bluuebunny/crossref_metadata_2025 huggingface dataset:
SPECIAL REVIEWS
Authors: DODD KATHARINE
Published: December 2021

THE subject of hypocalcemic states is one on which a great deal of work has been done but one in which there is as yet much disagreement concerning some points and a recognized lack of knowledge of others. In general it may be stated that hypocalcemic states are manifested clinically by signs and symptoms of tetany. The symptom complex of tetany is now less common than in former times when rachitic tetany was the most frequent cause of convulsions in infancy. It was well described in the older literature. The manifestations consist of central and peripheral nervous system symptoms, irritability often alternating with lethargy, nystagmus and strabismus, contractions and pain in the muscles of the face with "half moon eyes," "carp mouth," trismus and convulsions Edema, most marked in the hands, feet and around the eyes is often observed. Confirmatory signs of tetany may be elicited by special methods of examination. Chvostek's sign, jerking of the facial muscles when the facial nerve is tapped, is a sign of tetany in children from one month to two years of age. It is unreliable in newborn infants, in older children and adults since in them it may be present normally. When the facial muscles are in spasm with manifest tetany it can seldom be elicited. The peroneal sign consists of dorsiflexion and abduction of the foot on tapping the peroneal nerve on the lateral surface of the fibula just before the knee. Trousseau's sign is carpopedal spasm induced by pressure applied for some time over the upper arm or leg. Erb's sign, or increased electrical excitability of the peripheral nerves to the galvanic current, was the most reliable proof of tetany in the days before blood chemical analyses were available. The procurement of electrical reactions is such a time consuming procedure that they are seldom sought for now.
Skin Manifestations of Internal Disorders (Dermadromes)
Authors: DI SANT' AGNESE P. A.
Published: December 2021

This book represents the most recent attempt to provide a systematic description of the skin manifestations of internal disorders. The author has coined and used throughout the volume the term "dermadrome" to designate the dermal component of a syndrome. Thus for instance the characteristic exanthem is the "dermadrome" of scarlet fever, erythema multiforme and skin nodules the "dermadromes" of rheumatic fever.

The dermatologic symptoms are detailed under the heading of the various diseases. This facilitates reference within the text for those not conversant with all the intricacies of dermatologic classification.

Author and publisher have done a commendable job in presenting the material in clear and readable form.
Re: Multiple Cystic Tuberculosis of the Bones, McLemore Birdsong, M.D., and Camillus S. L'Engle, Jr. Pediatrics 1:767, 1948
Authors: SMYTH FRANCIS SCOTT
Published: December 2021

The report by Birdsong and L'Engle in the June issue of Pediatrics, leaves me unconvinced. It is difficult to explain the finding of tubercule bacilli by the authors. One would like verification by guinea pig inoculation. This would seem a desirable check, since, peculiar for tuberculosis that was not as yet terminal or overwhelming (tuberculous meningitis), the tuberculin skin test was negative.

The reproductions of the X-ray films of skull and pelvis are strikingly similar to those of the Hand-Schüller-Christian, Letterer-Siwe disease. I do not believe the absence of foam cells in the biopsy rules out xanthomatosis.
THE DISTRIBUTION OF GROUP B COXSACKIE VIRUSES IN A CHILDREN'S INSTITUTION
Authors: Rivadeneira Juan C. , Robbins Frederick C. , Crea Maria , Eiben Robert M.
Published: December 2021

Two cases of clinical poliomyelitis occurred within a week among 400 children in an orphanage. The first case was paralytic and was due to type 1 poliomyelitis virus. The second case was nonparalytic and only Coxsackie B virus, type 4, was isolated from his feces. This is thought to have been the causative agent of his disease.

At the time the two cases occurred, the stools of 153 well children, including the intimate associates of the patients, and 43 of the 55 adults in the orphanage, were tested in tissue culture for virus. Twenty-four agents, cytopathogenic for monkey kidney cells, were isolated from the children and none from the adults. The viruses isolated proved to be Coxsackie B2 and B4, except for two that were antigenically related to ECHO virus, type 14.

Antibody studies indicated that during the succeeding 2 months 24% of 50 children, not demonstrated to have been excreting virus at the time of sampling, developed neutralizing antibodies against Coxsackie B4 virus and 6% against B2. It was estimated that approximately 130 children were infected with Coxsackie B4 with only 1 clinical case of aseptic meningitis.

Serologic evidence indicated that approximately one third of the children had been infected with the virus related to type 14 ECHO virus, but that only one child developed a new infection during the 2 months of the study.

As no evidence could be found of inapparent poliomyelitis infection in the orphanage, it would seem likely that the isolated case of poliomyelitis became infected during a previous hospital admission, 11 days before he developed symptoms of poliomyclitis. During 2 days of contact he did not appear to have disseminated the virus to his associates in the orphanage.

