bluuebunny/crossref_metadata_2025 huggingface dataset:
A FIELD STUDY OF RETROLENTAL FIBROPLASIA IN MARYLAND
Authors: ROTHMUND HILDEGARD I. M. , RIDER ROWLAND V. , HARPER PAUL
Published: December 2021

A field study of prematures born in Maryland in 1952 showed that 5.5% of infants with a birth weight under 2000 grams had residual lesions of retrolental fibroplasia. This was almost four times the incidence in the only other similar report in the literature. Approximately half of the cases identified possessed some useful vision in the better eye. The incidence of residual lesions within each weight group was highest in those infants with the shortest periods of gestation. The disease was two to three times more frequent in babies cared for in the five top ranking hospitals than in the other 41 hospitals, and there was a direct relationship between the proportion of infants with residual lesions and the length of incubator care.
SURGICAL EMERGENCIES OF THE NEWBORN
Authors: Clatworthy H. Wm. , Ingalls Theodore Hunt , White Harvey , Smith Lowell D.
Published: December 2021

NATAL day mortality has not changed in the past 40 years and today neonatal deaths represent over half of all infant deaths. Pre-existing malformations, ofttimes surgically remediable, cause 15 per cent of neonatal deaths.

In newborn infants, respiratory distress (tachypnea over 60 per minute, dyspnea, or cyanosis) is produced by medical lesions such as atelectasis, pulmonary hyaline membranes, brain damage, cardiac malformations, and oversedation. Dr. Clatworthy explained that similar symptoms result from surgically correctable defects such as "air block," lung cysts, endobronchial plugs, intrathoracic tumors, and diaphragmatic hernia.

When presented with a newborn infant in respiratory distress, clear his upper airway of mucus, give oxygen if indicated, and after a physical examination, obtain roentgenograms of the chest. Dr. White stressed the importance of good radiographic examination, best achieved by obtaining upright lateral and AP chest films.

"Air block" may occur in resuscitated babies with atelectasis or aspiration pneumonia. The trapped air in the perivascular and interstitial tissues prevents adequate aeration of the lungs and this air may dissect along the great vessels and cause mediastinal emphysema or tension pneumothorax. While the former is treated expectantly, tension pneumothorax frequently requires judicious aspiration and occasionally closed thoracotomy.

Congenital lung cysts are frequently single, large ovoid defects with thickened walls and occasionally fluid levels. They require surgical removal. By contrast, treat postpneumonic pulmonary pneumatocele (usually secondary to staphylococcal infections) expectantly.

Do not confuse obstructive lobar or pulmonary emphysema of endobronchial origin with compensatory emphysema. Obstructive emphysema is manifested by a mediastinal shift to the normal side and spreading of the intercostal spaces with a depressed, immobile diaphragm on the affected side and is treated by immediate lobectomy or pneumonectomy.
NEPHROGENIC DIABETES INSIPIDUS
Authors: West James R. , Kramer James G.
Published: December 2021

1. Two cases of congenital diabetes insipidus resistant to pitressin, or diabetes insipidus of the nephrogenic type, occurring in male cousins during infancy have been described in which the most striking manifestations were recurrent pyrexia, polyuria, polydipsia, poor weight gain and development and hyperelectrolytemia.

2. The basic defect in these patients appears to be renal; in the nature of an endorgan failure to respond to the antidiuretic hormone of the posterior pituitary body.

3. The demonstration of the trait in the mothers of the patients and probably an uncle and maternal grandmother suggests genetic transmission by means other than the previously postulated sex-linked recessive pattern.

4. The literature pertinent to this condition is reviewed and some of the clinical features and diagnostic problems are discussed.
ESOPHAGEAL ATRESIA
Authors: Clatworthy H. William
Published: December 2021

Congenital atresia of the esophagus is not a medical oddity but a relatively common cause of neonatal infant morbidity and mortality. This lesion is susceptible to a single curative surgical procedure in at least 90 per cent of the patients, providing the diagnosis is made within the first or second day of life. Any newborn infant who (1) is delivered of a mother with polyhydramnios, or (2) suffers from excessive mucus or intermittent cyanosis, or (3) develops acute abdominal distention should be suspected of having esophageal atresia and have a catheter intubation of the esophagus performed immediately. If the catheter cannot be passed into the stomach, the newborn may be considered to have esophageal atresia until proved otherwise.

The outlook for infants with this isolated anomaly is good. One should expect that, if a well-integrated effort is made to save these patients, 65 to 75 per cent will survive.
HEMOPHILUS INFLUENZAE TYPE b PNEUMONIA
Authors: Nyhan William L. , Rectanus Daniel R. , Fousek Mildred D.
Published: December 2021

Five cases of pneumonia due to H. influenzae Type b are reported. Three were in infants, 1 in a 5-year-old boy and the fifth in a 62-year-old man. The consolidations in all were lobar or segmental in distribution, and pleural effusions occurred in 3 patients. Diagnosis was by growth of the organism in pure culture from the blood in 4 and from the lung at autopsy in 1. In 2 cases favorable therapeutic response was obtained with penicillin therapy, but in both streptomycin was added to the regimen following specific bacteriologic diagnosis.

