bluuebunny/crossref_metadata_2025 huggingface dataset:
ACUTE STAPHYLOCOCCAL PERICARDITIS
Authors: Horan Jeanne M.
Published: December 2021

A survey of bacterial pericarditis in children at Charity Hospital shows an increasing preponderance of staphylococcal infections. It is impressively less common as a complication of pneumonia and osteomyelitis than it was two decades ago. The site of entry for organisms is usually difficult to determine, but the pericarditis is always part of a generalized infection. In a minority of the patients it is the outstanding therapeutic problem. Though the child may be critically ill with a poor prognosis, the outlook is better than it was in preantibiotic days. Treatment should be influenced by careful evaluation of sensitivity of the causative organism to various antibiotics; open pericardial drainage may be necessary if the clinical response is poor. Earlier diagnosis may improve the outlook, and this will depend on a high degree of suspicion. Other factors seem less important in prognosis. Constrictive pericarditis will probably not be a problem if recovery from the acute stage occurs.
SERIOUS UNTOWARD REACTIONS TO THERAPY WITH CORTISONE AND ADRENOCORTICOTROPIN IN PEDIATRIC PRACTICE (PART I)
Authors: Good Robert A. , Vernier Robert L. , Smith Richard T.
Published: December 2021

THE INTRODUCTION of cortisone and adrenocorticotropin (ACTH) into clinical medicine by Hench et al. has profoundly influenced both medical practice and medical science. Voluminous literature which has collected during the 5 years since their introduction establishes securely the effectiveness of these hormonal agents in diseases previously refractory to medical management.

In the laboratory these drugs have also opened whole fields to investigation with a new experimental approach. Data already available suggest that ultimate discovery of the basis of the action of cortisone and ACTH will carry broad inmplications concerning physiologic function and mechanisms of disease.

A natural consequence of the introduction of such potent and versatile weapons into clinical medicine is that they should be widely used. In almost every human disease, ranging from the common cold to disseminated malignancy, the steroid hormones and ACTH have been tried. For example, it can be factually stated that few truly ill patients reach the diagnostic medical center without having had at least small amounts of cortisone or ACTH, and it is the extremely unusual patient who reaches the necropsy table without the "benefit" of ACTH, cortisone or one of its analogues.

As these drugs have been studied, it has become ever more apparent that they are extraordinarily potent pharmacologic agents which effect or control mammalian physiology in multitudinous areas, perhaps in several different ways. More gradually it has been realized that their effects are not all beneficial. Because of enthusiasm engendered by the availability of potent new pharmacologic agents, reporting from most clinics to date has emphasized the dramatic beneficial effects and tended to minimize the untoward side effects, toxic reactions and potential hazards of hormone therapy.

It is the purpose of this report to review some of the hazards of treatment with cortisone and ACTH in pediatric practice.
A COMPARISON OF ORAL AND INTRAMUSCULAR BENZATHINE PENICILLIN G FOR THE PREVENTION OF STREPTOCOCCAL INFECTIONS AND RECURRENCES OF RHEUMATIC FEVER
Authors: Markowitz Milton , Ferencz Charlotte , Bonet Alberto
Published: December 2021

The incidence of recurrences of rheumatic fever and streptococcal infections in 50 rheumatic subjects receiving a 200,000 unit tablet of benzathine penicillin G daily was compared with that of 56 rheumatic patients receiving 1,200,000 units of benzathine penicillin G intramuscularly every 4 weeks.

Three children in the oral penicillin group, who did not take their medication regularly, developed recurrences of rheumatic fever. No recurrences occurred among the patients receiving parenteral penicillin.

In patients who took the oral medication regularly, the incidence of streptococcal infections, as determined by a significant rise in antistreptolysin O titer, was the same as in those who received penicillin intramuscularly. Group A streptococci were found in the throat in about the same number of patients in each group.

Only one patient receiving oral penicillin developed an allergic reaction in contrast to four in the intramuscular group. In 12 additional patients in the latter group, medication was discontinued because of repeated local reactions or because the injections upset the child emotionally.

During the period of this study, in children followed in an outpatient clinic, a single daily dose of oral benzathine penicillin G, taken regularly, proved as effective in the prevention of rheumatic fever as monthly intramuscular injections of 1,200,000 units of benzathine penicillin G. The disadvantage of parenteral penicillin is the occurrence of reactions. While the use of this method is preferable for patients who cannot be relied upon to take oral medication regularly, its routine use for all patients does not appear necessary.
STUDIES OF RESPIRATORY INSUFFICIENCY IN NEWBORN INFANTS
Authors: Miller Herbert C. , Smull Ned W.
Published: December 2021

Serial measurements have been made of the resting tidal and minute volumes and respiratory rates on 40 premature infants during the first 2 weeks after birth.

The 40 infants were divided into three groups according to the trend of their respiratory rates. Infants whose respiratory rates were normal from birth (Group I) had the highest mean resting tidal volumes during the first 2 weeks. Mean resting tidal volumes were significantly lower throughout the first week among infants whose respiratory rates were initially high during the first hour and subsequently declined to normal (Group II) and among infants whose respiratory rates significantly increased after the first hour (Group III). Infants in Group III had the lowest tidal volumes and the most severe degrees of respiratory insufficiency. The mean resting tidal volume among infants in Group III was less at the end of the first week than that of infants in Group I at the end of the first day. Although tidal volumes in infants in Group II were in general much lower than normal the first few days after birth, exceptions to this rule may occasionally be encountered.

