bluuebunny/crossref_metadata_2025 huggingface dataset:
THE RELATIONSHIP BETWEEN FINDINGS IN PNEUMOENCEPHALOGRAMS AND CLINICAL BEHAVIOR
Authors: Knobloch Hilda , Sayers Martin P. , Howard William H. R.
Published: December 2021

In order to determine what correlation exists between pneumoencephalographic and clinical behavioral findings, three independent evaluations were done with 50 patients. A radiologist and neurosurgeon each classified the roentgenograms according to the presence or absence of ventricular dilatation, abnormality of cortical marking and other abnormalities. A pediatrician did Gesell Developmental Examinations and made estimates of intellectual potential and neurologic status. There was no significant correlation of adaptive and gross motor developmental quotients with the pneumoencephalographic diagnoses. Neither was a statistically significant correlation found between the pneumoencephalographic findings and the presence or absence of mental retardation or certain neurologic abnormalities. Age at examination did not vary significantly with the clinical diagnosis but the mean age of patients with abnormal air studies was less than 1 year compared to approximately 2.5 years for those with normal pneumoencephalographic findings. It was concluded that it is not feasible to predict intellectual functioning on the basis of pneumoencephalographic findings alone, and that particular caution needs to be exercised in the roentgenographic interpretation if the child is less than 1 year old at the time of pneumoencephalography.
Convulsive Seizures Following Phenothiazine Tranquilizers
Authors: SHAW EDWARD B.
Published: December 2021

Judging by the volume of advertising and of sales, tranquilizing drugs have been widely employed during the past several years. Physicians in general have not been fearful of adverse reactions and promotional literature has emphasized their essential harmlessness. Reactions, especially with large dosage, have been reported (Hollister, L. E.: New England J. Med., 257:170, 1957) but are best known to pharmacologists and psychiatrists. The pharmaceutical manufacturers have given some warnings but have mostly emphasized the ease with which most of these reactions, when recognized, may be treated.
Letters to the Editor
Authors: HILL LEE FORREST
Published: December 2021

Dr. Ulstrom in his letter implies that the four infants reported by himself, Smith and Heimlich under the title, "Transient dysproteinemia in infants, a new syndrome" were identical in clinical and laboratory findings with those reported by Sturgeon and Brubaker under the title, "Copper deficiency in infants" and by Lahey and Schubert under the title, "New deficiency syndrome occurring in infancy."

At the time the Committee on Nutrition was assembling its material on the feeding of solid foods to infants, such an identity had not been established.
Allergy in Pediatric Practice
Authors: MAY CHARLES D.
Published: December 2021

This is the kind of a book on Pediatric Allergy which practitioners and others interested in learning more about this subject have been waiting for. It is practical in the proper sense of the world—it is based on the concept that the most essential prerequisite for being practical is to understand what one is doing. The authors have fulfilled the expectation raised by a statement in the Preface: "A certain amount of basic scientific background is included. It is believed that this knowledge is essential for intelligent use of the actual diagnostic and therapeutic methods."
Statistical Manual of the American Association on Mental Deficiency
Authors: KUGEL ROBERT B.
Published: December 2021

Most statistics concerning mental retardation are inadequate because the definitions for the different etiologic categories have not been sufficiently clear and have not been agreed upon for general use. There is a great need for some attempt to make nomenclature a more universal one in this area. The Committee on Nomenclature of the American Association on Mental Deficiency, responding to this state of confusion, has revised the manual which was first brought out in 1920.
DETERMINATION OF NITROGEN BALANCE OF INFANTS LESS THAN 6 MONTHS OF AGE
Authors: Fomon Samuel J. , Thomas Lora N. , Jensen Robert L. , May Charles D.
Published: December 2021

The procedure employed by the authors for the performance of metabolic balance studies is reported in detail.

Data concerning the retention of nitrogen by infants during consecutively performed 3-day metabolic balance studies are presented.
Tumors of the Liver and Intrahepatic Bile Ducts
Authors: BLANC WILLIAM A.
Published: December 2021

This new fascicle of the Atlas of Tumor Pathology is of the same high quality as most of the previous fascicles of the series. It presents in condensed form the largest possible of up-to-date information, and combines, in a perfect balance, a profusion of excellent photographs and a well-written, sharp text. This is a timely publication, since ". . . The advent of the needle biopsy and a bolder surgical attack on neoplasms of the liver . . . make the understanding of liver tumors a matter of practical importance for all pathologists."
Annual Review of Medicine
Authors: MAY CHARLES D.
Published: December 2021

It is difficult to prepare a revealing review of a review. The reputation of the entire series of Annual Reviews of basic sciences and clinical medicine hardly calls for elaboration by detailed comment on each volume as it appears. Suffice it to say that here in the present volume one finds once again a superior collection of contributions written by authoritative individuals on a wide variety of topics of current interest. The pediatrician will find a competent section on pediatrics by Harold K. Faber and associates in which they were obliged to cover the many developments in this major branch of medicine in 17 pages, including a biblography of 150 papers.
Tuberculosis in White and Negro Children
Authors: DAMROSCH DOUGLAS S.
Published: December 2021

These two volumes present a detailed analysis of the records of 1,329 children admitted to the Harriet Lane Home during the period of the tuberculosis study from 1928 to 1944.

