bluuebunny/crossref_metadata_2025 huggingface dataset:
THE WEIGHT OF THE NEWBORN INFANT ACCORDING TO DESESSARTZ, FRANCE'S LEADING EIGHTEENTH CENTURY PEDIATRICIAN
Authors: C. T. E.
Published: December 2021

I have long been puzzled why a biologic statistic so mundane as the birth weight of the newly born infant was ignored by physicians until the end of the seventeenth century. And, even when they began to mention this weight, an erroneously high value was given by almost all the distinguished physicians of the day.1

Proof of this may be found in the following quotation from Jean Charles Desessartz's great pediatric text on the physical upbringing of infants, which was published in Paris in 1760.2

The infant who, in the first days after conception hardly equals the weight of a millet seed, develops little by little in the early months, and finally obtains such a prodigious increase in size, that at about nine months, the usual period of gestation, he weighs 12 livres or 13 pounds (livre = 489.5 gr)3 and at times as much as 14 livres or 15 pounds.
URINARY EXCRETION OF PHENOLIC AND INDOLIC COMPOUNDS, METACATECHOLAMINES, AND VMA BY FULL-TERM AND PREMATURE INFANTS
Authors: Nicolopoulos Demetre , Agathopoulos Anthony , Danelatou-Athanassiadou Calliope , Bafataki Marianthi
Published: December 2021

The 24-hour urinary excretion of phenolic and indolie compounds, metacatechol-amines, and VMA by full-term and premature infants on their first and fifteenth days of life was studied. The presence of metabolites from all three main catabolic pathways of tryptophan was noted in both groups of infants. 3-indole-acetic and 3-indole-propionic acids were present on the first day of life in the urine of full-term infants, but they were absent on the fifteenth day.

Twenty phenolic acids were observed in both groups of infants, but their excretion varied a great deal. Homogentisic acid was not excreted on the first day of life of full-term and premature infants, but it was found in the urine of full-term infants on the fifteenth day of life.

The variations of excretion of VMA generally followed that of metacatecholamines. The excretion of VMA by the premature infants on their fifteenth day of life is four- to fivefold that of the first day and reaches adult levels, in contrast to the moderate decrease of VMA excretion of the fuil-term infants on the fifteenth day. The degree of maturation of the enzymic systems involved is discussed as a probable cause of these variations.
ISLET CELL TUMOR IN THE NEONATE
Authors: Garces Ludivina Y. , Drash Allan , Kenny Frederic M.
Published: December 2021

The earliest documented case of hypoglycemia resulting from a functioning islet cell adenoma is reported. Hypoglycemia was diagnosed at 3 hours of age in a male infant with a birth weight of 3,177 gm (7 lb). The pregnancy and delivery had been uneventful. The infant was considered to have severe idiopathic hypoglycemia of infancy.

Pertinent laboratory features included the absence of documented hyperinsulinism, elevated plasma growth hormone, symptomatic hypoglycemia following oral glucose load, standard meal and glucagon administration, leucine and insulin sensitivity, and a normal response to I.V. tolbutamide. The clinical course was characterized by persistent hypoglycemia despite a therapeutic regimen consisting of ACTH, epinephrine, ephiedrine, glucagon, human growth hormone, chlorothiazides, trichlormethiazides, and diazoxide of optimum dosage and duration. Preoperatively, the growth pattern was along the 3rd percentile, skeletal maturation was less than birth level at age 6 months, mental age was two months behind the chronologic age, and the EEG was abnormal. After subtotal pancreatectomy at age 73½ months, the growth pattern reached the 75th percentile, skeletal maturation improved to the 6-month level within a 7-month postoperative period, mental age became consistent with chronologic age, and the EEG returned to normal.
THE EFFECT OF BUFFERED AND NON-BUFFERED ACD BLOOD ON ELECTROLYTE AND ACID-BASE HOMEOSTASIS DURING EXCHANGE TRANSFUSION
Authors: Pierson W. E. , Barrett Cynthia T. , Oliver T. K.
Published: December 2021

Exchange transfusions have been performed using buffered and non-buffered ACD blood. In 15 low risk infants receiving unbuffered blood, severe acidosis occurred in one during the transfusion. Other investigators have recently observed similar findings. In contrast, when blood was buffered prior to exchange transfusion in 26 high risk infants (i.e., with cardiorespiratory insufficiency), acidemia did not occur. Since the mortality of exchange transfusion is increased in infants with cardiorespiratory insufficiency, it appears that buffered ACD blood will lessen the risks.

It is recommended that, ACD blood is used for exchange transfusion in any infant, the blood should be buffered immediately prior to transfusion using 10 mM of 1.0-1.2 M THAM.
Changes of Format, Correction
Authors: Beatty William K.
Published: December 2021

I have read with some interest your recent editorial entitled "Changes of Format." This presents some interesting ideas, and I believe that we shall all benefit from them. I wonder if your proposed source for the key words comes from the Index Medicos rather than the Quarterly Cumulative Index Medicus, which ceased publication with the 1956 volume.
Children of Very Low Birth Weight: A Survey of 1,128 Children with a Birth Weight of 4 lb. (1800 g) or Less, by Alison McDonald. London: Published by the Spastics Society Medical Education and Information Unit in association with William Heinemann Medical Books, Ltd., 1967, 126 pp. $4.00
Authors: Avery Gordon B.
Published: December 2021

