bluuebunny/crossref_metadata_2025 huggingface dataset:
CHRONIC FAMILIAL NONSPHEROCYTIC HEMOLYTIC ANEMIA
Authors: LIPTON EARLE L. , GROSSMAN HERBERT J. , RICHMOND JULIUS B.
Published: December 2021

The authors have presented the problems in the diagnosis of an obscure anemia in two sisters which was apparently present at birth. The mechanism could not be established during the initial period of observation. Re-investigation revealed a nonspherocytic, familial, probably hereditary and possibly sex-linked hemolytic anemia.

These cases do not fit into any known specific category and are compared with other nonspherocytic hemolytic anemias recorded in the literature. It is suggested that other cases considered to be hypoplastic or aregenerative anemias be re-investigated to exclude the possibility of a hemolytic component.
RENAL RESPONSE OF PREMATURE INFANTS TO ADMINISTRATION OF BICARBONATE AND POTASSIUM
Authors: TUDVAD FOLKE , MCNAMARA HELEN , BARNETT HENRY L.
Published: December 2021

THE OBSERVATIONS to be described were undertaken in an attempt to answer the following questions: 1. Does renal immaturity play a role in the "physiologic" acidosis of the premature infant? 2. Can this acidosis be corrected by the administration of bicarbonate? 3. Is the premature infant able to excrete potassium as readily as the adult? The answers to these questions possess both physiologic and clinical interest.

The acidosis of the premature infant has been attributed to increased production of organic acids. However, immaturity of renal functions involving hydrogen ion excretion could be responsible for failure of the infant to correct the acidosis completely. In addition, a decreased maximum rate of tubular reabsorption of bicarbonate due to decreased hydrogen ion excretion would in itself result in a continuous drain on bicarbonate stores.

In regard to the second question, it is generally agreed that correction of the "physiologic" acidosis of the premature infant is not indicated. However, further knowledge may reveal circumstances where it is desirable to increase serum bicarbonate. If so, it would be of clinical importance to known whether the serum bicarbonate concentration of the premature infant can be raised to normal adult values by the administration of bicarbonate. If the maximum rate of tubular reabsorption of bicarbonate is decreased, bicarbonate administration would result not in increased serum bicarbonate concentrations but only in increased rate of excretion.

The third question has very clear clinical application. Safe treatment of potassium deficiency by the administration of potassium is dependent in large part upon the ability of the kidney to excrete potassium rapidly.
DIAGNOSIS AND PROGNOSIS OF HYPSARHYTHMIA AND INFANTILE SPASMS
Authors: GIBBS E. L. , FLEMING MARILYN M. , GIBBS FREDERIC A.
Published: December 2021

In the course of electroencephalographic studies on patients with epilepsy an abnormal pattern has been found that is peculiar to infants and young children. It occurs in patients with brief quivering spells, myoclonic jerks or spasms.1 This pattern (chart 1) has been called hypsarhythmia (mountainous arhythmia) and the clinical state with which it is associated is referred to as infantile spasms.

The present report is based on 237 cases with hypsarhythmia and infantile spasms. For the most part this group is made up of patients who were referred for electroencephalographic study by private physicians in the Chicago area; a few came from the Department of Pediatrics at the University of Illinois School of Medicine; 60% were males and 40% were females. On referral they bore such diagnostic labels as "colic," "petit mal epilepsy," "myoclonia," "spasms nutans" and "spasmophilia."
TRACHEOTOMY IN INFANCY
Authors: BIGLER JOHN A. , HOLINGER PAUL H. , JOHNSTON KENNETH C , SCHILLER FILMORE
Published: December 2021

The incidence of tracheotomy in infants under one year of age is increasing due to a broadening of indications, greater acceptance of tracheotomy as an adjunct to other therapy and a lower mortality through improvements in surgical technic and in the postoperative care of tracheotomized infants.

Tracheotomy for inflammatory lesions is decreasing, but the incidence of tracheotomy for congenital and miscellaneous lesions is increasing.

Of 62 infants under one year of age who required tracheotomy, congenital lesions were considered the cause of the respiratory obstruction in 32 cases (15 males and 17 females) and acquired lesions in 30 (21 males and 9 females). In 8 of the 30 infants in the "acquired" group congenital anomalies were indirectly responsible for the tracheotomy, since it was necessitated following extensive surgical procedures performed in an attempt to correct gross anomalies of organs other than those of the respiratory system.

There were 17 deaths in the series of 62 cases. Eight occurred in the miscellaneous group, principally those operated on for gross anomalies of other organs, 3 in the group of 17 congenital laryngeal anomalies, 4 in the group of 18 inflammatory lesions and 2 in the group of 8 neoplasms.

Tracheotomy is generally looked upon as an emergency life-saving procedure. However, in most cases it can be a planned, careful operation, preceded by the establishment of an airway to avoid cerebral and surgical trauma. The post-tracheotomy period is the critical period during infancy.
TOTAL BODY CHLORIDE OF CHILDREN IN POTASSIUM DEFICIENCY AND UNDER CIRCUMSTANCES OF POOR NUTRITION
Authors: CHEEK DONALD B.
Published: December 2021

(1) The distribution of bromide has been used to measure total body chloride in children of poor nutritional status and in circumstances of potassium deficiency.

