bluuebunny/crossref_metadata_2025 huggingface dataset:
THE RESPONSE OF PREMATURE INFANTS TO INFECTION WITH ATTENUATED POLIOVIRUS
Authors: Pagano Joseph S. , Plotkin Stanley A. , Cornely Donald , Leuterer Walter , Koprowski Hilary
Published: December 2021

Sixty-five premature infants were given CHAT type 1 live poliovirus vaccine. Seventeen other infants were retained as controls. Although 92% of the infants were infected with the attenuated poliovirus, only 59% of infected infants had a definite antibody response. The size of the infant did not seem to influence the duration of intestinal infection.

In 86% of the infants there were significant levels of transplacentally acquired antibodies with an over-all half-life estimated at 23 days. Moderately high titers of homotypic maternal antibodies in the infants did not interfere with infection, nor was there obvious inhibition of active immunologic responses.

Thirty-one of the infants were given a second feeding of the CHAT virus 2 to 5 months after the first administration. The primarily immunized infants were relatively, but seldom completely, resistant to re-infection. In contrast, infants that did not form antibodies after the primary infection seemed to be fully susceptible to re-infection. Moreover, there was no evidence of immunologic tolerance to poliovirus in these infants, for after the second infection poliomyelitis antibodies were invariably found.

We concluded that, while premature infants are highly susceptible to infection with CHAT poliovirus, their immunologic responsiveness—just as in newborn full-term infants—is distinctly less than in infants 2 or 3 months old, but that exposure to poliovirus in early life does not impair later immunologic functioning.
Hazards of Radioactive Fallout
Authors: Chusid Emanuel
Published: December 2021

Many of my patients are aware of the poisonous attributes of strontium-90 and its particular affinity for the bones of growing children. It would be an immense relief to them and to me to have available decontaminated milk and formula. It is my understanding that there is now available a relatively inexpensive process for removing radioactive strontium-90 from milk. This method involves the use of a simple ion-exchange resin column, and its estimated use would increase the cost of a quart of milk from five to ten cents.
NUTRITIONAL STUDIES OF CHILDREN WITH PICA
Authors: Gutelius Margaret F. , Millican Frances K. , Layman Emma M. , Cohen George J. , Dublin Christina C.
Published: December 2021

Thirty Negro children with pica were compared nutritionally with 28 control children from the same socioeconomic background. The following findings were statistically significant: lower hemoglobin concentrations, lower levels of ascorbic acid in plasma, less adequate diets, more reported respiratory illness, more recorded days of hospitalization, and more recorded anemia in infancy. No difference was detected between the two groups in clinical evaluation of nutrition or in the number of physical defects. Evidence from anthropometry showed no inferiority in the pica group. Ancillary information indicated that many unfavorable familial and environmental circumstances were also associated with pica, as well as certain behavior disorders of childhood, especially those involving orality.

In a double-blind experiment 16 children with pica received suitable doses of iron given intramuscularly, and 16 received similar injections of saline solution. Iron was not significantly more effective than saline solution in curing or improving the habit of pica. There was no correlation between changes in pica and changes in hemoglobin concentration. At 2 to 3 months after the treatment period, 10 treated children and 8 controls were without pica. The improvement in hemoglobin concentration was significantly greater in the treated group, but improvement in pica was approximately the same and highly significant in both groups. At 13 to 27 months after the treatment period, 11 of 14 children remaining in the treated group and 9 of 13 remaining controls were reported to be without pica. There were five severe relapses, two in the treated group and three in the controls, all of which took place in children with initial levels of hemoglobin above 10.5 gm/100 ml. These five children also came from the most seriously disturbed family situations in the whole series. If iron medication is a factor in curing certain cases of pica, the number of such cases in the present series is not sufficient to affect the statistical results.
SEPSIS AND JAUNDICE IN EARLY INFANCY
Authors: Bernstein Jay , Brown Audrey K.
Published: December 2021

In jaundice that developed in association with sepsis in early infancy, elevation of bilirubin levels in serum occurred in both the direct- and indirect-reacting fractions. The regurgitative nature of the jaundice, with retention of conjugated bilirubin, served to distinguish this condition from physiologic jaundice. Jaundice in the nine cases under study was most often associated with coliform sepsis, particularly in the presence of acute pyelonephritis, but other bacteria and other infectious processes were also implicated. The most consistent histopathologic observation in the liver was bile stasis, indicating an inability on the part of the cell to excrete conjugated bilirubin. This was accompanied by the intracellular accumulation of unconjugated bilirubin and by "toxic" cellular alterations, such as giant-cell transformation. These findings have been interpreted as evidence of primary hepatocellular damage.
INTELLECTUAL FUNCTION IN CHILDHOOD PROGRESSIVE MUSCULAR DYSTROPHY
Authors: Worden Don K. , Vignos Paul J.
Published: December 2021

A study of 38 boys with progressive muscular dystrophy indicated that they were functioning at lower intellectual levels than were a variety of control groups. Their academic achievement, however, was well correlated with their mental ages. No progressive mental deterioration was found. There was no relationship between tested intelligence and severity of illness, length of illness, or age of onset of illness. The only factor associated with lowered intellectual abilities was the presence of childhood progressive muscular dystrophy. A hypothesis was advanced concerning the possible nature of muscular dystrophy and its relation to intellectual retardation. Much very basic research is needed before such a hypothesis can be accepted.
Baby Care from Birth to Birthday
Authors: POWERS GROVER F.
Published: December 2021

