bluuebunny/crossref_metadata_2025 huggingface dataset:
PEDIATRIC OUTPATIENT DEPARTMENTS
Authors: Korsch Barbara Maria
Published: December 2021

The author of the following statement is one of a group of pediatricians with special interests in the functions of an outpatient department, especially in regard to the role of ambulatory care in pediatric education. This group has engaged in a series of informal discussions at the times of meetings of the American Pediatric Society and the Society for Pediatric Research.

It was generally agreed that general statements pertaining to the importance of the outpatient department, "pep talks" urging senior staff to participate in outpatient activities, and missionary zeal on the part of a few, will not suffice to achieve the maximum potentialities of outpatient departments.

The group discussions have demonstrated the need for objective standards for outpatient care, formulation of essential principles of good teaching in the outpatient department, and a further realization of the possibilities for research in the problems presented by ambulatory patients.

The remarks presented here do not constitute a comprehensive or formal report of the opinions of all who took part in the discussions, but are intended to be the author's formulation of some of the current problems in order to promote consideration by a larger audience.
TREATMENT OF HEPATIC COMA
Authors: SASS-KORTSAK ANDREW
Published: December 2021

A PECULIAR neurologic syndrome, combined with alteration in consciousness and culminating in coma, is one of the most serious manifestations of liver failure. Better understanding of the fundamental metabolic changes leading to the development of hepatic coma have resulted lately in improved methods of treatment and prevention.

The accumulation of ammonia in the blood and tissues was shown to be at least one of the important factors in the causation of hepatic coma. The ammonia derives from nitrogenous substances of unknown nature which are produced by the normal bacterial flora in the bowel from dietary protein and are absorbed into the portal venous system. An inability of the failing liver to convert ammonia to urea and the presence of natural or artificial shunts between the portal and systemic venous bed, allowing for these substances to bypass the liver, are the two key factors, either one or both of which may result in accumulation of ammonia in the body.
DECREASED AORTIC ATHEROSCLEROSIS IN CYSTIC FIBROSIS OF THE PANCREAS
Authors: Holman Russell L. , Blanc William A. , Andersen Dorothy
Published: December 2021

The degree of fatty streaking of the aorta (percentage of the intimal surface that stains red with Sudan IV) in 18 cases of fibrocystic disease of the pancreas was compared with that in 21 control cases of the same age group (6-13 years inclusive). All cases were of the white race. The average percentage of the intimal surface involved with fatty streaks was over four times as great in the control group as in the group with fibrocystic disease.

The metabolic abnormalities in cystic fibrosis of the pancreas are reviewed in an attempt to discover the mechanism whereby atherosclerosis of the aorta is suppressed. The low levels of most lipids and of chloride in the blood in this disease are pointed out, but in view of the complexity of both fibrocystic disease and atherosclerosis no satisfactory conclusions as to their relationship were attained.

Regardless of the ultimate interpretation of these data, fibrocystic disease of the pancreas appears to be the first human disease with decreased atherosclerosis to be documented.
NEONATAL THYROTOXICOSIS
Authors: Javett S. N. , Senior B. , Braudo J. L. , Heymann Seymour
Published: December 2021

Two cases of congenital goiter with severe thyrotoxicosis are described. In one instance, unusual tachycardia was noted in utero. The mothers, treated before conception with radioactive iodine and thyroidectomy, respectively, were, at the time of delivery, not only thyrotoxic, but markedly exophthalmic.

Treatment of the infants with Lugol's solution intravenously and orally, with the addition of propylthiouracil in one case, resulted in a return to normal after a few weeks.

Appraisal of the pathogenesis of neonatal thyrotoxicosis favors the transplacental passage of a thyroid-stimulating agent, probably derived from the mother's pituitary.

The thyroid status of neonates born of mothers taking medication for thyrotoxicosis reflects the interaction between the transmitted thyroid-stimulating agent and the particular drug being employed.
CLINICAL CONFERENCE
Authors: Arias Irwin , Schorr Julian B. , Fraad Lewis M.
Published: December 2021

Dr. Barnett: I think few of us would consider that we know enough new about pyloric stenosis to justify presenting an infant with it to a group of this type. However, the patient to be presented had what appears to be a complication of pyloric stenosis, which we had not encountered previously and one which is of both practical and theoretic interest. The patient will be described and the discussion opened by Dr. Fraad.

Dr. Lewis Fraad: Infants with congenital hypertrophic stenosis with or without complications continue to fascinate pediatricians, even though the first American cases were reported in 1788.

The patient is a boy, the first-born infant of a 21-year-old mother. The pregnancy and delivery were uneventful. The birth weight was 2.5 kg. Upon discharge from the newborn nursery at 6 days of age, occasional regurgitation of feeding was noted. By the age of 3 weeks the infant had gained only 90 gm. Five days prior to admission to the hospital, vomiting became profuse and projectile. One day before admission the infant's skin appeared yellow to the mother. Upon admission to the hospital at the age of 4 weeks, the infant's weight had decreased to 2,360 gm. He appeared dehydrated and markedly jaundiced. The liver was palpated at the costal margin. An olive-shaped mass measuring approximately 2.5 by 1.5 cm was easily palpated in the midepigastric region.