(2) In malnutrition there is an increase of extracellular water and of tissue chloride, per unit weight.

(3) One patient with fibrocystic disease revealed a deficit of body chloride during heat stress.

(4) Children with chronic gastro enteritis and potassium deficiency receiving only glucose and saline tend to develop chloride and water retention in the extracellular compartment. It is not known whether potassium deficiency per se is causally related to this finding.

(5) Deficits of extracellular sodium and of chloride have been revealed in four cases of hypotonic dehydration with cell potassium deficiency. Presumptive evidence only of potassium loss was presented in one case of pyloric stenosis, but conclusive proof was offered in the investigation of a child with acrodynia.
SIMPLE OVARIAN CYST IN A NEWBORN INFANT
Authors: SMITH RICHARD C.
Published: December 2021

A case of a simple serous cyst of the ovary in a newborn is presented. This is believed to be the fifth such case in the literature. A short review of the pertinent literature is discussed.
A FATAL CASE OF POLIOMYELITIS IN A NEWBORN INFANT DELIVERED BY CESAREAN SECTION FOLLOWING MATERNAL DEATH DUE TO POLIOMYELITIS
Authors: SWARTS CHARLES L. , KERCHER ERVIN F.
Published: December 2021

A fatal case of poliomyelitis in a newborn is reported. The case is important as the infant was delivered by cesarean section within a few minutes after maternal death due to acute poliomyelitis. The same immunological strain of poliomyelitis virus was isolated from both infant and mother.

While positive proof is not offered, this case plus a review of the literature offers strong evidence that transplacental transfer of the poliomyelitis virus can occur.
EDUCATION
Authors: SOLNIT ALBERT J. , SENN MILTON J. E.
Published: December 2021

1. The out-patient clinic is the most valuable place for the physician to learn how comprehensive pediatrics can be mastered in his every-day office and home-visit practice. It is also the logical place to teach the relationship of community resources to pediatric practice.

2. Comprehensive medical care of the child is defined as the prevention and treatment of physical disease, and the supervision of healthy growth and development, physical and psychological. Through his comprehension of physical, psychological and social forces that influence the child, the pediatrician enables the child and his family to take an active role in solving their health problem.

3. The interview should serve as a basic instrument of diagnosis and treatment. It should be flexible, and enable the patient to express fears, anticipations and questions about his symptoms. It should be practical in length of time and sequence, depending on the patient's symptoms and his reactions to being examined by the doctor.

4. The attitudes necessary for the practice of pediatrics are best acquired by the student through the demonstrations of his teachers and through his professional identification with them.

5. When pediatric teaching is focussed on the patient as a person, a student learns that:

a) Every patient is an interesting person. It can be as satisfying and important to care for a six-week-old infant who is well or a child who is going to camp, as one who suffers from a rare disease.

b) There is no such thing as a non-contributory family history. It is necessary to know the meaning that complaints or questions have for the mother and the child. This can only be obtained through the physician's expressed interest in both, and in his patient attitude and willingness to listen to what both have to tell him.

c) The physician is faced with a patient (child) who is extremely dependent on parents or parental figures. The parents and child form a unit. It is the pediatrician's goal to help improve the health of the child by understanding the child's position in the unit. He should utilize the assets of this unit for the child and parents.

d) His interest in and acceptance of the patient results in more effective diagnosis and treatment. This attitude develops gradually when adequate supervision is available.
A FAT ABSORPTION TEST USING IODIZED OIL, WITH PARTICULAR APPLICATION AS A SCREENING TEST IN THE DIAGNOSIS OF FIBROCYSTIC DISEASE OF THE PANCREAS
Authors: Silverman Frederic N. , Shirky Harry C.
Published: December 2021

A test is described for the evaluation of pancreatic function, particularly with respect to fat absorption, in fibrocystic disease of the pancreas. This test depends upon the fact that iodized fat (Lipiodol®) is digested and absorbed by normal children and the iodine is subsequently excreted in the urine in high concentration; whereas, in children with fibrocystic disease of the pancreas, the digestion of iodized fat is impaired and the amount of iodine excreted in the urine is greatly diminished. The test is a simple one, quantitation being accomplished by serial dilution of the urine; and the qualitative aspect is limited to a positive or a negative reaction for iodine with starch solution. Under the conditions used no proved case of fibrocystic disease of the pancreas has had a positive test for iodine in the urine in a dilution of greater than 1:2. A positive test for iodine after the ingestion of Lipiodol®, in a dilution of urine of 1:4 or greater, probably excludes fibrocystic disease of the pancreas as a diagnosis. Disturbed fat absorption from causes other than fibrocystic disease of the pancreas may also result in negative test, so that the test is better suited for exclusion than for final identification of fibrocystic disease of the pancreas.
SURGICAL JAUNDICE IN INFANCY
Authors: Kiesewetter William B. , Koop C. Everett , Farquahr John D.
Published: December 2021

Forty cases of surgical jaundice in the newborn and infancy period have been reviewed from which the following conclusions seem justified:

1. The predominant cause is atresia of the biliary ducts, either extrahepatic or intrahepatic.

2. The only liver function test of use in differentiating hepato-cellular jaundice from obstructive jaundice is the total bilirubin which declines or is irregular in the former and rises steadily and uninterruptedly in obstruction.

