bluuebunny/crossref_metadata_2025 huggingface dataset:
CORTICOTROPIN AND STEROID HORMONE THERAPY OF ALLERGIC STATES IN CHILDREN
Authors: Levin Samuel J.
Published: December 2021

This paper summarizes our experience with the practical use of ACTH and the steroid hormones in several hundred allergic children. The indications, contraindications and rationale of their use is discussed. It is particularly emphasized that the improvement induced in many allergic conditions is temporary and of short duration, unless the causative factors are removed. Hormone therapy should be regarded as a valuable supplement to, rather than a substitute for, conventional methods of symptomatic and immunological management.

Undesirable physiologic effects were not observed with short-term therapy of 5 to 7 days duration. In this series of approximately 200 patients in which these agents were used, long-term therapy was resorted to in 3 intractable cases and eventually discontinued in 2.

Caution is urged in the use of these hormones, especially for long-time treatment of allergic diseases since their deleterious effects on the growing child is still not completely known.

Allergic reactions to the gelatin vehicle in which ACTH is suspended, were encountered in 2 children. One child was apparently allergic to hydrocortisone used in nasal sprays.
STUDIES ON A NEUTRALIZING ANTIBODY AGAINST CANINE DISTEMPER VIRUS FOUND IN MAN
Authors: Karzon David T.
Published: December 2021

A reproducible test is described for the measurement of serum neutralizing capacity against a strain of CDV adapted to the chick embryo.

A heat-stable neutralizing substance against CDV was demonstrated in human serum and in high titer in the gamma globulin fraction.

The neutralizing substance is transmitted via the placenta quantitatively from the mother to the newborn infant. It is lost by the sixth month and reappears in the population between the second and tenth years of life. It reaches an incidence of almost 100 per cent in adults.

The evidence so far available indicates that the neutralizing substance has the properties of a true antibody, formed in response to an as yet unidentified infection with an agent identical to or bearing an antigenic structure in common with CDV.
IDIOPATHIC HYPOPARATHYROIDISM WITH BONY DEMINERALIZATION AND CARDIAC DECOMPENSATION
Authors: Schulman Jerome L. , Ratner Harold
Published: December 2021

Marked demineralization of the entire skeleton occurred in a 12-year-old girl with chronic idiopathic hypoparathyroidism. It is postulated that the demineralization was directly related to the unusual severity of the hypocalcemia.

The patient also manifested cardiac decompensation. There was no evidence of organic heart disease and the cardiac status improved coincident with the rise in serum calcium. It is postulated that the cardiac decompensation was the result of hypocalcemia.
THALLOTOXICOSIS
Authors: Grossman Herman
Published: December 2021

A review of the history, pharmacology, manifestations and treatment of thallium poisoning is presented.

A case of thallium poisoning is reported in an 8-year-old boy who presented with peripheral neuritis and alopecia. Thallium intoxication was proven by finding thallium in the urine, 1.8 mg./1., 2 weeks after the onset of symptoms.

The pediatric cases in the American literature since 1935 are summarized. There are 18 reported cases, including the present case. Ten of these eighteen children died. Sixteen patients had nervous symptoms, 11 had alopecia. Eight children gave a history of ingestion of rodenticide and in 5 the source of thallium was not known.
THE APPARENT ABSENCE OF SIGNIFICANT PRIMARY VASOSPASM IN ACUTE SPINAL POLIOMYELITIS
Authors: Trott Arthur W. , Hellstrom Mary D. , Green William T.
Published: December 2021

Measurement of skin temperatures under controlled conditions can be used as an index of the state of the cutaneous circulation.

During the first 40 days after the onset of poliomyelitis, there is no measurable alteration, based upon mean temperature values, in the cutaneous or deep circulation which can be attributed to the effects of the disease alone.

What little change in circulation was found in the group of patients with poliomyelitis seemed to be similar to that produced by bed rest alone in a group of non-poliomyelitic patients.
TREATMENT OF ATELECTASIS BY THORACIC TRACTION
Authors: Townsend Edward H. , Squire Lucy
Published: December 2021

A case of amyotonia congenita presenting recurrent atelectasis of the right lung has been successfully treated by thoracic traction.

This is the first time that atelectasis and its treatment have been visualized with ciné-fluorography.

It is suggested that application to treatment of neonatal, postoperative and other forms of atelectasis in childhood might be studied similarly.
THE PATHOGENESIS AND TREATMENT OF VIRILIZING ADRENAL HYPERPLASIA
Authors: Grumbach Melvin M. , Wilkins Lawson
Published: December 2021

SINCE the discovery by wilkins et al., in 1950, that in virilizing adrenal hyperplasia the clinical effects and the increased excretion of androgenic steroids can be suppressed by cortisone treatment, our knowledge of the primary metabolic disturbance underlying this disease has been advanced significantly through the work of a number of investigators. Considerable evidence has been obtained to support the observation of Bartter et al., in 1950, that in this disorder the ability of the adrenal cortex to synthesize gluconeogenetic hormone, or compound F, is impaired. This results in the increased secretion of ACTH in an attempt to provide sufficient compound F for homeostasis and secondarily leads to hyperplasia of the adrenal glands and the production of excessive quantities of adrenal androgen. In contrast to the normal, generally low levels of 17-hydroxycorticoids are found in plasma, and usually no significant rise occurs after the administration of ACTH. An excessive amount of endogenous ACTH is present in the blood which can be decreased readily by the administration of cortisone.

