bluuebunny/crossref_metadata_2025 huggingface dataset:
PREVALENCE OF SENSITIVITY TO TUBERCULIN AND HISTOPLASMIN AMONG HIGH SCHOOL STUDENTS IN MONTGOMERY COUNTY, MARYLAND
Authors: Edwards Lydia B. , Peeples William J. , Berger Anne G.
Published: December 2021

Skin testing with tuberculin and histoplasmin was combined with the annual roentgenographic examination of high school students in Montgomery County, Maryland, during the spring term of 1957. More than 3,200 students participated in the program. The tests were given by intracutaneous injection of a 5 TU dose of standardized tuberculin and a 1:100 dilution of histoplasmin H-42. Reactions were read in 48 to 72 hours by measuring the transverse diameter of induration. Photofluorograms of the chest were read without knowledge of the results of the skin test.

The prevalence of tuberculin sensitivity was found to be very low among white students throughout the county. It was estimated that only about 3% of the students had reactions indicative of a tuberculous infection. Histoplasmin sensitivity was many times more prevalent than tuberculin sensitivity and, moreover, showed striking differences in sections of the county no more than 20 miles apart, ranging from about 14% in the suburban schools in the southeast to more than 60% in the rural northwest. Pulmonary calcifications were most frequently associated with sensitivity to histoplasmin, occasionally with sensitivity to both histoplasmin and tuberculin and in no instance with sensitivity to tuberculin only.
EDUCATION
Authors: Green Morris , Senn Milton J. E.
Published: December 2021

Despite the frequent lack of integration of psychologic and social considerations in the medical care of patients, it has seemed to us that, more and more, medical graduates are seeking pediatric training that goes beyond the traditional. The authors have described the manner in which they have attempted to incorporate social and psychologic considerations into day-to-day teaching on an inpatient hospital service. Solutions to many of the remaining problems in providing experiences from which the trainee may learn attitudes and techniques easily applicable to private practice may be achieved through further experiments in pediatric education.
Partial Masculinization of the Female Fetus by the Administration of Oral and Intramuscular Progestins During Gestation
Authors: WILKINS LAWSON , JONES HOWARD W.
Published: December 2021

The purpose of this letter is to bring rapidly to the attention of pediatricians and obstetricians a type of sexual abnormality which, if recognized early, is of relatively little importance or can be readily corrected, but which if wrongly diagnosed or treated may be disastrous to both child and parents. During the past month, three infants have been born in Baltimore with this condition which is of iatrogenic origin.

We have studied 17 female patients showing, at birth, partial masculinization of the external genitalia consisting of an enlarged phallus, with or without varying degrees of fusion of the labioscrotal folds.
Letters to the Editor
Authors: FELDMANN FLOYD M.
Published: December 2021

Dr. Vollmer is quite right in pointing out that the references quoted in my article are selected. The number of published studies of patch tests which were done with simultaneous intracutaneous tests, using measured doses of standardized PPD, is small. I preferred to use those which seemed to me to demonstrate conclusively the variability in the dose of tuberculin delivered by the patch—for that is its most serious shortcoming.

Control studies such as these with results unfavorable to the patch are not rare or unique, but tend to be unreported for various reasons.
SYMPOSIUM: IATROGENIC DISEASE
Authors: Chute A. L. , Deamer William C.
Published: December 2021

THE MOST obvious physician-caused trouble in the field of allergy is the immediate constitutional reaction caused by the injection of an overdose of antigen during the course of desensitization treatment. Such a reaction can take several forms, including itching of the palms of the hands and soles of the feet, urticaria, angioedema, as well as asthma or hay fever—especially if the latter were the patient's clinical complaints. Shock can also occur and, in addition, there may be flushing of the face, headache, or vomiting and diarrhea. These symptoms, or any combination of them, are usually associated with a large local redness and swelling at the site of injection.

The more sensitive the patient and the greater the overdose, the more severe the reaction is likely to be, and the sooner it will occur after injection. Under these circumstances it may resemble anaphylactic shock and, like it, may be fatal. The number of such fatalities is certainly few; I personally can recall only one instance in which such a serious outcome was even in question. However, the patient who experiences a full-blown constitutional reaction is not in a position to take much comfort from statistics and would much prefer that his physician avail himself of all the means at his disposal to anticipate such an occurrence and thereby avoid it. These precautions include observance of the size of the local reaction 10 or 15 minutes after each injection so long as increases in dosage are being made, informing the patient and his parent that malaise, or occurrence of minor symptoms within an hour or two after treatment should be reported, and recognition of the patient initially as being very sensitive from the large size of the skin tests and the degree of severity of symptoms.
The Handicapped and Their Rehabilitation
Authors: BLUESTONE SEYMOUR S.
Published: December 2021

This volume appears at an opportune moment when educators are beginning to introduce in the undergraduate medical and paramedical curricula an understanding of each of the many other disciplines collaborating in a comprehensive rehabilitation program. Dr. Pattison is to be commended posthumously for this pioneer effort to clarify the interrelationship of the physician; the rehabilitation nurse; the occupational, physical, and speech and hearing therapists; the psychologist; the medical social worker; the vocational counsellor; and others on the rehabilitation team.
Lehrbuch der Kinderchirurgie
Authors: PICKETT LAWRENCE K.
Published: December 2021

This volume represents a composite of information on almost every conceivable aspect of pediatric surgery. To review such a volume in detail is far too great a problem for the present purposes. Suffice it to say that the presentation of the book is more complete in its coverage than any comparable text in this reviewer's experience.