The nature of this infection is discussed, and the value of routine admission blood cultures in its diagnosis emphasized. In treatment of H. influenzae Type b infections it is recommended that a combination of 2 antibacterial agents to which the organism isolated is found susceptible be used and that one of these be chloramphenicol or streptomycin.
IRON STORAGE IN THE FIRST FIVE YEARS OF LIFE
Authors: Smith Nathan J. , Rosello Salvador , Say M. Burhan , Yeya Kazuko
Published: December 2021

Iron storage in the first 5 years of life has been evaluated by chemical determination of "hemosiderin" iron concentration of samples of liver from 58 selected autopsies; histological preparations of the liver of these patients have been stained by the Prussian blue reaction.

Similarly prepared histological sections of particles from 109 bone marrow aspirates have been studied. It was not possible to identify normal variations in the content of iron in the bone marrow by the study of such histologic preparations, nor could iron deficiency states he differentiated from the normal by the bone marrow findings using this technique.

The normal fall in hemoglobin concentration during the first 2 months of life is associated with a high concentration of storage iron in the liver.

Iron deficiency anemia, most commonly encountered during the second year of life, occurs during that period in which the hemosiderin concentration of liver is lowest and storage iron reserves are minimal.
EDUCATION
Authors: Davison W. C.
Published: December 2021

THE CARE of chronically in children differs from that of adults in at least 3 ways. First, except for mental retardation and leukemia, and now even for leukemia, it is expected that the chronically ill child will recover. Hence the attitude of pediatricians and other general practitioners is more hopeful than that of internists, surgeons, psychiatrists and psychologists. Second children do not understand the reason for being ill, and sometimes are bewildered and rebellious. Third, in addition to all of the problems of chronically ill adults, children need tender loving care, education and provision for growth and development.

The goal of the pediatrician and family physician is to help children recover rapidly, happily and hopefully without invalidism and maladjustment, and team work obviously is essential.
ABNORMALITIES OF SEXUAL DEVELOPMENT
Authors: Gross Robert E. , Meeker Irving A.
Published: December 2021

A series of 75 patients with abnormalities of sexual development is presented and summarized. Twenty-eight of these patients had manifestations based on a hormonal disturbance, the adreno-genital syndrome. In the remaining 47, there was no evidence of a hormonal imbalance.

A classification is given which we have found useful. While the various abnormalities might seem to present a wide variety of deformities, we have felt that placing subjects into rather well-defined groups gives a clearer picture of the methods of therapy which are available for each of them.

Of the 75 children, 6 were true hermaphrodites and were proved to have gonads of both sexes. The remaining 69 have been called "pseudohermaphrodites" to indicate that while some parts of the sexual apparatus simulated those of the opposite sex in reality the gonads in each individual were of only 1 sex.

From the experience gained in dealing with these 75 children, it has become quite clear that cases of sexual abnormality are handled with the greatest facility and with least disturbance to child and family if the investigations are made in infancy. Then the best plan for handling the case thereafter can be formulated promptly and most intelligently. Adequate study of sexual abnormalities, excepting those in which there is a definite and readily identifiable adrenogenital syndrome, requires pelvic laparotomy to acquire the necessary information. Exploration under general anesthesia can be carried out even in the early days of life with safety and satisfaction.

Methods for treating and managing cases in the various groups are briefly outlined.
Letters to the Editor
Authors: SEVERINGHAUS ELMER L.
Published: December 2021

A warning needs to be given pediatricians and obstetricians about using unduly large doses of any water soluble vitamin K preparation in premature infants. Communications appearing in Lancet report fatal hemolytic anemia occurring in two small series of infants. The vitamin K was given in one on more doses of 10 mg. to these premature infants. No evidence of blood group incompatibility or Rh factor problem was found.

A further report appeared in substantiation of the hemolytic effect of very large doses (100 mg./kg.) of water soluble vitamin K given to rats. This hemolysis occurred only in rats deprived of vitamin E. It is known that vitamin E deficiency in rats leads to abnormally great hemolytic tendency.
AN IMPROVED DEVICE TO PREVENT HAND CONTACTS WITH THE HEAD AND CHEST IN CHILDREN
Authors: Dunham Berman S.
Published: December 2021

THE NEED to restrain the hands of children from contact with the head, face, neck, and chest continues over the years in the hospital and home in various medical and surgical conditions. With the increasingly early plastic repair of malformations and traumatic lesions about the head, and with the frequent use of indwelling nasal and oral catheters, the requirements for restraint have increased. Despite the shortage of nursing attendants, no adequate simplification of restraining methods has appeared.
STUDIES OF IRON REQUIREMENTS IN INFANTS AND CHILDREN
Authors: Sturgeon Phillip
Published: December 2021

The influence of administration of approximately 90 mg. of iron per day as ferrous sulfate was studied in 23 normal infants averaging 14 months of age. Comparison of hematologic values observed at the start and end of a 6-week therapeutic course were made. The results were compared with hematologic values of normal infants of the same age.

Reports by other investigators that a significant rise in the hemoglobin concentrations in normal infants can be achieved, with a therapeutic course of iron given orally were confirmed.

