bluuebunny/crossref_metadata_2025 huggingface dataset:
GUIDANCE IN MATERNAL AND INFANT CARE TWO MONTHS BEFORE AND AFTER THE BIRTH OF THE FIRST-BORN
Authors: CLAY AUGUSTA STUART
Published: December 2021

THIS study was made in the belief that family living and growth can be healthier if parents understand how mother and baby develop and what they need.

Eleven mothers were visited weekly for two months before and after the birth of their firstborn to discover what guidance they wanted, what was offered, and what additional guidance was needed. The writer secured their cooperation by agreeing to work with them as a consultant, to interpret their point of view to the doctor, to explain medical instructions when permitted, and to teach the normal growth processes of mother and baby.

Ten mothers were registered in the prenatal clinics of the New Haven Hospital; the eleventh had a private physician. They had no recorded problems beyond the needs of healthy pregnancy and they wanted to participate. Eight husbands agreed to take part in the study. The other three were overseas, but their wives reported for them. Backgrounds varied; 20 of the 22 had had college or high school education; all were between 18 and 32. None dropped out, and after the four months all asked for continued guidance.

Cases were too few and the study too brief for statistical evidence. But problems were uncovered which needed to be considered and which have largely been neglected in routine obstetric and pediatric care.

These parents wanted to learn—not in classes, but in the privacy of home—how to care for mother and baby without disrupting their accustomed way of living. All wanted the care and interest of one doctor for mother and one for baby. However, six women and five men preferred to talk with a consultant who was not a doctor, but who was affiliated with their doctors. The doctors seemed too busy for "little things" and "family affairs," and they saw so many doctors that they all seemed strangers. Once they felt sure that the consultant's interest was in themselves rather than in teaching them, they set the pace and pattern in the conference. There was no questionnaire, no probing, no set procedure. If they had any immediate interests or problems: job, move, presents, trips, in-laws, illness—these were discussed before they talked of pregnancy and baby.
REPORT OF THE MEETING OF THE ACADEMY EXECUTIVE BOARD
Authors: GRULEE CLIFFORD G.
Published: December 2021

A special meeting of the Executive Board of the American Academy of Pediatrics was held at Hotel Statler, Buffalo, N.Y., on Thursday, April 29, 1948. The meeting was called to order at 7:50 P.M. by the President, Dr. John A. Toomey. There were present Drs. Toomey, Sisson, Pease, Martmer, Grulee, Stringfield, Beaven, Barba, London, Wishropp, Munns, McElhenney, Spickard, McLendon, Snedeker, and by invitation, Drs. Joseph S. Wall, Coursen B. Conklin and John P. Hubbard.

It was moved, seconded and carried that when speakers are asked to appear on programs at meetings, they should receive 7½¢ for travel, and ten dollars a day for the time in service at the meeting. When they ask to appear on programs at meetings, they should not be reimbursed.

The Board went into executive session and after due deliberation the following resolution was adopted: "A committee of three members of the Executive Board shall be appointed to confer with the Board of Trustees of the American Medical Association and place before them the proposal, which has been passed by the Executive Board of the Academy, that there should be Federal subsidy for the teaching of pediatrics in the medical schools."

The President appointed the following Committee: Drs. Beaven, Sisson and Munns. Dr. Harvey F. Garrison, representing the Academy as liaison officer to the American Medical Association, was added to this Committee.

The meeting recessed at 11:50 P.M. and was called to order at 9 A.M. April 30, 1948, by the President.

It was moved, seconded and carried that any statements being made public by the Committee for Improvement of Child Health should be reviewed and approved by Drs. Wilson, Hill and Webb.

It was moved, seconded and carried that a representative of the Academy be empowered to place before the House of Delegates of the American Medical Association our resolution opposing S-1290 as written in the action taken at the February 1948 meeting.

It was moved, seconded and carried that the Committee to the American Medical Association be empowered to ask Dr. Harold H. Mitchell, Chairman of the Academy Committee on School Health, to accompany the Committee as an adviser during the conference with the Trustees.

A motion was made and seconded that Dr. Hubbard, as Director of the Committee for Improvement of Child Health, be encouraged and empowered to go ahead and seek funds for the Committee.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HARPER PAUL
Published: December 2021

The recommendations that federal tax funds be used for the support of pediatric education which were prepared by the Committee for Improvement of Child Health and approved by the Executive Board of the American Academy of Pediatrics are supported with the following reservations:

a. The recommendations of the Academy should acknowledge the need to strengthen the entire field of medical education while maintaining the Academy's qualification to speak for the pediatric aspects.

b. The recommendations should more clearly emphasize the desirability of extending medical training by an affiliation between outlying hospitals and medical centers. The purpose is more and better training in pediatrics for general practitioners as well as for pediatricians.

c. The recommendations should be amended to strengthen the position of the proposed advisory council on medical education and to require that there shall be no interference with academic freedom to develop medical education and to investigate disease.
Give Your Child A Chance
Authors: ALDRICH C. ANDERSON
Published: December 2021

This book adds another volume to the many already published on the subject of child care. Its preface and foreword are written by Donovan J. McCune, M.D., and Norvelle C. LaMar, M.D., respectively, who endorse the author's statements.