The book is written in German but is so well illustrated with photographs and drawings that one need not be a master of the language to understand the message.
A FAMILIAL METABOLIC DISORDER WITH STORAGE OF AN UNUSUAL POLYSACCHARIDE COMPLEX
Authors: Craig John M. , Uzman L. Lahut
Published: December 2021

A metabolic disease, characterized by the accumulation of a mixture of complex polysaccharides in liver, spleen, lung, kidney and reticuloendothelial system, is described in three patients. Its familial nature is indicated by the fact that two of the cases were siblings. The salient clinical features included hepatosplenomegaly, anemia, failure in physical development and susceptibility to respiratory infection. The disease simulates glycogen storage disease in the response in the epinephrine tolerance test, and in an inability to call on glycogen stores.

Histochemical tests on the tissue containing the storage cells indicated that the material was not glycogen, even though polysaccharide in nature. The storage material was isolated from the liver of one of the cases. This isolated material proved to be a complex consisting of two major moieties. The first appeared to possess a high molecular weight, was insoluble in organic solvents, and contained glucose, galactose, glucosamine and hexuronic acids as constituents. A small amount of peptides were associated with this fraction. The second major moiety of the storage material was soluble in ethanol and contained glucose, galactose, glucosamine, fatty acids, hexuronic acids and neuraminic acid as main constituents (hence a lipopolysaccharide).

Attention is drawn to the fact that the storage material would have been considered an "abnormal glycogen" if the customary procedures for the isolation of glycogen had been applied to the tissue. It is suggested that caution be exercised in future studies involving storage diseases where storage of an "abnormal glycogen" with an abnormality in side-chains is suspected.
RUMINATION: A PSYCHOSOMATIC SYNDROME OF INFANCY
Authors: Richmond Julius B. , Eddy Evelyn , Green Morris
Published: December 2021

This study has been concerned with observations of four infants manifesting the syndrome of rumination and the mothers of these infants. The findings suggest that the syndrome develops in response to a disordered relationship between parents and baby. Some formulations concerning the pathogenesis of rumination are presented. It is hoped that further studies of this and other syndromes reflecting disturbances in the development of object relationships in infants will provide a better understanding of healthy as well as disordered growth in early life.
STUDIES OF RESPIRATORY PHYSIOLOGY IN CHILDREN
Authors: Helliesen P. J. , Cook C. D. , Friedlander L. , Agathon S.
Published: December 2021

Determinations of lung volumes (residual volume, functional residual capacity, vital capacity, and total lung capacity) in 82 "hospital normal" and volunteer children are reported. These values correlated best with the individual's height, but almost as well with weight and surface area.

Values for lung compliance and flow resistance obtained from 77 children are also presented. Lung compliance correlated most closely with functional residual capacity and vital capacity. Resistance had a negative correlation with the height of the individual.

End-expiratory intrapleural pressures as measured with an intra-esophageal balloon were found to average -6.3 cm of water for 41 of the children.

Where data were available, relationships of lung volume, compliance and resistance were compared on the basis of height for infants, children and young adults, and found in most instances to be similar for all three groups.
CONTINUOUS SPLENIC-GONADAL FUSION WITH ECTROMELIA: TERATOGENESIS
Authors: Sommer Jaochim R.
Published: December 2021

A case of continuous splenic-gonadal fusion with ectromelia is reported.

The teratogenesis of the anomaly is discussed. A mesenteric attachment of the splenic cord is described, and the blood supply of the splenic cord was studied in serial sections.

The findings lend strong support to the theory that the splenic and gonadal-mesonephric structures fuse by means of the caudal limiting fold rather than across the coelomic epithehium.
THE AIMS OF Pediatrics: LOFTY BUT NOT AIRY
Authors:   The Editorial Board
Published: December 2021

What is Pediatrics trying to accomplish in the field of medical literature? This is a question continuously before the Editorial Board and one which should be considered occasionally with those for whom it is published. Note that a sweeping reference is not made to "the readers" as though the journal was meant to serve some homogeneous group. Preservation of health and treatment of disease during childhood and adolescence are the avowed objectives of pediatricians, but their fulfillment depends on the contributions of a vast and varied array of persons with related interests. It would be impossible for Pediatrics or any other medical journal to include all things for all men at all times.

An important step in determining the nature of a medical journal is to choose an appropriate place among the welter of printed material directed to the profession. This ranges from lively medical newspapers and gaily colored magazines and brochures, resembling the products of lay journalism, to staid uncompromising collections of scholarly papers.
A SIMPLE METHOD FOR OBTAINING VENOUS BLOOD FROM SMALL INFANTS
Authors: Anke Wolfgang
Published: December 2021

OBTAINING samples of venous blood from small infants presents a problem even to the experienced pediatrician. A method providing least trauma for baby and doctor is always desired. A simple technique for obtaining samples of venous blood from premature and small infants was described by Banus in 1957. A modification of his technique has been adopted in the present technique which employs simpler equipment and easily allows obtaining volumes of blood from 5 to 10 ml.

