bluuebunny/crossref_metadata_2025 huggingface dataset:
SCIENTIFIC TRUTH AND THE VOX POPULI
Authors: Weech A. Ashley
Published: December 2021

A NUMBER of times each year the postman delivers to each of us a fact-finding questionnaire. Some of these inquisitions emanate from commercial firms and represent a subtle way of advertising a product about which the queries are clustered. I respect and understand the objective of these communications and, because I am busy, invariably file them in the scrapbasket. Other well-intended attempts to sample public opinion originate in educational institutions, as the policy of editors of medical journals who wish to keep subscribers informed, or as a means of gathering data to be used by an author in preparing the manuscript of a paper. There is no denying that uncovering what is common practice may guide the teacher toward teaching how practice can be improved. There is, however, an inherent danger in the irrational assumption that majority opinion points the way to truth and sound practice.
EPIDEMIC NEPHRITIS IN A SCHOOL POPULATION
Authors: Siegel Alan C. , Rammelkamp Charles H. , Griffeath Harold I.
Published: December 2021

An outbreak of streptococcal infections among children attending kindergarten and second grade is described. During the course of the epidemic seven examples of acute hemorrhagic nephritis were observed. Routine examination of the urine of the boys who harbored Group A streptococci revealed 4 individuals who showed persistent hematuria and red cell casts but without symptoms of nephritis. In addition, transient hematuria was observed in several boys.

The epidemic of nephritis appeared to be due to Type 12 streptococci, an organism known to cause this complication. The importance of nephritis as a public health problem is emphasized since both apparent and inapparent examples of the disease may exist in populations infected with nephritogenic streptococci. Adequate measures are now available for the control of these infections.

Normal values are presented concerning the number of red cells excreted in the urine. Some of the factors which may influence the degree of hematuria are reviewed.
OXALOSIS
Authors: Burke Edmund C. , Baggenstoss Archie H. , Owen Charles A. , Power Marschelle H. , Lohr Oliver W.
Published: December 2021

A case is described in which oxalosis occurred in an 11-year-old boy. The patient had experienced the formation of numerous calculi and multiple operations for removal of the calculi. The clinical, pathologic and histochemical findings in the case are presented. The unusual features of the case are extensive deposits of calcium oxalate crystals in the kidneys, bone marrow, spleen, liver, blood vessels, and adrenal cortex.

Calcium oxalate, a relatively inert substance, appears to effect renal damage by virtue of its deposition in the renal tissue. While many aspects of oxalate metabolism remain obscure, it is generally presumed that oxalosis represents an as yet undefined metabolic defect.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: Silverman William A. , Fertig John W. , Kraus Arthur
Published: December 2021

Comparisons of the crude death rates of premature nurseries are untrustworthy. Statistical techniques of standardization, used in the study of the mortality rates of other population groups are applicable to the problem of hospital nursery rates.

A proposed method of computing Standardized Death Rates is presented to make due allowance for distribution differences in the structure of premature nursery population. Accurate recording of the exact age at the time of admission to the nursery and the exact age at the time of discharge (either dead or alive) is necessary for the computation. Age-specific death rates for infants of differing birthweight, gestational age, sex, color, and place of birth, obtained from the pooled experiences of many hospital nurseries may be adopted as a set of Standard Death Rates. These Standard Rates may then be applied to individual limited experiences to make valid comparisons possible. The need for obtaining such a set of Standard Death Rates is stressed.
GROWTH AND DEVELOPMENT OF NEGRO INFANTS
Authors: Scott Roland B. , Ferguson Angella D. , Jenkins Melvin E. , Cutter Fred F.
Published: December 2021

The time of occurrence of 12 neuromuscular patterns of behavior in the development of 2 groups of Negro infants from different socio-economic levels during the first year of life is presented. The Negro infants from the clinic showed acceleration over the Negro infants from private practice in their development from the 8th to the 35th week of life, after which time, the development of the 2 groups was essentially the same.

The Negro infants as a group showed acceleration in their development when compared with a group of white infants studied in a similar manner by Aldrich except in 2 patterns, "smiling" and "vocalization." A marked similarity was noted during the first 30 weeks of life in the development of the white and Negro infants from private practice whose socio-economic backgrounds were substantially similar.

The differences and similarities observed in the neuromuscular behavior in the 3 groups studied may be attributed mainly to environmental factors. The observed acceleration in the Negro infants is apparently an expression of greater permissiveness in daily care as practiced by the mothers or mother substitutes in the lower socio-economic classes.
CONCENTRATION OF BILIRUBIN IN CEREBROSPINAL FLUID IN HEMOLYTIC DISEASE OF THE NEWBORN
Authors: Stempfel Robert , Zetterström Rolf
Published: December 2021

1. Twenty-four full-term, newborn infants, of whom 23 were Rh-isoimmunized, were followed with serial determinations of the serum and spinal fluid bilirubin and spinal fluid total protein during the neonatal period. Of the 51 spinal fluid samples examined, measurable quantities of bilirubin were present in all cases.

