bluuebunny/crossref_metadata_2025 huggingface dataset:
TREATMENT OF TUBERCULOSIS IN CHILDREN
Authors: Jones Edna M. , Howard W. Leonard
Published: December 2021

The history of antimicrobial therapy (AMT) of tuberculosis in children at the Wm. H. Maybury Sanatorium is reviewed; its superiority over previous treatment is emphasized by the change in mortality. The importance of treating early cases of primary tuberculosis is shown by comparing the results of 2 similar groups of cases, one treated with and the other without antimicrobial therapy. Although the AMT cases showed markedly better progress as shown by roentgenographic clearing and conversion of gastric and pharyngeal cultures, the occurrence of temporary worsenings could not be prevented. The freshness of the disease seemed to be the most important factor in the development of worsening. In the AMT group they cleared more promptly and left less residuals than in the controls. Worsening was more likely to occur in the persistently positive culture cases among the controls but not among the AMT cases.

The various regimens of antimicrobial therapy are discussed; isoniazid is considered to be a necessary part of each AMT combination for the first year. The need for early diagnosis is emphasized and the values of early treatment are discussed. One of the weakest links in the antimicrobial therapy of tuberculosis in children would seem to be the delay in its use until the organisms have created large areas of caseous necrotic tissue in which to barricade themselves. If we knew the tuberculin reaction of all children and could start treatment at the time of conversion and continue for 9 to 12 months we should be able to eliminate generalized tuberculosis and prevent the possibility of endogenous reinfection later in life.
ANTISTREPTOLYSIN AND STREPTOCOCCAL ANTIHYALURONIDASE TITERS IN SERA OF HORMONE-TREATED AND CONTROL PATIENTS WITH ACUTE RHEUMATIC FEVER
Authors: Harris T. N. , Needleman Herbert L. , Harris Susanna , Friedman Sidney
Published: December 2021

Streptococcal antihyaluronidase and antistreptolysin O titers were determined at the time of hospitalization and 1 month later for patients with acute rheumatic fever included in a clinical study of the effects of ACTH and cortisone on this disease. The sera of the groups of patients receiving cortisone and ACTH showed a greater fall in serum titer in this interval in both tests than did the symptomatically treated control patients.
DAMAGE OF THE BONE MARROW DUE TO RH ANTIBODY
Authors: Giblett Eloise R. , Varela Jorge E. , Finch Clement A.
Published: December 2021

Detailed hematologic studies were carried out in an infant with hemolytic disease of the newborn following exchange transfusion who manifested a high titer of anti-D antibody in the serum and evidence of impaired erythropoiesis. The relation between falling antibody titer and resumption of erythrocyte production supports the hypothesis that the antibody may act against erythrocyte precursors. The various stages of involvement of the erythron by antibodies are discussed.
NEONATAL THROMBOCYTOPENIC PURPURA
Authors: Schoen Edgar J. , King Alexander L. , Duane Rose T.
Published: December 2021

A case of neonatal thrombocytopenic purpura in the newborn infant of a mother with idiopathic thrombocytopenic purpura is reported. The mother and the baby both had platelet autoagglutinins, and isoagglutinins were present for each other's platelets. The infant's agglutinins had disappeared by the age of 3 months. Cortisone administration had no definite effect on the thrombocytopenia in the baby. It is believed that this case offers further evidence that neonatal thrombocytopenic purpura is due largely to transmission across the placental membranes of maternal platelet antibodies which lead to destruction of the infant's platelets and to purpura. The possible use of exchange transfusion in neonatal thrombocytopenic purpura is briefly discussed.
THE USE OF GAMMA GLOBULIN IN THE TREATMENT OF MEASLES ENCEPHALITIS
Authors: Allen John E. , Frank Donald J.
Published: December 2021

A clinical review of 25 recent cases of measles encephalitis demonstrates the continued importance of measles in the field of contagious diseases.

A comparison of a group of patients with measles encephalitis treated with supportive therapy only, with a group treated with massive doses of gamma globulin, is presented. The over-all results of this study do not demonstrate any effect on the rate of sequelae or of complete recovery rate in those patients receiving massive doses of gamma globulin. While a possible decrease of mortality was demonstrated in those patients treated with gamma globulin, statistical analysis does not support this conclusion. This information is compared to that from a similar study by Odessky et al.

It is concluded that gamma globulin in massive doses is not indicated in the treatment of measles encephalitis.

The extreme importance of modifying all cases of measles in all age groups whenever possible is emphasized as a most potent tool for the prevention of measles encephalitis, as well as other post-measles complications.
SPECIAL ARTICLE
Authors: Payne Wilfrid W.
Published: December 2021

IT IS a great honour to be asked to give a lecture dedicated to Kenneth Black-fan. His work and reputation are known to all who have the good fortune to work in children's hospitals. Much of the work on which this paper is based stems from that which he and Dr. Gamble pioneered some 3 decades ago.

In recent years considerable advances have been made in our knowledge of the function of the renal tubules, and this in turn has enabled the student of human pathology to understand to some degree the previously inexplicable vagaries of some diseases now assumed to be due to renal tubular dysfunction.

A very full classification of these tubular defects has been made by Fanconi and I am greatly in his debt for it. However, I propose to rearrange this classification to some extent and to suggest a framework into which renal tubular defects can be fitted.

