bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECT OF SPLENECTOMY ON PORPHYRIA ERYTHROPOIETICA
Authors: Rosenthal Ira M. , Lipton Earle L. , Asrow Gertrude
Published: December 2021

Studies performed on a case of porphyria erythropoietica revealed a compensated hemolytic process. Cell survival studies, performed by the Ashby technique, showed the presence of erythrocytes of short life span, demonstrating an intracorpuscular defect in this patient. Fluorescence was found in a large percentage of the normoblasts of bone marrow aspirations, giving evidence that the bone marrow is the source of the excess porphyrins in this case.

Splenectomy was performed in an attempt to reduce hemolysis, diminish erythropoiesis and porphyrin production, and thus secure palliation of the disease. The spleen and a liver biopsy were analyzed for porphyrins, and a considerable concentration of uroporphyrin and coproporphyrin was found in each organ. Following splenectomy there was a marked reduction in porphyrin excretion followed by a gradual rise approaching the preoperative levels. Some amelioration of the hydroa estivale was found in the first summer after splenectomy. The rising level of porphyrin excretion, however, suggests that the improvement will probably not be sustained. It is the opinion of the authors, however, that splenectomy should be considered in cases of porphyria erythropoietica in which increased hemolysis can be demonstrated, even if no anemia is present, because of possible variation in the response to the operation of individual patients.
HYPERNATREMIA IN INFANTS
Authors: Finberg Laurence , Harrison Harold E.
Published: December 2021

It has been shown that hypernatremia may accompany dehydration in infants with diarrhea and with infections associated with interference with water intake. Suitable modification of the treatment dehydration for these patients has appeared to improve the results of their care.

Hypernatremic dehydration may be suspected from the history and clinical features and is readily diagnosed by laboratory procedures.

The occurrence of neurological manifestations, some of which may be irreversible, is a feature of outstanding importance. Despite loss of body water the usual changes in tissue turgor and the circulatory state associated with severe dehydration may not be present.

Because in this type of dehydration, a large intracellular water deficit exists, the repair solution should be relatively dilute with respect to sodium. The best results have been obtained by administering fluids which, if combined, would have a final sodium concentration of from 15 to 40 mEq./l.

Hypocalcemia has been a frequent complication and more study is needed to elucidate its pathogenesis. Awareness of its occurrence facilitates therapy.

As in other types of dehydration in infants, the potassium deficit may be impressive and should be corrected promptly after restoration of renal function.

The somewhat special treatment indicated for patients with hypernatremic dehydration makes recognition important. Recognition or suspicion from clinical signs and rapid laboratory diagnosis are essential for optimal management.
FURTHER STUDIES ON THE EFFECTS OF HYPOXIA ON THE RESPIRATION OF NEWBORN INFANTS
Authors: Miller Herbert C. , Smull Ned W.
Published: December 2021

The response to breathing 12 per cent oxygen by newborn premature and full-term infants and premature infants several weeks old has been studied. Comparisons show that newborn premature and full-term infants during the first days after birth failed to respond with increases in respiratory rate or tidal volume during the hypoxic state. In fact, there was some decrease in ventilation which was largely related to reductions in tidal volume. Premature infants several weeks old, on the other hand, showed an immediate and significant hyperpnea while breathing 12 per cent oxygen. The younger infants, particularly the premature infants, seemed to be less disturbed by the hypoxia than older infants. These results substantiated previous results obtained on full-term infants. The hypothesis was advanced that the chemoreceptor reflexes were less active immediately following birth than later on in life.
CLINICAL EVALUATION OF RESPIRATORY INSUFFICIENCY IN NEWBORN INFANTS
Authors: Miller Herbert C. , Conklin Eugene V.
Published: December 2021

Detailed clinical observations were made on the respiratory behavior of 96 newborn infants, 69 of whom were prematurely born. It was found that the infants could be divided into 3 main groups depending on the trend taken by their respiratory rates during the first few hours following birth.

All of the severe respiratory insufficiency and all the deaths occurred in the group of infants whose respiratory rates were approximately normal during the first hour but subsequently increased to 60 or more per minute sometime during the next 2 days. Some of the latter infants died during this 48-hour period of initial respiratory distress; others appeared to recover and some of these died a few days later.

There was a greater tendency for infants whose birth weights were 1500 gm. or less to have an increase in their respiratory rates during the first day or two following birth than for infants who weighed more than 1500 gm. at birth.

The trend of the respiratory rate was helpful in planning oxygen therapy during the first 2 days. Satisfactory criteria for using oxygen therapy after the first 2 days were not developed from the data in this study.

Retraction of the chest wall on inspiration during the first 24 hours was minimal or absent in infants whose respiratory rates did not increase after the first hour.
OBSERVATIONS ON THE ENDOMETRIUM AND OVARY IN THE NEWBORN
Authors: Ober William B. , Bernstein Jay
Published: December 2021

Post-mortem examination of endometria of 169 newborn infants reveals that 68 per cent are in an indifferent or proliferative phase, 27 per cent show secretory activity, and 5 per cent show progestational changes including decidual transformation of the stroma and changes analogous to those seen in adult menstruation.