There is little in the way of advice to which I would not subscribe. In fact it is remarkable that So many pages can be filled with so much advice which is highly acceptable. Miss Turner has done a masterful job of summarizing the liberal ideas of our times. However, one begins to doubt the efficacy of any book so full of instructions without an adequate discussion of the "whys" of liberal ideas.
MULTIPLE CYSTIC TUBERCULOSIS OF BONE
Authors: KREIDBERG MARSHALL B. , DOWNING DANIEL F.
Published: December 2021

Cystic tuberculosis of bone is an uncommon but by no means rare disease. It is often confused with syphilis, pyogenic osteomyelitis, malignant tumor, polyostotic fibrous dysplasia, eosinophile granuloma and other disorders which affect the skeleton. The diagnosis depends, first, on familiarity with the condition; second on the histologic features of material removed by biopsy; and, finally, on the demonstration of tubercle bacilli by guinea pig inoculation or by culture in the purulent discharge or in the excised tissues of the sinus.

A report of an exemplary case is presented.
AN OUTBREAK OF NAUSEA, VOMITING AND DIARRHEA ON A MATERNITY SERVICE; TRANSMITTED TO A CHILD CARING INSTITUTION AND TO PRIVATE HOMES
Authors: ABRAMSON HAROLD , FUERST HAROLD T.
Published: December 2021

An outbreak of epidemic nausea, vomiting and diarrhea in newborn infants is described. The communicability of the disorder is demonstrated by its direct spread to the residents of a child caring institution and to the occupants of a nearby tenement house. We are in agreement with the observations of Brown, Crawford and Stent and those of Cook and Marmion that the condition is a relatively mild one in newborn infants and that it should not be confused either clinically or epidemiologically with the syndrome epidemic diarrhea of the newborn.

A differential diagnosis should be made between this disorder and epidemic diarrhea of the newborn, salmonella infection of the newborn, and the diarrhea accompanying stomatitis in young infants, and should be based on clinical and epidemiologic factors.

Outbreaks in nurseries for newborn infants should be studied carefully and indiscriminate grouping of cases avoided. Distinctive and constant clinical and epidemiologic features should be sought in each outbreak to separate it from the general group of diarrheal disorders of the newborn.
CONGENITAL ANKYLOGLOSSIA (TONGUE-TIE) ASSOCIATED WITH GLOSSOPTOSIS (RETRUDED MANDIBLE) AND PALATUM FISSUM (CLEFT PALATE)
Authors: MAY HANS , CHUN LIN T.
Published: December 2021

A case of congenital ankyloglossia (tongue-tie) associated with retruded mandible, glossoptosis, and cleft palate is presented. A surgical procedure is outlined for reconstruction of the tongue-tie condition and complications and their management are discussed.
RHEUMATIC PNEUMONITIS IN CHILDHOOD
Authors: LEVY HAROLD B. , COFFEY JOHN D. , ANDERSON CHARLES E.
Published: December 2021

Sufficient data are presented to indicate the pathologic entity of rheumatic pneumonitis and its position of importance as an outstanding cause of death in rheumatic fever, either primarily or secondarily. In each of the five autopsied cases, there was sufficiently severe and widespread pulmonary involvement to suggest that the pneumonitis led the way to the fatal termination, either by impairment of the respiratory system alone, or by further adding to the load of an already dangerously impaired cardiac mechanism. If, as Stewart has said, the danger of bacterial pneumonia is such an acute one as a precipitating factor in heart failure, how much more perilous is the existence of a severe involvement which appears to be part and parcel of the rheumatic picture as a whole.
Round Table Discussion
Authors: PETERSON J. C.
Published: December 2021

Chairman Peterson: In this discussion we will attempt to clarify concepts concerning the use of skin testing material in the diagnosis of these two fungus infections. We will also attempt to show the relationship of minimal mild infections to the more serious infections.

Until the recent past, most of us have considered fungus infections to play a very minor or unimportant role in the production of disease process in children. All of us have been more or less aware of the fact that thrush and certain dermatomycoses are commonplace in early infancy and childhood respectively but serious infections are so rare that they are of little significance. In general, fungus infections have seemed to play an unimportant role in the spectrum of disease processes; only occasional rare severe infections being recognized.

In recent years we have been forced to the realization that fungus infection—generalized fungus infections—are much more common than we had previously suspected and that many of these infections have remained unrecognized or they have masqueraded under false pretenses and have been classified as other diseases.

The study of coccidiomycosis in California first pointed out the fungus infections, which have been recognized only as a generalized serious infection, might also exist in a much more benign form and might have a course which is entirely asymptomatic or nearly asymptomatic. In most of the fungus infections the recognition of the severe form of infection has antedated the recognition of the benign forms of infection. That is true of both of the fungus infections which we will discuss today.

The discussion of coccidioidomycosis will be led by Dr. Russel Mapes of Beverly Hills, Calif., who—though he is a practicing pediatrician—has had extensive experience with coccidioidomycosis in his work in the Army.