Volume I offers a collection of well selected and well reproduced roentgenograms illustrating the various manifestations of tuberculosis in childhood. Serial films are presented showing the evolution of roentgenologic change during the course of the patient's illness, along with brief clinical summaries. There are also examples of conditions, normal and abnormal, which enter into the differential diagnosis of tuberculosis, and there is a brief but useful discussion of the anatomy of the chest.
NEW PROGRAM OF HEALTH EDUCATION
Authors: OVERALL JAMES C.
Published: December 2021

IN KEEPING with the tradition established in Pediatrics, I am exercising the privilege of the President of providing copy for an Editorial of special interest to Academy members. It gives me pleasure to report on a development which has been under consideration by the Executive Board and special committees of the Academy for some 9 or 10 years and which has now become a reality.

Eight years ago, a committee served for 3 years trying to solve the problem of public relations as well as lay education. Unable to obtain at that time the necessary funds they felt were needed, this committee was disbanded at its own request. The problem was again attacked by a committee directed by a past president of the Academy and under a new name, the Committee on Health Information. This committee studied the problem from various angles with great vigor but again were unable to resolve the problem because of inability to obtain funds for a full-time staff necessary to carry out the assigned task. It was felt by the Executive Board that the membership should not be subjected to an increase in dues to support this project.
CLINICAL TRIALS IN INFANTS OF ORALLY ADMINISTERED ATTENUATED POLIOMYELITIS VIRUSES
Authors: Plotkin Stanley Alan , Koprowski Hilary , Stokes Joseph
Published: December 2021

Forty-six infants, ranging from less than 1 day to 6 months of age, were given more than 100 feedings of living, attenuated poliomyelitis viruses without the occurrence of major or minor illness. The strains used were CHAT (type 1), Wistar (type 1), Jackson (type 2), P-712 (type 2) and Fox (type 3).

All strains except the Jackson strain were found to be antigenic on oral administration. Response to vaccination was demonstrated in these infants by the presence after vaccination of antibody levels significantly in excess of those attributable to transplacentally acquired antibodies, and by the detection of fecal excretion of poliomyelitis virus.

Infants less than 2 months old were more difficult to immunize than older infants. The evidence suggests that biologic immaturity rather than transplacental antibodies caused the difference.

When the three types of poliomyelitis virus were fed at 3-week intervals, responses occurred to all types. No interference between types was observed when they were fed in all possible sequences.

Three infants given a second feeding of homotypic, attenuated poliomyelitis virus 3 to 5 months after a successful vaccination showed resistance to intestinal reinfection.
Ciba Foundation Symposium: Neurological Basis of Behaviour
Authors: LOW NIELS L.
Published: December 2021

The Ciba Foundation Symposium on the Neurological Basis of Behaviour is an interesting and stimulating review of much recent work in the field of organic behavioral science. Being a collection of the presentations of 19 groups of researchers it is not a homogeneous book but rather presents a spectrum of research projects varying from the electrophysiology of single neurones through studies in neuroanatomy by ablation and through drug research to an introductory historical and philosophical review of the relationship of mind and brain. The work presented in this symposium may not seem to have immediate application in present-day clinical medicine but it shows the way toward future understanding of the learning brain and to the organic basis of human action.
ALDOSTERONISM AND HYPERTENSION: THE INFLUENCE OF COMPLETE ADRENALECTOMY UPON ESSENTIAL HYPERTENSION IN A CHILD
Authors: Slater R. J. , Geiger D. W. , Leeson J. , Gornall A. G.
Published: December 2021

The favorable influence of complete adrenalectomy upon a 5-year-old boy suffering from severe essential hypertension and cardiac failure is described.

Repeated investigations failed to clarify the etiology of the hypertension. After extensive trials of medical management, including low intake of salt and administration of hypotensive drugs, only a moderate decrease in blood pressure was achieved and the clinical response was unsatisfactory. Since increased excretion of aldosterone and a sensitive hypotensive response to salt restriction implicated disordered adrenal function, a two-stage adrenalectomy was done.

The final achievement has been a marked improvement in cardiovascular status and reversal of impaired renal clearances. The boy has been readily maintained with administration of cortisone and 9-α-fluorohydrocortisone. Despite these preliminary favorable results, emphasis is directed to the extreme caution which must attend the decision to undertake such a procedure.
NEUROBLASTOMA SYMPATHETICUM
Authors: Gross Robert E. , Farber Sidney , Martin Lester W.
Published: December 2021

The treatment of patients with neuroblastoma does not lie solely in the province of a single specialty; it requires cooperation of pediatrician, surgeon, radiologist and tumor therapist. It is essential that they all be aware of the unique characteristics of this particular tumor if optimum results are to be obtained. The many factors found to influence the prognosis for a child with neuroblastoma are discussed.

