bluuebunny/crossref_metadata_2025 huggingface dataset:
OCCURRENCE OF INNOCENT ADVENTITIOUS CARDIAC SOUNDS IN CHILDHOOD
Authors: FRIEDMAN SIDNEY , ROBIE WILLIAM A. , HARRIS T. N.
Published: December 2021

A group of 500 children between the ages of 2 and 12 years was subjected to a special cardiac examination. Of these, 234 (46.8%) were found to have functional cardiac murmurs and 137 (27.4%) were found to have extra cardiac sounds.

There was a considerable degree of association between the occurrence of these two types of adventitious sounds. Neither, however, was found to be correlated with the degree of anemia present, the age, color, sex, state of nutrition, or the temperature of the subjects examined.

A strong association was found to exist between the quality of many functional cardiac murmurs and their point of maximal intensity over the precordium, those in the midprecordium being commonly of the vibratory type and those in the pulmonic region of the blowing variety.

The most valuable criteria for the differentiation of functional from organic heart murmurs in childhood are the acoustic quality and the point of maximal intensity of the murmur.
PLACENTAL TRANSFUSION: EARLY VERSUS LATE CLAMPING OF THE UMBILICAL CORD
Authors: Moss Arthur J. , Monset-Couchard Michelle
Published: December 2021

IATROGENIC interruption of the placental circulation at birth has, in most cases become an automatic procedure with little or no regard for the physiologic alterations evoked or for their subsequent effect upon the fetus. The relative merits of "early" and "late" clamping of the umbilical cord have been the subject of controversy for many years. More recently it has been suggested that the time of cord clamping may be involved in the pathogenesis of idiopathic respiratory distress syndrome (IRDS). As of this writing, the controversy of "early" versus "late" clamping remains unsettled. Review of the pertinent literature indicates that this is due largely to failure to define uniformly "early" and "late," failure by many to consider the effects of onset of respiration, of gravity, of uterine contractions, and, in some instances, to conclusions not completely warranted by supporting data.

In view of the potential significance of the issue and the current confusion surrounding it, critical re-examination appears to be in order. A major purpose of this review is to call attention to the areas of investigation needing further documentation.

Effect on Blood Volume

The blood volume of newly born infants has been studied by a number of investigators. In Table I are listed six studies in which the time of cord clamping was taken into account. In a study of 35 infants, DeMarsh, Windle, and Alt found a significant increase in blood volume when cord clamping was delayed until after separation of the placenta. In a similar study by Whipple, Sisson, and Lund these results were not confirmed.
Letters to the Editor
Authors: VON HOFE FREDERICK H.
Published: December 2021

In response to the letter written by Dr. R.A. Norton of Tacoma, Washington, addressed to Mr. W. J. Becker, and forwarded to the Editor of Pediatrics, I say AMEN!

Too many articles that appear in Pediatrics are of the type of lectures delivered which fully display the speakers' unusual knowledge of particular subjects but give the audience nothing to take home.

I should welcome more practical articles that may have application to the practice of pediatrics.
White and Nonwhite Mortality
Authors: CHUSID EMANUEL
Published: December 2021

Each year I scrutinize a little more thoroughly Myron Wegman's vital statistic summaries. I regard these as kind of report card of the state of health of our patients. One might estimate how effective we are by how the numbers look.

The white-nonwhite mortality differential which Dr. Wegman has noted has been painfully elaborated by Dr. Helen C. Chase. Her compilation of death registration figures shows that, in 1963, infant mortality rate for whites was 22.3, and for nonwhites was 41.7.
Insulin in Temporary Idiopathic Neonatal Hyperglycemia?
Authors: BURLAND W. L.
Published: December 2021

I read the report of a case of temporary idiopathic neonatal hyperglycemia from South Africa with some interest (Pediatrics, 38:1009, 1966). I must agree with the author, Dr. Geefhuysen, that the condition cannot readily be differentiated from true diabetes mellitus until remission occurs; but I would disagree over the decision to withhold insulin except where there is persistent dehydration and acidosis, and then to give it only by the intravenous route. Despite the absence of ketosis in the untreated infant, significant lowering of plasma pH can develop.
Letters to the Editor
Authors: MENXES JOHN H.
Published: December 2021

Dr. Dancis's letter underlines the complexities encountered in studying the various metabolic alterations resulting from a derangement of the internal environment as seen in phenylketonuria.

It is a clinical fact that phenylketonuric individuals have diluted hair and iris pigmentation and that this defect is reversible by restriction in phenylalanine intake or supplementation of a normal diet by tyrosine.

