bluuebunny/crossref_metadata_2025 huggingface dataset:
NON-SURGICAL TREATMENT OF UNILOBAR OBSTRUCTIVE EMPHYSEMA OF THE NEWBORN
Authors: KORNGOLD HERBERT W. , BAKER JOHN M.
Published: December 2021

1. The reported 22 cases of unilobar obstructive emphysema in infancy are reviewed. Eighteen of these cases were successfully treated by lobectomy or segmental resection. No cause of the obstruction was found in over 50% of the cases reported.

2. Two cases of unilobar obstructive emphysema in the newborn are presented. These patients were successfully treated by selectively decompressing the emphysematous lobe.

3. The non-surgical method of treatment is advocated in the newborn when lobar emphysema is newly established and reversible. It may be of value when surgery is indicated to improve the patient who is a poor risk.

4. The mechanism, by which selective decompression alleviates the partially obstructed bronchus, is open to conjecture. However, we postulate that the bronchus, is kinked by an overdistended emphysematous lobe and that retained viscid secretions augment the bronchial obstruction in the new born.
COMPARISON OF SKELETAL MATURATION WITH DENTAL STATUS IN JAPANESE CHILDREN
Authors: SUTOW WATARU W. , TERASAKI TARO , OHWADA KENJI
Published: December 2021

1. Data obtained from simultaneous skeletal maturation assessments and dental status evaluations on each of 1,360 Japanese children (678 boys and 682 girls) ranging in age from six to 14 years have been presented.

2. Statistically significant differences in number of permanent teeth were demonstrated between the skeletally above average and skeletally below average children, skeletally advanced children having the greater number of teeth. At individual age levels, consistent significant differences were not found.

3. Comparisons of the terminal (extreme) segments indicated statistically demonstrable differences in a greater number of individual age groups, especially among girls.

4. At each age level, the girls had a greater mean number of erupted permanent teeth than the boys.
THE TREATMENT AND PREVENTION OF EPIDEMIC INFANTILE DIARRHEA DUE TO E. COLI 0-111 BY THE USE OF CHLORAMPHENICOL AND NEOMYCIN
Authors: WHEELER WARREN E. , WAINERMAN BERTHA
Published: December 2021

Table IV represents a summary of our findings regarding the use of these two antibiotic drugs. We feel that both were effective in reducing the severity of the diarrhea, but that chloramphenicol was followed by the emergence of a distressing number of drug resistant strains of organisms which made it less satisfactory at the dosage level used than neomycin. An attempt to prevent cross infections by the prophylactic use of chloramphenicol failed. We would like to emphasize the relapsing nature of the disease, the need for special techniques to recognize the organism, its great transmisibility, and would caution others who treat outbreaks of this infection with antibiotics to be mindful of the need to watch for the development of drug resistant strains of the organism. Since neomycin appears to act in vivo as a bactericidal drug, it would seem to have theoretical as well as practical advantages over the broad spectrum antibiotic drugs in the treatment of this disease.[SEE TABLE IV IN SOURCE PDF.]
EDUCATION
Authors: PARMELEE A. H. , SWENGEL ETHEL , ADAMS JHON M.
Published: December 2021

A course in the medical school curriculum has been described. We have pointed out the integration with the basic sciences, growth and development and preventive medicine, and we have emphasized the relationship of the psychologic, economic and sociologic aspects of the patient's environment to disease.

The principle of self-education is emphasized throughout the four-year experience of the student. The close guidance of the student is provided by the active participation of the faculty of the School of Medicine and many additional people in the University and community.

The experiences of the student in the first two years of the course have been reviewed in an attempt to evaluate their achievements.

The total curriculum time of the Family Medicine Course for the four years is 116 hours. This represents approximately 23½% of the total curriculum time of the Medical School.
THE INCIDENCE OF CONGENITAL MALFORMATIONS: A STUDY OF 5,964 PREGNANCIES
Authors: MCINTOSH RUSTIN , MERRITT KATHARINE K. , RICHARDS MARY R. , SAMUELS MARY H. , BELLOWS MARJORIE T.
Published: December 2021

I. The plan is described of a prospective study of the outcome of 5,964 pregnancies, with special emphasis on the relationship of factors in fetal environment to the incidence of abortions, stillbirths, neonatal mortality and congenital malformations.

II. Data are presented on the overall incidence of congenital malformations according to sex, race, weight at delivery, maternal age and order of birth.

A. The incidence of congenital malformations among 5,739 products of conception weighing over 500 grams was 7.5%. The rate was 7.0% among infants born alive and surviving the neonatal period, 13.6% among antepartum deaths, 23.3% among intrapartum deaths, 29.6% among neonatal deaths and 70.6% among deaths occurring between the ages of one and 12 months.

B. The following relationships in incidence rates among live-born infants surviving the neonatal period were found.

1. The rate among males (8.4%) was half again as high as among females (5.5%).

2. Non-white infants had a higher rate (7.8%) than white infants (6.3%).

3. Infants weighing 2,500 grams or less had a higher proportion with defects (9.7%) than did those weighing over 2,500 grams (6.7%), although this difference occurred entirely among females.