EQUIPMENT (Figs. Ia and Ib)

Polyethylene catheter with attached No. 23-gauge needle (modified Murphy-Gardner set). Plastic needle-adapter. No. 20-22 gauge needle. Hemostat. Vacuum test tube.

PROCEDURE

The polyethylene catheter is connected to [See Fig. 1a,1b in Source Pdf] the plastic needle-adapter and the latter to a No. 20-22 gauge needle (Fig. lb). The catheter is clamped with the hemostat, which will maintain a good vacuum, and the needle inserted through the center of the rubber plug of the vacuum-containing test tube. A scalp vein is entered against the blood flow. As this is done the blood will flow several millimeters into the catheter. The hemostat is then released, permitting blood to flow through the polyethylene catheter into the test tube by means of the vacuum existing in the system. The polyethylene catheter and needle may be rinsed with heparin before assembling, in order to prevent clotting when large volumes of blood are required. Scalp veins are preferred to other peripheral veins, because the needle can be held firmly while in such a superficial vein, assuring a good flow of blood.

COMMENT

This technique has several distinct advantages over the more commonly used methods of venipuncture. Minimal equipment, which for the most part is inexpensive and disposable, is needed. There is less trauma to the infant than by standard procedures for blood-letting. With very little experience the technique can be performed with facility. Because suction is evenly controlled, the plasma obtained is usually free of hemolysis. There is almost no exposure to air with this system, so that blood for determination of carbon dioxide can be collected with accuracy, providing oil is added to the tube immediately after collecting the blood. The polyethylene catheter can be clamped during the procedure, and the collecting tubes can be changed, should both clotted and non-coagulated specimens be desired.
THE PHYSICAL ENVIRONMENT AND THE PREMATURE INFANT
Authors: Silverman William A.
Published: December 2021

I AM MOST grateful to the Academy for naming me as the recipient of an E. Mead Johnson Award for 1958 and pleased beyond measure by this great honor. I cannot allow this moment to pass without acknowledging with pleasure my debt of gratitude to Dr. Richard Day, who first awakened in me a curiosity about the meaning of proof for a clinician and to Dr. John W. Fertig for his patience as teacher, critic and collaborator.

This decision of the Awards Committee has given me cause for reflection. I interpret it to signal approval of and benevolent interest in the use of the planned trial as a device to help answer questions at the clinical level. I am encouraged to think that the rules of evidence that have applied in the laboratory are now increasingly consulted on ward rounds. Mr. John W. Gardner, president of the Carnegie Corporation, recently commented upon the difficulties that result from the acceptance of a double standard of excellence at different levels of human activity; he stated that, ". . . The society which scorns excellence in plumbing because plumbing is a humble activity and tolerates shoddiness in philosophy because it is an exalted activity will have neither good plumbing nor good philosophy. Neither its pipes nor its theories will hold water."

F. H. K. Green has recently been quoted as saying, ". . . when the value of a treatment, new or old, is doubtful, there may be a higher moral obligation to test it critically than to continue to prescribe it year-in, year-out with the support merely of custom or of wishful thinking." I am encouraged to believe that we have arrived at a point in time when this moral obligation may be included as one of our clinical responsibilities.

We were required to consider our responsibility very closely in this regard about 8 years ago when confronted with the challenge of retrolental fibroplasia. As we watched the early vascular changes of this condition develop, we reasoned that these proliferating vessels might be halted by the then newly available hormone, adrenocorticotropin (ACTH). We gave this substance to an infant when, from the appearance of the ocular fundi, it was clear that the disease was progressing. The fundi of this infant returned to normal. This sequence of events was repeated following the treatment of many infants during the next year.
ANTIBODY RESPONSE TO INFLUENZA-VIRUS VACCINE IN CHILDREN WITH NEPHROSIS: EFFECT OF CORTISONE
Authors: Kunin Calvin M. , Schwartz Robert , Yaffe Sumner , Knapp John , Fellers Francis X. , Janeway Charles A. , Finland Maxwell
Published: December 2021

Polyvalent influenza-virus vaccine was administered to 55 children; 44 of these children were in various stages of nephrotic syndrome, including 17 under treatment with adrenocortical hormones; 5 were children with the adrenogenital syndrome receiving replacement cortisone therapy, and 6 were normal controls.

Antibody response, as measured by the hemagglutination-inhibition test 2 weeks following a single subcutaneous dose of vaccine, was not significantly different in children with active or inactive disease, and appeared to be similar in those receiving hormone therapy and in those who were not.

The serum levels of gamma-globulin were lower in children with active nephrotic syndrome, but this did not affect either the prevaccination levels of influenza A prime antibody or the response to the vaccine.

