bluuebunny/crossref_metadata_2025 huggingface dataset:
ACADEMY PROCEEDINGS—PRESIDENT'S PAGE
Authors: Kennedy Roger L. J.
Published: December 2021

July 1, 1954, marks a milestone in the history of the American Academy of Pediatrics. For 22 years Doctor Hugh McCulloch has served the Academy, first as co-editor of the Journal of Pediatrics and since the establishment in 1948 of our own publication, Pediatrics, as Editor-in-Chief. Throughout his long term of office he has been an outstanding editor and in addition has found time to serve the Academy in many other ways. He was nominated by the Academy for membership on the American Board of Pediatrics and served as Chairman of the Committee on Rheumatic Fever, to mention only a few of his many activities. Few men have given as much of themselves to pediatrics and American medicine. Since he first served as a member of the Committee on Publication in 1931, Doctor McCulloch has been an inspiration to everyone who has had an opportunity to work with him. His superior qualities of executive ability and imagination have been important factors in establishing Pediatrics as an outstanding publication.

Doctor McCulloch has found it necessary to ask to be relieved as Editor-in-Chief because of increasing demands on his time. It was with sincere regret and profound appreciation of Doctor McCulloch's contributions to the American Academy of Pediatrics that the Executive Board acceded to his request. It is impossible to express the magnitude of the debt that the Academy owes Doctor McCulloch for his many years of service.

With the selection of Doctor Charles D. May as Editor-in-Chief, the Executive Board presents to its members a fellow member of the Academy who has a broad viewpoint of the responsibilities of the position. He is typical of the new leadership which steadily develops within the Academy and upon which we depend for even greater advances in the future.
VENO-OCCLUSIVE DISEASE OF THE LIVER
Authors: JELLIFFE DERRICK B. , BRAS GERRIT , STUART KENNETH L.
Published: December 2021

The clinical picture and autopsy findings of a fatal case of veno-occlusive disease of the liver (V.O.D.) occurring in a 10 month old Jamaican infant is reported. Points of similarity between V.O.D. and Budd-Chiari's syndrome, senecio poisoning and Indian infantile cirrhosis are noted. The possible eiology of V.O.D. is considered. It is postulated that V.O.D. is an important cause of cirrhosis of the liver in Jamaican children.
THE USE OF SERIAL HEMAGGLUTINATION TESTS IN FOLLOWING THE COURSE OF TUBERCULOSIS IN CHILDREN
Authors: PEDEN VIRGINIA H. , VINCENT KEITH E. , RICH EDITH
Published: December 2021

1. In cases of known pulmonary (or meningeal) tuberculosis in which X-ray (or spinal fluid) findings have become stabilized, a rise or fall in a previously stable hemagglutinin titer is a reliable indication that X-ray (or spinal fluid) evidence of improvement of the disease will follow within a few weeks.

2. A change in hemagglutinin titer occurring simultaneously with improvement in X-ray (or spinal fluid) findings serves as reliable additional evidence of improvement of the disease.

3. The significance of a changing hemaglutinin titer must always be evaluated with reference to X-ray (or spinal fluid) findings. A changing titer can be considered evidence of impending or beginning improvement of the disease only if the X-ray (or spinal fluid) findings are either static or improving.

4. A changing hemagglutinin titer was useful in predicting or confirming improvement of tuberculous disease in 38% of the group of cases studied. In the remaining cases, a change in hemagglutinin titer either failed to occur at all, or did not occur until after definite X-ray (or spinal fluid) improvement had taken place.

5. The absolute height of the hemagglutinin titer, in itself, was of no prognostic significance in connection with the course of tuberculosis in children.

6. In following the course of tuberculosis, the hemagglutination test is of more value in older children and in children with relatively mild forms of the disease than in infants or in patients with severe forms of tuberculosis, because the former are more likely to develop positive tests.

7. Tuberculin testing did not interfere with the use of the hemagglutination test in following the course of tuberculous disease.
THE ANTIBODY RESPONSE TO GRAM NEGATIVE ORGANISMS: AN EXPLANATION OF THE DIFFERENCES BETWEEN BACTERIAL AND HEMAGGLUTINATING ANTIBODY TITERS
Authors: RABE EDWARD F. , PLONKO MURIEL
Published: December 2021

1. 0 antigens to one strain each of Klebsiella type 55-97, Paracolon 0, Group 3, and S. Choleraesuis produce antibodies in rabbits which can be measured by the following techniques: bacterial agglutination, indirect hemagglutination using red blood cells sensitized with bacterial suspension, bacterial polysaccharide or Seitz filtrate of broth culture of the bacteria, and the hemolytic modificaion of the hemagglutination test using bacterial suspension or polysaccharide sensitized red blood cells as antigen.

2. The highest absolute titers are recorded with bacterial suspension sensitized red blood cells in either the hemagglutination test or the hemolytic modification of this test. Titer differences between paired sera are measured as well by the bacterial agglutination test as by the indirect hemaglutination test. This is true for any of the three bacterial antigens studies.

