bluuebunny/crossref_metadata_2025 huggingface dataset:
SPECIAL ARTICLE
Authors: Sapin Samuel O. , Donoso Ephraim , Braunwald Eugene , Grishman Arthur
Published: December 2021

Vectorcardiography is a method of graphically registering the total electrical activity of the heart and presents this in 3 dimensions.

The technique of obtaining vectorcardiograms and the determination of the electrocardiogram from the vector loop are discussed in a simplified manner.

The characteristics of normal and abnormal vectorcardiograms in infants, children and adults are presented.

Electrocardiograms in different conditions, e.g. conduction delay, right ventricular hypertrophy and normal variants may be indistinguishable, particularly in infancy. However, the vectorcardiogram clearly differentiates these entities.

The diagnostic accuracy of the electrocardiogram and vectorcardiogram was compared in a series of patients with unilateral ventricular hypertrophy due to congenital heart disease. The vectorcardiogram was superior to the electrocardiogram in diagnosing unilateral right ventricular hypertrophy as well as left ventricular hypertrophy. However, both the electrocardiogram and the vectorcardiogram are of greater value in detecting right than left ventricular hypertrophy.

The absence of right ventricular hypertrophy in the vectorcardiogram militates strongly against the existence of predominant right ventricular hypertrophy.

Axis deviation in the standard leads as a result of the vectorcardiographic studies is considered to be of little diagnostic importance.

The chief contribution of the vectorcardiogram in congenital heart disease is in the determination of the type of predominant ventricular hypertrophy and this renders it a most valuable addition to the diagnostic tools available in this field.
ACUTE HEMATOGENOUS OSTEOMYELITIS
Authors: Green Morris , Nyhan William L. , Fousek Mildred D.
Published: December 2021

The clinical records of 99 infants and children admitted to the Grace-New Haven Community Hospital with acute hematogenous osteomyelitis are reviewed.

The presenting symptomatology and physical findings are discussed. Detection of localized tenderness is the most significant early clinical sign. This was not, however, a common finding at the time of admission.

The diagnoses entertained in these patients at the time of admission are reviewed and the differential diagnosis is discussed.

The distribution of the bony lesions was similar to that noted by other authors. However, attention is called to the frequent involvement of the bony pelvis.

A specific bacteriologic diagnosis was made in 87 per cent of the patients. In 63 per cent staphylococcus was the etiologic agent. Beta-hemolytic streptococcus was considered the etiologic agent in 18 per cent. Staphylococcus was the most frequent offender in all age groups. In infants less than 2 years of age osteomyelitis was streptococcal in 27 per cent.

The average interval from the onset of symptoms to the development of positive roentgenographic signs was 10 days. The range was 3 to 17 days.

In treatment of patients suspected of having osteomyelitis, vigorous antibiotic therapy should be continued until at least 3 weeks have elapsed since the onset of symptoms. If at the end of that period roentgenograms remain normal and clinical signs and symptoms have been absent for at least 1 week, it would seem safe to discontinue treatment.

A detailed program for medical therapy is Presented and the indications for surgery are considered. Emphasis is placed on vigorous search for the infecting organism. The necessity for intensive treatment given over an extended period of time is stressed.
CONGENITAL INTRAHEPATIC BILIARY ATRESIA
Authors: Sass-Kortsak Andrew , Bowden Drummond H. , Brown Roderick J. K.
Published: December 2021

It seems that there are certain clinical and laboratory findings which may suggest the diagnosis of intrahepatic biliary atresia. This diagnosis should be considered when all incompletely obstructive, chronic, fluctuating jaundice is present in an infant who is otherwise healthy. Pronounced elevation of serum lipids, especially the neutral fat fraction, and dissociated changes in tests relative to biliary obstruction, should be regarded as further suggestive evidence. These features may be encountered as early as 2 to 3 months of age, as demonstrated in the present case.

There is not enough evidence at the present time to suggest that the above features, or a combination of them are specific for intrahepatic biliary atresia. Likewise, there is not enough evidence that the absence of these features excludes the diagnosis. The findings in the present case, and those in the previous reports on this condition, would rather serve to stress the importance of detailed investigation of infants suffering from an obstructive jaundice and the need for follow-up studies with tests repeated at regular intervals.

A tentative diagnosis of intrahepatic biliary atresia is probably justified when the above criteria are fulfilled, but a definitive diagnosis is dependent on examination of a representative biopsy specimen.
IDIOPATHIC HYPOPARATHYROIDISM
Authors: Harrison Harold E.
Published: December 2021

IDIOPATHIC hypoparathyroidism is one of the rarer abnormalities of endocrine function in childhood. For that reason it may be missed on occasion because it is not considered among the diagnostic possibilities. There have been 6 cases of idiopathic hypoparathyroidism seen at the Harriet Lane during the past 10 years and the youngest child of this series was 17 months when admitted. This child's symptoms may have begun in the neonatal period and this may be true of other children with hypoparathyroidism. An apparently authenticated case of congenital hypoparathyroidism has been reported by Rhyne and also by Calcagno and Rubin. The etiology of this disease is completely obscure. There is ordinarily no story of multiple cases in families, except for a group of cases in which there has been a strange combination of moniliasis, hypoparathyroidism and in some instances adrenal insufficiency. The possibility that severe moniliasis may produce toxic injury to parathyroid and adrenal glands has been suggested, as has been the converse notion that the spread of monilia infections is facilitated by the biochemical disturbances of hypoparathyroidism. Among the 6 cases in our series only 1 has shown obvious moniliasis and this has not been of the extraordinarily severe degree reported in the literature.

