bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECTS OF HYDRAZINOPHTHALAZINE (APRESOLINE®) ON BLOOD PRESSURE AND RENAL FUNCTION IN CHILDREN WITH ACUTE NEPHRITIS
Authors: MCCRORY W. W. , RAPOPORT M.
Published: December 2021

The response of hypertension occurring in acute nephritis in children to apresoline® has been studied. Significant temporary reductions in elevated blood pressure were produced by parenteral and oral apresoline® in 5 of 7 children with acute nephritis. The effect of this agent in two patients with hypertension and chronic renal disease was less impressive.

Studies of changes in renal function following parenteral administration of apresoline® were made in seven children with acute nephritis. Significant temporary depressions of the glomerular filtration rate and urine flow were observed in every instance in which apresoline® induced a fall in systemic blood pressure.

Apresoline® did not regularly induce an increase in renal plasma flow in these subjects. Changes in renal plasma flow were variable, and even decreases were observed. Even though apresoline® can induce a fall in blood pressure in children with hypertension and acute nephritis, this response may be associated with a temporary depression in renal excretory function.
INFECTIOUS MONONUCLEOSIS ENCEPHALITIS
Authors: WALSH FAITH C. , POSER CHARLES M. , CARTER SIDNEY
Published: December 2021

A case of severe encephalitis due to infectious mononucleosis is reported. An eight year old white boy developed meningeal signs, intermittent coma, opisthotonos, extensor spasms, mild papilledema and hyperpyrexia two weeks after the onset of a sore throat and cervical lymphadenopathy. The diagnosis of infectious mononucleosis was confirmed by a heterophile antibody titer of 1:1024.

The neurologic complications of the disease are uncommon in adults and are even more unusual in children. Only seven cases were found in the literature. Any or all parts of the nervous system may become involved; cerebrospinal fluid abnormalities may be the only manifestations of such involvement. The prognosis in children has been uniformly favorable with little or no neurologic residuals.

Electroencephalographic and cerebrospinal fluid studies made on patients with infectious mononucleosis indicate a higher incidence of nervous system involvement than is evident by clinical examination.

Serial heterophile agglutination determinations in patients with unexplained nervous system manifestations may clarify the diagnosis.
EDUCATION
Authors: POWERS GROVER F. , WASHBURN ALFRED H.
Published: December 2021

IN RECENT years much has been written about various aspects of medical education. I would hesitate to add another article to the literature were it not for a specific invitation from Dr. Grover Powers to contribute to his section in Pediatrics. This is a privilege and an opportunity which I welcome.

For the past 65 to 70 years pediatricians have striven—and for the most part successfully—to establish in medical schools separate departments of pediatrics. They have argued that pediatrics was an important specialty. They have pointed out that the small infant is a very different sort of organism than the school child; and that the latter presents very different health problems than does the mature adult. They have demonstrated conclusively that anatomic structure, physiologic functioning and responses to disease, or to therapeutic measures, are all unique for particular age levels.

The Child Research Council and the Department for the Study of Human Growth, University of Colorado School of Medicine, Denver.
SPECIFIC SERUM ANTIBODIES TO INFECTIOUS DISEASE AGENTS IN TARAHUMARA INDIAN ADOLESCENTS OF NORTHWESTERN MEXICO
Authors: Gajdusek D. Carleton , Rogers Nancy G.
Published: December 2021

A serologic-epidemiologic survey has been made on serum specimens collected at Sisoguichi in the Sierra Madre Occidentalis of Northwestern Mexico of 50 adolescent Tarahumara Indian boys and 6 adult Tarahumara. Search for evidence of previous contact with, and presumably, present immunity to 17 viruses, 5 rickettsiae, toxoplasma, 17 leptospiral serotypes, the treponeme of syphilis, and 5 bacteria has been conducted by use of tests for 53 specific antibodies, using mouse and tissue culture neutralization, complement-fixation, hemagglutination-inhibition, flocculation, treponemal immobilization, agglutination-lysis, and agglutination procedures.

Poliomyelitis antibodies to all 3 types were found in 51 per cent of the adolescents, while 78 per cent had antibodies to type 1, 90 per cent to type 2 and 63 per cent to type 3.

Mumps complement-fixing antibody was present in significant titer in 74 per cent of the adolescents, that for herpes simplex in 72 per cent and that for the psittacosislymphogranuloma venereum group in 18 per cent. These results are compared to data in the literature for other population groups. Three of fifty boys had specific complement-fixing antibody to epidemic typhus. Three of the fifty-six subjects studied had specific neutralizing antibody to encephalomyocarditis virus. The significance of this virus as a cause of aseptic meningitis and of other central nervous system disease in childhood is discussed elsewhere in this journal. There the suggestion is made, on the basis of the data summarized, that cases of encephalomyocarditis virus infection may be found in children in the United States once clinicians search for it as the cause of obscure central nervous system infections in young patients. Significant negative results include the absence of evidence for previous contact among these Tarahumara with any of 7 arthropod-borne viruses occurring in North America (EEE, WEE, SLE, VEE, CE, CT, YF), dengue types 1 and 2, lymphocytic choriomeningitis, murine typhus, Rocky Mountain spotted fever, rickettsialpox and Q fever. Only 1 boy had positive leutic serology.

