bluuebunny/crossref_metadata_2025 huggingface dataset:
ADRENAL FUNCTION IN THE PREMATURE AND NEWBORN
Authors: Gardner Lytt I.
Published: December 2021

THE special nature of adrenal function in newborn infants has excited the curiosity of physicians for half a century. Three groups of workers in 1911 nearly simultaneously described the strange involution which occurs in the cortex of the newborn's adrenal gland. Since that time much speculation and a few experiments have added somewhat to our knowledge. The recent development of chemical techniques for the estimation of adrenal steroids in the urine and peripheral plasma of the newborn have provided some very interesting data.

Let us review the earlier observations. The newborn adrenal glands weigh approximately .29 per cent of the total body weight, which is quite striking when compared with the adult glands averaging only about .014 per cent of total body weight. At the time of birth the infant's adrenal cortex is composed of 2 histologically distinguishable zones. One is an outer region ("adult cortex"), which is composed of a zona glomerulosa and of short strands of zona fasciculata. The inner region is quite extensive and makes up about 80 per cent of the entire newborn adrenal gland. This inner zone goes by several names: fetal transitional zone, internal cortex, or fetal androgenic zone. This zone is made up of large cells reminiscent of the adult zona reticularis. There is intense vascularization of this area, so much so that one early worker even suggested that it participates as a fetal hematopoietic organ. Involution of the fetal cortex begins just prior to or at birth in both full-term and premature infants.
PLASMA PIGMENTS IN ERYTHROBLASTOSIS FETALIS
Authors: Abelson Neva M. , Boggs Thomas R.
Published: December 2021

A method for measuring plasma pigments in erythroblastosis fetalis has been developed and submitted to preliminary clinical trial. There appears to be a correlation between amount and kind of plasma heme pigment and severity of disease and, therefore, the technique promises to be a useful tool in evaluating the need for treatment and the effect of exchange transfusion. There appears to be some hope that it may provide further clues as to the pathogenesis of a variable and often puzzling disease.
A NEW DIAGNOSTIC METHOD IN ALLERGIC DISEASE
Authors: Black Arthur P.
Published: December 2021

A test has been described in which dried protein allergen and plasma from a sensitized or allergic patient are mixed with living leukocytes and platelets either from the patient or a nonallergic donor, kept at 37°C. and observed under the microscope. If specific antibodies to the allergen are present in the plasma the polymorphonuclear leukocytes and platelets show toxic effects and the cells die within 15 minutes to several hours, whereas controls remain viable and actively motile. This cytotoxic reaction has been observed with food, pollen, epidermal, and inhalant allergens, and shows such correlation with clinical sensitivity as to be a helpful guide in determining which allergens are likely offenders and which are innocuous in a particular case. A positive reaction does not necessarily mean clinical sensitivity, but if the reaction is prompt and strong such sensitivity is likely. If the reaction is negative clinical sensitivity has not been found except following anaphylaxis.

It is believed that the technique described and the observations reported constitute a new and useful diagnostic method in allergic disease.
Airborne Contagion and Air Hygine
Authors: TOP FRAKLIN H.
Published: December 2021

The transmission of infections affecting man has been the object of much thought, theory and conjecture for many centuries. Host to host transfer of infectious agents remained largely in the province of speculation until the "Golden Age of Bacteriology" and the succeeding era of discovery of viruses. In the immediate past half century the experimental method has added considerably to the proposition that certain agents pathogenic to man are transmitted by air.

Well's book is a scholarly treatise on a subject to which he has given earnest consideration for over 20 years, namely, the importance of droplets, droplet nuclei and dust in the spread of infection.
CHANGES IN TOTAL CHLORIDE AND ACID-BASE BALANCE IN GASTROENTERITIS FOLLOWING TREATMENT WITH LARGE AND SMALL LOADS OF SODIUM CHLORIDE
Authors: Cheek Donald B.
Published: December 2021

Seventeen infants with acute gastroenteritis have been studied. These patients were divided into 2 groups, 1 receiving high sodium loads (average 18 mEq./kg.) and the other low loads (6 to 7 mEq./kg.) during the first 24 hours following admission to the hospital. Adequate fluids and potassium were also administered and the acidbase balance, serum electrolyte concentrations, and total chloride were obtained in most instances at the time of admission, at 24 hours and at 72 following admission. From 24 hours to 72 hours maintenance fluid and electrolyte were given to all patients.

Patients receiving high initial loads of sodium demonstrated persistent acidosis at 24 hours and a trend towards hypokalemia and/or metabolic alkalosis at 72 hours.

The administration of low initial sodium loads was associated with a more consistent reduction of acidosis at 24 hours and the finding of normal serum chemical values at 72 hours. It is pointed out that if diarrhea does not abate after admission, the administration of low sodium loads does not restore hydration or acid-base balance.

Progressive determination of total body chloride and body weight demonstrated large increments in body chloride in patients receiving high sodium chloride loads. This increment persisted in 3 patients and was associated with edema, and probable cell water subtraction.

It is considered that amounts of sodium of similar magnitude to the known deficits should be given initially in gastroenteritis except in the presence of hyperelectrolytemia. Other conditions of dehydration require different fluid therapy and sometimes the complete restriction of potassium (e.g., adrenal insufficiency).

