some codes have the force of law whereas others are prepared as guides, particularly for those industries manufacturing food which does not enter interstate commernce, and compliance may be voluntary unless local legislation exists to enforce these codes. Compliance with these standards is determined both by governmental agencies and manufacturers using selective sampling and assay of products at various stages prior to marketing. However, governmental agencies are able to spot check only a small number of the many lots of products and foods under their jurisdiction. The high quality of today's commodity foods and nutritional products has resulted in large part from widespread compliance, self-policing, and desire by industry to surpass the minimum requirements set by law and to provide the consumer with superior products.

Through the full co-operation of industry with governmental agencies, a great number and variety of food and nutrition products of high quality and uniformity is available to the consumer, and especially to the infant.
Editor's Note
Authors: Levin S.
Published: December 2021

Dr. Levin comments as follows:

Appropriately, Dr. George X. Trimble has changed his domicile from California to Missouri. I understand that the expression "I'm from Missouri" is equivalent to saying "I'm a sceptic, I must check your data."

These days it is perilous to note an observation without checking with Dr. Trimble first, for the Index Medicus is no longer sufficiently etailed.

"Critique and Cavil" is a short footnote contributed by Dr. Trimble himself on the subject of what he calls "chromatunia" (a hybrid of Greek and Latin: even Trimble can tumble).
WATER, AND SALT AND WATER: A DISTINCTION SHOULD BE MADE
Authors: Holliday Malcolm A.
Published: December 2021

It is nearly fifty years since Blackfan and Maxcy1 reported the recovery of nine infants with diarrheal dehydration who had been given isotonic saline intraperitoneally. The dramatic impact this had on the recovery rate of this disease is made apparent by noting that in the two previous years there had been reports describing the high mortality in infants with diarrheal dehydration when given alkali to correct the acidosis but nothing to correct the dehydration. Schloss and Stetson noted that mortality remained at 86% despite correction of chemistry. Howland and Marriott commented that "the administration of soda . . . will often overcome both the clinical and laboratory evidence of acidosis.
RENAL TUBULAR ACIDOSIS
Authors: Morris R. Curtis , Piel Carolyn F. , Audioun Evelyn
Published: December 2021

In two patients with the biochemical features of renal tubular acidosis, urine pH decreased appreciably following infusion of either a neutral (pH 7.4) 0.15 M solution of Na2HPO4/NaH2PO4 or 0.15 M Na2SO4. The fall in urine pH is interpreted as reSultillg from the non-reabsorbable nature of PO4= and SO4=. That the fall in urine pH is mediated by an increased lumen negativity is supported by the fact that concomitant with the decrease in urine pH, the urine concentration and rate of excretion of Cldecreased significantly.
Immunoglobulin Concentrations in Newborn Infants with Congenital Cytomegalic Inclusion Disease
Authors: McCracken George H. , Shinefield Henry R.
Published: December 2021

Immunoglobulin levels in the sera of 8 newborn infants with congenital cytomegalic inclusion disease (C.I.D.) were compared with immunoglobulin levels found in normal newborn infants. IgG levels in diseased babies were normal and IgM levels were significantly higher than normal. IgA was not detectable in the sera of normal newborns but was present in every infant with C.I.D. (range 18—74 mg/100 ml). It remains to be seen if specific antibody against cytomegalovirus is present in this immunoglobulin fraction.
Glycogen Storage Disease Previously Reported as Familial Hyperlipidemia
Authors: Jakovcic Smilja , Fuhrmann Walter , Hsia David Yi-Yung
Published: December 2021

In the April 1959 issue of this journal, under the title of "An Inborn Error of Lipid Metabolsim, "clinical studies were reported on two brothers with hyperlipidemia.1 Although these children presented several of the clinical and laboratory manifestations on glycogen storage disease of Von Gierke's type, this diagnosis was ruled out when histological examination of two liver biopsies done on one of the children at a three year's interval were reported as containing low or normal amounts of hepatic glycogen.
ACCEPTANCE OF PRESIDENCY
Authors: HUGUES JAMES G
Published: December 2021

Dr. Towsley, Fellow Members of the Academy and Guests:

I should like to express my deep appreciation to all of you for the high honor you have conferred upon me in selecting me as your new President. I assure you that in the year to come I shall do my best to justify your confidence and to serve the Academy to the best of my ability.