3. Liver biopsy is of value in confirming operative findings and giving some measure of prognosis based on the amount of hepatic damage.

4. The end results are discouraging, with 10 per cent operability and 68 per cent overall mortality in the whole series of those operated.

5. After medical causes have been eliminated, exploratory laparotomy should be carried out.
CLINICAL ASPECTS OF CEREBRAL ANGIOGRAPHY IN CHILDREN
Authors: Poser Charles M. , Taveras Juan M.
Published: December 2021

A series of 90 children subjected to cerebral angiography is reviewed. One hundred thirty-one cerebral angiograms were performed of which 117 were by the percutaneous method. All but 2 were done under general anesthesia. Cerebral angiography was of definite diagnostic value in 43.5 per cent of the patients.

No fatalities were encountered in this series. Morbidity and complications were present in 35 per cent of the procedures but all were mild and transient. Complications believed to be due specifically to angiography were present in 20 per cent. It is felt that the morbidity and complications are affected in some way by general anesthesia and premedication. Morbidity in cerebral angiography in children is lower than in pneumoencephalography performed under the same conditions in a comparable group of children.

Cerebral angiography is a useful and relatively harmless procedure in children when the proper precautions are taken and the indications are definite. The percutaneous technique is suitable for children of all ages.
A NOTE ON SPEECH RETARDATION IN MENTAL DEFICIENCY
Authors: Brown Spencer F.
Published: December 2021

THE DIAGNOSIS of retarded speech development in a preschool child is often a difficult problem, and many cases can be adequately evaluated only after extensive neurological, psychological, otological, and other examinations. Frequently the history will yield sufficient information to enable one to assign the cause of the retarded speech with a high degree of accuracy, although every presumptive diagnosis should be confirmed by appropriate examinations.

In the study of a large number of children with delayed speech, a curious item has frequently appeared in the histories. It was often discovered that the child began to use single words at approximately the average age normal age, namely about 12 months. These words are usually few—3 to 6 or 8. They are not used often but occur at variable intervals over a period of a few weeks to 6 or more months. Then these words disappear the child is not heard to use them again, and other words do not take their place. It must be pointed out that this is not a cessation of speech after a normal beginning. The words which the child uses do not emerge from a large amount of babbling. They come suddenly and unpredictably. Yet they are phonetic combinations which are used consistently—if sparingly—to refer to the same person or object.

In all instances in which such a history has been found, it has been the author's experience that the child in question is significantly mentally retarded. Conversely, such a pattern has not been found in any child of normal intelligence whose speech retardation is on another basis.
PATHOGENESIS OF SUBDURAL COLLECTIONS OF FLUID
Authors: Gitlin David
Published: December 2021

Eighteen patients with subdural accumulations of fluid were selected for study; of these, 11 had had acute bacterial meningitis, 1 had had subdural air secondary to pneumoencephalography, 5 had developed fluid secondary to trauma and 1 did not fit any of these categories.

The albumin: γ-globulin ratios and albumin : total protein ratios in the subdural fluids were considerably higher than these ratios in the corresponding serum samples.

These findings suggest that, although the forces involved are complex, the basic mechanism of fluid accumulation in the subdural space was similar in all these patients, namely, an effusion through irritated or damaged capillary walls.
PUBLIC HEALTH, NURSING, MEDICAL SOCIAL WORK
Authors: Laidlaw Elizabeth H.
Published: December 2021

THE PROBLEM that we have solved in the Tucson Schools in the last 3 years by means of the Revolving Health Fund of our Health Council, is one which, though definitely characteristic of Tucson, may also exist in other cities in the United States; consequently, we offer our solution in the hope that there may be other communities with the same types of problems who might benefit from our experiences. The problem is that of the financing of medical care for indigent children whose families cannot afford to pay a private doctor, yet whose income possibilities or resident and citizenship qualifications, do not entitle them to welfare aid or state and county medical care. In larger cities there are usually clinics available to such medical indigents at a low fee, and social workers to determine eligibility for this service.

But, in Tucson (and possibly in some other cities which have grown up rapidly under similar circumstances) the situation is somewhat unusual in certain respects, and it is because of these peculiar characteristics that we have had to evolve a plan tailored to meet our individual problem.

In solving this problem our Health Council has found it necessary to function not only as a coordinating and planning agency in the conventional sense, but also as an operating agency.
ADRENAL CORTICAL HORMONES AND INFECTION
Authors: Robinson Harry J.
Published: December 2021

Animal studies show that cortisone, hydrocortisone or the steroid prednisolone may lower the resistance of a variety of animal species to many infectious agents.

The mechanisms by which large doses of these hormones alter host resistance to infection appear to be related to a decrease in the movement and phagocytic activity of polymorphonuclear leukocytes, suppression of antibody formation, and an alteration in the function of the reticulo-endothelial system.

