bluuebunny/crossref_metadata_2025_split huggingface dataset:
PRESIDENT'S MESSAGE
Authors: Fischer Carl C. 
Published: December 2021

REGARDLESS of how we, as individual physicians, may feel about the role of the federal government in the individual practice of medicine, the time has long since passed when we can afford the luxury of ignoring it.
In past years the influence of the government on medicine has been mostly in general areas and perhaps least of all in that of pediatrics; but under the present administration there has been a decided change.
For this reason it seems necessary to me to call to the attention of all Fellows of the Academy the particular items in President Kennedy's message of February 26, 1962, which relate specifically to the practice of Pediatrics.
These may be considered to be three in number: The first of these dealt with the subject of immunization.
On this topic President Kennedy said:
I am asking the American people to join in a nationwide vaccination program to stamp out these four diseases (whooping cough, diphtheria, tetanus, and poliomyelitis) encouraging all communities to immunize both children and adults, keep them immunized and plan for the routine immunization of children yet to be born. To assist the states and local communities in this effort over the next 3 years, I am proposing legislation authorizing a program of federal assistance. This program would cover the full cost of vaccines for all children under 5 years of age. It would also assist in meeting the cost of organizing the vaccination drives begun during this period, and the cost of extra personnel needed for certain special tasks.
KLEBSIELLA-AEROBACTER PNEUMONIA IN INFANTS
Authors: Thaler Manning Michael 
Published: December 2021

Klebsiella pneumoniae and Aerobacter aerogenes organisms are indistinguishable by standard laboratory methods and should be grouped under the single name Klebsiella-Aerobacter in clinical discussions. Though serotypes 1, 2, and 4 are usually implicated in severe respiratory disease in adults, any type may prove pathogenic in infants. A case of Klebsiella-Aerobacter pneumonia in a 7-week-old infant in which a Type 16 organism was lethal is presented. The disease took a fulminating course, characterized by copious secretion of thick purulent mucus, in which a great number of Klebsiella-Aerobacter were found. These diminished rapidly following antibiotic therapy, but the patient died from the flooding of her respiratory passages with secretions.
The 36 cases of this condition reported in the world literature are discussed, with particular emphasis on early diagnosis and effects of antibiotic therapy. The mortality in sporadic cases is four times that reported during epidemics. The diagnosis is seen to be particularly elusive and is complicated by the use of drugs prior to culture. The significance of throat carriers, especially during periods of increased incidence is difficult to interpret. Gram stains of tracheal secretions are singled out as a simple procedure helpful in making a quick diagnosis and in following the effect of antibiotic therapy. A combination of streptomycin and chloramphenicol is suggested as the antimicrobial combination of choice, effective in over 90% of in vitro studies.
Taking Care of Physicians children
Authors: WESSEL MORRIS A. 
Published: December 2021

The articles, "The Physicians Children as Patients" by John H. Kennell and Willard D. Boaz, and "Should not Physicians' Families be Allowed the Comfort of Paying for Medical Care?" by Benjamin M. Spock, in the July, 1962, issue of Pediatrics call attention to an important medical problem.
Doctor-parents do indeed need help in establishing a definite, well-defined relationship with their pediatricians. The physician who accepts this professional role should describe clearly for the doctor family, as for any other family, his plans for carrying out his professional responsibilities and his desire to be of service to his patients.
EPIDEMIOLOGY OF ASTHMA IN CHILDREN, WITH PARTICULAR REFERENCE TO WIND SPEED AND WIND DIRECTION
Authors: Newell Guy René , Swafford Lida Inge 
Published: December 2021

There are many reports relating air pollution to asthma. Specific agents have been implicated, although not always concretely demonstrated. This study of 2,400 pediatric emergency visits for asthma compares its epidemiology in children and adults, particularly as to effects associated with wind speed and wind direction.
Outbreaks of asthma in children were not nearly as conspicuously related to wind speed and direction as were those in adults. The severity of attacks, as judged by emergency visits for relief, increased in the fall and fell off during the summer. More boys than girls were affected; the frequency of visits gradually built up with age, except for a drop at the immediate prepubertal ages, followed by a sharp peak at age 14 years. Thus "duration of exposure" could not be clearly related to the frequency of attacks. These observations have raised questions and speculations which we hope will lead to further studies.
Letters to the Editor
Authors: CONNELLY JOHN P. , CRAWFORD JOHN D. , WATSON JOHN 
Published: December 2021