Dr. Mapes: Coccidioidomycosis is an infection caused by the fungus Coccidioides immitis. It may occur as a mild, even inapparent infection, or in the more common pulmonary form which is self-limited and without sequalæ, or it may appear as the progressive disseminated disease known as coccidioidal granuloma. The history and background of this disease is interesting.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HARPER PAUL
Published: December 2021

OUR attention has been called to two corrections which should be made in the letter of Dr. Thomas O. Gamble as it appeared in this column in the September issue of Pediatrics Dr. Gamble writes:

"On page 365 I quoted the first objective of the Association of American Physicians and Surgeons. Quotation marks should have been placed at the end of the two sentences which are enclosed in parentheses. Anyone reading my letter might assume that the last two sentences represented my interpretation of the first objective. So, while I agree entirely with the objective and its interpretation, I should not be given credit for something which belongs to the A.A.P.S."

The second correction is made in the letter from Dr. William J. Orr, Buffalo, New York, which is published below.

Dr. Myron E. Wegman and Dr. Ralph V. Platou, Professor and Head, Department of Pediatrics, respectively of Louisiana State University of Medicine and Tulane University School of Medicine have polled the professors of pediatrics throughout the country to ascertain their experience with federal funds. The results of this survey are summarized in their letter.
Psychiatric Examination of the School Child
Authors: SHIRLEY HALE F.
Published: December 2021

This book, designed primarily for the medical practitioner, is intended to portray general psychaitric principles which the author's experience has shown to be useful in the clinical examination of the school child from five to 17 years of age. It is not intended to be a textbook in child psychiatry. The material is so organized, however, that it gives a good idea of what happens in a child psychiatry clinic when a child is referred for a psychiatric opinion. More important, it makes specific suggestions and describes methods of investigation which the physician can make use of in his practice. The author, a psychiatrist in Liverpool, England, has had experience in a child guidance clinic, a psychiatric clinic, a children's hospital, and a health department, and she has been able to watch the progress and development of many children over a period of from five to 10 years.
Traite de Dietitique du Nourrisson
Authors: FABER HAROLD K.
Published: December 2021

This volume on infant feeding contains chapters on the criteria of nutrition (physical and behavioral growth, relation between weight and height, physical peculiarities of the infant, etc.); breast milk and breast feeding; artificial feeding, including analyses of various species of milk, and of milk substitutes, and of various supplemental foods; vitamins and minerals; the modifications of milk; the technics of feeding; diet lists; and the feeding of premature and debilitated infants. In general, the outline parallels rather closely that of Jeans and Marriott' "Infant Nutrition" (fourth edition).
AUTHOR'S REPLY
Authors: BIRDSONG MCLEMORE
Published: December 2021

Your letter of July 26 was received and I will be glad to reply to Dr. Smyth's letter.

For your own enlightenment, we have reviewed the slides on this case and not only were the organisms found, but on two occasions about six months apart the biopsy showed typical pathologic changes of tuberculosis. The negative tuberculin that we experienced in this child can be explained on an overwhelming infection in that the child was quite toxic in the hospital and died within a couple of weeks after being discharged.
A SYNDROME OF RECURRENT INFECTION AND INFILTRATION OF VISCERA BY PIGMENTED LIPID HISTIOCYTES
Authors: Landing Benjamin H. , Shirkey Harry S.
Published: December 2021

The clinical and pathologic findings in two white male children with repeated infections, including lymphadenitis, aphthous stomatitis, enteritis, pneumonitis, osteomyelities, etc. are described. Tissue removed at laparotomy in one patient, and at necropsy in the other, showed infiltration of organs by lipid histiocytes containing yellow-brown pigment. Although the histochemical properties of the cells show similarities to the lipid histiocytes of Niemann-Pick disease, the condition described is considered to differ from other forms of lipid histiocytosis, as well as from other conditions producing susceptibility to infection. Concentrations of gamma-globulin in the serum of one of the patients were elevated, but whether the globulin is functionally effective is not known. The onset of symptoms in early infancy suggests that the disorder is genetically determined rather than acquired, but no evidence of familial occurrence has been obtained.
SALMONELLA OSTEOMYELITIS AND ABNORMAL HEMOGLOBIN DISEASE
Authors: Silver Henry K. , Simon Jimmy L. , Clement David H.
Published: December 2021

Two cases of salmonella osteomyelitis and abnormal hemoglobin disease are reported; the first in a white boy with combined sickle cell-Mediterranean anemia and the second in a Negro girl with hemoglobin C-D disease.

One case represents the first reported instance of salmonella osteomyelitis occurring in a patient with a mixed heterozygous hemoglobin disease while the other is the first observed in a patient with a hemoglobinopathy without sickling.

A complete review of the literature is presented.
ON THE ACCEPTANCE OF SOLID FOODS, AND OTHER FOOD PATTERNS, OF INFANTS AND CHILDREN
Authors: Beal Virginia A.
Published: December 2021

Serial nutrition histories have been taken since 1946 on 65 children enrolled in the Child Research Council series. As the age of introduction of solid foods into the diet has become progressively earlier over a 10-year period, the number of infants refusing to accept these solid foods when first offered has increased. The average age of willing acceptance of cereal is 2½ to 3½ months, of vegetables 4 to 4½ months, of meat and meat soups 5½ to 6 months; fruit has been accepted at progressively earlier ages and is now accepted at 2½ to 3 months. The age of transition from prepared baby foods to the family's diet has decreased from approximately 2 years to 13 months. No benefit, as reflected by concentration of hemoglobin, mean corpuscular volume or mean corpuscular hemoglobin concentration, was observed with high intakes of iron from prepared infant cereals.

