bluuebunny/crossref_metadata_2025 huggingface dataset:
SKIN INFECTIONS AND ACUTE NEPHRITIS IN AMERICAN INDIAN CHILDREN
Authors: Anthony Bascom F. , Perlman Lawrence V. , Wannamaker Lewis W.
Published: December 2021

Serial observations were obtained over an 18-month period of 270 Indian children with pyoderma. Beta-hemolytic streptococci, predominantly group A, and coagulasepositive staphylococci were recovered from the majority of lesions (80% and 70%, respectively), both on the initial and on subsequent cultures. The predominant agglutination patterns of streptococcal strains were similar to those described in other studies of superficial skin infections. Another agglutination pattern, 17/23/47, not previously observed to be prevalent in streptococci from skin lesions, was identified in a significant number of skin cultures. In addition, the hitherto undescribed association of M-types, including type 41 and a new M-type, with strains of T-agglutination pattern 3/13/B3264 was found. In striking contrast to the streptococcal strains, established "impetigo" strains of Staph. aureus (type 71 or other group II strains) were in the minority. Throat cultures of children with pyoderma suggested a limited relationship between infection or colonization of the pharynx and infection of the skin, while nasal streptococci were more closely correlated with and possibly derived from the flora of the skin lesions. Titers of ASO were not often elevated over control values in children with pyoderma, while anti-DNAse B titers were more commonly increased.

Group A streptococci isolated from skin lesions prior to or at the time acute nephritis was recognized included type 12 (M and T) and strains classified by T-agglutination as 5/27/44, 11 and 4. The role of infection or colonization of the upper respiratory tract in the relationship of pyoderma to nephritis was not clarified in these studies. Moreover, in view of the frequency of change of group A streptococcal strains in skin lesions, as shown in serial observations in this study, the nephritogenic significance of streptococci recovered from skin lesions at the time of recognition of nephritis must remain in some doubt. Questions concerning the pathogenesis of endemic nephritis associated with pyoderma can probably be most reliably answered by frequent, prospective observations of a normal population with significant occurrence of streptococcal skin infections.
The Lack of Association Between the Appearance of Complement Fixing Antibodies and the Recovery of Virus in a Child with Congenital Rubella
Authors: MONIF GILLES R. G. , HARDY JANET H. , SEVER JOHN L.
Published: December 2021

A case of congenitally acquired infection with rubella virus was studied longitudinally with virological and serological specimens. The appearance of specific complement fixing activity in the infant's serum was not associated with an alteration in the pattern of recovery of rubella virus.
IN UTERO EXPOSURE TO THE HIROSHIMA ATOMIC BOMB
Authors: Wood James W. , Johnson Kenneth G. , Omori Yoshiaki
Published: December 2021

A study was made by Miller in 1954 of children who were in utero and within 2,200 meters from the hypocenter at the time of the atomic bomb in Hiroshima. These earlier observations have with few exceptions been validated by this follow-up of the subjects at 20 years of age and the value and accuracy of clinical evaluation in early childhood is clearly indicated. The following conclusions are made.

Both small head size (circumference minus 2 SD or more) and mental retardation are most closely related to (1) maternal exposure within 1,500 meters from the hypocenter, and (2) a gestational age of less than 15 weeks.

The heads of infants with either small or normal circumferences at birth increase thereafter in circumference at the same rate and stop growing at the same age, thereby maintaining the same size relationships throughout childhood into adult life.

Mortality in the mentally retarded group as a whole exceeds mortality in normal children. For the group of all subjects exposed within 1,500 meters the mortality rate is higher than for the subjects located beyond 1,500 meters.
ANATOMIC FEATURES OF GROWTH FAILURE IN CONGENITAL HEART DISEASE
Authors: Naeye Richard L.
Published: December 2021

A quantitative study was undertaken of body size, organ size, and cellular structure in 220 individuals dying with congenital heart disease. Infants dying in the perinatal period had evidences of a mild intra-uterine growth retardation. Infants 1 month to 8 years of age had organ and cellular abnormalities closely resembling those usually found with chronic undernutrition. Older individuals dying with congenital cardiac malformations had organ and cellular abnormalities which may be related to chronic hypoxia.
Spinal Fluid Glucose in Neonatal Meningitis
Authors: NOGEN ALAN G.
Published: December 2021

Drs. Winterbauer, Fortuine, and Eickhoff detail under "Experience and Reason" in the October issue two patients in whom Group B streptococci were isolated from spinal fluid.

In the second patient they note a spinal fluid protein of 24.5 mg/100 cc while the glucose is 79 mg/100 cc. Are these values reversed or was a glucose infusion running? If these values are correct, I would appreciate a comment by the authors.
Diseases of the Nervous System in Infancy, Childhood and Adolescence
Authors: BARLOW CHARLES F.
Published: December 2021

The excellence and success of Dr. Ford's book is amply demonstrated because it has undergone five editions in the 29 years of its existence. The fifth edition of this eloquent survey of the neurological disorders of the young person follows the familiar format of previous editions. The book retains the unity of style and coverage provided by single authorship, and illustrative case reports expand the general discussion of many of the topics. Dr. Ford's occasionally anecdotal writing style is best exemplified by his frequent reports of conversations with former Hopkins colleagues about interesting neurological observations.
BEYOND ANATOMY
Authors: L. R. S.
Published: December 2021

