bluuebunny/crossref_metadata_2025 huggingface dataset:
THE PEDIATRICIAN AND THE PUBLIC
Authors: HARPER PAUL
Published: December 2021

TWO letters are presented which take opposing views of federal aid for medical education and for pediatric education in particular.

The first of these is from Alan Valentine, LL.D., President, University of Rochester, N.Y. Dr. Valentine read a paper on the financing of the privately endowed medical schools before the 1948 Annual Congress on Medical Education and Licensure. (J.A.M.A. 137:1, 1948.) He is eminently qualified to discuss this subject. His extraordinarily able and realistic presentation of the current and future financial needs of medical schools concludes with an answer to the contrary view of Dr. William C. Black. (Pediatrics 1:561, April, 1948.)

The second letter is from Dr. Thomas O. Gamble, Professor of Obstetrics, Albany Medical College, Albany, N.Y. Certain aspects of Dr. Gamble's letter require comment. In his third paragraph, Dr. Gamble quotes incompletely from the ICH Committee Report (Pediatrics 1:524, 1948) as follows: "It was finally agreed (Ed. note: i.e., by the ICH Committee) that neither the U. S. Children's Bureau nor the U. S. Public Health Service should be the administrative agency, but that the matter should be determined by the Federal Security Administrator, whose agency includes both the U. S. Children's Bureau and the U. S. Public Health Service. The correct quotation is: "It was finally agreed that neither the U. S. Children's Bureau nor the U. S. Public Health Service should be named the administrative agency . . . (etc.)." The position of the ICH Committee was and is that the Federal Security Agency, which already administers grants-in-aid for study and training in several fields of medicine, would be the logical administrative agency; it was not considered within the province of the ICH Committee to recommend which branch of this agency should be designated by the administrator. There was no attempt at "camouflage," as suggested by Dr. Gamble.

Dr. Gamble next attacks the recommended composition of the Council on Pediatric Education. He suggests that the Academy should say to the Federal Security Administrator:
Skeletal Tuberculosis, Vincente Sanchis-Olmos
Authors: LINDSAY DOUGLAS T.
Published: December 2021

This latest publication gives the English language audience the benefit of the author's many years of interest in orthopedic problems, and especially those of children. The text has been translated from Spanish by Dr. John G. Kuhns, with a foreword by Dr. Frank R. Ober, both of Boston, where the author completed preparation of the text.

Part I of the book very adequately presents current concepts of pathogenesis, etiology, allergic phenomena, pathology, and clinical types of skeletal tuberculosis. Constant awareness of the total systemic process is emphasized. Excellent chapters are included on differential diagnosis, auxiliary diagnostic procedures, and prognosis.
THE RECOGNITION AND TREATMENT OF INCREASED INTRACRANIAL PRESSURE IN INFANCY AND CHILDHOOD
Authors: WOODHALL BARNES
Published: December 2021

THE classical symptoms and signs of increased intracranial pressure may be recognized in the adult with a fair degree of accuracy. They consist, briefly, of headache, vomiting, the appearance of papilledema and a depressed or altered state of consciousness. They appear in the presence of any expanding lesion, be it brain tumor, traumatic hematoma or chronic infection, because of the relatively simple fact that the adult skull may be considered a closed box, incapable of significant expansion in terms of relief of intracranial hypertension.

This famous closed box theory upon which almost all the methodology of neurologic surgery depends was presented first by Monro and Kellie and was later modified to include the cerebrospinal fluid by Burrows. In the era of modern neuro-surgery the work of Dr. Lewis H. Weed has further refined this theory to include chiefly the stretch component of the inner confining membrane of the closed box, the dura mater.

In essence, the closed box theory of this long list of distinguished investigators states: (1) that the skull, pierced but by minor foramina, may be considered inexpansible, (2) that within the skull, brain tissue, arterial and venous circulating blood and cerebrospinal fluid rest in equilibrium influenced in the normal state only by postural head and body changes, (3) that any change such as that of an expanding brain tumor in the relative volume of these components of the closed box must be compensated for by a change in one or all of the constituents, and (4) that when the limits of this normal compensatory mechanism are attained, since the closed box can no longer expand, signs of increased intracranial pressure will develop (Fig. 1). Normal intracranial pressure in the adult is, in simple terms, a measure of the pulsating arterial systolic pressure, an unimpeded venous outflow, a stable brain volume, the normal production and absorption of cerebrospinal fluid and a solid inexpansible skull.

Identical factors operate in the maintenance of normal intracranial pressure in the infant or child although they may be envisaged as progressively changing factors due to the growth of the central nervous system and its envelope, the skull.
Tuberculosis: A discussion of Phthisiogenesis, Immunology, Pathologic Physiology Diagnosis, and Treatment
Authors: WILKINSON ERLE E.
Published: December 2021

This is a timely synthesis of current clinical knowledge on human tuberculosis and is particularly valuable because of the author's half-century of experience and leadership in the field. His approach to the consideration of the problem is largely immunologic and physiologic. In his discussions the author has attempted to make clinical processes stand out in their immunologic relationships to show tuberculosis in "its dual aspect of a metastasizing-destructive as well as a localizing-healing disease."