These data would suggest that types 2 and 4 Coxsackie B viruses probably do not cause pleurodynia because no cases with the symptoms of this disease occurred in spite of the high rate of infection with these agents.
OBESITY
Authors: Gordon Harry H. , Hill Lee Forrest
Published: December 2021

OBESITY may be encountered at any age in pediatric practice. In infancy it seldom causes concern either to parents or the physician. Parents, in fact, are inclined to view with approval and no little pride the overweight infant who eagerly consumes barge quantities of food. Such accomplishments are looked upon as indications of health at its best.

The physician's lack of concern stems from his knowledge that the obesity of the first year of life is almost certainly transitory and will diminish with the increased activity and lessened appetite which can confidently be expected during the second and preschool years. Stuart feels that the chief significance of obesity in the young infant with an excessive appetite appears to be the indication that the infant readily responds to a positive caloric balance by storing fat. "This," he states, "may be a portent of obesity to follow in adolescent or adult life, if the habit of overeating is developed and maintained." It would seem, therefore, that an indication clearly exists for the institution of parental education in the basic principle of good nutrition even at this early age.

Obesity in the preschool years is relatively uncommon. Thinness rather than obesity is the characteristic of this age period. During the early school years susceptible children, rather insidiously at first, begin to show the trend for excessive fat deposition. Its peak incidence occurs roughly between the years of 8 and 14. Many of these children will, during the next few years, gradually lose their obesity and emerge as young adults with quite acceptable figures (Fig. 1). Whether this comes about as a voluntary reduction in caloric intake or is the result of a readjustment in physiology of the body is not quite clear.
EXPERIMENTAL STUDIES ON THE PATHOGENESIS OF KERNICTERUS
Authors: Ernster Lars , Herlin Lennart , Zetterström Rolf
Published: December 2021

The effect of bilirubin on cellular energy metabolism has been studied in vitro. Bilirubin inhibits oxidative phosphorylation in isolated rat-liver and brain mitochondria, with a depression of the underlying respiration as a concomitant phenomenon. The latter effect can be prevented by the addition to the mitochondrial suspensions of diphosphopyridine nucleotide and cytochrome C.

In experiments with rabbits in vivo it has been shown that the penetration of bilirubin from blood into central nervous system is greatly enhanced by intracisternal treatment with p-chloromercuribenzoate, an agent which inhibits the function of the blood-brain barrier system. The increase of the concentration of bilirubin in the cerebrospinal fluid upon treatment with p-chloromercuribenzoate is parallelled by an equal increase of the total protein content.

The bearing of these findings on the pathogenesis of kernicterus, and some of the clinical implications are discussed.
SYMPOSIUM ON TUBERCULOSIS
Authors: Lincoln Edith M. , Sifontes Jose E.
Published: December 2021

A BRIEF review of present concepts of the fate of the primary complex may serve as a useful introduction to the problem of treating the infant or child with asymptomatic primary tuberculosis.

The primary lesion persists for months and gradually disappears, usually leaving calcification in the site of the primary focus and the corresponding lymph nodes. In most instances recovery is uneventful despite the almost universal occurrence of a hematogenous or lympho-hematogenous spread of tubercle bacilli, but this accounts for most of the severe complications of primary tuberculosis such as tuberculous meningitis and skeletal tuberculosis. The spread may be of various types and degrees but is usually an occult hematogenous dissemination from the primary lesion, which may take place during the incubation period or during the first few months after the appearance of the primary complex. Hematogenous spread also may be massive, resulting in miliary tuberculosis. Tubercle bacilli in the tracheo-bronchial lymph nodes may spread to other lymph nodes or other areas of the body through lympho-hematogenous dissemination. Common sites of invasion are the cervical lymph nodes and tonsils. The primary lesion may progress locally by excavation and by bronchogenic dissemination; it is then often called locally progressive primary tuberculosis.

The majority of the complications appear within the first year of infection in an infant or a child who has previously been asymptomatic.

In children, reinfection or chronic, adult type of tuberculosis is most common in adolescence. It may be of exogenous or endogenous origin. The endogenous type might be considered a distant complication of primary tuberculosis, since it is believed to occur as a result of activation of a dormant focus.
HEARING AND SPEECH DEFECTS
Authors: Bloomer Harlan , Herman George
Published: December 2021

The presentation stressed the importance of speech and language in the child's social and personality development; the far-reaching effects of speech and language disorders; the latitude of factors contributing to the various types of such disorders in children; and the therapeutic approach to the child with defective speech.

Speech consists of sounds produced by the upper respiratory and alimentary tracts and is described in terms of its phonologic elements (vowels and consonants); vocal pitch, volume and quality; melody and stress pattern; temporal factors of rate, rhythm, duration and phrasing; and expressive gestures. Spoken language is the symbolic use of these sounds.

Functions of speech and language are threefold: Emotional expression, self-communication and interpersonal communication. The last, in turn, serves the purposes of social interchange, interchange of information and social control.

Disorders of speech and language result in impairment of sociability, communication and effective social control. A child thus handicapped is likely to become socially retarded and psychologically maladjusted. Of high school children in the United States, roughly 5% suffer from some speech defect and over 2,000,000 of them would benefit from special help.