4. Maternal age had no effect on the incidence of congenital malformations.

5. White infants of lower birth order had a lower rate (5.3%) than did those of higher birth orders (8.2%). No difference according to birth order was observed among non-white infants.

III. A system of classification of malformations is described and discussed. Incidence rates by organ system groups are presented.

A. Less than one-half of the malformations found among live-born infants were suspected or noted at birth.

B. Malformations of musculo-skeletal system and skin were more frequent than malformations of other systems. Incidence rates by organ system groups are directly related to problems of diagnosis.

C. Of the malformed live-born infants, 14.8% had more than one malformation and in 9.1% more than one system was involved. Of the malformed stillbirths and neonatal deaths, 66.0% had more than one malformation and in 51.1% more than one system was involved.
ATRIAL SEPTAL DEFECTS IN CHILDREN
Authors: BRAUDO J. LEONARD , NADAS ALEXANDER S. , RUDOLPH ABRAHAM M. , NEUHAUSER EDWARD B. D.
Published: December 2021

1. Clinical and physiological data in 32 children with atrial septal defect are presented.

2. The physical findings in the typical case are characterized by an upper left sternal border soft systolic murmur, apical diastolic murmur and widely split pulmonic closure.

3. The radiological findings consist of right ventricular and atrial enlargement with prominent main pulmonary artery and pulmonary vascular engorgement.

4. The electrocardiograms show right bundle branch block with right ventricular hypertrophy.

5. The physiological data demonstrate a marked increase in pulmonary blood flow with no significant diminution in systemic cardiac index and the absence of pulmonary vascular disease.

6. The aim of surgical repair of atrial septal defect is the abolition of the left to right shunt.

7. Candidates for operation are patients with large atrial shunts and significant symptomatology or marked cardiomegaly without markedly increased pulmonary vascular resistance.

8. Operative results in nine children are presented.
GLYCOGEN STORAGE DISEASE OF THE LIVER
Authors: SCHULMAN JEROME L. , SATUREN PHOEBE
Published: December 2021

1. Three cases of glycogen storage disease occurring in the early neonatal period are presented. Two of these were in siblings, 1 of whom died at the age of 1 day.

2. Tachypnea and enlargement of the liver were the prominent manifestations of the illness. The similarity between this syndrome and other syndromes points up the need for instituting suitable clinical and pathologic diagnostic procedures in the early neonatal period.

3. Determinations of glycogen and glucose-6-phosphatase in the liver in 2 of these patients are presented.

4. Quantitatively standardized glucagon tolerance curves are presented in 2 of these patients and compared with those obtained in normal infants. The character of the response suggests its value as a diagnostic test in this condition.

5. Electroencephalographic tracings during periods with marked hypoglycemia and during periods with normal values for blood sugar were found to be essentially normal. It is suggested that some unusual mechanism for the maintenance of cerebral metabolism during hypoglycemia may be present.
GLYCOGEN STORAGE DISEASE OF THE LIVER
Authors: CORI GERTY T. , SCHULMAN JEROME L.
Published: December 2021

1. Glucose-6-phosphatase activity in homogenates of the livers of 2 infants with v. Gierke disease was found to be extremely low when compared to values obtained in other liver diseases or in normal livers.

2. In 1 of the 2 cases and in 4 controls the liver cells were counted. When the activity of the phosphatase was based on cell count it was found to be 12 times lower than the lowest and 37 times lower than the highest control value.

3. Phosphoglucomutase activity in the storage disease livers was within the range found in the controls whether based on weight or cell count.

4. The cell content of the liver of a 4-month fetus was found to be very high. The glucose-6-phosphatase activity per unit of weight was 9 times higher while per cell it was as low as in the v. Gierke liver. Phosphoglucomutase activity per unit of weight was within the normal range, per cell it was very low.
SURGICAL TREATMENT OF PULMONARY CYSTS IN INFANCY
Authors: SWAN HENRY , ARAGON G. E.
Published: December 2021

Although some lung cysts in infancy may be harmless and the pathology reversible, many of these lesions seriously jeopardize life by causing compression atelectasis with pneumonia, by enlarging to sizes incompatible with adequate respiratory function, or by becoming grossly infected. In such instances, surgical removal becomes urgent. The three cases of this disease seen at Colorado General Hospital in the past six years illustrated these complications, and all required surgical intervention. Lung cysts in infancy, if they are symptomatic, should be surgically removed, preserving as much pulmonary parenchyma as possible.
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors: KENNEDY ROGER L. J.
Published: December 2021

PERIODICALLY, it appears to be appropriate and perhaps even necessary to pause for a moment to consider the question, "Where are we going and by what means are we moving along our course?" In the case of the Academy, the answers are to be found in a consideration of the present structure and activities of the components of the group. A very brief, even categorical review of the committees, liaison representatives and official subdivisions will tell us much, and will serve to remind us that we are participants in a great vital program dedicated to the health and welfare of children.

Let us first consider the aims and activities of the various committees of the Academy. In the past few years, an increasing awareness of loss of child life through accidents has prompted the Committee on Accident Prevention to survey the causes and to initiate a program of prevention which has received nationwide attention.