3. Cross absorption tests with a Klebsiella antiserum and four forms of the homologous antigen indicate that the Klebsiella organism least two antigenic components giving rise to distinct antibodies.

4. Differences in titer between bacterial and hemagglutinating antibodies for Klebsiella are the result of the existence of two distinct antigenic components in the bacteria which are measured separately by each test.
REVIEW ARTICLE
Authors: KIBRICK SIDNEY
Published: December 2021

Newborns with signs of myasthenia gravis may be divided into two groups, depending on the presence or absence of myasthenia in the mother.

Those infants born of myasthenic mothers are characterized by severe signs at birth or within the first few days of life, usually require immediate neostigmine therapy, and occasionally die. Those that survive, however, become normal in a matter of weeks and show no signs of myasthenia thereafter despite cessation of treatment. These cases are designated as transitory myasthenia of the newborn.

The second group, less common, is composed of infants born of non-myasthenic mothers. Their signs are much less severe at birth but persist and tend to increase with age, the majority requiring neostigmine in childhood. These represent cases of "true" congenital myasthenia.

This paper presents three cases of transitory myasthenia of the newborn, three probable cases of the same syndrome, and one case of congenital myasthenia.

All of the previously reported cases are reviewed and the etiology of myasthenia gravis is considered.
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors:   THE COMMITEE ON HOSPITALS AND DISPENSARIES AMERICAN ACADEMY OF PEDIATRICS
Published: December 2021

THE HOSPITALIZATION of children represents a tangible and significant phase of present day practice of pediatrics. It therefore reflects with considerable sensitivity the changes which have been and are taking place in the medical care of children. For example, the prevailing emphasis on Preventive pediatrics and the lessening severity and frequency of infectious diseases which has been accelerated by the general use of antibiotics have both been major factors in bringing about a diminution in demand for numbers of pediatric in-patient beds. On the other hand, the more general use of intricate and expensive diagnostic and therapeutic methods and devices such as contrast medium roentgenology, electrocardiography and encephalography, elaborate chemical and other laboratory observations has led to an increasing use of hospitals on an in-patient or out-patient basis in order to make such facilities available to the child patient.

Furthermore, hospitalization reflects an other characteristic of pediatric practice–that it is a general medical discipline confined to an age span rather than a special discipline confined to an organ system. Therefore a hospital facility for children must accommodate a variety of illnesses as well as a variety of age groups, each with its own peculiar characteristics and needs.

In designing a guide to the pediatric aspects of hospital care, the Committee was immediately faced with the choice of producing either a detailed vade mecum embracing each of the manifold problems or of attempting to distill out, insofar as possible, what appear to be the basic principles underlying hospital care for children during this era of rapid development and change in the nature of pediatric care.
INFANTILE SPASTIC HEMIPLEGIA I. INCIDENCE
Authors: PERLSTEIN MEYER A. , HOOD PHILIP N.
Published: December 2021

The following facts seem to emerge concerning the nature and clinical correlations of various factors in the infantile spastic hemiplegic population.

A. The mean age for this series at the time of first examination was 6.5 years; means are consistent between large groupings where comparisons were made.

B. There were more right than left spastic hemiplegics (5:4).

C. Spastic hemiplegia occurred more often in males than in females (5:4).

D. The Negro subjects were distributed fairly randomly through the present spastic hemiplegic population; the nonsignificant differences in distribution which occurred were thought to be related to geographical and socio-economic factors and not to race, per se.

E. The incidence of postnatally acquired cases was approximately ⅓ of the spastic hemiplegic series as compared to 1/10 of the total cerebral palsied population.

F. The incidence of convulsions in this series was significantly higher than that reported for the general population, for all types of brain injury, for mixed spastic groups, and for most other series of spastic hemiplegics.

G. Congenital and postnatally acquired cases, convulsive and non-convulsive cases, and males and females were all distributed randomly between the left and right spastic hemiplegics of this series.

H. Congenital and postnatally acquired cases, as well as convulsive and non-convulsive cases, were distributed at random between the males and females of this series.

I. The postnatally acquired cases of spastic hemiplegia showed a significantly greater incidence of convulsions than the congenital group.
HEMOLYTIC AND PANCYTOPENIC SYNDROME ASSOCIATED WITH LETTERER-SIWE DISEASE
Authors: LIPTON EARLE L.
Published: December 2021

Two cases of Letterer-Siwe disease are described in which a hemolytic mechanism was the probable cause of the associated anemia. A review of the pertinent literature indicates that this may be an integral part of the disease in some cases.

The laboratory evidence and clinical response to adrenocorticotropin in the first case indicate an extrinsic and probably immunologic mechanism. It is speculated that an analagous process is also responsible for the total pancytopenia. Future acute reticuloendotheliosis cases should be studied in detail in order to further elucidate the etiology of the hematologic changes.
COR PULMONALE IN INFANCY SIMULATING CONGENITAL HEART DISEASE
Authors: MAXWELL IAN , WILSON REGINALD
Published: December 2021

1. Two cases of pulmonary arteriolar obstruction associated with hypertension of the lesser circulation have been described. Both cases were considered during life to be suffering from some form of congenital heart disease.

