bluuebunny/crossref_metadata_2025 huggingface dataset:
COMMITTEE ON ENVIRONMENTAL HAZARDS
Authors:   Committee on Environmental Hazards, Wehrle Paul F. , Brent Robert L. , Chisolm J. Julian , Doyle John L. , Fagan Emmett L. , Finberg Laurence , Miller Robert W. , Nahmias André J. , Thompson G. D. Carlyle , Horton Robert J. M.
Published: December 2021

The Committee on Environmental Hazards has recommended that the American National Standards Institute (ANSI) revise that portion of the American Standard Z66.1/64 pertaining to the lead content of paint downward from the present 1% to "minimum traces" or < 0.06% of the total weight of the contained solid, including pigment, film solids, and driers. This recommendation is based on a study of recently published materials which appeared after the 1% voluntary standard for lead was originally established in 1955 by ANSI.

At the same time, in response to the notice in the Federal Register of November 2, 1971 (21 CFR Part 191), the Committee recommended that Federal standards for lead content of paint used on surfaces accessible to young children be reduced to "minimum traces" on < 0.06%, and that paints containing more than this amount of lead be banned as hazardous substances.

On review and evaluation of available data in children and adults, an ad hoc committee (B. G. King, Chairman) recently concluded that, for children, the maximum daily permissible intake (DPI) of lead from all sources should not exceed 300 µg Pb/day. If average daily intake is maintained below this level, blood lead concentrations are unlikely to exceed 40 µg Pb/100 gm whole blood. At this level of intake, it is estimated that the amount assimilated by 1- to 3-year-old children could probably be excreted so no net increment in total body lead burden would be anticipated. It is estimated that approximately one half of this 300 µg Pb/day intake would be derived from usual food, water, and air, so intake from all other sources, on the average, should not exceed 150 µg Pb/day.
Isolette® Respirator Modification for Constant Negative Pressure
Authors: Andreasen Christian B.
Published: December 2021

With respect to the modifications to the Air-Shields Isolette® Respirator to provide a constant negative pressure and resulting problems reported, Air-Shields is offering to all owners of Isolette Respirators a modification kit incorporating many of the recommended changes in order to improve the reliability of these units.

It should be recognized that many of the problems reported are associated with its use in a mode for which it was not originally designed, and for this reason it is unfair to state that the Isolette Respirator was not adequately tested before manufacture.
Letter to the Editor
Authors: Rosenberg Steven
Published: December 2021

I have read with interest Dr. Pick's sentiments on the nurse-practitioner in your Letters column of December and would like to offer some thoughts on the subject. With the increasing trend toward sub-specialization there is a corresponding need for a generalist who is specifically trained to meet the needs of the "well" child and to recognize the "ill" child who requires the service of the pediatrician. The pediatric nurse-practitioner has been created to fulfill this role and take care of many minor problems too.
Letter to the Editor
Authors: Cohen Sanford N. , Neumann Lois L. , Ganapathy Saraswathy
Published: December 2021

In their recent article, Nathenson and his colleagues reported on the use of diazepam to control withdrawal symptoms in 18 infants born to heroin-addicted women. They suggested, "further experience, including comparative trials, now seems warranted" with this agent. We feel that this suggestion raises questions concerning both the safety of this agent for the newborn infant and the appropriate method for introducing any new drug into the pharmacopeia for nurseries.

In order to select therapeutic agents for introduction into use in newborn infants, there are several criteria that should be met.
Letter to the Editor
Authors: Riley Harris D.
Published: December 2021

I appreciate the opportunity to review the letter from Dr. Posner. He makes some important points regarding opportunities in the Indian Health Service (IHS). The Committee on Indian Health is well aware of the excellent opportunities for training in the IHS and has been active in attempts to recruit students and physicians, particularly pediatricians, to the IHS. Information outlining the opportunities for medical students on elective periods and for house officers in training has been provided by the Committee to the dean of each medical school and director of each pediatric training program in the U.S. and Canada.
PALMAR DERMATOGLYPHICS IN MONGOLISM
Authors: CUMMINS HAROLD , TALLEY CAROLYNN , PLATOU R. V.
Published: December 2021

It has been demonstrated that characteristic dermatoglyphic changes rank high in frequency among the variable stigmata which go to make up the syndrome of mongolism. Though they are not diagnostic alone, it is believed that these objective, measurable and unchanging evidences of mongolism seen in hand prints should be helpful in establishing an early diagnosis. Positive dermatoglyphics rank high in frequency among stigmata reported in typical examples of mongolism by 82 physicians. The technic for preparing prints is a simple one which requires very little practice for perfection; interpretation based on the empiric but definite criteria defined can be accomplished with relative ease. A series of five prints are reproduced.

