bluuebunny/crossref_metadata_2025 huggingface dataset:
THE PHYSICIAN, THE BATTERED CHILD, AND THE LAW
Authors: Harper Fowler V.
Published: December 2021

THE PROBLEM of physical and mental injuries inflicted on infants and small children has increasingly attracted the attention of physicians and welfare workers within the past few years. A bibliography prepared by the Children's Bureau in August of last year compiled a substantial number of scholarly articles in scientific journals dealing with abused children. Careful case studies reveal the seriousness of the problem, and several surveys, its extent. What informed persons have suspected and what many doctors and social workers have believed, has been demonstrated, viz., that parents too often are their children's worst enemies. It may be because one or more parent is psychotic, of extremely low intelligence, of uncontrollable temper, or was himself an abused child with serious psychiatric after-effects. The assumption that, generally, a child is "better off" in the home, surrounded by the loving care of his parents is no doubt sound enough, but the exceptions are sufficiently numerous to warrant more attention by appropriate agencies and professional individuals, public and private, than they have received.

The Children's Bureau held two conferences devoted to this matter during the year 1962. Participants included well-qualified pediatricians, social workers, psychiatrists, lawyers, judges, juvenile court staff personnel, administrative and professional hospital staff members, and others concerned with child health and welfare. There was general agreement that the physician is perhaps the first person who will obtain knowledge of a situation involving inflicted injuries on a child, that he should report his findings to an appropriate investigating authority for further action, and that state legislation is necessary to impose a legal obligation on the physician in this regard.
POLIOMYELITIS FOLLOWING RECENT MEASLES
Authors: Bloch Aaron , Massry Shaul
Published: December 2021

Fifty-seven cases of paralytic poliomyelitis, with nine deaths, occurred in the Ashkelon district of Israel in 1958. Of these, 15 cases in patients under 4 years of age, with 4 deaths, were found to have been concentrated in the small Even-Shmuel area, which had a total of only 381 children in this age group. The high selective incidence of poliomyelitis in two of the settlements in this area, Eytan and Uza (76 per 1,000 under 4 years), stood out in contrast to neighboring and other points of settlement, where the incidence was about six to seven times lower. Data on the clinical diagnosis, virology, Salk and other inoculations and injections, as well as nutritional and possible ethnic factors, were carefully considered in an attempt to understand the reason for this concentration. The major finding was that 12 of the 15 children with poliomyelitis had had severe measles some weeks previously. Clinical and epidemiologic data suggesting an association between the two illnesses are discussed. The scanty literature on an association between measles and poliomyelitis is reviewed.
SPONTANEOUS FUNCTIONAL CLOSURE OF VENTRICULAR SEPTAL DEFECTS IN FOURTEEN CHILDREN DEMONSTRATED BY SERIAL CARDIAC CATHETERIZATIONS AND ANGIOCARDIOGRAPHY
Authors: Agustsson M. H. , Arcilla R. A. , Bicoff J. P. , Moncada R. , Gasul B. M.
Published: December 2021

Spontaneous functional closure of ventricular septal defect, demonstrated by serial hemodynamic and angiocardiographic studies, in 14 patients, is reported. The typical holosystolic murmur disappeared in seven patients, and was replaced by an insignificant basal, ejection, systolic murmur in five of them. In the other seven patients the holosystolic murmur persisted, but decreased in intensity. On initial cardiac catheterization a left-to-right shunt at ventricular level was demonstrated in all 14 patients from oxygen saturation data and by angiocardiography. On subsequent cardiac catheterizations performed 13 months to 6 years later, no shunt was shown by oxygen saturation data and only by selective dye dilution studies and left ventricular angiocardiography was a small shunt demonstrable in six cases. Our findings substantiate the views and experiences of others that in some ventricular septal defects, which may occasionally be so large as to result in heart failure in infancy, spontaneous closure does occur. The possible mechanism for this closure is discussed. With this information added to our total experience with ventricular septal defects, we favor a conservative attitude in recommending surgical intervention in infants with this entity.
RHEUMATIC FEVER: THE PROBLEM OF DIAGNOSIS BASED ON INSUFFICIENT EVIDENCE
Authors: Blackman Norman S.
Published: December 2021

In 100 patients referred for consultation with a history of rheumatic fever and/or rheumatic heart disease, only 65 had a history of signs and symptoms sufficient to satisfy the modified Jones' criteria, used for guidance in the diagnosis of rheumatic fever. Moreover in patients without evidence of rheumatic heart disease referred because of a supposed history of rheumatic fever, the diagnosis could not be justified in one of every four children in this study. Many of the important manifestations of rheumatic fever do not require technical knowledge but merely interested and intelligent observation. The parents were found to be the most available and often the best source of information concerning a description of the manifestations of a previous episode of rheumatic fever. It is evident that the modified Jones' criteria are not being sufficiently used by the referring physicians as a guide in making a diagnosis. Clinical over-diagnosis was frequently encountered. Furthermore, there was a marked tendency for subsequent treating physicians to accept, and to perpetuate, a false "history of rheumatic fever" without critical evaluation. Obviously, whenever possible, the history should be justified by eliciting in detail the signs and symptoms observed in the past. Historical data must be obtained and compared with acceptable criteria for diagnosis, for the intelligent management of the patient depends upon such evaluation.
ROLE OF A SOCIAL WORKER IN A PRIVATE PRACTICE OF PEDIATRICS
Authors: Wishingrad Lester , Shulruff Joseph T. , Sklansky Alice
Published: December 2021

Experience with the use of a part-time social worker in a private pediatric practice for one year is presented. The medical team, including a caseworker, with the physician as the manager, is acceptable in private practice. With the aid of a caseworker a fuller service may be rendered to the patient. The patients who have the best relationship with the pediatrician are most likely to benefit from this program.