Cytologic manifestations of "physiologic" anemia of infancy were not altered significantly after 6 weeks of therapy. These included the mean cell volume (microcytosis) and mean corpuscular hemoglobin concentration (hypochromasia).

The chemical manifestations of iron deficiency previously reported in a normal infant population were confirmed; these included, compared to normal values in adult males, hypoferremia, hypercupremia, reduced saturation of the total serum iron binding capacity and increased free erythrocyte protoporphyrin. As indicated previously, these values suggest that in addition to the mild degree of iron deficiency anemia in the normal infant, there is depletion of his iron stores.

The short course of iron therapy employed in this study did not significantly alter the chemical manifestations of depleted iron stores.
A BACTERIOLOGIC INVESTIGATION OF OTITIS MEDIA IN INFANCY
Authors: Mortimer Edward A. , Watterson Reich L.
Published: December 2021

A technique is described by which the bacterial flora of exudative otitis media may be studied.

The clinical and bacteriologic data of 104 infants less than 2 years of age with clinical otitis media are presented.

The bacteriologic results indicate that pneumococci and H. influenzae are the chief bacterial causes of otitis media in infancy. Beta hemolytic streptococci were rarely isolated, and staphylococci could not be incriminated as causative agents. More than one-third of the cases of exudative otitis media were sterile.

Because of the multiplicity of potential pathogens present in the pharynx and nasopharynx, no accurate inference as to the bacterial flora of the middle ear could be made, except that an organism not found in the nose or throat was unlikely to be found in the middle ear.

The frequency with which H. influenzae was isolated from the middle ear suggests that antimicrobial drugs such as penicillin, effective primarily in Gram-positive infections, are not adequate therapy for otitis media in infancy.
THE ORIGIN AND SIGNIFICANCE OF THE ACADEMY'S DELLA ROBBIA INSIGNIA
Authors: Beaven Paul W.
Published: December 2021

SHORTLY after the Academy was organized, a discussion took place, the object of which was to find an appropriate design for an insignia which might appear on all certificates of membership, on programs, or on Academy publications. Although Academy records are completely silent about this discussion, for they have been thoroughly searched, it is obvious that a design was selected and was used as our insignia for a period of 10 years. Figure 1 is a replica of this insiginia.

The story of the selection of time insignia [See the FIG. 1. in source pdf] shown in Figure 1 is pieced together by information obtained by letters I have received from those who must have had a hand in its selection.

Dr. Marshall Pease writes that he has a vague recollection of time matter being brought up at a meeting of a small group of Academy members in Dr. Clifford Grulee's home. He thinks he remembers that Mrs. Grulee (though she herself says she cannot remember this) suggested a Della Robbia type of insignia.

Dr. Grulee, at any rate, remembers that he consulted with Mr. Jasper King, the director of C. L. Richetts in Chicago. The firm later became the Scriptorium, and this is the name of the firm that now makes the present insignia. Mr. King was not only a business man, Dr. Grulee writes, but was well acquainted with artistic work of many kinds. Mr. King now has no memory or records of this commission, buy Dr. Grulee says Mr. King submitted 2 or 3 examples. and it was from these that the first insignia was chosen.
Radiographic Atlas of Skeletal Development of the Knee, A Standard of Reference
Authors: NEUHAUSER EDWARD B. D.
Published: December 2021

This beautifully illustrated reference atlas is an outgrowth of the work initiated in 1926 by the former Professor of Anatomy of the Western Reserve University and Director of the Brush Foundation, T. Wingate Todd. It is to be considered as a companion to the Atlas of Radiographic Standards of the Hands and Wrists, previously published, and this volume should prove quite as valuable to all those interested in the growth and development of children. In this volume, the knee is used and from the films obtained skeletal age and maturation can be assessed with ease and considerable accuracy.
EVALUATION OF A CONDITIONING DEVICE IN THE TREATMENT OF NOCTURNAL ENURESIS
Authors: Behrle Franklin C. , Elkin Miriam Tate , Laybourne Paul C.
Published: December 2021

Twenty children with severe nocturnal enuresis and widely varying degrees of emotional maladjustment were treated with a conditioning device. The method proved effective in either entirely eliminating or markedly improving the enuresis in 15 of the children, regardless of their emotional status prior to treatment.

None of the children appeared to suffer significant undesirable effects as a result of therapy, and beneficial effects, other than improvement in the status of the enuresis, appeared to be confined to the subjective impressions of some of the mothers.