Antibiotics, in larger doses than usually employed, will control infectious diseases in cortisone- and hydrocortisone-treated animals and patients.

Despite the results of animal studies, the reported incidence of intercurrent infections in humans treated with adrenal cortical hormones appears to be relatively low. Complicating infections may be kept at a minimum if careful histories and physical examinations are employed to detect patients with latent infection on arrested tuberculosis.

Patients treated with adrenal cortical hormones should be followed carefully for signs of infection. If the latter is suspected, cortisone therapy should be gradually reduced, and vigorous antimicrobial treatment instituted as soon as diagnostic measures, including specimens for bacteriologic identification, are taken.

The use of adrenal cortical hormones in the treatment of active infection is still under investigation and requires further study before final conclusions can be reached. However, the results to date are encouraging in Waterhouse-Friderichsen syndrome, tuberculous meningitis, and various other life-threatening and unusually severe infections. Hence the cautious and discriminate use of these hormones in certain severe infections would appear to be a helpful adjuvant to other therapy.
Letters to the Editor
Authors: GIBLETT ELO , FINCH C. A.
Published: December 2021

We are happy to explain more fully our stand in respect to the point raised by Dr. Allen. It is stated that "our reasoning is based on the assumption that a 2-week-old infant with a hemoglobin level between 6 and 8 gm. is suffering from anoxia to the extent that he should normally be producing red cells at a rapid rate." This statement was considered "poorly founded" and it was "doubted that this assumption is correct even in part. . . ."
The Longitudinal Study of Individual Development
Authors: STUART HAROLD C.
Published: December 2021

This looseleaf manual presents techniques for appraising the developmental status and progress of children. It represents a method developed over recent years to facilitate the study of child development in its broadest aspects. Although the students at this school are preparing for teaching and other professional work with children, there is much of interest in this volume for those who are concerned with medical students. This applies particularly to the introduction of the latter to a knowledge of the growth and development of children from both physical and psychological standpoints.
Should the Patient Know the Truth
Authors: SHIRLEY HALE F.
Published: December 2021

Most physicians in practice are frequently confronted with the question of what to tell a patient who has a serious or fatal disease. Should the patient be told the truth? What, when, and how should he be told? What should his family be told? What are the therapeutic, ethical, religious, materialistic, and legal factors to be considered in coming to a decision?

This little book is an outgrowth of a discussion of such problems at a meeting of the New York Academy of Medicine.
Fluoridation as a Public Health Measure
Authors: TOP FRANKLIN H.
Published: December 2021

Fluoridation remains a controversial point on many fronts, but perusal of this monograph should settle many questions which have bothered the profession and the lay public alike. The book is the third to be published by the AAAS on the public health aspects of fluoridation. The series of 11 papers also includes a medical study of a population using an excessive amount of fluoride (8 parts/M.) in a natural water supply. The series of papers is directed to the problem of effectiveness of water fluoridation in reducing dental caries and various elements are considered, namely; dental benefits, public health, engineering and chemical aspects, metabolism of inorganic fluorides, acute fluoride poisoning and crippling chronic fluorosis, among several.
FURTHER OBSERVATIONS ON ELECTROLYTE CHANGE IN TUBERCULOUS MENINGITIS
Authors: Cheek Donald B.
Published: December 2021

The investigation of the disturbance of the electrolytes of the serum in 8 patients with tuberculous meningitis again demonstrates the frequent presence of metabolic alkalosis, hypochloremia and hyponatremia, a normal total content of chloride in the body and hypotonic expansion of the extracellular fluid (chloride space). Total content of water is normal or decreased in some instances (on the basis of total weight) so that the expansion of the chloride space can be considered as being occasionally, if not frequently, at the expense of water from the cells. The instances in which total content of water is increased could be explained on a malnutrition basis. The findings of metabolic alkalosis and hypotonic expansion of the chloride space are not the rule in purulent meningitis.

The penetration by bromide of the blood-spinal fluid barrier has been investigated in 7 cases of tuberculous meningitis and in 5 cases of purulent meningitis. In the former instance, bromide, penetrated the spinal fluid almost completely within 8 hours of injection, giving a [See equation in source pdf] ratio of about one. In purulent meningitis the degree of penetration was also increased in some instances, and it is not possible to differentiate tuberculous meningitis from purulent meningitis by the above method.

While the initial cause of the coexisting metabolic alkalosis remains obscure, it is pointed out that requirements for potassium should be more than fulfilled, and loads of sodium should not exceed maintenance requirements in the presence of this persistent metabolic alkalosis.
Congenital Heart Disease, Report of the Fourteenth M & R Pediatric Research Conference
Authors: LURIE PAUL R.
Published: December 2021

This brochure, which is already in the possession of most of the readers of this review, should not be ignored. To the pediatrician it is one of the most clinically useful of this Conference Report series. To those with special interest in pediatric cardiology it supplies information unobtainable elsewhere.