The book is well printed and beautifully illustrated. It takes a middle ground in respect to matters of infant care, particularly those of a controversial nature.
REPORT OF THE SECRETARY
Authors: GRULEE CLIFFORD G.
Published: December 2021

This has been a year of meetings. We have already had Areal Meetings in Buffalo, Milwaukee and Seattle, and now comes the Annual Meeting. For the year 1949, we plan to have but two meetings: the Areal Meeting at Atlanta, Ga., April 13-15, and the Annual Meeting at San Francisco, Calif., November 14-17. There are two reasons why the number of meetings has been reduced. The first is that the force in the central office is too overloaded with work to carry on four meetings a year. The second, and all important, is that the commercial firms will not support so many meetings in one society. As a consequence, we stand likely to have a deficit in each of the three areal meetings. However, in two of these, one of the commercial firms assured us that it would make up any deficit, so that we are now in a position to write these two meetings off the books. I wish to call your attention to the meeting of the Second Pan-American Congress of Pediatrics at Mexico City from November 2-5, 1949, which will be under the direction of the Mexican pediatric group.

Very few of our members have any conception of the amount of work which must precede one of our meetings, nor have they any conception of the amount of routine work which must be done in the central office. It seems likely that, in the not too distant future, we must enlarge our quarters and employ more help.

One of the most encouraging things that has happened in the last year has been the way the committees have taken hold of their jobs and carried them out. Of the Standing Committees, the Committee on School Health has been so regularly efficient that it becomes routine for us to exclaim about it. Such Committees as the Committee on Fetus and Newborn have done outstanding work. The Committee on Legislation has been on the job regularly. The Committee on Governmental and Medical Agencies has been discharged with thanks and its work is taken over by the Committee for Improvement of Child Health. This last committee, under the direction of Dr. James L. Wilson, and with an efficient secretary in the form of Dr. Hubbard, is rounding into form and will have many suggestions to make to the Academy.
THE SPEED OF THE SECONDARY IMMUNE RESPONSE TO TETANUS TOXOID WITH A REVIEW OF WAR REPORTS AND OBSERVATIONS ON SIMULTANEOUS INJECTION OF TOXOID AND ANTITOXIN
Authors: MILLER JOHN J. , RYAN MARY LOUISE , BEARD R. R.
Published: December 2021

A review of the 30 reported cases of tetanus occurring in actively immunized personnel of the British and American armies permits the following conclusions. The only type of tetanus that need be feared in recently immunized individuals is that which may occur following extensive trauma or massive contamination. It is characterized by short incubation periods, sometimes even less than one week. and a high case fatality rate. The reinjection of toxoid on wounding in two such instances failed to prevent death.

The speed of the antitoxin response during the week subsequent to a reinjection of tetanus toxoid was observed in a group of more than 150 actively immunized children. Marked individual differences were observed. Factors which influenced the speed of response were:

1. The type of toxoid employed in the basic immunization; alum-precipitated or aluminum hydroxide-adsorbed toxoid inducing a superior capacity to react promptly when compared to fluid toxoid.

2. The type of toxoid used for the reinjection (for the secondary stimulus); fluid toxoid inducing a more rapid rise in antitoxin than alum-precipitated toxoid.

3. The interval elapsing since the last injection of toxoid. When this interval was greater than four years the speed of response was occasionally slowed.

Experimental evidence is advanced indicating that the simultaneous injection of prophylactic antitoxin and tetanus toxoid in different extremities does not prevent the secondary immune response to the toxoid. It is therefore suggested that the maximal prophylactic effect against tetanus in severely wounded immunized individuals (and/or when immunization occurred more than four years previously) may be obtained by simultaneous injection of toxoid and antitoxin in different extremities.
THE ETIOLOGY OF EKIRI, A HIGHLY FATAL DISEASE OF JAPANESE CHILDREN
Authors: DODD KATHARINE , BUDDINGH G. JOHN , RAPOPORT SAMUEL
Published: December 2021

From a clinical, bacteriologic, chemical and pathologic standpoint, one can conclude that Ekiri is mostly bacillary dysentery complicated by tetany, that the diagnosis of Ekiri may occasionally apply to children suffering from tetany and some other infection or perhaps a noninfectious gastrointestinal upset or even tetany alone.

Manifest tetany as seen in hot summer weather, secondary for the most part to bacillary dysentery infection, is a far more serious disease than rachitic tetany without infection. It is characterized by hyperventilation, lethargy or delirium, tonic spasms of the muscles, vomiting, disturbances of the autonomic nervous system and severe clonic or tonic convulsions. The child may die in a sustained tonic spasm or the tetany may aggravate the fever and dehydration caused by the infection, so that circulatory collapse and cerebral anoxia ensue. Early and strenuous treatment of the tetany, the infection and the accompanying dehydration is necessary if the present high death rate of Ekiri is to be greatly reduced. Prevention of tetany in Japanese children by supplementation of their diet with calcium and of dysentery by improved sanitation would be a far better approach to the problem.
GENERALIZED NON-FATAL HISTOPLASMOSIS IN AN INFANT
Authors: BLUMBERG RICHARD W. , RUCHMAN ISAAC , JOHANSMANN RALPH J.
Published: December 2021

A case of systemic infection with Histoplasma capsulatum with recovery is reported. The organisms were recovered from the blood, bone marrow, and liver. No specific therapy was administered.