The inhibition by phenylalanine of tyrosinase derived from embryonic skin (Saunders, et al.), mushrooms (Dancis and Balis), or mammalian melanoma (Miyamoto and Fitzpatrick) suggests but one of several possible sites at which melanin formation may be inhibited in the phenylketonuric patient.
Letters to the Editor
Authors: SMITH CLEMENT A.
Published: December 2021

I was startled to find that my invitation to "All Humanity" to join in the army of those fighting for children had terribly disturbed Doctor Halpern. In my comment, I put pediatrics in the lead among those responsible, but recognized that we are going to need all the help we can get.
POSTMATURITY
Authors: S. C. A.
Published: December 2021

FEW discussions between members of the obstetric-pediatric partnership have been as troubled as those concerning prolonged pregnancy. The obstetrician, quite properly, has resisted pressure to take routine action more likely to reduce the safety of the many than to relieve the risks of the few, at least until they can be identified. His pediatric colleague, on the other hand, has stood by in vague but increasing alarm as the expected date falls further behind, and no one can seem to do anything about it. The problem is not yet solved. But both partners may, to some extent, be victims of confusion as to just what the problem is and how it should be attacked.
STUDY OF ADRENAL FUNCTION IN CHILDREN WITH MENINGITIS
Authors: Migeon Claude J. , Kenny Frederic M. , Hung Wellington , Voorhess Mary L.
Published: December 2021

CORTICOSTEROIDS were introduced into the therapeutic armamentarium in 1949, and initially there was considerable enthusiasm regarding their possible uses in infectious diseases. One authority in a review in 1957 commented as follows: "I am prepared to state that the use of ACTH or adrenocorticosteroids on a short term basis in carefully selected patients with severe infections, often with debilitating and painful complications, not only will frequently contribute to the recovery of patients, but also will at times prevent permanent and disabling sequelae. In preparation for this review over 1,000 reports in the literature have been surveyed, and the more pertinent references have been included." However, initial enthusiasm has abated, and there are now few, if any, situations in which it is universally agreed that steroid treatment of an infectious disease is beneficial.

Experience in this field has been acquired largely through the comparison of steroid treated with non-treated controls.

In order to help clarify the still debatable issue of whether steroid treatment might be beneficial in cases of fulminating meningococcemia, we have selected another approach. We have attempted to study adrenal function in steroid-untreated patients, and we have compared the data with those obtained in other types of bacterial meningitis and in aseptic meningoencephalitis.

METHODS

Patients Studied

Unselected patients (Tables I-IV) admitted for meningitis were studied at The Children's Hospitals of The District of Columbia and of Pittsburgh, and The Children's Medical and Surgical Center of Baltimore. House officers at those centers notified the authors at the time of, or shortly after, the patients' admission. Most patients were started on the study immediately after admission, but some of them were included after varying time lapses.
THE FIRST REPORT OF THE VALUE OF FISH LIVER OIL AS A CURE FOR RICKETS
Authors: C. T. E.
Published: December 2021

In spite of the enormous literature concerning the history and use of fish liver oil in the prevention and treatment of rickets, the following interesting report published in 1779 seems to have escaped the notice of all who have delved into this subject:

The following account of a method by which the inhabitants of the western isles of Scotland, excite a fever and cure the rickets, has lately been communicated to Dr. Duncan, by an ingenious gentleman, in whose veracity and accuracy our readers may put great dependence.

"We are indebted to the most uncultivated part of mankind for many useful discoveries, especially in medicine; and however inexplicable they may be by our theories, yet even the most unpromising of them deserve attention and trial, more especially when they may prove useful in saving the lives of many of our fellow-creatures.

"The medicine made use of in the western islands for the cure of rickets, is an oil extracted from the liver of the skate fish. The method of application is as follows. First, the wrists and ancles [sic] are rubbed with the oil in the evening; this immediately raises a fever of several hours duration; when the fever from the first rubbing subsides, the same parts are rubbed again the night following, and repeatedly, as long as the rubbing of these parts continues to excite the fever: after no fever can be excited by rubbing the wrists and ancles [sic] alone, they are rubbed again along with the knees and elbows. This increased unction [sic] brings on the fever again; and is practiced as before, till it no longer has that effect. Then the vertebrae and sides are rubbed along with the former parts, and this unction, [sic] which again brings on the fever, is repeated as the former. When no fever can be longer excited by this unction, [sic] a flannel shirt, dipped in the oil, is put upon the body of the patient; this brings on a more violent and sensible fever than any of the former unction, [sic] and is continued till the cure is completed, which commonly it is in a short time."
THE FUNCTION OF THE PEDIATRIC JOURNAL
Authors: C. T. E.
Published: December 2021

These facts being appreciated, the true work of the pediatric journal is rendered clear. It is the medium of communication between the observer and the practitioner. By observer is not meant simply the laboratory worker and the pathologist, but it includes the physician of the hospital and dispensary. It is not limited even to these, for we should not fail to appreciate the invaluable experiences gained by the general physician. To him we allot ample space in these pages and urge more frequent publication of the knowledge which he gains in his daily contact with disease. On the whole, however, it must be admitted that the most important and substantial advances in knowledge result from the researches of special workers. The wisely conducted medical journal, will be, therefore, in large degree, the medium of communication between such special workers and that great body of men who do the practical work of the profession.