These findings are in keeping with the suggestion that factors responsible for the occurrence of mongolism are operative prior to the third month of fetal life, and are consistent with known facts concerning embryologic development of epidermal ridges of the palms.
SUCCESSFUL TREATMENT OF C. DIPHTHERIAE SUBACUTE BACTERIAL ENDOCARDITIS WITH PENICILLIN AND STREPTOMYCIN
Authors: ALMKLOV JOHN R. , HANSEN ARILD E.
Published: December 2021

C. diphtheriae is an unusual causative organism in subacute bacterial endocarditis as only 17 cases have been recorded and none of these has survived. The 8 year old girl in this report is the first patient to have recovered. This child had two positive blood cultures for virulent intermedius strain of C. diphtheriae which was sensitive to 0.05 u./ml. of penicillin and to 3.0 u/ml. of streptomycin. The patient received penicillin therapy for one month and responded poorly. When streptomycin was also administered there was dramatic improvement. This clinical experiment tends to substantiate Hewitt's work in animals which demonstrates that streptomycin is much more effective than penicillin in saving guinea pigs injected with C. diphtheriae. In vitro tests with the organism isolated in this patient revealed neither evidence of synergism nor antagonism when studied with combinations of penicillin, streptomycin, sodium sulfadiazine and aureomycin. It is suggested in future cases that a combination of penicillin and streptomycin be used and that sensitivity tests be performed on the organism so that the physician may determine the proper dosage of antibiotic.
QUANTITATIVE METHOD FOR MEASURING H. PERTUSSIS ANTIBODY
Authors: ALEXANDER HATTIE E. , MACPHERSON CATHERINE , REDMAN WINIFRED
Published: December 2021

A quantitative chemical method which determines the agglutinin nitrogen content has been shown to be applicable to H. pertussis therapeutic antisera.

The two human H. pertussis antisera available for therapeutic purposes contain approximately the same agglutinin nitrogen content per vial, about 1 mg. A vial of the two rabbit antisera analyzed contains approximately 20 mg. of agglutinin nitrogen.

A simple slide agglutination test is offered as a procedure for determining the degree of antibody excess in the sera of patients after serum therapy. The greater the content of agglutinin nitrogen in the therapeutic antiserum administered, the higher the relative agglutinin titer in the patient's serum.
STUDIES OF AN OUTBREAK OF POLIOMYELITIS IN IOWA
Authors: WENNER HERBERT A. , BRANSON VERNON L.
Published: December 2021

In certain families poliomyelitis attacks many, if not all, members of the household. Not all members of the household develop paralytic poliomyelitis. The onset of illnesses among members occurs at the same time, suggesting a common exposure. The factors responsible for an intense common exposure of most, if not all, members in a household at risk are largely unknown.

In a search for poliomyelitic virus at extra-human sources in a rural epidemic, virus was detected in sewage and creek water. Poliomyelitis was not found in the entrails of birds, frogs or fish collected in the immediate areas of human cases of poliomyelitis.
NONLIPOID RETICULOENDOTHELIOSIS (LETTERER-SIWE'S DISEASE)
Authors: HAVARD EDWARD , RATHER LELLAND J. , FABER HAROLD K.
Published: December 2021

A case of nonlipoid reticuloendotheliosis (Letterer-Siwe's disease) with autopsy is reported. The relationship to essential xanthomatosis (Hand-Schüller-Christian) and to eosinophilic granuloma is discussed. Unusual features of our case, classical in other respects, were the severe leukopenia and thrombocytopenia, the presence of severe edema and ascites, associated with hypoproteinemia.
NEPHROTIC SYNDROME
Authors: BARNESS LEWIS A. , MOLL GRETCHEN H. , JANEWAY CHARLES A.
Published: December 2021

The records of 208 patients with the nephrotic syndrome seen in the Children's and Infants' Hospitals of Boston from 1926 to 1948 have been reviewed.

The main criteria found for differentiating between lipoid nephrosis and the nephrotic stage of chronic glomerulonephritis have been the presence of hypertension or azotemia for longer than one month in patients with the latter disease, which occurs more frequently in children over four years of age. Other features of the two diseases may be indistinguishable. Nonetheless, it is desirable to differentiate between them, as apparently few if any patients recover from the nephrotic syndrome if the evidences of glomerulonephritis are clear-cut.

Lipoid nephrosis is characterized by the insidious onset of edema in young children, usually between the ages of one and four. Findings include edema, hypoproteinemia, hypercholesterolemia and heavy proteinuria. Blood pressure may be elevated for short periods, but rarely over one month. Microscopic hematuria does not exclude the diagnosis, though macroscopic hematuria is usually evidence of glomenular involvement.

Symptoms and findings in lipoid nephrosis may persist for from one to three years without specific therapy. Exacerbations with infection, followed by remissions shortly after the infection, and remission soon after the onset of the disease are relatively common. Prognosis is not related to the number or duration of exacerbations. Death before 1942 was chiefly due to an intercurrent infection. Since 1942, with the advent of sulfadiazine and the newer antibiotics, death from infection has become less common, and has usually occurred at home, presumably because treatment was not promptly instituted.

There is apparently no constitutional defect in these children before the onset of the disease, and growth and development are normal after recovery.

No form of treatment has been found wholly satisfactory. Paracentesis, transfusion and low salt diet are the most common supportive measures used here. Antibiotics are valuable during infections and have apparently lowered the mortality of the disease in recent years. Focal sources of infection should be eliminated by operative procedure only when surgical intervention is definitely indicated. Injections of salt-poor concentrated human serum albumin and the induction of measles are being evaluated as methods of inducing a diuresis.