The results suggest an abnormal increase of total body sodium with sodium loading during circumstances of potassium loss, a contention well supported by animal experiments.
QUANTITATIVE ULTRAMICRO-ANALYSIS FOR THE CLINICAL LABORATORY
Authors: Kaplan S. A. , Carmen F. T. del
Published: December 2021

Methods are described for analysis for glucose, nonprotein nitrogen, inorganic phosphorus, calcium, alkaline phosphatase, bilirubin, sodium, potassium, pH, chloride, cephalin flocculation, total cholesterol, total protein and albumin. The quantities of plasma or serum required for analysis range from 0.02 to 0.1 ml. and the performances of the analyses are simple enough to enable them to be used in clinical laboratories.
REVIEW ARTICLE
Authors: Gardner Lytt I.
Published: December 2021

THE IDENTIFICATION and measurement of adrenocortical steroids in body fluids over the past 2 decades have made possible an extensive exploration of adrenal function. This review is restricted to adrenocortical metabolism in the fetus, infant and child. No attempt will be made to cover all of this rapidly developing area of endeavor. Certain aspects have been treated in other review articles, to which the reader is referred. The reviews by Moore on fetal endorinology, Klein on neonatal adrenal physiology, Lieberman and Teich and Roberts and Szego on steroid biochemistry, White and Wettstein and Anner on adrenal cortical hormones, Ingle on cortisone and Gaunt, Renzi and Chart on aldosterone are especially useful. The books by Wilkins and by Talbot and colleagues contain helpful treatments of this area. Due to the prolific nature of even the review literature, it is necessary to make a rather arbitrary selection of material.

NEWER METHODOLOGY

Within recent years a number of methods have been developed for the estimation of hormones in urine and plasma. Several techniques for the chromatographic separation of the 17-ketosteroids in urine have been described. Of particular value in the diagnosis of virilizing adrenal tumor has been the development of colorimetric methods for the estimation of dehydroepiandrosterone in urine. Some progress has been made in the estimation of corticosteroids in the urine. Techniques for the measurement of 11-oxygenated neutral 17-ketosteroids, pregnanetriol and pregnanediol in the urine of patients with congenital adrenal hyperplasia have been described.

There has been a blossoming of methods for estimating steroids in plasma. Several varieties of techniques are now available for the measurement of corticosteroids and 17-ketosteroids in plasma.
Phenylbutazone
Authors: BATES TALCOTT
Published: December 2021

Phenylbutazone (Butazolidin®), introduced into clinical usage in 1952 as an antirheumatic agent in gout, rheumatoid arthritis and other periarticular diseases, has gained widespread usage among adults, and a report of its accidental ingestion by a 2-year-old infant may therefore be of interest.

On March 8, 1955, during a period of parental strife, a 24-month-old female infant was left alone at home with a 39-month-old sibling. At 9:30 A.M. she was discovered to have ingested 2 or 3 tablets of aspirin and phenacetin, and a small bottle of cough syrup, containing no potentially toxic or systemically active ingredients.
"Team Approach"
Authors: SKINNER RICHARD G.
Published: December 2021

I read with great interest the article in the March, 1956, issue of Pediatrics entitled "The President Comments." For some time I have been associated with the Florida Crippled Children's Commission, with the local United Cerebral Palsy Unit, and with a "Cleft Palate Team." In all of these endeavors we are faced with the problem of having 3 or 4 different physicians rendering care to the same child, and it is forever evident that the parent becomes confused. Different doctors say virtually the same thing but in a different way, and the parents tend to misinterpret what is said and get the impression that each doctor is telling them something different.
Culture and Human Fertility
Authors: KEETTEL W. C.
Published: December 2021

This book is divided into 2 parts. Part I deals with problems of general theory as related to human fertility. Part II presents a number of specific studies undertaken by the author and other collaborators in this investigation. These specific studies are attempts to find out the relation of cultural conditions to fertility in nonindustrial and transitional societies. This book will chiefly be of interest to individuals interested in population problems.
ATRESIA OF THE VAGINA IN INFANCY
Authors: Whittlesey Robert H. , Atik Mohammad , Jones James C.
Published: December 2021

Cystic lower abdominal masses in female infants may be due to enormous distention of the upper vagina, secondary to either atresia of the vaginal canal or to an imperforate hymen.

Obstruction of urinary or gastrointestinal systems may result, and may cause the only symptoms.

Diagnosis can usually be made preoperatively by careful and adequate roentgenographic studies.

Safe treatment of the condition requires open operation for the establishment of an outflow tract.
NEW TECHNIQUES IN THE DIAGNOSIS AND TREATMENT OF MEGALOURETERS
Authors: Swenson Orvar , Fisher John Herbert
Published: December 2021

Studies on 60 patients with megaloureters are described.

Thirty-two patients proved to have a defect in parasympathic innervation of the bladder. The defect in bladder function was the cause of ureteral dilatation. Bladder neck resection is the treatment of choice.