The curve of intake of nutrients rises rapidly and smoothly in early infancy. During the preschool period there is a marked decrease in appetite and while calorie intake continues to rise slowly, protein intake reaches a plateau and calcium intake decreases markedly. Median milk intake between 2 and 3 years of age is 16 ounces daily. After 3 years the intake of all nutrients rises.
NONADRENAL FEMALE PSEUDOHERMAPHRODISM AFTER ADMINISTRATION OF TESTOSTERONE TO MOTHER DURING PREGNANCY
Authors: Grunwaldt Edgar , Bates Talcott
Published: December 2021

THE DIAGNOSIS of nonadrenal female pseudohermaphrodism should be based on the following criteria: (1) the external genitalia should show hypertrophy of the clitoris and some degree of labial fusion; (2) in infants, measurement of 17-ketosteroids or pregnanetriol should be performed to rule out the adrenogenital syndrome; in older patients this syndrome can be ruled out clinically by the lack of precocious puberty and progressive masculinization; (3) laparotomy should reveal a female internal genital apparatus, and (4) adequate biopsies of both gonads should show normal ovaries, excluding the possibility of ovotestes and true hermaphrodism.

The subject of pseudohermaphrodism is adequately covered by Wilkins et al. in a recent article in which 12 cases of nonadrenal female pseudohermaphrodism are mentioned; however, not all of these meet the four conditions described above. There are two in the literature in which pseudohermaphrodism followed the occurrence of masculinizing tumors (arrhenoblastoma) during pregnancy, but no mention was found of a case in which testosterone had been administered to the mother.

CASE REPORT

History

This infant was the first born of a 28-year-old white woman who consulted her obstetrician because of nausea and vomiting 10 weeks after the onset of the last menstrual period. On that day 100 mg of testosterone propionate was administered intramuscularly, and 10 mg of methyl testosterone three times a day was prescribed. Three days later another 100 mg of testosterone propionate was administered. She had taken 30 mg of testosterone by mouth daily for 51 days when administration was discontinued because of deepening voice.
ULTRAMICRO DETERMINATION OF SALICYLATES IN BLOOD SERUM
Authors: MacDonald Roderick P. , Ploompuu Jaan , Knights Edwin M.
Published: December 2021

A rapid, simple method is described for determining salicylate concentration in ultramicro quantities of blood. The xanthroproteic reaction as described by Volterra and Jacobs is used with solutions of sodium salicylate as reference standards.
MECHANISMS CONCERNED WITH APPETITE
Authors: Brobeck John R.
Published: December 2021

THE TITLE given to this paper is a bit inappropriate for a discussion in physiology, since the word "appetite" has a psychologic rather than physiologic meaning. Both hunger and appetite, as well as satiety, refer to sensations or affective states, and none of the three words has an accurate or precise definition. In the following discussion they are used only for convenience, and with only their common English meanings. They cannot be studied directly in human infants nor in laboratory animals, but only indirectly by simple observation as to whether food is or is not accepted, or by noting the amount of food eaten or the rate of eating. Perhaps a better title is "Mechanisms that regulate intake of food," using the word, "regulate," as it is used in the case of respiration. For example ventilation of the lungs is said to be regulated through the interaction of respiratory centers, reflexes, stretch receptors and chemoceptors. Analogous mechanisms doubtless serve to regulate feeding.

Like the regulation of respiration, the control of intake of food is one of the important functions of the central nervous system. The digestive apparatus is concerned only in a limited way and that as a system regulated, rather than as the regulator. Sherrington noted as early as 1900 that feeding persists after operations upon the stomach, including nearly complete removal of the organ. If such an operation leaves the tract adequate for digestion, it does not lead to any primary, quantitative disturbance of feeding behavior. Similar conclusions may be drawn from observations upon patients who have undergone the several types of operation upon nerves supplying the stomach and intestine, including patients subjected to vagotomy.
COMMITTEE ON ACCIDENT PREVENTION
Authors:   ACCIDENT PREVENTION COMMITTEE
Published: December 2021

The Committee on Accident Prevention of the American Academy of Pediatrics, in co-operation with the Surgical Section of the same organization, has prepared the following statements to cover the emergency management of childhood skeletal trauma and burns. Both of these statements are endorsed by the Committee on Trauma of the American College of Surgeons and have been approved by the Federal Civil Defense Administration.

EMERGENCY CARE OF CHILDHOOD SKELETAL TRAUMA

1. Evaluate and splint where they lie before moving. Do not attempt reduction.

2. Move cervical injuries face up on a rigid support with manual traction applied gently by cupping chin at the time of moving. Sand bags on either side of neck to prevent turning, if possible.