The pertinent laboratory findings in the blood at the time of admission were as follows: Hemoglobin, 19.5 gm/100 ml; CO2 content, 37.2 meq/l; chlorides, 79 meq/l; sodium, 142 meq/l; potassium, 3.0 meq/l; bilirubin, 18 mg/100 ml of which 13.1 mg was reported to be of the indirect-reacting variety.

Oral feedings were discontinued. With hydration by intravenous fluids, the electrolyte concentrations in the serum returned to normal values but the high value for bilirubin and the jaundice persisted. Identification of the type of bilirubin by paper chromatography revealed that it was all of the indirect variety. Ramstedt pylorotomy and liver biopsy were performed on the third hospital day.
THE CUTANEOUS REACTION TO EGGWHITE
Authors: London Richard L. , Glaser Jerome
Published: December 2021

A study of 400 allergic patients of all ages, who were skin tested with eggwhite, is reported. The authors agree with those who believe that a positive reaction in infants who have in no known way been exposed to eggwhite after birth is in all probability due to intrauterine sensitization. There is a possibility, however, that some reactions to eggwhite may be due to a primary histamine or serotonin releasing substance present in the eggwhite which has no relationship to antigen-antibody reaction. The circumstances under which this takes place are not known.

In all age groups the family history was positive in about 65% of cases.

It was surprising to find, in view of previous opinions, that in the youngest age group (infants up to 2 years of age), the skin test was positive in less than half the patients (42%) in the presence of clinical sensitivity. It was also unexpected to find that the number of patients clinically sensitive to eggwhite but giving negative skin tests increased as age advanced. This justifies the common practice of eliminating egg as a trial measure in the diet of the first age group, regardless of the results of skin testing, and suggests that this should be done in any age group where food is considered a possible etiologic factor.

In the youngest age group somewhat more than one-third (34%) of the patients reacted positively to eggwhite but were not clinically sensitive. This finding was completely unexpected as it had been thought that in this age group a positive skin test to eggwhite was practically pathognomonic of clinical sensitivity.

In this study more positive reactions in children to eggwhite were obtained (70.5%) than in a somewhat comparable series where the incidence was much less (20%). We attribute this to the fact that in our series both scratch and intradermal tests were made while in the other series only scratch tests were done. This reflects the greater sensitivity of the intradermal test.

Only about half the patients of all ages who react to eggwhite are also clinically sensitive.

Attention is drawn to a theory which explains why a positive cutaneous test to a food, as eggwhite, may be clinically significant in atopic dermatitis even though the test (wheal reaction) does not reproduce the type of dermatitis being studied.

There was no definite evidence, because the number of cases studied is far too small, to indicate that the severity of asthma which may ultimately develop in infants not asthmatic at the time of skin testing is proportional to the strength of the initial reaction to eggwhite.
Pediatric Neurosurgery
Authors: RANSOHOFF JOSEPH
Published: December 2021

This volume, consisting of the work of 24 individual physicians, was organized and edited by I. J. Jackson, M.D. and Raymond K. Thompson, M.D.

The book is directed mainly towards the neurosurgeon, and while certain sections may be of interest to the pediatrician, it is not basically oriented for their use. A number of sections of interesting statistics are available, however, for the pediatrician to peruse; this is particularly true of the sections on brain tumors by Lyle French, M.D., and the intracranial vascular malformations by Lester Mount, M.D. On the other hand, from a strictly neurosurgical point of view, there are certain sections in the book which leave a good deal to be desired.
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION, American Academy of Pediatrics
Published: December 2021

The above discussion may be summarized by stating that the Food and Drug Administration is actively protecting the public from chemicals which constitute almost an indigenous part of our civilization. From the standpoint of the physician, this does not require immediate concern, but knowledge of the multitude of food additives, the extent to which insecticides are used, and the constant vigilance of the Administration are factors to be recognized. Continuous vigilance on the part of everyone concerned with infant and child health is a necessity for continuous health.
Patterns of Transaminase Activity of Serum as Diagnostic Aid in the Newborn
Authors: KOVE SIMON
Published: December 2021

I have read with interest the paper "Glutamic-oxalacetic transaminase of serum in infancy and childhood" by Stanton and Joos (Pediatrics, 24:362, 1959). The statement is made that "S-GOT is elevated in diseases of the liver, but the results are too variable for specific differentiation of hepatic diseases in early life." This conclusion is in sharp contrast to the reported findings of my colleagues (Goldstein, S., Perry, R., and Wróblewski, F.) and myself and some clarification of these divergent views appears to be in order.
ANTIBIOTICS IN THE TREATMENT OF BETA-HEMOLYTIC STREPTOCOCCAL PHARYNGITIS: FACTORS INFLUENCING THE RESULTS
Authors: Stillerman Maxwell , Bernstein S. H. , Smith Martha L. , Gittelson Stanley B. , Karelitz Samuel
Published: December 2021

The effectiveness of penicillin V, penicillin V potassium, benzathine penicillin G, erythromycin and tetracycline in eradicating beta-hemolytic streptococci from the pharynx of 410 infected patients or carriers was studied. Penicillin V and penicillin V potassium were administered in daily oral doses of 375 to 750 mg (600,000 and 1,200,000 units), respectively, for 10 days. The benzathine penicillin G was injected once intramuscularly in similar doses. The broad spectrum antibiotics were given in daily oral doses of 30 to 50 mg/kg, up to 1 gm, for 10 days.