Fifteen patients proved to have defects in ureteral peristalsis as the cause of ureteral dilatation. Replacement of some of these defective ureters with narrowed segments of ileum has proved successful.
PEDIATRIC GYNECOLOGY AND ENDOCRINOLOGY
Authors: Greenblatt Robert B. , Bennett James W.
Published: December 2021

MANY mothers bring their young daughters to the pediatrician because they have noticed a discharge on the child's underclothing. Most of such discharges are nothing more than desquamation of the epithelial cells at perhaps a more rapid pace than usual. Such a discharge, commonly referred to as "whites," occurs normally in the adult female. No pathologic process is involved in either the child or the woman and no treatment is indicated. On the other hand, a discharge which is irritating, malodorous, and provokes an inflammatory response, has a pathologic background. By far the greater number of such cases fall into one of the following categories:

(a) Nonspecific vaginitis which may be due to the presence of organisms which find their way into the vaginal canal either through insertion of the child's finger or some foreign object, or may appear for no apparent predisposing reasons. Among the organisms found are pneumococcus, streptococcus, staphylococcus, diphtheroids, colon bacillus, etc. The treatment consists primarily of removing or correcting the underlying factor and cleansing measures. Frequently, attention to the technique of cleansing the rectal area following a bowel movement, daily bathing and a pitcher douche with saline twice a day will clear up the discharge. Sulfonamides by mouth, locally, or both may be effective in some cases. In other cases, the local use of a specific antibiotic such as Terramycin® or Aureomycin® has been effective (a 50 mg. capsule may be inserted into the vaginal canal daily for 5 to 7 days).

(b) Another group of cases is due to the presence of foreign bodies in the vaginal canal. Any number and type of foreign bodies have been found in the vaginal canals of small children, such as safety pins, pencils, sticks, etc. The presence of a foreign body sets up an irritant reaction and causes a discharge, in most instances with a bloody component. The diagnosis may be made by inspection or by gentle rectal examination, pressing the vaginal wall through the rectum.
Biological Specificity and Growth
Authors: GITLIN DAVID
Published: December 2021

This book is a compilation of 11 papers that were presented at the Twelfth Growth Symposium, which was held at the University of New Hampshire on June 14 to 22, 1953, under the joint auspices of the Society for the Study of Development in Growth and the Committee on Developmental Biology of the National Research Council. The topic for this Symposium was "Biological Specificity and Growth" and the broadness of the subject was such that the subjects discussed varied from problems of specificity in the sexuality of plants, as presented by John Raper, to a discussion of host-parasite relationships by W. H. Taliaferro.
CARCINOMA OF THE THYROID IN CHILDHOOD
Authors: Winship Theodore
Published: December 2021

Data from 334 collected cases of childhood thyroid carcinoma have been compiled and studied. Possible etiologic factors are discussed, including congenital and geographic influences, and the effects of soybean diet, cobalt medication and the irradiation to the neck in infancy.

The clinical and pathologic manifestations and the prevalence of this disease are discussed on the basis of the large series.

Various methods of treatment and the results are reviewed. The usual 5-year follow-up period is of little value in thyroid carcinoma. Data from a 20-year follow-up of a large series of cases may indicate the best methods of therapy.
THE PROBLEM OF NODULES IN THE THYROID GLAND
Authors: ASTWOOD E. B.
Published: December 2021

The conclusions suggested by this brief review are that: (1) Nodules in the thyroid are so frequent that removal as a routine procedure is impractical and, if half of clinically normal glands are indeed nodular, impossible. (2) Histologic changes in thyroid tissue frequently suggest a diagnosis of cancer when no life-threatening lesion actually exists. (3) Fatal cancer of the thyroid is rare and operations upon nodular glands will neither cure nor prevent true thyroid carcinoma. (4) Currently the only practical method of treatment for nontoxic thyroid enlargement, nodular or diffuse, is suppression of the gland by the administration of thyroid preparations in adequate doses. Surgical procedures, roentgen irradiation and radioiodine therapy are largely palliative measures in true carcinoma of the thyroid gland.
DIAGNOSIS AND MANAGEMENT OF DYSAUTONOMIA
Authors: Linde Leonard M.
Published: December 2021

The variability of severity and of presenting complaint in both classical and variant forms of dysautonomia is stressed.

Psychological evaluation of these children has not borne out the initial clinical impression of mental retardation.

Drug treatment of the vomiting crises and preventive psychological management of the emotional instability is discussed.

Awareness of the widespread evidences of autonomic and central nervous system dysfunction will eliminate unnecessary diagnostic procedures and delayed diagnosis of dysautonomia.
AN APPRAISAL OF PNEUMOENCEPHALOGRAPHY IN MENTAL RETARDATION AND EPILEPSY
Authors: Charash Leon I. , Dunning Henry S.
Published: December 2021

A series of 151 pneumoencephalograms done on children in the New York Hospital during the last 16 years as a diagnostic procedure in mental retardation and epilepsy, classified as idiopathic, is surveyed.

Analysis of these cases and evidence from a review of the literature are cited to demonstrate the paucity of useful information to be derived from this procedure in these conditions.

Two deaths and nine nonfatal, but serious, complications are reported, in contrast to the usually stated concept of the safety of the procedure in these conditions.

Based on this experience and on reports in the literature, it is recommended that pneumoencephalography be abandoned as a diagnostic procedure in the study of these conditions.
THE ENERGY METABOLISM OF INFANTS AND YOUNG CHILDREN DURING POSTPRANDIAL SLEEP
Authors: Lee Virginia A. , Iliff Alberta
Published: December 2021

The energy metabolism of healthy infants, from 1 through 37 months of age, was measured with an open circuit chamber within 3½ hours of the time they had been fed and while they slept with little or no motion. Satisfactory results were obtained in 248 tests on 38 boys and 246 tests on 40 girls.