Adverse behavior encountered during treatment indicated a need for judicious supervision of therapy along with the cooperation of patients.
Child Behavior
Authors: LITTLE SHERMON
Published: December 2021

This book is a recent addition to the publications which have come out either directly from Dr. Arnold Gesell, or have been sponsored by him. It is avowedly a combination of information which was previously offered in the 2 books, Infant and Child in the Culture of Today and The Child from Five to Ten, but in addition, it is advertised as the first book to provide specific advice on what to do about behavior problems in the first 10 years of life.
The Plasma Proteins in Pregnancy
Authors: KEETTEL W. C.
Published: December 2021

This book seems to fulfill a useful purpose since plasma proteins play an important role in fluid balance and are suspected to be of etiologic significance in the edema of toxemias. Previous studies have reported wide discrepancies in the analysis of these substances. This monograph gives the reader a comprehensive account of the structure of blood protein, the plasma protein alterations in normal pregnancy, and the alterations encountered in the various common complications of pregnancy.
STUDIES OF CARBOHYDRATE METABOLISM IN THE NEWBORN
Authors: Cornblath Marvin , Levin Ephraim Y. , Gordon Harry H.
Published: December 2021

Capillary-venous differences in concentrations of blood sugar were measured in 55 newborn infants during the first 15 hours of life. The capillary-venous difference is related to the capillary level under fasting conditions. The administration of glucose by gavage in doses of 2 to 3 gm./kg. led to a prompt rise in concentration of glucose in capillary blood and an increase in capillary-venous difference. The administration of .03 µg./kg. of epinephrine led to a prompt increase in concentration of glucose in capillary blood but to a decrease in the capillary-venous difference.

The relation of these findings to homeostatic mechanisms in the newborn was discussed.
IRON METABOLISM
Authors: SCHULMAN IRVING
Published: December 2021

THE CLINICIAN has long been aware of the fact that iron deficiency anemia is most prevalent during infancy. Continuing studies of iron metabolism have disclosed many factors which help explain the basic mechanisms of the anemia and the peculiar vulnerability of the infant. The following comments pertain to a review of the subject appearing in this issue of Pediatrics.

The concept that the baby is born with "iron stores," in terms of reserve depots, is no longer tenable. Almost the entire quota of iron with which the baby begins life is that contained in his circulating hemoglobin. This initial endowment is influenced by three major factors: 1) the length of gestation; 2) the amount of blood transferred from placenta to infant in the first few minutes after delivery, and 3) prenatal factors affecting intrauterine hematopoiesis, an aspect which may be highly significant since even in normal full-term infants the concentration of hemoglobin in cord blood has been found to vary within a range of 5 gm./100 ml. of blood.
Cardiovascular Surgery
Authors: ADAMS PAUL
Published: December 2021

This book contains the proceedings of the International Symposium on Cardiovascular surgery held at Henry Ford Hospital, Detroit, Michigan, March, 1955. As such, it includes papers by 60 world-known participants in the fields of cardiovascular physiology, diagnosis and surgical technique. In addition there are contributions from 17 discussants. Approximately a fifth of the volume is devoted to newer diagnostic techniques and clinicalanatomic correlations as related to adjustments between systemic and pulmonary circulations. The remaining portions of the book are devoted to historical aspects and present the status of surgery for various malformations of the heart.
DETERMINATION OF CONCENTRATION OF BILIRUBIN IN SERUM
Authors: Hsia David Yi-Yung , -Hsia Hsio Husan , Gofstein Ralph M. , Winter Augusto , Gellis Sydney S.
Published: December 2021

DURING the past few years, the measurement of the concentration of bilirubin in the serum has become very important in the pediatric field because of its value in the management of erythroblastosis fetalis and other forms of jaundice during early infancy. In previous communications, a micro modification of the standard method of Malloy and Evelyn was presented for the determination of the concentration of bilirubin in the serum of capillary blood. Although this method has proved to be very satisfactory, some have found the long waiting period for the development of the azobilirubin color a real objection.

The present method overcomes this drawback by employing a dilute solution of caffein sodium benzoate as a catalyst, as first suggested by Jendrassak and Grof, and an increased strength of the diazo reagent as described by White and Duncan. It is well known that although the azobilirubin reaction continues to progress at a slower rate indefinitely, Malloy and Evelyn have shown that a 30-minute waiting period can be considered sufficient for the development of color when the ordinary diazo reagent is used. Using the 30-minute reading as the end point at which the reaction may be considered 100% completed, it can be seen (Fig. 1) that this same point is reached using caffein alone in 15 minutes, and using both caffein and a strengthened diazo reagent at 3 minutes. In the latter instance, the reaction does not change appreciably during the ensuing 26 minutes and may for all practical purposes be considered as complete at 4 minutes. [See the FIG. I. in Source pdf]
AN EPIDEMIC OF GROUP A, TYPE I STREPTOCOCCAL INFECTIONS IN NEWBORN INFANTS
Authors: Langewisch William H.
Published: December 2021

An epidemic of group A, type 1 streptococcal infection occurring in newborn infants is described. Uncomplicated omphalitis constituted the majority of infections; three patients developed a deep tissue infection of the extremities as a secondary complication. Investigation revealed an upper respiratory infection due to a group A, type 1 streptococcus in a pediatrician as the probable source of the epidemic. Therapy and recurrences of infection after inadequate treatment are discussed. A review of the pertinent literature indicates the rarity of such an epidemic.
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION, American Academy of Pediatrics, Inc.
Published: December 2021

THE Committee on Nutrition has been designated by the Executive Board of the American Academy of Pediatrics to serve in a consultative capacity in determining the suitability of advertisements of nutritional products in the official publications of the Academy.

Understanding between industry and the medical profession will be fostered by a readily available statement of the basis upon which judgment of advertisements of nutritional products will be made. Assurance can be given that this will be applied objectively, fairly and with sympathetic understanding of the position of industry.

