bluuebunny/crossref_metadata_2025 huggingface dataset:
SPECIAL ARTICLE
Authors: LANMAN THOMAS H.
Published: December 2021

IT IS a great honor to be asked to present the first William E. Ladd Lecture before the American Academy of Pediatrics. This I appreciate and as this is the first lecture in my former Chief's honor, I shall devote my time more to Doctor Ladd and what he accomplished during his long and devoted service as Chief of the Surgical Service of the Boston Children's Hospital than to the presentation of anything new.

In these days of great changes in the surgical field, it is very easy to overlook or even to forget the good things that were done in the past. I said "changes" rather than advances for some of the changes of today are not advances. It is easier to appreciate the extraordinary widening in the field of surgical endeavor that has been made possible by improvements in pre- and postoperative care, anesthesia, and the more effective means to combat infection than it is to remember what was done in a previous generation without such new and valuable aids.

When I began my service at the Boston Children's Hospital in 1919, most of the deaths on the Surgical Service were caused by infection. Long surgical procedures involving an open thoracotomy were impossible. Prolonged operations on the gastrointestinal tract carried a heavy mortality largely because of our lack of knowledge of fluid balance. In those earlier days, an operation that exceeded an hour in length was considered to be entering a very dangerous phase.

It is well, however, to review some of the types of cases done in those days and to keep in mind that the basic principles one had to follow at that time are still valid and that the good results of today are by no means entirely due to modern methods. Let me cite a few examples.
HYPERTENSION IN INFANCY, WITH ANOMALOUS RENAL ARTERY
Authors: Snyder C. Harrison , Bost Roger B. , Platou R. V.
Published: December 2021

The importance of persistent study, and of renal arteriography, has been illustrated by investigations in an infant who had severe hypertension. Aneurysms of a double right renal artery, together with ischemia of the right kidney, were clearly demonstrated by arteriogram, leading to nephrectomy and apparent cure.
A NEW METHOD FOR ASSAY OF PROTEOLYTIC ACTIVITY OF DUODENAL FLUID COMPARED WITH OTHER METHODS IN THE STUDY OF FIBROCYSTIC DISEASE OF THE PANCREAS (MUCOVISCIDOSIS)
Authors: Leubner Hugo , Shwachman Harry
Published: December 2021

(1) A modification of the gelatin viscosity method is described for routine use in determining proteolytic activity of duodenal fluid. This method is compared to the Andersen-Early method and to the method of Free-Myers which uses casein as a substrate.

(2) The sensitivity of the gelatin viscosity method is shown in the assay of commercial pancreatic preparation where a dilution of approximately 1/100,000 is within the optimal range of activity. In routine assay of duodenal fluid a 1/3,000 dilution is optimal.

(3) In a study of duodenal fluid from 3 groups of patients, the results with 3 methods; the viscosity method, the Andersen-Early method, and the Free-Myers modification of the Anson method, are compared. These 3 methods are in agreement when there is practically complete loss of pancreatic function. However, in patients with partial pancreatic insufficiency the Andersen-Early method is not sufficiently quantitative to detect these changes. It is pointed out that approximately 85 per cent of the substrate is used up before any change in activity is detected by the Andersen-Early method.

(4) The gelatin viscosity method and the Free-Myers method are sufficiently quantitative as a measure of proteolytic activity, although there are occasional discrepancies between measurements by these methods which are presumably due to the relative concentration of trypsin and chymotrypsin in the duodenal fluid.
AN ADAPTATION OF THE CAPILLARY pH ELECTRODE FOR PRACTICAL USE
Authors: Cook Charles D. , Cherry Ruth B. , Karlberg Petter
Published: December 2021

CAPILLARY electrodes for pH meters have been applied to the accurate determination of pH when only limited samples were available. This type of electrode has proved particularly valuable for the study of plasma or blood from infants or small animals. However, the problem of frequent plugging and breakage encountered while filling and rinsing the capillary by gravity and/or capillary action has made the micro pH electrode difficult, if not impractical, to use for routine work. Other authors have described a suction system applicable only to the cleansing of a different type of capillary electrode.

The accompanying diagram shows how a simple suction system may be attached to the Beckman capillary to allow easy, controlled filling with buffer solutions, plasma or blood, and to permit thorough rinsing.
SERUM DESOXYRIBONUCLEASE ACTIVITY IN PREMATURE AND TERM INFANTS
Authors: Obrinsky William , Kurnick Nathaniel B. , Fichter Elaine G.
Published: December 2021

1. Mothers at term show a striking reduction in serum DNase activity and, as a group, their differences from normal adults are highly significant. 2. Postnatally, prematures differ significantly from term infants in serum DNase activity whereas term infants show no differences from adults. An explanation suggested by the evidence is that prematures exhibit hepatic immaturity in regard to DNase clearance so that when the burden of this function is transferred from placenta to liver it is inadequately performed. On the other hand, the livers of term infants are adequate to assume this task when the ductus venosus is closed and the placental circulation eliminated.
THE DIAGNOSIS AND TREATMENT OF GENERALIZED CYTOMEGALIC INCLUSION DISEASE OF THE NEWBORN
Authors: Margileth A. M.
Published: December 2021

1. A case of cytomegalic inclusion disease of the newborn is reported. The incidence, etiology, pathology, clinical and laboratory findings, differential diagnosis, prognosis and treatment are discussed.