2. The pathogenesis of the pulmonary vascular lesions has been discussed. In one case, the lesion appears to have been a congenital dysplasia of arterioles throughout both lungs. In the other necrotizing arteriolitis was present in one lung which was also atelectatic. It was absent in the other well aerated lung though vascular lesions associated with pulmonary hypertension were present bilaterally.

3. The clinical picture of these patients has been described. It is suggested that this is sufficiently distinctive to permit clinical recognition and differentiation from congenital cardiac anomalies.
WATER AND ELECTROLYTE METABOLISM IN INFANTS FED COW'S MILK MIXTURES DURING HEAT STRESS
Authors: DARROW DANIEL C. , COOKE ROBERT E. , SEGAR WILLIAM E.
Published: December 2021

Complete balances of water, fat, N, Cl, Na, K, P and Ca were determined on normal infants during exposure to a hot and a cool environment. Milk diets were used offering different osmolar loads at the usual intakes of water per 100 calories. Two infants were fed on evaporated milk providing only 100 gm. of water per 100 calories.

The data show that high evaporative water losses decrease urine volumes at hot environmental temperatures. At water intakes of 150 ml. per 100 calories, the usual cow's milk mixtures with or without added carbohydrate do not lead to urines approaching the physiological limitations of urinary concentration at 90° to 93°F.(32.2 to 33.9°C). Protein or electrolyte greater than evaporated milk induces more concentrated urines. Limitation of water to 100 gm. per 100 calories of evaporated milk induces maximal urinary concentration at this temperature and beginning symptoms of heat prostration. The water intake of these infants on this diet was large owing to high caloric food intake. Under the stimulation of the metabolism by high food intake and the limitation of water intake in relation to osmolar excretory load, heat balance could not be attained without concentrating body electrolyte. Recovery at a lower temperature occurred on this diet.

The osmolar loads of infant food was discussed in relation to extrarenal losses of water. Low osmolar loads provide a margin Of safety if water intake is low, if extrarenal expenditure of water is high or if renal ability to concentrate the urine is limited. The osmolar load of cow's milk is such that reducing this load by dilution with water and addition of carbohydrate is indicated until the caloric concentration is that of human milk, i.e., 150 gm. of water per 100 calories.
Round Table Discussion
Authors: SMITH CARL H. , SCHULMAN IRVING , ERLANDSON MARION
Published: December 2021

The purpose of this round table as stated by Dr. Carl H. Smith was to review those phases of the anemias of infancy and childhood which commonly confront the practitioner. It was emphasized that the approach to a pediatric hematologic problem is unique in that a blood dyscrasia must be evaluated against the shifting blood levels inherent in the growth of children and also that it frequently necessitates on appraisal of fetal conditioning factors as well as post-natal hematopoietic influences. Dr. Smith pointed out that many of the essential diagnostic procedures, such as a meticulous history and physical examination, the basic blood studies including complete blood count, reticulocyte count and interpretation of the blood smear, and the comparison of the above studies with the normal range of blood values for each age group, are well within the working realm of any pediatric practitioner. An etiological classification of anemias into blood loss, excessive blood destruction and hemolysis, bone marrow depression or infiltration, and deficiency of building materials for hemoglobin or red cell formation was suggested. Reference should be made to the age periods of most frequent occurrence. Further specialized procedures were discussed, as well as laboratory tests of which stool guaiac, serum bilirubin, blood urea nitrogen, Coomb's tests, and red cell fragility test were considered to be essential in the investigation of any problematic anemia.

In a discussion of the physiology of neonatal blood formation and the anemia of prematurity by Dr. Schulman, cumulative data from the literature were shown to illustrate that the hemoglobin and red cell concentrations in the fetus increase through the second trimester of intrauterine life and tend to level off during the third trimester.
CONGENITAL MALFORMATIONS OF THE CARDIOVASCULAR SYSTEM IN A SERIES OF 6,053 INFANTS
Authors: Richards Mary R. , Merritt Katharine K. , Samuels Mary H. , Langmann Alfred G.
Published: December 2021

The incidence of cardiovascular malformations has been studied in a large series of unselected infants. The overall rate was 0.83 per cent, and it varied from 7.7 per cent in infants who were either stillborn or died within the first month (16 of 209), to 0.6 per cent in infants who survived for more than 1 month (see Table I).

The accuracy of these incidence rates is discussed, and it is concluded that they are probably somewhat low.

Live-born infants weighing less than 2500 gm. at birth who survived for a month or more have a higher incidence of cardiovascular malformations than do those weighing more than 2500 gm. at birth. This difference is of statistical significance.