This excellent monograph is a survey of 1,128 children whose birth weights were less than 4 lb (1,800 gm). The original birth records were collected as part of an earlier study of retrolental fibroplasia; the births occurred between 1951-1953. A remarkably high proportion of these children were tracked down and studied at the age of 6 to 8 years with respect to intelligence, hearing, sight, and neurological defects, especially cerebral palsy.
GAMMA-A IMMUNOGLOBULINS AND THE CONCEPT OF LOCAL IMMUNITY
Authors: Smith Richard T.
Published: December 2021

The concept that an active immune response could be generated at the tissue level, particularly in reference to the gastrointestinal and respiratory tracts, is an old and venerable one. It was, however, without substantial scientific basis until recently, when the active generation and secretion of antibody activity onto these surfaces was clearly demonstrated.

The key observations were: (1) that anti-viral and anti-bacterial antibodies were present in the secretions of individuals recovered from active infection, (2) that secreted antibodies were dominantly of the gamma-A immunoglobulin class, and (3) that protection against reinfection could be best stimulated by local infection or application of the agent to the mucus surface.
FAMILIAL NONHEMOLYTIC JAUNDICE: BILIRUBINOSIS AND ENCEPHALOPATHY
Authors: Gardner William A. , Konigsmark Bruce W.
Published: December 2021

The unique pathological findings of a case of congenital familial hyperbilirubinemia are presented. The patient (Case 3 of Crigler and Najjar's original report), although severely jaundiced, had developed normally without evidence of neurological disease until 15½ years of age. He then developed a progressive neurological deterioration which was clinically similar to infantile kernicterus.

At autopsy most of his organs showed extensive intra- and extracellular deposition of bile pigment, particularly the renal papillae, atrial endocardium, intestinal mucosa, Kupffer cells of the liver, and the perivascular adventitia.

Although no pigment was found in the central nervous system, there was striking neuronal loss and gliosis of the thalamus. Moderate neuronal loss was found in the putamen, caudate nucleus, dentate nucleus, and red nuclei. No histopathological changes were found in the hippocampus or cerebral cortex.

It is suggested that the patient suffered from a late onset of "kernicterus" with involvement, in this older patient, of regions of the nervous system somewhat different from those in infantile kernicterus.
FLUID-FILLED LUNG DUE TO AIRWAY OBSTRUCTION IN THE NEWBORN
Authors: Griscom N. Thorne , Harris G. B. Clifton , Wohl Mary E. B. , Vawter Gordon F. , Eraklis Angelo J.
Published: December 2021

Airway obstruction classically leads to either atelectasis or emphysema. Obstructions developing in utero might be expected to cause different phenomena, however, since fetal lungs contain fluid, not air.

The two newborn infants presented here demonstrate the pathophysiologic effects of total intrauterine bronchial occlusion and the consequent retention of pulmonary fluid. One infant had extrinsic occlusion of the left main-stem bronchus by a small bronchogenic cyst. The other had atresia of the bronchus leading to his accessory left upper lobe. In each the obstructed pulmonary tissue was expanded and filled with fluid. In neither case did the clinical and roentgenographic findings suggest airway obstruction pre-operatively. The contrast with the atelectatic and emphysematous manifestations of later-life airway obstruction is marked. Those who care for newborn infants must be aware that a chest mass or opaque lung by x-ray or large but fluid-filled pulmonary tissue upon thoracotomy may in fact represent remediable airway obstruction.
CHILDREN IN I836 ARE NO LONGER RESPECTFUL OF THE AGED
Authors: C. T. E.
Published: December 2021

Mrs. L. H. Sigoumey of Hartford, Connecticut, was a prolific writer of books to improve the minds of children and their parents during the period prior to our Civil War. The quotation below from one of her most popular books might have been written today!

The universal opinion of those, who scrutinize the state of society in our country, is that in the treatment of the aged, there is a diminution of respect. Even the authority of parents, and teachers, seems to be borne with uneasiness, and to be early shaken off. Those, whose memory comprises two generations assert, that most palpably in these points, the former days were better than these.1
Multidisciplined Patient Care Rounds
Authors: Brazleton T. Berry
Published: December 2021

The value of multidisciplined, weekly rounds concerned with patient care is emphasized. These rounds are important in a busy, acute hospital in improving the atmosphere and in offering an opportunity for the staff to focus on the total patient and his family. These rounds foster communication and teamwork between physicians, nurses, social workers, play therapists, physical therapists, dieticians, school teachers, outpatient personnel, and community follow-up agencies. Their value in a large hospital has been proved in the following specific areas: (1) teaching child development, the impact of illness and hospitalization on a child and his family, and the psychosomatic aspects of all disease; (2) improving the diagnostic value of history taking and observation of the child and his family; (3) uncovering areas of ignorance and stimulating research in these areas; (4) role sorting and airing of tensions so the disciplines can develop teamwork; (5) documentation of plans on the patients' charts so continuity of care can be more effective; and (6) improving the atmosphere of the hospital so the need for a patient care committee at an administrative level is established.
Fetal Malformations Caused by Amnion Rupture During Gestation, by Richard Torpin, M.D. Springfield, Illinois: Charles C Thomas, 1968, 165 pp., $11.50
Authors: Warkany Josef
Published: December 2021