Symptomatically, speech and language disorders may be classified into five groups: (1) "articulatory disorders," characterized by substitutions, omissions and distortions of sounds; (2) "cluttering," defined as rapid, dysrhythmic slurring and clustering of sounds; (3) "stuttering," the repetition, prolongation or blocking of sounds and words, often associated with overflow facial grimacing and spasmodic movements of trunk and extremities and, usually, psychologic reactions to stuttering; (4) "voice disorders," ranging from complete absence to abnormalities in quality, pitch, intensity and melody; and (5) "language disorders," subdivided into (a) "delayed speech" (after age 3 years) and (b) "aphasia," resulting from lesions in the central nervous system. An additional group of speech disorders has as etiology some physical abnormalities: (1) "cleft palate speech," with disturbed voice quality and articulation; (2) "cerebral palsy speech," with disturbances in articulation, voice, rhythm and sometimes also delay in language development; and (3) "hearing impairment," which results in improper development of articulation, voice and language.
TOLERANCE OF INFANTS AND CHILDREN TO FAT ADMINISTERED INTRAVENOUSLY
Authors: Williams Margaret L. , Kaye Robert
Published: December 2021

One hundred forty-six intravenous infusions of fat emulsions were given to 78 infants and children. In 15 subjects receiving 3 to 6 infusions on successive days, no significant changes occurred in concentration of nonprotein nitrogen, bilirubin or alkaline phosphatase in the serum; the cephahin flocculation test, concentration of urobilinogen in the urine and routine urinalysis were not abnormal. Three instances of increased values in the zinc turbidity test were noted. Four infants developed mild anemia.

During infusions administered at an average rate of 5 ml/kg/hr for periods of 4 to 6 hours, concentrations of ketones in the blood increased an average of 7.1 mg/100 ml (1.2 mM/l) in non-fasted subjects and 13.2 mg/100 ml (2.3 mM/l) in fasted subjects. This is interpreted as suggestive evidence of utilization of fat during the infusion.

Temperature elevations of more than 1.1°C (2°F) occurred during or after the infusion in 23.9% of infusions with a marked increase in frequency at infusion rates greater than 5 ml/kg/hr. Vomiting occurred in 12.3%. Other unfavorable reactions were uncommon.
VENTRICULAR SEPTAL DEFECT IN INFANCY AND CHILDHOOD
Authors: Agustsson Magnus H. , DuShane James W. , Swan H. J. C.
Published: December 2021

Data on hemodynamic findings in 19 infants and children with ventricular septal defect are presented. The ages of these patients ranged from 3 months to 14 years. Significant elevation of pulmonary arterial pressure was found in 17 of the 19 patients studied. Left-to-right shunts, at times of large magnitude, were found in all these patients. However, right-to-left shunts accounting for up to 50 per cent of systemic flow were also obtained, even in young patients. A history suggestive of cardiac failure was obtained in seven patients. Cyanosis was constant in one patient and was found intermittently in three others. A systolic murmur was heard in most cases in the third or fourth intercostal space. In four additional patients a diastolic murmur was also identified. The electrocardiogram provided valuable information, which correlated with the relationship of pulmonary and systemic arterial resistances, the status of intracardiac shunting of blood, and the total pulmonary blood flow. These factors are considered to be of paramount importance in selection of patients for the operative closure of ventricular septal defect. It has been demonstrated that the hemodynamic status of the patient may be difficult to assess at the time of cardiac catheterization because of the unpredictable effect of anesthesia on ventilation. The use of dye-dilution curves in the diagnosis and evaluation of both right-to-left and left-to-right shunts is a vital factor in the adequate assessment of the patients from the hemodynamic standpoint.
Fluoride and Dental Caries
Authors: TRIEGER NORMAN
Published: December 2021

The benefits to the teeth derived from controlled supplements of fluoride to the communal water supply have been well documented. However, it has been estimated by the National Research Council (The Problem of Providing Optimum Fluoride Intake for Prevention of Dental Caries. A Report of the Committee on Dental Health, Division of Biology and Agriculture, National Research Council, Publication 294, November, 1953) that even if all municipal water supplies were fluoridated, close to half the population would still be without this benefit.
CLINICAL CONFERENCE
Authors: Eichenwald Heinz F.
Published: December 2021

Dr. Moore (Resident): E.P., a male born of Greek parentage, was 6 weeks of age at the time of his first admission to the New York Hospital. He had been well until 8 days prior to admission when he began to sneeze frequently, and his eyes began to water and his cry became hoarse. On the following day the family physician made a diagnosis of croup and prescribed tetracycline, 50 mg every 6 hours, nose drops, cough syrup and syrup of ipecac. Six days before admission an intermittent cough was noted. The patient's condition remained essentially unchanged until 2 days prior to admission when he became febrile, anorectic and developed a paroxysmal type of cough which occasionally terminated in vomiting. At this time penicillin, intramuscularly, was added to the regimen. He was admitted to the New York Hospital with the diagnosis of pneumonia.