As Dr. Towsley indicated in his very scholarly analysis of current and future problems associated with the delivery of high quality pediatric care to the vast numbers of children in our present and future populations, this is an exciting era for pediatrics and pediatricians. There are enormous problems to be solved, but it is well to realize that the Academy has enormous strength—strength through its strong organizational pattern at the national and state levels—strength through its numerous committees of experts—and the strength that is associated with solidarity of purpose.

With all these advantages, and with the full support of all of you, I face the future confident that we shall find solutions to our problems, and that the American Academy of Pediatrics will continue to play a leading role in affording proper pediatric services for the nation's children.

In conclusion, and in the name of the entire membership of the Academy, I should like to express our great affection for you, Harry, and our deep appreciation of your devotion to the work of the Academy, not only during your term as President but also through the many years before. We will be needing your help and guidance in the future, and you should look forward to only a brief rest—after which you will again be in action for the Academy.
To the Executive Director of the Academy of Pediatrics:
Authors: EIDELMAN ARTHUR
Published: December 2021

A recent advertisement in Pediatrics (June 1965), raises a question as to the efficacy of the process for reviewing advertising copy.

The advertisement in point is from Merck Sharpe and Dome Co. which proclaims that the hospitalization of an infant with croup (viral?, H. influenza?, spasmodic?), can be averted by the timely injection of Decadron (dexamethasone). Nowhere in the advertisement are any appropriate references cited to support this still controversial mode of therapy.

in reviewing the literature, this reader is struck by the lack of any well controlled study indicating value to steriod therapy in the management of the hospitalized croup patient, let alone in home treatment.
Sir Thomas Barlow, Bt. London: Dawsons of Pall Mall, 1965, 111 pp., $2.80
Authors: Cone Thomas E.
Published: December 2021

The chief object of this small volume is to offer a picture of Sir Thomas Barlow (1845-1945) and of his outlooks and interests by publishing three of his most important lectures. These are: The Bradshaw Lecture on "Infantile Scurvy and its Relation to Rickets," delivered before The Royal College of Physicians of London in 1894, the Harveian Oration on "Harvey, The Man and The Physician" read before The Royal College of Physicians in 1916, and the Murtle Lecture on "Fra Paolo Sarpi and His Time" delivered at The University of Aberdeen in 1919.
RESPONSE TO JENNER'S EPOCHAL ANNOUNCEMENT OF 1798
Authors: Washington John A
Published: December 2021

To Pediatricians long in practice the administration of Salk and Sabin poliomyelitis vaccines and the use of measles vaccine have been exciting and gratifying experiences. That the advent of the new vaccination against smallpox was similarly stirring to alert physicians of 1800 is evidenced by the following excerpts from Samuel Scofield's Treatise on Vaccina or Cowpock published in 1810.1 The prospect of controlling this scourge stimulated a widespread demand somewhat comparable to that for poliomyelitis vaccine. Facilities for communication, supply, and transport were so vastly inferior that the extensiveness of its use in a few years time is surprising.

Eleven years have now elapsed since the world was put into possession of this inestimable blessing by the accurate and indefatigable Jenner. . . . The Cowpock Inoculation has been practiced in every quarter of the Globe. . . .

In the West-Indies I have witnessed the most salutory effects from it in preserving the Blacks from smallpox, which so frequently commits the most terrible ravages in tropical climates.

It has received the patronage of every government under whose cognizance it has come and in many countries, as America, Great Britain, France, Italy. . . . institutions have been established for the gratuitous inoculation of the poor.