A statistical analysis of the results of these determinations included the means, the standard error of the means, and the standard deviations of the means for cal/hr, cal/hr/m2, cal/hr/kg, and cal/hr/cm referred to age, as well as cal/hr referred to weight, height, and surface area, respectively, for boys and girls.

Scatter diagrams for cal/hr and cab/hr/ m2 referred to age for boys were given.

In order to differentiate normal thyroid activity from abnormal activity in children of this age, it was found that the best methods of reference to use for comparison, i.e., the methods which gave the least dispersion from the mean in healthy infants, were cal/hr/m2 referred to age and cal/hr referred to surface area, while the least desirable methods of reference for such use, i.e., the methods which showed the widest dispersion from the mean, were cal/hr/kg and cal/hr referred to age. Tentative standard values obtained from the mean trend lines were given for cal/hr/m2 for age and cal/hr for surface area.

It was found that, from ½ to 3½ hours after feeding, there was no change in the effect of food on the metabolic rate or on the respiratory quotients. No significant changes were found in the respiratory quotients with age.

It was concluded that differences between the energy production of boys and girls up to 3 years of age could be attributed to differences between the sexes in body size for age and body weight for height.

The mean heat production of children from 18 to 36 months of age was found to be from 3 to 9% lower in tests done during sleep in the postprandial state than in those done during the usual awake fasting conditions.
SEVERE IDIOPATHIC HYPERCALCEMIA OF INFANCY
Authors: Daeschner George L. , Daeschner C. William
Published: December 2021

A syndrome occurring in infants and characterized clinically by anorexia, vomiting, constipation, hypotonia, hypertension, characteristic facies, and severe mental-motor retardation, and by the laboratory findings of hypercalcemia, azotemia and impaired renal function has recently been described by British and Swiss workers. The disease apparently occurs in two forms, referred to as mild and severe. The literature concerning the severe form has been reviewed and an additional case reported. Hypersensitivity to vitamin D with excessive calcium absorption has been demonstrated in the mild form of this syndrome and has also been proposed as the metabolic abnormality responsible for the pathologic features of the severe form of the disease.
RECENT ADVANCES IN THE MANAGEMENT OF RENAL DISEASE IN CHILDREN (PART 1)
Authors: McCrory Wallace W. , Macaulay Duncan
Published: December 2021

THIS REVIEW makes no claim to be exhaustive. In the discussion of topics selected we have not hesitated to make judgments based on our clinical experience when reports give vague or conflicting views. We have given background information when this was felt necessary to make clear the reasons for some aspects of treatment. In cases where there have been no notable recent advances, we have, for the sake of completeness, given brief accounts of currently accepted methods of management. It is hoped that the paper will thus be helpful, not only as a guide to the recent literature, but also in the management of patients.

ACUTE GLOMERULONEPHRITIS

Before attempting to evaulate recent developments in the management of this disease in children, it is salutary to review some of the results obtained by earlier workers. Frisk and Klackenberg report a 10-year follow-up study of 239 cases of which 230 were typical acute glomerulonephritis. Two hundred fourteen of the patients were located and wherever possible the follow-up examination included recording of blood pressure and an Addis count of the urinary sediment. The survey gave the following results: death during the acute phase, 5 (2.3%); permanent renal damage after 10 years, 12 (5.6%) (8 were symptom-free despite the urinary changes); doubtful urinary findings, 10 (4.7%) (all in good health); completely recovered, 187 (87.4%). Davis and Faber report from California a 2-year follow-up of 102 children which revealed an immediate mortality of 5.9% and an over-all recovery rate of 81.3%. They referred to other series with very similar results.
Mechanisms of Congenital Malformations. Proceedings of the Second Scientific Conference of the Association for the Aid of Crippled Children (1954)
Authors: WARKANY JOSEF
Published: December 2021

For many years the Association for the Aid of Crippled Children has supported teratologic research in many ways. Among the activities of the Association scientific conferences and publication of their proceedings play an important role. In the present volume one will find brief summaries of papers presented at a conference in 1954 and abstracts of the discussions contributed by the participants. Part I dealing with physical, chemical and sociological aspects of the fetal environment contains an interesting report by J. Walker of Aberdeen, Scotland, on the effects of obstetrical, physical and environmental factors on the incidence of stillbirths, neonatal deaths and prematurity.
RECENT ADVANCES IN THE MANAGEMENT OF RENAL DISEASE IN CHILDREN (Part II)
Authors: McCrory Wallace W. , Macaulay Duncan
Published: December 2021