When during the nineteenth century rational explanations of congenital malformations were sought by scientists, mechanical injuries and amniotic disorders were usually considered probable causes of various deformities. Ballantyne in 1904 devoted 30 pages to amniotic disease in teratogenesis and distinguished eight groups of facts pertinent to the amniotic theories. In subsequent decades genetic and exogenous teratogenic theories overshadowed mechanical and amniogenic explanations so much that the latter are now almost forgotten when the etiologies of congenital malformations are discussed.
HISTORY'S LESSONS
Authors: Coles Robert
Published: December 2021

The article in this issue by Dr. Harry Elam more than makes its point, and the point is more than worth being made at this particular moment in American history. What is more, I regret to say that, though the remarks are heavily psychological in nature, a large number of our psychiatrists also need to understand, as do pediatricians, the evolutionary process that has resulted in what Dr. Elam calls "malignant cultural deprivation." The sad fact is that just about all of us, even some of our best historians, whom one imagines ought to know better, find it hard to think about what went on hundreds of years ago-in Africa, on the high seas between Africa and America, and finally, in this nation of ours, founded in protest against monarchist authoritarianism, yet able for decade after decade to sanction an explicit and devastating kind of slavery.
THE SITE OF AIRWAY OBSTRUCTION IN CYSTIC FIBROSIS
Authors: Mellins Robert B.
Published: December 2021

Evidence has been presented that some patients with cystic fibrosis have significant amounts of obstruction to the ventilation of portions of lung, as indicated by tests of the distribution of ventilation, but they have little or no evidence of obstruction by conventional measurements of airway resistance.1-5 This discrepancy may be attributed to the fact that various tests of pulmonary function differ in sensitivity with respect to small and large airway obstruction. It is the purpose of the present Commentary to summarize the evidence for this hypothesis and to suggest that differences in the extent to which measurements of airway resistance and distribution of ventilation are altered in patients with cystic fibrosis may be used to localize the site of obstruction and to follow the different stages in the natural history of the pulmonary disease.
THE HUMAN BIOCHEMICAL GENETICS OF AMINO ACID TRANSPORT
Authors: Scriver Charles R
Published: December 2021

What is the relevance of these investigations when so many other problems in medicine seem to claim priority? First of all, these studies are one of several approaches toward an understanding of the plasma membrane, which is an essential cellular component, but whose physical and chemical characteristics are poorly understood. Research into the human biochemical genetics of amino acid transport has led us to believe that many gene loci control a wide spectrum of specific membrane proteins which act as sites where amino acids migrate across cell membranes; this is a valuable concept in its own right, and it is in keeping with much other work on the nature of membrane transport processes. At first it seemed redundant that more than one site should serve the transport of a single amino acid. Yet, this is apparently a long-standing adaptation of cellular membranes. Microorganisms face their environment armed with membranes adapted to absorb solutes in one way at low concentrations and in another at high concentrations. Kepes has described the obvious advantages which such constitutive functions might have for the economy of an organism which may have to adapt to a nutritional environment fluctuating between dearth and abundance.

See image in the PDF file

Retention of complex membrane systems in metazoan species stabilizes the commerce of intermediate metabolism and contributes to the equilibrium between the cell and its environment; without this equilibrium, perhaps we would not recognize perturbation so readily, and some forms of disease, such as can be detected by the screening tests now in vogue, would go unrecognized. Without mediated transport, human malnutrition would be a worse scourge than it is, because tissues which can transport efficiently against a chemical gradient will accumulate as much nourishment as possible from the environment, even in famine. But, there is another reason to study membrane transport. We hope the time will come when we know enough to design molecules for therapeutic purposes, to "fit" different transport sites, and to direct their traffic into particular tissues or to probe particular functions. If this should happen, then genetics, biochemistry, pharmacology, and many of the other disciplines would be united in one enterprise for the benefit of the patient.
LOWE'S SYNDROME: A SEARCH FOR THE CARRIER STATE
Authors: Holmes Lewis B. , McGowan Bernard L. , Efron Mary L.
Published: December 2021

An attempt to detect the female carriers of this X-linked disease has been carried out in three families, including two whose affected male infants were subjects of the original report of this syndrome. No lens opacities were found in two sets of parents. In the third family both parents had multiple small opacities. There was no difference in the urinary amino acid response of either the mothers or the fathers to an oral ornithine loading test.

It has been concluded that neither test is reliable in the detection of the female carrier of the oculo-cerebro-renal syndrome.
A CLINICAL APPROACH TO THE MEASUREMENT OF CEREBRAL DYSFUNCTION
Authors: Crichton John U. , Mackoff Harley P.
Published: December 2021

Cerebral dysfunction is seldom measured by objective means. Previous attempts to do so have mainly been concerned with abnormalities of motor behavior, though some attempts at measurement of attentional factors have been made. Because oculomotor hyperkinesis might involve both these facets of cerebral dysfunction, electro-oculography was used in the present study to record eye movements in different groups of subjects. Twenty-five children aged 6 to 12 years with no known neurological disease, 25 children aged 5 to 11 years with minimal cerebral dysfunction, and 16 children aged 5 to 14 years with more gross forms of neurological disease were tested.