The delay of over a year between conference and publication which was necessitated by a painstaking editorial job has resulted in some loss of glamor. For example, human cross circulation in intracardiac surgery, new and sensational at the time of the conference, is already discarded by its proponents, in favor of the pump-oxygenator.
WEIGHT GAINS IN THE FIRST FOUR WEEKS OF INFANCY: A COMPARISON OF THREE DIETS
Authors: Gross Ruth T. , Moses Lincoln E.
Published: December 2021

Four hundred seven healthy, full-term infants were divided into three groups and fed, respectively, a formula of evaporated milk and water with 5% carbohydrate; human milk; and a special modified evaporated milk designed to simulate human milk. No other foods were added to the diet. A comparison of the three groups was made, based on weight gains from birth to the end of the first 4 weeks. The conclusions refer only to weight gains; no attempt was made to determine the superiority of any particular diet.

The data show no significant differences in the 4-week weight gains among the three groups of infants, although sensitive statistical methods could be validly applied to the problem. These methods are explained.

The authors wish to emphasize the many variables which must be taken into account in a study of this sort; the necessity for careful selection of valid statistical methods; the importance of critical clinical judgement in the evaluation of the results.
THE PROBLEM OF ABSENT OR DEFICIENT GAS PATTERN IN THE INTESTINES IN EARLY INFANCY
Authors: Feinberg S. B. , Margulis A. R. , Nice C. M.
Published: December 2021

The variety of conditions and combinations that can produce absence or deficiency of the intestinal gas pattern should be kept in mind. It is important to realize that mechanical obstruction is not the only one which causes this picture and that surgery which may be contemplated may not only be unnecessary but also disastrous. This is especially important for the admitting officer to remember. The exact mechanism producing the same roentgenographic picture in so many different conditions is not entirely clear and may not necessarily be common to all. Experimental work is necessary.
GASTRIC ACIDITY ON THE FIRST DAY OF LIFE
Authors: Ebers Dale W. , Smith Dorothy I. , Gibbs Gordon E.
Published: December 2021

The initial gastric contents of the newborn were found to have a median pH of 5.4 at ages of 15 to 60 minutes. Specimens taken 1 hour later, representing the fresh secretion produced in the interval since the first specimen, showed a pH of 3.1 which [See Table 1 in Source Pdf] decreased only to 2.2 by 5 to 6 hours. The clinical implication of the findings is that the newborn does not have much of the antiseptic effect of gastric acidity at birth but develops it within a few hours.
The Hunterdon Medical Center
Authors: LESSER ARTHUR J.
Published: December 2021

This is the story of the development of an unusual hospital and health center in a rural county that had no hospital facilities. It is of interest not only because of what was achieved, but also how it was done. It is a demonstration of democratic processes at work in a county, of citizen initiative and participation with physicians in the development of a medical center, and of a co-operative effort of government and private resources.
TUBERCULOUS MENINGITIS TREATED WITH HYDROCORTISONE AND CORTISONE
Authors: Szabo Gershon , Sterk Velimir V. , Berman Shimon
Published: December 2021

A case of tuberculous meningitis complicated by increased intraventricular pressure due to subarachnoid block is presented. On the basis of clinical observation the usefulness of intraventricular and intrathecal therapy with hydrocortisone combined with the antituberculous agents is stressed. Certain problems associated with this form of therapy are presented and discussed.
OPHTHALMOLOGIC FINDINGS IN CHILDREN WITH CEREBRAL PALSY
Authors: Schachat Walter S. , Wallace Helen M. , Palmer Myra , Slater Beatrice
Published: December 2021

In a study of 98 children with cerebral palsy, 67 (68%) had either gross ocular defects or significant refractive errors, or both.

Only 20 children were known to be under the care of an ophthalmologist. Ophthalmologic recommendations were indicated for 69 children.

Seventeen children had a visual handicap severe enough to warrant special educational measures. Forty-three children were found to have strabismus, the most frequent ocular defect found. This was approximately evenly divided between esotropia and exotropia. Children with the spastic types of cerebral palsy had twice as many ocular defects and twice as many refractive errors as the athetoid types.

A complete ophthalmologic evaluation of every child with cerebral palsy is recommended as part of the total examination of the child.
CONGENITAL MALFORMATIONS AND OBSTETRICS
Authors: Davis M. Edward , Potter Edith L.
Published: December 2021

The existence of a malformation in a fetus is not often associated with abnormalities of pregnancy or labor. The chief concern of the obstetrician is in counseling the parents concerning future childbearing.

Malformations were reported by the National Office of Vital Statistics as responsible for 4.4 neonatal deaths per 1000 live births during the first 3 months of 1950. They accounted for 24% of the deaths of infants weighing over 2500 gm; 7% of the deaths of infants weighing under 2500 gm; that were born in the U.S. during this interval.

In a study of 5000 consecutive births at the Chicago Lying-in Hospital in 1951 and 1952, 210 surviving infants were found to have certain conditions considered to be malformations. It was thought that not more than 10% of these infants, or 4.2 per 1000 births, would be handicapped by the malformations. Coupling this with the deaths and stillbirths occurring during the same period gives a total of 10.6 per 1000 births. Thus about 1% of reported births are infants with lethal or handicapping malformations which can be diagnosed at or soon after birth.

