bluuebunny/crossref_metadata_2025 huggingface dataset:
GROUP A STREPTOCOCCAL INFECTIONS IN A CHILDREN'S HOME
Authors: Moffet Hugh L. , Cramblett Henry G. , Black Joyce P.
Published: December 2021

School-age children living in a children's home had pharyngeal cultures made on 485 consecutive infirmary admissions during a period of 14 months by inoculating the throat swab on the surface of a sheep blood agar plate. ASO titers were determined for the acute and convalescent phases of 95% of the 321 untreated illnesses associated with negative cultures. A rise in ASO titer occurred in 3.6% of these illnesses.

ASO titers were also determined on pairs of sera for 51 of 53 untreated febrile illnesses associated with negative streptococcal cultures in 1962 and a rise in ASO titer occurred for only one of these illnesses (2%).

This simple method for pharyngeal cultures is adequate and accurate as a laboratory aid to the practicing physician for the diagnosis of streptococcal pharyngitis in normal children. Bacitracin sensitivity showed an excellent correlation with Group A streptococci. Studies of duplicate swabs indicated that overnight storage of a dry swab at room or refrigerator temperature was associated with the recovery of more than 10 colonies of hemolytic streptococci from 80% to 88% of the swabs whose duplicates had more than 50 colonies.
SERUM ANTIBODIES IN STAPHYLOCOCCAL DISEASE
Authors: Quie Paul G. , Wannamaker Lewis W.
Published: December 2021

Serum antibody titers to the staphylococcal Muller factor and alpha-hemolysin were determined in population groups of various ages and in maternal-cord serum pairs. There was evidence for placental transmission of antibodies and after 2 years of age most persons demonstrated antibody to both of these staphylococcal extracellular products.

Antibody titers in patients with staphylococcal lesions were usually in the upper range of those found in the normal population of similar age, but no striking or consistent elevation of titers was observed in association with or following staphylococcal disease. Exceptions, due in part perhaps to age, were found in patients with staphylococcal pneumonia whose sera often contained no measurable antibody and in certain patients with recurrent skin infection whose sera contained alpha-hemolysin antibodies but failed to demonstrate Muller factor antibodies. The general similarity of antibody titers in patients with staphylococcal lesions to those in normal persons suggests that the antibody response to staphylococcal Muller factor and to alpha-hemolysin is little different after a staphylococcal lesion than after nasal or cutaneous colonization. These findings emphasize that, in addition to antibodies to toxins, presently ill-defined cellular bactericidal mechanisms are necessary for complete defense against staphylococcal disease.
GOUT IN INFANCY MANIFESTED BY RENAL FAILURE
Authors: Rosenthal Ira M. , Gaballah Saeed , Rafelson Max E.
Published: December 2021

A case of gout in a male infant manifest at the age of 7 weeks by signs of renal failure is reported. The child recovered after alkalinization of his urine increased the solubility of precipitated uric acid in the renal tubules. Evidence for gout was found in the maternal and paternal sides of the family. A metabolic study employing N15-labeled glycine demonstrated increased incorporation of glycine into uric acid of the same magnitude previously found in some adult patients with gout.
THE EFFECT OF PROMAZINE ON THE ACTIVITY LEVEL OF RETARDED CHILDREN
Authors: Schulman Jerome L. , Clarinda Sister Mary
Published: December 2021

Promazine was administered to six hyperactive retarded boys in a long-term double-blind study. There were four dose levels —40, 60, 80, and 160 mg per day. The effect on activity level was measured with actometers. There was no effect on daytime activity when the placebo and drug levels were compared. There was a significant but clinically unimportant effect on night time activity.
A Case of Spider Bite with Severe Hemolytic Reaction
Authors: MINTON SHERMAN A. , OLSON CHARLOTTE
Published: December 2021

A 7-year-old boy developed a severe hemolytic reaction following a bite by a spider. A hemorrhagic and necrotic lesion developed at the bite. Although the arachnid responsible was not available for identification, the syndrome is typical of bites by spiders of the genus Loxosceles and quite different from that associated with bites or stings of other arthropods of this geographic region. A specimen of Loxosceles reclusa was later collected in the patient's house.

The mechanism of hemolysis and indeed the entire mode of action of Loxosceles venom is very little understood. Regarding a case they observed, Weiner and associates conclude, "It seems likely that the hemolytic system did not require participation of the patient's tissues in the production of antibodies." The Coombs test was negative in their patient but was positive in one case as reported by Nance. It was not done in the case reported here. Atkins et al. could not reproduce the massive hemolysis syndrome with Loxosceles venom in rabbits and guinea pigs, although intestinal and muscle hemorrhages were seen. The local necrotic lesions are readily produced in experimental animals. While reactions similar to the one reported here occur in only a small percentage of Loxoscles bites, they represent a potentially fatal complication. Therapy in this case was symptomatic and supportive except for administration of ACTH and prednisone before admission. These agents had no discernible effect on the course of the envenomation.
The Use of Gastrostomy in Feeding Premature Infants
Authors: BERG ROBERT B. , SCHUSTER SAMUEL R. , COLODNY ARNOLD H.
Published: December 2021

Gastrostomy was carried out in lieu of gavage feeding on each of 11 premature infants whose birth weights ranged from 454 to 1249 gm (1 lb to 2 lb 12 oz). None of the 4 deaths were related to the gastrostomy per se or the effect of the procedure on the infant. In the 7 remaining patients feeding was successful, and, to date, their development has been satisfactory. It is recommended that the simple and safe method of gastrostomy feeding be considered for the small or frail premature who will require prolonged mechanical aid to feeding.
Muscular Dystrophy in Man and Animals
Authors: DANOWSKI T. S.
Published: December 2021

This volume of twelve chapters by multiple contributors is the most comprehensive treatment of the subject of muscular dystrophy and related disorders available to date. It is under the editorship of a worker in the field.

