bluuebunny/crossref_metadata_2025 huggingface dataset:
CHILDHOOD AND ADOLESCENT ADDICTIVE DISORDERS
Authors: Freedman Alfred M. , Wilson Ethel A.
Published: December 2021

While the average pediatrician may seldom see a young addict in his practice, he should be alerted to the extent to which such possibility presently exists in all strata of our society. Since there has been an increasing trend among middle- and upperclass high school and college students to experiment with a variety of addictive and hallucinogenic substances, problems of addiction are no longer found only in the lower socioeconomic classes. We repeat that such behavior represents a general pathological response to inner and outer stresses with which young people cannot cope. The reasons for this particular behavioral response are complex and much remains unknown about the individual psychic and physical factors that predispose certain individuals to it. Nevertheless, this is no excuse for discouragement or inaction but rather a challenge to the creative capacity of the medical and allied professions which have successfully met such challenges in the past.

Legal obstacles to medical discretion in the treatment of addicts must be removed. Addiction must be seen as a civil, not a criminal matter, and the criminal behavior that may result from addiction must not be confused with the disease itself. The medical profession must assume responsibility for scientific investigation and carefully controlled experimentation with all treatment modalities. Finally, there must be a careful examination of the society in which addiction develops and spreads. It is our belief that vigorous and thoroughgoing investigation and scientific experiment may lead to the possibility of much-needed change in the environment in which addiction flourishes and in the human beings already addicted.
Status of Exchange Transfusion
Authors: BOGGS THOMAS R.
Published: December 2021

While respecting Dr. McKay's wisdom and judgment, I feel obliged to take issue with certain of the concepts he seems to champion in his article "Current Status of Exchange Transfusion in Newborn Infants" (Pediatrics, 33:763, 1964). I was pleased to read the Journal's "Introductory Note" carefully pointing out that such articles, while usually contributed by a member of the Editorial Board, reflect the author's own practice.

First, I cannot agree with Dr. McKay that it is currently possible to identify which infant with idiopathic hyperbilirubinemia and a serum bilirubin concentration of 18 mg/100 ml if premature, or 20 mg/100 ml if full term, is, and which is not, at risk as far as concerns kernicterus.
CHRONIC DIARRHEA AND ALKALOSIS
Authors: Tucker Virginia L. , Wilmore Douglas , Kaiser Carolyn J. , Lauer Ronald M.
Published: December 2021

Three balance studies were carried out in a patient with severe diarrhea with alkalosis which had its onset in the neonatal period. The patient excreted frequent, profuse, watery stools containing large quantities of chloride, sodium, and potassium. The urine was quite hypotonic. When sufficient amounts of sodium, potassium, and chloride were provided in the diet and the child was not allowed to become dehydrated, body electrolyte and water could be maintained in a physiological range. This did not affect the volume, frequency, or content of the stools. This patient was considered to be similar to the two cases of "congenital alkalosis" with diarrhea originally described by Gamble and Darrow.

An investigation of causes of the metabolic abnormality of this patient which had not been previously studied were presented. An exploratory laparotomy failed to demonstrate an anatomical lesion which might explain the patient's basic problem. No abnormal endocrinopathy could be demonstrated. The child did fail to hydrolyze lactose in one out of three lactose tolerance tests. The absence of lactase activity in the duodenum was confirmed by a duodenal biopsy. Since a number of investigators have recently demonstrated a transient lactase deficiency in association with chronic or acute diarrhea, which resolved when the underlying problem was corrected, it was considered quite unlikely that this was the intrinsic defect in this child.
OPTIC ATROPHY IN CHILDHOOD
Authors: Schwartz James F. , Chutorian A. M. , Evans Robert A. , Carter Sidney
Published: December 2021

An attempt has been made to determine the significance and outcome of optic atrophy as an apparently isolated entity in the pediatric age group.

A follow-up study was made of 48 children who presented in early childhood with optic atrophy with no known cause and no obvious systemic or neurological disease. It was found that the prognosis for useful vision is in general favorable in this group of cases. However, the significant incidence of mental retardation and other neurological impairment was noted for those children who had manifested severely impaired vision under one year of age. There was no correlation between specific symptoms and the outcome of vision. The patients with idiopathic optic atrophy were compared with other patients who presented with optic atrophy without signs of systemic or neurological disease on initial examination but who were later found to have underlying disease. X-ray findings of enlargement of the optic foramina, deformity of the sella turcica, and suprasellar calcification or hyperostitic changes in the region of the optic foramen were found to be important differential diagnostic features, as was the presence of proptosis or visual field defects, reflecting involvement of the optic chiasm or retrochiasmal visual pathways. By the use of these features and certain laboratory determinations it was possible to separate the idiopathic group from patients whose optic atrophy was secondary to optic nerve and chiasm gliomas, other intracranial neoplasms, fibrous dysplasia, congenital syphilis, and orbital neurofibroma. Problems in the diagnosis and differential diagnosis of optic atrophy have been discussed.
An Electronic Aid for Timing Urine Collection Periods in Non-Catheterized Infants
Authors: KALLEN R. J. , BURG F.
Published: December 2021