Unlike many other aspects of pediatric practice, dealing seriously with emotional and social problems does not automatically produce dramatic results. Much work is required for rewarding success. With the aid of a well-trained, mature, social worker, the pediatrician does more counseling rather than less. Pediatric practice becomes more exciting and gratifying.
CLOSURE OF THE DUCTUS ARTERIOSUS IN THE NEWBORN INFANT
Authors: Moss Arthur J. , Emmanouilides George , Duffie Edward R.
Published: December 2021

Hemodynamic observations were made in 71 normal newborn infants up to 60 hours of age. A right-to-left or bidirectional shunt through the ductus arteriosus was demonstrated in 8 of 63 infants. Evidence of a definite left-to-right shunt was found in 7 of 30 infants. The data indicate that a bidirectional shunt is present shortly after birth and may persist for as long as 6 hours. This eventually becomes entirely left-to-right, and by 15 hours of age the shunting of blood either becomes physiologically insignificant or ceases entirely.
APLASIA OF THE TRACHEA
Authors: Witzleben C. L.
Published: December 2021

A case of tracheal aplasia is described, and the literature concerning this rare anomaly is reviewed. The lesion has so far been uniformly fatal. Infants with this condition have severe early respiratory distress and may present a difficult problem in laryngeal intubation. In five of the seven cases in which the sex was noted, the infant was male. Only one of the infants has had significant associated anomalies. The constant anatomic feature is the absence of the trachea from the cricoid to or slightly above the level of the main stem bronchi. At this point a fistula with the esophagus is usually present. The larynx may or may not be defective. The lesion appears to be an aplasia rather than an atresia. The immediate administration of nasogastric oxygen is indicated when the anomaly is suspected. This may allow sufficient time for corrective surgery to be attempted.
PROGRESS OF PREMATURE INFANTS FED A FORMULA CONTAINING DEMINERALIZED WHEY
Authors: Barness Lewis A. , Omans Walter B. , Rose Catharine S. , György Paul
Published: December 2021

One hundred fifty-two premature infants were fed a formula in which the protein was partially derived from demineralized electrodialyzed whey. The resulting formula has the same fat, carbohydrate, and protein content as the other commercially available "simulated human milks," but 50% of the protein is from whey and the total electrolyte load is lower. In consequence the total osmolar load is considerably reduced. Studies of infants fed this new formula were compared with studies using a "simulated human milk."

The new formula was well accepted. The infants grew well in weight and height. Values for blood urea nitrogen, and total protein and phosphorus in serum, were the same for both formulas. Slight but significant differences were found in cholesterol, albumin, and gamma-globulin levels. The difference in the food efficiency ratio between the two formulas was not statistically significant.
VIRILIZATION ACCOMPANYING HEPATOBLASTOMA
Authors: Behrle Franklin C. , Mantz Frank A. , Olson Robert L. , Trombold James C.
Published: December 2021

A case of hepatoblastoma associated with virilization in a 3-year-old boy is presented. Three additional cases culled from the literature are discussed to point out the striking similarities in this group. Their distinctive character allows differentiation of this disease from other causes of isosexual precocity in the male child. Interesting findings in the pituitary glands of two of the children raise questions as to the nature of the gonadotropin involved in the virilization process.
RESEARCH ON PREMATURE INFANTS—SOME PERSPECTIVES
Authors: LEVINE S. Z.
Published: December 2021

THERE ARE A number of reasons why I appreciate deeply your invitation to join in these dedication exercises of the Clinical Research Center for Premature Infants. This Center for the care and study of premature infants extends to the West Coast a field of study in which I, on the East Coast, have been interested for many years. Equally gratifying is the circumstance that it will have Dr. Norman Kretchmer, my long-time colleague and good friend, as its Principle Investigator; and Dr. Sumner Yaffe, his distinguished associate, as its first Program Director. Under their direction and with a team of competent workers, with splendid facilities and an adequate budget, we are assured of imaginative exploration and new approaches to the many unknowns still awaiting solution.
THE ACADEMY AND CHARLIE BROWN
Authors: S. C. A.
Published: December 2021

THE Scientific Session of the Northern California Chapter of the American Academy of Pediatrics was addressed on May 25 (after dinner) by Charles M. Schulz, creator of the comic strip called Peanuts. Mr. Schulz, whose small characters have become in a sense the neighborhood children of people everywhere, resides in Northern California and is thus the actual neighbor or fellow-townsman of several fortunate and alert members of the group to whom he spoke. Dr. Charles Peck, in an appreciative and neighborly introduction, expressed local pediatric concern over the growth and development of Charlie Brown, a central member of the Peanuts group. Alarmed by their observations of head circumference and cervical anatomy (or its lack), and wishing to caution Mr. Schulz against an unsuspected hydrocephalus or an undiagnosed Klippel-Feil deformity, our Northern California brethren had gone to the trouble of having Charlie Brown drawn with 50 percentile head circumference, and at least some neck, for Mr. Schulz's guidance. A photograph of this drawing, in its unique frame, is reproduced here (Fig. 1) through the kindness of all concerned.