In those cases wherein there are no demonstrable metastases, the treatment of choice consists of total excision, followed by local x-ray irradiation; this has resulted in a cure rate of 88%. In those cases wherein total excision is not possible, partial surgical removal followed by x-ray irradiation and tumor chemotherapy has given a cure rate of 64%. In those cases where only biopsy has been performed, x-ray irradiation and chemotherapy has still given a salvage, with a cure rate of 38%.

When there are metastases to the liver alone, about two-thirds of babies can be cured by x-ray therapy. Whenever bony metastases have appeared in any case, the prognosis is extremely poor, and it is rare for such an individual to survive, regardless of the form of therapy.

An aggressive attack on neuroblastoma in infancy and childhood, combining sungeny, x-ray irradiation and tumor chemotherapy, has shown a progressive improvement in results. During the period 1950-1957, cure rates have risen to 36.7% for all patients entering the hospital, regardless of age of the patient on extent of the neoplasm. For babies under a year of age, cures have occurred in 56%, and if there were no demonstrable metastases to bone at the time of hospitalization, the cures have been 70%.
PEDIATRICS AND SOCIETY
Authors: WISHIK SAMUEL M.
Published: December 2021

The article that follows describes the method of holding small discussion groups with mothers, in addition to the physician on nurse or both talking to each mother individually. In this instance, the group discussion technique was used in the setting of a child health conference. Pediatricians might think of how the procedure can be applied in their private offices. Back in the 1930's when I was in private practice, I would hold Saturday morning meetings with five or six couples in a group discussion. We talked about all kinds of things, apparently with mutual advantage to the parents and myself. I was particularly pleased at the opportunity to involve the fathers in such a situation. Doubtless other pediatricians in private practice have been doing the same thing. If any who have had experiences of this kind would write and tell us about them, it would be of interest to our readers. I believe that this is a tool which can be extremely useful to the practicing pediatrician in his counseling of parents on child management.
ANTIBIOTIC PROPHYLAXIS
Authors: Hodes Horace L.
Published: December 2021

Chemoprophylaxis is very effective and should be used freely after known exposure to dangerous bacteria which are very sensitive to an antibiotic. Into this category falls prophylaxis against beta-streptococcal, meningococcal and gonococcal infections.

The value of preventing beta-hemolytic streptococcal infections in children who have suffered an attack of rheumatic fever is established beyond a doubt.

Antibiotics generally should not be used during an acute viral infection for protection against possible secondary bacterial invasion.

In general, antibiotic prophylaxis should not be used to attempt to reduce the incidence of bacterial infections in children who are suffering from a chronic disease of nonbacterial origin, such as diabetes or nephrosis.

The use of antibiotic prophylaxis in surgery should be limited to certain specific indications. It should not be used in "clean" elective surgery.

Antibiotic prophylaxis may be of value for small premature infants during the first week of life, but much more data on this point are required. For full-term newborn infants chemoprophylaxis has only limited usefulness, except for ophthalmia neonatorum. In the light of present knowledge, antibiotic prophylaxis should be used to help control outbreaks of staphylococcal and E. coli diseases in the nursery.
GROWTH OF NEGRO PREMATURE INFANTS
Authors: Cherry Flora F. , Bancroft Huldah , Newsom William T.
Published: December 2021

A series of measurements of weight, length, head, and chest circumferences in Negro prematures from birth through 1 year of age has been presented. All cases were managed by standardized hospital and follow-up care routines. The data are presented in tabular form for males and females in two birth weight categories—1,001 to 1,500 gm and 1,501 to 2,000 gm. In the graphic presentations, sexes were considered together because differences were small. The growth charts depict usual ranges and limits encountered in weights, lengths, and head circumferences. Head and chest measurements are also compared. It is felt that this material will be useful to clinicians following the progress of individual premature infants.
THE CHILD WITH MONGOLISM IN THE HOME
Authors: Schipper Martha Taylor
Published: December 2021

The records of 43 children with mongolism living at home are reviewed to determine what the presence of such a child means to the parents and the normal siblings.

Long-range decisions are usually not needed for the infant with mongolism, and the pediatrician can best serve the child and his family by assuring them that it is "all right" to have the child at home. In this series only two families were disrupted during the neonatal period of the affected infant.

The child with mongolism will require somewhat more than average medical care, and his parents will need more than average support and continuous counseling.

Of 43 families, 31 adjusted to the affected child without adverse effect on their way of living. The families with problems were found to need specific help and were referred to social workers or family agencies.

In 33 families the normal siblings adjusted to the abnormal one with minimal adverse effects; several teen-age siblings were more realistic than their parents in accepting the assets and limitations of the handicapped child.

As the child with mongolism approaches adolescence, he may be deprived of optimal training and personal guidance if he continues to live at home and in a community where no provisions are made for him; and without an adequate plan, he may come to dominate family living. In communities where special classes, social groups and sheltered workships exist, the pediatrician can continue judicious temporizing.