In this series approximately one half of the patients with a clinical diagnosis of lipoid nephrosis have apparently recovered completely without residual disease, while a small number show persistent albuminuria or hypertension. It is hoped that with closer supervision of the patients and with adequate chemotherapy, this figure can be significantly increased in the future.
SPECIAL REVIEWS
Authors: SIMMONS VAUGHAN P.
Published: December 2021

Careful research by numerous investigators has shown the thymus to be a producer of lymphocytes and myelocytes (and possibly also erythrocytes) which reach the circulation via the veins and lymphatics. It is therefore no longer necessary to consider the thymus as an enigmatic organ—an organ of unknown function—when its hematopoietic role is apparent. Likewise, it is sheer folly to go on believing that the thymus is merely an organ of infancy and childhood after it has been pointed out repeatedly by numerous workers in the field that this view is incorrect. One must have a moving dynamic concept of the organ as it is capable of swift and extensive changes in form and structure which take place under physiologic conditions chiefly by an unloading of its cortical cells into the vascular system and by the production of more to augment and replace them.

The thymus plays a far more important role in the genesis and perpetuation of leukemia than has hitherto been believed. The old but erroneous ideas about the immigration of cells into the thymus have led previous investigators astray in the interpretation of the histologic pictures presented in the thymus in both normal conditions and in leukemia. Leukocytes seen in the periphery of the lobules and in the interlobular septa have almost invariably been described as entering or "infiltrating" the thymus without any basis in fact; actually the cells are formed in the thymus and are migrating from it. The ultimate function of the thymus will not be clarified until the role of these leukocytes it produces—its chemical messengers—has been completely elucidated.
CLINICAL CORRELATES OF THE FAST AND THE SLOW SPIKE-WAVE ELECTROENCEPHALOGRAM
Authors: LENNOX WILLIAM G. , DAVIS JEAN P.
Published: December 2021

In order to test an hypothesis that slow spike and wave formations may be only the immature form of the 3/sec. dart and dome formation of "petite absence" and to learn more about the meaning of a dysrhythmia that consists of an alternation of wave frequency, a comparison was made of the clinical histories and examinations of 200 patients belonging to each group. The group with the slow pattern contained relatively more males; the patients were younger both when seizures began and at the time of examination, their history contained a greater variety of seizure phenomena and their EEGs more associated abnormalities. The evidence of brain damage that antedated seizures was much greater and the family history of epilepsy was somewhat less in the slow group as contrasted with the fast; and yet, heredity played as great a part in the slow group as in a large unselected group of "genetic" epileptics. Intelligence of the slow group was lower than that of the fast.

Slow spike-hump discharges are more diverse in configuration and distribution, more often localized and solitary than dart-dome discharges. The slow form is less often identified with specific clinical symptoms, though in this group of children, 53% had a history of one or more of the petit mal quartette. Astatic (akinetic) falls or simple or massive myoclonic jerks may accompany solitary discharges. Massive jerks were confined to the very young. Of the infants, 55% had this form. Periods of sudden stillness, staring, sagging, small jerkings or mild tonicity, often without full loss of consciousness, may be the clinical correlates of serial discharges. Though less responsive to tridione® or other therapy than the faster variety, control of seizures and even of this peculiar spike-hump dysrhythmia may be possible.
INFANTILE TOXOPLASMOSIS
Authors: RODNEY M. B. , MITCHELL N. , REDNER B. , TURIN R.
Published: December 2021

A fatal case of infantile toxoplasmosis with autopsy findings is described, bringing to 21 the number of acceptable autopsied cases. The characteristic central nervous system necrosis and calcification were present in this case. In addition, focal chorioretinitis, involvement of the spinal cord and of the periorbital and paravertebral striated muscles and the heart were present. Of great interest is the finding of testicular involvement which has been described in only one other previous case.
CARDIAC AND AORTIC ARCH ANOMALIES IN THE OFFSPRING OF VITAMIN A DEFICIENT RATS CORRELATED WITH SIMILAR HUMAN ANOMALIES
Authors: WILSON JAMES G. , WARKANY JOSEF
Published: December 2021

Fetal and newborn rats from mothers fed vitamin A deficient diets prior to and during pregnancy exhibited some degree of malformation in 75% of the cases. Twenty-eight of 64 severely abnormal young studied after serial sectioning showed congenital cardiovascular malformations. These consisted of defects in the interventricular septum and in the aortico-pulmonary septum; and of various aortic arch anomalies, such as retroesophageal subclavian artery, right aortic arch, double aortic arch, absence and other variations of the ductus arteriosus and absence of a pulmonary artery. There were also several cases in which the fourth aortic arch was absent and the heart communicated with the descending aorta through the pulmonary trunk and an enlarged ductus arteriosus; in other instances the communication was affected through a persisting third arch which rose high into the neck.

