bluuebunny/crossref_metadata_2025 huggingface dataset:
The Borderland of Embryology and Pathology
Authors: BLANC WILLIAM A.
Published: December 2021

This book lives up to the expectation of the reader of the other Willis' classics : "Principles of Pathology," "Pathology of Tumours," and "Spread of Tumours in the Human Body." It encompasses an amazing sum of personal experience and of knowledge of very scattered subjects in the fields of medical and biologic literature This treatise makes for stimulating reading by offering a fresh point of view on old and seemingly settled problems, by brilliant treatment of classical subjects—like metaplasia—and by the insertion of these caustic, dogmatic and definitive remarks and unorthodox statements which are Willis' trademark. A good part of the teaching value of this admirable book may well derive from the stimulus of reader antagonism. One is constantly forced to reconsider the facts or one's interpretations in the quest for an argument in the lively dialogue conducted by the Master. It is obviously impossible for any one man to achieve proficiency in all the fields treated in the book and to append a perfect balanced and up-to-date bibliography to each chapter. Still, the numerous sins of commission or omission which may be picked up by specialists in narrow fields are mere trifles in view of the wealth of clear and condensed information and good basic bibliography.
PRIMARY HYPEROXALURIA
Authors: Shepard Thomas H. , Creighton S. Allison , Krebs Edwin G. , Lee Lou-sein W. , Thuline Horace C.
Published: December 2021

The clinical and pathologic findings in a case of primary hyperoxaluria and calcium oxalate nephrocalcinosis in a 7-year-old boy are described and discussed in relation to similar reported cases. The diagnosis was suspected because of nephrocalcinosis in the absence of an abnormality of calcium metabolism and proven by the demonstration of increased urinary excretion of oxalate. Splenomegaly and yellow deposits in the Meibomian glands are described.
STUDIES ON CONGENITAL HEMOLYTIC SYNDROMES
Authors: Erlandson Marion E. , Schulman Irving , Smith Carl H.
Published: December 2021

Rates of destruction of erythrocytes and of effective production of erythrocytes and hemoglobin have been determined in eight patients with sickle cell anemia. The method employed was based upon survival of chromium-labeled erythrocytes in patients in whom a state of hemopoietic equilibrium was present.

Rates of destruction and production of erythrocytes tended to be greater than in patients with homozygous thalassemia and congenital spherocytosis.

Comparison of data from patients with the same three congenital hemolytic disorders has indicated that peripheral indexes such as concentration of hemoglobin and hematocrit do not accurately reflect the true comparative degrees of anemia in terms of total volume of erythrocytes. Plasma volume was markedly expanded in patients with sickle cell anemia and very little, if at all, in congenital spherocytosis. Intermediate values were found in patients with thalassemia.

Two patients with sickle cell anemia in whom the spleen was enlarged demonstrated splenic sequestration of erythrocytes. The role of the spleen in this disease has been discussed.

Hepatic sequestration of erythrocytes was demonstrated in all eight patients to a significantly greater degree than in patients with other congenital hemolytic disorders.

Results of studies of erythrocyte survival in one patient when well and when in crisis indicated that hyperhemolysis was not a significant feature of the painful crisis.

Contraction of plasma volume during a painful crisis of sickle cell anemia has been described.

Studies in patients with sickle cell-thalassemia and sickle cell-hemoglobin C disease demonstrated that the hemolytic defects were less severe than in the usual patient with sickle cell anemia.
THERAPEUTIC AGENTS FOR REDUCTION OF INTRACRANIAL PRESSURE
Authors: MATSON DONALD D. , ROBERTSON JAMES T.
Published: December 2021

SHRINKAGE of brain volume may be highly desirable in a variety of disease states in order to decrease intracranial pressure and thereby prevent irreversible compression of the brain stem. Temporary reduction of cerebral swelling may also be beneficial in: 1) granting time for planning elective surgical intervention, 2) facilitating the technical problems of brain retraction, and 3) minimizing the dangers of post-operative edema.

Pressure of the cerebrospinal fluid varies inversely with the osmolarity of the serum providing blood pressure remains relatively constant. Numerous hypertonic solutions have been employed experimentally and clinically in an attempt to reduce cerebral swelling. These have included glucose sucrose, saline, magnesium sulphate and concentrated human plasma.
IDIOPATHIC SPONTANEOUS HYPOGLYCEMIA IN CHILDREN
Authors: Haworth J. C. , Coodin Fischel J.
Published: December 2021

Seven cases of idiopathic spontaneous hypoglycemia in children are reported. A review is made of 51 case reports of this condition found in the literature.

The onset of symptoms occurred under the age of 6 months in 60% of the cases and of these, over half showed permanent neurologic sequelae. Of 23 cases first developing symptoms when over 6 months of age only 3 later showed permanent brain damage. Of the total 58 cases, 90% first developed symptoms when under 2 years of age.

Although an elevation of the blood sugar to normal levels is often seen during treatment with ACTH, some patients do not respond favorably to this treatment, nor to treatment with adrenocorticosteroids. Treatment by dietary means is of little value.

