bluuebunny/crossref_metadata_2025 huggingface dataset:
COMMITTEEON NUTRITION
Authors:   Committee on Nutrition, Clement David H. , Forbes Gilbert B. , Fraser Donald , Hansen Arild E. , Lowe Charles U. , May Charles D. , Smith Clement A. , Smith Nathan J. , Fomon Samuel J.
Published: December 2021

The majority of infants obtain total nutrition from milk during the early weeks or months of life. It seems logical, therefore, that knowledge of the usual composition as well as the variation in makeup of this biologic fluid should be of prime concern to those supervising the nutrition of infants. For this reason the memorandum which follows has been prepared by the Committee on Nutrition of the American Academy of Pediatrics.

Milk is not constant in composition from one human or animal to another, at all periods of lactation, or even hourly through the day. Unqualified statements about human or cow milk and comparison of the milks of different species may, therefore, be somewhat misleading when specific samples of milk are considered. It is fortunate that a significant and comprehensive literature is available concerning the variations to be expected.

SOURCES OF INFORMATION CONCERNING HUMAN AND COW MILK

A list of the major sources of such information is given here. These references are concerned with human milk or with cow milk as compared to human milk. Detailed data on cow milk are available in the extensive literature of the dairy industry.1,2

A series of 21 papers on the secretion and composition of both human and cow milk, including an extensive bibliography has been published in the British Medical Bulletin.3

Macy, I. G.: Composition of human colostrum and milk.4

Kon, S. K. and Mawson, E. H.: Human Milk. Wartime Studies of Certain Vitamins and other Constituents.5 This report presents 12 studies and a summarizing conclusion on the fat and vitamin content of milk.
In Reply: Pathogenesis of Hyposthenuria in Sickle Cell Anemia
Authors: Keitel Hans G.
Published: December 2021

In reply to the question raised by Dr. Morgan, it is now well established that urea plays an important part in the concentration of urine. Starting at a very low level of urea excretion, the urinary concentration maxima (as obtained during prolonged fluid deprivation, or following sustained vasopressin stimulation) is less than normal. When the rate of urea excretion is increased to the normal level, the maximal urinary concentration ability increases, but when the rate of urea excreted increases markedly, the urinary concentration maxima once again decreases.
STUDIES IN EXPERIMENTAL HYPERTONICITY
Authors: Sotos Juan F. , Dodge Philip R. , Meara Patricia , Talbot Nathan B.
Published: December 2021

Hypertonicity of the body fluids was induced in rabbits by the intravenous infusion of different hypertonic solutions (NaCl. NaCl plus NaHCO3, sucrose, mannitol and urea). The results obtained in this study indicate the following.

There is no significant correlation between the clinical syndrome or death and values for total body water, total body solutes, total extracellular or intracellular volume, or concentration of sodium or chloride in the plasma. The clinical manifestations and death can occur in the absence of in tracranial hemorrhage.

Hypertonicity, by creating an osmotic gradient between extracellular fluid and brain, is the important factor in producing the characteristic clinical syndrome and death, but is not the immediate cause of these abnormalities. The osmolality necessary to produce these alterations was greater in animals infused with urea.

Hypertonicity produces these alterations by decreasing water and increasing ion concentration in the brain. The resulting functional impairment of neurones accounts for the clinical and electroencephalographic abnormalities. The increased values of sodium and chloride in the brain reflect an impairment of function of either brain cells, "blood-brain barrier," or both. Acidosis, hyperkalemia and hyerphosphatemia ensue as a result of hypertonicity.

Unless death is imminent, all of the abnormalities described are reversible.
INFLUENCES OF DEPLETION OF POTASSIUM, OF SODIUM, OR OF WATER ON FUNCTION AND STRUCTURE OF THE KIDNEY
Authors: Kerpel-Fronius E. , Romhányi G. , Gáti B. , Dobák E.
Published: December 2021

Sublethal potassium losses were produced in rabbits by the repeated administration of theobromine. In experimental periods of 1 week, no significant decrease in the maximal concentrating ability of the kidneys, in creatinine urine:plasma (U:P) ratio and in creafinine clearance were observed, neither were histologic alterations evident.

See table in the PDF file

Prolongation of potassium deficiency (after theobromine-induced depletion) to 2-3 weeks by feeding a diet poor in potassium, reduced rabbits' ability to produce maximally concentrated urine, moderately decreased the creatinine clearance and induced damage in the renal collecting ducts and, subsequently, a striking dilatation of distal tubules. Presence or absence of metabolic alkalosis had no effect on renal alterations in potassium-depleted animals. Relations of structural (renal and myocardial) and functional alterations are discussed.

Sodium depletion reduced glomerular filtration rate (GFR) and concentrating ability much more than experimental potassium depletion. The defect in the concentrating mechanism is refractory to vasopressin both in sodium and in potassium depletion. Histologic changes accompanying sodium depletion consist in hydropic degeneration of the proximal convoluted tubules.
CONTACT-TYPE DELAYED HYPERSENSITIVITY IN INFANTS AND CHILDREN: INDUCTION OF RHUS SENSITIVITY
Authors: Epstein William L.
Published: December 2021

The frequency of contact sensitization to a Rhus allergen, pentadecyl catechol, was determined in 102 infants and children 1 month to 8 years of age.

