bluuebunny/crossref_metadata_2025 huggingface dataset:
Letters to the Editor
Authors: CORNBLATH MARVIN , FORBES AUDREY E. , PILDES ROSITA S. , LUEBBEN GERTRUDE , GREENGARD JOSEPH
Published: December 2021

We appreciate Dr. Tow's comments and apologize for not referring to him by name, although his classical book, Diseases of the Newborn, published in 1937, was included in the bibliography.

We also agree that expert obstetrical care and management are critical in the intact survival of every newborn.

Our only disagreement is that we firmly and unequivocally believe that carefully controlled studies in the care of the low birth weight infant are essential if we are to avoid making "full cycle" every 20 to 30 years based on clinical impressions.
RED CELL METABOLISM IN THE PREMATURE INFANT
Authors: Oski Frank A.
Published: December 2021

Red cell glucose consumption and C14 O2 production from glucose-I-C14 and glucose-U-C14 were measured in 17 premature infants, 15 normal adults and 7 patients with reticulocytosis. The red cells from the premature infants consumed significantly more glucose and produced more C14 O2 than did the cells from normal adults but did not differ in this regard from patients with elevated reticulocyte counts. The percent of glucose metabolized by the pentose phosphate pathway in the red cells of the infants was as great, and often greater, than that observed in the other two groups. The red cells of the premature infants also demonstrated an ability to respond to methylene blue. The pentose phosphate pathway would appear to be intact in the red cells from these infants and inadequate generation of NADPH2 is not responsible for the ease with which these cells develop oxidative denaturation of hemoglobin.
MEDICAL HELP AND MATERNAL NURSING CARE IN THE LIFE OF LOW-INCOME FAMILIES
Authors: Alpert Joel J. , Kosa John , Haggerty Robert J.
Published: December 2021

A Family Health Calendar was kept by a sample of 78 low-income families for a 4-week period as part of a longitudinal research project. The Calendar presents the mother's perception of her role in family health. The data obtained indicate: (1) about one-fourth of the symptoms experienced by family members receive no sponse; (2) about one in every eight such symptoms receives medical attention; (3) it is almost exclusively the mother who takes action in response to symptoms; (4) this maternal nursing care includes supervision of health status, decision making, administration of home treatment, and arrangement for medical help; (5) the infrequency with which help is given to the mother in nursing care does not seem to be associated with family disorganization but rather with social norms, which define nursing care as belonging in the exclusive domain of the mother.
DIAGNOSIS AND TREATMENT: INTERPRETING THE POSITIVE SCREENING TEST IN THE NEWBORN INFANT
Authors: Scriver Charles R.
Published: December 2021

THE recent interest in metabolic screening in the newborn period stems from the belief that early detection of certain hereditary metabolic diseases provides the best opportunity to initiate treatment. It has been implied generally that identification of an aberrant biochemical phenotype is synonymous with disease; treatment ought, therefore, to be initiated to restore the normal phenotype in order to prevent harm to the patient. A practical application of this philosophy emerged in the case of phenylketonuria; a nation-wide alert to prevent mental retardation provided fertile ground for "phenylketonuria" screening programs to take root and appear abruptly in the mainstream of medical care. Many state legislatures were convinced that eradication of any cause of mental retardation was an important venture; thus, enabling or compulsory legislation was passed to achieve this end. How to interpret the "positive screening test" and how to divine its true significance has, therefore, become a problem which could face any pediatrician at any time in North America today.

A recent editorial in Pediatrics commenting on neonatal screening programs noted that they may bring both good and harm. An accompanying article described the vicissitudes which beset several investigators of neonatal tyrosinemia. Early impressions suggested that infants would benefit from treatment of their tyrosinemia; however, the need for treatment in most infants with tyrosinemia was not substantiated after more detailed investigations had been performed. It is easy to see how harm might have been done in terms of quite unnecessary treatment for neonatal tyrosinemia, although at one point it seemed that it might be good to screen all infants for neonatal tyrosinemia.
Handbuch der Kinderheilkunde
Authors: EICHENWALD HEINZ F.
Published: December 2021

Volume III of the Handbuch der Kinderheilkunde contributes another significant segment to the encyclopedic exposition of the entire field of pediatrics, which eventually will occupy nine large volumes. Volumes II and IV have previously been reviewed in this journal. Also available at this time are Volume V (Infectious Diseases) and Volume VII (The Lungs, The Heart, Cardiopulmonary Function, The Kidneys, and The Urinary System).

Volume III deals with two separate fields, immunology and social pediatrics. It contains contributions by 67 authors; most authors are from Germany but some are also from Switzerland Poland, and the United States.
ELECTROPHORETIC STUDIES OF PLASMA PROTEINS IN NORMAL CHILDREN
Authors: KNAPP ELIZABETH L. , ROUTH JOSEPH I.
Published: December 2021

Electrophoretic studies of plasma proteins have been made for 54 healthy children ranging in age from birth to 17 years. Mean values for most plasma protein fractions agreed well with previously published results for normal adults and children, but changes in the relative concentration of some of the components with age were noted.

Although the percentage of albumin decreased from infancy to midchildhood and appeared to be lowest in children 5 to 11 years old, figures for absolute concentration of albumin in gm./100 ml. showed no significant decrease in albumin for this age group.