Briefly, tubular functions can be separated into 3 groups (Fig. 1).

I. Reabsorption in Bulk

Water

Sodium

Chloride

Bicarbonate

This group represents the main constituents of the glomerular filtrate and is often considered to be reabsorbed by the proximal tubule, but it is quite likely that the distal tubule also takes part.

II. Specific Reabsorption

Glucose

Phosphate

Individual amino acids

Calcium

Uric acid

Potassium (?), etc.

These substances are reabsorbed specifically, and this is assumed to occur in the proximal tubule.

III. Maintenance of Biophysical Body Constants

Regulation of pH [SEE THE FIG 1 IN SOURCE PDF]

Regulation of size of extracellular fluid space

Regulation of plasma osmotic pressure
ON FINGER-SUCKING
Authors: SENN MILTON J. E.
Published: December 2021

ONE OF the perennial problems of child care for parents and professional folk alike is that of finger-sucking. Over the years as even now, parents have worried about this practice and brought it to the attention of their physicians who, like dentists, have had strong feelings on the subject.

American pediatric literature from the Eighteenth Century down to the present time has frequently discussed finger-sucking as to its normality, prevention and cure. As with most issues, there have been advocates as well as opponents of the idea that this behavioral trait was beneficial to the well-being of an infant.
GOITERS IN CHILDHOOD
Authors: Crawford John D.
Published: December 2021

CHILDREN with various types of goiter presently constitute approximately 16 per cent of the new admissions for primary endocrine disease seen in the Adolescent Endocrine Clinic at the Massachusetts General Hospital. Hence, it is evident that these conditions are by no means uncommon. In all fairness to the non-endocrinologist, however, the frequency of occurrence should be put in a second frame of reference. Such perspective is gained by noting that only about 1 per cent of the total new admissions to this hospital are comprised of patients with primary endocrine disorders.

Thyrotoxic goiter and 5 other types will be given consideration; the latter include neonatal goiter, the goiters of adolescence and lymphocytic infiltration, the goiter of defective thyroxin synthesis and, finally, thyroid carcinoma. Iodine deficiency goiter has become so rare in this country as a result of prophylaxis as to deserve no more than mention. In the past 5 years we have encountered only 1 case, that in a boy of 8 years, a recent immigrant from the Italian Alps.

NEONATAL GOITER

Goiters in newborn infants are not seen frequently but every pediatrician who deals with neonates should be in a position to recognize the syndrome, understand its causation and prognosis and to advise therapy. These goiters are seen most frequently in infants born of mothers receiving iodides for hay fever or asthma or of mothers being treated for thyrotoxicosis with one of the thyroid synthesis blocking agents. In the first instance, iodide or an iodide metabolite appears to cross the placenta and block the fetal TSH secretion.
ARTHROGRYPOSIS
Authors: Kanof Abram , Aronson Stanley M. , Volk Bruno W.
Published: December 2021

Three typical cases of arthrogryposis are presented.

Neurological examination points to involvement of the central nervous system in this illness.

Repeated muscle biopsies in all 3 patients and a complete post-mortem examination in 1, suggest that this may be an infantile form of neuromuscular atrophy rather than a primary disease of either the joints or the muscles.

Neither the use of steroid therapy nor prostigmine produced lasting benefits, although ACTH did seem to produce a definite, though slight, effect in freeing motion in the smaller, peripheral joints.

One patient may have benefited from application of rehabilitation techniques.
TRANSFUSIONS IN PEDIATRIC PRACTICE: INDICATIONS AND LIMITATIONS
Authors: Smith Carl H.
Published: December 2021

The effectiveness of transfusion of whole blood or any of its components depends in large measure on a clear understanding of the anticipated role in supplying a specific deficiency or correcting a pathologic state while realizing the limitations and hazards.

A prerequisite in infants and children is a knowledge of the normal changes occuring at various developmental periods so as to appraise the abnormality more accurately and to determine the need and extent of reparation.

The pathogenesis of various bleeding disorders has been more precisely characterized so that treatment can be prescribed with greater selectivity.

Except during active hemorrhage, holding blood requirements to a minimum frequently serves the patient to greater advantage than maintaining normal hemoglobin levels by frequent and maximal administrations of blood. This restriction is especially pertinent in the refractory anemias—the aplastic-hypoplastic and chronic hemolytic groups. Here multiple transfusions result not alone in hemosiderosis but in a potential suppressive effect on erythropoiesis and hemoglobin synthesis. The retarding effect of transfusion must also be considered in the management of the convalescent anemic phase of erythroblastosis and in the anemia of prematurity.

It should be emphasized that the hemoglobin concentration at which transfusion is indicated for patients who require single on multiple administrations of blood cannot be arbitrarily fixed but varies with the attendant clinical signs and symptoms and the promise of relief by this form of treatment.
Letters to the Editor
Authors: KOZINN P. J.
Published: December 2021

Dr. Slotkowski's comments on the lack of unanimity in terminology for the newly recognized complication of cowpox vaccination summarizes many important factors.