3. Spine injuries should not be flexed in transportation.

4. Lower leg injuries, transport in pillow strapped with belt.

5. Upper leg injuries, transport with both legs and trunk bound to board without circulatory interference.

6. Lower arm injuries, transport with splint such as rolled newspaper, gentle compression wrapping and sling.

7. Upper arm can be bound to chest with lower arm supporting in sling.

8. Open injuries or open wounds, cover with sterile dressing, do not dust with antibiotic, but systemic antibiotic is useful. Do not attempt to retract bone back under skin. Get to surgical care promptly.

9. Do not cover distal tips of extremities if it can be avoided thus allowing a circulation check to be made from time to time.

EMERGENCY CARE OF BURNS

1. Burns are due to thermal agents (scalds or fire); chemical agents (battery acid or lye); radiation (sunburn or nuclear); and electrical energy.
PEDIATRICS AND SOCIETY
Authors: MAY CHARLES D.
Published: December 2021

PEDIATRICIANS practice medicine in a setting which inevitably exposes them to the influence of social customs and beliefs. They are drawn into the midst of family relationships and cannot fail to notice the interplay of forces affecting the development of the new generation. Change is a sign of life in the social order; it should be cultivated sympathetically as a source of improvement—not opposed futilely by prejudice as though a threat.

It follows that pediatricians are obliged to examine their role in society continuously or surely they will be found unqualified to exercise appropriate influence and guidance. In the contemporary adjustment of pediatrics to the social trends, practitioners and teachers must acquire orientation in many areas not covered in their training.
THE RELATIVE MERITS OF ISONIAZID AND OTHER THERAPEUTIC AGENTS IN THE TREATMENT OF TUBERCULOUS MENINGITIS IN CHILDREN
Authors: Ratner Bret , Klimkiewicz George R. , Ellis William C. , Malone H. John , Dolgin Joseph
Published: December 2021

Isoniazid (Rimifon®) given alone from the inception of tuberculous meningitis effected a complete cure in two patients.

Isoniazid given as the sole therapeutic agent effected a cure in 11 patients with tuberculous meningitis who had failed to recover with streptomycin alone or in combination with other antituberculous drugs.

Two infants recovered completely from miliary tuberculosis during administration of isoniazid from the inception of the disease. Because such infants usually develop tuberculous meningitis, we might consider that they had incipient meningitis which was aborted.

Five patients developed severe sequelae while receiving streptomycin for tuberculous meningitis. They were then given isoniazid alone and showed no further sequelae nor did meningitis recur.

Three patients died who received streptomycin followed by isoniazid alone.

Of the 21 patients the survival rate was 86%. The survival rate of the 13 patients with bacteriologically proved tuberculous meningitis was 77%. The eight cases not bacteriologically proved are discussed.

From our experience, it seems reasonable to conclude that isoniazid administered alone in the treatment of tuberculous meningitis does not produce neurologic residua. The neurologic sequelae produced by streptomycin, such as deafness, hydrocephalus or mental vegetation, once established, cannot always be corrected by isoniazid. However, one child who was becoming blind while receiving streptomycin, recovered sight completely after administration of isoniazid alone.

The high survival rate of 77% in the 13 patients with bacteriologically proved tuberculous meningitis treated with isoniazid alone from the inception of the disease, or after treatment with streptomycin, gives evidence for the remarkable therapeutic effects of isoniazid.

The modes of action of isoniazid and streptomycin are compared and their relative merits as therapeutic agents are discussed. Whether isoniazid should be used alone or in combination with other drugs are questions for further study.
SMA® and Vitamin B6
Authors: BESSEY OTTO A. , ADAM DORIS J. D. , HANSEN ARILD E.
Published: December 2021

We have received a letter from Dr. M. Z. Bierly, Jr., Medical Department, Wyeth Laboratories, calling attention to the fact that our paper in Pediatrics concerning vitamin B6 and infantile convulsions failed to make clear that the infants studied fed SMA® received the product which was on the market in 1952 and 1953, and not the present product which according to Dr. Bierly has contained pyridoxine at a level of 0.4 mg per reconstituted quart since July 1953.
The Importance of Overweight
Authors: REILLY WILLIAM A.
Published: December 2021

Doctor Hilde Bruch has brought together her rich and long experience with obesity. She develops the point of view that obesity is due to extra caloric intake and inactivity; she stresses the point that hyperphagia is the primary problem and is mainly based on psychologic causes. Dr. Bruch approaches overeating from the newer knowledge of metabolic and neurologic regulations and from psychiatric thinking. Organic defects, including endocrinopathies (Cushing's syndrome) as causes of obesity, occur only rarely.
ALIMENTARY TRACT OBSTRUCTION IN THE NEWBORN INFANT
Authors: Jones Thomas W. , Schutt Robert P.
Published: December 2021

From this discussion and analysis of 132 cases of congenital obstruction of the alimentary tract, several conclusions can be drawn:

A challenge still exists for a further reduction of the mortality rate of the newborn with congenital anomalies of the alimentary tract. This challenge can be met only by early diagnosis and treatment.

There is a gradual increase in the number of newborn infants with congenital alimentary tract anomalies being seen and treated at the Children's Orthopedic Hospital each year.

Eighteen per cent of infants with atresia of the alimentary tract have additional areas of obstruction.