Through his continuing contacts with the affected child and his family, the pediatrician can support the parents in their decisions, at the same time pointing out the values and hazards of keeping the child at home at various stages of development.
Convulsive Disorders of Children
Authors: BRAY PATRICK F.
Published: December 2021

This work covers the diagnosis and management of seizures in children and it is presented in a succinct and straightforward manner. In the introduction the authors have pointed out again that seizures are a manifestation of disordered brain function and that confusion in seizure nomenclature has arisen from limited knowledge about etiology. The suggested system of seizure classifications is presented with appropriate qualifications and will be useful for the clinician. The section on "Benign Febrile Convulsions" (B.F.C.) presents a paradox because the authors give evidence in discussion that convulsions which occur with fever are often first manifestations of more serious conditions which are not truly benign. Although the authors make it clear that they are aware of these diagnostic pitfalls, it seems unwise and misleading to apply the reassuring term, Benign, to this group of patients.
TRANSPLACENTAL TRANSMISSION OF WESTERN EQUINE ENCEPHALITIS
Authors: Copps Stephen C. , Giddings Luther E.
Published: December 2021

A case of serologically proven western equine encephalitis in a newborn infant is presented. Evidence strongly suggests the transplacental transmission of the virus in this case.
PHAGE GROUPS AND ANTIBIOTIC SENSITIVITY OF STAPHYLOCOCCUS AUREUS ASSOCIATED WITH CYSTIC FIBROSIS OF THE PANCREAS
Authors: Pittman Fred E. , Howe Calderon , Goode Louise , di Sant'Agnese Paul A.
Published: December 2021

In this study, 198 strains of hemolytic, coagulase-positive Staph. aureus were recovered from 84 patients with cystic fibrosis of the pancreas and some of their relatives. The majority of the organisms fell into phage group III and were resistant in vitro to penicillin and other antibiotics. No single phage type seemed to be unduly prevalent in this group of patients with cystic fibrosis of the pancreas.
POSTHEMORRHAGIC ANEMIA AND SHOCK IN THE NEWBORN
Authors: Kirkman Henry N. , Riley Harris D.
Published: December 2021

Acute fetal blood-loss usually occurs during labor and delivery. This condition may be the second commonest cause for anemia in infants at birth. Although the causes for fetal hemorrhage are diverse, they result in a single entity, posthemorrhagic anemia or shock immediately after birth. The signs and management are essentially the same regardless of cause. It is suggested that "posthemorrhagic anemia and shock in the newborn" be an accepted and standard pediatric diagnosis. The infants are pale but have no hepato-splenomegaly or edema. If the condition is severe the infants have weakness, tachycardia and distress out of proportion to any degree of cyanosis. Pallor persists in spite of administration of oxygen. Under such conditions immediate re-expansion of blood volume is imperative and lifesaving.
STUDIES OF RESPIRATORY PHYSIOLOGY IN CHILDREN
Authors: Cook C. D. , Helliesen P. J. , Kulczycki L. , Barrie H. , Friedlander L. , Agathon S. , Harris G. B. C. , Shwachman H.
Published: December 2021

Tidal volume, respiratory rate and lung volumes have been measured in 64 patients with cystic fibrosis of the pancreas while lung compliance and resistance were measured in 42 of these. Serial studies of lung volumes were done in 43.

Tidal volume was reduced and the respiratory rate increased only in the most severely ill patients. Excluding the three patients with lobectomies, residual volume and functional residual capacity were found to be significantly increased in 46 and 21%, respectively. These changes correlated well with the roentgenographic evaluation of emphysema. Vital capacity was significantly reduced in 34% while total lung capacity was, on the average, relatively unchanged. Seventy per cent of the 61 patients had a signficantly elevated RV/TLC ratio.

Lung compliance was significantly reduced in only the most severely ill patients but resistance was significantly increased in 35% of the patients studied. The serial studies of lung volumes showed no consistent trends among the groups of patients in the period between studies. However, 10% of the surviving patients showed evidence of significant improvement while 15% deteriorated. [See Fig. 8. in Source Pdf.]

Although there were individual discrepancies, there was a definite correlation between the clinical evaluation and tests of respiratory function, especially the changes in residual volume, the vital capacity, RV/ TLC ratio and the lung compliance and resistance.
Epilepsy Handbook
Authors: DAVIS JEAN P.
Published: December 2021

This practical volume will serve as a useful guide to physicians who are unfamiliar with recent advances in the diagnosis and treatment of epilepsy. The various types of attacks, associated electroencephalographic changes, presumptive causes and most effective forms of treatment are presented in the order of their occurrence with increasing age. The authors discuss the etiology and differential diagnosis of several conditions resembling epilepsy. Principles of antiepileptic medication are considered with brief summaries of various drugs currently used in therapy. The management of status epilepticus and comments on adjunctive treatment and counseling are included.
THE EFFECT OF MATERNAL NARCOTIC ADDICTION ON THE NEWBORN INFANT
Authors: Cobrinik Ralph W. , Hood R. Thornton , Chusid Emanuel
Published: December 2021

During the past 5 years there have been 22 newborn infants born of mothers who were narcotic addicts at the Flower and Fifth Avenue Hospitals and the Metropolitan Hospital in New York City. It is the purpose of this paper to present the clinical findings in these infants and notes on treatment.