Examination of the ovaries in 115 of these cases shows gonadotropic changes in 38 per cent. Examination of the 42 adequately sectioned ovaries from this group plus 31 from cases in which the endometrium was not available shows gonadotropic activity in 90 per cent. The observation of atretic follicles indicates that cellular response to gonadotropic stimuli is present and occasionally completed in utero.

It is concluded that the endometrial and ovarian changes are unrelated and that each is secondary to a different endocrine stimulus.

Evidence is adduced to indicate that progesterone is capable of traversing the "Arthus' phenomenon" thereby producing a were infective hyperplasia of the spleen, placental membrane and producing the decidual transformation of the endometrial stroma.
ACUTE POLIOMYELITIS IN INFANTS UNDER ONE YEAR OF AGE: EPIDEMIOLOGICAL AND CLINICAL FEATURES
Authors: Abramson Harold , Greenberg Morris
Published: December 2021

In order to compare the epidemiological and clinical features of poliomyelitis in infants under 1 year with those in children and adults, a study was made of all cases of poliomyelitis that occurred in New York City in 1949 and 1950. This revealed the following characteristics of the disease among infants in the first year of life:

Clinically recognizable poliomyelitis was of infrequent occurrence among infants under 1 year of age. It was even more infrequent among infants in the first 6 months of life. This is in marked contrast to the findings in the 1950 epidemic in Israel, where one-third of all cases occurred in the first year of life, and one-tenth in infants in the first half year of life. Male infants exhibited a greater susceptibility to the disease than females. Fatalities in this age group were high, particularly among infants under 3 months, with some predominance of deaths in males.

Under 1 year of age, non-paralytic poliomyelitis was unusual, especially in the first 6 months of life. Paralytic forms of the disorder were dominant, spinal involvement being more common than bulbar. Case fatality occurred chiefly in bulbar forms of the disease, as in older children and adults. The fatality rate was higher than in older children and higher than in all ages combined.

The onset of poliomyelitis among infants under 1 year of age was variable. It was acute, with fever, or fever with nuchal spasm, or the triad of fever, nuchal spasm and spasm of back muscles. Temperature at onset of illness averaged 98.3°F.(36.8°C.), with a low of 97.6°F.(36.3°C.), and a high of 102°F.(38.8°C.). Temperatures recorded subsequently during the day of onset of illness were from 99.9°F. (37.7°C.) to 105°F.(40.5°C.), the mean being 102.8°F. (39.3°C.). The interval between onset of illness and first detection of paralysis averaged 5.5 days, with a spread from the day of onset to 25 days later. Paralysis of a single limb occurred more frequently than of 2 or more limbs, and the ratio of arm to leg paralysis was about 1 to 3.

Initial spinal punctures in infants under 1 year were made on an average of 3.4 days after onset of illness in non-paralytic cases, and 5.7 days in paralytic cases. The spinal fluid was usually clear, with a mean count of 91 lymphocytes/mm. . The average sugar content was 55 mg./and protein 72 mg./100 ml. of fluid.
TUBERCULOUS OSTEOMYELITIS OF THE MALAR BONE
Authors: Chick Forris E. , Printz Philip A. , Borak David
Published: December 2021

The patient is a 6-year-old colored female, admitted to Seton Hospital on June 16, 1954. The past history was one of normal development and health with no significant illness. The family history was non-contributory. The child was well until May, 1953, when the mother noticed a slowly developing swelling along the infraorbital area and lateral to the left eye. A diagnosis of cellulitis of the left side of the face was made, presumably due to infection of the sinuses or the teeth. As there was no response to therapy, the mother brought the child to a clinic in New York in June, 1953, where the lesion was incised and drained. The incision was made about one-half inch below the outer canthus of the left eye. Because of non-closure and continued drainage for 4 months, the mother had the child admitted to a city hospital.
EDUCATION
Authors: White Park Jerauld
Published: December 2021

ALL OF US who are concerned with training pediatricians for the practice of pediatrics must agree that the time has come to say with Browning's Rabbi,

"Something is wrong: there needeth a change.

But what? Or where? At the last or first?"

The answer is: at both first and last. I write with whatever authority may have been conferred by 35 years in the private practice of pediatrics, plus a fair amount of part-time clinical teaching. As I retire from private practice (but not yet from clinic and ward work) I lay down my telephone and say, "For this relief much thanks." Thirty-five years of night-and-day pediatrics, with the endless raucous obbligato of the telephone, have led inevitably to reflections upon certain obvious trends in pediatric education as well as in pediatric practice, reflections based upon happy association with young pediatricians in and out of hospital training.
PROGRESSIVE VACCINIA ASSOCIATED WITH AGAMMAGLOBULINEMIA AND DEFECTS IN IMMUNE MECHANISM
Authors: Kozinn Philip J. , Sigel M. Michael , Gorrie Rachel
Published: December 2021

A fatal vaccination reaction is reported in an infant 3 months of age, characterized by the continuous enlargement of time original vaccination and progressive development of new lesions. Virologic and histologic logic examinations indicated that the lesions were caused by vaccinia virus. Clinical and laboratory findings suggested that the disease was associated with agammaglobulinemia and defects in the immune mechanism. Differential features of this disease, generalized vaccinia and variola are presented in the discussion.

