bluuebunny/crossref_metadata_2025 huggingface dataset:
Los usos de la etnohistoria: cañaris e incas en la construcción nacional ecuatoriana y peruana
Authors: Solari Mirko
Published: December 2021

Tras las independencias, los Estados nacionales andinos se erigen sobre la base de la cartografía colonial. En la antigua Audiencia de Quito (actual Ecuador), la obra de Juan de Velasco constituye un significativo anclaje identitario, vinculado a una sucesión de hechos mitológicos y disputas dinásticas al interior de la confederación Quito-Puruhá. En el Perú, se advierte una apropiación del legado inca por parte de las élites criollas y, en ambos casos, la historiografía que enaltece el pasado prehispánico convive con la marginalidad de las poblaciones indígenas. La incorporación de los cañaris al relato nacional ecuatoriano revela múltiples desafíos. Este pueblo, masivamente afectado por los traslados mitmas durante el incanato, no formaba originalmente parte de la confederación Quito-Puruhá (base prehispánica de la ecuatorianeidad); más bien, se opuso a ella. Asimismo, la tendencia de identificar a Atahualpa como inca «proto-ecuatoriano» contrasta con el apoyo de los cañaris a Huáscar, «inca peruano». Si a ello se suma el apoyo de algunos sectores de cañaris (locales y mitmas) a la empresa colonial hispana, la imagen de este pueblo resultaría desfavorable para ambas historiografías nacionales. La apropiación selectiva del pasado, las oposiciones republicanas ancladas en presuntas desavenencias prehispánicas, así como una lectura etnocéntrica de la historia («legitimidad real», dinastías, discutibles cartografías, imaginarios civilizatorios), caracterizan los usos de la etnohistoria en la elaboración de proyectos republicanos en Ecuador y Perú.
A subtle stroke
Authors: Nascimento Rafael Ferreira , André Diogo Raposo , Freitas João Miguel , Freitas João Patrício , Freitas Rafael
Published: December 2021

Introduction: The authors present a clinical case of an ischemic stroke that presented with anomic aphasia. Case report: A 75-year old woman was brought to the emergency department with an anomic aphasia that had started that day. The neurological exam confirmed the anomic aphasia with no other associated findings. The Head-CT Scan showed focal points of ischemic gliosis without any other acute changes that could suggest vascular lesions particularly in the middle cerebral artery territory. The patient was hospitalized in the cerebrovascular disease unit with the diagnosis of ischemic stroke. During her stay at the unit, the patient developed a decreased nasolabial fold prominence on the right side, motor aphasia, dysmetria and a lack of balance while walking. On the fourth day, the patient underwent an MRI that revealed a sub-acute infarction in a partial territory of the left middle cerebral artery with a partially re-canalized thrombus in the inferior M2 branch of this artery. Blood work showed a dyslipidemia. The echocardiogram detected a type 1 diastolic dysfunction with an ejection fraction of 55%. Patient was discharged after 8 days. Currently, the patient is followed in the cerebrovascular diseases department. The neurological evaluation demonstrates aphasia with some impairment of comprehension and naming, the speech has fluency loss showing occasional anomic pauses and paraphasias. Conclusion: The authors alert to the fact that a stroke can present itself in multiple ways, stressing the role of the clinical symptoms in its diagnosis.
Methods of care and non-pharmacological treatment of delirium in elderly patients
Authors: Derkacz-Jedynak Marzanna , Malisz Marta Sudoł , Brodziak Andrzej , Różyk Myrta Alicja
Published: December 2021

The occurrence of delirium in the elderly population is an indication for rapid implementation of adequate treatment. The treatment itself is not focused on administering drugs, but depends on all available knowledge about the patient such as the patient’s medical history, living conditions or communication skills. Delirium is usually a result of the overlapping predispositioning and triggering factors. Prevention is based on eliminating or mitigating the conditions promoting this clinical syndrome. Non-pharmacological treatment includes: avoiding orthostatic and postprandial hypotension, maintaining physical fitness, monitoring mood disorders, especially depressive syndrome and improving cognitive functions. It is crucial to determine and address these factors among patients. Proper, relevant actions need to be implemented. This basic knowledge and appropriate involvement of caregivers (both formal and informal) are necessary to reduce the frequency, duration and severity of delirium, which develops in observed patients. Non-medical caregivers are advised to follow the rules formulated by geriatrists of proceeding with patients in order to minimize the risk of developing delirium.
MYASTHENIA GRAVIS IN YOUNG CHILDREN
Authors: BOWMAN J. ROBERT
Published: December 2021

Three cases of myasthenia gravis occurring in young children have been presented.

All infants and children having ptosis of the eyelids should be given the "prostigmin test."