The student of childhood tuberculosis will find here a valuable source of information as well as much mental stimulation concerning solved and unsolved problems in this disorder.
ANTIBIOTIC THERAPY
Authors: Neter Erwin , Hodes Horace L.
Published: December 2021

THE LIBERAL, though not indiscriminate, use of antibiotics in pediatrics has resulted in far more assets than liabilities, although the statement has been made that 90% of antibiotics used in this country today are wasted. Often the pediatrician is able to select the correct and most effective antibiotic on the basis of clinical examination alone. At other times, laboratory examinations are necessary to establish an etiologic diagnosis. This information frequently allows the selection of the most favorable antibiotic when the bacterial species is of predictable sensitivity. Cases in which the bacterial species isolated are of unpredictable sensitivity require determination of the in-vitro efficacy of antibiotics. It must be stressed that many bacterial pathogens are as sensitive to penicillin and other antibiotics today as they were years ago, and that the emergence of antibiotic-resistant bacteria is not a general phenomenon. For example, the vast majority of strains of group A hemolytic streptococcus, gonococcus, pneumococcus, influenza bacillus, and the spirochete of syphilis have not become antibiotic resistant. In contrast, the staphylococcus has become a serious problem, particularly in hospitals and hospital-acquired infections. With the widespread use of penicillin and other antibiotics the percentage of antibiotic-resistant bacteria isolated from lesions in man has increased substantially. In addition, workers in hospitals rather frequently have become carriers of these strains and thus may in turn spread the infection to patients.

Status of Current Antibiotics

During the last few years several antibiotics have been added to the armamentarium of the physician. The present status of these antibiotics or special preparations may be summed up as follows.
Letters to the Editor
Authors: SILVERMAN FREDERIC N. , ROBINOW MEINHERD
Published: December 2021

Doctor Amberg's letter voices an opinion which is shared by a good many of our colleagues. At the time that our review "Radiation Hazards in the Field of Pediatrics" was written, our recommendation for the general use of personal radiation diaries was in line with current ideas and with the recommendations of the reports of both the British Medical Research Council and the American National Academy of Sciences.

Since that time, strong objections to the keeping of such records have been raised by many individuals active in the field of radiation and radiation protection.
THE ASSOCIATION BETWEEN ANTIBODIES AGAINST POLIOMYELITIS AND MUSCLE WEAKNESS IN A NORMAL POPULATION
Authors: Sachs David , Bailey Jean , Baumeister Jacqueline , Furcolow Michael L.
Published: December 2021

A total of almost 450 persons was studied in three communities in an attempt to establish a relationship between subclinical poliomyelitis infection and muscle weaknesses. Each person in the study was examined for muscle weaknesses by a physical therapist, and determinations for neutralizing antibodies in each person were made with each of the three recognized types of poliovirus.

It is shown that the presence of antibodies against poliomyelitis was associated with the presence of mild muscle weakness in two middle class communities, but not in a third community of lower socio-economic status. The association in the first two communities is interpreted as confirmation of the clinical impression that inapparent poliomyelitis infections can cause detectable residual muscle weaknesses. Muscle weaknesses were present in almost all of the children examined in the third community, but were not associated with the presence of antibodies against poliomyelitis. It is conjectured that this high prevalence of muscle weaknesses might be due to deficient nutrition.

In order to investigate the reliability of the muscle evaluation technique, 29 children were independently examined by each of two physical therapists with experience in using the technique. The results confirm the results of Lilienfeld et al. in showing that the technique is relatively reliable.
A FURTHER DESCRIPTION OF THE PATHOLOGIC PHYSIOLOGY OF CONGENITAL MEGACOLON AND THE RESULTS OF SURGICAL TREATMENT
Authors: Hiatt Robert B.
Published: December 2021

Follow-up results of a series of patients with congenital megacolon operated upon between the years 1947 and 1955 are presented. The operative procedure was complete removal of the rectum and lower sigmoid with replacement by more proximal colon and a sigmoido-anal anastomosis.

A discussion of the problem of anal continence in normal children as well as children upon whom a "pull through" procedure has been done has been presented.

This study revealed that 50% of patients who have had pull through procedures became completely continent within 1 year, 34% became continent within 5 years, and 16% have some residual difficulty with bowel control. Analysis of the reasons for imperfect anal control reveals that enterocolitis and psychologic maladjustment are two prominent features.

It is concluded that the replacement of the rectum and lower sigmoid by proximal colon in congenital megacolon has proven successful as manifested by long-term follow-up study.
Letters to the Editor
Authors: SNYDERMAN SELMA E.
Published: December 2021

Dr. Milch made some interesting comments about alcaptonuria which, however, are controversial. No attempts were made in my paper, which was a general review article on amino acid metabolism, to explore the various facets of this problem.