Some type of seizure either focal or generalized is the usual manifestation which brings the child to the physician. The seizures may persist for several years without becoming more severe and may be treated as epilepsy. One of the patients in this series was admitted at the age of 15 years.
ACTIVE IMMUNIZATION WITH INFLUENZA VIRUS A AND B IN INFANTS AND CHILDREN
Authors: Glazier Manuel M. , Benenson A. S. , Wheeler Ralph E.
Published: December 2021

With the aim of finding a method of influenza virus A and B vaccination with maximal antibody response and minimal untoward reaction, a wide range of dosage and other variations in method were tested among 614 unselected children, of which 110 were studied serologically.

Systemic reactions occurred in 22.8 per cent of the children following 1 or more injections and were severe in 9.2 per cent. Reactions were not related to family or individual history of allergy, sex or bodytype structure. Reactions did occur more often and more severely in the very young when the same dosage of vaccine per kg. of body weight was given. Moreover, at different ages systemic reactions were more frequent and more severe when larger doses of vaccine per kg. of body weight were given.

No differences in serologic response were found in children who had systemic reactions to the vaccine and those who had none.

Serologic response was good even among those children who received the minimum amounts of vaccine per kg. of body weight.

The results suggest that primary vaccination is fairly effective with a single small injection of 0.1 ml. vaccine, intradermally, or 0.2 ml. vaccine, subcutaneously. An even higher and more rapid response in antibody titer is probable when 2 small (0.1 ml.) injections of vaccine are given a week apart. There is no higher rise in blood titer of antibody when the primary vaccination is accomplished by a larger dose (0.6 ml. or 0.7 ml.) following a smaller initial dose.

A booster dose, whether in a small amount (0.1 ml.) or a larger amount (1.0 ml.) and given 3 to 7 months after the primary vaccination, resulted in a similar favorable rise in titer among the groups which had been given various amounts for primary vaccination.

The elevated titer in vaccinated children persisted above the preimmunization levels for 12 to 18 months.
DIABETES IN CHILDREN
Authors: Read Charles H. , Baer Paul E.
Published: December 2021

EMPHASIS was placed on the primary objective of the physician in planning a therapeutic program for children with diabetes; the promotion of normal growth and development, including intellectual, moral, and social areas. To attain this objective, the physician must provide maximal simplification in his therapeutic plan, so that the pattern of life of the child with diabetes will deviate as little as possible from that of his normal contemporaries.

The relationship between level of "control" of diabetes (i.e., approximation to normoglycemia and aglycosuria) and the age of onset of the degenerative changes associated with this disease assumes paramount importance in governing the degree of simplification which can be safely permitted in any therapeutic program. While stressing the fact that such complications ultimately occur no matter what plan of management is pursued, and viewing the evidence on the true relationship between "control" and the appearance of degenerative changes as not yet entirely clear, Read nevertheless considers that all published experimental and clinical studies indicate that better "control" is directly correlated with later onset of degenerative lesions. He therefore believes that the aim of therapy should be to promote an essentially normoglycemic, aglycosuric state, with less than 5 per cent of the daily carbohydrate intake appearing in the urine.

With these objectives in mind, Read and Baer described the plan which they currently employ in the treatment of 110 diabetic children at the State University of Iowa, where an average of 1 new diabetic is admitted every 3 weeks. As they practice in a hospital center, they serve on a consultative basis, receiving patients by referral from doctors throughout Iowa. This means initiating regulation of the diabetes and subsequently re-evaluating progress by means of clinic visits 1 to 5 times yearly, at the discretion of the referring physicians.
THALASSEMIA-HEMOGLOBIN C DISEASE IN WHITE SIBLINGS
Authors: Erlandson Marion , Smith Carl H. , Schulman Irving
Published: December 2021

Two white sisters of Italian parentage in whom thalassemia-hemoglobin C disease was found, have been presented. This is the third report of such cases and the first in white individuals. This disease produces a microcytic anemia which is usually mild but which may be severe. Splenomegaly may or may not be present.