2. This is the fourth case of cytomegalic inclusion disease diagnosed prior to death, and the second case which is still living.

3. Any infant with the following features may be considered as a possible case of cytomegalic inclusion disease: (a) Prematurity; (b) evidence of erythroblastosis with jaundice, hemolytic anemia, reticulocytosis, and an increasing serum bilirubin with a negative Coombs test; (c) thrombopenia with bleeding manifestations; and (d) hepatosplenomegaly.

4. The finding of cytomegalic inclusion cells in the urine confirms the diagnosis.

5. The importance of making a presumptive diagnosis of cytomegalic inclusion disease within the first 24 to 36 hours of life has been emphasized since exchange transfusion may be the initial treatment of choice.

6. Cortisone is apparently of value in suppressing the hemolytic process and in improving the thrombopenia. Gamma globulin may be of value in milder cases which do not receive exchange transfusion.

In conclusion, we now have methods of diagnosing and treating cytomegalic inclusion disease of the newborn; a disease which has usually been fatal and, presumptively, is caused by the salivary gland virus. The infection apparently occurs during intrauterine life. Further viral diagnostic studies must be made to clarify the etiology and pathogenesis of this clinically new viral disease.
RENAL DISEASE IN CHILDREN
Authors: Barnett Henry L. , Metcoff Jack
Published: December 2021

Incidence and Epidemiology

A frequent kidney disease in childhood, is usually recognized if gross hematuria is present, but may not be recognized in the absence of this manifestation. In the presence of epidemics of this disease it has been discovered that nearly 20 times the number of recognized cases of the disease may exist in a community as otherwise unrecognized cases unless specially sought for. Acute hemorrhagic nephritis is often associated with infections caused by Group A, Type 12 Hemohytic streptococcus. The occurrence of acute nephritis following infection with one of the specific nephrogenic streptococci may account for the limited recurrence of instances of acute nephritis; owing to development of type-specific immunity. Current knowledge concerning the incidence of acute hemorrhagic nephritis is largely based on data from hospital statistics.

Clinical Course

The clinical course of acute nephritis indicates that between 90 and 95 per cent of children with this disease recover completely; 3 to 5 per cent die, usually in the acute phase during the first week of the disease, and that the remaining 2 to 5 per cent develop chronic glomerulonephritis. Few patients with glomerulonephritis have a long latent interval following the acute phase, with subsequent chronic glomerulonephritis; the chronic form of the disease usually occurs, if at all, within a few years of the initial episode. Few if any patients with acute glomerulonephritis in childhood subsequently develop the nephrotic syndrome. The nephrotic syndrome has been observed only following explosive onsets of acute nephritis associated with variable periods of anuiria, and obvious extensive nephron damage.
THE PEDIATRICIAN AND THE PUBLIC
Authors: Askin John A. , Glaser Kurt
Published: December 2021

IN SPITE of a short period of sovereignty— less than 7 years—the State of Israel is playing an important role in matters pertaining not only to the Middle East but, in some respects, in matters of importance to the whole world. In medicine the advances in Israel have been no less striking than the progress made in other fields. It is felt that the pediatricians of our country might be interested to learn about Israel's medical status, particularly pertaining to pediatrics.

Palestine, of which the present Israel is a part, was in Old Testament times known as Canaan or Philistia because of the tribes which lived there. Palestine was the home of the Jewish people from the time Joshua conquered the land, about 1400 B.C., until the Romans destroyed the Jewish State in the year 70 A.D. Around 630 A.D. the country came under Moslem power. From 1516 to the end of World War I Palestine was a part of the Turkish Empire. In 1917, the British Government issued the famous Balfour Declaration which promised the Jews of the world that they could build a national homeland in Palestine. The League of Nations made the land a British mandate in 1920. From then until World War II Palestine was at several occasions plunged into violent civil war between the Jews and the Arabs. After World War II in 1947 Great Britain announced a decision to give up the Mandate.
STUDIES OF 17-HYDROXYCORTICOSTEROIDS. VII: EFFECTS OF THERAPY ON CONCENTRATION OF 17-HYDROCORTICOSTEROIDS IN THE PLASMA OF PATIENTS WITH RHEUMATIC FEVER
Authors: Seely J. Rodman , Ely Robert S. , Done Alan K. , Ainger Lorin E. , Kelley Vincent C.
Published: December 2021

1. Data are presented concerning plasma 17-OHCS concentrations in patients receiving therapy for rheumatic fever. Serial values were obtained for individual patients receiving bed rest, cortisone orally or intramuscularly, lyophylized ACTH, ACTH-gel or salicylates.

2. The groups treated with bed rest or salicylates developed no elevations of their plasma 17-OHCS; those given cortisone orally or lyophylized ACTH intramuscularly demonstrated a variable pattern of levels of plasma steroids; and those receiving cortisone or ACTH-gel intramuscularly showed sustained elevations of plasma 17-OHCS during therapy.