It is hoped that thereby this statement can assume the status of a Code of Ethics and Etiquette in the promotion of products intended for maintenance of optimal nutrition or treatment of disorders of nutrition in infancy, childhood and adolescence.

The Committee on Nutrition will remain receptive to counsel from all sources, and sensitive to the implications of its own statements and actions. The following principles will be continuously re-examined in the light of experience and pertinent evidence.

Good Advertising

Good advertising serves the interest of both merchant and consumer. Good advertising begins with a reliable product. Good advertising achieves a pleasant informative memory of the product and its usefulness in the mind of the consumer. In short, this implies an honest product, truthfully and artistically advertised. Honesty is the best cornerstone upon which to build the type of promotion that will serve the mutual interest of industry, the consumer, and the medical profession.

Quality of the Product

Proof of quality of the product must at all times be available to those who must evaluate promotional material. This applies to foods and to individual ingredients such as vitamins, minerals, amino acids, fatty acids, etc.
HYPOCALCEMIA OCCURRING ON THE FIRST DAY OF LIFE IN MATURE AND PREMATURE INFANTS
Authors: Gittleman I. F. , Pincus J. B. , Schmerzler E. , Saito M.
Published: December 2021

The incidence of hypocalcemia on the first day of life in mature infants born to mothers per vias naturales who had uncomplicated pregnancies and labors is 1.2%.

In our series of infants born to mothers who had complications during pregnancies and/or labors, every one had hypocalcemia on the first day of life.

Infants delivered by cesarean section because of cephalopelvic disproportion or because of "repeat" section had an incidence of hypocalcemia of 13.7% while those infants delivered by section because their mothers had pathologic states during pregnancy had an incidence of 36.8%.

The effect of complications during pregnancy and/or labor was not apparent when we studied the incidence of hypocalcemia in premature infants on the first day of life. We noted that the avenue of birth or the presence or absence of complications during pregnancy and/or labor did not affect significantly the incidence of hypocalcemia on the first day of life.

There is a significant positive correlation between weight of the premature infant and the total concentration of calcium in the plasma.

There was no significant statistical correlation between the mean concentrations of protein and of calcium in the serums of the premature infants studied.

We have speculated that, because premature births occur during the third trimester of pregnancy, the adrenocorticosteroids, which attain their highest concentration in the maternal serum during this period, may exercise a depressing effect on the concentrations of calcium in plasma of infants.
PSYCHOSOMATIC FACTORS WITH PARTICULAR REFERENCE TO THE PARENTS OF THE COLICKY INFANT
Authors: Bakwin Ruth M.
Published: December 2021

Whatever the etiology of colic in infancy, and multiple causes seem most likely, there is little doubt that emotional factors enter the picture. Whether these constitute one of the causes of colic on only intensify it, is at present impossible to determine.

Some investigators have found the colicky infant to be hypertonic, tense, fussy, unhappy even before the onset of specific symptoms. McGee in 1943 suggested that fetal hiccoughs were common in babies who later developed colic.

Spock has emphasized that fatigue of the infant in late afternoon may be a factor, and Gesell has pointed out that there is heightened tension and increased irritability in infants, starting at about 4 weeks of age and continuing to 2 on 3 months, as evidence by increased appetite, more frequent crying, and greaten difficulty in getting to sleep.

Wessel and others have found family tensions greater and more frequent where there are colicky babies than where the infants are contented.

The mother of the infant with colic has been described as tense, anxious, uncertain, inconsistent in her handling of the baby and often rejecting him. The psychiatrist's explanation of the reasons for this personality includes early rejection of the baby, rivalry with infant on husband, conflicts about accepting the feminine or maternal role and her dependency needs.

A simpler explanation would seem to be that as it is the mother who first responds to the infant's needs, she feels frustrated and concerned if she is unable to satisfy them. Feeding is the focus of the first emotional relationship between the mother and child, and if this does not go well, the mother may become very upset.
AN ANALYSIS OF ETIOLOGY OF COLIC IN INFANTS
Authors: Breslow Lawrence
Published: December 2021

The subject of so-called "three-months-colic" in infancy can be considered from two major viewpoints. The first, and by far the most popular today, is the emotional or psychosomatic; other papers in this panel consider this in some detail. The second point of view is based on the belief that colic in infants is essentially a manifestation of gastroenterospasm, resulting from overloading the small intestine with disturbing substances. This may be due to a low threshold in a hypertonic (psychosomatic) infant when subjected to an ordinary quantity of poorly tolerated material, or to a normal threshold being exceeded by an abnormal quantity.

With the latter in mind, 90 infants who seemed to have the usual manifestations of colic were studied as to etiology. Five main factors were considered:

1. Poor feeding technique.

2. Hunger.

3. Intolerance to carbohydrate added to the formula.

4. Intolerance to butter fat added to the formula.

5. Intolerance for, or allergy to, cows milk proteins.

After the first 2 factors were eliminated by the usual methods from consideration as a cause of gastroenterospasm, carbohydrate was removed from the formula as completely as possible. In those infants in whom the symptoms disappeared, this procedure was repeated one or more times until there was no question as to the role played by the sugars. If the symptoms failed to be alleviated, the infant was placed on a formula low in, or free of, butter fat.
STUDIES OF RESPIRATORY INSUFFICIENCY IN NEWBORN INFANTS
Authors: Miller Herbert C. , Behrle Franklin C. , Smull Ned W. , Blim Richard D.
Published: December 2021

Serial determinations of pH, carbon dioxide tension, carbon dioxide content and oxygen saturation of the blood were made on newborn infants and correlated with the trends of their respiratory rates.