Lethal malformations involved the central nervous system more often than any other part of the body, with anencephaly the most common single anomaly. Cardiac malformations were second, with those of the gastrointestinal and genitourinary tracts about equal in third and fourth places.

Malformations occur more commonly in males than females and in white than non-white and in the children of women who are near the beginning or end of the age when reproduction is possible.

Genetic disturbances can rarely be shown to be the cause of lethal malformations.
Letters to the Editor
Authors: TUDOR R. B.
Published: December 2021

I am writing concerning an article by Reichelderfer and Nitowsky which appeared in Pediatrics for December, 1956, reporting a controlled study of the use of the Bloxsom air lock. Seventy-two infants were placed in the air lock and 71 received routine care in an incubator. There were no significant differences noted in over-all mortality rates, in mortality rates during the first day of life on in the incidence of relief of respiratory distress between the group of infants exposed in the air lock and those placed in the incubator.
PREMATURITY AND RICKETS
Authors: Eek S. , Gabrielsen L. H. , Halvorsen S.
Published: December 2021

Sixty-nine premature infants receiving different dietaries and with birth weights below 2,000 gm were studied with chemical, clinical and radiologic methods. Vitamin D was given to all infants from the age of 4 days.

The concentrations of calcium, phosphorus and phosphatase in the serum showed variations toward those seen in active rickets. These changes were somewhat more marked in infants fed human milk than cow's milk. Supplementation of human milk with dried skimmed cow's milk did not significantly alter these changes.

Craniotabes was more frequently seen in premature infants fed human milk than cow's milk. Otherwise, no clinical signs of rickets were found.

All the premature infants were born with a metaphyseal zone of rarefaction. These zones are believed to be the result of a disturbance in ossification which occured during the last weeks of pregnancy, perhaps caused by a factor which was also responsible for the premature birth. They gradually merge with the general osteoporosis developing 10 to 13 weeks after birth. Later, periosteal double contours are visible. These double contours are the first signs of an improved mineralization.

There was no correlation between abnormal chemical findings and the most conspicuous radiologic or clinical findings. No case of recognizable rickets was observed among the infants studied.

This risk of rickets, despite an adequate supply of vitamin D, is probably not as great as stated by previous investigators, and is probably the same whether the infants are fed human milk or cow's milk.
A SUMMARY OF SOME CLINICAL ASPECTS OF OBESITY
Authors: Gordon Harry H.
Published: December 2021

AS A POINT of departure for this summary I wish to present an outline of mechanisms for the development of obesity. With minor changes, it is one recently proposed by Van Itallie and is based on the concept that there exist multiple etiologic factors— genetic, traumatic and environmental—in the development of obesity.

The fact that there are two main categories—1) regulatory, i.e., with no primary metabolic abnormality, and 2) metabolic—does not imply that patients with obesity obey some law higher than that of the conservation of energy. Studies by Newburgh and his co-workers established this for all patients beyond argument from wishful nonbelievers. Mayer has stressed, however, that Newburgh's work should not serve as a rigid, at times puritanical, obstacle to consideration of the problems of individual patients, a point of view inherent in Newburgh's listing of different "proximate causes to which some persons respond (in part) by overeating."

Patients with a regulatory disorder may develop obesity as a result of increased caloric intake or decreased caloric output or frequently both. Under increased caloric intake, we have two categories, "organic" and "functional." We have put quotes about both headings because this common form of categorization implies a sharp division in our thinking and sometimes interferes with our therapeutic approach to patients; most of us still feel more comfortable with a patient whose complaints are organic rather than so-called functional. We think of nephrosis and galactosemia as organic diseases but, in the present state of our knowledge, have to fall back on calling the increased glomerular permeability of the former and the enzymatic defect of the latter, lesions in chemical anatomy. Perhaps advances in electronmicroscopy and histochemistry will ultimately make use of this term more literal.
Blindness in Children
Authors: ALLEN HENRY F.
Published: December 2021

The development of children blind from birth is a specialized subject about which there has been a gradual accumulation of specialized knowledge. The present book stems from a project which originated as a result of the appearance of a rapid increase of blindness from retrolental fibroplasia in the late 1930's and early 1940's. The concepts and principles introduced in this book represent a significant advance and provide, for the first time, a flexible framework upon which to base an intelligent program for blind children from their earliest days.
INFLUENCE OF PRIOR ACTIVE IMMUNIZATION ON THE PRESENCE OF POLIOMYELITIS VIRUS IN THE PHARYNX AND STOOLS OF FAMILY CONTACTS OF PATIENTS WITH PARALYTIC POLIOMYELITIS
Authors: Wehrle Paul F. , Reichert Ralph , Carbonaro Ory , Portnoy Bernard
Published: December 2021

Isolations of poliovirus from 55 household contacts of 12 patients with paralytic poliomyelitis demonstrate that prior immunization does not prevent the acquisition of inapparent infection with poliovirus under conditions of household exposure.