The infant's blood appeared to lack γ-globulin. Nevertheless, the serum yielded positive results in the hemagglutination inhibition and neutralization tests, though not in the complement fixation test. Some of the reactive substances in the serum, especially the neutralizing substances, were probably antibodies passively acquired.

Pathologically, the disease was characterized by lymphopenia, absence of healing and lack of inflammatory response.

The infant was treated unsuccessfully with γ-globulin and plasma from recently vaccinated donors. Successful treatment of this condition has recently been reported by the use of antivaccinal γ-globulin.
THE EPIDEMIOLOGICAL EVALUATION OF A NON-CELLULAR PERTUSSIS ANTIGEN
Authors: Felton Harriet M. , Verwey Willard F.
Published: December 2021

A brief discussion of the background and current status of pertussis immunization has indicated the need for a more satisfactory immunizing agent.

The clinical evaluation of a new non-cellular pertussis antigen is described.

Statistical analysis of data from 197 children completely immunized with the non-cellular antigen, 207 completely immunized with whole organism vaccine and 238 non-immunized control children suggest the following conclusions:

The epidemiological data relating to the non-cellular antigen indicates its ability to produce a satisfactory level of immunity to pertussis.

The significantly higher agglutinin titers and better protection in humans suggest that there is a better response to time non-cellular antigen than to the control vaccine even though mouse protective activities were approximately equal.

The non-cellular pertussis antigen caused a febrile reaction of shorter duration than the control vaccine and other less quantitative measures of toxicity indicated that the non-cellular antigen was less toxic than the control vaccine.

The frequency of pertussis cases in both immunized groups was significantly lower than in the non-immunized control group.

The groups employed in the study were significantly uniform and thus permitted a valid comparison of the results among the various groups.
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors: Bost Crawford
Published: December 2021

IT Is twenty-five years since the founding of the American Academy of Pediatrics. I doubt that any medical specialty society has had so great an influence in its field or contributed more widely to activities of allied organizations as has the Academy. Our earlier history has been understandably and finely recorded in the volume written by Marshall Pease published in 1951. Since the period covered in this book, as before, each president has described in his own fashion the achievements and activities of the Academy during his year. Such phenomenal growth has occurred that the president's message has come to be a way of bringing into focus for the members the broad field of activities that constitutes the Academy program. In each recent year we have learned of the transactions of the Evanston office, the Executive Board and the National Committees and liaison representatives. With increasing experience communications regarding the many efforts and vast influence of State and local committees are being reported. One day will be found the way to record the important contributions by those members who individually work for Academy objectives. Theirs is an equal devotion. So many are the activities of the organization that it is increasingly difficult to keep our members accurately informed. Since this is a year which marks a special milestone in the lifespan of the Academy, it seems fitting to parade before our minds some of the structures we have built in these years. With this reminder freshly before us, each then in his own way can evaluate our present position and help to plan our future.
SPECIAL ARTICLE
Authors: Brazelton T. Berry
Published: December 2021

Seventy healthy, apparently happy babies were studied in an attempt to evaluate the common occurrence of extranutritional sucking and its importance. Sixty-one manifested an appreciable amount of extra sucking which seemed to be gratifying in itself to the infant and which did not necessarily represent fatigue, hunger or discomfort. The onset of this varied from birth to 3 months of age. Its intensity increased until 7 months then began to decrease spontaneously, coincident with other motor accomplishments. By 12 months all but 4 of these babies had ceased to suck their hands except under stress. Only 2 have continued beyond the age of 2 years. The importance of extranutritional sucking as a source of gratification in infancy is pointed out. Its occurrence is normal and its disappearance is spontaneous in most infants when not inhibited
OBSTRUCTIVE JAUNDICE COMPLICATING HEMOLYTIC DISEASE OF THE NEWBORN
Authors: Stempfel Robert , Broman Birger , Escardó Florencio E. , Zetterström Rolf
Published: December 2021

In a consecutive series of 83 Rh-isoimmunized infants, 7 had significantly elevated levels (greater than 1.0 mg./100 ml.) of direct bilirubin in the cord blood and developed obvious biliary obstruction. In no instance was a low concentration of direct bilirubin in the cord blood associated with the development of this condition. Serially determined electrophoretic separations of the serum proteins in 6 of the 7 patients revealed patterns not unlike those seen in the normal infant.

In exchange transfusions calculated to remove 85 per cent of the infant's blood, the total bilirubin concentration of the serum was reduced 30 to 50 per cent in infants with and in those without biliary obstruction. However, for the purpose of maintaining the total bilirubin concentration below "critical" levels, it was found that exchange therapy is less efficient, from a temporal standpoint, in infants whose hemolytic disease is complicated by biliary obstruction.

