bluuebunny/crossref_metadata_2025 huggingface dataset:
NEONATAL GROWTH IN WEIGHT OF NORMAL INFANTS ON FOUR DIFFERENT FEEDING REGIMENS
Authors: NYHAN WILLIAM L. , WESSEL MORRIS A.
Published: December 2021

Neonatal weight changes of 400 normal infants were studied statistically. The series was composed of 200 infants fed on a flexible schedule of which 100 were breast-fed and 100 were bottle-fed; and 200 infants fed on the conventional four-hour schedule, of which 100 were breast-fed and 100 were bottle-fed. During the first week of life the ad lib-fed babies had smaller weight losses than the schedule-fed babies and the bottle-fed babies had smaller losses than the breast-fed babies. The duration of weight loss was longer in the breast-fed babies. By the time of the six week postnatal clinic visit, the group that had been breast-fed in the nursery had gained significantly more than the group that had been bottle-fed in the nursery. There were otherwise among the four groups no significant differences in weight gain during this period. It was felt that the observed differences among the four groups parallelled the expected differences in food intake.
DECREASE IN SERUM GAMMA GLOBULIN (AGAMMAGLOBULINEMIA): REPORT OF 3 CASES
Authors: HAYLES ALVIN B. , STICKLER GUNNAR B. , MCKENZIE BERNARD F.
Published: December 2021

A study has been made regarding three boys who had agammaglobulinemia and who were seen at the Mayo Clinic during a period of seven months. In each there was a history of frequent infections since infancy. All three patients demonstrated relatively normal serum proteins except for greatly decreased amounts of gamma globulin. The deficiency in gamma globulin was demonstrated by use of paper electrophoretic analysis of serum proteins.

One of the patients, an infant, died while under treatment at the clinic. The second patient continued to have frequent infections in spite of the administration of gamma globulin at frequent intervals; he died later at home. The third patient has been maintained in good health by monthly injection of gamma globulin.
AMINOPHYLLINE POISONING
Authors: ROUNDS VINCENT J.
Published: December 2021

The toxic actions of aminophylline manifest themselves in three categories; first, excessive stimulation of the central nervous system; second, gastric irritation resulting in severe vomiting, and third, effects on the kidney. Six cases have been presented demonstrating all of these toxic manifestations. It is believed that alertness to these signs and symptoms in the future will prove aminophylline poisoning to be a relatively common, often serious problem. In the practise of pediatrics more caution should be exercised in using aminophylline, especially with regard to dosage.
EVALUATION OF THE FLUSH TECHNIQUE FOR THE DETERMINATION OF BLOOD PRESSURE IN INFANCY
Authors: Sullivan Margaret P. , Kobayashi Mahomi
Published: December 2021

Using the flush technique, 3 systolic blood pressure readings were taken in the right arm and right leg of 160 Japanese infants of approximately 9 months of age. Analysis of the data obtained on 103 babies who were quiet or nursing when all determinations were made showed the following:

1. A sex difference in systolic blood pressure could not be demonstrated by statistical methods; there was no apparent relationship between blood pressure and height or weight.

2. No difference could be demonstrated between arm and leg pressures by statistical methods.

3. The difference in systolic pressures among infants in this study was highly significant. This variability among patients was greater than the variability among the 3 observations on an extremity of an individual patient.

4. The method may be considered a satisfactory clinic or office procedure if its limitations are recognized. One blood pressure reading on a patient by this method is of little value. A minimum of 3 readings should be obtained and averaged. Five readings are recommended for routine blood pressure determinations. For more exacting studies, 8 readings might be taken and averaged.
CITRIC ACID METABOLISM IN INFANTS DURING THE NEONATAL PERIOD
Authors: Gittleman I. F. , Pincus J. B. , Kramer B. , Sobel A. E. , Schmerzler E.
Published: December 2021

1. Serum citric acid, calcium and phosphorus levels were measured on the first day of life and on the day of discharge from the hospital in 275 newborns. A statistically significant fall in the serum citric acid level by the end of the first 5 days of life was found in all groups studied.

2. A statistically significant positive correlation between calcium and citric acid levels was found in Groups I, III, V and VIII. Groups VI and IX had a positive correlation which was statistically not significant. In Groups II, IV and VII the correlation was negative but statistically not significant.

3. No single known factor that influences citric acid metabolism was considered to completely and adequately explain the serum citric acid fall during the first week of life and the tendency for the serum citric acid to rise in the second week of life.

4. Fluctuation in parathyroid activity comes closest to providing an explanation.
FREQUENCY AND SIGNIFICANCE OF CARDIAC MURMURS IN THE FIRST YEAR OF LIFE
Authors: Richards Mary R. , Merritt Katharine K. , Samuels Mary H. , Langmann Alfred G.
Published: December 2021

The frequency of cardiac murmurs in early infancy has been studied in a large series of unselected infants. In the immediate postnatal examination, a murmur was heard in 1.7 per cent. With repeated examinations, however, at 6 and at 12 months of age, the proportion of infants in whom a cardiac murmur was heard at some time rose to 7.0 per cent of 5,017 full-term singlebirth infants and to 9.9 per cent of 364 premature single-birth infants. Non-white infants had a significantly higher prevalence of murmurs than did white infants at both the 6 and 12 month examinations.