However, the cases with prolonged vaccinia represent more than an unfortunate and interesting complication of a minor office procedure. They are a "window" through which some of the fragments of the immune mechanism can be seen. At least 5 different types of defects have been recognized and not all are present in every case.
PLASMA PROTEIN PATTERNS IN PREMATURE INFANTS OF VARYING WEIGHTS ON THE FIRST DAY OF LIFE
Authors: Saito M. , Gittleman I. F. , Pincus J. B. , Sobel A. E.
Published: December 2021

Plasma protein patterns were studied by paper electrophoresis on the first day of life in 59 premature infants. These babies were divided into 3 groups according to weight. A fourth group was used as a control.

The total proteins, albumin, globulins, alpha 1, alpha 2, beta and gamma fractions were determined. This study also included the estimation of fibrinogen levels in the plasma of these prematures.

The concentrations of total proteins, albumin and globulin varied directly with the weight of the infants. Alpha 1, alpha 2 and beta globulins did not vary with the weight of the infants. Gamma globulin varied directly with the weights of the infants, the lowest mean gamma globulin level being observed in the lowest weight group. The mean fibrinogen content, however, was highest in the lowest weight group.
IDIOPATHIC ACQUIRED HEMOLYTIC ANEMIA IN YOUNG CHILDREN
Authors: O'Connor Walter J. , Vakiener Jane M. , Watson R. Janet
Published: December 2021

Two cases of idiopathic acquired hemolytic anemia have been presented. Following splenectomy and the administration of hormones intermittently for 4 months one has had a complete remission lasting 5 years. This patient had spherocytosis and increased osmotic fragility. The second child, apparently identical except for normal erythrocyte fragility and absence of spherocytosis, has been asymptomatic for 12 months after similar therapy, although the Coombs test remains positive.

The course during hormonal therapy in these patients and in others already reported in the literature suggests with the reservations discussed, that the treatment is of some value.
Biochemistry and the Central Nervous System
Authors: NAJJAR VICTOR A.
Published: December 2021

A very timely book whose author is one of Europe's noted biochemists and one of the foremost workers in the field of biochemistry of the brain. The methods he developed for in vitro study of metabolism of the brain, as affected by electrical stimulation, have advanced this aspect of physiology of the brain to a considerable extent. It is comforting, therefore, to know that the author's command of this subject stems to a great extent, from his personal contact and contributions in the field.
ROENTGENOGRAPHIC MANIFESTATIONS OF CONGENITAL MEGACOLON (HIRSCHSPRUNG'S DISEASE) IN EARLY INFANCY
Authors: Berman Carroll Z.
Published: December 2021

The roentgenographic findings in the first month of life were reviewed in a series of 23 infants with histologically proven [See FIG. 9. in source pdf] Hirschsprung's disease. The plain roentgenograms of 18 of the babies showed significant large bowel distention and 12 had prominent colonic fluid levels. In 15 of 19 of the patients which had been subjected to barium enema, the roentgenograms are diagnostic of congenital megacolon. In 5 of 7 of the infants contrast enemas in the first week of life demonstrated the characteristic deformity.

The conclusions which appear justified from this investigation are:

Congenital megacolon (Hirschsprung's disease) may be strongly suspected in the newborn period in a large majority of cases from the appearance of plain roentgenograms of the abdomen made in recumbent and erect projections.

In some instances, roentgenograms in the inverted position supply additional or substantiating evidence of the disease.

In lesions starting in the proximal half of the colon, the abdominal distention involves mainly small bowel, and the differentiation from low jejunal or ileal obstruction is usually not possible from the plain roentgenograms. Here examination by barium enema may be expected to establish the diagnosis.

When the segment of achalasia begins above the ileocecal valve, the plain roentgenograms again indicate small bowel obstruction, but here barium enema does not demonstrate a significant contour or caliber abnormality of the colon. In this type of case, follow-up roentgenograms 24 and 48 hours after the enema will often show considerable retention of the barium thus suggesting the diagnosis which must be confirmed by biopsy.

When the proximal end of the involved segment of colon is low in the rectum, the lesion may be very difficult to demonstrate by barium enema.

The age factor alone, i.e., the performance of the examination very early in infancy, does not of itself preclude demonstration of the lesion of Hirschsprung's disease by barium enema.
Poliomyelitis Vaccination: A Preliminary Review
Authors: K. FABER HAROLD
Published: December 2021

Anyone desiring a concise, authoritative and critical review of the present status (as of February, 1956) of vaccination against poliomyelitis will find this pamphlet useful. The difficult problems of safety testing of inactivated vaccine and their solution are dealt with in considerable detail. The final pages are devoted to immunization with living attenuated virus in discussions by its two principal proponents, Drs. Sabin and Koprosky.
A SIMPLE TECHNIQUE FOR THE DIAGNOSIS OF NONLIPID HISTIOCYTOSIS
Authors: Moore Tom D.
Published: December 2021

Summaries of two cases of nonlipid histiocytosis (Letterer-Siwe disease) proved by biopsies of lymph node and skin are presented.

A technique is described whereby the diagnosis of this disease may be aided by a touch preparation of the skin lesions.