Serologic surveys of this type offer the possibility of evaluating the infectious disease problem in a community in which little medical observation has been made and of adding significant new epidemiologic information to data obtained from records of reportable diseases in communities where accurate reporting of infectious diseases has long been the practice.
MUCORMYCOSIS
Authors: Harris Jerome S.
Published: December 2021

The present report is that of a child with the typical symptomatology of Mucormycosis of the central nervous system. The diagnosis was established during life by biopsy and culture. The organism was identified as Rhizopus arrhizus, a member of the family Mucoraceae. The patient recovered on therapy which consisted of rigid control of the diabetes, desensitization against the fungus and the administration of iodides.

The literature on "Mucor'" infections in humans has been reviewed with particular reference to the rare instances of involvement of the nervous system. The typical story is that of a poorly controlled diabetic patient who develops a fulminating orbital or nasal infection and dies in a few days with signs of invasion of the central nervous system. Examination reveals a necrotizing, inflammatory and vascular occlusive process in which broad non-septate hyphae may be seen. Until the present case, diagnosis has not been made during life, the infecting fungus has not been cultured or identified and no patient has survived.
DELAYED EFFECTS OCCURRING WITHIN THE FIRST DECADE AFTER EXPOSURE OF YOUNG INDIVIDUALS TO THE HIROSHIMA ATOMIC BOMB
Authors: Miller Robert W.
Published: December 2021

Thirty-three children who were exposed while in utero to the Hiroshima atomic bomb have head circumferences 2 or more standard deviations below normal. Twenty-four of these were between the seventh and fifteenth week of gestational age at the time of detonation of the bomb. The incidence and the severity of microcephaly increases as the distance from the hypocenter decreases. Mental retardation occurred in 15 of the 33 patients. The incidence of this defect was also related to distance from the hypocenter and gestational age. No other embryologic effects of exposure to the atomic bomb have been detected to date.

In 6 years ending in December, 1954, 19 persons who were within 2100 meters of the hypocenter have developed leukemia before attaining the age of 19 years. The annual incidence of this disease among those who were within 1500 meters and who were younger than 10 years of age at the time of exposure is 1:1000.

There are no cataracts that impair vision among the present pediatric group. An increased incidence of a mild visual disability, the cause of which is thus far indefinite, has been found among those now 16 through 19 years of age who were within 1800 meters of the bomb center. The incidence of chronic otitis media is the same for the 2 exposure groups, as are the means of the hematologic values for the patients with this ailment. There is no increase in the tumor incidence of the exposed children as compared with the nonexposed. There are no data to prove it, but the impression is that among the survivors the fear of late effects may be common and potentially disabling. Of those 19 years of age and younger, there were 2771 within 3000 meters of the hypocenter at the time of detonation of the bomb who were examined in 1954. Twenty-four of these had sequelae of the blast or thermal effects of the bomb other than well-healed scars. No other abnormalities related to atomic bomb exposure have been identified.

The review of the literature and the data presented in this report describe the late effects of exposure of young subjects to ionizing radiation or to nuclear weapons as known in the early part of 1955. The new information may be useful in the further definition of the tolerance of humans to ionizing radiation.
ACUTE POISONING WITH ISONIAZID TREATED BY EXCHANGE TRANSFUSION
Authors: Katz Ben E. , Carver Max W.
Published: December 2021

A case of acute isoniazid poisoning has been reported in a 19-month-old child. Treatment by exchange transfusion was successful and is suggested as a method of treatment to be considered in this as well as other forms of acute drug poisoning.
ELECTROENCEPHALOGRAPHIC STUDIES ON CHILDREN HAVING MEASLES WITH NO CLINICAL EVIDENCE OF INVOLVEMENT OF THE CENTRAL NERVOUS SYSTEM
Authors: Grossman Herbert J. , Gibbs Erna L. , Spies Harold W.
Published: December 2021

Serial electroencephalograms were done on 189 patients having measles with no clinical evidence of involvement of the nervous system. Using stringent criteria, 74 patients had considerable abnormality of the electroencephalogram. These findings could not attributed to any complications. Only one patient under 1 year of age (11 months) had evidence of electroencephalographic abnormality. The abnormalities observed were qualitatively and normalities observed were qualitatively and quantitatively similar to those seen in measles encephalitis, in most cases reverting to normal within 1 week. Approximately 4% had some residual electroencephalographic abnormality.
CANDIDA INFECTIONS IN CHILDREN WITH NEOPLASTIC DISEASE
Authors: Winter William D. , Foley George E.
Published: December 2021

A 1-year study of 165 patients of the Tumor Therapy Clinic and 1,004 general pediatric patients revealed a significantly increased carrier rate of Candida among children with malignant disease. The carrier rate also was increased among those with certain other chronic diseases in the general group. Treatment with antibiotics and/or cortisone, general condition of the patient, and primary diagnosis were all factors affecting the carrier rate. The development of localized or disseminated Candida infection could was be predicted for an individual but was regularly associated with vigorous antibiotic treatment and ultimately poor general clinical condition.
CURRENT PROBLEMS IN DIABETES
Authors: Klein R. , Laron Z.
Published: December 2021