Children between 3 and 8 years were readily sensitized and showed a depth of sensitivity and intensity of reaction comparable to that seen in adults. Infants below the age of 1 year had a markedly depressed ability to react to Rhus allergens. Children between 1 and 3 years old assumed an intermediate position, being more reactive than infants, but less so than older children.

Theoretically these observations suggest that the mechanism of delayed hypersensitivity matures more slowly than other processes of immunity and resistance.

Clinically the findings mean that lack of exposure is a more important factor than lack of susceptibility in explaining the diminished incidence of clinical Rhus sensitivity in children below the age of 8 years.
IDIOPATHIC HYPERGLYCINEMIA AND HYPERGLYCINURIA: A NEW DISORDER OF AMINO ACID METABOLISM. I
Authors: Childs Barton , Nyhan William L. , Borden Margaret , Bard Leslie , Cooke Robert E.
Published: December 2021

Observations are reported of a patient afflicted with a disease previously unknown to us. The outstanding features of the syndrome are: onset in the neonatal period of episodes of vomiting, lethargy and ketosis; neutropenia; periodic thrombocytopenia; hypogammaglobulinemia; hyperglycinemia and hyperglycinuria; developmental retardation; and intolerance of protein of more than approximately 0.5 gm/kg of body weight/day and of protein hydrolysate and of leucine.
STUDIES ON HYALINE MEMBRANES
Authors: Aronson Natalie
Published: December 2021

Pulmonary hyaline membranes were studied by observations on their dissolution in vitro by proteolytic enzymes, by streptokinase and by urea with and without added thioglycollic acid. Pepsin, trypsin and chymotrypsin dissolved the hyaline membranes both in sections of human lungs as well as in sections of mouse lung with the experimentally produced disease, whereas streptokinase, alone, failed to do so. The combination of 8 molar urea with 2% thioglycollic acid partially removed the hyaline membranes from lung slices. These findings are consistent with the view that fibrin is an important component of pulmonary hyaline membranes.

Four possible therapeutic agents were evaluated in the experimental disease in mice, produced by prolonged exposure to high concentrations of oxygen. Chymotrypsin, trypsin and chloropromazine did not influence the mortality rate or incidence of pulmonary lesions. Heparin treatment led to a striking increase in mortality and to an increased incidence of pulmonary hyaline membranes.
STUDIES OF TOCOPHEROL DEFICIENCY IN INFANTS AND CHILDREN
Authors: Levin Stanley , Gordon Mordecai H. , Nitowsky Harold M. , Goldman Carmen , di Sant'Agnese Paul , Gordon Harry H.
Published: December 2021

A bulb ergographic method for estimating muscle strength was modified to permit quantitative measurements. Studies in a group of 13 convalescent children without muscle disease established the reliability of the method for repeated observations.

Forty-five patients with cystic fibrosis, whose clinical conditions appeared stable, were accepted in a double-blind study comparing the effect of tocopherol or a placebo on serum tocopherol, S-GOT, weight gain, subjective improvement, and muscle strength as measured by the ergograph. Measurements were made at the beginning of the study, and 2 and 6 months after beginning tocopheryl acetate (10 mg/kg/day) or placebo therapy.

Although statistically significant increases in serum tocopherol, weight, muscle strength, and clinical improvement were found at 2 and 6 months after beginning of the study, there were no significant differences between the two groups, except in serum content of tocopherol. In the tocopherol treated group, serum tocopherol became normal (0.83 to 1.05 mg/100 ml), but remained low (0.20 to 0.33 mg/100 ml) in the placebo group.

Although the present study did not demonstrate a clinical functional effect of tocopherol therapy in patients with cystic fibrosis, its administration is recommended because of previously reported biochemical and pathologic evidence of vitamin E deficiency in these subjects.
THE EPIDEMIOLOGY OF ACCIDENTAL POISONING IN AN URBAN POPULATION
Authors: Wehrle Paul F. , DeFreest L. , Penhollow J. , Harris Virginia Goddard
Published: December 2021

A group of 100 children who had experienced one episode of accidental poisoning were studied. A group of matched controls were selected from a previous randomized population derived from the City of Syracuse. The composition of study and control groups was similar in all gross characteristics tested.

The poisoned group was found to have many more subsequent episodes of poisoning than the control group. These children were more active and mischievous, were more likely to experience falls, had more frequent separation experiences from the parents, and the maternal-child relationships appeared to differ significantly in several characteristics.

It would appear that the repeater concept in accidental poisoning is established and presents a challenge to those presently concerned with prevention of accidental poisoning in children.
PRESIDENT'S MESSAGE
Authors: Wheatley George m.
Published: December 2021

ONE OF THE most important projects of the Academy in recent years has been the sponsorship of postgraduate courses. This program grew out of discussions of the Executive Board, led by Carl Fischer. The idea was welcomed by the Committee on Medical Education, then chaired by Ed McClusky, and a subcommittee was named to study the proposal. They found few courses tailored to the pediatricans's need as a specialist. It was also evident that more opportunity for clinical conference teaching and teaching from patients should be provided. The architect of the report outlining the plan for these courses was the Subcommittee of the Education Committee headed by Harry Towsley. This Committee's report was accepted by the Executive Board in April, 1958. The Academy's program is designed to provide the membership with postgraduate courses both in subspecialty areas and in general pediatrics. The Academy's headquarters staff administers the courses under the capable direction of our Secretary, Bob Frazier, and the supervision of the Subcommittee on Postgraduate Education. Appropriately, the first postgraduate course was held at the University of Michigan Medical School, March 2, 3, 4 and 5 of 1959. Two courses were held the first year, the other being at Vanderbilt under Amos Christie. Four were conducted in 1960, and during this academic year, six courses have been planned.