An automatic signaling device for the timing of micturition has been constructed from readily available components and is herein described. It utilizes two transistorized units and has the advantages of being compact and portable.
Mongolism in Newborns: A clinical and cytogenetic study
Authors: ATKINS LEONARD
Published: December 2021

The author states that this thesis is devoted principally to a study of the phenotype of newborn mongoloids. Data obtained by himself from clinical and cytogenetic studies of 38 newborn mongoloid children born during 1961-1962 in southern Sweden are presented. An additional 5 cases of suspected mongolism proved to have normal karyotypes. A further 20 cases of newborn mongoloids born during 1962-63 in the same area were examined cytogenetically by the author, and clinical data from these cases were obtained by questionnaries.
HOW MUCH VIROLOGY SHOULD THE PEDIATRICIAN KNOW?
Authors: CRAMBLETT HENRY G.
Published: December 2021

EDITORIAL boards are confronted from time to time with philosophical questions concerning the type and content of articles worthy and desirable of presentation in their medical journals. Yet there can be little argument with the guiding principle that each respective journal should publish experimental data resulting from any sound clinical or basic investigations applicable to the special interests and experience of its readers. It is, however, more difficult for the individual reader to be sure which of so many articles he must read in order to remain abreast of developments eventually significant for the care of infants and children. The pediatrician will need to exercise prudence in selection of such articles—prudence which will be influenced by his own special interests.
ACUTE RESPIRATORY ILLNESS IN THE PREMATURE NURSERY ASSOCIATED WITH RESPIRATORY SYNCYTIAL VIRUS INFECTIONS
Authors: Berkovich Sumner
Published: December 2021

Two mid-winter outbreaks of respiratory disease in a premature nursery, one in 1962, and the second a year later in 1963, are described. The majority of the 14 infected prematures were severely ill. They presented with mild upper respiratory symptoms that continued for from 1 to 8 days before the acute onset of dyspnea. Nine had radiologic evidence of pneumonia. Certain clinical manifestations were sufficiently characteristic to suggest a common etiology. The virologic data that support the association of these epidemics with respiratory syncytial virus infection are presented in detail.
Unexpected Finding from a PKU Newborn Screening Program
Authors: COFFELT R. WENDELL
Published: December 2021

We wish to draw attention to the unexpected finding of a maternal phenylketonuria case from our Guthrie PKU newborn screening program here in Burbank, California.

The first specimen taken from the infant involved was on the third day of life and registered 6 mg/100 ml phenylalanine content in the blood. This occurred very early in our program and at that time we did not feel an immediate follow-up should be done unless the result appeared above 6 mg/100ml. The next specimen was taken when the baby was 6 weeks old routinely in the doctor's office.
Neonatal Listeriosis, and the Problem of Retrieving Medical Information
Authors: DELTA BASIL C.
Published: December 2021

I was most interested in the recent paper of Ray and Wedgwood which reported six cases of neonatal listeriosis, along with a review of the literature (Pediatrics, 34:378, 1964). In the article it is stated: "There are 63 welldocumented cases of neonatal listeniosis in the United States and Canadian literature."

It is surprising that in such a review article several recent reports have been omitted. Details of the additional cases of listeric infection in the newborn are being submitted in a summarized form (Table I) to complete the review for the benefit of the readers of Pediatrics.
Neonatal Hypoglycemia and Early Feeding
Authors: DAVIES PAMELA A. , SMALLPEICE VICTORIA
Published: December 2021

Dr. Naeye (Pediatrics, 34:415) has much of interest to say about organ composition in newborn parabiotic twins and neonatal hypoglycemia. He suggests that gluconeogenesis from protein is the source of the glucose which must be necessary after hepatic glycogen is exhausted "since adequate alimentary carbohydrate is often not available for several days." We write only to put forward a practical point.

For the past two years we have conducted a trial of the immediate feeding with undiluted breast milk of infant weighing 1,000-2,000 gm at birth.
THE DEVELOPMENT OF THE LUNGS OF LAMBS
Authors: Orzalesi M. M. , Motoyama E. K. , Jacobson H. N. , Kikkawa Y. , Reynolds E. O. R. , Cook C. D.
Published: December 2021

1. Lambs with estimated gestational ages from 55 to 154 days were delivered by cesarean section. Observations were made on animals in the fetal state and after the onset of respiration in lambs of more than 130 days gestation. Spontaneously born lambs were also studied.

2. Measurements of arterial blood gas tensions, pH, lactic acid concentration, and blood pressure showed that the animals were always in good condition.

3. Normal surface activity of lung extracts was first found in fetuses of about 126 days gestation and was present in the lambs of more than 130 days gestation which breathed.

4. Electron microscopy showed that cells containing osmiophilic inclusion bodies first appeared at about 120 days gestation and preceded by only a few days the appearance of normal surface activity of lung extracts. The number of cells containing osmiophilic inclusion bodies as well as the total number of inclusion bodies increased toward term. There was no apparent difference in the number of these cells or the total number of inclusion bodies in the lungs of lambs which breathed as compared to fetuses of comparable gestational age.

5. The water content of the lungs per unit of dry tissue decreased during gestation until about 95 days and then increased again until term. After the onset of respiration the water content rapidly decreased.