Although all three groups showed an increase in mean tidal volumes of about 25% at the end of 24 hours over the volumes obtained during the first 3 hours after birth, the respiratory rates were different. In Group I the increase in tidal volume was accompanied by no significant change in respiratory rate; in Group II, by a significant decrease in respiratory rate; in Group III, by a significant increase in respiratory arte. During the second day Group III showed clinical improvement accompanied by a significant decrease in mean respiratory rate but not by any significant increase in mean tidal volume.

Fluctuations in mean minute volumes in Groups II and III on the first 2 days were largely dependent on changes in respiratory rates.
BLOOD PROTHROMBIN, PROCONVERTIN AND PROACCELERIN IN NORMAL INFANCY: QUESTIONABLE RELATIONSHIPS TO VITAMIN K
Authors: Fresh J. W. , Ferguson J. H. , Stamey C. , Morgan F. M. , Lewis J. H.
Published: December 2021

One hundred fourteen newborn infants were followed for the first 6 weeks of life by specific tests for concentrations of prothrombin, proconvertin and proaccelerin in the blood. The concentration of proaccelerin is usually above normal at birth, while those of the two other factors are below normal and fall further in the first 2 or 3 days as well as showing a secondary dip at some time in the second to the sixth week. These fluctuations are not significantly affected by small doses of vitamin K, given to mother before delivery or to infant at birth. This suggests an endogenous controlling mechanism. An experiment with a "synthetic plasma" suggests that the excess proaccelerin compensates for the deficiencies of the other two factors in preventing the normal infant from developing any bleeding condition.
PHYSICOCHEMICAL DIFFERENCES OF MUCOPROTEINS IN DUODENAL FLUID OF PATIENTS WITH CYSTIC FIBROSIS OF THE PANCREAS AND CONTROLS
Authors: di Sant'Agnese Paul A. , Dische Zacharias , Danilczenko Antonina
Published: December 2021

An abnormality of mucous secretions has been postulated repeatedly in order to explain many of the pathologic findings and clinical symptoms of cystic fibrosis of the pancreas. However, little evidence in support of this hypothesis has been forthcoming heretofore. Investigations reported in this paper have shown that the mucoproteins in duodenal fluid obtained from patients with cystic fibrosis of the pancreas have a different physicochemical behavior as compared with a group of controls.

In 89 out of 92 normal individuals and patients (children and adults) with a variety of disease the mucoproteins of duodenal contents after precipitation with an ethanol-benzene mixture were completely soluble in water. In 58 out of 64 patients with cystic fibrosis of the pancreas a considerable part of the precipitated mucoproteins was not soluble in water. This water-insoluble fraction could not be brought into solution by the action of trypsin, but dissolves in 1N NaOH after heating.

The water-insoluble mucoprotein was present in the duodenal contents of all patients with cystic fibrosis of the pancreas who also had pancreatic achylia, and in 8 of 14 patients with cystic fibrosis of the pancreas who had retained a significant degree of pancreatic function. Absence of a water-insoluble mucoprotein from the duodenal contents of 6 of the 64 children in whom the diagnosis of cystic fibrosis of the pancreas was established may be explained on the variablity of involvement in this disease.

The fact that a water-insoluble mucoprotein was recovered from the duodenal contents of three patients in whom the diagnosis of cystic fibrosis of the pancreas could not be established calls for additional observation; it is still possible that some or all of these three cases actually have this disease in an unrecognized form.

Complete correlation has not been demonstrable between the presence of water-insoluble mucoprotein in the duodenal contents and the fully established clinical and laboratory picture of cystic fibrosis of the pancreas. Lack of complete correlation does not interfere to an important degree with the usefulness of the determination of the solubility of the mucoprotein fraction of the duodenal content as a diagnostic measure.
SERIOUS UNTOWARD REACTIONS TO THERAPY WITH CORTISONE AND ADRENOCORTICOTROPIN IN PEDIATRIC PRACTICE (PART II)
Authors: Good Robert A. , Vernier Robert L. , Smith Richard T.
Published: December 2021

The problem confronting the pediatrician who considers the use of ACTH and cortisone in treatment of a patient is considered.

Serious untoward side reactions observed in the treatment of 340 children with ACTH and adrenocortical hormones are documented.

Potential hazards of treatment with ACTH and adrenocortical hormones, not yet expressed clinically, are indicated.

The implications of these observations in the use of ACTH and steroid hormones in clinical pediatrics are considered.
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION, American Academy of Pediatrics, Inc.
Published: December 2021

THE DEMONSTRATION of the importance of the content of solutes in the food of infants has introduced a new and important consideration in infant feeding. It is now apparent that a formula or diet satisfactory in all other respects may, under certain circumstances, be detrimental to the infant because of the excessive load of solutes presented to the kidney. Such circumstances include principally the feeding of unusually large amounts of electrolytes and protein to normal infants exposed to relatively high environmental temperatures for prolonged periods of time or to infants with renal insufficiency.