As the department of pediatrics cannot be restricted to a few consultants in large cities or teachers in medical colleges, so the pediatric journal cannot be limited in its scope. While its best contributors are drawn largely from the ranks of the true specialists, the man to whom it should prove of the greatest actual value is the general practitioner, to whom the diseases of children are of such vital importance. The true aim of such a journal should be the education of the profession at large in the important department which it represents. It should constantly strive to place the knowledge which is being continually accumulated by skilled observers, in such forms as to be most available for practical use. It has been the aim of the Archives throughout its whole history to attain this end, and no departure will be made from this policy.
CONGENITAL MESOBLASTIC NEPHROMA OF INFANCY
Authors: Bolande Robert P. , Brough A. Joseph , Izant Robert J.
Published: December 2021

A congenital mesoblastic nephroma occurring in eight infants is described. This tumor is composed primarily of fibroblastic tissue, and malignant epithelial components are missing. Foci of cystic and/or dysplastic tubules are always present. The tumor is thought to be histogenetically related to Wilms' tumor. Survival seems to be excellent following nephrectomy alone.
DIAGNOSIS AND TREATMENT: THE COMPLICATIONS OF STEROID TREATMENT
Authors: Eberlein Walter R. , Bongiovanni Alfred M. , Rodriguez Carmen Saenz
Published: December 2021

WHEN administered in pharmacologic amount, the adrenal glucocorticoids act in an almost magic way to suppress the overt manifestations of a large variety of inflammatory diseases, for which there is no known cause or cure. It is for this nonspecific purpose, rather than for replacement therapy of adrenocortical insufficiency states, that the steroids are so widely used. The extent of their use may be judged from the fact that total manufacturer sales of these products currently exceed $100 million annually.

To date, the pharmaceutical houses have synthesized over 1,500 corticosteroid analogues, only a few of which have proved in practice to be superior to cortisol and cortisone as anti-inflammatory agents. The analogues have been created in an attempt to avoid some of the undesirable effects which result from the pharmacologic use of cortisol or cortisone. Table I lists the major metabolic changes produced by the natural steroids and the clinical picture which develops when they are given or secreted in excess. It should be emphasized that the newer steroids avoid only one of these "complications," the action of cortisol given in large doses to cause sodium retention and potassium loss, thus producing edema, hypertension, hypokalemia, and metabolic alkalosis. The avoidance of edema and hypertension has certainly proved desirable in the treatment of nephrosis or rheumatic carditis, conditions for which cortisone is now rarely prescribed. And yet, if given in large enough amount, the analogues, such as prednisone, will produce profound muscular weakness, presumably via this same mechanism.

The possible complications listed in Table I ought to warn the physician not to use these steroids to treat trivial ailments.
Letters to the Editor
Authors: LOMBROSO CESARE T. , LERMAN PINCHAS
Published: December 2021

We gratefully acknowledge the kind remarks addressed to our paper by Drs. Kidd and Prichard, as well as their suggestions regarding the pathophysiology of breathholding spells (BHS).

We were cognizant of the differing views on the subject and indeed an effort to reconcile some of these was one of our aims. As we tried to point out, there seem to be at least two main mechanisms by which a "seizure" can be precipitated in "breathholders," namely through "ischemic anoxia" or through "anoxic anoxia."
The Management of Transient Tyrosinemia of the Newborn
Authors: CHASE H. PETER , O'BRIEN DONOUGH
Published: December 2021

The recent study by Avery, et al. makes a significant and much needed contribution to our understanding of transient tyrosinemia in the newborn. These investigators concluded that this condition is "relatively innocuous" and that there appears to be no indication for a change in general dietary recommendations for newborn infants, although their report applies only to observations in the neonatal period. On the basis of this, the pediatrician might reasonably feel that he has no responsibility either to look for or treat this quite common delay in enzyme maturation in the premature infant.
SCHOOL UNDERACHIEVEMENT IN THE ADOLESCENT
Authors: Hammar S. L.
Published: December 2021

Seventy-three adolescents, referred to the University of Washington Adolescent Clinic for school underachievement were evaluated for this study. Four times more adolescent boys than girls were referred for this problem. Twenty were found to be psychogenic underachievers, 40 had evidence of specific learning disorders, and 13 were mentally retarded. The problems of school achievement were not recent in onset but had, in most cases, been recognized in the early grades. The onset of puberty and rapidly approaching maturation, however, awakened the concerns of the parents and the teachers regarding the need for more diagnostic evaluation, vocational and academic planning, and guidance on managing the associated behavioral problems. The physician's role in management of school underachievement and the need for earlier recognition and therapeutic intervention is discussed.
TWO MISTAKEN DIAGNOSES OF FATAL ILLNESS IN BROTHERS
Authors: Winkelmayer Richard , Judd A. Bradford , Stearns Richard P.
Published: December 2021

Understanding the emotional impact of physical illness is generally recognized as an indispensable aspect of good medical practice. The diagnosis of fatal illness and the feelings connected with it possibly present the most difficult challenge in the art of medicine. We have tried to present some of the factors that led a mother to influence independent specialists to supply her with diagnoses of fatal diseases for two of her children. We feel that such processes are quite often at work, and we might have dismissed the untenable diagnosis of a fatal disease with the remark, "such things happen," were it not for the fact that this unlikely event happened twice in the same family. As physicians, we should all like to believe that our knowledge of the science of medicine is sufficient to remove us from the possibility of parental or other influence in such an instance. However, we are always exposed to these influences, and we may be swayed by them more often than we care to admit.
CEREBRAL GIGANTISM IN CHILDHOOD
Authors: Milunsky Aubrey , Cowie Valerie A. , Donoghue Elaine C.
Published: December 2021

Two cases of cerebral gigantism in childhood are reported, and 14 earlier cases are reviewed. The major manifestations of this non-progressive neurological disorder included gigantism, macrocrania, dolichocephaly, mental retardation, characteristic facies, high arched palate, and ataxia or clumsiness.