With this experience of almost three years, judging by the member and the generally favorable comments of those who have attended, it is apparent that our postgraduate program has gotten off to a very good start. I congratulate all those who were instrumental in bringing this program into being.
Congenital Malformations of the Heart: Vol. I: General Considerations
Authors: DOYLE E. F.
Published: December 2021

This new edition of the famous textbook first published in 1947 includes all the most important data that have accumulated in the rapidly advancing field of congenital heart disease since that time. Medical students and pediatricians as well as cardiologists will be grateful for the lucid, meticulous treatment of a difficult subject which Dr. Taussig has made readily understandable.

Because of expansion of the chapters on the individual malformations and the addition of many new sections, such as those on pulmonary hypertension, aortic septal defect, Taussig-Bing anomaly and endocardial fibroelastosis, the text has doubled in length and is now divided into two volumes.

Volume I covers embryology, methods of diagnosis, special diagnostic procedures, cyanosis and medical care.
CAPILLARY LYMPHANGIOMA OF THE TONGUE COMPLICATED BY GLOSSITIS
Authors: Koop C. Everett , Moschakis Elias A.
Published: December 2021

The eight children in this series had a syndrome of lingual capillary lymphangioma complicated by glossitis. Three with major lymphangiomas of the tongue and subglottic areas became symptom-free following surgical removal of the major lesion and electrodesiccation of the hemorrhagic lymphangiectasias on the tongue. Four of the remaining five, all of whom had major cystic hygromas of the neck, had partial glossectomy; one of these became asymptomatic. The four symptomatic children presented a recurrent syndrome of a painful edematous tongue characterized by the eruption on its surface of vesicles and hemorrhagic papillary lesions that could be relieved by electrodesiccation, which would be immediately followed by glossitis, edema and pain. Changes in the growth of the mandible and dentition also occurred.
Letters to the Editor
Authors: SCHULMAN IRVING
Published: December 2021

I have read with great interest the thoughtful commentary by Dr. Fred H. Harvie on the Special Report of the Committee on Fetus and Newborn relating to Standards for Planning and Design of Newborn Nurseries (Pediatrics, 25:1083, 1960). Inasmuch as this report was issued during my term as Chairman of the Committee, I have requested permission of Dr. William Silverman, the present Chairman, to submit a reply together with his.

Firstly, I believe that it is important to stress that the special meeting which resulted in the issuance of the report was concerned primarily with problems in the design and construction of newborn nurseries and not with the basic techniques which are to be followed in the actual operation of the nursery.
COMPREHENSIVE PEDIATRICS
Authors: Bleck E. E. , Headley Lee
Published: December 2021

As a result of a 4-year experience with a preschool nursery program for children with cerebral palsy, the following conclusions have been reached.

The program should include parent participation, parent education, group psychotherapy for parents and individual counseling.

The services of a nursery school director, physical therapist, occupational therapist, speech therapist and graduate psychiatric social worker and a physician trained in cerebral palsy are essential to insure maximum success in treatment, delineating prognosis and directing the parents and the childern toward the future.

The program, as described, has eliminated not only a great deal of financial waste but emotional waste as well. Considering the continuous searching of parents for a cure as a result of misleading and incomplete medical information, coupled with virtually no counseling, the emotional waste for such parents is obvious. No substitute has been found for facing up to and understanding the problem objectively at an early age.
ACIDOSIS IN PREMATURE INFANTS DUE TO LACTIC ACID
Authors: Goldman Herbert I. , Karelitz Samuel , Seifter Eli , Acs Hedda , Schell Norman B.
Published: December 2021

Sixteen premature infants were fed a proprietary lactic-acid milk preparation for 7 to 10 days and were compared to 16 control infants fed non-acidified half-skimmed milk. The experimental group gained less weight (6.5 gm/kg/day) than the controls (14.0 gm/kg/day). This poor weight gain in the experimental group was associated with the production of a metabolic acidosis, the average blood pH decreasing from 7.39 to 7.25, and the average carbon dioxide content in plasma decreasing from 19.6 to 14.8 meq/l. Corresponding averages in the control group showed no appreciable change.

A similar study was carried out in six pairs of premature infants, with a formula of half-skimmed milk compared with the identical formula to which lactic acid was added. The results were similar to those in the first study with regard to the poor weight gain and decrease in carbon dioxide content in plasma of the infants fed the acidified milk.

Addition of lactic acid to the feeding mixture was followed by a prompt increase in excretion of lactate in the urine, which corresponded to approximately 4% of the lactic acid fed. In four premature infants, 24-hour urine collections demonstrated an increase in excretion of sodium and ammonia, associated with the increased excretion of lactate. The increase in excretion of lactate is considered the major mechanism responsible for the observed acidosis.

