bluuebunny/crossref_metadata_2025 huggingface dataset:
PRACTICE OF PEDIATRICS
Authors: Wishik Samuel M.
Published: December 2021

WITH THE RECENT INTEREST in re-evaluation of the practice of pediatrics, it is gratifying to obtain some tangible evidence concerning the demands that are being made upon practicing pediatricians and information on the effectiveness of certain aspects of their work. Such documentation is contained in the fine, thoughtful report on health supervision of young children in California, recently issued by the Bureau of Maternal and Child Health of the Department of Public Health of the State of California.*

The comprehensive report presents the combined findings of a child health survey made in 1956 with Children's Bureau support and of other studies on the status of health supervision of infants and preschoolage children in California.
PRACTICE OF PEDIATRICS
Authors: Tisza Veronica B. , Angoff Kristine
Published: December 2021

The observation of preschool children in a hospital playroom emphasizes the young child's grief and regression during hospitalization. The younger the child the less he is able to play unless relationship with an available and "constant" mother-substitute is established. Children younger than 4 years old need an active approach from the teacher, while the preschool children from 4 to 6 years reach out and compete for the teacher's attention. Once the grief is relieved and the pain of separation is alleviated, the children are ready to play out actively whatever they had to endure passively during the illness and hospitalization. These observations highlight the meaning of the teacher as the most important single factor, the indispensable constituent of a hospital's playroom. Young children do not need a great variety of toys in this setting, but they do need available and interested adults. Case histories are presented to demonstrate the psychotherapeutic function the playroom teachers may perform in selected cases.
PRENATAL AND POSTNATAL GESTATION IN MAN
Authors: S. C. A.
Published: December 2021

Many pediatricians, especially those concerned with teaching in medical schools, wonder whether the anthropologists and other professional students of human behavior might not be able to help us cope with problems of the child and his family. Certainly Professor Montagu suggests much for our consideration in his recent communication to the J.A.M.A.1 In a paper so brief that everyone not only should but can read it, Montagu points out that man is born in a remarkably helpless state considering his relatively long period of gestation. Other animals remaining comparably long in the uterus are much better able to fend for themselves either immediately at the end of their "uterogestation" or after very brief subsequent "exterogestation."
WHAT THE JUVENILE DIABETIC KNOWS ABOUT HIS DISEASE
Authors: Etzwiler Donnell D.
Published: December 2021

It was the purpose of this study to determine what the juvenile diabetic knows about his disease. It is evident from the data presented that this knowledge increases with age; however, there appears to be a significant difference between the knowledge of children 6 to 11 years old and that of children 12 years and older. It is advised that self-care not be urged upon diabetics until the time at which they can comprehend the important fundamentals of their disease and its management. The possibility of adverse effects of such early training is briefly discussed.
NEED FOR COLLABORATION OF PEDIATRICIAN AND ORTHODONTIST
Authors: Moorrees Coenraad F. A. , Sisson Warren R. , Peckos Penelope S. , Christie R. George , Baldwin DeWitt C.
Published: December 2021

At the Forsyth Dental Infirmary, Boston, the orthodontist, pediatrician, nutritionist and child psychiatrist collaborate to promote a more comprehensive approach to the patient with malocclusion of the teeth. Each discipline contributes a special facet to the total clinical assessment of the child. The diagnostic conference serves as an important educational experience in the program of the postgraduate fellows in orthodontics. The active participation of the orthodontist in this approach broadens his view of orthodontics as a health service and makes it possible for him to follow the same methods and procedures in his own practice. He is in a better position to determine when to consult medical specialists and to solicit their collaboration. In turn, the pediatrician learns to recognize the handicaps that dental and facial deformities can exert on the physical and psychologic well-being of his patients. He becomes aware of the significance of the different varieties of malocclusion and of the proper timing for orthodontic treatment.
PARAPROTEINEMIA WITH SECONDARY IMMUNE GLOBULIN DEFICIENCY IN AN INFANT
Authors: Stoop J. W. , Ballieux R. E. , Weyers H. A.
Published: December 2021

A report is presented of a girl who died at the age of 7 months, after having developed multiple infections. She was the fourth child in one family to die in this way. Mention is made of the importance of using immunologic techniques in serum examination in children with recurrent infections. By these techniques, a marked immune globulin deficiency was demonstrated in this case, and large quantities of paraproteins were demonstrated. It was impossible to diagnose any of the diseases known to be associated with paraproteinemia. A correlation is suggested between the paraproteinemia and the marked increase in plasma cells found at necropsy in the spleen, thymus and lymph glands. It is suggested that the case may have involved a hereditary inborn error of metabolism of the plasma cells. Therapeutic attempts with antibiotics and human gamma-globulin were unsuccessful. The fact that administration of gamma-globulin caused a marked increase in a paraprotein fraction indicates a disturbance in the protein metabolism.
PLASMA-CELL HEPATITIS
Authors: Bumbalo Thomas S. , Bellanti Joseph A. , Terplan Kornel L.
Published: December 2021