THE ARTICLE, "Anatomy is Destiny," by Dr. Ellen Rothchild in this issue is a reminder of the need to put into perspective the signs and symptoms of marked changes observable in the sexual attitudes and behavior of a significant segment of our adolescents. Since many of our younger generation appear to be displaying greater freedom about sexual matters and a changing sexual morality, this would seem an appropriate time for the pediatrician to take a new look at his role in dealing with developing sexuality in his patients. Pediatrics, in partnership with the schools and church, has been an active participant in bringing the problems around sexual development, adjustment, and maturity out of the shadows into the light where they could be included in discussions with parents and their children.
CUMULATIVE EFFECT OF PERINATAL COMPLICATIONS AND DEPRIVED ENVIRONMENT ON PHYSICAL, INTELLECTUAL, AND SOCIAL DEVELOPMENT OF PRESCHOOL CHILDREN
Authors: Werner Emmy , Simonian Kenneth , Bierman Jessie M. , French Fern E.
Published: December 2021

This is a report of the relationships found between perinatal complications of the newborn and quality of the early childhood environment, and physical, intellectual and social development at age 2. The study group of 670 is a representative sample of live births during the Kauai (Hawaii) Pregnancy Study in 1955.

Each newborn infant was rated on a 4-point scale based on type and severity of complications recorded during pregnancy, labor, and delivery. Two percent had severe complications and 10% had moderate complications, leaving 88% subject to no complications judged to be more than mild. Distributions of perinatal scores were not significantly affected by ethnic origin, age of mother, socioeconomic status, family stability, or mother's intelligence.

The quality of the environment of each child was also rated on scales based on socioeconomic status, family stability, and mother's intelligence in order to reflect material opportunities, intellectual stimulation, and emotional support available during the first 2 years of the child's life. Three-quarters or more of the families were judged to be average or above by each of the environmental influences.

At age 2, children were given pediatric and psychological examinations. Fourteen percent were rated below average in health status or physical development, 16% in intellectual development, and 12% in social development, findings consistent with previous studies. However, there was relatively little overlap among the children identified as below normal by the three criteria confirming the need for cooperative assessment by pediatricians and psychologists.

With increasing severity of perinatal stress, there was an increase in the proportion of 2 year olds considered to be below normal in physical status and in intellectual and social development. In all three areas, the developmental lag was especially pronounced for children with severe perinatal stress.

In general, the quality of the home environment had a significant effect on both mental and social development by age 2, and the effect increased with severity of perinatal complications.

It is important not to overlook the potential benefits of good early environment not only for children born with perinatal stress but also for the much larger number without stress who are born to families providing an unfavorable home environment. As the effects of environment are already apparent by age 2, it is necessary to provide enrichment programs much earlier than in current practice.
SIGNIFICANCE OF MYCOPLASMA INFECTIONS IN CHILDREN WITH RESPIRATORY DISEASE
Authors: Glezen Wm. Paul , Thornburg Gloria , Chin Tom D. Y. , Wenner Herbert A.
Published: December 2021

Techniques for the detection of mycoplasma have been utilized in a longitudinal study of respiratory disease in a children's home. M. pharyngis or M. salivarium were detected in almost half of throat samples obtained from children when well or ill. Neither M. pharyngis nor M. salivarium seems to be related etiologically to respiratory disease.

During the first year of observation for mycoplasma, there was no evidence of recent infection with M. pneumoniae. However, in the autumn of 1964, 27 of 46 children had a positive throat sample and/or a significant rise in complement fixing antibodies to M. pneumoniae. M. pneumoniae was recovered from 5 children with a mild pneumonitis and from 10 children who were well. Multiple isolations of M. pneumoniae were obtained as much as 3 months apart from some children. The outbreak was characterized by a rather slow progression of infection and a relatively prolonged carrier state.
"ANATOMY IS DESTINY"
Authors: Rothchild Ellen
Published: December 2021

Though of fundamental biologic importance, the anatomic sexual changes of adolescence are also decisive for psychic growth. These changes are welcomed with a variety of emotional reactions and serve, psychologically, to consolidate a girl's feminine identity and support her eventual growth toward individuality and independence. The physician's approach in managing this aspect of adolescent growth can facilitate or hinder progressive emotional development. Bearing in mind the psychological implications of adolescent sexual changes, the physician can help pave the way for the teenage girl's continuing physical and psychological maturation.
COMPARISON OF RECTOSIGMOID MOTILITY IN NORMAL CHILDREN, CHILDREN WITH RECURRENT ABDOMINAL PAIN, AND CHILDREN WITH ULCERATIVE COLITIS
Authors: Kopel Frederic B. , Kim Ih Chin , Barbero Giulio J.
Published: December 2021

Rectosigmoid motility was evaluated in 18 children with recurrent abdominal pain without evident organic etiology, in 10 children with ulcerative colitis, and in 18 normal children.

A heightened response to prostigmine, with increased rectosigmoid motility, was demonstrated in the children with recurrent abdominal pain. The physiologic implications of this finding are discussed, and the relationship of this entity to the spastic colon variety of the adult irritable colon syndrome is noted.