3. It is suggested that successful hormone therapy of rheumatic fever is not dependent upon sustained elevations of adrenal cortical steroids in the plasma.
ELECTROENCEPHALOGRAPHIC FINDINGS IN BREATH HOLDING SPELLS
Authors: Low Niels L. , Gibbs Erna L. , Gibbs Frederic A.
Published: December 2021

After reviewing the literature on breath holding spells, it seemed desirable to determine whether any electroencephalographic abnormality is revealed by recordings during sleep in such cases. One hundred twenty-nine children between the ages of 7 months and 11½ years with breath holding spells were examined electroencephalographically while awake and during sleep. Seventy-seven of these children were boys and 52 were girls. All these children but one had normal electroencephalograms. One tracing taken during a breath holding spell is reproduced which shows slow wave but no seizure activity. The clinical diagnosis is discussed and it is concluded that the electroencephalogram in combination with the history and clinical observation is of value in the differential diagnosis between breath holding spells and convulsive disorders.
SPECIAL ARTICLE
Authors: Bluestone Seymour S. , Deaver George G.
Published: December 2021

1. The handicapped are an integral part of society to-day and do not exist as a group apart with separate lives. Their needs and nights are the same as those of any other person; their problems are the problems of all people and should be considered as a part of those of the whole society.

2. The handicapped person should be regarded as a whole person, physically, mentally, socially, and emotionally, rather than within the narrow confines of his handicap.

3. Plans should be made with and for the handicapped person on the basis of his abilities, not disabilities, and of capabilities, not limitations, to most fully develop his assets.

4. If these plans are to be reflected in care and treatment services for the handicapped, teamwork of the highest order is required of professional personnel in the medical, therapeutic, educational, social and vocational adjustment fields.

An outline of the objectives, philosophy, and methods of such teamwork has been presented. Rehabilitation is not prescribed in capsule form. It comes only in long hours and weeks and years of ceaseless efforts and tedious training given by dedicated persons. We have made no attempt to elaborate on the techniques employed in representative patients, but hope to make this the subject of a future report.

Rehabilitation has been shown to be both feasible and rewarding. The results of the team approach to the rehabilitation of adults has far surpassed any other method. While objective analysis of pediatric rehabilitation is not yet available, it is axiomatic that the results must be equally commendable. Countless previously hopelessly crippled children have already been salvaged.

Every community should have access to a rehabilitation center such as has been described, where the total needs of the handicapped child can be evaluated and appropriate recommendations made. The majority of such children can then he referred for treatment through existing community resources. Only the more complex problems would remain at the center for more elaborate handling by the team method.

The pediatrician must recognize his responsibility as an active participant in the rehabilitation of children and indeed, must assume the leadership of this challenging new field.
INFANTILE SPASTIC HEMIPLEGIA
Authors: Perlstein Meyer A. , Hood Philip N.
Published: December 2021

From this study the following conclusions emerge regarding the relation of intelligence of infantile spastic hemiplegics to various factors.

The spastic hemiplegics of the present series were retarded approximately 20 I.Q. points below normal individuals. The mean I.Q. scores and the incidence of mental retardation were in close agreement with several early reports. The marked difference from the recent reports of Hohman and others reporting consecutive series of cerebral palsied patients is attributed to the fact that the present study is based upon a selective population.

Left and right hemiplegics did not differ significantly either in mean I.Q. scores or in the incidence of mental deficiency.

Male and female hemiplegics did not differ significantly, either in mean I.Q. scores or in the incidence of mental deficiency.

The mean I.Q. scores of the congenital and acquired cases did not differ significantly nor was there a greater incidence of mental deficiency in either of the 2 groups.

Mental deficiency was significantly related to the presence of convulsions in this series of spastic hemiplegics; the mean I.Q. score of the convulsives was significantly lower than that for the nonconvulsives by 12 I.Q. points.

There was a significantly greater number of mental defectives below the age of 6 than above that age, although the mean I.Q. scores did not differ significantly between the 2 groups.

When the subjects were grouped into age levels of 1-year intervals, there was no greater incidence of mental deficiency nor did the mean I.Q. scores differ significantly at any year level.

The infectious and traumatic groups of acquired etiologies showed no significant difference in mean I.Q. scores.

The toxemia of pregnancy group showed approximately the same incidence of mental deficiency and the same mean I.Q. score as the group composed of all other congenital etiologies of spastic hemiplegia.
GLYCOGEN DISEASE OF SKELETAL MUSCLE
Authors: Zellweger H. , Dark A. , Haidar G. A. Abu
Published: December 2021

Two cases of glycogen storage disease primarily affecting the skeletal muscle are presented. The patients were not related to each other, but both are from consanguineous families. In both cases a tentative clinical diagnosis was confirmed by skeletal muscle biopsy.

Histologic studies of the skeletal muscle reveal a picture similar to that found in glycogen disease of the myocardium. Individual fibers show severe vacuolization with massive deposits of glycogen within the vacuoles. Large quantities of a basophilic material (presumably identical with that found in myocardial glycogenosis) are also found within the vacuoles. This material is characterized as an acid mucopolysaccharide; its histochemical and tinctorial properties are described. A method is given for avoiding the apparent discrepancy which may occur between the histochemical and biochemical estimations of glycogen content of skeletal muscle. The destruction of skeletal muscle is so severe and so extensive that the clinical signs of neurological involvement present in both our cases can be quite adequately and entirely accounted for by the local muscular damage.