Unpleasant though it may be to contemplate the prospect of a world engaged in another holocaust of war, the need for preparedness has been recognized at all levels of our civil structure, and in consonance with the emphasis on national alertness, the Academy has established a Committee whose purpose it is to compile information as to the possible needs of children in wartime and the role that pediatricians can play in satisfying those needs, if the occasion demands it.

During the lives of most of us, contagious and infectious diseases have become increasingly less common and less severe. In order that the most effective means of controlling, as well as treating, these diseases may be available to all, the Committee on Control of Infectious Diseases has issued and, at intervals, has revised a manual that contains the latest and most reliable information that can be supplied by a panel of experts in the field.
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors: Bodian David
Published: December 2021

THE HOPE that accompanies the renewed attempts at immunization against poliomyelitis is due in large part to the convergence of 3 events. The first is a succession of important advances in methodology; the second, an improved understanding of the disease process itself; and the third, the revival of general immunologic concepts which had been well established for other viral diseases, but which had been discredited in relation to poliomeyitis for many years.

I should like to examine briefly some of the basic findings relating to the mode of action of immunization procedures now being developed in this field. Immunization against most diseases has long been known to rest on 2 distinct but related aspects of infection; first, the behavior of the parasite in the host tissues; and second, the immunological responses of the host, especially its production of antibody. Although our understanding of the mechanism of infection is as yet incomplete, our present model, as summarized in Figure 1, is based on solid information and should be adequate for practical purposes. It is clear enough that 2 of the principal places where virus multiplies are, first, certain unknown tissues in the upper and lower parts of the alimentary tract and, second, nerve cells in the brain and spinal cord. Approximately 90 per cent of adults in this country have experienced the primary infection in the alimentary tract without harm to themselves. About 1 per cent by the age of 20 have also experienced the paralytic effects of the subsequent infection in the central nervous system (CNS).
CONGENITAL ABSENCE OF THE SPLEEN WITH CONGENITAL HEART DISEASE
Authors: Bush James A. , Ainger Lorin E.
Published: December 2021

1. The clinical, hematologic and post mortem findings in a case of splenic agenesis have been presented. Because of its association with cyanotic congenital heart disease and situs inversus of the abdominal viscera, the anomaly was suspected prior to death. The presence of hematologic abnormalities similar to those found after splenectomy supported this impression. These abnormalities were: target cells, decreased osmotic fragility, Howell-Jolly bodies, transient normoblastemia, siderocytosis, and leukocytosis.

2. The blood picture in splenic agenesis is sufficiently specific to permit the antemortem diagnosis to be suspected even in the absence of severe associated anomalies.
ACID-BASE HOMEOSTASIS DURING EXCHANGE TRANSFUSION OF NEWBORN INFANTS WITH PRESERVED BLOOD
Authors: Graham Bruce D. , Heyn Ruth M.
Published: December 2021

Preserved donor blood is usually unphysiologic and would be incompatible with life if it were to represent the total state of chemical equilibrium of the body.

This study indicates the rapid metabolic adjustment made by a newborn infant when receiving an exchange transfusion.

Data obtained on 19 donor "bloods" indicated donor blood to have usually a blood pH below 7.00, low plasma CO2 and chloride content, and higher than normal plasma total base and "R" fractions.

Data obtained from 4 infants before and after exchange transfusion reveal that these infants adjust readily so that at completion of the transfusion a normal blood "acidbase balance" picture is found.

Mechanisms by which this may be accomplished through metabolism of sodium citrate, citric acid, and lactic acid, are discussed.
EXTRAPYRAMIDAL CEREBRAL PALSY WITH HEARING LOSS FOLLOWING ERYTHROBLASTOSIS
Authors: Byers Randolph K. , Paine Richmond S. , Crothers Bronson
Published: December 2021

Follow up studies on 23 cases of kernicterus are reported. The familiar combination of extrapyramidal palsy, defects of hearing, and disturbance of eye movement was found. The physical picture evolves with advancing age but changes according to a reasonably consistent pattern, which has been presented. The eventual degree of handicap, both physical and mental, is less than is commonly believed to be the case. Review of these cases leaves the writers with a feeling that the patients and their families find ways of utilizing assets which are ingenious and effective.

It is disconcerting to find how often defects of hearing are unrecognized, or are left a matter of controversy, even when every method of testing is used. It is also interesting to find how little agreement there is on physiotherapy and apparatus.

Further series of observations on older children may lead to agreement on many important matters which are still confused.
THE HEMATOPOIETIC AND GOITROGENIC EFFECTS OF COBALTOUS CHLORIDE IN PATIENTS WITH SICKLE CELL ANEMIA
Authors: Gross Ruth T. , Kriss Joseph P. , Spaet Theodore H.
Published: December 2021

Four children with sickle cell anemia were treated with cobaltous chloride. In each case there was an initial satisfactory hematopoietic response. This response could not be sustained with prolonged therapy, and in 3 children the hemoglobin concentration dropped below time pre-treatment values. All 3 children in whom thyroid function was evaluated developed enlargement of the thyroid gland. One developed severe myxedema, and 2 developed laboratory evidence of depressed thyroid function. Thyroid biopsies were performed in 2 and showed extreme hyperplasia. The clinical and laboratory findings reverted to normal when cobalt was withdrawn.