No change in the status of activity of nephrosis occurred during the period of immunization or immediately thereafter, even in patients who had moderate febrile reactions to the vaccine.

The failure of any of the groups to respond serologically to the Asian strain component of the vaccine is discussed.
ADMINISTRATION OF GLUCURONIC ACID TO ICTERIC NEWBORN INFANTS
Authors: Jeliu Gloria , Schmid Rudi , Gellis Sydney
Published: December 2021

Fourteen icteric newborn infants were treated with varying amounts of glucuronic acid or sodium glucuronate, administered by oral or intravenous routes. No significant change in concentration of bilirubin in the serum was observed.

Experimental evidence and biochemical considerations do not suggest that the administration of glucuronic acid enhances the formation of bilirubin glucuronide.

It is the authors' opinion that at present the use of glucuronic acid should not be considered as an alternative for exchange transfusion in the treatment of newborn infants with high concentrations of bilirubin in the serum.
ON THE TEACHING AND PRACTICE OF THE NEW PEDIATRICS
Authors: MAY CHARLES D.
Published: December 2021

AN EDITORIAL in the February issue posed the question, "Can the New Pediatrics be Practiced?" The point was made that the answer may depend partly on economics—on the value placed on pediatricians' services. Because of a full realization there are other aspects of the matter, the readers were invited to share their thoughts.

Judging from the comments in recent Letters to the Editor, some ideas about the teaching and practice of the "new pediatrics" seem prevalent:

1) Group practice and health insurance plans may be ways to cope with the economics.

2) There is widespread discontent with the discrepancy between the emphasis in pediatric training and the nature of the experiences encountered in practice.

3) One type of training is not apt to be equally suitable for all the broad groups of pediatricians (academicians and consultants, general practitioners, and public health administrators).
RESPONSE OF THE NEWBORN INFANT TO MAJOR SURGERY
Authors: Colle Eleanor , Paulsen Elsa Proehl
Published: December 2021

Balance data for sodium, potassium, chloride, nitrogen, and water were obtained postoperatively in 15 newborn infants operated upon in the first 4 days of life and in 5 control newborn infants.

The infants showed a response in terms of electrolyte and water balances which is significantly different from that reported in adults:

The volumes of urine were equal to or greater than those in normal infants of a comparable age. The data suggest a diminished capacity of the newborn to conserve water postoperatively, but a normal capacity to dilute the urine. No evidence of retention of water was observed.

The urinary excretion of sodium and chloride was equal to or larger than that of normal infants. The infants who had losses postoperatively from gastrointestinal suction showed no capacity to reduce renal excretion of these ions while they suffered these large extrarenal losses.

The concentrations of sodium and chloride in the serum remained normal or became slightly elevated postoperatively.

Losses of potassium and nitrogen in the urine were of the same relative magnitude as those in adults.

The observed responses are discussed in terms of the function of antidiuretic and adrenocortical hormones in the newborn infant.

The application of these data to practical considerations of fluid and electrolyte therapy in the postoperative management of the newborn infant are discussed briefly.
CEROID STORAGE DISEASE IN CHILDHOOD
Authors: Oppenheimer Ella H. , Andrews Edward C.
Published: December 2021

Two cases of ceroid storage in childhood are reported. In both cases there was a long history of nutritional disturbance and cirrhosis of the liver was found at necropsy. In one case the storage of ceroid followed the pattern of so-called "lipidoses," with massive numbers of ceroid-filled cells in the spleen, liver and intestinal mucosa. In the other case the deposition of ceroid occurred mostly in macrophages in the liver. No ceroid was found in smooth muscle or other parenchymal cells as in vitamin E deficiency.
TREATMENT OF SHIGELLOSIS WITH TETRACYCLINE IN INFANTS UNDER 2 YEARS OF AGE
Authors: de la Torre Joaquin A. , Olarte Jorge , Joachin Alicia
Published: December 2021

Ninety-eight infants under 2 years of age, hospitalized with gastroenteritis due to a shigella infection (92 Shigella flexneri and 6 Shigella boydii) were studied in order to investigate the effectiveness of tetracycline in their treatment.

During the first 60 hours of hospitalization, clinical recovery was induced in 28 of the 98 cases using only intravenous fluids and a period of fasting, but no antibiotic. Eleven infants died in the same period. Of the 28 who recovered, 3 had clinical relapses.

The remaining 59 infants were divided at random in two groups: one, with 26 cases, received tetracycline; the other, formed by 33 patients, received a placebo. From the 26 who were given tetracycline there were 14 recoveries (53.8%) and 12 failures (4 deaths [15.3%] and 8 cases [30.7%] that required a change from tetracycline to another drug). In the 33 control patients, there were 11 recoveries (33.3%) and 22 failures (7 deaths [21.2%] and 15 cases [45.4%] that became worse and needed an antibiotic).