Pneumoencephalography in 10 out of 11 cases revealed a dilated ventricular system. Normal fasting plasma growth hormone levels were found in our patients, but both showed evidence of impaired function of the hypothalamic-pituitary axis in that these levels failed to rise following marked hypoglycemia. Abnormal dermatoglyphic patterns are reported and their value as an aid to diagnosis is mooted.

Both the cause and the nature of the neurological lesion remain obscure. The evidence favors a pathogenic mechanism operative in utero.
SUBDURAL HEMATOMA OF THE POSTERIOR FOSSA: REPORT OF A CASE
Authors: Pitlyk Paul J. , Miller Ross H. , Stayura Lois A.
Published: December 2021

A case of a newborn infant with a subdural hematoma of the posterior fossa is presented. The clinical course, diagnosis, treatment, and results of limited follow-up are given. A survey of the literature with respect to this lesion as well as a brief discussion of the incidence, mechanism of development, clinical manifestation, treatment, and prognosis is included.
Some Disenchantment with a Disputatious View
Authors: GERSH MARVIN J.
Published: December 2021

Dr. Leon Eisenberg, commenting on Dr. Julius Richmond's provocative Aldrich Award Address in the May 1967 issue of Pediatrics, offers us a double exhortation.

The first part of his comment, it seems to me, is addressed to his own colleagues in child psychiatry. He chides them for their ignorance of pediatrics, a point of view with which I have no quarrel.

The second part of his comment is addressed to the pediatric community, of which I am a member.
Letters to the Editor
Authors: LOMBROSO CESARE T.
Published: December 2021

Thank you for sending over the letter by Dr. Catzel regarding anemia and breathholding spells. We have looked for the presence of anemia in our patients and found it in only a minority. Most of these belonged to the cyanotic form. While we agree completely with the statement that anemia, when present, aggravates the condition and that correcting it will alleviate and even prevent any further clinical manifestations (not the breathholding itself), we find it difficult to accept the notion that iron deficiency is at the basis of all breathholding attacks.
The Camp Physician's Manual
Authors: HEALD FELIX
Published: December 2021

This is a well written book with appropriate coverage of the major health problems commonly encountered in summer camps. The author demonstrates the dilemma that must be solved by each camp or camp physician. Either the camp dispensary or physician should be equipped to function as a first aid station on to function as an emergency room in a hospital. Part of the decision will have to be made on the local availability of proper medical facilities.
Care of the Dying Child
Authors: Bergman Abraham B. , Green Morris
Published: December 2021

From our observations of dying children and examination of the child's emotional and cognitive development, we have outlined some of the major considerations in the child's psychological reactions to his own dying. This has been illustrated by clinical vignettes. It has become increasingly apparent that a more systematic investigation of the child's psychological reactions to his own dying will have to take into account the adult's tendency not to perceive the dying child's behavior and verbal communications of his own fears because of the anxieties evoked in the adult by the dying child. It should be the aim of future research in this area not only to examine systematically how children express their knowledge or sense that they are dying, but also to determine the principles, techniques, and limitations of communicating with these children in a therapeutic manner. Intuition cannot be relied upon, especially in an area so highly charged with anxieties for the responsible adults. Only through a more thorough understanding of the dying child's ways of communicating his sense of dying will we be able to know and teach how to help the dying child psychologically and come to appreciate the limitations of our knowledge and psychological therapy.
Programs of the Cancer Control Program—U. S. Public Health Service
Authors: Schulte Charles J. A.
Published: December 2021

ON JANUARY 1, 1967, the Cancer Control Program will become part of the National Center for Chronic Disease Control within the Public Health Service's new Bureau of Disease Prevention and Environmental Control. Our primary mission is to stimulate and encourage the application of currently available techniques of cancer prevention, cancer detection, and cancer control to the community at the grass roots level. If this will be the case after the reorganization remains to be seen. Figure 1 shows the new organization of the Public Health Service.

By way of illustration, I think it would be well to briefly outline a few of our activities. An area of heavy emphasis has been the use of the Papanicolaou smears for cervical cancer control. These programs have been responsible for developing certified cytotechnology training schools, supporting and training large numbers of cytotechnicians. In addition, we are supporting some 90 hospital-based cervical cancer screening projects across the country. A program to encourage the general practitioner to screen his private patients in the office is jointly sponsored by the American Academy of General Practice and the Cancer Control Program.

The very grave problem in the United States of smoking and carcinoma of the lung is the major responsibility of tile National Clearinghouse for Smoking and Health, a part of the Division of Chronic Diseases which developed out of the Cancer Control Program.