Myasthenic symptoms and signs were evident at birth in Case I, and this is the first case of congenital myasthenia gravis to be reported in the medical literature.
A FURTHER STATEMENT ON FEDERAL AID FOR PEDIATRIC EDUCATION
Authors:   Committee for the Improvement of Child Health
Published: December 2021

The Executive Board and the Committee for the Improvement of Child Health have proposed this plan as a coordinated, nation-wide effort directed at the heart of the problem, the assurance of a steady and nationally distributed supply of qualified physicians, well trained in a field of great need. They have agreed that the Federal government is the only agency which can be expected to finance and administer a program nation-wide in scope. The plan provides adequate safeguards for the maintenance of complete academic freedom by the medical schools. A National Advisory Council of nine physicians would be in a strategic position to oversee the administration of the law. Acceptance of funds by schools, hospitals and individuals would be entirely voluntary.

There are no startling new avenues opened by this program. The Federal Government contributes 80% of the budget of one medical school, makes grants directly to medical schools for teaching purposes under the provisions of successfully operating programs, and contributes to a number of others through grants and fellowships for research. Among these are 13 pediatric departments which receive direct government grants of some sort. In addition, 27 schools are largely tax supported by funds from states and municipalities.

The principle of an individual receiving a specialized education, in return for which he gives certain years of service is as old as the United States Military and Naval Academies. It is in operation in medicine now in five states and through several foundation grants.

There are advantages to starting such a program in one field only. By doing so it becomes possible to study the problem through the actual operation of a plan which is restricted in cost and scope. If it proves unsatisfactory it can be abandoned without too great dislocation. If it is successful, there can be formulated a more comprehensive plan based on experience which has been gained.
ROUND TABLE DISCUSSION
Authors: GESELL ARNOLD , AMATRUDA CATHERINE S.
Published: December 2021

Chairman Gesell: Custom has it that the Chairman should launch the discussion with an introductory statement. I shall be brief because behavior problems are numerous enough. Besides we propose to divide this session into two parts. At the end of the first half, Dr. Amatruda, who has had an incomparably rich experience with all sorts of infants and children, will make a statement introducing the subject of developmental defects and deviations, Although we shall touch upon a wide variety of problems during the morning, we shall probably not wander very far from the central theme of growth and development.

All children, whether normal, subnormal, atypical, or superior are confronted with the universal problem of development—of growing up. The most serious behavior problems are those which interfere with optimal development, taking as a base line the natural growth potentials of the child. Many problems may seem serious and may be very troublesome, without greatly harming the child's fundamental welfare. The degree of troublesomeness often depends upon the attitude of the parents. This business of growing up applies to the parent as well as the child. She (or he!) may not take a mature grown-up attitude toward the child's conduct. The problem is thereby aggravated or even created. Change the attitude and the problem evaporates—disappears in thin air. In our discussion we shall have to reckon with the parent-child relationship as a clinical reality, as a bundle of symptoms which register the actual state of affairs. Problems cannot always be solved by direct frontal attack. They must be approached peripherally via the parents' psychology. The most magic cures which the pediatrician can effect in the field of behavior disorders may be achieved by altering the parents' philosophy.

Every parent has a philosophy of child care. It may not be formulated in words, but it expresses itself in actions, attitudes, in alibis, in questions, in misgivings, in protests. Even before the child is born the expectant mother may reveal her general outlook, and may profit from a hint or two by way of psychologic orientation to the tasks of parenthood which lie ahead. In fact, this Round Table might give brief consideration to the possibility of prenatal guidance in the primipara, assuming the aid and acquiescence of the obstetrician.
The Rh Factor in the Clinic and the Laboratory. Special Issue No. 2 of Blood,The Journal of Hematology
Authors: ABELSON NEVA M.
Published: December 2021

In November, 1946, an International Hematology and Rh Conference was held in Dallas, Tex-Mexico City. This volume records most of the papers and discussions presented at the conference on subjects pertaining to the Rh factor. Clinicians will be particularly interested in a paper by Chown on variations in erythroblastosis fetalis, a paper by Davidsohn on correlation of Rh antibodies clinical findings, and a paper by Wallerstein on treatment of erythroblastosis fetalis by substitution transfusion. Other reports, such as those on the relationship of the A and B factors to the Rh factor and to erythroblastosis fetalis, and a paper on a possible third order of antibodies, suggest new fields of investigation and techniques of serologic diagnosis.
Blood Derivatives and Substitutes
Authors: PONCHER HENRY G.
Published: December 2021

Since the advent of blood banking in the United States in 1937 vast advances in the preparation, storage and utilization of blood, blood derivatives and substitutes have occurred. The second World War provided additional stimulus for the investigation of the potentialities of these substances. It is therefore appropriate for the authors of this volume to summarize the accumulated knowledge concerning blood derivatives and substitutes as they have long been active in investigations in this field.

The volume is well organized and comprehensive in its scope. From a concise historic discussion the authors proceed to consider the fundamental chemistry and physiology of plasma.
Histopathology of the Ear, Nose and Throat
Authors: PROETZ ARTHUR W.
Published: December 2021

Until the appearance of this volume a study of the histopathology of the ear, nose and throat was largely a matter of searching the library for incidental paragraphs in textbooks and current journals. This first comprehensive volume on the subject is complete and authentic.