This commendable evidence of diligence in the practice of child health at the local level is but one reason for comments. For in the long run, the originator of these children may tell us more than we can tell him. Has not he, through Charlie Brown, already reported an interesting case in the literature? And may he not enliven and enlighten those pages as well as the newspapers? Many of those who watched and listened with delight while Mr. Schulz drew and described these children that evening must have felt, with Emily Dickinson, that "Much madness is divinest sense." The madness of Charlie Brown and the wisdom of Mr. Schulz are like that. We can learn from them.
BEHAVIORAL OBSERVATIONS ON PARENTS ANTICIPATING THE DEATH OF A CHILD
Authors: Friedman Stanford B. , Chodoff Paul , Mason John W. , Hamburg David A.
Published: December 2021

There are few tasks in the practice of medicine as difficult as trying to help the parents of a child afflicted with a disease which is invariably fatal. Since the physician cannot change the reality of the tragic situation, he frequently feels totally unable to lessen the parental suffering. However, understanding the nature of the stress as experienced by the parents, and appreciating that there are characteristic ways in which they cope with the situation, should enable the physician to offer helpful support in a majority of cases.

Forty-six parents of children with neoplastic disease were involved at the National Institutes of Health (NIH) in a study of the adrenal cortical response under conditions of chronic psychological stress and this work has been reported elsewhere.1 The present paper is concerned with the clinical impressions gained over a 2-year period while this study was in progress and the implication of these findings to physicians caring for children with similar diseases, adding to what is presently in the litenature.2-8

SUBJECTS AND GENERAL METHOD OF STUDY

The 46 subjects represented one or both parents of 27 children, all of whom had been referred for treatment with chemotherapeutic agents to the Medicine Branch of the National Cancer Institute. In all cases, the child had previously been hospitalized elsewhere for clinical evaluation, and the suggestion for referral was most frequently made by a physician at the time he communicated the diagnosis to the parents. In a minority of cases, the matter of referral was initiated at a time later in the child's clinical course.
THE NEUROMUSCULAR MATURATION OF THE HUMAN INFANT, Myrtle B. McGraw, New York, Hafner Publishing Co., 1963, 140 pp., $3.75
Authors: Byers Randolph K.
Published: December 2021

This little book (first published in 1943 and re-issued with new introduction and bibliography is a useful reminder that human neuromuscular development is not a straightforward, simple, single-line graph but is the result of waves of motor development of different sorts occurring at different stages.

The work set out to attempt to correlate various motor activities in the infant with developmental observations in the cerebral tissue of infants. While this was not effectively accomplished the observations did point out that motor development goes through various stages with waxing and waning of different types of involuntary activity, which eventuate into well-integrated motor activity.
DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS IN CHILDHOOD, H. S. Baar, Stella Baar, K. B. Rogers, and E. Stransky, New York, Hafner Publishing Company, 1963, 902 pp., $60.00
Authors: Schulman Irving
Published: December 2021

Drs. H. S. Baar and E. Stransky published in 1928 one of the first books devoted exclusively to blood diseases in children. The present volume represents an attempt by these writers and their co-authors to produce, in the face of serious obstacles, a modern text on the same subject. The senior authors have been separated from each other by vast distances and the careers of both were turned away from specialization in pediatric hematology over twenty years ago.
THE STANDARDIZATION AND INTERPRETATION OF SUBMAXIMAL AND MAXIMAL TESTS OF WORKING CAPACITY
Authors: Taylor Henry L. , Wang Yang , Rowell Loring , Blomqvist Gunnar
Published: December 2021

IT IS generally agreed by work physiologists that the capacity to perform long continued physical work in a temperate environment is related to the capacity of the cardiovascular respiratory system to deliver oxygen to the muscles (the maximal oxygen intake). Since under carefully standardized conditions in selected homogeneous groups the pulse rate at submaximal levels of work is systematically related to the maximal oxygen intake, it follows that the capacity to perform physical work can be estimated from study of the pulse rate at [SEE FIG. 1. IN SOURCE PDF.] submaximal work levels. Work physiologists have employed for this purpose, the response of the pulse rate to a standard task or have measured the amount of work required to elevate the pulse rate to predetermined pulse levels. Work physiologists have been preoccupied with the estimation of the capacity to do physical work.
THE RELATION OF CARDIOVASCULAR TESTS TO MEASUREMENTS OF MOTOR PERFORMANCE AND SKILLS
Authors: Fowler William M. , Gardner Gerald W.
Published: December 2021

Children with congenital heart disease or asthma had marked decreases in physical working capacity but only slight changes from their predicted scores in most motor performance tests. Children with early muscular dystrophy had marked decreases from expected values in both physical working capacity and motor performance tests. Fitness apparently depends on the character of the test, and a patient must be severely and acutely ill or have a neuromuscular disease before significant changes occur in motor performance tests.