Studies with intravenous injection of racemic sodium lactate failed to show any deficiency in lactate metabolism in the premature infants.

It is suggested that lactic-acid milks not be used for premature infants.
OCCURRENCE OF PNEUMOCYSTIS CARINII PNEUMONIA IN CHILDREN WITH AGAMMAGLOBULINEMIA
Authors: Burke Barbara A. , Krovetz L. Jerome , Good Robert A.
Published: December 2021

Two case histories of patients having apparent congenital agammaglobulinemia who succumbed to Pneumocystis carinii pneumonia are presented. The high incidence of agammaglobulinemia or extreme hypogammaglobulinemia among patients with Pneumocystis pneumonia in Great Britain, Canada and the United States is stressed. The absence or gross deficiency of plasma cells in the pulmonary lesions and in the hematopoietic tissues of the children having agammaglobulinemia and Pneumocystis carinii infection is contrasted to the extensive plasmacytosis occurring in most children succumbing to infection due to this organism. The use of Giemsa staining of imprints from fresh or previously frozen pulmonary tissue as an ideal method for demonstrating the parasite is emphasized.
IDIOPATHIC HISTIOCYTOSIS
Authors: Oberman Harold A.
Published: December 2021

The clinical and pathologic aspects of 40 cases of eosinophilic granuloma of bone, Hand-Schüller-Christian disease and Letterer-Siwe disease have been reviewed.

These cases were unified by a localized or generalized histiocytic proliferation. However, they could not be subdivided accurately on the basis of either clinical or microscopic findings.

Histologically there was inconstant correlation of foam cells, tissue eosinophilia and fibrosis with clinical course. Nevertheless there was a suggestion that the presence of a homogeneous histiocytic infiltrate, with no eosinophils or foam cells, pointed to a poor prognosis, whereas the presence of large aggregates of eosinophils augured a more favorable course.

With some exceptions, those patients presenting with disease confined to bone had little tendency toward dissemination, whereas those presenting with visceral on soft tissue lesions and generalized maculopapular skin eruptions usually died after a rapid course. Patients with skeletal and visceral or soft tissues lesions at onset had a variable outcome, with marked hepatomegaly and generalized cutaneous involvement being poor prognostic signs.

It is concluded that these conditions probably represent various manifestations of a single disease process and that clinical assessment of rapidity of progression is the best guide to ultimate outcome.
FREQUENCY OF CARDIAC ARREST ASSOCIATED WITH ANESTHESIA IN INFANTS AND CHILDREN
Authors: Rackow Herbert , Salanitre Ernest , Green Lynne T.
Published: December 2021

At the Columbia-Presbyterian Medical Center, infants less than 1 year of age have a frequency of cardiac arrest during anesthesia, of 1:700, thought to be due to anesthesia, and a frequency of 1:600 attributed to anesthesia plus unknown causes. Children 1 to 12 years of age have a frequency of cardiac arrest during anesthesia of 1:2,300, thought to be due to anesthesia, and a frequency of 1:1,700 attributed to anesthesia plus unknown causes.

The mortality and frequency of cardiac arrest during anesthesia in children (as defined by the number of deaths, and cardiac arrests due to anesthesia, in proportion to the incidence of anesthesia) cannot be determined in most previous reports because the total incidence of anesthesia for children was not presented.

At the Columbia-Presbyterian Medical Center, the frequency of cardiac arrest during anesthesia in infants less than 1 year of age was found to be significantly higher than that in children 1 to 12 years of age or in adults 13 years of age or older. The rate for all children, infants plus children 1 to 12 years, is also significantly higher than the rate for adults. However, the rate of cardiac arrest during anesthesia in children 1 to 12 years of age was not significantly different from the rate in adults.
CHROMOSOMAL STUDIES IN SOME VARIANTS OF MALE PSEUDOHERMAPHRODITISM
Authors: Alexander D. S. , Ferguson-Smith M. A.
Published: December 2021

Nine chromatin-negative patients with varying degrees of ambiguity of sex differentiation were found to have a somatic chromosome number of 46 and an XY sex chromatin constitution in cells from bonemarrow culture. The findings are discussed in relation to Jost's theory of sex differentiation.
EDUCATION
Authors: Green Morris , Segar William E.
Published: December 2021

This communication represents an effort to discharge the obligation implied by Spence: "The care of patients in hospitals is a subject which demands scientific study, and experience based on such study. . . . The need for this is greatest of all in children's hospitals."

The program presented here attempts to deal with a number of current problems in patient care and pediatric education through the development of an adequately staffed and equipped diagnostic center in the outpatient department, a new arrangement for domiciliary care, and reorganization of the inpatient service for the provision of intensive medical, surgical and nursing care.
Symptoms of Narcotic Withdrawal in a Newborn Infant Secondary to Medical Therapy of the Mother
Authors: FISCH GILBERT R. , HENLEY WALTER L.
Published: December 2021

To the Editor:

In all published reports on the effect of maternal addiction on the newborn infant, the mothers were shown to be morphine or heroin addicts. We would like to call attention to a newborn infant who exhibited narcotic withdrawl symptoms secondary to medical treatment for regional ileitis in the mother.