While the subject at large may not concern the pediatrician, he will find the description of otitis media, nasal infections and tonsillitis of special interest, as well as a chapter on oral and pharyngeal pathological manifestations of constitutional disease.
FULMINATING MENINGOCOCCEMIA TREATED WITH CORTISONE; USE OF BLOOD EOSINOPHIL COUNT AS A GUIDE TO PROGNOSIS AND TREATMENT
Authors: HODES HORACE L. , MOLOSHOK RALPH E. , MARKOWITZ MILTON
Published: December 2021

The total blood eosinophil count has been studied as an indicator of the adequacy of the adrenocortical response to the stress of acute infection. Marked eosinopenia was found in seven children on the first or second day of acute meningococcal infection of mild or moderate severity and in 18 other patients with rubeola, pneumonia or diphtheria. During convalescence the number of eosinophils in the blood became normal. An eighth patient, who was admitted during the recovery stage of mild meningococcal infection, exhibited a normal count which decreased sharply after the administration of ACTH.

In three patients admitted with fulminating meningococcal infection, an initial eosinophil count of 75/cmm. was found in one and 130/cmm. in the other two. The eosinophil count response to the administration of ACTH did not return to normal until the third week in Case 2. These findings lend support to the belief that adrenal cortical function may be impaired in patients with overwhelming meningococcal infection.

Cortisone was employed in addition to usual forms of therapy in the treatment of three children with fulminating meningococcemia. One patient died shortly after admission and the other two patients survived. It is believed that cortisone was of value in these latter two cases and that one of these patients would have certainly succumbed without its use. Cortisone may prove to be of value in the treatment of fulminating meningococcal infection because it is much more potent in overcoming stress than previously employed adrenal extracts. It is suggested that the circulating eosinophil count may be of value as a guide in the prognosis and treatment of meningococcal infections.
HYDROCOLPOS IN INFANCY AND CHILDHOOD
Authors: ANTELL LEON
Published: December 2021

A case of hydrocolpos in an infant 6 days of age is reported with a review of the literature. A new feature, consisting of areas of ecchymosis of the skin, is added. The source and nature of the fluid, as well as the pathology, method of diagnosis, prognosis and treatment of the condition are discussed.
CAT SCRATCH SYNDROME
Authors: WATERS WILLIAM J. , KALTER SEYMOUR S. , PRIOR JOHN T.
Published: December 2021

The clinical, laboratory and pathologic findings of a series of cases of cat scratch syndrome have been reviewed. In spite of a variable clinical course, certain features associated with a selected group of laboratory tests appear to be constant enough to be of diagnostic value.

A history of contact with a cat and/or scratch which is usually associated with a peripheral skin lesion, lack of lymphangitis, presence of regional lymphadenopathy with tenderness to palpation are the most constant clinical findings. Fever, so frequently emphasized as a characteristic clinical sign, may be extremely variable in type and duration or entirely absent. A skin test with cat scratch antigen has been positive in all cases. Lacking this antigen, a negative Frei skin test in conjunction with a positive complement fixation test (Lygranum C. F.) is suggestive evidence for the diagnosis.

With positive evidence from the above data, biopsy of an affected gland with its relatively nonspecific pathologic picture is not considered essential for the establishment of the diagnosis of cat scratch syndrome.
THE PRESIDENT'S PAGE
Authors: QUILLIAN WARREN W.
Published: December 2021

WITHIN the past few years American medicine has made tremendous strides in prestige and influence. The Academy has contributed its part to this advance. But, progress has not been gained by accident. Behind the scenes in organized medicine are many conscientious and tireless workers who, by their enthusiasm and consecrated effort, are accomplishing the tasks with which they are confronted. Committee members are often unsung heroes in the solution of problems pertaining to the furtherance of more adequate medical care for children. The individual Academy member occasionally forgets how much so many of us owe to so few in the practical application of our ideals.

For example, those of you who attended the Annual Meeting at Toronto last fall heard the panel discussion on Pediatric Education; and saw the exhibit, describing some of the aims and objectives of our Committee on Medical Education. Under the inspired leadership of the Chairman, Dr. Lee F. Hill, this group is making progress in attempting to answer some of the questions posed by the Academy Survey of 1946-48. During the current year, continuation of regional conferences throughout the United States and Canada, with emphasis upon the problems of undergraduate education, has resulted in an intelligent exchange of ideas and an opportunity for discussion unparalleled in the history of North American medical schools. The inevitable result of these discussions will be an improvement of standards for medical education. Interpretation and evaluation of new ideas, inclusion of practical and progressive concepts for the betterment of medical school curricula, requires a great deal of time and effort.
Pediatric Residency Training in An Era of Managed Care: An Introduction to Proceedings of a National Conference
Authors: Finkelstein Jonathan A.
Published: December 2021