Reduced rectosigmoid activity was observed in the children with ulcerative colitis.
A POSTVERTEBRAL ENTODERMAL CYST ASSOCIATED WITH AXIAL DEFORMITIES: A CASE SHOWING THE "ENTODERMAL-ECTODERMAL ADHESION SYNDROME"
Authors: Prop N. , Frensdorf E. L. , van de Stadt F. R.
Published: December 2021

A postvertebral tissue mass excised from the lumbosacral region of a 10-week-old child contained a small coelomic cavity and a convoluted enteric cyst with a blind branch. Some cleft vertebrae occurred at the level of the tissue mass.

The ontogenetic development of this complex of anomalies is explained on the basis of an amended theory of Beardmore and Wiglesworth. The primary etiological factor is supposed to have been an adhesion among entodermal and ectodermal cells in the median plane of the embryo in a bilaminar stage. An adhesion of this type can be assumed to cause the following developmental disturbances: (1) a dorsal enteric diverticulum (or fistula), (2) a split (or diverted) notochord and a cleavage of vertebrae, (3) a cleft spinal cord. These defects can be modified by growth and processes of repair. With a reference to the primary anomaly produced, "the entodermal-ectodermal adhesion syndrome" has been proposed as a name for the final complex of malformations.
Extensive Hydatid Disease in a 4-Year-Old Child
Authors: KUMAR RAJ , MEHTA SAROJ
Published: December 2021

A 4-year-old child with widely disseminated hydatid disease is presented. The problem regarding diagnosis and treatment in such a case has been discussed.
CHILD DEVELOPMENT: A BASIC SCIENCE FOR PEDIATRICS
Authors: Richmond Julius B.
Published: December 2021

ALTHOUGH I have considered presenting some of the work of our group on this occasion, I have elected, rather, to discuss an issue which I feel to be of importance not alone to those of us interested in child development, but to all pediatricians (and indeed to all interested in child welfare). I refer to the role of child development in pediatrics—most particularly academic pediatrics.

To the members of this section it is no surprise to observe that teaching and research in child development have not been integrated into the mainstream of academic pediatrics. It continues, with rare exceptions, to be treated as a minority group in the academic community, even though a knowledge of child development is a major concern of the practicing pediatrician. This relative neglect causes me to inquire as to whether we are to have two cultures or one in pediatrics. At the outset I wish to indicate that my bias is clearly in favor of a unitarian view. For, I believe we continue this dichotomy at our peril in pediatric teaching and research.

Perhaps we can deal with this problem better if we understand how we came to be this way. I will, therefore, attempt to develop my thesis from an historical perspective. These periods are arbitrarily defined; although starting dates are given, there are no end points, since each new period is telescoped into the rich history of its antecedents (Fig. 1).

The prescientific era in pediatrics (prior to 1900) was rich in contributions to our understanding of child development.
Informed Consent
Authors: HERSHEY NATHAN
Published: December 2021

Although I could write at great length to express all my criticisms of Dr. Silverman's proposal to permit a "physician-friend" of a minor child to be substituted for the child's parent as the person who could authorize the child's participation in the research study which offers the child no immediate benefit, I will endeavor to be brief.

First, are there any scientifically-derived data to show that attempts to obtain consent from parents of minor children for participation in studies have been rebuffed on such a scale that the requirement for consent has interfered with the proper conduct of one study?
MINUTE ABSORPTION OF DIPHTHERITIC ANTIBODIES FROM THE GASTROINTESTINAL TRACT IN INFANTS
Authors: VAHLQUIST BO , HÖGSTEDT CURT
Published: December 2021

Human serum rich in antibodies against diphtheria was given orally to newborns and to older infants. With few exceptions, an absorption of antibodies could be traced only in the first week of life and even then only in minute amounts (<0.30% of the total antibody amount administered). The implications of these findings for the value of human milk as an antibody source are discussed.
METHODS USED IN TREATMENT OF DIARRHEA WITH POTASSIUM AND SODIUM SALTS
Authors: FLETT JAMES , PRATT EDWARD L. , DARROW DANIEL C.
Published: December 2021

The actual procedures used in the treatment of 153 cases of diarrhea with potassium chloride in addition to the other established therapeutic methods are described.

The mortality was 6% and study of the fatal cases indicated that a large proportion of these cases apparently died from nutritional injury developing before the onset of the diarrhea or from injury as a result of dehydration developing before treatment was started.

The serum bicarbonate returns to normal somewhat more slowly than when larger doses of sodium bicarbonate (or lactate) are given. However, the absence of alkalosis, the infrequency of low serum calcium and the infrequency of the "postacidotic state" suggest that slow restoration of the concentration of serum bicarbonate may be advantageous.

In no instance was low concentration of potassium in serum encountered. On the other hand serum potassium remained normal or slightly high during recovery. In no instance were symptoms referable to potassium intoxication encountered and in no instance was death associated with high concentration of potassium in serum.

The method of treatment is safe and produces results as good as have been obtained in any similar group of cases. The method is relatively simple to carry out and is equally applicable to diarrhea of the newborn and that of older infants.
FATAL BORIC ACID POISONING IN A NEWBORN INFANT
Authors: ABRAMSON HAROLD
Published: December 2021

A case is reported of a 9 day old baby who died from boric acid poisoning. The chemical was applied as an ointment to a large excoriated area of the baby's buttocks and as a powder on the diapers.