We are engaged in a number of developmental projects, such as the flexible fiber optic proctosigmoidoscope. We hope to be able to produce a proctosigmoidoscope that will reach the splenic flexure.
ETIOLOGIC INTERRELATIONSHIP IN DOWN'S SYNDROME, HYPOTHYROIDISM, AND PRECOCIOUS SEXUAL DEVELOPMENT
Authors: Pabst H. F. , Pueschel S. , Hillman D. A.
Published: December 2021

This report describes results of endocrine and immunological investigations performed on an 8-year-old, hypothyroid, mongoloid girl with precocious puberty. Based on these studies, animal experiments, and a review of the pertinent literature, it is suggested that the observed hypothyroidism and Down's syndrome may both be related to thyroid autoimmunity, and the sexual precocity may be due to the response of the ovary to excessive TSH stimulation.
Upper and Lower Gastrointestinal Tract Bleeding Induced by Whole Cow's Milk in an Atopic Infant
Authors: KRAVIS LILLIAN P. , DONSKY GORDON , LECKS HAROLD I.
Published: December 2021

The case of a 5-month-old infant who developed hematemesis as well as lower intestinal tract bleeding following a second exposure to homogenized cow's milk is presented as an example of unusually severe cow's milk allergy. Serum precipitins, hemagglutinins, and PCA antibodies were all present at the time of the acute reaction, but only skin-sensitizing antibodies could be demonstrated when the infant was asymptomatic and not ingesting milk.

Hypocalcemia, an elevated serum alkaline phosphatase level, and a marked microcytic, hypochromic anemia were associated with milder manifestations of milk intolerance in this same patient 2 months earlier. This unusual triad of laboratory findings can be interpreted as resulting from early damage to the intestinal mucosa by a local milk-antigen-antibody interaction.
Sozialmedizinische Aspects in Der Paediatrie (Postgraduate Courses in Pediatrics) Vol. 20
Authors: BROOKSALER FRED S.
Published: December 2021

Volume 20 of the popular Swiss Postgraduate Courses in Pediatrics, edited so expertly by Professor E. Rossi, is devoted to social pediatrics. The papers included cover such topics as accidents in children and adolescents, the mild forms of mental retardation, the handling of health problems by the school physician, caries prophylaxis, the care of the neglected child, and left-handedness as a cause for learning difficulty in school. Except for the chapters concerning legal aspects of adoption under Swiss law and insurance coverage for handicapped children in Switzerland, the approaches to the problems discussed are not different from those in the English-speaking world.
GRANULOMATOUS CYSTITIS OF CHILDREN, BILHARZIA LIKE, OCCURRING IN BRITISH COLUMBIA
Authors: Johnson H. W. , Elliott G. B. , lsraels S. , Balfour J.
Published: December 2021

Two cases of focal granulomatous cystitis are reported in children from British Columbia. The urologic lesions in both showed a distribution and clinical course which were bilharzial like. In one, after many therapeutic failures, use of an anti-bilharzial drug produced prompt healing. This was also noted in two instances reported by other investigators. [See FIG. 10. in Source PDF]

Zones intervening between the focal granulomata of foreign-body type showed eosinophilic cystitis. The links between this syndrome and eosinophilic gastroenteritis are reviewed. One case of eosinophilic cystitis, also in a child, is described. By exclusion all three cases we studied are thought to be parasitic in origin. The distribution reported to date appears to be in sea coast areas of North America, as in "clam digger's itch" another schistosomal disease.
HIGH URINARY DIVERSION WITH AN ILEAL CONDUIT IN CHILDREN
Authors: Holland James M. , King Lowell R. , Schirmer Horst K. A. , Scott William Wallace
Published: December 2021

High ileal diversion has been performed on 26 children with destroyed ureteral function in the authors' experience. Fifteen were azotemic when diverted. Renal function has improved or stabilized in 21 of the 23 patients (91%) who survived operation followed for as long as 8 years. Pyelographic appearance has improved or stabilized in 34 of 39 kidneys (87%) in these children.

Ten patients were diverted more than 5 years ago. Renal function has improved or stabilized in all seven who are now alive.

High ileal diversion has thus proved to be safe and reliable. Although azotemic children also can be salvaged, the authors advocate earlier high diversion of kidneys drained by badly dilated and poorly functioning ureters.
CYSTATHIONINURIA IN GALACTOSEMIA AND CERTAIN TYPES OF LIVER DISEASE
Authors: Lieberman Ellin , Shaw Kenneth N. F. , Donnell George N.
Published: December 2021

Studies of secondary cystathioninuria in three infants with untreated galactosemia are described. Excretion of cystathionine became normal and generalized aminoaciduria disappeared when galactose was eliminated from the diet. Observations also are presented on excretion of cystathionine and other sulfur amino acids by patients with various types of liver disease.
Letters to the Editor
Authors: MOSS ARTHUR J. , MONSET-COUCHARD MICHELLE
Published: December 2021

Many of the issues raised by Dr. Baum are discussed in the original article, i.e., the importance of the influence of gravity and of uterine contractions as well as the onset of respirations and the time factor.