The percentage and the absolute concentration of α2-globulin were highest in infancy and decreased gradually with increasing age.

Both the percentage and the absolute concentration of γ-globulin decreased from unusually high values in the newborn infant to unusually low values in infancy, then gradually increased with age to reach the normal adult level in midchildhood, 5 to 11 years of age. These changes are believed to be related to the loss of passive immunity received by the infant from its mother and the accumulation of antibodies and the development of active immunity in the child.
HUMORAL ANTIBODY FORMATION IN INFANTS AGED ONE TO THREE MONTHS INJECTED WITH A TRIPLE (DIPHTHERIA-TETANUS-PERTUSSIS) ALUM-PRECIPITATED ANTIGEN
Authors: BRADFORD WILLIAM L. , DAY ELIZABETH , MARTIN FREDERICK
Published: December 2021

Immunization of infants, 1 to 3 months of age, with an alum-precipitated antigen containing diphtheria and tetanus toxoids and Hemophilus pertussis organisms resulted in satisfactory humoral antibody levels against diphtheria and tetanus. Ninety-seven per cent of the subjects tested revealed more than the generally accepted level of protection against diphtheria and 94% showed a similar result against tetanus.

In regard to pertussis, only a few of the immunized infants developed agglutinative titers of 1:320 or higher. However, analysis of the titers in terms of the expected number of cases of pertussis, if subjected to family exposure, indicates that probably 75% of the infants were protected.

When tested six months after the completion of the original series of injections, each of 29 infants gave positive skin reactions to the injection of agglutinogen.
UNUSUAL SYNDROME ASSOCIATED WITH CANDIDA ALBICANS INFECTION
Authors: BAIRD KATHARINE H.
Published: December 2021

A syndrome associated with candida albicans infection is described. It consists of alopecia, dwarfing, paronychia and eruptions of lesions localized to certain areas of the body. The case of this syndrome presented is unusual in that the child responded to oral thymol therapy and has continued to make good progress.
UNILATERAL MULTICYSTIC KIDNEY IN INFANTS
Authors: RAVITCH MARK M. , SANFORD MARSHALL C.
Published: December 2021

Four infants are reported with unilateral replacement of the kidney by large cysts. These cases and six similar ones found in the literature show: (a) a large abdominal mass producing pressure symptoms only; (b) a normal contralateral kidney; (c) progressive increase in size of the mass; (d) adequate renal function after resection of the involved kidney.
MERCURY POISONING FROM CALOMEL PRODUCING SUBACUTE ACRODYNIA AND ITS TREATMENT WITH DIMERCAPROL
Authors: CARITHERS HUGH A.
Published: December 2021

A 6 month old child received calomel in teething powders over a two months' period. Symptoms suggestive of acrodynia developed. BAL was effective in treatment.
A Simple Method for Blood Pressure Measurements in the Premature and Newborn Infant
Authors: KAFKA HEINZ
Published: December 2021

The commonly used methods for taking blood pressure, either by palpation of the artery or by auscultation of Korotkov's sound, cannot easily be applied in the very young. The importance of these measurements, however, has found general recognition as shown by the numerous methods and devices designed for this purpose. The most popular is the flush method originally described by Gaertner and later brought into more extensive use by Goldring. Between this simple method and the rather sophisticated instrument described by Currens is a variety of others. With these instruments, various cuffs have been used, either single occluding cuffs or two separate cuffs—one proximal occluding, the other distalsensory.
Letters to the Editor
Authors: ZISMAN ALAN S.
Published: December 2021

In the March 1967 issue of Pediatrics you have reprinted the letter of Dr. R. A. Norton, who, as a private practitioner, finds the articles in Pediatrics esoteric and almost useless.

As just another ordinary practitioner, I must disagree with Dr. Norton. I find the journal informative, provocative, and of great value. I find that, in a manner of speaking, it reflects the world in which I live and the field of medicine in which I serve. As a case in point, I take the issue in which Dr. Norton's letter appears, that of March 1967.
Letters to the Editor
Authors: GEEFHUYSEN J.
Published: December 2021

Thank you for forwarding the letter relating to a further case of temporary idiopathic neonatal hyperglycemia published by W. L. Burland.

I apologize for overlooking Dr. Burland's port of a case of temporary idiopathic neonatal hyperglycemia, which brings the total to date up to 18.

The infant described by me was rehydrated intravenously within 24 hours and thereafter was maintained on oral fluids of 360 ml expressed breast milk and 120 ml water per 24 hours. The infant gained weight normally and did not become dehydrated on this regime. Therefore, in this case no insulin appeared necessary.
Benign Intracranial Hypertension
Authors: SMITH STEPHEN A. , NEWMAN ARTHUR J.
Published: December 2021

Rose and Matson's article in the February issue ofPediatrics (39:227, 1967) seems to indicate a relationship between preceding infection and the development of benign intracranial hypertension. It would be of interest to know the antibiotics used to treat these children's infections.

we have recently encountered a 5-year-old girl with congenital abnormalities of the urinary tract and urinary tract infection who developed headache, vomiting, diplopia, papilledema, and separation of sutures while being treated with tetracycline. She had not received vitamin A, steroids, or other antibiotics.
IDIOPATHIC PULMONARY HEMOSIDEROSIS
Authors: Repetto Guillermo , Lisboa Carmen , Emparanza Eugenia , Ferretti Ricardo , Neira Manuel , Etchart Martin , Meneghello Julio
Published: December 2021

Eleven cases of idiopathic pulmonary hemosiderosis were studied over a 10-year period. The main clinical features were irondeficiency anemia and mild recurrent hemoptysis. Pulmonary opacities which changed in a few days were constantly seen radiologically during the acute episodes. In addition, permanent reticulation and miliary-type stippling were present in the children who developed lung fibrosis.