The complex of clinical findings in narcotic withdrawal in a newborn infant has been well documented.1-5 The second baby of a mother afflicted with regional ileitis demonstrated hyperirritability, constant crying, vomiting and anorexia at 48 hours of age.
A Practical Outline for Preparing Medical Talks and Papers, Robert M. Zollinger, M.D., William G. Pace, III, M.D., and George J. Kienzle, B.A. New York, Macmillan, 1961, 57 pp., $1.95
Authors: S. C. A.
Published: December 2021

This booklet of 64 pages is as simple, practical, and prosaic as the reminders inside its front and back cover for the medical man when (A) returning from meetings ("Answer accumulated mail. Report interesting and new information to staff. Outline plans for new projects.") and when (B) preparing for visitors ("Plan coffee breaks. Special honorarium must be arranged well in advance."). Between these covers there is a wealth of useful detail, some of it also a little self evident, but well worth the time of any speaker or writer, and required reading for most.
A New Transparent Infant Proctoscope
Authors: OEcoNoMoPouLAs Chris T.
Published: December 2021

Proctological conditions are not uncommon in the pediatric age group and in many cases may present a challenging diagnostic problem. An example of this is the symptom of rectal bleeding. Approximately 10% of cases present with bleeding per rectum during infancy may be of obscure origin. These children may undergo painful and expensive investigations, such as barium enemas and hematologic tests, and may remain hospitalized for a week or more.

This is probably due to lack of proper investigation of the anal canal.
The Pathology of the Fetus and Infant, Ed. 2, Edith L. Potter. Chicago, Yr. Bok. Pub., 670 pp., $22.00
Authors: Craig John M.
Published: December 2021

A second edition of Dr. Potter's justifiably classic volume "The Pathology of the Featus and Newborn" has been issued with the title and subject matter expanded to include diseases affecting infants after the newborn period. It has been increased by about 100 pages of text. The general format of the volume has been preserved, with chapters on early development, the pathology of specific perinatal events, infections, malformations and humors. These are followed by successive chapters devoted to single organs or organ systems.
STEROID MYOPATHY
Authors: Byers R. K. , Bergman A. B. , Joseph M. C.
Published: December 2021

Weakness developing during the administration of a variety of steroids has been reported both experimentally and clinically. The condition remains sufficiently unfamiliar to warrant an additional report of the clinical manifestations and pathologic findings as demonstrated on biopsy.

Ellis1 was regularly able to produce wide-spread necrosis in skeletal muscle of rabbits by the administration of 10 mg/kg/day of cortisone acetate, for 7 to 21 days. Though severe lesions were evident pathologically at the height of the reaction, complete restitution of function was reported 6 days after the omission of cortisone. In contrast to skeletal muscle, cardiac and smooth muscle remained unaffected both functionally and histologically. Mor phologically, cortisone-induced skeletal myopathy resembled that seen in potassium deficiency, but in the latter condition necrosis occurred in cardiac muscle as well. Oral administration of potassium did not protect the animals treated with cortisone, nor did generous doses of alpha-tocopherol. No evidence of virus infection could be discovered in the animals treated with cortisone, though pathologically similar lesions have been observed in a variety of infections.

Weakness incident to the treatment of various diseases by triamcinolone (9-alpha-fluoro-16 alpha-hydroxyprednisolone) has been reported.2-5 Recovery from weakness occurred in a relatively short time following the omission of the drug, or following the substitution of non-halogenated steroid, particularly methylprednisolone or prednisone in dosages thought to be pharmacologically comparable. Weakness with eletromyographic evidence of myopathy following 11 weeks of treatment of asthma with dexamethasone (9 alpha-fluoro-16 alpha methylprednisolone) in doses of 2.25 mg/day in an adult male has been reported.6
DEATHS IN CONGENITAL ADRENAL HYPERPLASIA
Authors: Cleveland William W. , Green Orville C. , Wilkins Lawson
Published: December 2021

Since the advent of cortisone for treatment of congenital adrenal hyperplasia, eight patients have died, representing a mortality of approximately 8%. These cases are presented, with an analysis of the findings in an attempt to explain the cause of death. In three of these cases errors in management were considered as factors in the terminal illness. One child died of an unrelated disorder. The remaining four died under circumstances that allow no ready explanation for their death. The possible mechanisms in these patients are discussed, including a poorly understood relationship of disturbance in the central nervous system to disorders of adrenal metabolism.
THE IMPACT OF INFANTILE AMAUROTIC FAMILIAL IDIOCY (TAY-SACHS DISEASE) ON THE FAMILY
Authors: Kanof Abram , Kutner Bernard , Gordon Norman B.
Published: December 2021

Although in its sociologic implications infantile amaurotic familial idiocy (Tay-Sachs disease) bears some resemblance to other types of fatal illnesses in children, such as leukemia,1 muscular dystrophy2,3 and some forms of brain deficit,4 it is unique in several respects. The illness makes its appearance early in life, there is usually a period of uncertainty as to diagnosis, its course is steadily downward without periods of remission, it is of comparatively short duration, and it is hereditary. A fatal hereditary disease in an infant bears with it a large number of reactions and decisions, which involve an ever-widening circle of persons. Not only is there an invariable emotional effect upon the parents, but, as will be indicated in this report, close relatives, friends, neighbors and associates are to some extent also concerned. The disease represents a family crisis, and it is the purpose of this study to report and assess the major methods with which families cope with the crisis, the problems they face, the solutions they undertake, and the help we may be able to offer. Moreover close and prolonged contact with the parents of infants with amaurotic familial idiocy has given us many opportunities to observe the physician-parent relationship that develops during this illness. We are impressed with the need to understand the parental problems, and we hope to make suggestions to the physician confronted with this illness.