Because of the many unknown and complex factors, a definition of placental transfusion was not attempted. Concerning Dr. Baum's proposed definition, it would seem to be purely theoretic to consider a "redistribution" of red cells between the placental and fetal circulations since, to our knowledge, neither the total circulating red cell mass of the placenta and baby nor its prenatal distribution is known.
Occurrence of Acute Glomerulonephritis in Sibling Contacts of Children with Sporadic Acute Glomerulonephritis
Authors: DODGE WARREN F. , SPARGO BENJAMIN H. , TRAVIS LUTHER B.
Published: December 2021

Additional cases of acute glomerulonephritis in sibling contacts were observed in from one fourth (proven by renal biopsy) to one half (proven and suspected) of the index case sibships examined. These data suggest that the occurrence of acute glomerulonephritis in family contacts of children with sporadic acute poststreptococcal glomerulonephritis is so common as to warrant close observation of the other siblings.
ANNUAL SUMMARY OF VITAL STATISTICS—1966
Authors: Wegman Myron E.
Published: December 2021

One cannot very well summarize an article of this character, but it does seem that we may take encouragement from what appears to be recent, more rapid progress in relation to infant mortality. At the same time, the steadily worsening relative position of the United States among comparable countries of the world should stimulate us to further effort. Citizens of the wealthiest country in the world, whose whole history is built on concern for its people, can hardly be content when clearly unnecessary deaths, which could be prevented by increased national effort, take place. The situation needs to be a matter of permanent concern to all practicing pediatricians, as well as to the Academy.
PRESIDENT'S ADDRESS
Authors: Anderson William S.
Published: December 2021

THE Thirty-sixth Annual Meeting of the American Academy of Pediatrics terminates an eventful year of increased activities expansion, and new responsibilities of far-reaching importance. The Academy membership continues to increase rapidly and the total membership following the recent Executive Board meeting is well over 10,000. The new responsibilities have necessitated the addition of new personnel to the Central Office staff. Mr. George Degnon will work with the Council on Pediatric Practice, especially on pending legislation planned by governmental agencies. Dr. Robert S. Mendelsohn will administer the consultation program of the Academy for all Head Start programs throughout the country.

The current year has also brought increased activity in the relationship of the Academy to the other medical organizations. The Medical Intersociety Council, the AMA Interspecialty Committee, the Council of Medical Specialty Societies, and the more recently organized Joint Council of Pediatric Societies have continued to meet and work together along many lines of mutual interest and concern. The Joint Commission on Mental Health for Children has been exceedingly active and now has six task forces composed of extraordinary talent in every aspect of mental health. It is hoped and expected that the final report of this joint commission will be a monumental document.

It would be impossible for me to delincate the accomplishments of all the various committees of the Academy. However, I would like to pay tribute to two of these committees whose diligence and productivity have been particularly outstanding.

The Council on Pediatric Practice has met many times and the workshop conferences both last October and at this meeting have been very highly successful.
Deafness, Hypothyroidism, and Pendred's Syndrome
Authors: BARGMAN GERALD J. , GARDNER LYTT I.
Published: December 2021

The recent case report of MacGillivray, et al. in Pediatrics nicely demonstrates the relationship of neonatal hyperbilirubinemia and congenital hypothyroidism and also points out the association of congenital hypothyroidism with deafness. Their patient, in addition to being jaundiced, apparently did not respond to loud auditory stimulation when "maximally hypothyroid" at 1 month of age; but, at 6 months of age, "when the patient was euthyroid," no hearing deficit was thought to be present. While, as suggested by the authors, myxedematous changes in the mucosa of the eustachian tubes might account for what appeared to be a transient hearing loss, other factors should be considered.
Fun Society
Authors: Bakwin and Bakwin .
Published: December 2021

Of primary importance in the production of juvenile delinquency is the social setting. A society in which young people are led to believe that to have fun is the primary aim of life, a society in which moral restraint and personal responsibility are minimized, a society in which authority—parental religious, community—is flaunted breeds delinquency.
The Pediatrician and Community Mental Health
Authors: Brines John K.
Published: December 2021

In a recent questionnaire to determine the extent to which pediatricians were involved in community mental health activities, members of the Academy's Massachusetts Chapter were asked, "What role do you consider appropriate for the pediatrician?" One third of those answering this question considered their roles as primarily medical ("consulting, advising, screening") . Two-thirds saw the pediatrician as "sharing in the team effort, planning, coordinating, preventing problems, sharing in a learning experience, managing simple emotional problems." In more than one half of the returns, this question was left unanswered.
The Marihuana Papers, edited by David Solomon. Indianapolis, Indiana: Bobbs-Merrill, 1966, 448 pp., $10.00
Authors: Grossman Elmer R.
Published: December 2021

One of the hallmarks of man is his irrepressible desire to attain altered states of consciousness. For thousands of years, and in every culture, individuals of our species have sought ways to change, at least briefly and from time to time, the way it feels to be alive. Fermented spirits, hallucinogenic mushrooms and cactus, narcotics, betel nuts, tobacco and marihuana, tranquilizers, fasting, flagellation, meditation and prayer–the list of methods is a long one but the goals are not dissimilar.
Letters to the Editor
Authors: Baker H. , Kellogg Rhoda
Published: December 2021

In a short paper such as the one we are discussing (based as it is on a large amount of original work), it is not possible to answer many of the questions that may arise in the mind of any one reader. When Dr. Work consults the bibliography of the article in question, he will find that reference 3 ("Analyzing Children's Art," available in January 1968) discusses the work of Bender, Frostig, and many others who have examined child art extensively.
SERUM IMMUNOGLOBULINS: I. LEVELS IN NORMAL CHILDREN AND IN UNCOMPLICATED CHILDHOOD ALLERGY
Authors: Buckley Rebecca H. , Dees Susan C. , O'Fallon W. Michael
Published: December 2021