It seems clear that cobaltous chloride is a goitrogenic agent in man. The anemia which recurs with prolonged therapy is unexplained. It may be secondary to hypothyroidism or to other causes.

Indiscriminate use of cobalt as a hematinic should be avoided.
PHEOCHROMOCYTOMA—LOCALIZATION BY AORTOGRAPHY
Authors: Snyder C. H. , Rutledge L. J.
Published: December 2021

Aortography, with visualization of the adrenal arteries, was successful in localizing a pheochromocytoma in a 13-year-old boy. The tumor was removed and hypertension was relieved. The usefulness and risks of aortography for localization of adrenal tumors have been emphasized. The co-existence of pheochromocytoma with neurofibromatosis has again been recorded.
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors: Smith Clement A. , Cook Charles D.
Published: December 2021

The usual incidence of births of 2500 gm. (5 lb. 8 oz.) and under is approximately 7 per cent. Higher rates should arouse suspicion of socio-economic as well as medical factors. Approximately 15 per cent of premature infants die neonatally, usually within the first 48 hours; the later the death, the more likely is it preventable. Certain aspects of premature infant care were discussed as summarized below:

Incubators should be used to maintain stable body temperatures of 96° to 98°F. in the larger and 94° to 96°F. in the smaller infants and constant humidity (50 to 60 per cent), as well as to isolate the infant. Feeding may be delayed 2 days in any premature and up to 4 days in many smaller ones, with probable reduction in risks of aspiration and fatigue. Gavage feeding was recommended, the choice between use of an indwelling tube or one inserted at each feeding depending on the experience of the nursing personnel.

Supplemental O2 appears to be related to the incidence of retrolental fibroplasia. Ten days may be as dangerous as 20, but the safe limits of duration and concentration of O2 or the effects of age and pulmonary or circulatory pathology of the infant await results of current studies. Certainly O2 should be used (in the lowest concentrations needed) to relieve cyanosis. Days spent in gradual reduction after clinical needs are satisfied may prove to be of more harm than good. Adjustable gas mixing valves now available will be useful in preventing accidental excess once the safe limits are estabhished.
THERAPY OF ACUTE RHEUMATIC FEVER
Authors: Done Alan K. , Ely Robert S. , Ainger Lorin E. , Seely J. Rodman , Kelley Vincent C.
Published: December 2021

Sixty-two children with acute rheumatic fever were treated with either ACTH, cortisone, salicylates or bed rest alone. Data concerning the effect on acute symptoms and follow-up observations of residual cardiac murmurs are presented. In addition, similar follow-up data on 18 previously-reported patients treated with ACTH are presented.

Joint symptoms responded somewhat more rapidly to ACTH or cortisone than to salicylates, but an impressive response occurred to all of the drugs. Fever subsided within a few hours to 2 days in almost all individuals treated with any of these drugs.

Elevated erythrocyte sedimentation rates returned to normal much more rapidly in the ACTH (mean 16 days) and cortisone (mean, 12 days) groups than in the salicylate (mean, 43 days) or bed-rest (mean, 48 days) groups.

Although laboratory evidence of "rebound" in the form of an elevation of erythrocyte sedimentation rate occurred in 52 per cent of patients in the hormone-treated groups upon reduction or withdrawal of therapy, clinical evidence of "rebound" was rare in these groups but relatively common among the salicylate-treated patients.

After follow-up periods as long as 3 9/12 years, residual cardiac murmurs were rare in the hormone-treated patients as compared to those treated with salicylates or with bed rest alone. Three years after discharge from the hospital, 6 per cent of the hormone-treated patients and 82 per cent of those not treated with hormones had residual cardiac murmurs. Moreover, the appearance of new murmurs following discharge was rare in the hormone groups and the murmurs which appeared were not persistent. New, persistent murmurs were noted relatively commonly following treatment with salicylates or bed rest alone.

The importance of adequate dosage and individualization in therapy of rheumatic fever with ACTH and cortisone is stressed. The conclusions drawn are: the optimal initial doses of ACTH and cortisone are at least 1 I.U. and 3 mg. per pound per day, respectively; the initial daily dose should be continued until all laboratory and clinical evidence of rheumatic activity has disappeared; and then therapy should be decreased gradually but only if the patient shows no evidence of reactivation of rheumatic fever.
NEONATAL ANOXIA
Authors: Apgar Virginia , Girdany B. R. , McIntosh R. , Taylor H. C.
Published: December 2021

In a study designed to measure the effect of delayed oxygenation of newborn infants' blood on intelligence in later life, capillary blood oxygen content or saturation was measured at various intervals in the first 3 hours after birth, and in the same individual subjects intelligence was later assessed by Stanford-Binet test. Technically satisfactory data for both variables—blood oxygen content and I.Q.—were available in 243 randomly selected subjects. The distribution of postnatal blood oxygen values shows wide scattering during any finite time interval arbitrarily marked off in the first hour following delivery, but averages for the first 3 successive 5-minute periods of independent respiration rise progressively, the average for the second 15-minute period is higher than for the first, the average for the second half-hour higher than for the first, and by the second hour most infants have stabilized at average adult levels of blood oxygen content. The distribution of intelligence quotients for the group as a whole conforms closely to that of a normal curve.