THE PREVENTION of the vascular disease accompanying long-term diabetes mellitus is the most important problem in diabetes at the present time. The importance of this problem is dramatized by the following statistics from the Metropolitan Life Insurance Company Policy Holder Statistics and those of the Joslin Clinic for 1954. Diabetic coma accounted for 4.8% of all deaths in diabetic patients among the Metropolitan Life Insurance Company policy holders and 0.7% amongst the deaths of diabetics in the Joslin Clinic group. Eighty-three per cent of the deaths in diabetics in the Metropolitan Life Insurance Company group were due to vascular changes. The comparable figure for the Joslin Clinic group is 72%. Table I shows the figures in tabular form. It has been shown that, whatever other factors there may be in the causation of the vascular components of diabetes, these degenerative manifestations do increase with increasing length of survival with diabetes mellitus. There seems to be general agreement on this fact. Therefore, [SEE TABLE I IN SOURCE PDF.] the increase in vascular manifestations associated with diabetes would be expected in association with the decline of deaths from coma and the survival of diabetics for an appreciable period of time.

The emotionalism aroused in the proponents of the various regimens to prevent vascular changes in diabetes mellitus makes it difficult to ascertain the facts about this problem but at the same time emphasizes its importance.

An impartial review is needed of what is known about the etiology and prevention of these dread manifestations of diabetes mellitus. That is the main purpose of this article. To do this properly will require consideration of many factors related to the disease.
THE PEDIATRICIAN AND THE PUBLIC
Authors: de Silva C. C.
Published: December 2021

Ceylon is a small island, the economy of which is almost wholly agricultural based as it is on tea, rubber and coconut. It grows only half its requirements of its staple food, rice, and hence its rapidly growing population gives great cause for anxiety. The state of child health of such a country, where the per capita income is less than $100 a year, is naturally related very closely to the general economic standard of the nation and this is dependent largely on the population pressure. Unless we can increase our wealth by increasing production and productivity by opening virgin land, of which there are 3¼ million acres, and by industrialization, our standards will go down rather than up. Since independence in 1948, however, in spite of a rapidly growing population, one can say that the standard of living has risen, except among the underemployed and unemployed section of the urban dwellers who comprise 15% of the total population. This is reflected by the rise in the expectation of life at birth which was 42.8 years in 1946 to 59.3 years in 1954, and the marked lowering of the infant mortality rate which has already been referred to.

A very large proportion of deaths in children occur from acute disorders such as nutritional deficiencies, pneumonias and diarrheas. Nearly two-thirds of the total deaths in the hospital are caused by such preventable illnesses. Forty-five per cent of the total deaths occur in children under 5 years and 49% under 10 years. Quite apart from any superior consideration, this is sheer economic waste because such a high proportion of our man power dies before any measure of productivity can be achieved. For this reason, if for no other, the state must provide more care to the forgotten generation of children between the ages of 1 and 5 years.

Though environmental sanitation is important, and should by no means be neglected, it appears that as far as children are concerned nutrition must receive first priority in any public health measures. Until we can increase the consumption of more calories, more protein and more vitamins A and B, it is futile to expect much improvement in the present state of child health in Ceylon. This is not merely an economic problem but needs attack at the educational, social and cultural levels.

Though the number of admissions to the Children's Hospital, Colombo, has increased rapidly year by year, the fatality rates for almost every common condition have fallen equally, and in some instances more rapidly. There is, therefore, reason for happiness as well as for tears, for hope as well as for depression but not for despair.
CONGENITAL DEFECTS OF THE LYMPHATICS IN INFANCY
Authors: McKendry J. B. J. , Lindsay W. K. , Gerstein M. C.
Published: December 2021

Congenital defects of lymphatics in infancy are manifested by chylous ascites, chylothorax and lymphedema.

One case of congenital chylous ascites and two cases of congenital chylothorax, are added to the literature. Eight cases of [See FIG. 11. in Source Pdf.] congenital lymphedema are reviewed from the hospital records with a follow-up study.

No mention of combinations of these manifestations was found in the literature. A case report of chylous ascites with lymphedema is presented and some experimental work is presented in a case of lymphedema with chylous ascites and chylothorax.

Numerous large lymphatic spaces were present in the intestinal mesentery, serosa and bowel villi. The subcutaneous tissues of the involved limbs showed many dilated lymphatic channels. The uninvolved limbs showed similar, but less extensive, changes.

The pathologic picture is one of multiple dilated lymphatic channels, with failure of peripheral channels to communicate with the larger lymphatics.

Experimental evidence is provided to show that the chyle in the thoracic and abdominal cavities can be explained by a back pressure phenomenon of parietal and visceral lymphatics rather than small breaks in the thoracic duct which we were unable to demonstrate.

In the past, hypoplasia and absence of the thoracic duct, has been postulated in cases of chylothorax. This work does not support that view.
PHEOCHROMOCYTOMA IN CHILDREN
Authors: Cone Thomas E. , Allen Marvin S. , Pearson Howard A.
Published: December 2021

Three additional children under 12 years of age with functionally active pheochromocytomas are presented.