Although there was no apparent interference with enteric multiplication of poliovirus, an accurate estimate of the relative rates of acquisition of infection with poliovirus between immunized and unimmunized children of comparable ages was not possible. However, enteric infection with poliovirus appeared to be slightly less frequently encountered among the age group most frequently immunized.

Poliovirus was present in the pharynges of previously immunized contacts of patients with paralytic poliomyelitis less frequently and in lower titer during the study period than in those without prior immunization.

The apparent diminution in both presence and concentration of poliovirus in the pharynx in infections acquired after immunization may be important in the epidemiology of this infection in an immunized population where high standards of environmental sanitation are observed and good personal hygiene is practiced.
CONGENITAL DEFECTS IN ADRENAL STEROID SYNTHESIS
Authors: Bongiovanni Alfred M.
Published: December 2021

SCRUTINY of the adrenocortical steroids excreted in the urine of patients with the adrenogenital syndrome (due to congenital adrenal hyperplasia) has afforded an opportunity to localize the biochemical defects attributable to an inborn error of metabolism and has elucidated the normal pathway for biosynthesis in the adrenal gland in man. The studies of Hechter on the biogenesis of hydrocortisone in the beef adrenal has indicated a stepwise oxidation of progesterone toward the fulfillment of the requirements for the final product, namely hydrocortisone. Hydrocortisone is indeed a "final product" in the economy of the pituitary adrenal axis: When its rate of secretion is low, larger amounts of adrenocorticotropin (ACTH) are released in an attempt to stimulate the adrenal cortex. If the target gland cannot properly synthesize hydrocortisone, the pituitary continues to stimulate the gland, which produces large quantities of "abnormal" intermediary metabolites. Certain of these latter substances are androgenic and account for the clinical manifestations.

An oxygen function must be introduced into the progesterone molecule at carbons 17, 21 and 11 in order for the adrenal cortex to manufacture hydrocortisone. The oxygen is introduced at each position, presumably under the control of separate enzymes tentatively termed "hydroxylases" and specified by the position they affect. If one or more of these enzymes is lacking, hydrocortisone is not produced, or is synthesized in limited quantities. Depending upon the particular enzymatic defect, the unusual metabolites measured in the blood and urine vary, as does the type of disease encountered.

In all forms of the adrenogenital syndrome virilization is present.
ENTEROVIRUSES
Authors: EICHENWALD HEINZ F.
Published: December 2021

A NUMBER of years ago, investigations utilizing monkeys resulted in the recovery of three types of poliomyelitis viruses from the human gastrointestinal tract. More recently, the use of infant mice led to the discovery of an entirely new family of enteric viruses, the Coxsackie agents, which, on the basis of histopathologic reactions in mice, are divisable into two subgroups: A, with 19 serologically distinct members; and B, with 5.

A further advance in methodology, the use of simplified methods of tissue culture, resulted in the isolation of a third family of viruses from the intestinal tract, named, by general agreement, the enteric cytopathogenic human orphan (ECHO) group.
STOSSTHERAPY IN ACUTE RESPIRATORY INFECTION IN CHILDREN
Authors: STEIGMAN ALEX J.
Published: December 2021

STOSSTHERAPY is a word of Germanic origin, Stoss referring to "a thrust" or "a push." The term has been used to describe a method of treating rickets with a single massive dose of vitamin D. In a recent article (Brit. M. J., 1:487, March 1, 1958) the author "thrusts" antibacterial agents at children and compares the results with conventional treatment by antibacterial agents over a period of some days.

The chief contribution of this paper is to remind the reader that careful earlier studies showed that a single massive dose of sulfonamide can be curative of pneumococcal pneumonia in children, a fact established almost 20 years ago. In the debit side is the introduction of a burdensome word in a paper remarkably devoid of appropriate documentation.

Between October, 1952, and October, 1954, 174 children with acute lower-respiratory-tract infection were treated at the Evelina Children's Hospital of Guy's Hospital, London, with penicillin by injection or oral sulfonamide, or a combination of both. The personal preferences of no less than 14 doctors who admitted these patients dictated the decisions regarding therapy.
THE ADMINISTRATION OF OXYGEN TO INFANTS AND SMALL CHILDREN
Authors: Batson Randolph , Young William C.
Published: December 2021

Oxygen therapy techniques have been discussed and data have been presented which support the contention that most commerically available equipment does not fulfill the prerequisites for adequate oxygen therapy, especially when such devices are to be used for the treatment of infants and small children.

The open-top oxygen box method for oxygen therapy is superior in every respect including efficiency, economy, and practicality. Observations supporting this have been reported.

The open-top oxygen box constructed with transparent material and equipped with humidification apparatus and cooling chamber, has the following advantages: The speed (10 minutes) with which one can obtain therapeutic concentrations of oxygen with satisfactory humidity and temperature; the maintenance of therapeutic concentrations of oxygen during patient care procedures; easy observation of patient through transparent plastic walls; claustrophobia is not experienced by patient; adequate wash out of carbon dioxide with no necessity for soda-lime tube; easy accessibility to patient for care, observation and conversation; ideal suitability for high humidity or "mist" treatment of tracheobronchitis and other upper respiratory infections; portability (total weight 19 kg); economy (incurs less than half the expense of oxygen tents during operation and the initial cost of equipment is far less).