The bacterial cure rate was 84% for 224 patients treated with penicillin V and penicillin V potassium, and 86% for 129 patients treated with benzathine penicillin G in combined doses. Forty-eight percent of 23 patients treated with erythromycin and 38% of 34 patients treated with tetracycline were cured.

The majority of the clinical bacterial relapses developed 14 to 28 days after the onset of treatment with penicillin V orally and 24 to 32 days after benzathine penicillin G, 375 mg intramuscularly. Approximately half of the patients with bacterial relapses had clinical manifestations of pharyngitis.

Factors which might be responsible for the development of relapses and failures are discussed.

Complications consisted of one case of otitis media and one case of glomerulonephritis, developing 12 and 22 days, respectively, after the onset of treatment. No case of rheumatic fever was observed.

The data indicate that penicillin was definitely more effective than erythromycin and tetracycline in eradiating beta-hemolytic streptococci from the host, in the doses used. There was no significant difference in the effectiveness of penicillin V, penicillin V potassium and benzathine penicillin G.

Attention is drawn to the relapse-and-failure rate of 15% in these patients despite penicillin therapy.
THE ENZYMATIC EXPRESSION OF HETEROZYGOSITY IN FAMILIES OF CHILDREN WITH GALACTOSEMIA
Authors: Donnell George N. , Bergren William R. , Bretthauer Roger K. , Hansen R. G.
Published: December 2021

Assay of galactose-I-phosphate uridyl transferase in erythrocytes has been applied to a study of 14 families in which a known case of galactosemia has occurred. Including normal controls, 278 individuals were involved.

The method employed was sensitive enough to differentiate between homozygous, heterozygous and normal individuals.

The results substantiate the conclusion that galactosemia is a genetic disease transmitted by simple autosomal Mendelian inheritance.
Pediatric Pathology
Authors: BLANC WILLIAM A.
Published: December 2021

Great courage was needed to begin to write such a book, replete with facts, discussions, theories and original or dissenting views. The field is still filled with controversial problems. Every one of the 50 or more pediatric pathologists may well have his own opinion about each debatable condition and probably has strong personal feelings about it. The author of a pediatric pathology book has to know well the pathology of the adult and its implications—or its origin—in the pediatric age group.
USE OF A FAT EMULSION INFUSED INTRAVENOUSLY IN INFANTS AND CHILDREN
Authors: Kaplan S. A. , Strauss J. , Yuceoglu A. M.
Published: December 2021

One hundred and twenty-one intravenous infusions of fat were given to 47 subjects; 105 of these were given to infants and children below the age of 13 years.

Less than 10% of the infusions were followed by development of fever in excess of 101.5°F. Some of the patients who developed a febrile reaction had other possible causes for the development of fever, such as infection.

None of the subjects showed a hemorrhagic tendency, anemia, leukopenia or thrombocytopenia, or jaundice.

The indications for the intravenous use of lipid were: acute diarrheal disease, chronic caloric deprivation,"surgical" lesions of the gastrointestinal tract, acute renal failure, and certain diseases of the nervous system.

Chemical analysis of the total lipids, cholesterol and phospholipids in the plasma showed that there was an increase mostly in the fatty acid fraction of the serum lipids during an infusion and that there was a return to normal levels 24 hours after beginning the infusion. There was no striking change in the cholesterol concentration of the serum during or after the infusion. The phospholipid content of the serum increased slightly, but returned promptly to normal levels.

The dosage of lipid used intravenously was 30 ml/kg, infused over 6 hours. Since the emulsion supplies 160 cal/100 ml, this dosage provides 48 cal/kg.

Examination of the liver at necropsy or by biopsy showed an accummulation of black-brown pigment in some cases, which is similar to the pigment that has been observed previously in the livers of patients and experimental animals receiving fat intravenously. Microgranulomas were not seen. Using the dosage described, no lesions attributable to the intravenous use of lipid other than the development of pigment were observed.

It is suggested that Lipomul-I.V.® may be safely administered intravenously to infants and children providing the dosage used is not in excess of that recommended. A second infusion may be given safely 48 hours after the first infusion. If visual inspection of the serum shows that the milky opalescence has been lost, a second infusion may be given 24 hours after the first.
ADOLESCENT GYNECOLOGY—A 5-YEAR STUDY
Authors: Heald Felix P. , Sturgis Somers H.
Published: December 2021

One hundred thirty-six girls were seen in 5 years by the consultant in gynecology in a general medical clinic devoted to adolescents. The primary diagnoses were classified in seven categories, the clinical characteristics of which have been presented briefly. In the discussion two points were emphasized: a) the difference in incidence and etiology of certain gynecologic complaints, and b) the indications for a different type of management in adolescent girls as compared to adult women.
MARFAN'S SYNDROME (ARACHNODACTYLY)
Authors: Kohn Jerome L. , Strauss Lotte
Published: December 2021

Close observation of a patient with Marfan's syndrome throughout the duration of his life (18 years) provided an unusual opportunity to study the clinical evolution of the syndrome from birth. The diagnosis was confirmed by necropsy which showed advanced structural alterations of the cardiovascular system unsuspected during life, as well as nonspecific skeletal changes.