Important advances in clarification of the series of transformations by which the adrenal cortex synthesizes compound F or hydrocortisone from precursors have been made by Hechter and his associates and [SEE FIG 1 IN SOURCE PDF] others. Jailer suggested that in virilizing adrenal hyperplasia there is a metabolic block in this synthetic pathway between 17-hydroxyprogesterone and hydrocortisone (Fig. 1). The observation by Bongiovanni of an excessive quantity of pregnanetriol, a metabolite of 17-hydroxyprogesterone, in the urine of patients with this disease contributed substantial evidence to the support of such and hypotheses.
THE ROLE OF TRACE ELEMENTS IN HEMOPOIESIS AND IN THE THERAPY OF ANEMIA
Authors: Bush James A.
Published: December 2021

The physiologic importance of copper and cobalt in erythropoiesis is well established. Their importance as a supplement to natural diets for human subjects has not been demonstrated. Although some patients with the nephrotic syndrome or sprue may be partially depleted of copper, further studies will have to be done to determine whether the addition of copper to the diet is of any clinical benefit. With the possible exception of these 2 conditions, there is no evidence that therapy with copper has any value.

Cobalt, when administered in pharmacologic quantities, may under certain circumstances be a potent erythropoietic stimulant. However, toxic side effects may be associated with its administration and it remains to be determined whether on not the benefits outweigh the possible disadvantages. In iron deficiency anemia there is no indication for cobalt therapy. This anemia responds quite satisfactorily to iron alone.

Molybdenum deficiency has not been observed in man. Its role in hemopoiesis is unknown. Evidence for the usefulness of molybdenum-iron preparations in the treatment of anemias is not impressive.
Letters to the Editor
Authors: SLOTKOWSKI EUGENE L.
Published: December 2021

New cases of complications of smallpox vaccinations are being reported in the pediatric literature.

The report of Bigler and Slotkowski in 1951 of prolonged vaccinia was the first in recent American medical literature. Since that time, oven a dozen cases have been reported. If untreated, these cases end fatally. With the development of hyperimmune vaccine gamma globulin, there is hope that the patients may recover.

Even though the recognition of this condition is relatively recent, there appears to be a lack of unanimity as far as terminology is concerned.
THE SERUM PROTHROMBIN CONSUMPTION TEST IN INFANCY AND CHILDHOOD
Authors: Sussman Leon N. , Cohen Ira B.
Published: December 2021

This study of 101 children ranging in age from newborn to 13 years indicates that time serum prothrombin consumption test is of value in the examination of the coagulation system of children and newborn infants. The values obtained from the study of the blood of adults seem applicable to children. It is interesting to note that those factors in the mechanism of coagulation measured by the serum prothrombin consumption test are as completely developed at birth as in adult life. The ease of performance of this test with commercially available reagents places the test within reach of any well-equipped laboratory and facilitates the study of coagulation defects.
Sexual Precocity
Authors: GARDNER LYTT I.
Published: December 2021

The development of quantitative methods for the diagnosis of endocrinologic states has taken place in large part since the 1930's. Extensive clinical surveys done prior to that time have limited value, since it oftentimes is not possible to be certain of the diagnoses involved. This study of 69 patients with sexual precocity by Dr. Jolly is therefore particularly welcome, since it provides us with a sizeable series of such cases in whom the diagnoses have been established by modern techniques.
DOSAGE OF DRUGS IN INFANTS AND CHILDREN: III. NEOSTIGMINE
Authors: Patterson Paul R. , Lipton Earle L. , Unna Klaus R. , Glaser Kurt
Published: December 2021

The susceptibility of healthy children to neostigmine by hypodermic injection was studied in controlled experiments on 45 children ranging in age from 1 month to 12 years. Minimum effective doses (MED) of neostigmine were determined by their effect in stimulating salivary and sweat glands, and in increasing gastrointestinal motility.