Change in skin sensitivity to histoplasmin from negative in the early stage to positive in the convalescent stage was noted. No cross reactions with various other fungus antigens were observed.
TRENDS IN HEALTH LEGISLATION AND ADMINISTRATION
Authors: WALL JOSEPH S.
Published: December 2021

AS GENERALLY expected, the proponents of national compulsory health insurance lost no time after the opening of the 81st Congress.

In his State of the Union Address delivered to Congress on January 5, 1949, President Truman called again for legislation for a national health program—a request he made in his first health message to Congress November 19, 1945. At that time, three years ago, he said:

"In the past, the benefits of modern medical science have not been enjoyed by our citizens with any degree of equality. Nor are they today. Nor will they be in the future unless Government is bold enough to do something about it.

"People with low or moderate incomes do not get the same medical attention as those with high incomes. The poor have more sickness, but they get less medical care. People who live in rural areas do not get the same amount or quality of medical attention as those who live in our cities.

"Our new economic bill of rights should mean health security for all, regardless of residence, station, or race—everywhere in the United States."

On the same day (November 19, 1945) the Wagner-Murray-Dingell Bill was introduced as S. 1606. After extensive hearings and some modifications, a similar bill (S. 1320) was introduced in the 80th Congress by Senator Murray with the additional sponsorship of Senators Pepper, Chavez, Taylor and McGrath, all Democrats.

In his message to the Democratic 81st Congress President Truman said:

"We must spare no effort to raise the general level of health in this country. In a nation as rich as ours, it is a shocking fact that tens of millions lack adequate medical care. We are short of doctors, hospitals, and nurses. We must remedy these shortages. Moreover, we need—and we must have without further delay—a system of prepaid medical insurance which will enable every American to afford good medical care."

On the same day Senator Murray introduced for himself, and senators Wagner, Pepper, Chavez, Taylor and McGrath a bill 5.5, "to provide a national health insurance and public health program." Two identical bills had already been introduced in the House, HR. 345 by Representative Celler and HR. 783 by Representative Dingell. All three bills are exact copies of last year's bill, S. 1320. (Copies of these bills may be obtained from the Superintendent of Documents, Government Printing Office, Washington 25, D.C., or from the committees to which they have been referred.)
CHILD HEALTH SERVICES AND PEDIATRIC EDUCATION
Authors: SISSON WARREN R. , HUBBARD JOHN P.
Published: December 2021

The Study of Child Health Services and Pediatric Education has been reported in summary for the country as a whole and is being reported in more detail for the individual states. To summarize a summary approaches a reductio ad absurdum. But now that this momentous Study is not only completed but published, it is timely to point to a few of its most conspicuous highlights.

With the permission of the Commonwealth Fund, to whom we are indebted for publication of the report, we have reproduced below the final chapter of the report itself. These few pages are in the nature of a few drops of juice squeezed out of the fruits of our labors.

The full published report has been boiled down as much as has seemed consistent with an undertaking taking of this magnitude. In a first volume is to be found a general summary of child health services and pediatric education with a number of charts illustrating some of the most important findings. We have purposely avoided over-weighting this volume with heavy statistical tabulations. For those who are interested in more detail and a further analysis of the data, a second volume has been prepared containing methodology, definitions, comprehensive tabulated data, and the basic schedules used in collecting the desired information. So now, in two volumes, the report is available, prepared both for those who have general interest and for those who have more particular concern with the health of children and the training of the doctors responsible for their care—John P. Hubbard, M.D.
A SIMPLIFIED INFUSION SET FOR INFANTS
Authors: SUTTON MACK
Published: December 2021

A simple, convenient, and compact apparatus for infusion and transfusion is described. Its advantages and some common errors encountered during its use in over a thousand infusions and transfusions to infants and children are discussed. Detailed instruction for assembly and operation are given, and its convenience in home or hospital is emphasized.
THE EFFECT OF SMALLPOX VACCINATION DURING PREGNANCY ON THE INCIDENCE OF CONGENITAL MALFORMATIONS
Authors: GREENBERG MORRIS , YANKAUER ALFRED , KRUGMAN SAUL , OSBORN JOHN J. , WARD RICHARD S. , DANCIS JOSEPH
Published: December 2021

Following an outbreak of variola in New York City early in 1947, more than five million people were vaccinated. Among these there were observed 4,172 women in the first trimester of pregnancy. They gave birth to 68 children with malformations, an incidence of 1.63%. A control, nonvaccinated group of 2,186 women in the same period of pregnancy, gave birth to 30 malformed infants, an incidence of 1.37%.

The vaccinated group gave birth to 343 premature infants, a rate of 8.2%, while the nonvaccinated group gave birth to 185 prematures, a rate of 8.5%.

Deaths from congenital malformations in New York City during the four months representing the first trimester of pregnancy of the observed women numbered 259, a rate of 48.8 per 10,000 live births. In the corresponding months of the preceding year the number of deaths was 290, a rate of 47.2 per 10,000 live births.