Of the 58 cases, 25 underwent partial pancreatectomy; 15 were cured and 10 were not. It is the authors' belief that partial pancreatectomy should be performed in those cases which do not respond to medical treatment within 1 to 2 years.

The pancreas was examined histologically in 29 cases and in 9 of these there was evidence of hypertrophy or hyperplasia of the islets of Langerhans.

No familial incidence was noted with the exception of two reported series.

Of the total 58 cases, 7 died; in 3, the death was a direct result of the hypoglycemia.

The etiology is discussed. Although few cases have been studied, high levels of circulating insulin-like activity in serum have been previously recorded in two patients. A normal value in one patient is recorded here. Cases may be classified as leucine-sensitive and leucine-insensitive according to the blood sugar response to this amino acid. The possibility exists that another cause may be an inability to raise the blood glucose by the release of adrenalin.

The "syndrome of idiopathic hypoglycemia of infants" as described by McQuarrie is believed by the authors not to be a single clinical entity.
CLINICAL TRIAL TO ASSESS THE EFFECTIVENESS OF GAMMA-GLOBULIN IN ACUTE INFECTIONS IN YOUNG CHILDREN
Authors: Finkel K. C. , Haworth J. C.
Published: December 2021

A controlled clinical trial was conducted to test the effectiveness of gamma-globulin in the treatment of acute infections in children under the age of 2 years. A total of 102 children with acute infections were divided by random selection into three treatment groups: patients in the first group received gamma-globulin 0.2 ml/lb, in the second group 0.1 ml/lb, and the third group which received no gamma-globulin, served as controls.

The three groups were comparable with respect to age, sex, length of illness and diagnoses. The administration of gamma-globulin to the two treatment groups did not affect the recovery time as compared with the controls.

The presence of physiologic hypogamma-globulinemia in the early months of life was confirmed, and a steady increase in level of gamma-globulin was demonstrated with increasing age.

In this series there was a statistically higher incidence of severe infections in infants under 6 months of age. Patients with severe in infections recovered more slowly than those with mild infections. No correlation was found between recovery time the age of the patient or the initial level of gamma-globulin.

In those children 13 to 24 months of age there was a statistically significant correlation between initial level of gamma-globulin and the history of previous infection.
PRIMARY HYPEROXALURIA
Authors: Shepard Thomas H. , Lee Lou-sein W. , Krebs Edwin G.
Published: December 2021

Hyperoxaluria has been studied in a family and found to be inherited as a probable autosomal dominant. Only one member of the family developed nephrocalcinosis. The possible existence of a second form of hyperoxaluria with elevated concentrations of uric acid in the blood is discussed.
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION, American Academy of Pediatrics
Published: December 2021

IMPLANTATION and feeding of various synthetic and natural estrogenic hormones especially diethylstilbestrol, to achieve improved efficiency of feed and better quality of carcass is a common practice among producers of livestock and poultry in this country. Androgenic agents have been used only experimentally to date. The preparations dosages and techniques employed are regulated by the Food and Drug Administration. Despite their requirement that no detectable residue of estrogenic hormones be present in edible tissues of treated animals offered for sale, some individuals maintain that the use of these hormones should be banned entirely because they believe that controls are inadequate to insure proper usage, and that analytic methods are not sensitive enough to detect minute quantities of hormones, whose repeated ingestion even in trace amounts might prove harmful.

Fortunately, extensive data have been gathered on the physiologic effects of stilbestrol and other estrogenic agents, their therapeutic uses and toxicology. Also, the quantities of estrogenic residues in the tissues of treated animals have been determined.

Greatest concern has been expressed over effects of stilbestrol on reproductive function on growth, and its possible carcinogenic properties. There is no doubt that stilbestrol can suppress ovulation in women if given in adequate amounts during the proper period of the menstrual cycle; and a relatively large dose (25 mg) may produce temporary impotence, but not sterility, in the male. These effects do not persist, however, when the dosage is discontinued, as the drug is destroyed and excreted in 3 or 4 days.

Relatively little is known about the specific effects of stilbestrol on children since its therapeutic use has concentrated on adults.
Human Biochemical Genetics
Authors: CHILDS BARTON
Published: December 2021

In 1953 Dr. Harris published a previous book entitled An Introduction to Human Biochemical Genetics. This book was a part of The Galton Laboratory Memoir Series, was paperbound and numbered 96 pages. The present volume represents a thoroughly revised and updated version of the first. It has hard covers, 310 pages, and a striking, handsome dust jacket. In 1953 human genetics, still a little off-beat, was just beginning to attract the attention of physicians.
CLINICAL CONFERENCE
Authors: White Harvey
Published: December 2021

Thorough familiarity with normal variations and insignificant anatomic deviations is essential to the practice of clinical pediatrics. Through constant observation and experience differentiation from disease becomes possible. In radiology this same problem exists and is probably more significant, as roentgenograms record only the situation as of a particular moment-an inherent weakness of the method. In radiology many standard procedures are established so that results may be duplicated and progress of disease evaluated. Deviations from standard procedures often simulate disease. In addition to this pitfall, there are many anatomic variations to plague the radiologist at the time of interpretation.