Even in the absence of a familial history the syndrome should be suspected when arachnodactyly and excessive length are noted at birth or in the presence of accelerated longitudinal growth early in life.

Notwithstanding early recognition and restriction of physical activity, the evolution of the disease could not be modified, or fatal complications prevented. While it is understood that the prognosis varies in subjects with this affliction, experience with this patient emphasizes that even in a subject with minimal or no cardiovascular symptoms the prognosis must be guarded.

The Marfan syndrome may be a more common hereditary disorder than is usually realized. Present trends in research in this disease give hope that the underlying metabolic disorder may eventually be clarified. It is conceivable that a test may be developed which would not only offer a much needed diagnostic tool, but a valuable aid in genetic investigation of this disorder.
ENCEPHALITIS AFTER YELLOW FEVER VACCINATION
Authors: Feitel Morris , Watson Ernest H. , Cochran Kenneth W.
Published: December 2021

A case of encephalitis after yellow fever vaccination in a young infant is reported. The results of efforts to identify a virus and the probable etiology are discussed. From the negative results of attempts at virus isolation and from epidemiologic criteria, it is concluded that there is a cause and effect relationship between the administration of yellow fever vaccine and the occurrence of subsequent encephalitis in this infant.
STUDIES ON SMALLPOX AND COMPLICATIONS OF SMALLPOX VACCINATION
Authors: Kempe C. Henry
Published: December 2021

Introductory remarks the presentation of the E. Mead Johnson Award affords the recipient the honor of publicly acknowledging his debts to his teachers. I pay such grateful tribute to Dr. Grover Powers and Dr. Edward B. Shaw, my preceptors in academic pediatrics and to Dr. Joseph Smadel who introduced me to the pox viruses and urged me to take another look at the well-trodden field of smallpox. Helpful in his own way was the senior virologist who urged me instead to get involved in another, more fruitful field because "smallpox leaves no room for further work, having been well studied in the 1920's" and who, thereby, strengthened my resolve to re-examine current concepts in the field of smallpox and smallpox vaccination, a subject which has occupied us for the past 14 years. I also acknowledge my lasting debt to my associate, Dr. Henry Silver, who has been a critical colleague, supporter and friend over many years.

The WELL KNOWN clinical observation that it is sometimes difficult to vaccinate the very young chi'd against smallpox led to our early assessment of passive immunity as a modifying factor1 and this, in turn, resulted in the development of hyper-immune vaccinal gamma-globulin and its use in the prevention of smallpox after known exposure.2 The principal subject of this report will be our therapeutic experience with hyperimmune vaccinal gamma-globulin in over 300 patients suffering from serious complications of smallpox vaccination. Finally, we hope to show how basic immunologic studies can be of great value in the management of some of the unfortunate patients whose experience with the vaccinia virus has been a tragic one.
ACID MUCOPOLYSACCHARIDES IN URINE IN GARGOYLISM
Authors: Steiness Ib
Published: December 2021

The present paper is a report on a study of a new screening test elaborated by Dorfman for the demonstration of mucopolysaccharides in small urine samples. The study comprised three patients with gargoylism, their parents and siblings and two control groups consisting of 57 children supposedly without any abnormalities in connective-tissue metabolism and 13 patients with more special diseases. Only the patients with gargoylism showed positive reactions, but a single negative reaction in a randomly selected urine sample does not rule out a diagnosis of gargoylism.

The results suggest that the screening test is a valuable diagnostic aid.
THE PIERRE ROBIN SYNDROME (GLOSSOPTOSIS, MICROGNATHIA, CLEFT PALATE)
Authors: Smith J. Lawton , Stowe Fred R.
Published: December 2021

Thirty-nine cases of the Pierre Robin syndrome have been reviewed. In one-fourth of the cases, a history of an intrauterine disturbance in early pregnancy was noted. The entity appears to occur more frequently in offspring of elderly mothers. A positive family history was noted in two instances. The history is typical, with difficulty in swallowing and recurrent cyanotic episodes noted in the newborn. The child often reveals marked sternal retraction, excessive mucous secretion and stertorous respirations which appear quite alarming when in the supine position, but there is usually marked improvement when the child is placed in the prone position, allowing the ptotic tongue to fall forward. Physical examination reveals micrognathia (producing an "Andy Gump" appearance), cleft palate or other defects of the hard and soft palate, and various anomalies of the tongue, the most common being glossoptosis. The associated defects are discussed.

In the majority of cases the Pierre Robin syndrome is seen without other significant defects than the triad of micrognathia, cleft palate and glossoptosis. Medical and nursing care are considered. Attention is drawn to the occurrence of ocular disease in these children, e.g., congenital glaucoma and retinal detachment. It is recommended that all cases of the Pierre Robin syndrome have a thorough ophthalmologic examination under anesthesia, including dilatation for ophthalmoscopy and tonometry, prior to 1 year of age.
ANAPHYLACTOID PURPURA
Authors: Vernier Robert L. , Worthen Howard G. , Peterson Raymond D. , Colle Eleanor , Good Robert A.
Published: December 2021

Forty-five children with anaphylactoid (Henoch-Schönlein's) purpura were studied.