6. The blood content of the lungs per unit of dry tissue increased significantly during gestation and there was a further probable increase after the onset of respiration.
THIRTEEN BOYS WITH PROGRESSIVE SEPTIC GRANULOMATOSIS
Authors: Carson Merl J. , Chadwick David L. , Brubaker Charles A. , Cleland Robert S. , Landing Benjamin H.
Published: December 2021

1. Thirteen boys are described who present a syndrome of chronic suppurative lymphadenitis, chronic dermatitis, chronic pulmonary disease, and hepatosplenomegaly, with an eventually fatal outcome.

2. The cases described appear to have the same basic disorder as those previously reported by Landing and Shirkey and by Bridges, Berendes, and Good.

3. Despite the frequent finding of hypergammaglobulinemia, no defect of antibody synthesis has been demonstrated.

4. The existence of an as yet unidentified physiological defect common to these patients is suggested.
PRELIMINARY REPORT
Authors: Chu J. , Clements J. A. , Cotton E. , Klaus M. H. , Sweet A. Y. , Thomas M. A. , Tooley W. H.
Published: December 2021

HYALINE MEMBRANE DISEASE, or idiopathic respiratory distress syndrome, is the commonest cause of death in the newborn. Although it has been the subject of much investigation, its etiology and pathogenetic mechanisms have remained obscure. Accordingly, there are several theories about its causation and many opinions about its optimal therapy, some of these seemingly contradictory. As a result of recent studies, both our own and those of others, we believe that we have gained sufficient new insight into the functional basis of this syndrome to select therapeutic procedures more rationally than before and to suggest that the syndrome be renamed the pulmonary hypoperfusion syndrome.

We believe that the syndrome reflects the calling into action of reflex vasoconstriction which tends to centralize the circulation of the blood when the fetus or newborn infant is subjected to one or more of several stresses, such as hypoxemia, acidemia, hypothermia, and hypovolemia. This type of response has been observed in several animal species and tends to preserve blood flow to the brain, heart, and placenta at the expense of flow to other organs, especially the gut, the kidneys, and the lungs and has survival value in the presence of these stresses. Since the ductus arteriosus is patent in the fetus and newborn infant, however, blood flow to the alveolar capillaries may be virtually cxeluded by pulmonary vasoconstriction, and ischemic damage is more likely in the lungs than in other organs. It is for this reason that we prefer to emphasize the occurrence of pulmonary hypoperfusion in this syndrome.
THE BI-DIRECTIONAL PLACENTAL TRANSFER OF I131 3:5:3' TRIIODOTHYRONINE IN THE RHESUS MONKEY
Authors: Schultz Marvin A. , Forsander Jean B. , Chez Ronald A. , Hutchinson Donald L.
Published: December 2021

The placental transfer of I131-labeled triiodothyronine has been studied in Rhesus monkeys. The majority of maternal to fetal placental transfer of radioactivity was in the form of iodide and a chemically unrecognized compound on chromatograms. Only traces of triiodothyronine or thyroxine were detected. In the fetal to maternal transfer studies, triiodothyronine was more readily transferred into the maternal circulation with small amounts of iodide and a similar unknown compound appearing. This substance may be sulfate conjugated triiodothyronine. There was a considerably higher concentration gradient used in the fetal to maternal transfers than in the reverse direction. The implications of this gradient difference are discussed.

The data from this study add further evidence to the clinical experience that maternal thyroid hormones are not readily available to meet all of the fetal needs during the latter part of pregnancy.
International Conference on Intrauterine Fetal Surgery
Authors: LUCEY JEROLD F. , FRIEDMAN EDWARD
Published: December 2021

A NUMBER of research workers in obstetrics, pediatrics, physiology, hematology, pathology, internal medicine, immunology, aerospace medicine, and veterinary science are currently working on problems involving surgical approaches to the fetus in utero. To stimulate and facilitate communications between research workers interested in this new field, a small workshop conference was held in Stowe, Vermont, November 9-11, 1964. This conference was supported by a research grant (HD-01151-01) from the National Institute of Child Health and Human Development and was jointly sponsored by the University of Vermont College of Medicine and the Vermont State Health Department.

Three of the papers presented at this conference, and the discussion that followed their presentation, have been selected for rapid publication in this journal because of their immediate clinical interest.

The first step toward direct treatment of the human fetus has already been made. It can be anticipated that others will follow. The commonly held myth that one cannot study or treat the fetus without seriously jeopardizing survival will be examined much more critically in the future.

Who will be the physician for the fetus of the future remains to be determined. A successful answer will almost certainly require close co-operation between many specialties.
IMPAIRMENT OF INTESTINAL HYDROLYSIS OF LACTOSE IN NEWBORN INFANTS
Authors: Boellner Samuel W. , Beard Alice G. , Panos Theodore C. , Ross Ann
Published: December 2021

A total of 122 oral lactose, glucose, glucose-galactose, and intravenous galactose tolerance tests were performed on 38 premature infants age 0-44 days and on 11 term infants age 0-3 days with the following conclusions:

1. Median fasting blood glucose levels were lower in premature infants than in term infants; values in premature infants rose steadily from 36 mg/100 ml in infants less than 3 days of age to 70 mg/100 ml in infants over 15 days of age.