Of the 71 full-term infants who had murmurs at the birth examination and were re-examined at both 6 and 12 months, 49 (69 per cent) had no murmurs at either of the later examinations.

Of the 150 full-term infants who had murmurs heard for the first time at 6 months and were re-examined at 12 months, 90 (60 per cent) had no murmur at the 12-month examination.

Of the total number of 353 murmurs heard in full-term infants, 166 were ultimately interpreted to be functional, and 25 to be organic murmurs. The remaining 162 were inconstantly present, and were probably all functional murmurs.

In our experience, a murmur heard at birth carries a 1:12 probability of congenital heart disease; if it is again heard at 6 months, this chance is 1:3; and if the murmur persists to 12 months, the chance is 3:5 that congenital heart disease is present. When a murmur is first heard at 6 months, and persists until 12 months, the probability of congenital heart disease is 1:7; and when a murmur is first heard at 12 months, the probability falls to 1:50.

Premature infants were found to be similar to full-term infants in all respects, insofar as their small numbers made comparisons possible.

Finally, the relative rarity of cardiac murmurs in the newborn period has been demonstrated once more.
HEMOGLOBIN C. REPORT OF THE HOMOZYGOUS CONDITION AND OF COMBINATIONS WITH NORMAL AND SICKLE CELL HEMOGLOBIN
Authors: Morgan James L. , Bowles Richard M. , Harris Jerome S.
Published: December 2021

Two families showing abnormal hemoglobin types are described. One case represents the fifth reported instance homozygous C disease. The clinical picture is discussed, and the importance of electrophoresis in making a definitive diagnosis is stressed.
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors: Kempe C. Henry
Published: December 2021

THE SCOPE of the topic is such that one must present many simplifications in a positive manner. As an aid to memory in classifying the ever-increasing number of antibiotics and their antibacterial spectra and dosages, 2 charts have been prepared which are self-explanatory (Tables I and II). In all types of oversimplification one may quarrel with 1 or more points, but the material presented can be of practical value in daily practice.

CHOICE AND DOSAGE OF COMMON ANTIBIOTICS

Antimicrobial drugs are classified as bacteriocidal (those which kill bacterial organisms) or bacteriostatic (those which primarily inhibit bacterial multiplication which, however, resumes upon the removal of the bacteriostatic drug). Bacteriocidal agents actually differ from bacteriostatic agents only in the fact that their action is irreversible. The difference between bacteriostatic and bacteriocidal action appears to be a quantitative rather than qualitative one. Agents may be bacteriostatic at a given concentration and for a given exposure, while increasing concentration or exposure may cause a progressive shift toward bacteriocidal action.

Primarily bacteriocidal agents in current use are penicillin, streptomycin, polymyxin B, bacitracin, and neomycin. Primarily bacteriostatic agents are tetracycline and all related compounds, chloramphenicol, erythromycin, and all sulfa drugs. The dosages of these drugs are given in Table I.

A simple way to recall the antibacterial spectrum of antibiotics: pathogens are divided into rods (most of which are gram negative) and cocci (most of which are gram positive). Bacteriocidal agents which kill rods only are streptomycin and polymyxin B; bacteriocidal agents killing cocci only are penicillin and bacitracin; neomycin is bacteriocidal for a wide variety of rods and cocci.
FEEDING PREMATURE INFANTS—A COMPARISON OF VARIOUS MILKS
Authors: Kagan B. M. , Hess J. H. , Lundeen Evelyn , Shafer Kathleen , Parker Julia B. , Stigall C.
Published: December 2021

Premature infants of birth weight between 1,000 and 2,000 gm. were given isocaloric feedings at the rate of 82 calories per kilogram body weight per day between the seventh and twenty-eighth days of life using: 1) human milk characteristically low in ash content; 2) modified human milk with slightly increased protein and ash content and slightly lowered fat content; 3) a cow's milk mixture which simulates human milk in protein, carbohydrate and fat and provides a moderate ash content, and 4) a one-half-skimmed cow's milk mixture providing high protein, low fat and high ash. These milks produced increasing weight gains in the order in which they are named.

The increased weight gain over that provided by isocaloric amounts of human milk appears to be directly related to the increase in ash intake rather than to the percentage of protein, carbohydrate or fat. Comparable analysis of data from another study in which 120 calories per kilogram body weight were fed supports this observation.

Several recent studies have demonstrated the relative immaturity of renal function in the premature infant under 1 month of age, with a resultant tendency to retain water on high mineral intakes. The increase in weight gain in relation to the increase in intake of ash may be a reflection of the poor renal function of young premature infants and their relative inability to excrete the increased solute load, with resultant obligate water retention.

These data suggest a probable difference in character of weight gain during and after the first month of life in premature infants on diets of mineral concentration higher than that of human milk. This difference should be reflected in body composition, determination of which might well be an interesting subject for future investigation. Further study may demonstrate that weight gain has serious limitations as a criterion for normal development of the premature infant during the first month of life.
MASSIVE BLEEDING FROM DUODENAL ULCER IN INFANCY TREATED BY GASTRECTOMY
Authors: Neilson J. R. , Black J. H.
Published: December 2021

1. An infant of 18 months with massive bleeding from a duodenal ulceration has been treated by gastrectomy after failure of conservative medical and surgical methods of treatment.