Gross and microscopic pathology, findings on electron-microscopy, and the results of tissue culture studies are discussed in the first five chapters. Chapters VI, VII, and VIII deal with the clinical aspects of this and related myopathies. Findings in metabolic and endocrine myopathies, in polymyositis, and in congenital disorders are available for comparison. Chapter VI, which deals with the clinical aspects of human muscular dystrophy, is particularly valuable in its detailed exposition of the symptoms and signs in these entities.
Illustrated Speech Anatomy
Authors: MORRIS HUGHLETT L.
Published: December 2021

In the preface, the author states his purpose as being to meet a need for a single, well-illustrated, anatomy text which deals exclusively with structures involved in the production of speech. He states further that the general format of the book is one which is intended to counteract the tendency (of students, presumably) to deal with anatomy in terms of word lists and rote memory. He has achieved his goal, particularly if his text is written primarily for students who are beginning their studies of speech production.
RELATIONSHIPS OF Po2, Pco2, AND pH TO ONSET OF BREATHING OF THE TERM LAMB AS STUDIED BY A FLOW-THROUGH CUVETTE ELECTRODE ASSEMBLY
Authors: Harned Herbert S. , Rowshan Ghodratolah , MacKinney Loren G. , Sugioka Kenneth
Published: December 2021

1. Study of the relationships of pO2 pCO2, and pH to the onset of breathing of term lambs was performed using a specially designed flow-through cuvette electrode assembly.

2. By altering the blood gas tensions of ewes under spinal anesthesia, changes were elicited in the pO2, pCO2, and pH of the fetal arterial blood supplying carotid bodies and the respiratory center.

3. When 100% oxygen was administered to the ewe, fetal arterial pO2 rose to an average of 29.1 mm Hg, pCO2 rose to 49.4 mm Hg, and pH fell. When 6.5% CO2, 21% oxygen, and 72.5% nitrogen were administered to the ewe, a more marked rise in pCO2 and fall in pH were elicited, and a significant rise in pO2 occurred. When 10% O2 and 90% N2 were administered, a fall in pO2 occurred with slight fall in pCO2.

4. None of these changes in arterial gas tensions of the fetus initiated respirations.

5. After occlusion of the cord, all of the animals initiated rhythmic respirations.

6. When a gas mixture high in CO2 and low in oxygen was administered to the ewe, there was severe spasm of the umbilical veins and usually respirations were initiated in the fetus.
Modern Trends in Human Reproductive Physiology
Authors: SMITH CLEMENT A.
Published: December 2021

For the pediatrician curious enough to pursue the life history of his patient into its prenatal phase or the obstetrician interested in more than one of his two patients, this small book will be of great usefulness. Of the twenty-one chapters, twelve are by Australian or New Zealand workers, the Editor, a Professor of Obstetrics and Gynaecology at the University of New South Wales, among them. The international flavor is augmented by Swedish, German, and Scottish contributors.
HISTOPLASMOSIS IN CHILDREN
Authors: Tesh Robert B. , Shacklette Martha H. , Diercks Fred H. , Hirschl Daniel
Published: December 2021

Two cases of children with disseminated histoplasmosis and four with acute pulmonary histoplasmosis are presented. The unreliability of basing a diagnosis on the skin and serologic tests early in the course of the disease is stressed. A plea for cultures in those cases clinically suspected of having histoplasmosis is made. A positive blood culture obtained from one child with the acute pulmonary form of the disease lends evidence to the belief that in many cases of acute histoplasmosis, the organism is temporarily disseminated by the blood stream.

Two cases of progressive, disseminated histoplasmosis, treated with sulfonamides are presented. This suggests that certain of the sulfa drugs are effective in the treatment of disseminated histoplasmosis, and that controlled clinical studies comparing the effectiveness of sulfa with Amphotericin B are needed.
A LONG-TERM FOLLOW-UP STUDY OF SMALL PREMATURE INFANTS
Authors: Dann Margaret , Levine S. Z. , New Elizabeth V.
Published: December 2021

One hundred children, prematurely born, with birth or minimum weights of 1,000 gm or less, of 183 discharged alive from the Premature Nursery of The New York Hospital from 1940 through 1957, were examined between 1950 and 1962. Historical and social data and findings on physical and psychometric examinations were evaluated.

With rare exceptions, physical health was good; only 3 patients had cerebral palsy; one of these and 4 others had convulsions, but in 2 of these the convulsive disorder appeared unrelated to prematurity.

The children exhibited a tendency to catch up in height to normal standards for chronologic age, but often not until after 4 years of age.

The incidence of eye defects was 59%; the most frequent were retrolental fibroplasia, strabismus, and myopia.