There was no apparent increase in the ratios of stillbirths to total births in 1947, during the months when the stillbirths may have been conceived, over the ratios of the corresponding months of the previous year.

There is no evidence from these studies that smallpox vaccination of women in the first trimester of pregnancy has any deleterious effect on the developing embryo.
FINANCIAL ASPECTS OF PEDIATRIC EDUCATION
Authors: HUBBARD JOHN P. , MITCHELL JOHN MCK.
Published: December 2021

A year ago we presented at the Annual Meeting of the Academy some of the findings that were beginning to emerge from the Study of Child Health Services. This comprehensive nation-wide survey is now complete and in publication. One of the most important aspects of this study is the fact that it has coupled with a study of services an evaluation of the training of those who are rendering the services.

Many members of the Academy participated in the collection of information from practicing physicians, hospitals and community health agencies. The results of these inquiries are now in the hands of state chairmen who are reporting the findings for their own areas. These state reports which are appearing in increasing number contain not only a summary of the data but also include recommendations as to what ought to be done within the state to fill existing gaps and to improve the health of children.

But the information on pediatric education is less familiar to the many who participated in state programs. This part of the study was necessarily conducted from a central office with one of us, Dr. Mitchell, making a personal visit to each of the 70 approved medical schools and nearly all of the hospitals approved for pediatric residency.

Now that we have reached a point where we can see the whole picture, the Study of Pediatric Education appears in a place of prominent, if not dominant, importance. Service is, after all, a dynamic function, and can be only so good as the training, skills and abilities of the individuals who give it. In the last analysis, good medical care for children depends not so much on the physical facilities of the hospitals or the expansion of health services as upon the judgment and skill of physicians. This skill is the result of training and experience. It was this very fact which at the outset led to the inclusion of an evaluation of pediatric education and which now appears as the logical starting point for a program for the improvement of child health.
Psychiatric Research
Authors: PRUGH DANGE G.
Published: December 2021

In this slight volume are reprinted six papers read at the dedication, on May 17, 1946, in Waverly, Massachusetts, of the Laboratory for Biochemical Research at the McLean Hospital, the mental disease department of the Massachusetts General Hospital. As the first in this series of addresses, Cecil K. Drinker contributes a dignified historical survey of past researches at the McLean Hospital, where, at the turn of the century, Otto Folin undertook a monumentally conceived but unfinished study of disorders of cerebral metabolism.
RUPTURE OF ANEURYSM OF THE CIRCLE OF WILLIS IN THE NEWBORN
Authors: NEWCOMB ALVAH L. , MUNNS GEORGE F.
Published: December 2021

A case of spontaneous cerebral hemorrhage from an aneurysm of the circle of Willis is reported in the male of newborn twins. The smaller female twin died earlier with similar symptoms and signs, but no intracranial autopsy was performed.
An Atlas of Detailed Normal Pneumoencephalographic Anatomy
Authors: NEUHAUSER EDWARD B. D.
Published: December 2021

For many years a number of excellent texts of normal pneumoencephalographic anatomy have been available. In this atlas, Dr. DiChiro, who is head of the section of Neuroradiology of the National Institute of Health, Bethesda, Maryland, admirably supplements these previous studies. Utilizing 283 LogEtron reproductions of roentgenograms obtained during fractional pneumoencephalography, the detailed anatomy is clearly demonstrated. Most of the reproductions are accompanied by simple line and stipple sketches that are helpful, as identifying numbers and arrows are, with a few exceptions, placed on the sketches alone so that the excellent roentgenograms are unmarred by numerous reference marks.
Problems of Blood Pressure Measurement in Childhood
Authors: RUDOLPH ABRAHAM M.
Published: December 2021

Drs. Moss and Adams have presented the results of their investigations on the measurement of blood pressure in children and infants and have also reviewed the whole subject. Their careful observations on the significance of cuff size in the auscultatory method and their experiences with the flush method of pressure measurement in infants are of extreme importance to all pediatricians. This information is presented in great detail, as is the technique for direct intra-arterial pressure measurement. A section on manometry and recording equipment for direct recording of arterial pressure by needle puncture is rather superficial but is adequate for an understanding of the types of equipment available.

This monograph is recommended to all concerned with measurement and recording of blood pressure in infants and children, as a careful evaluation of the problems, advantages, and disadvantages of various techniques.
RECURRENT POLYSEROSITIS ("PERIODIC DISEASE," "FAMILIAL MEDITERRANEAN FEVER") IN CHILDREN
Authors: Shapiro Tehila R. , Ehrenfeld Ernest N.
Published: December 2021

A series of 19 cases of recurrent polyserositis is presented. All but one child were of Oriental Jewish parentage, and the disease sometimes showed a familial occurrence. The average age of onset was 4 years. The symptoms consisted of fever; abdominal, chest, and joint pains; and skin eruptions. The clinical manifestations often simulated those of acute rheumatic fever, particularly since cardiac murmurs occurred in more than half of the patients. The laboratory findings were those accompanying nonspecific inflammations such as leukocytosis, accelerated enythrocyte sedimentation rate, elevated antistreptolysin titer, and positive C-reactive protein. Though some patients showed transitional albuminunia, no cases of amyloidosis were found. The difference in the clinical manifestations in children as compared with adults, and possible etiological factors are discussed.
The Resident in the Non-University Hospital (Continued)
Authors: HARRINGTON EDWIN D.
Published: December 2021

I read Dr. Fink's letter in the April issue of Pediatric (29:678, 1962) with great interest.