The presence of large numbers of both microspherocytes and target cells in the blood smear should suggest the possibility of this diagnosis. Confirmatory evidence is found in studies of the blood of family members.
Erythroblastosis Fetalis
Authors: ALLEN FRED H.
Published: December 2021

I should like to comment on the conclusions of Giblett, Varela, and Finch (Pediatrics, 17:37, 1955), which appeared to me to be poorly founded. Their reasoning is based on the assumption that a 2-week-old infant with a hemoglobin level between 6 and 8 gm. is suffering from anoxia to the extent that he should normally be producing red cells at a rapid rate. I doubt that this assumption is correct, even in part, and they have presented no data on nonerytroblastotic infants to support it.
Growth at Adolescence
Authors: GALLAGHER J. ROSWELL
Published: December 2021

Tanner need offer no apologies for this excellent book, which so clearly describes the changes in bodily form and function which occur during adolescence. We are in his debt for a succinct review of the major aspects of the physiologic changes of adolescence, clear illustrative material, hints for needed research and a bibliography which will prove invaluable to anyone interested in this field.

The phenomena of physical growth, its orderlines and its variability, are described in detail.
VASCULAR HEMOPHILIA
Authors: Schulman Irving , Smith Carl H. , Erlandson Marion , Fort Eleanor , Lee Richard E.
Published: December 2021

The coagulation and vascular aspects of the von Willebrand syndrome have been studied in seven children.

Six of the children demonstrated a severe defect in the coagulation mechanism which was found to result from a marked deficiency in antihemophilic globulin. The latter deficiency was found in boys and girls, was familial, and apparently occurred in a manner distinct from the sex-linked recessive inheritance of classical hemophilia.

Morphologic capillary abnormalities were noted in the nail-beds of the fingers and in the bulbar conjunctivae of children with and without associated deficiency of antihemophilic globulin.

Administration of fresh plasma resulted in correction of both bleeding time and coagulation defects in a patient with the combined vascular-coagulation abnormality.

The vascular abnormality was found to be independent of deficiency of antihemophilic globulin or any of the known platelet factors.

Classification of the von Willebrand syndrome into at least two groups was recommended: patients with vascular defect plus AHG deficiency (vascular hemophilia), and patients with vascular defect and normal coagulation status (pseudohemophilia).
PRACTICAL TECHNIQUES OF OBSERVING, INTERVIEWING AND ADVISING PARENTS IN PEDIATRIC PRACTICE AS DEMONSTRATED IN AN ATTITUDE STUDY PROJECT
Authors: Korsch Barbara Maria
Published: December 2021

None of the material presented in the Attitude Study Project and outlined here represents completely original observations or basically new techniques. The material is presented as an aggregate of observations, techniques and experiences from different sources which have been found helpful to pediatricians in re-evaluating the psychological content of their day-to-day contacts with patients. Emphasis is on techniques of observation, interviewing and giving advice and reassurance that may enable the physician to function more satisfactorily in relation to his patients without requiring study or modification of the basic unconscious processes operating in the patient and the physician. This emphasis is selected for practical reasons such as the limitation of time for individual patient visits in pediatric practice, the insufficient number of trained psychiatrists in the community and the limited psychiatric training available to the majority of pediatricians. It is realized that ideally any emotional problem deserves to be considered more intensively with attention to the unconscious processes and basic relationships involved. But, it has been observed that increased skill of observation and improved techniques in interviewing patients as well as the acquisition of information and knowledge in the field of child development and family relationships contribute toward the pediatrician's interest in these portions of his subject and in some cases also help in improving his basic attitudes and relationship with his patients.
Ears to Hear, Advisory Committee on Hearing Conservation and Rehabilitation. Chicago, Commission for Handicapped Children
Authors: DENHOFF ERIC
Published: December 2021

Ears to Hear, a guide for the development of hearing conservation programs in local communities, published by the State of Illinois Commission for Handicapped Children, Advisory Committee on Hearing Conservation and Rehabilitation, outlines the steps necessary to achieve a complete hearing conservation program. The organization, consultation techniques, personnel, standards, and plans for medical, educational and social follow-up are discussed. Facilities in the State of Illinois for the diagnosis and treatment of hearing programs are enumerated.
You and Your Child
Authors: BYERS RANDOLPH K.
Published: December 2021

Dr. De Kok's book is a very comfortable discussion of the relations between mother, father, and a baby throughout the early years of life.

Its greatest strength, it seems to me, is the pointing out of the fact that all of the processes of growing up and education in the home and in school form a continuum in which a developmental pattern can be discerned. For instance, her chapter on sex education points out that sex education is not something that can abruptly be given by a parent at a certain age, but that sex education begins with the adorning consciousness of the child himself and continues until sexual maturity needing here and there a little guidance and a little information from home rather than an abrupt lecture on "the facts of life."
INCIDENCE OF ABNORMAL URINARY FINDINGS IN CHILDREN EXPOSED TO THE ATOMIC BOMB IN HIROSHIMA
Authors: Sullivan Margaret P. , Takahashi Yasushi
Published: December 2021

Urinary abnormalities have been studied in 2,031 boys (1,039 exposed, 992 control) and 1,963 girls (985 exposed, 978 control) in Hiroshima, Japan, as a part of the continuing medical survey being carried on by the Atomic Bomb Casualty Commission from 1951 through 1953.