A 12½ year old girl had plasma-cell hepatitis, with features of chronic liver disease and plasma cell infiltration of the liver, arthritis, hypergammaglobulinemia, and a weakly positive LE cell phenomenon. The patient showed a good clinical response to steroids, and maintenance therapy has been continued with them. Immunofluorescent studies, by means of the indirect staining techniques of Coons, with patient's serum and cryostat cut sections of monkey liver have revealed staining of liver nuclei, bile canaliculi and a diffuse cytoplasmic staining. The findings in this case are presented with a brief discussion of some of the current theories on pathogenesis.
ESOPHAGEAL AND GASTRIC ABNORMALITIES IN DYSAUTONOMIA
Authors: Linde Leonard M. , Westover Joseph L.
Published: December 2021

In a study of esophageal and gastric abnormalities in six children with dysautonomia, absent or decreased lower esophageal peristalsis was noted in all. A dilated atonic esophagus was noted in those with more severely decreased peristalsis, and emptying occurred only in the erect position in those with marked impairment. Varied degrees of pylorospasm and impaired gastric motility were present. Motility in the small intestine appeared to be normal. Difficulty in swallowing was especially marked in two patients. The radiologic demonstration of absent or decreased lower esophageal peristalsis may be of value as a diagnostic aid in dysautonomia.
In Reply: Treatment of Rheumatic Fever
Authors: Dorfman Albert
Published: December 2021

Dr. Illingworth raises an important problem regarding the validity of withholding steroid treatment from patients with acute rheumatic fever but who show no evidence of carditis. The conclusion reached in our paper (Pediatrics, 27:692, 1961) was based on the finding that only 1 of 26 patients not treated with steroids demonstrated a significant murmur at the end of one year. Apparently Illingworth has had a less favorable experience. It is obvious that this decision depends upon the estimated risk of heart disease of such patients as compared with the risks inherent in hormone therapy.
General Outpatients and Special Clinics
Authors: Kanof Abram
Published: December 2021

The article by Green and Segar on a "New Design for Patients Care" (Pediatrics, 28:825, 1961), as well as the Commentary by Dr. McKay (Pediatrics, 28:695, 1961), interested me greatly; I would like to add a few comments. I quite agree with Dr. McKay that the scheme proposed by Green and Segar is not necessarily required for the amelioration of the problem of diagnostic inertia. As a long-time and enthusiastic summer Vermonter, I subscribe enthusiastically to the statement regarding the financial integrity of Vermonters, and I feel that while we probably could not reach the ideal 5.2 average attained at Mary Fletcher Hospital, most communities could do much better than they do if the points made by Dr. McKay were followed.
Electromyography in Congenital Torticollis
Authors: Chamberlin Robert W.
Published: December 2021

In reference to the article by Baxter et al. (Pediatrics, 28:442, 1961), it would appear that the use of electromyography to aid in the selection of patients for early surgical correction of congenital torticollis is a useful concept. The two patients in the "minimal" and the three in the "moderate reduction" categories that did well without operation would certainly indicate conservatism in recommending early operation for these groups as commented upon by the authors. It would also be most helpful if the authors would run some controls on the severe category as well.
ETIOLOGY AND COURSE OF CERTAIN HEMIPLEGIAS WITH APHASIA IN CHILDHOOD
Authors: Byers Randolph K. , McLean William T.
Published: December 2021

The histories of 12 children who suffered acquired hemiplegia with aphasia have been reviewed. Although in four the onset was prolonged, it was usually not sufficiently characteristic to allow diagnosis and treatment prior to the development of the complete syndrome. The dominant hemisphere, as demonstrated by the lesion, did not correspond accurately with socially described handedness. Arteriograms were successful in demonstrating vascular malformation or thrombosis in six of seven children on whom they were attempted. Recovery has been followed in 10 children over a period of years. All regained speech spontaneously, and four appear intact, or virtually so. All of the others show psychologic and neurologic residue. Psychologic steps during recovery have been briefly indicated, and one child having an expressive aphasia has been more fully described. Two children have had recurrent seizures.
Materno-fetal Transfusion: A Common Phenomenon?
Authors: Andrews B. F. , Thompson J. W.
Published: December 2021

Michael and Mauer1 reported the first three cases of materno-fetal transfusion as a cause of plethora in the neonatal period. They used the following criteria for confirmation of the diagnosis: (1) demonstration of maternal erythrocytes in the infant's blood, (2) presence of a low fetal hemoglobin concentration for the gestational age of the infant, (3) presence of beta-2M-globulin which is not usually present in any quantity in cord blood or during the early neonatal period, and, of course, (4) elevated erythrocyte count, hemoglobin, and hematocrit.
THE CHILDREN'S BUREAU AND THE AMERICAN ACADEMY OF PEDIATRICS
Authors: Shaw Edward B.
Published: December 2021