These three children are of further interest becaues of the familial nature of the pheochromocytomas.

Two of the cases are the first to be reported in sisters less than 10 years of age.

These two sisters demonstrate that children may have multiple pheochromocytomas, located both within the abdomen and in the chest. The older of the two sisters had an intrathoracic pheochromocytoma as well as pheochromocytomas of both adrenal glands. The younger sister had a pheochromocytoma of the right adrenal gland and another in the region of the aortic bifurcation.

Of striking interest was the finding of bilateral pheochromocytomas in the mother of the two girls. This is the first report in which a mother and her children had functionally active pheochromocytomas.

The literature is reviewed and the characteristics of these tumors as well as the laboratory diagnosis are discussed.
HEMOPHILUS INFLUENZAE TYPE b CELLULITIS
Authors: Green Morris , Fousek Mildred D.
Published: December 2021

Six cases of cellulitis associated with infections due to H. influenzae type b are reported. In four instances the etiologic relationship was proved by blood cultures while in the other two cases the etiologic relationship was suggestive.

Cellulitis of the face due to H. influenzae type b presents a characteristic clinical picture which should suggest the possibility of this specific etiology.
PERSISTENT DIARRHEA AS THE PREDOMINANT SYMPTOM OF HIRSCHSPRUNG'S DISEASE (CONGENITAL DILATATION OF COLON)
Authors: Stockdale Earl M. , Miller C. Arden
Published: December 2021

The case histories of two infants with absence of ganglion cells in a distal segment of colon are presented. These cases are remarkable in that the predominant symptom in each was persistent diarrhea rather than constipation. Megacolon was not present.
EFFECT OF PENICILLINS V AND G ON CARRIERS OF VARIOUS GROUPS OF STREPTOCOCCI IN A CHILDREN'S HOME
Authors: Wehrle Paul F. , Feldman Harry A. , Kuroda Kenzo
Published: December 2021

Penicillin V satisfactorily eliminated Group A streptococci from the nasopharynx of carriers when used in a total daily oral dose of 400,000 units administered in two divided doses, morning and evening during a 10-day period. Half this dose for a similar 10-day period was considerably less effective. These results were entirely comparable with those observed with penicillin G administered in single or double doses of 250,000 units daily for 10- day periods under the conditions of this study.

The need for daily doses of at least 400,000 units of penicillin V or 500,000 units of penicillin G for effective eradication of streptococci from carriers has been demonstrated.

A high incidence of infection with streptococci of Group G was observed but did not appear to be associated with clinical disease. No increased prevalence of Group G organisms was apparent among any age group or in any of the apartments studied in contrast with Group A infections.
CONCENTRATION OF FIBRINOGEN IN THE PLASMA OF NORMAL NEWBORN INFANTS
Authors: Taylor Paul M.
Published: December 2021

Concentrations of fibrinogen in the plasma have been determined for the first several days of life in a series of normal infants, and during the first 12 hours post partum in some of their mothers. The mean value for the infants on the first day was 231 mg/100 ml, as compared to 440 mg/100 ml for the mothers, and 280 mg/100 ml for a group of healthy adult controls. A slight increase in the mean concentration of fibrinogen is seen during the first 3 days of life. Sex, color, birthweight and the concentration of fibrinogen in the mother's plasma do not influence the infant's initial concentration of fibrinogen. There is no correlation between clotting times and concentrations of fibrinogen over the range of concentrations of fibrinogen encountered. A correlation may exist between the initial concentration of fibrinogen of the infant and the degree of hepatic immaturity.
NEUROLOGIC MANIFESTATIONS OF LEUKEMIA
Authors: Gilbert Enid F. , Rice E. Clarence
Published: December 2021

Three cases of acute lymphocytic leukemia with neurologic manifestations are presented in which the clinical signs, together with the findings in the spinal fluid, closely resembled those of acute bacterial meningitis.

Review of the literature reveals an infrequent occurrence of neurologic symptoms in leukemia. When present, they usually represent a terminal phenomenon.

The occurrence of a low content of sugar in the cerebrospinal fluid in association with meningeal infiltration of the brain in patients with leukemia has been reported. The relation of this phenomenon to the glycolytic activity of leukemic cells is discussed.
CONCENTRATION OF PYRUVIC ACID IN THE BLOOD OF THE NEWBORN INFANT
Authors: Gonzales Romulo F. , Gardner Lytt I.
Published: December 2021

THERE are several aspects of carbohydrate metabolism in the newborn infant which are peculiar to that age group. The normal, full-term newborn exhibits concentrations of glucose in the blood between 15 and 120 mg/100 ml.1 Concentration of glycogen in the liver may be as high as 10 gm/100 gm wet-weight immediately after birth and then there is a precipitous decrease.2 There is a relative resistance of the fetus and newborn to anoxia.3-4 This phenomenon has been attributed to the preponderance of anaerobic over aerobic metabolism in the tissues of the newborn.5 Further data seemed desirable concerning the concentrations of intermediates in the blood, other than glucose, in the carbohydrate metabolism of the newborn.