2. Following orally administered lactose, 30- and 60-minute increments in blood glucose values were significantly less in premature and term infants younger than 3 days than in older infants. This was not true following oral administration of glucose.

3. In premature infants 0-3 days of age, 30- and 60-minute increments were significantly less following lactose than after either glucose or glucose-galactose. After 2 weeks of age, lactose tolerance tests were similar to glucose tolerance tests.

4. Intravenous galactose tolerance tests showed competent conversion of galactose to glucose in all age groups.

5. Significantly greater increments in blood glucose values were observed in premature and term infants less than 3 days of age when lactase was introduced into the duodenum prior to lactose administration.

From the present study, it appears that hydrolysis of lactose in the intestine of the newborn infant is relatively impaired during the first few days of life. Further studies with quantitative assays of lactase activity in the intestinal epithelial cells will be necessary to determine whether an absolute insufficiency of lactase exists at birth.
CARDIODYNAMIC STUDIES IN THE NEWBORN
Authors: Rudolph Arnold J. , Vallbona Carlos , Desmond Murdina M.
Published: December 2021

Patterns of instantaneous heart rate were studied in 74 premature infants with idiopathic respiratory distress syndrome. Half (50.3%) of the recordings showed this finding during the course of the disease. It was found most frequently during the first 24 hours after birth. This finding is reversed in recovering infants.

Based on present data, persisting fixation of the heart rate in an infant with idiopathic respiratory distress appears to be indicative of a poor prognosis, whereas the presence or return of fluctuations in the recording of such an infant may permit a more favorable outlook.
CARDIODYNAMIC STUDIES IN THE NEWBORN
Authors: Vallbona Carlos , Rudolph Arnold J. , Desmond Murdina M.
Published: December 2021

This study was undertaken to evaluate the degree of changes in instantaneous heart rate of 60 premature infants who did not have respiratory distress. The majority of infants exhibited fluctuations in cardiac frequency which were not as marked as those reported in the healthy term neonate; an observation more evident in the premature infant of less than 1,250 gm in birth weight. The findings suggest (a) that there is cardioregulatory activity even in the very small premature infants and (b) that the cardioregulatory centers of the premature are not as responsive as those of the newborn at term.
AGANGLIONIC AND FUNCTIONAL MEGACOLON IN CHILDREN—A DIAGNOSTIC DILEMMA
Authors: Kottmeier Peter K. , Clatworthy H. William
Published: December 2021

Megacolon in early infancy and childhood may be due to a number of causes. The proper treatment must necessarily depend upon the accuracy of the diagnosis as to etiology in each patient. We have reviewed our cases of functional megacolon, i.e., "meconium plug syndrome," "acquired constipation," or "colonic inertia" and have encountered examples of unnecessary enterostomy, colostomy and/or pull-through procedures which were performed for what appeared to be congenital aganglionic megacolon. We have also observed numerous examples of prolonged unproductive conservative treatment in patients who were subsequently proven to have aganglionic megacolon. A review of the conventional signs and symptoms and radiographic studies which were carried out on these patients suggests that these observations alone are insufficient to establish a diagnosis and allow for definitive therapy. The full thickness rectal wall biopsy has, by contrast, been an extremely valuable diagnostic aid. At the present time, we do not feel that a definite diagnosis can be established without rectal biopsy which, when properly performed and studied by an experienced pathologist, will differentiate between patients who require major surgery and those who may be expected to respond to conservative medical management.
ENDOGENOUS RENAL CLEARANCE RATES OF FREE AMINO ACIDS IN PRE-PUBERTAL CHILDREN (Employing an Accelerated Procedure for Elution Chromatography of Basic Amino Acids on Ion Exchange Resin)
Authors: Scriver Charles R. , Davies Eluned
Published: December 2021

Six male and three female children in good health and between the ages of 3 and 10 years were studied. Fasting plasma concentrations and urine excretion rates of free amino acids were measured using automated ion exchange chromatography, utilizing a modified method for analysis of the basic amino acids. Endogenous clearance rates and net tubular absorption of plasma amino acids were also calculated.

The plasma concentration of free amino acids is generally slightly lower than in the adult subjects and renal clearance rates are slightly higher. Less than 5% of the filtered amino acid load is excreted in the urine. Intra-individual variation tends to be smaller than inter-individual variation.
WHOSE CHROMOSOMES TO COUNT IN MONGOLISM?
Authors: McKay R. James
Published: December 2021

Every physician who must make decisions in the management of a child with Down's syndrome faces the problem of whether or not chromosomal analyses should be done and, if so, upon which members of the family. The purpose of such analyses is the identification of those individuals who may be expected to have an increased incidence of mongolism among their offspring as a result of a translocation of a 21 chromosome, a 21 isochromosome, mosaicism for 21-trisomy, or 21-trisomy itself. However, the high cost and difficulty of obtaining chromosomal analyses require that their number be kept to the minimum necessary, and that appropriate short cuts in the laboratory method also be applied whenever possible. The following paragraphs will attempt to lay a base for, and to outline, a logical and practical approach to the chromosomal screening of relatives of patients with Down's syndrome.

Table I lists various parental abnormalities involving the 21 chromosome, together with the theoretical proportion of cases of mongolism to total live births for each. In considering this table, the reader should keep in mind that it refers to an estimated 1 or 2% only of parents of patients with Down's syndrome. In an estimated 98-99% of instances, both parents are chromosomaliy normal.