Intelligence quotients determined in 99 of the prematurely born children showed a wide range (59 to 142); the average I.Q., 94.8, was significantly below the I.Q. of 106.9 found in 49 full-term sibling controls. These values were not appreciably altered by retesting, by adding more younger siblings, or by comparing premature with sibling on tests done at similar ages. Thirteen of the 99 prematurely born children had I.Q.'s below 80; among the 83 of similar birth weight but not available for examination, 32 were known to be mentally retarded and 6 of these were in institutions.

The most important variable appeared to be the socioeconomic status; a significantly higher proportion of the premature children with I.Q.'s above 100 was found among families who had private medical care. An apparent advantage of white over nonwhite children was interpreted as secondary to socioeconomic level.
A Characteristic Bone Marrow Finding in the Hurler Syndrome
Authors: Pearson Howard A. , Lorincz Andrew E.
Published: December 2021

Seventeen of eighteen patients with the Hurler syndrome demomstrated a characteristic, perhaps pathognomonic, accumulation of mucopolysaccharide granules in their bone marrow. These can be easily recognized by conventional hematologic techniques for preparation and staining of bone marrow. Since large amounts of bone marrow material can be obtained, bone marrow aspirates could conceivably provide an accessible source of tissue mucopolysaccharide for analysis and study. Reilly bodies are so infrequently found that we feel their importance as a diagnostic feature has been overemphasized.
HYPOPHOSPHATEMIC RICKETS WITH RENAL HYPERGLYCINURIA, RENAL GLUCOSURIA, AND GLYCYL-PROLINURIA
Authors: Scriver Charles R. , Goldbloom Richard B. , Roy Claude C.
Published: December 2021

A syndrome of hypophosphatemic rickets, hyperglycinuria, and glucosuria has been found in an adolescent boy. No familial or acquired cause was discovered. The condition began in late childhood. Nine years after its onset dramatic alleviation of extreme osteomalacia and muscle weakness was obtained with phosphorus supplementation of the diet. A number of additional observations were made:

1. The hypophosphatemia was the result of diminished net tubular conservation of phosphorus. On several occasions there was also evidence compatible with net tubular secretion of phosphorus. Hyperparathyroidism was not a factor in this phenomenon.

2. Impaired renal tubular absorption of transport of glycine and glucose was also demonstrated. The inhibition of transport was probably non-competitive in nature.

3. A newly described peptide, glycylproline, was excreted in urine before treatment. The bound hydroxyproline content of urine was also elevated. Both findings disappeared progressively as remineralization of bone occurred.
CRYPTOCOCCOSIS (TORULOSIS) IN CHILDREN
Authors: Siewers C. M. F. , Cramblett Henry G.
Published: December 2021

Four cases of disseminated cryptococcosis in children are reported, two of whom had cryptococcosis without involvement of the central nervous system. All but one patient, a child with leukemia, survived. Two of the survivors were treated with amphotericin B intravenously, while one child recovered after long-term sulfadiazine therapy.

Cryptococcosis should be considered in the differential diagnosis of disease in children with unexplained fever, lymphadenopathay, hepatosplenomegaly, or pulmonary involvement. Central nervous system involvement is not invariably present, and can be prevented if therapy with amphotericin B is instituted early. The necessity of appropriate and repeated fungal cultures is emphasized.
MAPLE SYRUP URINE DISEASE, WITH PARTICULAR REFERENCE TO DIETOTHERAPY
Authors: Snyderman Selma E. , Norton Patricia M. , Roitman Ellen , Holt L. Emmett
Published: December 2021

1. Our experiences with 7 patients with maple syrup urine disease are described.

2. It has been shown that the abnormal biochemistry and the neurological manifestations of maple syrup urine disease can be controlled by a diet low in the branched chain amino acids—leucine, isoleucine, and valine. If control is instituted sufficiently early, there is evidence that mental defect can be prevented.

3. A fourth abnormal amino acid, formerly thought to be methionine, has now been identified as alloisoieucine and evidence has been obtained that this is formed from isoleucine. Indications for restricting the methionine intake no longer exist.

4. Some of the hazards of dietotherapy in this disease are discussed, among them the existence of an unknown nutritional factor which is deficient in synthetic diets containing all the known dietary essentials.

5. The limitations of exchange transfusion for the immediate initial therapy of the disease are pointed out.
SEPTICEMIA IN INFANTS AND CHILDREN
Authors: Johnston Richard B. , Sell Sarah H.
Published: December 2021

Four thousand twenty-one consecutive blood cultures obtained from infants and children during the period 1956 through 1962 were analyzed. Two hundred eighty-four (7.1%) of these were positive, representing 198 patients with clinical evidence of septicemia. The over-all mortality rate was 30%. Approximately one-fourth of the patients were newborn babies, with 38% mortality rate; while another one-fourth were children with a chronic underlying disease, with 53% mortality rate.

Of the microorganisms identified in the blood cultures, staphylococci, the enteric bacteria, D. pneumoniae and H. influenzae were found in greatest numbers. In children with chronic disease, the enteric bacteria (63% mortality rate) and staphylococci (70% mortality rate) were most common. In previously well children, D. pneumoniae (17% mortality rate), H. influenzae (9% mortality rate) and staphylococci (17% mortality rate) were the most frequent.

During the first year of life, staphylococci —coagulase-negative as well as coagulasepositive strains—and the enteric bacteria dominated the neonatal period, while D. pneumoniae and H. influenzae were most prominent after the first month.