As we have considered this problem at a community hospital in suburban Philadelphia it has seemed to us necessary to answer two questions: (1) What is the problem? and (2) Who is responsible for the solution of the problem?

Essentially, we see the problem of adequate inpatient coverage as a service problem, not a problem in medical education. I would agree with Dr. Fink that his patients "would undoubtedly receive better care with a qualified resident on duty."
Speech Disorders
Authors: LENNEBERG ERIC H.
Published: December 2021

Clinical speech disorders are abundant, but our theoretical knowledge about them is scarce. This volume is an excellent summary of the present state of work in the field. The author, one of Europe's most distinguished neurologists, covers both the esoteric (origin of language) and the practical (anatomy and physiology of language); whatever the topic, the presentation is succinct, stimulating, and at times brilliant. The key to Sir Russell's approach to speech and language is his conviction that physiology is "the link between the anatomy of the brain, in terms of which we describe lesions, and psychology, in terms of which we apprehend speech disorders."
Voice and Speech Disorders: Medical Aspects, with Sections on Otology-Audiology and Surgery of Head and Neck
Authors: LEDEN HANS VON
Published: December 2021

This book represents an ambitious project—to cover the entire area of human communications in one large volume. The title is misleading, for the text covers not only the medical aspects of voice and speech disorders but extensive chapters on otology, audiology, surgery of the head and neck, radiation therapy, habilitation and rehabilitation, school and public vocational programs, etc. The variety of material offered in 27 chapters by 36 different authors from the disciplines of medicine, audiology, speech and voice pathology, dentistry, rehabilitation, education, acoustics, music, and government assures valuable information for any reader regardless of his academic background.
CARDIAC COMPLICATIONS OF CEREBRAL ARTERIOVENOUS FISTULA IN INFANCY
Authors: Levine O. Robert , Jameson A. Gregory , Nellhaus Gerhard , Gold Arnold P.
Published: December 2021

Four infants with congenital arteriovenous malformation of the vein of Galen are discussed, in each of whom there was clinical or roentgenographic evidence of cardiac involvement secondary to the arteriovenous shunt.

Infant 1 was a neonate who presented solely with signs of severe circulatory congestion. The infant died at 48 hours of age despite therapy directed at relief of congestion and improvement of cardiac function.

Infant 2 presented during infancy with roentgenographic evidence of cardiomegaly secondary to cerebral arteriovenous fistula. Chest roentgenograms showed decrease in size of the cardiac image after reduction of the fistula. Partial anomalous pulmonary venous drainage was an associated finding at autopsy.

Infant 3 underwent operation for complete removal of a cerebral arteriovenous aneurysm, and died 7 hours postoperatively with clinical evidence of circulatory overloaded.

In Case 4 cardiovascular studies were done prior to successful reduction of cerebral arteriovenous fistula, and were repeated 4 weeks postoperatively. The shunt was demonstrated by a marked elevation of oxygen saturation of internal jugular venous blood as compared with iliac venous blood; this discrepancy was markedly diminished after operation. Cardiac output was measured by the dye-dilution technique and postoperatively showed a 50% decrease as compared with the abnormally high preoperative determination.

The hemodynamic effects of arteriovenous fistula are discussed. The precise mechanisms responsible for the compensatory increase in blood volume are incompletely understood. The increased cardiac output is accomplished by means of augmented stroke volume in accordance with the Starling law of the heart. While phlebotomy may appear to be indicated in an attempt to reduce the circulatory load resulting from a large arteriovenous shunt, it also deprives the patient of a homeostatic response useful in maintaining adequate perfusion distal to the shunt. Digitalis should be administered when myocardial failure contributes to circulatory congestion.
LOWER INCIDENCE OF SEX CHROMATIN IN BUCCAL SMEARS OF NEWBORN FEMALES
Authors: Smith David W. , Marden Philip M. , McDonald Michael J. , Speckhard Mark
Published: December 2021

The incidence of the sex chromatin mass in buccal cells of newborn females is often lower during the first day or two of postnatal life, as compared to later ages. This finding allows for misinterpretation of the significance of buccal smear results during the first day or two. A similar phenomenon was noted in mothers during the day prior to delivery and for one to two days thereafter. This suggests a common etiology for this effect in both the mother and the newborn infant.
PARATHYROID FUNCTION IN VITAMIN D DEFICIENCY RICKETS
Authors: Taitz L. S. , de Lacy C. D.
Published: December 2021

A study of South African Bantu infants with vitamin D deficiency rickets revealed marked elevation of the phosphorus excretion index (PEI) as measured by the method of Nordin and Fraser. This finding is interpreted as evidence of secondary hyperparathyroidism, since the PEI was depressed by intravenous calcium infusion. In view of the inverse relationship demonstrated between phosphorus excretion and the plasma phosphorus levels in these children it is suggested that secondary hyperparathyroidism may play a fundamental role in the evolution of the biochemical findings in this disease. An hypothesis is put forward to explain the histologic differences between rickets and primary hyperparathyroidism on the basis of the double action of parathyroid hormone. The PEI is a suitable technique for investigation of problems of calcium-phosphorus metabolism in childhood.
Hospitals and Children: A Parent's-Eye View: A Review of Letters from Parents to the Observer and the BBC
Authors: MCINTOSH RUSTIN
Published: December 2021