The cases that recovered, and had a sufficient number of stool cultures after treatment, are too few to permit conclusions on the usefulness of tetracycline from the bacteriologic point of view; nevertheless they show, as has been previously reported, that a certain number of patients who recovered, with or without antibiotic, continued to have stool cultures positive for shigella.
OCCURRENCE OF PSEUDOTUMOR CEREBRI (BENIGN INTRACRANIAL HYPERTENSION) DURING TREATMENT OF CHILDREN WITH ASTHMA BY ADRENAL STEROIDS
Authors: Dees Susan C. , Mckay Hamilton W.
Published: December 2021

The development of pseudotumor cerebri (benign intracranial hypertension) is described in three young boys with asthma, who were receiving small doses of adrenal steroids during a stage of withdrawal of treatment. These patients had received continuous steroid treatment for several years, beginning in late infancy. They had acquired the appearance of Cushing's disease.

The mechanism by which pseudotumor cerebri developed in these three children was not determined. Various hypotheses are discussed.

Attention is called to the sequence of events in these children with asthma as another possible complication of prolonged use of steroid therapy.
SPINAL CORD TUMORS IN CHILDREN
Authors: Haft Harold , Ransohoff Joseph , Carter Sidney
Published: December 2021

The case histories of 30 children (15 years of age and under) with spinal cord tumors have been analyzed.

There was no significant age or sex distribution.

A third of the tumors were intramedullary and a half were extradural. The lesions were largely in the thoracic cord.

Symptoms averaged 1½ years in duration prior to diagnosis, with shorter histories for malignant extradural tumors. The principal symptoms were abnormality of gait and pain. The principal signs were leg weakness, reflex changes and sensory deficits.

The most important diagnostic aids were plain roentgenograms, lumbar puncture and myelography.

Twenty-seven of the thirty tumors were confirmed at laminectomy.

X-ray therapy was given to 20 patients.

Fifty per cent of the patients have done well. Prognosis is poor in those with neuroblastoma or sarcoma and in those developing intracranial extension.

To avoid delay in the management of children with seemingly bizarre neurologic and other symptoms and signs, an awareness of the possible presence of a spinal cord tumor is essential. Once this is accomplished, further tests should make it possible to achieve early diagnosis and therapy.
Roentgenanatomie der Neugeborenenund Säuglingslunge
Authors: SCHWARZ GERHART S.
Published: December 2021

This book is much more than its modest title implies. It deals not only with the lung of newborns and infants but with all parts of the thorax. It treats in 17 separate chapters the shoulder girdle, the ribs and spine, the sternum, development of the lung during fetal life, anatomy of the bronchial tree, the vascular system, the lymph duct system, the thymus, diaphragm, the pleura and several other pathologic or anatomic problems.

From this, one might deduce that it is merely a review of all that is known about the infant chest, bringing all of the better known papers on this subject under one roof. This is, however, not the case. This book is a report on the author's own investigation on the subjects enumerated above.
SURGICAL AND ORTHOPEDIC ASPECTS OF INFECTIONS IN NEWLY BORN AND YOUNG INFANTS
Authors: Sieber William K. , Ferguson Albert B.
Published: December 2021

Trends in Infecting Organisms

The relative frequency of various organisms recovered from superficial abscesses oven the years is shown in Table I. These data document the clinical impression that with the introduction of penicillin, the pneumococcus practically disappeared as a cause of abscesses; a gradual reduction of streptococcic infections occurred; and the staphylococcus emerged as the most common organism responsible for peripheral abscesses.

Minor Infections

Furunculosis and pyoderma have assumed importance with increased incidence of staphylococcic infections in nurseries.

Breast abscesses are peculiar to infants 2 to 3 weeks of age, in whom they owe their origin to estrogenic hypertrophy of the breast. Incision and drainage is often necessary and should not be delayed when a 3-to 4-day course of antibiotic therapy fails to cause recovery.

Paronychia, subungual abscess, and infected ingrown toenail are common, often slow to improve, and may be a source of septicemia. Infants who persist in pulling the feet up and down, while resting the stomach, will irritate the toes and cause ingrowing. Often the nail itself is slow to grow. Surgical excision, either a wedge or complete removal of the toenail, should not be done. The lateral mounds of granulation tissue can be removed by silver-nitrate cauterization and kept below the level of the nail by pressure with cotton and adhesive tape. Most important, the family must be cautioned against impatience. Actual abscesses must be drained.

Pneumonitis and Empyema

Pnemonitis and empyema in young infants have been occurring with increasing frequency in the past several years. Staphylococcic pneumonia with empyema in infants is not a new disease; even the nature of the disease has not altered. Since 1955, Staphylococcus aureus, coagulase positive, has become the most common responsible organism in the empyema complicating bacterial pneumonia in young infants.
Statistics and Faith
Authors: SCHNEIDER A. J.
Published: December 2021

Many, if not most, readers of scientific articles such as are appearing in Pediatrics have limited fundamental understanding of statistical methods. The same may be said of contributors to Pediatrics. Yet most of us have by now acquired sufficient sophistication to recognize the importance of subjecting data to statistical analysis before accepting or rejecting hypotheses. I do not feel that I am over-generalizing, however, when I suggest that very often this historical development has merely resulted in a partial transference of faith on the part of the reader from the author as a person to the author's statistician, or worse, to such expressions as p < 0.05, etc. Editorial policy, it seems to me, tends to foster such dependence of the reader.
Embryonic Nutrition
Authors: VILLEE CLAUDE A.
Published: December 2021

This little book contains six reports which were given at a conference held at Brown University, July 23-24, 1956. This was one of a series of ten conferences held that year under the auspices of the National Academy of Sciences and the National Research Council. The proceedings of each conference is being published separately.