In January, 1802, an institution was established in this city (New York) for the purpose of vaccinating the poor gratis. . . . To this establishment the author of the present treatise was appointed Resident Surgeon. . . .

From late accounts we are informed that the Cowpock has been received in the East-Indies with the greatest enthusiasm and many millions have already been vaccinated.
INCREASED INCIDENCE OF SEVERE HYPERBILIRUBINEMIA AMONG NEWBORN CHINESE INFANTS WITH G-6-P D DEFICIENCY
Authors: Lu Tsung-Cho , Wei Huoyao , Blackwell R. Quentin
Published: December 2021

Twenty-six G-6-P D deficient cases (3%) were found among 878 Chinese newborn males. Serum bilirubin levels were significantly higher in th G-6- P D defint infants than in premature and full-term Chinese neonates studied previously. Ten of the 26 subjects had peak bilirubin levels above 20 mg/100 ml. These results suggest that a substantial proportion of the male Chinese neonates who develop severe neonatal jaundice come from the relatively small proportion with G-6-P D deficiency.
Development and Disorders of Speech in Childhood
Authors: KOLODNY ROSLYN
Published: December 2021

Development And Disorders Of Speech In Childhood is a fitting memorial and tribute to its first author, who was both a pediatrician and pioneer in the diagnosis and treatment of speech disorders in children. Dr. Isaac Karlin founded and organized the first hospital-affiliated speech clinic in this country and was the first to realize the role pediatricians had to play in speech defects.

This is a well written, easily comprehensible book covering every aspect of speech problems a pediatrician might ever encounter. The book is printed on beautiful paper with good-sized type and clearly demarcated headings, all of which add to the pleasure in reading. It is well organized and has clear lucid drawings.
ATTITUDINAL FACTORS IN CONGENITAL HEART DISEASE
Authors: Linde Leonard M. , Rasof Beatrice , Dunn Olive Jean , Rabb Ethel
Published: December 2021

This study considers the behavioral implications of congenital heart disease for the pediatric patient, his siblings, and his parents. The effects of a disease on the child, on his siblings, and on his parents and the interplay among these individuals are explored. The impact of the physician's diagnosis is illustrated by the induced significant changes in family attitudes, which are not necessarily related to disease severity or child incapacity.

Poorer adjustment and anxiety in the cardiac child related more highly to maternal anxiety and pampering than to his degree of incapacity. Maternal protectiveness and pampering were significantly greater in the cardiac than in the normal group and were highest in the cyanotic group. The best predictor of maternal protectiveness was maternal anxiety, and it was found that the addition of other variables such as incapacity and child dependence failed to improve prediction substantially. Maternal anxiety seemed related to the presence rather than to the severity of the heart condition.
AN APPROACH TO THE PROBLEM OF INTERSEX: THE ROLE OF THE GENERAL PEDIATRICIAN
Authors: Tibbs Betty Suits
Published: December 2021

A case of intersex, male pseudohermaphroditism in an adolescent, is reported as an example of the complicated medical problem which lends itself in the diagnosis and treatment to the multi-discipline approach emphasizing the relationship of one physician, the pediatrician, to the patient. The pediatrician recognizes and evaluates the problem, informs the parents of the problem, organizes the multi-discipline approach, counsels and supports the family during diagnosis and treatment, and provides follow-up care for the patient and family.
Medical Care of the Adolescent
Authors: JOHNSTON JOSEPH A.
Published: December 2021

The second edition of Medical Care of the Adolescent has been enlarged by contributions from eight authors. It is an excellent compilation of essays on a variety of illnesses, some peculiar to and others modified by their occurrence in the rapidly shifting growth pattern of adolescence. Such comments as this reviewer has to offer represent some personal bias based on a 25-year study of adolescents with tuberculosis. The chief contribution of that study was the demonstration that the abrupt increase in the reinfection or adult type of this disease could be attributed to a failure to provide adequately for the nutritional requirement of the adolescent and, in particular, the diminished ability to retain nitrogen incidental to the decelerative phase of growth marked by the menarche.
INTESTINAL CYTOCHROME RESPONSE WITH REPAIR OF IRON DEFICIENCY
Authors: Dallman Peter R. , Sunshine Philip , Leonard Yolanda
Published: December 2021