Some infants whose respiratory rates were normal from birth and some whose rates were initially high but subsequently returned to normal levels exhibited mild uncompensated respiratory acidosis for 3 or 4 hours after birth. Thereafter, acid-base balances were normal. All infants whose respiratory rates followed either of the above two trends oxygenated their blood 91% or better within a few minutes of birth.

There was a marked tendency for infants whose respiratory rates increased significantly on the first day or two after birth to have a moderate to severe uncompensated respiratory acidosis which was worse at birth and sometimes persisted for several days, usually with improvement. Some of the infants whose respiratory rates increased significantly after birth had moderate to severe hypoxemia, which also was worse at birth and tended to improve with increasing age.

The hypothesis was advanced that one of the basic difficulties in neonatal respiratory insufficiency was a reduction of resting tidal volume; the latter was universally associated with a significant increase in respiratory rates during the first day or two after birth and sometimes with an uncompensated respiratory acidosis and occasionally with hypoxemia.
COLLABORATION BETWEEN PEDIATRICIAN AND CHILD PSYCHIATRIST IN A RURAL MEDICAL CENTER
Authors: Hunt Andrew D. , Parmet Morris
Published: December 2021

A medical care program for a rural community has been described. A group of specialists operate in a consultative and supportive role to the general practitioner. His status and integrity are maintained in a noncompetitive relationship. It is believed that this setting provides a structure for effective postgraduate education on a continuing basis. A collaborative relationship between pediatrics and child psychiatry within this same framework is utilized for indoctrination of family physicians in principles of mental health, largely by working individually around specific case material. Two cases of severe constipation referred by the same family physician are presented. His participation in the management of the first case appeared to have resulted in a degree of understanding of the problem which enabled him to manage the second case, 1 year later, in an unusually skillful and understanding fashion.
Community Programs for Mental Health
Authors: RICHMOND JULIUS B.
Published: December 2021

Pediatricians, often called upon to participate in the planning and implementation of mental health programs, will appreciate this volume as a reference source. The editors have performed a valuable service in bringing together a number of papers based on the mutual concerns of the Community Service Committee of the National Institute of Mental Health and the Midcentury White House Conference on Children and Youth. The volume stems from the editors' concern that "the field of mental health promotion was becoming so broad and its activities so developed as to call for survey, and that it would also be important to know the theoretical basis of all these efforts and the extent of their effectiveness."
Das Skelett des Kindes (The Skeleton of the Child)
Authors: CAFFEY JOHN
Published: December 2021

This small book contains most of the useful radiologic knowledge about the growing skeleton in the traditional classification and traditional descriptions, and illustrations. Technically the book is excellent; the illustrations are clear, carefully cropped and clearly labelled. The first 32 pages are devoted to normal skeltal findings and normal variations; this important aspect of the subject could have been increased to advantage. The graphs and drawings on velocity of ossification appear to be unnecessarily complicated and inconvenient to an American reader accustomed to tables of frequency distribution with all measurements of central tendency, and variation measured in standard deviations.
A Pictorial History of Medicine
Authors: SHRYOCK RICHARD H.
Published: December 2021

Dr. Bettmann has at last provided us with a pictorial history of medicine which is comprehensive in scope, rich in its illustrations, and generally sound in its running commentaries. Anyone who will consider the difficulties inherent in each of these connections, will recognize the extraordinary nature of the achievement.

With regard to scope, the work covers the entire story of Western medicine from the Egyptian period to the end of the Nineteenth Century. Moreover, it includes the social and professional, as well as the scientific history. Since the text is secondary to the illustrations, rather than the reverse as in most histories, content is divided into units with appropriate headings.
THE DURATION OF THE HEMAGGLUTININ RESPONSE IN THE SERUM OF CHILDREN WITH SHIGELLOSIS AND SALMONELLOSIS
Authors: Neter Erwin , Dunphy Donal
Published: December 2021

A study of the duration of the hemagglutinin response in the serum in 18 children with shigellosis and/or salmonellosis (total of 20 infections) revealed that, in the absence of the chronic carrier state or chronic or recurrent infection, a substantial reduction in the hemagglutinin titer in the serum or a return to normal titer took place within a period of from 4 months to 2 years. This decrease was not paralleled by similar changes in the titers of hemagglutinins against heterologous enteric bacteria, nor was the hemagglutinin response to the infection associated with a parallel rise of heterologous hemagglutinins. The hemagglutinin titers were invariably higher (from 2-to 64-fold) than those of the bacterial agglutinins. The usefulness of the enterobacterial hemagglutination method for the detection of subclinical enterobacterial infections is illustrated. Criteria for the serologic diagnosis of these maladies are presented.
THE UMBILICAL POLYP, A REMNANT OF THE OMPHALOMESENTERIC DUCT
Authors: Crawford Stanley E.
Published: December 2021

THE PURPOSE of this paper is to report a recent case of an umbilical polyp and intestinal obstruction during the neonatal period. Umbilical polyps are rare. When present, they may be associated with Meckel's diverticulum because both are remnants of the omphalomesenteric duct. The presence of the visible polyp may give an external clue to otherwise obscure intraabdominal symptoms.