2. In the presence of marked indirect hyperbilirubinemia, the spinal fluid bilirubin was predominantly indirect-reacting, though no linear relationship exists between the serum and spinal fluid bilirubin. It is suggested that this is a manifestation of individual variations in blood-brain barrier permeability within the neonatal period. A significant correlation between the spinal fluid indirect bilirubin and the spinal fluid total protein is further evidence to support this view.

3. Spectrophotometric absorption studies of 13 serum and spinal fluid samples from 8 infants with hemolytic disease of the newborn are discussed. These studies tend to confirm the observation that there is no direct correlation between the hyperbilirubinemia and the spinal fluid bilirubin concentration, though the configuration of the absorption pattern of the serum closely follows that obtained from the corresponding spinal fluid.

4. The findings in the Rh-isoimmunized group of infants were not unlike those observed in a single case of "physiologic jaundice" presented.

5. The question of indirect bilirubin neurotoxicity is briefly reviewed.
ANAPHYLACTOID PURPURA (SCHÖNLEIN-HENOCH SYNDROME)
Authors: Wedgwood Ralph J. P. , Klaus Marshall H.
Published: December 2021

A long-term follow-up study of 26 children with anaphylactoid purpura (Schönlein-Henoch Syndrome) is presented. The average length of follow-up was 4½ years. Of these 26 children, 10 were found to have an apparent latent nephritis characterized by hematuria and cylinduria, but without marked proteinuria. Nine of the ten children were over the age of 6 years at the time of onset of purpura; 6 had proteinuria or hematuria during the acute phase of the disease. It is suggested that this renal sequela of anaphylactoid purpura may constitute one of the origins of chronic renal disease "of unknown etoiology" which occurs in adult patients.
CHANGES IN TOTAL BODY CHLORIDE DURING GROWTH
Authors: Forbes Gilbert B. , Reid Allen F. , Bondurant June , Etheridge John
Published: December 2021

Total body content of chloride has been estimated in a series of infants and young adults by the method of radiobromide dilution.

Results obtained by this method compare favorably with those reported for direct chemical analysis.

Total body content of chloride is approximately 50 mEq./kg. body weight in young infants, 43 mEq./kg. in older infants, and 26 to 33 mEq./kg. in adults.

Changes in chloride content occurring during growth can be described by the use of the differential growth equation, which states that chloride content is a simple power function of body weight.

The similarity between the differential growth constants for sodium and chloride is noted.
COMMON ORTHOPEDIC PROBLEMS IN CHILDREN
Authors: Larson C. B.
Published: December 2021

Foot Problems

NORMALLY the foot functions differently in stance than it does in motion. During stance, static stresses are most important. The foot may be divided at the midtarsal joints into the hindfoot which receives 60 per cent of the weight-bearing stress and the forefoot which receives 40 per cent of the stress. The spring ligament normally transmits the stresses from hindfoot to forefoot. All degrees of foot shape and size may be natural for a particular individual. Similarly, the gait pattern of a child varies considerably within the normal range. The child should be allowed to establish his own normal gait pattern. During the toddling stages the child's shoe soles should be flexible enough to bend at the toe. One should avoid the use of rigid shoes. Some of the conditions which may alter normal stance or gait follow.

Simple Foot Strain

Long arch strain is due to abnormal stress on the longitudinal ligament. Inflammatory repair of the ligament produces pain which can be demonstrated by finding an area tender to palpation. Some patients have a depressed longitudinal arch or long spring ligament without foot symptoms. A diagnosis of long arch strain cannot be made unless tenderness is present. A tight heel cord may produce foot strain. The foot accommodates to a tight heel cord by pronation of the forefoot. To correct a tight heel cord, the child should stand away from the wall (while facing it) with the heels flat, then lean forward count to 3. Repeat 5 times twice daily.

Pronation
PÄdiatrischer Röntgenatlas: Eine Sammlung Typischer Bilder
Authors: CAFFEY JOHN
Published: December 2021

This atlas is a handsome volume of 328 pages containing 700 halftones of roentgenograms and schematic drawings. Technically the book is excellent; it is printed on very fine sheets of highly coated stock. The original roentgenograms have all been carefully cropped so that the illustrations in the book present maximal visualization of the important roentgen features. Numerous semischematic line drawings accompany many of the halftone cuts and add much to their clarity. Legends are as a rule voluminous and contain much pertinent clinical data with descriptions of the salient roentgen findings. The larger legends and introductory material to the different section are printed in a single pagewide unbroken column which makes for difficult reading.
FACTORS INFLUENCING THE SPREAD OF BETA HEMOLYTIC STREPTOCOCCAL INFECTIONS WITHIN THE FAMILY GROUP
Authors: Breese B. B. , Disney Frank A.
Published: December 2021

From this study the following conclusions can be drawn about the spread of streptococcal disease:

Approximately one-half to one-fourth of sibling contacts will develop streptococcal infection.

Less than 1 in 20 of the parents will develop streptococcal infection from a sick child.

Although in larger families there were more secondary attacks than in smaller families, the number of such attacks was roughly proportional to the number exposed, and the secondary attack rate in individuals was no higher than in smaller families.

Although the age of the primary case bore little relation to the attack rate in siblings, the age of the exposed children did seem related. Those under 2 years of age and those over 10 were least frequently attacked while the 3-and 4-year-ld children seemed most susceptible.