This conference dealt primarily with the subject of how the growing embryo converts its food energy into the structures and functions peculiar to its species. The present state of knowledge in this field does not delineate the mechanisms involved. However, these articles summarize some of the basic information regarding the nutritional requirements and metabolism of the embryo, the formation and activity of enzymes, the synthesis of proteins, and the use of antigens as tracers of embryonic synthesis.
POSSIBLE ROLE OF HUMIDIFYING EQUIPMENT IN SPREAD OF INFECTIONS FROM THE NEWBORN NURSERY
Authors: Sever John L.
Published: December 2021

Because of the increasing importance of the newborn nursery in the occurrence of nosocomial epidemic infections, an investigation was conducted on the role of humidifying equipment in this connection.

The results of this study indicate that an extremely high degree of gross contamination existed in the water of the humidifying devices in use in the newborn nursery. After the institution of the described procedures governing the care and cleansing of the humidification equipment, the degree of bacterial contamination was reduced to a low level.
IDIOPATHIC HYPERCALCEMIA
Authors: Smith David W. , Blizzard Robert M. , Harrison Harold E.
Published: December 2021

A case of idiopathic hypercalcemia present from early infancy and diagnosed at 5 years of age is reported in which the serum assay of vitamin D indicated elevated levels. After discontinuation of supplemental vitamin D and a diet low in calcium the concentrations of calcium and vitamin D in the serum gradually returned to normal over a period of 18 months. Roentgenograms of the bones showed evidence of demineralization rather than increased density as reported in other cases of "idiopathic" hypercalcemia. During a subsequent 2-year follow-up the patient has maintained a normal serum calcium. The etiology is discussed with particular reference to the role of vitamin D in this case
Tumors and Tumorous Conditions of the Bones and Joints
Authors: BLANC WILLIAM A.
Published: December 2021

Dr. Jaffe's book is, according to all authorities, the best available source of information on bone tumors. It has the vigor and unity seen only in books written by a single author. It sums up a lifetime's experience in bone pathology for those who could not directly benefit from the master's teaching and original views. The author emphasizes a classification based on the definition of clinico-pathologic entities and not on the somewhat artificial derivation from cellular types. This treatment is less traditionally didactic, unlike that of Lichtenstein's for example. The treatise will be a superb teaching aid even for students and nonspecialists because of the concerted clinical, morphologic and therapeutic approach.
Behavioral Analysis
Authors: ROSE JOHN A.
Published: December 2021

This work of Dr. Levy's is the endpoint of a triumph in scientific discipline and the outcome of a long period of investigative work in maternal attitudes.

The material is presented in an interesting way, in that the reader is introduced step by step to the processes of logic and method which are used to solve the problems raised by accumulated observations of behavior. Thus, as mentioned by the author, the content of the book may be examined with equal interest and stimulation by people with interest in different facets of research in child development or general interaction research. As he says, "The reader can share the author's trials and predicaments and thereby attain a firmer grasp and a more valid critique of the data and the method of analyzing them.
THE EFFECTS OF A SOYBEAN PRODUCT ON THYROID FUNCTION IN HUMANS
Authors: Van Wyk Judson J. , Arnold Mary B. , Wynn James , Pepper Francis
Published: December 2021

A 10-month-old infant reared on a soybean product (Mull-Soy®) from birth developed a goiter and hypothyroidism, which was cured by the administration of 4 drops of Lugol's solution and the replacement of the soybean product by whole cow's milk.

After this soybean product was withdrawn but while the patient was still hypothyroid, the thyroid had a high uptake of I131 with rapid discharge into the blood as PBI131. Reinstitution of this soybean product suppressed the thyroidal uptake of I131 and completely inhibited the appearance of PBI131 in the plasma.

Studies in normal adult subjects revealed that this soybean product did not interfere with the absorption of iodine, iodine uptake by the thyroid, oxidation of iodide to iodine or the release of PBI131 in most subjects. Two subjects, however, who had a high plasma level of PBI131 while receiving whole cow's milk had a significant suppression in the PBI131 while receiving this soybean product. This was not associated with a concomitant reduction in the plasma PBI127 thereby indicating that excessive loss of hormonal iodine bad not taken place.

These studies suggested that a goitrogenic agent was present in this particular soybean product, which interfered with thyroid hormone synthesis in susceptible individuals, and which raised the daily requirement for iodine.
HYPERKALEMIC FAMILIAL PERIODIC PARALYSIS
Authors: Egan T. J. , Klein R.
Published: December 2021

The clinical histories of three families are described, who have a variant of familial periodic paralysis characterized by high concentration of potassium during paralytic episodes unassociated with diminished urinary excretion of potassium. Data are presented concerning five hospitalized patients from the three families. The data indicate that the rise in concentration of potassium in serum results from a shift of potassium into the extracellular phase. During the recovery period potassium travels in the opposite direction.