Although the observed proportion of cases of mongolism to total live births approximates the theoretical ratio among the infants of mothers with the phenotype characteristic of Down's syndrome, the observed proportion is lower than the theoretical ratio among the children of parents with a normal phenotype and a chromosomal abnormality predisposing to mongoloid offspring.
The Value of the Tuberculin Skin Test as a Screening Test for Tuberculosis among BCG-Vaccinated Children
Authors: Lifschitz Martin
Published: December 2021

Results of tuberculin testing of 250 Navajo infants and children, vaccinated as newborns with Rosenthal BCG is reported. The incidence of strong reactors to 5 TU of PPD is very low after one year. It is suggested that tuberculin testing of BCG-vaccinated children as screening for tuberculosis, under the conditions outlined above, is both feasible and practical. Three cases of primary pulmonary tuberculosis so discovered are reported.
A Case Report of "Cape Cod" Rocky Mountain Spotted Fever with Multiple Coagulation Disturbances
Authors: Atkin M. David , Strauss Herbert S. , Fisher George U.
Published: December 2021

A case of "Cape Cod" Rocky Mountain Spotted Fever complicated by thrombocytopenia, circulating anticoagulant activity, and deficiency of Vitamin K-dependent clotting factors that responded to the intravenous administration of Vitamin K has been presented. To our knowledge, this is the first such case described.

Coagulation studies supported, in part, by grants from the Wimpfheimer Foundation and the John A. Hartford Foundation.

We are indebted to Dr. Sherwin V. Kevy of the Children's Hospital Medical Center for performing tests of fibrinolysis and to Dr. Edward S. Murray of the Department of Microbiology of the Harvard School of Public Health for his assistance in the isolation of Rickettsia and the performance of the serologic tests for diagnosis.
Genetics and Disease, Alfred G. Knudson, Jr. New York: McGraw-Hill Book Company, 1965, 294 pp., $10.50
Authors: Gerald Park S.
Published: December 2021

The current interest in genetics has resulted in the recent appearance of numerous reviews and monographs on the subject. Many of these have been of such a general approach that hey are difficult for the clinician to translate no terms useful at the bedside. This condensed treatise by Dr. Knudson is one of the few which attempts to perform this translation.

Readers are guided systematically from the basic concepts of Mendel's "Laws of Inheritance" through almost the entire range of clinically applicable genetics, up to and including the regulatory models proposed by Jacob and Monod.
Red Urine (Continued)
Authors: Trimble George X.
Published: December 2021

Dr. S. Levin of Johannesburg, South Africa, in his contribution "Red Urine: The Monday Morning Disorder of Children" (Pediatrics, 36: 134, 1965) remarked: "Over the past 20 years he Index Medicus does not list the phenomenon of red urine as a consequence of the ingestion of colored food."

Whether his statement is a reflection of inadequate survey of the medical literature by Index Medicus, or of the difficulty of making an accurate search by Index Medicus of the medical literature over a 20-year span, I am nable to say.
TOWARD A NEW DIMENSION IN HUMAN GROWTH
Authors: Forbes Gilbert B.
Published: December 2021

It is with a deep sense of appreciation that I accept this honor, and proudly join the roll of distinguished Borden Awardees. In doing so, I should like to pay special tribute to two of my mentors—Dr. William Bradford and the late Dr. Alexis Hartmann—who stimulated and encouraged me in my work, and more importantly, gave me time in which to pursue it; and to Dr. John Hursh, of the University of Rochester Atomic Energy Project, for his most generous collaboration.

The measurement of human subjects in systematic fashion is a recent innovation, dating only to the early nineteenth century. This period also marked the rise of modern chemistry, and by mid-century von Liebig had found that sodium was the principal cation in body fluids while potassium was predominant in cells, and Carl Schmidt had analyzed blood serum in great detail.

The year 1857 saw the publication of one of the first attempts to analyze the body as a whole. The young author, Albert von Bezold*, analyzed the bodies of small animals for water, solids, and ash1, and announced as a result of his findings a fundamental concept in regard to tissue composition, namely, that animals possess water, organic matter, and ash contents which are characteristic of species and age. He found that growth was accompanied by a decrease in percentage of water and an increase in ash; and further that these changes occurred more rapidly in the early phases of the growth process. Similar trends in composition were predicted for man.
Pageant of Toys, by Mary Hillier. London: Elek Books, 1965, 155 pp., 50s
Authors: Cone Thomas E.
Published: December 2021

This charming, beautifully illustrated book would be enjoyed just as much by the pedaitrician's wife as by the pediatrician. It is one of those books all of us occasionally come across which appeal not only to the nostalgic, sentimeiltal side of our lives but also fill a gap in our knowledge of how and what children did with their playtime in the past. The author shows clearly how important a study of toys would be if we were to try to understand the social history of children.
PRESIDENT'S ADDRESS
Authors: TOWSLEY HARRY A.
Published: December 2021

IN Ancient Greece, the change of one generation of the Olympic games to the next was symbolized by the passing of a torch, the flame of which was never allowed to die.