The Tavistock Institute of Human Relations, in which Mr. Robertson carries out research in child development, has long been known for its emphasis on the risk of inflicting serious and lasting damage on the personality of a young child by separating him from his accustomed home environment, especially during hospitalization. Many pediatricians in this country have seen the film "A Two-Year-Old Goes to Hospital," and not a few have been privileged to hear Dr. Bowlby or Mr. Robertson plead eloquently for acceptance of the mother into the hospital setting when a patient younger than 5 years of age is admitted.
PEDIATRIC MANPOWER IN THE UNITED STATES, AND ITS IMPLICATIONS
Authors: Stewart William H. , Pennell Maryland Y.
Published: December 2021

About 12,276 physicians (including those in training programs) are currently engaged in the practice of pediatrics. Of this number, 11,317 (or 92%) classify themselves as full-time specialists. More than half of the total have been certified by the American Board of Pediatrics. Three-fourths of the full-time pediatricians are in clinical practice. Eleven per cent are in other forms of practice such as hospital staff, teaching, or administration. The other 13% are in training programs as interns or residents. Fifteen per cent of the full-time pediatricians are women. Those reported as nonwhite number 187. Among the pediatricians engaged full-time in clinical practice, 61% are under age 45. The Northeast region and the West have more than their share of pediatric manpower in relation to child population; the North Central region and the South are in less favorable positions. Pediatrics ranks fifth among some 30 specialties in terms of medical manpower. At the present time, pediatricians comprise 8% of all specialists. The ratio of pediatricians to the child population under 15 years of age rose from 7.3 per 100,000 in 1940 to 16.3 by 1961. The ratio of general practitioners to the population under 15 years of age fell from 345 in 1940 to 135 per 100,000 in 1961. When pediatricians are combined with general practitioners, the ratio fell from 352 in 1940 to 151 in 1961.
REPORT OF THE COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

MANAGEMENT of the allergic infant often includes extensive dietary restriction in addition to avoidance of milk. A milkfree formula may thus become a major or even sole source of most essential nutrients for many months. Furthermore, the occasional coexistence of anorexia and intercurrent infection in children with allergic manifestations, and losses of proteinthrough the skin of patients with severe eczema, makes adequacy of diet a major concern of the physician caring for such patients.

Published reports of deficiency diseases developing in infants receiving various milk-free formulas indicate the importance of an awareness of composition and nutritional properties of these diets. Deficiencies of vitamin A and thiamine, have occurred in infants receiving milk-free formulas not fortified with vitamins, and goiter due to iodine deficiency (or increased iodine requirement) has been reported to occur in infants receiving a soya bean formula unsupplemented with iodine.

The present report provides information regarding composition and nutritional adequacy of certain infant formulas commonly employed as cow milk substitutes.

SOYA BEAN PRODUCTS

Composition

Information on the composition of the most frequently used commercial preparations is given in Table I.

Soyalac: Liquid and powder products are prepared from an aqueous extrat of whole soya beans to which has been added soya oil, sucrose, dextrose, dextrins, maltose, and iodised sodium chloride, When diluted with water to supply 67 cal/100 ml (20 cal/oz). Soyalac liquid supplies 2.05 gm of protein/100 ml, the least protein content of commercially available soya bean formulas. Formulas of Soyalac Powder with the same caloric strength provide 2.85 gm of protein/100 ml and differ in other important respects from Soyalac liquid (Table I).
Letters to the Editor
Authors: BEAL VIRGINIA A. , MEYERS ALDULA J. , MCCAMMON ROBERT W.
Published: December 2021

We appreciate Dr. Diamond's comments and agree with him in principle. The matter of what level of hemoglobin is acceptable as the bottom of the "normal" range at one year is not easily settled, which is why we stated "if one accepts an arbitrary level of 10 gm." We too feel that no level may be arbitrarily applied in any measurement with such wide individual variation. While other hematologic data were available on all subjects, the tables were already so bulky as to give us pause in requesting publication space for them beyond the hemoglobin and MCHC values, especially since none of the other determinations, including reticulocyte and erythrocyte counts, packed cell volumes, and the other indices that may be derived from them disagreed with or added materially to the data presented.
WELFARE AND THE CHILDREN'S BUREAU
Authors: BARBA PHILIP S.
Published: December 2021

IN THE fifty-first year of its existence, the Children's Bureau moves to a new administrative home. A completely new home in the sense that it is a new administrative house in the geography of the Department of Health, Education, and Welfare. Initially, the Bureau was in the Department of Commerce and a year later in the Department of Labor, where the Bureau Chief reported directly to the Secretary. From 1946 until now, the Bureau was located in the Social Security Administration of the Department of Health, Education, and Welfare, and the Chief reported to the Commissioner of the Agency. In the new Welfare Agency the Chief of the Children's Bureau will officially report to the Welfare Commissioner, who in turn will report to the Secretary of the Department of Health, Education, and Welfare.
DISTINCTIONS BETWEEN SUBGROUPS OF ASTHMATIC CHILDREN
Authors: Purcell Kenneth
Published: December 2021

The present investigation was designed to explore further the hypothesis that asthma is more often employed as a learned, defensive-adaptive response by rapidly remitting than by steroid dependent asthmatic children. Specifically, it was predicted that rapidly remitting, as compared to steroid dependent children, would more often report emotional arousal with negative affect as provocative of asthma.