Cases of otitis media in the primary case seemed to be associated with a higher attack rate in siblings than any other clinical manifestation of disease.

Delay in treatment of the primary case beyond 2 days was associated with a rapidly increasing attack rate in sibling contacts.

Of the types of Group A streptococci which caused disease in the period studied, type 3 was associated with a much higher attack rate in siblings than other types.

Approximately half of the "secondary" cases occurred simultaneously, prior to, or more than 5 days after the onset of illness in the case which the physician was called to treat.
HYPERIMMUNE VACCINAL GAMMA GLOBULIN
Authors: Kempe C. Henry , Berge Trygve O. , England Beatrice
Published: December 2021

Hyperimmune vaccinal gamma globulin was prepared from the blood of 320 adult donors who showed maximal skin response to smallpox vaccination and who donated 1 pint of blood each, 4 to 6 weeks after such successful vaccination.

Hyperimmune vaccinal gamma globulin contains neutralizing antibodies in excess of those found in ordinary gamma globulin.

While with the present tests available it is not possible to accurately make a quantitative comparison, it is likely that the antibody content of hyperimmune vaccinal gamma globulin is at least threefold that of ordinary gamma globulin.

In a group of 75 individuals intimately exposed to smallpox and vaccinated after exposure, 8 cases and 3 deaths occurred. Among 56 individuals who received identical vaccination followed by prophylactic doses of hyperimmune vaccinal gamma globulin, there were 2 secondary cases, with 1 fatality.

Both groups were comparable from the standpoint of proportionate distribution of susceptible individuals and the severity of exposure to disease.

While the number of contacts in each group was too small to warrant drawing a definite conclusion, it appeared to be established in the direction of increased protection following administration of passive immunity in the form of hyperimmune vaccinal gamma globulin.

It would appear that the experience so far is encouraging enough to continue and to expand the use of hyperimmune vaccinal gamma globulin in the prophylaxis and therapy of serious dermal complications of smallpox vaccination.
CHRONIC NONSPECIFIC DIARRHEA IN INFANTS AND CHILDREN TREATED WITH DIIODOHYDROXYQUINOLINE
Authors: Cohlan Sidney Q.
Published: December 2021

In a preliminary study, 40 infants and children with chronic nonspecific diarrhea, a syndrome characterized primarily by continuous or intermittent unexplained mild diarrhea and often variously diagnosed as celiac disease, starch intolerance, or intestinal allergy, were treated with diiodohydroxyquinoline. Good responses, manifested by subsidence of diarrhea in 1 to 4 days, ability to tolerate a full diet and relief of tenesmus were observed in 29 of 40 cases treated. There were six therapeutic failures and response was equivocal in five cases. Therapeutic trials consisting of a period of response to diiodohydroxyquinoline with subsequent relapse following withdrawal of medication was observed in 24 cases with three consecutive successful trials in one patient, two trials in each of 10 patients and one trial in each of 13 patients.

A double-blind placebo study in 41 subsequent cases of chronic nonspecific diarrhea resulted in a therapeutic correlation of 53% with 22 cases responding to drug but relapsing on placebo. There were 18 failures including 12 patients who did not respond to drug or placebo, 2 patients who responded to placebo, and 4 who responded to drug but did not relapse on placebo.

The results seem to indicate that diiodohydroxyquinoline is useful as a nonspecific agent which may effect some fundamental mechanism common to nonspecific diarrheas.
THE PSYCHOLOGIC ASPECTS OF PEDIATRIC PRACTICE
Authors: Levine Milton I. , Bell Anita I.
Published: December 2021

In spite of the fact that masturbation involves almost all human beings in every culture, comparatively little has been written on the subject.

Until very recently masturbation was defined in the medical literature as a sexual perversion and a damaging activity to be prohibited at all costs.

In the beliefs of certain religious faiths masturbation is considered a sin.

The evolution of masturbatory activity as observed from infancy through adolescence is presented.

Masturbation can be understood as a "discharge phenomenon" undertaken to relieve a state of tension existing in the human body.

As the child develops he is normally subjected to increased tensions due to restrictions and frustrations forced upon him by the family and culture. Being permitted no normal outlet, he resorts to the release he has known from infancy, and has the fantasy that certain forbidden or temporarily impossible wishes take place.

The feelings of guilt, increased by parental attitudes, are associated with a fear of having damaged their sexual organs and a fear of consequent ill health.

Excessive masturbation as defined, must be viewed as a symptom of the child's unhappiness or emotional instability.

The role of the pediatrician is to explain ordinary masturbation to the parent as a normal physiologic function.

When the physician is presented with the problem of a child with excessive masturbation he should attempt to detect factors responsible for an emotional upset.
EMOTIONAL FACTORS IN THE ETIOLOGY OF COLIC IN INFANTS
Authors: Levine Milton I.
Published: December 2021

There is probably no practicing pediatrician who has not attempted to treat the so-called "colicky" baby. Changes in the formula, the type of nipple used and the size of the nipple hole, attempts at posturing the baby, giving warm water, barley water, fennel tea, sedatives, antihistamine drugs, and antispasmodics—all of these have been tried with varied degrees of success but none with spectacular success.