A history of nephritis was given by .28% of exposed boys, .49% of control boys, .20% of exposed girls, and .20% of control girls. Isolated abnormalities were found in 2.3% of exposed boys, 1.9% of control boys, 3.8% of exposed girls and 2.6% of control girls. Brief, transitory urinary changes without further evidence of urinary tract disease were found in 1.3% of exposed boys, .91% of control boys, 1.2% of exposed girls and .81% of control girls. Abnormalities were present for as long as 1 year in .48% of exposed boys, .40% of control boys, .81% of exposed girls, and .72% of control girls. There was no evidence of permanent damage in the 22 children in this group of 24 with adequate follow-up studies. Chronic renal disease, active or inactive, was suspected in .48% of exposed boys, .60% of control boys, 1.8% of exposed girls and 1.0% of control girls who showed urine abnormalities for longer than 1 year.

Case summaries have been presented in relation to six exposed children with histories of nephritis or with albuminuria and hematuria who had experienced one or more of the major radiation symptoms after the bombing.

There was no statistical difference in the incidence of nephritis or urinary abnormalities of a serious nature between the exposed and control groups. There was no statistical difference in the incidence of major radiation symptoms when the entire exposed group was compared with exposed children showing urinary findings of a serious nature.

The above data should be considered a progress report. The urinary findings in this study group should be reviewed in the future to determine whether or not renal damage has occurred in children exposed to the atomic bomb in Hiroshima.
PROPHYLAXIS OF THE ACUTE ASTHMATIC ATTACK IN INFANTS AND CHILDREN BY THE USE OF SYMPTOMATIC MEDICATION
Authors: Glaser Jerome , Smelzer Marilyn F.
Published: December 2021

A highly satisfactory method of aborting on reducing the incidence and severity of most asthmatic attacks in infants and children is presented.

The modus operandi is discussed.
VARYING DEVELOPMENTAL MECHANISMS IN TERATOLOGY
Authors: Patten Bradley M.
Published: December 2021

The great variety of developmental mechanisms which may be involved in the genesis of abnormalities is emphasized. The following examples are presented: Too little growth; too little resorption; too much resorption; a resorptive process normal in character but occurring in an abnormal location; a growth process normal in character but occurring in an abnormal location and, finally, too much growth of some particular structure or tissue. With this variety of developmental mechanisms involved, the futility of expecting to find any blanket cause of congenital defects should be self-evident. Moreover, one would not expect to find the various causative factors even in the same category.

See figure in the PDF.file

In cases of too little growth, i.e., cases of the "developmental arrest" type, one would naturally look for deficiency factors, or for inhibiting factors-genetic or environmental.

In the case of too much or too little resorption as a secondary moulding process, or with growth or resorptive processes out of their normal territory, one would look for regulatory factors. So, also, with disturbances in timing, which were not discussed but which I believe we will find of great importance when we know more accurately the rate at which critical developmental process should normally progress.

See figure in the PDF.file

Finally, especial emphasis is placed on defects involving the overproduction of a tissue, or a structure, because the factors which might cause overgrowth must be of a different nature than the inhibiting or deficiency factors we have so long been accustomed to emphasize.

See figure in the PDF.file

I feel certain that in other papers in this conference there will be stressing of the multiplicity of etiologic factors, as well as similar emphasis on the variety of developmental mechanisms involved. I believe that we shall gain the conviction that each type of defect and each possible etiologic factor must be intensively studied on an individual basis if we are to make sound progress instead of bogging down in a morass of vague generalizations.
IS THERE SPECIFICITY OF ACTION IN EXPERIMENTAL TERATOGENESIS?
Authors: Wilson James G.
Published: December 2021

Time-specificity has been well established in numerous experiments in which a teratogenic agent has been shown to cause different malformations when applied at different times in development. These time-specific effects are related to definite stages or events in embryonic development which might be regarded as periods of special susceptibility. Excessive doses tend to obscure time-specificity by causing teratogenic effects at times other than during periods of special susceptibility.

Recent experiments have indicated that, irrespective of time, many teratogenic agents seem to produce distinctive patterns of anomalies which differ qualitatively and quantitatively from those caused by other agents. The association of a particular group of malformations with a particular agent may be termed agent-specificity.

Agent-specificity is not always readily apparent for reasons such as: a) elimination of certain types of abnormalities by fetal death of affected individuals, b) fluctuations in the pattern resulting from variations in dosage of the agent, c) variable reactions to the same agent in different species or even different strains, and d) varying interests and methods of study on the part of the investigator. When due allowance is made for such variables, distinctive patterns of malformations can often be associated with particular teratogenic agents.