Respiratory function tests, including diffusing capacity of lungs, were studied in five children and an attempt was made to correlate lung structure and function.

Diagnosis was confirmed by necropsy or by the finding of siderophages in sputum, gastric washing, pulmonary puncture, or surgical lung biopsy. The last procedure was the only method by which the disease was diagnosed in three children after the other methods were negative.
Anticipating the Response to Amphetamine Therapy in the Treatment of Hyperkinetic Children
Authors: CONRAD W. GLENN , INSEL JONATHAN
Published: December 2021

It appears that there are two kinds of significant variables pertinent to a positive response to amphetamines: (1) organic factors, which appear primary, and (2) emotional factors, which, if present, counteract or interfere with the drugs' action. In general, those children responded positively to the drug who showed an organic background, positive parent-child relationship, and the absence of severe psychiatric problems in the parents. Seventy-five percent of the O and OE children with parents who were not grossly deviant improved while none became worse.

As with all retrospective studies the absence of a control group prevents examination of such factors as "placebo effect" or the effect of other services received at the Center or in school. However, since positive responses were usually immediate and were maintained over extended periods of time, often after other forms of treatment were unsuccessful, it is felt that these other variables were not significant contaminants.
HOW WELL DO PATIENTS TAKE ORAL PENICILLIN? A COLLABORATIVE STUDY IN PRIVATE PRACTICE
Authors: Charney Evan , Bynum Rufus , Eldredge Donald , Frank Donald , MacWhinney James B. , McNabb Neal , Scheiner Albert , Sumpter Edwin A. , Iker Howard
Published: December 2021

A study of how well children took oral penicillin when prescribed for streptococcal pharyngitis or otitis media was conducted in three private pediatric group practices. The presence of penicillin in the urine, as determined by the Sarcina lutea culture method, was used to assess the compliance rate. A total of 459 patients were studied—107 at five days of therapy and 352 at nine days.

Eighty-one percent of the patients were taking the penicillin as prescribed on the fifth day, and 56% were taking it on the ninth day. Another 13% were erratic takers at the end of therapy. The children with pharyngitis were somewhat more likely to complete therapy than those with otitis media. A number of factors were studied in an attempt to differentiate those who complied with the therapy from those who did not. The take rate was unrelated to age or sex of the child, duration of symptoms, or doctor's estimate of severity of disease at onset. It was correlated with mother's estimate of severity, whether or not their usual doctor prescribed the medicine, and certain personality traits of the mother as perceived by the pediatrician. The implications of the study for the use of oral therapy in children are discussed.
PEDIATRIC USE OF THE RAPID PLASMA REAGIN (CIRCLE) CARD TEST
Authors: Herweg John C. , Hoffmann F. Donald , Reed Charles A.
Published: December 2021

In the United States, in 1966, 370 infants under 1 year of age were reported as having congenital syphilis. This is a twofold increase since 1957. Despite this fact, routine serologic testing for syphilis is not done on most infants and children hospitalized in the United States. For use in those institutions where routine serologic testing for syphilis is felt to be desirable, the Rapid Plasma Reagin (Circle) Card Test has been found to be a simple, practical, and inexpensive screening method.
Fatal Chloroquine Ingestion: An Increasing Hazard
Authors: CARSON JOHN W. , BARRINGER MICHEL L. , JONES ROBERT  E.
Published: December 2021

A fatal case of poisoning with chloroquine is presented in order to increase the awareness of the physician to (1) the severe toxicity of the drug, (2) the lack of specific treatment, and (3) the increasing availability of the drug to children.
Factors Associated with Impairment of the Early Development of Prematures
Authors: AVERY GORDON B.
Published: December 2021

This monograph reports a prospective study of the development up to the age of 15 months of 331 infants of low birth weight and 50 control infants of normal weight. Originally started to evaluate the effects of hyperbilirubinemia, the investigation was broadened to include birth weight, social condition, maternal complications, hypoxia, neonatal weight loss, and neonatal infections among the factors analyzed. The study team consisted of a psychologist, pediatrician, social worker, and psychiatrist.

The published results contain no real surprises but represent carefully obtained documentation of the aftereffects of low birth weight and perinatal complications.
Relationship of the Physician in Practice to a Children's Cancer Clinic
Authors: McClelland Charles Q.
Published: December 2021

I WANT to make clear in the beginning that I am not a hematologist, and I am certainly not a cancer expert. However, I have been asked to present the views of a general pediatrician. I have divided the content of my presentation into three areas. First, the initial period of diagnosis of malignant disease in a child; second the relationship of the primary physician, or the practicing pediatrician, to the family and the clinic in the course of the illness; and, finally, the relationship of the physician to the family and clinic during the terminal stages and, indeed, after the death of the child.