The ability of these children to fix a target visually over a period of 120 seconds (when a visual distraction was provided) was found to distinguish normal children from those with cerebral dysfunction when the total duration of fixation on the target was used as a measurement. The duration of the first fixation was statistically significantly longer and the number of discrete fixations was significantly fewer in the normal children, but the range of measurements was too great for these variables to be of use in an individual case. Among normal children, ability to attend to the task was found to improve with increasing age, and girls were found to be better performers than boys of the same age.

The method is potentially useful not only as a diagnostic aid but also in the assessment of progress, whether the children are treated or not.
Letter to the Editor
Authors: Cone Thomas E.
Published: December 2021

Until Dr. Heller's letter arrived, I had been disappointed not to have received a single letter regarding my paper on children with fever, because I was sure that others might disagree with some of the things I wrote.

The differences in the major causes of fever seen by private practitioners as compared with those of us in full-time hospital practice interest me greatly. I would be delighted to cooperate with Dr. Heller in a prospective study to compare our experience with his.
Academy Meetings in Chicago
Authors: Hervada Arturo R.
Published: December 2021

I strongly endorse Dr. B. K. Silverman's (Pediatrics, 43:1010, 1968) and Dr. S. R. Halpern's (Pediatrics, 43:469, 1969) suggestion to move our annual meeting to other American cities.

In the jet era and in a society that drives 15 miles to buy a hamburger or 10 miles to see a movie without batting an eyelash, it seems to me that to meet in Chicago because of its geographical location is no longer a valid reason.
Three Centuries of Children's Books in Europe, ed. 2, by Bettina Hürlimann, translated and edited by Brian W. Alderson. London: Oxford University Press, 1967, 297 pp., 45 s ($5.40)
Authors: Cone Thomas E.
Published: December 2021

Why so few physicians have acquired an interest in the books written for children over the past two or three centuries—either to educate or to amuse them—has long puzzled me. For the pediatrician especially, even a cursory knowledge of the changing contents and of the literary style of these books will immensely broaden his perspective and understanding of how it came about that the child has risen from his older place as an ill-formed adult at the edges of society to his present position as the cultural hero of our society—an invention of modern times.
Clinical Toxicology of Commercial Products: Acute Poisoning, ed. 3, by Marion N. Gleason, M.Sc., Robert E. Gosselin, M.D., Ph.D., Harold C. Hodge, Ph.D., D.Sc., and Roger P. Smith, Ph.D. Baltimore: The Williams and Wilkins Co., 1969, 1539 pp., $24.50
Authors: Alpert Joel J.
Published: December 2021

It is a pleasure to review a classic. The authors have recognized a need and filled it superbly. The book's purpose is to assist the physician in dealing quickly and effectively with acute chemical poisoning, arising through the misuse of commercial products and is divided into seven sections. The first section deals with first aid and general emergency treatment and is a general approach to poisoning. References to other sections are included. The second section is an alphabetical compilation of chemical substances commonly found in commercial products.
DIAGNOSTIC LUNG PUNCTURE IN THE PNEUMONIAS OF INFANTS AND CHILDREN
Authors: Klein Jerome O.
Published: December 2021

Lung punctures were performed on 32 occasions in 28 infants with pneumonia to assist in specific bacteriologic diagnosis. The aspirates yielded pure cultures of Diplococcus pneumoniae and Staphylococcus aureus each in four patients and E. coli in two patients. The procedure is performed as for a thoracentesis and requires no special instruments. Three children had pneumothoraces and one had a small hemoptysis following the procedure, but only one child exhibited even minimal respiratory distress as a result of the tap. The literature on lung aspirates was reviewed with respect to the value and potential liability of the procedure. At present, diagnostic lung punctures should be considered in three groups of children with lower respiratory disease: (1) the critically ill child in whom a specific etiologic diagnosis is of major importance to guide antimicrobial therapy, (2) the child who has deteriorated while on therapy and in whom an etiologic agent is not available from the usual upper respiratory tract cultures, and (3) the child with pneumonia complicated by underlying disease or drugs limiting normal host defense mechanisms. In these three instances, the advantages of a specific etiologic diagnosis outweighs the small risk from the lung puncture.
WHEN AND BY WHOM WAS THE WORD PEDIATRIC FIRST USED?
Authors: C. T. E.
Published: December 2021

The magnificent, A New English Dictionary on Historical Principles, usually known as the Oxford English Dictionary (O.E.D.), is rarely in error. But, it is in regard to the chronology of the word paediatric (pediatric). The editors of the O.E.D. traced each of the 414,825 words contained in the dictionary from their earliest known appearance in English.

The O.E.D. claims that the word paediatrlc first appeared on page 1065 of the November 3, 1894, issue of the Lancet as follows: "Professor Bokai, the well-known paediatric physician...."1

In January 1884, however, a monthly journal with the title, The Archives of Pediatrics, was begun in New York City under the editorship of Dr. William Perry Watson.

Three years later, on September 9, 1887, after the adjournment of the Ninth International Medical Congress, a number of physicians interested in child health organized a new society which they named the American Pediatric Society.2

I have not been able to find the words pediatric, pediatrics, or pediatrician used in the literature prior to the year 1884, at least in this country.

If any reader knows of an earlier appearance of these words, the Editorial Office of Pediatrics would be delighted to receive such information.
OF LAUGHTER IN CHILDREN AS VIEWED BY SIR GEORGE FREDERIC STILL (1868-1941)
Authors: C. T. E.
Published: December 2021

As pediatrics has become increasingly specialized, especially during the past quarter of a century, it seems to me that the dominant figures of our specialty write less and less about the commonplace problems of childhood which still continue-as they did in the past-to bother parents and vex more practitioners.