Accordingly a study was made of the normal concentration of pyruvic acid in the newborn for the first 5 days of life. Data on concentration of pyruvic acid in the blood have also been obtained in normal adults, pregnant and parturient women, and on venous and arterial blood from the umbilical cord.

PATIENT MATERIAL AND METHODS

The control or normal adult group was predominantly composed of white females and consisted of hospital employees and student nurses in the reproductive age period. Previous studies by others showed no significant difference between males and females6 or between whites and Negroes.7 The controls were divided into a group which supplied venous blood and another group which supplied capillary blood. Minimal squeezing proximal to the site of puncture was applied during all collections. The group of pregnant women consisted of both private and clinic patients, while the parturient group consisted of clinic patients only.
GRANULAR CELL MYOBLASTOMA IN CHILDHOOD
Authors: Bishop Harry C. , Wagner Bernard M.
Published: December 2021

The granular cell myoblastoma is a rare tumor of childhood with only 10 cases previously reported. The occurrence of the tumor in the vulva of a 6-year-old child is presented.

No authentic case of this tumor in its malignant form has been recorded in childhood. The granular cell myoblastoma should be considered in the differential diagnosis of soft tissue tumors in children and offers an excellent prognosis.
STUDIES OF THE PHARYNX
Authors: Bosma James F.
Published: December 2021

THE INCREASING relative and absolute incidence of bulbar poliomyelitis1-34 has provided a valuable opportunity for the study of neurologic impairment of the pharynx. The varied distribution of impairment within the musculature of the area of the pharynx is appropriate to the typical pathologic finding in this disease of discrete and focal necrosis irregularly distributed in nuclear areas.21 This variety of impairments has been utilized to evaluate the contribution of specific elements of the musculature in this area to its general motor performance. Over the period of the past 7 years, a succession of patients having poliomyelitic disability in the area of the pharynx has been observed clinically, with supplementary cinema studies of the visible pharynx and the external neck27 and fluoroscopic and rapid-sequential roentgenographic studies, in which visualization of the pharynx was facilitated by radiopaque media. A useful classification of poliomyelitic impairments of the pharynx has been derived, with recognition of the compensatory and alternative maneuvers which they invoke.

This report is particularly concerned with related impairments of swallow and of speech which results from deficient motor control of the oropharyngeal and the palatopharyngeal orifices. The observations are related to general anatomic, physiologic, and neurologic studies of the pharynx.35 Normal motor function of the lower pharynx and function impaired by poliomyelitis are considered in a succeeding report.36

PATIENT MATERIAL

The normal subjects include 9 children, 7 to 13 years of age, and 11 young male adults, in each of which subject an examination of the area of mouth, pharynx, and neck was performed to obviate anatomic and neurologic abnormality.
HEREDITARY AND ENVIRONMENTAL FACTORS IN THE PATHOGENESIS OF RHEUMATIC FEVER
Authors: Diamond Eugene F.
Published: December 2021

A study of cases of rheumatic fever admitted to La Rabida Sanitarium over a 5-year period was carried out to evaluate heredity and environment as etiologic factors in rheumatic disease. The incidence of rheumatic fever was shown to be higher in families where one or both parents were known to have a positive family history of rheumatic fever. The incidence of rheumatic fever was compared in environmental groups. A totally unfavorable environment was shown to increase the incidence of rheumatic fever. No single unfavorable environmental factor changed the incidence of rheumatic fever.

The incidence of rheumatic fever in each environmental group was higher when there was a positive family history for rheumatic fever, indicating an hereditary factor in the family incidence of rheumatic fever. Analysis of the various mating types in the families with a positive rheumatic trait was carried out. Agreement with a simple autosomal recessive gene inheritance was obtained in families where both parents had a definite family history, but no agreement was obtained in cases where only one parent gave a positive family history.
IMMUNOLOGIC AND BIOCHEMICAL STUDIES IN INFANTS AND CHILDREN WITH SPECIAL REFERENCE TO RHEUMATIC FEVER
Authors: WILSON MAY G.
Published: December 2021

CERTAIN individuals are more susceptible than others to many conditions. In recent years it has become clear that in rheumatic fever, susceptibility of the host is an important factor in the pathogenesis of the disease. It was concluded from genetic and epidemiologic studies that susceptibility to rheumatic fever is on a genetic and age basis. Although the susceptible child cannot be identified at the present time, the number of children expected to be susceptible in a group of families of known genotype may be determined on the basis of recessive inheritance. It may, therefore, be postulated that distributed among a group of families of known hereditary background are children who are susceptible and insusceptible to the acquisition of rheumatic fever.

As a direct result of long term observation of rheumatic families over a period of 30 years, a second generation of children of known hereditary background is available to us for exploratory studies. This group includes children from families in which one or both parents are rheumatic, or in which neither parent is rheumatic. In this group there are normal (insusceptible), susceptible and rheumatic children.

The nature of the hereditable factors which may be responsible for susceptibility is obscure. Recent advances in biochemical genetics have provocative implications in rheumatic fever. Of particular interest are the observations which demonstrate that such biochemical reactions as enzyme and protein specificities are gene determined.