Many of the cardiovascular anomalies observed in the rats closely simulated malformations observed in man ; others have not been reported to occur in man but they are considered theoretic possibilities. If they are encountered in children, their interpretation may be facilitated by the description of these experimental results in the rat. It is emphasized that present clinical and experimental observations indicate that environmental as well as genetic factors may alter the development of the cardiovascular system.
GROWTH
Authors: WASHBURN ALFRED H.
Published: December 2021

IT IS with a very real sense of humility that I accept the Borden Award from the Academy of Pediatrics. I am happy to receive it in San Francisco since this was the scene of some of my earlier adventures in pediatrics. It is not quite polite, I suppose, to question the wisdom of the committee which made this award. Perhaps, however, its members will not be offended if I point out that I am only one member of a team—that such contributions as have been made from the Child Research Council during the past two decades are the product of the teamwork and loyalty of many investigators. A brief description of our institute will serve as an easy introduction to my subject.

We are following intensively a small group of individuals. At present we have 137, ranging in age from birth to 25 years. Each new baby is registered in the study early in his prenatal career. Thus we have the opportunity of knowing something about the mother's health and diet, as well as some beginning understanding of the family and home into which this new human being is to be born. Each baby is then observed frequently, regularly, and from many different aspects through infancy, childhood, adolescence and on into the mature years; for we have become an institute engaged in following the whole life-span of individual persons. We try to make use of the wisdom and skills from many fields of science. We are not using human subjects as "guinea pigs" to contribute new knowledge to a specific field but, instead, all fields of science are being utilized to contribute to an awareness of the unique individuality of each child—to an understanding of how his own peculiar characteristics and patterns of growth contribute to his chance for healthy development and happy adaptation to his environment.
FOLLOW-UP STUDIES IN A BOY WITH MIXED ADRENAL CORTICAL DISEASE
Authors: GARDNER LYTT I. , SNIFFEN RONALD C. , ZYGMUNTOWICZ ANIELA S. , TALBOT NATHAN B.
Published: December 2021

Supplementary data are presented concerning the metabolic and physical status of a boy with apparent mixed adrenal cortical disease. These data suggest that he has been suffering from (a) at least a relative deficiency of the adrenal cortical Na-K regulating hormone and (b) both a relative and absolute excess of adrenal cortical androgens. It appears that the adrenal cortical sugar-fat-nitrogen regulating hormones were being produced in approximately normal amounts. The excess androgen production was associated with hyperplasia of adrenal cortical zona reticularis-like cells located both in the adrenals and the testes. It is suggested that the hyperplasia was the result of excess stimulation by adrenocorticotropic hormone. The effects of these derangements upon the patient's growth and development are described.
HERPES SIMPLEX VIRUS NOT THE ETIOLOGIC AGENT OF RECURRENT STOMATITIS
Authors: DODD KATHARINE , RUCHMAN ISAAC
Published: December 2021

The virus of herpes simplex is not the usual etiologic agent of recurrent aphthous or ulcerative stomatitis.

In reported cases in which the herpes virus has been recovered from the mouths of individuals suffering from recurrent stomatitis or the titer of antibodies has risen in the blood serum following infection, it seems probable that these were chance findings which bore no relation to the etiology of the disease.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: WEGMAN MYRON E.
Published: December 2021

THE five White House Conferences represent in no small degree the stages in the development of pediatrics in the United States. The first Conference was called by President Roosevelt in 1909 to meet the needs of the orphaned, abandoned, and neglected children. It was the year in which the American Association for the Study and Prevention of Infant Mortality was organized. It was at a time when there was not a single fully developed pediatric clinic in the U.S.A.

As a result of this Conference the Children's Bureau was established in 1912, and it has continued to give at the Federal level leadership in the prevention of disease, improvement in the care of children and standardization of child labor practices. The American Association for the Study and Prevention of Infant Mortality was organized to solve a problem by what today is called the multidisciplinary approach. It focused the attention of the pediatrician, the public health nurse, social worker, statistician, public health officer, and interested lay groups on the problem of high infant mortality, with a resulting remarkable success. A reduction of the infant mortality rate from 150 to 40 has been accomplished in the last 40 years. We must not forget that in 1909 we did not know how many babies were born in the United States. Complete birth registration was not accomplished until 1933.
ANGIOCARDIOGRAPHY IN INFANTS AND CHILDREN
Authors: KEITH JOHN D. , MUNN JOHN D.
Published: December 2021

An apparatus is described which permits taking four roentgenograms/sec. Its use in angiocardiography is demonstrated by a series of cases with congenital cardiac anomalies. This method of investigation has proved most useful in studying the cyanotic group and in demonstrating shunts from right to left. A variety of different technics may, however, yield useful information in the noncyanotic group also. The procedures outlined are most valuable in the newborn period where congenital cardiac anomalies are so commonly encountered and where their differentiation is particularly difficult. The information collected in this manner has been, in many instances, a help to the surgeons in planning suitable surgery.
DOES GLUTAMIC ACID ADMINISTRATION INFLUENCE MENTAL FUNCTION?
Authors: LOEB HAROLD G. , TUDDENHAM READ D.
Published: December 2021

Thirty-three feebleminded individuals, mostly adolescents and without epilepsy or other neurologic involvement, were divided into two groups well matched as to intelligence quotient, sex, age and type of feeblemindedness. One group received orally 1(+) monosodium glutamate, 24 gm. daily, for 17 wk. The other group served as controls and received a placebo given at the same time and in like manner. Throughout the entire period of the investigation, experimental and control cases were patients in the same institution, on the same regimen and receiving the same care and diet, the latter being prepared in a central kitchen.