As towering a figure as Sir George Frederic Still considered the everyday phenomena of the life of a child of such importance that he wrote a delightful book entitled Common Happenings in Childhood,1 which contained eight beautifully written chapters on such common things as crying, laughter, temper, appetite, and sleep in childhood.

A good example of Still's interest in the ordinary is the following quotation from his chapter "Of Laughter" in this book.

To have attained a high degree of this control has been regarded by some as a mark of superiority. Chesterfield, writing to his son, aged sixteen, in 1748, says:

"How low and unbecoming a thing laughter is! Not to mention the disagreeable noise that it makes and the shocking distortion of the face that it occasions. . . . I am sure that since I have had the full use of my reason nobody has ever heard me laugh. I could heartily wish," he says, "that you may often be seen to smile, but never heard to laugh while you live."

Chatham, in his letters to his nephew, in 1754, writes only less strongly to similar effect.

One can only think that these paragons of selfmastery must have been nearly as dull as that Crassus whom both Pliny and Cicero mention as remarkable for never having laughed in the whole of his life, except on one occasion, and that was when he saw a donkey eating lettuces. . .
THE ADSORPTION OF BILIRUBIN BY SEPHADEX AND ITS RELATIONSHIP TO THE CRITERIA FOR EXCHANGE TRANSFUSION
Authors: Kaufmann Nathan A. , Kapitulnik Jaime , Blondheim Solomon H.
Published: December 2021

Small quantities of bilirubin (BR) were adsorbed by specially preparedh small columns of Sephadex G-25 from artificially jaundiced sera. The amount of bilirubin adsorbed from sera with bilirubin-albumin molar ratios between 1 and 2 was linearly related to the bilirubin concentration of the serum. There was no demonstrable adsorption of bilirubin by the column at ratios below 1.

Sephadex columns may be of value in determining the time when exchange transfusion should be performed to prevent kernicterus.
SERUM INSULIN IN NEWBORN INFANTS WITH ERYTHROBLASTOSIS FETALIS
Authors: A. George L. , Driscoll Shirley G. , Steinke Jurgen
Published: December 2021

Serum insulin and glucose measurements were performed soon after birth in 12 infants with erythroblastosis fetalis (EBF) and 14 normal neonates. In addition, in eight infants with EBF, insulin levels were determined at birth and again prior to exchange transfusion. Significant elevation of serum immunoreactive insulin (29.6 ± 5.1 versus 10.1 ± 2.2 µU/ml, mean ± SEM) was found in the EBF group and was not related to bilirubin levels or hematocrits. Comparison between immunoreactive insulin level at birth and prior to exchange transfusion showed no difference. The possibility of predisposition to hypoglycemia in EBF should lead to frequent monitoring of blood glucose and appropriate measures to prevent or treat this complication.
CHILD ABUSE SYNDROME: THE "GRAY AREAS" IN ESTABLISHING A DIAGNOSIS
Authors: Silver Larry B. , Dublin Christina C. , Lourie Reginald S.
Published: December 2021

Despite almost universal legislation requiring physicians in the United States to report instances of suspected child abuse and in the face of published efforts to clarify and to define legal, medical, and social issues associated with the "batered child syndrome," some physicians find it hard to accept the reality of willful abuse of children.

An attempt was made to explore further those situations in which the physician found it difficult to establish or rule out the diagnosis of child abuse. In each of the types of such cases, the major issues were the physician's subjective personal feelings, his misunderstandings of the Child Abuse Laws, or of his role and responsibilities.

It is easy to comment that, if the physician understands that the Child Abuse Laws only make him responsible for reporting a case in which there is reasonable cause to suspect a case of abuse and if he understands that he is not responsible for establishing that the case is truly one of child abuse or for indentifying the abuser, then there would be few cases in the "gray area." It is not as easy to explain away or develop an approach to minimize the physicians' subjective feelings or personal views which confound his ability to establish this clinical impression.

It is essential that all suspected instances of abuse be reported. Only then can community agencies become active to protect the child, to assist the family, and to interrupt the pattern of violent behavior.
CARE OF THE CRITICALLY ILL CHILD: ACUTE ADRENAL INSUFFICIENCY
Authors: Bongiovanni Alfred M.
Published: December 2021

In the article, "Care of the Critically Ill Child: Acute Adrenal Insufficiency," by A. M. Bongiovanni (PEDIATRICS, 44:109, 1969), the maintenance doses of cortisone, page 110, should read, "(about 25 mg per m2 per day by mouth)."
Salt-Losing Congenital Adrenal Hyperplasia (Continued)
Authors: Cohen John M.
Published: December 2021

In a letter to the editor (Pediatrics, 43:636, 1969) , Doctors Marks and Fink reported a 65% incidence of the salt-losing variant of congenital adrenocortical hyperplasia in 40 patients seen in their clinic. This incidence was notably higher than any previously reported.