The over-all mortality rate of patients with septicemia rose significantly over the 7 years of this study. The reasons for this are discussed.
ALTERATIONS IN THE GLUCOSE TRANSPORT MECHANISM IN PATIENTS WITH COMPLICATIONS OF BACTERIAL MENINGITIS
Authors: Williams R. D. Brooke
Published: December 2021

Glucose diffusion tests were made on 8 children with bacterial meningitis, in 7 [SEE TABLE IV AND FIG 8. IN SOURCE PDF] of whom the organism had been identified. The results of the tests were correlated with the outcome of the illness. Of 3 patients who recovered without sequelae the glucose diffusion patterns were normal in 2 cases, while the third case had somewhat low curves. In 4 cases of proven bacterial meningitis with complication all the tests were abnormal. Three of these were cases of proven hydrocephalus and there was a reversal of the normal pattern of diffusion for the entry of glucose into the cisternal and lumbar regions. An actual lowering of the cisternal glucose following the intravenous injection of glucose was observed in two cases with initial very low spinal fluid sugars. The hypothesis is proposed that alterations in the blood cerebrospinal fluid barrier perhaps due to increased metabolism of arachnoid lining cells or edema in [SEE FIG 9 IN SOURCE PDF] addition to the action of bacteria and leukocytes contribute to the persistent hypoglycorrhachia seen in complicated cases of bacterial meningitis.
The Value of Iron Therapy in Pica
Authors: MCDONALD ROBERT , MARSHALL SHEILA R.
Published: December 2021

As doubt had been cast upon the reputed efficacy of iron in the treatment of pica, a double blind controlled trial was carried out in an endeavor to establish a firmer conclusion in the matter.

One group of children received intramuscular iron and a control group of equal mean age were given intramuscular injections of normal saline.

Three to 4 months later nearly all of those given iron had lost their pica, but it was still present in three-quarters of the controls. After 5 to 6 months there was no significant difference between the two groups and this failure of maintenance of cure may have been related to a fall in mean hemoglobin level which occurred.

Five children who initially received saline and in whom pica was still present were given iron at 6 months and all lost their pica.

Our experience is that pica can be cured by iron in nearly all cases, but that permanent cure may be dependent upon the maintenance of adequate hemoglobin levels.
Chemistry and Therapy of Disorders of Voluntary Muscles
Authors: BYERS RANDOLPH K.
Published: December 2021

This little book is an excellent review of current literature relative to the physiology and diseases of muscles as opposed to neural structures. It contains very well-condensed accounts of each of the well-described diseases of muscle with a sufficient consideration of what is known of their physiologies to be a guide to treatment.

For persons interested in the study of muscle physiology and diseases a full bibliography follows each chapter and forms a very valuable contribution.

The first chapter on the physiology of muscle is by R. G. Williams and the description of the diseases and their treatments by Dr. Murphy.
PSYCHOACTIVE DRUGS IN PEDIATRICS
Authors: Lourie Reginald S.
Published: December 2021

SINCE THE ADVENT of the so-called psychoactive drugs (tranquilizers, mood relievers, and stimulants) the large literature on their clinical uses has included relatively little research into the effects of these drugs upon children. In spite of this, experience with the younger age group seems to justify an attempt to establish a few rules of thumb for pediatric practitioners.

In general, the tranquilizers have been divided into two categories: major and minor. The so-called major tranquilizers include the phenothiazines and Rauwolfia derivatives. Whereas in adults these drugs have an important role in alleviating the behavioral and thinking disturbances in psychoses, parallel results are not usually to be expected in psychotic children. Only occasionally does one see a psychotic child whose thinking disturbance or bizarre behavior has responded to tranquilization and then usually when the dosage is high. Often before any other effective changes would be available, the child will be so tranquilized as to be out of effective communication, usually in a sleep state. Where any useful effect has been obtained in the childhood psychoses, it has usually been from a phenothiazine rather than a Rauwolfia derivative.

Children in whom phenothiazines have been found to be useful are usually those with acute, often overwhelming, anxiety. These drugs appear to be of little value in the chronic anxiety states or with chronically established symptoms such as habit disturbances, tics, enuresis, character disturbances, etc. In acute anxiety states and in the acute psychotic symptoms of early adolescence, the phenothiazines often will relieve crisis symptoms. With overwhelming postoperative anxiety or transitory psychotic states, these drugs have been helpful. They must, however, be given in adequate dosage, and this varies greatly from individual to individual. One must find for each child the dose which is clinically effective without so fully tranquilizing the individual that he cannot function. A common mistake is the administration of ineffectual small doses or even a single dose. It must be recognized that a sustained blood level is necessary for continuing effectiveness of the medication.
SCHOOL FAILURE
Authors: Glaser Kurt , Clemmens Raymond L.
Published: December 2021

Modern preventive pediatrics recognizes that the school life of the child is one of the important environmental forces affecting his total well-being. Learning difficulties, or any problems interfering with adequate functioning in school, thus enter within the province of pediatric care.

While the cause of a learning difficulty may be purely educational, to be handled adequately by the school authorities, the problem is frequently more complex and involves a variety of physical, emotional, or social factors. The pediatrician, through his close acquaintance with the child, his family, and their environment, is in the strategic position to seek and co-ordinate the services needed for the correction of these multi-faceted problems. In order to do so he must be thoroughly acquainted with the many factors which may interfere with a child's school performance so that he can correctly evaluate the problem and find the appropriate avenue for help in the individual child.
THE EMOTIONAL CORRELATES OF SYDENHAM'S CHOREA
Authors: Freeman John M. , Aron Alan M. , Collard Jean E. , MacKay Mary C.
Published: December 2021

1. During a long-term follow-up study of patients previously hospitalized with Sydenham's chorea, a high incidence of psychological disturbance was encountered prior to the onset of chorea, and at the time of current evaluation, an average of 29 years later.