Over 400 years ago, Thomas Phaire (The Boke of Chyldren: 1544), wrote: ". . . but my purpose is here to doo theyme good that haue moste nede, that is to saye chyldren." With only modernization of the spelling, these words express the objectives and sentiments of the 50 years of activity of the Children's Bureau. The American Academy of Pediatrics, founded some 20 years after the Bureau, had exactly the same incentives. John Lovett Morse, in his presidential address in 1932, gave the Academy a motto borrowed from that of a medical fraternity: "Not for ourselves alone." It is proper that the Academy and Pediatricians everywhere should take reverent note of the history and accomplishments of the Children's Bureau and duly applaud, on April 2, the fiftieth anniversary of its founding.
Genetic Mechanisms in Human Disease. Chromosomal Aberrations. Edited by M. F. Ashley Montague. Springfield, Illinois, Thomas, 1961
Authors: Warkany Josef
Published: December 2021

It was a commendable effort to collect in a single volume many of the important contributions that in recent years have demonstrated chromosomal anomalies associated with constitutional disorders in man. The book contains 55 articles on this subject, all of them published previously in the Lancet or in other medical journals. Two introductory chapters deal with the status of cytogenetics in medicine and with the standard system of nomenclature of human mitotic chromosomes. The book ends with a chapter "Chromosomes for Beginners" reprinted from the Lancet.
Infantile Colic: An Evolutionary View
Authors: Levin S.
Published: December 2021

May I communicate an idea unaccompanied by data, but perhaps justified by the following Biblical text: "Remember the days of old, consider the years of many generations." Deuteronomy, 32:7

How old is man? If recent finds in East Africa can be substantiated, tool-using man is not a half-a-million, but nearer to 2 million years old. Homo is certainly 75,000 generations, and perhaps double that since the time that he branched off from the primate stem.
In Reply: Circumcision and the Tribe
Authors: Spock Benjamin
Published: December 2021

1. If I could only find the secret of how to know for sure what is best for children's welfare, I too could write more authoritatively. Meanwhile I'm glad there are parents to share the responsibility with. They antedated all the child care professions by thousands of years, and most of them have kept their feet on the ground during the shifting professional doctrines of the twentieth century.

2. I gave what I thought were several good reasons for circumcision.
ATRESIA OF THE COMMON PULMONARY VEIN
Authors: Lucas Russell V. , Woolfrey Bertram F. , Anderson Ray C. , Lester Richard G. , Edwards Jesse E.
Published: December 2021

Among the causes of pulmonary venous obstruction is atresia of the common pulmonary vein. This entity is described in three patients. The anatomic abnormality in these patients was the absence of any functional connection between the pulmonary veins and the left atrium, and anomalous pulmonary venous connection in the usual sense was not present. The results of the severe pulmonary venous obstruction imposed by this abnormality are reflected clinically in severe cyanosis, congestive cardiac failure, and early death. Roentgenograms revealed the diffuse reticular pattern in the pulmonary fields associated with pulmonary venous obstruction. Angiocardiographic techniques permit anatomic diagnosis of this cardiac abnormality and allow its differentiation from the other cardiac abnormalities responsible for pulmonary venous obstruction. Because the cul-de-sac-like confluence of the pulmonary veins is of ample size and lies immediately behind the left atrium, surgical relief of this condition seems possible.
THE PROPHYLAXIS OF ALLERGIC DISEASE IN INFANCY
Authors: Glaser Jerome
Published: December 2021

Whatever the personal feelings of anyone regarding the method of prophylaxis of allergic disease just reviewed may be, its importance is such that it deserves rechecking by unprejudiced observers. Although these studies cover a period of over 25 years of personally observed patients, it should not take nearly that long to determine whether or not potentially allergic infants, as here defined and treated in the manner discussed, will show a lessened incidence of atopic dermatitis than a control series. It is not necessary to show that infants with atopic dermatitis are more likely to develop subsequent allergic disease than infants who have not had atopic dermatitis, as this is well documented and the verification of this portion of the study is not so urgently required. Practically speaking, the most desirable type of study can not well be done by a co-operative investigation involving many physicians and does not lend itself easily to a clinic study except possibly in one particularly organized for that purpose. The infants must be followed from birth by a pediatrician with a genuine interest in and knowledge of allergy. He should be particularly familiar with the differential diagnosis between atopic dermatitis, which is an allergic disease, and seborrheic dermatitis, which is not an allergic disease, although both are called lergic disease, although both are called eczema, since these are so frequently confused in early infancy.

In conclusion, one may state that the pediatrician, through applied science, has solved the problem of adequate nutrition of the human infant and in addition the infant can now be successfully protected against many serious infectious diseases. However, in the light of present day knowledge this is not enough. The immunologic status of the infant with respect to allergy must also be considered. For this purpose human breast milk is doubtless the ideal food. If the trend away from breast feeding cannot be reversed, then the use of a well-tolerated nutritionally adequate substitute for the customary cow's milk feeding of the newborn infant, which has less serious consequences immunologically, must be considered. The increased cost of such feeding over cow's milk cannot be regarded as a legitimate reason for not doing this in view of the suffering and economic loss that may be incurred in some infants as a result of possible sensitization to cow's milk. At present soy bean milk appears to be a suitable and practical substitute, although it is possible that eventually other preparations yet to be discovered may prove to be equally or more satisfactory.
Hyperbilirubinemia of the Newborn and Prenatal Administration of Vitamins
Authors: D'Adesky Raymond G.
Published: December 2021

It is now admitted that hyperbilirubinemia suffices to produce kernicterus in the neonate. Therefore, the prophylaxis of kernicterus parallels that of hyperbilirubinemia. Any factor thought to favor or induce hyperbilirubinemia commands full investigation. Among the different pharmacologic agents responsible for the production of hyperbilirubinemia, the administration of large doses of vitamin K or its precursors to the newborn has been incriminated in many instances.