As a working hypothesis it seemed reasonable to postulate that in a susceptible child, abnormal physiologic, chemical, immunologic or hormonal responses might be found.

Differences might then be observed in certain reactions between the normal group and a group containing a high proportion of genetically susceptible children.

This approach does not conflict with the concept that exogenous factors, irrespective of their nature, may also be operative. If the nature of the endogenous factors were known, the role of possible exogenous agents would be clarified.
THE RESPONSE OF YOUNG INFANTS TO INGESTION OF AMMONIUM CHLORIDE
Authors: GORDON HARRY H. , MCNAMARA HELEN , BENJAMIN HELEN R.
Published: December 2021

The results of observations of the effect of ingestion of ammonium chloride on the acid-base excretion of three premature and three full term infants are presented. Two of the three premature infants showed a definitely diminished ammonia and increased sodium excretion as compared with the full term infants. The results suggest that some premature infants may have a renal tubular disability.

One of the two infants with diminished ammonia formation and the third premature infant, the two smallest in the series, became listless, refused their feedings, and developed depressed fontanelles and diminished elasticity of the skin. This could not be correlated with changes in serum CO2 content or chlorides or with the presence or absence of an adequate urinary formation of ammonia and conservation of sodium. Since the infants who became dehydrated gained weight while doing so, shifts of water and electrolytes from extracellular to vascular or intracellular compartments must have occurred. It is suggested that the tendency of young infants to disturbances of acidbase balance may be conditioned by disabilities in intracellular metabolism as well as by renal dysfunction.

The implications of the limitations and variability in homeostasis for therapy are discussed.
Special ReportFROM THE COMMITTEE ON SCHOOL HEALTH AND THE COMMITTEE ON RHEUMATIC FEVER
Authors:   Committee on School Health,   Committee on Rheumatic Fever
Published: December 2021

This joint report of the Committees on School Health and Rheumatic Fever of the American Academy of Pediatrics has been prepared as a guide to school authorities in determining what can be done about this disease through the schools.

The school occupies a unique position in relation to rheumatic fever control. Rheumatic fever causes more deaths than any other disease in children of school age. A first attack usually occurs in children at the age when they are in the first or second grade and recurrences are most common up to the age when children are leaving high school. The insidious onset of so many cases during the school years suggests that teachers and others in daily contact with school children should be aware of early signs and symptoms which may mean acute rheumatic fever.

The periodic school health examination when done hastily without removal of clothing may miss children with rheumatic heart disease. On the other hand, children may be labeled with the diagnosis of a rheumatic heart because a heart murmur Was wrongly interpreted. This serves to emphasize the opportunities as well as the difficulties of discovering rheumatic fever and rheumatic heart disease in school children.

Improvement of School Medical Procedures

The American Academy of Pediatrics believes the problem of what to do about rheumatic fever through the schools is an integral part of what should be done about the health of all school children. The following recommendations, while pointed towards case-finding and health supervision of the rheumatic child, will, if applied, lead to better health service for all school children.

The periodic school medical examination should be improved:

1. By obtaining a health history of the child from the parent and the teacher, if possible, at the time of the child's examination.

2. By being performed without haste and with the child disrobed.

3. By the employment of physicians trained in pediatrics, if possible. Where this is not feasible, arrangements should be made for giving physicians who make school medical examinations additional clinical training in normal child growth and development as well as in children's medical problems including rheumatic fever and heart disease.

4. By allowing time for the physicians to plan with the nurse and parent for medical attention. The examination is then more likely to be of greater aid in getting medical care for school children who need it.
INTERNATIONAL NEWS AND REPORTS
Authors: FIELD C. ELAINE
Published: December 2021

The subject of the discussion on Thursday morning July 1 was "Neonatal Mortality and Morbidity." With the president Sir Leonard Parsons in the chair, Dr. Agnes R. MacGregor (Edinburgh) opened the proceedings by giving a pathological survey.

She stressed the importance of cooperation between clinician and pathologist to improve certification of death and thus the accuracy of statistics. Unfortunately most records are from maternity hospitals which are not entirely representative of the whole community. Intracranial hacmorrhage and infection caused the highest number of deaths in the neonatal period, but there had been a considerable rise of developmental defects as a cause in premature infants. Dr. MacGregor considered that an infant can survive a mild intracranial haemorrhage at birth but that haemorrhage is not necessarily present in all babies showing cerebral irritation, which may be caused by oedema of the brain. She concluded that infection was the overwhelming cause in her series of deaths after the seventh day of life.
INFECTIOUS CROUP: III. HEMOPHILUS INFLUENZAE TYPE B CROUP
Authors: RABE EDWARD F.
Published: December 2021

Croup due to H. influenzae type B occurred in 8% of a group of 347 cases of infectious croup. Bacteriologically and pathologically the disease was distinct from diphtheritic and so-called "virus" croup.