A simple, structured interview procedure for obtaining data on children's perceptions of the precipitants of asthmatic attacks was described in some detail. The results of interviews with 38 children (20 rapidly remitting and 18 steroid dependent) offered support for the main hypothesis. In addition, extrinsic factors such as colds, allergies, and weath variations, particularly the latter, were reported as precipitants of asthma more frequently by the steroid dependent than by the rapidly remitting children. On the basis of some of the obtained data, an explanation of the relationship between crying and asthma was offered as an alternative hypothesis to the well-known concept of asthma as a symbolic, suppressed cry for the mother.
USE OF DEVELOPMENTAL CHARTS IN TEACHING WELL CHILD CARE
Authors: Leavitt Samuel R. , Gofman Helen , Harvin Donya
Published: December 2021

Over 400 patients in our Well Child Clinic have been evaluated since September, 1961, with the aid of newly designed developmental charts. These charts are used as supplements to the usual complete patient evaluation, and the findings are discussed with a consultant. They are designed to give a graphic summary of the child's growth and development, including school performance and behavioral patterns which can be easily compared yearly. These charts are used as teaching aids to help the student physician understand more fully the concepts of Well Child care.
ALBRIGHT'S HEREDITARY OSTEODYSTROPHY (WITHOUT HYPOCALCEMIA)
Authors: Papaioannou A. C. , Matsas B. E.
Published: December 2021

A case of Albright's hereditary osteodystrophy without hypocalcemia (pseudo-pseudohypoparathyroidism) is presented. In a review of 41 cases reported in the literature we found that the most commonly described features in order of frequency were short metacarpal or metatarsal bones (92%), short stature (76%), round face (71%), mental retardation (64%), obesity (61%), ectopic calcinosis (35%), and exostoses (23%). The familial occurrence of pseudohypoparathyroidism and pseudo-pseudohypoparathyroidism in members of the same family, the inconsistency of hypocalcemia in many cases, and the similarity of the main manifestations and sex ratio in both conditions suggest that these are merely two forms of the same syndrome. It seems that this is an hereditary syndrome showing the phenomenon of pleiotropy. The basic defect is still unknown. The proposed terminology for this syndrome is discussed. It is concluded that only the skeletal dysplasia and the radiographic features can distinguish this disorder from idiopathic hypoparathyroidism.
THE CONTROL OF BODY TEMPERATURE IN THE SMALL NEWBORN INFANT BY LOW-ENERGY INFRA-RED RADIATION
Authors: Agate Frederic J. , Silverman William A.
Published: December 2021

A description is given of the development of systems for the control of body temperatures in small infants by low-energy infra-red radiation. An operative system was devised which has been in use for more than 4 years, with results which will be the subject of a subsequent report. "Moribund" and "healthy" simulated infants were warmed by conventional hot air blowers and by low-energy infra-red radiation from a conductive glass plate. The warming curves are presented.
NEUTROPENIA IN AN INFANT SECONDARY TO HYDROCHLOROTHIAZIDE THERAPY: WITH A REVIEW OF HEMATOLOGIC REACTIONS TO "THIAZIDE" DRUGS
Authors: Schotland Marilyn G. , Grumbach Melvin M.
Published: December 2021

A 10-month-old infant had an asymptomatic maturation arrest of granulopoiesis secondary to hydrochlorothiazide therapy. In view of the absence of symptoms in this case and the possible lethal consequences, periodic examinations of the blood in patients receiving long-term "thiazide" treatment appears to be warranted.
Parathyroid Function in Vitamin D Deficient Rickets
Authors: BUTLER ALLAN M.
Published: December 2021

The paper by Taitz and deLacy on Parathyroid Function in Vitamin D Deficient Rickets (Pediatrics, 30: 884, 1962) states: "Although some workers have shown elevation of calcium concentrations by parathyroid hormone in rachitic subjects, the problem is further complicated by reports that tetany associated with rickets or osteomalacia is sometimes refractory to administered parathyroid hormone,6,7 thus raising the possibility that low calcium level may result, not from a failure of the parathyroid gland to keep pace with increased demands, but from an acquired failure of bone and kidneys to respond to increased circulating parathyroid hormone.
Pica and Milk Intake
Authors: CATZEL PINCUS
Published: December 2021

The article of Gutelius et al., called "Nutritional Studies of Children with Pica" (Pediatrics, 29:1012, 1962) has just come to my notice. I would like to compare my experiences in Klerksdorp, a mining town in the Western Transvaal, Republic of South Africa. In Klerksdorp I deal mainly with white patients of good nutritional status and "middle-class" income group. Housing is good, and every house has its own garden.

My cases of pica fall into the sand-eating group—only one in 36 which I've investigated had a craving for cigarette ash, and none for paper, plaster, dirt, or laundry starch.
Letters to the Editor
Authors: EICHENWALD HEINZ F.
Published: December 2021

Doctor Harvie's letter contains a number of assertions, none of which are supported by valid evidence. He reports his experience, which conflicts with that obtained under controlled conditions in nurseries specifically constructed to obtain such observations. He is certainly entitled to his opinions, but they are no more than that.