A careful evaluation of etiologic factors in this group of 50 cases revealed the following:

a) Maternal age and parity are of some importance as predisposing factors in the causation of cardiovascular malformations. The risk of having an infant with a congenital malformation of the heart or great vessels is greater in the third pregnancy than in the first, especially in women over 30.

b) No association between maternal infections early in pregnancy and the occurrence of cardiovascular malformations in the offspring was noted, except for a suggestive bit of evidence that herpes simplex in the first 3 months may be related to the tetrad of Fallot. However, the number of cases of first trimester maternal herpes in this group of 50 cases was not significantly greater than in the entire population, and in all probability the observed association is coincidental.

c) Obstetric and medical complications failed to show any correlation with the incidence of vascular anomalies.

d) Genetic factors could not be satisfactorily evaluated.

The types of malformations encountered are listed, and the methods of diagnosis are discussed. Twenty-three of the fifty cases are still not completely diagnosed, and of these, 20 are alive, and are still under observation.

The development of the symptoms in the tetrad of Fallot and in patent ductus arteriosus is discussed. A rather marked difference in maternal age and parity in the two conditions is apparent, but unexplained.

Routine RG of the chest in newborn infants was considerably less valuable than clinical evidence in the diagnosis of congenital heart disease.

The mortality rates for the group of 50 cases are discussed. Twenty-seven of the fifty patients survived more than 2 years.

Associated malformations, involving systems other than the cardiovascular system, occurred in 18 of the 50 cases (36 per cent), and organs derived from the embryonic ectoderm were most frequently affected. Mongolism (4), and cleft palate, cataract, diaphragmatic hernia (3 each) were the most frequently noted anomalies, and the association was thought to be of definite significance in the case of mongolism, and in fatal cases of diaphragmatic hernia.
HEMOLYTIC DISEASE OF THE NEWBORN DUE TO ANTI-A AND ANTI-B
Authors: Shumway Clare N. , Miller Gerald , Young Lawrence E.
Published: December 2021

Ten infants with hemolytic disease of the newborn due to ABO incompatibility were studied. In every case the investigations were undertaken because of jaundice occurring in the first 24 hours of life. The clinical, hematologic and serologic observations in the infants and the serologic findings in the maternal sera are described. Evidence is presented to show that the diagnosis of the disorder rests largely upon the demonstration of spherocytosis, increased osmotic fragility of the red cells, reticulocytosis, and hyperbilirubinemia in a newborn infant whose red blood cells are incompatible with the maternal major blood group isoantibody and against whose cells no other maternal isoantibody is demonstrable.

The anti-A or anti-B in each of the maternal sera tested in this series hemolyzed A or B cells in the presence of complement. Other serologic findings in the maternal sera were less consistently demonstrated.
VITAMINS—PAST AND PRESENT
Authors: György Paul
Published: December 2021

IT is with gratitude and humble appreciation on that I accept the Borden Award for 1954 from the American Academy of Pediatrics. The feeling of gratitude is based on the acknowledgment by pediatric peers and colleagues of research activity conducted over a period of many years. This happens to be the first occasion that a recipient of the Borden Award given by the Academy of Pediatrics has received previously a Borden Award given by the American Institute of Nutrition for the year 1951. I am inclined to see in this event, a welcome justification and support of my professional career with its division of activities between the clinical-pediatric and the experimental-nutritional fields.

In accordance with the stipulation of the Award Committee it is proposed to give in the following, a summary of the research work for which the award was granted. The results achieved were made possible by the cooperation of a large number of helpful collaborators.

The problem of qualitative nutrition has been recognized early to be of paramount importance for the dietary management of the growing organism: infant and child. Vitamins are part of this over-all problem. As a young, beginning pediatrician in the early Twenties, deeply immersed in the clinico-chemical study of rickets and tetany, I had been particularly impressed by the use of animals for the solution of nutritional problems. At that time, the group working under McCollum, Park and their associates at Johns Hopkins, as well as Alfred Hess and Steinbock had published their classical studies on experimental rickets in rats. My first attempt to duplicate their observations, including those on the activation of inert oils by ultraviolet irradiation as potent preventives of experimental rickets, had been—for reasons never understood —unsuccessful.
DIASTEMATOMYELIA
Authors: Holman Colin B. , Svien Hendrik J. , Bickel William H. , Keith Haddow M.
Published: December 2021

Diastematomyelia is an uncommon congenital malformation of the neural axis manifested by separation of the lateral halves of the spinal cord. A case is presented in which the complaint was increasing curvature of the spine. Preoperative diagnosis of this lesion was established by roentgenography. The condition is a serious congenital abnormality which is susceptible to treatment and, therefore, early diagnosis is of practical importance.
THE TREATMENT OF INTUSSUSCEPTION IN INFANCY AND CHILDHOOD
Authors: Packard George B.
Published: December 2021

1. The experience at the Denver Children's Hospital over the past 20 years has been analyzed in 2 10-year periods. Results in the last 10 years represent more accurately the improvements in general therapy including anesthesia, fluid and electrolyte replacement and anti-bacterial agents.

2. One hundred twenty-four cases of intussception were treated during the 20 years with an overall mortality rate of 7.2 per cent, and an operative mortality rate of 3.3 per cent. In the past 10 years, 89 cases were admitted, of which 3 died, all deaths being in moribund cases not mechanically treated, leaving no mortality following hydrostatic or surgical procedures.