2. A 33-month follow-up shows excellent progress.

3. It is hoped that future reports, especially of follow-up surveys, will aid us in the choice of a method of treatment in those patients where radical care seems indicated.
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors: Lowe Charles U. , Danowski Thaddeus S. , Ebert Richard
Published: December 2021

Chairman Lowe: We have planned a program which will begin with a presentation of certain theoretical concepts of parenteral fluid therapy and will finish by offering what we believe to be practical concepts.

Dr. Danowski will present a physiological and biochemical background, including the use of water and the necessity for certain electrolytes in a parenteral fluid program.

Dr. Ebert will discuss the use of blood, plasma and blood substitutes and describe the place of each in therapeutics.

I, in turn, will attempt to utilize their remarks, to draw them together and thus provide a practical program of parenteral fluid therapy.

We are interested, particularly, in providing a basis for therapy of patients who have undergone surgery. I think you are all aware that many of the pediatric problems in parenteral fluid therapy which plagued pediatricians 10 and 15 years ago are no longer serious problems. I have in mind, particularly, diarrheal disease. But we are faced with a real challenge in terms of therapy for the infant or child who is to undergo surgery or who has undergone surgery. So, we will attempt to emphasize this aspect.
A STOPCOCK FOR USE IN EXCHANGE TRANSFUSIONS
Authors: Sobel Irwin Philip , Horowitz Leon
Published: December 2021

EXCHANGE transfusions through the umbilical vein may be performed in several ways. In the open method, a nurse draws donor blood through a two-way stopcock which is connected to the bottle by autoclaved polyvinyl tubing. The syringe filled with donor blood is handed to the operator or his assistant who injects it directly into the umbilical vein catheter. The advantages of this multiple syringe method are simplicity, speed and minimal opportunity for the formation of blood clots in the system. The disadvantage is the danger of the formation of an air embolus, because during the changing of syringes the umbilical vein catheter is in direct communication with the air. In the closed method, the operator draws donor blood from the bottle and injects it into the umbilical vein catheter by means of 2 three-way stopcocks fastened in tandem. The advantages of this single syringe method are the completely closed system and the avoidance of changing of syringes. The disadvantages are: 1) the keys of the 2 three-way stopcocks can be arranged in 9 different positions; 2) the chances of clotting are increased because of the use of 2 stopcocks, and 3) a direct connection between the blood in the bottle and the umbilical vein is possible. The stopcock to be described was designed to incorporate advantages of both methods while avoiding their disadvantages.

The female end of the stopcock (see Fig. 1) is connected to the bottle of donor blood by means of autoclaved polyvinyl tubing; the male end is inserted into the umbilical vein catheter; and the sidearm is fitted onto the syringe.[See Fig 1 in Source Pdf]
RENAL HYPERCHLOREMIC ACIDOSIS WITH NEPHROCALCINOSIS AND RENAL RICKETS IN A SIX-YEAR-OLD BOY
Authors: Jurow Seymour S. , Warthen Robert O
Published: December 2021

A case of hyperchloremic acidosis, nephrocalcinosis and renal rickets occurring in a 6-year-old boy is presented.

Many cases of this disease and its variants begin in childhood and awareness of the conditions may help to bring patients to treatment earlier.

An associated, but probably unrelated, mild hemolytic anemia and splenomegaly of unknown etiology is described.
A SURGICAL TREATMENT PROPOSED FOR EITHER ENDOCARDIAL FIBROELASTOSIS OR ANOMALOUS LEFT CORONARY ARTERY
Authors: Paul Raphael N. , Robbin S. Gwin
Published: December 2021

A new surgical approach is suggested for the treatment of endocardial fibroelastosis and anomalous left coronary artery.

The recommended procedure (poudrage) has been shown in some cases to produce an effective collateral circulation to the myocardium in patients with coronary heart disease.

Four patients have been presented, 3 of whom have survived approximately 1 year with clinical improvement. During most of this time the patients have not been receiving digitalis.

Of the 3 living patients, in 1 the diagnosis of anomalous left coronary artery is suggested on the basis of history of "anginal attacks" and electrocardiograms suggestive of anteroseptal myocardial infarction. The other 2 patients do not fulfill the criteria for anomalous left coronary artery but are clinically endocardial fibroelastosis.

One patient died following surgery and necropsy failed to demonstrate any cause of death other than the underlying condition itself.

The need for further follow-up is recognized. With utilization of this procedure in more patients the relative merits or faults may be brought out. However, it appears, that its use may be recommended in these conditions because they are statistically incompatible with life for any appreciable time and the procedure is relatively free of risk even in the case of diagnostic error.
STUDIES OF FIBROCYSTIC DISEASE OF THE PANCREAS (MUCOVISCIDOSIS): CHYMOTRYPSIN ACTIVITY OF DUODENAL FLUID
Authors: Richmond Reid C. , Shwachman Harry
Published: December 2021

A study of the chymotrypsin activity of duodenal fluid, using the method of Ravin, Bernstein, and Seligman, is presented. The method is applicable to routine assay and is a reliable reflection of pancreatic function. In addition, this assay is specific for chymotrypsin activity in contrast to the customary tests for protease activity, which use casein or gelatin as substrates. In 40 patients with complete pancreatic insufficiency due to fibrocystic disease of the pancreas the chymotrypsin activity of the duodenal fluid was not measurable (i.e., less than 5 µg. of β-naphthol liberated from the substrate).