It is suggested that boric acid should be discarded in medical practice, since its potential toxicity represents a hazard that is out of proportion to the doubtful therapeutic value of the drug. Boric acid has been outmoded by more effective modern medications.
LUNG PHOSPHOLIPIDS AND SURFACE TENSION CORRELATIONS IN INFANTS WITH AND WITHOUT HYALINE MEMBRANE DISEASE AND IN ADULTS
Authors: Brumley George W. , Hodson W. Alan , Avery Mary Ellen
Published: December 2021

Infants who have died with hyaline membrane disease have low concentrations of pulmonary phospholipids and reduced concentrations of saturated fatty acids at the alpha position of lung phosphatidyl choline. There is a highly significant correlation (p< .001) between levels below 12.6 mg of pulmonary phospholipid per gram wet weight lung and high minimum surface tension values of lung saline extracts.

Infants without hyaline membrane disease have high concentrations of pulmonary phospholipids (22.3 mg per gram wet weight). Infants who recovered from HMD and died of other causes show values intermediate to those of HMD and non-HMD infants. The excess above the critical minimum noted here suggests a reservoir of pulmonary surfactant.
COMMITTEE ON NUTRITION
Authors: LOWE CHARLES U. , COURSIN DAVID BAIRD , HEALD FELLX P. , HOLLIDAY MALCOLM A. , O'BRIEN DONOUGH , OWEN GEORGE M. , PEARSON HOWARD A. , SCRIVER CHARLES R. , FILER L. J. , KLINE O. L.
Published: December 2021

THE Committee on Nutrition of the American Academy of Pediatrics has strongly endorsed the use of milk and infant formula products as primary vehicles for vitamin D supplementation to ensure a total vitamin D intake of 400 I.U. per day by all infants and children. Although in the United States there are significant regional differences with respect to dairy practices in fortifying fluid milk, almost three-fourths of all whole milk sold at retail is fortified with vitamin D, and almost all evaporated milk and infant formula products contain 400 I. U. of vitamin D per reconstituted quart. In addition, vitamin D is readily available in vitamin supplements, and, undoubtedly as a result of the wide distribution and ready availability of vitamin D, the incidence of infantile rickets in the United States has remained at a very low level.

This report draws attention to the lack of vitamin D in nonfat dry milk, a product used in significantly increasing amounts for preparing milk for home use for children, and possibly for infants. The use of nonfat dry milk has been accelerated recently by the increase in prices of fluid milk. For example, in 1965, the last year for which figures are available, consumer sales of nonfat dry milk amounted to 2.5 billion pounds of fluid equivalent, or about 5% of the total national consumption of milk. This total reflects an increase in consumption of almost 70% over the past 10 years.

The lack of vitamin D in certain major sources of milk for the population invites the reappearance of rickets.
Letters to the Editor
Authors: KEMPE C. HENRY
Published: December 2021

I want to tell you what fun I had reading the March issue of Pediatrics. I think the journal has a lot of interest for a great range of potential readers.
Letters to the Editor
Authors: VALDES-DAPENA MARIE
Published: December 2021

It has recently come to my attention that in the review article "Sudden and unexpected death in infancy: A review of the world literature 1954-1966" I failed to make mention of a current and very valid hypothetical explanation, that involving a genetically determined disorder of cardiac conduction. This subject should have appeared together with the section on "Neural Mechanisms" on page 133.

I regret that this entity was not included in the original presentation because certainly that discussion of recently suggested etiologic mechanics is incomplete without it.
Management of Infants with Ventricular Septal Defects
Authors: VOGEL JOHN H. K. , BLOUNT S. GILBERT
Published: December 2021

The article "Early Surgical Correction of Large Ventricular Septal Defects" by Sigmann, Stern, and Sloan which appeared in the January issue of Pediatrics (39:4, 1967) again illustrates the great concern in properly dealing with infants having such defects. Their 30% mortality in infants under 2 years of age with severe pulmonary hypertension is truly a remarkable surgical feat. However, as indicated by Dr. Nadas, in the preceding commentary, this must be weighed against the results of medical therapy and palliative surgical procedures.
CONGENITAL MALFORMATIONS IN OFFSPRING OF PHENYLKETONURIC MOTHERS
Authors: Stevenson Roger E. , Huntley Carolyn C.
Published: December 2021

A family study has been presented in which two PKU females on non-restricted diets have had 16 abortions, 6 offspring who died in infancy, and 4 presently surviving children. All live births to these females have had varying combinations of premature birth weight, microcephaly, cardiac defects, mental and physical retardation, dislocated hips, and strabismus. Each of the offspring tested was non-phenylketonuric. Thus, adverse effects of elevated maternal blood phenylalanine or associated metabolic abnormalities on the developing fetus are suggested.

An additional finding of interest was the presence of normal phenylalanine tolerance tests in the three children of the PKU mothers available for testing.

The problem thus presented by reproduction in a PKU mother may become more prevalent with the advent of the many state programs now operating to detect and treat PKU in the neonatal period. From the cases reported previously and those of the present study, it would seem desirable to keep the blood phenylalanine levels of PKU females in the normal range during the child bearing years. Lowering of high levels after the usual delay in diagnosing pregnancy may prove to be inadequate. However, because phenylalanine levels have not yet been controlled in a PKU mother during gestation, there is no proof that such control will preclude the birth of defective offspring.