A review of the literature earlier than 1916 is well summarized in a book by Thomas Cullen. This unusual volume lists six cases of umbilical polyp accompanied by other pathologic complications of Meckel's diverticulum. This author stressed that in these cases it should be pointed out to either the patient or his parents that possible intra-abdominal duct remnants may, at any time, give rise to symptoms such as intestinal obstruction. Penberthy and Benson reported a 9-year-old male with an umbilical polyp which had been present since birth and was without discharge. This youngster died following operation for intestinal obstruction due to volvulus about the diverticulum and its fibrous connection with the umbilical polyp. These authors pleaded for early elective operations in these cases prior to such complications. Gross gave other reasons for observation, and exploration at a reasonably early age, if a Meckel's diverticulum is suspected. Peritonitis from a ruptured Meckel's diverticulum is peculiarly dangerous; in young children the protecting omentum is inadequate and the migrating nature of the anomaly adds to the danger. Fluid from perforation of a diverticulum is usually of greater volume than that found in appendiceal rupture and abscess.
ACTIVITY OF GLUTAMIC-OXALOACETIC TRANSAMINASE IN THE SERUM IN THE NEONATAL PERIOD
Authors: Kove Simon , Goldstein Stanley , Wróblewski Felix
Published: December 2021

The activity of glutamic oxaloacetic transaminase (GOT) in the serum was determined by the spectrophotometric method in 63 normal term newborn infants, varying from birth to 11 days of age. The normal range of activity in the newborn period varied from 13 to 105 units (with the exception of one infant in whom the level was 160 units). This is a considerably wider range than that of 5 to 45 units found in normal adults. Allowing for an error of about ±10% inherent in the method of determination of GOT, activity as great as approximately 120 units, which in adults would be indicative of some pathologic state, must be considered physiologic in the newborn infant.

The activity of GOT was not related to the age of the infant within the neonatal period studied, and varied widely in different infants for each day of age, without any distinctive pattern. Variations of the activity of GOT in specimens of cord blood studied ranged below 59 units, which was lower than for any other day of the neonatal period adequately investigated. No infants were studied repeatedly.

No relation was found between the concentration of bilirubin and the activity of GOT in the serum.
CORRECTED TRANSPOSITION OF THE GREAT VESSELS OF THE HEART
Authors: Anderson Ray C. , Lillehei C. Walton , Lester Richard G.
Published: December 2021

Corrected transposition of the great vessels is described, together with the probable embryologic basis for the defect. This defect has assumed great importance because of the necessity of recognizing its presence before surgical exploration for correction of the frequently associated ventricular septal defects and pulmonary stenosis. The presence of corrected transposition interferes with the surgical approach because of the anomalous coronary pattern and the inverted location of the defects.

The physical and laboratory findings in 17 patients are tabulated and discussed. These included six with a ventricular septal defect, three with pulmonary stenosis, one with a ventricular and an atrial septal defect, one with a ventricular septal defect and left-sided atrioventricular valve stenosis, one with a ventricular septal defect and pulmonary stenosis, two with a reversing patent ductus arteriosus, and three with a ventricular septal defect and a small leftsided ventricle.

The electrocardiogram usually shows A-V block, most often first degree, or A-V dissociation, inverted QRS patterns in the precordial leads (qR in V1 and RS in V6), peaked P waves in lead 2, widened QRS complexes, and upright T waves in the precordial leads, beginning either in RV4 or V1. Roentgenograms may demonstrate an unusual appearance of the upper left border of the heart. The main pulmonary artery may deeply indent the barium-filled esophagus, and the left pulmonary artery may be noted to be medially placed.

The diagnosis can be definitely established by angiocardiography in the anteriorposterior view. The main pulmonary artery lies medially, and the aorta arises from the upper left border of the heart. Also diagnostic is the anomalous and difficult course taken by the cardiac catheter in entering the medially-placed pulmonary artery. This defect should be suspected in all patients where the pulmonary artery cannot be entered at cardiac catheterization.

If pulmonary stenosis is present, the second sound below the left clavicle will not be as soft as usually noted with this defect.

