bluuebunny/crossref_metadata_2025 huggingface dataset:
GRULEE AWARD
Authors: GRULEE CLIFFORD G.
Published: December 2021

IT IS WITH great pleasure that I accept the privilege of making the Clifford G. Grulee Award for 1959. This is the ninth time the Award has been made since its creation in 1951.

The Clifford G. Grulee Award is made to a non-office holding member of the American Academy of Pediatrics for outstanding service to the Academy and its programs. It is regarded as the greatest honor the Academy can bestow upon one of its Fellows.

This year the recipient of the Grulee Award, Dr. Wyman C. C. Cole, is well known to all of us.

Dr. Cole was born in Minneapolis in 1893. He attended the University of Minnesota and graduated from the Medical School of that University in 1919.

After doing his internship and residency training at the University Hospital in Minneapolis, Dr. Cole moved to Detroit to practice pediatrics. He is Chief of the Pediatric Department at Woman's Hospital; a senior physician at Harper Hospital, and is on the faculty at Wayne University School of Medicine.

Dr. Cole has served as Academy State Chairman for Michigan, as well as a member of the Academy's Nominating Committee. For several years he was Secretary of the Pediatric Section of the American Medical Association and last year was Chairman of the Section.

It is felt that Dr. Cole's principal contribution to the Academy was his service as Chairman of the American Academy of Pediatrics' Committee on Fetus and Newborn from 1952 to 1957. During this period Dr. Cole guided the committee in the preparation of the 1954 and the 1957 editions of Standards and Recommendations for the Hospital Care of Newborn Infants. This publication is very highly regarded and has been widely distributed. Before retiring from the committee Dr. Cole supervised the preparation of the manuscript for the pamphlet Resuscitation of the Newborn Infant and suggested the mode of distribution which has resulted in 80,000 copies of this booklet being sent to pediatricians, obstetricians, general practitioners and hospital administrators.

Though not an Academy effort, it is of interest to know that Dr. Cole has a son, Dr. Wyman C. C. Cole, Jr., who is also a Fellow of the Academy.

It is with great pleasure that I present this medal symbolizing the Grulee Award to Dr. Cole.
Orthodontics
Authors: CARTER WM. J.
Published: December 2021

In the October issue of Pediatrics (24:686, 1959), Dr. George Bates asked whether methods of orthodontic treatment could be developed which are simpler and more adaptable to the average family budget. Dr. Cohen, who authored the original article (Pediatrics, 23:956, 1959), replied by giving five excellent recommendations to remedy the problem confronting the dental profession. I feel that one phase, preventive orthodontics, deserves additional comment. The situation of increasing the number of trained orthodontists is not easy to remedy either now or in the immediate future. The cost of orthodontic therapy is also not likely to be significantly lower. Any treatment which involves an extended period of therapy ranging from 18 to 36 months is costly regardless of whether it be done by a pediatrician, orthopedist or orthodontist. Therefore, the very nature of treating complicated malocclusions in the permanent dentition is tedious, time-consuming and accordingly expensive.
CLINICAL SYNDROMES ASSOCIATED WITH DEFICIENT FIBRINOLYTIC ACTIVITY OF THE LUNG
Authors: Lieberman Jack
Published: December 2021

Plasminogen-activator activity in lung was investigated in 211 controls and 8 children with fibrocystic disease of the pancreas. Twenty-seven of the 211 controls lacked enzyme activity of the whole lung homogenate, while 7 out of the 8 specimens from children with fibrocystic disease lacked activity. The defect in all 7 of the specimens from patients with fibrocystic disease was shown to be due to excessive inhibition, and the inhibitor could easily be removed by washing the lung sediment with normal saline solution. Eight of the controls showed a similar pattern of enzyme inhibition.

A new hypothesis as to the pathogenesis of fibrocystic disease is proposed which postulates the existence of an abnormal protease inhibitor in both the lungs and pancreas. The manner in which such an enzyme defect could account for the manifestations of the disease, and the possible role of a proteolytic enzyme in mucoprotein synthesis are discussed.
PNEUMOCYSTIS CARINII PNEUMONIA
Authors: Wilson Joyce F. , Crass Gwendolyn , Garza Bettie L.
Published: December 2021

PNEUMOCYSTIS pneumonia, considered by Jirovec in 1954 to be "one of the most serious medical problems in the whole of Europe," has until quite recently received little attention in the United States. This entity, which occurs endemically or epidemically within hospital nurseries, appears to have a predilection for premature or dystrophic infants, although it has been reported several times in adult subjects. Three recent review articles describe the taxonomy of the parasite as being controversial and the mode of transmission unknown. Definitive ante-mortem diagnosis is difficult. Treatment is unsatisfactory and mortality ranges from 15 to 100%. During the past few years over 2,000 cases of interstitial plasma cell pneumonia attributed to Pneumocystis carinii have been described from Czechoslovakia, Germany, Austria, Switzerland, Hungary, Yugoslavia, Denmark, France, Italy, Sweden, Finland, Scotland, England, Canada, Australia, Brazil, Chile, the United States, and most recently from South Africa.