Although mechanisms of agent-specificity were not discussed in detail, it was suggested that each agent acts by interfering with a particular metabolic process in a specific way in the differentiating and growing embryo. Such action can be localized, generalized or selectively distributed, depending on the distribution within the embryo of the process concerned.
EXPERIMENTAL PRODUCTION OF CONGENITAL CLEFT PALATE: GENETIC AND ENVIRONMENTAL FACTORS
Authors: Fraser F. Clarke , Walker B. E. , Trasler Daphne G.
Published: December 2021

Experimental studies and theoretic considerations on the problem of palate closure and the ways it may fail have led to the following conclusions:

The process of palate closure involves the delicate integration of a number of processes, each under the influence of genetic and environmental factors. These processes include the building up of a force within the palatine shelves enabling them to overcome the resistance of the tongue and meet in the mid-line, provided the width of the head and the width of the shelves are appropriate.

The process of palate closure can go wrong in a number of ways, each of which may result in a cleft palate: (a) the intrinsic shelf force may be impaired, e.g., by fetal and maternal genes and by cortisone; (b) the resistance of the tongue may be increased, e.g., by the mechanical stresses on the embryo following amniotic puncture; (c) the head may be too wide to allow the palatine shelves to meet in the mid-line; (d) the shelves may be too narrow to meet in the mid-line.

Obviously it is useless to argue about whether cleft palates are genetically or environmentally determined, or to attempt to find any one cause or cure that will account for all of them. Nevertheless our efforts to clarify the situation are justified, as each etiological factor that is understood may allow some reduction in the frequency of this defect.
ACUTE PANCREATITIS IN CHILDREN
Authors: Blumenstock David A. , Mithoefer James , Santulli Thomas V.
Published: December 2021

Four cases of acute pancreatitis in children are presented. Thirty-six cases reported in the literature are briefly reviewed.

The diagnosis of acute pancreatitis is rarely made in children before operation or necropsy because the disease is confused with the more frequent causes of abdominal pain and vomiting in this age group. However, the clinical history and abdominal signs may be suggestive of acute pancreatitis. The diagnosis can be confirmed by demonstrating elevation of the concentration of amylase in the serum, provided mumps is not present.

In contrast to adult patients, acute pancreatitis in children is seldom related to disease of the biliary system.

Acute pancreatitis in children may be produced by trauma, acute infection and mechanical obstruction of the pancreatic ducts by round worms. The etiology of the majority of cases, however, remains unknown.

The complications of acute pancreatitis in children include diabetes mellitus, retroperitoneal hemorrhage, pseudocyst formation and hypocalcemic tetany.

Treatment of uncomplicated acute pancreatitis should be conservative if the diagnosis can be made without operation.
MAST CELL LEUKEMIA PRESENTING AS URTICARIA PIGMENTOSA
Authors: Waters William J. , Lacson Perpetua S.
Published: December 2021

The concept of "urticaria pigmentosa" as a benign dermatologic syndrome needs revision. Generalized organ involvement may be present and in this case, with demonstration of the tissue mast cells in the peripheral blood and bone marrow, we chose to classify it as a form of leukemia.

The differentiation between tissue mast cells and blood basophils is emphasized.

Post-mortem examination revealed generalized infiltration of the body organs with tissue mast cells.

"Heparin" and histamine determinations on frozen, post-mortem specimens of liver showed a concentration of approximately 100-times normal.

Tissue mast cells were demonstrated in the peripheral blood.

The factors associated with the hemorhagic diathesis are reviewed.
STUDIES OF THE PHARYNX
Authors: Bosma James F.
Published: December 2021

Performance of the hypopharynx was observed clinically and roentgenographically during oropharyngeal inflation, phonation, and swallow in a group of 20 normal subjects and 27 patients recovered incompletely from bulbar-pharyngeal poliomyelitis.

The varied disabilities of motor performance of the hypopharynx resulting from poliomyelitis have been classified, with indication of the particular muscular paralyses causing certain of these entities of disability.

Recent contributions to physiologic and clinical understanding of the motor event of swallow are reviewed. The total failure of swallow in poliomyelitis is not completely explained by familiar paralytic phenomena and possible alternative explanations of contracture or sclerosis of the sphincter muscles, distortions of afferent elements of the swallow reflex, disability of a swallow center, or of functional impairment must be considered.
SYSTEMIC LUPUS ERYTHEMATOSUS AND SYNDROMES POSSIBLY RELATED
Authors: Ogryzlo M. A. , Smythe H. A.
Published: December 2021

Attention is drawn to the difficulties that may be encountered in the positive identification and classification of many patients suspected of suffering from systemic lupus erythematosus. Much of this is due to a lack of specific criteria, either clinical or pathologic, for the diagnosis of the disease. The problem has been made more difficult by the recognition of a number of other syndromes that bear a superficial resemblance to systemic lupus erythematosus, yet differ in clinical manifestations, natural course, prognosis and other respects.

A feature common to the group is the presence of the L.E. cell phenomenon. The related conditions differ from lupus enythematosus in that the L.E. phenomenon may only be demonstrable intermittently especially during severe exacerbations of the disease, while at the same time disturbances in the electrophoretic pattern of the serum proteins may be much more profound.