No significant correlation was found between levels of blood oxygen content measured in the first 3 hours after birth and intelligence as gauged by Stanford-Binet testing in early childhood.

An incidental finding of this study is the meager value of the Gesell developmental rating of adaptive behavior, measured at approximately 2 years of age, in predicting the Stanford-Binet intelligence quotient as measured at approximately 5 years of age.
THE COMBINED EFFECT OF BIRTH WEIGHT AND LENGTH OF GESTATION ON NEONATAL MORTALITY AMONG SINGLE PREMATURE BIRTHS
Authors: Schlesinger Edward R. , Allaway Norman C.
Published: December 2021

The combined effect of birth weight and length of gestation on mortality during the neonatal period was studied, using information obtained from birth and death certificates filed with the New York State Department of Health for births occurring during 1949, 1950, and 1951 in New York State, exclusive of New York City. The study covered 436,254 single live births over 20 weeks gestation for which data on both birth weight and length of gestation were available. Case fatality rates were determined by birth weight and gestation groups for the entire neonatal period and for 3 age intervals during the neonatal period.

For the neonatal period as a whole a characteristic pattern is observed. Within each birth weight group 2500 gm. or less, longer gestation increases the chance of survival; within each gestation group 36 weeks or less, a higher birth weight has a similar effect. A typical example is the range in fatality rates for infants weighing 1001 to 1500 grams at birth. Within this birth weight group, the fatality rate ranges from 40 per cent in the gestation group of 36 weeks or over to 75 per cent in the 24 to 27 weeks gestation group.

When fatality rates are computed for 3 successive age periods within the neonatal period, the combined effect of birth weight and gestation produces a characteristic pattern of fatality which is found to be most clearly defined during the first day after birth. However, a similar pattern of fatality is found to exist as well in the age periods from 1 through 6 days and for the remainder of the neonatal period.
CYCLIC VOMITING AS A FORM OF EPILEPSY IN CHILDREN
Authors: Millichap J. Gordon , Lombroso Cesare T. , Lennox William G.
Published: December 2021

Thirty-three children in whom a diagnosis of cyclic or periodic vomiting was made did not present evidence of intrinsic disease of abdominal and other viscera, and the cause of the symptoms had not been determined. They were then studied for evidence of a cerebral origin of the recurrent, paroxysmal autonomic symptoms which would justify classification of the syndrome as an autonomic epilepsy.

Supportive evidence was found in a preponderance of the following: A family or personal history of epilepsy, migraine, or related episodic nervous system disorders; a history or signs of acquired damage to the brain; abnormalities of the electroencephalogram, and the beneficial effect of medication of proven value in epilepsy or in autonomic dysfunction.

Each of the 33 children in this study could qualify, in our opinion, for a diagnosis of autonomic epilepsy. Five illustrative case histories are related.
DEVELOPMENT AND GROWTH OF HEMATOPOIETIC TISSUES
Authors: Osgood Edwin E.
Published: December 2021

1. Growth in body weight, organ weight, volume, or number of cells is better described over long periods of time by a straight line on log log paper than on arithmetic or semilog paper.

2. A most useful form of the equation describing these straight lines is [see equation in source pdf] where y = any measured variable and t = time from fertilization in prenatal life, and from birth in postnatal life. [see equation in source pdf] or the slope of the straight line.

3. The advantages and disadvantages of this equation are presented. Among its chief advantages are: the fact that the semilogarithmic plot, because of the steadily increasing doubling time, cannot be a good model; the advantages of a straight line over a complex curve; the fact that readable values are obtained over factors of as much as one millionfold increases in values; that the scales are easy to read in the periods of most rapid growth; that the equation is independent of the units or the base of the logarithms used; that the ratios of the exponent x can be used in allometric studies; and, that equidistant parallel lines describe the range of distribution of individual data from the logarithmic mean or median. Its disadvantages, which apply to all other equations of growth equally, are that it does not express the true complexity of the growth processes nor the extreme readjustments that occur in the first few days after birth.

4. Growth in body weight of the fetus and child, and of the organs and cells of the hemic system are presented more as examples of a method of analysis, which should lead to better data in the future than as final standards.

5. The qualitative development of the hematopoietic system in the early fetal period is outlined.

6. The first data on the number of cells in the human fetus are given.

7. Particularly interesting observations are: the constant values for lymphocytes during most of childhood; the approximately equal numbers of the non-nucleated and nucleated cells in the fetus; the consistent change in growth rate between 7 and 8 years; and the relatively constant total hemoglobin in postnatal life at 1 per cent of body weight.

8. The simplicity and clinical usefulness of this method of analysis of growth data suggests that it could well be used in the practice of every pediatrician and in many types of research.