The successful use of this technique in the two cases described supports its validity.
Talking With Patients
Authors: WORK HENRY H.
Published: December 2021

This books seems to be quite truly a good thing in a small package. The author has attempted to delineate in a very few and quite readable pages both the principles and techniques involved in talking to and with patients. In doing so, he has avoided the common concept that such relations are merely a matter of instinctive understanding on the part of the physician and something only to be gained from experience. Instead, he sets forth the common personality patterns with which patients meet their physician, and points out how to deal with the anxious, angry, confused, and even the overly affectionate individual.
CELONTIN® (PM-396) IN THE TREATMENT OF EPILEPSY
Authors: Livingston Samuel , Pauli Lydia
Published: December 2021

One hundred thirty-six patients with epilepsy, mostly children, were treated with Celontin® for periods ranging from 6 to 15 months. The maximum dosage of one or more other anticonvulsant agents administered for periods of 1 year or more had previously proved inffective in controlling seizures in 85 of these patients.

Celontin® was effective in controlling minor motor and psychomotor seizures in this group of patients.

The frequency of spells was reduced in some of the patients with petit mal epilepsy. Patients with major motor seizures were not significantly benefited by this drug.

Side effects were experienced by 18 of the 136 patients treated. Drowsiness was the most frequently occurring side effect. There were no irreversible toxic disturbances.
SOME CONCEPTS OF PLASMA PROTEIN METABOLISM, A.D. 1956
Authors: Gitlin David
Published: December 2021

[In presenting the First E. Mead Johnson Award for 1956 to Dr. Gitlin, Dr. Bakwin, President of the Academy, made the following remarks:

["Dr. David Gitlin was born in New York, in 1921. He received the M.D. degree from New York University College of Medicine in 1947. Prior to this he was honored by being the Naumberg Scholar to the University of Puerto Rico in 1940-41, and was awarded the Borden Undergraduate Research Award in Medicine in 1947.

["Dr. Gitlin had his internship at Morrisiana City Hospital; from there he went to Harvard as a Research Fellow in Pediatrics and later served as a Fellow in Medicine; an intern on the Medical Service, an Instructor in Pediatrics, Assistant Physician, and an Associate in Pediatrics, all at the Children's Medical Center and Harvard Medical School.

["Dr. Gitlin is certified by the American Board of Pediatrics and is a Fellow of the American Academy of Pediatrics. During his short career Dr. Gitlin has been an energetic, tenacious, imaginative worker. He has accomplished much in investigation and has published over 30 papers.

["To quote his Chief, Dr. Charles Janeway, `Dr. Gitlin's researches represent a coherent, progressing series of studies in which, by the use of chemical, immunochemical, and histochemical methods, with good physiologic reasoning, he is gradually elucidating some basic problems of the physiology of human plasma and structural proteins and the derangements in disease.' It is for these works that the Academy's Committee on Awards has selected Dr. Gitlin as the recipient of the First E. Mead Johnson Award for 1956. Dr. Gitlin will honor us by giving a résumé of what he considers to be his important works."]
EARLY RECOGNITION OF RHEUMATOID DISEASE WITH COMMENTS ON TREATMENT
Authors: Gauchat Robert D. , May Charles D.
Published: December 2021

WITHIN the past 10 years, increasing attention has been focused on children with chronic deforming arthritis. With few exceptions, such children have claimed interest of those concerned primarily with rheumatoid arthritis in adults, orthopedic surgeons and workers in the field of physical medicine, to whom these patients have presumably been referred for care by pediatricians and general practitioners. Lack of general pediatric interest in this disease is suggested by the small number of pertinent papers in the pediatric literature. Furthermore, the relative lack of importance of these children in the general thinking of students of arthritis is suggested by the fact that a current statistical study of the incidence and prevalence of rheumatoid arthritis in a large American metropolitan area has been arbitrarily limited to patients 15 years of age or older.

Is rheumatoid arthritis sufficiently common within the pediatric group to deserve pediatric attention? Although there have been only a few statistical studies, the available evidence suggests that the incidence of new cases in the general population, under 15 years of age, is roughly the same for rheumatoid arthritis, diabetes mellitus and nephrosis, approximately 3 new cases per 100,000 persons under 15 years of age each year. In round numbers, 1200 new cases of rheumatoid arthritis, of diabetes and of nephrosis occur annually within the childhood population of this country. Parallel comparison of the amounts of attention paid to these three groups of patients by pediatricians would belabor the point. These juvenile victims of rheumatoid arthritis certainly deserve increasing pediatric attention, and we suggest that they also present many stimulating challenges.
PRODUCTION OF CONGENITAL ANOMALIES IN MAMMALS BY MATERNAL DIETARY DEFICIENCIES
Authors: Nelson Marjorie M.
Published: December 2021

Multiple or single congenital anomalies may be produced experimentally by certain maternal dietary deficiencies. The similarity of the anomalies resulting from all acute dietary deficiencies and other acute teratogenic procedures is striking. When the dietary deficiency is controlled by the use of anti-metabolites, it can easily be demonstrated that the teratogenic effects vary with the time of instituting the deficiency and with its duration or severity. It can also be demonstrated that the period of sensitivity to the teratogenic dietary deficiencies is usually limited to the critical period of differentiation and organogenesis, as it is in irradiation. However, fetal vitamin deficiencies similar to those observed in the adult can probably be produced by the deficiency later in pregnancy. The severe fetal damage is in marked contrast to the relatively slight effects on the maternal organism. Presumably, although this point has not been proven, the effect of the deficiency is directly on the fetus and indicates that certain vitamins play a highly significant role in embryonic differentiation and organogenesis. We already have considerable knowledge concerning the biochemical reactions with which the B vitamins are concerned in adult tissues. It is possible that, by use of these specific vitamin deficiencies as tools, we may succeed in identifying certain key reactions in embryonic differentiation and organogenesis and thus advance our knowledge of chemical embryology.