Of the 20 mothers (there were two sets of twins), 18 were taking heroin, one morphine, and in one the drug could not be determined. The maternal dosage of heroin ranged from 2 to 45 mg/day. The route of administration was intravenous in 14, subcutaneous in one, intranasal as snuff in one, and unknown in four.

Birth weights ranged from 1,100 to 3,600 gm with a mean of 2,600 gm. Nine weighed less than 2,500 gm and three weighed more than 3,200 gm. All of the infants were normally developed.

Twenty newborn infants demonstrated clinical findings with onset from birth to the fourth day. In 16 of these, symptoms and signs were present during the first 24 hours. In all of these 20 infants there were tremors, excessive crying, sleeplessness, restlessness, or hyperirritability. Vomiting and poor feeding were observed in 10 infants, diarrhea in 6, yawning and sneezing in 6, fever in 4, and convulsions in 1. There was apparently a direct relationship between severity of the infant's signs and symptoms and the size of the maternal narcotic dosage.

There was complete recovery of all the newborn infants.

The diagnosis presented no problem when a clear history of maternal narcotic addiction was available. However, this history was often not elicited or was emphatically denied. Careful physical examination of the mother usually revealed needle marks and other stigmata of narcotic addiction.
PRESIDENT'S MESSAGE
Authors: OVERALL JAMES C.
Published: December 2021

The American Academy of Pediatrics, in attempting to fulfill one of the principal objectives of the Academy, has this year entered into a new phase of medical education by arranging a series of postgraduate courses for pediatricians. The need for such courses has been studied and considered by the Executive Board and the Committee on Medical Education for several years. Two years ago, the first step was taken when the Academy agreed to co-operate in publicizing a course on Pediatric Orthopedics that was presented in New Orleans at Tulane University School of Medicine by Drs. Ralph V. Platou and Clifford G. Grulee, Jr. This course was so successful and the arrangement so satisfactory that the Committee on Medical Education recommended that two regular Academy-sponsored courses be given early in 1959.

These two courses were held in March of this year; the first course at Ann Arbor was presented by the Pediatric Department of the University of Michigan under Drs. James L. Wilson and Harry A. Towsley, and the second course was at Nashville under the direction of Drs. Amos Christie and O. Randolph Batson of the Pediatric Department of Vanderbilt University. These courses were extremely well received as attested by the numerous commendatory letters that were directed to the officers of the Academy as well as to those who directed the courses. This great interest in the postgraduate program was considered sufficient evidence of the need for such courses and, therefore, warranted the plan to increase the number of courses to four during the coming school year.

The Subcommittee on Postgraduate Courses at a recent meeting laid the groundwork for the courses in the coming year. The schedule of courses as planned is as follows:
RECENT OBSERVATIONS ON PATHOGENESIS OF CYSTIC FIBROSIS OF THE PANCREAS
Authors: di Sant'Agnese Paul A.
Published: December 2021

The pathogenesis of cystic fibrosis, the common denominator responsible for the widespread dysfunction of so many or perhaps all exocrine glands, is not known. The basis defect, whatever its nature, is genetically transmitted and there is suggestive evidence that it may be present in varying degrees and so affect the variety and severity of clinical manifestations in different individuals. There are accumulating data to indicate that the heterozygous state may be identified by biochemical or physiologic tests.

The abnormal chemical structure of mucoproteins in duodenal contents of patients with cystic fibrosis tends to decrease the solubility, while the abnormal physicochemical behavior shows that these mucoproteins are easily denatured and rendered insoluble. If this were true of mucous secretions throughout the body it would be possible for a change in the physicochemical environment of these mucous secretions to cause irreversible precipitation of mucoproteins in organs such as the pancreas, liver and others, thus initiating the chain of clinical events and leading to many of the symptoms manifested by patients with the disease.

Despite the almost constant and striking association of Staphylococcus aureus and the respiratory involvement in cystic fibrosis, the distribution of bacteriophage types of this microorganism resembles that found in other hospitalized patients.
GLUTAMIC-OXALACETIC TRANSAMINASE OF SERUM IN INFANCY AND CHILDHOOD
Authors: Stanton Robert E. , Joos Howard A.
Published: December 2021

Activity of glutamic-oxalacetic transaminase in serum (S-GOT) has been evaluated in normal infants and children and in a wide variety of diseases, including convalescent rheumatic fever, renal disease, hemolytic disease, infections and various hepatic disorders.

In 46 normal children, the observed range was 7-41 units. The range of normal values in newborn infants was somewhat wider, 29-79 units.

Convalescent rheumatic fever and infections not involving the liver were associated with normal S-GOT. S-GOT was normal with the hemolytic diseases in the absence of fulminant hemolysis. It was frequently exceptionally low in association with renal disease, and slightly elevated for a few days after major surgery.