The purpose of the present communication is to consider whether any practical advantage is achieved by feeding a normal infant, in a normal environment, a formula containing fewer solutes or relatively more water than are contained in one composed of cow's milk and carbohydrate in the usual proportions, fed at a concentration of 150 ml/100 cal (20 cal/oz). From this point of view the question can be raised as to whether there is any advantage in feeding unusually dilute formulas to newborn infants.

Origin of the Renal Solute Load

The load of solutes requiring excretion by the kidneys is derived almost entirely from the protein and electrolyte in the diet. In Table I the content of nitrogen and electrolytes is listed for human and cow's milk. Also given in the table are calculated values for the approximate quantity of solutes requiring excretion by the kidney. It will be noted that an infant receiving 133 cal/kg from human milk would be required to excrete 14.0 m0sm/kg/day while an infant receiving 133 cal/kg from whole cow's milk without added carbohydrate would be required to excrete 60.9 m0sm/ kg/day. Furthermore, it is apparent that an infant receiving two-thirds of the calories from cow's milk and one-third from added carbohydrate would need to excrete only two-thirds the quantity of solutes excreted by the infant fed cow's milk without added carbohydrate (2/3 X 60.9 = 42.7 m0sm/kg/day).
SKIN TURGOR AS A QUANTITATIVE INDEX OF DEHYDRATION IN RATS
Authors: Laron Zvi , Crawford John D.
Published: December 2021

ADMISSIONS to hospitals in many areas of the world are still composed to a great extent of infants with severe dehydration secondary to diarrhea, vomiting, heat prostration and the like. Laboratory facilities are sometimes unavailable; frequently even when at hand, their analytic results are not returned with sufficient promptness to help in the initial therapeutic decisions. Thus, there are needed easy and at least semiquantitative methods of estimation of the extent of dehydration. Preferably these methods should be such that they can be carried out at the patient's bedside.

In pediatric and medical textbooks1-3 loss of skin turgor is often mentioned as a sign of dehydration. Apparently few efforts have been made to see whether there is a quantitative correlation between changes in skin turgor and extent of water boss. In the experiments to be reported, skin turgor has been quantitatively related to the extent of dehydration in rats. The correlation has been studied in two types of deficiency state, primary water depletion with relatively small loss of solute and, alternatively, primary solute depletion with concomitant water deficiency. The results obtained suggest that a standardized clinical technique of estimation of skin turgor may be of value in assessing degrees of dehydration and fill the aforementioned need for a simple bedside index.

MATERIAL AND METHODS

Albino rats weighing 230 to 310 gm were used. Two groups were studied: Group I consisted of 36 rats dehydrated for periods up to 50 hours by simple water deprivation, dry rat chow* being offered ad libitum meanwhile in order to reduce weight loss from inanition.
SKIN TURGOR AS A QUANTITATIVE INDEX OF DEHYDRATION IN CHILDREN
Authors: Laron Zvi
Published: December 2021

SKIN TURGOR measured quantitatively in rats with induced dehydration, has been demonstrated to vary with the degree of dehydration. However, two different correlations have been found depending on whether dehydration was primarily due to water loss or primarily due to loss of electrolyte as well as water.1

The present study was undertaken in an attempt to evaluate the application of this simple measurement to children. In the following report, the correlation of skin turgor time and degree of dehydration in children with primary water depletion and in children suffering from diarrhea are presented.

MATERIAL AND METHODS

The patients studied form two groups. The age distribution and the size of the groups are shown in Table I.

The patients in the first group were infants with diarrhea who were admitted to the isolation ward of the Children's Hospital of Pittsburgh during the winter of 1956. Determinations of the weight, skin turgor, concentrations of electrolytes in serum and nonprotein nitrogen in the blood were made before therapy with fluids was begun and afterwards at various intervals, usually 12 and 24 hours. Change in weight was used as an index of change in hydration. Normal weight was considered to be the weight achieved after complete rehydration as judged by clinical state and "plateauing" of the rapid weight gain. This method of assessment correlated well with the data obtained on three of the patients who happened to have been weighed by their own physician prior to their illness. Patients in whom complete rehydration was not achieved in 36 to 48 hours after admission to the hospital were excluded from this study.
ACUTE JEJUNAL OBSTRUCTION SECONDARY TO TRAUMATIC INTRAMURAL HEMATOMA
Authors: Moody E. Earl
Published: December 2021

This case report acids one more to the nine reported cases of intestinal obstruction in children due to hemorrhage occurring in the duodenum or jejunum following a minor nonpenetrating injury to the abdominal wall. Delay in making a correct diagnosis and instituting the proper treatment was due primarily in this case, as in all others reported, to a lack of knowledge that such obstruction could follow such an apparently minor injury to the abdominal wall. Nothing in the symptomatology, physical findings or laboratory data alone can be considered diagnostic of an intramural or subserosal hematoma in the intestinal tract. These, however, coupled with a history of trauma to the abdominal wall and roentgenograms which show the "coiled spring" appearance, lead to a correct diagnosis.
THE RHEUMATIC CHILD AND HIS WORLD
Authors: Galdston Iago
Published: December 2021

IT IS PROVERBIAL that a fool can ask more questions than a wise man can answer. It is not proverbial that for the question-asking fool there is some hope and for the others, none. Now it is my intention on this occasion to play the fool awhile, to ask a great number of questions, and I cordially invite you to join me in this game.