The four stumbling blocks to truth invented by the Anglican sage, Brother Roger Bacon, O.F.M., are: (1) the influence of fragile or unworthy authority, (2) custom, (3) the imperfection of undisciplined senses, and (4) the concealment of ignorance by ostentation of seeming wisdom. We are guilty of a violation of number three but would like not to extend our guilt by trespassing the fourth stumbling block.
In preparing a response to Dr. R. Rapkin's letter regarding our recent article, "Neonatal Hyperphosphatemia," we uncovered two errors: a minor one in Table II and a more serious one in Table III, which alters the findings. In Table II the mean serum phosphorus value on day three should read 0.09 mg/ml.
Sweat Electrolytes in Glycogen Storage Disease, Type I
Authors: SHWACHMAN HARRY 
Published: December 2021

This correspondence is stimulated by the article by Doctors Harris and Cohen which appeared in Pediatrics, 31:1044, 1963.
I am indeed pleased to learn that some patients with glucose-6-phosphatase deficiency (von Gierke's disease) have elevated sweat electrolytes. We recall one patient tested by us with this deficiency and he showed the following values: at 5 10/12 years of age, sodium 18.8 meq/l, chloride 23.9 meq/l, potassium 7.3 meq/l. I consulted Dr. Paul di Sant-`Agnese, who is an authority on both glycogen storage disease and cystic fibrosis.
Prophylactic Vitamin D Dosage after Infancy
Authors: BAKWIN HARRY 
Published: December 2021

In the report of the Nutrition Committee, American Academy of Pediatrics on the "Prophylactic Requirement and the Toxicity of Vitamin D" (Pediatrics, 31:512) the same prophylactic dose of vitamin D is recommended for children and adolescents as for infants. This seems to me unrealistic.
Before the introduction of widespread vitamin D prophylaxis, all the babies over 3 or 4 months on the infant's ward at Bellevue Hospital had rickets during the late winter and spring. The only variation was in degree. Rickets was never seen after the first year or two except for an occasional case of "renal rickets" and "coeliac rickets."
MILK ALLERGY
Authors: Saperstein S. , Anderson D. W. , Goldman A. S. , Kniker W. T. 
Published: December 2021

The examination of sera from milk allergic children, children allergic to substances other than milk, and normal children, revealed no significant differences relative to coated tanned cell hemagglutinin titer or the presence of precipitating antibody as measured by gel diffusion for milk components.
The passive cutaneous anaphylaxis test revealed a high percentage of positive responses with sera from milk allergic individuals only.
The presence of milk hemagglutinins could not be demonstrated in the cord sera from 30 newborns.
The results of this study suggest that the passive cutaneous anaphylaxis technique deserves further evaluation as a laboratory method for the confirmation of milk allergy.
"THE CIRCULATION OF BLOOD THROUGH SKELETAL MUSCLE"
Authors: Hyman Chester 
Published: December 2021

MOVEMENT, that most grossly apparent manifestation of life, results from skeletal muscle contraction. Energy for contraction is ultimately obtained from the external environment so that fuels for transformation in the muscle cell must be brought from the gut or liver by the circulation. Continuing activity clearly depends on adequate tissue perfusion which maintains constant the environment of the cell and assures each tissue its necessary nutrients. In skeletal muscle, the vast range of potential activity would require either a constant blood flow adequate for the maximum demand, or, a rapidly and accurately adjusting circulation to meet the immediate needs of the tissue. Since the principle of parsimony rules most biological systems, instead of the prodigal maximum blood flow to resting muscle to provide for the occasional burst of activity, the variable blood flow system is the more logical and the actual solution. However, at times the maximum needs of active muscle may exceed the blood supply to incur a blood flow debt which must be repaid after the contraction. These general concepts are supported by numberless casual observations and many careful scientific studies performed over the past centuries. Specific information of the mechanisms regulating the circulation in skeletal muscle has accumulated during the past half century and several new concepts have been proposed in the past two decades. What follows is a summary and personal evaluation of our present knowledge of these mechanisms.
Traditionally, a description of the morphologic stage prefaces the examination of any physiologic mechanism; in this case, we must examine the arrangement of tubes which carry the blood through skeletal muscle.
REPRODUCTIVE FAILURE IN FAMILIES OF PATIENTS WITH IDIOPATHIC DEVELOPMENTAL RETARDATION
Authors: Tips Robert L. , Smith George , Meyer Donald L. 
Published: December 2021