The following are examples of roentgenograms which have simulated disease but upon investigation proved to be normal:

1. The gaseous pattern in the infant differs from the adult. Ordinarily, we are taught that gas in the small bowel suggests obstructive ileus. In the infant under 2 years of age, gas in the small bowel is normal. After this age or after the child begins to walk the gas in the small bowel disappears and its presence then assumes significance. Improved intra-abdominal circulation, better co-ordination of diaphragmatic movements is responsible for greater absorption of gas in the small bowel after this age (Fig. 1).

Large amounts of air in the stomach are not necessarily due to obstruction. A very hungry baby will swallow huge amounts of air to a point of distending the abdomen. We know this occurs and is without significance, as we use this phenomenon for diagnostic pyelography. In this procedure, the ravenously hungry child is given a bottle of formula after the intravenous or intramuscular injection of contrast material is administered.
SPECIAL REPORT
Authors: SCHULMAN IRVING
Published: December 2021

Although these principles for the staffing and design of newborn nurseries should be followed so as to ensure maximum safety, nothing can obviate the need for trained and conscientious personnel who are in constant attendance and give careful attention to proven and accepted techniques of cleanliness. If infected persons are permitted to come into contact with infants or if faulty techniques are used, no physical arrangement, however elaborate, will entirely prevent unfortunate accidents from occurring. All aspects of technique must be reviewed periodically and all mechanical aids such as ventilation checked frequently, if they are to provide maximum protection.
Catalog of the Clifford G. Grulee Collection on Pediatrics
Authors: MCINTOSH RUSTIN
Published: December 2021

Many pediatricians know that in 1948 Clifford Grulee donated his private collection of medical books to the John Crerar Library in Chicago. Comparatively few have had an opportunity to appreciate its quality and scope. With the publication of this catalogue, under the editorial supervision of Herman H. Hinkle, the librarian of the John Crerar Library, and made possible by a grant from the Gerber Baby Food Fund of Fremont, Michigan, one can now take its measure with some accuracy.
ROLES OF HEREDITY AND ENVIRONMENT IN INTELLECTUAL DEVELOPMENT
Authors: McCandless Boyd R.
Published: December 2021

The Interesting yet controversial article by Knobloch and Pasamanick in this issue of Pediatrics throws additional, and badly needed, scientific light on four hotly disputed issues of intellectual endowment and development.

1) Race: The Knobloch-Pasamanick data demonstrate that, during infancy (approximately the first year of life), there are no Negro-white differences in developmental quotients, if circumstances of pregnancy-history, birth-weight, and rate of physical development are evened-out statistically.

2) Socioeconomics and race: Differences, when found, are more reasonably accounted for by socioeconomic status than by race.

3) Reliability of tests in infancy: The paper presents data sharply at variance with those existing in the literature concerning tests available for infants.
HISTOLOGIC OBSERVATIONS IN ERYTHEMA TOXICUM NEONATORUM
Authors: Lüders Dieter
Published: December 2021

The first histologic description of lesions of erythema toxicum neonatorum is given. It is shown that erythema toxicum neonatorum is related to the pilo-sebaceous follicle. The histologic picture is quite different from that of other rashes considered in the discussion of the clinical differential diagnosis.

The papule of erythema toxicum neonatorum shows an accumulation of leukocytes with a predominance of eosinophils within the layers of the hair follicle just below the dermal-epidermal junction of the skin. The pustule of erythema toxicum neonatorum is the result of an accumulation of these cells within the superficial epidermis encircling the hair. The papulo-pustular lesion shows also histologically a combination of both components. The microscopic changes associated with the macule and erythema are meager; only a few perivascular eosinophils are present in the dermis.

The cause of erythema toxicum neonatorum is unknown.
PROBLEMS OF INTERNATIONAL POSTGRADUATE TRAINING IN SOCIAL PEDIATRICS
Authors: Masse Nathalie P.
Published: December 2021

The results of international postgraduate education are difficult to assess; the various questionnaires, evaluation sessions, personal contacts between delegates and the teaching body and information on the development of services in the countries, may give some indications of the efficacy and usefulness of the efforts made by the different agencies who devote themselves to this work. From the information we have gathered, our efforts in this field seem to have contributed to the stimulation of interest in the medico-social problems of the child, to improvement to some extent of the standards of work, and to the promotion of international co-operation.
COMMITTEE ON CONTROL OF INFECTIOUS DISEASES
Authors:   Committee on Control of Infectious Diseases, Coriell Lewis L. , Dent John H. , Hodes Horace L. , Kempe C. Henry , McNaughton George A. , Top Franklin H. , Walcher Dwain N. , Ward Robert , Weller Thomas H. , Valdes Jose M. , Steigman Alex J.
Published: December 2021

Immunization with formaldehyde-inactivated vaccine is recommended for all children and young adults. The course recommended earlier was two 1-ml intramuscular injections (1 month apart) followed by a third 1-ml injection (after an interval of approximately 7 months). This is probably adequate for older children and adults.

Preliminary evidence indicates that a considerable proportion of infants have a less than optimal or relatively short-lived antibody response when immunized in this fashion. Vaccination of infants should be started at about 1½ to 2 months of age. The Committee recommends that children under 5 years of age be given a series of three 1-mi injections (1 month apart) followed by a fourth injection (up to 8 months later) and then a fifth injection (at about 4 yearsof age).