On May 4, 1996, a conference sponsored jointly by the Division of Medicine of the Health Resources and Services Administration and the Ambulatory Pediatric Association brought together pediatric educators from academic medical centers and managed care organizations to address the challenges and opportunities for pediatric residency training, given current trends toward increasing managed care for children. This supplement is designed to bring the issues discussed there to a broader audience of pediatricians and educators. The contributions are written by the participants of that conference, with invited commentaries to add additional perspectives on each topic. The papers were reviewed by an editorial board of leaders in pediatric education with experience in relevant areas. This introduction describes the impetus for the conference and highlights a number of critical issues facing pediatric postgraduate training that are presented in greater depth in the contributions that follow. Finally, this paper summarizes the recommendations of the conference for meeting the challenges of training pediatricians in these areas.
Developing Models for Pediatric Residency Training in Managed Care Settings
Authors: Devries Jeffrey M. , Berkelhamer Jay E. , Molteni Richard A. , Edwards Karen S. , Kachur Elizabeth K.
Published: December 2021

The preparation of pediatric residents to function optimally in managed care environments challenges educators to create a new set of educational objectives and competencies and to incorporate these into curricula that are already full. Many of the skills needed to practice managed care are those that have been required for the practice of pediatrics in any setting. Nevertheless, the emergence of managed care requires the identification of new knowledge to be acquired and new skills and attitudes to be incorporated into daily practice. These competencies can be identified most thoroughly through collaboration among physicians, educators, and leaders of managed care organizations. This joint effort should also serve to establish a foundation on which collaborative, mutually beneficial learning environments can be created. The development of curricula that provide the opportunities needed to attain managed care proficiencies requires an individualized approach for each program that takes into account the degree of managed care penetration in each training environment. Programs in which a managed care approach to patient care predominates will be able to promote most easily their trainees' incorporation of these principles into routine practice. Those with less regular exposure will be forced either to promote managed care principles in an environment in which they may not be accepted or practiced, or to join in partnership with managed care organizations (MCOs) to train residents. Regardless of the setting, evaluation methodologies must be developed to ensure that each of the core competencies has been learned, can be applied to clinical situations, and is retained throughout the training period.

These efforts require the development of faculty who understand and can model a managed care approach to patient management. The ongoing evolution of managed care systems encourages the development of new, creative strategies to train faculty, who may find themselves learning about this emerging environment at the same time as are their trainees.
Continuous Improvement Learning for Residents
Authors: Headrick Linda A. , Richardson Amy , Priebe Gregory P.
Published: December 2021

Physicians must be ready to assume an active role in the design, implementation, and improvement of emerging models of health care delivery. Knowledge and skill in continuous improvement prepare them to engage seriously in the processes of change, on the basis of the same scientific principles they always have relied on in the use of evidence to improve outcomes. This includes include the ability to 1) identify the health needs of the individuals and communities for which they provide health services; 2) assess the impact of current practice with appropriate outcome measures; 3) discover what in the process of health care may be contributing to less than desired outcomes; 4) design and test interventions to change the process of care to improve outcomes; 5) act as an effective member of the interdisciplinary team required to complete these tasks; and 6) consider ethical principles and professional values when making decisions about change in health services delivery. Graduate medical education presents special opportunities and challenges for learning about continuous improvement. Early experiences at Rainbow Babies and Children's Hospital in Cleveland and Children's Hospital in Boston suggest how we might prepare pediatricians and other physicians to create positive change and continually improve health care.
General Pediatric Teaching Clinics and Managed Care
Authors: Badgett J. Thomas
Published: December 2021

Academic general pediatric divisions can function as effective primary care providers in a managed care environment. Residents training in these programs are expected to be better equipped to enter a work environment that is increasingly structured in a managed care format. Positive and negative consequences of managed care in an academic setting are discussed. Recommendations for successful implementation of resident training in the world of managed care are shared.
The Impact of Graduate Medical Education Financing Policies on Pediatric Residency Training
Authors: Bazell Carol , Salsberg Edward
Published: December 2021

Objective. To review special issues related to pediatric residency training in managed care organizations, the effects of the changing health care system on the demand for pediatricians and the potential impact on financial support for residency training, current methods of financing graduate medical education (GME), possible future approaches to financing GME, and policy directions to support training of pediatricians well prepared for future practice.

Methods. We reviewed current information on residency education in managed care settings, including the rationale for training in such settings and the realities of such educational experiences. We then assessed the evidence concerning the supply and demand for pediatricians in the present health care marketplace, with its evolution to managed systems of health care. We summarized current approaches to financing GME through Medicare, Medicaid, private insurers and purchasers, and direct federal and state support, with emphasis on the financing of ambulatory training which could occur in managed care settings. Lastly, we described factors influencing the upcoming revolution in GME financing and outlined possible new policy directions for the financing of relevant GME training experiences.

Results. Appropriate training experiences in managed care organizations may be a valuable strategy to address the current disconnect between the traditional hospital-based education of pediatricians and the expanded competencies necessary to practice in intensively managed, integrated and accountable health systems. Present pediatrician supply appears to be in relative balance with health maintenance organization staffing patterns and with needs-based requirements estimates. However, the pediatrician-to-child population ratio is predicted to increase rapidly over the next decade, leading to an oversupply of pediatricians under likely future health care delivery system scenarios. Medicare is the largest explicit payer of GME training costs, historically directing reimbursement primarily for hospital-based education. Numerous innovative financing strategies are being considered to facilitate funding of GME training in ambulatory settings and to open up funding to greater public scrutiny and accountability.