9. The methods employed should be equally applicable to other species and to the growth of many tumors.

10. This equation and method of growth analysis take into consideration the relativity of biologic time.
VARIX OF THE SIGMOID SINUS
Authors: O'Connor Walter J. , Cook Albert W. , Bedo Andrew W.
Published: December 2021

An infant of 5 months who had an extracranial varix of the sigmoid dural sinus is described. A correct preoperative diagnosis of the nature of mass was not made and the infant died during surgical exploration as a result of air embolism. The embryologic, diagnostic and therapeutic implications are discussed.
ABSORPTION OF ISOHEMAGGLUTININS IN THE NEWBORN
Authors: Bowman John M.
Published: December 2021

Nineteen babies were fed human sera containing anti-A, B, or D (Rho) isohemagglutinins. Preliminary experiments indicated that if 1 unit of isohemagglutinin per ml. of a baby's plasma volume is injected intravenously, this can be detected for at least 16 hours after its introduction.

The babies were fed and retained 34 to 978 units of isohemagglutinin per ml. of plasma volume. Only in the blood of the baby fed the highest amount could absorption be demonstrated, the fraction absorbed being about 0.10 per cent of the amount fed.
CONGENITAL ABSENCE OF THE SPLEEN
Authors: Polhemus Donald W. , Schafer William B.
Published: December 2021

A case of congenital absence of the spleen accompanied by atrioventricularis communis, partial situs inversus, and other anomalies is presented. Similiar reported cases are discussed with emphasis on the frequency of the specific anomalies. It is suggested that an ante-mortem diagnosis of this syndrome can be made when the proper roentgenologic and hematologic evidence described is present.
PEDIATRIC RESIDENCY PROGRAM
Authors: Deisher Robert W.
Published: December 2021

DURING the past 10 to 15 years, the type of practice carried on by pediatricians has been undergoing a change. There are fewer seriously ill children requiring long-term treatment and follow-up since many of the common infectious diseases of childhood are detected early and, because of modern methods of treatment, prevented from becoming serious. Although pediatricians have fewer patients who require hospital care, this is balanced by the fact that there is an increasing use of the pediatrician for health supervision or "well child care." Parents are becoming more aware of the need for supervision of the child's physical and emotional growth and development through the extensive attention given this in popular everyday literature and by the fact the pediatrician himself is now encouraging this more than formerly.

This change in pediatric practice is being reflected gradually in the type of preparation given the pediatrician in his residency training. When one thinks of the tremendous amount of knowledge available regarding normal growth and development and of the growing importance of the field it is evident that real knowledge in this area cannot be obtained quickly and without effort. Therefore it is of sufficient importance to be included in routine residency training. There is no question that the resident needs much more of his time spent in the hospital caring for seriously ill children than in the well-child area of pediatrics.
HEART CATHETERIZATION IN INFANCY
Authors: Sones F. Mason
Published: December 2021

Cardiac catheterization is one of the most useful diagnostic technics presently available in the study of congenital heart disease. Contrary to widely expressed opinion, it may be safely and advantageously applied to the solution of problems presented by small infants and children. The effective control of any disease process depends in large measure upon early diagnosis and treatment. This fundamental concept has often not been squarely faced in its application to congenital heart disease. The result is that all too frequently we have been satisfied merely with treatment of the survivors of the infantile period. It is true that the largest number of children who die during the first 2 years of life because of congenital heart disease have lesions that are not presently amenable to surgical approach. It is obvious, however, that unless precise diagnosis is first made possible within the limited period of their survival, the outlook for such children will remain hopeless. The major stimulus for definitive diagnosis in early infancy has been recognition of the fact that a significant number of children die during this period with undiagnosed lesions that could have been cured or improved by surgical procedures. This problem may be largely eradicated by the effective and judicious use of presently available technics.
FOR THE WELFARE OF CHILDREN
Authors: Beaven Paul W.
Published: December 2021

THIS is the Preface to a newly published volume containing the annual addresses (1921-1955) of the first 25 presidents of the American Academy of Pediatrics. These addresses, unlike those of other medical societies, are not scientific in content. Nor were they composed to make history. They were essentially personal observations on current problems considered important by each president as he concluded his span of office. Moreover, they reflect many impressions and aspirations. So when these addresses are assembled in one volume, they become, in a sense, both a history of the Academy and of our specialty during these 25 years.

These presidential addresses have an underlying theme: the dedication of the pediatrician to child welfare. They underscore the important fact that the Academy was not formed for the benefit of its members. Rather, it was dedicated to a program which would give children a better future, not only in physical but also in mental and social health. This altruism is evident in almost every essay. We should never forget this aim, for therein lies the reason for our being.

Naturally, nearly all of the presidents are but names to most of our members. Reprinting their addresses can remind all of us of the initial and enduring purpose of the American Academy of Pediatrics. What we read in these addresses, as would obviously be the case, differs with each author. There are long addresses and there are short ones. Some of them are pessimistic and some are optimistic. A few are mainly factual, while others are truly literary.

In order to introduce each of the presidents, their photographs are reproduced. A short appreciation of each president follows, written by one or more contemporary personalities. Remarks on each essay follow, giving in some instances the background of its composition and delivery. The address is then reprinted.