It is obvious from the numerous treatments advised that little is really understood as to the true etiology. Is it a reaction to some gastrointestinal allergy; is it due to poor feeding techniques, with subsequent swallowing of air; is it due to a fat or carbohydrate intolerance, or is it related to something more inherent in the physiological structure or emotional environment of the particular child?

It seems evident from the abdominal distention, the flexing of the legs, and the passage of flatus that there is undoubtedly abdominal pain. But what causes colicky babies to develop abdominal pain?

If one observes these infants he will note that in almost every instance the child can be categorized as a "hypertonic" baby. Such are the active, keyed-up infants so sharply differentiated from more relaxed and placid infants—often from birth.

These hypertonic infants react more acutely to their environment, to their unsatisfied needs or to outward stimulation. They react violently to sudden noises, they vomit and regurgitate easily, and they usually sleep shorter periods and less soundly than other infants.

On the assumption that this hypentonicity might be related to the colic, a study was instituted in 1947 in an attempt to determine: 1) if relaxation of the baby would cause a disappearance of the symptoms; 2) if there were unsatisfied emotional or physiological needs of the infant causing the child to react with increased hypertonicity and subsequent colic, and 3) if such needs were satisfied could the symptoms of colic be dispelled without resorting to other means such as formula changes, sedatives, rocking or carrying?
COMMENTS ON THE PANEL DISCUSSION OF COLIC
Authors: Ratner Bret
Published: December 2021

Dr. Glaser requested me to summarize the subject matter presented at this panel. In his opening remarks Dr. Glaser implied that the broad pediatric attitude rather than the purely allergic approach towards the subject of colic would be stressed. I do believe that this has been achieved.

It should be obvious that it is not always wise to refer a colicky baby for an allergic work-up. I am certain that if the pediatric allergist did have such an infant referred to him, he would have to muster all his general pediatric knowledge to effect the proper solution.

It appears to me that if the colicky baby has a basic allergic cause for his intestinal spasms the increased use of heat-denatured foods, such as certain of the proprietary modified cow's milk formulas, and other heat denatured milks, hard boiled eggs (in those few instances in which the infant is not sensitive to ovomucoid), either precooked cereals which are marketed today or cereals that are thoroughly cooked at home, and precooked canned foods, would have had a great influence in reducing the incidence of colic in infants. Some of this audience may not believe that the incidence of colic has been reduced.

Dr. Fries has shown in a very fine study of the intestinal tract through a roentgenographic technic that true spasms may occur in any part of the gastrointestinal tract when food to which the child is sensitive is introduced orally. He studied only older children who were proved to be sensitive by skin test.
SPECIAL ARTICLE
Authors: Minear W. L.
Published: December 2021

The majority of the members of the American Academy for Cerebral Palsy voted to exclude progressive neurological diseases and neoplastic diseases of the brain from the classification of cerebral palsy. The lesion left by the removal of a brain tumor, however, is still considered one of the etiological factors of cerebral palsy.

Cerebral palsy comprises the motor and other symptom complexes caused by a non-progressive brain lesion (or lesions).

The nomenclature and classification questionnaires indicate that the members of the American Academy for Cerebral Palsy wish to accept a motor classification, listing each type of cerebral palsy separately: Spastic, Athetoid, Tremor, Rigidity, Ataxic, Atonic, and Mixed.

The following choices as a basis for classification of cerebral palsy were made by the American Academy for Cerebral Palsy:

First choice: Motor Symptoms

Second choice: Topographic Involvement

Third choice: Etiology

Fourth choice: Anatomical Site (of lesion)

Fifth choice: Severity of Involvement

Sixth choice: Degree of Muscle Tone

Seventh choice: Supplemental Data

The first 3 choices above should be used by the medical record librarian and by doctors discharging patients with cerebral palsy from hospitals or institutions so as to establish a common understanding and uniformity to hospital records. It is understood that the neuroanatomical classification (Fourth choice) is to be used when it can be proven, but not by presumption.

The majority of the members approve of tension, non-tension, dystonic, and tremor-like types of athetosis. The other types were rejected for various reasons. Probably, some of the other types would have been accepted if understood by the members. Each type is described and defined herein. There is a general lack of agreement on the various terms used in cerebral palsy. Definitions of these terms are now being made by a committee for a meeting in 1955.

There is a good deal of evidence that neurological signs and symptoms change in the child with cerebral palsy as the nervous system matures and that one must be cautious in making a final descriptive or symptomatic diagnosis in infancy. The pattern of changing neurological symptoms from infancy through childhood should be studied.

The high cervical syndrome described by Fay is being confused with cerebral palsy. This syndrome needs further study. It should be determined whether the term cerebrospinal palsy would not be more appropriate for the entire neurological group.

The American Medical Association's Standard Nomenclature of Diseases and Operations (Fourth Edition), commonly used by medical record librarians, is not suitable for the classification of cerebral palsy. In this edition, all cerebral palsy is coded "Cerebral spastic infantile paralysis" with supplementary terms added to denote various types.