Evidence of recent streptococcal infection, as determined by positive ASO titers, was found in 13 of 39 patients (33%), an incidence of positive ASO titers only slightly higher than that expected in children with nonstreptococcal illness. This observation suggests that streptococcal infection is not the major cause of anaphylactoid purpura.

Microscopic study of skin biopsy specimens from 12 children showed perivascular cellular infiltration of the dermis. Numerous leukocyte-platelet thrombi were observed in small dermal vessels.

Muscle biopsy specimens were usually normal.

Kidney biopsy specimens from 11 children with anaphylactoid purpura-nephritis of variable severity and duration were studied. The principal microscopic abnormality consisted of focal lesions of fibrinoid deposition and endothelial proliferation within scattered glomeruli. Renal biopsy specimens obtained during clinical recovery from anaphylactoid purpura-nephritis showed focal glomerular scars. The differences between the glomerular pathology of anaphylactoid purpura-nephritis and other forms of glomerulonephritis are discussed.

Clinical, experimental and pathologic data are reviewed which support the concept that anaphylactoid purpura is a form of diffuse vascular disease, probably caused by hypersensitivity to a variety of agents.
THE UTILIZATION OF IRON ADMINISTERED ORALLY
Authors: Woodruff Calvin W.
Published: December 2021

Single doses of orally given ferrous sulfate in the range of 1.5 to 2.0 mg/kg as elemental iron are more efficiently absorbed than larger doses when administered under fasting conditions. Such doses should be given three times daily in order to furnish iron at a rate commensurate with the ability of infants to synthesize hemoglobin. Treatment should be continued for a total period of approximately 3 months.
EARLY MANIFESTATIONS OF THE CARDIOVASCULAR DISORDERS IN MARFAN SYNDROME
Authors: Papaioannou A. C. , Agustsson M. H. , Gasul B. M.
Published: December 2021

We have studied four children varying in age from 5 months to 26 months with typical features of Marfan syndrome. Aside from the routine clinical and laboratory procedures, phonocardiograms, cardiac catheterizations, angiocardiograms and retrograde aortograms were performed. All patients had demonstrable aneurysms of the aortic sinuses of Valsalva and dilatation of the ascending aorta and of the main pulmonary artery. One case had a partial anomalous venous return to the innominate vein. The phonocardiograms demonstrated accentuated pulmonic closures, mid or late systolic murmurs and in one case an apical pansystolic murmur. The anomalies found at necropsy in one infant at the age of 12 days and other congenital heart defects in three older patients are reported. The general aspects of the disease are discussed and a review of the associated cardiac lesions in previously reported cases is presented. Attention is called to the minimal clinical findings of serious underlying cardiac lesions at a very early age, which can only be demonstrated by angiocardiography and retrograde aortography. To our knowledge these are the youngest patients in whom these cardiovascular lesions were demonstrated during life.
DETERMINATION OF ERYTHROCYTE SURVIVAL IN NEWBORN INFANTS BY MEANS OF CR51-LABELLED ERYTHROCYTES
Authors: Kaplan Eugene , Hsu Ku Shin
Published: December 2021

There is no difference in the rate of Cr51 elution from intact cord or adult erythrocytes Variable results of survival studies suggest that placental blood is unsuited for valid and precise measurement of erythrocyte life span. Decreased survival is not present for the erythrocytes of the normal full-term newborn infant in the first 5 days of life when compared with the adult. In the premature infant of the same age shortened life span is found of erythrocytes produced in utero. This may contribute in some degree to the characteristic increase in severity of premature anemia and hyperbilirbinemia. The apparent reduction in erythrocyte life span during the second and third months of life in both premature and full-term infants ma reflect an older erythrocyte population resultant from decreased erythropoiesis in the first weeks of life.
Gesundeit und Leistungsfahigkeit im Kindes- und Jugendalter
Authors: STERN PETER
Published: December 2021

This book constitutes a valuable contribution to the problems of physical fitness of today's children and adolescents. According to the World Health Organization's definition, "health is a state of complete physical, mental and social comfort." The authors proceed to prove in a series of interesting statistical, sociologic and physiological studies, why the general state of health of West Germany's youth falls short of this goal. In spite of the great reduction of infant mortality and the increase of general life-expectancy in the past 80 years, the situation of the child in modern society is considered to be unsatisfactory.

One third of the West German population lives in big cities, believed to create a hostile environment to children, i.e. lack of security and "Lebensraum."
PROGRESSIVE MUSCULAR DYSTROPHY: AUTOSOMAL RECESSIVE TYPE
Authors: Jackson Charles E. , Carey Joshua H.
Published: December 2021

A description is presented of the autosomal recessive type of childhood muscular dystrophy appearing in 14 members (9 males, 5 females) of one closely inbred kindred. The clinical description of these individuals is supplemented by data on values for proteins, protein-bound iodine, hexosamine and glutamic oxaloacetic transaminase in serum, and excretion of amino acids and creatine-creatinine. In comparing this autosomal recessive type with the more common sex-linked recessive type of childhood muscular dystrophy, the most reliable differentiating feature noted was the presence of dystrophy in a female within a family.