2. Seventy-five per cent of patients with Sydenham's chorea were currently found to manifest evidence of psychiatric disturbance.

3. A control population similarly evaluated showed a 25% incidence of psychiatric disability—about the expected incidence for the general population.

4. This study emphasizes the need to consider psychological factors as part of the total evaluation of patients with Sydenham's chorea.
Audiological Evaluation of the Pediatric Patient
Authors: ROBINSON GEOFFREY C.
Published: December 2021

This short, readable book describes the hearing evaluation of preschool children with communication disorders. The authors, an audiologist and an otologist, emphasize that in addition to peripheral hearing loss, other auditory pathology or additional problems (mental retardation, brain damage, psychological problems) may contribute to the communication handicap. They espouse the multiple discipline or team approach in the medical setting.

There are six chapters, four of which describe methods for individual and group hearing evaluation. Standard techniques of hearing evaluation are not applicable to very young children who cannot give a voluntary response to an auditory stimulus.
MOTHERS' OPINIONS OF THEIR PEDIATRIC CARE
Authors: Deisher Robert W. , Engel William L. , Spielholz Robert , Standfast Susan J.
Published: December 2021

An opinion survey of mothers who take their children to pediatricians in Seattle, Washington, was carried out during the summer of 1963 in order to gain information on the mothers' concept of the pediatrician's role and how satisfied they were with the care their children were receiving.

Some comparisons were made with the results of others studies where pediatricians and general practitioners were surveyed.

It was found that in general Seattle mothers were very satisfied with their pediatricians and the care which their children were receiving from them. The important factors contributing to this high degree of satisfaction were discussed, as well as the areas of least satisfaction. Aspects of the doctor-patient relationship and the art and science of medicine were found to be more important in selection and satisfaction with a doctor than ancillary factors such as fees, willingness to make house calls, and time spent waiting in the office. These latter were the focus of most of the mothers' dissatisfactions. In the area of well-child care and advice, more information was desired on accident prevention, dental care, behavior problems, sleep, and toilet training. The most important reasons for obtaining well-child care were immunizations, physical examinations, and reassurance of normal development. The results also suggest a need for more emphasis on well-child checkups during the second year of life, and for continued expert health supervision during the adolescent years. It was concluded that from the mothers' point of view the modern pediatrician does and can expect to continue to play an important role in the life of the child, family, and community.
THE DIAGNOSTIC VALUE OF SERUM CREATINE KINASE IN NEUROMUSCULAR AND MUSCULAR DISEASE
Authors: Vassella Franco , Richterich Roland , Rossi Ettore
Published: December 2021

Serum creatine kinase activity in 200 patients was studied in order to check whether this determination might be of help in differential diagnosis between primary and secondary (neurogenic) myopathies.

Elevated CK values are found physiologically in children, pregnant women, and after exercise. In pathological states increased serum enzyme concentrations (probably the expression of a defect in cellular permeability) are constantly present in the Duchenne type of progressive muscular dystrophy. More variable values are encountered in other types of muscular dystrophy and in metabolic disorders like Refsum's syndrome, coproporphyria, and hypothyroidism. In states of necrosis or injury to muscle cells like in polymyositis, dermatomyositis, after burns or trauma, serum CK concentrations vary according partly to the amount of muscle mass involved. Enzyme concentrations can be markedly increased after tetany or epileptic seizures. Normal values or occasionally slightly increased values are found in neurogenic myopathies. High CK values in patients with muscular atrophies should permit the clinician to exclude the differential diagnostic group of neurogenic myopathies.

As a diagnostic tool CK proved to be more reliable than transaminases or lactic dehydrogenase because of its higher muscle specificity and a slightly greater sensitivity.
Dynamic Classification of Bone Dysplasias
Authors: COHEN JONATHAN
Published: December 2021

With the exception of the skill, the bones have more varieties of lesions about which little or nothing is known than do any other tissues of the body. While mast of these lesions, known largely through their roentgenological appearance and empirical course, are rare, the total group is numerous enough to engage the interest of many. Any approach to useful classification or increased understanding of etiology or pathogenesis would be welcome. Whether Rubin's novel approach fulfils this need in any measure is problematic.
Psychological Development in Health and Disease
Authors: WOODBURY CHARLES B.
Published: December 2021

This is a work admirably comprehensive in scope, and theoretically sophisticated in its panoramic survey of the human personality in relation to the processes of health, disease, development, and adjustment. Its hard-thought analyses of fundamental reaction-mechanisms and their parameters of variation provide much more than broad generalizations, though seldom dealing with the concrete reality of a single specific case.