The past history, family history and review of systems were noncontributory.

Physical examination revealed a well-nourished, white male with no evidence of respiratory distress. Rectal temperature was 39.3°C, apical pulse rate was 150/min, respirations were 30/min. There was no retraction on cyanosis. Examination of the ears was normal. There was a grayish-white, plaque-like, exudative lesion over the left lateral aspect of the soft palate. The pharynx was injected. Shotty lymphadenopathy was present in the cervical chains bilaterally. There was a sinus tachycardia with no cardiac murmurs audible. The lungs were clear to percussion and auscultation. The liver was palpable 1 to 2 cm below the costal margin. The spleen and kidneys were not palpable. The remainder of the examination was not remarkable.
DENTISTRY IN CHILDREN
Authors: Losch Paul K. , Boyers Charles L.
Published: December 2021

IT SEEMS only proper to begin this discussion with a few words about dental decay. Certainly in view of the prevalence of this disease, it deserves recognition as one of the great health problems.

The study of dental caries as a disease process has received a striking amount of attention in the past few years, yet we are forced to go back to an early theory of the etiology of this disease in order to discuss it intelligently.

Many years ago a theory was proposed in which it was stated that bacteria, with their enzyme systems working on a substrate of fermentable carbohydrate found primarily in plaques upon the smooth surfaces of teeth, lead to the decalcification of the mineral portion of the tooth. The theory also stated that the organic material is then destroyed by proteolysis. Much of the work which has been done in the field of caries since the time of this proposal has borne out the soundness of the original theory. But certainly we cannot regard dental caries as such a simple and straightforward disease. As a matter of fact, we know that dental caries is an extremely complex disease and each new area of research merely emphasizes this point. For instance, we know that dental caries cannot arise without bacteria being present. This has been demonstrated in the experiments with animals raised in a germ-free environment in which it has been shown conclusively that no caries occurs. To further elucidate the picture, we also know from the experiments of Shaw and Kite that animals fed by stomach tube will not develop dental decay.
COMPLICATIONS OF HYPERBILIRUBINEMIA IN THE NEWBOR—POSSIBLE RELATION TO THE METABOLISM OF AMMONIA
Authors: Gorten Martin K. , Shear Sheila , Hodsdon Marilee , Bessman Samuel P.
Published: December 2021

Concentrations of ammonia in blood from the umbilical vein have been determined during the course of 20 exchange transfusions on 16 infants. One of these infants subsequently died of kernicterus and another died with liver damage and intracranial hemorrhage. Only these two infants had concentrations of ammonia in blood from the umbilical vein greater than 2 µg/ml during exchange transfusion when half of the blood had been administered. The only other infants with significantly elevated concentrations of ammonia in blood from the umbilical vein had siblings who had died of kernicterus.

A steady but gradual rise in the content of ammonia in stored blood has been shown to occur during storage. There is no relation between the content of ammonia in stored blood and the concentration of ammonia in the blood of the patient during exchange transfusion.

It is postulated that the ammonemia of the patient with impairment of liver function due to hyperbilirubinemia causes a failure of energy metabolism of nerve cells, resulting in an increased permeability of the cells to bilirubin. Once the cells are stained, the lesion is irreversible.
CONCERNING THE CHOICE OF THERAPY FOR CHILDHOOD HYPERTHYROIDISM
Authors: Arnold Mary B. , Talbot Nathan B. , Cope Oliver
Published: December 2021

Representative experiences with surgical and medical (i.e., propylthiouracil) methods of managing juvenile thyrotoxicosis have been summarized and compared. The findings indicate that these methods are equally capable of eliminating the overt clinical manifestations of Graves' disease and that they yield approximately equal numbers of "cured" patients at the end of a 2-year period. Provided due care is taken, the risk of serious complications due to these forms of treatment also can be kept very low.

While the surgical and medical regimens may be similar in the foregoing respects, they appear to differ considerably in terms of their impact on the life of the patient and his family. One involves a brief period of detailed medical supervision culminating in hospitalization for surgery with its very slight, but definite mortality risk. Thereafter apart from possible need to take a dose of thyroid daily, the patient may be considered essentially normal. By contrast, the other requires that the patient remember to take a dose of medication approximately every 8 hours for a minimum of 2 years. One of these doses may of necessity have to be taken in the middle of the night at an hour when children are normally allowed to sleep undisturbed. Medical therapy also requires that the patient remain accessible to his physician for regulation of dosage and for prompt recognition of drug toxicity, which should be suspected every time the child has a sore throat or fever. It is concluded that these requirements of medical management may in themselves constitute a significant handicap to the child and his parents. It follows that they are deserving of consideration in choosing between subtotal thyroidectomy and prolonged chemotherapy as treatment for children with Graves' disease.
ACCIDENTAL INGESTION OF ESTROGENS BY CHILDREN
Authors: Hertz Roy
Published: December 2021

History: The first family consisted of a boy, 5 years of age (Case 1) and a girl, 7 years of age (Case 2). The mother had noted distinct enlargement and nodularity of the breasts in both children and had consulted a pediatrician. The changes in the breasts became apparent in both children at about the same time. The pediatrician had rather complete records of the physical development of the children since the early postnatal period and had never previously noted any abnormality in them.