I want to inquire into The World of the Rheumatic Child, into his internal as well as into his external world, or, as Claude Bernard has phrased it, into his milieu interieur and into his milieu exterieur. Now there is some method to my folly, and it amounts to this. We know a great deal about the disease rheumatic fever and about its devastating effects within the body of its victim. But we do not know a great deal, indeed only a very little, about the victim within whose body the disease effects its devastations. I said—we know a great deal about the disease itself. In preparation for this talk I "re-surveyed the literature" and I found it, as I have known it to be, not only enormous in quantity but most impressive in quality. It is literally studded with masterpieces of etiologic research, of clinical surveys, of pathologic studies, of follow-up surveys, of epidemiologic analyses, and of therapeutic enterprises. In my review of the literature I came upon some old and esteemed friends whose works I had witnessed "in the making," the studies, for example, of Wyckoff, and those of Alfred Cohn; Claire Ling's penetrating statistical analyses, Pearl Raymond's biologic speculations, May Wilson's classical and encyclopedic résumé of knowledge—and upon a host of others, too numerous, really, to catalogue.
INFECTIOUS CROUP: I. ETIOLOGY
Authors: RABE EDWARD F.
Published: December 2021

Acute infectious croup can be divided into three etiologic categories; namely, diphtheritic croup, H. influenzae type B croup, and so-called "virus" croup. The clinical divisions of this disease, i.e., laryngitis, laryngotracheitis, and laryngotracheopneumonitis, are of prognostic value, but have no etiologic significance.
TREATMENT OF AN INFANT WITH PAROXYSMAL AURICULAR TACHYCARDIA
Authors: MOORE ROBERT L.
Published: December 2021

Paroxysmal tachycardia occurs more frequently in infants, than is generally recognized; and, undoubtedly, is frequently misdiagnosed.

A case is reported of an infant who had 31 attacks of paroxysmal tachycardia between the ages of eight days and five and a half months. Many of the paroxysms would not stop spontaneously and heart failure would occur.

Quinidine, acetyl-beta-methylcholine, and digitalis were all found to be effective in controlling the attacks. The first two seemed to be more effective than the last. Because of the violent reaction to acetyl-beta-methylcholine, it is thought best to use this method only if the other two fail to bring relief.
Round Table Discussion
Authors: MCBRYDE ANGUS , MULHERIN PHILIP A. , HARRIS JEROME S. , LONDON ARTHUR H.
Published: December 2021

Chairman McBryde: Diarrhea is a symptom which may result from many causes. For the sake of simplicity let us state that it may be due to (1) enteric infections, notably the dysentery and salmonella groups, (2) to parenteral infections, and (3) the absence of those factors which result in the relative freedom from severe diarrhea in the private patient group. These factors are proper food, as to quantity, quality, and clean preparation, reasonable clothing, adequate vitamin intake, regularity of schedule, regular advice as to feeding, and the tendency to seek medical advice at an early hour. These factors often do not obtain in the rural and lower economic classes due to ignorance, to lack of cleanliness and to the remoteness or non-availability of medical advice and hospital facilities. I would like to show the following slides concerning the incidence of diarrhea.

Slide #1 is taken from reports of the Bureau of Census and is probably grossly inaccurate. Nevertheless it shows the general trend of infant mortality rates due to diarrhea and enteritis under one year of age in the United States. There has been a steady decrease in the death rate from diarrhea and enteritis under one year of age from a level of 44 per 1000 population in the ago group in 1900 to only 4 in 1940. Many of the data here are from estimated figures. The roles played by the development of logical infant feeding with clean milk, education of the public, increased medical knowledge, and availability of medical care need not be commented upon.

The following table shows the infant mortality (death under 1 year per 1000 living births) from diarrhea and enteritis for individual states for the year 1940, exclusive of reported cases of dysentery, and is quite instructive. Lack of proper bacteriologic studies again cloud the data. It can be seen, however, that we are in an appropriate area for the discussion of the management of diarrhea in infancy. The states not listed have mortality rates between 1.2 and 3. Dysentery rates, especially in the southern states are about one-tenth those of diarrhea and enteritis, while in the north few dysentery deaths are reported.
Proceeding of Conference on Methods for Evaluating Nutritional Status of Mothers, Infants and Children
Authors: STUART HAROLD C.
Published: December 2021

The comments of Dr. Icie Macy Hoobler, Chairman, and 22 guest conferees, well qualified to discuss this subject, are reported in the Conference Proceedings. The first half of this Report is devoted to problems relating to the determination of food intakes and the conversion of items of foods into specific nutrients.