Jejunal biopsies were obtained from five iron-deficient infants 24 to 32 hours after an intramuscular injection of iron-dextran. Newly produced cells at the base of the villus appeared to have a higher cytochrome-oxidase activity compared to the older cells at the tip which were produced during a period of iron deficiency. These results in man, similar to those previously described in the rat, suggest that the repair of intestinal cytochrome-oxidase activity which accompanies treatment of iron deficiency is limited by the rate of new cell production.

In the iron-deficient rat histochemical evidence of cytochrome-oxidase repair corresponds closely to the extent of migration of new cells up the villus as indicated by autoradiography, between 8 and 48 hours following simultaneous administration of tritiated thymidine and iron-dextran. Colchicine, which arrests cell division at metaphase, interferes with cytochrome-oxidase repair when administered simultaneously with iron-dextran.

Enzymes not known to contain iron or require it as a cofactor were assayed in jejunal scrapings from iron-deficient and control rats. Aspartate transcarbamylase, alkaline phosphatase, sucrase, and maltase activities were normal in the intestinal mucosa of the iron-deficient rat.

No intestinal malfunction was demonstrated in the iron-deficient rat by determination of fecal fat excretion, I131 PVP excretion, and transport of glucose and galactose in everted sacs of the jejunum and the ileum.
RENAL LOCALIZATION FOR PERCUTANEOUS BIOPSY BY SCANNING WITH TECHNETIUM-99m-IRON COMPLEX
Authors: Forland Marvin , Gottschalk Alexander , Spargo Benjamin H. , Grossman Burton J.
Published: December 2021

Renal scanning with technetium-99m-iron complex has proven to be a rapid and accurate method for kidney localization prior to percutaneous renal biopsy. Kidney tissue was obtained on each of 17 biopsies in patients ranging from age 3 to 15 years. The physical properties of this scanning agent make it an isotope of choice in the pediatric age group and radiation exposure with this technique is less than ½ rad.
SERUM ALBUMIN RESERVE PSP DYE BINDING CAPACITY IN INFANTS WITH KERNICTERUS
Authors: Lucey J. F. , Valaes T. , Doxiadis S. A.
Published: December 2021

Observations have been reported on the serum albumin PSP reserve dye binding capacity in a group of 93 newborn infants with total serum bilirubin concentrations ranging between 20 to 52 mg/100 ml. Eleven of these infants had a clinically established diagnosis of kernicterus at the time of these measurements. The PSP reserve dye binding capacity in these neurologically damaged infants was not different from that found in clinically normal infants with the same degree of jaundice. We, therefore, do not believe that this test is sufficiently sensitive to serve as a useful adjunct in assaying the risk of neurologic damage at a particular serum concentration of bilirubin.
Letters to the Editor
Authors: NORTH A. FREDERICK
Published: December 2021

While I agree wholeheartedly with the general conclusions of The Committee on Fetus and Newborn regarding "Nomenclature for Duration of Gestation, Birth Weight, and Intrauterine Growth" (as reported in this issue) I am disturbed that the report uses the term "intrauterine growth" for a concept which is more accurately described as "stature at the time of birth."

In the most general sense, size at the time of birth does define a rate of growth since the time of implantation.
Parents of Mentally Retarded Children
Authors: HASITAVEJ RASMEE
Published: December 2021

I have something on my mind that I wish to rid by writing to you. This is neither new nor complicated like most of the articles in your journal; but, it is important, especially to young physicians who first confront the parents of mentally retarded children who are admitted to state institutions.