The teratogenic dietary deficiencies can provide abundant material for the pathologist to study the early stages of specific anomalies. For the physiologist, studies of anomalous conditions before and after birth are possible for some organs and systems. Studies of the interrelations of nutritional and genetic factors should lead to increasing knowledge concerning individual susceptibility to such teratogenic conditions and the application of these findings to man. The briefness of the period necessary to affect fetal development and the irreversibility of fetal damage by dietary supplementation later in pregnancy must be emphasized.
THE MENTAL PROGNOSIS IN HYPOTHYROIDISM OF INFANCY AND CHILDHOOD
Authors: Smith David W. , Blizzard Robert M. , Wilkins Lawson
Published: December 2021

A study of 128 children with hypothyroidism is presented. The mental attainments are evaluated in relation to the severity and age of onset of symptoms, and in relation to the age when adequate therapy was instituted. A summary diagram is provided depicting the duration of hypothyroidism in relation to the mental attainments for adequately treated patients.

The best result in severe cretinism, insofar as mental achievement is concerned, is obtained by early adequate therapy. Ten of twenty-two patients in the complete absence of thyroid function treated adequately before 6 months of age, and 12 of 29 patients treated adequately before 12 months of age eventually attained an I.Q. greater than 90. In contrast, none of 50 patients who were inadequately treated, or were treated after 12 months of age, attained such an I.Q.

Mild cretinism, with partial thyroid dysfunction, appears to confer partial protection against mental impairment as 13 of 32 such patients attained an I.Q. of 90 or greater even though not treated early.

Hypothyroidism acquired after 2 years of age apparently exerts little or no serious, irreversible effect on mental development as 13 of 17 patients with acquired hypothyroidism achieved an I.Q. of 90 or greater.

Neurologic sequelae, characterized by spasticity, tremor, and hyperactive deeptendon reflexes, are found frequently in severe cretinism, but not in mild cretinism or acquired hypothyroidism. The severity of neurologic sequelae parallels mental retardation. Early therapy apparently prevents, in part, these sequelae as only 4 of 22 patients with severe cretinism treated adequately in the first 6 months of life had these findings but 22 of 57 patients treated after this age or inadequately treated in the first 6 months, were afflicted with neurologic sequelae.

Early, adequate therapy may fail to establish normal mentality in a certain percentage of patients; 12 of 22 patients treated adequately in the first 6 months of life did not attain an intelligence quotient of 90 or greater. These patients apparently incurred such severe damage to the brain in utero that normal cerebral function could never be established. This surmise is supported by data presented showing a correlation of the severity of retardation of osseous development at birth with the severity of mental impairment.
CONGENITAL ABSENCE OF THE ABDOMINAL MUSCULATURE AND ASSOCIATED ANOMALIES
Authors: Metrick Seymour , Brown Rowine H. , Rosenblum Arthur
Published: December 2021

A summary of 38 cases of absence of the abdominal musculature reported in the literature since 1950 is presented. Four additional cases of this syndrome observed by the authors are described. Anomalies associated with the syndrome are discussed. The diagnosis and treatment of accompanying obstruction of the genitourinary or gastrointestinal systems are stressed.
IDIOPATHIC PULMONARY HEMOSIDEROSIS
Authors: Soergel Konrad H.
Published: December 2021

Two fatal cases of idiopathic pulmonary hemosiderosis are reported. A review of the literature shows the prognosis of this disease to be, at least in young patients, somewhat better than generally thought. A positive diagnosis in the living patient is possible with the help of certain diagnostic measures which are discussed. Increasing familiarity with the rather typical manifestations of this disorder may lead to the discovery of a larger number of patients who have a mild form of the disease. The value of splenectomy and therapy with adrenocorticotropin and cortisone is still questionable, but further trials are necessary, possibly together with the use of antihistaminic drugs. Intermittent increases in pressure in the pulmonary circulation, due to a defective vasomotor control, appears to be the most likely pathogenetic mechanism but more investigations are needed to arrive at any positive conclusion.
CLINICAL CONFERENCE
Authors: Engle Mary Allen
Published: December 2021

Dr. Engle: When pulmonic stenosis occurs as an isolated congenital malformation of the heart, it usually is due to fusion of the valve cusps into a dome with a small hole in the center. In Figure 1 the pulmonary artery has been laid open so that one can see the three leaflets of the pulmonary valve are completely fused, and that there is only a small, central, pinpoint opening which permits blood to leave the right ventricle and enter the pulmonary circulation.

Valvular pulmonic stenosis is much more common than subvalvular or infundibular stenosis, where the obstruction to pulmonary blood flow lies within the substance of the right ventricle. There it may be due to a diaphragm of tissue which obstructs the outflow of the right ventricle, or to an elongated narrow tunnel lined with thickened endocardium, or to a ridge of fibrous or muscular tissue just beneath the pulmonary valve.