We have a ritual in our Academy wherein the president, when he retires, passes on a report of the accomplishments of his presidential year and the new president catches the torch and carries forward the flame in what I hope will be a never ending ascension of our traditions.

My predecessors were men of dedication and experience in our profession, and they accounted for their stewardship in the final rite with words of grandeur and wisdom. Some of you have heard most, if not all, of the presidential addresses that have been given since our Society was founded in Detroit, 35 years ago. Knowing this, I approach this moment with some trepidation and with a humble spirit, but with the conviction that I must say the things to you that are in my heart and mind.

Before I go further, I must acknowledge that my ascension to this highest honor that may come to any pediatrician came unexpectedly because of the passing of our friend and colleague, who had been nominated to serve this year. The passing of Harold Flanagan and Frank Douglass, your last president, was a sad loss to the Academy, for in their lives they practiced the precepts of the Academy and its founding principles. We sincerely memorialize their many contributions to the cause of children's health and their love of humanity.
Congenital Malformations, Papers and Discussion Presented at the Second International Conference. New York: The International Medical Congress, Ltd., 1964
Authors: NORMAN A. P.
Published: December 2021

This collection of the papers and discussion presented at the Second International Conference on Congenital Malformations fills the reader with awe and admiration for the immense strides made in the past few years in knowledge of this subject. Such an accumulation of learning, however, makes much of the book way beyond the capacity of the ordinary clinician, such as the reviewer, to fully understand, or at least to retain clearly in his mind.

A lengthy first section deals with the chromosomes and their abnormalities and ably demonstrates how far research has gone in this field; perhaps it also demonstrates the limitations of the visual method of hunting for variations in chromosome appearance; its application in clinical medicine does tend to recall the old gibe about stamp collecting.
DELAYED CLOSURE OF THE DUCTUS ARTERIOSUS IN PREMATURE INFANTS
Authors: Danilowicz Delores , Rudolph Abraham M. , Hoffman Julien I. E.
Published: December 2021

Five premature infants with delayed closure of the ductus arteriosus have been presented. In 3 of these infants, hemodynamic data from serial cardiac catheterization studies document a decrease in left-to-right shunt through the ductus with clinical evidence of spontaneous closure.

The possible roles of inadequate muscular development of the ductus, hypoxemia, the degree of prematurity, and the association of neonatal complications in delayed closure are discussed.
CARINAL TRIFURCATION WITH CONGENITAL TRACHEOBILIARY FISTULA
Authors: Stigol Luisa C. , Traversaro J. , Trigo E. R.
Published: December 2021

This report calls attention to an uncommon fistula presenting clinically with yellow bile-stained sputum and demonstrable by endoscopic examination. When the diagnosis is made, therapy requires surgical extirpation of the fistulous channel.
The Immune Response of Children with Chronic Lymphocytic Thyroiditis to a Viral Challenge
Authors: Root Allen W. , Bongiovanni Alfred M. , Eberlein Wanlter R.
Published: December 2021

Twenty-eight children with CLT and 22 control subjects were immunized with an adenovirus vaccine. The mean anti-Adenovirus Type 7 titer after vaccination in the group with CLT was significantly less than that in the control group. No significant changes occurred in anti-thyrold antibody titers consequent to the immunization. Patients with CLT had higher mean anti-A and anti-B titers than did control subjects. It is concluded that patients with CLT do not hyperrespond to a viral challenge.
COMMUNITIES IN ACTION
Authors: Richmond Julius B.
Published: December 2021

As a result of the summer experience certain inferences may be drawn:

1. There is great interest—latent until now—in our communities in the health, education, and welfare of our young children.

2. Communities have shown remarkable resourcefulness and energy in developing comprehensive programs for young children.

3. Communities have demonstrated a remarkable capacity to mobilize in a short period of time.

4. Professionals of various disciplines have a deep commitment to applying what they know about the needs of children when offered the necessary support.

5. Alternate administrative patterns make possible a variety of programs and local options which are highly desirable at this stage of our knowledge.
THE FALLACY OF THE FAT IRON-DEFICIENT CHILD
Authors: Judisch J. M. , Naiman J. L. , Oski F. A
Published: December 2021

The charts of 156 children with nutritional iron-deficiency anemia were reviewed to re-examine the popular impression that such children are usually fat. Instead, a marked preponderance of underweight children was found. Treatment with iron resulted in accelerated weight gain in these children, producing a normal distribution curve. Growth curves prior to the diagnosis of iron-deficiency anemia showed a common pattern of early rapid weight gain with subsequent slowing as the anemia developed.
Experíence and Reason Briefly Recorded
Authors: LAFER CHARLOTTE Z. , MORRISON ALAN N.
Published: December 2021

Amegakaryocytic thrombocytopenic purpura in association with the unusual finding of a transient hypoplastic anemia is reported. The hematologic abnormalities completely disappeared despite the persistence of rubella virus to age 7 months. The influence of concurrent steroid administration cannot be evaluated.
The Emotionally Battered Child
Authors: ISAACSON EDWARD K.
Published: December 2021

I have been observing the attitude of victory in the actions and statements of fellow pediatricians lately concerning the achievement of the goal of legislative action taken by the several States in the implementation of laws regarding the "Battered Child." I can say with pride that this action is long overdue in a population that cannot logically control its actions at all times for or against other human beings.