The MED of neostigmine for stimulation of salivation is in all age groups smaller (by 6 to 38 per cent) than the MED increasing gastrointestinal motility. The average MED either for glandular (.025 to .036 mg./kg.) or gastrointestinal (.036 to .045 mg./kg.) activity fails to show significant differences among the various age groups when expressed in terms of body weight. Exceptions were found exclusively in children weighing more than 30 kg. The findings do not support the view that a physiologic vagotonia is present in infants.
POLIOMYELITIS IN A FAMILY WITH OCCURRENCE OF LOCALIZED PARALYSIS AFTER INOCULATION WITH COMBINED DIPHTHERIA, PERTUSSIS, TETANUS VACCINE
Authors: Neva Franklin A.
Published: December 2021

The simultaneous occurrence of paralytic poliomyelitis in 3 of 5 siblings, all of whom had been recently injected with DPT vaccine, is described. Attention is directed to the possible provoking effect of the antigen injection to development as well as site of paralysis. However, failure of the other 2 siblings to develop paralytic disease also indicates that recent injection of antigen is not the sole determining factor in the development of paralysis under the circumstances described. Laboratory data are also presented.
EDUCATION
Authors: Yankauer Alfred , Tschida Ethel , Engle Mary Allen , Phaneuf Madeleine
Published: December 2021

The organization and content, of institutes for physicians and nurses in the care of premature infants at the New York Hospital-Cornell Medical Center, 1949-1954, are described. Participants and observers were drawn from 24 states and the Territory of Hawaii, and 11 foreign countries.

Several indications of the need and value of this type of graduate training have been discussed, based on 5 years of experience with the program.

Responses to a detailed questionnaire seeking the opinion of those who attended the institutes from 1949 through 1953 has been analyzed. Responses were received from 72 per cent of the group. They indicated that the institute had met existing needs in large part and that the experience was worthwhile. Concrete evidence of improvements in hospital and in public health practice was reported and was considered related to attendance at the institute.

In view of the favorable nature of this critical evaluation and a continuing demand for this type of training experience, the institutes will continue to be offered.
TAUSSIG-BING COMPLEX ASSOCIATED WITH ANOMALOUS RIGHT SUBCLAVIAN ARTERY ARISING PROXIMAL TO COARCTATION OF THE AORTA
Authors: Alcott Donald L. , Sanfilippo Philip , Edwards Jesse E.
Published: December 2021

A case of the Taussig-Bing complex with necropsy findings is reported. Of additional interest was the unusual occurrence of associated malformations of the aortic-arch system, including coarctation of the aorta and anomalous origin of the right subclavian artery proximal to the coarctation. A narrow patent ductus arteriosus was present and probably represented a temporary phase in the process of normal anatomic closure. A single coronary artery that divided into the two main coronary arteries shortly after its origin also was present.

Origin of the anomalous right subclavian artery proximal to a zone of aortic coarctation is an extremely rare arrangement among malformations of the aortic-arch system.
SYMPTOMATIC HYPONATREMIA IN ACUTE INFECTIONS OF THE CENTRAL NERVOUS SYSTEM
Authors: Nyhan William L. , Cooke Robert E.
Published: December 2021

Acute hyponatremia has been noted on seven occasions in five patients with acute infections of the central nervous system. Symptoms were those of water intoxication and the response to the administration of hypertonic saline was prompt and dramatic. The hyponatremia appears to be due to acute expansion of the extracellular fluid volume in association with antidiuresis. Frequent determinations of the concentrations of electrolytes in the serum and prophylactic limitation of water intake are recommended as possible means of reducing mortality in disease of the central nervous system.
Timing of Booster Dose of Antipoliomyelitic Vaccine
Authors: FABER HAROLD K.
Published: December 2021

The reinforcing, or booster, dose of poliomyelitis vaccine, according to the latest bulletin of the National Foundation for Infantile Paralysis (NFIP), should not be given until at least 7 months have elapsed since the primary "take" . . . ," and "The ideal dosage schedule for the Salk poliomyelitis vaccine, as presently constituted, is two 1-ml doses, intramuscularly, spaced to 6 weeks apart, with a booster dose of 1 ml given at least 7 months to 1 year later."
Genetics and Metabolism
Authors: CHILDS BARTON
Published: December 2021

It is increasingly apparent that the hereditary chromosomal material functions by governing the metabolic capabilities of organisms. It is also true that metabolic processes are very similar in organisms of all degrees of cellular differentiation and organization. Though the authors of this excellent book state in their preface that the book was written for graduate students of genetics, biochemistry and microbiology, it has pertinence for students of all kinds of biology, including medicine.

In the past, genetics in medicine consisted principally of accumulation of pedigrees and evidence for inheritance and the mode of inheritance of characteristics.
PSYCHIATRIC STUDY OF MENTALLY RETARDED CHILDREN OF PRESCHOOL AGE
Authors: Woodward Katharine F. , Siegel Miriam G.
Published: December 2021

This is a preliminary report of a proposed 3-year project for the study and treatment of a group of 8 mentally retarded preschool children. It represents the combined efforts of a clinic team, consisting of psychiatrist, pediatrician, psychologist, social workers, and nursery school teachers. The aim is to determine whether psychogenic factors are responsible for all or part of the retardation and if they are, whether the child can be helped to function at a normal on a higher level. The children selected for this study have no demonstrable organic basis for the retardation, and are free from familial tendency toward mental deficiency.

We have excluded from this project children ordinarily classified as "schizophrenic," yet most of our children reveal some schizoid features in varying intensity. Our preliminary findings would tend to corroborate the impressions of other workers in the field that many children who are labelled "mentally deficient" fit more correctly into a borderline psychotic group. Seven of the eight children in this study belong in this group although mental retardation was the main criterion for selection.