The last decade has provided the interested physician with a number of advances in the management of these complicated problems. A means of prompt diagnosis of the existence of chronic renal insufficiency is often afforded the physician by the presence of certain common but typical symptoms (failure of growth, recurrent bouts of vomiting, and/or dehydration without apparent cause, convulsions, refractory anemia, and bone disease). Early recognition of the existence of chronic renal failure is very important since the rate of deterioration of renal function can be lessened by eradicating associated active infection of the urinary tract and prompt surgical intervention when indicated for relief of obstructive uropathy. Since progressive loss of functioning renal tissue may result from a number of different disturbances (congenital hypoplasia or obstructive unopathy with or without associated infection, other anomalies, polycystic kidneys, chronic pyelonephritis, or glomerulonephritis, etc.) exact diagnosis is essential for the establishment of appropriate therapy. Symptomatic improvement manifested by return of appetite, relief of vomiting, increased activity tolerance, and at times some degree of growth can be achieved by foregoing a "do nothing" attitude. Only the principles of treatment will be reviewed and available sources should be consulted for details. An increased intake of water and output of urine is needed to permit excretion of solutes by a kidney with limited concentrating and diluting abilities. Since patients with renal insufficiency have a limited capacity for flexibility in renal response to administered loads of water, electrolyte, and solutes, excesses or inadequacies in intake are not tolerated and should be avoided. Regulation of the content of electrolytes in the body is aimed at maintaining the patient at his symptomatic best rather than chemically normal.
INTRACELLULAR COMPOSITION AND HOMEOSTATIC MECHANISMS IN SEVERE CHRONIC INFANTILE MALNUTRITION
Authors: Frenk Silvestre , Metcoff Jack , Gómez Federico , Ramos-Galván Rafael , Cravioto Joaquin , Antonowicz Irena
Published: December 2021

Data obtained in a study of chemical composition of tissues in malnourished pre-school children are reported. In most cases, muscle and skin show an increase in total content of water, sodium and chloride. These changes are less striking but persist during "dehydration" judged on clinical grounds.

The content of potassium in muscle was slightly to moderately decreased particularly in clinically edematous children. Edematous patients also had a markedly decreased intracellular concentration of potassium. In general, no correlation between intracellular concentration of sodium and potassium was found in muscle. Muscle obtained shortly before death or immediately after death frequently showed a marked shift of water and sodium into the intracellular compartment. A low ratio of concentration of potassium to noncollagenous nitrogen as compared to normals generally was observed.

The skins of subjects without clinically demonstrable edema had comparable amounts of water but less fat per unit of dry fat-free solids than those of children with pitting edema. No particular correlation was found between overhydration and increase in content of the ("excess") chloride of the non-extracellular phase.
Perinatal Mortality in New York City: A Study of 955 Deaths, Committee on Public Health Relations of the New York Academy of Medicine
Authors: HARPER PAUL
Published: December 2021

This is the second report of a study of infant mortality in New York City undertaken by the Committee on Public Health Relations of the New York Academy of Medicine. The first report was concerned with hospital facilities for infants and mothers.

The present report concerns the clinical study of 955 individual infant deaths. The purposes were:

1. To determine as accurately as possible the causes of perinatal mortality.

2. To determine the extent of preventability of perinatal deaths.

3. To obtain additional data concerning past obstetrical history and prenatal care of mothers, analgesia and anesthesia, medical care and detailed pathologic findings.
IDIOPATHIC HYPONATREMIA IN AN INFANT WITH DIFFUSE CEREBRAL DAMAGE
Authors: McCrory Wallace W. , Macaulay Duncan
Published: December 2021

A female infant, 5 months of age, with evidence of diffuse cerebral damage was found to have hyponatremia in the course of ordinary investigation.

Measurements of total body chloride by the thiocyanate-space method at widely different concentrations of chloride in the serum yielded results within the expected normal range. The infant was unable to excrete an acute water load as rapidly as normal infants. Serum from the patient during a hyponatremic phase showed significantly greater antidiuretic activity than that of a normal child.

We concluded that the hyponatremia was due to dilution of body fluids secondary to water retention on the basis of disturbed renal function. The hyponatremia was resistant to correction by administration of salt or mineralo-corticoids. A relation between fluid intake and concentration of sodium in the serum was demonstrated which suggested that on normal fluid intakes the child was unable to excrete solute-free water in a normal manner. This may represent the result of damage to the cerebral osmoreceptors as part of generalized brain damage. The data do not support the concept that the hyponatremia resulted from true salt-wasting, either cerebral or renal in mediation. If correction of such a state is desirable, the most useful therapeutic measure would appear to be limitation of the intake of fluid to slightly more than the amount needed to cover water expenditure from insensible losses, obligatory urine volume and growth requirements.
INTAKE OF VITAMIN B6 AND INFANTILE CONVULSIONS: A FIRST APPROXIMATION OF REQUIREMENTS OF PYRIDOXINE IN INFANTS
Authors: Bessey Otto A. , Adam Doris J. D. , Hansen Arild E.
Published: December 2021

Nine infants, 1 to 12 months of age, with convulsions due to inapparent cause, have remained free of seizures after a change to a diet providing an increased amount of vitamin B6, or after administration of vitamin B6 as such. Five of these infants had been receiving a proprietary milk mixture found by analysis to be low in content of vitamin B6 (0.085 mg/l), two were breastfed and two, who developed convulsions in the neonatal period, had been receiving an evaporated milk mixture.