A predominance of males was noted in those infants with Hirschsprung's disease and jejunal and ileal atresia, while a predominance of females was found in those infants with imperforate anus.

Infants with anal malformations and alimentary tract atresia exhibit the highest incidence of associated congenital anomalies (31.2% to 75.0%).

The groups of infants with meconium ileus and esophageal and duodenal atresia had the greatest incidence of prematurity (12.5% to 38.5%).

In infants with anal malformations, there is found a 68% incidence of rectal fistulae of one type or another.

Infants with anal malformations have the best prognosis, while infants with meconium ileus and those with multiple lesions, have the poorest.

Temporary gastrostomy, when used after primary repair of esophageal atresia, appears to be of distinct benefit.

In the majority of instances the diagnosis can be established by the aid of a single plain roentgenogram of the abdomen. This should be done routinely in any case of a newborn infant who has persistent vomiting and/or abdominal distention.
Letters to the Editor
Authors: DIETRICH HARRY F.
Published: December 2021

I greatly appreciate the opportunity you gave me to withdraw from publication the letter which precedes. I have reviewed (as objectively as I can) pertinent events subsequent to the writing of that letter. In part they have been:

1. The approval of an additional $2,500,000 to the U.S. Public Health Service for work on "Asiatic flu."

2. A reaffirmation by the Surgeon General that we are really in for it unless there is mass immunization.

3. A natural parroting of this dire warning by State, County and City Health Departments.
Traumatic Head Injury and the Diagnosis of Abuse: A Cluster Analysis
Authors: Boos Stephen C. , Wang Ming , Karst Wouter A. , Hymel Kent P.
Published: December 2021

OBJECTIVES

Data guiding abusive head trauma (AHT) diagnosis rest on case-control studies that have been criticized for circularity. We wished to sort children with neurologic injury using mathematical algorithms, without reference to physicians’ diagnoses or predetermined diagnostic criteria, and to compare the results to existing AHT data, physicians’ diagnoses, and a proposed triad of findings.

METHODS

Unsupervised cluster analysis of an existing data set regarding 500 young patients with acute head injury hospitalized for intensive care. Three cluster algorithms were used to sort (partition) patients into subpopulations (clusters) on the basis of 32 reliable (κ > 0.6) clinical and radiologic variables. P values and odds ratios (ORs) identified variables most predictive of partitioning.

RESULTS

The full cohort partitioned into 2 clusters. Variables substantially (P < .001 and OR > 10 in all 3 cluster algorithms) more prevalent in cluster 1 were imaging indications of brain hypoxemia, ischemia, and/or swelling; acute encephalopathy, particularly when lasting >24 hours; respiratory compromise; subdural hemorrhage or fluid collection; and ophthalmologist-confirmed retinoschisis. Variables substantially (P < .001 and OR < 0.10 in any cluster algorithm) more prevalent in cluster 2 were linear parietal skull fracture and epidural hematoma. Postpartitioning analysis revealed that cluster 1 had a high prevalence of physician-diagnosed abuse.

CONCLUSIONS

Three cluster algorithms partitioned the population into 2 clusters without reference to predetermined diagnostic criteria or clinical opinion about the nature of AHT. Clinical difference between clusters replicated differences previously described in comparisons of AHT with non-AHT. Algorithmic partition was predictive of physician diagnosis and of the triad of findings heavily discussed in AHT literature.
INCIDENCE OF CRANIAL NERVE PARALYSIS IN POLIOMYELITIS IN RELATION TO PRESENCE OR ABSENCE OF TONSILS
Authors: Top F. H.
Published: December 2021

A study of patients from a largely rural area in Iowa corroborates the evidence of many previous studies that bulbar and bulbospinal types of poliomyelitis occur more commonly in persons whose tonsils have been removed irrespective of the time in life the operation was performed. The tonsillectomy rate for all cases was the lowest encountered thus far. Agreement is not on the same level as noted in the author's Detroit composite study previously reported, and is more marked for bulbospinal than for the bulbar type of poliomyelitis (some studies combine bulbar and bulbospinal cases).

Adjustment for age reduces differences between cases with tonsils absent and tonsils present by clinical type and further strengthens the finding of Paffenbarger and of the author's Detroit composite study that age must be reckoned with in an assessment of the problem.

Incidence of paralyses of cranial nerves by tonsillectomy status is similar to the Detroit composite study in the case of palatal and pharyngeal paralyses but less strongly; incidence of paralysis of the facial nerve is dissimilar.
Regulation and Mode of Action of Thyroid Hormones
Authors: REILLY WILLIAM A.
Published: December 2021

This colloquium is mainly of interest to investigators, but does have some points of interest to medical practitioners.