The cause of intrahepatic biliary obstruction is discussed and the prognostic value of the concentration of direct bilirubin in the cord blood of erythroblastotic infants is stressed.
INEFFECTIVENESS OF DIAMOX IN THE TREATMENT OF CHILDHOOD EPILEPSY
Authors: Livingston Samuel , Peterson Don , Boks Lydia
Published: December 2021

Diamox® was administered to 58 patients who suffered from frequent convulsive seizures of various types. This drug failed to control the spells of any of these patients.
Letters to the Editor
Authors: BECKER HARRY F.
Published: December 2021

The letter from Roswell D. Johnson, M.D., which was published in the January, 1956, issue of Pediatrics, and which dealt with the subject of Voluntary Plans for Medical Insurance is so subject to misinterpretation that I believe some correction should be made. It is realized that the letter in question deals primarily with pre-payment "insurance." Blue Cross is not insurance, and so technically is not concerned with Doctor Johnson's criticism of "insurance" plans. Blue Cross is "pre-payment," however, and because of the belief of the public and many physicians that all of these plans are insurance, I feel that it should be clearly stated that Doctor Johnson's statements with regard to hospital pre-payment do not apply universally where Blue Cross Plans are considered.
THE USE OF INDIRECT ARTERIAL PULSE TRACINGS IN THE DIAGNOSIS OF CONGENITAL HEART DISEASE
Authors: Donoso Ephraim , Sapin Samuel O. , Kuhn Leslie A. , Grishman Arthur
Published: December 2021

Studies were made of the carotid arterial pulse curves, recorded by indirect means utilizing a crystal microphone system, of 21 normal patients and 38 patients fulfilling the clinical criteria of congenital aortic or subaortic stenosis, 6 of whom had coexisting coarctation of the aorta.

There were definite and constant abnormalties in the pulse curves of the carotid artery in the group with aortic or subaortic stenosis. These were characterized by the presence of an initial sharp anacrotic notch placed low on the ascending limb of the Pulse curve; a series of systolic vibrations on the ascending limb, the graphic representation of a palpable thrill in the carotid vessels of these patients; plateau formation near the peak of the curve; a slow rise of the ascending limb of the curve to reach a later peak than normally seen; and, in some cases, an increased duration of systole as measured from the beginning of the carotid upstroke to the dicrotic notch of the carotid.

Although the patients studied would appear to fulfill the clinical criteria for diagnosis of congenital subaortic stenosis as opposed to congenital aortic valvular stenosis, it is emphasized that the differential diagnosis of these 2 conditions may not be possible during the life of the patient.

It is stressed that congenital aortic or subaortic stenosis may be considerably more frequent than can be judged by previously reported necropsy statistics and that, in addition, there may be a frequent association of these conditions with coarctation of the aorta.
Practical Pediatric Dermatology
Authors: SULZBERGER MARION B.
Published: December 2021

In view of his inevitable daily encounters with skin diseases, it is axiomatic that every pediatrician should possess and know how to use at least one modern textbook devoted to dermatology; and here is a modern text written expressly for pediatricians by an experienced dermatologist. Dr. Leider has succeeded in his objective and has compressed into 433 pages a wealth of practical experience in the diagnosis and treatment of skin diseases in infants and children.
PNEUMOCYSTIS CARINII—ETIOLOGIC AGENT OF INTERSTITIAL PLASMA CELL PNEUMONIA OF PREMATURE AND YOUNG INFANTS
Authors: Gajdusek D. Carleton
Published: December 2021

Pneumocystis carinii, a parasite found almost a half century ago in the lungs of small mammals and of man in Brazil and, subsequently, in the lungs of man and of wild and laboratory rodents in Europe, has been identified with increasing frequency in the lungs of patients dying from interstitial plasma cell pneumonia of premature and young infants. The microorganism is found with considerable regularity in such patients, and has, in addition, been found in material obtained by lung puncture during life. Although its morphologic characteristics and life cycle have been well worked out, its taxonomic position remains a matter of conjecture. It has been tentatively classed as a protozoan of the Class Haplosporidia, but many authors believe it to be a fungus. The organism is not often encountered in the lungs in serial, unselected necropsies, but it has been found occasionally in lungs of older children and adults debilitated by chronic infections or malignant neoplasm and rather more frequently in association with cytomegalic inclusions in the lungs and salivary glands of infants and adults. However, it has been regularly identified in lungs of interstitial plasma cell pneumonia patients with only rare exceptions. Recently infection with what appears to be this microorganism has been transmitted to infant mice and kittens.

The wide geographic distribution of natural infection with this agent in wild and domestic mammals of many species, the fact that it was first discovered in man and animals in South America, its frequent identification in the lungs of infants afflicted with this unique pneumonia of infancy, a disease which has now been reported in the United States, and the recent identification of Pneumocystis carinii in a diseased human lung from Canada, make it essential that American pediatricians be aware of this parasite as a potential human pathogen. Only further study will establish clearly what role this organism plays in the pathogenesis of human disease and settle the controversy as to whether it is fungal or protozoan.
INFANTILE HEMANGIOENDOTHELIOMA OF THE LIVER
Authors: Crocker Diane W. , Cleland Robert S.
Published: December 2021

Three cases of infantile hemangioendothelioma of the liver are reported, one with spontaneous regression. In two cases there was cardiac hypertrophy, dilatation and failure, presumably due to arteriovenous shunting within the tumor.