After 1 year of preliminary study it is our impression that psychogenic factors exist in these cases. Progress reports will be published in the second and third years of study of this group with publication of a follow-up study of all of the children and their siblings. The topics to be covered in these reports will include details of case histories with emphasis on personality dynamics, and the special therapeutic techniques developed to meet the unique needs of these children.

With the aid of a clinical team approach, those children in our group who attended regularly revealed changes of a positive nature, reflected in the attainment of skills more appropriate to their age bevel. We agree with Kanner that "Every person of a lower than average I. Q. has obtained a right to be studied with full attention to the genetic, physical, cultural, socio-economic, educational and emotional determinants...."

If psychiatry can make a positive contribution to the understanding and treatment of mentally retarded children, it should be instituted at a very early age, as soon as there is any suspicion of retardation. In the hope that the problem will correct itself spontaneously, parents and physicians tend to postpone such study until the child has reached school age.

In line with modern trends toward prevention, further and more intensive investigation of this problem at the preschool level might avoid problems later in life for the child and for the family. It is possible that such studies might reduce to a measurable degree the population of our institutions for the mentally defective child.
SALMONELLOSIS IN INFANTS AND CHILDREN
Authors: Clyde Wallace A.
Published: December 2021

An analysis of 100 consecutive cases of salmonellosis in infants and children from the files of Vanderbilt University Hospital is presented. Points covered with comparison to other studies in the literature where applicable include: age, sex, and racial incidence; types of organisms implicated; mode of treatment; duration and outcome of the disease; and discussion of symptoms, signs and laboratory data for the principal clinical syndromes.

Salmonellosis in children differs in several respects from the usual picture encountered in adults: Onset is more acute, with greater severity of symptoms; leukocytosis is the rule in infants, with gradually increasing leukopenia as age increases; differential leukocyte counts are usually within normal limits for the ages of the patients; the incidence of complications is high.

Enteric isolation is an important aspect of convalescent care.
CONGENITAL HYPOPLASTIC ANEMIA
Authors: Pearson Howard A. , Cone Thomas E.
Published: December 2021

A case of congenital hypoplastic anemia is reported in which a course of ACTH was followed by evidence of remission in the peripheral blood and marrow. The remission had been maintained for 10 months by administration of cortisone.

The effectiveness of an interrupted regimen of administration of cortisone in maintaining remission and yet avoiding clinical signs of hypercorticism is described.

An abnormality of tryptophan metabolism, as evidenced by the finding of anthranilic acid in the urine was noted. The anthranilic aciduria persisted during cortisone therapy despite a beneficial effect on production of reticulocytes and hemoglobin.

Concentration of tryptophan in the blood and urinary excretion of 5-hydroxyindole acetic acid were normal.
PULMONARY LESIONS OF NEWBORN INFANTS
Authors: Landing Benjamin H.
Published: December 2021

The results of a statistical analysis of the relation of various lesions in the lungs of newborn infants to each other, and to the age and sex of the babies, are presented. The pulmonary lesions studied were: atelectasis, emphysema, interstitial emphysema, hemorrhage, acute pneumonia, edema, presence of squamous cells in alveoli, hyaline membranes, and immaturity. Of 45 possible relations analyzed (e.g., atelectasis and hyaline membranes, immaturity and acute pneumonia, etc.), 14 gave results significantly different from those due to chance. Of particular note, in view of current opinion on the genesis of neonatal pulmonary hyaline membranes, was the failure to demonstrate a significant relation of pulmonary edema to any of the other pulmonary lesions studied.
THE EVOLUTION OF A PEDIATRIC SOCIETY
Authors: Bakwin Harry
Published: December 2021

TWENTY-SIX years ago a small group of pediatric leaders met in the library of the Harper Hospital in Detroit to complete plans for the formation of a new society. A number of considerations contributed to the origin of this society, prominent among which was the rapidly growing number of well-trained pediatricians, but the immediate impetus was the White House Conference called by President Hoover in Washington in 1929. Here, with the guidance of many of the founders of the Academy, a program for child health was developed which could be best carried out by an organization of pediatricians.

In this way the Academy came into being. From the very beginning an appreciation of the broader aspects of pediatrics has colored its activities. The particular circumstances under which it was formed certainly had much to do with its interests and aims.

The founding fathers were not content with simply another "scientific society." True, there were scientific sessions, where the newer developments in pediatrics were presented and discussed. But, from the very start, the Academy took an active part in all matters relating to the health and welfare of children. And from the very start, the Academy showed that it was truly representative of all its members—practitioners, teachers, investigators, public health workers.