In systemic rheumatoid disease the prognosis without steroid therapy is better than in systemic lupus erythematosus, although the morbidity may be great.

The reactions which follow administration of certain chemotherapeutic agents are of considerable interest, particularly in view of the similarity to lupus erythematosus and rheumatoid arthritis, and the reversibility on withdrawal of the offending agent.

The relationship of these syndromes to each other and to classical systemic lupus erythematosus has not yet been resolved, and inclusion of them under the diagnosis of systemic lupus erythematosus at this time must be regarded as premature.
CYSTIC FIBROSIS OF THE PANCREAS
Authors: di Sant'Agnese Paul A. , Lowe Charles Upton
Published: December 2021

IN THE COURSE of a review of all features of the disease, the following points were particularly noteworthy:

Incidence

This disease accounts for almost all cases of pancreatic insufficiency in children. The incidence in the population of the United States is between 1 in 600 and 1 in 10,000 live births, with a probable average incidence of 1 in 2,500. There is no sex predominance. There is, however, a difference in racial predilection, being rarely seen in the Negro and never in Mongolians. It is a familial disease, displaying the characteristics of a mendelian recessive gene. This means that in an affected family the disease may occur in approximately 25% of the offspring, that both parents must be carriers of the trait and that two-thirds of the non-affected children are also carriers. Birth order has no effect on the inheritance of this disease. The fact that it is usually a lethal disease indicates that the mutation rate for this gene must be very high; the frequency of the single gene in the population has been calculated to be approximately 1 in 50.

Pancreatic Insufficiency

Clinical evidence of poor digestion and absorption of protein and fat is seen in the increased quantities of these substances in the feces, which causes the feces to be bulky, foul smelling, foamy and greasy. Another clinical effect of malabsorption is seen in the failure of the newborn infant with cystic fibrosis of the pancreas to regain birth weight in the first 10 days of life. In the absence of other evidence of disease, this is a sign suggestive of pancreatic failure.
Bloxsom Air Lock
Authors: BLOXSOM ALLAN
Published: December 2021

It is needless to state that I was disappointed with the conclusions of the article by Reichelderfer and Nitowsky (Pediatrics 18:918, 1956). A careful scrutiny of the article shows three major discrepancies. One of the discrepancies is in the length of treatment I have advocated in the air lock, and the other two point up the fact that in the groups studied both ends fail to make provision for the effect of immaturity (or maturity) on the survival rate of the premature infant.
Letters to the Editor
Authors: REICHELDERFER THOMAS E. , NITOWSKY HAROLD M.
Published: December 2021

We appreciate the opportunity of responding to the betters of Dr. Allan Bloxsom and Dr. R. B. Tudor, and we would like to make the following comments:

First, concerning the duration of exposure of infants in the air lock, this was selected because of three factors. The first of these was the experience cited in Bloxsom's report on the use of the air lock (J.A.M.A., 146:1120, 1951) where 98% of a group of 50 full-term infants and 58% of 50 premature infants (not 44%, as noted in his letter) who required resuscitation were kept in the air lock for 12 hours or less.
Letters to the Editor
Authors: QUICK ARMAND J.
Published: December 2021

I wish to call your attention to a matter concerning the article of Fresh et al., "Blood Prothrombin, Proconvertin and Proaccelerin in Normal Infancy: Questionable Relationships of Vitamin K" which appeared in Pediatrics (19:241, 1957). On page 248 the following statement occurs: "Notwithstanding the insufficiently substantiated claims of Quick et al., that the simple `prothrombin time' determination is uninfluenced by an excess of factor V or factor VII,...."

I consider such a statement inexcusable. While they could have said that "we regard the claims to be insufficiently substantiated, etc.," they made their statement to appear as a fact, which is not justified.
Letters to the Editor
Authors: FRESH JAMES W.
Published: December 2021

Thank you for the opportunity to see the letter from Dr. Quick. I consider the question (Whether the one-stage prothrombin determination, as was described by Dr. Quick and his associates, is affected by two or three times the normal amount of proacclerin in the presence of a deficiency of prothrombin, in the ranges that occur in the plasma of most newborn babies?) is answered. It certainly is affected, and anyone who wishes to repeat our work with our methods is free to do so.
Schönlein-Henoch Syndrome
Authors: GLASER JEROME
Published: December 2021

The increased incidence of the Schönlein-Henoch syndrome in recent years has been commented upon by Diamond and Rubin (discussion, Am. J. Dis. Child., 90:544, 1955) and more recently by Derham and Rogerson (Arch. Dis. Childhood, 31:364, 1956). The latter authors suggest that this may be more apparent than real due to the interest aroused by Gairdner's valuable and exceedingly well written paper (Quart. J. Med., 17:95, 1948).