Conclusions. Although reforms in federal GME financing have been limited to date and other significant changes have been largely state-based, it is likely in the future that explicit funds will be targeted to specialties in demand that prepare physicians well for future practice. Pediatricians and medical educators must intensify their voices in the financing debate to ensure a productive future for quality pediatric residency training.
Evaluation of the Community Access to Child Health Program
Authors: Minkovitz Cynthia , Grason Holly , Aliza Barbara , Hutchins Vince , Rojas-Smith Lucia , MD Bernard Guyer
Published: December 2021

Objective.

Increasing attention is being focused on the need for pediatricians to promote child health in their respective communities. The objective of this study was to evaluate, retrospectively, the American Academy of Pediatrics' Community Access to Child Health (CATCH) Program.

Study Design.

Case studies of 12 Community Pediatric projects in existence from 1989 to 1995 with varying degrees of involvement in the CATCH Program. In-person interviews were conducted with 17 pediatricians, 3 CATCH leaders who were not pediatricians, 27 project advisory committee members, 42 project staff, 47 community partners, 22 public health representatives, and personnel in 13 affiliated institutions.

Results.

These projects established or enhanced child health services. Although most pediatricians' interest in community child health preceded CATCH, mentoring, training, and peer support contributed to ongoing involvement. Community factors that facilitated project development included historical collaborative efforts and active public health agencies. However, across sites, significant barriers related to attitude and resource limitations were noted. Attitudinal barriers included both institutional concerns (eg, competition among providers or distrust among community agencies and organizations) and cultural concerns (eg, general negative perceptions of providers about Medicaid beneficiaries or of members of minority population toward medical or government establishments).

Conclusions.

In an era of devolution of responsibility to local communities, there are likely to be more opportunities for pediatricians to work with community members to promote child health. Specific strategies should be refined and expanded to support pediatricians' involvement in community-based activities, particularly because it is recognized that insurance alone will not guarantee children's health.
Combined Use of Growth Hormone and Gonadotropin-releasing Hormone Analogues in Precocious Puberty: Theoretic and Practical Considerations
Authors: Walvoord Emily C. , Pescovitz Ora Hirsch
Published: December 2021

The rationale underlying the use of gonadotropin-releasing hormone analogues (GnRHa) to treat patients with central precocious puberty is reviewed. GnRHa are now considered the treatment of choice for patients with central precocious puberty, but the adult heights that these patients attain often fall short of what would be expected according to their genetic potential. This has led to investigations of whether adding growth hormone to GnRHa therapy can improve adult height. The results of recent combination trials are presented and analyzed.
The Physiology of Pigmented Nevi
Authors: Kincannon Jay , Boutzale Christine
Published: December 2021

Melanocytes are pigment-producing cells derived from the neural crest. These specialized exocrine cells produce melanin, which is packaged and dispersed to neighboring keratinocytes in organelles called melanosomes. Within the melanocyte, tyrosine is converted to dopa, and then dopaquinone via the bifunctional enzyme tyrosinase. Dopaquinone is oxidized further to form the pigment melanin. Each epidermal melanocyte secretes melanosomes to approximately 36 adjacent keratinocytes, forming an epidermal melanin unit. Genetically programmed constitutive skin color is determined by the amount of cutaneous melanin pigmentation.

The common mole or acquired melanocytic nevus (AMN) is a collection of nevomelanocytes grouped into nests located in the epidermis (junctional nevus), dermis (dermal nevus), or both (compound nevus). It is hypothesized that nevomelanocytes are derived from either epidermal melanoblasts or dermal Schwann cells. AMN first appear at ∼1 year of age, peaking in number during the second or third decades of life, and disappearing by the seventh to ninth decades. AMN may appear suddenly or become more prominent in response to sun exposure, cortisone and corticotropin, blistering diseases, chemotherapy, immunosuppression, and other factors that are not well-defined. Reports of AMN increasing in size and darkening in color during puberty and pregnancy have been reported but not quantitated systematically.melanocytes, keratinocytes, acquired melanocytic nevi.
THIRD-GENERATION SYPHILIS
Authors: WRIGHT PHYLLIS M. , INOUE TETSU JI
Published: December 2021

A family study tracing a syphilitic infection from grandparents to mother to infant is presented. Data are presented which fulfill the rigid criteria necessary for diagnosis of a case of third-generation syphilis.
REPORT OF THREE CASES OF IDIOPATHIC FAMILIAL HYPERLIPEMIA: USE OF ACTH AND CORTISONE
Authors: GASKINS ALBERT L. , SCOTT ROLAND B. , KESSLER ALTHEA D.
Published: December 2021

Three cases of idiopathic hyperlipemia with associated sicklemia in siblings are reported. One case was treated with ACTH and one with cortisone neither of which had any apparent lasting effect upon the disease.
PUBLIC HEALTH ASPECTS OF PROBLEMS OF CURRENT INTEREST IN NEONATAL PEDIATRICS
Authors: BAUMGARTNER LEONA
Published: December 2021

The salient facts regarding fetal, neonatal and infant mortality in the United States are presented, using the most recent national figures available, or those from other large population groups. A plea is made for the use of perinatal mortality rates in order to obtain a better picture of the success of current programs designed to reduce infant loss.