Recently, I have come across two cases in which the ingestion by the mother of a multi-vitamin preparation containing 0.5 mg of vitamin K, daily up to the morning of delivery, was followed by the development of hyperbilirubinemia high enough in one case to necessitate two exchange transfusions.
CHRONIC HEPATITIS WITH HYPERGAMMAGLOBULINEMIA IN CHILDHOOD
Authors: Grossman Aaron , Rosenthal Ira M. , Szanto Paul B.
Published: December 2021

Eight cases of chronic hepatitis with marked hypergammaglobulinemia occurring in pediatric patients are reported. Arthralgia, abdominal pain, skin rashes, and bleeding tendencies were present in these patients, but none had a positive lupus cell preparation. Administration of adrenocortical steroid drugs was followed by clinical improvement in four cases and no significant change in one. Despite the administration of adrenocortical steroid drugs, three patients died. At autopsy, postnecrotic cirrhosis was found in each of these three cases. The etiology of the syndrome of chronic hepatitis with marked hypergammaglobulinemia has not been established. Cases occurring in children do not appear to differ significantly from cases in adults. There is some evidence that autoimmunization against hepatic tissue is important in pathogenesis, but this hypothesis has not been definitely established.
B. MUCOSUS CAPSULATUS (FRIEDLÄNDER) MENINGITIS; RECOVERY OF A THREE-WEEK-OLD INFANT TREATED WITH SULFADIAZINE AND STREPTOMYCIN
Authors: DANIEL W. A.
Published: December 2021

B. mucosus capsulatus (Friendländer) meningitis has been a disease entity for approximately 60 years. It occurs chiefly in very young or aged males. The diagnosis in the pediatric age group is especially difficult because of the paucity of symptoms and physical findings referable to the central nervous system or of any primary source of infection. meningitis differs from other types in that the spinal fluid becomes almost gelatinous unless treatment is quickly employed. Less than 50 cases of B. mucosus capsulatus meningitis have been reported, and only five of these have recovered. With the use of streptomycin and sulfadiazine, the mortality rate may be greatly reduced if the cases are diagnosed and treated early in the course of the illness.

A case of B. mucosus capsulatus meningitis occurring in a three-week-old male infant who recovered has been presented.
ADJUSTMENT OF ELECTROLYTES AND WATER FOLLOWING PREMATURE BIRTH (With Special Reference to Edema)
Authors: SMITH CLEMENT A. , YUDKIN SIMON , YOUNG WINIFRED , MINKOWSKI ALEXANDRE , CUSHMAN MARGARET
Published: December 2021

Many premature infants are born with an edema which is probably the expression of a physiologic mechanism common to all and intensified in some. Clinical observation has shown this to be a disabling condition and prejudicial to survival. Measures which assist its removal, if otherwise safe, may be advantageous even to prematures in whom edema is not severe enough to be visible. Conversely, procedures likely to augment an edema already present might tend to produce it in nonedematous babies.

This investigation has shown an association between manifest edema, an increased breakdown of body protein, and relatively large amounts of Na and K in the urine. All these changes characterize the phase between birth and feeding. Whether or not edema is present, K is rapidly reaccumulated when feeding is begun, and its replenishment reaches an amount considerably above that present at birth. Disappearance of the edema is accompanied by losses of Na and Cl. These alterations occur whether or not water is administered and are ultimately proportional to the amount of edema originally present. Edema usually clears in a day or two but may occasionally persist for a week or more. The time of its disappearance, like the mechanism of its presence, is governed by unknown, perhaps endocrinologic factors. It could not be "washed out" of the body by an increased water intake in the one infant subjected to that procedure. There is every reason to believe its presence would be increased or prolonged by administration of sodium-containing solutions. On the other hand, since K appears to be present in relative insufficiency at premature birth, we propose to investigate the possible advantages of providing added K in early feedings. The clinical implications of the N balances are not clear.

In this clinic, the problem is at present met by allowing no intake whatever for as long as four days after birth, the time being governed by the degree of edema. The excess body water and much of the excess Na are usually removed during this phase. Reduction of body weight by as much as 20% may occur, and the concentration of extracellular fluid becomes significantly increased. On the other hand, danger from aspiration is avoided, and when intake is ultimately begun, the organism is no longer encumbered by edema. Should it be possible in the future to facilitate readjustment of body chemistry by early oral administration of specially designed solutions, the resultant advantages would still have to be weighed against the aspiration hazard.
CLINICAL OBSERVATIONS ON THE USE OF HYALURONIDASE
Authors: BURKET L. CLAIR , GYÖRGY PAUL
Published: December 2021

The use of hyaluronidase was observed in 116 infants and children in such procedures as hypodermoclysis, phthalein excretion test and urography. Eight tenths of a milligram (0.8 mg.) of the dry substance dissolved in 1 ml. of distilled water was used as a standard amount of the enzyme for all procedures.