The changes in the cardiovascular system which result from obstructed pulmonary blood flow are so characteristic that they permit the ready recognition of this condition. Proximal to the constriction, these changes manifest the burden placed on the right ventricle, which enlarges and hypertrophies. On physical examination this is demonstrated by the precordial bulge and tapping impulse just to the left of the sternum, where the rib cage overlies the anterior (right) ventricle. Radiographically, both by fluoroscopy and in roentgenograms in the frontal and both oblique views, right ventricular enlargement is seen. In the electrocardiogram, the precordial leads show a pattern of right ventricular hypertrophy.
Advances in Pediatrics, Vol. IV
Authors: GAUCHAT ROBERT D.
Published: December 2021

Seven subjects which have occupied the attention of many clinical and experimental pediatricians during the past few years are reviewed by recognized authorities in the current volume of this series. Stewart H. Clifford has written a lucid discussion of postmaturity, based primarily upon his own clinical experience and summarizing current knowledge of the pathophysiology, treatment and prognosis of postmature infants. Dr. Clifford's therapeutic recommendations should be of interest to practicing pediatricians and obstetricians. Charles A. Janeway and David Gitlin have provided a general review of the chemistry, physiology and clinically recognizable disorders of the metabolism of gamma-globulins, which includes practical guides to diagnosis and treatment.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HAVILAND JAMES W.
Published: December 2021

Dear Dr. Park: It is pretty generally agreed that medical practice in this country has been based on the premise of free choice of physician by the patient, and maintenance of a satisfactory, direct, doctor-patient relationship without the intervention of a third party. At present the opponents of tax-supported, government-controlled medical care are convinced that some form of voluntary, prepaid medical insurance constitutes the best means of protecting our free choice of physician and direct doctor-patient relationship principles.

Some 40 years ago the beginnings of voluntary, prepaid medical care plans were made in this country. These beginnings were made in the Pacific Northwest. They had their origin here because of the peculiar demands of the local, hazardous industries of lumbering, mining and fishing. Contract practice came into being, and received tremendous impetus from the Industrial Insurance Law which was passed in Washington in 1917. Competition for contracts became so intense during the depression period which started in 1929 that vicious methods threatened the structure of medical practice in the State, and it seemed likely that most of the physicians would be relegated to practicing as salaried individuals under a form of health insurance. It was at this time that the various county medical service bureaus in the State of Washington were revived or organized. In Pierce County (Tacoma) a Bureau had been in continuous operation since 1917, and in King County (Seattle) one had been in operation from 1917 to 1925. These bureaus had been organized primarily to contract for work under the State Industrial Insurance Law, and to guarantee a free choice of physician to the workers who belonged to the Bureau. In May 1933 the King County Medical Service Bureau Society was instrumental in organizing the King County Medical Service Bureau to compete with existing contract groups, and to block a proposal by an insurance company for selling insurance and hiring physicians to render necessary medical care.
THE VOLUME OF EXTRACELLULAR BODY FLUIDS IN MALNUTRITION
Authors: KERPEL-FRONIUS E. , KOVACH S.
Published: December 2021

Extracellular body fluid volume, as measured by the thiocyanate method, was found to increase per kilo of weight considerably in malnutrition. In severe malnutrition nearly half of the body is made up of extracellular water. The absolute amount of the latter is, however, decreased, though proportionately to a smaller extent than fat and protoplasmic tissue. The amount of cellular tissue is consequently even smaller than indicated by the proportion of the actual weight of the marantic infant to the ideal weight of healthy infants of the same age. The greater hydrolability of marantic infants is thought to have some bearing on the described change in the distribution of body fluids.
SEVERE ERYTHEMA MULTIFORME OF THE PLURIORIFICIAL TYPE (STEVENS-JOHNSON SYNDROME)
Authors: SHAFFER BERTRAM , MORRIS PAUL
Published: December 2021

A case of severe erythema multiforme of the pluriorificial type resulted in total complete blindness due to bilateral involvement of the cornea.

This eruption followed the administration of trimethadione and anterior pituitary extract. The possibility that trimethadione was the cause of the syndrome was considered.
SUBCUTANEOUS ADMINISTRATION OF A SULFADIAZINE-SULFAMERAZINE COMBINATION IN CHILDREN
Authors: SLOBODY LAWRENCE B. , LEHR DAVID , WILLNER MILTON M.
Published: December 2021

The feasibility of intermittent subcutaneous administration of a sulfadiazine-sulfmerazine combination (2.5% aqueous solutions of the sodium salts in equal amounts) in infants and children was evaluated by means of absorption-excretion and therapeutic studies.

In 60 children with acute infections, intermittent injections of this combination at 12 hour intervals on the basis of 0.13 gm./kg. to 0.2 gm./kg. in 24 hours, gave excellent and well sustained blood and urine levels of sulfonamide and resulted in a highly satisfactory therapeutic response. No local reactions were encountered in more than 500 individual injections.

The incidence of systemic toxicity from the sulfadiazine-sulfamerazine combination was lower than that reported in similar treatment with either compound employed separately. Renal complications, in particular, appear substantially decreased despite the omission of adjuvant alkali therapy. Only one sensitization reaction was observed in this series.