From the standpoint of the allergist another explanation which appears to be very logical may be offered which would account for an actual increase in the incidence of this disease.
Statistics
Authors: DAY RICHARD
Published: December 2021

I wonder if it would be worthwhile to call the attention of readers of Pediatrics to an error which is made from time to time in the statistical analysis of clinical data, and which has escaped the eyes of editors more than once.

The error arises when an investigator has a large mass of facts, a punch card machine but no hypothesis. To illustrate, consider a clinical survey in which 100 different relationships are tested by the chi-square method.
Sweat Test for Cystic Fibrosis of the Pancreas
Authors: KUSHNICK THEODORE , BOFFA JOHN A.
Published: December 2021

Following Barbero's report (Pediatrics, 18:189, 1956) concerning a simplified sweat test for the diagnosis of cystic fibrosis of the pancreas, it occurred to us that an even simpler modification might make the test available in small communities. With the aid of a private clinical laboratory (Elizabeth Biochemical Laboratory, Elizabeth, N.J.), Barbero's tube test was modified so that it might be done in the patient's home as well as in the hospital.

Method

The patient's back is thoroughly washed with soap and water, followed by thorough rinsing with tap water.
Congenital Anomalies of the Viscera
Authors: WARKANY JOSEF
Published: December 2021

This concise pathologic embryology appears at a time when pediatricians and many other medical specialists are showing an increased interest in congenital malformations and their origin. While most textbooks of embryology deal chiefly with normal development and treat malformations briefly, the presentation is reversed in this volume. Dr. Bremer, Hersey Professor of Anatomy, Emeritus, at Harvard University, who has been associated with the Boston Children's Hospital for many years, is an authority on normal and abnormal human embryology.
A Developmental Questionnaire for Infants Forty Weeks of Age: An Evaluation
Authors: STITT PAULINE G.
Published: December 2021

This monograph is a detailed evaluation of a developmental questionnaire intended for use as a screening device to recognize abnormal behavioral development in infancy. It was one part of a long-term multiphasic study of premature infants, being conducted at the Johns Hopkins University School of Hygiene and Public Health, under the direction of Dr. Paul Harper.

The questionnaire used was based on Gesell's Developmental schedules and his thesis that functional tests of behavior can define central nervous system maturity and integrity.
The Rochester Regional Council
Authors: LESSER ARTHUR J.
Published: December 2021

This book is the report of an evaluative study of the objectives, operations and experience of the Rochester Regional Hospital Council which was established in 1946. A description is given of an area of service, how the Council is organized, its responsibilities and relationships with other agencies in the region, the Council's programs of education, research and hospital advisory services and the participation of the Council in regional hospital planning and construction. The authors give an evaluation of the program and devote a chapter to suggestions for its further development.
Die Pflege des Gesunden und des Kranken Kindes (The Care of the Healthy and the Ill Child)
Authors: MCKAY ROBERT J.
Published: December 2021

This is a complete text and reference book for "infant's and children's nurses." It has little use for the American pediatrician unless he is interested in seeing the material "baby-nurses" are taught in Germany. For its purpose, the book is up to date and most of the information conforms surprisingly to American ideas. The photographic illustrations are good. Many of the techniques described involve the use of equipment not in general use in the United States. This, together with the fact that few American nurses read German, will limit the usefulness of this book in the United States.
Round Table Discussion
Authors: SMYTH FRANCIS SCOTT
Published: December 2021

Chairman Smyth: It is our purpose at this Round Table Discussion to discuss asthma in children with special emphasis on the practical aspects of such care.

A literal interpretation of the word asthma is "to breathe hard." This is the symptom in labored respiration after violent exercise, with oxygen lack in high altitudes, so also the lack of oxygen caused by circulatory and cardiac disturbances. Such usage of the term, "labored breathing" also implies a primary obstructive phenomena in the lungs, or a pneumonia. Thus, we find our differential definition requires further limitation. Asthma is really a symptom with many possible causes. So, for our own purposes of definition, we are going to limit the subject of asthma to those patients whose labored breathing is due to edema, secretions, and smooth muscle spasm induced by allergic sensitivity.

No element in the diagnosis is more important than the history of the patient. A good history cannot be obtained in one interview but is the result of persistence by the physician and of cooperation and understanding by the parents. A diary-like history kept by the mother will be invaluable. Many times we have interviewed anxious parents when the child was having an acute asthmatic attack, and got nowhere on the family history. You suspect there may be a bilateral allergy inheritance but you can elicit no information as to a constitutional inherited factor. This is equally true of the initiation of symptoms. The parents may deny any other allergic symptomatology, but as they begin to understand the problem, you will obtain further information extremely valuable for your study. The physician wants to know the season of the year in connection with the onset of symptoms, the locus of the first attack, has the child had repeated colds, any dermatitis of an allergic nature, etc. Once the intelligent mother has understood the problem, her observations can be as accurate as those of the physician, and in several instances, I have seen her come up with a solution of certain phases of the problem which has been very apt.