Hyaluronidase provided an effective expedient to fluid diffusion in subcutaneous therapy. From clinical observations, the speed of flow in any one case is dependent upon: 1. general development of the patient, 2. state of hydration of the patient, 3. activity of the patient, 4. position of the needles in the skin, 5. original speed of the flow and 6. type and amount of fluid given.

There was no significant change either in dye excretion or total renal fluid excretion when hyaluronidase was used in the phthalein excretion test.

Hyaluronidase reduced the amount of dye necessary when given subcutaneously to secure adequate visualization in urography.

Repeated urinalyses in many of the procedures showed no evidence of renal pathology.

There were no instances of thermal reaction, spread of infection, or reactivation of infection that could be attributed to the use of the enzyme.
TRENDS IN HEALTH LEGISLATION AND ADMINISTRATION
Authors: WALL JOSEPH S.
Published: December 2021

THE handwriting is on the wall for all to see. The people of the country have elected a President who has repeatedly during his years in office and during his campaign speeches proclaimed his intention to extend social security and to establish a national health program based upon compulsory health insurance. Heretofore he has been obstructed by a Republican Congress: now, as Republican Speaker Joseph Martin has succinctly pointed out, it cannot be doubted that the President can get through any legislation he really wants.

One of the President's close advisors is Mr. Oscar Ewing, Administrator of the large and powerful Federal Security Agency, which we can predict with reasonable assurance will soon be elevated to cabinet status. The creation of a cabinet department encompassing government activities in medicine and public health, education and social welfare gained considerable momentum in the 80th Congress. Furthermore, it is expected that the Hoover Commission created by the Republican 80th Congress will include in its report on organization of the government's executive branch the formation of such a department. A new name has already been suggested for this branch of the government: The Department of Human Resources.

Mr. Ewing has, on many occasions, made his position very clear. In a speech delivered three days after the election he reviewed the recently published report entitled "The Nation's Health," a report which followed the National Health Assembly in point of view of time but did not in all respects follow the recommendations made by those attending the conference. In his November 5th address he stated:
SUCCESSFUL REMOVAL OF HEMANGIOMA OF THE LIVER IN AN INFANT
Authors: SHULLER THURMAN , ROSENZWEIG JOSEPH L. , AREY JAMES B.
Published: December 2021

A large solitary benign hemangioma of the liver was successfully removed from an infant 22 days old.
COMBINED IMMUNIZATION AGAINST DIPHTHERIA, TETANUS AND PERTUSSIS IN NEWBORN INFANTS
Authors: DI SANT'AGNESE PAUL A.
Published: December 2021

A comparison was made of antibody production by newborn infants and by older children following prophylactic inoculation against diphtheria, tetanus and pertussis. In all instances the same triple combined antigen ("Alhydrox") was used, and the same routine was followed. First injection of vaccine was administered to all newborn infants at seven days of age. Most of the "older" children were between six and 12 months of age at first injection.

Incidence and severity of systemic reactions to administration of the triple combined antigen increased with subsequent injections in newborn infants; the reverse was true of the "older" children. No such difference was found between the two age groups in local reactions to inoculation. Five sterile abscesses were observed in the newborns; none in the "older" children.

Pertussis agglutinin titers achieved after immunization were consistently higher (even after booster dose) in "older" children than in infants injected in the newborn period.

"Older" children produced significantly higher diphtheria antitoxin titers after prophylactic injection than the newborn infants. After administration of a booster dose, however, diphtheria antibody production in the two age groups was comparable.

No difference was found at any time in tetanus antitoxin levels achieved after inoculation by the newborn infants and the "older" children.

It was concluded that during the first year of life the capacity to produce antibodies in response to an antigenic stimulus increases with advancing age. It was felt, however, that in some instances the immunologic handicap due to tissue immaturity can be overcome if a sufficiently great antigenic stimulus is given.

Evaluation of antibody titers achieved by newborn infants after prophylactic injection of triple combined antigen reveals that the results of immunization against tetanus and diphtheria were satisfactory. The results of inoculation against pertussis were considered to be unsatisfactory, mainly because the proportion of infants who produced "protective" agglutinin titers fell far short of the 90% which is the maximum that can be expected.