The physician may be surprised to see these parents behave differently from other people they have known until he stops and thinks for a little while the reason behind this behavior.
PORPHYRINURIA
Authors: WOODY NORMAN C.
Published: December 2021

An infant born of a mother suffering from acute porphyria excreted excessive amounts of uroporphyrin and coproporphyrin in the urine during the first few weeks following birth. In the course of the next several months the infant was entirely free from unusual signs or symptoms, except that her stature at 11 months was small. No similar case has previously been recorded. The term "passive porphyrinuria" is suggested to describe this condition.

While an excess of porphyrins in the fetal environment may have resulted in stunting of growth, other evidences in this patient offer support to the belief that the pathologic lesions of porphyria result from the metabolic error and not from the presence of these pigments per se.
THE PATHOGENESIS OF FIBROCYSTIC DISEASE OF THE PANCREAS
Authors: ZUELZER WOLF W. , NEWTON WILLIAM A.
Published: December 2021

Pathologic studies and clinical data from 36 fatal cases of fibrocystic disease of the pancreas support the concept that the basic pathologic process consists in an anomaly of secretory function and frequently involves other glandular structures besides the pancreas—notably the respiratory tract, the intestinal tract and the biliary system.

The development of fixed organic lesions in the affected organs was found to be variable and to depend to some extent on the time factor. Extrapancreatic lesions were rare and inconspicuous in infants dying in the newborn period, whereas, in patients who had survived the newborn period, involvement of the respiratory tract was constant and changes in other systems were commonly encountered. Variations in the intensity of the pancreatic changes suggested the possibility of a postnatal onset of the process in some cases.

Inspissation of abnormally viscid meconium in the small intestine was the sole demonstrable cause of complete intestinal obstruction in four of the five patients dying with meconium ileus in the newborn period. It was shown however that inspissation of meconium as part of the disease process can lead to secondary obliteration and organic atresia of the intestine in utero. Evidence was presented to show that the atresia of the cystic duct frequently encountered in older infants is due to a similar process of secondary obliteration.

A detailed study of the pulmonary lesions encountered in 28 patients with respiratory symptoms indicated that the original pathologic process in the lungs is analogous to that in the pancreas and consists in an accumulation of viscid secretion in the air passages. The resulting state of respiratory obstruction is an important component of the disease process which by itself can lead to death. This point was illustrated by a representative case history. The respiratory tract, being, in contrast to the pancreas, accessible to bacterial invaders, usually becomes the seat of secondary infection which is perpetuated in the presence of inadequate drainage from the plugged air passages and leads to progressive inflammatory changes.

No evidence for a primary nutritional factor in the genesis of the pulmonary changes was found. The conclusion was reached that nutritional deficiencies play a secondary though clinically important part in the evolution of the disease process.
PANCREATIC FUNCTION IN SCARLET FEVER
Authors: VÉGHELYI PETER V.
Published: December 2021

Determinations of enzymes in both the duodenal juice and the blood were undertaken in 32 children suffering from scarlet fever. Abnormal values were found in 26 patients. In 10 of these, the dysfunction showed a regular pattern. In the first days, the output of pancreatic enzymes was found high above the normal while those in the blood decreased. After the first week the activity of enzymes in the duodenal juice decreased and at the same time the blood enzymes attained high levels. Conditions returned to normal in the fourth week. Similar, but less marked and incomplete changes, were found in three other children while in the rest incomplete dysfunctions or only hypofunction occurred. Of the three enzymes, the output of lipase was the one most frequently and most severely affected.

In two patients the symptoms observed pointed to an inflammation of the pancreas.

The dysfunctions were in no connection with either fever or complications. In most cases there was no parallelism in the secretion of the single enzymes.
CHRONIC INTUSSUSCEPTION
Authors: REISMAN HENRY A. , WOLK ARTHUR D.
Published: December 2021

THE proper and prompt diagnosis of intussusception constitutes one of the important emergencies in pediatric practice. The acute type, however, does not present as great a diagnostic problem as does chronic intussusception. Its diagnosis is usually facilitated by the classical symptomatology of colicky pain, vomiting, abdominal distension with blood and mucus in stools occurring in a male infant. Chronic intussusception, on the other hand, presents no such typical picture. In fact, evidence pointing to it is often vague and the signs of intestinal obstruction are frequently lacking.