It seems unnecessary to mention the importance of the physical examination. In a sense, it is the clinician's scientific approach, i.e., accurate observation which not only clarifies the differential diagnosis to a great extent, but also brings to light the nutritional status, contributing infections, and the general make-up of the child. These are often of the utmost significance in any program designed to bring relief from the asthma, as well as to assure robust health.
TRENDS IN HEALTH LEGISLATION AND ADMINISTRATION
Authors: ALLEN RAYMOND E. , BLOEDORN WALTER L. , ANDERSON DONALD G. , JOHNSON JOSEPH L. , RUTSTEIN DAVID D. , REED LOWELL
Published: December 2021

DURING the first four days of May, the National Health Assembly met in Washington. The Assembly which was called by Federal Security Administrator Ewing, at the request of President Truman, opened in a charged atmosphere. As expressed by one observer: some of the delegates came to Washington with eyebrows at top mast, freely airing suspicions that the four-day conference was a Democratic political expedient. That the Assembly avoided many of the pitfalls lying in its path was a notable achievement. Evidence of its success appears in an editorial of the Journal of the American Medical Association which credits Mr. Ewing and his associates for having dispelled the doubts and anxieties which had originally existed.

May 1, not only marked the opening of the Assembly, it was also, by Presidential proclamation, "Child Health Day." The subject of child health was therefore the central theme of the opening luncheon which was presided over by one of the past presidents of the Academy, Dr. Lee Forrest Hill, Dr. Hill reviewed for the Assembly the Academy's nation-wide survey of the existing medical facilities and services available to children. He also described briefly the formation of the continuing committee—the Committee for Improvement of Child Health—charged with the responsibility of analyzing the hardwon facts and translating them into an action program.

The Assembly's assignment was a formidable one: to review the whole field of health and to set forth the feasible goals which might be realized in the next decade. In order to cover as much ground as possible, 14 sections were formed. The subjects assigned to these groups and a list of their Chairmen are an interesting array:

Section 1. What is the Nation's Need for Health and Medical Personnel? Algo D. Henderson, Chairman.

Section 2. What is the Nation's Need for Hospital Facilities, Health Centers and Diagnostic Clinics? Charles F. Wilinsky, Chairman.

Section 3. What is the Nation's Need for Local Health Units? Haven Emerson, Chairman.

Section 4. Chronic Disease and the Aging Process. James R. Miller, Chairman.

Section 5. A National Program for Maternal and Child Health. Leona Baumgartner, Chairman.
Dental Caries
Authors: BOYD JULIAN D.
Published: December 2021

In this volume Dr. Gottlieb elaborates his views as to the etiology, pathology, clinical aspects and prophylaxis of dental caries. In considerable measure he departs from the prevalently advocated chemo-bacterial theory of the cause of tooth decay, which places emphasis solely on the deleterious effects on the teeth of acids formed through carbohydrate fermentation. Gottlieb believes that caries is initiated through the action of proteolytic bacteria which act on the organic elements of the tooth, especially the lamellae of the enamel and the tubules of the dentin. Having breached the tooth's defenses through these channels, he believes that the interior of the tooth becomes susceptible to the decalcifying effects of acids formed through fermentation of carbohydrate residues in the oral cavity.
The Scientific Paper— How to Prepare It, How to Write It
Authors: MCCULLOCH HUGH
Published: December 2021

The earlier text, published first as a mimeographed pamphlet under the title, "Preparation of Scientific and Technical Papers," has been thoroughly revised and largely rewritten. The directions given are for the preparation of a thesis or dissertation, but they apply also to the writing of other types of scientific papers, and to the preparation of manuscripts on scientific or technical subjects. The book serves as a useful guide and reference in this particular field. It is unfortunate that literature references are not given in the form of the Quarterly Cumulative Index Medicus. The style, therefore, in this respect differs considerably from that ordinarily used in medical literature.
HEMOLYTIC STREPTOCOCCAL VAGINITIS IN CHILDREN
Authors: BOISVERT PAUL L. , WALCHER DWAIN N.
Published: December 2021

The value of culturing all vaginal discharges can not be overemphasized. Hemolytic streptococcal vaginitis has been misdiagnosed as gonococcal vaginitis when only a direct smear of the discharge has been utilized for diagnostic purposes. Hemolytic str. are frequently found in the nasopharynx of those children with hemolytic streptococcal vaginitis. In those instances where grouping and typing of the streptococci from both the vagina and the nasopharynx were done, the same group and the same type were found in both places.
CLINICAL USE OF ALCOHOL-REFINED TOXOIDS
Authors: RUEGSEGGER J. M. , LOOSER G. K.
Published: December 2021

Alcohol-refined toxoids of diphtheria and tetanus were inoculated into 31 adults and 550 children.

These alum-precipitated toxoids are associated with many fewer and less severe reactions, both in adults and children, than those following the use of ordinary toxoids.

Within the limits of a year's observation after inoculation, such toxoids appear to be able to stimulate an adequate and durable immunity as adjudged by serial antitoxin titrations.