1. The family histories of 30 patients with idiopathic developmental retardation were analyzed with respect to pregnancy records of nonaffected female kindred. Comparison was made with data from the family histories of 27 similarly ascertained control patients.
2. The mothers and maternal aunts of retardates were found to have abnormal pregnancy records, i.e., a markedly decreased reproductive rate and increased fetal loss (reproductive failure). Similar findings were not noted in the histories of the maternal grandmothers or other females in the families.
3. The comparison study suggests genetic factors as an influence on reproduction in the maternal families of retardates but their nature remains unknown.
4. The utilization of these findings in clinical genetic counseling is briefly discussed.
PHENYLKETONURIA
Authors: Kleinman David S. 
Published: December 2021

The dietary regimen is a difficult one; it must be closely controlled by the physician if complications are to be avoided. Although effective in limiting pathology, if administered early and maintained, evidence is not yet presented as to whether it is fully protective.
Estimates of the incidence and prevalence of phenylketonuria are not well established. There are indications that, although rare, the incidence may be considerably higher than the 1 in 20,000 to 25,000 births previously estimated. Discrepancies in the estimates should be explored for possible explanation. These may relate to different population frequencies, definitions of mental retardation, and screening and testing procedures.
The degree of variability in the manifestations (or expressivity) of phenylketonuria in mental retardation and other effects has not been adequately examined. Investigation of the factors relating to this variability may provide information regarding the mechanics of pathology and lead to improved screening and therapeutic measures.
ERYTHROCYTE ACETYLCHOLINESTERASE ACTIVITY IN ABO HEMOLYTIC DISEASE OF THE NEWBORN
Authors: Kaplan Eugene , Herz Fritz , Hsu Ku Shin 
Published: December 2021

Erythrocyte AChE is reduced in ABO hemolytic disease of the newborn. This enzyme alteration is not present in all infants with ABO disease, nor in all erythrocytes of affected infants. Treatment of erythrocytes with anti A or B antibodies has not resulted in AChE decrease, but such decrease regularly follows erythrocyte treatment by proteolytic enzymes. While AChE is normal in Rh hemolytic disease of the newborn it is decreased in one infant exhibiting features of both ABO and Rh disease.
The measurement of erythrocyte AChE activity provides a simple colorimetric test to confirm the diagnosis of ABO hemolytic disease of the newborn. The reduced activity of this surface located erythrocyte enzyme in ABO disease and in paroxysmal nocturnal hemoglobinuria suggests that a similar extracorpuscular mechanism could be involved in both conditions. The demonstration of an enzymatic abnormality in erythrocytes associated with an immune hemolytic anemia may yield a model system for further study of cellular reactions in immune diseases.
FREE AMINO ACIDS OF CORD PLASMA AS COMPARED WITH MATERNAL PLASMA DURING PREGNANCY
Authors: Ghadimi H. , Pecora P. 
Published: December 2021

The free amino acids of cord blood as compared with maternal blood taken within a few minutes were studied by the use of ion-exchange column chromatography.
Twenty-two paired plasma samples from immature, premature, and full-term caesarean sections and vaginal deliveries were studied. The material also included three cases of advanced maternal diabetes. In addition bloods from four healthy women after parturition were also analyzed to compare with blood obtained at the end of pregnancy.
The results indicate that (a) all the ratios of free amino acids of cord to maternal blood are above 1 and mostly about 2, (b) the discrepancy is brought about by decreased maternal and increased fetal values, (c) the ratios obtained from blood taken at the second trimester of pregnancy are somewhat higher than those of full-term, (d) an active transport mechanism responsible for the transfer of amino acids against a concentration gradient is in operation probably during the entire pregnancy, (e) essential and nonessential amino acids are transported across the placental barrier indiscriminately, and (f) maternal diabetes and the route of delivery do not affect the concentrations of free amino acids on both the fetal and maternal side.
ORAL POLIOVIRUS VACCINATION IN CHILDREN: A STUDY SUGGESTING ENTEROVIRUS INTERFERENCE
Authors: Feldman Roger A. , Holguin Alfonso H. , Gelfand Henry M. 
Published: December 2021