First: It would seem to me, that with the demonstration of a defect in a single enzyme system that alcaptonuria is a single disease, not a "syndrome." Alcaptonuric individuals may differ in their clinical manifestations, but the common denominator is the biochemical defect.
Ten Million and One—Neurological Disability as a National Problem
Authors: DENHOFF ERIC
Published: December 2021

This monograph summarizes the results of the Conference on Neurological Disability as a National Problem held at Arden House, Harriman, New York, in December, 1955. It was attended by more than 50 highly qualified specialists with various interests in the field who met to explore the realistic possibilities of meeting the problems posed by more than 10 million patients suffering from more than 300 clinical entities loosely grouped together as "neurologic disabilities." Neurologic disabilities are defined as those disorders which are associated demonstrably with dysfunction, disease, or injury of the nervous system, the brain, the spinal cord, and the peripheral neuromuscular connections.
APPENDICITIS IN CHILDHOOD
Authors: SHAW EDWARD B.
Published: December 2021

ELSEWHERE in this issue of Pediatrics is presented a series of cases of appendicitis in childhood in which the end results of surgical care approach perfection. In 1,358 cases there was but a single postoperative death—this from brain abscess!

Comparable results of surgical care are obviously not available everywhere. In 1955 the mortality from appendicitis in the United States was 2,273. Among children less than 5 years of age, there were 102 deaths; from 5 to 9 years, 75; from 10 to 14, 59; and from 15 to 19, 48 (a total childhood mortality of 284).

It is surprising to note uniformly high incidence of appendiceal rupture, abscess, and peritonitis in almost every large surgical series reported from numerous centers.
ANIMAL PARASITES AND HUMAN DISEASES
Authors: Beaver Paul C.
Published: December 2021

PARASITES fall only roughly into the two categories implied in the title of this discussion. While a few of them are totally dependent upon human hosts, and some are able to develop only in other animals, a majority of the parasites commonly referred to as "parasites of man" are in reality parasites of other animals. In the latter group are such familiar examples as Trichinella, found in rats and many other animals, including pigs; Balantidium and some lesser protozoa of pigs; Toxoplasma, which occurs in many wild and domesticated animals. Trypanosoma cruzi, which is carried by a variety of animals, is the cause of Chagas' disease commonly seen in parts of South America and found recently in a child in Texas. Other examples include Isospora of undetermined hosts, possibly including the dog; Trichostrongylus species that commonly are found in sheep and goats; the small tapeworms, Hymenolepis nana and Hymenolepis diminuta, of rats and mice; and the common dog tapeworm, Dipylidium caninum. There are others whose endemicity in any area depends somewhat on the presence of suitable non-human hosts, and still others that are able to reach maturity in man but are rarely involved in medical problems because infection is acquired only by eating uncooked earthworms and insects. It might be mentioned, as a matter of interest, that occasionally other animals may acquire parasitic diseases from their human associates, as for example dysentery and diarrhea in dogs, caused by Entamoeba histolytica and Strongyloides stercoralis.

In all of the above mentioned parasitic infections, diagnosis is usually based on conventional laboratory methods, and both clinical and laboratory workers are generally familiar with the problems presented by them.
The Lower Urinary Tract in Childhood
Authors: CAFFEY JOHN
Published: December 2021

Two radiologists (Kjellberg and Ruhde) and one urologist (Ericsson) investigated the lower urinary tracts of 1,155 infants and children at the Caroline Institute in Stockholm, Sweden. This book contains their findings, clearly illustrated in great detail. This is the most comprehensive report by far on this subject, and it has the unique value that the voiding urethrograms were studied in serial simultaneous crossfire frontal and lateral projections. As a result, much new important information, heretofore not available in English, is included in a small book.
OPHTHALMIA NEONATORUM
Authors: Mellin Gilbert W. , Kent Mary P.
Published: December 2021

Silver-nitrate prophylaxis for gonorrheal ophthalmia neonatorum was discontinued from April, 1957 through October 25, 1957 in the Sloane Hospital for Women of the Columbia-Presbyterian Medical Center.

Six nurseries were kept under surveillance for discharging eyes. The incidence of discharging eyes was 3.2% of 1,974 infants observed. This incidence rate is analyzed by nursery and by months.

Specimens from the 64 infants with discharging eyes and 19 controls were cultured. The results of the cultures from the discharging eyes and the controls were very similar except for four isolations of N. gonorrhoeae from discharging eyes.

This represented a marked increase in incidence of gonorrheal ophthalmia neonatorum over the 10 cases which had occurred in the Medical Center in the previous 25 years.

Two cases of gonorrheal ophthalmia neonatorum were clinically obvious on the second day. One had only a minor discharge on the eighth day. The other was home on the fourth day and returned to the hospital on the sixth day with obvious symptoms. All recovered uneventfully.

None of the mothers were suspected of having gonorrheal infection, although two had positive cultures from the cervix post partum.