A practical disadvantage associated with the only presently available method of lowering blood phenylalanine, the low phenylalanine diet, is the inability of adults to tolerate the taste.
DESCRIPTIVE EVALUATIONS OF CHILD DEVELOPMENT AND OF DEVELOPMENTAL SETTINGS
Authors: Caldwell Bettye M.
Published: December 2021

This paper has described and supported with research data what is essentially a philosophy of evaluation—one which suggests that the most important function of developmental evaluation is descriptive rather than diagnostic and as compressing a history rather than predicting a future. Behavioral evaluations are necessary to accomplish these other objectives; but, until assessment techniques are far more elegant than they are today, they should not be expected to accomplish them alone. Further, it has been suggested that naturalistic descriptions are as valuable and as necessary as structured ones. Finally, a plea has been made that more research attention be directed to the task of evaluating environments. A crude attempt to do this on our own part has carried some important empirical fuel to the theoretical fire which describes development as influenced by the milieu in which that development occurs.
ORAL-FACIAL-DIGITAL SYNDROME IN A CHROMOSOMALLY NORMAL MALE
Authors: Mandell Frederick , Ogra Pearay L. , Horowitz Sidney L. , Hirschhorn Kurt
Published: December 2021

Oral-facial-digital syndrome has been described almost exclusively in females. The few males that have been reported with classical features of the syndrome have had abnormal karyotypes. A 20-month-old, living, male child with characteristic clinical features of oral-facial-digital syndrome is described. This child has a normal chromosome complement of 46 with an XY sex chromosome constitution. It is suggested that the survival of this child represents the extreme of the variability of expressivity in this syndrome.
DIAGNOSIS AND TREATMENT: PSYCHOGENIC, RECURRENT, ABDOMINAL PAIN
Authors: Green Morris
Published: December 2021

RECURRENT abdominal pain represents a frequent cause for medical consultation. At least 1 school child in 10 suffers from this complaint. Slightly more common in girls than in boys and unusual before the age of 5, recurrent abdominal pain has its greatest incidence in children 9 to 10 years of age. In 1,000 unselected school children Apley found the complaint to occur more frequently in girls (12.3%) than in boys (9.5%); more than one fourth of all girls at age 9 were affected.

Both organic and psychogenic etiologic possibilities need be considered together in each such case. The present discussion will be largely concerned with the latter. It is intended that a subsequent article will be concerned with organic abdominal pain.

CHARACTERISTICS OF PSYCHOGENIC, RECURRENT, ABDOMINAL PAIN

About one half of the children whose pain is psychogenic will have been symptomatic less than 1 year at the time of consultation; others will have had complaints for 1 to 5 years. Some children experience six or seven episodes a day while others one a week or one a month. Although this symptom may be related directly to stressful situations, this relationship is uncommon. A temporal relation to meals is rare, and the pain almost never awakens the child from sleep. Individual attacks are usually 5 to 30 minutes in length but may persist for hours.

Episodes usually began gradually rather than abruptly. The pain is generally constant and mild or moderate rather than colicky and severe. Descriptions are vague: "It just hurts," "It feels funny," or "I don't know."
POST-IRRADIATION MESENCHYMAL CHONDROSARCOMA
Authors: Sears William P. , Tefft Melvin , Cohen Jonathan
Published: December 2021

The case being reported is that of an unusual variety of chondrosarcoma of the vertebrae now called mesenchymal chondrosarcoma. It developed in a 12-year-old girl following radiation therapy for an intra-abdominal malignancy. Data on necropsy showed unequivocal venous spread and widespread pulmonary embolization.
Early Introduction of Solid Foods
Authors: ACKERMAN BRUCE D. , YARBROUGH ELSIE
Published: December 2021

In a recent issue of Pediatrics, Helen A. Guthrie suggested that the current practice of early introduction of solid foods to the infant's diet might be undesirable. Some comments regarding the data and conclusions presented appear to be in order.

The data presented in Table II imply that an infant's iron requirement is 4 mg per day. Calculations based on iron stores at birth and iron requirement for normal hemoglobin concentration at 1 year of age suggest that the requirement is actually 8 mg per day.
SMOKING BEHAVIOR OF NEWTON SCHOOL CHILDREN—5-YEAR FOLLOW-UP
Authors: Salber Eva J. , Abelin Theodor
Published: December 2021

The smoking habits of Newton, Massachusetts, high school students attending the tenth grade were investigated in 1959 at the age of 15. In 1965 a stratified random sample of these students was again studied in order to examine change in smoking behavior and to identify characteristics which predict future smoking behavior in teenagers.

Between the ages of 15 and 21, the percentage of smokers doubled among the girls and almost doubled among the boys, with 55% of the girls and 63% of the boys now smoking. The heavier smokers at age 15 smoked even more at 21. Only 12% of the 15-year-old smokers had stopped smoking, but 36% of nonsmokers had become smokers and 71% of discontinued smokers had resumed smoking, thus pointing to the stability of the smoking habit and to the instability of the discontinued smoking status among young people.

Variables predicting relapse by discontinued smokers included parents who smoked, poor academic achievement at school, heavier consumption of cigarettes before discontinuing, judgment of smoking as harmless and a disbelief in the causative role of smoking in lung cancer. Students who had stopped smoking because of influence of others relapsed more readily while those who had stopped because they did not enjoy it were less likely to relapse.