TIME OF INITIAL DIAGNOSIS

First of all, at the time of the initial diagnosis of cancer and a malignant disease in a child, all physicians who serve as family physicians go through some rather serious self-searching problems of their own. This is not a straightforward illness, and there is a great deal of concern, such as "did I miss this diagnosis or did I completely overlook something critical here that has been going on for some time." This is a question that almost everybody who is thoughtful in their relationship with children will ask themselves. In some, it is a very destructive kind of response and, in others, perhaps constructive; but, nevertheless, it is a real one and a frightening one for a physician to face. Secondly, many physicians ask the question: "How can I get rid of this patient? Nobody likes doctors who take care of dying kids; how can I unload this patient?" I am talking of what many people have told me of their feelings.
DERMAL ERYTHROPOIESIS IN NEONATAL INFANTS
Authors: Brough A. J. , Jones D. , Page R. H. , Mizukami I.
Published: December 2021

Six cases of a unique transient dermatopathy occurring in neonatal infants and consisting of extramedullary dermal erythropoiesis are described. The process is transient. Three cases, on clinical, pathologic, and cultural grounds, were shown to be associated with viral infection due to cytomegalovirus. Two cases were presumed to be due to congenital rubella virus infection on clinicopathologic grounds. The sixth case was presumably associated with viral infection of unknown etiology. Embryologic and pathogenetic aspects of the cutaneous lesions are discussed.
COLD DIURESIS IN THE NEWBORN
Authors: Fisher D. A.
Published: December 2021

The effect of environmental temperature on urine volume, urine osmolality, creatinine excretion and clearance, and sodium and potassium excretion has been investigated in groups of incubated (seven) and non-incubated (six) newborn, term infants. Environmental temperature for the "warm," incubated infants ranged between 32.6 and 37.6°C; corresponding values for the cooler, non-incubated infants were 22 and 30°C. Fluid intake in the two groups of infants was similar.

Urine volume during the second day in the cooler infants was significantly greater and urine osmolality significantly less than the values in the warm infants. Creatinine excretion throughout the study and creatinine clearance during the second day were similar in the two groups of infants. Although a tendency to greater sodium and potassium excretion was observed in the colder infants at all collection periods, this difference was statistically significant only for potassium excretion between 12 and 24 hours and for total (48 hour) potassium excretion.

These data document a "cold diuresis," unrelated to water intake, in newborn infants maintained at ambient temperatures below 30°C. This diuresis is not due to increased glomerular filtration rate. It is not observed during the first 12 to 24 hours of life, probably because glomerular filtration during this early period is limiting. The electrolyte diuresis characteristic of adults acutely exposed to cold was not observed in the present study, suggesting that the mechanism of the increased electrolyte excretion during cold exposure is independent of the mechanism of water diuresis.
INSULIN RESISTANCE IN DIABETES IN JUVENILES
Authors: Guthrie Richard A. , Murthy D. Y. N. , Womack William
Published: December 2021

A discussion of insulin resistance in a 10-year-old girl successfully treated with pork insulin is presented. This patient had antibodies to beef insulin. The insulin requirement with beef insulin was in excess of 200 units per day and decreased to about 35 units per day with pork insulin. There was no response to steroid administration.

The literature is reviewed for the very limited number of cases of insulin resistance in children. Only 16 cases under 16 years of age were found. The different types of management of these children with insulin resistance are discussed.
Kohlenhydratstörungen im Kindesalter (Postgraduate Courses in Pediatrics) Vol. 19
Authors: ZELLWEGER HANS
Published: December 2021

The rapidity with which new volumes of Postgraduate Courses in Pediatrics appear is impressive, and is to be credited to the proficient and industrious editor of this series, Professor E. Rossi of Berne, Switzerland.

Volume 19, Disturbances of Carbohydrate Metabolism, consists of nine chapters, two written in French and seven in German. The purpose of this booklet is to acquaint the practitioner with some of the newer aspects of carbohydrate metabolism disturbances. Some of these disturbances (notably the glycogenoses, disaccharidase deficiencies, and monosaccharide malabsorption syndrome) have been omitted from the discussion.
A NEW ANTIBODY TEST FOR RUBELLA
Authors: MICHAELS RICHARD H. , MEDEARIS DONALD N.
Published: December 2021

THE development of serologic methods for rubella is of considerable importance; a clinical diagnosis of rubella cannot be made reliably and the hazards of fetal infection with this virus are significant. Recently Stewart, et al. reported the successful application of the hemagglutination-inhibition technique to assay of rubella virus antibodies. With the use of red blood cells from 1-day-old chicks, the authors devised an hemagglutination-inhibition (HI) test which appeared to have the reliability and sensitivity of the standard neutralization test but was simpler, more rapid, and less expensive to perform. Sever and his associates have confirmed and extended these observations in an article which appears elsewhere in this issue.
THE SIGNIFICANCE OF THE PH1 CHROMOSOME IN ACUTE MYELOBLASTIC LEUKEMIA: SERIAL CYTOGENETIC STUDIES IN A CRITICAL CASE
Authors: Mastrangelo Renato , Zuelzer Wolf W. , Thompson Ruby I.
Published: December 2021

Serial cytogenetic studies of the bone marrow during a prolonged complete remission of AML in a child revealed a dual population of Ph1-positive and -negative cells whose proportions varied with therapy. Although the further course remained typical of AML, blood and bone marrow during remission intermittently showed features consistent with incipient CML. The blastic stem line emerging in relapse was 100% Ph1 positive and showed aneuploidy and a marker chromosome.