3. In the last 10-year period, 47 cases were treated with initial surgery with no deaths; 39 were treated with initial barium enema, 19 of these enemas being followed by surgery, also with no deaths.

4. Most of the successful barium enema cases were those of short duration. But short duration does not insure reduction nor does the method always fail in late cases.

5. The main advantage of barium enema would seem to be its simplicity and an even chance of success in early cases thus avoiding unnecessary surgery and economic loss. The main advantage of initial surgery would seem to be its more positive approach and more definite assurance of adequate treatment.
CONGENITAL PITRESSIN RESISTANT DIABETES INSIPIDUS OF RENAL ORIGIN
Authors: Macdonald William B.
Published: December 2021

1) The history of a male infant who presented soon after birth with features of failure to gain weight, dehydration and pyrexia of obscure origin, has been described. A diagnosis of pitressin resistant diabetes insipidus was made.

2) Renal function tests and post-mortem examination, including microdissection of the kidney, indicates that the basic defect in water metabolism was a functional inability of the distal renal tubules to respond to antidiuretic hormone.

3) Consequent dehydration was insufficient to cause circulatory collapse, but affected renal clearances.

4) There was evidence of increased catabolism and poor protein utilisation.

5) Hyperosmolarity of the extracellular fluid was accompanied by a rise in body temperature, probably due to a depression of sweat gland activity.

6) Post-mortem evidence suggests that infants with pitressin resistant diabetes insipidus should be investigated for cystine storage disease.
EDUCATION
Authors: Blattner Russell J.
Published: December 2021

BECAUSE of the great variation and considerable confusion in designating the years of training in Intern and Residency Training Programs throughout the country, it was suggested by the Committee on Medical Education of the American Academy of Pediatrics, that a survey be undertaken to determine preference, if any, for a more standard form of nomenclature. Accordingly, an enquiry was sent to the Chiefs of Pediatrics of all hospitals listed in the Residency and Intern Number of the Journal of the A.M.A. (Sept. 26, 1953).

The message sent out was:

"There is need to standardize terminology used in designatimig the years of training in Intern and Residency Programs.
THE PEDIATRICIAN AND THE PUBLIC
Authors: ILLINGWORTH R. S.
Published: December 2021

I thought that Dr. Park's article in Pediatrics about the National Health Service was a very fair one. Personally I am quite convinced that the Health Service has been a great success, but of course we all have criticisms of details in its working. Dr. Park is certainly right in saying that the people as a whole are entirely in favour of it. I have never yet heard a comment by a patient to the contrary. Neither do I know personally any consultant who feels that the country would be better off without it.

The training of the practitioner is, of course, a problem which exercises all of us. I agree with Dr. Park's point that much of the training comes from the consultant. Those of us in a teaching position try our best to contribute something by writing careful detailed reports to the practitioners about cases referred to us in the Out-patient department or admitted to our wards, by organising clinical meetings and courses of lectures for family doctors, and by taking part in the medical societies in the city and towns in the region. Nevertheless I certainly agree that there are considerable difficulties in giving adequate postgraduate training for General Practitioners.
VIRAL AND RICKEITSIAL DISEASES
Authors: Robbins Frederick C. , Gold Eli
Published: December 2021

INTRODUCTION

IT WILL not be possible to cover exhaustively the field of virus and rickettsial diseases in this brief summary. The growth and basic properties of viruses and rickettsiae as well as the pathogenesis of diseases due to these agents will be reviewed in outline form. Epidemiology and immunity and current opinion on prophylaxis and therapy will be discussed. Finally, we will consider some recent developments and speculate a bit on what the future may offer.

It is hoped that some of the more basic material presented, although admittedly elementary, will help to orient the reader. An understanding of some of the procedures conducted in the virus laboratory may make the physician aware not only of what can be done to help diagnostically, but also what cannot be done.

FUNDAMENTAL INFORMATION CONCERNING PROPERTIES OF VIRUSES AND RICKETTSIAE

A) Size

1) Rickettsiae are large enough to be seen with the light microscope and do not pass through porcelain filters. The rickettsia of Q fever does have filtrable form.

2) Viruses vary tremendously as to size. Some are highly complicated organisms (e.g., vaccinia), others such as tobacco mosaic virus, are apparently large protein molecules.

Psittacosis and related organisms occupy intermediate position between rickettsiae and true viruses.

B) Culture

No virus or rickettsia has ever been propagated except in the presence of living cells.

C) Life Cycle

Most of time available information concerning infection of time cell and multiplication of viruses is derived from studies with bacterial viruses (bacteriophage). This may or may not be fully applicable to animal viruses but the cycle is represented below:
HUGH McCULLOCH
Authors: POWERS GROVER F.
Published: December 2021

AN OUTLINE of the career of Hugh McCulloch, founding editor of Pediatrics, is as follows:

He was born in Marianna, Arkansas, August 20, 1888, of Scottish ancestry, the son of a judge. He graduated A.B. from the University of Arkansas and received his M.D. from the Johns Hopkins University in 1912. His post-doctoral experience was an intern and resident in internal medicine at the Barnes Hospital in St. Louis, service of Dr. George Dock, Professor of Medicine in Washington University.