It considers the dynamic actions of iodine metabolism and the alteration of thyroid function as influenced by the other endocrine glands and the influence of the hypothalamus on the pituitary control of the thyroid. Briefly the purpose of the discussion was to consider questions running from the regulation of the thyroid gland to the mode of action of its hormone.
HEMATOLOGIC STUDIES OF CHILDREN WITH LEAD POISONING
Authors: Watson R. Janet , Decker Elisabeth , Lichtman Herbert C.
Published: December 2021

Thirteen cases of lead poisoning in children were studied hematologically and compared with a similar age group with uncomplicated nutritional iron deficiency anemia. Both groups had a moderate to severe microcytic hypochromic anemia, with a low plasma iron and per cent iron saturation. The group with lead poisoning also had an increase in stippling, target cells and reticulocytes, not present in the other group. The total iron-binding capacity was lower in the lead-poisoning group. The most prominent finding was a great increase in free erythrocyte protoporphyrin in the lead-poisoning group. The group with lead poisoning probably had previous nutritional iron deficiency anemia upon which the lead poisoning had superimposed other hematologic changes. It is not known whether the coincidence of nutritional iron deficiency anemia and lead poisoning has special significance.
BENIGN FAMILIAL POLYCYTHEMIA IN CHILDHOOD
Authors: Auerback Marvin L. , Wolff James A. , Mettier Stacy R.
Published: December 2021

This is a review of benign familial polycythemia—a disease marked by high values for erythrocyte count and hemoglobin, not associated with significant symptoms, leukocytosis or thrombocytosis.

Two families are described, some of whose members have this condition.

It is hoped that greater knowledge of prognosis may be obtained by further observations of these patients.
ACUTE IDIOPATHIC HYDROPS OF THE GALLBLADDER NOT DUE TO CALCULI, POSSIBLY TO INFECTIOUS HEPATITIS
Authors: McGahan John J. , Whittinghill John A.
Published: December 2021

Two cases of acute hydrops of the gallbladder in children, not due to calculi, are reported.

An infectious etiology of the condition, in relation to infectious hepatitis, should be considered more thoroughly because of the observation of its occurrence in neighboring children in an epidemic of infectious hepatitis.
EPILEPTIC EQUIVALENTS IN CHILDREN
Authors: Snyder C. Harrison
Published: December 2021

Many symptoms in children, occurring in paroxysms, may be shown by electroencephalography to represent epileptic equivalents, and may respond favorably to anticonvulsant therapy.

These symptoms include headache, abdominal pain, leg aches, nausea or cyclic vomiting, fever and night terrors.

A syndrome has been described which is due to cerebral dysrhythmia but lacks a truly paroxysmal character—a condition resembling neurasthenia, with superimposed attacks of headache, fever, or pain in the abdomen or extremities.

Diagnosis of all these conditions requires a high degree of suspicion balanced by cautious skepticism. The diagnosis can be confirmed electroencephalographically and by the response to anticonvulsant therapy.

Warning is given against overzealous interpretation of minor electroencephalogram irregularities, and against overoptimistic appraisal of the results of therapeutic trials.

Given such a cautious attitude, the physician may find the electroencephalogram a useful tool in the study of children with various paroxysmal complaints or personality disorders.
PUBLIC HEALTH, NURSING, MEDICAL SOCIAL WORK
Authors: Feldmann Floyd M.
Published: December 2021

As a pediatric problem, tuberculosis has undergone striking change in the past decades, yet few diseases have the complicated interrelationship of personal and community significance that is peculiar to tuberculosis. Management of the tuberculous patient has become largely a matter for hospital and specialized outpatient services, and the individual practitioner has been chiefly concerned with case finding in his own practice. Since the tuberculin test is such an important tool in this respect, the editors thought such a review as presented by Dr. Feldmann of particular importance.

A number of controversial points are touched on. In any public health procedure a routine screening test has value in relation to the proportion of positives likely to result. A test which results in more than 50% positive is not very helpful. On the other hand, a test with one positive in 1,000 is probably too expensive. Dr. Feldmann points out the cogent reasons for routine tuberculin testing and the pediatrician will need to consider these reasons in the light of the conditions in his community and the relevant local and state health program.

Some may be disturbed by the criticism made of the patch test, yet it is important to recognize its limitations. Failure of the patch test to detect all positives has been well known and most pediatricians have thought it useful chiefly as a preliminary test to find the more sensitive reactors.
CLINICAL CONFERENCE
Authors: Scaglione Peter R.
Published: December 2021

Dr. Scaglione: During the past 2 years in the Babies Hospital, two instances have been observed of severe disturbance of the central nervous system in patients in an edematous phase of nephrosis and undergoing rapid diuresis during adrenal steroid therapy.

The first patient to show this alarming reaction was a 6-year-old white girl who, while being treated with intramuscular adrenocorticotropin (ACTH), rapidly lost fluid and developed marked hypochloremic, hypokalemic alkalosis. She became comatose for several weeks and, since that time, has had a convulsive disorder resistant to therapy. She also underwent severe impairment of intellect and is now considered to be hopelessly retarded. The second patient, to be presented in greater detail, is a child who reacted in a similar manner while receiving prednisone, but she has apparently suffered no permanent alteration in intellectual function.