The following psychologic tests were administered before and after the experimental period: Stanford-Binet (Form L before and Form M after), Cornell-Coxe Performance Ability Scale, Porteus Maze, Thurstone and Thurstone Primary Mental Abilities and the Rorschach Test.

On the basis of detailed statistical analysis employing the method of co-variance, no significant difference between control and experimental subjects could be shown, and it was therefore concluded that a beneficial effect of glutamic acid in the treatment of feeblemindedness has not been demonstrated.
CONGENITAL ANOMALIES OF THE ESOPHAGUS
Authors: LADD WILLIAM E.
Published: December 2021

AS THIS is the first general meeting of the Academy since the establishment of a surgical section, it would seem fitting to comment on our hopes for this venture. The last few decades have seen great advances in all fields of medicine. Among the most widely known, perhaps, are insulin, antibiotics, chemotherapy, water balance, vitamin and hormone therapy and other laboratory discoveries. I want, however, to call your attention to some of the advances which have been made in the field of pediatric surgery and to remind you that although these have been aided by laboratory achievements they would have been impossible without the cooperation of the pediatrician.

Please recall that roughly 30 years ago atresia of the bile ducts carried a mortality of 100%. Intestinal obstruction due to midgut volvulus had an equally high mortality. Congenital diaphragmatic hernia—other than those through the esophageal hiatus—had an estimated 90% mortality. The recovery of a patient with intestinal atresia was indeed a rare incident. The mortality from intussusception, and even from pyloric stenosis, was nearly 60%.

Today the mortality in these and other conditions has been reduced by from 25% to 75%, and in some conditions to nearly zero. This striking lowering of mortality has been brought about largely by men, both medical and surgical, who devote their energies to the care of infants and children. It seems, therefore, particularly opportune and appropriate that these pediatricians and pediatric surgeons should join together in a concerted effort to advance the care of this age group. I, for one, am sufficiently optimistic to believe that greater advances will be made in the decades to come if we all work together and with one goal in mind; namely, the improvement of the lot of the afflicted child. The establishment of a surgical section in this Academy certainly should help the pediatrician, the pediatric surgeon and last, but far from least, sick children.
STUDIES OF THE CARDIOVASCULAR AND RENAL SYSTEMS IN THE NEWLY BORN INFANT USING FLUORESCEIN
Authors: SLOBODY LAWRENCE B. , ROOK GEORGE D. , LEVBARG MORRISON , MORCY MADELAINE
Published: December 2021

The circulation time with fluorescein has been determined in 90 normal newborn infants immediately after birth.

The umbilical vein-to-lip time was determined in 45 newborn infants. The mean circulation time was 4.8 ± 0.7 sec. with a range of 3.1 to 7.0 sec. The ductus venosus-to-lip time was determined in 45 newborn infants. The mean circulation time was 4.4 ± 0.6 sec. with a range of 3.3 to 5.8 sec.

Polyethylene tubing 0.047 internal diameter and 5% fluorescein 0.1 ml. in 5% sodium bicarbonate solution are recommended for the determination of circulation time in the newborn infant immediately after birth.

This determination is simple and accurate and may aid in the differential diagnosis of cyanosis of the newborn infant.
ELECTROENCEPHALOGRAPHIC FINDINGS IN SICKLE CELL ANEMIA
Authors: HILL FONTAINE S. , HUGHES JAMES G. , DAVIS BILLIE CAMP
Published: December 2021

Electroencephalographic findings in 38 cases of sickle cell anemia are presented, of which 35 patients were children under 14 years of age.

The EEGs were considered to be abnormal in 26 patients. Of special interest was the fact that all children under 6 years of age had abnormal EEGs.

In the group as a whole, there were nine patients with a past history or the presence of nervous system symptoms who had normal EEGs, and three in this group whose tracings were thought to be borderline.

A brief review of the principal pathologic changes in the brain in sickle cell anemia is presented, and a discussion is given of the way in which these changes might influence brain potentials.

Abnormal brain potentials in patients with sickle cell anemia are considered to be due primarily to cerebral anoxia, and secondarily to degenerative processes in nerve cells.