In 1915 McCulloch began his career in pediatrics under Dr. Borden Veeder at the St. Louis Children's Hospital, and Washington University. McCulloch later was an associate of McKim Marriott and Alexis Hartman; he became chief of the Cardiac clinic at the Children's Hospital and physician-in-charge of Ridge Farm, the convalescent institution of the hospital. There was an interlude of 2 years during World War I when McCulloch served as Captain with Base Hospital Number 21, the Washington University Unit.

While in St. Louis, McCulloch in addition to school and hospital responsibilities carried on a private practice and from 1932 to 1948 was co-editor with Borden Veeder of the Journal of Pediatrics; he also served as associate Editor of the American Heart Journal.

In 1948, McCulloch accepted the position of Chief of Staff and Director of Medical Service at LaRabida Jackson Park Sanitarium in Chicago; he also serves as Professional Lecturer in Pediatrics in the College of Medicine, University of Illinois. The Sanitarium is a very stimulating and valuable teaching center due to McCulloch's broad active interests in education.

In the same year (1948) Pediatrics was established by the American Academy of Pediatrics and McCulloch was appointed Editor; a position he held until his resignation June 30, 1954.
IDENTIFICATION OF URINARY 17-KETOSTEROIDS IN RHEUMATIC FEVER
Authors: Lubschez Rose
Published: December 2021

1. The combined use of chromatographic separation of urinary 17-ketosteroid extracts on alumina columns and infra-red analysis of the fractions has permitted the identification of the major components in 5 mg. of a mixture of α ketosteroids.

2. In 4 non-rheumatic children, 4 rheumatic (inactive) children and 1 patient with active rheumatic carditis, the steroids identified in the urinary extracts were androsterone, Δ androstenolone, etiocholanolone and 11-keto etiocholanolone. Other steroids were present in insufficient quantity to be identified.

3. In 1 patient with active rheumatic carditis, the steroids excreted during an 8-day course of ACTH therapy were Δ androstenolone, etiocholanolone,11-hydroxy androsterone, 3 α, 11 β androstanediol-17-one, and 1 compound of possible clinical significance which has been reported by other investigators, the structural formula for which is not known.

4. There appears to be no inherent difference between the urinary ketosteroids of rheumatic (inactive) and non-rheumatic children.
SPECIAL ARTICLE
Authors: McCulloch Hugh
Published: December 2021

La Rabida Sanitarium is situated on the shore of Lake Michigan in the South Shore district not far from the University of Chicago with which La Rabida has a close affiliation, its research program being directed from the Department of Pediatrics and Bobs Roberts Memorial Hospital for Children.

La Rabida derives its name from the convent Santa Maria de Rabida near Palos de Moguer, Andalusia, in Spain where Columbus visited when he was seeking funds to support his proposed trip "around" the world. He was interviewed by the prior, Juan Perez de Marchena, who also was interested in this new conception. Later a friend of the prior, Garcia Fernandez, a physician and a resident in Palos became interested in the discussion. He agreed that Queen Isabella, who at that time was residing in nearby Granada, should be approached and the matter presented. The outcome of this focal combination of persons is history. A replica of this convent was built in 1893 for the World's Columbian Exposition located in Jackson Park by the Spanish government to house its important exhibit. After the close of the exposition the Spanish consul encouraged a group of women interested in child welfare on the south side of Chicago to use the building for a summer time day nursery for sick infants and mothers living in the hot crowded west side and stock yards districts. After many difficulties, the venture succeeded and has been continued. Visitors to the present hospital as late as 1952 could see in the harbor across the road the full size replica of the "Santa Maria," one of the 3 ships, made for the Columbian Exposition and navigated across the Atlantic Ocean from Spain. The decaying wooden structure has now been removed.
SPECIAL ARTICLE
Authors: Fishbein Morris
Published: December 2021

THE POET John Donne wrote that no man is an island. Never was this more apt than when applied to the person who is suffering with a crippling disease. For him isolation is disastrous. If intelligent and left too much alone, he becomes embittered, sullen and perhaps an enemy of society. If unintelligent, he deteriorates slowly and steadily into a parasitic, vegetable-like existence, which may eventually sap the lives of all about him. The modern approach to the problem emphasizes adjustment of the handicapped person to the family, the community, and even the nation. All these forces are brought to bear from the social, economic and psychologic points of view, so that such a person is able to live an existence as nearly normal as possible. He contributes to rather than lives upon the society that encompasses him. This consideration of the social aspects of rheumatic heart disease is concerned with these problems and with the extent to which the individual, the family, the community and the nation are able to solve them.