A conservative approach to the problem of active immunization in early infancy is urged. It is suggested that until further work is done, routine prophylactic inoculations not be started before the age of three months.
Physical Fitness Appraisal and Guidance
Authors: SHAFFER THOMAS E.
Published: December 2021

Professor Cureton and his associates in physical education at the University of Illinois present in this volume a wealth of information and experience in the field of estimating physical fitness. Certainly welcome at any time, the book is especially appropriate now when interest in positive improvement of health, i.e., fitness, is increasing. Total fitness, of course, implies more than freedom from physical disease or disability; and omission of sections on mental, social and emotional fitness is recognized by the authors early in the book. This volume comprises a review of the literature on testing physical fitness, an analysis of 22 tests for appraisal of physique, organic efficiency and motor efficiency applied in 1945 to 110 first-year medical students and the use of test results in health counseling. Attention is focused on the challenge to improve the health of supposedly normal individuals.
CENTRAL AUTONOMIC DYSFUNCTION WITH DEFECTIVE LACRIMATION
Authors: BRIDGES THOMAS J. , POOL J. LAWRENCE , RILEY CONRAD M.
Published: December 2021

The postoperative changes in a 4 yr., 10 mos. old boy with central autonomic dysfunction associated with defective lacrimation are reported. The operative procedure was division of the tentorium on the right side. Immediately following operation there was a transitory disappearance of the lability of blood pressure and abnormal reactions to mild anxiety. These features returned to their preoperative state within three weeks, but since then appear to have abated somewhat. Lacrimation, however, first made its appearance about six days after the operative procedure and has persisted to the time of writing, over three months later. Exact interpretation of these phenomena has not been attempted.
ANTEPARTUM DIAGNOSIS OF CONGENITAL ANOMALY OF THE HEART
Authors: BERREY BEDFORD H. , HELMAN RICHARD G.
Published: December 2021

THE recognition of congenital anomalies of the heart of the fetus has received scant mention in medical literature. Because such a condition was observed and correctly diagnosed antepartum, this report of the case should be of interest.

Hyman states that the condition may not be noted because enough time is not devoted to adequate fetal cardiac auscultation. Other aspects of the routine examination are regarded as more important and to detect the presence or absence of the sounds of the fetal heart usually suffices.

The incidence of congenital heart disease declines with advancing age, especially the more severe lesions which are incompatible with life beyond the first weeks or months following birth. Clinical evidence of congenital heart disease has been noted in 0.3% of newborn infants and in from 0.05% to 0.15% of school age children. Maude Abbott, in 3,633 autopsies of all age groups, recorded 43 cases (1.2%) with congenital anomalies of the heart.

Perusal of medical literature of the past hundred years shows that Massman, in 1854, was the first to record the recognition of an unusual fetal cardiac murmur; he suspected a congenital anomaly of the heart, and this diagnosis was confirmed at autopsy. Barth, in 1880, likewise described a case which was confirmed at autopsy.

Padgett, in 1894, the first American to record such a diagnosis, believed that he heard the murmur of mitral valvular disease in a fetus and his suspicion was substantiated at autopsy. Others reporting similar cases included Bellot and Andry and Lacroix.

Hoehne, from a study of his own case and seven others collected from the literature, proposed three criteria for the diagnosis of fetal congenital cardiac lesions: 1. There is a murmur rough in character, of constant duration and intensity, but not synchronous with the maternal pulse. 2. For the most part, there is a constant defect in both heart sounds; usually the first and occasionally only the first sound is heard. 3. The murmur is heard over the entire abdomen of the mother with greatest intensity in the area where the fetal cardiac sounds are heard best.

During studies of routine fetal phonocardiograms in 31 cases, Sampson and others reported one case of fetal congenital anomaly of the heart. Dipple made a comprehensive review of the literature and added two cases of his own, each having an interventricular septal defect, a patent foramen ovale and a patent ductus arteriosus.
MULTIPLE HEMORRHAGIC HEPATOMA (L'ESPERANCE)
Authors: RATHMELL THOMAS K. , MAINS M. PAUL
Published: December 2021

A case of multiple hermorrhagic hepatoma of the liver in an infant of five months is reviewed with illustrations of the gross and microscopic pathology.

Hepatomas of infants differ somewhat from those seen in adults.

In the light of our findings, descriptions of bone in hepatic neoplasms should be accepted with reservations.
INTERNATIONAL NEWS
Authors: NEALE A. V.
Published: December 2021

In the last few years there have been great developments in the field of child health. Academic recognition has come relatively late. Before the war there were only four university chairs in the medical faculties, two in Scotland, which were concerned with pediatrics. Three of these were concerned essentially with diseases of children and one, founded in Edinburgh in 1931, was called a chair of "Child Life and Health" giving the emphasis to preventive as well as curative measures. Since 1942, however, many universities have established chairs of "Child Health," each working out in its own way the most satisfactory arrangements in accordance with local conditions. It is thought that it would be of interest to print a series of contributions from holders of the new chairs in England to illustrate the modern developments. The order is purely fortuitous and not necessarily historical.
OBSERVATIONS ON 117 PATIENTS OPERATED ON FOR CONGENITAL PULMONARY STENOSIS
Authors: DAMMANN J. F. , GIBSON STANLEY , POTTS WILLIS J.
Published: December 2021

Operations were performed on 117 patients with congenital pulmonary stenosis or atresia.