Prophylaxis for gonorrheal ophthalmia has been reinstituted in this Medical Center.
Letters to the Editor
Authors: LOSCH PAUL K.
Published: December 2021

Unfortunately, we have not kept records, which would justify publication under the critical eye of the statistician, on the subject of frenectomy. Nonetheless, I believe the fact that we have not seen a single case in this clinic in over 14 years where we felt justified in interfering surgically supports our strong clinical conviction against this operation. We have not closed our minds completely but are convinced that in most cases the diastema existing between the superior central incisors is an inherent congenital pattern rather than a developmental accident due to the insertion of the frenulum.
Perinatal Pulmonary Pathology and "Hyaline Membranes"
Authors: GRUENWALD PETER
Published: December 2021

In an article on perinatal pulmonary pathology (Pediatrics, 22:41, July, 1958) Briggs and Hogg observed "a new pathologic appearance—hyaline type of atelectasis with the absence of the true membrane." I have described this in the past, perhaps not in very conspicuous places and partly after submission of Briggs and Hogg's article. In pointing this out, I do not wish to claim priority, but rather to point out that this condition has been investigated and, to a certain extent, explained.
Testing Urine for Phenylpyruvic Acid
Authors: PAINE RICHMOND S.
Published: December 2021

May I be permitted to reply to Dr. Manuel Ingall's comment in Pediatrics (22:408, August, 1958) concerning the degree of freshness required in testing urine specimens for phenylpyruvic acid with ferric chloride?

I had not meant to imply in my article (Pediatrics, 20:290, 1957) that a positive test could be obtained only with specimens voided immediately previously. Undoubtedly, most samples from phenylketonuric patients will give positive tests with ferric chloride even when hours or days old, especially if refrigerated.
SEVERE GENERALIZED DISEASE (ENCEPHALOHEPATOMYOCARDITIS) OCCURRING IN THE NEWBORN PERIOD AND DUE TO INFECTION WITH COXSACKIE VIRUS, GROUP B
Authors: Kibrick Sidney , Benirschke Kurt
Published: December 2021

Two fatal cases of generalized infection in the neonatal period with Coxsackie virus, Group B, Type 4 were studied. The virus was present in high titer in the myocardial tissue of both infants and recovered as well from the spinal cord and liver of one. In the latter case, the infection was acquired in utero as indicated by the onset of illness at 13 hours of age and death at 36 hours.

Both virus strains, when inoculated into newborn mice, produced acute destruction of the anterior horns of the spinal cord, indistinguishable from that induced by poliomyelitis virus.

The clinical and pathologic features in 25 cases of this disorder are reviewed.
The Story of Human Emotions
Authors: KORSCH BARBARA
Published: December 2021

This is a confused and confusing treatise on subjects related to human emotions and mental hygiene. For professional workers with children, there is certainly nothing to be learned. For lay readers, there might be some helpful information tucked away especially in the latter chapters that deal with problems of adolescents and adults, with the development of more wholesome attitudes toward sexual matters, and with increased tolerance and understanding of some of the less rational aspects of human behavior.
Infectious Diseases of Children
Authors: BRADFORD WILLIAM L.
Published: December 2021

The well qualified authors of this book have fulfilled their stated purpose, namely, "to provide a concise and handy description of certain common infectious diseases."

On casual inspection one might get the erroneous impression that it is too concise, an impression completely erased by careful reading of individual chapters. The material consists of a rare combination of conciseness and completeness.
CLINICAL CONFERENCE
Authors: Sobel Edna H. , Taft Lawrence T.
Published: December 2021

Dr. Barnett: The patient to be presented and discussed by Dr. Taft and by Dr. Sobel provided a series of perplexing problems relating to diagnosis, treatment and prognosis. Some of the questions raised have been answered but others relating particularly to prognosis and future treatment remain. To preserve the chronologic order of the problems as they were presented to us, the presentation will be introduced by Dr. Taft, to whom the patient was referred initially because it was believed that the primary difficulty was one of mental retardation.

Dr. Taft (Assistant Professor of Pediatrics): This infant, at the age of 18 months, was referred to the Developmental Evaluation Clinic by his private physician. The physician had requested an investigation to determine why the infant was slow in psychomotor development and why he was obese.

The relevant history revealed that this was the mother's first pregnancy which was uneventful. Except for vitamins no other medications were taken during the gestation. The delivery and the immediate post-natal course were unremarkable. The patient weighed 5 lb 4 oz at birth.

During the neonatal period the infant was extremely apathetic and listless. He sucked poorly. At 6 weeks of age he was hospitalized for bronchopneumonia.

From the history, his motor development was delayed. He gained head control at 6 months; rolled over at 8 months; and sat unsupported at 1 year of age. He followed objects at 4 months; spoke single words at 1 year; and had conditioned tricks at 13 months.

At approximately 8 months of age it was noticed by the parents that the patient was gaining weight rapidly and had a spurt in linear growth. At this time his appetite became ravenous.
Pneumocystis Carinii Pneumonia
Authors: MCNEAL JOHN B. , GRUNT JEROME A.
Published: December 2021

Since 1955, six cases of Pneumocystis carinii pneumonia have been reported from the United States. These have been widely distributed geographically and we wish to report the seventh case—the first one from Louisiana—to remind pediatricians of the clinical features of this peculiar disease which occurs mainly in infants.

The patient, a 9-month-old white male, had lived in the New Orleans area his entire life. At about 3 months of age, he developed a chronic unproductive cough which persisted despite administration of a wide variety of antibiotics prescribed by a number of Physicians. For 3 weeks prior to admission, there had been progression of the symptoms of respiratory distress, and for 3 days the baby had been dyspneic and cyanotic.
THE PERSISTENCE OF POLIOMYELITIS ANTIBODIES AFTER PRIMARY IMMUNIZATION OF YOUNG INFANTS
Authors: Batson Randolph , Christie Amos , Turner Dorothy , Michal Mary , Barrick Jewell H.
Published: December 2021

Data has been presented showing that, although 4 months after the third injection of poliomyelitis vaccine, antibody levels were quite high, at 12 months there was a definite and striking decrease in antibody titers.