Physical Findings: When the children were first seen by the author there was unquestioned enlargement of the breasts in both the boy (Fig. 1) and the girl (Fig. 2). In the girl each breast (Fig. 3) contained a nodule, 1 cm in diameter, which was firm and slippery and free from the overlying skin. There was distinct stimulation of the areolae but the mammary glands were not especially prominent to direct inspection. No secretion could be expressed from either breast. There was a fine fuzz of pubic hair but no axillary hair. The labia showed distinct enlargement and the vaginal mucosa was unduly moist and vascular. Rectal examination revealed no uterine enlargement. There was a fine but unquestioned increase in the hair on the upper lip and the mother felt this was of recent origin. The skin was clear of acneiform or other type of eruption and the remainder of the physical findings were not remarkable.

The breasts of the boy (Fig. 4) also presented a distinct nodular enlargement.This was more readily palpable than visible. In addition he had been noted to have a recent enlargement and increased turgidity of the penis (Fig. 1).
Children Without Tears
Authors: RILEY CONRAD M.
Published: December 2021

I read with interest Dr. Pryles' letter in Pediatrics (20:920, 1957) in which he commented on the not infrequent phenomenon of crying without tears among retarded children. He also stated that such children displayed other phenomena of dysautonomia.

During the years in which I have been interested in dysautonomia I have had occasion to see a moderate number of individuals who fail to produce tears when crying but who could not be considered to have dysautonomia. These have ranged all the way from an otherwise normal Irish boy, who also had corneal anesthesia, to retarded epileptics.
CORRECTED TRANSPOSITION OF THE GREAT VESSELS ASSOCIATED WITH INTRACARDIAC DEFECTS
Authors: Fink Burton W. , Adams Forrest H. , McFall Russell A. , O'Loughlin Bernard J.
Published: December 2021

Four patients are presented to show how associated defects, such as ordinary transposition and interventricular septal defect, may confuse the diagnosis of corrected transposition of the great vessels. Three patients had interventricular defects, one of whom also had a patent ductus arteriosus associated with the primary defect.

The diagnoses were confirmed by surgery in two patients, and necropsy examination in one of these. Cardiac catheterization and angiocardiography should be performed prior to surgical repair in patients suspected of having an interventricular septal defect.
CLINICAL CONFERENCE
Authors: Davidson Murray
Published: December 2021

Dr. Levine: The patient to be presented is an infant who had chronic diarrhea. Studies performed on this patient by Dr. Murray Davidson, Assistant Professor of Clinical Pediatrics, suggest that there are multiple factors involved in the production of the celiac syndrome. Dr. Davidson will discuss the patient's illness and observations made.

Dr. Murray Davidson: To many pediatricians the diagnosis of celiac syndrome means difficulty in absorption of nutrients. According to this concept the diagnosis cannot be made unless there is evidence of excessive stool loss of ingested material. An important contribution to our understanding of the condition has been made by the Dutch and British workers who have demonstrated steatorrhea related to the ingestion of gluten in patients with the celiac syndrome.

On the other hand, to some, celiac syndrome merely implies a state of chronic diarrhea. Thus, some cases of diarrhea related to milk ingestion have been called celiac syndrome because of chronicity of symptoms. To the best of our knowledge there are no published reports of such patients in whom detailed study has revealed evidence of malabsorption or a relationship to a specific protein in milk as has been shown in the studies with gluten.

In this paper it is our intention first to report a patient who fulfilled the criteria for celiac syndrome upon ingestion of a specific milk protein, and then to examine the current classification of the conditions which make up the celiac syndrome.

D.B., a 5-week-old infant, was admitted to the New York Hospital with a history of severe and chronic diarrhea from birth, manifested while receiving evaporated and skim milk formulae as well as Nutramigen®.

Stool cultures failed to reveal any pathogens. Study of the urinary tract, gastrointestinal tract and adrenal function revealed no cause for diarrhea.
STATEMENT FROM THE EXECUTIVE BOARD
Authors:   THE EXECUTIVE BOARD
Published: December 2021

THE FOLLOWING is an excerpt from the Abstracts of the Executive Board Meeting of October 2 to 5, 1957, presented at the Business Meeting of the Academy during the Annual Meeting on October 9, 1957. It is published here at the request of the Executive Board.