Clinically this form of croup is characterized by the extreme rapidity of onset and the severity of symptoms. The outstanding clinical signs and symptoms encountered were: severe sore throat, epiglottitis with supraglottic edema, extreme early prostration, marked leukocytosis with a high polynudear percentage, tender anterior cervical adenitis, and necessity for very early tracheotomy in selected cases.

Treatment consists of two important parts: relief of respiratory obstruction and treatment of the accompanying bacteremia and toxemia. The former calls for early tracheotomy to avoid the frequent adverse results of thoracic extra-alveolar air; intubation is contraindicated. Treatment of the second problem calls for transfusions of whole blood plus early administration of type-specific rabbit antiserum and sulfadiazine and streptomycin in high dosage.

Death from H. influenzae type B croup is attributed to bacteremia and toxemia, aided by progressive respiratory tract obstruction.
SEPSIS IN NORMAL AND PREMATURE INFANTS WITH LOCALIZATION IN THE HIP JOINT
Authors: Howard Philip J.
Published: December 2021

The case reports of five patients with sepsis, localizing in the hip joint, are presented. The age of onset was before 30 days of age. The weights at birth were in the premature range in three, normal in two; the first clinical sign was swelling of the region of the hip and thigh. The organisms were coagulase positive staphylococci in three cases, unknown in two cases.

The differential diagnosis included cellulitis, trauma to the hip, and septic arthritis with abscess formation. Poliomyelitis, cancer, toxic synovitis and osteomyelitis of the femur were considered.

Roentgenograms have been selected to show the slightness of the changes at onset, and the changes at 1, 5, and 12 years of age.

Treatment should include general supportive measures, including administration of blood and nutritive elements, antibiotics and early drainage of the joint to prevent permanent damage of the head of the femur. This condition must be suspected in every instance of regional swelling of the hip in the newborn infant. Such swelling is an urgent indication for diagnostic aspiration of the joint.
Using Helping Mothers Survive to Improve Intrapartum Care
Authors: Evans Cherrie L. , Kamunya Rosemary , Tibaijuka Gaudiosa
Published: December 2021

Data from the past decade have revealed that neonatal mortality represents a growing burden of the under-5 mortality rate. To further reduce these deaths, the focus must expand to include building capacity of the workforce to provide high-quality obstetric and intrapartum care. Obstetric complications, such as hypertensive disorders and obstructed labor, are significant contributors to neonatal morbidity and mortality. A well-prepared workforce with the necessary knowledge, skills, attitudes, and motivation is required to rapidly detect and manage these complications to save both maternal and newborn lives. Traditional off-site, didactic, and lengthy training approaches have not always yielded the desired results. Helping Mothers Survive training was modeled after Helping Babies Breathe and incorporates further evidence-based methodology to deliver training on-site to the entire team of providers, who continue to practice after training with their peers. Research has revealed that significant gains in health outcomes can be reached by using this approach. In the coronavirus disease 2019 era, we must look to translate the best practices of these training programs into a flexible and sustainable model that can be delivered remotely to maintain quality services to women and their newborns.
CHEMICAL ANALYSES OF BLOOD FROM THE UMBILICAL CORD OF THE NEWBORN: RELATION TO FETAL MATURITY AND PERINATAL DISTRESS
Authors: MacKinney Loren G. , Goldberg Irving D. , Ehrlich Frances E. , Freymann Katherine C.
Published: December 2021

The oxygen saturation of the blood in the umbilical vein is significantly higher when the initial gasp occurs prior to clamping. Presumably an increment of oxygen is added by this respiration so that the oxygen saturation at the moment of sampling no longer represents the oxygenation status of the fetus by means of the placenta. In the evaluation of any data on oxygen saturation in the blood of the umbilical cord, serious consideration must be given to this time relationship.

In general where the clinical status of babies is poor at birth, the oxygen saturation is significantly lower than in babies without distress, when sampled before respiration. More specifically, there seems to be a direct relationship between lower oxygen saturation and clinical evidence of difficulty in initiating respiration.

Premature infants sampled before initiation of respiration have lower values for oxygen saturation than mature or postmature infants. This difference is not explained solely by the less favorable neonatal clinical status of some premature infants.

The oxygen saturation of postmature infants sampled before respiration is not lower than that of mature infants.

The oxygen saturation of infants delivered by cesarean section is lower than those delivered by other means.
DEFECTIVE STEROIDAL BIOGENESIS IN CONGENITAL ADRENAL HYPERPLASIA
Authors: Bongiovanni Alfred M. , Eberlein Walter R.
Published: December 2021

Dr. Alfred M. Bongiovanni is a young man who started research work as an investigator at the Marine Biological Laboratory, Woods Hole, Massachusetts, even before he received his B.S. degree from Villanova College in 1940. While at Villanova, Dr. Bongiovanni received the Kolmer Medal for Excellence in Science. In 1943 he received his M.D. from the University of Pennsylvania, following which he immediately served a 2-year tour of duty in the United States Navy.