Each address shows in its own way how the Academy has succeeded or failed to achieve its original aims:
PRIVATE RESIDENTIAL INSTITUTIONS FOR THE CARE OF MENTALLY HANDICAPPED CHILDREN
Authors: MUNNS GEORGE F. , BRAHDY M. BERNARD , BYERS RANDOLPH K. , DENHOFF ERIC , JONES MARGARET H. , KOBES HERBERT R. , PERLSTEIN MEYER A. , TAUSSIG HELEN B. , YANNET HERMAN
Published: December 2021

THE CHOICE of a private institution which can offer effective training and education to a mentally handicapped child has always been a difficult problem for the average physician. Very little information has been available concerning most of these institutions. We hope that the present study together with follow-up studies by the state committees will be of future assistance in this respect.

Special local committees under the direction of the state chairmen, were appointed to carry on the study at state levels. An "outline" or questionnaire was prepared by our committee which was designed to elicit pertinent information. A "guide" was also prepared which offered information to the local committees concerning desirable methods and practices to be looked for in institutions under scrutiny.

The 5-page outline or questionnaire was designed to reveal many details concerning these institutions, such as location, source of income, type of construction, fees, recreational facilities, type of patients accepted, segregation problems, etc., but most of all, information was sought concerning the training, experience and education of the attending staff. Information was particularly sought regarding the availability of research and consultation facilities and whether an intelligent and effective program of therapy, instruction, training and education was being conducted.

Questionnaires and information were received from 33 states and 82 institutions representing a total population of more than 117,000,000.

We shall report here only information of practical interest to the average physician. The "outlines" from which the information was compiled have been returned to the states which submitted them to be used for future reference by the state committees.

Eleven states reported that they have no private residential institutions for the care of mentally retarded children. In this group there are, no doubt, an unknown number of small custodial or boarding homes which are probably to be found in all states.
SERUM GAMMA GLOBULIN LEVELS IN NORMAL INFANTS
Authors: T. O. Orlandini , Sass-Kortsak A. , Ebbs J. H.
Published: December 2021

Changes of serum gamma globulin levels with age are described in a group of 140 normal infants from birth to 2 years of age.

The mean cord blood level of gamma globulin is significantly higher than the level in the mother's blood. This relation is, however, by no means constant in the individual pairs, as one-third of the 28 pairs showed the opposite relationship.

The gamma globulin level drops soon after birth, reaching about one-third of the birth value at 1 month of age. After very little change between 1 and 3 months, the levels start to rise and adult values are closely approximated by 2 years of age.

Breast-fed newborns show as rapid a decrease in gamma globulin levels as do artificially fed newborns. Colostrum does not, therefore, seem to contribute significantly to the serum gamma globulin levels in humans.

The above described changes in serum gamma globulin levels with age appear to be different in direction, timing, and extent, from changes observed in the other serum protein fractions.

The decrease of serum gamma globulin in the first month of life has the characteristics of a simple exponential decay. Comparison of this decay curve with that of passively acquired antibodies, and consideration of available data on gamma globulin turnover rates, warrant the hypothesis that there is practically no gamma globulin formation in the first month of life.
THE TREATMENT OF SALMONELLOSIS WITH MASSIVE DOSES OF PENICILLIN COMPARED WITH OTHER METHODS OF THERAPY
Authors: Rabe Edward F.
Published: December 2021

Salmonellosis can be treated with intramuscular crystalline penicillin in large doses. Although the results are not consistently good, the clinical course and bacteriologic "cures" in 7 cases compared favorably with the results in 19 cases treated with chloramphenicol and other drugs.

Serum penicillin levels varying from 4.2 to 48.0 units/ml. occur in time sera of patients receiving 150,000 units (0.090 gm.)/ kg./24 hr. of crystalline penicillin intramuscularly divided into 6 doses.

The problem of dependable elimination of the carrier state in patients with salmonellosis by chemotherapeutic means remains unsolved. The value of penicillin in combination with an easily administered dosage form of probenecid deserves further investigation.
PERICARDITIS IN THE NEWBORN
Authors: Valdes-Dapena Marie , Miller William H.
Published: December 2021

A review of the literature has revealed 9 instances of pericarditis in fetuses and newborn infants less than 2 days of age. In only 2 of these are the histologic findings available. We have reported the macroscopic and microscopic findings in 2 additional patients with pericarditis, 1 of whom was a premature stillborn fetus. The second patient was a full-term infant who lived for 4 days and who manifested sufficient evidence of cardiac dysfunction to warrant electrocardiographic studies.
SPECIAL ARTICLE
Authors: Harris T. N. , Harris Susanna
Published: December 2021

STUDIES on the site of formation of antibodies have been in progress in this laboratory for some time. The investigations to be reviewed here are those conducted in recent years using the technic of cell transfer. These studies followed an earlier series in which the experimental approach involved the injection of particulate antigenic material into the tissues of rabbits and the examination of tissues and fluids of the lymphatic system for antibodies to the antigen injected.

It had been observed that when antigens were injected into the hind foot pads of rabbits, homologous antibodies could be found in whole tissue extracts of the draining lymph nodes at titers which might, in the early days of the antibody response, exceed the concentration of the antibody found in the blood serum at the same time. These findings were in agreement with those of McMaster et al. In the case of pooled mouse lymph nodes regional to sites of injection of antigens. It was also shown in this earlier series of studies that antibody could be found in lymph obtained from the efferent lymphatic vessel of lymph nodes draining sites of injection of antigens and, furthermore, within the lymph in higher concentration in extracts of the cells of the lymph than in the lymph plasma.