The following statement was adopted by the Board to be given to the members at the Annual Meeting by the President, transmitted to advertisers in Pediatrics by the Business Manager of Pediatrics and appear in the official publication of the Academy, Pediatrics:

The American Academy of Pediatrics recognized the Physicians' Council for Information on Child Health as an independent organization engaged in a program seeking to improve the health of children. The American Academy of Pediatrics has no connection with the Physicians' Council for Information on Child Health. The two organizations are not related in any way. The American Academy of Pediatrics has no control over the Physicians' Council, its directors, executive committee, officers or members. The Academy has no special knowledge of the program, policy or actions of the Physicians' Council, other than is disclosed by the publications of the Physicians' Council. The policy of the American Academy of Pediatrics is to co-operate with any organization interested in the improvement of child health and welfare.
SYMPOSIUM ON CONGENITAL METABOLIC DISEASE
Authors: Lowe Charles U. , Childs Barton
Published: December 2021

MOST of the conditions to be considered in this symposium share one feature: their genetic origin. It could be profitable then to outline some of the principles of gene action and of the characteristics of genetic disease which will apply equally to all of the disorders to be reviewed.

To begin, a definition of gene action is offered. This must be an empirical one since it is not known, with any precision, what a gene is. However, it is known that the genetic material provides the most basic mechanism for homeostasis, ensuring that offspring will exhibit the characteristics of the parent, whether the offspring be daughter cells or human beings. This is accomplished by means of control over the formation and design of the vital molecules of the organism; those molecules which in their turn control its intricate and interrealted metabolic functions. It is for the most part these metabolic functions which we attempt to measure in the elucidation of gene action in disease, and it will be seen in the ensuing discussions that only rarely is one able to make any direct assessment of the physicochemical properties of these molecules which bear a specific relationship to the gene.

Much more commonly, a measurement is made of some form of activity of such substances, and a stepwise elucidation may be accomplished of the secondary effects which are consequent upon alterations in reaction rates or reaction failure. It is, in general, these secondary, tertiary, or consequential effects which are most easily measured, and which are the overt expressions of the disease. The principle illustrated here is, what a gene is said to do, depends upon which function we measure.
Letters to the Editor
Authors: EBERLING E. W.
Published: December 2021

The following comments in regard to the letter from Dr. Heinz Wittig are respectfully submitted.

First, we have seriously considered acute virus pneumonia in our patient, as well as interstitial pneumonia with giant cell reaction due to virus, and acute disseminated inclusion disease of the newborn. No evidence for the presence of any of these pathogens could be found during life or at autopsy. We made careful examinations for the presence of intranuclear or intracytoplasmic inclusion bodies throughout various tissues throughout the body, but were unable to identify any such evidence of virus infection.
Fluoride and Dental Caries
Authors: DOTY J. ROY
Published: December 2021

I wish to direct attention to a report by the Council on Dental Therapeutics of the American Dental Association (J. Am. Dental A., April, 1958) on prescribing supplements of dietary fluorides.

An examination of the letter by Dr. Trieger (Pediatrics, 20:919, 1957) reveals several areas of possible confusion. (1) There was an inadvertent confusion of sodium fluoride with the fluoride ion, which makes up less than half of the weight of the compound. Thus the quantity of fluoride suggested is somewhat less than half the quantity which was probably intended to be incorporated in the prescription.
HYDRAMNIOS AS AN AID TO THE EARLY DIAGNOSIS OF CONGENITAL OBSTRUCTION OF THE ALIMENTARY TRACT: A STUDY OF THE MATERNAL AND FETAL FACTORS
Authors: Lloyd James R. , Clatworthy H. William
Published: December 2021

ALTHOUGH the association between hydramnios and congenital anomalies of the alimentary tract of the fetus has been recognized for more than 75 years, little emphasis has been placed upon this prenatal maternal abnormality as an aid to the earlier diagnosis of obstructive disease in the newborn. With the exception of isolated case reports which were summarized by Taussig in 1927 and the more recent observations of Mengert and Bourland, Castanier et al., and Clatworthy and Lloyd, the diagnostic significance of this relationship has not received proper recognition. Fortunately, today, the majority of anatomic abnormalities of the alimentary tract which are encountered in the neonate can be surgically corrected, if the diagnosis can be established and the treatment instituted before the infant has deteriorated irreversibly. A more general appreciation of the importance of hydramnios as a diagnostic sign of obstructive disease by physicians responsible for the care of the infant during the perinatal period should improve infant salvage.

Recent surveys of our experience at the Columbus Children's Hospital with neonates having obstructing lesions of the esophagus or intestine attracted our attention to the fact that many of these infants were delivered of mothers who suffered from acute or chronic hydramnios. In an effort to determine the significance of the interrelationship between hydramnios in the mother and congenital obstruction of the alimentary tract in the fetus, a study was undertaken which included not only a survey of all infants admitted to the Children's Hospital with alimentary tract obstruction but also an analysis of a series of obstetric cases at the University Hospital in women with pregnancy complicated by hydramnios.
THE FLUSH METHOD FOR DETERMINING BLOOD PRESSURES IN INFANTS
Authors: Moss Arthur J. , Liebling Wilbert , Adams Forrest H.
Published: December 2021

Observations were made on 551 Caucasian infants from 1 day to 1 year of age. All subjects had normal cardiovascular status and were free from acute or chronic infections. A total of 1,712 measurements of blood pressure were obtained by the flush technique. It is known that measurements made using the flush technique approximate the mean rather than the systolic blood pressure. The values obtained were analyzed in relation to sex, age and body weight. No correlation is found between sex and blood pressure or between body weight within a given monthly age category and blood pressure. Measurements of blood pressure show a pronounced and highly significance rise following the first week of life. During the first 9 months of life the readings are somewhat higher at the wrist than at the ankle. Thereafter, the converse is true. The significance of these findings is discussed.