In the present state of knowledge, additional injections seem advisable as indicated in Table I. A recall injection should be given before traveling abroad or before entering an epidemic area.

Preparations containing inactivated poliovirus vaccine combined with diphtheria and tetanus toxoids and pertussis bacilli are now available. Such quadruple preparations should be given according to the manufacturer's directions, in general adhering to the schedule presently used for DPT (see Table I). For reasons of safety and to avoid possible loss of antigenic potency, it is considered advisable for physicians not to improvise mixtures of combined diphtheria, pertussis, and tetanus antigens and poliomyelitis vaccine.

See table in the PDF file

There are few contraindications to poliomyelitis vaccination. It may be performed safely at any time of the year, even when poliomyelitis is prevalent.
EXPERIMENTAL CARCINOGENESIS WITH IRON-DEXTRAN
Authors: Schulman Irving
Published: December 2021

Two Articles in this issue of Pediatrics report on the use of an iron-dextran complex (Imferon), a preparation which, on April 25, 1960, was withdrawn from the American market. This action was taken by the distributor, Lakeside Laboratories, upon recommendation of the Food and Drug Administration and followed publication of experiments which demonstrated the induction of sarcomas in mice and rats at the sites of repeated injections of the drug. In view of the extensive clinical use of Imferon in recent years it seems appropriate to review critically the evidence for the possible carcinogenicity of the preparation and the justification for its removal from the market.
THE EFFECT OF TONSILLECTOMY ON THE INCIDENCE OF STREPTOCOCCAL RESPIRATORY DISEASE AND ITS COMPLICATIONS
Authors: Chamovitz Robert , Rammelkamp Charles H. , Wannamaker Lewis W. , Denny Floyd W.
Published: December 2021

A population of military men with acute streptococcal respiratory infections (diagnosis established by clinical, bacteriologic and serologic studies) was investigated. Evidence is presented indicating that individuals who have had a tonsillectomy are neither more nor less susceptible to acute streptococcal infections of the respiratory tract. Once individuals acquire a streptococcal infection, the clinical course of the acute illness is not modified appreciably by the presence or absence of the tonsils. However, if antibiotic therapy is withheld, suppurative complications occur less frequently in those patients who have had their tonsils removed.

Tonsillectomy did not alter significantly the attack rate of acute rheumatic fever as a sequel of streptococcal infections, nor did it reduce significantly the development of valvular heart disease in patients with acute rheumatic fever. Moreover, it appears that streptococcal infections are less readily recognized in tonsillectomized patients and, therefore, are more likely to escape treatment appropriate for the prevention of rheumatic fever.
IRON DEFICIENCY IN THE PREMATURE INFANT
Authors: James John A. , Combes Mollie
Published: December 2021

Iron-dextran was given intramuscularly to 84 small prematurely born babies during their stay in the nursery; 97 similar babies were not so treated and served as controls.

By 8 to 10 weeks of age, values for hemoglobin in the babies who received iron-dextran were significantly higher than in the controls and remained high throughout the first year. Virtually all of the control babies became anemic and hemoglobin levels below 5 gm/100 ml were observed in four infants.

There was no difference in the rate of growth or in the incidence of common infections in the two groups.

It is concluded that intramuscular injections of iron given prophylactically in the nursery will effectively prevent iron-deficiency anemia in premature infants and that this practice has definite clinical applicability. (See Addendum.)

Prevention of iron deficiency anemia does not reduce the high incidence of common infections experienced by prematurely born infants.
EDUCATION
Authors: Mendelsohn Robert S.
Published: December 2021

A therapeutic nursery school and the role of the pediatrician in this school have been described. This type of treatment facility is of importance to pediatricians who increasingly are confronted with behavior disturbances of children of preschool age.
Combinations of Antibiotics
Authors: Jawetz Ernest
Published: December 2021

I read with interest the paper by Haggerty and Ziai (Pediatrics, 25:742, 1960). I fully agree with the authors' recommendation that acute bacterial meningitis of infants be treated with multiple drugs directed at the most likely etiologic agents until a specific single organism has been identified. However, the authors' repeated references to some of my past publications force me to call attention to some possibly misleading statements in their paper.

After the initial demonstration of "antibiotic antagonism" in vitro and in experimental animals, we pointed out repeatedly (Arch. Int. Med., 90:301, 1952; Pharmacol.
In Reply: Combinations of Antibiotics
Authors: Haggerty Robert J.
Published: December 2021

I am delighted to have Dr. Jawetz again bring to the attention of your readers his definitive work on the subject of antimicrobial combinations. We certainly have no quarrel with the points he reiterates. Our choice of words, "It is not clear why these results are at variance with the experimental data of Jawetz or the clinical data of Lepper and Dowling," was probably unfortunate, for Dr. Jawetz points out why the results did differ from his experimental work.
CEREBRAL ARTERIOVENOUS FISTULA ASSOCIATED WITH CONGESTIVE HEART FAILURE IN THE NEWBORN
Authors: Glatt Benjamin S. , Rowe Richard D.
Published: December 2021

Two infants with congestive failure in the newborn period were found to have congenital arteriovenous fistulae at post-mortem examination. One case died at 5 months of age with advanced neurologic disease; the other died at 3 days in severe congestive heart failure. In neither case were there developmental cardiac anomalies.