It is suggested that serious consideration be given to the routine administration of a fourth, 1-ml, injection of poliomyelitis vaccine 12 months after the third injection.

It would seem advisable to follow this practice unless it can be demonstrated that the state and degree of hypersensitivity, without detectable antibodies, is sufficiently great to result in a protective response when natural infection occurs.
CURRENT MANAGEMENT OF NEPHROSIS
Authors: Riley Conrad M. , Scaglione Peter R.
Published: December 2021

A statistical evaluation is presented, which reveals a significantly improved survival of children with nephrosis under modern management.

The status of the survivors in a small sample seems much better in the current series.

The evidence that such improvement is due to the more intensive use of adrenalactive steroid therapy is circumstantial but highly credible.

A program for steroid administration, which has seemed satisfactory, is presented. The risks inherent in such hormone treatment appear to be more than counterbalanced by the reduction in early mortality.
PRACTICAL THERAPEUTIC IMPLICATIONS OF IMMATURITY
Authors: KRETCHMER NORMAN
Published: December 2021

RECENTLY, there has been considerable agitation concerning harmful effects of a few particular drugs administered to premature infants and also to infants during the neonatal period. It may be presumptuous to state that the administration of drugs at any period during life involves risk, but hazard increases with lack of knowledge of biochemistry and physiology of the organism. Inadequacies in pharmacologic knowledge are in particular evidence in pediatric medicine. It is becoming more and more apparent that the neonatal infant demonstrates characteristic organ and tissue functions much different from those encountered in the mature individual. This new information has not been sufficiently utilized by some clinical investigators or by manufacturers of pharmaceutical agents.

When a drug is administered it is metabolized in a definite fashion, and an overdose may yield unpleasant and sometimes deadly effects.
SEVERE APNEA AND IRREGULAR RESPIRATORY RHYTHMS AMONG PREMATURE INFANTS
Authors: Miller Herbert C. , Behrle Franklin C. , Smull Ned W.
Published: December 2021

Premature infants with severe respiratory insufficiency (respiratory Group III) had more irregular respiratory rhythms and more severe apnea than healthy premature infants (respiratory Groups I and II). Birth weight did not appear to be a factor in the occurrence of severe apnea unless severe respiratory insufficiency was present.

The prognosis for survival was significantly poorer among infants with severe apnea than among those who did not have severe apnea. The greater the delay after birth before the first attack of apnea occurred, the better were the chances for survival.

Severe apnea seemed to be an extreme form of irregular breathing in premature infants. There was a direct relationship between the degree of irregularity of the respiratory rhythms and the occurrence of long, single periods of apnea. Clinical attacks of severe apnea were observed almost exclusively among infants having the most irregular respiratory rhythms.

It is suggested that markedly irregular respiratory rhythms and attacks of severe apnea are the results of enfeebled respiratory centers and that the latter is one of the characteristic features of premature infants with severe respiratory insufficiency (respiratory Group III).

Atmospheres of 40% oxygen were associated with longer periods of apnea than was room air. However, better oxygenation of the blood appeared to be maintained through long periods of apnea in 40% oxygen than in room air.
METABOLIC CONSEQUENCES OF PANCREATIC INSUFFICIENCY IN CYSTIC FIBROSIS OF THE PANCREAS: A STATISTICAL ANALYSIS
Authors: Lowe Charles Upton , Pessin Vivian
Published: December 2021

OVER the years opinion has varied on the nature of the dietary regimen which most effectively compensates for the specific digestive defect in cystic fibrosis of the pancreas. This paper comprises a review of the literature and a statistical analysis of available data to determine whether the accumulated evidence supports any dietary recommendations.

HISTORICAL BACKGROUND

All reviews of pancreatic function begin with the work of Claude Bernard. This is appropriate since he first correctly described in two papers, 1849 and 1856, the role of the pancreas in the digestive process in dogs. A series of confusing experiments, many of them faulty, led in the next 80 years to changing estimates of the importance of this gland in digestion.

The first point at issue was whether the pancreas was involved in digestion. Some investigators questioned, while others substantiated, Bernard's observations. Abelmann, working in the laboratory of Minkowski, was principally responsible for confirming the work of Bernard.

After the necessity of the pancreas for normal digestion had been established, the route of excretion of the pancreatic digestive ferments was disputed. Some claimed all excretion was via the blood, some were uncertain of the route; finally Hess and Pratt et al. showed that the secretion was directly into the bowel. Hess, by careful dissection, demonstrated that the dog has from two to five accessory pancreatic ducts, and Pratt and his associates showed that ligation of all ducts to exclude pancreatic juice from the intestinal tract always produced marked impairment in absorption of fat and nitrogen. These early reports have been critically reviewed by Handelsman.