Seven of the infants became free of convulsions when given an evaporated milk mixture supplying an average of 0.26 mg of vitamin B6 daily. Four of these seven infants were studied for biochemical evidence of deficiency of vitamin B6 by the use of a tryptophan loading test. All four excreted large amounts of xanthurenic acid after receiving 0.54 gm/kg of DL-tryptophan. One to 1.4 mg of vitamin B6 daily were required to prevent the excretion of xanthurenic acid. In contrast, 10 of 11 control infants receiving 0.2 to 0.5 mg of vitamin B6 daily failed to excrete xanthurenic acid when similarly tested and two of these infants, who began to excrete xanthurenic acid after receiving for 1 month a diet low in content of vitamin B6, ceased to do so after receiving 0.3 to 0.4 mg of vitamin B6 daily. This suggests that the requirement of vitamin B6 of the seven infants who had developed the deficiency is, for some reason greater than that of the average infant.

The two infants whose convulsions appeared in the neonatal period required 2 to 5 mg of vitamin B6 daily to eliminate the seizures. One of these is still dependent upon a supplement of 2 mg of vitamin B6 daily. However, these two infants, like the control infants, required only 0.3 to 0.4 mg of vitamin B6 daily to prevent excretion of xanthurenic acid after receiving a dose of tryptophan. It seems probable that these two infants have anomalous metabolism of vitamin B6 rather than simple deficiency.

In view of the above observations, it is recommended that an infant's diet contain 0.2 to 0.3 mg of vitamin B6 daily. However, since there are occasional instances of anomalous requirements, it is suggested that a therapeutic trial dose of 5 to 10 mg of pyridoxine hydrochloride daily be given to any infant with convulsions resulting from inapparent cause.
AN EVALUATION OF THE FLUSH METHOD FOR DETERMINING BLOOD PRESSURES IN INFANTS
Authors: Moss Arthur J. , Liebling Wilbert , Austin Wallace O. , Adams Forrest H.
Published: December 2021

Using the flush technique, determinations of blood pressure were made on 294 normal infants from 1 day to 1 year of age and on 23 additional infants and older children with congenital heart disease. Analysis of the data showed that:

The method was found to be a practical and relatively accurate procedure in the office or clinic.

The pressure at the ankle was usually significantly lower than that at the wrist.

Comparative studies with auscultatory and direct measurements indicated that values obtained by the flush technique represent the mean rather than the systolic blood pressure.

Readings obtained with a 5 cm blood pressure cuff did not differ significantly from those obtained with a 7.0 cm or 9.5 cm cuff.
CHILDREN WITH CEREBRAL PALSY
Authors: Wallace Helen M. , Losty Margaret A. , Sanders David , Siffert Robert S. , Tobis Jerome S. , Rich Herbert
Published: December 2021

This report describes the findings and interim results of a follow-up study of 770 children with cerebral palsy who were cared for under the aegis of the New York City Financial Aid Program from 1945 to July 1, 1954. The findings seem to indicate that some redirection of the program to include development, expansion and improvement of some alternate services within the community is advisable. It is likely that this same type of follow-up study would be of equal value for children of other diagnostic groups, and similar studies might be initiated.
The Lung as a Mirror of Systemic Disease
Authors: SEEBOHM PAUL M.
Published: December 2021

The major portion of this text describes the pulmonary manifestations of systemic diseases as observed by roentgenogram. In addition there are complete but brief descriptions of the systemic characteristics of the diseases discussed. Attention is drawn to the nonspecificity of abnormalities in the roentgenograms, and the necessity of correlating these with other clinical evidence, especially the history, is emphasized. As one reads the book he suspects the author has had the experience of being requested to evaluate roentgenograms of the chest before the patients had a history taken and a physical examination performed.
Radiology of the Alimentary Tract in Infancy
Authors: CAFFEY JOHN P.
Published: December 2021

This book deals chiefly with the radiographic problems of the alimentary tract during the first 12 months of life. It contains 282 pages. Its seven sections are illustrated profusely with clear and carefully cropped prints of roentgenograms and several line drawings.Numerous illustrative case histories are given at the end of each main section; it is questionable whether these add sufficiently to justify the increase in the bulk of the book.

The first section on the esophagus is probably the best in the book. The discussion of gastroesophageal incompetence covers 34 pages.
RADIATION HAZARDS IN THE FIELD OF PEDIATRICS
Authors: Robinow Meinhard , Silverman Frederic N.
Published: December 2021

The different types of injury from external sources of ionizing radiation are briefly described and the manifestations of radiation injury in the fetus, the infant and the child are reviewed.

If radiation therapy for malignant disease is excluded from consideration, it is found that x-ray damage to skin, other tissue destruction, and growth impairment are relatively minor radiation hazards compared to the dangers of leukemia and other malignancy and of radiation-induced genetic damage.

Consideration is given to somatic radiation injury as largely an individual problem and genetic injury as a population problem. This point of view is reflected in the differing recommendations concerning "permissible doses" for individuals and for populations.

Medical radiation represents a major and presumably growing source of exposure to individuals and to the population in the United States. Various ways are shown in which excessive diagnostic exposure to x-rays, especially in children, can be reduced without interference with requirements of diagnosis.

Control of avoidable radiation can be accomplished by combined attack from different fronts. The more important approaches to radiation safety are discussed. They include attention to technical detail, personnel monitoring, maintenance of radiation records, radiation safety through legislative control and public education.