S-GOT is elevated in diseases of the liver, but the results are too variable for specific differentiation of hepatic diseases in early life. The test is best employed in conjunction with careful clinical evaluation and with other measures of liver function.
RELATION OF DURATION OF BED REST IN ACUTE RHEUMATIC FEVER TO HEART DISEASE PRESENT 2 TO 14 YEARS LATER
Authors: Lendrum Bessie L. , Simon Albert J. , Mack Irving
Published: December 2021

THE MEDICAL management of children with acute rheumatic fever has undergone remarkable changes in the past decade. It is no longer considered "radical management" to mobilize a patient promptly upon disappearance of the acute signs and symptoms of rheumatic activity instead of imposing prolonged periods of bed rest. A few investigators have recently advocated permitting ambulation and physical activity to tolerance within the first few days after the onset of the acute attack even in the presence of myocarditis.

There are very few data available in the literature, however, to support the clinical impression that prolonged bed rest is not necessary to secure optimal myocardial healing. For this reason it seems desirable to record clinical studies designed to test the validity of this impression.

In 1946 when Herrick House was converted from a summer residence for children convalescing from rheumatic fever to a year-round convalescent home, it became one of the first institutions to abandon prolonged bed rest. Detailed description of the Herrick House program has been published previously. A long-term study was undertaken by the medical staff at that time to determine whether abandonment of prolonged bed rest was harmful. The cardiac status of children who had been treated at Herrick House was determined by periodic examinations. All the children in the study were examined by at least one of the authors. The medical care, however, was not provided by the physicians who performed these follow-up examinations. Observations made during the first 4 years after the initiation of the study have been reported. The conclusion was reached that abandonment of prolonged bed rest and restriction of activity did not appear to affect the heart adversely and may have benefited it. The purpose of this paper is to present further observations on the same and additional children followed from 2 to 13 years.
GENETIC STUDIES IN GALACTOSEMIA
Authors: Donnell George N. , Bergren William R. , Roldan Maria
Published: December 2021

Response to oral administration of galactose, with dosage related to body surface, has been examined in 39 members of 13 families in which galactosemia has occurred.

Genetic analysis of the families indicates an autosomal recessive mode of transmission of the defect. The finding of decreased tolerance to galactose in groups of parents and siblings is consistent with this analysis. Controls are included.

The oral galactose tolerance test is not considered suitable for detection of an individual galactosemia carrier. The range of values of normals and heterozygotes overlap. Specific enzymatic methods may be more applicable.
FLUORESCENCE OF THE ERYTHROCYTES IN LEAD POISONING IN CHILDREN: AN AID TO RAPID DIAGNOSIS
Authors: Whitaker Jo Anne , Vietti Teresa J.
Published: December 2021

In seven children with lead poisoning, a thin wet-preparation of erythrocytes was examined under ultraviolet light. In every case red fluorescence was found in 75 to 100% of the erythrocytes. The fluorescence appears to be related to the amount of free protoporphyrin in the erythrocytes. Over 150 preparations of erythrocytes from patients with a variety of other clinical conditions showed 0 to 50% fluorescent erythrocytes. This test is a simple, rapid, reliable method to aid in the diagnosis of lead poisoning in children.
COMPOSITION OF TRACHEOBRONCHIAL SECRETIONS IN CYSTIC FIBROSIS OF THE PANCREAS AND BRONCHIECTASIS
Authors: Chernick Warren S. , Barbero Giulio J.
Published: December 2021

Tracheobronchial secretions obtained by bronchoscopic aspiration from patients with cystic fibrosis and patients with chronic bronchiectasis were analyzed for the major organic and inorganic constituents. The tracheobronchial secretions from patients with cystic fibrosis contained, on a weight basis, at least twice the quantity of organic material found in bronchiectatic secretions.

Analysis of the secretions for nitrogen, carbohydrate, hexosamine and lipids indicated that, on a dry weight basis, similar quantities of these organic constituents are found in the two types of secretions. The only organic component which was found to be consistently different was desoxyribonucleic acid; a higher content was found in cystic fibrosis secretion.

Analysis of the inorganic constituents revealed a higher content of sodium and potassium in the bronchiectatic secretion when calculated both on the basis of wet and dry weight, whereas phosphorus was found to be higher in the cystic fibrosis secretion.

The calcium content in the total cystic fibrosis secretion was found to be twice that in the bronchiectatic material; however, when calculated on the basis of dry weight, both types of secretion contained similar amounts of calcium.

The influence of ionic composition of the surrounding media on high molecular weight polymers is discussed and the postulation made that an alteration in the ionic concentration may be responsible for the peculiar characteristics observed in the tracheobronchial secretions of patients with cystic fibrosis.
Carcinogenesis: Mechanisms of Action
Authors: DARGEON HAROLD W.
Published: December 2021

This is a meticulous record of the symposium on "Carcinogenesis: Mechanisms of Action" held June 24-26, 1958 at the VII International Cancer Congress in London.

The volume contains 17 different papers by distinguished investigators in many experimental disciplines from England, United States, Australia, Germany, France, Holland and India. At the end of each paper, there are additional brief but succinct discussions and inquiries from those attending the symposium.