Previously reported cases of glycogen disease of skeletal muscle are reviewed. It was found that Werdnig-Hoffmann's progressive muscular atrophy could be distinguished from glycogen disease of skeletal muscle by the early appearance of pseudo-bulbar symptoms (especially dysphagia) in the latter disease.

The relationship between the myocardial and the skeletal muscle forms of glycogen disease is discussed. Although clinically the 2 conditions may appear as 2 distinct entities, quantitative laboratory methods show considerable overlap in the 2 conditions.

Skeletal muscle biopsy is indicated in every instance of progressive muscular weakness in order not to miss a possible case of glycogen storage disease primarily affecting skeletal muscle. The high glycogen content estimated biochemically and the histological picture described above are pathognomonic for this disease.
PULMONARY AGENESIS
Authors: Clark Harriette , Scott Roland B. , Johnson John B.
Published: December 2021

Two cases of agenesis of the lung, both with anomalies of the urinary tract, have been presented. In 1 patient the diagnosis was made at post-mortem examination at the age of 5 weeks. Associated anomalies in this patient included defect of the interatrial septum, anomalous drainage of the pulmonary vein into the right atrium, and congenital bilateral ureterovesicle obstruction with dilatation of the ureters and kidney pelves. In the second patient, the diagnosis was made at the age of 3 years. A follow-up study 12 years later substantiated the diagnosis and revealed pelvic location of fused kidneys with short ureters bilaterally. In the latter case, the lung anomaly has not resulted in any dysfunction of the heart or pulmonary circulation. There has been some decrease in ventilatory function but not sufficiently severe to result in respiratory symptoms. This patient is living and well at the time of this report.
MODIFICATION OF SELF-RETAINING ELECTROCARDIOGRAPHIC ELECTRODES FOR USE ON PREMATURE INFANTS
Authors: Eisner Victor
Published: December 2021

CONVENTIONAL electrocardiographic electrodes are ill-adapted to use on small premature infants. The size of these electrodes and the necessity of using rubber straps to attach them make it difficult to obtain adequate electrical contact without the risk of injury to the baby. Furthermore, such electrodes cause sufficient discomfort so that a vigorous infant rarely lies quietly. The "infant-size" electrodes are scarcely better on the smaller babies. We have had no success using suction type electrodes.

Lepeschkin in 1951 described a self-retaining precordial electrode designed for use on adults. The following apparatus is constructed to permit the use of Lepeschkin electrodes for all leads on extremely small infants.
A BAROMETRIC METHOD FOR MEASURING VENTILATION IN NEWBORN INFANTS
Authors: Drorbaug James E. , Fenn Wallace O.
Published: December 2021

A barometric method for measurement of ventilation of newborn infants is described.

Experiments with cats are reported to show the degree of accuracy obtainable at present. The variation from standard methods was found to average±1 per cent.

Minute volume, frequency, and tidal volume of premature infants measured by the barometric method are within the range of such measurements made by plethysmographic methods.

The barometric principle deserves further study since it offers the possibility of securing ventilation data with a minimum disturbance to the infant.
PEDIATRIC SURGERY—A FIVE-YEAR (1949-1954) REVIEW
Authors: Pickett Lawrence K. , Krovetz L. Jerome
Published: December 2021

SURVEYS of pediatric wards throughout the country show the steady growth in the percentage of patients classed as surgical as opposed to those treated medically. In many centers, the surgical patients outnumber the medical ones. Obviously much of this shift is due to the use of antibiotics for infection, with more home care now possible for diseases previously requiring hospital care. Fathered by Dr. William E. Ladd, whose career was so admirably reviewed by Dr. Thomas H. Lanman recently, the growth of the sub-specialty of pediatric surgery has been rapid. Increasing numbers of surgeons are devoting their entire time to the care of children.

As the problems of children are dealt with more uniformly and the results of treatment of the varied embryological mishaps improve, there are increasing reports in the literature of value for those centering their attentions on these problems. Editorial comment has been made from various centers as to the proper training for a pediatric surgeon, and the place of this specialty in the ever growing list of sub-specialties.

Two contributions to the field in text form have been presented. Ladd and Gross first emphasized abdominal surgery of infants and children. In 1953, Gross presented the compilation of the experiences at the Boston Children's Hospital in a very complete form covering the cases at that hospital and referring to the work of many others.

In 1948, Coe edited a group of papers on various aspects of the surgery of infants and children, as presented before the meeting of the American Academy of Pediatrics.
THE INFLUENCE OF SURGERY ON RENAL FUNCTION IN INFANCY
Authors: Calcagno Philip L. , Rubin Mitchell I. , Singh Walter S. A.
Published: December 2021

The data presented suggest that post-operative oliguria in a variety of surgical procedures in infants is, at least in large measure, due to dehydration.

The renal tubular capacity, as regards concentration, in the immediate post-surgical state is maintained.

There is no apparent defect in the capacity of the kidney to excrete water in the post-surgical period in these infants.