Submaximal work load cardiovascular tests had a low or insignificant relationship to most tests of motor skills and performance, unless extremes of body build were eliminated or in trained subjects. Most motor performance and cardiovascular tests were highly specific with little correlation to each other, and varied in their relationship to height, weight, and physique. These variables played a minor role in motor performance tests with the possible exception of endurance events. Physical working capacity, however, correlated highly with many of these factors. Cardiovascular and motor performance tests had a similar relationship to age and sex. Both showed increases with age and a superiority of boys over girls. Physical working capacity values had less overlap at the earlier ages and less of the fluctuation or decreases in performance characterized by girls in the motor performance tests.

Reports that American children were less fit than children from other countries are contradictory and open to criticism. The results depend on the type of tests, and differences between various geographical areas in this country were often as great as the differences between European and American children, even when similar tests were used. This suggests the need to exercise caution when comparing physical fitness tests and casts doubt on the use of such data as evidence that American children are physically unfit.
Phenylketonuria and the Guthrie Test
Authors: LESSER ARTHUR J.
Published: December 2021

The report of the discussion of the California group regarding the Guthrie test (Pediatrics, September, 1963) is an unusually interesting statement and in many ways is representative of the kinds of discussions that have accompanied td the trials of the Guthrie test since it was first proposed. The report seems to be a mixture of attempts at scientific objectivity in evaluating the test as well as justifications for the course followed in California. In this way there is expressed the basic problem which is presented to physicians and hospitals generally which, I think, explains many of the objections which have been expressed regarding the Guthrie test.
A NOMOGRAM FOR THE X-RAY EVALUATION OF SOME MORPHOLOGICAL ANOMALIES OF THE PELVIS IN THE DIAGNOSIS OF MONGOLISM
Authors: Nicolis F. B. , Sacchetti G.
Published: December 2021

Some morphological anomalies of the pelvis were radiologically evaluated in 25 mongoloid children within the first year of life, in comparison with 45 normal children, through the measurements of the acetabular and iliac angles. The results were statistically analyzed according to the model of discriminant functions, and the combination of the two measurements which gives the best discrimination between mongoloid and normal children was established; on this basis, a nomogram is presented, where-by a quantitative estimation of the morphological anomalies can be made, for diagnostic purposes, without numerical calculations and with a low error.
NATAL AND NEONATAL TEETH
Authors: Bodenhoff Jessie , Gorlin Robert J.
Published: December 2021

The occurrence of natal and/or neonatal teeth is a rare anomaly, which for centuries has been associated with diverse superstitions among many different ethnic groups. The incidence of natal and/or neonatal teeth is far more frequent than previously supposed. Review of 359 recorded cases suggests an incidence of at least 1 in 3,000 births. Natal teeth are more frequent than neonatal teeth, the ratio being approximately 3 to 1. Rarely, a child will exhibit both natal and neonatal teeth. There appears to be no sex preference. Most frequently (ca. 85% of the cases), the natal or neonatal teeth are the deciduous mandibular incisors. In almost 90% of the cases, the teeth are of the normal deciduous complement. The rest are supernumerary. In about 60% of the cases, both of the natal and/or neonatal mandibular incisors erupt prematurely. Occasionally, a child may be born with a considerable number of his deciduous teeth erupted. Several such cases have been cited. About 70% of the natal and/or neonatal teeth are firmly fixed but a small number subsequently become loose. Similarly, a small fraction of those initially loose become fixed. Though the etiology is not known, approximately 15% had parents, siblings, or other near relatives with a history of natal and/or neonatal teeth. In several well-documented cases, the inheritance pattern has been that of an autosomal dominant trait. Three syndromes have been associated with natal teeth: (a) chondroectodermal dysplasia or Ellis-van Creveld syndrome, (b) oculo-mandibulo-dyscephaly with hypotrichosis or Hallermann-Streiff syndrome, and (c) pachyonychia congenita or Jadassohn-Lewandowski syndrome. Natal teeth may also be associated with cleft lip, cleft palate and cyclopia. Histologic investigation has revealed a failure of root formation despite eruption, a large vascular pulp, irregular genesis of dentin and a failure of cementum formation.
Disgruntled Pediatrician Syndrome Continued, with Improvement
Authors: CHILD STANLEY R.
Published: December 2021

It is with dismay that again we read of the "Disgruntled Pediatrician Syndrome" (Pediatrics 32:465, 1963). Lest possible future pediatricians be negatively influenced by such commentary let me add a voice of encouragement.

A pediatrician is a physician first, foremost, and always. He should never be a technician or scientist studying the young human organism. A physician is a scientist, humanitarian, teacher, counselor, and community leader.
HYPERBILIRUBINEMIA IN BREAST-FED INFANTS
Authors: Newman Arthur J. , Gross Samuel
Published: December 2021

The case records of 11 infants with prolonged hyperbilirubinemia have been presented. The elevation of indirect reacting bilirubin in these infants may be due to interference with the normal conjugating mechanism by a substance present in breast milk.