The breadth of its interests was reflected in the committee activities. In the first year of its existence there were, among others, Academy committees on Medical Education, Hospitals and Dispensaries, the relation of the Academy to Philanthropic, Welfare and Health and similar agencies, Nursing Education in Pediatrics, and Mental Hygiene. In this way the Academy of Pediatrics showed its awareness of its social obligations and its influence was felt early. As the Academy membership has grown in experience and in numbers, and as the Academy has extended its interests in more and more fields, it has attained a position of eminence and high respect among philanthropic and government agencies which have to do with children; and the help and guidance of the Academy is sought widely.
Device for Regulating Intravenous Infusion
Authors: SHURTLEFF DAVID B.
Published: December 2021

Clinical and metabolic studies have PEDIATRIC I.V. DRIP [SEE FIG I. IN SOURCE PDF] indicated that critically ill patients may lose temporarily a major portion of their usual tolerance for water and certain electrolytes (New England J. Med., 252:856, 1955). As a result, they are apt to become water-intoxicated if given too much solute-free water and salt-intoxicated if given too much saline, especially during the operative and immediate postoperative periods.

It would appear that one simple way to avoid these difficulties is to keep the rate of intravenous fluid administration down to approximately 1200 ml/m2 of body surface area per 24 hours during such critical periods. In the adult of 1.8 m2 (70 kg), this rate of administration would mean the delivery of an absolute total of about 2200 ml/day.
THE INNOCENT(FUNCTIONAL) CARDIAC MURMUR IN CHILDREN
Authors: Fogel David H.
Published: December 2021

THE DEVELOPMENT of modern cardiac surgical techniques is one of the great milestones in medicine. Its ramifications have been wide and deep. In its wake of many curative and palliative procedures for congenital and acquired heart disease, there is a renewed interest in the significance of the cardiac murmur. In former years the murmur was merely noted. Today, it is pursued until its etiology is firmly established with the hope that the final investigation will lead to remedial or palliative surgery. Many times the murmur turns out to be a functional one. This has prompted the physician to pose questions concerning the incidence and characteristics of the innocent or functional systolic murmur, especially in children. The answer is not readily obtained.

REVIEW OF THE LITERATURE

The accepted definition1 has been listed as, "Innocent (functional) murmurs are usually systolic in time, more often faint than of moderate intensity and usually blowing in quality. They are often inconstant and vary in intensity with change in posture. The commonest is a systolic murmur at the pulmonic area, which is usually best heard with the patient supine and during expiration. An apical systolic murmur is also common. Such murmurs are unaccompanied by any evidence of structural disease such as an enlargement of the heart, abnormal cardiac silhouette on roentgenologic examination or an abnormal electrocardiogram." It is the author's opinion that this general definition is not specifically descriptive for children; the commonest functional murmur in children is not located in the pulmonic area, it is not blowing, and further, an innocent apical systolic murmur is uncommon.
NEUROLOGIC DISEASES IN INFANCY AND CHILDHOOD
Authors: Hawke William A. , Prichard John S.
Published: December 2021

THE SEMINAR was conducted in four 3-hour sessions and aimed to cover the more important features of pediatric neurology.

DEVELOPMENT

Dr. Hawke reviewed the normal development of the central nervous system in the infant and child which is so important in the assessment of neurologic disorders in this age group. It was noted that the nervous system was particularly immature and changing rapidly in the first 2 years of life. Development was related to myelination and it was emphasized that this was not a steady process but a pattern of sequences of rapid and slow growth. Motor and sensory development appeared to develop from above and to proceed downward, so that eye-control develops before hand- and legcontrol. Development was related to three functioning levels of the central nervous system—the brain stem, the archipallium, and the neopallium. It was observed that the newborn baby functioned at the brain stem level, and to illustrate this an example was given of the hydranencephalic baby which behaves perfectly normally for the first few weeks of life. The anchipallium, which includes part of the temporal lobe, the cingulate gyrus and basal ganglia, supervenes on the brain stem and may be considered responsible for the basic emotions and some primitive motor and sensory control. The neopallium, which includes most of the cerebral hemisphere, becomes dominant in primates. Its function is intellectual rather than emotional and is responsible for skills, discrimination and fine movements. The clinical application of these developmental patterns are innumerable but illustrations were given of changes in physical signs in static brain lesions.
USE OF ADRENAL HORMONES IN TREATMENT
Authors: Bongiovanni Alfred M. , Eberlein Walter R.
Published: December 2021

THE DISCUSSION of therapy with adrenal steroid hormones dealt with fundamental concepts of steroid metabolism and the application of these principles to the treatment of various important diseases of pediatric interest. This summary is limited to the basic concepts of therapy with steroids because a discussion of theory is considered likely to be of more lasting value than a temporary summing-up of clinical results.

The human adrenal cortex secretes two main types of steroid hormones, the socalled mineralocorticoids and the glucocorticoids. The first is normally represented by aldosterone, the action of which is mimicked by the synthetic steroid, desoxycorticosterone. (DOCA stands for the acetate of desoxycorticosterone.) Aldosterone secretion appears to be regulated by changes in the volume of extracellular fluid of the body via an hypothalamic-pituitary mechanism. The actions of the mineralocorticoids are widespread but mainly concern the kidney and the sweat glands, leading to retention of sodium and, with it, of water in exchange for potassium. Deficiency of mineralocorticoid, as in Addison's disease, results in loss of sodium and water, accumulation of potassium, dehydration, hypotension, and ultimately renal failure and death.