The observations of Pratt et al. have been confirmed repeatedly. Coffey et al. published extensive metabolic data which seem to have ended any confusion. Experimental achylia pancreatica was produced in dogs by either ligation of all pancreatic ducts or by extirpation of the pancreas. Both operations had the same effect on fat and nitrogen absorption.
Readings in Medical Care
Authors: MAY CHARLES D.
Published: December 2021

This is not a book that lends itself to review, but it should be known to those engaged in teaching diverse aspects of pediatrics. As the title implies, it is a collection of readings in medical care. The material covers a wide range of topics on the social and public health aspects of medicine and the hospital, office and home care of patients. It is a useful source of reference material to acquaint the student with his future position in the community and the impact of economic circumstances on medical care.
PUBLIC HEALTH, NURSING, AND MEDICAL SOCIAL WORK
Authors: Wegman Myron E.
Published: December 2021

Every physician who has been through an internship is familiar with the Standard Nomenclature of Diseases and Operations. Far fewer know the International Statistical Classification of Diseases, Injuries and Causes of Death or appreciate the relationship between the two. Official inauguration of the use of the Seventh Revision of the International Classification of Diseases on January 1, 1958 offers occasion for reviewing some of the considerations affecting the proper naming and classification of diseases and causes of death.

It is necessary to clarify the distinction between a "nomenclature" and a "classification." A nomenclature is a list of all terms considered satisfactory in medical usage at the time the nomenclature was prepared. Its primary purpose is to promote use of the same name for the same disease, a necessity for comparability of reports and effective study of a disease. To achieve such uniformity there must be some background of usage and custom, as well as a systematic reference work to help the physician arrive at and use the standard term as a final diagnosis for his case. The Standard Nomenclature of Diseases and Operations of the American Medical Association is in practically universal use in the major institutions of the U. S. A. The Nomenclature itself, while detailed and inevitably complicated by extent of coverage and inclusiveness, follows such a logical pattern that under the pressure of institutional rules and routines it is not difficult to use the system efficiently. Individual physicians, however, are not so disposed to spend the time necessary to follow the Nomenclature and tend rather to use the terminology popular in the geographic area where they are working. Development of local terminologies and usages is perhaps the greatest limiting factor militating against a really general nomenclature.
Recent Advances in Paediatrics
Authors: MAY CHARLES D.
Published: December 2021

All of the chapters in this volume are timely, interesting and authoritative. The book should be consulted by anyone wishing to enjoy clear summaries of the current state of knowledge in some of the more important areas of development in pediatrics. Particularly noteworthy are the chapters on jaundice in the newborn and one on physical growth. If one has come to feel that the subject of physical growth is no longer a dynamic subject, he will be relieved of this notion by the stimulating essay by Dr. Frank Falkner. Here one can find an unusually clear discussion of the essentials in the measurement of growth along with a concise and objective review of the present trends in research in this field.
Can The New Pediatrics Be Practiced?
Authors: SCHRODER J. R.
Published: December 2021

In regard to the editorial appearing in the February issue of Pediatrics (23:253, 1959) entitled "Can the New Pediatrics Be Practiced?" You have hit the nail on the head! The questions you raise are being pondered by most practicing pediatricians throughout the land.

For various reasons I feel that certified pediatricians should continue to enter the field of active pediatric practice, but I think it is high time "to bring the public to recognize, and be willing to pay for, the best of professional guidance and treatment."
Letters to the Editor
Authors: SILVER GEORGE A.
Published: December 2021

I was very impressed with your editorial in the February 1959 issue, "Can the New Pediatrics be Practiced?"

Here at Montefiore Hospital, N.Y., in the Division of Social Medicine, we have been experimenting with methods of practice that may give all the specialties of medicine an opportunity to practice Twentieth Century medicine as they have been taught. Pant of the problem is financing, but I do think a larger part is in the need for restructuring medical practice, and I hope that many more experiments can be developed to test new structures.

I am enclosing a recent publication of mine which outlines our own "new" basis for medical practice as a contribution to family health (See Yale J. Biol. & Med., 31: 29, 1958).
Treatment of Maple Syrup Disease
Authors: MENKES JOHN H.
Published: December 2021

In the course of further investigations on the excretory products in maple syrup disease the strong likelihood has arisen that the defect is more extensive than is indicated in my previous article (Pediatrics, 23:348, 1959). Initially, the presence of high urinary levels of alpha-ketoisocaproic acid together with the excretion of the keto analogues of valine and isoleucine suggested an abnormality in the metabolism of branched-chain amino acids. This postulate, however, does not explain the excretion of a cyclic ester of alpha-hydroxybutyric acid, which, as first suggested by A. J. Smith and L. B. Strang (Arch. Dis. Childhood, 33:109, 1958), is responsible for the maple syrup odor. This compound could well arise as a degradation product of methionine, of which the urinary excretion is also high (Brit. M. J., 1:91, 1959), by way of alpha-ketobutyric acid.
Sins of Their Fathers
Authors: KUGEL ROBERT B.
Published: December 2021

This is not just another book dealing with some of the problems of juvenile delinquency. It is an exceptional book in many ways. The author, who has had both psychiatric and pediatric training, draws heavily upon her 5 years of experience as a staff psychiatrist for the New York Children's Courts to present well the many diverse aspects which foster juvenile delinquency. The facts are presented fairly, neither sensationally nor oppressively, so that the data which are communicated come very much to life. In addition Dr. Rittwagen has a considerable flare for writing, infrequently seen in medical writing, such that many facts which need to be presented are woven into the fabric of the story like a well narrated novel.
Can the New Pediatrics Be Practiced?
Authors: CUTLER CHARLES H.
Published: December 2021

This is written in answer to your request for "thoughtful comment" on your editorial "Can the New Pediatrics Be Practiced?" (Pediatrics 23:235, 1959).