A powerful predictor of change from nonsmoker to smoker was the student's own anticipation of smoking. Nonsmokers were less likely to become smokers if they objected to smoking on moral or aesthetic grounds.

Social class, parental smoking, and school achievement are still related to smoking at age 21, but mainly due to an effect before the age of 15.

It is suggested that antismoking programs might be more effective if conducted before the age of 15.
THORACIC GAS VOLUME CHANGES IN PREMATURE INFANTS
Authors: Thibeault D. W. , Wong M. M. , Auld P. A. M.
Published: December 2021

Serial measurements of thoracic gas volume and arterial oxygen tension in a group of small premature infants are reported. The study demonstrated that when thoracic gas volume reached levels for normal, full-term infants arterial oxygen tension approached full-term values. The study indicates extensive pulmonary abnormality in clinically non-distressed premature infants, most likely due to persistent atelectasis or partially aerated alveoli. Observations suggest that the infant attempts to correct this abnormality by frequent periodic hyperinflations or sighs.
GLYCOGEN METABOLISM IN FETAL, NEONATAL, AND INFANT MUSCLE OF THE RHESUS MONKEY
Authors: Bocek Rose Mary , Beatty Clarissa H.
Published: December 2021

Muscle fiber groups from fetal, neonatal, and infant rhesus monkeys (Macaca mulatta) were incubated with glucose-C14 under aerobic and hypoxic conditions. Glycogen concentrations in the 90-day fetal and 4 to 5-day-old neonatal and infant series were lower when incubated under hypoxic than under aerobic conditions. The percent of glucose uptake appearing in glycogen was lowest at 90 days fetal age and highest in the infant series. Hypoxia markedly decreased glucose-C14 incorporation into glycogen. The dilution of the lactate-C14 produced indicated that glycogen turnover can be demonstrated under aerobic conditions as early as 90 days fetal age (55% of gestation) and that glycogen is mobilized from fetal and neonatal muscle under both aerobic and hypoxic conditions. Hypoxia increased glycogen mobilization, and the magnitude of glycogenolysis was similar in 90-and 120-day fetal, neonatal, and infant muscle but higher in muscle from fetuses near term (150 and 160 days). Therefore, the increased resistance of the near-term fetus to anoxia which would be fatal to older animals may be partially explained by the increased availability of glycogen stores.
THE INVOLVEMENT OF THE LABIAL MUCOUS SALIVARY GLAND IN PATIENTS WITH CYSTIC FIBROSIS. II. THE HETEROZYGOTE STATE
Authors: Sweney Laura R. , Hedrick Michael C. , Meskin Lawrence H. , Warwick Warren J.
Published: December 2021

Eosinophilic plugs occur frequently in the acini of the labial mucous salivary glands of children with cystic fibrosis. Similar changes are rare in normal children or in siblings of patients with cystic fibrosis. These changes become frequent in adults. Although they appear earlier and more frequently, and significantly more severely in adults who are heterozygotic for cystic fibrosis, this criterion cannot be used to identify the heterozygote.

These observations suggest that factors are operating in patients with cystic fibrosis which affect certain tissues or their secretions in such a way that changes occur in childhood which would ordinarily not be seen until later in adult life.
Immunological Response of the Newborn Infant to Coxsackie B-4 Infection
Authors: SIEBER OTTO F. , KILGUS ANDREW H. , FULGINITI VINCENT A. , PEARLMAN DAVID
Published: December 2021

The sequence of antibody formation was followed from birth to 3 months of age in an infant who developed a mild neonatal Coxsackie B-4 virus infection. The infant produced specific 19-S Coxsackie B-4 neutralizing antibody by 14 days of age, with persistence of neutralizing activity in a 2 ME resistant fraction of immunoglobulin by 3 months of age.
The Heart and Circulation in the Newborn and Infant
Authors: GERSONY WELTON M.
Published: December 2021

This book evolved from a recent symposium on the circulatory problems of the newborn sponsored by the Chicago Heart Association. Participating in the symposium were physicians eminently qualified in neonatal cardiopulmonary physiology and surgery. The papers are organized into six broad topics, which initially review the course of physiologic events from the fetus to the infant, then proceed to a consideration of current information related to the responses of the neonatal circulatory system to cardiac malformations.
Care of the Family of the Child with Cancer
Authors: Friedman Stanford B.
Published: December 2021

EACH parent of a fatally ill child must adjust, in his own way, first to the threatened loss and then to the actual death of his child. The nature of this adjustment reflects, to varying degrees, the parent's mode of coping with past crises, his previous experiences with illness and death, and the idiosyncratic meaning this particular child may have to him. Thus, the physician can be of most help to the parents if he is aware of important landmarks in the history of the family and problems that they have had to face. His knowledge of previous patterns of family behavior in times of stress can aid him in encouraging parents along lines that have been successful in the past and in supporting attempts to adapt to the present situation. For many parents, this may be their first personal experience with death, and this may place additional demands and requests upon the physician.