Six areas for future attack are suggested: 1. Development of several research institutes to study the problems of human reproduction from a multidiscipline approach.

2. An organized program to raise standards of care in all lying-in hospitals with particular emphasis on activities which can be carried on by nurses and doctors at the local level.

3. Further experimentation with and development of ways to supply better service or pay for medical care for certain groups. More attention could be paid to regional plans whereby services of large medical centers are brought to smaller, less well cared for areas; to hospitalizing women with previous history of or current complications of pregnancy, including labor; to providing expert pediatric and obstetric consultation more freely, to supplementing the prenatal diet, et cetera.

4. Acceleration of activities which bring about closer cooperation between obstetric and pediatric services with full cooperation of general practitioners, nurses, nutritionists and all those involved in the care of mother and baby. More local studies of neonatal deaths with the studies used as the basis for community action and professional education.

5. Development of better prenatal service for all mothers in the local community.

6. Continued experimentation with methods of solving the many social problems created by the low economic and social status of those families which contribute so heavily to fetal and neonatal mortality rates today.
SYNDROME OF CONGENITAL HEMIHYPERTROPHY, SHORTNESS OF STATURE, AND ELEVATED URINARY GONADOTROPINS
Authors: SILVER HENRY K. , KIYASU WILLIAM , GEORGE JACK , DEAMER WILLIAM C.
Published: December 2021

Two cases of a syndrome of hemihypertrophy, shortness of stature, and elevated levels of urinary gonadotropins are reported. One of the children was a male, the other a female.

The hemihypertrophy and shortness of stature had been present since birth and the elevated gonadotropins were found at 5½ and 6 years, respectively.

The possible relationship to other conditions in childhood including those which also have increased gonadotropins is discussed.
STUDIES OF THE IMMUNOLOGY OF THE NEWBORN INFANT
Authors: DANCIS JOSEPH , OSBORN JOHN J. , JULIA JUAN F.
Published: December 2021

Two groups of 10 infants each were maintained on isocaloric milk formulas in which the protein content differed. One group received a milk formula containing 2.0% protein providing approximately protein 3 gm/kg. body weight; and the other group received a formula containing 3.6% protein providing approximately 5½ gm/kg. body weight. Both groups were immunized with diphtheria toxoid and the antitoxin response measured.

No difference in the antitoxin response between the two groups was seen.

This suggests that a high level of milk protein in the diet does not measurably improve the ability to produce antibodies.
PERSISTENCE AND DISTRIBUTION OF TOXOCARA LARVAE IN THE TISSUES OF CHILDREN AND MICE
Authors: SMITH MARGARET H. D. , BEAVER PAUL C.
Published: December 2021

Two young mentally defective children were infected with a small number of embryonated eggs of the dog ascarid, Toxocara canis. They remained asymptomatic clinically but developed eosinophilia which persisted for more than 13 months.

Tissues from mice infected experimentally with the same dose of dog ascarid eggs were examined at intervals up to one year after infection. In the early stages of infection the larvae were found principally in the liver and lungs, but in the later stages they were most numerous in the brain.

It seems not improbable that some of the neurologic manifestations associated with ascariasis may be due to actual presence of Toxocara larvae in the tissues of the central nervous system, rather than to toxic or allergic effects of Ascaris lumbricoides.

This new evidence, added to previous observations on the effect of dog and cat ascarids in children, re-emphasizes the need for ridding household pets of their intestinal parasites at frequent intervals.
CONGENITAL MALFORMATIONS AND BIRTH INJURIES IN NEW YORK CITY
Authors: WALLACE HELEN M. , BAUMGARTNER LEONA , RICH HERBERT
Published: December 2021

1. In 1951, a total of 1,501 children was reported to have been born alive with one or more congenital malformations, an over-all reported incidence of 9.2 per 1,000 live births.

a. Two-thirds of the babies were delivered by a private physician in a hospital, and one-third on a ward service in a hospital. The incidence in the two groups and in white and nonwhite babies was approximately the same. However, the incidence in babies weighing less than 2,500 gm. was twice that in those babies weighing more.

b. Club foot, dactylism, cleft palate and/or harelip, and hypospadias were the most frequent types of congenital malformations reported, accounting for 78% of the total.

c. There were 128 babies reported with cleft palate and/or harelip, an over-all incidence of 0.79 per 1,000 live births.

d. The effect on neonatal mortality is presented.

2. In 195 1 a total of 377 children was reported to have been born alive with one or more birth injuries, an over-all reported incidence of 2.3 per 1,000 live births. One half were reported with severe birth injury. The reported incidence was the same regardless of type of patient (private or ward service), color, or birth weight.