A brief review of the literature on congenital cerebral arteriovenous aneurysms and a discussion of their circulatory effect is presented.

It is suggested that the neonatal heart works near its maximum capacity and congestive failure may be readily precipitated.

Extracardiac conditions responsible for congestive failure are enumerated.
STATUS EPILEPTICUS IN PETIT MAL
Authors: Merlis Sidney
Published: December 2021

Occurrence of petit mal status epilepticus in a 12-year-old girl is reported, and the literature to date is reviewed.

The necessity of the electroencephalogram for the accurate diagnosis of this condition is stressed.

The aggravating effect of diphenylhydantoin sodium in cases of petit mal is again suggested.

The use of carbromal in the case herein reported appeared to be helpful in the control of the petit mal seizures.
A HAZARD OF EXCHANGE TRANSFUSION IN NEWBORN INFANTS—NEGATIVE PRESSURE IN THE UMBILICAL VEIN
Authors: Mintz A. A. , Vallbona C.
Published: December 2021

The development of the replacement transfusion for the prevention of brain damage associated with elevated levels of bilirubin in the blood has prompted numerous papers related to this procedure. The present report deals with a frequently observed phenomenon occurring during exchange transfusion, which seldom attracts attention until a disastrous episode takes place. This was our experience, and it therefore seemed desirable to re-evaluate the pathophysiology associated with pressure changes in the umbilical vein of the neonate.

This report will present a case of marked negative pressure in the umbilical vein of a neonate exhibiting inspiratory stridor of partial airway obstruction, and also the physiologic data from some animal experi ments to demonstrate this phenomenon.

CASE REPORT

Infant B was the second-born, male twin of a 24-year-old, Rh-negative, gravida 4, para 3 mother. At term the maternal Rh antibody titer was 1:32. The membranes ruptured spontaneously 48 hours prior to delivery. Labor was induced with oxytocin (Pitocin) administered intravenously. Twin Infant A was delivered spontaneously, unassisted; it was then found that twin B presented as a "transverse lie." This second twin was delivered in 15 minutes by version and extraction. Respiration was initiated after endotracheal aspiration and was normal for 1 hour, after which an inspiratory stridor was noted associated with moderate cyanosis. The stridor and cyanosis improved with oxygen-mist therapy. The baby weighed 2,930 gm and the blood was Rh-positive and Coombs' positive, as was the blood of his twin. Bilirubin in the serum at birth was 3 mg/100 ml; hemoglobin, 14.5 gm/100 ml.
CALCIFICATION OF CARTILAGE IN THE TRACHEA AND LARYNX IN INFANCY ASSOCIATED WITH CONGENITAL STRIDOR
Authors: Goldbloom Richard B. , Dunbar J. Scott
Published: December 2021

A 4½-month-old boy with calcification of the tracheal, hyoid and cricoid cartilages is reported. These changes were associated with laryngeal and tracheal narrowing and congenital stridor. No significant metabolic disturbance was demonstrated.

Follow-up examinations of this patient up to the age of [unknown] years revealed progressive diminution of the stridor and a moderate reduction in the intensity of the cartilage calcification. The tracheal lumen returned to normal caliber.

The patient's mother, at 37 years of age, showed laryngeal and tracheal calcification. We do not yet know if this is significant, but the possibility that the condition may be genetically determined must be considered.

The etiology of this syndrome remains obscure. To our knowledge this is the third such case to be reported in the medical literature. It is suggested that an intrinsic congenital anomaly of the cartilage matrix in the affected areas may result in increased susceptibility to premature calcium deposition.
REGROWTH AND OVERGROWTH OF THE THYMUS AFTER ATROPHY INDUCED BY THE ORAL ADMINISTRATION OF ADRENOCORTICOSTEROIDS TO HUMAN INFANTS
Authors: Caffey John , Silbey Robert
Published: December 2021

The oral administration of adrenocorti-costeroids provokes rapid atrophy of the thymus which is followed consistently, after stoppage of the steroid, by rapid regrowth of the thymus and, in some cases, over-growth.

Steroid-induced shrinkage of the thymus makes possible visualization of the true cardiac image which is often masked by the overlapping lobes of a large thymus. Such shrinkage may prevent the spurious diagnosis of cardiomegaly, and the use of more elaborate and hazardous methods such as opaque angiocardiography and cardiac catheterization.

Steroid shrinkage of the thymus is indicated only in patients who have cardiac signs and symptoms combined with enlarged deformed mediastinums in which the true cardiac image cannot be seen radiographically.

Steroid shrinkage is not indicated in patients who have cardiac signs and symptoms combined with small mediastinums, or in patients who have large mediastinums without cardiac signs and symptoms.

Steroid shrinkage should not be tried when there are other factors which suggest greater than the probable benefits to be derived from their use.