Hydrocortisone is the predominant glucocorticoid normally secreted by the adrenal cortex in response to stress or injection of adrenocorticotropin(ACTH). It appears that the concentration of hydrocortisone in the blood regulates the amount of ACTH secreted by the anterior pituitary; as it decreases, the hypothalamus stimulates the pituitary to release more ACTH in an effort to raise it; conversely, as the concentration increases, the hypothalamus inhibits pituitary release of ACTH and the adrenal cortex becomes inactive.
Oxygen Therapy and Survival Rate in Prematures
Authors: GORDON HARRY H.
Published: December 2021

To the Editor:

The recent publication (Pediatrics, 18: 511, 1956) of a caution on the use of oxygen in the care of premature infants prompts this letter.

Although the Cooperative Study of Retrolental Fibroplasia confirmed, beyond question of even the most skeptical, previously published reports of investigators from many countries that excessive use of oxygen caused retrolental fibroplasia, the conclusions reached concerning the relation of oxygen restriction to survival rate of the infants are not clear.
American Children Through Their Books
Authors: CAULFIELD ERNEST
Published: December 2021

This is not only a book about children's books, but it is also a comprehensive survey of various aspects of child life in America during the colonial and early national periods. Miss Kiefer's major conclusion is that the American Revolution marked the beginning of the American child's emancipation, and that by 1835 one finds the child emerging as a distinct personality not only in respect to religion but also in education, manners, health and recreation. The chapter on "War with the Devil," in which is discussed the gruesome theology of early New England and its effect on all phases of child behavior, is skillfully handled with both respect and delicate irony.
SPECIAL REVIEWS
Authors: SCHLESINGER R. WALTER
Published: December 2021

The scope of diagnostic procedures suitable for routine use in a viral laboratory has been discussed in relation to the general problem and the etiologic diversity of viral infections affecting the central nervous system. Diagnostic tests are available for a limited number of these diseases but their practical usefulness depends on observance of certain stringent requirements which the laboratory must impose on clinicians and pathologists who desire aid in the specific diagnosis. Among these are the choice of suitable test materials and their proper collection, storage, and shipment. It has been emphasized that all requests for diagnostic study must be accompanied by detailed clinical, laboratory, and epidemiologic data.

Since the specific diagnosis of this group of diseases does not affect therapy or outcome in the individual case, the tests available at present have their greatest practical significance as epidemiologic tools.
EDUCATION
Authors: Yannet Herman
Published: December 2021

WHILE there has always been a shortage of qualified professional personnel in the field of mental retardation, the relatively recent stimulation of public interest in this field has greatly multiplied the need. Among the many reasons for this unusual recent interest, two seem paramount. First, has been the phenomenal growth of a strongly organized, increasingly well oriented, and intensely enthusiastic national parent organization. This has resulted in making available more funds than ever before for this problem as well as stimulating a high level of federal interest and activity. This will eventually remove one important block to progress in this field, the lack of financial support for many of its aspects. Secondly, the increasing public acceptance and support of research, both basic and applied, and the growing faith in its ability to solve the problems of prevention as well as to greatly improve the problems of present management, are tending to exchange the past aura of helpless futility to one of expanding hopefulness.
OBSERVATIONS ON AN EPIDEMIC OF STREPTOCOCCAL INFECTIONS AND RECURRENCES OF RHEUMATIC FEVER AMONG CHILDREN TREATED WITH PENICILLIN
Authors: Markowitz Milton
Published: December 2021

An outbreak of streptococcal pharyngitis among children in a convalescent hospital has been described. Eleven of thirty-three subjects with rheumatic fever, under close observation, developed group A streptococcal infections while they received a single daily oral dose of 200,000 units of benzathine penicillin G.

Treatment of the streptococcal infections was carried out with therapeutic doses of various penicillin preparations. Four children who received single injections of 600,000 units of benzathine penicillin G, developed recurrences of rheumatic fever.

The results of the study indicate that a single daily oral dose of 200,000 units of benzathine penicillin G is inadequate for the prevention of streptococcal infections in a closed or semiclosed community of rheumatic fever subjects. It is suggested that at least twice this dosage be employed in such an environment. The data based on a small series of cases suggest that the treatment of acute streptococcal infections with a single intramuscular dose of 600,000 units of benzathine penicillin G will not prevent recurrences of rheumatic fever in highly susceptible patients.
Children without Tears
Authors: PRYLES CHARLES V.
Published: December 2021

As a consultant in pediatrics to the Wrentham (Massachusetts) State School, an institution for mentally retarded children, I had noted that a number of infants and children crying vigorously, did so without tears. A random examination in two wards containing many different types of retarded children, revealed the absence of tears in 7 of 32 children examined. A more complete survey is now being conducted, with collection of data regarding the type of mental deficiency, age, sex, race, etc.
Currents in Biochemical Research 1956
Authors: FOMON SAMUEL J.
Published: December 2021

Because most chemical reactions occurring in living organisms are catalyzed by enzymes and because recent developments in methodology have given great impetus to studies of these substances, it is perhaps not surprising that enzyme chemistry is prominently featured in a collection of essays recounting important advances in biochemical research during the past 10 years. The mechanism of synthesis of enzymes and of interaction between enzyme and substrate, the importance of certain of the prosthetic groups, co-enzymes and co-factors, electron transfer and kinetics of enzyme activity are all considered.
THREE CASES OF MYOCARDITIS IN CHILDREN LESS THAN ONE YEAR OF AGE
Authors: McCue Carolyn M.
Published: December 2021

A brief discussion of the historic aspects of myocarditis in children is given.