The chymotrypsin activity in 53 patients with normal pancreatic function and without symptoms referable to fibrocystic disease of the pancreas varied from 11 to 65 µg. of βd-naphthol except for the lowest value in this control group of 8 µg.

In another group of 62 children with sufficient symptoms to call for duodenal fluid assay (failure to gain, abnormal feces or repeated respiratory infections) the range of chymotrypsin activity was similar to that of the control group. The duodenal fluid assay and clinical course excluded fibrocystic disease of the pancreas in this group.

The chymotrypsin assay is useful in the study of patients with partial pancreatic insufficiency from progressive loss of pancreatic function as the disease progresses.

In view of occasional diagnostic failures, based on assay of a single enzyme, it is important to determine the total enzyme activity of duodenal fluid for proper complete evaluation of pancreatic function.
FURTHER OBSERVATIONS ON CYSTINE STORAGE DISEASE
Authors: Parker William S. , Prader Andrea , Fanconi Guido
Published: December 2021

Two cases of cystine storage disease, both diagnosed during life, are presented. Both cases presented typical symptoms. Cystine crystals were found and needles resembling those of tyrosine could also be found in bone marrow and pus. The level of serum amino acids was normal in both cases. The urine contained increased organic acids, mainly due to an increase in the amino acids, and a normal ammonia content. Post-mortem examination of one patient is reported. Case 2, following treatment with alkali, vitamin D and salt free diet, has shown improvement in weight, rickets, amino aciduria and glycosuria but not in growth, albuminuria and concentrating capacity of the kidneys.
OBITUARY
Authors: HUGHES JAMES G.
Published: December 2021

THE AMERICAN Academy of Pediatrics has suffered a great loss in the death of one of its past presidents, Dr. Edward Clay Mitchell of Memphis, who died February 1, 1955, at the age of 73 after an illness of 15 years. He was one of the pioneer pediatricians of the South and exercised a tremendous influence in helping establish pediatrics as a major specialty not only in this area but nationally. He will be long remembered by his many friends because of his active participation in the progress of pediatrics and also because of his strong personality and good fellowship. Most of all he will live in the memory of many parents and their children, now grown, whom he treated through the years with such high professional ability and such personal interest.

Dr. Mitchell was born in Corinth, Illinois, the son of a surgeon, and his grandfather and other members of the family were doctors. His brother, Dr. John M. Mitchell of Evanston, is a member of the American Academy of Pediatrics. He attended West Point for 3 years and later graduated in medicine from Northwestern University. His postgraduate training in pediatrics was at the Michael Reese Hospital in Chicago, and in Vienna.

The years at West Pont undoubtedly left a lasting impression on Dr. Mitchell, for he was noted for his erect carriage, almost military bearing, and his strong qualities of leadership. He maintained an open mind and paid courteous attention to suggestions, but he was a most decisive person and a man of action. When he was in charge of anything there was seldom any doubt as to who was the leader and he tackled all assignments with amazing energy.

When his formal medical training was finished, Dr. Mitchell established a thriving pediatric practice in Memphis in 1908, where he was almost the first person to limit his work to the care of children.
THE BREAST MILK BANK AS A COMMUNITY PROJECT
Authors: Kimball E. Robbins , Jones Elizabeth , Lewis Myrtle E. , Kolb Ethel R.
Published: December 2021

1. The management of breast feeding is outlined.

2. The organization of our breast milk bank as operated by Evanston Hospital and Junior League volunteers is described.

3. The establishment of a breast milk bank has enabled us to increase the number of premature infants fed breast milk threefold. Their weights and length of hospital stay are presented.
ERYTHROMYCIN IN THE TREATMENT OF DIPHTHERIA AND DIPHTHERIA CARRIER STATE
Authors: Beach M. W. , Gamble W. B. , Zemp C. H. , Jenkins Margaret Q.
Published: December 2021

The treatment of acute diphtheria has not been drastically changed by the use of antibiotics. Antitoxin remains the primary form of therapy. However, the eradication of virulent diphtheria bacilli from the upper respiratory tract of patients with the active disease and of carriers is of considerable importance in the control of the disease.

Streptomycin is effective in vitro and in infections produced experimentally but it has not been clinically evaluated in acute diphtheria or in the carrier state.

Chlortetracycline, chloramphenicol, and oxytetracyline, although active against the causative organisms, have not had sufficient clinical trial to permit evaluation in the control of diphtheria and the carrier state.

Penicillin eradicates C. diphtheriae from the nasopharynx in 75 per cent of patients within a period of 3 to 4 days.

In this study erythromycin eradicated the C. diptheriae from the nose and throat in all of the cases in an average of 2 days in the active cases and in an average of 3 days in the carrier state.

In the treatment of diphtheria erythromycin appears on the basis of the present and of previous studies to be the most promising antibiotic developed to date.