This effort to clarify the processes through which the phenomena known as cancers are initiated, promoted and accelerated by the constantly growing awesome list of recognized carcinogens is particularly timely. While the contributions are almost entirely from the laboratory the clinical implications, particularly to the pediatrician, of the influences of age, environment immunity, genetic factors, are challenging even if at present highly speculative.
The Physician and Group Practice
Authors: MAY CHARLES D.
Published: December 2021

This book provides a comprehensive treatment of the many aspects of the establishment and operation of group practices. The contributions of a wide assortment of experienced people have been skillfully grouped by the editor who is Executive Director of the American Association of Medical Clinics. The book appears to be complete in its coverage, authoritative and practical. Members of existing group practices and those entertaining the establishment of a group practice or becoming a member of a group should find the contents of this volume exceedingly useful.
FAMILIAL FIBROCYSTIC PULMONARY DYSPLASIA AND ITS RELATION TO THE HAMMAN-RICH SYNDROME
Authors: Donohue W. L. , Laski Bernard , Uchida Irene , Munn J. D.
Published: December 2021

Attention is drawn to a peculiar "interstitial pneumonitis" in five infants from three families.

In one of these families with three infants, there was chronic pulmonary disease in four adults; in another family, in one infant and one adult. In each adult the total picture, from data available, was identical with that of the Hamman-Rich syndrome.

In order to distinguish these cases from others included in the Hamman-Rich syndrome, the term familial cystic fibrosis of the lungs or familial fibrocystic pulmonary dysplasia is suggested.

The genetic implications are discussed.
PRESIDENTIAL ADDRESS
Authors: Overall James C.
Published: December 2021

THE BY-LAWS of the American Academy of Pediatrics state that at the Annual Meeting, a "Presidential Address shall be delivered." Thus each President is given the privilege of stating his views concerning the Academy whether these views are directed toward the past, present or future, or possibly a summation of all.

Any organization is only as strong as its membership and the interest and participation of that membership in the current affairs and problems. Many times, I am sure, all of the State and District Chairmen have had this question asked of them: "What would I get out of being a member of the Academy?" My answer to this question would be: You get out of it almost exactly what you put into it. If you wish to belong to an organization just to have the privilege of saying you are a member, then, of course, you would realize little benefit from that organization. The so-called dead wood in any organization is usually made up of the free riders who do nothing except complain about what is being done or attempted. New and constructive ideas are the main stimulus of most any group but destructive criticism and non-participating members can hinder or at least lessen the progress. Therefore, if I could make but one plea to the membership of the American Academy of Pediatrics it would be to take an active part.

Possibly in order to help you decide to take an active part, it would not seem amiss to again remind you of what was stated originally on the purposes of the Academy and I quote directly from the Executive Board meeting in 1931:

Purposes of the Academy:

1. To create reciprocal and friendly relations with all professional and lay organizations that are interested in the health and protection of children.

2. To foster and encourage pediatric investigation both clinically and in the laboratory by individuals and groups.
Feeding of Soybean Product and Development of Goiter
Authors: SHEPARD THOMAS H.
Published: December 2021

Van Wyk et al. have recently reported an infant who developed goiter and hypothyroidism while being fed a soybean product (Mull-Soy®). Although soybean milks have been used extensively for a number of years, this report and that of Rawson are the only reported instances of soybean goiters in humans. Consequently it may be of importance to report that during the past 5 months we have observed three children with thyroid enlargement which is apparently related to the intake of a soybean milk (Mull-Soy®). Although all of the children have been clinically euthyroid, they have had avid uptakes of I131 and somewhat low protein-bound iodine in the serum.
Letters to the Editor
Authors: SARETT HERBERT P.
Published: December 2021

The soybean is one of many foods known to contain potentially goitrogenic substances. The effects of these goitrogens may be diminished by processing of the bean, or eliminated by addition of iodide to the diet.

In view of the paper in this issue of Pediatrics on the goitrogenic effect of a soybean milk used in infant feeding, it is important to report our previously unpublished results with Sobee®. Though Sobee® is a soybean preparation it is not goitrogenic as measured by an increase in the relative weights of the thyroid gland in rats.
Letters to the Editor
Authors: CAFFEY JOHN
Published: December 2021

We have seen lesions, similar to those depicted by Dr. Woolley, follow acute osteomyelitis, trauma and scurvy. These lesions have never been seen by us in proved typical cases of vitamin A poisoning—either in the acute phase or during and after healing. Several years ago, however, we received films from Chicago in which one tibia was shortened and there was cupping of the tibial metaphyses at both ends, and the epiphyseal ossification centers were partially buried in the cups. This patient was said to have had vitamin A poisoning 7 years before.

I consider these to be nonspecific lesions which develop in a variety of circumstances.
Environmental Influences on Prenatal Development
Authors: CHILDS BARTON
Published: December 2021

This useful and interesting book consists of the proceedings of one of the Developmental Biology Conference Series held under the auspices of the National Academy of Sciences and the National Research Council. The conference was held at the Roscoe B. Jackson Memorial Laboratory in Bar Harbor, Maine and was attended by about 20 authorities from the United States and Europe.