It is with this consideration that the following two cases of chronic intussusception of differing location and etiology are presented.

Case Reports

Case 1. W.B., 5 yr. old white male, was admitted to the Pediatric Service of Queens General Hospital on December 3, 1947 because of abdominal pain of 8 wks.' duration. Pain was localized to the para-umbilical region, intermittent and colicky in nature. Attacks were of 5 to 10 secs. duration, recurring frequently throughout the day except in the 2 wks. prior to admission when the incidence decreased to about 1 attack every 3 days. Pain was not related to or influenced by excitement, emotion, food, defecation, micturition or diversion.

The only episode of vomiting occurred 4 days prior to admission. At the onset of the present illness, patient had mild constipation easily relieved by enemata. This was followed by mild diarrhea. In the wk. prior to hospitalization, the mother noted dark red blood in the stools. Patient had anorexia, wt. loss of 3.2 kg. and complained of fatigue and lethargy.
SYSTEMIC INFECTION WITH SALMONELLA ANATUM
Authors: SUNG CHIEH , FOURNIER J. , CHANG SIANG-YUEN
Published: December 2021

A case of Salmonella anatum septicemia in an infant is presented. It is believed that this is the first recorded instance of this systemic infection in man.

The clinical features, laboratory studies on the isolated organism, and the available epidemiologic data on the organism, Salmonella anatum, are discussed briefly.
INFLUENZAL VACCINATION IN INFANTS AND CHILDREN
Authors: PETERMAN M. G. , KORES V.
Published: December 2021

Forty-nine children from 4 months to 13 years of age were immunized by a single intracutaneous injection of influenzal vaccine. An immune response, as indicated by the increase in serum antibody titer, was produced in 99% of the children. The response in the group below 2 years of age was greater than previously reported responses to the subcutaneous injection of influenzal vaccine.
MANAGEMENT OF INTRATHORACIC NERVE TUMORS IN YOUNG CHILDREN
Authors: JONES JOHN C. , EFFLER DONALD B.
Published: December 2021

A brief review of the literature referring to intrathoracic nerve tumors in children is presented. The neurogenic tumors have an expected incidence of malignancy of about 40%.

Four case histories are reported in which neurogenic tumors of the posterior mediastinum were removed with apparent cure. Only one of these children had objective or subjective signs which could be attributed to their neoplasms. All of the neoplasms were benign.

Prompt thoracotomy is advocated in the child with a suspected neurogenic tumor of the mediastinum. Periods of observation, procrastination and roentgen therapy are to be condemned for it is impossible to predict with any degree of certainty which tumor will or already has undergone malignant changes. A brief discussion of the operative management and complications is presented.
TRENDS
Authors: FAUST OTTO A.
Published: December 2021

A MONTH ago we stated in this column that, in accordance with recently expressed policy of the Executive Board of the Academy, attention would be given henceforth to significant activities which are being directed toward the improvement of child health and which may, at least in part, have resulted from the Academy's Study of Child Health Services. We then reviewed the "Premature Infant Care Program" which has been instituted in North Carolina to meet deficiencies which had been revealed in the Study's "Pilot State."

While progress is being made along the front line of state programs, it is also gratifying to note progress in pediatric education.