The responsibility of the physician in promoting public understanding of radiation hazards is emphasized.
INFANTILE BERIBERI ASSOCIATED WITH WERNICKE'S ENCEPHALOPATHY
Authors: Davis Ruth Alice , Wolf Abner
Published: December 2021

An infant, 5½ months of age, died after a brief acute illness characterized by irritability and somnolence leading terminally to coma, and by excessive sweating, abdominal distension, tachypnea and tachycardia. Acidosis and azotemia were marked. He was found at necropsy examination to have pathologic findings compatible with both beriberi and Wernicke's encephalopathy.

Investigation of the dietary history and analysis of the formula fed the patient confirmed the suspicion of deficient intake of thiamine.

This is the first case report in which the coexistence of these two pathologic conditions in a child proven to have had an inadequate diet, has been documented. It lends further support to the thesis that Wernicke's encephalopathy is caused by nutritional deficiency.

The importance of vitamin supplementation of restricted diets used in the therapy of infantile eczema is emphasized.
HEMOLYTIC DISEASE OF THE NEWBORN DUE TO THE RARE BLOOD FACTOR, rhw(Cw)
Authors: Sacks M. O. , Schlutz C. , Dagovitz L. , Vanecko M.
Published: December 2021

This case serves to emphasize several features in the management of hemolytic disease of the newborn, including the importance of noting clinical icterus, the importance of proceeding with therapy even though the specificity of the sensitizing antigen is unknown, and the importance of a detailed investigation for the offending antibody. This includes the use of a panel of erythrocytes by personnel practiced in its function. As most blood banks do not have such panels or personnel, it is recommended that studies on cases of hemolytic disease of the newborn, where a serologic diagnosis has not been made, be done in a qualified laboratory. Blood samples should be forwarded to such a laboratory for testing.
KERNICTERUS IN PREMATURE INFANTS ASSOCIATED WITH LOW CONCENTRATIONS OF BILIRUBIN IN THE PLASMA
Authors: Harris Ruth C. , Lucey Jerold F. , MacLean J. Robert
Published: December 2021

Concentrations of bilirubin in the plasma of 85 premature infants weighing less than 2000 gm at birth were measured daily for the first 6 days of life. These measurements are presented and discussed. Nine cases of kernicterus which developed with relatively low concentrations of plasma bilirubin are reported.

Laboratory studies are cited to support the hypothesis that the development of kernicterus in these infants was enhanced by the use of the antibacterial combination of penicillin and Gantrisin®.

Attention is called to the effect which antibacterial therapy may have upon the concentration of bilirubin in the plasma of premature infants and to the lower values for plasma bilirubin which occur in dying infants.
CHEMICAL AND CLINICAL OBSERVATIONS DURING TREATMENT OF CHILDREN WITH PHENYLKETONURIA
Authors: Berry Helen K. , Sutherland Betty S. , Guest George M. , Umbarger Barbara
Published: December 2021

Three children with phenylketonuria between the ages of 2½ and 4½ years have been treated with three different diets low in content of phenylalanine during the past 18 months. In Diets I and III restriction of phenylalanine was accomplished by use of casein hydrolysates from which phenylalanine had been removed and other amino acids added. In Diet II intake of phenylalanine was limited by restriction of total intake of protein in the diet. Diets II and III were commercial preparations. All diets were fed in semisolid form combined with natural foods. After an initial period of hospitalization for regulation of intake of phenylalanine, treatment was carried out at home. Except during the early months of treatment intake of phenylalanine was not severely restricted. Nutritional disturbances were encountered as a result of apparent amino acid deficiencies in Diet I. Inadequate caloric intake and low intake of protein also contributed to poor nutritional status at one stage in the treatment.

Biochemical abnormalities characteristic of phenylketonuria were improved when phenylalanine was restricted in the diets of the three children. All three showed improvement in motor ability, increased awareness, lengthened attention span, decreased tenseness and irritability. No change in mental status on objective testing was demonstrated. The improvement in behavior motor control, and ease of handling was such that the parents were unwilling for the children to receive diets with normal content of phenylalanine. This reaction of the parents should be taken into consideration whenever administration of a diet low in content of phenylalanine is considered.
HOMOTRANSPLANTATION OF PARATHYROID GLAND IN IDIOPATHIC HYPOPARATHYROIDISM
Authors: Akers David R. , Binkley Edward L. , Miller Alvin P.
Published: December 2021

A case of idiopathic hypoparathyroidism, in which homotransplantation appears to have been successful after a lag of 2 years, is reported. The donor was an infant and transplantation was done directly into a vascular area. Delay in function of the transplant may have been related to long continued administration of parathyroid extract.
DIALYSIS IN PEDIATRICS, INCLUDING USE OF THE ARTIFICIAL KIDNEY
Authors: HOLLIDAY MALCOLM A.
Published: December 2021

AN EXTENSIVE experience has been reported on use of the artificial kidney in adults. In contrast, two reports concerning 10 patients comprise the bulk of published experience in the pediatric age period. None of the children in these reports was less than 5 years old. This discrepancy suggests either that clinical situations requiring dialysis are less frequent in children or a more suitable alternate means of dialysis is available for children, or both.