In 201 normal individuals from infancy to adulthood, serum concentrations of immunoglobulins G, A, and M are presented as geometric mean values (mg/l00 ml) and as percents of adult mean values for each of these proteins. A statistical analysis revealed a significant relationship between age and both IgG and IgA concentrations up to ages 6 and 7 years. No correlation was present between age and immunoglobulin concentrations beyond that time, suggesting that the adult concentrations of IgG and IgA are normally reached and maintained after ages 6 and 7 years. In contrast, analysis of the IgM data suggested that the adult value is reached by age 1 year. No truly significant differences were found in immunoglobulin concentrations which could be attributed to sex. Significantly higher concentrations of IgG were found in normal Negro than in normal Caucasian subjects after age 6 years, but no significant differences were found below this age for IgG or at any age for IgA and IgM.

Similarly determined serum immunoglobulins in 85 allergic children, selected because they had no complicating illnesses, were compared with the normal group according to the age of the child. No significant differences were found in concentrations of either IgG or IgA. Some differences were found in IgM, but these were small and were primarily associated with the relationship of IgM to age in the allergic group.
BENIGN RECURRENT CHOLESTASIS IN A CHILD
Authors: Stark Harry
Published: December 2021

A 17-month-old female patient developed signs of biliary obstruction, as evidenced by jaundice, pale stools, severe pruritus, bilirubinuria, and slightly elevated serum levels of cholesterol and alkaline phosphatase. These signs remitted spontaneously after 6 months. During the subsequent 5 years, the child suffered eight further such episodes, recurring at irregular intervals and lasting 1 to 6 months. During icteric episodes, BSP retention was increased and cholangiograms showed no biliary dye excretion. Laparotomy revealed no hepatic or biliary pathology.

Between periods of jaundice, all signs of biliary obstruction disappeared, BSP retention became normal and normal cholangiograms were obtained. Four liver biopsies, performed over 6 years, demonstrated marked cholestasis, with no distortion of the lobular pattern and no evidence of progressive histological changes.

The patient is believed to represent a further case of "benign recurrent cholestasis." In this condition, beginning in childhood or early adulthood, there is no evidence of progressive liver damage, despite numerous recurrences of biliary tract obstruction.
LIPID METABOLISM IN THE NEWBORN
Authors: Zee Paulus
Published: December 2021

Triglyceride, cholesterol and cholesteryl ester concentrations in the cord serum of 10 infants were determined and found to be considerably lower than in the mother's serum. The fatty acid compositions of the cord serum triglycerides and cholesteryl esters were significantly different from those of the mothers. The linoleate fraction of these esters was especially low.

Plasma triglyceride concentrations in full-term, healthy infants rose significantly 9 hours after birth. The fatty acid distribution of these triglycerides at 12 hours varied from that at birth; this difference was also reflected in reported plasma free fatty acids and suggests a precursory relationship. The plasma total cholesterol concentrations did not alter in the first 12 hours, nor did the fatty acid distribution of the cholesteryl esters change significantly.

A method to measure low concentrations of triglycerides in small samples is described.

The differences between maternal and cord serum lipids suggest that fetal lipids do not originate directly in the mother. The rise in plasma triglycerides is part of an increased fat mobilization occurring after birth.
INTRACTABLE DIARRHEA IN EARLY INFANCY
Authors: Avery Gordon B. , Villavicencio Olmedo , Lilly John R. , Randolph Judson G.
Published: December 2021

Twenty infants with intractable diarrhea, whose onset was before 3 months of age, were analyzed. Twelve had identifiable pathological entities sufficient to explain their protracted diarrhea. A systematic diagnostic scheme for such babies is presented.

Eight of the 20 infants had no identifiable cause for diarrhea of such severity and refractoriness, and these babies were termed non-specific enterocolitis. Six of these latter eight babies died and at autopsy had widespread enterocolitis with destruction of the mucosa and inflammatory infiltration. The authors believe that in these latter cases, regardless of the initial cause of the diarrhea, certain vicious cycles came into play which perpetuated the diarrhea. Preliminary evidence suggests that colostomy and, perhaps adrenal corticosteroids, may be useful in the therapy of refractory enterocolitis, particularly if applied before the terminal stages of the disease.
CONGENITAL STENOSIS OF THE RIGHT MAINSTEM BRONCHUS
Authors: Chang Nora , Hertzler J. H. , Gregg R. H. , Lofti M. Wael , Brough A. J.
Published: December 2021

Successful resection of an uncomplicated, localized stenosis of the right main stem bronchus of congenital origin was performed on a 5-month-old child whose symptoms began in the neonatal period.
IMMEDIATE AND LONG-TERM EFFECTS OF INTERVENTIONS EARLY IN PROLONGED HOSPITALIZATION
Authors: Rie Herbert E. , Boverman Harold , Grossman Burton J. , Ozoa Natividad
Published: December 2021

Knowledge about their illness, anxiety level, and concern about hospitalization were studied in hospitalized children with rheumatic fever, who were either tutored about their illness or engaged in group psychotherapeutic meetings, within 3 weeks of hospitalization. Comparisons following these procedures revealed reduced anxiety in the tutored group, increased knowledge about rheumatic fever in both groups but not in a control group, and no difference with respect to concern about hospitalization. Nineteen months after discharge, neither group showed a decreased anxiety level, both showed far less concern about hospitalization, and the children given "psychotherapy" showed more lasting knowledge about rheumatic fever.