These data provide no justification for inducing dehydration in the postoperative period, on the premise of impaired renal function in infants and young children.
CLINICAL AND METABOLIC VARIATIONS IN THE ADRENOGENITAL SYNDROME
Authors: Bongiovanni Alfred M. , Eberlein Walter R.
Published: December 2021

The evidence for a well-defined block in the biosynthesis of compound F in patients with congenital virilizing adrenal hyperplasia has been reviewed. The presence of large quantities of pregnanetriol in the urine of most patients with this disorder suggests an inability of the adrenal cortex to convert 17-hydnoxyprogesterone into compound F. A second site of the block in the biosynthesis of compound F has been demonstrated in a patient with this disorder complicated by hypertension. The conclusions regarding the newly proposed location of the disorder are based on the discovery of large quantities of compound S and its metabolites, in both the blood and urine, of a patient with virilization and hypertension. This compound had not been previously described in this syndrome, and its presence may point to the nature of the disorder in those forms of time syndrome associated with high blood pressure. Other abnormalities of the steroid pattern in this variant of the disease include the complete absence of 11-oxygenated 17-ketosteroids otherwise present in large quantities. It is not possible at the present time to explain the hypertension on the basis of the steroids described. However, remission of most manifestations of this disorder, including the hypertension and unusual steroid pattern, following treatment with compound F has been noted.
NEUROBLASTOMA IN CHILDHOOD
Authors: Koop C. Everett , Kiesewetter W. B. , Horn Robert C.
Published: December 2021

Forty-five patients with neuroblastoma are reviewed, 41 more than 16 months post-operative. Fifteen of the forty-one are alive and well, a survival of 36.6 per cent.

There appears to be some correlation between survival of patients with neuroblastoma and a major surgical insult to the tumor. In 22 patients where biopsy alone was carried out, there was a mortality of 87 per cent. In 19 patients treated by a surgical attempt at radical removal of the tumor, without subsequent radiation therapy, 12 survived, a rate of 63 per cent.

Time age of the surviving patients at the time of diagnosis was 4.4 months as contrasted with an average of 34 months for those who died.

The survival of 11 of 15 patients for periods ranging from 16 months to 12 years after diagnosis is unrelated to x-ray therapy.

No patient in this series, free of gross metastases at the time of operation, has died up to the time of this report. Forty-nine per cent of the surviving patients had gross metastases, but no patient with metastases to lung or bone survived.
SPECIAL ARTICLE
Authors: Cohen Seymour S. , Barner Hazel D.
Published: December 2021

Studies have been described with a thymine-requiring strain of E. coli. This organism dies in the absence of its requirement. It has been shown that nuclear and cytoplasmic syntheses are no longer balanced under conditions of thymine deficiency and continuing unbalanced synthesis results in the loss of the power to multiply. Thymine deficiency and death of other bacterial strains may be provoked by sulfanilamide in the presence of certain metabolites which then support unbalanced growth. The killing action of low doses of ultraviolet irradiation also appears to depend on growth and may be prevented by inhibiting protein synthesis. It was shown that many bactericidal treatments are similar in that they appear to affect nucleic acid metabolism and to require continuing growth for their lethal actions to be manifest. A selective inhibition of DNA synthesis appears to be capable of inducing death by unbalanced growth.
SPECIAL ARTICLE
Authors: Nicholson Jesse T.
Published: December 2021

Cartilaginous tumors in children may be divided into peripheral and central types according to their location in long bones. The peripheral tumors are by and large osteochondromata. The central tumors are mainly enchondromata.

Cartilaginous tumors do not respond favorably to irradiation but are best treated by wide resection. Periosteal chondroma, chondroblastoma and chondromyxoidfibroma appear to respond to complete curettement and substitution of chips of bone.

Osteochondroma and enchondroma should be watched through the growth period. Their increase in size is gradual during this period.

Pain in, or enlargement of, a cartilaginous tumor, particularly after completion of growth, should be regarded as development of chondrosarcoma.

Surgical biopsy of a chondroma is indicated when diagnosis is questionable or when growth of the tumor is accelerated.
EDUCATION
Authors: WILSON JAMES L.
Published: December 2021

I am glad to write you a note in support of my opinion that the time has come to increase the required pediatric training in hospitals for Board certification in Pediatrics from 2 to 3 years. I must state at the beginning that I don't believe that one can advocate this increased requirement as a necessity in absolute terms. The whole concept of the desirability of Board certification in any field has been challenged repeatedly, although I believe any objections that have been raised to such organizations apply less to pediatrics than to any other program. American children, in my opinion, are immensely better off due to the establishment of the Board of Pediatrics and the Academy of Pediatrics.
Letters to the Editor
Authors: FABEER HAROLD K. , ELEY R. CANNON , PLATOU RALPH V.
Published: December 2021

In its report of October 4, 1955, the Committee on the Control of Infectious Diseases of the American Academy of Pediatrics, in somewhat guarded and carefully couched terms, approved the resumption of vaccination against poliomyelitis (Pediatrics, 16: 737, 1955). This report was accepted by the Executive Board and was presented to the general session of the Academy on the morning of October 5, without any opportunity for dissident opinions to be expressed or debated. A good many physicians, particularly those who have closely followed recent developments, we believe, still have misgivings over the safety of the vaccine which have not been wholly allayed by the Committee's statement.
EDITORIAL
Authors: MCINTOSH RUSTIN
Published: December 2021