During the last 30 years, 52 patients with the syndrome of congenital adrenocortical hyperplasia have been seen at the Massachusetts General Hospital. All cases have been of the sort attributed to either partial or complete block in the 21-hydroxylase enzyme.
A Radiographic Standard of Reference for the Growing Knee, by S. Idell Pyle, Ph.D., and Normand L. Hoerr, Ph.D., M.D. Springfield, Illinois: Charles C Thomas, 1969, 135 pp., $6.25
Authors: Wilkinson Robert H.
Published: December 2021

This atlas is an important aid to those physicians concerned with assessment of skeletal maturation of children. It represents the compilation of an enormous amount of material on the radiographic developmental features of the knee. This information is presented in such an orderly and concise manner that the physician can quickly and accurately evaluate the skeletal age of a child.

While the hand and wrist as characterized by Greulich and Pyle are perhaps more widely used for estimation of the degree of skeletal maturation, this atlas of the growing knee is a valuable supplement.
Infektionskrankheiten, Vol. II/1, edited by O. Gsell and W. Mohr. Berlin/Heidelberg/New York: Springer-Verlag, 1968, 554 pp
Authors: Eichenwald Heinz F.
Published: December 2021

The present two volumes represent the second of a three-part publication whose aim (in the words of the editors) is "to summarize existing knowledge" in the field of infectious disease. The series is intended to be useful to "the practicing physician, the clinician, and the academician." The two previously published volumes dealing with viruses succeeded admirably in these aims. However, Part II of the series, devoted to bacterial disease (except pneumococcal illnesses, unaccountably exiled to a future volume dealing with nickettsiae, protozoa, and deep mycoses) is less successful, and, in some ways, represents a distinct disappointment.
Child Care in a Developing Community (A Preliminary Survey), by K. S. Gokulanathan, M.B.B.S., and K. P. Verghese, M.B.B.S. Ernakulum, India: Anand Press, 1967, 72 pp., no price given
Authors: Kaul Surendra
Published: December 2021

This short monograph is the outcome of the experiences of two highly trained Indian pediatricians who, after returning home following their successful completion of pediatric training in the United States and the United Kingdom, found they could not find professional positions. It is commendable that the authors took the initiative of setting up a "polyclinic" of their own and establishing it on the foundations of good pediatric standards of practice learned abroad; in doing so they did not discard all the ancient and even venerable traditions of traditional Indian medical practice.
FAMILIAL UREMIC MEDULLARY CYSTIC DISEASE
Authors: Alexander Fred , Campbell Sara
Published: December 2021

The typical clinical features of uremic medullary cystic disease—anemia, polyuria, polydypsia, and uremia—were observed in three young siblings (the typical setting of familial juvenile nephronophthisis). Renal juxtemedullary cysts were found at autopsy in one sibling, confirming the concept that these two diseases are truly rehated. The mother of the siblings studied in this paper demonstrated an inability to concentrate urine.
The Pediatrician and the Marijuana Question
Authors: Gleason Charles H.
Published: December 2021

I would like to report my reaction to the views of Drs. Nader and Haggerty on the role of the pediatrician in the marijuana question.

Their number two view, "The effects are dependent upon many factors, including the psychological makeup of the user," seems to me to be the most urgent consideration at this stage of our knowledge.

It is unlikely that many of us are aware of our own psychological makeup and thus are unable to predict the outcome of a trial of the use of marijuana.
RADIOISOTOPE CARDIAC POOL SCANNING IN CHILDREN
Authors: Winship William S. , Houlder Anthony E. , van der Horst Ronald L. , Gotsman Mervyn S.
Published: December 2021

Seventeen children in congestive heart failure with a large heart shadow on the chest radiograph and four children without cardiac disease were studied by cardiac blood pool scanning using Tc99 m.-labelled human serum albumin to establish normal values and to assess the value of this technique in diagnostic practice.

Patients with cardiac dilatation caused by endocardial fibroelastosis or congestive cardiomyopathy had a large heart on chest x-ray, and most of this consisted of a large blood pool. They were clearly differentiated from patients with a pericardial effusion who had a large heart on chest x-ray but a small cardiac pool, with a pericardial halo and prominent cardiohepatic gap due to the surrounding effusion.

Cardiac pool scanning is a valuable diagnostic procedure in this group of seriously ill children, but immediate pericardiocentesis should not be deferred if sufficient time is not available to undertake the investigation. The radiation dose is low, side effects do not occur, and the investigation can be completed in less than 30 minutes.
THE PEDIATRICIAN AND THE PUBLIC
Authors: STEBBINS ERNEST L.
Published: December 2021

DR. ERNEST L. STEBBINS, whose communication appears below, is Professor of Public Health Administration and Director of the Johns Hopkins University School of Hygiene and Public Health. He has previously worked as epidemiologist and District Health Officer in State Health Departments and has held the position of Assistant Commissioner of Health in New York State and Commissioner of Health in New York City. He was at one time professor of epidemiology at Columbia University. He is secretary of the American Board of Preventive Medicine and Public Health and holds numerous other committee and board memberships.
ELECTROLYTE AND NITROGEN BALANCE STUDIES IN INFANTS FOLLOWING CESSATION OF VOMITING
Authors: DANOWSKI T. S. , AUSTIN A. C. , GOW R. C. , MATEER F. M. , WEIGAND F. A. , PETERS J. H. , GREENMAN L.
Published: December 2021

Abnormally low levels of serum potassium were observed prior to or during therapy of infants with a history of prolonged or recurrent vomiting.

Balance studies indicate that either dilution of body fluids with low potassium solution, or transfers of potassium into cells, or both processes were responsible for the hypokalemia.