The muscle involvement in these two types of diseases was similar except for the preservation of the zygomaticus muscles of the face in the autosomal recessive type as compared with the involvement of these muscles and resultant flat smile in the sexlinked recessive type of dystrophy. Pseudohypertrophy of the calf muscles occurred in 4 of 14 affected individuals of this kindred and therefore cannot be considered a dependable differentiating feature. The patients with the autosomal recessive type of muscular dystrophy had a later age of onset (5 to 13 years), a slower progression and a possible longer life span than those having the sex-linked recessive type. The importance of differentiating muscular dystrophy into types based on mode of inheritance is emphasized.
VISCERAL LARVA MIGRANS
Authors: Snyder C. Harrison
Published: December 2021

An analysis has been presented of the clinical features of visceral larva migrans based on the study of 20 cases seen during a 10-year period at the Ochsner Clinic. The disease is seen in small children who eat dirt and who thus ingest the ova of the canine roundworm, Toxocara canis. Larvae of the parasite invade the liver, causing hepatomegaly with extreme eosinophilia, and usually fever and anemia.

Migration of the larvae to other organs may result in pneumonitis, encephalitis or myocarditis. Lesions may also be seen in skin, kidneys and possibly in bone. Proof of diagnosis requires biopsy of liver or other infected tissue. Treatment with diethylcarbamazine (Hetrazan) may be helpful, but even without treatment, once pica is stopped most patients recover.

Serious sequelae are seen in the form of intraocular granulomata, sometimes causing blindness. These lesions, because they resemble retinoblastoma, have in the past led to unnecessary enucleation of the eye. Enucleation for suspected retinoblastoma, therefore, should not be performed without due consideration of the possibility of a benign granuloma caused by T. canis.
ALLERGENICITY OF COW'S MILK PROTEIN
Authors: Crawford Lloyd V. , Grogan Fred T.
Published: December 2021

Our immunochemical analysis by serumagar precipitation indicates that heat-denatured milks, as compared to homogenized milks, have completely lost their ability to elicit an antigenic reaction with lactalbumin antibodies. In these experiments heat-denatured milks as compared to homogenized milks were markedly reduced in their ability to react antigenically with alpha-casein and beta-lactaglobulin antisera.
Hospital Infection: Causes and Prevention
Authors: SPRUNT KATHERINE
Published: December 2021

This useful book is critically written, easy to read and well documented. The first of its two sections, Epidemiology of Hospital Infection, contains such chapters as Staphylococcal Infections in Maternity Units, Staphylococcal Sepsis of Surgical Wounds, Infection with Haemolytic Streptococci, and Infections Due to Gram-Negative Bacilli; it includes more general topics such as Various Infections Occurring in All Types of War, and General Factors Influencing the Occurrence of Infection. The second section, Control of Hospital Infection, contains chapters on Administrative Control of Hospital Infection, Operating Theatre Design and Practice, Control of Infection in Wards, etc.; it includes discussions of such problems as The Use of Antibiotics in the Prevention and Treatment of Hospital Infection (methods of sterilization and investigation procedures to be employed in outbreaks of infection).
MORTALITY FROM VARICELLA IN CHILDREN RECEIVING ADRENOCORTICOSTEROIDS AND ADRENOCORTICOTROPIN
Authors: Finkel K. C.
Published: December 2021

Forty-four cases of varicella infection in patients receiving adrenocorticotropin or adrenocorticosteroids have been reviewed. Six patients died, all except one of whom suffered from leukemia. In view of the reported deaths from varicella in individuals with diseases other than leukemia who were receiving adrenocorticosteroids, it is concluded that these drugs may increase the mortality from varicella. However, the findings reported in this review indicate that many of the deaths from varicella infection that occur in patients receiving adrenocorticosteroids are more likely due to the effects on immune mechanisms by underlying disease rather than the administered adrenocorticosteroids.
PRESIDENT'S MESSAGE
Authors: Wheatley George W.
Published: December 2021

ABOUT 10 years ago when the Committee on Accident Prevention was created, the Academy focused national attention on accidents as the No. 1 cause of death in childhood and a major contributor to disability, disfigurement and crippling. One of the most spectacular features of this Committee's program is its efforts to prevent and treat poisoning in children, as demonstrated by the amazing growth of poison control centers. Through these community facilities, valuable data on the occurrence and frequency of childhood poisoning have been brought to light. This information has documented an impression held for a long time by many pediatricians: namely, that the creativeness of modern chemistry is both a boon and a bane, the latter all too often in the case of toddlers from about 1 to 4 years of age. Legislation has always been one of the most important means of accident prevention, including accidental poisoning. For example, an early and very effective law aimed at reducing lye burns and deaths from corrosive poisoning in children was the Federal Caustic Poisons Act of 1927, which was developed with the support of organized medicine, under the able leadership of Chevalier Jackson, Sr.

But as new products and new hazards increased, new legislation was required for greater protection. The Federal Hazardous Substances Labeling Act of July 1960 grew out of the concerted efforts of organized medicine and the industries concerned. This law now adds a new dimension to health protection from a wide variety of hazardous products found in or about the home, in addition to the 12 substances formerly labeled "Poison" under the old Caustic Poisons Act.