Massive rapid regrowth of the thymus following steroid-inducing atrophy was not associated with clinical signs or symptoms in any of our cases.
Growing Up in Newcastle upon Tyne: A Continuing Study of Health and Illness in Young Children within their Families, F. J. W. Miller, et al. New York, The Oxford University Press for the Nuffield Foundation, 1960, 369 pp., $5.75
Authors: Deisher Robert W.
Published: December 2021

In order to appreciate this book one should be familiar with the volume on the same subject "A Thousand Families in Newcastle on Tyne." That told of all the children born in Newcastle in May and June of 1947 who were intimately observed by Sir James Spence and his collaborators. During the first year of these children's lives a complete record was kept of their illnesses and other significant observations.

This volume continues the intimate follow-up of the 847 children age 1 to 5 and their families.
DISCUSSING PROBLEMS IN NEWBORN BABIES WITH THEIR PARENTS
Authors: Kennell John H. , Rolnick Alice R.
Published: December 2021

A STUDY of child rearing is being carried out at Western Reserve University Medical School and University Hospitals of Cleveland by a staff consisting primarily of four pediatricians, three psychiatrists, and four child therapists. In addition there is a psychologist and a nurse. One of the aims is to clarify some of the psychologic factors in the everyday problems of parents, about which they commonly turn to pediatricians for help.

In order that the psychiatrists and child therapists may see problems as they are usually presented to a pediatrician, each of them (as well as each of the four pediatricians) has functioned as a counselor to one family. One of the pediatricians performs physical examinations and acts as physical consultant for the seven non-pediatric counselors.

Each mother had up to an hour of consultation a week with her counselor from the last trimester of pregnancy until her baby was at least 6 months old. It is planned that bimonthly visits will be made by the mother until the child is at least 3 years of age. After each week's clinical session, the staff has had 2 hours for discussion.

Of the 12 babies delivered in this study, 8 had definite neonatal problems of concern to both the physician and family. This is a high proportion, but not surprising considering the small size of the sample as well as figures available from larger series. Statistics gathered during 12 months in the newborn service at University Hospitals of Cleveland show that out of 4,288 infants, 20% present medical problems.
Epidermolysis Bullosa Letalis
Authors: Mautner Hans
Published: December 2021

A paper of Roberts et al.(Pediatrics, 25:283, 1960) was published in which it was claimed that pemphigus hereditarius was described first by Herlitz. When the paper of Herlitz is read, it can be found out that the disease was first described by me and it has even been called in some of the earlier publications "Mautner's disease."

I would like to ask if there is a possibility of publishing this letter in one of your issues.
PUBLIC HEALTH
Authors: Wegman Myron E.
Published: December 2021

For the first time in 3 years it is gratifying to note that the infant mortality in the United States has not increased. The estimated rate for 1959, 26.4, was about 2% lower than the 1958 rate of 26.9 and is at the same level as the 1957 rate. Low point thus far for the United States was in 1956, when the rate was 26.0.

There was relatively little change in the other important rates—births, deaths and marriages. The natural increase in the population, that is births (including an estimate for those unregistered) minus deaths, was 2,632,000, giving a rate of increase of 14.9 per 1,000 population, essentially the same as the 1958 rate of 15.0.
AN ACCOUNT OF THE ORIGINS OF THE INVESTIGATIONS OF JAMES L. GAMBLE AND AN ANALYSIS OF HIS CONTRIBUTIONS TO PHYSIOLOGY AND MEDICINE
Authors: Wallace William M.
Published: December 2021

The investigative work of James L. Gamble found its instigation in the accentuated peculiarities of disease in infants and children, but as much as any other research in the field of pediatrics, his contributions have been universally applicable to all areas of medicine. The enormous and fruitful body of knowledge of water and electrolyte metabolism now at hand had much of its origin and a considerable segment of its basic foundation arise from the pioneer work of a small group of American pediatricians. Not only were their investigations of great value as pure contributions to the natural sciences, but their work has had an enormous practical application. In a review in 1950 by Darrow and Pratt1 it is stated: "Probably the proper use of water and electrolyte solutions is responsible for saving more lives of seriously ill patients than is the use of any other group of substances." Dr. Gamble was the last survivor of this small group of originators of basic concept upon which so much has been constructed.

As a sketch of Gamble's life is available elsewhere,2 it seems more pertinent in this place to undertake a résumé of the history of the period of remarkable scientific achievement in which Gamble played so great a role. The study of the body fluids had its inception in efforts to understand and treat the dysenteric diseases. During the Nineteenth Century a few physicians studied the effects of abnormal losses of intestinal fluids, drew surprisingly correct conclusions and even assayed, with success, treatment with parenteral fluids.
SOME THOUGHTS ON NORMAL, OR STANDARD, VALUES IN CLINICAL MEDICINE
Authors: Schneider Albert John
Published: December 2021

Clinical medicine, for all its achievements, is built on the logically inconsistent dichotomy of health and disease. Our first function as physicians is somehow to decide whether a patient belongs in an ill-defined category of healthy individuals, or to the general class of nonhealthy individuals. Unless we are content to act on general impressions, we proceed by first dismembering the patient bit by bit until he is not a person at all, but rather an association in time and place of assorted discrete attributes or characteristics. Each of these attributes is considered as being normal or not, either separately or in relation to a few others. If the right combination of abnormal attributes can be found, the patient is then re-assembled as a member of a particular class of previously defined diseases, or becomes the first member of a new class. If no such combination is apparent, he is reborn as healthy, at least for the present.