The diet history is contrasted with a food intake record, the former being an attempt to find an "average" intake drawn from a long period of time, while the latter aims at recording accurately what was eaten during a short but specific period. Either a three or a seven day period is usually chosen for the food intake record. It is stressed that the diet history should be taken by an experienced interviewer who has the ability to obtain the desired information regarding the patient's food habits.
EDITORIAL
Authors: WHEATLEY GEORGE M.
Published: December 2021

THE application of the principles of preventive medicine to children has brought about almost unbelievable improvement in mortality from the so-called common childhood diseases. In fact, the control today over smallpox, diphtheria, the diarrheal diseases, pneumonia, and others, has brought pediatrics face to face with the present leading cause of childhood mortality—accidents. Accidents not only kill more children after infancy than does any single disease but also, in the ages from one to 14 inclusive, accidents take as many lives as pneumonia, diarrhea and enteritis, measles, diphtheria, meningitis, poliomyelitis, whooping cough, and scarlet fever combined.

This month the Academy, in cooperation with the U. S. Children's Bureau, the National Safety Council, and the Metropolitan Life Insurance Company, is beginning a sustained national effort to reduce accidents to young children.
TOXOPLASMOSIS IN CHILDREN
Authors: ADAMS FORREST H. , ADAMS JOHN M. , KABLER PAUL , COONEY MARIAN
Published: December 2021

Five proven cases of toxoplasmosis in infants and nine cases in which the clinical and laboratory evidence strongly suggested this diagnosis in infants and children are presented.

We have pointed out that only one or two of the cardinal manifestations may be evident in a patient in whom the diagnosis has been established by the finding of the typical pathologic lesions and the organism. This was the case in two of the patients reported, both of whom had internal hydrocephalus but did not have either cerebral calcification or chorioretinitis.

The presence of internal hydrocephalus particularly with spinal fluid changes such as elevated protein and pleocytosis should suggest to the clinician the diagnosis of toxoplasmosis. When the classical triad or tetrad of symptoms and signs of the disease is present and the neutralization test is positive, the diagnosis probably should be made since isolation of the organism from the patient is so difficult at the present time.

Jaundice can be the presenting complaint in a patient with congenital toxoplasmosis.
REPLACEMENT TRANSFUSION AS A TREATMENT FOR ERYTHROBLASTOSIS FETALIS
Authors: DIAMOND LOUIS K.
Published: December 2021

THE treatment of hemolytic anemia of the newborn often requires support by compatible blood transfusions. In the years before the discovery of the Rh factor, such blood was usually compatible only according to the A-B-O group, and for convenience the patient's father was often used as a donor. This meant the use of Rh-positive blood. It was found frequently at this time that the infants' blood levels tended to fall rapidly even with repeated transfusions. In many such cases the infused Rh-positive cells are destroyed much more rapidly than are Rh-negative cells as shown by Mollison in England and confirmed by us. It seemed best, therefore, as a first step in improving treatment, to use only Rh-negative blood as a means of achieving the highest blood levels for protection of the patient, and this step was logically inaugurated after 1941.

In the more acute and severe cases of erythroblastosis the infant's anemia often progressed so rapidly in the first 48 hours that several small transfusions proved inadequate. In such patients, by recently developed technics, it has been possible to demonstrate that the serum of the baby still contains free maternal anti-Rh agglutinins and that all of the infant's own red blood cells are often completely coated with this antibody leading probably to a more rapid destruction of the infant's cells. The removal of as much as possible of the baby's own blood should theoretically help diminish the damage resulting from the presence of this free and bound antibody in the circulation and in the tissues. Such reasoning led to the trial of replacement transfusion for the treatment of erythroblastosis. Replacement transfusion is not a new procedure in pediatric practice as many of you know, but to perform it in a newborn infant has added difficulty to an inherently difficult technic.

The earlier method consisted of entering the longitudinal sinus and a peripheral vein, or two peripheral veins, or a vein and an artery. These usually required more or less body exposure for a newborn infant on an operating table, often requiring an hour or more for the procedure and this sometimes caused shock-like symptoms from cold and trauma.
Round Table Discussion
Authors: HARTMANN ALEXIS F.
Published: December 2021

Acidosis and alkalosis are terms used to describe opposite types of disturbance of acid-base balance of the body fluids. From the chemical point of view acidosis may be defined as the condition in the blood characterized by a reduction of the BHCO3/HHCO3 ratio, and alkalosis as an increase. When BHCO3 is primarily affected, the disturbance is referred to as metabolic in origin; when HHCO3 concentration is the first to be altered, the resulting change is considered to be of respiratory origin. Primary changes of either BHCO3 or HHCO3 usually stimulate compensatory changes in the other which tend to restore the original normal ratio. When compensation for acidosis is incomplete, an increased H+ ion concentration (decreased pH) of the blood results, and such a change is referred to as acidemia. The opposite condition is called alkalemia.

From the clinical point of view a much broader concept of acidosis and alkalosis exists and includes in addition all related changes in metabolism (carbohydrate, fat, protein, water, mineral, enzyme) which may give rise to definite symptoms and signs of illness. Such metabolic changes may be either primary or secondary, and, as either, may be very important in determining prognosis as to life or death.

In practice one is prompted to consider the possibility of acidosis or alkalosis by noting suspicious signs or symptoms and then diagnoses with certainty the presence and extent of change by chemical determinations of serum CO2 content and pH.