A complete classification for cerebral palsy is presented, using the majority opinion from questionnaires sent to the members of the American Academy for Cerebral Palsy during 1953 as a basis.
CYTOMEGALIC INCLUSION DISEASE
Authors: Medearis Donald N.
Published: December 2021

A brief review of the literature concerning cytomegalic inclusion disease has been presented. Representative cases from the files of The Cincinnati Children's and the Cincinnati General Hospitals have been included to demonstrate the variety of clinical pictures which may be associated with the presence of visceral inclusions of the human salivary gland virus. Analysis of the cases reviewed leads to the conclusion that there are three general syndromes associated with this disease. The clinical features of the first resemble those of severe erythroblastosis fetalis on neonatal sepsis. The second syndrome is not so clearly defined, but is most commonly characterized by chronic respiratory disease, and gastrointestinal disorders in infants beyond the newborn period. The third group consists of patients in whom the visceral inclusions probably are the result of a virus infection or dissemination due to debility from a variety of diseases.
AN APPARATUS FOR GRADING THE VISUAL ACUITY OF INFANTS ON THE BASIS OF OPTICOKINETIC NYSTAGMUS
Authors: Gorman John J. , Cogan David G. , Gellis Sydney S.
Published: December 2021

An apparatus for grading visual acuity by means of the opticokinetic response is described. Not only is the apparatus useful for determining visual acuity but it should also be of considerable value in determining the presence or absence of vision. While lack of response is not final proof of blindness, a positive response definitely indicates the presence of vision. Ninety-three of onehundred newborns 1½ hours to 5 days of age were found to perceive a pattern which when viewed at 6 in. (15 cm) corresponds to a Snellen notation of 20/670 This index may be found to be lower when the study is repeated using a full range of line patterns.
INTRACELLULAR COMPOSITION AND HOMEOSTATIC MECHANISMS IN SEVERE CHRONIC INFANTILE MALNUTRITION
Authors: Gómez Federico , Ramos-Galván Rafael , Cravioto Joaquin , Frenk Silvestre , Janeway Charles A. , Gamble James L. , Metcoff Jack
Published: December 2021

IN SPITE of recent progress in the study of severe malnutrition of dietary origin, the mortality still is very high. In the 733 cases studied by Gómez et al. the over-all mortality was 35%. The majority of deaths occurred during the first 48 hours after admission to the hospital, and the outstanding features were electrolyte disturbances associated with diarrhea and/or bronchopneumonia. Similar observations have been reported from other areas of the world.

Although the ultimate goal in the solution of the problems of malnutrition, as in any other disease, lies in prevention, or at least in earliest treatment, not enough emphasis has been given to the study of those factors responsible for the high mortality observed in this condition. Actually very little is known about the homeostatic mechanisms of children affected with severe chronic malnutrition. Water and electrolyte imbalances occurring in malnourished infants, such as attend superimposed diarrheal dehydration, usually are evaluated according to concepts derived from studies on well-nourished infants, without taking into consideration the fact that the chronically malnourished child has been abnormal for a long time before an episode of severe dehydration necessitates hospitalization.

A great variety of environmental factors play a role in chronic malnutrition but, in general, the course of the disease is more or less constant. The chronically underfed child apparently becomes adapted to his metabolic status by slowing or almost complete cessation of growth, but suffers bouts of mild diarrhea which persist for a week or two, then disappear for a period of 8 to 10 days only to reappear with increased severity. Frequently the first bout coincides with convalescence from one of the infantile exanthematous diseases.
NEEDLE BIOPSY IN CHILDREN WITH NEPHROSIS
Authors: Galán Enrique , Masó Calixto
Published: December 2021

Needle biopsy of the kidney was done in 20 children with nephrosis for estimation of degree of glomerular damage in the early stage of the disease and of its change after intensive adrenal steroid therapy.

The mean number of glomeruli per biopsy was 18.7 with a standard deviation of ±8.4 and a range of 6 to 42.

Glomerular involvement was seen in 100% of cases and in 5 to 100% of nephrons in material obtained at biopsy. Thickening of capillary basement membrane was present in 90% of cases and 32.4% of glomeruli; cellular proliferation in 65% of cases and 17.3% of glomeruli; hyalinization in 55% of cases and 8.9% of glomeruli; and fibrosis in 65% of cases and 12.8% of glomeruli.

Lesions of various types were simultaneously present in most cases, but thickening of the capillary basement membrane was the predominant one. The nephrotic syndrome was observed in cases having histologic changes similar to those described as membranous, chronic azotemic, proliferative and lobular glomerulonephritis.

Adrenal steroid therapy was given to induce a complete clinical-biochemical remission of the nephrotic syndrome. It occurred, usually but not always after the appearance of induced Cushing's syndrome, and was observed in 81.2% of children treated with adrenal steroids. Histologic improvement was observed in 90% of patients who had biopsy taken before and after therapy. Four patients of the total group (20%) showed a marked decrease of glomerular lesions.

Administration of a maintenance dose of steroid hormone was necessary for prolonging biochemical remission of the nephrotic syndrome. Administration of prednisone seemed to decrease cellular proliferation and to arrest the progress from thickening of capillary basement membrane to obliteration of the glomerular capillary.