On July 29, 1789, Edward Jenner, who first introduced vaccination against smallpox, reported to the medical society in Gloucestershire, England, on "Disease of the Heart Following Acute Rheumatism." The case was illustrated by dissection. This was probably the first reference to rheumatic fever in scientific medical reports. Unfortunately neither the paper nor any record other than its title has ever been found. Perhaps the first physician who pointedly called attention to the association of acute rheumatism and heart disease was David Pitcairn, born in 1749.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: Lowe Charles U.
Published: December 2021

Afghanistan is a country in south central Asia, approximately rectangular in shape, with an area estimated at 250,000 square miles. Its borders have been inadequately surveyed and many sections are as yet unvisited by foreigners. The Hindu Kush Mountains divide it roughly from northeast to southwest; they make surface transportation slow and difficult, and along with the desert areas of the southwest sector, reduce the tillable land to less than 20,000 square miles. In spite of this, Afghanistan raises more than enough food to feed its Population and has sufficient surplus to export. Its climate is hot in the summer and very cold in the winter, while rainfall is scarce, rarely averaging more than 11 inches Per year.

Racially, 5 ethnic groups make up its population. In the east, and along the Pakistan border, one finds the Pathans. These are tall, frequently fair individuals, claiming descent from both the Greek legions of Alexander and the ancient tribes of Israel. In a broad band running mainly along the Russian border and the Oxus River are the Turkmen, herdsmen and breeders of karakul sheep. South of these, and inhabiting the center of the country from Kabul to Meshed in Persia live the Hazaris, descendents from Genghis Kahn's slaughtering hordes.
THE PEDIATRICIAN AND THE PUBLIC
Authors: Jennings Percy H.
Published: December 2021

The purpose of this article has been to discuss certain aspects of a pediatric group partnership agreement and to outline one possible method of setting up pre-payment financing in a pediatric practice. Some assistance may from this be given to those doctors who are in the process of their planning. It is hoped that other pediatricians who have had parallel experience will contribute further discussion concerning either subject, so that this section in Pediatrics can serve as a well-rounded help in planning the relationships and the finances within a pediatric office.

Any group of doctors desiring to work together in medical practice will produce a partnership arrangement which meets the individual desires and needs of the members involved. We have mentioned here a few of the issues which must be discussed and settled. There will of course be as many different ways of solving these issues as there are doctors combining in groups, since the human personality varies widely. Our effort has been to settle these issues in such a way as to allow for the greatest universality of control and the greatest unity of organization within our group of physicians.

Pre-payment pediatric care, by comparison with pay-per-visit care, tends to carry a different emphasis with greater interest in preventive medicine and in the normal health problems of childhood growth. The degree of this emphasis in a doctor's practice toward well child care and away from illness care is determined by the amount of time that a particular pediatrician allots to routine health supervision visits. A given pediatrician's interest in trying out or in enlarging the pre-payment method of financing in his practice will be influenced by his own desire to emphasize preventive medicine.
BORIC ACID POISONING TREATED BY EXCHANGE TRANSFUSION
Authors: Boggs Thomas R. , Anrode Harry G.
Published: December 2021

A new approach to the treatment of boric acid poisoning is presented. In the absence of any antidote or specific therapy for this type of poisoning, an exchange transfusion using a quantity of blood approximately 4 times the patient's blood volume was performed.

The amount of boric acid removed was quantitatively measured by a technique which is described. The values thus obtained demonstrated that the exchange transfusion resulted in the removal of at least 36 per cent of the total boric acid in this infant's body. Twenty-four hours later a second exchange transfusion was performed using a volume of blood 2 times the infant's circulating blood volume. This exchange was shown to have resulted in the removal of 20 per cent of the remaining boric acid.

In view of the high mortality rate previously reported in similar cases, we believe that the performance of this procedure on our patient materially contributed to his recovery.

The favorable evidence presented in this report, suggests that exchange transfusion should be undertaken in selected cases of boric acid poisoning and is worthy of further evaluation.

Semi-quantitative and quantitative techniques for the estimation of the boric acid content of blood and urine are described.
EDUCATION
Authors: Thelander Hulda E.
Published: December 2021

IT IS a year and a half since the World Conference on Medical Education was held in London. Soon after the sessions a number of journals carried short reports of the meetings or abstracts of some of the speeches. This conference was too significant to be quickly forgotten. Fortunately the entire proceedings are now available in book form under the title First World Conference on Medical Education published by the Oxford University Press. It should be in every medical school library.

There probably will be other international conferences on medical education in the future. I would like to urge that medical schools make it possible for their younger teachers to attend such a conference.
IDIOPATHIC LETHAL GRANULOMA OF THE NOSE AND FACE
Authors: Lane Harold C. , Dodd Katharine
Published: December 2021

A case of "idiopathic lethal granuloma of the nose and face" is submitted. The patient died after failure to respond to all modes of treatment. In addition to the case report a brief survey of the literature is presented regarding etiology, symptomatology, clinical course, diagnosis and treatment.