The most important signs and symptoms of acidosis are: hyperpnea, which is considered not primary, stupor, dehydration, ketosis and strongly acid urine. Any or all may be absent. The most important signs and symptoms of alkalosis are: depressed respiration, considered compensatory, or hyperventilation, considered primary, tetany, and forceful vomiting, thought to be the result of pyloric or high intestinal obstruction, and strongly alkaline urine. Again any or all such symptoms may be absent. Furthermore, ketosis may be associated with alkalosis; secretion of alkaline urine may give rise to acidosis, and alkalosis may be accompanied by formation of acid urine. Also, it is not unusual to see in the same subject conditions favoring the development of both acidosis and alkalosis, but with the presence of neither.

For absolute diagnosis of acidosis or alkalosis two of the three variables, BHCO3, HHCO3 and pH have to be determined. Since pH and BHCO3 usually move in the same direction, it has been widespread clinical practice to determine only BHCO3 by determining serum CO2 content by the Van Slyke manometric method. In this connection it should be remembered that when so determined about 20/21 of the CO2 comes from BHCO3, the remainder coming from HHCO3 In the past it was customary not to separate BHCO3 and HHCO3, but to record them together as the total CO2 content.
THE VARIABILITY IN MANIFESTATIONS OF UNTREATED PATIENTS WITH PHENYLKETONURIA (PHENYLPYRUVIC ACIDURIA)
Authors: Paine Richmond S.
Published: December 2021

One hundred six cases of phenylketonuria have been surveyed in 11 institutions in New England and Eastern Canada.

Data not previously available (and of some degree of uncertainty as to reliability) are presented as to the ages at which patients with phenylketonuria achieve the ability to sit unsupported, to walk independently, and to say recognizable words. A small number of patients achieve these steps at reasonably near the normal age and the degree of variability is such that early developmental timetables should not be overemphasized in interpreting possible effects of any treatment of the disease.

Both eczema and seizures are proportionately more frequent in severely retarded patients with phenylketonuria than in those with lesser degrees of intellectual defect. If present at the time an experimental treatment is instituted, they would provide more objective evidence of possible benefit. Electroencephalograms were abnormal in 79% of patients for whom tracings were available and would provide one means of evaluating plans of treatment even in the absence of seizures.

While the majority of these patients have blue eyes and blond hair, there is enough evidence to suggest a tendency to darkening of the hair with age that this also should be used with caution in evaluation of treatment.

Frequencies of various neurologic manifestations are presented, including unusual hand posturing, tremor, hyperreflexia, clonus and spasticity. These are all variable enough that a reasonably positive diagnosis [See FIG. 2. in Source Pdf.] by physical examination is not possible, and further, they are not well adapted to evaluation of treatment.

The distribution of intelligence quotients in patients with phenylketonuria appears to follow a continuous curve and to include a small number of persons with borderline normal or better intelligence. In assessing the effect of any treatment, it is unwarranted to ascribe to that treatment the attainment of borderline normal intellectual levels that may be reached by small numbers of patients, especially if originally tested in infancy or early childhood.

The effect of any therapy can be adequately evaluated only by comparing changes in a number of treated patients with phenylketonuria, with changes in comparable control patients, selected on the basis of intelligence, age, physical accomplishments, and status with respect to hair color, eczema, convulsive seizures and electroencephalographic findings.
PUBLIC HEALTH, NURSING, MEDICAL SOCIAL WORK
Authors: Wallace Helen M. , Igel Amelia , Losty Margaret A.
Published: December 2021

Need for a foster home placement program for handicapped children in an urban area was demonstrated by sending a questionnaire to hospitals and convalescent homes, and by careful review of certain children whose inpatient care was being paid for by the official Crippled Children Program. The outstanding fact was that a significant number of handicapped children were being retained in institutions for social, and not medical, reasons. Agreement was reached among social agencies that a co-ordinated community program for foster home placement of handicapped children was necessary but a definitive method was not evolved nor were adequate funds secured to finance costs.
Beyond Newborn Resuscitation: Essential Care for Every Baby and Small Babies
Authors: Berkelhamer Sara K. , McMillan Douglas D. , Amick Erick , Singhal Nalini , Bose Carl L.
Published: December 2021

Helping Babies Breathe (HBB) addresses a major cause of newborn mortality by teaching basic steps of neonatal resuscitation and improving survival rates of infants affected by intrapartum-related events or asphyxia. Addressing the additional top causes of mortality (infection and prematurity) requires more comprehensive education, including content on thermal and nutritional support, breastfeeding, and alternative feeding strategies, as well as recognition and treatment of infection. Essential Care for Every Baby (ECEB) and Essential Care for Small Babies (ECSB) use educational principles developed with HBB as a model for teaching basic newborn care. These programs complement the content provided with HBB, further integrate counseling of families, and advance the agenda of providing quality care to all infants at birth. ECEB and ECSB have further demonstrated that engagement of individuals through active participation in their education empowers providers at all levels. With added experience teaching and implementing ECEB and ECSB, the next generation of newborn educational programs will likely incorporate bedside teaching and clinical exposure, multimedia platforms for demonstrating clinical content, and added efforts toward quality improvement. Through ECEB and ECSB, the attention brought to the newborn health agenda with HBB has only grown. Although current global health issues pose new challenges in implementing this agenda, these programs together provide a critical framework to both educate and advocate for optimal care of every newborn.
Development and Impact of Helping Babies Breathe Educational Methodology
Authors: Singhal Nalini , McMillan Douglas D. , Savich Renate , Matovelo Dismas , Santorino Data , Kamath-Rayne Beena D.
Published: December 2021