Subsequent to publication of "Child Health Services and Pediatric Education," specific and detailed information for his own department was sent confidentially to each of the heads of pediatric departments of the medical schools. Thus, each department head could evaluate his own school in comparison with others. In reply we have received some rather dramatic evidence of the effective use which has been made of a knowledge of the facts. The following letter is only one of many of those received recently from deans and professors of pediatrics:
INTERNATIONAL NEWS
Authors: GAISFORD WILFRID
Published: December 2021

Manchester is one of the latest of the British universities to establish a separate chair of child health. This title was chosen in preference to pediatrics to denote the increased interest being taken in the preventive aspects of medicine in general and of pediatrics in particular. It is also a term that is better recognized by the laity, to whom an appeal for funds to start the Department was made in 1944. As a result of this appeal annual donations were promised from Manchester and neighbouring local authorities and from the voluntary children's hospitals for a period of 5 years, and sufficient money was raised thereby to start the department in September 1947.
ESSENTIAL THROMBOCYTOPENIC PURPURA IN THE NEWBORN INFANT
Authors: BLUESTONE SEYMOUR S. , MASLOW HERMAN L.
Published: December 2021

A case of essential thrombocytopenic purpura in a newborn infant is reported. It is one of the few cases where the mother of the patient did not herself have this disease. It is believed to be the first case in a newborn infant which was treated by splenectomy. Observations are made to aid in the selection of such cases for surgery and which, incidentally, lend support to the humoral theory of the pathogenesis of the disease.

A newborn infant with essential thrombocytopenic purpura may be expected to benefit from splenectomy, providing the usual indications exist, only if the mother is herself free of the disease.
PENICILLIN RESISTANCE OF NONHEMOLYTIC STREPTOCOCCI FROM RHEUMATIC CHILDREN RECEIVING PROPHYLACTIC PENICILLIN
Authors: KRUMWIEDE ELMA
Published: December 2021

The nonhemolytic streptococci in the throats of children receiving prophylactic oral penicillin tend to be more resistant than those isolated from children who are not receiving penicillin.

Children who are not receiving penicillin carry some strains which are as resistant as those carried by the children on penicillin prophylaxis.

The higher resistance of the nonhemolytic streptococci isolated from children on penicillin prophylaxis appears, in most instances, to be due to the selection of resistant and the elimination of more sensitive strains.

Although the penicillin-resistance of nonhemolytic streptococci isolated from the throats of children receiving prophylactic penicillin is increased, the resistance is not as great as that reported for some strains of nonhemolytic streptococci isolated from patients whose subacute bacterial endocarditis was successfully treated.
Round Table Discussion
Authors: YANNET HERMAN , DEAMER WILLIAM C. , BARBA PHILIP S.
Published: December 2021

Convulsions in children may be divided into 2 large groups: (1) the acute symptomatic, nonrecurring, and (2) the chronic recurrent type. The term "epilepsy" is reserved for the latter group. Some of the factors responsible for the so-called acute convulsions are also responsible for certain of the chronic recurring convulsive disorders, but only by virtue of the structural changes in the brain that may result from the action of these etiologic factors. Table I attempts to summarize these etiologic agents. In the left hand column are listed the more important factors that may stimulate convulsions in children. Those marked by an arrow identify the factors that may, in addition, produce cerebral structural changes which then may serve as the causes for the recurring convulsions, or epileptic state. Some of these etiologies need only be mentioned in passing; others require more comment.

Birth Trauma: It is not uncommon to observe newborn infants, usually following prolonged or difficult deliveries, who develop convulsions during the 1st few days of life, which usually are generalized, but may also be focal in nature. Sometimes, the delivery in these cases may have been considered by the attending obstetrician as entirely within normal limits. Whether treated with sedatives or untreated, these spells usually cease after some days never to recur. In the absence of other causes, it must be assumed that these convulsions are the result of a "cerebral insult" the nature of which is often not entirely clear and which leads to no significant cerebral pathology.
FAMILIAL AGOITROUS CRETINISM ACCOMPANIED BY MUSCULAR HYPERTROPHY
Authors: Cross Harold E. , Hollander Charles S. , Rimoin David L. , McKusick Victor A.
Published: December 2021

Radioiodine (I131) studies failed to detect functioning thyroid tissue in two sibs with cretinism. These patients would have been considered athyreotic by the usual criteria but technetium-99M scanning revealed thyroid tissue in one patient. Because the safe dose of technetium is nearly 40 times that of I131, this isotope is more likely to detect a small or hypoactive thyroid gland. The studies reported here suggest that the diagnosis of athyreotic cretinism should not be based on I131 studies alone.