Diagnosis in the patient with a typical tetralogy of Fallot is not difficult. Variations from this typical picture, noted on physical examination, roentgenogram and fluoroscopy, are discussed.

Six patients with tricuspid atresia are reviewed with particular reference to differential diagnosis.

One patient with pulmonary valve stenosis and a patent foramen ovale is presented.

An aortic-pulmonary anastomosis was accomplished in 105 patients with 10 deaths, a mortality rate of 9.5%. Twelve patients were explored with a mortality of 50%. The over-all mortality was 13.8%. The causes of death are reviewed.

Results have been slightly less satisfactory in older patients with a right aortic arch than in those patients with a left aortic arch.

Excessive cardiac enlargement has occurred in a few instances.
CHANGE IN THIOCYANATE AND SODIUM24 SPACES DURING GROWTH
Authors: FELLERS FRANCIS X. , BARNETT HENRY L. , HARE KENDRICK , MCNAMARA HELEN
Published: December 2021

The spaces occupied by one or more of the four substances, thiocyanate, sodium24, mannitol and inulin, were determined in 36 subjects ranging from premature infants to adults.

No conclusions could be drawn concerning the spaces occupied by mannitol and inulin, since, under the conditions of the observations in our human subjects, neither of these spaces reached a constant value.

There is a definite decrease in the spaces occupied by thiocyanate and sodium24 as growth proceeds. If the changes in the spaces occupied by these two substances reflect corresponding changes in extracellular fluid volume, they indicate that young infants have an extracellular volume which is 57 (sodium24) to 78 (thiocyanate)% greater than that of the adult.

The decrease in the spaces occupied by thiocyanate and sodium24 occurs at two distinct periods of growth: primarily during early infancy and also during adolescence.
TRENDS IN HEALTH LEGISLATION AND ADMINISTRATION
Authors: WALL JOSEPH S.
Published: December 2021

ON March 21 the Hoover Commission's final report on the reorganization of the Government's medical and hospital services was submitted to the Congress. The report prepared by the bi-partisan l2-man Commission is not in accord with the proposal to create a cabinet department of welfare which would include the present functions of the Federal Security Agency—a proposal which is incorporated into a House bill (H. R. 782) and, as stated in this column a month ago, has been approved by the House Committee to which it was referred. In contrast to H. R. 782, the Hoover Commission recommends a new cabinet department to direct the welfare and educational program of the Federal Government and a new and separate United Medical Administration. The UMA would be responsible directly to the President and should, according to the Commission, be headed by "the ablest medical and health administrator whose services can be obtained by the government," with three assistant administrators and an advisory board composed exclusively of Federal officials. It is noteworthy that the qualifications recommended for the person who should head the UMA does not specify that he should be a doctor of medicine.

The cabinet department, for which no name has as yet been proposed, would have jurisdiction over the Bureau of Old Age and Survivor's Insurance, the Bureau of Public Assistance, the Children's Bureau, the Bureau of Education, the Bureau of Vocational Rehabilitation, the American Printing House for the Blind, the Columbia Institution for the Deaf and the Bureau of Indian Affairs.
JET INJECTION IN PEDIATRIC PRACTICE
Authors: HUGHES JAMES G. , JORDAN ROBERT G. , HILL FONTAINE S.
Published: December 2021

The technic of jet injection is described. It represents the first fundamental change in the basic principles of injection in almost 100 years.

The method is relatively painless, is practically innocuous to tissue, and has technical simplicity.

Information is presented dealing with depth of penetration of substances injected, pain response of children, local effects on tissues, blood levels of penicillin and of streptomycin given by jet injection, and clinical response of patients given penicillin by this technic.

Discussions are given concerning the need for chemical inertness of the metal used in the metapule, viscosity of material which can be injected and the possibility of inadvertent intravenous injection.

The proper instrument for children under 10 years of age is one of 75 pounds spring pressure, and for children 10 years of age or older 100 pounds spring pressure. With these strengths it has consistently been possible to secure intramuscular injections in the deltoid and triceps areas, and subcutaneous injections in the lateral thigh area. Injections over large veins should obviously be avoided.

Jet injection offers promise in the field of pediatrics chiefly because of its relative painlessness. It may prove of value in mass immunizations, not only because of pain prevention and technical simplicity, but also because the transmission of viral agents from one subject to another by contaminated needles would be avoided.

Further investigations are indicated, for the relief of pain is one of the foremost functions of a physician.
PHONOCARDIOGRAPHIC DIFFERENTIATION OF THE MURMUR OF MITRAL INSUFFICIENCY FROM SOME COMMONLY HEARD ADVENTITIOUS SOUNDS IN CHILDHOOD
Authors: HARRIS T. N. , FRIEDMAN SIDNEY , HAUB CARL F.
Published: December 2021

Phonocardiographic tracings were recorded in children with known insufficiency of the mitral valve, children with a variety of systolic murmurs without blowing quality and children with no audible cardiac murmurs.