The potential, ultimate impact of minimal interventions during crises is noted and the described procedures constitute relatively economical means of helping hospitalized children with their distress and to gain knowledge of their illness.
Letters to the Editor
Authors: Hathaway William E.
Published: December 2021

Dr. Lopez is correct. Inadvertently, the normal values stated for LDH and SGOT were for adults. Our laboratory's values for the newborn period agree with those cited by Dr. Lopez. However, the patient's LDH of 6750 units is still abnormally high. The point regarding elevated LDH in myeloproliferative disorders is still applicable.
Parental Acceptance of Delegated Pediatric Services
Authors: Skinner Alfred L.
Published: December 2021

The Council on Pediatric Practice of the American Academy of Pediatrics has published a manual of standards1 which permits delegation of some well-child services to "pediatric assistants." For example, approximately half of a well baby's visits for health supervision might not involve the pediatrician personally.

When this proposal was discussed with colleagues, many expressed their preference to provide these services themselves as they were trained to do, and they doubted that the aide's services would be acceptable to parents in their practices. Therefore, a survey of parental acceptance of assistant's services seemed desirable.

In my practice 4 years ago I started such a plan for large families to improve their compliance2 with health supervision stalldards.
Baby Gymnastics, by Detleff Neumann-Neurode and completely revised by Wendula Kaiser. Oxford: Pergamon Press, 1967, 39 pp., $2.50
Authors: Holt K. S.
Published: December 2021

This is a slim volume with a hard cover which is printed clearly on high quality paper and contains many good quality photographs. It is the first English edition of a book which has enjoyed three editions in the original German. To some extent it is a tribute to Neumann-Neurode, who devised a series of exercises for babies, and one part of the book describes how the techniques spread throughout Germany. One section gives instructions about how to perform exercises for normal healthy babies; another section describes exercises specially designed for babies who have some muscle weakness or other defect.
THE PULMONARY LYMPHATICS IN NEONATAL HYALINE MEMBRANE DISEASE
Authors: Lauweryns J. M. , Claessens St. , Boussauw L.
Published: December 2021

Histometrical measurements have revealed that the mean diameter of the pulmonary lymphatics is consistently greater in the idiopathic respiratory distress syndrome, when compared to a control group of other newborns. This lymphangiectasis and congestion is most marked in the perivenous lymphatics, less in the peribronchial and periarterial, and least in the pleural lymphatics.

This hitherto unreported morphologic feature of hyaline membrane disease seems to be most closely related to the known disturbance of alveolocapillary barrier permeability; it remains, however, a challenge to the investigator as some anatomical and histophysiological characteristics of the lymphatics of the lung, together with other aspects of the disease (i.e., surfactant deficiency, even neonatal pulmonary arterial hypoperfusion and venous congestion) could play important roles as well.
A PHYSICIAN'S LETTER WRITTEN IN 1772 SUGGESTING TREATMENT FOR HIS AILING INFANT NEPHEW
Authors: Binns Jonathan , C. T. E.
Published: December 2021

Few letters written by either English or American eighteenth century physicians about the treatment of sick infants have come down to us. Most of our information about the care of such infants comes from the handful of pediatric texts published in that century. The letter below, written by Dr. Jonathan Binns in 1772 to the parents of his ailing 11-month-old nephew, starkly points out the therapeutic limitations of pediatric practice two centuries ago. The infant about whom this letter was written had a high fever and was lethargic.

So far as I can judge from little Tommy's case, I think it proper that he continues sucking. If he would take any other sustenance I would advise you to give him a little red or white wine every day. He may, at different times, take about one Glass; but be very cautious of it if his eyes be somewhat sore and inflamed. Red port is preferable to white, provided he is sufficiently open in his belly. You might also try him to take once a day a few spoonfuls of weak broth made of the lean part of beef or mutton.1
NEONATAL EXCHANGE TRANSFUSION AND CHILDHOOD LEUKEMIA
Authors: Dawson Peter J. , Meighan S. Spence
Published: December 2021

In a search for evidence of a possible viral etiology for human leukemia, a comparison was made of the incidence of childhood leukemia among babies receiving exchange blood transfusion and those who had no such transfusion. During a 16-year period in the state of Oregon, no difference in the likelihood of contracting leukemia was detected between the two groups.
When We Deal with Children, Selected Writings by Fritz Redl, M.D. New York: The Free Press, 1966, 511 pp., $8.95
Authors: Sussex James N.
Published: December 2021

I began reading this book with some reluctance because I am not ordinarily enthusiastic about collections of an author's previous writings. Papers collected in such a fashion are frequently only peripherally related to each other, often lack continuity or central theme, and more often than not appear to have little other purpose than that of publishing another book.

I soon changed my mind as I read this book. Not only have I consolidated in my own mind many of the things Dr. Redl has said in the past about emotionally disturbed children but, in addition, I have gained a new and deeper understanding of him as a person and of his philosophy of working with children.