My apparent facetiousness is not intended to obscure the fundamental fact that we have not found any other satisfactory way to arrive at intelligent decisions. On the contrary, in the historic development of quantitative medicine, we have deliberately cultivated just this approach in contrast to the impressionistic approach. With ever increasing numbers of attributes becoming available for forming judgments, the responsibility for understanding what we are doing becomes greater and greater, both for those who elect to define these attributes and for those who plan to use them in the conduct of medical practice.
PERITONEAL DIALYSIS IN INFANTS AND SMALL CHILDREN
Authors: Segar William E. , Gibson Robert K. , Rhamy Robert
Published: December 2021

Ten infants and children ranging in age from 3 days to 34 months have been treated with peritoneal dialysis. All 10 were anuric on severely oliguric. Three had salicylate intoxication, and three had boric acid poisoning as additional complications. Three of the 10 children, including the only patient with irreversible renal disease, died. All seven who survived made complete and uncomplicated recoveries from their acute illness. One now has evidence of residual renal damage.

The technique of peritoneal dialysis is described and the indications, contraindications and complications are discussed. The data presented indicate that peritoneal dialysis is an effective type of dialysis, that it is safe, that it can be accomplished with a minimum of equipment and that a highly trained team is not essential for its efficient use. It is superior to exchange transfusion in the treatment of most types of poisonings and is the only practical procedure currently available by which dialysis of an anuric infant or small child can be accomplished.
INTERRELATIONSHIPS OF MATERNAL AND FETAL CIRCULATIONS
Authors: Adams Forrest H. , Assali Nicholas , Cushman Marjorie , Westersten Allan
Published: December 2021

Epinephrine and norepinephrine injected intravenously into pregnant ewes produced a prompt increase in maternal arterial pressure but a significant and sustained decrease in uterine arterial blood flow.

Angiotensin injected intravenously into pregnant ewes produced a prompt increase in maternal arterial pressure (similar to epinephrine and norepinephrine) and an increase in uterine arterial blood flow.

In the doses used, epinephrine, norepinephrine and angiotensin injected intravenously into pregnant ewes produced no significant observable effects on the arterial pressure and blood flow in the umbilical cord on heart rate in the fetus.

Epinephrine and norepinephrine injected in the umbilical vein of lambs in utero produced a prompt and significant rise in umbilical arterial pressure and umbilical arterial flow only when large doses (five times effective adult doses/kg body weight) were used. Effective adult doses (kg body weight) injected into lambs in utero produced no significant change in arterial pressure or blood flow in the fetus.

Angiotensin injected intravenously into lambs in utero produced no significant change in arterial pressure or blood flow in the umbilical cord.

Vasoactive drugs injected into the mother on into the fetus did not appear to cross the placenta in either direction in physiologically effective amounts.
A VALVE FOR RESPIRATORY STUDIES IN INFANTS
Authors: Golinko Richard J. , Rudolph Abraham M.
Published: December 2021

PULMONARY function studies in small infants have been limited in the past by failure to develop practical methods for collecting expired gas samples. Adaption of a respiratory valve suitable for use in small subjects with small tidal volumes has been difficult and has led to the use of techniques with the body plethysmograph, contour face mask and large head chamber. The body plethysmograph offers only indirect data and requires considerable prepration before each study. In addition, it has the disadvantage that once the infant is placed in the plethysmograph chamber further manipulations of the infant are not possible. Systems using the contour face mask on head chamber involve a large dead space which may be quite significant when one considers the small volumes dealt with. In order to overcome the problem of large dead space, Cayler et al., similar to others, circulated air across the face of the contour mask. However, because of the dilution effect, differences in the composition of the inspired and expired gases were very small and therefore the chance for error in the calculations was increased.

Berglund and Karlberg, and Geubelle et al., while studying functional residual capacity in infants, found that practically all quiet, healthy newborn infants breathe through the nose and can also tolerate the insertion of small tubes in their nostrils for varying periods. On the basis of these observations, a respiratory valve has been designed for insertion directly into the nostrils, permitting collection of total expired air. The valve, especially adapted for use in small infants, offers minimal resistance to respiration and has a dead space of 0.8 ml.
PEDIATRICS ABROAD
Authors: Johnstone Douglas E.
Published: December 2021

FOR THE past few years, about 5,000 Americans annually have toured Russia. Some are delegations of physicists, astronomers or governmental officials. Some go individually or in groups as tourists, out of curiosity. In November, 1958, I visited the U.S.S.R., sponsored by the Rockefeller Foundation. I hoped to learn something of how Russian physicians treat allergic children, what Russian medical students are taught about the theory and clinical management of allergic disease, and what sort of laboratory or clinical investigations are being carried on in the field of pediatric allergy. These hopes were outlined in letters to the Director of the Academy of Sciences and the Deputy Minister of Public Health of the U.S.S.R. My plans were also known to Dr. Samuel Feinberg of Chicago, who was the president of the Third International Congress of Allergology.
THE EARLY ANEMIA OF ACUTE RHEUMATIC FEVER
Authors: Mauer Alvin M.
Published: December 2021