In this work antibodies were being measured in extracts of lymphatic tissue. The experimental situation was complicated by the fact that the lymphatic system is one which is spread throughout the body and of which each unit (spleen, lymph nodes) consists of 2 major portions each of which, in turn, contains several species of cells.
Letters to the Editor
Authors: MCLEAN C. C.
Published: December 2021

I am writing in regard to the penicillin contents in the Salk poliomyelitis vaccine. Polymyxin has been proven and accepted as a suitable substitute. If the penicillin content is removed the benefits obtained from the use of the vaccine will not be affected.

The individuals who have so much to do with the direction of the process of the production of the Salk vaccine have:

1. Due to the fact that so few children reacted to the vaccine at the time given, concluded that there was little or no danger of sensitization from the penicillin content.
Letters to the Editor
Authors: SILVERMAN WILLIAM A.
Published: December 2021

Those concerned with the care of premature infants should be alerted to a possible noxious effect of sulfisoxazole (Gantrisin®) when this drug is administered to very small infants in the first few days of life.

The relative effectiveness of 2 prophylactic antibiotic regimens on newborn infants whose birthweight was less than 2,000 gm. was the subject of a controlled trial which has just been completed in the premature nursery of Babies Hospital. Ninety-seven infants received oxytetracycline (Terramycin®) 5 mg./kg./12 hr. for the first 5 days of life.
THERAPEUTIC EFFECTS OF ACTH AND CORTISONE IN RHEUMATIC FEVER: CARDIOLOGIC OBSERVATIONS IN A CONTROLLED SERIES OF 100 CASES
Authors: Harris T. N. , Friedman Sidney , Needleman Herbert L. , Saltzman Herbert A.
Published: December 2021

The therapeutic effects of ACTH and cortisone have been studied in a series of 100 patients with acute rheumatic fever, with special emphasis on cardiologic observations. This series involved cyclical alternation among hormone-treated patients and control patients. The latter received symptomatic and supportive therapy, but not salicylates in large doses.

Observations on such patients during the period of hospitalization (did not indicate any significant difference between hormone-treated and control subjects in terms of the appearance or disappearance of cardiac murmurs, the degree of transmission of apical systolic murmurs, incidence and duration of pericarditis, or other cardiologic phenomena recorded.

Rates of occurrence of "rebound" phenomena and of complications of the hormone therapy have also been reported.
COARCTATION OF THE AORTA WITH CONGESTIVE HEART FAILURE IN INFANCY—MEDICAL TREATMENT
Authors: Lang Henry T. , Nadas Alexander S.
Published: December 2021

Nine infants with uncomplicated coarctation of the aorta in congestive heart failure are presented.

The symptomatology was dominated by feeding problems, failure to thrive, dyspnea, and cyanosis.

On physical examination, in addition to signs referable to the coarctation, signs of both left and right-sided congestive heart failure were noted.

The roentgenographic survey revealed marked generalized cardiomegaly and pulmonary congestion.

Electrocardiograms in the infants less than 6 months of age showed left, right, or combined ventricular hypertrophy, whereas those more than 6 months of age all showed left ventricular hypertrophy.

Medical treatment, consisting of digitalis, oxygen, mercurial diuretics, diet low in sodium, and antibiotics, was successful in all instances. Digitalization was maintained throughout infancy. Operative intervention can be safely postponed until late childhood unless medical management is not successful.

A review of the pertinent literature is presented.
INFANTILE SPASTIC HEMIPLEGIA V. ORAL LANGUAGE AND MOTOR DEVELOPMENT
Authors: Hood Philip N. , Perlstein Meyer A.
Published: December 2021

A study of the onset of walking and oral language in the present series of patients with spastic hemiplegia has led to the following conclusions.

The group composed of all patients with congenital hemiplegia plus those who acquired spastic hemiplegia before the onset of walking and talking showed a delay from normals of 9 months in walking and talking words and a delay of 6 months from normals in using sentences.

When only the patients with congenital hemiplegia are considered, the delay is again 9 months for walking and first words an 7 months for the use of sentences.

The patients with acquired hemiplegia walked and talked earlier than those congenitally involved; the delay for walking being 5 months, for first words, 8 months, and 4 months for sentences. The differences between the "congenital" and "acquired" groups, though not statistically significant, suggest that those patients with some normal period of development predating the onset of spastic hemiplegia, acquire their motor and language skills earlier.

Although patients with left hemiplegia walked and talked from 2 to 3 months earlier than those with right hemiplegia, the differences were not statistically significant.

The presence of seizures delayed walking 6 months, talking of words nearly 9 months and sentence usage less than 1 month.

Mental deficiency likewise delayed motor and language development.

Mental deficiency was a much more potent factor in delaying walking than was the presence of seizures.

The physical defect of hemiplegia per se does not retard the rate of motor and speech development more than 4 to 5 months.