FAMILY BACKGROUNDS

The study is based upon interviews with parents of children who have or have had amaurotic familial idiocy. (Two of the families have had children with lipid histiocytosis of phosphalide type, also called Niemann-Pick disease.)
GROWTH AND DEVELOPMENT OF NEGRO INFANTS
Authors: Scott Roland B. , Hiatt Howard H. , Clark Bettie G. , Kessler Althea D. , Ferguson Angella D.
Published: December 2021

We have presented size and growth velocity data for weight, length, pelvic breadth, and head and chest circumference during the first year of life in Negro infants observed in a well-baby clinic. The subjects were normal, healthy infants of families in the lower middle economic class. We have compared our data with similar data representing two white and two Negro samples studied by other investigators. In general, pelvic breadth, and head and chest circumference were found to be slightly larger in the white than in the Negro samples. For pelvic breadth and chest circumference, the annual growth velocities were higher in the white than in the Negro samples. Growth in pelvic breadth was found to decelerate more rapidly in the white than in the Negro samples. However, we verified no statistically significant difference by race. In general, the males of both races were larger in all dimensions than the females. The males showed the higher annual growth velocities. Growth was found to decelerate more rapidly in the males than in the females. In general, whenever any two groups were compared, it was found that growth decelerated more rapidly in the one with the higher first-quarter growth velocity. This was true in 42 of 45 comparisons.
INFLUENCE OF PRIOR DIETARY PROTEIN LEVELS ON RESISTANCE TO THE STRESS OF PROTEIN DEPLETION
Authors: Vaughan Oliver W. , Filer L. J. , Churella Helen
Published: December 2021

One-day-old piglets were fed diets of either 50% or 14% protein for 8 weeks; they were given intravenous injections with S35-methionine-labeled plasma protein and were given a nonprotein diet. The plasma protein turnover and the nitrogen excreted were estimated by measuring the S35 activity and the nitrogen in aliquots of blood, urine and feces. During a 102-day period of protein privation, the animals that had received the high-protein diet lost little weight, while pigs previously fed a low level of protein lost 4.4 kg. However the high-protein group had a considerably faster rate of plasma protein turnover, catabolized a much large quantity of protein, and excreted more S35 and nitrogen than did the low-protein group. It is concluded that high-protein diets may make pigs less well able to cope with the stress of sudden protein deprivation.
BEHAVIOR OF SABIN TYPE 1 ATTENUATED POLIOVIRUS IN AN INFANT POPULATION INFECTED WITH ECHO 14 VIRUS
Authors: Ingram Virginia G. , Lepow Martha L. , Warren Robert J. , Robbins Frederick C.
Published: December 2021

Twenty-five babies fully susceptible to poliovirus, and dwelling in an infant home, were fed Sabin LSc2ab Type 1 attenuated poliovirus. Although 40% of the infant population was infected concurrently with ECHO 14 virus, little effect was noted upon either acquisition of infection with attenuated poliovirus or the development of immunity to it. Sixty-six per cent of the unvaccinated infants who were studied became infected with poliovirus, and some were noted to excrete it for as long as 2 months. Poliovirus persisted in the institution for at least 3 months following the last feeding of vaccine. No illness could be attributed to the ECHO 14 virus, and little immunologic response was demonstrated to this virus in the study population.
ELECTROENCEPHALOGRAPHIC STUDY OF PATIENTS WITH ACUTE ASEPTIC MENINGITIS
Authors: Gibbs Frederic A. , Gibbs Erna L. , Carpenter Phyllis R. , Spies Harold W.
Published: December 2021

One hundred fifty-eight patients with aseptic meningitis were studied electroencephalographically during the acute phase of the illness. Slow activity was more common among children below 10 years of age (44%) than among adults (10%). With the exception of two cases, the electroencephalogram either normalized quickly after recovery from the acute illness or returned to what was believed to be the pre-illness abnormality. In one of the two persons who developed persistent abnormalities, slow activity continued long after the acute phase of the illness was over, and in the other the slow activity was complicated by the development of 6-per-second positive spike discharges.

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See table in the PDF.file

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Slow activity in the acute phase of the illness was more common when the infection was caused by ECHO virus (26%) than when it was caused by Coxsackie (14%). The sporadic cases of aseptic meningitis that were usually caused by a nonidentifiable agent were associated with a slightly higher electroencephalographic morbidity than the cases occurring in epidemics of known etiology.