There are precautions that should be taken in employing open-top oxygen box therapy: due to air currents the device should not be placed in direct drafts or in the vicinity of electric fans. Because of the small size of the box in its present form it is impractical for use in children over the age of 8 years. Medical personnel should be constantly alert to the possibility of apertures that can develop because of improper application or rents in the sleeve.
CONGENITAL DISORDERS OF THE MECHANISM FOR COAGULATION OF BLOOD
Authors: Didisheim Paul , Lewis Jessica H.
Published: December 2021

Ninety-two new cases of hemophilia A and 16 of hemophilia B are reported.

The data, together with those from other reported series, suggest that hemophilia A and B comprise over 90% of all congenital hemorrhagic diseases due to defective formation of a fibrin clot. Of those with deficiencies of AHF or PTC, the incidence of PTC deficiency is about 16%.

The rise in age at death of patients with hemophilia from 14.5 to 29 years since 1940 is largely attributed to the wide use and availability of fresh blood and its derivatives.

The usefulness of various coagulation tests in the differential diagnosis of the congenital abnormalities of the clotting mechanism is demonstrated.

With the development of more sensitive diagnostic techniques, the concept of hemophilia has broadened to include many cases of very mild clinical disease in patients with essentially normal life expectancy. Specific assay procedures are necessary for diagnosis.
AVITAMINOSIS E IN CYSTIC FIBROSIS OF THE PANCREAS
Authors: Blanc William A. , Reid Joseph D. , Andersen Dorothy H.
Published: December 2021

Ceroid-pigment is present in the smooth muscle fibers of the gastrointestinal tract of patients with cystic fibrosis of the pancreas. It is first seen during the second year of life. It is found in all patients of 5 years of age and older, and the amount increases with age.

It has not been found in other pediatric conditions with the exception of biliary atresia and cirrhosis of the liver.

Extensive ceroid deposit probably represents an expression of prolonged and severe vitamin-E deficiency, related to protracted malabsorption of fat-soluble tocopherols.

Alterations of striated muscle appear to be rare and minimal in cystic fibrosis of the pancreas.
ACUTE POISONING ASSOCIATED WITH INHALATION OF MERCURY VAPOR
Authors: Matthes Fred T. , Kirschner Rudolph , Yow Martha D. , Brennan James C.
Published: December 2021

Four cases of pneumonitis associated with the inhalation of mercury vapor are described in detail. Three of the four cases were fatal.

The illness was characterized by the sudden onset of tachypnea, cough, fever, gastrointestinal disturbances and central nervous system manifestations.

Ordinary laboratory tests were not helpful in establishing the diagnosis. Quantitative analysis of the urine for mercury was suggestive but not diagnostic. Roentgenograms of the lungs revealed interstitial pneumonitis.

Analysis of tissue for mercury in the lungs, liver and spleen of two of the cases showed substantially increased mercury content.

The outstanding pathologic features in the three fatal cases were erosive bronchitis and bronchiolitis, with severe interstitial pneumonitis.

The presently accepted mode of therapy for acute poisoning due to ingestion of mercury is early use of BAL. Its use is probably also indicated in acute poisoning due to inhalation of mercury vapor. Supportive care in the form of oxygen, mist, and parenteral fluids is indicated.
Neuropathology
Authors: BLANC WILLIAM A.
Published: December 2021

This book appears after some classic American textbooks (Hassin, Courville, Malamud) and the large German treatise of Scholz. However, it does not duplicate any of these texts and presents a synthetic view of today's pathology. The authors have managed to give, in most chapters, a sound basis of historical background and traditional morphologic descriptions, a clear view of the outstanding contributions of modern functional anatomy and pathology, and a glimpse at the future, in the light of very recent contributions.
The Cerebrospinal Fluid: Production, Circulation, and Absorption, Ciba Foundation Symposium
Authors: LANMAN JONATHAN T.
Published: December 2021

This Ciba Symposium records the proceedings of a meeting held in London in May, 1957 to discuss the cerebrospinal fluid. The papers presented may be roughly grouped in the fields of anatomy, physiology, and clinical medicine. Those in the field of anatomy are excellent and in keeping with the current renaissance in this field. They include observations on the early development of the telencephalic choroid plexus, suggesting a progression of diverse functions for this tissue during ontogeny, and a study of the mature choroid plexus using the electron microscope.
The Infantile Cerebral Palsies
Authors: REMBOLT R. R.
Published: December 2021

The authors, in addition to Sir Francis Walsche who wrote the Foreword to this volume, comprise a committee known as The Little Committee, which was formed 100 years after the publication of Little's classical descriptions of cerebral palsy. This committee was formed "for the purpose of studying the clinical problems of diagnosis, prognosis, and management, and the administrative problems involved in training medical and other personnel for work in the field of cerebral palsy." The authors enjoy "the hospitality of Queen Mary's Hospital for Children, Carshalton, Surrey."