Arithmetic means and the range of normal blood pressure are presented. Exclusive of the first week of life, the range of normal blood pressure during the first year is from 51 to 93 mm Hg for the upper extremity and from 44 to 92 mm Hg for the lower extremity.
IATROGENIC DISEASE
Authors: MAY CHARLES D.
Published: December 2021

SOME revealing papers from a Symposium under the heading "Iatrogenic Disease" appear in this issue. The rapidly increasing array of therapeutic agents affords many opportunities for the physician to do harm as well as to benefit the patient. This precarious position is not new to the physician, but in the sincere desire to rid the patient of his ailment or to relieve his symptoms, one is inclined to overlook the possibility that the treatment may be harmful.

Full realization of this is difficult to acquire in an age when disease is seldom observed to run its natural course without the influence of what is mistakenly termed "heroic" therapy, often recommended as intensive or energetic.
HYPERTONIC DEHYDRATION (HYPERNATREMIA): THE ROLE OF FEEDINGS HIGH IN SOLUTES
Authors: Colle Eleanor , Ayoub Elia , Raile Richard
Published: December 2021

An epidemic of gastroenteritis during which an unusually high incidence of hypertonic dehydration was encountered in infants is reported.

Analysis of the feedings received by the infants during the initial phase of diarrhea indicates that those who developed hypernatremia had received feedings in which the ratio of solutes to water was higher than that in the estimated continuing losses of fluid through stools, urine, and skin and lungs.

Considerations to be employed in the prevention and treatment of hypernatremia and dehydration during diarrhea are discussed.

The physician must develop his clinical judgment in determining when parenteral rather than oral therapy is required in diarrhea—and not depend on a routine regimen or solution for oral therapy.
VALUES FOR COPPER, IRON AND IRON-BINDING CAPACITY IN THE SERUM IN KWASHIORKOR
Authors: Lahey M. Eugene , Behar Moises , Viteri Fernando , Scrimshaw Nevin S.
Published: December 2021

The results of a study of 10 Guatemalan children with kwashiorkor indicate that the concentration of copper in serum is substantially reduced and that hypoferremia and a reduction in the iron-binding capacity of serum occur as well.

Although the possibility that a dietary deficiency of copper occurs concomitantly with deficiencies of protein and other nutrients is not eliminated, comparison of these biochemical abnormalities with those noted in experimental animals suggests that the changes are secondary to inadequate protein intake.
GILDED ANTIBIOTICS
Authors: MAY CHARLES D.
Published: December 2021

THE COMPETITIVE struggle between producers of antibiotics has recently placed emphasis on a supposed virtue of newer derivatives in achieving higher concentrations in the blood faster than previous products. Among the products being promoted as possessing this doubtful advantage are minor combinations or mixtures of the parent antibiotics or their more soluble derivatives with such agents as citric acid, phosphates and glucosamine. Typical of these gilded products are: tetracycline and citric acid (Achromycin V®), tetracycline phosphate complex (Tetrex®, Sumycin®), oxytetracycline and glucosamine (Cosa-Terramycin®) and triacetyloleandomycin and glucosamine (TAO®).

The insignificant extent to which these adjuvants can be credited with producing increased levels of antibiotics in the blood by the new mixtures has been discussed elsewhere.
THE PENTOSE PHOSPHATE PATHWAY IN HUMAN ERYTHROCYTES
Authors: Gross Ruth T. , Hurwitz Ruth E.
Published: December 2021

Metabolism in erythrocytes was studied in a group of premature and full-term, newborn, healthy infants by assay of the following enzymes: glucose-6-phosphate dehydrogenase, 6-phosphogluconic dehydrogenase and aldolase. Concentrations of fetal hemoglobin and stability of GSH were also determined.

The studies indicate increased metabolic activity in the erythrocytes of young subjects. The pentose phosphate pathway appears to be very active at birth with gradual decline, to values found for adult subjects, in the second 6 months of life.

GSH is unstable in newborns less than 3 days of age despite high levels of activity of G6PD in the same subjects.
Precocity of African Children
Authors: KNOBLOCH HILDA
Published: December 2021

After reading Dr. Cobb's letter (Pediatrics, 21:867, 1958) concerning the "Precocity of African Children" as reported by Geben et al. (Pediatrics, 20:1055, 1957), I feel it essential to make some comment lest the readers of both the article and Dr. Cobb's letter are left with the impression that the accelerated development of Negro infants has been definitely established, and that there is a biological decline with increasing age. I feel this is particularly important since work in which I participated a number of years ago helped foster this concept in regard to gross motor behavior.