Electroencephalography offers a new approach to the determination of the incidence and character of cerebral dysfunction in sickle cell disease.
INCUBATOR CARE OF THE PREMATURE INFANT
Authors: DANCIS JOSEPH , CARDULLO HUGO M.
Published: December 2021

The available data indicating the optimal conditions for premature infants are reviewed. The deficiencies in our knowledge are stressed. The designs of incubators now available are discussed and their effectiveness in controlling environmental conditions is outlined. The necessity of frequent checking and servicing of the incubators to insure proper performance is emphasized.
Round Table Discussion
Authors: GLASER JEROME , FRIES JOSEPH H. , BAKER JULIA , HORESH ARTHUR J. , DEES SUSAN C. , LECKS HAROLD I. , GRAUBARTH JULIAN , SLESINGER HYMAN A.
Published: December 2021

Chairman Glaser: By gastrointestinal allergy is meant an allergic reaction in an organ of the gastrointestinal tract. While gastrointestinal allergy most commonly occurs from foods, it may also be produced by allergens from other sources, as for example the patient with ulcerative colitis described by Rowe whose condition was shown to be due to the inhalation of pollen. By food allergy is meant an allergic reaction caused by a food, regardless of the tissue in which the reaction occurs; thus atopic dermatitis of infants may be the result of an allergy to egg, for example.

McGee believes that the first allergic reaction to occur in the human being may occur in utero, most commonly as a manifestation of allergy to food ingested by the mother, in the form of "fetal hiccoughs." While such spasmodic movements of the fetus are well authenticated, the general acceptance of McGee's views awaits confirmation by other investigators. The first allergic manifestation to occur in the newborn human being is urticaria. The urticarial wheals seen in the newborn infant, however, may not necessarily be due to an allergic reaction per se but may be due to the unstable vasomotor regulating mechanism of the newborn child. However, in many instances the urticarial wheals are produced by substances ingested by the infant or carried through the mother's breast milk when the infant nurses.

Colic or gastroenterospasm is the first clinical manifestation of allergy in the newborn human being of which the parents may complain. This commonly starts during the first weeks of life and usually terminates regardless of therapy by the time the infant is 3 months of age.
SPECIAL REVIEWS
Authors: HOLLANDER MILTON H. , STARK MERITT W.
Published: December 2021

A fatal case of hemorrhage in an infant 10 weeks of age due to a bleeding duodenal ulcer is presented.

The relative infrequency of duodenal ulcer in infancy is cited. The relationship to trauma and burns and to vascular, chemical and neurogenic theories are discussed. Diagnosis, including the use of roentgenograms, is presented. Hemorrhage is the only definite sign pointing to duodenal ulcer. After persistent vomiting, with or without blood, plus melena and the appearance of sudden collapse, the possibility of peptic ulcer should be considered.
CONGENITAL DEFICIENCY OF ABDOMINAL MUSCULATURE WITH ASSOCIATED GENITOURINARY ABNORMALITIES: A SYNDROME
Authors: EAGLE J. FREDERICK , BARRETT GEORGE S.
Published: December 2021

Nine cases of congenital deficiency of the abdominal musculature with associated genitourinary abnormalities are presented, the literature is reviewed and the pathogenesis and treatment are discussed.

It is emphasized that when congenital deficiency of the abdominal muscles is recognized, particularly in a male infant with undescended testes, or when there is a patent urachus, obstructive manifestations in the genitourinary tract must be searched for and corrected at the earliest possible moment. Urinary symptoms in these cases are usually not present.
SPECIAL REVIEWS
Authors: GLASER KURT , LIMARZI LOUIS R. , PONCHER HENRY G.
Published: December 2021

The bone marrow of 151 normal infants, children and young adults ranging in age from birth to 20 years was studied. The data were statistically evaluated and recorded in table and graph form. The following observations were made:

1. The height of the various layers in the centrifuged specimen as obtained by aspiration of 1 cc. or fraction thereof of marrow fluid was compared in the different age groups and showed an increase with progressing age of the fat and myeloid-erythroid cell layers and a decrease of the mature red cell layer.

2. The cellular composition of the bone marrow varies with age.

3. Marked variations occur during the first year of life and particularly during the first month. Thereafter up to the end of the observation period the changes are of minor extent and average values for this age group were established for all cells.

4. The cells of the erythroid series show a sharp decrease in number during the first days of life and reach essentially stable values (23.12%) by the end of the first month with a temporary decrease around the third month of life.

5. The myeloid series shows an increasing during the first two weeks of life followed by a sharp drop around the third week and the establishment by the end of the first month of values close to the average percentage as calculated for the period from 1 to 20 years (60.59%).

6. The lymphocytes increase in number during the first weeks of life, followed by a gradual decrease during the first and second year and thereafter do not show marked variations in number. (Average:16.03%.)

7. The individual cells of the myeloid and erythroid series show a pattern similar to the one described for the entire series of which they are part. There is, however, a tendency for the younger cells to slightly decrease in number and the older cells to increase with advancing age. Numerical variations with age on cells occurring in smaller numbers are less noticeable than on cell groups occurring in higher percentages.

8. The myeloid-erythroid ratio is the expression of the numerical relationship of the myeloid and erythroid series. The values are low at birth, increase rapidly during the first two weeks and approach the 1 to 20 year average (2.95) during the first year.