3. The 1951 data for New York City are compared with similar data for upstate New York for 1940-1942. The over-all incidence in reported congenital malformations in the two groups is similar, although some differences occurred in the frequency of individual malformations. The over-all incidence of reported birth injury in upstate New York was more than three times that in New York City; the incidence of each type of birth injury was higher in the upstate group.

4. The use of such data in planning services for these children in a community is discussed.
RELATIONSHIP BETWEEN THE HEMOGRAM OF THE INFANT AND THAT OF THE MOTHER DURING PREGNANCY
Authors: WOODRUFF CALVIN W. , BRIDGEFORTH EDWIN B.
Published: December 2021

In the absence of maternal iron deficiency, maternal hemoglobin concentration is not related to the development of iron deficiency anemia in infancy.
STUDIES OF IRON REQUIREMENTS IN INFANTS AND CHILDREN
Authors: STURGEON PHILLIP
Published: December 2021

On an average the newborn infant serum compared to the normal adult male is hyperferremic (S.I. 193 µg./100 cc.), hypocupremic (S.C.51µg./100 cc.), and his free erythrocyte protoporphyrin is increased about two-fold (E.P. 55 µg./100 cc.). His total serum iron-binding capacity appears to be 50% or more saturated.

At 12 hours of age marked hypoferremia (S.I. 46 µg./100 cc.) is present and the total iron-binding capacity as measured in this study is 100% saturated. There is slight, if any, change in the serum copper or erythrocyte protoporphyrin during the first few hours or days of life.

From two weeks through one month of age an essentially normal pattern is present except for the slightly elevated (two-fold) protoporphyrin.

By 4 to 10 months of age, on an average, the normal infant has the pattern characteristic of infancy, namely, hypoferremia (S.I., 50 µ. g/100 cc.), hypercupremia (S.C., 146 µg./100 cc.), reduced saturation of the total serum iron-binding capacity (12%) and elevated free erythrocyte protoporphyrin (E.P., 70 µg./100 cc.).

Extreme ranges in values are found in different individuals at most ages.

The suggested explanation for these findings is that on an average, the normal infant relative to the adult is totally depleted of his iron reserve and that his state of "physiologic anemia" constitutes an additional, but lesser, iron deficit.
FACTORS INVOLVED IN THE PRODUCTION OF ALVEOLAR RUPTURE WITH MECHANICAL AIDS TO RESPIRATION
Authors: WILSON JAMES L.
Published: December 2021

The amount of alveolar rupture and hemorrhage resulting from artificial respiration tion is dependent not only upon the degree of pressure and the time it is applied but also on the proportion of total lung volume that is expansible. The danger of such rupture is greater for a given pressure change, the greater the amount of unexpansible lung. The amount of atelectasis, pulmonary congestion or obstruction that prevents expansion of lung is clinically not quantitatively measurable, so that no exact rule for time and pressures can be established that will be completely safe.
EFFECT OF ADDED CARBOHYDRATE ON GROWTH, NITROGEN RETENTION AND RENAL WATER EXCRETION IN PREMATURE INFANTS
Authors: CALCAGNO PHILIP L. , RUBIN MITCHELL I.
Published: December 2021

With added carbohydrate in the formula during these short balance periods, there resulted a better weight gain, while on both a constant nitrogen intake and with a 19% reduction in dietary protein intake.

Nitrogen retention in these premature infants was greater both when the nitrogen intake was greater and when the total calories, as carbohydrates, were greater. Similar changes occurred in sodium and potassium retentions.

Infants fed "added carbohydrate" had a lower BUN level and a decreased urinary excretion of urea, sodium and potassium. Thus the kidney was presented with a lower total osmolar load for excretion.

The urine concentration on the various diets is a simple reflection of the load demanding excretion and the available expendable water. In the presence of a limited renal concentrating capacity, as is seen in the premature infant, and with suboptimal fluid intakes, a diet offering a smaller load for renal excretion would seem desirable.
BILIRUBIN ENCEPHALOPATHY
Authors: WATERS WILLIAM J. , RICHERT DAN A. , RAWSON HELEN H.
Published: December 2021

Peripheral blood specimens from cases of varying degree of clinical severity of hemolytic disease of the newborn infant have been examined spectrophotometrically and a curve consistent with the presence of bilirubin was found in each case.

Extracts of the pigmented brain areas from five cases of hemolytic disease of the newborn infant, who died with clinical signs of brain damage, were examined spectrophotometrically and in each intance a curve consistent with bilirubin was obtained. An extract from comparable sections of brain not appearing grossly pigmented contained essentially no such pigment when examined spectrophotometrically.

Crystals were obtained from a chloroform extract of pigmented brain areas and when re-dissolved showed a typical type curve for bilirubin.