One means for study of environmental influences on development consists of an examination into the causes of morphologic abnormalities. The book begins with some consideration of such defects.
PRIMARY CARCINOMA OF THE LIVER IN INFANCY AND CHILDHOOD
Authors: Shorter Roy G. , Baggenstoss Archie H. , Logan George B. , Hallenbeck George A.
Published: December 2021

The clinical and pathologic findings in 11 cases of primary hepatic carcinoma occurring in infancy and childhood are presented from the records of the Mayo Clinic from 1905 through 1958. These tumors are rarely encountered in routine practice. All the children were of Caucasian stock and there was no previous history of hepatic disease in 10 cases. In the remaining case the patient had been treated by radiation therapy for hemangioma of the liver 6 years previous to admission to the Clinic. No common factors of possible etiologic significance were present in these patients.

Some of the features of previous reports in this field have been described and they are compared and contrasted with the findings in the 11 cases presented. On histologic grounds such tumors of the liver can be divided into two groups: primary carcinomas and mixed tumors. Of the 11 tumors presented seven were considered to be examples of primary carcinomas and four were mixed tumors.

The presence of a sarcomatous-like stroma is considered necessary for the diagnosis of a mixed tumor in the absence of osteoid tissue, cartilage, bone or muscle. It is also contended that the presence of osteoid tissue in any amount precludes the diagnosis of primary carcinoma and necessitates a designation of mixed tumor. All the tumors were considered to be malignant and extrahepatic metastasis is described in seven instances. The tumors proved to be fatal within 2 years from the onset of symptoms in 10 cases. In the remaining case, although the child is alive, multiple pulmonary metastatic lesions are present.
KWASHIORKOR IN A NORTH AMERICAN WHITE MALE
Authors: Diamond Israel , Vallbona Carlos
Published: December 2021

The clinical and pathologic features of kwashiorkor are described in an 11-year-old white male resident of Kentucky. The syndrome was present for 2 years. Remissions occurred with adequate diet and relapses were not prevented by vitamin therapy. Characteristic lesions in the skin, liver, pancreas and thyroid were present. In addition, lesions in the alimentary tract characterized by hyperplasia of the epithelium are described; these are believed to be an integral part of the syndrome.
A TEACHING PROGRAM IN COMMUNITY PEDIATRICS
Authors: Rogers Kenneth D.
Published: December 2021

AT THE School of Medicine of the University of Pittsburgh, the Department of Pediatrics has organized a series of field experiences intended to acquaint future physicians with programs and facilities outside the confines of the Medical Center which are concerned directly or indirectly with the health and welfare of normal and exceptional children. During their pediatric outpatient service, senior medical students in groups of six to eight spend 6 half-days in "community pediatric" training. Each student is loaned a collection of selected reprints, booklets and mimeographed material pertinent to the areas covered in the community experiences. They are urged to read the appropriate material before each field trip in order that their observations may be meaningful and productive. Additional preparation is given at the visit site by approximately an hour's group discussion of the general area to be covered, specific items to be noted, and questions to be considered during the experience. No attempt is made to cover all aspects of the program being viewed. Informal discussion and interpretation are maintained by the instructor throughout the field trip.
THE PRACTICE OF PEDIATRICS
Authors: Gersh Marvin J. , Mascia Armond V. , Mellins Robert B.
Published: December 2021

ALTHOUGH the joining together of physicians in the practice of medicine has become prevalent in recent years, the philosophy underlying group practice, the advantages to patient as well as to physician, have not received much attention in the pediatric literature. Since our experience has led us to believe that pediatrics can be practiced more effectively in a group arrangement and because group practice, for us, has been both stimulating and enjoyable, we believe that others may be interested to learn of our experience. While it will be apparent that group practice has led to a better life for each of us, in our opinion its ultimate justification must be continually available and constantly improving medical care.

Our group had its origin in a solo practice in 1950 by A.V.M. He was joined in 1953 by M.J.G. and in 1957 by R.B.M. Since that time, we have operated as a group in the sense that patients understand that they are to be cared for by any one of the members of the group and that they are patients of the group.
PUBLIC HEALTH
Authors: Wheatley George M. , Richardson Stephen A.
Published: December 2021

IN ALL COUNTRIES for which there are vital statistics, accidents are a major cause of death and disability among children. In countries where the food supply is adequate and infectious diseases have been brought under control, accidents have become the leading cause of death in the age group 1 to 19 years. For example, in such countries as Australia, Canada, Sweden, West Germany, and the United States, more than one-third of all deaths in this age group are caused by accidents.

The number of children who are injured by accidents fan exceeds the number who are killed. Although no accurate international figures are available, the Morbidity Survey conducted by the United States Public Health Service indicates that in the United States, for every child under 15 killed by accident, 1,100 children are injured severely enough to require medical attention or to be restricted in their activity for at least a day.