Unfortunately, such family history is usually not available to the physician who ultimately assumes the care of a fatally ill child. Furthermore, it is often difficult, and inadvisable, to obtain such information in detail at the time parents are preoccupied with an acute crisis. It therefore is useful for physicians to realize that there are many problems these parents face in common, and a number of studies have described more or less characteristic ways of reacting to them. This does not imply that stereotype behavior will be observed in parents sharing this common experience. However, if the physician is consciously aware of common modes of adjustment used by parents, he will be in the position of anticipating some of their needs, problems, and sources of anxiety.
BENIGN VI NERVE PALSIES IN CHILDREN
Authors: Knox David L. , Clark David B. , Schuster Frank F.
Published: December 2021

The case histories of 12 patients who developed a VI nerve palsy after an apparently benign illness have been presented. The palsy developed in children of any age in 7 to 21 days after fever or upper respiratory illness and cleared, in all but one child, within 10 weeks. Two etiologic mechanisms are possible: otitis media and its complications, or neuritis after systemic viral illness.

The most important conclusion is that this is a relatively benign entity which first presents with malignant implications. Recognition of this syndrome allows the clinician to cautiously defer complicated diagnostic studies, such as arteriogram and pneumoencephalogram, with the expectation of improvement in the VI nerve palsy.
CITRULLINEMIA WITH DEFECTIVE UREA PRODUCTION
Authors: Morrow Grant , Barness Lewis A. , Efron Mary L.
Published: December 2021

The second case of citrullinemia is described in a 21-month-old female. In contrast to previous patients with urea cycle enzyme defects, the present child fails to produce normal amounts of urea. Physical growth has been adequate, except for microcephaly. Unfortunately, her psychomotor milestones are slow.

Triiodothyronine, pyridoxine, and neomycin were given with no beneficial effects. Nitrogen balances in addition to protein and arginine loading studies suggest alternate pathways for the degradation of arginine.
An "Epidemic" of Congenital Facial Paresis and Heart Disease
Authors: CAYLER GLEN G.
Published: December 2021

During 1966 five patients who had congenital partial lower facial paresis and heart defects were seen at the Sutter Memorial Hospital. The author had not previously seen these two lesions associated. The five patients reported were from a total of 44 infants with congenital heart defects who were seen in 1966 and examined during the first 12 weeks of life—an incidence of 11%. During 1966 the author observed no instances of facial paresis in a group of 30 infants (also examined during the first 12 weeks of life) who had functional murmurs. The partial facial paralysis was unilateral and, except for the side involved and slight differences in severity, was exactly identical in all cases and involved only the lower-lip depressors (the mentalis and the quadratus labii inferior).
MYCOPLASMA INFECTIONS IN CHILDHOOD
Authors: Clyde Wallace A. , Denny Floyd W.
Published: December 2021

Mycoplasmas compose a ubiquitous group of minute microorganisms which include saprophytes, commensals, and pathogens. Of the seven species which have been isolated from man, only Mycoplasma pneumoniae has clearly established pathogenicity. Research continues to seek other possible disease relationships, since there are various animal diseases caused by mycoplasmas which have counterparts among human illnesses of unknown cause.

M. pneumoniae can be associated with a wide spectrum of respiratory tract disease, including bullous myringitis, pharyngitis, tracheobronchitis, pneumonia, and subclinical infections. These illnesses are generally mild and occur most frequently between ages 5 and 19 years in slowly progressive epidemics. The clinical aspects of the disease are indistinguishable from virus-associated syndromes, and epidemiologic features are often more suggestive of the diagnosis. Techniques for M. pneumoniae cultivation and serodiagnosis are now adaptable for use in clinical laboratories. Non-specific diagnostic tests, especially cold hemagglutination, have distinctly limited usefulness in pediatrics.

M. pneumoniae is sensitive to the tetracycline drugs and erythromycin; administration of these antibiotics shortens the clinical course of disease but may not be effective for prophylaxis or elimination of the carrier state. For these reasons, vaccines could provide more effective control and are being developed; however, greater experience concerning the relative role of M. pneumoniae among other respiratory disease agents is required before the need for control measures in the general population can be assessed.
Letters to the Editor
Authors: SINCLAIR JOHN C. , SCOPES JON W.
Published: December 2021

Our purpose in the cited report was to develop the hypothesis that systematic variation in body composition of newborn babies affects the expression of their metabolic rates. The information which we culled from the literature to aid in exploring this hypothesis shows a similar directional tendency in change in body composition in the two studies where a wide range of fetal weights was encompassed: namely, disproportionately increasing fatness and decreasing calculated extracellular fluid volume with increasing fetal weight.
Reticuloendothelioses in Childhood: A Clinical Survey
Authors: CROCKER ALLEN
Published: December 2021

Doctor Dargeon's short monograph is a remarkable text, with the principal strength derived from its testimony to the author's special devotion to the pediatric patient with these unusual syndromes of the reticuloendothelial system. The book has importance as part of the historical record of the slowly-accumulating published knowledge about the clinical problems of children with histiocytic disease. The illustrative material is of considerable interest throughout, and the introductory section on the anatomy and physiology of the reticuloendothelial system is clear and valuable.
EXPERIENCES WITH JERYL LYNN STRAIN LIVE ATTENUATED MUMPS VIRUS VACCINE IN A PEDIATRIC OUTPATIENT CLINIC
Authors: Young M. L. , Dickstein B. , Weibel R. E. , Stokes J. , Buynak E. B. , Hilleman M. R.
Published: December 2021