Introduction of cow's milk formulas should be carried out as part of any extensive investigation of prolonged hyperbilirubinemia of the indirect type in otherwise well infants who have been wholly breast fed from birth.
EMOTIONAL IMPLICATIONS OF CONGENITAL HEART DISEASE IN CHILDREN
Authors: Glaser Helen H. , Harrison Grace S. , Lynn David B.
Published: December 2021

Mothers of 25 children with congenital heart disease were interviewed to elicit family reactions to the patient's disorder. Problems for parents included: vague apprehension about the behavior of the newborn, uncertainty about the diagnosis, anxiety about the child's symptoms, fears of death, feelings of guilt, disappointment and irritation with their burden, overprotective attitudes, attempts to provide the child with a normal active life, difficulties with discipline, and various problems related to hospitalization, cardiac catheterization, and heart operation. The physician's role in management of such patients is aided by awareness on his part of the general and specific impact of this handicapping disorder of childhood.
A MICRODIFFUSION TEST FOR CONGENITAL GALACTOSEMIA UTILIZING GALACTOSE-I-C14
Authors: London Morris , Marymont Jesse H. , Fuld Jeanne
Published: December 2021

A method for the detection of congenital galactosemia is presented. Galactose-1-C14 and whole blood are placed in a microdiffusion apparatus utilizing a rotating wheel to mix and to renew surfaces in the reaction vessel. The C14O2 liberated is collected in a drop of sodium hydroxide, washed into a planchet, dried, and counted in a gas-flow counter.

The technique is simple, does not require expensive equipment, utilizes stable reagents, and is well adapted for use as a screening procedure.

The test does not detect the carriers of the genetic defect for galactosemia.
Congenital Cutaneous Candidiasis
Authors: JAHN CHARLES L. , CHERRY JAMES D.
Published: December 2021

A case of congenital cutaneous moniliasis is described. The infection occurred without known rupture of the fetal membranes. It is of interest that such extensive congenital infection occurred without gross evidence of placental infection.
Gamma-Globulin for Premature Infants
Authors: CAREY DONALD E.
Published: December 2021

The conclusions of Amer et al. (Pediatrics 32:4, July, 1963) associating benefits with the administration of gamma-globulin to premature infants are provocative.

I was bothered, however, as was the commentator (Dr. Hodes) by the "disproportionate loss of participants between the two groups," 45 from the gamma-globulin groups and 68 from the controls. The authors state that there was no evidence these losses biased the final samples. If, on the other hand, the populations actually were comparable, one would have expected the chances of a family dropping out of either group to be equal. This would have meant about 56 dropouts from each group.
Mothers' Milk Bank at the Delaware Hospital
Authors: HANDY MARGARET L.
Published: December 2021

It has been called to our attention that the services of The Delaware Hospital Mothers' Milk Bank are not adequately publicized. For this reason we would like to mention a few salient facts about our milk bank.

For sixteen years this milk bank has been supplying breast milk to all areas of the United States. During these years frozen breast milk has been sent as far as Califorina with excellent results.

Upon request from the attending physician, breast milk is available for premature and allergic infants. Also, we have supplied large quantities of breast milk for research purposes.

This milk is available at a cost of $.30 an ounce which meets the cost of production. However, in indigent cases the milk is provided free of charge.
PROBLEMS IN NEONATAL OBSTRUCTIVE JAUNDICE
Authors: Bennett Dale E.
Published: December 2021

All cases of neonatal obstructive jaundice at St. Louis Children's Hospital were reviewed. The total of 57 included 32 cases of extrahepatic biliary atresia and 16 biopsy-proven cases of giant-cell hepatitis. As a result, the author has reached the following conclusions:

Giant-cell hepatitis can be distinguished from extrahepatic atresia in almost all cases by study of a liver biopsy. The important morphologic criteria include the presence in atresia of bile duct proliferation and of intraductal bile stasis, and the absence of significant hepatic architectural disorganization early in the course of the disease. Clinical data and most laboratory tests are of little use in distinguishing between atresia and neonatal hepatitis. Serial bilirubin determinations are useful, as falling levels over a period of weeks is strong evidence for hepatitis. At laparotomy cholangiography is the most valuable diagnostic tool, with frozen section of value when radiographic studies cannot be made.

Biliary atresia carries an extremely poor prognosis, for few patients have a correctable lesion (12% in this series). Furthermore, the mortality and morbidity of biliary tract surgery in infants is high, irrespective of the age of the patient at operation. This poor prognosis is not due to delay in operation, since cirrhosis and hepatic insufficiency develop relatively late in biliary atresia. Delay of operation until age three months will adversely affect only a very rare patient with atresia.

Neonatal hepatitis is a frequent cause of neonatal obstructive jaundice. Exploratory laparotomy in these patients has a high morbidity and mortality, especially when a prolonged ductal dissection is performed. Early operation (4-8 weeks) will result in more cases of hepatitis being subjected to a hazardous procedure. There is evidence to indicate that if operation is delayed until 3 months of age, many of these patients will show evidence of resolution of their disease, especially a serial fall in bilirubin, and need not be explored.