Clinical and pathologic aspects are discussed.

The similarity of this tumor to the infantile hemangioma of the skin is cited and a similarity of natural evolution suggested.

Therapeutic and prognostic implications of such a natural course are discussed.
REPEATED PSYCHOMETRIC EVALUATIONS OF PRESCHOOL CHILDREN WITH CEREBRAL PALSY
Authors: Kogan Kate L.
Published: December 2021

Test scores for 31 children with cerebral palsy who had had two or more psychometric examinations within a 3-year period were reviewed.

The average shift from one examination to another was 6.5 I.Q. points.

It was likely that the changes in test scores due to retesting were largely attributable to the probable errors of the test scores, and that the intelligence quotient may be no less consistent for handicapped children than for an unselected population.
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION, American Academy of Pediatrics
Published: December 2021

The following contribution was prepared at the request of the Committee on Nutrition as a step towards filling a long-felt need, namely, statement of the essential principles governing scientific appraisal of nutritional substances through clinical trials with humans. It is necessary to ascertain the validity of methods which may be employed for this purpose before attempting to devise practicable plans for clinical testing of products. Only on this basis can the results of clinical trials be properly evaluated. Pediatricians and manufacturers of nutritional products have both been handicapped in selection of truly beneficial products because of lack of suitable criteria for judging the effect of substances on nutrition in the period of rapid growth and development in infancy and childhood.

The critique which follows is not to be construed as a recommendation that any one of the methods mentioned is a superior approach in the conduct of clinical trials of substances, nor does it constitute a simple plan for specific clinical trials. Instead, it is emphasized that "uncritical use" of any technique is valueless. If one of these methods is to be employed (especially indirect measurements, such as short-term balance studies), to secure information on the effects of a substance on growth and nutrition, the considerations outlined must be respected.

Definition of ideal or optimal nutrition is not attempted in this communication. That would present even greater difficulties of an almost philosophic nature. The methods discussed are concerned with comparison of the state of nutrition achieved in test- and control-groups by substances under appraisal, through the use of various available indices.
THE CONDUCT OF CLINICAL TRIALS OF SUBSTANCES PROPOSED FOR THE NUTRITION OF INFANTS AND CHILDREN
Authors: Lowe Charles U. , Pessin Vivian
Published: December 2021

ANIMAL experiments may offer evidence of the value of a substance for human nutrition, but only well-conducted clinical trials can result in a verdict. Unless substances are tested on human subjects, judgment should be withheld. Though the design of experiments varies, certain general principles pertain to all experimentation; in addition, special considerations apply in the field of nutrition. The outline which follows presents some of these principles and considerations and should be useful to those conducting clinical trials.

A statement of specific objectives should be prepared as the first step. In order to estimate the necessary sample size, estimates of expected results must be obtained, or deduced, either from the literature or from a pilot experiment. All possible sources of bias, such as age, sex, race, etc. should be listed in advance and considered in planning the study. Decisions must also be made concerning the following: 1) population for which the results will be relevant; 2) controls; 3)criteria for judging results; 4) sample size and duration of study; 5) form of reporting results. Whenever possible the people who give treatments and make measurements should be unable to distinguish between the study and the control subjects.

I. POPULATION

The type of population for which the conclusion is intended will determine the choice of subjects. For example the value of a foodstuff for all infants should be studied in subjects from a heterogeneous population. Alternatively, a dietary supplement for treating deficiency must be assayed in deficient subjects. Such a supplement would probably produce no signficant changes in normal subjects but even if it did the results would not necessarily apply to treatment of deficiency.
TRENDS IN MAMMALIAN TERATOLOGY
Authors: Gluecksohn-Waelsch Salome
Published: December 2021

It Might be worth while to begin a discussion of this topic with some historical considerations, because it may help to elucidate and to evaluate modern trends of mammalian teratology. It is probably true for all disciplines of science, but particularly so in the case of mammalian teratology, that the influence of the cultural environment of the time plays a decisive role in determining the attitude towards a particular science and its trends. It is obvious that teratologic phenomena are among those events of nature which fascinate and stimulate the imagination, not only of the scientist directly concerned with the problem, but also of the layman who happens to come across monstrosities of one or the other kind.

Everybody knows of the role monsters played in Greek mythology. Descriptions of congenital abnormalities may be found in pre-Aristotelian times but it was Aristotle who made a first attempt at causal analysis, and thus introduced the scientific approach to problems of teratology. It is interesting to consider the argument with which he refuted the possible existence of monsters-which were thought to be part man, part animal: Aristotle was correct in denying the existence of such chimaerae but he was not correct in the choice of his argument which stated that different organisms could not develop together because of different gestation times. Modern trends of thought would lead us to argue against the existence of this type of monstrosity in terms of genetic differences.