Monovalent oral poliovirus vaccine type 1 was fed to two groups of children comparable in all respects except that in one group there was a high rate of naturally occurring infections with Coxsackie B4 and poliovirus type 3. Approximately 30% of the children in the latter group were found to have "wild" enteroviral infections during the two-week period beginning with vaccine feeding, and 38 of 128 of them (30%) who were "serologically susceptible" failed to show serologic evidence of vaccine "take" eight weeks after vaccination. In the other group, with no documented "wild" enteroviral infections during the two-week period, only three of 70 susceptibles (4%) failed to show a serologic response. This difference was attributed to the interfering effect of concurrent enterovirus infection on infection (and successful vaccination) with the OPV strain.
Community vaccination programs scheduled in the cold months of the year should avoid the possibility of enterovirus interference.
THE MODERN MORBIDITY OF PERTUSSIS IN INFANTS
Authors: White Robert , Finberg Laurence , Tramer Arnold 
Published: December 2021

Seventy-five children who had pertussis during early infancy and survived from a group having less than 1% mortality were recalled and examined, along with controls, for evidences of chronic pulmonary disease, neurological impairment, intellectual performance, and current behavior.
The data show no incidence of chronic pulmonary disease and no significant neurological sequelae in this small sample.
There was a statistically significant reduction in performance on the Wechsler Intelligence Scale for Children for the Negro group who had pertussis, compared to the controls, but not for the white pairs.
These observations give renewed justification for urging comprehensive immunization programs against pertussis.
Legal Action and the "Battered Child"
Authors: WILSON REGINALD A. 
Published: December 2021

I support the views expressed in Pediatrics (31:899, 1963) on this subject by F. V. Harper and others. However, this and many similar articles may generate a climate in which the social agencies will become overaggressive, and the punitive pendulum swing too far. I feel this happened in the following instance:
The patient was an infant, age four months, with subdural haematoma, blindness, fragmented metaphysis, and subperiosteal callus (right femur). There was a history of minor injury when the car stopped suddenly with the crib loose on the rear seat.
AN OUTBREAK OF URINARY TRACT AND OTHER INFECTIONS DUE TO E. COLI
Authors: Sweet Avron Y. , Wolinsky Emanuel 
Published: December 2021

In a premature infant nursery 3 infants died of E. coli infections and 5 babies contracted urinary tract infection due to E. coli within a 5-month period. The causative organisms were found to be resistant to tetracycline, streptomycin, chloramphenicol, and sulfisoxazole, and sensitive to kanamycin, polymyxin B, and nitrofurantoin. From throat and stool cultures of 25 infants in the nursery, E. coli with this susceptibility pattern were recovered from 13. Of these, 9 were serotype 04:H5 and one was group 04 but nonmotile. Isolates from the urine of 3 infants with urinary tract infection and meninges of one fatal case were serotype 04:H5. Stool cultures revealed group 04 E. coli only in infants with that organism in the throat.
The findings indicate that an outbreak of infections due to E. coli 04:H5 had occurred as a consequence of widespread colonization with that organism in a premature infant nursery. The unusual incidence of urinary tract infection due to a specific E. coli serotype indicates that urosepsis in the newborn can occur in epidemic form.
CARDIOVASCULAR MALFORMATIONS IN TURNER'S SYNDROME
Authors: Rainier-Pope Christopher R. , Cunningham Russell D. , Nadas Alexander S. , Crigler John F. 
Published: December 2021

1. Cardiovascular disease associated with Turner's syndrome is more frequent than hitherto reported. In this study, 36 patients were investigated and it was found that in 16 (44%) there was some form of cardiovascular abnormality.
2. Pulmonic stenosis was found to be as frequent as the more commonly reported coarctation of the aorta.
3. Patients with typical Turner's syndrome, who are chromatin negative, may have coarctation of the aorta or pulmonic stenosis. When buccal smears are chromatin positive, stature is within normal limits, or hypertelorism is present, the most likely cardiovascular lesion will be pulmonic stenosis.
A THERAPEUTIC APPROACH IN 100 CASES OF THE RESPIRATORY DISTRESS SYNDROME OF THE NEWBORN INFANT
Authors: Hutchison James H. , Kerr Margaret M. , Douglas T. A. , Inall J. A. , Crosbie J. C. 
Published: December 2021