After discharge from the Navy, he filled residencies at the Children's Hospital of Philadelphia from 1947 to 1949. During the years 1949 and 1950, Dr. Bongiovanni served as Assistant Physician at the Rockefeller Institute in New York and in 1950-51 returned to the Children's Hospital of Philadelphia as Assistant Director of Clinics. In 1951 he was appointed the National Foundation of Infantile Paralysis Fellow to the Research Division of the Children's Hospital of Philadelphia. New opportunities and promotions quickly followed with an appointment as Assistant Professor of Pediatrics at Johns Hopkins in 1952; Senior Research Associate in the Pediatric Endocrine Division and Assistant Professor of Pediatrics at the University of Pennsylvania in 1954; and in 1955 Associate Professor of Pediatrics at the same university.

Dr. Bongiovanni is a Diplomate of the American Board of Pediatrics and a member of the Editorial Board of the American Journal of Medical Sciences and of numerous professional societies. In 1956 Dr. Bongiovanni received the Ciba Award.

Dr. Bongiovanni has been author of about 50 articles, the great majority of which are on endocrinology and at least 23 of them with Dr. Eberlein, who is the co-recipient with Dr. Bongiovanni of this Award, as a co-author.
STUDIES OF TOCOPHEROL DEFICIENCY IN INFANTS AND CHILDREN
Authors: Gordon Harry H. , Nitowsky Harold M. , Tildon J. T. , Levin Stanley
Published: December 2021

VITAMIN E was recognized some 35 years ago as a fat-soluble substance necessary for reproduction in the rat. Its potency is measured by assay for fertility and its synonym, tocopherol, comes from Greek words which mean "to bear offspring." Review of the original studies of Mason and his co-workers and of his interpretive writings provides a good stimulus for pediatric interest in the subject. It is proposed to review some literature on the pathologic lesions produced in animals and on the tocopherol content of foods, and then summarize data collected at the Colorado General, Sinai and Johns Hopkins Hospitals on tocopherol deficiency in infants and children. Most of the latter data and detailed references to the literature have been published elsewhere.

PATHOLOGIC FINDINGS IN EXPERIMENTAL ANIMALS

Although vitamin E has been dubbed the anti-sterility vitamin, its absence from the diet has produced a variety of pathologic states, differing from one species to another, and at different ages in the same species. Some of the conditions found are: Fetal resorption; testicular degeneration; encephalomalacia; "exudative diathesis"; generalized edema; brownish discoloration of smooth muscle, adipose tissue and liver; acute hemorrhagic necrosis of the liver; degeneration of renal tubules; focal necrosis of cardiac muscle; and nutritional muscular dystrophy.

Provocative findings in E-deficient animals that call to mind clinical problems in premature infants are: Hemorrhagic manifestations in rat fetuses and chick embryos; hemorrhages in the lungs, visceral and cranial cavities in puppies; subcutaneous, pulmonary and cerebral edema in young chickens, anemia in monkeys; and hemolysis after administration of large doses of vitamin K to rats.
HYPERSENSITIVITY REACTIONS ASSOCIATED WITH SODIUM PARA-AMINOSALICYLATE THERAPY
Authors: Matsaniotis N. , Jacobs J. , Smith M. H. D.
Published: December 2021

Among 100 tuberculous children treated on a regimen including PAS, 3 developed a hypersensitivity reaction attributable to this drug. These three cases and a fourth from our files are presented, and the literature concerning such reactions in adults is reviewed.

Agranubocytosis was the prominent feature in one patient and jaundice in another. The various symptoms and sequential pattern of events that characterize the hypersensitivity reaction to PAS are described. Desensitization to the drug, which is a safe and nearly always successful procedure, was achieved in three patients. There is no specific treatment and the best insurance against irreversible or even fatal effects is the prompt discontinuation of the drug.
PETS IN THE HOME: INCIDENCE AND SIGNIFICANCE
Authors: Carithers Hugh A.
Published: December 2021

The incidence of pets in the home is discussed, and their significance as a health hazard to children is evaluated. A series is reported in which 300 parents of 617 children receiving routine office pediatric care were questioned regarding pets in the home. The results of this survey emphasize the importance of more research to clarify the relationship between animal and human disease.
LYMPHANGIOMA OF THE GENITALIA IN CHILDREN
Authors: Gueukdjian S. A.
Published: December 2021

Lymphangioma is an uncommon benign neoplasm of the lymphatic system. It is suggested that if surgical and pediatric interest were directed to it, the condition would be diagnosed more often. Localization of these tumors in the region of the groin and external genitalia is unusual and presents diagnostic problems. The majority of cases occur in childhood. A case in a 3-year-old boy is reported. Treatment is by excision but recurrences are to be feared.
STUDIES IN SICKLE CELL DISEASE
Authors: Shields George S. , Lichtman Herbert C. , Messite Jacqueline , Watson R. Janet
Published: December 2021

In newborn infants with sickle cell trait, the percentage of erythrocytes capable of being sickled in vitro gradually rose during the first 4 months of life. A concomitant fall in the percentage of Hgb F was demonstrated. The percentage of cells which could be induced to assume the sickled shape was found not to be correlated with the percentage of Hgb S, but instead was correlated with the reciprocal of the concentration of Hgb F.

The specific reaction rate of alkali resistant hemoglobin in the infants less than 3 months of age was found to differ from that found in adults and in infants more than 3 months of age.