Patty H. is an 8-year-old Negro female who had the onset of edema in July 1955. During the first 6 months of the disease, she was given two courses of prednisone therapy in a local hospital and this resulted in prompt diuresis, but there was equally rapid re-accumulation of edema following cessation of therapy. The urine showed persistent proteinuria, cylindruria and hematuria. In January of 1956 she was treated again with prednisone at the Duke University Hospital in North Carolina. A moderate diuresis was obtained but she required admission 3 months later because of marked anasarca. The patient was then treated with a 12-day course of ACTH-gel (20 units/ day) following which she underwent a massive diuresis and lost approximately 14 liters of urine in 4 days.
PRESIDENTIAL ADDRESS
Authors: Martmer Edgar E.
Published: December 2021

THE GROWTH and development of the American Academy of Pediatrics are matters of record set forth in able fashion by Marshall Pease in his History of the American Academy of Pediatrics and Paul Beaven's For the Welfare of Children, a compilation of the Presidential Addresses beginning with Dr. Isaac Abt's presentation at the first annual meeting of this organization.

These two volumes recite the accomplishments of the Academy during its first 25 years. The small group of 32 men present at the organizational meeting in 1930 has increased to more than 5,000 members distributed throughout the western hemisphere.

The founders conceived the Academy as a service group dedicated to the improvement of child health and welfare. Able leaders through the years have strengthened its position and influence by their untiring efforts to attain these objectives and have been aided at all times by the co-operation of the members.

The influence of the Academy in matters relating to child health and welfare is demonstrated by the respect with which its pronouncements are received by medical organizations, governmental agencies and lay groups. Its counsel is sought whenever matters relating to child health and welfare are considered.

We have a great responsibility to maintain our position in the field of child health and welfare and to extend the influence of the Academy.

We must continue to be an organization of high ideals and noble purposes, for our growth demonstrates our objectives are worthwhile.

The success which the Academy has achieved in fostering interest in pediatrics and correlating all aspects of the work for the welfare of children has been accomplished by providing leadership, our willingness to co-operate with interested groups, and through education.
ESSENTIAL FATTY ACIDS AND INFANT NUTRITION
Authors: Hansen Arild E.
Published: December 2021

Arild Edsten Hansen was born in Minneapolis during the last year of the last century and grew up in that city. He was educated in the schools of Minneapolis and at the University of Minnesota where he received his degrees: B.S. in 1923, M.B. in 1924, M.D. in 1925 and Ph.D. in 1934. Arild Hansen also spent the years 1929 and 1930 in post-graduate studies at Heidelberg and Vienna. He served the University of Minnesota as an Assistant and an Instructor of Pediatrics until 1934. The year 1934-35 was spent as an Alexander Brown Coxe Fellow at Yale University. Upon returning to Minnesota, Dr. Hansen became Assistant Professor of Pediatrics. in 1937 Associate Professor and in 1942 Professor. In 1944 Dr. Hansen traveled from the extreme north to the extreme south of the United States to become Professor of Pediatrics and Head of the Department at the University of Texas Medical Branch in Galveston. Dr. Hansen is a member of numerous scientific societies. He has a long career in investigation and published many articles on a variety of topics but especially on lipid metabolism.

IN A PRESENTATION such as this, no doubt, one is allowed the equivalent of a certain degree of "poetic license" in reviewing the work which has led to commendation by the Committee on Awards of the American Academy of Pediatrics. Collaboration is not only an essential feature of present day investigative endeavors, but also a social reward. As with everyone else, perhaps, who has attempted to pursue "ideas," the writer has found persons who stand out as vital and indispensable in seeking to establish fantasy or fact in relation to concepts conceived. In regard to the subject of the essential fatty acids, it has been my pleasure and privilege to work in the most stimulating manner with the late William R. Brown, Mildred R. Ziegler, George O. Burr, Irvine McQuarrie, William R. Wilson and in recent studies for which this award is being given with Doris J. D. Adam, and especially with Hilda F. Wiese of the University of Texas School of Medicine.
STUDIES OF CARBOHYDRATE METABOLISM IN THE NEWBORN
Authors: Cornblath Marvin , Levin Ephraim Y. , Marquetti Estela
Published: December 2021

Administration of glucagon produced a prolonged hyperglycemia in normal fullterm and premature infants delivered vaginally.

In infants, both full-term and premature, 5 days of age and more, the hyperglycemia after administration of glucagon was shorter and resembled that of older infants and children.

The hyperglycemia in premature infants, both newborn and 5 days of age and older, was less than that in full-term infants of comparable age.
OBSERVATIONS OF A METABOLIC LESION IN COW'S-MILK ALLERGY
Authors: Crawford John D. , Kerrigan Gerald A. , Arnold Mary B.
Published: December 2021

Clinical and metabolic studies of two infants allergic to cow's milk are described. In both babies episodes of clinical deterioration culminating in a cyanotic, peripheral circulatory shock-like state were repeatedly observed upon exposure to cow's milk. Despite clinical evidence of diminished circulatory volume, chloride space measurements suggesting increase in extracellular fluid volume at the expense of intracellular fluid were associated with the allergic reaction. Balance data indicate that external losses of sodium and water were small, and internal accumulation of potassium large, at the height of development of the metabolic disturbances.

The metabolic responses are discussed with reference to possible mechanisms of production. It is evident that further experimental work is required for their elucidation. However, these studies indicate that allergy should be considered in the differential diagnosis in infants who show metabolic derangements which may superficially suggest primary renal or adrenal disease.