The generally static and dogmatic trend of the Middle Ages is reflected in the absence of any causal considerations of teratology during that time.
GENERALIZED MAST CELL DISEASE AND URTICARIA PIGMENTOSA
Authors: Rider Thomas L. , Stein Arthur A. , Abbuhl John W.
Published: December 2021

The case which is presented and review of the literature indicate that urticaria pigmentosa may be accompanied by mast cell infiltration of many tissues and viscera. No definite conclusions may be drawn regarding etiology, incidence, or prognosis of this disorder. The evidence indicates that both local and generalized symptoms occur which are principally related to the pathophysiologic changes resulting from mast cell activity, i.e., fibrous tissue proliferation, hyperemia and edema.

In the case reported herein there was no histologic evidence of fibrous tissue increase but it is postulated that the hepatosplenomegaly and the bone changes in roentgenograms may be in part due to such changes. The dermatographism, skin flushing, salivary gland swelling and gastrointestinal symptoms are probably due to the physiologic action of mast cell products, i.e., histamine and serotonin.

The diagnosis of generalized mast cell disease can be made in a patient who presents a chronic maculopapular skin rash, dermatographism, hepatosplenomegaly and mast cell infiltration of the bone marrow. Demonstration of mast cell infiltration in the skin and other tissues is confirmatory but not necessary.
TESTING OF VISUAL ACUITY IN PRESCHOOL CHILDREN
Authors: Allen Henry F.
Published: December 2021

The high incidence of amblyopia indicates the need for testing of vision in preschool children 3 years of age and older.

The responsibility for seeing that vision is tested rests with the child's physician.

Because of extra-ocular influences, results of acuity testing in young children must be regarded merely as minimum values.

Unsatisfactory tests should be repeated at monthly intervals, until definite results are obtained.

The illiterate E is recommended as the most useful test for children who can comprehend it.

A new picture test, for children who cannot comprehend the illiterate-E test, is described and evaluated in terms of a 30-ft denominator.
HEART PUMP AND OXYGENATOR
Authors: Mustard W. T.
Published: December 2021

THIS PAPER is a general review of the development of the artificial heart-lung to facilitate open-heart surgery. At the close of World War II many centers began investigating the possibility of total cardiac bypass. Oven the past decade, pump oxygenerators of various types have become popular and recent clinical successes throughout the world have given further impetus to the study of problems posed by the artificial heart-lung apparatus.

The subject divides itself into three separate parts, the first two being concerned with the maintenance of life in an experimental animal during a total cardiac bypass. One must take all the blood from the animal and return it to the animal by means of a pump. Secondly, one must oxygenate the blood before returning it. The third part of the problem confronting the surgeon is the selection of cases and correction of defects in human subjects.

The pumping mechanism must duplicate as nearly as possible the action of the chambers of the heart. Pumping action must be smooth so as to prevent hemolysis and to avoid turbulence with thrombosis. It is not difficult to construct a pump with which hemolysis can be kept to relatively negligible amounts. Most of the pumps in use throughout the world give an hemolysis of less than 50 mg of hemoglobin per 100 ml of blood, which is perfectly safe. Turbulence with thrombosis can be overcome by removing valves inside the stream and placing valves outside of, rather than within the stream of blood. Furthermore, heparinization of the blood lessens the tendency to thrombosis.
EMOTIONAL PROBLEMS IN CHILDREN
Authors: Langford William S. , Wilking Virginia N. , Olson Elma
Published: December 2021

As emotional problems in children are closely rebated to disturbances in parent-child relationships, much of the discussion was focused around this aspect of the topic. Much of the pediatrician's activities with parents concerns itself with attempts to influence parent-child relationships for the benefit of the child patient. A great deal has been learned in child psychiatry about the management of untoward and destructive parental behavior. Much of this knowledge can be used by the pediatrician in his day by day practice. Although, some psychiatric techniques are not applicable in the practice of pediatrics, it is important for the pediatrician to understand his role and not to assume that he is or needs to be a psychiatrist in his attempts at solving difficulties which are presented to him.

Psychiatry has learned some things of what the parent-child relationship shouldn't be. The question might then be raised, "What is a good one?" This can be defined as the capacity in the parent to meet with the child in all matters of day by day living without undue tensions, anxieties on preoccupations. Brenneman has pointed out that about 80% of the practice of pediatrics is in dealing with the parents and one most work through them in an effort to solve the child's problems. There is seldom a situation that involves only the child. It almost always involves the parents and their interaction with the child. Our understanding of many emotional problems has been furthered by our greater knowledge of child behavior and yet we are still too ready to categorize parents and especially mothers with such words as hovering, rejecting, cold, warm, etc., which have little real meaning in terms of understanding how they got that way.
Mental Deficiencies
Authors: KUGEL ROBERT B.
Published: December 2021

This is not, in the usual sense of the word, a textbook on mental deficiency. Rather it is a book concerned primarily with the social issues which are part of the problem of mental deficiency. For several decades, Dr. Wallin has been actively concerned with the problems of mental deficiency and brings an extraordinary background of experience to bear in the writing of this book.