A method of treatment in 100 cases of the idiopathic respiratory distress syndrome of severe degree is described. This includes the rapid correction of metabolic acidosis with 8.4% solution of sodium bicarbonate (1 ml = 1 mEq). The sodium bicarbonate is given by periodic intravenous injections by the umbilical vein, and the dosage is controlled by frequent estimations in the blood of the pH, pCO2, plasma standard bicarbonate and base excess by means of the Astrup micro-apparatus. The total daily fluid intake by the same route is brought up to 60 ml/kg with 20% fructose solution.
In view of the serious prognostic significance of severe or persisting respiratory acidosis, which cannot be relieved by sodium bicarbonate, a trial of Tris-(hydroxymethyl)-aminomethane (THAM) was made in 26 cases. In each of these very severely affected infants the pCO2 was above 70 mm Hg. The results failed to show sufficient advantage to justify the increased risks with THAM.
The mortality figures in the trial series have been compared with those recorded in the same hospital in cases of comparable severity which were treated by standard methods in 1960 and 1961. The over-all mortality rates in 1960, 1961, and the trial series, including patients who also had intraventricular hemorrhage or other major complications, were 66, 64, and 46% respectively. The mortality rates in cases of the uncomplicated respiratory distress syndrome in 1960, 1961, and the trial series were 49, 44.7, and 11.5% respectively.
It is considered that the improvement in the mortality figures with this type of supportive therapy is sufficiently striking to encourage its trial use in other centers.
DIAGNOSIS AND TREATMENT: MANAGEMENT OF IDIOPATHIC THROMBOCYTOPENIC PURPURA
Authors: Schulman Irving 
Published: December 2021

THE TERM idiopathic thrombocytopenic purpura (ITP) should be reserved for that hemorrhagic disorder characterized by a subnormal platelet count (usually below 50,000/cu mm) in the presence of a normal marrow containing normal or increased megakaryocytes and the absence of systemic disease capable of inducing thrombopenia. Bone marrow examination is mandatory to rule out leukemia, other infiltrative disorders, and hypoplastic and aplastic states; an L.E. preparation is indicated as are the careful search for systemic infection and renal disease and the detailed inquiry concerning drug ingestion. Although no specific antecedent event can be identified in most cases of ITP, it is recognized that some of the common childhood exanthemata may occasionally be followed by thrombocytopenic purpura (e.g., rubella, rubeola, varicella).
The rational approach to treatment must be based upon understanding of the natural history of the disease. Acute ITP has an excellent prognosis and approximately 80% affected children will make a complete and permanent recovery without specific therapy. Of these, three-quarters will recover within 3 months of onset, most within 4 to 6 weeks. Approximately 20% of cases will persist longer than 6 months and are then usually designated as chronic.
The mortality rate in acute ITP is extremely low and most of the urgency for treatment stems from concern over central nervous system hemorrhage. It seems clear that the incidence of CNS bleeding is no greater than 2-4% and that in most series reporting a greater incidence cases were not limited to ITP but included instances of thrombotic thrombocytopenic purpura and purpura fulminans, i.e., disease states associated with vasculitis.
Pediatric Hazards of Drugs in Solutions Convenient for Administration to Adults
Authors: AXLINE STANTON G. , SIMON HAROLD J. 
Published: December 2021

Studies on the clinical pharmacology of drugs in newborn infants have uncovered a problem of overdosage which may be more common than generally appreciated. Several medicaments are available only in a limited number of highly concentrated formulations. The requirements of premature and full-term newborn infants for very small total dosages necessitate very careful measurements of minute quantities of drug, and overdosage can readily occur.
Specifically, Kanamycin is available in only two formulations for injection containing respectively 250 and 333 mg/ml. The dosage of this agent for newborn infants is approximately 8 mg/Kg of body weight 12 hourly.
Correction to be Expected from the Pan American Medical Association
Authors: HODES HORACE L. 
Published: December 2021

Recently many pediatricians received a letter stating that Dr. Lawrence B. Slobody and I had proposed them for certification as DIPLOMATE in the Pediatric Section of the Pan American Medical Association, Inc.
I write to inform the readers of this Journal that neither Dr. Slobody nor I ever proposed anyone for certification for Diplomate in the Pan American Medical Association. Furthermore, I did not authorize the use of my name in this connection, and Dr. Slobody has informed me that he did not do so either.