It is the final conclusion of the author that the management of obstructive jaundice in this age group should be conservative, and that operation should not be performed until a patient is three months of age, and even later if a falling trend is noted in serial bilirubins.
The Depression of Tuberculin Reactivity during Chickenpox
Authors: STARR SAUL , BERKOVICH SUMNER
Published: December 2021

Chickenpox causes tuberculin sensitivity to be depressed in some cases. Such an effect may develop in the incubation period, is most marked during the first 6 days with rash, and rapidly disappears in most cases.
Keeping Pediatricians in Practice
Authors: GOULD KENNETH S.
Published: December 2021

By way of introduction let me introduce myself. I am a board certified pediatrician, a graduate of New York University College of Medicine, with pediatrics training at Bellevue and Kings County Hospitals, as well as a period at Children"s Hospital of Michigan as a Hematology Fellow. This experience coupled with private practice of several years makes me somewhat conversant with the problems and rewards of the practicing pediatrician.
THE IMPRINTING OF NUTRITIONAL DISTURBANCES ON THE GROWING BONE
Authors: Park Edwards A.
Published: December 2021

WHEN nutritional disturbances in the young animal become so severe that nutrient material is inadequate to go around, in the economy of nature the bones are sacrificed. Preference is given to those organs on which continued existence depends and, if they also suffer, they do not do so to a comparable extent. In the crisis the bones simply cease to grow and, when the crisis is over, proceed to carry on again as if nothing had happened. Nature's method of shedding the burden of the skeleton and, presumably, of the other extra-vital tissues in periods of nutritional stress leaves marks in the growing bones, as seasonal sapless periods leave their marks in trees in the form of rings and as the fasting spawning periods in the anadromous fishes record themselves by lines in the scales. Doubtless, the soft tissues of the locomotor system, like the bones, reflect these nourishment withdrawals, but the resulting cellular changes are not located in areas where they can be recognized and, moreover, are probably evanescent anyway. The marks in the trunks of trees, in the scales of fishes and in the growing bones of warm-blooded animals can be recognized because they are strung out seriatim, for the reason that linear growth takes place in increments, one superimposed upon another in the order of time, and also because the material is durable. Although growth arrest marks in the bones originate in the organic matrix, the matrix becomes immediately infiltrated with mineral matter so that the marks become petrified in situ, so to speak.
Pocket Reference—Guide to Microbiology
Authors: MACLAREN JOHN A.
Published: December 2021

The author is to be commended for gathering together so many pertinent facts about medical microbiology. Many clinicians and laboratorians will find it profitable to consult this handy reference on innumerable occasions. Those individuals with either a responsibility or a deep concern for diagnostic microbiology will find this book of particular interest since it presents its message in a series of well-designed "flow sheets," one for each area of disease. This arrangement is most convenient for reviewing quickly the essentials of the subject. Since it fulfils its purpose as a pocket reference it can be recommended as a useful aid in the diagnosis of microbial disease.
AORTIC STENOSIS IN INFANCY
Authors: Feldman Bernard H. , Scott Lewis P.
Published: December 2021

1. Four infants with congenital aortic stenosis of varying severity have been presented.

2. Clinical findings of severity include congestive heart failure, diminished pulse volume, and electrocardiographic evidence of left ventricular hypertrophy and strain.

3. Congestive heart failure which responds to digitalis therapy is not, in itself, a criterion for surgical intervention in infancy.

4. The presence of left ventricular hypertrophy and strain usually indicates the need for surgical intervention.
PEDIATRIC RECREATION
Authors: Blumgart Eleanor , Korsch Barbara Maria
Published: December 2021

ILLNESS creates difficult problems for a child and hospitalization adds to these by separating him abruptly from his parents and from the customary ways of life. Concerned with these problems, the Division of Pediatric Recreation at New York Hospital—Cornell Medical Center has developed a program which attempts to provide a maximum of individualized support for both the child and the parent during hospitalization. Many hospitals have recognized the importance and value of this type of pediatric service. For example, the Cleveland Metropolitan General Hospital, Western Reserve University, has developed a comprehensive program of child care on a pediatric service in a general hospital situation. Emma N. Platt has given a detailed description of this in "Working with Children in Hospitals." A program at the Boston Floating Hospital, Tufts University School of Medicine, has been described by Veronica B. Tisza, M.D., and Kristine Angoff.

The Pediatric Department of the New York Hospital–Cornell Medical Center has a long-standing tradition of emphasizing the importance of comprehensive patient care and of devoting special attention to the emotional, social, and recreational needs of the patients. To implement these aims the Division of Child Development was organized in 1947; the sub-Division of Pediatric Recreation is one of the major aspects of its activities. The Division's facilities include a nursery school which is used as a laboratory to teach and demonstrate normal growth and development. The school is attended by a group of "well" children from the neighborhood and a trained nursery school staff provides a typical nursery school program.
BCG Vaccination and Profound Lymphopenia
Authors: MATSANIOTIS N. , ECONOMOU-MAVROU CLEOPATRA
Published: December 2021

In the February, 1964, issue of Pediatrics a letter to the Editor was published by Rosen and Janeway, in which a strong point was made that fatal progressive vaccinia following smallpox vaccination in children with agammaglobulinemia may be the result of coexisting congenital thymic alymphoplasia. It is the purpose of this letter to draw attention to the fact that children with thymic alymphoplasia may be equally susceptible to fatal generalized BCG infection.