The impression was gained that clinicalbiochemical and anatomic improvement of the nephrotic syndrome was not permanent unless spontaneous healing occurred, and that longer observation is required to evaluate the effect of prednisone.
Trembling of the Chin
Authors: GORDON HYMAN H.
Published: December 2021

Since reading the article, "Trembling of the Chin" (Pediatrics, 19:453, 1957) I have become aware of its frequency, particularly in newborns and often in crying children. One mother of an older child in a clinic for the mentally retarded supplied a better description of this manifestation, which she also had shown in childhood, when she was "mean." Her name for this condition was "Shivering Chin." I was unable to get a history of multiple occurrences in the genealogy of the families observed.
Infant Metabolism, World Health Organization
Authors: FOMON SAMUEL
Published: December 2021

This is a report of the proceedings of the World Health Organization's Seminars held in Leyden and Stockholm in October-November, 1950. The timeliness of this edited transcript of the meetings is somewhat lessened by the considerable delay in publication. Furthermore, the greater portion of the material is readily available elsewhere. The various panels concerned the metabolism of water and electrolytes, of calcium, phosphorus and vitamin D, of protein, of vitamins and of metals. Other panels dealt with basal metabolism, the use of isotopes, the evaluation of nutritive status and the metabolism of premature and full-term newborn infants.
FAMILIAL PAROXYSMAL DYSFUNCTION OF THE AUTONOMIC NERVOUS SYSTEM (A PERIODIC DISEASE), OFTEN PRECIPITATED BY EMOTIONAL STRESS
Authors: Heiner Douglas C. , Blitzer John R.
Published: December 2021

Two children and their father, currently under investigation, have displayed paroxysmal symptoms which include a rash, angioneurotic edema, severe symptoms from the gastrointestinal and urinary tracts and other evidences of dysfunction of the autonomic nervous system. Attempts at medicinal therapy failed to ameliorate the attacks.

A striking hereditary pattern is present suggesting a simple dominant type of inheritance.

Emotional factors have been found to be capable of precipitating these paroxysms which have many features in common with paroxysmal disorders described in the literature under the terms periodic peritonitis, cyclic vomiting, hereditary angioneurotic edema and "periodic disease."

It is important that careful evaluation of hereditary and emotional factors be made in all patients exhibiting recurrent symptoms of unexplained etiology. Psychiatric study and psychotherapy may offer a means to alleviate the symptoms in some of these patients.
CLINICAL CONFERENCE
Authors: Wolff James A.
Published: December 2021

Dr. Wolfe: I shall discuss two cases of methemoglobinemia which we have seen in the past 2 years produced by the application of benzocaine ointment. These are, as far as I have determined, the first reported cases of methemoglobinemia due to benzocaine (ethyl aminobenzoate), and indeed the first cases of methemoglobinemia due to the application of an ointment.

The first of these patients was admitted in 1954 at the age of 7 weeks. Birth and neonatal history were normal. Eczema began at the age of 4½ weeks. The baby was treated with a variety of ointments and dietary changes without improvement.

The infant was admitted to the Babies Hospital at 7½ weeks of age on the day the parents had been given an ointment, which they were told contained coal tar. At 7 o'clock that evening the ointment was applied widely to the baby's skin. Approximately 45 minutes later the mother heard the baby screaming. On entering the infant's room she found that the color of his skin was black. She rushed the baby to the hospital where the diagnosis of methemoglobinemia was suggested. Blood was obtained and was found to appear chocolate brown. The baby was given 3 ml of a 1% solution of methylene blue, intravenously. This brought about a prompt change in the color; within 10 minutes the baby was no longer cyanotic.

Marked tremors had been noted on admission. These continued throughout most of the evening but by the next morning had entirely disappeared. The baby was discharged home the following morning without further laboratory investigation. Neither the concentration of methemoglobin in the blood nor any other laboratory data were obtained.
SOLITARY TUBERCULOMA OF THE MEDULLA OBLONGATA
Authors: Tegeris Andrew S.
Published: December 2021

The incidence and clinical manifestations of intracranial tuberculomata are discussed, with special reference to those in the medulla oblongata.

A case of tuberculoma in the medulla is presented. The tuberculoma is believed to have resulted from hematogenous dissemination of tubercle bacilli from the right lung.

The pathogenesis, pathology, complications and course of intracranial tuberculomata are reviewed.
EXTRACORTICAL CEREBROSPINAL FLUID IN NORMAL HUMAN FETUSES
Authors: Lanman Jonathan T. , Partanen Yjrö , Ullberg Sven , Lind John
Published: December 2021

A layer of cerebrospinal fluid surrounds the developing brain of normal human fetuses. The layer was found to occupy 13 to 26% of the intracranial space. Convolutions appeared in the hemispheres while this layer was still present.

Neither growth of the skull nor the appearance of cortical convolutions is secondary to pressure from growth of the brain into a confined cranial space.
THE ISLETS OF LANGERHANS IN PANCREATIC FIBROSIS
Authors: Larsson Yngve
Published: December 2021

A survey is given of earlier views on the occurrence of diabetes and decreased glucose tolerance in cystic fibrosis of the pancreas, as well as on the structure of the islet tissue in this disease and in experimental fibrosis of the pancreas.