My answer is, "Yes, it Can!" It follows that the subject of this communication must be the "how" of that statement.

The mere fact that "vague rumblings of discontent with the practice of pediatrics" are being expressed, and that the official journal of the American Academy of pediatrics contains an editorial on this fact, thus inviting discussion, is a sign of healthy growth. It seems to me that, if properly directed, these trends can be used to anabolize rather than to catabolize our specialty.

It is true that pediatrics as a discipline within the structural framework of medicine is firmly established.
Letters to the Editor
Authors: WINEBERG JULIUS J.
Published: December 2021

Pediatric practice consists of 85 to 90% of minor illness and well baby care. The remaining 10 to 15% often requires the highly-skillful and specialized training for which pediatricians were prepared. When one becomes dissatisfied, the argument is that he has defects of personality, and after all, it is very wonderful to watch children grow and have patients invest so much faith in their doctor. Regardless of such rationalizations as these, if a man spends 2 years devoted to acquiring a highly-specialized skill and then enters a practice which 90% of the time does not require this skill, then he has not really been trained for a specialty.

The 10% of cases which do serve as a challenge to the skill and training of a pediatrician represents in essence a subspecialty. If it is a subspecialty, then who shall carry on the tradition and knowledge of pediatricians? Where shall pediatric education be directed?
Letters to the Editor
Authors: CODDINGTON R. DEAN
Published: December 2021

Your editorial in the February issue of Pediatrics was most apropo and frank—a just criticism of the economics of the "new pediatrics." Your invitation for further comment has stimulated me to write concerning two other aspects of the problem.

First of all, a conflict of interests arises in the young pediatrician's mind when, on the one hand, he wants to encourage the mother to return as often as necessary in order to build up his practice while, on the other hand, he is attempting to help her develop independence. If he truly helps her to handle the many vexing problems of child rearing and minor illnesses, he will develop a pleasant practice with a limited number of frustrating telephone calls and few night visits. However, this is poor economics for the pediatrician starting out in practice.
Transplacental Passage of Vitamin K Analogue
Authors: GARDNER LYTT I.
Published: December 2021

In the March issue of Pediatrics (23:553, 1959), Lucey and Dolan reported an interesting study of hyperbilirubinemia in newborn infants associated with the administration of a vitamin K analogue to the mothers. These authors hypothesized that the vitamin K analogue passed through the placenta and had a hepatotoxic effect on the newborn infants. In support of this concept, we have obtained evidence suggesting that a synthetic vitamin K analogue given to a mother prepartum may pass across the placenta and become incorporated into the tissues of the newborn infant.

This observation was made fortuitously during a study of adrenal corticosteroids in adrenal tissue from the human newborn (Helvet. paediat. acta, 12:147, 1957). Analyses were made by paper chromatographic techniques on adrenal tissue obtained at necropsy of 12 infants, 9 of whom were less than 11 days old.
FAILURE OF SULFONAMIDES TO INCREASE THE THERAPEUTIC EFFECTIVENESS OF PENICILLIN IN THE TREATMENT OF STREPTOCOCCAL INFECTIONS
Authors: Breese Burtis B. , Disney Frank A. , Talpey William B.
Published: December 2021

A group of children with beta hemolytic streptococcal infections were divided by lot into two comparable groups. One was treated with penicillin orally, the other with penicillin plus a sulfonamide. No difference could be found in the initial response to therapy or the subsequent recurrence or carrier rate in the two groups.

It is therefore concluded that, in the treatment of streptococcal infections in children, the addition of a sulfonamide to penicillin offers no therapeutic advantage.
Recent Progress in Hormone Research, Vol. XIV. The Proceedings of the Laurentian Hormone Conference
Authors: GARDNER LYTT I.
Published: December 2021

This is the 14th volume of this valuable series of the Laurentian Hormone Conference. The editor continues the same excellent format as in the previous volumes. There are 14 monographs on various aspects of endocrinology each followed by a bibliography and verbatim record of the discussion.

The volume is divided into five sections: I. Hormone Structure and Function; II. Hormones in Growth and Development; III. Aspects of Reproduction; IV. Hormones and Metabolism; and V. Neurohumors.

Of special interest to pediatricians is the section on cytologic tests of chromosomal sex by Grumbach and Barr.
STAPHYLOCOCCAL INFECTIONS
Authors: Wheeler Warren E.
Published: December 2021

THE STAPHYLOCOCCUS problem has been placed high on the agenda of the Public Health Service for this year. Last year it was Asian flu vaccine. The year before it was poliomyelitis vaccine. This year it is the problem of hospital-acquired staphylococcus infection.