This reviewer was impressed by several aspects: by Dr. Engel's valuable introductory discussion, in the first place, concerning the nature of clinical education–a discussion germane to such varied fields as clinical psychology, the education of teachers, and the case method of business training.
Hemangiomas, Hepatic Involvement, Congestive Failure
Authors: ROBBINS BENJAMIN H. , CASTLE ROBERT F.
Published: December 2021

The article "Multiple Hemangiomas in an Infant with Cardiac Enlargement" by Drs. Cooper and Bolande in Pediatrics (35:27, 1965) demonstrated a patient with cardiomegaly which was thought to be secondary to multiple arteriovenous fistulas in the hemangiomas. Postmortem pathologic and angiographic studies in their case supported this hypothesis. We would like to note a complementary case with primarily hepatic involvement recently seen in our institution in which cardiac manifestations were present and then disappeared as the tumors underwent spontaneous regression.
Depigmented Nevi: The Earliest Sign of Tuberous Sclerosis
Authors: GOLD ARNOLD P. , FREEMAN JOHN M.
Published: December 2021

Depigmented nevi may be the initial cutaneous manifestation of tuberous sclerosis. In the child presenting with infantile spasms, the presence of depigmented nevi suggest the diagnosis of tuberous sclerosis.
SCHOOL MEDICAL SERVICE IN PERSPECTIVE
Authors: Mitchell Harold H.
Published: December 2021

THE PROBLEM of quantity and quality of school medical service has concerned some leaders in public health and education in this country for more than 50 years. To achieve a balance between quantity and quality within budget limits is a problem of great difficulty. The growth of population and increasing demands for service may at any time upset the best laid budget plans. In what follows, I shall deal with the progress of school medical service and consider those policies which have had a bearing upon the quality of services.

Emphasis on Quantity

About 1905, when physicians in schools began to give attention to non-contagious conditions of school children, many physical defects were noted. This was the beginning of a new type of official action in behalf of the health of school children. By 1923 many states had laws requiring annual school medical inspection. However, as there had been no specific standards of quantity or quality, those responsible for the service were troubled by the dilemma of deciding how much of each they should plan for.

How much medical service was needed? Nearly every school medical and nursing service was reporting enormous numbers of defects found and this kept the focus upon a concern for more examinations and coverage to find them all. During the 1920's communicable disease epidemics encroached so heavily upon the time of doctors and nurses in the schools as to stop all examinations and follow-up work. In between epidemic periods the demand for inspections of suspected cases of communicable disease caused interference with the search for defects.
A NEW CONGENITAL HEMOLYTIC ANEMIA WITH DEFORMED ERYTHROCYTES (? "STOMATOCYTES") AND REMARKABLE SUSCEPTIBILITY OF ERYTHROCYTES TO COLD HEMOLYSIS IN VITRO
Authors: Miller Gerald , Townes Philip L. , MacWhinney James B.
Published: December 2021

A new variant of congenital hemolytic anemia is described. The principal clinical findings are moderately severe hemolytic anemia, jaundice, and splenomegaly; congenital ptosis of an eyelid may possibly be an associated anomaly. Splenectomy resulted in clinical improvement but did not completely arrest abnormal hemolysis nor alter red cell abnormalities. Laboratory data are presented which characterize the condition; the principal abnormalities detected thus far are: (1) abnormal morphology of the erythrocytes ("stomatocytes"); ) increased osmotic fragility and autohemolysis; (3) storage instability greater at 5°C than at 37°C; (4) decreased concentration of reduced glutathione despite normal G-6-P-D and G-6-P-D coupled glutathione reductase activities. The disorder is compared with hereditary spherocytosis and hereditary stomatocytosis; similarities to and differences from these disorders are reviewed.
RELATIVE HYPERMETABOLISM IN INFANTS WITH CONGENITAL HEART DISEASE AND UNDERNUTRITION
Authors: Lees Martin H. , Bristow J. David , Griswold Herbert E. , Olmsted Richard W.
Published: December 2021

1. Twenty-one infants with various forms of congenital heart disease leading to congestive heart failure, arterial unsaturation, or a combination of both events were studied with respect to resting oxygen consumption. Comparison was made with 21 control infants considered to be of normal growth and to have normal cardiac and respiratory systems.

2. Mean oxygen consumption for infants with heart disease was 9.3±2.4 ml/min/ kg compared to 7.3±0.8 ml/mm/kg for controls. Markedly undergrown infants with heart disease (60% or less of the 50th percentile weight for age) had a mean oxygen consumption of 10.9±1.4 ml/mm/kg compared to a mean of 7.5±2.0 ml/min/kg for infants with heart disease who were greater than 60% of the 50th percentile weight for age. Relative hypermetabolism seemed to relate to the degree of undernutrition rather than to any specific clinical finding.

3. Possible mechanisms of undernutrition and of relative hypermetabolism in the infant with heart disease are discussed.
Generalized Bone Changes and Thrombocytopenic Purpura in Association with Intrauterine Rubella
Authors: RAUSEN AARON R. , LONDON ROBERT D. , MIZRAHI ABRAHAM , COOPER LOUIS Z.
Published: December 2021

Two newborn infants are presented whose mothers had rubella in the first trimester of pregnancy. Both infants were born with thrombocytopenic purpura and suggestive evidence of a hemolytic disorder. The second infant had congenital heart disease as well.