Erythromycin is advocated as an adjunct to and not as a substitute for antitoxin in the treatment of acute diphtheria.
CONGENITAL SUBAORTIC STENOSIS CAUSED BY FIBROMA OF LEFT VENTRICLE
Authors: McCue Carolyn M. , Henningar Gordon R. , Davis Edward , Ray John
Published: December 2021

The clinical, laboratory and pathological findings in a 4-year-old child with a myocardial fibroma are correlated. The normal growth and development, excellent exercise tolerance, basal systolic murmur and thrill, moderate A2 with marked cardiac enlargement, and left ventricular strain by electrocardiogram were typical of subaortic stenosis and this was the clinical diagnosis. The tumor so invaded the wall of the left ventricle that an atomical subaortic stenosis was produced.
SPECIAL ARTICLE
Authors: Ash Rachel , Fischer Doane
Published: December 2021

A review is presented based on 138 children with a proven diagnosis of patent ductus arteriosus, including an analysis of the physical, electrocardiographic and roentgenographic findings. Operations on 116 of these children were performed with no deaths. Simple ligation with silk ligatures was used in 110 cases. There has been no instance of re-canalization. The criteria for diagnosis and selection for surgical correction are discussed.
Casimer Funk, Pioneer in Vitamins and Hormones
Authors: Day Paul L.
Published: December 2021

This is the story of the scientific career of the Polish-born scientist whose only claim to greatness was the coining of the word "vitamine." Were it not for that one fact, Casimir Funk's name would be no better known than hundreds of other biochemists who have made equally important contributions to nutrition and biochemistry. It is a story of frequent, and seemingly aimless, wanderings from one laboratory to another and from one country to another. Always in search of security, Funk rarely stayed in one place more than a few years; more often than not, what promised to be a well-equipped laboratory turned out to be empty, inadequate quarters.
STATISTICAL REPORT ON INCIDENCE AND DURATION OF BREAST FEEDING IN RELATION TO PERSONAL-SOCIAL AND HOSPITAL MATERNITY FACTORS
Authors: Jackson Edith B. , Wilkin Louise C. , Auerbach Harry
Published: December 2021

The incidence of breast feeding at the New Haven Hospital (University Service) and the discontinuance of nursing during the puerperium is reported for a 10-year period (1942 through 1951), with a review of the literature over this decade.

The incidence of breast feeding at the New Haven Hospital declined sharply from 81.9 per cent in 1942 to 48.9 per cent in 1946, with a tendency to level off after a slight rise in 1947.

There was a significant increase in per cent of mothers who stopped breast feeding in the hospital at a time (1942 through 1944) when a significant decrease in per cent of mothers starting to breast feed was occurring. On comparing the proportion of discontinuance between rooming-in and nursery (non-rooming-in) mothers (1947 through 1949) a statistically significant difference was found between the two groups, the rooming-in group showing less cessation of nursing during the hospital period.

In follow-up studies of the duration of breast feeding of the rooming-in and nursery mothers (1947 through 1949) the average duration between the two groups shows a significant difference in each of the years studied; the 3-year averages for the two groups likewise show a statistically significant difference, the rooming-in mothers nursing longer. The average duration within either group does not differ significantly from year to year.

On relating incidence and duration of breast feeding to difficulty of labor, as rated from hospital records during 1949, it was found that time incidence of breast feeding decreases with the increasing difficulty of labor.
THE VALUE OF PEDIATRIC-PSYCHIATRIC TEAMWORK IN THE TREATMENT OF RHEUMATIC FEVER
Authors: Green Maurice R. , Wile Renée
Published: December 2021

The object of this paper is to present a useful outline of pediatric-psychiatric teamwork on a pediatric ward, for children suffering from rheumatic fever.

In general, reactions of anxiety, rebelliousness, and depression were displayed by the children under treatment. Upon observation, their negative behavior seemed to be related to feelings of loneliness, guilt, and fear. This created certain difficulties for the children and staff members, and their problems were worked out in joint conferences of pediatric and psychiatric personnel.

Much thought was given to the problems presented by those children who found it most difficult to accept being bedridden. Various suggestions were made and steps taken to solve these difficulties on an individual basis for each child. An entertainment and occupational therapy program was found to be a most valuable aid in easing the situation for both patients and personnel.

Examples are given to illustrate how children, who appear similar at admission, can present very different problems. Case histories cited also show the importance of the family's cooperation for the child's full recovery and rehabilitation, both physically and mentally.

The contribution of each member of the team is discussed, and the value of treating sick and emotionally disturbed children through a pediatric-psychiatric program of care is demonstrated.
Letters to the Editor
Authors: STURGEON PHILLIP
Published: December 2021

Although I was not first author on either of the second or third paper referred to by Dr. F. A. Allen, Jr. in his letter to you of February 6, 1956, I sincerely appreciate the opportunity of submitting a reply. Dr. Allen's letter, as I interpret it, contains two types of criticism, one scientific and the other editorial. First, it appears he finds some of the conclusions, ideas or both expressed in those papers are scientifically unsound.
Aspects of Synthesis and Order in Growth
Authors: FORBES GILBERT B.
Published: December 2021

This book, a collection of papers delivered at a recent symposium of the Society for the Study of Development and Growth held at Dartmouth, does not present the subject in the classical pediatric manner. Rather, it is a consideration of the problems of growth and differentiation first at the molecular level and later from the standpoints of enzyme function, genetic action, and the more fundamental aspects of biosynthesis and growth determinants.