Because of its local irritant effect, the subcutaneous administration of sodium sulfathiazole is not recommended.

Subcutaneous therapy with a combination of sodium sulfadiazine and sodium sulfamerazine has a definite place in the treatment of the infant and small child. The combination seems preferable to single sulfonamides because of a distinctly lower toxicity. These findings confirm our previous studies with oral administration of sulfonamide mixtures.
CHILDHOOD BEHAVIOR SEQUELAE OF ASPHYXIA IN INFANCY
Authors: ROSENFELD GEORGE B. , BRADLEY CHARLES
Published: December 2021

On the basis of an analysis of the records of 673 children referred for in-patient psychiatric treatment, the majority of those having a history of pertussis in infancy, or asphyxia neonatorum, showed a characteristic behavior syndrome.

The behavior syndrome consisted of the six following traits: Unpredictable variability in mood, hypermotility, impulsiveness, short attention span, fluctuant ability to recall material previously learned, and conspicuous difficulty with arithmetic in school.

Each of these behavior traits occurred from once and a half to twice as frequently in patients with a history of asphyxia in infancy as in a control group.

The syndrome, consisting of at least five of the six traits, occurred more than eight times as frequently in the patients with a history of asphyxia as in a control group.

The syndrome occurred significantly more frequently in children with a history of pertussis when the illness occurred in the first three years of life rather than later.

Since this behavior syndrome presents a serious handicap to successful social adjustment in later childhood, strenuous therapeutic efforts should be made toward eliminating asphyxia as a complication of illness in infancy.
Round Table Discussion
Authors: AIKMAN JOHN
Published: December 2021

Chairman Aikman: Pediatrics and medicine in general are so full of emergencies that it is difficult to know which ones to consider. At times the line between medicine and surgery is not sharply drawn. The problems are different in various parts of the country due to social conditions, the local poisonous plants, insects, food poisonings, diseases and lastly customs of the people. The problems of Texas are in many ways different from those of New York. The ease with which emergencies develop make the physician humble, and the solutions of these problems require ingenuity, resourcefulness, and courage. Knowledge regarding these matters is almost impossible to secure on a minute's notice, especially outside of the hospital.

No emergencies present more variety and interest than the poisoning accidents of children. Here we have unusual, dramatic, and even fantastic problems presented for immediate solution and treatment. The constant introduction of new poisons into agriculture and industry is astonishing. Unfortunately, there is considerable lag before the danger of new chemicals is detected and effective measures for treatment found. The magnitude of the problems can be appreciated when we know that the California Agricultural Code has jurisdiction over nearly 5,000 materials introduced for pest control of all kinds. A large part of these may become a problem when brought in the reach of and in contact with the runabout child. The National Safety Council reports that poisoning was the third most important cause of accidental deaths in the home in 1944. Deaths from falls were 16,900, mostly in the aged; burns 6,300, about 30% in children less than five years of age; and 2,090 deaths were from accidental poisoning, 680 of these occurred in children under five years of age. In 1929 there were 530 deaths but in 1937 only 440 deaths were reported, 217 of which occurred during the second year of life. The increase in 1944 is probably due to the larger birth rate and to unsatisfactory living conditions.

Poisons will produce nearly every symptom from mild skin rashes to convulsions, coma and death. Poisoning may easily be mistaken for disease and the number of cases overlooked has been estimated as high as 80%. It has recently been pointed out that salicylate and especially aspirin may add confusing symptoms to those of the disease being treated. The amount of accidental poisoning in small children is impossible to determine because only the reporting of fatal cases is required.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: EMERSON HAVEN
Published: December 2021

OF ALL the specialties of medical practice none has contributed more than pediatrics to the two basic purposes of public health service; namely, the building of healthy minds in healthy bodies, or the guidance of growth and development of children; and the control of preventable diseases, especially those of nutrition and the acute communicable diseases of childhood. The obstetricians and general practitioners have done almost as much in their spheres of influence to advance the safety and length of life.

In spite of the contributions of physicians in general, and of certain specialties in particular, there is a widespread indifference to and practical ignorance of the administrative structure upon which almost all the voluntary efforts and independent professional resources of our communities must rest for practical and continuous constructive results.

For the moment we shall ignore the potential accessary benefits which may in the decades ahead accrue from the World Health Organization, in which our country is quite certain to participate. We rècognize that our federal and state governments are not authorized by law to conduct the health departments of cities, counties, towns, villages or any other jurisdictions of local government except to meet an emergency resulting from neglect and incompetence of local authority and in view of the fact that the federal and state health administrations can and should supplement but not replace local health services.
IMMUNOLOGIC AND BIOCHEMICAL STUDIES IN INFANTS AND CHILDREN, WITH SPECIAL REFERENCE TO RHEUMATIC FEVER
Authors: DEGARA PAUL F.
Published: December 2021

Agglutinative antibodies for three different strains Str. hemolyticus, beta, group A, were studied in 497 sera from 372 children. A high titer was found in approximately 9% of well children.

There was no significant difference between rheumatic and non-rheumatic subjects in the incidence of high agglutinin titers for Str. hemolyticus.