A controlled study of B level Jeryl Lynn strain live attenuated mumps virus vaccine was carried out during June through November 1966 in the pediatric outpatient clinic of the John F. Kennedy Memorial Hospital in Philadelphia. Altogether, 924 children were given the vaccine and paired sera were taken from a sample of 101 of the children for purpose of measuring initial serologic status for mumps and for ascertaining antibody responses. Based on the results obtained, it was estimated that roughly 410 of the children who were vaccinated were initially seronegative for mumps. Forty-eight of the 49 children sampled who were initially without antibody developed mumps antibody following vaccination, giving a seroconversion rate of 98%. The vaccinated children presented no evidence of fever or other untoward clinical reaction referable to the vaccine. It was concluded that the vaccine was safe, highly efficacious in stimulating the production of neutralizing antibody, and readily applicable to the routine pediatric clinic.
TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS COMPLICATED BY NEPHRITIS IN CHILDREN
Authors: Hagge Wolfgang W. , Burke Edmund C. , Stickler Gunnar B.
Published: December 2021

The clinical course of 41 patients who had systemic lupus erythematosus complicated by nephritis with symptoms beginning before they were 15 years old was reviewed. The retrospective analysis showed a definite trend toward prolonged survival among the patients receiving high doses of steroids, compared to those receiving no or low doses. We conclude that it is no longer justified to withhold high-dose steroid therapy from children with lupus nephritis, but it should be emphasized equally that this does not apply to children with discoid lupus erythematosus, rheumatoid arthritis with a positive LE clot test, or drug-induced lupus erythematosus. Our present plan of management is outlined.
Renal Lesions in Congenital Rubella
Authors: MENSER MARGARET A. , ROBERTSON S. E.J. , DORMAN D. C. , GILLESPIE AILSA M. , MURPHY A. M.
Published: December 2021

Renal lesions have rarely been reported in congenital rubella. A male infant with classical rubella syndrome defects and agenesis of the left kidney is described. Rubella virus was present in his urine for 10 months. His renal function, although poor initially, improved progressively. It is suggested that congenital rubella infection was responsible not only for his renal defect but also for a slowly resolving nephritis.
Intravenous Cutdown—Technical Aid in Cannulation of Small Vessels
Authors: KRAMER S. G.
Published: December 2021

The method for performing intravenous cutdown in most institutions is usually standardized up to the point of the actual insertion of cannula or catheter. At this point the difficulty inherent in placing a relatively large tube into a collapsible lumen is frequently apparent. Occasionally the vessel is injured and the cutdown is lost. The vein may be quite fragile, separate, and retract upward or false passage may occur into the wall or surrounding tissues. The method shown (Fig. 1-3) has eliminated these difficulties and is technically easy to accomplish. No special equipment other than the equipment found with the standard tray is required.
COMMITTEE ON NUTRITION
Authors: LOWE CHARLES U. , COURSIN DAVID BAIRD , HEALD FELIX P. , HOLLIDAY MALCOLM A. , O'BRIEN DONOUGH , OWEN GEORGE M. , PEARSON HOWARD A. , SCRIVER CHARLES R. , FILER L. J. , KLINE O. L.
Published: December 2021

This memorandum presents suggested safe minimal levels for vitamin and mineral content of formulas designed to provide total nutrition for infants. These levels must not be equated with recommended daily allowances; rather, they represent levels below which distinct hazards may be encountered. In addition, maximal and minimal values for vitamin and mineral supplements are suggested. The maximal levels will provide intakes close to ideal. A supplement containing less than the stipulated minimal levels will probably serve no useful purpose.
PIGMENTED LIPID HISTIOCYTOSIS AND SUSCEPTIBILITY TO INFECTION: ULTRASTRUCTURE OF SPLENIC HISTIOCYTES
Authors: Bartman Jacqueline , Van de Velde Robert L. , Friedman Frederick
Published: December 2021

Electron microscopy of splenic histiocytes from a patient dying of pigmented lipid histiocytosis was carried out. Intracytoplasmic bodies were observed which were considered related to abnormalities in the oxidation of unsaturated fatty acids.
CHRONIC FIBROSING PANCREATITIS IN CHILDHOOD: A CAUSE OF RECURRENT ABDOMINAL PAIN
Authors: Williams Thomas E. , Sherman Neil J. , Clatworthy H. William
Published: December 2021

An unusual instance of chronic fibrosing pancreatitis in a young girl is presented. This represents the sixth case reported in the literature. This diagnosis should be suspected in cases of long-term, unexplained, recurring, disabling, abdominal pain. Complete evaluation of the etiologic factors and anatomy before laparotomy is essential. A thorough examination of the pancreatobiliary tree during surgery and a careful biopsy will prove the diagnosis. The etiology of this fibrosing process cannot be explained for obstruction does not appear to be a predominant factor.
Mongolism
Authors: ZELLWEGER HANS
Published: December 2021

This booklet, one of the smaller volumes of the Ciba Foundation series, consists of eight papers presented at the May 1966 Conference on Mongolism, organized in commemoration of Dr. John Langdon Haydon Down, who a century ago published his original report on mongolism. It was fully appropriate, therefore, to begin the conference with a biographical sketch of Langdon Down by Lord Brain, Chairman of the Executive Council of the Ciba Foundation. Various epidemiologic, cytogenetic and biochemical problems of mongolism were discussed thereafter. The topics are not related to each other but present recent research done by the speakers.