Three cases are presented as myocarditis, showing cardiac enlargement, absence of significant murmurs, marked electrocardiographic changes and normal blood pressure.

In two of the cases the electrocardiograms improved and the size of the heart decreased as the patients made clinical improvement during a 12- to 18-month period. In the third patient, who died, pathologic reports are presented as well as electrocardiographic records.

Although myocarditis is not frequently found in children less than 1 year of age, its presence must be suspected in children with the findings mentioned and appropriate therapy begun promptly.
CHEST RADIOGRAPHY OF PREMATURES
Authors: Bauman William Allen , Nadelhaft Jerome
Published: December 2021

The chests of 104 unselected, newborn prematures were studied by roentgenogram in the first 72 hours of life in a routine manner which yielded satisfactory roentgenograms and involved minimal disturbance of the patients. Nineteen of the infants showed clinical signs of dyspnea sufficient to suggest that they were suffering from some degree of the respiratory distress syndrome. Thirty-five of the total number presented roentgenographic pictures compatible with hyaline membrane syndrome. Twenty-five of the infants died within the first 8 days of life. Of the 23 in this fatal group who came to necropsy, 10 had hyaline membranes: Eight of these had shown during life both respiratory distress and pulmonary roentgenographic appearance of bilateral diffuse increased reticulogranularity. In statistical analyses, this association is found to be highly significant (p < 0.006).

That several infants with both these abnormalities survived indicates that prematures may recover from the respiratory distress syndrome. Until the diagnosis can be established with greater certainty during life, the possibility of spontaneous recovery must be considered in the evaluation of therapeutic measures.

In the individual case, a premature who has a high retraction score and pulmonary roentgenograms demonstrating increased reticulogranularity has a greater chance of dying with hyaline membrane formation than does the infant who fails to show these symptoms and signs during life.
PSYCHOLOGIC STUDIES BEFORE AND AFTER CLITORIDECTOMY IN FEMALE PSEUDOHERMAPHRODITISM CAUSED BY CONGENITAL VIRILIZING ADRENAL HYPERPLASIA
Authors: Rosenwald Alan K. , Handlon Joseph H. , Rosenthal Ira M. , Hyde John S. , Bronstein I. Pat
Published: December 2021

Psychobogic tests were performed with five female pseudohermaphrodites with congenital adrenal hyperplasia both before and some time after clitoridectomy. Of these children, four had been reared as girls. The child who had been reared as a boy underwent change of sex assignment at the age of 6 years, after performance of the initial psychologic tests. None of the children showed evidence of significant psychopathology before clitoridectomy. None showed evidence of deleterious psychologic effects after the operation. The child whose sex was changed at the age of 6 years apparently made a good adjustment and showed no adverse effects as evaluated by psychologic tests.

If there is no significant psychopathology, clitoridectomy may be performed without fear of deleterious psychologic effects in female pseudohermaphrodites who have been reared as girls. While, in general, change of sex assignment should not be done in any hermaphrodite beyond the infantile age period, female pseudohermaphrodites with adrenogenital syndrome who have been reared as boys, because of an original diagnostic error, should be individually evaluated with regard to possible change of sex assignment. Despite the apparent success in the case reported here with its unusual special circumstances, the psychologic hazards involved will make reassignment of sex inadvisable in most of these cases.
Alcaptonuria
Authors: MILCH ROBERT AUSTIN
Published: December 2021

I have read with considerable interest the excellent review article by Dr. Selma E. Snyderman in Pediatrics (21:117, 1958), entitled, "The Metabolism of Amino Acids." There are, however, a few minor points in regard to the discussion of alcaptonuria which I should like to call to the attention of your readers.

First, with respect to pathogenesis: Alcaptonuria is, in fact, not a disease, but rather the temporally initial manifestation of a very distinct syndrome, characterized by alcaptonuria, ochronosis and arthritis.
INSULIN-PRODUCING CAPACITY OF THE PANCREAS OF CHILDREN WITH DIABETES MELLITUS
Authors: Klein R. , Marks J. , Mirsky I. A.
Published: December 2021

Children with diabetes mellitus of varying duration were given tolbutamide and indole-3-acetic acid by mouth. The response of the concentration of sugar in the blood to these insulin-dependent hypoglycemic agents was measured. It was demonstrated that children with diabetes of recent origin do respond to these agents. Hence, it is postulated that the pancreas is capable of secreting insulin early in the course of juvenile diabetes. This ability is gradually and steadily lost so that children with diabetes of over 2 years duration are almost uniformly unresponsive to these two hypoglycemic agents. The data suggest that after a variable period of clinically evident diabetes mellitus, the pancreas of the child becomes exhausted and incapable of secreting insulin.
STURGE-WEBER-DIMITRI DISEASE
Authors: Falkinburg L. W. , Silver M. L. , Kay M. N. , Stoll J.
Published: December 2021

A case of Sturge-Weber's disease, confirmed by necropsy, in a female 2 3/12 years old, is presented.