THIS issue of Pediatrics contains a description of the role of trace elements in hemopoiesis, a critical study which was presented at the annual meeting of the American Academy of Pediatrics held in Chicago in early October, 1955. James Allen Bush, the author, although not actually a Fellow of the Academy, made the presentation at the invitation of the Program Committee. He imbued his message with a rare combination of enthusiasm, clear thinking, mature judgment and a fine appreciation of the true goals of clinical investigation. Those who heard him in Chicago could not fail to be impressed by the sincerity of his search for truth.
A STUDY OF THE UPTAKE OF IODINE (I-131) BY THE THYROID OF PREMATURE INFANTS
Authors: Martmer Edgar E. , Corrigan Kenneth E. , Charbeneau Harold P. , Sosin Allen
Published: December 2021

In a series of 65 premature infants weighing from 991 to 2481 gm. and 5 full-term infants from 2522 to 2694 gm., who were from 1 to 63 days old, the uptake of I-131 by the thyroid 24 hours following the administration of 5 µc. orally or by means of a polyethylene tube in the stomach, as measured by both a Geiger-Mueller counter and a scintillation counter, ranged from 10 to 60 per cent. In 2 cases with an uptake of less than 10 per cent and 3 cases bordering 60 per cent, technicalities and the possible surreptitious use of thyroid by the mother may account for the variation. The range of uptake of I-131 as recorded in this series of infants is within the limits of normal as recorded in studies of children and adults using the Geiger-Mueller counter.

The difference in percentage uptake as recorded by the Geiger-Mueller counter and the scintillation counter, after acquiring experience with the equipment, was less than 5 per cent.

The technique, and the scintillation counter used, are described. I-131 administered orally or by a polyethylene tube in the stomach is well tolerated and in this series did not cause vomiting.

The activity of the thyroid gland in premature and full-term infants, as revealed by the uptake of I-131 24 hours following administration, is discussed and evidence is presented that in such individuals the thyroid functions in a manner similar to that found in children and adults.
GROUP THERAPY IN A CHILDREN'S HOSPITAL: PRELIMINARY REPORT
Authors: Fineberg Henry H. , Johnson Margaret , Leiden Irving , Lynch Helen
Published: December 2021

WE WISH to describe a therapy group formed as an experiment in a pediatric hospital setting. Part One of the paper presents the rationale and structure of the group. The second part is designed to give the reader a descriptive summary of the group and individual activity covering the series of 12 meetings, with no attempt at dynamic evaluation of the material presented. The latter will be reserved for a later communication.

Part One

Our interest in establishing a group program in this setting was based upon the observation that a prophylactic measure was needed for those children who, because of long hospitalizations, were not adequately stimulated for emotional growth. In addition, certain children showed a variety of emotional needs which we felt would be better understood and dealt with in a group program. These children may or may not have been considered "problems" on the ward.

It was decided that the social group worker would provide an opportunity for the children to function in a social group with as little adult-imposed restriction as was reasonable, so that the child could evidence as clearly as possible his characteristic patterns of behavior in a group of peers.

No formal psychodynamic diagnosis was made on any child prior to admission to the group. A tentative dynamic formulation in regard to behavior and personality organization was made for each child after each meeting. This aided appropriate handling of the child in the group and made it possible to give recommendations to hospital personnel who would influence the child when away from the group.
SEPTICEMIA OF THE NEWBORN
Authors: Smith Richard T. , Platou Erling S. , Good Robert A.
Published: December 2021

The problem of neonatal septicemia has been considered and pertinent literature reviewed. Criteria for the diagnosis of this disease modified from the criteria of Silverman and Homan are presented.

Fifteen cases of septicemia occurring in the neonatal period are presented. The clinical manifestations, laboratory findings and bacterial etiology are considered and compared to those previously reported.

Early diagnosis and intensive broadspectrum antibiotic therapy resulted in the cure of 13 of 15 cases. There were 2 deaths.

The significance of these observations and the pathogenic mechanisms involved in this disease are discussed.
NUTRITIONAL REQUIREMENTS IN EARLY LIFE
Authors: Holt L. Emmett
Published: December 2021

IN ACCEPTING the Borden Award I must say how deeply I appreciate this honor. One's efforts in the realm of science tend to have a somewhat jaundiced look in retrospect, but when someone else thinks they have merit it is very heartening. I have chosen the nutritional requirements of children for my topic, if only to show how little we know about it and how important it is to know more.

Why is it important to study nutritional requirements today? Isn't it true that infant feeding is a dead subject? Can't we feed a child today in a hundred different ways and have it thrive? That is certainly true of the normal subject in our own country. Food shortage is no problem. The problem of digestibility has been solved by a variety of processing techniques. We can supply the necessary nutrients with a wide margin of safety. We have no difficulty in meeting caloric and protein requirements, and vitamin deficiencies are almost a thing of the past. Why should we worry all out nutrition? The answer is, however, not hard to find. We may have mastered the problem of nutrition in health, but we have scarcely touched the problem of nutrition in disease. In the autopsy room we still see plenty of infants and children who are emaciated as the result of disease. Their nutrition has failed. If it could have been maintained the result might have been different.