The administration of glucagon or epinephrine during an acute attack terminated the attack promptly. The administration of 10 to 15 mg of dextro-amphetamine sulfate daily in Spansule® form effectively controlled symptoms in two patients, and resulted in definite improvement in a third patient, treated for periods varying from 3 to 7 months.
FAVORABLE RESPONSE OF CALCINOSIS UNIVERSALIS TO EDATHAMIL DISODIUM
Authors: Davis Helen , Moe Peter Johan
Published: December 2021

Marked improvement occurred after the administration of a chelating agent (Na2EDTA) to a 12-year-old Negro girl with calcinosis universalis. The effectiveness of the regimen was indicated by a decrease in ectopic calcification of the subcutaneous tissue. A slight increase in urinary excretion of calcium occurred during the administration of the chelating agent, but it is difficult to evaluate the significance of this chemical finding. The results reported point to the necessity for further therapeutic and chemical studies employing Na2EDTA in this disorder.
A SIMPLE RAPID METHOD FOR DETERMINATION OF SPECIFIC GRAVITY OF SMALL SAMPLES OF URINE
Authors: Goldman Allen S.
Published: December 2021

THE THERAPY of infants with disturbances in fluid balance is greatly assisted by knowledge of the specific gravity of the urine. Frequently only a few milliliters can be collected at any one time, while a minimum sample of 25 ml is necessary for use of the smallest urinometers currently available. The existing methods of determining specific gravity of one drop of urine are somewhat laborious, and require expensive equipment and the services of a relatively skilled technician.

The present report describes a method which is rapid and simple and requires only a few drops of urine in its use. It is similar in principle to the determination of specific gravity of blood by the copper-sulfate method. For use with urine, mixtures are employed of two relatively nonvolatile liquids, immiscible with water, and with specific gravities nearly equally above and below the range in urine. The specific gravity of urine is determined by allowing one drop to fall into each of a series of tubes containing a mixture of the two liqquids made up to various specific gravities ranging from 1.005 to 1.030 (Fig. 1). That mixture in which the drop of urine comes most nearly to remaining still (neither rising nor falling after coming to rest) approximates the specific gravity of the urine. The total sample needed is only a few drops, which can be quite small if a dropper with a small opening (2 mm) is used. The determination takes a few minutes. A year's supply of the mixtures can be made in one afternoon and costs less than $6.00.

MATERIALS

The two solutions used were selected from the flotation method of Kirk, using a density gradient system. These are Liquid 1, dibutyl-n-phthalate (Eastman), specific gravity 1.04820°; and Liquid 2, kerosene, specific gravity 0.8220°. (Similar results were obtained by substituting California mineral oil, specific gravity 0.842-0.88420°, for kerosene.)
Skeletal Changes Associated with Increased Vitamin A Ingestion
Authors: WOOLLEY PAUL V.
Published: December 2021

Dr. C. L. Mitchell, chief of the orthopedic section at the Henry Ford Hospital, has sent me a copy of the April, 1959, number of the Bulletin of the Hospital for Special Surgery containing an article by John B. Griffin entitled, Hypervitaminosis A.

This report describes briefly three children (twins [fraternal] aged 2 years; the other 19 months) with painful limps. Each is purported to have received about 200,000 units daily of "water soluble" vitamin A from roughly 4 months of age to the first birthday. The bony changes described and illustrated are limited to cupping of the metaphyses so that the distal epiphyses of the femurs (and in one illustration, of the tibia) appear imbedded within or sunken into the substance of the diaphysis.
A Challenge to Practitioners
Authors: HARNED HERBERT S.
Published: December 2021

The recent series of communications relating to the practice of pediatrics has stated the problems more clearly than the solutions to these problems. In an Editorial (Pediatrics, 23:1038, 1959), a statement was made which summarized the problem of "discontent with the discrepancy between the emphasis in pediatric training and the nature of experiences encountered in practice" and suggested that "one type of training is not apt to be equally suitable for all the broad groups of pediatricians (academicians and consultants, general practitioners, and public health administrators)." Thus, a large part of the burden of solving the problem of the practitioner was placed on the shoulders of the pediatric educators.
Pathologie Und Klinik Des Salz-Und Wasserhaushaltes
Authors: FORBES GILBERT B.
Published: December 2021

A quarter century ago, in a short article "Über die Beziehungen zwischen Salz- und Wasserhaushalt bei experimentellen Wasserverlusten", the author of the present work announced to the medical world the fact that two types of clinical dehydration could be distinguished the difference lying in whether the primary deficit was one of salt or of water. The ensuing years have witnessed a continuing study by Professor Kerpel-Fronius of the various phenomena—both clinical and physiologic—associated with disturbances of electrolyte and water metabolism. Much of his own work is reviewed in this book, some of it previously reported in journals not readily available in this country.
DESCRIPTION OF PROJECT
Authors: Stuart Harold C. , Reed Robert B.
Published: December 2021