9. The data reported in the literature were recorded in order to complement and compare the findings of this study.

10. The normal bone marrow pattern as described may contribute to the interpretation of the cellular composition of the bone marrow under abnormal conditions. However, the diagnostic significance of individual cell findings may be limited by the great variations occurring normally in the cellular composition of the bone marrow of healthy individuals.
STUDIES ON THE ADMINISTRATION, ABSORPTION, DISTRIBUTION AND EXCRETION OF AUREOMYCIN IN CHILDREN
Authors: WHITLOCK COLEMAN M. , HUNT ANDREW D. , TASHMAN SYLVIA G.
Published: December 2021

Data are presented on the administration, absorption, distribution and excretion of aureomycin in children. From these data, tentative oral and intravenous dosage schedules of, respectively, 11 mg./kg. body weight every 4 hours and 6.6 mg./kg. body weight every 12 hours are proposed. The same total daily oral dose (60 mg./kg. body weight) divided into less frequent individual doses than every four hours might prove equally effective and well tolerated. The possibility of uptake of aureomycin by some or all the cells of the human body is also suggested. The observation of apparent photosensitivity occurring during aureomycin ingestion is reported.
MULTIPLE FRACTUERS ASSOCIATED WITH SUBDURAL HEMATOMA IN INFANCY
Authors: LIS EDWARD F. , FRAUENBERGER GEORGE S.
Published: December 2021

An infant with subdural hematoma associated with multiple fractures was presented. The etiology was not established.
Long-Term Outcome of Hemophilus influenzae Meningitis Related to Antiobiotic Treatment
Authors: Lindberg Johan , Rosenhall Ulf , Nylén Olle , Ringnér Åke
Published: December 2021

Of 82 patients treated for Hemophilus influenzae meningitis from 1968 to 1975, a total of 22 (26.8%) showed neurologic or psychologic sequelae, or both. Auditory impairment was the most common type of sequelae; it occurred in 15 patients. Complications during acute illness were more frequent in patients who later developed sequelae than in patients who recovered completely. Sequelae were more often found in patients who received both ampicillin and chloramphenicol concomitantly compared with patients who were treated with one of these drugs. A possible antagonistic interaction between ampicillin and chloramphenicol is discussed.
Primary Meningococcal Conjunctivitis
Authors: Newton Dale Alan , Wilson William Grady
Published: December 2021

Primary meningococcal conjunctivitis is a rare disorder with clinical characteristics that are similar to those of gonococcal conjunctivitis. Although infections of the conjunctivas occur as unusual complications of meningococcemia, primary meningococcal conjunctivitis has been reported even less frequently. We recently observed a patient with primary meningococcal conjunctivitis. This case reinforces the need for bacteriological identification of the etiologic agent in acute conjunctivitis to avoid mismanagement.

CASE REPORT

A 9½-year-old white girl had a red eye of three hours' duration. While riding her bicycle, she noted increased tearing, followed quickly by yellow conjunctival discharge and minimal lid edema. There was no pain, photophobia, history of trauma, or known exposure to conjunctivitis.
Traumatic Pneumatocele From a Revolving Restaurant
Authors: Swank Ralph L. , Wolfson Sorrell L.
Published: December 2021

Revolving restaurants and lounges are becoming very popular. Usually rotating at about one revolution per hour, their motion is inconspicuous. Distracted or inebriated adults or inattentive children may be caught by the progress of the moving parts. Two such incidents have occurred recently in Tampa, Florida. The case of one child is presented.

CASE REPORT

A 3-year-old boy was leaning out of a booth in a revolving restaurant when the motion of the floor compressed him between the booth and the stationary wall. The space between the end of the booth and the wall was 12.5 cm (Fig. 1). He was trapped until the rotation of the restaurant was stopped by turning off the motor and his father pulled him out, with considerable effort.
Acute Confusional State in Children With Migraine
Authors: Emery E. Stanley
Published: December 2021

A wide variety of paroxysmal visual, sensory, and motor disturbances with or without headache is included in the migraine syndrome, but disturbances in consciousness and mental functioning as a part of the migraine syndrome in children are not well recognized.1 In 1970, Gascon and Barlow reported four children, ranging in age from 8 to 16 years, who displayed acute confusional states during an attack of migraine.2 This report describes similar episodes in four additional children in order to call attention to this disorder and provide additional characterization.

See figure in PDF file

CASE REPORTS

Case 1

An 8-year-old girl fell off her sled and rolled down a hill.
Insurability and employability of young cardiac patients
Authors: Manning James A.
Published: December 2021

The conference ended with a sense of improved understanding by the cardiologists, medical directors of life insurance companies, and physicians in industrial medicine of the shared problems and of the opportunities to liberalize the restrictions on insurance and on employment of the adult with congenital heart disease and to remove them altogether for the individual with a bona fide innocent murmur. Like clinical cardiology, insurance medicine is an ever-changing field, and medical directors of insurance companies are willing to consider that they can insure many conditions they had previously declined.
Children in Divorce: Intervention in the Phase of Separation
Authors: Derdeyn Andre P.
Published: December 2021

Divorce of their parents can create difficulties for the development of young children. The ability of children to integrate the various losses involved in the breaking up of a family is impeded by limitations of their cognitive understanding of events taking place during the separation phase. Because their thinking process is as yet immature, children often feel responsible for the divorce, and they otherwise distort the meaning of the events about them. The pediatrician can often guide and encourage parents to facilitate their children's understanding and acceptance of the changes in their lives.
Summer Camp Hemodialysis for Children With Chronic Renal Failure
Authors: Primack William A. , Greifer Ira
Published: December 2021