The defect in thyroid metabolism is unknown. On the basis of a normal salivary to plasma I131 ratio and the lack of significant thyroidal uptake, it is unlikely that these patients had one of the previously described thyroid metabolic defects. Evidence suggests autosomal recessive inheritance in this family. The clinical signs of cretinism included muscular hypertrophy, a complex known as the Debré-Sémélaigne syndrome. Marked clinical improvement followed institution of levothyroxine therapy.

This syndrome has not been reported previously in sibs.
PEDIATRIC CONSULTATION IN ADOPTION PRACTICE
Authors: Smith Donald C.
Published: December 2021

Certain recent trends and developments in the field of adoption have emphasized the role of the pediatric consultant in adoption practices. These changes include a steady increase in the number of adoption placements each year, a significant decrease in the ratio of adoptive parents to adoptable children, a broadening of the concept of adoptability, and an acceptance by both the agency and adoptive parents of the child with special problems and needs.

By providing consultant services to an adoption agency, a pediatrician assumes important and satisfying responsibilities that not only test his diagnostic skills and knowledge of the natural history of childhood disease, but also demand an understanding of current trends and developments in adoption practice, the role of community agencies in adoption, and insight into the consultation process itself. The role of consultant gives the pediatrician an exceptional opportunity to contribute to the effectiveness of the adoption agency and thus to the welfare of children in his community.
Children's Scribbles
Authors: Work Henry H.
Published: December 2021

The September issue was full of things of interest to me. One article, however, caused me some concern. I found it difficult reading the article on children's scribbling1 and finally got some advice from the psychologists in our department. They, too, had difficulty because it sounded as though someone was beating a drum rather than merely setting forth data.

In considering this paper, one is struck by a lack of reference to certain basic material. Many years ago Loretta Bender, through her pioneering use of children's scribbling, evolved much of her well-known basic projective testing.
Children's Diseases, by A. Koltypin and N. Langovoi, edited by V. Vlasov (Translated into English). Moscow: Mir Publishers, 1966, 517 pp. (about $5.00)
Authors: Cone Thomas E.
Published: December 2021

To my knowledge this is the first Soviet textbook of pediatrics to be translated into English; for this reason, pediatricians in this country interested in comparing Soviet pediatric practice with ours will find this well written and nicely illustrated book fascinating and yet puzzling. Puzzling because, although the publication date is 1966, much of the text will seem so dated. This may be explained by noting that the two senior authors, both of whom were great figures in Soviet pediatrics, died in the 1940's (Koltypin in 1942 and Langovoi in 1947).
EVALUATION OF JET-TYPE AND ULTRASONIC NEBULIZERS IN MIST TENT THERAPY FOR CYSTIC FIBROSIS
Authors: Doershuk Carl F. , Matthews LeRoy W. , Gillespie C. T. , Lough M. D. , Spector S.
Published: December 2021

Measurements of the water content of the air in a "mist tent" revealed only .026 to .029 gm of water per liter of air in jet-type tents and .044 to .075 gm of water per liter of air in ultrasonic tents.

Forty-one cystic fibrosis patients who showed persistent pulmonary function test evidence of hyperinflation and airway obstruction despite intensive, comprehensive home therapy, including the use of a jet-type mist tent, were studied after two pre-substitution control periods, after 1 month in an ultrasonic mist tent, and then 1 month and 4 months after return to the jet-type tent. During the 1 month in the ultrasonic mist tent significant changes in the direction of improvement were observed in all parameters of pulmonary function studied. Reversal of these changes was observed 1 month after return to the jet-type tent. These results provide objective evidence of the value of "mist tent" therapy in the treatment of the obstructive pulmonary lesion of cystic fibrosis and of the effectiveness of the ultrasonic nebulizer, at least for the short-term treatment of patients with advanced pulmonary disease.