My associates and I have had the opportunity of studying a farily large number of outbreaks of staphylococcal, streptococcal, and Esch. coli disease in a variety of different hospital nurseries: we were uniformly impressed by the fact that the most rigid application of "Listerian principles" failed to control these epidemics, or for that matter, decreased colonization rates significantly.
FETAL ADRENAL TRANSPLANTATION ATTEMPT IN JUVENILE ADDISON'S DISEASE
Authors: Kohlenbrener Robert M. , Sheridan Joseph T. , Steiner Matthew M. , Inouye Tohru
Published: December 2021

The clinical history and management are presented of a boy who, at age 8 years, had onset of adrenal insufficiency of undetermined cause. He was controlled well with corticosteroid therapy and had trouble only during infections and hot weather. At age 12 years adrenal cortex tissue from a premature infant was transplanted into his abdominal wall. ACTH was given daily for 3 months to stimulate the transplant. No measurable 17-OHCS were present in his blood during this time. Seven and 9 months after the transplantation intravenous ACTH tests revealed low but definite concentrations of 17-OHCS in his blood. Ten months after the transplantation he was "stressed" by stopping his exogenous steroid therapy for 17 days. He developed progressive signs of adrenal insufficiency, but he also responded with measurable concentrations of 17-OHCS in his blood. Chromatographic analysis of his urine during the "stress" period revealed a steroid profile that suggested adrenal cortex activity. His corticosteroid production at best was only 10% of normal. The transplant was not examined directly.
UMBILICAL VESSEL ANGIOCARDIOGRAPHY IN THE NEWBORN INFANT
Authors: Sapin Samuel O. , Linde Leonard M. , Emmanouilides George C.
Published: December 2021

Angiocardiography from an umbilical vessel approach was performed in 10 critically sick newborn infants. The umbilical vein route was successfully employed up to the eighth day of life, while the umbilical artery was safely used as late as age 5 days. This approach has advantages over other methods of catheterization and angiocardiography. Angiocardiographic quality was satisfactory for accurate interpretation.
PERIPHERAL BLOOD AND BILIRUBIN VALUES IN NORMAL FULL-TERM PRIMAQUINE-SENSITIVE NEGRO INFANTS: EFFECT OF VITAMIN K
Authors: Zinkham William H.
Published: December 2021

Serial determinations of hematocrit, reticulocyte, and bilirubin values were carried out during the first 8 days of life in 30 fullterm primaquine-sensitive Negro infants placed on three different schedules of vitamin K prophylaxis: 10 did not receive vitamin K, 10 were given 2.5 to 7.5 mg of the tetrasodium diphosphate salt of menadione (Synkavite) intramuscularly, and 10 received 1.0 to 18.75 mg of vitamin K1 (Konakion) intramuscularly during the first 24 hours of life. Similar observations were made on 60 full-term Negro infants who had normal or only slightly decreased levels of erythrocyte glucose-6-phosphate dehydrogenase activity. Although none of the infants manifested bilirubin levels greater than 14.5 mg/100 ml, the values in the primaquine-sensitive infants not given vitamin K were significantly higher than those observed in the other babies on the fifth and eighth days of life. The bilirubin values in all the infants were similar during the first day of life; maximal levels, however, occurred later in 5 of the 10 primaquine-sensitive infants who did not receive vitamin K.

Reticulocyte counts were elevated in many of the primaquine-sensitive infants, regardless of their vitamin K grouping. The primaquine-sensitive infants could not be differentiated from normal babies on the basis of hematocrit values, the occurrence of Heinz bodies, and the morphology of the erythrocytes.

The suggestion is made that primaquine-sensitive Negro newborn infants have a shortened survival time of the erythrocyte, predisposing them to the development of hyperbilirubinemia. Furthermore it is suggested that the capacity of some primaquine-sensitive infants to maintain normal bilirubin levels in the face of increased bilirubin formation is affected by the administration of vitamin K1.

Reasons are given for using vitamin K1 rather than the water-soluble analogues of vitamin K, in the prophylaxis of hemorrhagic disease of the newborn. A dose of 18.75 mg of vitamin K1 was given safely to four primaquine-sensitive full-term Negro newborn infants. Until there is conclusive evidence that these large doses are necessarily beneficial, then no more than 2.0 mg of vitamin K1 should be given to these infants.
ERYTHROKINETIC STUDIES OF THE ANEMIA OF LEAD POISONING
Authors: Leikin Sanford , Eng Gloria
Published: December 2021

Erythrokinetic studies using Fe59 and Cr51 simultaneously, and bone marrow myeloid-erythroid counts, were performed on seven children with the iron intractable anemia of lead poisoning. In all, a microcytic, hypochromic anemia was present. Normal results were obtained in one child. Three patients with relatively short histories of intoxication demonstrated a pattern consistent with a hemolytic process. The remaining three had more prolonged histories, and their erythrokinetic patterns displayed evidence of erythroid hypoplasia. These results indicate that lead involves hematopoesis by more than one mechanism and at several hematologic levels, depending upon the duration of toxicity.