We have rapidly reviewed the cases of fatal generalized BCG infection reported in the literature and have found both direct and indirect evidence that all cases in whom pertinent information is available had profound peripheral lymphopenia.
Perinatal Mortality
Authors: CLIFFORD STUART H.
Published: December 2021

Following the second world war, the research activities of the National Birthday Trust Fund were directed to the investigations of factors in the prenatal period and during labor which might have a bearing on the early death or abnormality of the baby. A Perinatal Survey of England, Scotland, and Wales was carried out in 1958 involving some 25,000 babies at delivery or death, with the collection of all available information about the mother's background, her pregnancy and labor, and with detailed necropsy inquiry on the stillbirths and neonatal deaths.
CONGENITAL NEUROBLASTOMA INVOLVING THE PLACENTA
Authors: Strauss Lotte , Driscoll Shirley G.
Published: December 2021

Two cases of placental involvement by congenital metastasizing neuroblastoma are reported. The diagnoses were made upon histological examination of the placenta. The tumors apparently arose in the periadrenal sympathetic plexus and may have been multicentric. These appear to be the first reported instances of placental metastasis of fetal neoplasms.

Clinically both cases resembled severe erythroblastosis fetalis. Similarities in the gross and histological appearance of these placentas and those seen in severe isoimmunization disease are discussed. While transplacental metastasis from mother to fetus is known to occur, the reverse has not been encountered. An explanation for this is sought in immunological mechanisms. Analogies are drawn to other types of placental and fetal disease.
TETANUS OF THE NEWBORN INFANT
Authors: Pinheiro Dacio
Published: December 2021

Tetanus in the newborn infant is still a most important public health problem in Brazil. An analysis of 238 cases, admitted in a two-year period to the pediatric service of the University Hospital in Sao Paulo, is presented. It is suggested that prognosis is related more closely to amount of tetanospasmin produced and absorbed by the central nervous system than to some of the more traditional indices of clinical severity. The plan of treatment in use is presented, since the over-all recovery rate compares very favorably with other published reports.
THE RELATIONSHIP OF MATERNAL ANTIBODY, BREAST FEEDING, AND AGE TO THE SUSCEPTIBILITY OF NEWBORN INFANTS TO INFECTION WITH ATTENUATED POLIOVIRUSES
Authors: Warren Robert J. , Lepow Martha L. , Bartsch Glenn E. , Robbins Frederick C.
Published: December 2021

1. Over 1,000 infants were fed attenuated polioviruses during the first 3 months of life and susceptibility to infection with these agents was shown to be related to dose of virus, titer of maternal antibody, method of milk feeding, and age at vaccination.

2. Larger doses of virus elicited a response in a high proportion of infants, but even the smallest dose employed was of nearly optimal effectiveness in infants with little or no maternal antibody.

3. No significant differences between the 3 types of polioviruses were observed other than those which could be related to differences in maternal antibody titer for the 3 types.

4. Maternal antibody had a direct relationship to the incidence of infection, particularly in breast-fed babies and in bottle-fed infants vaccinated on the first day of life.

5. Human milk contains poliovirus neutralizing substances (probably antibody but not specifically characterized) in concentrations related to the antibody titer in the mother's serum. However, a number of significant discrepancies between the antibody content of the serum and milk or colostrum were observed. It is postulated that infection is prevented by neutralization of the virus in the lumen of the infant's gut.

6. Susceptibility of bottle-fed babies increases rapidly during the first three days of life, but remains relatively unchanged thereafter. A reasonable hypothesis to explain this phenomenon is that maternal antibody in the infant's gut, whether from ingested amniotic fluid or by leakage from his circulation into the intestine, inactivates virus given on the first few days of life, but not later.
COMPARABILITY OF THREE METHODS OF ASSESSING THE DEVELOPMENTAL LEVEL OF YOUNG INFANTS
Authors: Caldwell Bettye M. , Drachman Robert H.
Published: December 2021

This study reports on the comparability of results obtained via three different techniques for evaluating the developmental level of young infants. The three procedures—the Cattell Infant Intelligence Scale, the Griffiths Mental Devolpmental Scale, and a Composite Scale assembled by the [See Table IV in Source Pdf] authors—were found to yield similar means for a total of 56 infants ranging in age from 6 weeks to 22 months. For 28 age-matched infants representing Negro male and female and Caucasian male and female groups, no significant differences in test scores were associated with subgroup classification. For this smaller group, mean differences among the three test procedures were statistically significant though numerically small. Correlations among the three types of examination were high and positive. The data warrant confidence in the use of brief screening procedures requiring a minimum of time and apparatus for obtaining information about the current developmental status of infants.
THE COMPOSITION OF MUSICS FOR MAN Or Decoding From Primitive Cultures The Scores For Human Behavior
Authors: Gajdusek D. Carleton
Published: December 2021

PRIMITIVE MAN has attracted the imagination, curiosity, and romanticism of men of Western culture for centuries—even millennia. Herodotus and Xenophon were compelled to report their brief contacts with him and his cultures, and centuries of explorers, travelers, adventurers, and poets have marveled at and enthusiastically recounted their experiences in uncivilized societies. Civilized man may see in the surviving remnants of primitive cultures his own origins and realize intuitively in observing them that other solutions to the problem of society and communal life are possible than those which historical events have selected to be his own lot, or condition humaine.