Hazardous products include those that are flammable, toxic by ingestion, inhalation or absorption, explosive, caustic, irritant or strong sensitizers. Because parents often are not aware of the danger of such products, the articles are readily available to young children for unsafe investigation. Jensen and Wilson reported, in a study of 100 cases of poisonings in children, that "in 53 cases the poison was not in its usual place, either because it was in use, because persons other than the parents had left it out, or because the parents themselves were careless."

Recent mortality data reveal that there are at least 1,400 deaths at all ages from solid and liquid substances, with about 450 deaths in children under 5 years. Last year 35,000 cases of accidental poisoning were reported to the National Clearinghouse from 182 centers in 37 States. The National Health Survey has estimated that 822,000 ingestions of toxic substances occur each year.

Both the householder and physician will benefit from the requirements of this new law. Information to prevent accidents from household products and to offer appropriate first aid when accidents occur must now be readily available to users and physicians. The hazardous substance must be revealed, together with such precautionary warnings and measures as are necessary for safe use and handling of such products.
BCG VACCINATION AGAINST TUBERCULOSIS IN CHICAGO
Authors: Rosenthal Sol Roy , Loewinsohn Erhard , Graham Mary L. , Liveright Dorothy , Thorne Margaret G. , Johnson Violet , Baison H. C.
Published: December 2021

A series of 1,716 BCG-vaccinated and 1,665 nonvaccinated infants, all born at the Cook County Hospital in Chicago between February, 1937, and February, 1948, were followed until February, 1960 (23 years). Among the vaccinated there was a total of 17 cases of tuberculosis (0.43/1,000/yr) and 65 cases in the nonvaccinated 1.7/1,000/yr), a reduction of 75%, statistically highly significant (p 0.001). The morbidity was 0.41/1,000/yr (16 cases in 1,716) in the vaccinated subjects and 1.5/1000/yr (59 cases in 1,665) in the controls, or a reduction of 74% (p 0.001). There was one death from tuberculosis in the vaccinated subjects and six in the controls, or a reduction of 83%. The number of deaths is too small for meaningful statistical analysis.

Comparisons of the control and vaccinated groups were made for subsequent contact to tuberculosis in the home and environment, sex, race, birth weight, observation years, follow-up care, general health and reasons for loss from study. The over-all comparability of the two groups was adequate in most respects. Statistically significant differences were assessed for medical importance. In 639 families in which there were both vaccinated and control siblings, 8 of the 790 vaccinated subjects developed tuberculosis as compared with 30 of the 845 control individuals. The difference is highly significant (p 0.001). Thirteen cases of nonfatal tuberculosis developed in the controls 2 years of age and under and none in the vaccinated. There were three deaths from tuberculosis in the controls under 2½ years of age (miliary tuberculosis plus meningitis in all) and one death in the vaccinated group (meningitis). The latter was an infant who had not converted at 6 months of age and was not revaccinated. Following vaccination, 99.3% became tuberculin positive and 82.4% were still positive, after 8 years, to a single vaccination.
PRESIDENT'S MESSAGE
Authors: Fischer Carl C.
Published: December 2021

FROM TIME to time Presidents of the American Academy of Pediatrics have used this means of sharing with the fellowship, thoughts which seem to them to be of mutual interest.

Last year, President George Wheatley had such a message in every issue, covering a wide variety of interesting and stimulating topics.

I will not plan to necessarily continue this policy of having a message for each issue, but will do so whenever the subject matter seems to warrant one.

At this, the beginning of a new year for the Academy, it seems appropriate to present to the membership at large a few of the thoughts which I presented in Chicago upon my inauguration as your President.

It has recently been my pleasure to reread the two little volumes sent to all Academy Fellows a few years ago, the one containing the Presidential addresses of the first 20 presidents, and the other, Dr. Marshall Pease's stimulating "History of the Academy." I heartily recommend these to any of you who might be interested in the conception, delivery and growth and development of our organization.

Of first importance at this time, it seems to me, is the review of the primary objectives of our Academy as originally drawn up by Dr. Grulee and his associates more than 30 years ago.

These are: "The object of the Academy shall be to foster and stimulate interest in Pediatrics and correlate all aspects of the word for the welfare of children which properly come within the scope of pediatrics."
THE PROBLEM OF COMPARING HOME REARING VERSUS FOSTER-HOME REARING IN DEFECTIVE CHILDREN
Authors: Birch Herbert G. , Belmont Lillian
Published: December 2021

A methodologic critique of the study by Centerwall and Centerwall concerning the effects of home nearing and foster-placement rearing on mongoloid children is advanced. The data are considered from the point of view of the requirements necessary for an adequate investigation of this problem. The general question of institutional placement is considered in the light of English studies on small group residential centers for defective children.
HYPERTENSION IN EMBRYOMA (WILMS' TUMOR)
Authors: HUGHES JAMES G. , ROSENBLUM HERMAN , HORN LACY G.
Published: December 2021

A case of Wilms' tumor of the right kidney is presented, in which the dominant clinical features were extreme elevation of blood pressure and hypertensive encephalopathy, associated with cardiac decompensation and death. Generalized convulsions and right hemiplegia developed, believed to have been due to cerebral anoxia incident to angiospasm. No metastases were found, and no other cause for arterial hypertension was discovered. This patient is thought to be the first case reported where death from Wilms' tumor was due to the hypertensive factor.

The literature with reference to the association of hypertension with Wilms' tumor is reviewed.