The probable existence of deficits of body potassium incurred prior to the balance studies and their therapeutic implications have been discussed.
STUDY OF PULMONARY HYALINE-LIKE MATERIAL IN 4117 CONSECUTIVE BIRTHS
Authors: MILLER HERBERT C. , JENNISON M. HARRY
Published: December 2021

A study has been made of 4117 consecutive births including 66 stillborn infants and 85 neonatal deaths. Autopsies were done on 22 stillborn infants and 71 infants dying during the neonatal period.

From the autopsy study of neonatal deaths it was found that at least 15% of all live-born premature infants weighing between 1000 and 2000 gm. at birth had hyaline-like material in their lungs. The incidence of the pulmonary lesion was found to diminish progressively as the birth weight of the infants increased, so that it was practically non-existent in infants weighing over 3000 gm. at birth.

It was found that 90% of all infants weighing over 1000 gm. at birth and dying in the first 48 hours of life had hyaline-like material in their lungs at autopsy providing their mothers' pregnancies and labors had been free of serious complications and providing that the infants themselves had no other clinically recognized disease or defect of a serious nature.

No relation was found between the presence of the pulmonary lesion and the race, sex, order of birth of the infant or the age of the mother and length or type of labor. The lesion was not produced by the aspiration of food.

The symptomatology of the infants dying with hyaline-like material in their lungs was characterized by marked respiratory difficulty, including retraction of the lower chest wall with inspiration. The symptoms were not pathognomonic, but few premature infants with similar symptoms survived.

The pathogenesis of this pulmonary lesion remains unknown. The theory is advanced, based on the facts brought out in this study, that the hyaline-like material in the lung is the result of an etiologic agent that not only injures the lung of the fetus, but also causes the premature birth of the infant so injured.
EXPERIMENTAL BASIS FOR PREDICTION OF THERAPEUTIC EFFICACY OF STREPTOMYCIN IN INFECTIONS CAUSED BY GRAM NEGATIVE BACILLI
Authors: ALEXANDER HATTIE E. , LEIDY GRACE , REDMAN WINIFRED , SIMAKOW EROS
Published: December 2021

Cells with varying degrees of resistance to streptomycin, 25, 100 and 1000 µg./cc., have been demonstrated in large populations of eight species of gram negative bacilli prior to exposure to streptomycin. These resistant variants exhibit traits characteristic of bacterial mutants and therefore arise spontaneously, independent of the action of streptomycin.

The known differences in therapeutic efficacy of streptomycin among infections caused by these eight species have been demonstrated to be closely correlated with two factors.

1 . In infections in which streptomycin has been proven of therapeutic value—H. influenzae, H. pertussis and E. coli—the rate of occurrence of new mutants resistant to 25 and 100 µg./cc. is so low that they cannot be expected to play a significant role in emergence of resistance during streptomycin therapy.

In cultures of organisms causing infections in which streptomycin has been unsuccessful therapeutically—Salmonella, S. typhosa and Ps. aeruginosa—the rate of occurrence of mutants resistant to 25 and 100 µg./cc. is relatively high; these mutants doubtless play an important role in emergence of resistance to streptomycin and therapeutic failure.

2. Streptomycin in a concentration of 10 µg./cc. is primarily bactericidal against the species which cause infections in which streptomycin therapy has been of value. This concentration is not primarily bactericidal against those organisms causing infections in which streptomycin has failed therapeutically.

These data suggest that knowledge of these two factors in vitro can offer a reliable basis for predicting the therapeutic efficacy of streptomycin in a given infection. For example, in Shigella and H. parapertussis infections, in which streptomycin has not been clinically evaluated, one can predict success in the former and failure in the latter.
TREATMENT OF ERYTHROBLASTOSIS
Authors: MOLONY CLEMENT J.
Published: December 2021

The first two years' experience with the substitution transfusion in the Los Angeles area is reported and analyzed. Forty-five cases were substituted. Results of therapy are compared with 35 cases studied at the Los Angeles Children's Hospital during the same period but which were not treated with a substitution transfusion.

Mortality figures favored the use of the conservative, multiple simple transfusion method of treatment in the series reported. Even in groups of comparable severity, the substituted cases showed a higher mortality.

Evidence is presented that errors in technic may have had an appreciable effect on the poor showing made by the substitution transfusion method of therapy. However, such errors may be inherent in any radical procedure.

The series of cases is analysed as to mortality, development of kernicterus, effect of previous pregnancies, effect of previous siblings with erythroblastosis, effect of transfusions, correlation of the Coomb's test with severity of disease, correlation of maternal antibody titer with severity of disease, transfusions needed for a cure and length of stay in the hospital.

An objective standard to measure the severity of an individual case is suggested. Although empiric, it allows for summations and resolves a case down to a numerical figure. Thus the case can be compared to other cases in an analysis of any phase of the disease. Use of the Coomb's (or antiglobulin) test is described. This test was found to be reliable, liable, easy to perform and extremely sensitive. There was a good correlation between strength of the test and severity of a case. Substitution transfusions were not performed unless the test was positive.

Errors in performing the substitution transfusion are described. These errors included using too little blood, delaying the operation too long, giving blood into the umbilical vein, injecting calcium improperly and failing to protect the infant against exposure and dehydration.