The report is primarily intended to bring the attention of pediatricians to a syndrome known to otorhinologists for several years. Since we first became interested in the condition other physicians have recalled having seen similar lesions occurring in children; thus, it seemed appropriate to publish a case in the pediatric literature.
LISTERIA MENINGITIS
Authors: Selinger Bernard , Becker Frederick P.
Published: December 2021

A case of Listeria monocytogenes meningitis in the neonatal period, diagnosed primarily by blood culture, is presented. Recovery was uneventful. The organism showed in-vitro sensitivity to erythromycin, oxytetracycline, chlortetracycline, and penicillin, and was resistant to several sulfornamide compounds.
CONTRIBUTIONS OF THE LABORATORY TO THE PRACTICAL MANAGEMENT OF DISORDERS OF BODY WATER AND ELECTROLYTE
Authors: Cooke Robert E.
Published: December 2021

In the treatment of patients with disturbances in the volume of body fluids, laboratory data are of value in the planning of minor modifications in usual deficit therapy as well as in the evaluation of the effectiveness of such therapy. In conditions in which the volume of body fluids is not disturbed, accurate analyses permit approximate calculations and gradual correction of deficits in concentration of electrolyte. As therapy is continued, the laboratory is essential for the detection of patients who show an unusual response to the supply of ordinary requirements and a consequent failure in the regulation of normal body composition.

Regardless of the multiplicity of laboratory determinations, proper interpretation and therapy depend nonetheless upon frequent and accurate clinical evaluation.
A TECHNIQUE FOR QUANTITATIVE URINE COLLECTION IN THE METABOLIC STUDY OF INFANTS AND YOUNG CHILDREN
Authors: Newberry Evelyn , Van Wyk Judson J.
Published: December 2021

THE DIAGNOSIS, study, and treatment of an increasing number of diseases of infancy and childhood are dependent upon the reliable collection of the total 24-hour excretion of urine. Serial collections are often necessary for prolonged periods of time. In the Endocrine Clinic of the Harriet Lane Home a large number of infants with the adrenogenital syndrome have been studied for periods ranging from several weeks to 522 days without interruption of the urine collections and without adversely affecting the welfare of the infants.
SPECIAL ARTICLE
Authors: Stokes Joseph
Published: December 2021

NO ONE to our knowledge in this hemisphere before 1855 had thought infants and children were sufficiently different from adults to warrant special care and facilities for them when they were sick.

This meant that no one had really faced the proposition that the well child—and this means a healthy mind and spirit in a healthy body—must precede the healthy adult.

Only a few perhaps in the last century have faced, in the field of health, the potentialities of the bending of the twig—whether before birth, soon after birth, in infancy, in childhood, or in adolescence.

Until the middle of the Nineteenth Century medicine was too much engaged in the saving of life alone to center its interest in the future potentialities of the child, healthy in mind, spirit, and body. And midway between the discoveries of the life saying procedure of anesthesia and the microbiologic origin of infectious diseases it was natural that a Philadelphia physician—an emissary from our western hemisphere—should be deeply affected and stimulated by the saving of infants' and children's lives he witnessed in London. The emissary was Dr. Francis West Lewis and his stimulus was the mother of all children's hospitals in the English-speaking world—The Great Ormond Street Hospital of London. When Dr. Lewis visited Great Ormond Street just before 1855 he was not thinking so much of the healthy mind and spirit in a healthy body as he was of the infants and children who suffered and died literally by the tens of thousands because of the lack of knowledge of the origins of diesases and of methods for their treatment and control.
Letters to the Editor
Authors: FABER HAROLD K.
Published: December 2021

Forgive my delay in commenting on Dr. C. C. McLean's earlier inquiry regarding the possible dangers arising from the addition of penicillin to the Salk vaccine. I have only recently received a copy of the revised "Minimum Requirements: Poliomyelitis Vaccine," issued by the Public Health Service of the U. S. Department of Health, Education and Welfare.

In the first revision, dated April 12, 1955, it is stated (sect. 2.2) that the "virus for preparing vaccine is grown in tissue cultures containing . . . (c) penicillin and streptomycin in a concentration of not more than 200 units of micrograms per ml., respectively."
THE PEDIATRICIAN AND THE PUBLIC
Authors: Dean R. F. A.
Published: December 2021

IN THE proper study of human nutrition, it is impossible to keep a limited objective, because the problems that at first sight appeared to be academic are quickly seen to be problems in ecology. The difficulty of selection of the most profitable lines of enquiry increases greatly, and the present account of the Infantile Malnutrition Group will probably be found to illustrate that difficulty only too well. As always happens in practice, the selection made was dominated to a large extent by familiarity with certain techniques, and other investigators with different techniques at their command would undoubtedly have chosen differently. The account also attempts to indicate the necessary scope of an enquiry into the effects of undernutrition on the development of the African child, and into the measures required to eradicate the undernutrition.

I. THE ORIGINS OF THE GROUP

1. Mulago Hospital Kampala

Early in 1951, the author and one assistant, a biochemist, arrived in Uganda. Their aim was to find to what extent some earlier work on the use of plant proteins, carried out in Germany shortly after the recent war, might be applicable to East Africa. It was at once obvious that nowhere in Uganda would it be possible to find an orphanage, or similar institution, where a collection of young children might be closely observed under controlled conditions.