From the electroencephalographic as well as from the clinical point of view, aseptic meningitis is relatively benign. It is associated with less disorder than measles, which produces slow activity in 50% of cases. About as many patients developed slow activity during the acute phase of aseptic meningitis (33%) as mumps, but like mumps (and various other virus infections) aseptic meningitis can be followed by persistent electroencephalographic abnormalities. Because the viruses that cause aseptic meningitis may produce lasting brain disorder, they cannot be considered innocuous or inconsequential.
ECHO 9 VIRUS INFECTION AND CONGENITAL ABNORMALITIES: A NEGATIVE REPORT
Authors: Kleinman Herman , Prince James T. , Mathey Wayne E. , Rosenfleld Abraham B. , Bearman Jacob E. , Syverton Jerome T.
Published: December 2021

Approximately 200,000 residents of Hennepin and Ramsey counties in Minnesota developed an aseptic meningitis syndrome during the summer and fall of 1957. One fourth of the patients had a maculopapular rash very similar to that of rubella. The etiologic agent was found to be ECHO virus type 9. This epidemic provided an opportunity to determine whether infection with this virus during the first trimester of pregnancy could be related to the appearance of congenital defects such as occurs in rubella.

From March 3 through June 13, 1958, 10,109 liveborn infants and 105 stillborn infants were delivered in the 12 Minneapolis and 10 St. Paul hospitals serving these two counties. All mothers had been exposed to the 1957 epidemic. Public health nurses interviewed 9,990 mothers in the hospitals within a few days after birth for detailed histories of infection during pregnancy. On the basis of these interviews it was judged that 6.5% of the mothers had historic evidence of an ECHO 9 infection during pregnancy. Serologic evidence of ECHO 9 infection in the recent past was present in 19% of 853 antibody titrations carried out on cord blood specimens from abnormals and normals (controls).

To discover anomalies not recognized at birth, a follow-up was carried out 11 to 12 months later by the public health nurses by telephone interviews of some 9,600 mothers.

There were 356 major and minor congenital anomalies recognized during the first year of life. An additional 63 hernias were diagnosed during the first year for a total of 419 anomalies found in 10,109 live births in the study. This rate of 41.4 total anomalies per 1,000 live births, or 4.1%, is well within the rates reported by other authors. A total of 39.6% of the anomalies were diagnosed at birth and 60.4% during the first year of life. Of the anomalies, 61% occurred in males and 39% in females; 1.5% of the infants had major abnormalities and 0.74% died as a result of these anomalies during their first year of life.

There were 105 stillbirths recorded, or 10.4 per 1,000 live births. This compares with a rate of 13.6 for Hennepin and Ramsey counties for the year. Among the stillbirths, 11.4% died from congenital anomalies, in comparison with 10.95% statewide for the year.

A statistical analysis of the findings which compares the ECHO 9 antibody titer distributions in the cord blood of the normal and the abnormal infants does not justify the conclusion that ECHO 9 infection in the mother increases the incidence of congenital anomalies in the offspring. The only exception to this generalization is in the case of skin abnormalities, where there is a statistical suggestion of association.
ANNUAL SUMMARY OF VITAL STATISTICS—1960
Authors: Wegman Myron E.
Published: December 2021

Each year the National Vital Statistics Division (formerly, National Office of Vital Statistics), a unit of the Public Health Service, publishes a summary of the provisional vital statistics of the United States of America, based on estimates derived from monthly reports on certificates filed in registration offices around the country. For 1960, this is published in Volume 9, No. 13, May 31, 1961, of the Monthly Vital Statistics Report. Previous experience has shown that the estimates reflect quite well, with certain reservations, the final reports available much later.

As in previous years1 an abstract of the data most likely to interest pediatricians is presented herewith.
In Reply: Indications for and Risks of Replacement Transfusion
Authors: Wishingrad Lester , Elegant Lawrence D.
Published: December 2021

We agree with most of the points that are so ably made in the letter of Drs. Newman and Gross. We do not consider "a positive Coombs test sufficient indication for an exchange transfusion in an erythroblastic infant born into a family in which previously affected siblings have required exchange transfusions." We did say, however, that "if a family has a previous history of severe erythroblastosis, the baby is Rh positive, and the result of Coombs test is positive, we find early replacement transfusion essential."
An Answer to the Breast Feeding Problem
Authors: Bates George
Published: December 2021

I note a communication (Pediatrics, 28:851, 1961) in which Dr. William O. Jones of the National Institute at Bethesda is "saddened" to hear about mothers who fail in their attempts to breast feed. His theories about how to change this situation seem logical, but they have been tried by most of us long ago and found to be impractical.

Cheer up, Dr. Jones, you may take it from an old practitioner that these mothers and babies do very well in spite of the absence of breast feeding!
In Reply: Electromyography in Congenital Torticollis
Authors: Baxter Chadwick F.
Published: December 2021

By all means, we agree with Dr. Chamberlain's observation that it would be most helpful to run controls on the severe category as we have in the minimal and moderately severe categories as reported in the paper. It is a little difficult for those of us who are acquainted with the occasional case that goes on to severe deformity to treat the child that falls in this severe group with the conservative approach. However, this is undoubtedly the result of biased clinical experience.
SOME PHYSICAL GROWTH STANDARDS FOR WHITE NORTH AMERICAN CHILDREN
Authors: Falkner Frank
Published: December 2021

In another paper1 the author has commented upon physical growth and discussed the use of standards, growth charts, and indicators of growth progress and maturity. If the principles covered in this paper are kept in mind, the pediatrician and scientists investigating growth may find it useful to refer to a set of standards suitable for assessments of North American white children.