Roentgenographic changes in the metaphyseal ends of several long bones, observed in the first infant at 3 days of age, regressed completely by 2 months of age. The second infant had roentgenographic evidence of metaphyseal changes of a lesser degree, limited to the distal ends of the femora. These changes were no longer present at 6 weeks of age. Both infants were shown to be harboring an interfering agent with the characteristics of the rubella virus.
Congenital Rubella and Thrombocytopenia: Report of Two Cases with Initial and Follow-up Viral Cultures
Authors: COCHRAN WILLIAM D. , CORNFIELD MICHAEL , FRIEDBERG DAVID
Published: December 2021

Recent advances have made it possible to isolate rubella virus from affected persons and to propagate the virus in tissue culture. The virus may be identified by the unique cytopathogenic changes in human amnion tissue culture by interference with ECHO virus type 11 in monkey kidney tissue culture. Thus an even closer correlation between an active rubella infection in the mother in the first trimester of pregnancy and the clinical findings of the rubella syndrome is now feasible.

The rubella epidemic of 1964 can be expected to produce significant numbers of infants with the congenital rubella syndrome. This paper reports the clinical history of two cases of rubella associated with thrombocytopenia in the newborn.
Letters to the Editor
Authors: CLEMENTS JOHN A. , KLAUS MARSHALL H. , TOOLEY WILLIAM H.
Published: December 2021

Drs. Normand, Reynolds, and Strang pose several important questions concerning our recent paper, "The Pulmonary Hypoperfusion Syndrome." We considered these and other questions bearing on the subject before submitting our preliminary report, and we plan to deal with them in our next paper. We feel that it is desirable, however, to comment on a few points now.

Drs. Normand, Reynolds, and Strang argue that the frequent occurence of respiratory distress in premature babies together with their observations that the amount of surfactant in the lungs increases with increasing maturity indicates a cause-effect relationship.
The Child (Perspectives in Psychology Series)
Authors: CONE THOMAS E.
Published: December 2021

Most of us in pediatric practice are aware of the limitations of our understanding of the diverse and ever changing schools of thought in philosophy, psychology, and the social sciences during the last two centuries which have led to a revolutionary change in the importance of the child's role in our social structure. This book will help to overcome these limitations because it offers a broad view of the changes both subtle and profound which have seen the child emerge from an inconsequential member of society to a position of central importance.
MANAGEMENT OF ESOPHAGEAL ANOMALIES
Authors: Martin Lester W.
Published: December 2021

Esophageal anomalies continue to present a challenge to the pediatrician, the surgeon, and the nursing staff.

The rocky road to recovery is fought with a multitude of life-threatening complications demanding immediate attention and requiring all of the services of a specialized institution designed and equipped for the care of infants.

In our series, for the past seven years, we can report a 100% recovery following surgical correction of the anomaly for 37 consecutive infants with a birth weight greater than 2,000 gm. One additional infant died before the anomaly could be corrected. Therefore, 97% of all infants admitted with a weight of over 2,000 gm have survived. For those with a birth weight of less than 2,000 gm, the outlook is most dismal, with only 2 survivors out of 11 infants.

An emergency gastrostomy was performed with local anesthesia on each infant as soon as the diagnosis was confirmed. The definitive operation was then delayed for from 3 to 21 days for treatment of pneumonia, hyperbilirubinemia, or other anomalies of a more urgent nature. The over-all recovery rate for the last seven years has been 80% for 49 infants.
The Prophylaxis of Parental Overdependence
Authors: WEATHERMAN HAROLD V.
Published: December 2021

I've read Doctor Charles E. Brown's commentary on "A School Administrator's Role in School Health" in the June, 1965, issue of Pediatrics with enthusiasm, and offer him my hearty congratulations for it.

One excerpt from this is priceless to me, a pediatrician, who has been in practice for over thirty years. I am referring to the following: "The doctor, who either consciously or unconsciously encourages a mother to phone him every time a baby cries for more than a few minutes, or runs a temperature for more than a few hours, is not only making his own life difficult, but is contributing to the possible development of problems that will later on be shared by the schools.
Phenylketonuria Detection
Authors: ASHLEY CARL G. , BRANDON GATLIN R.
Published: December 2021

As a result of the current trend toward mandatory legislation providing for testing of all newborns for phenylketonuria, questions have arisen concerning various problems involving testing programs. We have had numerous inquiries about our program and feel that it might be helpful to show some of our experiences.

We began a pilot program in July, 1960, which involved ferric chloride testing of urinesoaked filter papers returned to our laboratory. Mothers of all live-born infants in two hospitals in Oregon were given instructions to return urine-impregnated filter papers in a return envelope to us when the baby was 4 weeks old.
Narcotic Withdrawal Reaction in a Newborn Infant Due to Codeine
Authors: Van Leeuwen G. , Guthrie R. , Stange F.
Published: December 2021

An infant who demonstrated a narcotic withdrawal reaction after codeine deprivation is presented. We believe this is the first report of narcotic withdrawal symptomatology due to this drug.
STUDIES IN CYSTIC FIBROSIS
Authors: Shwachman Harry , Kulczycki Lucas L. , Khaw Kon-Taik
Published: December 2021

The present report is an analysis of 65 patients with cystic fibrosis who are 17 years of age as of January 1, 1964. The oldest patient in this series is 32 9/12, with a mean age of slightly over 20½ years for the entire group. It is unique to have the opportunity to follow a large group of patients from early life beyond adolescence in a pediatric center by the same group of physicians. The follow-up period varied from over 20 years in 2 patients to less than 3 years in 6 patients, with an average of over 11½ years for the whole group. The earliest diagnosis was made at 2 days in an infant with meconium ileus. This boy, now 17 years, is our oldest survivor of meconium ileus corrected surgically.