Intravenous glucose tolerance tests were performed in three patients with cystic fibrosis. of the pancreas, and normal glucose tolerance curves obtained.

Fibrosis of the pancreas was produced experimentally in rabbits by ligation of the pancreatic duct. In eight of nine such animals, the glucose tolerance was normal. Histologically, the pancreas exhibited total acinar atrophy, with cystic dilatation of the ducts, between which numerous small islets of Langerhans of fetal type were compressed. The general picture was similar to that seen in the fetus and in cystic fibrosis of the pancreas. Quantitative determinations of the islet volume showed a great reduction in size of the islet tissue, due chiefly to a marked decrease in area of the individual islets. The alpha-to-beta cell relations were, however, normal.

The results are discussed, and compared with those in alloxan-diabetic animals and with animals with experimentally produced hypertrophy of the pancreas. In the latter the islet tissue hypertrophies as well (Fig. 7).

The prenatal relations between the exocrine and endocrine tissues of the pancreas may also exist postnatally. The resistance to the diabetogenic effect of alloxan present in animals with the pancreatic duct ligated seems to be associated with the immature, fetal structure of the islet tissue in acinar fibrosis.
MINOR MOTOR EPILEPSY
Authors: Livingston Samuel , Eisner Victor , Pauli Lydia
Published: December 2021

The diagnosis, treatment and prognosis of minor motor epilepsy, based on study of 698 children, are discussed; 622 were followed for intervals ranging from 3 to 22 years.

Minor motor seizures begin most often between 3 and 12 months of age.

Brain damage is prominent in the general clinical manifestations of patients with minor motor epilepsy.

Hypsarhythmic abnormalities are present in the electroencephalograms of most patients.

Minor motor seizures rarely recur after 5 or 6 years of age.

These spells are exceedingly difficult to control with anticonvulsant drugs. A ketogenic diet is the most effective therapy.

The most serious aspect of minor motor epilepsy is the associated mental retardation.

Presumptive etiologic factors are discussed.
CHRONIC ASTHMA IN CHILDHOOD: DOUBLE-BLIND CONTROLLED STUDY OF TREATMENT WITH GAMMA-GLOBULIN
Authors: Abernathy Rosalind S. , Strem Edward L. , Good Robert A.
Published: December 2021

To evaluate the effect of injections of gamma-globulin upon the course of asthma, observations were made with 22 asthmatic children ranging in age from 1½ to 5½ years. They had suffered from asthma from 1 to 13 years and were selected as subjects because they had not made satisfactory improvement under allergic management over an average of 2.4 years. They were placed in two groups by random assignment, one of which received injections of gamma-globulin.

Without knowledge of the treatment being given, one author examined each child at the time of each injection and one month after the last injection. Roentgenograms, vital capacity, complete blood counts and chemical determination of the blood proteins were performed at the initial and final visits.

Fifteen of the twenty-two patients improved clinically, eight in the treatment group and seven in the control group. No significant differences between the groups were noted in the amount of asthma, physical growth, hemoglobin value or eosinophilia. The concentration of gamma-globulin in the serum increased in the treated patients. Nevertheless, there was no difference in the incidence of infection in the two groups and in both it was equal to that in a normal population.

This double-blind controlled study offers no evidence to support the view that treatment with gamma-globulin has a beneficial effect on the course of chronic asthma in children.
PUBLIC HEALTH, NURSING, MEDICAL SOCIAL WORK
Authors: James J. A.
Published: December 2021

A study has been made of the number of deaths and admissions to the hospital of similar groups of premature and full-term Negro infants between 1 and 24 months of age. About twice as many ex-prematures died or required admission to the hospital; in this population ex-prematures may account for 25% of admissions during the first 2 years of life. Lower respiratory tract infections and diarrheal disease accounted for the majority of admissions to the hospital and deaths. Illness was commoner in babies of low birth weight, and in those under 6 months of age.

It seems probable that more intensive surveillance of the premature infant after discharge from the nursery might decrease this high incidence of sickness. Special attention should be paid to the early detection and treatment of infections, which are the principal cause of major illness. Some possible lines of approach to the investigation of this problem are discussed.
STUDIES ON THE BIOCHEMISTRY OF CONNECTIVE TISSUE
Authors: Dorfman Albert
Published: December 2021

The nature and diversity of acid mucopolysaccharides of connective tissue have been discussed. It is probable that these substances play a variety of physiologic roles.

Insulin affects the rate of synthesis of acid mucopolysaccharides in skin. There is a striking decrease in concentration in the skin of diabetic animals. This is restored toward normal by the administration of insulin.

Acid mucopolysaccharides are excreted in the urine of patients with Hurler syndrome. At least two different polysaccharides are involved. The amount of each in the tissues and urine vary in different patients.
BACTERIAL ENDOCARDITIS IN CHILDREN WITH HEART DISEASE
Authors: Cutler Joseph G. , Ongley Patrick A. , Shwachman Harry , Massell Benedict F. , Nadas Alexander S.
Published: December 2021

A series of 24 cases of bacterial endocarditis occurring in younger individuals, with either congenital or rheumatic heart disease, is presented. A recovery rate of 83% was obtained.

The clinical features, bacteriology and therapy are discussed along with complicating factors arising during therapy.