The South Pacific, particularly, has been the source of romantic yearnings, and a large number of gifted artists and scientists have voyaged there from Europe and America in search of Rousseau's Noble Savage. The Elysium which men of the romantic Western world have seen in the homeland, and the idyll they see in the lives of the South Sea Islanders, especially of the Polynesians, have preserved to this day their mysterious attraction. Pierre Loti, Robert Louis Stevenson, Joseph Conrad, Paul Gauguin, our Americans, Henry Adams and Herman Melville, and, more recently, Somerset Maugham and James Michener, have told the tales of the South Pacific with brush and pen more dramatically, if less exactly, than Bronislav Malinowsky, Alfred Russell Wallace, Charles Darwin, and Captain Cook. I think that I need no further defense or excuse of my concentration upon, and my prolonged sojourns in, the South Pacific region during the past decade than this list of illustrious predecessors.
INFANTS OF LOW BIRTH WEIGHT AMONG 5,000 DELIVERIES
Authors: Gruenwald Peter
Published: December 2021

Among 5,000 consecutive deliveries there were 536 infants of low birth weight (401-2,500 gm). Those weighing more than 1,000 gm are analyzed according to stated gestational age and normal standards of birth weight for gestational age. The incidence of chronologically mature infants, and of those retarded in intrauterine growth, was determined for infants weighing 1,001-2,000 gm, 1,001-2,250 gm, and 1 001-2,500 gm. Perinatal mortality figures for the various types of infants of low birth weight are given.
DYSGAMMAGLOBULINEMIA: REPORT OF A CASE WITH A FAMILY HISTORY OF A CONGENITAL GAMMA GLOBULIN DISORDER
Authors: Ackerman Bruce D.
Published: December 2021

An additional male child with dysgammaglobulinemia is reported. In this instance an older sibling, deceased, had clinical and histopathologic findings suggestive of a congenital gamma globulin deficiency.

The preponderance of males among recognized examples of dysgammaglobulinemia, and the presently reported patient whose male sibling also appears to have had a congenital gamma globulin deficiency, suggest that dysgammaglobulinemia, in this particular family, was transmitted as a sexlinked recessive characteristic.

It remains unclear whether agammaglobulinemia and dysgammaglobulinemia represent two closely related genetic abnormalities, or whether they represent variable expression of a single genetic disorder. Study of additional pedigrees containing examples of dysgammaglobulinemia will be required to answer this question.
PURPURA FULMINANS
Authors: Bouhasin John D.
Published: December 2021

A case of purpura fulminans following varicella was shown to be a defibrinating syndrome and was treated successfully with fibrinogen alone. The similarities between the Shwartzman phenomenon and purpura fulminans are discussed and are shown to support the hypothesis that purpura fulminans is primarily an immunological disease, similar to the Shwartzman phenomenon, resulting in intravascular thrombosis.
CEREBRAL FUNCTION IN INFANCY AND CHILDHOOD, Albrecht Peiper, M.D. New York: Consultants Bureau, 1963, 683 pp., $25.00
Authors: Barlow Charles F.
Published: December 2021

The translators and publishers of the English language edition of Professor Albrecht Peiper's extraordinary book have earned the gratitude of this reviewer. I suspect there are a number of my English-speaking colleagues as well who have "read" little beyond the illustrations of the German edition and have wistfully fluttered the pages of this massive volume, half promising themselves to return. Now it is possible to return in comfort to this effective translation. The book is strongest in its elaborately detailed description of position, movement, and locomotion, sections which alone fully justify the book.
Isolation of Rubella Virus from a Mother and Fetus
Authors: Heggie Alfred D. , Weir William C.
Published: December 2021

This study reports isolation of rubella virus from a primagravida in the first month of pregnancy and subsequent recovery of the agent from viable fetal tissue delivered by uterine curettage 57 days after onset of the maternal exanthem.
A MANUAL OF PAEDIATRICS FOR STUDENTS AND PRACTITIONERS IN SOUTH-EAST ASIA, edited by Pinchas Robinson and Arvid Wallgren. Calcutta: Orient Longmans, Rev. Ed., 1963, 504 pp., price not listed
Authors: Webb J. K. G.
Published: December 2021

Pediatrics in South East Asia is still a very young field of medicine. Although pediatric departments under trained pediatricians were established in a few universities in the region as long as 25 years ago this has become general only in the course of the last decade. During this period formal teaching in child health and disease has become a required part of the undergraduate medical curriculum and although universities have often been quite inexplicably reluctant to include a section on pediatrics in the qualifying examination, medical students have been increasingly willing and even anxious to read suitable pediatric texts.
Lower Incidence of Sex Chromatin in Newborn Females Delivered by Cesarean Section
Authors: WEGMANN THOMAS C. , SMITH DAVID W.
Published: December 2021

The previously reported low incidence of sex chromatin in buccal cells of newborn females has been confirmed in babies born by cesarean section. However, there was no comparable change in sex chromatin percentage for their mothers as had been reported for vaginally delivered women. Further studies on vaginally delivered mothers raised some doubt as to the validity of the previous maternal results.