Certain considerations deemed of value to the surgical management of the associated intracardiac defects occurring in this series of patients with corrected transposition are presented.
SURGICAL COMPLICATIONS OF STAPHYLOCOCCIC PNEUMONIA
Authors: Fisher John H. , Swenson Orvar
Published: December 2021

The surgical complications of staphylococcic pneumonia are empyema, pneumothorax, fibrothorax and pneumatocele. Experience with 18 patients treated for one or more of these complications during the past 5 years is reported. Empyema and pneumothorax occur frequently, and early in the course of the illness are best managed conservatively by intercostal insertion of a catheter connected to water-sealed drainage. The patients are critically ill and require careful supportive therapy in addition to specific antibiotics. Fibrothorax and pneumatocele rarely require surgical intervention, since the organizing exudate and the blebs present after staphylococcic pneumonia subside spontaneously without symptoms in the majority of patients. In patients with progressive symptoms and increasing deformity, complete resection of the organized exudate and cystic lung is recommended.
ACCIDENTAL INFECTION WITH VACCINIA VIRUS
Authors: Cramblett Henry G. , Szwed Clarence F. , Utz John P. , Kasel Julius A. , McCullough Norman B.
Published: December 2021

A patient with accidental vaccinia of the eyelids, face, nose, lips and pharynx is reported. Clinically the lesions underwent a vaccinoid (partial immune) type of response, which was consistent with some degree of pre-existing, partial immunity, even though by accepted standards the child had not been previously successfully vaccinated.

Application of a rapid method for detecting the presence of vaccinia virus, using combined tissue-culture and serologic techniques, is described. Isolation of the virus in 1-day-old suckling mice is also discussed. Other laboratory methods useful in the diagnosis of infections due to vaccinia are presented.

General considerations of the clinical aspects of vaccination are reviewed.

The complications of vaccination and their treatment are discussed.
SOCIAL CHANGE AND CHILD HEALTH
Authors: Ellis Richard W. B.
Published: December 2021

IT IS a singular privilege to be invited to honour the memory of a great physician who has made pediatric history and at the same time to express my personal indebtedness to him. It falls to few men to influence the thought and practice of a generation of pediatricians in such full measure as did Kenneth Blackfan. This influence can be traced not only throughout the American continent, but is widely disseminated in Europe, Australasia, and the Far East. It depends not only on his published works, but even more on the manner of man he was. In attempting to recapture something of his essential character, three features have particularly impressed my memory. The first is Kenneth Blackfan's basic integrity. Tolerant of much, his tolerance never extended to work that was slipshod or fell short of complete honesty. Secondly, his modesty. He never attempted to shine at the expense of others, and it follows from this, I think, that he was so successful in working in complete harmony with others equally distinguished in their own fields. In honouring the name of Kenneth Blackfan, we honour also the names of Dr. Gamble, Dr. Ladd, Dr. Crothers and Dr. Osgood, to mention only the leaders of a team which was to achieve so much. Finally Kenneth Blackfan was remarkable in his capacity for looking ahead. During his working life, pediatrics was still a relatively youthful discipline, and it is due in no small measure to his vision that it has achieved such overwhelming importance in the world today.
PEDIATRICS AND SOCIETY
Authors: Moss Arthur J. , Litman Neil N. , Liebling Wilbert , Siegel Sheldon C. , Lovin Bailey J.
Published: December 2021

A description of the function of a private pediatric group is described. The group consists of five pediatricians, each with a subspecialty, and six part-time consultants. This method of practice has been well received in this particular locality. It is felt that the standards of private medical care can be adequately maintained and even enhanced when pediatrics is practiced in this manner.
Counseling and Psychotherapy with the Mentally Retarded
Authors: KUGEL ROBERT B.
Published: December 2021

This book is a collection of several papers concerned with the problems of counseling with mentally retarded individuals and their parents. The editors have culled the scientific writings on this broad subject and have organized them into chapters dealing with such areas as psychotherapy, psychodrama, speech therapy, parent counseling, etc. It is entirely timely, at this moment when there is much interest being expressed in this problem, that this book should appear. The editors are well aware that the papers vary greatly as to their scope and general quality, but the articles are representative of thought in each particular area.
TWO ADDITIONAL EXAMPLES OF VIREMIA IN ASYMPTOMATIC POLIOMYELITIS INFECTION
Authors: Davis David C. , Melnick Joseph L.
Published: December 2021

Two contacts of patients with poliomyelitis were shown to have viremia. In both instances type 1 virus was found in the stool and in the blood. Neither of these contacts showed detectable neutralizing antibodies to the virus at the time the serum specimens were collected. It was because they were excreting virus and were without detectable antibodies that they (as well as six other similar persons) were studied for the possible presence of viremia.
PATHOLOGY IN LEUKEMIA COMPLICATED BY FATAL MEASLES
Authors: Simpson C. Lenore , Pinkel Donald
Published: December 2021

A fatal case of measles complicating leukemia in an infant is reported. Giant-cell pneumonia and a few giant cells in lymph nodes were seen as in previously reported cases. In addition, necroses in liver, lymph nodes, thymus, pancreas and kidney associated with giant-cell formation and inclusion bodies were observed.
Orthopedic Surgery in Infancy and Childhood
Authors: BONFIGLIO MICHAEL
Published: December 2021

The need for a text encompassing the field of orthopedic surgery in infancy and childhood has been met by the author and his colleagues. The subject matter has, for the most part, been arranged according to regions so that one may make easy reference to the many conditions affecting an area. Unfortunately this regional approach detracts from the complete exposition of a single disease process, such as osteomyelitis. The interpretation of each syndrome and its management primarily reflects the writer's experience and point of view with minimal reference to other possible methods of treatment.