The educational pedagogy surrounding Helping Babies Breathe (HBB) has been transformative in going beyond a curriculum focused only on basic neonatal resuscitation; indeed, it created the framework for an educational program that has served as a model for replication for other impactful programs, such as the Helping Mothers Survive and other Helping Babies Survive curricula. The tenets of HBB include incorporation of innovative learning strategies such as small group discussion, skills-based learning, simulation and debriefing, and peer-to-peer learning, all of which begin the hard work of changing behaviors that may eventually affect health care systems. Allowing for adaptation for local resources and culture, HBB has catalyzed innovation in the development of simplified, pictorial educational materials, in addition to low-tech yet realistic simulators and adjunct devices that have played an important role in empowering health care professionals in their care of newborns, thereby improving outcomes. In this review, we describe the development of HBB as an educational program, the importance of field testing and input from multiple stakeholders including frontline workers, the strategies behind the components of educational materials, and the impact of its pedagogy on learning.
THE VALUE OF MICROSCOPIC EXAMINATION OF THE STOOL FOR EXTRACELLULAR STARCH IN THE DIAGNOSIS OF STARCH INTOLERANCE
Authors: Davidson Murray , Bauer Charles H.
Published: December 2021

Among 203 casually passed stool specimens obtained from children with no apparent gastrointestinal disease, 43% contained some extracellular starch by microscopic examination.

By prematurely emptying the rectum with a small enema, the amount of extracellular starch found microscopically could be increased.

If the colon is "sterilized" with neomycin, the content of microscopic extracellular starch of casually-passed stools will likewise be increased.

It is concluded that the presence of some microscopic extracellular starch in the stool is normal, and that in diarrheal states not related to starch malabsorption the content of extracellular starch would be increased.

It is suggested therefore, that the iodine test for extracellular starch in stools is not a useful tool, and that the diagnosis of starch malabsorption cannot be made on the basis of an "increased" content of extracellular starch demonstrated by this technic.
VISCERAL SQUAMOUS CANCER IN CHILDREN
Authors: Moore Condict
Published: December 2021

Cases of squamous carcinomas, excluding carcinoma of the skin, reported in children have been reviewed. The disease is a medical curiosity.

Most squamous carcinomas in children have occurred in the mouth and pharyngeal region.

There is no evidence that these squamous cancers do not respond to the same methods of treatment and to the same degree as do the squamous cancers in adults.

A case is reported of a patient with squamous carcinoma of the tongue, treated by surgery, who is living and well nearly 2 years after therapy.
EXPERIENCES WITH MEPROBAMATE IN CEREBRAL PALSY
Authors: Charash Leon I. , Cooper William
Published: December 2021

A group of 40 patients with cerebral palsy of various types and degrees of severity has been studied carefully while receiving meprobamate therapy. In 11 of these patients (27.5%), the medication caused a definite deterioration in clinical status. In all cases this proved to be reversible after discontinuation of the medication. In 12 patients (30%) there was no change in the clinical status despite the fact that the medication was given over a period of at least 2 months to the point of inducing drowsiness. Seventeen patients (42.5%) experienced initial improvement of a subjective and objective nature, but this was sustained in only four patients (10%) and in these it was purely subjective. In no case was there any permanent objective evidence of improvement.

Of the 14 patients in whom the medication was abruptly discontinued, five (35.5%) developed prominent withdrawal symptoms. The remaining 26 patients, from whom the medication was gradually withdrawn over a period of 2 to 3 days, did not demonstrate these manifestations.

It is not the intention of the authors to discredit the use of chemical agents in cerebral palsy. The search will surely go on and there may be optimism that research will eventually produce an agent with some specificity for cerebral palsy.
EPIDEMIOLOGY OF A STREPTOCOCCAL OUTBREAK IN A SCHOOL: ATTEMPT AT CONTROL BY MASS PROPHYLAXIS WITH PENICILLIN V
Authors: Poskanzer David C. , Feldman Harry A. , Mou Thomas W. , Kuroda Kenzo
Published: December 2021

An attempt was made to abort an epidemic of streptococcal infection in a rural school including kindergarten through third grade by the use of mass, oral penicillin V prophylaxis for 10 days. Half of the classes received 200,000 units of penicillin V once daily and the others received two doses daily. In both instances, there was a decline in the carrier rates but neither regimen was entirely satisfactory. Unusual resistance to penicillin could not be demonstrated in streptococci isolated after the treatment period.