A hemodialysis unit was established at a rural summer camp for children. Required medical treatment was planned so as to interfere as little as possible with normal camp programs. Campers who require dialysis were mixed fully into the population of normal campers. Twenty-two children participated during the first summer of operation. Our experience indicates that children on maintenance hemodialysis can be integrated with normal peers in a recreational program and can improve their self-image and self-confidence. The program also demonstrates that chronic pediatric hemodialysis can be safely performed in a rural satellite unit.
Denver: A Metropolitan Public School Scoliosis Survey
Authors: Drennan J. C. , Campbell J. B. , Ridge H.
Published: December 2021

A successful method for screening pupils for scoliosis in a metropolitan public school system is outlined. The incidence of scoliosis increased to greater than 3% in the seventh-grade population. Approximately 15% of the patients with established diagnoses required active management.
Ethics Rounds in a Children's Medical Center: Evaluation of a Hospital-Based Program for Continuing Education in Medical Ethics
Authors: Levine Melvin D. , Scott Lee , Curran William J.
Published: December 2021

Clinical rounds in medical ethics were established in 1971 in a large medical center to provide a forum for the multidisciplinary discussion of moral dilemmas in health care. The rounds consisted of case presentations and analyses by professionals primarily from the fields of law, pediatrics, religion, and philosophy. Five years of experience with these rounds were reviewed. Certain predominant themes emerged from the discussions. The most common involved the process of selecting a decision-maker. The rounds were evaluated with regard to their impact and educational value. Although these sessions often did not lead to diametric change in position by participants, they did help to sensitize participants and to clarify and expose critical issues. Ethics rounds may offer a constructive response to the current outcry for more stringent consideration of moral values in hospital settings.
Sickle Cell Anemia in the Newborn
Authors: Hegyi Thomas , Delphin Elise S. , Bank Arthur , Polin Richard A. , Blanc William A.
Published: December 2021

The clinical presentation of homozygous sickle cell disease is unusual in the neonatal period. Recently, we have encountered a newborn infant whose disease was apparent at birth and who died at 5 days of age. The findings at autopsy suggested a sickle cell crisis with multisystem involvement that was present prior to birth. Laboratory findings confirmed homozygous sickle cell disease without the presence of elevated levels of hemoglobin S. The cause of the unusually severe clinical course of the disease in our patient is the object of the discussion.
Screening for Duchenne muscular dystrophy
Authors: Roses Allen D. , Nicholson Garth A. , Roe Charles R.
Published: December 2021

Recently, it has been suggested that all newborn male infants be screened for Duchenne muscular dystrophy (DMD) by measuring creatine phosphokinase (CPK) levels.1,2 One of the main arguments for this approach is that mothers of affected infants who have no known family history of DMD can be counseled. Current genetic counseling advice, however, is based on a theory that many DMD patients represent new mutations.3-5 Zellweger and Antonik have stated the theory when they say, "DMD is inherited as an X-linked recessive trait in two-thirds of the cases, and is due to new mutations in the rest of the cases.l
Incorrect Dose of Methylphenidate
Authors: Roberts Wendy , Kinsbourne Marcel , Varga James , Swanson James
Published: December 2021

In a letter which appeared in the June 1975 issue of Pediatrics (page 895), a child's adverse response to a single 40-mg dose of methylphenidate is reported. The reaction was described as idiosyncratic, with reference to a maximum recommended dose of 2 mg/kg. This reference is incorrect and potentially misleading. In fact, the source cited (Goodman and Gillman, 1970, p. 354) specified a daily dose of 2 mg/kg to be administered in three divided doses (and then only as a maximum to be approached gradually, the recommended initial dose being as little as 0.25 mg/kg).
Polygraphic Studies of Normal Infants During the First Six Months of Life: III. Incidence of Apnea and Periodic Breathing
Authors: Hoppenbrouwers Toke , Hodgman Joan E. , Harper R. M. , Hofmann Elvira , Sterman M. B. , McGinty D. J.
Published: December 2021

The incidence of apnea and periodic breathing was studied in full-term infants between birth and 6 months of age. Apnea was defined as a pause equal to or exceeding six seconds, periodic breathing as two cessations of breathing within a 20-second period, each equal to or longer than three seconds but less than six seconds. Sleep and cardiopulmonary variables were monitored.

Apnea was common in the normal full-term infant. The incidence of apnea was highest in the newborn period and apneas exceeding 15 seconds were limited to this age. A reduction in apnea incidence occurred between birth and 3 months of age; thereafter, the incidence remained unchanged. The majority of apneas occurred during active sleep (AS). Few minutes were classified as indeterminate; the number of apneas during these minutes was comparable to those during AS. The incidence of apneas during quiet sleep was low. Periodic breathing remained stable across the ages, occurring primarily in AS.

Apnea exceeding 15 seconds is rare in infancy. The tabulation of shorter apnea may be of limited value in identifying infants at risk for abnormal apnea due to extreme variability among infants. The sleep-waking state of the infants must be considered in order to evaluate apnea counts.