It is pleasing to me to see the position pediatricians have taken as one of the first national organizations to realize the importance of this situation. The Academy was one of the first bodies to urge the formation of hospital infection committees. Pediatricians by training, experience, tradition and in many other ways are eminently qualified to lead in this regard.

We have seen the establishment of many of these hospital infection committees. Some of these committees find themselves in the position of consultants, and they sometimes hardly know what to do. So, my remarks this morning will be directed to you as though half of you were serving on infection committees in your hospitals and the other half were chiefs of services of newborn nurseries. I shall confine my remarks to the newborn nursery. One word regarding hospital infection committees—the formation of such a committee, even of an active committee, does not abrogate the responsibilities of a chief of service nor the individual physician. One cannot delegate to others the responsibility of protecting your patients from hospital-acquired disease. You cannot as chief of a nursery expect the committee to protect you from the staphylococcus problem.

I should like simply to state a few principles, and then tell you a little bit about where you can obtain some help as members of infection committees (summarized in the table).

The first principle is that as far as the newborn nursery goes, most of the staphylococcal lesions appear after the baby goes home, and you may not know about them. This indicates that one must look hard for trouble. One can't wait until it comes to him. The primary function of the infection committee is surveillance, and knowing when you have trouble and when you don't. The best way I know of to assess this situation is to establish some kind of survey after babies go home.
Arachnodactyly Heart
Authors: G. S.
Published: December 2021

Cardiovascular lesions are known to be frequently associated with arachnodactyly. The most common pathologic finding is cystic medionecrosis, particularly affecting the aorta, which often gives rise to aneurysm formation. Congenital cardiac malformations have also been described in patients with arachnodactyly; the more common lesions encountered are coarctation of the aorta and septal defects. From his experience at the Gronigen Clinic, Netherlands, the author reports another, but less frequently observed, finding of myocardial hypertrophy and fibrosis, in the absence of other cardiovascular pathology; this lesion leads eventually to cardiac decompensation and demise. The term "arachnodactyly heart" is proposed to designate the primary myocardial pathology in this hereditary disease.
THE EFFECT OF RUBEOLA ON TUBERCULOSIS UNDER ANTIMICROBIAL THERAPY
Authors: Kendig Edwin L. , Hudgens Robert O.
Published: December 2021

That rubeola exerts a deleterious effect on unhealed tuberculosis is generally accepted. In this report, intercurrent measles appeared to cause no untoward effect in five patients with tuberculous meningitis, already receiving therapy consisting of isoniazid, streptomycin and para-aminosalicylic acid.
TECHNIQUE FOR INSERTION OF PLASTIC CATHETER INTO SAPHENOUS VEIN
Authors: Randolph Judson
Published: December 2021

FOR THE sure delivery of fluid into the blood stream of a patient, it sometimes becomes necessary to place a plastic tube in a selected vein. This procedure can be accomplished by anyone who possesses a moderate knowledge of anatomy and sterile technique and is familiar with the apparatus involved. In infants and obese children the isolation and catheterization of a suitable vein is more difficult.[See FIG. 1., FIG. 2. in Source PDF]

On most pediatric services it is the responsibility of the pediatric resident staff to perform such "cutdown" procedures, when indicated. In many community hospitals this task falls to the lot of the busy attending pediatrician. In the middle of the night, with a tiny patient in profound shock, the insertion of a catheter into a vein may be a demanding assignment. In such a situation the attempts of the uninitiated are [See FIG 3 In Source PDF] usually characterized by a generous incision, with much spreading and dissection of the tissues. This invites infection; in addition, any significant delay may be costly.

A saphenous vein "cutdown" is frequently used in conjunction with major operative procedures at the Children's Medical Center. Saphenous phlebitis is rare, and its occurrance in a child does not have the more serious connotation that it does in the adult. Under the stimulus of good-humored chiding by the senior residents, each incoming junior house officer acquires a flare in the art of cannulating veins. The time elapsing from preparation of the skin to bandaging averages under 5 minutes. The factors responsible for such rapidity are: an anesthetized patient, repetition of a routine, and an exact knowledge of the anatomy involved.

Four anatomic characteristics make the saphenous vein ideal for cannulation under direct vision (Fig. 2). These are: 1) its constancy (one can depend upon its presence just anterior to the medial malleolus); 2) it is the only structure of importance in this location (there are no arteries or tendons in the space immediately anterior to the malleolus; the tiny saphenous nerve should offer no confusion, and its division is of no great moment); 3) the vein lies on tough periosteum; and 4) its elasticity allows it to be withdrawn from a short incision without danger of rupture. Each of these facts serves importantly in the delivery of the vein, which, after all, is the key to the "cutdown" procedure.
Natural Child Rearing
Authors: KORSCH BARBARA M.
Published: December 2021

This "practical manual for reasonable parents" presents an odd combination of information. On the one hand there are a series of simple practical recommendations for infant care and child rearing through adolescence, based on currently accepted principles from psychology, psychoanalysis and related fields. On the other hand there are a number of condensed theoretic psychoanalytic expositions on topics such as the stages of early psychosexual development and the traditional concept of the oedipal situation. The practical portions of the text concerning feeding schedules and other aspects of infant care as well as the later chapters on parental handling of children of school age and adolescence are non-controversial, but also fail to present any new material or even a new approach.