The findings support the view that the blastic crisis of CML is identical with AML, for they indicate that the blastic transformation of Ph1-positive cells can occur before the normal marrow population has been completely replaced by descendants of the mutant clone and the proliferative phase of CML has been reached. This further suggests that CML should be included among the conditions carrying a high risk of acute leukemia and that it is the chromosomal defect rather than the myeloproliferative process which constitutes the predisposing factor, in analogy to trisomies and other chromosomal aberrations.
Placental Transfusion or Redistribution of Circulating Red Cell Mass
Authors: BAUM RICHARD S.
Published: December 2021

The splendid review of placental transfusion published in your July issue (Pediatrics, 40:109, 1967) bravely suggests reasonable definitions of "early" and "late" cord clamping. Placental transfusion itself is not defined, but once again the implication is, "It is what a baby gets when his cord isn't clamped early."

Although cord clamping clearly can influence hugely the placenta-to-baby transfer of blood, might not placental transfusion be defined more accurately by not focusing on considerations of clamping time?
Letters to the Editor
Authors: MACGILLIVRAY M. H. , CRAWFORD J. D. , ROBEY J. S.
Published: December 2021

The frequency of the clinical association between deafness and hypothyroidism leads us to look forward eagerly to full publication of the results Drs. Bargman and Gardner have obtained with their interesting experimental model. As pointed out in their letter, it is difficult to exclude the diagnosis of Pendred's syndrome in the case we reported recently, although the possibility seems unlikely.

There is no evidence of inheritance of her disorder as a recessive trait since the child is not the product of a consanguineous marriage nor has she any affected siblings or other relatives.
READJUSTMENT IN DISTRIBUTION OF ALVEOLAR VENTILATION AND LUNG PERFUSION IN THE NEWBORN
Authors: Ledbetter Marion K. , Homma Takeshi , Farhi Leon E.
Published: December 2021

An increased urinary-alveolar PN2 difference was demonstrated in normal, full-term infants during time first 6 days of life. This uADN2 results only from regions of the lungs with a low VA/Q and is not affected by true venous admixture, a diffusion barrier, or the presence of atelectasis. The mean aADN2 of 25 mm Hg on the first day of life was comparable to the N2 difference found in patients with severe emphysema. The mean PN2 difference decreased gradually and by time sixth day was approximately 10 mm.

The histologic signs of amniotic detritus in the lungs of virtually all new-born infants dying of non-respiratory causes on the first day of life and the subsequent lower incidence of these materials in the lungs of infants dying during the first week suggests the possibility of partial obstruction and low VA/Q in some regions of the lung. The temporary increase in uADN2, which was found in some cases may indicate that atelectatic areas may open at different times.
NEEDLE BIOPSY OF THE LIVER IN INFANCY AND CHILDHOOD
Authors: Walker W. Allan , Krivit William , Sharp Harvey L.
Published: December 2021

Two hundred ten percutaneous liver biopsies were reviewed. No serious complications were noted. The significance of the technique was discussed. This procedure is a safe and accurate means of diagnosing and studying liver disease in the pediatric patient.
Children of Phenylketonuric Women
Authors: Fraser G. R.
Published: December 2021

I was interested to see the excellent report and review of cases of congenital malformations in offspring of phenylketonuric mothers by Drs. Stevenson and Huntley (Pediatrics, 40:33, 1967). It is becoming increasingly clear that, for reasons which are not entirely understood, a proportion of females who are homozygous for the gene causing phenylketonuria escape the worst effects of the condition and are able to live normal, married lives and to reproduce. It would seem clear also that the prognosis for their children is poor, presumably due to damage in fetal life due to the maternal disturbance of metabolism.
ACTIVITY, CALORIE INTAKE, FAT STORAGE, AND THE ENERGY BALANCE OF INFANTS
Authors: Rose Hedwig E. , Mayer Jean
Published: December 2021

Activity has long been known to be a major factor in the energy balance of moving organisms. Recently, the relative inactivity of obese individuals and the hyperactivity of thin individuals have received much attention. A study of the relationships of activity, growth, fat storage, and calorie intake of 31 infants living under normal home environmental conditions suggests that the unusually fat and the unusually thin infant may have, respectively, a smaller and larger number of active cells and, therefore, lower and higher BMR's per unit of body mass than the average individual. This would seem to confirm the theory that BMR is a function of inherent mitochondrial activity rather than of body size or shape.
Congenital Atrial Flutter: Report of a Case Documented by Intra-uterine Electrocardiogram
Authors: Blumenthal Sidney , Jacobs Jerry C. , Steer Charles M. , Williamson Susan W.
Published: December 2021

A newborn infant shown to have atrial flutter in utero and after delivery was successfully converted to normal sinus rhythm with intramuscular digoxin. He remains well at 2 years of age. This is the first patient to be reported in whom atrial flutter was demonstrated by intra-uterine electrocardiography. This arrhythmia, when present in newborn infants without other signs of heart disease, has a good prognosis.
Possible Explanation for the Decline of Hypercalcemia
Authors: Barness Lewis A.
Published: December 2021

In a conversation I mentioned that I could understand why hypercalcemia had decreased in England but I was unaware of any logical explanation for why it had decreased so much in incidence in this country. In England until a few years ago almost 2,000 units of vitamin D were added to milk, whereas in this country milk allegedly contained about 400 units per reconstituted quart. Since idiopathic hypercalcemia became a recognized entity, the vitamin D content of milks in England has been decreased.
Hand-Washing for Nursery Technique
Authors: Lee Henry F.
Published: December 2021

It is satisfying to see careful questioning of old rules and techniques as exemplified in the communication from Drs. Silverman and Sinclair (Pediatrics, 40:900, 1967) concerning the questionable value of gowns and masks in nurseries.