A positive van den Bergh was obtained on the extract solution.
RELATION BETWEEN SERUM TOCOPHEROL AND HEMOLYSIS IN HYDROGEN PEROXIDE OF ERYTHROCYTES IN PREMATURE INFANTS
Authors: MACKENZIE JULIA B.
Published: December 2021

The low serum tocopherol which is characteristic of premature infants fed partially-skimmed milk mixtures is invariably associated with some degree of hemolysis of the red blood cells after exposure to H2O2 in vitro. Wide fluctuations occur in the degree of hemolysis (9 to 98%) despite the constant low values found for serum tocopherol (0.2 mg./100 cc.). The administration of small daily doses of vitamin E increases the amount of blood tocopherol (approximately 0.5 mg./100 cc.) to a level where no hemolysis of the red cell occurs.

Thus, it appears that in premature infants a critical level of serum tocopherol exists, above which complete protection against hemolysis is achieved, and below which there is invariably some susceptibility of the erythrocyte to the hemolytic action of hydrogen peroxide.
AN INQUIRY INTO THE ETIOLOGY OF ACUTE BRONCHIOLITIS OF INFANTS
Authors: WOOD SARAH H. , BUDDINGH G. JOHN , ABBERGER BENJAMIN F.
Published: December 2021

Tracheal aspirates and nasopharyngeal swabs obtained from 51 infants under 2 years of age with acute bronchiolitis were subjected to a careful bacteriologic study. The cases in this series were encountered during the 13 month period from November 1, 1951, to December 1, 1952.

H. influenzae was recovered from 36 of the 51 infants. Of these, 26 proved to be H. influenzae type a and 6 proved to be H. influenzae type b. The four remaining were rough untypable strains.

An increase in type specific antibody measured by a slide agglutination technic and by the Quellung reaction could be demonstrated in 46 infants. No increase in antibody titer could be demonstrated in 5. An increase in antibody titer to H. influenzae type a was demonstrated in 37 and to H. influenzae type b in 9 of the series.

Combined bacteriologic and serologic evidence indicating that H. influenzae type a was involved in the infectious process was obtained in 26 cases. An increase in antibody titer to type a only was demonstrated in 11 others. In two from whom rough nontypable strains were isolated, an increase in titer to type a was demonstrated. Evidence for infection with type a was thus obtained in 37 of the 51 infants. From 2 infants H. influenzae type a was recovered but no increase in antibody titer could be demonstrated.

Combined bacteriologic and serologic evidence for infection with H. influenzae type b was obtained in 5 infants. An increase in titer to type b was demonstrated in 2 others. A titer increase to type b was demonstrated in 2 more from whom rough untypable strains were isolated. Evidence for infection with type b was thus obtained in 9 of the 51 infants. H. influenzae type b without evidence of titer increase was obtained in one.

No H. influenzae were isolated nor could an increase in antibody titer be demonstrated in the remaining 2 infants of the series.

Cold hemagglutinin reactions were negative in 36 pairs of sera tested. No increase in antihemagglutinating titer to influenza virus A or B could be detected in 46 paired sera. A fourfold, but not greater, increase in antihemagglutination titer to influenza virus C was detected in 5 patients of the series.

Reversion of rough untypable H. influenzae to smooth specifically typable strains was achieved by culturing the micro-organisms in chick embryos infected with influenza virus type A.

It is postulated that H. influenzae types a and b must be strongly considered as participating in the pathogenesis of acute bronchiolitis of early infancy. Whether other bacterial or viral agents alone or a combination of bacteria and viruses can be implicated in the etiology of this disease must be determined by further investigation.
THE TRANSMISSION OF INFECTIONS
Authors: SMITH MARGARET H. D.
Published: December 2021

IN CASTING about for a topic which would be interesting enough to express to the Academy and to Mead Johnson my gratitude and pleasure at receiving this award, I hit an unsurmountable snag. I was reminded of the situation which often arises when a large party of people set forth for a climb in the mountains: the more energetic members head for the summit by the shortest route, making use of even the rockiest shortcuts; once up, they rest a bit, survey the horizon and then slither down in a matter of minutes, prepared to give to the stay-at-homes a concise description of the expedition. But there are apt to be a few in the party who mosey along, picking blueberries and looking at the view; they are likely to lose themselves along the way and never reach the the summit; on returning home they seem quite content, but are unable to give anyone else a very clear picture of where they have been. Dr. Wilkins and Doctors Robbins and Weller belong in the first category and I, unfortunately for this occasion, in the second. Rather than applying myself to the study of one problem I seem to have meandered among several. So instead of presenting an exact account of each, I shall try to relate some of the ideas which have come to mind along the way.

During the war we were deluged week after week with problems of the most practical sort concerning the management of patients with meningitis, severe diphtheria, croup, rubeola, encephalitis, pertussis, poliomyelitis and so on. And the peacetime experience at the Charity Hospital in New Orleans differs little, in many respects, from wartime experience elsewhere.
HETEROTOPIC ORIGIN OF BOTH CORONARY ARTERIES FROM THE PULMONARY ARTERY
Authors: TEDESCHI C. G. , HELPERN M. M.
Published: December 2021

The case is presented of a 13 day old white female infant who at autopsy revealed heterotopic origin of both coronary arteries from the pulmonary artery. The anomaly was not complicated by associated defects. The literature on the subject, including four comparable cases, is reviewed.