Disease poses special problems for the nutritionist. It may affect the organs of digestion, assimilation and utilization, and thus limit the quantity of nutrients available to the body. It may impose limitations on particular types of food and, finally, it may impose special nutritive requirements. We are all familiar with the increased caloric demands made by fever and there is evidence, too, of an increased nitrogen requirement at this time. We are familiar, too, with the demineralizing effects of acidosis and with an increasing number of situations in which potassium losses from the cells need to be replaced.
ECZEMA ASSOCIATED WITH THROMBOCYTOPENIC PURPURA AND PURULENT OTITIS MEDIA
Authors: Huntley Carolyn C. , Dees Susan C.
Published: December 2021

The case histories of five male children, who had eczema, thrombocytopenic purpura, and purulent otitis media terminating with death, are reported. Four of the group lived about 2 years, one survived for 7½ years. The role of allergy, infection, drug therapy including steroid hormones, and splenectomy is discussed. In three of the group a family history of this symptom complex is compatible with a sex-linked recessive character as was true in Aldrich's case. The hereditary pattern and the combination of symptoms differentiate these patients from the majority of children with either eczema or purpura.
A SCREENING TEST FOR CYSTIC FIBROSIS OF THE PANCREAS USING ANALYSIS OF SALIVA
Authors: Hart Wayne , Naime Mansour J.
Published: December 2021

A screening test for cystic fibrosis of the pancreas utilizing analysis of saliva for iodine after oral administration of Lipiodol® is presented. Tables provide the results obtained from testing 11 children who have cystic fibrosis of the pancreas and 30 children who have no evidence of this disease. It is indicated that the test can be easily and rapidly performed.
CONGENTAL, MULTIPLE PERIPHERAL STENOSES OF THE PULMONARY ARTERY
Authors: Gyllenswärd A. , Lodin H. , Lundberg A. , Möller T.
Published: December 2021

A report is given of eight cases of congenital, multiple peripheral stenoses of the pulmonary artery, diagnosed by means of cardiac catheterization and selective angiocardiography. These cases are divided into two types on the basis of the anatomic features, i.e., type I—simple membranous stenosis distal to the pulmonary valve, and type II–multiple, short or long bilateral constrictions extending from the main trunk to relatively fine branches.
THE INCIDENCE OF THE NEPHROTIC SYNDROME IN CHILDREN
Authors: Rothenberg Michael B. , Heymann Walter
Published: December 2021

The results of a 5-year survey of the incidence of the nephrotic syndrome in children, in Ohio are presented. For the Greater Cleveland Area, with a total population of 1,500,000, there were 0.8 new cases per year per 100,000 total population and 6.9 new cases per year per 100,000 children aged 0 to 9 years; using an average duration of this disease of 2 to 5 years, there were 1.5 to 3.8 active cases per year per 100,000 total population and 13.8 to 34.5 active cases per year per 100,000 children aged 0 to 9 years. For the state of Ohio, with a total population of 8,000,000, there were 0.5 new cases per year per 100,000 total population and 2.3 new cases per year per 100,000 children aged 0 to 9 years; again using an average duration of this disease of 2 to 5 years, there were 1.0 to 2.5 active cases per year per 100,000 total population and 4.6 to 11.4 active cases per year per 100,000 children aged 0 to 9 years.

A nationwide survey of the incidence of the nephrotic syndrome in children has been attempted, using death rates as an indicator of incidence. A possibly higher, or at least equal incidence of this disease in non-white than white children was found. A higher incidence of this disease in both the white and non-white populations of certain southern states as compared to the North was noted.
Neurology and Psychiatry in Childhood
Authors: MACQUEEN JOHN C.
Published: December 2021

The book Neurology and Psychiatry in Childhood records the proceedings of annual meeting of the Association for Research in Nervous and Mental Diseases. Thirty-four similar publications record the previous annual meetings of the Association. The decision to discuss so broad a theme as the neurologic and psychiatric problems of childhood determined that the topics presented at the meeting would be of wide variety.

A major portion of the book is devoted to a presentation of current thought concerning a variety of common neurologic problems of childhood.
Clinical Pathologic Conferences of Cook County Hospital
Authors: CALCAGNO PHILIP L.
Published: December 2021

Clinical pathologic conferences have been a popular form of teaching for many decades. This popularity in such presentations has found support not only because of the enlightening solutions derived to answer unexplained clinical puzzles, and stimulation acquired for continued research into both basic and clinical investigation, but moreover this form of exercise attempts to satisfy in part a basic need emotionally for physicians who are confronted with many challenging problems. The Cook County hospital staff has long used this medium for teaching house staff and attending physicians and in this volume Popper and Kushner have compiled examples of cardiovascular-renal problems.
Sauglings-Enteritis (Enteritis in Infants)
Authors: NETER E.
Published: December 2021

More than 25 years ago Dr. Adam advanced the idea of the etiological role of certain biotypes of Escherichia coli in infantile diarrheal disease. During the past decade extensive studies have revealed the fundamental correctness of this concept. It is fitting, therefore, that Dr. Adam should have undertaken the editorship of the present volume on enteritis in infants. The book appeared in time for exhibition at the Eighth International Congress of Pediatrics at Copenhagen. Shortly thereafter, Dr. Adam passed away.
PARENTERAL ADMINISTRATION OF RESERPINE IN THE TREATMENT OF HYPERTENSION DUE TO ACUTE AND CHRONIC NEPHRITIS
Authors: Daeschner C. William , Moyer John H. , Bell William R. , Clark John L.
Published: December 2021

Parenteral administration of reserpine has been evaluated for its antihypertensive effect in normal subjects, in patients with hypertension due to acute nephritis and in a limited number of patients with hypertension due to chronic nephritis.