Nothing that follows here implies the slightest criticism of their valuable work or conclusions or suggests omissions in the frame within which they are working.

An experience of 20 years in both large center city nurseries and in an active community hospital leads me to agree with their conclusion that gowns and masks are not an important part of nursery technique.
Hoarseness and Palatal Petechiae as Clues in Identifying Streptococcal Throat Infections
Authors: Dyment Paul G. , Klink Lon B. , Jackson Donald W.
Published: December 2021

An attempt was made to establish a relationship between the presence of hoarseness and palatal petechiae and the results of throat cultures performed on children with acute throat infections. A total of 1,307 throat cultures were performed and the results were compared to the presence or absence of these two factors. It is concluded that, if a physician uses either of these two clinical "clues" to distinguish between streptococcal and non-streptococcal throat infections, he will be wrong one quarter of the time. The use of inexpensive office techniques for throat cultures is encouraged.
Béla Schick, 1877-1967, a Gracious Man
Authors: Cone Thomas E.
Published: December 2021

In his tenderly written eulogy in the February issue, Dr. Hodes calls attention to Dr. Schick's warmth and friendliness towards others. Although I was not a close personal friend, I was the recipient over the years of a number of neatly, hand-written letters from this great man. These letters always had a gracious tone reminiscent of a bygone era. An example of this is the following written to me in 1964 when Dr. Schick was in his eighty-seventh year:

Oct. 23, 1964

I Just returned from Israel two days ago and found your kind letter of October 10th awaiting me. As much as I would like to attend your meeting Monday evening I feel that it will be impossible for me to do so at the present time.
VIRAL EXANTHEMS AND ENANTHEMS
Authors: Horstmann Dorothy M.
Published: December 2021

Time Was when measles, rubella, scarlet fever, and the "fourth disease" were the infections to he considered when dealing with puzzling rashes. Events in the past generation have changed the problem considerably and complicated it to an extraordinary degree. This is due largely to the discovery in the late 1940's and early 1950's of several whole new families of viruses, including the Coxsackie, echo-, and adenoviruses. In the subsequent two decades the pathogenic potential and diverse clinical associations of these agents, which number close to 100, have gradually emerged. One of the most striking features has been an uncovering of an etiologic relationship to the so-called "summer exanthems."l,2
RENIN ACTIVITY, ALDOSTERONE SECRETION, AND CONGENITAL ADRENAL HYPERPLASIA
Authors: Bongiovanni Alfred M.
Published: December 2021

A Relationship between the kidney and hypertension has been recognized for centuries. For the past three decades various manipulations of the kidney, beginning with the "Goldblatt kidney," have been known to produce hypertension. Thus, it has long been suspected that some humoral factor originating in renal tissue was involved. There is now evidence that this renal factor is renin and it appears to originate in the juxtaglomerular apparatus. The exact mode of its release is not entirely clear, but it seems probable that subtle changes in blood volume or perhaps blood viscosity play a role. Hormonal control has not been ruled out. It is known that sodium depletion leads to increased release of renin.
WHICH ENVIRONMENTAL TEMPERATURE DOES THE PREMATURE INFANT PREFER?
Authors: Brück K.
Published: December 2021

At first glance it may seem to be easy to find the most beneficial thermal environmental condition for the young premature infant. Whoever is of this opinion may be surprised to find an elaborate new article by Glass, Silverman, and Sinclair. appearing in this issue;1 it gives the impression that still more data are needed before a definite answer can be given to this question, particularly if age is included as a variable. Thus, a commentary on past achievements in this field as well as on the questions still open to discussion may not be out of place.

A crucial point in the history of thermal premature care arose, in my opinion, with the introduction of the modern type of transparent incubator, in which the baby was placed unclothed.
IgM ANTIBODIES IN ACUTE TOXOPLASMOSIS: I. DIAGNOSTIC SIGNIFICANCE IN CONGENITAL CASES AND A METHOD FOR THEIR RAPID DEMONSTRATION
Authors: Remington Jack S. , Miller Michael J. , Brownlee I.
Published: December 2021

The present study was undertaken to develop a simple technique for demonstration of IgM-toxoplasma antibodies in acute congenital toxoplasmosis. Such antibodies were demonstrable by each of the four methods used, but their sensitivities varied considerably. The underlying difficulty in interpretation of results obtained in the dye and hemagglutination tests following reductive cleavage appeared to be the high titer of IgG-toxo-plasma antibodies in all sera tested, which "hides" the effect of 2-ME on the IgM-toxoplasma antibodies. Because IgG-toxoplasma antibodies do not interfere with the demonstration of IgM-toxoplasma antibodies in fractions obtained by sucrose density gradient ultracentrifugation or with the IgM-fluorescent antibody test, these two methods proved the most sensitive for demonstration of IgM-toxoplasma antibodies in congenital cases. Whereas the former of these two methods is a laborious procedure requiring facilities rarely available in clinical laboratories, the IgM-fluorescent antibody test is easily learned and it can be performed in 2 hours.