In the group with cyanotic congenital heart disease, bacterial endocarditis occurred most commonly in those with tetralogy of Fallot. In the acyanotic group there was a slight predominance of those with ventricular septal defect and coarctation of the aorta. In the patients with rheumatic heart disease, mitral insufficiency was the predominant lesion.
CONGENITAL SUBGLOTTIC HEMANGIOMAS OF THE LARYNX AND TRACHEA IN INFANTS
Authors: Campbell J. S. , Wiglesworth F. W. , Latarroca Rocco , Wilde Henry
Published: December 2021

Our experience with five cases of congenital subglottic hemangioma is amplified by a review of 14 previously reported cases. The 19 patients were all less than 1 year of age, and 12 of them were girls. All showed evidence of laryngeal obstruction, which was usually episodic and usually sufficiently severe to require tracheotomy. Detection of subglottic stenosis by roentgenographic, laryngoscopic or bronchoscopic examinations permitted clinical diagnosis to be made in 11 cases, in 7 of which recovery or clinical improvement was attained by roentgen or radium therapy, or by surgical excision of the lesion. Twelve patients died: death resulted from asphyxia in eight cases that were undiagnosed or misdiagnosed clinically. Since subglottic hemangiomas have been overlooked at gross post-mortem examination of the larynx, histologic examination of the subglottic region is advocated as a routine necropsy procedure in cases of unexplained death in infancy.
Genetics of Chondroectodermal Dysplasia
Authors: METRAKOS JULIUS D. , FRASER F. CLARKE
Published: December 2021

We read with great interest the two excellent case histories of chondroectodermal dysplasia (Ellis-van Creveld syndrome) that were reported recently by Smith and Hand (Pediatrics, 21:298, 1958). We must take issue, however, with the conclusion that "The statistical probability of siblings having the complete tetrad of defects is rather remote...." This conclusion appears to be based on the assumptions that the four members of the tetrad (chondrodysplasia, ectodermal dysplasia, polydactylism and congenital heart disease) are caused by four different genes, and that the characteristic association of abnormalities to form a syndrome is due to linkage.
PRIMARY XANTHOMA TUBEROSUM IN CHILDREN
Authors: McCleary Jack E. , Brunsting Louis A. , Kennedy Roger L. J.
Published: December 2021

A brief classification of xanthomatoses is presented. In an attempt to remove some of the confusion contributed by the several different meanings for the term "hyperlipemia," the term "hyperneutralipemia" is introduced to indicate an elevation of the concentrations of neutral fat in the serum. The term "hyperlipemia" is retained to mean an elevation of values for any of the blood lipids. The term "primary xanthoma tuberosum" designates the classic idiopathic form of xanthoma tuberosum associated with hypercholesteremia and without hyperneutralipemia.

The primary purpose of this paper is to review the outcome of 11 cases of primary xanthoma tuberosum in children seen at the Mayo Clinic. Five of the eleven are known to be dead from cardiovascular disease, and one other is presumed to be dead. In five of the six patients angina pectoris developed before death. Two patients who are still living have angina pectoris, one having suffered myocardial infarction.

Necropsy of four patients showed atheromatous involvement of the coronary blood vessels to be a prominent finding. Three of the patients died before they reached the age of 15 years.

Two of the patients were brother and sister. Of the remaining nine patients, four gave a family history of cardiac disease occurring in a close relative early in life and five patients had relatives with cutaneous xanthomas. In the one family studied, all five members had hypercholestenemia.
ABSENT SPLEEN SYNDROME
Authors: Polhemus Donald W. , Schafer William B.
Published: December 2021

The syndrome of congenital absence of the spleen with atrioventricularis communis and partial transposition of the abdominal viscera is briefly discussed. Because of absence of the spleen, these patients have been found to exhibit specific abnormalities of peripheral blood, namely, normoblastemia and Howell-Jolly bodies and Heinz bodies in the erythrocytes. A case is presented illustrating the method of making a diagnosis based upon the hematologic findings.
CHEMICAL MICROANALYSIS: ANALYSIS OF CAPILLARY AND VENOUS BLOOD
Authors: Kaplan S. A. , Yuceoglu A. M. , Strauss J.
Published: December 2021

The concentrations of cholesterol, chloride, sodium, potassium, urea, calcium, phosphorus, total protein, albumin and glucose were measured in plasma obtained from capillary and venous blood collected nearly simultaneously from the same subject. With the exception of glucose, there was no difference in the concentrations of any of these substances between capillary and venous blood.
Hazard to Newborn Infants of Administration of Long-acting Sulfonamides to Pregnant Women
Authors: LUCEY JEROLD F. , DRISCOLL TIMOTHY J.
Published: December 2021

Recently there have appeared on the market several new long-acting sulfonamides. One of these is sulfadimethoxine (Madribon®). It is reported to have low toxicity and a sustained chemotherapeutic action in vivo. After oral ingestion, blood levels in the human adult have been shown to be maximal in 4 to 12 hours, and to decline gradually thereafter with a half-life of 36 hours. This sustained blood level occurs because the excretion of sulfadimethoxine is determined primarily by its rate of conversion to a glucuronide in the liver.