This legislative action and pediatric "victory." to me, is only the first phase of the protection of the entire child.
Letters to the Editor
Authors: ROBINAULT ISABEL P.
Published: December 2021

Thank you for bringing to the attention of the editor of Pediatrics that 47 states now protect children from being battered. Although my letter which quoted 20 states was published in July, it had been written in December 1965. At that time, the excellent statement of February 1966, had not been published yet by Pediatrics.

Your vigilance is most appreciated since it is only by combined effort that sustained change will take place for the benefit of all children.
Heart Disease in Children: Diagnosis and Treatment
Authors: FASHENA GLADYS J.
Published: December 2021

This 5½ lb tome is the most detailed and comprehensive treatise on nearly all aspects of pediatric cardiology yet to be published. It is based on 1,943 carefully studied personal cases of the authors and represents the distilled experience of two eminent pediatric cardiologists as well as one of the country's outstanding cardiac pathologists. A few chapters are written by associates of the authors, each an authority on the subject matter of the chapter prepared.
EXPERIMENTS OF NATURE INVOLVING BRANCH-CHAIN AMINO ACIDS
Authors: S. C. R.
Published: December 2021

RESEARCH which goes to the core of the problem directly and with finesse can elicit admiration. The investigation reported in this issue by Dancis and colleagues will find a number of readers experiencing such appreciation.

Hypervalinemia has been reported in only one infant in the world, but rarity is not the reason for its interest; this "experiment of nature," discovered as if by accident, has been a most informative disease. Working with as little as 2 ml of blood taken from the patient, Dancis and colleagues studied the metabolism of valine in the white cells in the sample. The simplicity of the "biopsy" and the elegance of the isotope methods are most exemplary.
GALACTOSE METABOLISM IN THE NEWBORN INFANT
Authors: Donnell George N. , Ng Won G. , Hodgman Joan E. , Bergren William R.
Published: December 2021

A marked increase was noted in the production of labeled carbon dioxide from galactose-1-C14, and a lesser increase from glucose-1-C14, by erythrocytes of newborn infants as compared to those of adults. It is considered that the increased metabolic activity reflects a greater capability of erythrocytes of newborns to phosphorylate the particular sugars.

Estimates were made of galactose-1-phosphate uridyl transferase and galactokinase activities of intact erythrocytes by incubation with galactose-1-C14. Intracellular transferase activity, as measured by the ratio of labeled galactose-1-phosphate to labeled uridine diphosphate galactose, correlated with hemolysate measurements, but the amount of labeled nucleotide alone did not. Intracellular galactokinase activity correlated with hemolysate values provided that galactokinase activity was considered to be represented by the sum of the galactose-1-phosphate and nucleotide produced during incubation with galactose.

The rate of removal of galactose from the blood of newborns after intravenous administration was slower than with adults. However, the rate of disappearance cannot be considered to reflect galactose utilization until more is known concerning regulatory factors in the newborn infant.
EFFECT OF SEDATION ON OXYGEN CONSUMPTION OF CHILDREN UNDERGOING CARDIAC CATHETERIZATION
Authors: Baum David , Brown Arthur C. , Church Sue C.
Published: December 2021

A study of oxygen consumption following sedation was performed in cardiovascular patients between 1 month and 5½ years of age. Oxygen consumption fell in all 17 subjects during cardiac catheterization (average fall 34%). Four of these children underwent a second study with similar sedation but without catheterization, and all demonstrated a fall in oxygen consumption (average fall 25.9%). This drop was particularly marked in the younger children. The change in oxygen consumption following sedation followed a roughly consistent pattern, reaching a minimum in ½ to 2 hours (generally shortly after the cardiac catheter was introduced into a blood vessel) and returning to control levels as blood was sampled and the procedure was completed. Thus, when using cardiac catheterization and the Fick principle to calculate cardiac output, simultaneous measurement of oxygen consumption and blood sampling is essential to obtain accurate results in the sedated child.
COMPLICATIONS OF SMALLPOX VACCINATION UNITED STATES 1963
Authors: Neff John M. , Levine Ronald H. , Lane J. Michael , Ager Ernest A. , Moore Helen , Rosenstein Beryl J. , Millar J. Donald , Henderson Donald A.
Published: December 2021

Four thousand nine hundred physicians in four states, representing 4.8% of the population of the United States, were surveyed in order to assess the frequency and types of complications that occurred during 1963 in association with smallpox vaccination. Four hundred ninety-one physicians initially reported observing 810 complications during this year. On follow-up of these cases, many were not actually complications or were complications that occurred in a year other than 1963.