He attempts to shed light on certain aspects of the problem where there has been an abundance of confusion and misconception.
Heritable Disorders of Connective Tissue
Authors: NEEL JAMES V.
Published: December 2021

The contents of this book first appeared as a series of papers in the Journal of Chronic Diseases from November, 1955, through May, 1956. These papers, with additions, have now been collected into a volume which is an excellent summary of the heritable disorders of connective tissue.

After brief introductory chapters dealing with some general characteristics of hereditary syndromes, and with the biology of normal connective tissue, the author devotes successive chapters to the Marfan syndrome, the Ehlers-Danlos syndrome, osteogenesis imperfecta, pseudoxanthoma elasticum, and the Hurler syndrome.
The Prevention of Cruelty to Children
Authors: REINHART JOHN B.
Published: December 2021

This volume is written by a British physician about child care conditions in various parts of England as seen through the eyes of the National Society for the Prevention of Cruelty to Children. His definition of cruelty is broad "to include neglect and mental cruelty," and he states, "any child who is frequently unhappy is the victim of cruelty."

Dr. Housden has divided the book in three sections: past, present, and future. A great deal of the book is an accounting of the physical and social conditions met with by workers in social agencies, chiefly the NSPCC.
Amino Acid Handbook
Authors: FOMON SAMUEL J.
Published: December 2021

As indicated by the title, the book is strictly a reference work and will be primarily useful to individuals working in the general field of chemistry and metabolism of amino acids. The emphasis on technology and factual material, rather than on reiteration of controversial interpretations of available data, has allowed the authors to encompass a surprising amount of information in a book of modest size.

The first portion of this handbook deals primarily with chemical, microbiologic and, especially, chromatographic methods of analysis of amino acids.
TREATMENT OF INFANTILE DIARRHEA WITH STREPTOMYCIN AND AN ORAL AMIGEN MIXTURE
Authors: GOETTSCH ELVIRA , COBLEY GEORGE , MULLOY MARY
Published: December 2021

In a severe epidemic of infantile diarrhea in 1945 and subsequently, bacteriologic cultures of the nasopharynx and the catheterized urine showed a predominance of gram-negative organisms of the colon group.

The response of seriously ill infants with parenteral diarrhea to streptomycin was dramatic, presumably because of the specific action of the drug against the gram-negative organisms. Streptomycin was used both orally and intramuscularly in the later stages of the disease.

Suggestions are offered for fluid and electrolyte replacement by means of an oral amigen mixture, which permits the introduction of potassium, calcium, and nitrogen as well as sodium and chloride by mouth shortly after admission.

The use of streptomycin and the oral amigen mixture, as an adjunct to the customary routine employed in previous years, effectively shortened the hospital stay, decreased the amount of intravenous therapy, and reduced the mortality. During the eight month period of observation no deaths were encountered which could be attributed to diarrhea.
EDITORIAL
Authors: MCCULLOCH HUGH
Published: December 2021

THE following statement was received in the form of a "letter to the Editor' from Dr. Edna Miller of New York City, who commented, "What better way is there to reach pediatricians than through the medium of their new publication Pediatrics?"

"Dentists are constantly informing parents and others in charge of young children as to the need for an early 'first visit with the dentist.'

"Much of the irremedial damage, dentally and psychologically, is due to the pain and traumatic experience that necessarily follow the discovery of decayed teeth by the dentists, or the uncomfortable sensation of an acute dental abscess felt by a child.

"When children are first seen by the dentists at the age of two and one-half or three years, and thereafter at frequent, regular intervals, the procedures are usually painless; or, if pain is unavoidable, the dentist has already impressed the child with his sincerity. He is then no longer a stranger, visited only at a moment of emergency, who does unfamiliar, unpleasant things with elaborate equipment.
CONGENITAL ALVEOLAR DYSPLASIA
Authors: MACMAHON H. EDWARD
Published: December 2021

A morphologic anomaly of the lungs of new-born infants has been described. It is commonly associated with atelectasis and can be responsible for atelectasis. These two conditions are often confused. It is suggested that this anomaly is an expression of retardation in normal alveolar development. It may lead to death by asphyxia, and children who survive seem unusually susceptible to pneumonia. The etiology is unknown. The term "congenital alveolar dysplasia of the lungs" has been suggested to designate this form of anomaly involving pulmonary alveoli.
OUTLINES FOR WELL BABY CLINICS
Authors: HEWITT EDITH S. , ALDRICH C. ANDERSON
Published: December 2021

IN 1946 we presented a description and explanation of a set of cards used by the Rochester Child Health Project in its well baby clinics. These cards, it was hoped, would help the attending physicians to learn about and to record the evidences of growth and development of babies as they appear in the first twelve months of life. In this article we shall describe and explain a similar set of cards devised for use in the second year.

After the first year, growth and development are not so rapid as they are earlier; the changes from month to month are not so evident and methods of managing a child need not be altered so frequently. Therefore the mothers are asked to bring children in for conferences at fourteen, sixteen, eighteen, twenty-one and twenty-four months of age only. Thus, only five cards are needed in the second year.