Measurements of plasma volume in a group of patients with early acute rheumatic fever are reported. The results of this study indicate that the decrease in hematocrit values observed during this phase of the disease is most often related to dilution of the erythrocyte mass by an increased plasma volume.
THE EFFECT OF HIGH HUMIDITY ON BODY TEMPERATURE AND OXYGEN CONSUMPTION OF NEWBORN PREMATURE INFANTS
Authors: Miller Herbert C. , Behrle Franklin C. , Hagar David L. , Denison Terry R.
Published: December 2021

Relative humidity between 80 and 90% increased the body temperatures of both healthy and sick premature infants, the increase being greatest in the least mature infants. No significant, consistent increase in oxygen consumption was observed to accompany the increase in body temperature produced by high relative humidity. Low relative humidity between 20 and 60% did not prevent the return of body temperature to normal values after the initial decrease immediately following birth. The return to normal was slower in the less mature infants. Low relative humidity was not incompatible with the survival of very small premature infants maintained in an ambient temperature betwen 88 and 90°F (31.1 to 32.2°C).
SYSTEMIC MANIFESTATIONS DUE TO ALLERGY
Authors: Crook William G. , Harrison Walton W. , Crawford Stanley E. , Emerson Blanche S.
Published: December 2021

The data on 50 patients with systemic manifestations due to allergy seen at the Children's Clinic, Jackson, Tennessee, during the period 1956 through 1960 is presented. Detailed case histories are recorded for four of these patients. The findings on the remainder are given in tabular form.

Uniformly, the symptoms and signs in these children were fatigue, irritability, pallor in the absence of anemia, and infraorbital circles. Most of them also had nasal congestion, abdominal pain and headache. A variety of other signs and symptoms, including those of nervous system involvement, may also be present.

The literature on this condition is reviewed in detail showing that this condition has been described under several different names by many observers during the past 40 years. In spite of these descriptions, few physicians are aware that allergy causes such systemic manifestations.

In conclusion, it is suggested that allergy be included in the differential diagnosis of any child with generalized body symptoms of undetermined cause.
PRESIDENT'S MESSAGE
Authors: Wheatley George W.
Published: December 2021

ONE OF THE characteristics of democracy in the United States is the important role of voluntary associations and of private citizens in organizing and raising funds to combat health and social problems. This phenomenon was already well established more than 130 years ago; it was even then commented on at some length by Alexis de Tocqueville in his classic and monumental study of our democratic institutions. In his view, the health of a democratic society could be measured by the quality of the functions performed by private citizens.

Pediatricians as child health experts and citizens have always taken an active part in the voluntary health movement. In an earlier President's Page I commented at length on some of these contributions. My reason for bringing the subject up again is to call attention to a current Rockefeller Foundation study of health and welfare agencies under the direction of Dr. Robert H. Hamlin. The preliminary report was scheduled to be released in April. Several years ago our Executive Board, impressed with the growth and fund-raising efforts of voluntary health organizations, discussed some of the same questions that Dr. Hamlin's group is now exploring. Among them were: Are so many agencies needed? Is there unnecessary duplication? Are so many solicitations necessary? What are the agencies doing with the contributions they receive? As a result of the Board's concern, a special committee prepared a statement giving the Academy's position, particularly with reference to the use of these funds for research.

Concern with the scope and purpose of voluntary health agencies is not new. Forty years ago the National Health Council came into existence to serve as a clearing-house and advisory body for national voluntary health agencies. This was the first clear-cut endeavor to meet the problem of duplication of effort, and to strengthen the attack on public health issues. Fifteen years ago the Gunn-Platt report, under the auspices of the National Health Council and supported by the Rockefeller Foundation, constituted another landmark in the evaluation of the programs of voluntary health agencies. The report stressed the need for increased agency cooperation in planning.

The National Health Council, now composed of 52 active members, of which, as you know, the Academy is one, is embarked on two special projects in this area: 1) development of a statement of the role of a voluntary health agency; and, 2) a project to produce uniform accounting principles and reporting procedures for voluntary health agencies. Reports are expected in 1961.

Other medical organizations in the Council include the American Medical Association, American Academy of General Practice, Association of American Medical Colleges, National Medical Association, and Association of State and Territorial Health Officers.
GENERALIZED LYMPHOHISTIOCYTIC INFILTRATION
Authors: Nelson Paul , Santamaria Armando , Olson Robert L. , Nayak Nabeen C.
Published: December 2021

Three cases representing a familial disease not previously described are reported. The disease occurred in children under the age of 7 years and was characterized clinically by an acute but protracted course, with fever, anemia, leukopenia, thrombocytopenia, hepatosplenomegaly, pneumonitis and meningitis. Pathologically, there was extensive infiltration of many organs and tissues by lymphocytes and histiocytes with remarkable involvement of the central nervous system and neurohypophysis.

The nature of this disease is uncertain, but a generalized cellular, metabolic or biochemical etiology is suggested.

Significant differences from Letterer-Siwe disease and Chédiak-Higashi syndrome are pointed out.