Accidental infection was the most common complication. Generalized vaccinia and eczema vaccinatum occurred at a frequency of 238 and 80, respectively, per million primary vaccinations. Severe complications were infrequent. No deaths and only one case each of post-vaccinal encephalitis and vaccinia necrosum were detected. The high frequency of many preventable complications and the disproportionate frequency of complications in infants suggest that morbidity and mortality now associated with smallpox vaccination could be significantly reduced if primary vaccination could be deferred until after the first year of life and if more care were taken to detect individuals in whom complications can be expected to occur.
THE DIAGNOSIS AND MANAGEMENT OF BRONCHIOLITIS
Authors: Holdaway D. , Romer A. C. , Gardner P. S.
Published: December 2021

We have described our concept of bronchiolitis—an acute epidemic disease of infants and young children with obstruction of terminal bronchi and bronchioles, secondary hypoxia, and exhaustion. RSV is the commonest virus to invade the lower respiratory tract in young children. This probably explains the high incidence of this organism in bronchiolitis, but a control population is necessary for interpretation of the virus isolations. Only four RSV infections were found in 295 children (1.4%) without respiratory disease compared with 124 in 211 children (59%) with bronchiolitis. Neither adenoviruses nor other viruses were isolated from the cough swabs of "control children." This confirms not only the etiological significance of RSV in bronchiolitis but also suggests that adenoviruses isolated in this disease may also be causally related. Treatment is described and we accept in spirit, if not in detail, the judgment of Reynolds and Cook that "oxygen is vitally important in bronchiolitis and there is little conclusive evidence that any other therapy is consistently or even occasionally useful." The indications for the correct, and sometimes necessary, use of antibiotics need more precise definition by therapeutic trial and a better understanding of the causes of death in this disease.
Pediatric Consultation in a Public Mental Hospital
Authors: BOVERMAN HAROLD , MENDELSOHN ROBERT S.
Published: December 2021

The number of children in state mental institutions is inevitably increasing. At the same time it is increasingly difficult to generate enough staff adequate for caretaking, training, and supervision. There are no instant solutions to this problem; no hidden panaceas that might make it right soon. Hoping for some partial help, it makes sense to review the place of the pediatrician in the state mental hospital and the hospital's traditional sources for program design as well as staff training and supervision.

Such hospitals were designed for adults. In addition, they both benefit and suffer from a massive tradition and inertia.
Nomenclature, Duration of Gestation, Birth Weight, Intrauterine Growth Dissenting Views
Authors: YERUSHALMY J.
Published: December 2021

Thank you for letting me see an advance copy of the Fetus and Newborn Committee's report on nomenclature and for the opportunity to comment on it. I believe that the overall effect of the report is to substitute gestational age for birth weight in classifying the newborn. This conclusion follows from a number of statements in the report, but mostly because a specific designation ("pre-term") is provided for short gestation and none for low birth weight. If the recommendations are followed, "pre-term" will replace "pre-mature" and short gestation will become the major criterion.
Letters to the Editor
Authors: FISCHER CARL C.
Published: December 2021

The Council on Pediatric Practice has, as Dr. Wineberg states, gone on record as recognizing the increasingly important role of ambulatory care programs in the pediatrics of the future.

We do not, however, share his pessimism for steps in this direction are not only rapidly coming but also, in many of our teaching institutions, are already here.

Dr. Wineberg seems to imply that the department chairmen are the major influence in delaying the evolutionary process. Rather, it seems to me practitioners and teachers alike must work together to show the pediatricians of the future the importance of this major portion of pediatric practice not only through improving the quality of both the staff and the faculties of these services but through curricular changes designed to demonstrate both the need for and the benefits of experience in this area.
Skin Dimples
Authors: TUTTLE ROBERT
Published: December 2021

In Doctor Keith Hammond's brief report concerning skin dimples and rubella1 in the February issue of Pediatrics he states that no one has reported a peculiar, discrete, deep dimpling of the skin over the patella and certain bony prominences as a physical finding of early infancy.

This statement is somewhat unusual in that this phenomena has been well described by Doctor Caffey and is well illustrated in his textbook of Paediatric X-ray Diagnosis, fourth edition, where these characteristic dimples have been seen in infants suffering from prenatal bowing which commonly regresses during early childhood.
School Excuse Card
Authors: WOLF I. J.
Published: December 2021

The amount of paper work in pediatric practice is increased by the number of excuses that have to be written for patients who are out of school due to illness, who are delayed in the office during school hours, or who have to be excused from physical education.

In order to reduce the necessary amount of paper work, the author has devised the illustrated School Excuse card.

Pediatricians may have the same card printed up by their own printers or may request the name of the author's medical stationery service.
AN EVALUATION OF ELECTROENCEPHALOGRAPHY IN THE DIAGNOSIS OF BRAIN TUMORS OF CHILDREN
Authors: DRUMHELLER JOHN F. , KEITH HADDOW M. , BICKFORD REGINALD G.
Published: December 2021

A study was made of the electroencephalograms of 50 children who had proved neoplasms of the brain. In 9 of 12 children who had tumors of the cerebral cortex, the localization afforded by the EEG was correct. In 8 children who had supratentorial tumors of or near the brain stem no localizing or consistent electroencephalographic pattern was observed.

In 21 (70%) of 30 children who had tumors of the posterior fossa a bilateral abnormality was observed in the EEG recorded from the occipital region or occipital and contiguous regions.

It is acknowledged that the abnormality found in this last group also is found occasionally in conditions other than in brain tumors of the posterior fossa. These conditions usually can be excluded by use of the history and other laboratory aids.

Electroencephalography in the study of brain tumors in children should not be considered as an infallible test but rather as a diagnostic aid to be used and evaluated with the help of a clinical history and other diagnostic and laboratory aids.