The biologist and the botanist have been quick to take up the newer tools of immunochemistry, tracer techniques and enzyme chemistry in an attempt to further elucidate the problems of growth and development at the cellular level.
Diagnosis of Congenital Heart Disease
Authors: LURIE PAUL R.
Published: December 2021

This is not a textbook, nor an encyclopedic reference, but rather a full report of the intensive diagnostic study of a series of 396 cases of congenital heart disease by a group whose reputation is wide and well deserved. The introduction states that of 342 cases subjected to full study, only 5 resulted in uncertain diagnoses. This seems incredible until one sees the superb quality of their angiocardiography, the outstanding feature of the book.

The authors combined several technical developments in this achievement; biplane 12/second roll-film changer, exposure times as short as 0.003 second on infants and selective injection of the contrast material into the chamber established by immediately prior catheterization being most crucial.
STUDIES OF DISTAL COLONIC MOTILITY IN CHILDREN
Authors: Davidson Murray , Sleisenger Marvin H. , Almy Thomas P. , Levine Samuel Z.
Published: December 2021

A suitable technic for measuring gastrointestinal pressures and motility in children is described and critically evaluated.

Data from 40 normal children are presented. These data show characteristic and different patterns in closely related segments of the distal colon, with a tendency to broader wave forms in the lower rectum. The possible physiologic implications are reviewed.

Comparison of the data is made with data available from adults and, although the findings agree, differences in classification and interpretation are made.

The potential usefulness of the technic for pharmacologic studies is discussed.
THE GENERATION OF THROMBOPLASTIN AND LEVELS OF PLASMA THROMBOPLASTIN COMPONENT IN THE BLOOD OF INFANTS
Authors: McElfresh Arthur E. , Sharpsteen J. Randolph , Akabane Taro
Published: December 2021

Infants less than 6 months of age have decreased thromboplastin generation, resulting in part from a deficiency of plasma thromboplastin component. Some factor or factors other than a low level of plasma thromboplastin component may contribute to this deficiency.

By the age of 1 year the majority of infants generate thromboplastin normally, and have normal levels of plasma thromboplastin component.
KERNICTERUS
Authors: Day Richard
Published: December 2021

Toxicity of heme pigments, in addition to that previously reported has been demonstrated as follows:

By depression of oxygen uptake by bilirubin bathing relatively intact cells of yeast and diaphragm; by hematin bathing yeast, diaphragm and minced brain, and by mesobilirubin bathing mouse diaphragm.

Oxidation cancels the toxicity of bilirubin. Cytochrome C cancels the toxicity of bilirubin and hematin. Mesobilirubin was not tested with cytochrome C.

By immobilization of Tetrahymena pyriformis by bilirubin at a concentration as low as 15 mg./100 ml. Oxidation of the bilirubin or the addition of cytochrome C cancels the action of the bilirubin. Hematin does not immobilize the animals. Removal of the bilirubin restores the protozoa to full activity.

Survival of newborn rats following intraperitoneal injection with bilirubin or hematin is impaired.
RECENT DEVELOPMENTS IN INFECTIOUS DISEASES
Authors: Hodes Horace L. , Steigman Alex J. , Gribetz Donald
Published: December 2021

TEN major topics and several minor ones were discussed during this seminar. The following is a summary of the major points of the discussion and includes some of the pertinent questions raised by the participants.

POLIOMYELITIS VACCINE

Two types of vaccine are potentially available to immunize a person against a virus disease. A "killed" virus vaccine is one which induces immunity despite the fact that it is made of virus which has been rendered noninfectious by physical or chemical means (ultraviolet light, formaldehyde, phenol, etc.). A "live" virus vaccine contains virus mutants which produce only a modified infection and yet induce immunity against the original virus disease. The modified infection may be accompanied by no clinically recognizable disease (yellow fever) or by a recognizable mild illness (vaccinia). The former type of vaccine has the advantage of producing immunity without producing infection. Its disadvantages include difficulties with "killing" and problems concerning the safeguards against noninfectiousness. The "live" vaccine has the advantage of producing a higher degree of, and longer lasting immunity than the "killed" vaccine. Disadvantages are concerned with possible virulence of the virus mutants, with production of disease in the injected individual, and spread of the infection to others. The presently available Salk vaccine for immunization is of the "killed" virus vaccine variety, the virus having been made noninfectious by treatment with formaldehyde.

The need for active immunization of the population against poliomyelitis is emphasized by the facts that virtually no children 3 to 5 years of age have antibody against all 3 types of poliomyelitis virus and less than 40 per cent of this age group have antibody against even 1 type.
Cerebral Palsy—Its Scope and Management
Authors: PERLSTEIN MEYER A.
Published: December 2021

This pamphlet upholds the tradition of excellent, small monographs on specialized subjects, for which the Public Affairs Pamphlets have become known. In abbreviated form, this gives a short survey of the nature, incidence, and clinical characteristics of the various types of cerebral palsy. Résumé of the purposes of therapy and of the methods of therapy are given. An excellent section deals with the community and social aspects of the problem. A list of resources is given for those interested in either learning more about the subject or seeking places where aid for a cerebral-palsied child may be obtained.
Ciba Foundation Symposium on "Hypertension" Humoral and Neurogenic Factors
Authors: CALCAGNO PHILIP L.
Published: December 2021