Carrier studies were conducted in 124 families of children in the school sample. Prior to the prophylaxis regimen the carrier rate for Group A streptococci was 7% for adults more than 24 years of age and 24% in their children in the school being studied. Forty families which did not have children in the school also were cultured. None of the adults more than 24 years of age in this group was found to have streptococci in contrast with 4% of adults (cultured the same day) in the school-associated families. These observations tend to support the hypothesis that the school is the focus of infection and that families with children in school have a higher rate of infection than families without children in school. However, in both groups of families the adults appeared to be relatively resistant to infection.

Within the school, the focus of infection appeared to be the individual classroom rather than the grade level. Rates of positive cultures for Group A streptococci in different classrooms within the same grade ranged from 0 to 71%.

Numerous isolations of Group C streptococci were made in the school population. The age distribution paralleled the age distribution of the children from whom Group A organisms were isolated. In addition, titers of antistreptolysin-O in persons from whom Group C organisms were isolated were similar to those in persons with Group A strains. It is suggested that Group C infections may have contributed to the course of the epidemic.
FOOD ALLERGY AND FOOD INTOLERANCE IN RELATION TO THE DEVELOPMENT OF GOOD EATING HABITS
Authors: Pratt Edward L.
Published: December 2021

The clinician caring for infants and children does not wish to interfere unnecessarily with their diets and thereby jeopardize their nutrition and their development of good eating habits. Yet serious illness may be completely relieved by eliminating an offending ingestant, so the physician does not wish to overlook this therapeutic measure. If he turns to recent medical reports for help, he is confused and bewildered by the varying definitions and by the lack of critical judgment applied to the cases reported. When a patient improves after removing a food from his diet, is it the result of the quantity, quality or pharmacologic properties of the food or because of the psychologic associations with the food? If a purified fraction of the food, administered—withheld—readministered under controlled conditions appropriately produces symptoms, is this an example of intolerance or allergy?

The need is urgent for extensive investigations of the basic mechanisms and for sound clinical studies in the fields of food intolerance and, particularly, of food allergy. Continuation of noncritical attitudes towards food allergy can only further debase this subject and may well lead to neglect of its true value, to the detriment of the patients. "If the gravity of decisions in medical research are greater than in other research, so much greater is the need to plan the investigations for the avoidance of bias and for the elimination of subjective judgments about alternative explanations of the results."

At the present time, one must conclude that the physician should respect the importance of promoting good eating habits and that, while he should readily suspect foods as a cause of symptoms, he will accept this situation only after carefully designed studies of the patient demonstrate it. Otherwise: "Cava medicum, nocere atque sanare potest!" (Beware of the physician: he can harm as well as heal!)
REMARKS AT THE PRESENTATION OF THE PORTRAIT OF JOHN HOWLAND
Authors: Gamble James L.
Published: December 2021

WE OWE Edwards A. Park a large debt for the sketch of John Howland illustrated by anecdotes displaying his personality which he gave us in his John Howland address.

Howland was a New Englander to the core and a loyal son of Yale of the Class of '94. His medical career began in New York where, after 3 years as a student in New York University Medical School and a 2-year internship at the Presbyterian Hospital, he became associated with L. Emmett Holt, Sr. and decided to enter the then opening field of pediatrics. His fine abilities as a physician were rapidly recognized. He also began his investigative career in New York.

In the year 1910 at the age of 39 he was appointed Professor of Pediatrics at the Medical School of Washington University in St. Louis, which had just been reorganized on a full-time basis. He was disappointed by the inadequacy of the equipment there and unwilling to wait several years for the building of the projected new hospital. He resigned after 6 months and returned to New York.

This hiatus in his careen in academic medicine was a short one. In the year 1912 he was called to the chair of Pediatrics at the Johns Hopkins Medical School to succeed Von Pirquet who had returned to Germany to accept the professorship at Breslau. This was a much coveted post. Also, I have been told, he was much aggrieved over having contracted trichinosis from eating Baltimore sausages.

During the 2 years that Von Pirquet was in Baltimore, the Department of Pediatrics had no quarters of its own and was obliged to use space borrowed from the Medical Outpatient.
The Mentally Ill Child
Authors: KUGEL ROBERT B.
Published: December 2021

The subtitle of this book, A Guide for Parents, indicates the group for whom the authors wrote. Unfortunately such books written by professional workers often are presented in such a way that the content is either too simple or too complex so as to be of very little use to parents. Such would seem to be the situation with this book.

The title gives one the impression that this book might deal with some of the problems which confront parents of emotionally disturbed children.
MULTIPLE SCLEROSIS IN CHILDREN
Authors: Gall John C. , Hayles Alvin B. , Siekert Robert G. , Keith Haddow M.
Published: December 2021

Forty cases of disease of the central nervous system, characterized by several episodes and disseminated lesions, with onset in childhood and clinically typical of multiple sclerosis, were studied.

The disease as it occurs in children does not appear to differ clinically from the disease as observed in adults, in respect to mode of onset, symptoms, physical findings, and changes in the spinal fluid. In the Mayo Clinic series, however, almost twice as many girls as boys were affected.

A pediatrician confronted with a child showing evidence of scattered neurologic deficits that remit, particularly a disturbance of vision and co-ordination, should consider the possibility of multiple sclerosis.