Serologic diagnosis of infection in newborns is often complicated by the presence in the infant of maternal antibodies. The difficulty in interpretation of serologic results in cases of suspect congenital toxoplasmosis is magnified by the high prevalence of toxoplasma antibodies in the normal childbearing population (and thus in their offspring). Demonstration of IgM antibodies in newborn infants (in the absence of a placental leak) appears to be diagnostic of congenital toxoplasmosis. Because of the difficulty encountered in recognition of congenital cases which do not appear to have the "classical" signs and because of the infrequency with which the diagnosis can be established, even in these latter cases, the IgM-fluorescent antibody test will hopefully prove simple enough to perform to be useful as a test for the definitive diagnosis of acute congenital toxoplasmosis.
THE CAREER DEVELOPMENT PROGRAM IN MATERNAL AND CHILD HEALTH
Authors: Wallace Helen M. , Dooley Samuel , Eisner Victor , Fraser Constance
Published: December 2021

Studies have indicated a need to recruit and train young physicians with specialty board training for positions in the field of maternal and child health. To meet this need, a program has been established at the University of California School of Public Health at Berkeley in conjunction with the departments of pediatrics of three schools of medicine. The program consists of 2 years of pediatric clinical training and 1 year of public health training with a major in maternal and child health, and it is designed to encourage young physicians to complete specialty training in pediatrics while obtaining the degree of master of public health.

Evaluation after 4 years of operation indicates that the program is meeting its objectives.
Metabolic Reference Standards for the Neonate
Authors: Burmeister W.
Published: December 2021

I would like to comment on the article by J. C. Sinclair, et al. (Pediatrics, 39:724, 1967), "Metabolic Reference Standards for the Neonate." In the course of my work on the composition of the human organism, I also found the difference weight-extracellular fluid (= W-ECF). The fact that the composition of W-ECF is a rather constant one may be seen from the following calculation: if total body water content is assumed to be 71% of body mass with newborn and 61% with male adults, it follows that the proportion of intracellular water in W-ECF remains almost unchanged during growth.
SHOULD PEDIATRICIANS PROVIDE MEDICAL CARE FOR THEIR FRIENDS' CHILDREN?
Authors: Carey William B. , Sibinga Maarten S.
Published: December 2021

Gratifications and discomforts encountered by the pediatrician socially involved with parents of his patients are discussed. This situation is identified as a potential source of unfavorable consequences. Current practices, positive and negative aspects of this dual relationship, and suggestions for management are presented.
EIGHTEENTH CENTURY ENGLISH CHILDREN ARE TOLD HOW TO BEHAVE CORRECTLY
Authors: C. T. E.
Published: December 2021

Children's books during the eighteenth and nineteenth centuries in both England and this country frequently contained detailed instructions on what polite society considered to be good manners for children.

This passage from an English children's book written in 1762 was read and committed to memory by many children in England and also in this country:

Of Behavior

Before you speak make a Bow or Curtesy, and when you have received your Answer make another.

Be careful how you speak to those who have not spoke to you.

Nothing shows the difference between a young Gentleman and a vulgar Boy so much as Behavior in eating.

Never touch your Meat with your Fingers.

Pick your Bones clean and leave them on your plate; they must not be thrown down.

Seldom blow your Nose and use your Handkerchief for that Purpose, making as little noise as you can.

Never spit in a Room.

Never sing or whistle in Company: these are the idle tricks of vulgar children.

Take care not to make Faces nor Wink.

Keep your Hands quiet, and use no antick Motions.

Never laugh immoderately at a Story told by another Person. Never laugh at all at what you tell yourself.

Never talk about any Thing but what you know.

How foreign all this would seem to the contemporary child!
DOCTOR HUGH SMITH DESCRIBES THE CLINICAL INDICATIONS FOR PRESCRIBING GENUINE ESSENCE OF BALM OF GILEAD—A WONDER DRUG TWO CENTURIES AGO
Authors: C. T. E.
Published: December 2021

A book which obtained much vogue during the last third of the eighteenth century in England was Hugh Smith's Letters to Married Women on Nursing and the Management of Children.1 This book passed through at least six English editions and was translated into French and Dutch. Dr. Smith's book contained a great deal of common sense about child rearing practices. Few pediatricians are aware that he was the first writer in England to teach that breast milk alone was sufficient for the feeding of infants up to the age of 6 or 7 months.

But like other practitioners of his time he did not think it unethical to sell his own pharmaceutical preparations as is evident by this advertisement on the last page of his book.