Following infections, presumably streptococcal in origin, approximately 46% of the children examined had high agglutinin titers for Str. hemolyticus.

In active rheumatic fever, agglutinins were present in high titers in nine out of 11 patients who had experienced an antecedent illness, presumably streptococcal in origin. Of 23 patients with no history of such an infection, only three had streptococcal agglutinins.
INFECTIOUS CROUP. II. "VIRUS" CROUP
Authors: RABE EDWARD F.
Published: December 2021

Of the three etiologic types of infections croup the most frequently occurring type in this study was so-called "virus" croup.

The pathology of so-called "virus" croup is distinct from that of croup due to H. influenzae type B and C. diphtheriae. It is similar to viral influenza in man and viral laryngotracheitis in chickens.

Clinically "virus" croup is a progressive disease with downward spread of the infection in the respiratory tract. The inflammation can extend to various regions resulting in the clinical forms of the disease known as laryngitis, laryngotracheitis, or laryngotracheopneumonitis. The mortality increases as the disease spreads down the respiratory tract.

There is no well-founded specific treatment for "virus" croup. However, sulfadiazine should be given to all infectious croup patients until cultures of the rhinopharynx and blood assure the absence of H. influenzae type B. Continued chemotherapy should be given all patients severely ill with the disease.

The most frequent and severe complication of "virus" croup is some form of extraalveolar thoracic air. The most common cause of death is respiratory embarrassment.
An Account of the Weather and Disease of South Carolina
Authors: CAULFIELD ERNEST
Published: December 2021

Lionel Chalmers of Charleston, South Carolina, came nearer to being a pediatric specialist than any other physician of the American colonial period. Although Douglass had written on scarlet fever, Bard on diphtheria, and Rush on infantile diarrhea, Chalmers not only published his observations on these diseases but also covered a much wider range of pediatric subjects. He appears to have been among the first in this country to appreciate that rickets did not include all bony deformities, that "nine-day fits" of infants was the same disease as tetanus of adults, and that thrush was not usually a primary cause of death. He also wrote on infant feeding, weaning, teething, worms, convulsions, impetigo and obstructive laryngitis. He was most original and perhaps at his best in his descriptions of whooping cough and mumps.
Re: Congenital Alveolar Dysplasia of the Lungs by H. Edward MacMahon, Pediatrics 2:43, 1948
Authors: POTTER EDITH L.
Published: December 2021

No organ in the body has been the object of a greater number of erroneous descriptions and interpretations of normal and abnormal processes than has the lung and it seems unfortunate that your journal has been guilty of, adding to the welter of misstatements about this organ. simultaneously in the July issue of the AMERICAN JOURNAL OF PATHOLOGY and in PEDIATRICS Dr. H. Edward MacMahon has described a condition under the title "Congenital Alveolar Dysplasia of the Lungs" which he has found in many infants. He believes it is a congenital malformation often incompatible with life, resulting from the failure of alveoli to develop normally. He describes a clinical picture in which the infant is usually normal at birth, becomes progressively dyspneic and cyanotic and often dies of respiratory failure in 36 to 48 hours. Postmortem examination reveals red purple lungs that are of increased size and weight, that contain no visible air and sink in water. In relation to microscopic examination, he states, "There are too few alveoli and there is too much interstitial tissue." "The histologic structure of the lung bears a resemblance to the pattern in a three to four-month-old fetus." "In its simplest form the histologic picture resembles the pulmonary pattern that one finds during the fourth and fifth month of intrauterine life," "This picture of a large lung composed of an excess of primitive but highly vascularized interalveolar mesenchymal tissue, a diminished number of alveoli and many overdistended alveolar ducts constitutes the essential findings in congenital alveolar dysplasia."
JUVENILE RHEUMATOID ARTHRITIS
Authors: LOCKIE L. MAXWELL , NORCROSS BERNARD M.
Published: December 2021

Twenty-eight cases of juvenile rheumatoid arthritis have been observed over a period of 14 years. The results prove that a high proportion of these patients recover completely and that the older pessimistic prognosis is not justified. The etiologic factors, the clinical characteristics, the differential diagnosis, and treatment of the disease have been discussed. We have attempted to correlate our findings with the reports of several other observers to make possible a more comprehensive review of this important disease of children.
Round Table Discussion
Authors: SAKO WALLACE
Published: December 2021

Four monthly doses of an alum-precipitated mixture of diphtheria toxoid and H. pertussis vaccine administered after the third or fourth month of life should confer immunity to diphtheria and pertussis.

Three monthly or bimonthly doses of an alum-precipitated "triple" mixture of diphtheria toxoid, H. pertussis vaccine, and tetanus toxoid administered after the sixth month of life should confer immunity to diphtheria, pertussis, and tetanus.

Alternate gluteal regions are the sites of choice for alum-precipitated antigens in children under three years.

When performed three months or more after the final dose of mixed alum-precipitated antigens the positive pertussis agglutinogen skin test and the negative Schick test for diphtheria were adequate evidence of immunity.

Before a previously immunized child attends kindergarten or school, one stimulating dose of alum-precipitated mixed antigen is recommended.

Probable exposure to a disease of a previously immunized child warrants very prompt administration of one stimulating dose of the respective fluid antigen.