It is true that in a group of Negro infants examined in New Haven in 1944 and 1945, the gross motor developmental quotients were found to be higher than the norms on which the Gesell Developmental Schedules were standardized.
Chemistry in Biology of Mucopolysaccharides: A Ciba Foundation Symposium
Authors: CRAIG JOHN M.
Published: December 2021

This volume, containing some 17 chapters, all by outstanding investigators, gives a broad survey as well as much factual and interpretive detail in a difficult and complex field of biology. The discussions lay much stress on methods of purification and identification. These problems are central to all the facets of the areas treated, which include specific structural types of mucopolysaccharides and those of various sources such as of botanical, bacterial, hematologic, urinary and epithelial origin. Of particular interest to students of disease are the chapters on the pharmacologic aspects of the polysaccharides, and those dealing with the alterations in plasma, and polysaccharides found in urine in pathologic states, and those found in milk.
Pneumoencephalograms and Clinical Behavior
Authors: KUGEL ROBERT B.
Published: December 2021

In the article on "Pneumoencephalograms and Clinical Behavior" (Pediatrics, 22:13, July, 1958), Dr. Knobloch makes a general conclusion "that it is not feasible to predict intellectual functioning on the basis of pneumoencephalographic findings alone, . . . ." Although many people might accept this statement as reasonable, even prior to reading the article, I would question whether the data presented can support this conclusion.

I would call attention in this article to the statement, "for those who are not familiar with the Gesell Developmental Examination, . . . it has been found that correlation between examinations in infancy and at 3 and 7 years is high, being 0.5 for 50 children at 7 years of age."
The Student-Physician: Introductory Studies in the Sociology of Medical Education
Authors: MORRIS WOODROW W.
Published: December 2021

In recent years it has been increasingly noted that health sciences, services and education may look to the behavioral sciences, particularly psychology, sociology and anthropology, for the techniques and methods which will lead to continued growth and progress in the health fields. In September, 1957, the Association of American Medical Colleges published The Appraisal of Applicants to Medical Schools, which is the report of the Fourth Teaching Institute of the Association. This Institute was one of two sponsored by the Association on the general topic, "Evaluation of the Student." The second was held at Atlantic City in the fall of 1957 under the sub-heading, "The Ecology of the Medical Student." In the first of these Institutes, in the words of George Packer Benny, "medical deans and teachers opened the doors of their medical schools to their university colleagues in psychology. . . ." and having done so found vigorous stimulation to seek answers along novel and different pathways in their considerations of the problems inherent in student evaluation.
NOCARDIOSIS
Authors: Beckmeyer William J.
Published: December 2021

A case of cutaneous granuloma with purulent regional lymphadenitis is described in a 3-year-old male. N. asteroides was isolated from the lesions. The patient was successfully treated with sodium sulfadiazine. This represents a rather unusual infection with only 11 reported cases in the pediatric age group, none of the patients presenting a cutaneous lesion. A short résumé of the case and clinical features of the disease are discussed.
PATHOGENESIS OF LESIONS IN THE NERVOUS SYSTEM IN HYPERNATREMIC STATES
Authors: Finberg Laurence
Published: December 2021

Seven infants with hypernatremic dehydration developed subdural effusions or bleeding. One of these was a previously normal infant accidentally poisoned by excessive ingestion of salt. This infant and five of the others had significant neurologic damage, ranging from moderate to severe. It appears that the hypernatremic dehydration was responsible for the subdural lesions in these patients and responsible for permanent damage in at least three of them. Changes in chemical anatomy and lesions of the cerebral vessels are discussed with regard to producing lesions of the central nervous system in hypernatremic dehydration.

At present no salutary therapeutic approach to the complication of subdural effusions occurring during hypernatremic dehydration has been found.
THE RENAL RESPONSE TO ADMINISTRATION OF ACETAZOLAMIDE (DIAMOX®) DURING SALICYLATE INTOXICATION
Authors: Schwartz Robert , Fellers Francis X. , Knapp John , Yaffe Sumner
Published: December 2021

Advanced salicylate intoxication in young children may produce severe acidosis due not only to the production and accumulation of organic acids in tissues, but also to the diminished content of buffer cation which is secondary to the loss of buffer cation during the excretion of organic acids.

The excretion of an intensely acid urine all but prevents the excretion of free salicylate and thereby perpetuates the toxic effects of this ion.

Despite severe deficit of buffer cation, the kidney responds to administration of a carbonic anhydrase inhibitor with excretion of alkaline urine. The magnitude of the loss of buffer cation is unpredictable both before and after enzyme inhibition. However, the systemic acidosis may be controlled by infusion of solutions of sodium bicarbonate, but frequent determinations of pH and content of carbon dioxide in the serum are mandatory.

While the alterations in acid-base disturbance may be controlled during administration of acetazolamide, the occurrence of neurologic complications late in the course must be accepted as a serious additional hazard which may preclude the successful therapeutic value of this agent.