Of C. and G. Kearsley, no. 46, Fleet-Street, may be had Genuine Essence of Balm of Gilead (A Recipe of the Author of this Work)

Being a chemical preparation, whose balsamic virtues of the most eminent physicians of every age have allowed to esceed all other things yet discovered in the Materia Media, for COUGHS, HOARSENESS, and TIGHTNESS across the BREAST. It opens the CHEST, and loosens the PHLEGM; relieves Pains in the Side, and Weakness of the Reins; cleanses internal ULCERS, such as those of the LUNGS and BLADDER, brings them into a proper state of digestion; removes hectic Heats, creates an appetite, and helps digestion; and in ASTHMATIC and CONSUMPTIVE Cases, when every other prescription had failed, this had been known repeatedly to perform a Cure.
PARTIAL DELETION OF LONG ARMS OF CHROMOSOME 18
Authors: Kushnick Theodore , Matsushita Geraldine
Published: December 2021

A patient with the physical stigmata associated with partial deletion of the long arms of one number 18 chromosome is described. Abnormal genitalia may be part of this syndrome in males.
DIAGNOSIS AND TREATMENT: THE SALVAGE OF CRITICALLY ILL NEWBORN INFANTS WITH CONGENITAL HEART DISEASE
Authors: Fyler Donald C.
Published: December 2021

The natural course of congenital heart disease in the newborn infant may last only a few days or weeks; yet, many of these babies are salvageable through surgery. The clinician's problems include the necessity for early detection through recognition of persistant cyanosis or respiratory symptoms, exclusion of primary lung disease through chest x-rays and blood gas determinations, and establishing an accurate diagnosis as rapidly as possible through cardiac catheterization. An aggressive surgical approach to these critically ill infants can then result ill many survivors.
Letters to the Editor
Authors: Nellhaus Gerhard
Published: December 2021

The finding of Drs. Cloutier and Stickler that 3 of 15 children (20%) with idiopathic hypopituitarism and normal intelligence had head circumference measurements of less than -2 S.D. was most interesting. Since my own experience with hypopituitary dwarfs was limited, additional data was obtained from Dr. Thomas Aceto, Jr., of the Children's Hospital of Buffalo, Sew York, and Dr. John D. Crawford of the Children's Service of the Massachusetts General Hospital, Boston, Massachusetts.
Letters to the Editor
Authors: Mortimer Edward A.
Published: December 2021

I agree with Dr. Schmitt's position that tetracycline is rarely, if ever, indicated in pediatrics. I would modify his comments only to say that I believe otitis media under 5 years of age should be treated with something in addition to penicillin, such as a sulfonamide, because of the possible presence of Hemophilus influenzae. Therapy with penicillin and sulfonamide is probably cheaper than erythromycin.
New Use of Simple Equipment to Treat Dyspneia in Infants
Authors: Chusid Emanuel
Published: December 2021

There is a special kind of joy in discovering for oneself the dramatic use of simple equipment.

At Mount Vernon Hospital, Dr. Norman Becker and I have recently found that placing a small baby in a semi-recumbent position in a plastic seat such as Infanseat within a Cnoupette can give substantial relief to the dyspneic baby. In both Dr. Becker's patient (a small infant with pertussis) and my patient (a 3-month-old infant with bronchiolitis), the change in position from supine to that of semirecumbency in the seat was marked by a sudden and obvious improvement of the babies' respiratory status.
Facial Palsy Following Measles Vaccination, a Possible Connection
Authors: Snyder Russell D.
Published: December 2021

I recently had the opportunity to see a peculiar neurologic problem which occurred following measles vaccination. This letter is written to call the attention of other physicians to this apparent complication, to encourage physicians to watch for the complication, and hopefully, to obtain a response from physicians who may have encountered a similar problem.

In February 1968, a 14-nlonth-old boy presented with a mild, left lower facial weakness. The weakness had a sudden onset 8 days following vaccination with a live measles virus vaccine (Lirugen), 0.5 cc subcutaneously.
IMMUNE GLOBULIN LEVELS IN THE SUDDEN DEATH SYNDROME
Authors: Stiehm E. Richard , Gold Eli
Published: December 2021

Serum levels of γG, γM, γA, and total immune globulins were determined on 88 infants with the sudden death syndrome (SDS) and compared with levels on 16 infants who died from known cause and 177 normal age-matched controls. Immune globulin levels in all groups were similar except that SDS infants aged 4 to 6 months had higher mean levels of total gammaglobulin than controls. Immune globulin levels were not correlated with sex or milk agglutinin titers. Three SDS infants (3.5%) had hypogamma-globulinemia and 13 SDS infants (15%) had either elevated γM globulins (9 cases) or diffuse hyper-gammaglobulinemia (4 cases). We conclude that primary derangement of antibody proteins is not a frequent cause of SDS.
CANDIDIASIS: STUDIES PERTAINING TO ITS ASSOCIATION WITH ENDOCRINOPATHIES AND PERNICIOUS ANEMIA
Authors: Blizzard R. M. , Gibbs J. H.
Published: December 2021

Forty-four patients with chronic or recurrent candidiasis of the dermis, mucous membranes, or both, have been studied in relation to associated diseases. Thirty-one patients (Group I) had at least one associated disease. Thirteen (Group II) had only candidiasis. Neonates with oral moniliasis, children with chronic debilitation, and children receiving antibiotics were eliminated from the study. Idiopathic hypoparathyroidism was the most common associated disease of the patients in Group I (26 of 31 patients). Addison's disease also was common (14 of 31 patients). Hypothyroidism, alopecia, cirrhosis, pernicious anemia, and primary gonadal failure also occurred. Evidence for subclinical disease of the thyroid, adrenal cortex, and gastric mucosa, as reflected by tissue specific antibodies, was common in patients with candidiasis. Anti-kidney antibodies also were found in 18 patients, but their significance is unclear. No etiological relationship between the candidiasis and the associated diseases could be demonstrated.