The diagnosis was made in 8 patients in their first year of life and 34 of the 65 patients were diagnosed under 10 years of age. Fifty-one of the 65 patients were diagnosed by us and 14 were diagnosed prior to referral. Forty-two or 65% of patients are male, whereas the sex incidence is equal in infancy and childhood. Of interest are the 7 patients who are married. None have borne children. The present clinical status of these patients is excellent in 7, good in 19, mild in 29, and moderate in 10. The type of follow-up care was considered good in 43 cases, fair in 13, and poor in 9. Brief attention is given to changing concepts of the disease especially as it relates to diagnosis and therapy. Since 1954 when the sweat test was introduced by us as a practical method we have considered this the most reliable single diagnostic test. Prior to 1954 all patients were subjected to duodenal intubation. These patients with no pancreatic insufficiency but with typical pulmonary features considered to have cystic fibrosis were subsequently found to have a positive sweat test. The changes in therapy as it has evolved over the years are mentioned. The most important single advance noted was the introduction of broad spectrum antibiotics in 1948, followed in the last 10 years by a variety of measures designed to keep the bronchopulmonary tree "clean."

We feel that the early detection of this disease, plus the application of our current modes of therapy, will not only prevent numerous complications but will provide a much better prognosis for life.
GROWTH STATUS OF CHILDREN EXPOSED TO FALLOUT RADIATION ON MARSHALL ISLANDS
Authors: Sutow W. W. , Conard R. A. , Griffith K. M.
Published: December 2021

Longitudinal studies on 38 children who were exposed to fallout radiation on Rongelap and Ailingnae atolls, Marshall Islands, in March, 1954, have shown retardation in both statural growth and skeletal maturation among the exposed boys as compared to non-exposed comparison children. The retardation was noted among boys who were under 5 years of age when exposed to the fallout, being most prominent among those who were 12 to 18 months old at time of exposure. No statistically significant differences were noted in the growth patterns between the exposed and the non-exposed group of girls and between 39 children born to exposed parents subsequent to fall-out and 53 children born to non-exposed parents.
HOMOCYSTINURIA: A REPORT IN TWO SIBLINGS
Authors: Kennedy Charles , Shih Vivian E. , Rowland Lewis P.
Published: December 2021

1. Two cases of homocystinuria at ages 14 and 21 are described, in which the typical features of the disorder were found: subluxation of the optical lenses, mental retardation, seizures, pes cavus, blotchiness of the skin. Additionally, emotional lability was prominent and breath-holding attacks had been present in infancy. Neither had suffered any apparent vascular occlusive episode. Prominent in both of the children described was generalized osteoporosis and narrowing of joint spaces.

2. Homocystine and methionine were found to be elevated in urine, plasma and cerebrospinal fluid.
PEDIATRICIANS AND A COMMUNITY CHILD GUIDANCE CLINIC
Authors: Thorpe Helene Smith , Halpern Werner I.
Published: December 2021

A personal survey was conducted of fifty-two pediatricians in thirty-two private practices to determine their impressions of psychiatric consultation with a community child guidance clinic. Their comments were correlated with data from Clinic records over a five-year period. Prolonged waiting for initial service and ineffective communication were major problems voiced by pediatricians and confirmed by Clinic records.

Improvements in these problems can occur when attention is given to more expeditious intake procedures, to a better use of professional co-ordination, and to improved educational programs in child mental health care.
Quantitative Data on Infants of Diabetics
Authors: GRUENWALD PETER
Published: December 2021

Naeye's recent paper: Infants of Diabetic Mothers: a Quantitative, Morphologic Study, calls for comment pertaining largely to the significance of the quantitative data presented. Findings are based on 30 autopsies; in 4 of these the birth weight was below 80% of predicted values, and in 5 cases between 80 and 120%. It would have been particularly interesting to see an analysis of the latter 5 cases as they are comparable in birth weight with the author's controls.
Soya Alpha-Galactosides
Authors: RAPKIN RICHARD H.
Published: December 2021

In their careful study of Soya Alpha-Galactosides (Pediatrics, 36:231, 1965) Gitzelmann and Auricchio do not discuss an important result of their work. If raffinose is capable of producing diarrhea in a healthy boy, would it not do the same in children with "milk allergy," gastroenteritis of viral etiology, or other sundry causes of diarrhea?

Conclusions based on response to Soya formulas in such situations should, therefore, be cautiously made. Uncritical use of formulas should be condemned and these authors have revealed an important piece of information which needs confirmation regarding Soya formulas.
Non-Hemolytic Hyperbilirubinemia
Authors: MAURER HAROLD M.
Published: December 2021

On what basis do Drs. Wishingrad, Cornblath, Takakuwa, Rozenfeld, Elegant, Kaufman, Lassers, and Klein (Studies of Non-Hemolytic Hyperbilirubinemia in Premature Infants, Pediatrics, 36:162, 1965) recommend exchange transfusion for non-hemolytic hyperbilirubinemia of the premature at a serum bilirubin level equal to or greater than 24 mg/100 ml when no significant difference is apparent in mortality and neurological sequelae in the study groups at greater than 24 mg/100 ml serum indirect bilirubin? The only patient who developed kernicterus in the study already demonstrated symptoms and signs at 10.8 mg/100 ml indirect serum bilirubin which tends to exclude him from the study group called "greater than 24 mg/100 ml."