The murmurs of valvular insufficiency produced tracings with a completely patternless and disorganized wave form. The other nonblowing murmurs all yielded tracings of uniform sine-wave character, regardless of their acoustic quality. Of these, the majority were "twanging-string" murmurs, the loudest of these with a distinct buzzing quality; the others were "snorting," "scraping" or "grating" in quality. Clinical observations indicated that these nonblowing murmurs were not indicative of cardiac disease.

The murmurs of mitral insufficiency were significantly longer than the nonpathologic murmurs, but the latter showed, on the average, fully as great amplitude on the tracings. Physical and clinical implications of these findings are discussed.
Pediatrics and the Emotional Needs of the Child
Authors: LASELL SIDNEY J.
Published: December 2021

This short selective account of the Conference at Hershey, Pennsylvania in March 1947 of 44 pediatricians, psychiatrists, and psychiatric social workers, gathered at the invitation of the Commonwealth Fund, asks many questions and offers many suggestions regarding the teaching of and the experimental approach to comprehensive pediatrics. In a number of papers and considerable discussion the definition of the work and training of the pediatrician with psychologic insight was suggested. In considering what is known of emotional and physical growth and development, and the pediatrician's place in mental health, the participants offered new ways of training medical students, doctors, nurses and social workers so as to secure greater insight and integration among these allied disciplines.
PEDIATRIC CARE FOR MIGRANT WORKERS: AN OPPORTUNITY FOR TEACHING AND INVESTIGATION
Authors: Bergstrom William H. , Devlin Leo B.
Published: December 2021

A teaching clinic, staffed by the Department of Pediatrics, was conducted in nearby (central New York) migrant camps during the summer under the auspices of the State Health Department. It was well received by public health nurses and parents. It was valuable to the Department as a teaching operation and as a source of information in an area of pediatrics hitherto little explored. The nature of the clinic and timing of its activities made it appropriate as an elective for a few interested students or as a rotating house staff assignment. This report is submitted in the hope that other medical centers may consider similar combined teaching, service, and investigative ventures.
PERCUTANEOUS RENAL BIOPSY IN CHILDREN
Authors: Dodge W. F. , Daeschner C. W. , Brennan J. C. , Rosenberg H. S. , Travis L. B. , Hopps H. C.
Published: December 2021

Since 1951, when the percutaneous renal biopsy was introduced as an adjunctive method for study of patients with renal disease, reports of some 4,000 kidney biopsies have appeared in the literature. Only about 250 of these, however, have been performed in children.

A biopsy specimen containing 5 to 10 glomeruli has been reported to be adequate for interpretation and to be representative of the total renal parenchyma in 84% of the cases with diffuse renal disease.

Using a biopsy technique similar to that described by Kark, we have obtained an adequate specimen in 92% of 205 kidney biopsies performed in 168 children with diffuse renal diseases.

Seven deaths have been previously reported in the literature. The circumstances surrounding the death of these seven patients and of the one death that occurred in our series are described. Perirenal hematoma has had a reported incidence of 0.4%. It has been our experience, as well as that of the other investigators, that if blood boss is replaced, the patient has an otherwise uneventful course and the mass subsequently disappears. Gross hematuria has had a reported incidence of 5.2%. Microscopic hematuria, lasting for 6 to 12 hours after biopsy, has been found to be the rule rather than the exception.

The complications which have occurred have been associated with bleeding, and therefore a careful history concerning bleeding tendency and a study of the clotting mechanism is essential if the risk of needle renal biopsy is to be minimized. In addition to a bleeding tendency or defect in clotting mechanism, most investigators are agreed that the presence of only one kidney or an uncooperative patient are absolute contraindications to renal biopsy.

The renal biopsy is primarily, at present, an additional and most useful investigative tool in the elucidation of the pathogenesis, natural history (by serial studies) and effectiveness of specific therapy upon the various renal diseases. It is of practical clinical importance in the selection of those patients with the nephrotic syndrome in whom glucocorticoid therapy is likely to be beneficial or the patient with anuria whose renal lesion is probably reversible with time; and, as a guide to the effectiveness of therapy in patients with pyelonephritis or lupus nephritis. It is not a technique that can be recommended for general or casual use.

A classification of the pathohistobogic findings of diffuse glomerulonephritis, patterned after Ellis, is presented and discussed. This classification will be used in the description and discussion of various renal diseases and systemic diseases with associated nephritis in the three subsequent papers.
ELECTROCARDIOGRAPHIC FINDINGS IN HEALTHY PREMATURE INFANTS
Authors: Levine O. Robert , Griffiths Sylvia P.
Published: December 2021

The electrocardiographic findings in 87 healthy premature infants, ranging in age from 1 day to 1 month, are presented. The data illustrate the problems inherent in establishing "normal" standards in the neonatal period since exceptional figures are encountered for most of the parameters measured. Analyses of time intervals and amplitudes are therefore tabulated by frequency distribution, range and median values.

The general configuration of the electrocardiogram closely resembles that observed in full-term infants of comparable age. In both, the precordial pattern is that of right ventricular preponderance. The electrocardiogram of the premature infants differs chiefly in the lower voltage of all the major complexes in the limb leads.