The artificial kidney is used in four clinical circumstances in adults: 1) acute tubular necrosis from prolonged shock, nephrotoxic poisons, drug sensitization and hemolysis, 2) acute glomerular failure associated with acute glomerulonephritis, cortical necrosis, thrombotic thrombopenic purpura and other acute vascular disorders; 3) acute renal failure in patients with chronic renal disease in whom decompensation results from a reversible state, such as an infection; 4) acute poisoning with a dialyzable agent.
ANTIBACTERIAL ACTIVITY OF SERUM AFTER ORAL DOSES OF TRIACETYLOLEANDOMYCIN, ERYTHROMYCIN, POTASSIUM PENICILLIN V AND PENICILLIN V
Authors: Kunin Calvin M. , Pryles Charles V. , Finland Maxwell
Published: December 2021

Triacetyloleandomycin, in this study, produced antistreptococcal and antistaphylococcal activity in the serum of normal men and in children comparable to that produced by equivalent amounts of the erythromycin preparations used. The better and more rapid absorption of oral doses of potassium penicillin V as compared with acid penicillin V was confirmed. It was also shown that penicillin V, either as the acid or as the potassium salt, produced significantly higher peak levels of antibacterial activity than either erythromycin or triacetyloleandomycin.
Injections of a Vitamin-K Compound in Mothers and Hyperbilirubinemia in the Newborn
Authors: LUCEY JEROLD F. , DOLAN ROBERT G.
Published: December 2021

Recently we became aware of an association between the administration of a large amount, 72 mg, of a vitamin-K analogue (menadione sodium bisulfite, Hykinone®) intravenously to mothers in labor and the occurrence of marked, early hyperbilirubinemia in newborn premature infants. We have encountered seven such cases, the details of which are listed in the Table. These infants were first noted to have markedly elevated levels of bilirubin in the serum between 40 and 72 hours of age. All but one were treated with exchange transfusion in an effort to prevent neurologic damage (kernicterus) from hyperbilirubinemia.
HAZARDS OF TECHNOLOGIC ADVANCE
Authors: RICHMOND JULIUS B.
Published: December 2021

ELSEWHERE in this issue appears an article on hazards relating to the entrapment of children in refrigerators and their potentialities for obtaining release. This represents an excellent application of a developmental approach to a significant hazard. It also provides interesting and important data concerning reactions of children to a specific stressful situation.

This study points to a great need in our modern, industrial society. As technologic advances continue, it is well to evaluate these in relationship to potential hazards. As pediatricians we have a specific responsibility to point to hazards relating to children.

Industry too would do well to consider their responsibilities to society more specifically.
DIAGNOSIS OF HISTOPLASMOSIS USING PRECIPITIN REACTIONS IN AGAR GEL
Authors: Heiner Douglas C.
Published: December 2021

An easy-to-perform immunologic test for histoplasmosis is described.

The test, involving precipitin reactions in agar gel, appears to have greater sensitivity and specificity than currently available tests for histoplasmosis. It is useful in the study of small or large numbers of patients.

It has been possible to demonstrate at least one antigen common to H. capsulatum, B. dermatitidis, and C. immitis. This antigen may be responsible for cross reactions. Instances are cited wherein problems of cross reactions and false-positive reactions have been clarified by means of precipitin-in-gel studies.

Precipitin reactions in agar have provided presumptive diagnosis of histoplasmosis in a patient with acute pericarditis, which rapidly progressed to constrictive pericarditis necessitating pericardiectomy.
PLASMACYTOSIS OF BONE MARROW AND HYPERGAMMAGLOBULINEMIA IN ACUTE LEUKEMIA
Authors: Stickler Gunnar B. , Pinkel Donald
Published: December 2021

Transient extreme plasmacytosis of the bone marrow and hypergammaglobulinemia were observed in a patient suffering from acute leukemia. A high degree of correlation was found between these two phenomena. Evidence is cited from the literature supporting the thesis of a causal relationship. The reason for plasmacytosis associated with hypergammaglobulinemia remains obscure but may have been the manifestation of a reaction to penicillin.
RECENT TRENDS IN ACCIDENT PREVENTION
Authors: Starbuck George W.
Published: December 2021

ALTHOUGH pediatricians have always been concerned, as individuals, with the problem of child safety, the intense interest of the American Academy of Pediatrics in accident prevention dates back only to 1950. At that time, the spectacular conquest of the common childhood diseases during the previous three decades had forced a remarkable drop in the mortality rate from disease, whereas, in sharp contrast, decrease in the accident death rate had remained alarmingly slow—in fact, almost static (Figs. 1 and 2). This has focused attention and renewed emphasis on the still formidable problem of accidents, aptly described by Dietrich as childhood's greatest killer. Then, as now, accidents were the leading cause of death among children 1 to 14 years of age, accounting for fully one-third of all deaths at the elementary-school ages, and causing untold crippling, suffering and disability (Table I).

NEW NATIONAL COMMITTEE SETS ITS OBJECTIVES

When these facts were demonstrated to the Executive Board of the American Academy of Pediatrics, it established for the first time, in 1950, a Committee on Accident Prevention with Dr. George M. Wheatley serving ably as chairman.

The Committee adopted three broad approaches in its attack on accidents of childhood: education, engineering, and legislation. Physicians caring for children were to be alerted to the magnitude of the accident problem and encouraged to educate parents by pointing out specific hazards and initiating safety training of children. The Committee was to work with strategic groups, such as the American Standards Association, toward developing manufacturing standards for minimizing accidents involving such products as children's toys, clothing and furniture.