IN 1929 the senior author initiated the "Center for Research in Child Health and Development" as a research activity of the newly organized Division of Child Hygiene at the Harvard School of Public Health. Subsequently, this Division became the Department of Maternal and Child Health. This "Center" was organized to provide staff and facilities for the periodic and broadly oriented follow-up of individual children from birth throughout childhood and of their mothers during pregnancy. The term "Center" was then used because the project was conducted in a building outside the School with the co-operation of the Children's Hospital, the Boston Lying-in Hospital, the Forsyth Dental Infirmary for Children and members of their respective staffs. Early in 1930 the first prospective mother was enrolled at the Boston Lying-in Hospital for study of her family and the course and outcome of pregnancy. The program carried out at the hospital was designed to provide background for the subsequent enrollment of her infant at birth for continuing periodic studies during early childhood. The initial plans were gradually extended in respect to breadth of studies and the length of periodic follow-up was extended throughout adolescence and included a terminal, more comprehensive eighteenth-year examination. In 1939 the last mother was enrolled during pregnancy and in 1956 the last child still being followed was discharged because of having completed the terminal examination. One hundred and thirty-four children, 67 boys and 67 girls, were followed to 18 years. These constitute the Maturity Series upon which the present group of reports is based.

The nature of the studies originally carried out under this project and the progress made between 1930 and 1938 were described in a Monograph published by the Society for Research in Child Development, hereinafter referred to as Monograph I. This dealt in considerable detail with the children enrolled and their families, with the methods of selection and follow-up, with the composition and operations of the multidisciplinary staff and with the methodologies and techniques then employed in the collection and recording of data.
ASPECTS OF BILIRUBIN METABOLISM—BEFORE AND AFTER BIRTH
Authors: DANCIS JOSEPH
Published: December 2021

INTEREST in hyperbilirubinemia in the newborn infant has, over many years, resulted in the accumulation of a considerable amount of information. However it is only recently that advances in knowledge of the biochemistry involved have permitted bringing together the many clinical and laboratory observations into a meaningful picture. There are still important gaps in our knowledge, permitting some speculation and inviting further investigations, but many of the major features are now clear.

Bilirubin has limited solubility in water but is easily soluble in organic solvents. Conjugation with glucuronic acid reverses these solubility characteristics. Transport of unconjugated bilirubin ("indirect" bilirubin) within the body is facilitated by binding with protein which increases its water solubility. To excrete bilirubin into proteinpoor aqueous media, such as urine or bile, it must first be conjugated to increase its water-solubility.
USE OF AMINO ACIDS AS DIETARY SUPPLEMENTS
Authors: MAY CHARLES D.
Published: December 2021

A PREVIOUS Commentary on this subject (Pediatrics, 17:965, 1956) concluded that amino acid imbalance is "readily produced by an excess of lysine" and that its use as a supplement should not be generally accepted until there is convincing evidence for the need and for the safety of this practice. It should be carefully noted that two requirements must be satisfied before supplementation of the diet with an amino acid can be justified—it must certainly be harmless but it must also be beneficial.

The place of amino acid supplementation in practical human nutrition has continued to attract the attention of scientists and commercial enterprises. Authoritative guidance in this important and complex field has just been made available in a comprehensive report of the Committee on Amino Acids of the Food and Nutrition Board, National Research Council.
THE FREQUENCY OF THE POSITIVE SEX-CHROMATIN PATTERN IN MALES WITH MENTAL DEFICIENCY
Authors: Mosier H. David , Scott Lawrence W. , Cotter Lloyd H.
Published: December 2021

A survey of the sex-chromatin pattern in 1,252 males with mental deficiency revealed 10 apparent males with positive sex-chromatin patterns and with IQs ranging from 22 to 66. Nine of these are postpubertal and have findings characteristic of Klinefelter's syndrome. One patient is prepubertal and sexually immature. One of the patients has a few features suggesting mongolism. One patient is a twin; the other twin died at birth. He has an older halfbrother who has mongolism. Another patient has twin siblings, one of whom has mongolism.

Recent reports of similar surveys confirm that about 1% of mentally deficient males have Klinefelter's syndrome. However, our data indicate the incidence is lower than that among the severely retarded and rises two- or threefold above that among the mildly retarded. The best control data indicate the incidence in the general population is about 0.2% or less. On the basis of these data, it appears that Klinefelter's syndrome with positive sex-chromatin pattern is likely to be associated with some degree of mental deficiency. The relation of the brain disorder to the anomalous sex-chromatin pattern is unknown.
CHRONIC LEAD ENCEPHALOPATHY
Authors: White Harry H. , Fowler Fred D.
Published: December 2021

Chronic lead encephalopathy must be considered in the differential diagnosis of pediatric patients who present with manifestations of schizophrenia, behavior disorders or degenerative diseases of the central nervous system. Determination of urinary coproporphyrin is a simple, fast screening procedure applicable to office practice. The prognosis for normal mental development following encephalopathy is poor. It is hoped that early recognition of the more subtle signs of central nervous system involvement will allow treatment to be instituted soon enough to prevent the crippling mental deterioration which is so often a sequela of lead poisoning.