A technic for the substitution transfusion is presented in detail with suggestions for avoiding the errors made in these cases. The theoretic advantages inherent in the substitution transfusion are enumerated.
ELECTRIC SYSTOLE (QT INTERVAL) IN ACUTE RHEUMATIC PERICARDITIS IN CHILDREN
Authors: TARAN LEO M. , ORDORICO DOTTY
Published: December 2021

Thirteen cases of acute rheumatic pericarditis in children are presented. The diagnostic pattern is discussed. The observation is made that the electric systole (QT interval) is shortened in all cases of pericarditis studied irrespective of the type and severity of the attack. The conclusion is made that a shortening of the duration of the QT interval during the course of active rheumatic carditis, in the absence of other factors (digitalis or salicylate therapy) known to shorten the duration of the QT interval, should always raise the suspicion of the presence of acute pericarditis.
CLINICAL RECOVERY FOLLOWING PROLONGED ANURIA IN AN INFANT TWO MONTHS OF AGE
Authors: WARREN S. A. , GROSS W. V.
Published: December 2021

A case of prolonged (107 hours) renal shut-down due to potassium bromate poisoning is presented.

Emphasis is placed upon the extreme youth of the patient and his clinical recovery on a conservative regime.

There is included a brief description of the management which consisted of fluid and electrolyte restriction.

A review of the pertinent literature is included.
IDIOPATHIC HYPOPARATHYROIDISM WITH PAPILLEDEMA IN A BOY SIX YEARS OF AGE
Authors: COLLINS-WILLIAMS C.
Published: December 2021

A case is reported of a boy with idiopathic hypoparathyroidism, moniliasis and the celiac syndrome. Moniliasis developed at the age of 16 months and was apparently cured promptly but evidence of C. albicans infection was found at several subsequent visits. At the age of 5 years he began to pass loose stools and at 5 10/12 years was diagnosed as having the celiac syndrome.

At 6 6/12 years he entered hospital in severe tetany and was found to have hypoparathyroidism. The bones were normal by roentgenogram and no intracranial calcification was observed. While he was in the hospital bilateral papilledema developed, then receded, apparently in response to therapy for the hypoparathyroidism. Treatment consisted of calcium gluconate intravenously and large doses of calcium gluconate, water-soluble vitamin D, AT-10 and creamalin® by mouth, as well as a high protein, low fat, low phosphorous diet. The stools became normal shortly after this diet was started.

Brief reference is made to his brother in whom moniliasis developed at the age of 17/12 years and the celiac syndrome at about 3 years. At 9 years he still has no evidence of hypoparathyroidism. The four other siblings are well.

The 22 previously reported cases of papilledema associated with hypoparathyroidism and the seven previously reported cases of moniliasis associated with hypoparathyroidism are briefly reviewed.
PLASMA INFUSION THERAPY FOR HURLER'S SYNDROME
Authors: Crocker Allen C.
Published: December 2021

Ever since the first report from Houston of the "plasma infusion" approach to modification of the Hurler's syndrome picture there has been a wide popular feeling that the beginnings of a "treatment" were at hand for this group of inborn error diseases. Intriguing data on alteration of the pattern of urinary mucopolysaccharide excretion, and, to some extent, of the children's clinical manifestations, opened a real hope that a substantial mechanism existed for rendering more normal the skewed metabolism of these patients. In addition, the authors commented that "human plasma infusions . . . seemed to fit the recommendations" given in a previous PEDIATRICS Commentary for theoretically useful therapeutic trials of new materials in patients with inborn error syndromes.
CHANGING INCIDENCE OF HEMOPHILUS INFLUENZAE MENINGITISX
Authors: Smith Edward W. P. , Haynes Ralph E.
Published: December 2021

We studied the incidence of Hemophilus influenzae meningitis at the Columbus Children's Hospital (CCH) during the following intervals: Period A (1942 to 1950), Period B (1951 to 1959), and Period C (1960 to 1968).

Other investigators have reported an increase in the incidence of influenzal meningitis, but there has been no predictable relationship to the number of hospial admissions. Thre was a 399% increase in the number of patients with H. influenzae meningitis at the CCH from Period A to Period C, roughly proportional to the rise in total hospial admissions during he same time.

Children under 5 years of age constitute the major population at risk. Incidence stated in terms of population at risk appears to be a reliable method of comparing experience in specific geographic areas during specific periods of time. The experience at the CCH, using this method, indicates a significant increase in this disease without comparable increases in meningitis caused by other bacteria.
The Preponderance of Males in the Idiopathic Nephrotic Syndrome of Childhood
Authors: Heymann Walter , Makker Sudesh P. , Post Robert S.
Published: December 2021

In this communication we will limit the discussion to children or adults who have massive proteinuria, hyperlipemia, and hypoalbuminemia occurring initially in the absence of preceding and persistent azotemia, hypertension, or decreased renal function and not in association with any recognized inciting agent or pre-existing systemic disease. It is considered distinct from the nephrotic syndrome (NS) occurring in the course of other renal diseases caused by chemical agents or in association with systemic diseases such as lupus erythematosus and other collagen diseases, amyloidosis or diabetes mellitus.
The Little League Again
Authors: Allman Daryl
Published: December 2021

We have received the following inquiry:

How long should a preadolescent or adolescent boy be allowed to pitch in a Little League Contest? What are the risks of serious or permanent injury to the shoulder or elbow related to pitching and how can they be avoided?