This case, aside from its rarity, is noteworthy in that it is confirmed by necropsy, that the facial lesion is bilateral while the brain lesion is unilateral, and that there is an unusual amount of mineral deposit in the brain considering the short duration of the disease.

A general review of this interesting condition is presented.

As far as we have been able to tell, this case is the eighteenth confirmed case of Sturge-Weber's disease recorded in the American literature.
SYMPOSIUM: ANIMALS AND DISEASE INTRODUCTORY REMARKS
Authors: Top F. H.
Published: December 2021

AT FIRST blush the symposium title is arresting—and perhaps an odd one to many whose practice is limited to the diseases of children. Animals are prone to diseases. These diseases may affect man, and adults would appear to be more frequently involved than children. However, animal diseases transmissible to man and called the zoonoses, are becoming more obvious in their frequency because of the changing character of infections during the past 50 years—and children contract the zoonoses frequently enough to warrant consideration.

The beginning of the present century seemed to usher in a change in the incidence and severity of many infectious diseases and particularly the so-called "common communicable diseases of childhood." It was certainly true for diseases of bacterial etiology relating to both morbidity and mortality whereas the incidence of several viral diseases such as chickenpox, measles, rubella and mumps remained the same, but the sting of complications and the threat of death were markedly reduced. The latter is well illustrated in Table I, which shows a comparison of death rates for certain diseases using the years 1900, 1925 and 1950 as mileposts. Deaths are chosen as a measure because case information is meager for the United States at large. The period between 1900 and 1925 was the era in which rapid strides were being made toward an improvement of community hygiene, while a consciousness of the importance of personal hygiene became evident around 1910. Between 1925 and 1950 the likely influences were an improved economy, better housing and more adequate nutrition for the general population.
CAT SCRATCH DISEASE
Authors: Wentworth Frederick H.
Published: December 2021

SINCE the first report by Debré in 1950 of a syndrome of regional lymphadenopathy after a cat scratch, a number of publications reporting several hundred cases have firmly established cat scratch disease as a clinical entity. The role of the cat in the natural history of the disease is not clearly understood, but the available evidence suggests the cat acts as a vehicle of transmission of an infectious agent although its role as a reservoir of infection has not been completely ruled out. The usual method of transmission appears to be inoculation of the agent at the site of a cat scratch, but other possible methods of transmission such as inhalation of the agent are substantiated by the several reported cases with a history of contact with cats but with no definite history of a scratch.

Daniels and MacMurray in 1954 reported an analysis of 160 cases, and in 1955 Kalter and associates summarized 250 cases which had come under their observation. Both of these reports gave excellent descriptions of the clinical features of the illness and this paper has drawn heavily upon their observations.

The primary feature of the clinical syndrome of cat scratch disease is lymphadenopathy which is usually regional and restricted to the drainage area of the site of the inoculation. Involvement of the lymph nodes of the upper extremity after inoculation on the hand or arm is most frequently observed. Cervical or inguinal involvement is not uncommon and occasionally generalized lymphadenopathy has been reported. The nodes are usually quite large, ranging up to several centimeters in diameter.
STUDIES ON THE ALLERGENICITY OF COW'S MILK
Authors: Ratner Bret , Dworetzky Murray , Oguri Satoko , Aschheim Lydie
Published: December 2021

Oral challenge with heat-denatured milk produced no reactions in guinea pigs sensitized parenterally to beta-lactoglobulin and alpha-lactalbumin, but produced typical anaphylactic reactions in animals sensitized to the heat-stable alpha-casein. In contrast, feeding of pasteurized skimmed milk resulted in frequent reactions in animals sensitized to alpha-casein and betalactoglobulin and one reaction in an animal sensitized to alpha-lactalbumin.

Oral administration of heat-denatured milk failed to produce sensitization, even as tested by intravenous challenge with pasteurized skimmed milk. In contrast, pasteurized skimmed milk, given orally, resulted in sensitization of about two-thirds of the animals, as tested later by oral challenge with pasteurized skimmed milk, and of an even greater proportion as tested by intravenous challenge.

Although alpha-casein is generally considered to be heat stable, under the conditions of these experiments the evidence indicated that it may be partially denatured by heat.

These studies, designed to stimulate clinical sensitization to milk, suggest that heatdenatured milk can be fed safely to individuals allergic to milk, unless they are extraordinarily sensitive to the heat-stable alpha-casein.