The greatest reduction in blood pressure was obtained in the patients with severe hypertension (diastolic 130 mm of mercury or greater) due to acute nephritis while patients with mild hypertension (diastolic blood pressure less than 110 mm of mercury) showed a less marked response. This has led to the designation of reserpine administered parenterally as an antihypertensive rather than a hypotensive agent.

Reserpine appears to be safe and effective for use in the hypertension associated with acute nephritis when given parenterally in doses of 80 to 150 µg/kg of body weight. In certain patients the hypertension is resistant to parenteral administration of reserpine and the addition of hydralazine may be necessary for ideal control of blood pressure. In our experience only rare patients have required combined drug therapy.

Patients with chronic nephritis and hypertension show a decrease in blood pressure with reserpine either parenterally or orally. However, in some patients the addition of a ganglionic blocking agent may be necessary to achieve ideal control of the patient's hypertension.

Renal hemodynamic studies show a decrease in renal function associated with acute reduction in blood pressure. This decrease is not marked and within an hour is usually followed by a gradual return of renal function toward normal.
GALACTOSE TOLERANCE IN GLYCOGEN STORAGE DISEASE
Authors: Schwartz Robert , Ashmore James , Renold Albert E.
Published: December 2021

Observations on a 3-month old infant with hypoglycemia and hepatomegaly from hepatorenal glycogen storage disease are reported.

The diagnosis was based on analysis of the liver as well as typical clinical and laboratory findings. The liver histologically showed accumulation of glycogen and fat and biochemically was found to be deficient in glucose-6-phosphatase.

An oral galactose tolerance test resulted in lactic acidosis with failure to detect any galactose or rise in concentration of glucose in the blood.

An intravenous galactose tolerance test on two occasions resulted in the normal disappearance of galactose; however the concentration of glucose remained unchanged or declined, and that of lactate rose.

The intravenous galactose test offers a further means for evaluating the glycolytic pathways in the liver in glycogen storage disease.
A REGIONAL PLAN OF INTEGRATED MEDICAL SERVICES FOR HANDICAPPED CHILDREN
Authors: Clark Esther B.
Published: December 2021

A regional plan providing special medical services for handicapped children based on 3 years of operation of such a plan is described. It is an integrated plan for the habilitation and rehabilitation of the mental, emotional and physical disabilities of children by the unit operation of a nursery school for mentally retarded children, a rehabilitation clinic and a child guidance clinic. The children remain under the care of their personal physicians, and a true "team approach" to the "whole child" with his problems is accomplished in a situation which is economical, practical, efficient and effective.
CLINICAL CONFERENCE
Authors: Dorfman Albert
Published: December 2021

Dr. Dorfman: The patient to be presented is a 9-year-old white female who was first admitted to Bobs Roberts Hospital on October 7, 1954. During a large part of her illness she was on the service of Dr. Klara J. Prec.

Her past history, family history, birth history and early development are not pertinent to the present complaint. The present illness is related to a disease that had its onset with fever and sore throat at the age of 4 years. Despite therapy with unidentified antibiotics, only poor recovery occurred. It was recognized a week later that she had anemia and an elevated erythrocyte sedimentation rate.

The patient was hospitalized in another hospital with a diagnosis of acute rheumatic fever. At this time she was treated with antibiotics and acetylsalicylic acid and after 4 weeks was discharged to her home.

After 1 week at home, her parents felt she was not doing well and the patient was admitted to La Rabida Jackson Park Sanitarium at that time. At the time of this admission in 1951, the pulse rate was elevated and a grade 3 systolic murmur was heard over most of the precordium. The heart was markedly enlarged as measured by roentgenogram. A throat culture was positive for beta-hemolytic streptococcus.

During the following 4 months she remained at La Rabida. The streptococcal infection was eradicated. She was treated intermittently with salicylates and had a steady, progressive improvement, so that at the end of this time she was discharged with no evidence of active rheumatic fever, but evidence of mitral insufficiency was present.
Six Children
Authors: KORSCH BARBARA
Published: December 2021

Six Children is a book by a school psychiatrist who, in spite of rather extensive experience, has retained a very limited understanding and a rigid outlook concerning the emotional and psychological problems of children. She divides the problems she has encountered into six categories exemplified by the Six Children in the title:

1. The quick-thinking child.

2. The slow-thinking child.

3. The child whose brain has been injured.

4. The child maladjusted emotionally.

5. The child of unusual cultural background.

6. The child of unusual training.