To produce a set of standards for the evaluation of growth in the United States poses many large problems. First, in such a large country, geographic considerations are important; comparing a Californian child to Eastern seaboard standards may be misleading. Second, children today are maturing earlier and earlier, and thus they are bigger age for age than children of yester year2-7; hence, it is important to use recently collected data. Third, ethnic factors must be considered; there really is no such things as a typical "North American white child" but data from studies of specific racial groups cannot be used. Clearly, then, with these, and with many other biometric considerations, we are not going to find any data published or unpublished that will give us exactly what we need. The standards that will be given here are therefore a compromise. They represent a collection of the best presently available data, and they are for guidance only, representing patterns of growth. The sources used are listed in Appendix I. It has been shown1 that known ranges of a measurement are more useful criteria in evaluating growth than are norms. Much attention has been given to such ranges in the production of these standards.
STENOSIS OF THE PANCREATIC DUCTS IN FIBROCYSTIC DISEASE
Authors: Snyder William H. , Cleland Robert S.
Published: December 2021

Casts of the pancreatic ducts utilizing the vinyl acetate technique showed stenosis in the terminal portion in two consecutive specimens from patients who died of cystic fibrosis. Because of the extreme shortness of the markedly constricted segment of the duct (less than 1 mm) in one case and the short, tiny, curled stenotic area that overlay the common duct in the other, both strictures might have been missed even if the serial section technique had been used. Vinyl acetate injection of the ducts of the pancreas offers a unique and potentially valuable technique for elucidation of basic pathologic changes in the pancreas in this disease. Additional material and further studies are indicated, but the occurrence of a constriction of the main duct of the pancreas is perhaps more frequent than heretofore realized. Whether the stenosis is a congenital malformation of the duct or the result of abnormal secretion of the gland during the developmental phase is not known.
INFANTILE SCURVY AND NUTRITIONAL RICKETS IN THE UNITED STATES
Authors:   Committee on Nutrition, Blumberg Richard W. , Forbes Gilbert B. , Fraser Donald , Hansen Arild E. , Smith Nathan J. , Sweeney Michael J. , Fomon Samuel J.
Published: December 2021

During the summer of 1960, the Committee on Nutrition of the Canadian Pediatric Society requested co-operation of the Committee on Nutrition of the American Academy of Pediatrics in evaluation of the problem of scurvy in Canada. Reports in the Canadian literature in 1958 and 19591-6 recorded occurrence of 180 cases of scurvy during the 15 years from 1945 through 1959, and personal communications accounted for 142 cases not recorded in the literature. It was somewhat difficult to derive a satisfactory estimate of the true incidence of scurvy from these figures. However, an unpublished report by Dr. J. W. Davies, Chief Medical Officer of Health, Newfoundland, indicated that 77 cases of scurvy had been diagnosed in 1959 for an estimated 30,000 children less than 2 years of age, an incidence of 2.5 cases per 1,000 children.

As an aid in evaluation of the problem of scurvy in Canada and to obtain information concerning the magnitude of the problem in the United States, a survey was carried out concerning incidence of scurvy in the United States during the years 1956 through 1960, inclusive. Questionnaires concerning the incidence of scurvy and rickets among children admitted to the hospital were mailed to 294 hospitals that maintain approved7 residency programs in pediatrics. Replies were received from 176 of the 294 hospitals (60%). Preliminary tabulation and analysis of results were then carried out, and a brief summary was mailed to each hospital. At the time of this mailing a second questionnaire was sent to those hospitals that had not responded to the initial questionnaire.
THE ACADEMY AND PEDIATRIC OPPORTUNITIES IN UNDEVELOPED COUNTRIES
Authors: Diamond Louis K.
Published: December 2021

Last october, in a talk before the American Academy of Pedatrics, on Nutritional Anemia in Tropical Countries, I mentioned several important reasons why American physicians, especially pediatricians, should seriously consider working for a year or more in some of the underprivileged countries abroad. Three points deserve special emphasis. First, it can constitute a period of most valuable training and experience.1 In our own country, it is not unusual these days for a man to complete his internship and still have failed to see important and formerly epidemic diseases in all their manifestations. How many Residents now can recognize the early signs and symptoms of measles, smallpox, diphtheria, tetanus, tuberculosis, and typhoid fever, to mention just a few.
ENLARGEMENT OF THE SUBMAXILLARY SALIVARY GLANDS IN CYSTIC FIBROSIS
Authors: Barbero Giulio J. , Sibinga Maarten S.
Published: December 2021

A survey for submaxillary enlargement was carried out in 106 children with cystic fibrosis and 300 normal children. Submaxillary enlargement was found in 2% of the normal children and 92% of the children with cystic fibrosis. Chronic enlargement of the submaxillary glands is one of the clinical findings frequently present in children with cystic fibrosis, and it may also have diagnostic value. Cystic fibrosis must be considered as an important cause of chronic enlargement of the submaxillary glands in the pediatric age group.