The Proceedings of the Symposium on Humoral and Neurogenic Factors in Hypertension, July, 1953, are presented and made available in an informative and stimulating manner through the generous support of the Ciba Foundation. Although many mechanisms appear to be operating in the production of hypertension, this symposium chose to evaluate and identify those mechanisms relevant to essential hypertension. Consideration is given to the role of the proprioceptive reflexes arising from the carotid sinus and the arch of the aorta, neurogenic, humoral and renal factors in the pathogenesis of hypertension.
THE USE OF INDIRECT ARTERIAL PULSE TRACINGS IN THE DIAGNOSIS OF CONGENITAL HEART DISEASE
Authors: Kuhn Leslie A. , Sapin Samuel O. , Grishman Arthur , Donoso Ephraim
Published: December 2021

The femoral, radial and carotid pulse curves of 22 normal patients and 33 patients with coarctation of the aorta were studied by indirect means using a crystal microphone and a standard electrocardiograph machine for recording purposes.

In general, certain definite abnormalities can be noted in the pulse tracings of patients with coarctation when compared with the normal group. In the normal patients, the femoral and radial pulsations began, on the average, simultaneously, whereas in the patients with coarctation of the aorta, there was an average delay of 0.01 second in the onset of the femoral pulsation as compared to the radial. There was considerable variation in both normal patients and those with coarctation, however, in the relative time of onset of the two pulses. This variation renders the use of the time of onset of the two pulses a poor diagnostic criterion for coarctation of the aorta, unless the femoral delay exceeds 0.02 second. It was also demonstrated that the relative priority of onset of the femoral or radial pulsation had little relationship to the age of the patient or the relative proximity to the heart of the two pulses, but more probably was dependent upon the speed of propagation of the pulse wave to the two extremities.

More valuable information, from a diagnostic standpoint, can be derived from analysis of the contour of the femoral pulse curve and its relationship to the carotid pulse curve. The patients with coarctation of the aorta showed a definitely prolonged ascent of the femoral pulse, regardless of the time of onset in relation to the radial. The time interval between the peak of the femoral pulse wave and dicrotic notch of the carotid pulse was constantly considerably less in the patients with coarctation than in the normals.

It is felt that pulse wave recording by indirect means reflects the pulse curve relationships derived by direct arterial puncture with satisfactory accuracy and gives the same useful information in the diagnosis and postoperative follow-up of cases of coarctation of the aorta. In addition, it is simpler and quicker than direct arterial puncture and is associated with no discomfort for the patient.
SEX-LINKED HEREDITARY NYSTAGMUS
Authors: Lein John N. , Stewart C. Thomas , Moll Frederic C.
Published: December 2021

Two families with hereditary sex-linked nystagmus are reported. In 1 family there were 9 males affected in 6 generations and in the other 5 males in 5 generations. The hereditary characteristic is presumably carried on the X chromosome as in red-green color blindness and hemophilia. The characteristics of the syndrome are discussed.
ERYSIPELATOUS SKIN NECROSIS IN A NEWBORN INFANT CAUSED BY LETHAL TOXIN OF STAPHYLOCOCCIC ORIGIN
Authors: Burton Irving F. , Sosin Allen
Published: December 2021

A case of staphylococcus infection in a 2-week-old infant is presented. There was clinical evidence of lethal toxin, dermonecrotoxin, leukocidin, erythrolysin, fibrinolysin and hyaluronidase (spreading factor). The latter 2 exotoxins were manifested as an erysipelas. A brief discussion of a possible source of this organism and the clinical manifestations of these exotoxins is presented.
Les Gamma-Globulines et la Médecine des Enfants
Authors: GITLIN DAVID
Published: December 2021

This paper-backed volume, written entirely in French, is a collection of 14 papers presented at an International Seminar on Gamma-globulin held in Paris in December, 1954. The subjects covered ranged from the physicochemical characterization of the gamma-globulins to the therapeutic uses of these plasma proteins in the treatment of such diseases as poliomyelitis, the exanthemata, typhoid fever, pertussis and infectious hepatitis. The normal metabolism of gamma-globulin is discussed and also considered are those diseases associated with abnormalities in gamma-globulin metabolism, such as hypogammaglobulinemia and hypergammaglobulinemia.
ADVERTISING IN PEDIATRICS
Authors: MAY CHARLES D.
Published: December 2021

THE WELFARE of children is greatly improved by the many essential and useful products provided through the enterprise of commercial organizations. An important service is rendered the practicing physician when such products are brought to his attention by appropriate advertising. Advertising in a medical journal is a favorite means for accomplishing this purpose. A twofold benefit results; to the purveyor of the product, and to the physician—who not only becomes acquainted with a product he may use to the benefit of his patients, but also, through the financial support the journal receives, he may be served by a better medical literature.