The following material appears on the respective cards. Information given under the numbered headings appears on the faces of the cards; the explanatory notes are printed on the reverse.

CARD 1. SUBJECTS TO BE CONSIDERED AT THE AGE OF FOURTEEN MONTHS

1. Development : Baby walks; may even be able to run and climb. Pushes, pulls and piles large objects. May turn pages of a book one at a time.

2. Habits: Eating—Baby may have full adult diet, except for nuts, berries, fat meats and highly seasoned foods. May continue to have bedtime bottle if he desires it. Self-feeding with fingers, spoon, cup or glass should be encouraged even if result is messy.

Sleeping—Baby's night sleep may be disturbed. May take one or two naps, tending toward one.

Elimination—Bowel: Baby may indicate time for bowel movement.

Bladder: Mother may "catch" urine in toilet; if not successful, she should stop trying for two or three weeks; progress should not be forced. Mother understands meaning of "catching" from explanation given her concerning bowel control when child was in sixth month of life.

3. Social adjustment: Baby is becoming increasingly independent; wants to help undress and feed himself; objects to play pen. Enjoys the rhythm of singing, of the radio and of being read to.

Speech—Baby can say a word or two, especially if composed of repeated syllables (mama, byebye).

4. Physical examination: Examiner records anything noteworthy.
ACCIDENTAL INJURIES IN EPILEPTIC CHILDREN
Authors: AISENSON MILTON R.
Published: December 2021

The records of 960 residential patients engaged in a full athletic program at a children's psychiatric hospital were reviewed in order to compare the incidence of potentially serious injuries in convulsive and non-convulsive children.

Of 210 convulsive children, 2.8% were so injured. Of 750 non-convulsive children, 2.9% were so injured.

Since no extra risk of injury was found in convulsive children, it is suggested that they be allowed full participation in physical education programs in schools and camps.
THE PSYCHOTHERAPEUTIC ROLE OF THE PEDIATRICIAN
Authors: SENN MILTON J. E.
Published: December 2021

THE pediatric literature of this country has always been edectic. In the past few years it has drawn increasingly on material from a variety of sources relating to the psychologic aspects of child care. The number of papers in pediatric journals on child psychology, deviant behavior and mental illness, mental growth and development, psychiatric treatment, sociology, and even anthropology bears witness to this occurrence. Another testimony to the pluralism of pediatric interest is evidenced in the composition of the program of this meeting where one series of papers is devoted to the topic of psychiatry in relation to pediatric practice. In the training of the pediatrician emphasis is also placed on preparation of the physician for multiple and changing roles in work with children and their parents. From the fields of psychology, psychiatry, education, and that less easily classified area which is called, "growth and development," the pediatrician is advised how to make pediatric practice more effective through the use of technics which have been found useful in each of these disciplines. For example, the pediatrician is urged to become acquainted with the facts of growth and development so that as a "developmental pediatrician" he may predict and interpret behavior of children to their parents; and, along with proper understanding of the parents, may relieve their hopes, fears and mental conflicts.

In another instance, the educator admonishes the physician to follow him in the use of pedagogic guidance. Still another example may be cited from the field of modern psychiatry where the pediatrician is urged to employ such technics as suggestion, persuasion, reassurance, re-education, desensitization, ventilation and a long list of other psychotherapeutic methods which on the surface appear less formidable and more understandable than many of the words used in psychiatry, but which, nevertheless, need definition and clarification before anybody is able to use them safely in a therapeutic sense.

Psychiatry, pediatrics, psychology and education have made contributions to the field of psychotherapy.
PARANATAL FACTORS AFFECTING ADJUSTMENT IN CHILDHOOD
Authors: STEVENSON STUART SHELTON
Published: December 2021

In an unselected series of 226 children, 73.9% were judged to be in good physical condition during the first two days of life. Of the children in good physical condition, only 19.2% were later judged to be maladjusted; whereas, of the children in poor physical condition, 39.0% were later considered maladjusted. This is a highly significant difference and it is concluded that a child's neonatal condition may effect his adjustment in later childhood.

No single factor among the ones studied is demonstrably critical in affecting later adjustment. However, several maternal factors acting in gestation and during delivery, certain specific neonatal difficulties, and certain factors which might act anatomically or environmentally, are shown to increase the percentage of infants judged to be in poor neonatal condition.

Intelligence, as revealed by the intelligence quotient, is not the critical factor which determines adequacy of adjustment in childhood, although it is related to it.

The maladjusted child may be a victim of a physically damaged brain. He should be given all possible aid in his development and in his relations to other human beings.

A child whose history includes a difficult birth and neonatal period should be brought up with more than the usual regard for his possible emotional deficiencies and difficulties.

Many paranatal factors may affect the condition of the newborn infant. With a knowledge of the relationship of neonatal condition to childhood maladjustment, it is hoped that all of these factors may be studied with a broader perspective for their possible effects beyond the first days of life.