The mechanisms by which Wilms' tumors may produce unilateral renal ischemia with arterial hypertension are discussed.

The presence of clearcut hypertension in a child with a kidney area mass points toward the probability of a Wilms' tumor.
American Medical Research, Past and Present, Studies of the New York Academy of Medicine Committee on Medicine and the Changing Order
Authors: MAY C. D.
Published: December 2021

This monograph is one of a series resulting from studies by the Committee on Medicine and the Changing Order of the New York Academy of Medicine.

The objective in this report was to trace the historical development of medical research and to define and describe the role of medical research in the social order particularly as regards support for research from government agencies.

The comprehensive grasp of the complexities of medical research which Dr. Shryock reveals commands genuine admiration and respect from anyone engaged in such research. Indeed, few engaged in various aspects of medical research could claim anything like his familiarity with the broad outlines of this field.
LUNG VOLUME IN THE NEWBORN INFANT
Authors: Klaus M. , Tooley W. H. , Weaver K. H. , Clements J. A.
Published: December 2021

The plethysmographic technique of Du-Bois and associates has been modified for use in newborn infants and found suitable for the measurement of lung volume. Of 37 normal infants studied with this method, most achieved full functional residual capacity during the first few minutes of life.
Juvenile Rheumatoid Arthritis
Authors: DODD KATHERINE
Published: December 2021

The 110 children of whom this retrospective study is composed are to me a most unusual group of juvenile rheumatoid arthritics. The average interval between the onset of the disease and the time the children were seen at the Columbia Presbyterian Medical Centre was 4.4 years, and the average time before diagnosis was made 1.6 years. The onset of the disease was monarticular in 39% of the cases, and 30 patients had a painless arthritis.
A 20-YEAR FOLLOW-UP STUDY OF "INNOCENT" MURMURS
Authors: Marienfeld Carl J. , Telles Norman , Silvera Jack , Nordsieck Marie
Published: December 2021

One hundred fifty-four phonocardiograms showing vibratory "innocuous" systolic murmurs were chosen from a group taken in 1939. Of the patients, 139 now adults were located; 96 were re-examined by history, physical examination, roentgenograms, electrocardiograms, and a repeated phonocardiogram. Two of this group had heart disease, presumably related to the childhood murmur. Two individuals had heart disease not related to the previous murmurs. Despite the fact that not all 154 could be located, the low 20-year incidence of heart disease and the complete disappearance of the murmur in 80% of those examined appear to indicate the great likelihood that the childhood vibratory, low-frequency, mid-systolic apical and precordial murmur is indeed innocuous and should not be taken as evidence of heart disease unless there is other evidence.
LEFT HEART CATHETERIZATION IN INFANTS AND CHILDREN
Authors: Brockenbrough Edwin C. , Braunwald Eugene , Ross John , Morrow Andrew G.
Published: December 2021

Experiences with left heart pressure measurements in 111 infants and children are reviewed. These studies were performed by means of transseptal left heart catheterization or anterior percutaneous left ventricular puncture. The only significant complication was the development of left pneumothorax in two patients following the latter procedure. The techniques are briefly described, and the importance of left heart catheterization in the clinical management of infants and children with heart disease is illustrated by means of selected clinical examples.
THE DISTRIBUTION OF FETAL HEMOGLOBIN IN THE BLOOD OF NORMAL CHILDREN AND ADULTS
Authors: Zipursky Alvin , Neelands Peter J. , Pollock Janet , Chown Bruce , Israels Lyonel G.
Published: December 2021

Studies of fetal hemoglobin (HbF) in the blood of infants and children, together with some observations of adult hemoglobin (HbA) in adults, suggest the following: HbA and HbF may be present in the same erythrocyte. The HbF concentration in erythrocytes is high at birth but decreases to low levels by 6 months of age. The postnatal decrease in HbF is due largely to the production of cells containing mostly or perhaps entirely HbA. HbF and HbA are not formed in separate cell clones. All erythropoietic cells have the capacity to produce both fetal and adult hemoglobin.
GROWTH AND NUTRITION OF INFANTS
Authors: Rueda-Williamson Roberto , Rose Hedwig E.
Published: December 2021

A longitudinal study was conducted on growth and food intake of 67 unselected healthy, full-term infants from 2 to 15 months of age. The length and weight progress of infants in the study was, during the first year of life, very similar to progress as reported in an earlier study by other investigators, indicating that no striking change in size of 2-to-12-month-old infants had occurred in this area during 30 years, despite changes in feeding practices. The study infants had high calorie and very high protein intakes as compared with Recommended Allowances of the National Research Council. The question of whether some of the very high intakes seen in this study could be potentially harmful or at least beyond the range of optimum nutrition was raised. The desirability of establishing nutritional ceilings was considered. The correlation between length increment and calorie or protein intake was not significant. The correlation coefficients between weight increments and calorie intake were significant but low, indicating that other variables beside food intake influenced size and speed of growth. The correlations between iron intakes and hemoglobin levels and between fat, protein, and calorie intakes and cholesterol levels were not significant. Individual case studies indicated that the most important variables in the energy balance, beside food intake and growth, were illness and physical activity. Environment affected the balance indirectly inasmuch as it influenced physical activity.