It is evident that the advertising pages should be considered as a source of information. As such, these pages impose a grave responsibility upon us; it is our aim to have all the information brought to the readers of Pediatrics both accurate and clear.
PATENT DUCTUS ARTERIOSUS WITH REVERSAL OF FLOW
Authors: Anderson Ray C. , Adams Paul , Varco Richard L.
Published: December 2021

Ten cases are presented of children having patent ductus arteriosus with reversal of shunt. Cyanosis, often greater in the toes, was present in all. Exertional dyspnea developed early. Murmurs were of no diagnostic value, but an accentuated pulmonic second sound was uniformly present. Right ventricular preponderance was found in all cases on the electrocardiogram. Cardiac size varied on roentgenography, but there was usually prominence of the pulmonary artery segment. Six cases showed evidence of bi-directional shunts, one showed only a reversed shunt, while data were insufficient to determine this point in the remaining three. Three patients had surgery, one with a successful outcome. The latter was a 1-year-old infant in whom lung biopsy at surgery revealed only minimal pulmonary arterial changes.

Forty-five cases are reviewed from the literature. The majority of these occurred in adults. Twenty-two have been subjected to surgery, four with good results, three of the latter being children.

The differential diagnosis is briefly discussed. The safest and simplest diagnostic test to perform is the determination of oxygen saturation of samples of blood obtained simultaneously from the right brachial and femoral arteries. Angiocardiography and cardiac catheterization also provided helpful information. The diagnosis will not be made unless the examiner keeps the entity in mind. The entity can no longer be considered rare.

Surgical treatment of the condition has been very disappointing, especially in the adult. There is reason to believe that surgical intervention very early in life will yield a higher salvage rate.
IN-VITRO EVALUATION OF NEPHROTOXIC SERA IN EXPERIMENTAL NEPHROSIS
Authors: Rothenberg Michael B. , Stavitsky Abram B. , Heymann Walter
Published: December 2021

Boyden's hemagglutination method with the modifications described by Stavitsky and Adler has been used for the evaluation of the nephrotoxicity of rabbit anti-rat kidney sera. Results of 81 determinations on 43 nephrotoxic sera and 10 control sera indicate a useful correlation between nephrotoxicity and hemagglutination titer.
EXPERIMENTAL STUDIES OF ALLERGIC COLIC
Authors: Fries Joseph H.
Published: December 2021

The purpose of this presentation is to discuss true allergic colic—as differentiated from the many other forms of colic. An allergic etiology probably accounts for only a small fraction of the colic seen in infancy. Nevertheless, it is worth emphasis because it is in this field that one can present objective evidence.

It used to be generally assumed that "infantile colic" implied only a spastic disturbance of the small intestine. In the light of present understanding, this spastic phenomenon may involve not only the small intestine, but also the colon, and even the pylorus of the stomach.

THE EXPERIMENTAL STUDIES

One does not have to speculate on the "modus operandi." It has been possible to demonstrate visible evidence of this otherwise subjective phenomenon by roentgenogram. In atopic children, specifically chosen because they were subject to intestinal cramps from known foods, it was possible to activate various parts of the gastrointestinal tract by feeding these allergenic foods concealed in barium. These studies were published in detail some time ago.

We could produce segmental contraction of the small intestine, demonstrating configurations on the roentgenogram comparable to those seen in sprue or celiac disease; and observe pylorospasm and colonic spasm in association with cramping abdominal pain, varying from mild to severe. Many of these children had confirmatory positive cutaneous tests to the provocative foods. Although these observations were made on children 4 to 14 years of age, there is no reason to doubt that similar mechanisms are operative in infants. Obviously infants are not suitable subjects for such studies.
THE GENERAL STATE OF AMERICAN PEDIATRICS IN 1855 WITH PARTICULAR REFERENCE TO PHILADELPHIA
Authors: Caulfield Ernest
Published: December 2021

IN VIEW of the tremendous advance in pediatrics during the past half century, one might think that a full century ago no one could have known very much about the care of children. To read the newspapers of that day, one might also conclude that it was an age primarily of quacks and patent medicines—of worm cures, hive syrups and of little liver pills. But to appreciate the true status of American pediatrics in 1855 one must judge it not only by the standards of our time but also by the standards of a century earlier, and when that is done it will be seen that American pediatrics in the mid-Nineteenth Century had also made considerable progress. In 1755 the care of the sick was generally in the hands of well-meaning yet untrained practical nurses whereas in 1855 people were turning to physicians who were usually medical school graduates, well acquainted with a vast number of new and important publications. More and more pediatric articles were appearing in the many American journals; and in the review of a new book, one writer mentioned "the numerous publications on the management of infants and children with which the press has been loaded." Indeed, the press was loaded, for the Philadelphia physician had at his command no less than 8 fairsized textbooks in English devoted exclusively to the care of children.

The second quarter of the Nineteenth Century saw a definite trend toward pediatrics as a specialty. There is no need to discuss here the numerous elementary guides which were intended primarily for mothers and which were precursors of the textbooks, or the many systems of general medicine with their chapters on pediatric subjects, especially since this trend may be well illustrated by mentioning only the impressive list of textbooks published in Philadelphia.
EDUCATION
Authors: Green Morris , Stark Mary
Published: December 2021

CONTINUITY of medical care and health supervision is receiving increased emphasis in both undergraduate and graduate medical education. Clinical training in pediatric health supervision has generally been inferior to experience in the care of illness. Although it has been assumed that adequate skill in the care of well children could be developed after completion of formal training, this supposition may be questioned in view of the dissatisfaction expressed by many practitioners with their preparation for this aspect of child care. Pediatric house officers have generally taken for granted that they would be provided adequate experience in the diseases of childhood. They are beginning to expect similar preparation for health supervision.