The first case of interstitial plasma cell pneumonia in the United States was reported in 1955 by Lunseth et al. Although their patient, a 7-week-old male, manifested clinical symptoms consistent with plasmacytic pneumonia, no characteristic alveolar exudate was demonstrated, and no mention was made of Pneumocystis carinii as the causative agent. Kitto in 1957 reviewed lung sections from nine infants who had died of interstitial pneumonia during a 7-year period at a North Dakota hospital. He found a 4½-month-old female in whom the pulmonary alveolar septae were infiltrated with monocytic cells, many of which had the appearance of plasma cells. It was believed that the interstitial infiltration of plasma cells coupled with the history of recurrent respiratory tract infection justified the presumptive diagnosis of interstitial plasma cell pneumonia; however, he stated, "no staining techniques to demonstrate the presence of the parasite in lung sections were attemped."

As seen in Table I, only eight deaths due to interstitial plasma cell pneumonia in which Pneumocystis carinii has been unequivocally demonstrated have been reported from the United States: one from Connecticut, two from Oklahoma, one from Georgia, one from Arizona, one from California, one from Louisiana, and the case here reported from Texas.
Medical Research Council Special Report Series No. 296. Weight Gains, Serum Protein Levels, and Health of Breast-fed and Artificially-fed Infants. A Clinical and Biochemical Study Based on 946 Infants and Children at The Mother's Hospital (Salvation Army) and The Queen Elizabeth Hospital for Children
Authors: FOMON SAMUEL J.
Published: December 2021

Longitudinal observation of weight grains and concentrations of protein in the serum of 744 infants (521 full-term and 223 premature) are presented in considerable detail. The presentation of the data well illustrates the complexities of analysis of data concerning gain in weight in the first year of life. Data concerning growth in length are not presented.

Premature infants receiving a formula of ½-skimmed cow's milk with added carbohydrate gained weight more rapidly than did those fed human milk. The difference was greatest with respect to infants with lowest birth weights.
Acetazolamide in Therapy of Salicylate Poisoning
Authors: BONGIOVANNI ALFRED M.
Published: December 2021

The study on salicylate poisoning by Feuerstein et al. (Pediatrics, 25:215, 1960) is extraordinarily well documented. It is refreshing to find numerous levels of salicylate in the bloods of their subjects in Table II.

One cannot help recall that only yesterday, the program of treatment recommended by Coburn for rheumatic fever required salicylate blood levels in the neighborhood of 35 mg/100 ml. I personally remember several cases where this level was exceeded and, indeed, such an occurrence was not uncommon in the course of seeking to achieve this "ideal" blood concentration.
MULTIPLE GENETIC MECHANISMS IN VITAMIN D-RESISTANT RICKETS
Authors: WINTERS ROBERT W. , GRAHAM JOHN B.
Published: December 2021

VITAMIN D-resistant rickets of the "simple" type is one of the most commonly encountered forms of metabolic bone disease in modern pediatric practice. In this disorder, rickets similar to that due to vitamin D deficiency develops in the face of usually adequate amounts of vitamin D and heals only with massive and sustained doses of the vitamin. Biochemically, the cardinal abnormality is hypophosphatemia, apparently the result of diminished tubular reabsorption of phosphate from the glomerular filtrate. Whether the renal abnormality is based upon a primary defect within the tubule cell or is a secondary effect, as for example from secondary hyperparathyroidism, is not yet known.
COCKAYNE'S SYNDROME
Authors: Macdonald William B. , Fitch Kenneth D. , Lewis Ian C.
Published: December 2021

A syndrome of heredo-familial dwarfism with multiple disturbances of growth and development is described in three of a family of five children.

Since the original description by Cockayne 24 years ago, only one other family and one isolated case similarly affected, have been recorded. Although the syndrome resembles progeria in certain respects, it appears to be a distinct entity, with many features not found in progeria. This is supported by normal plasma lipids.

The disorder may be due to an inborn error of metabolism, but attempts to identify the nature of this have not been successful.
IDIOPATHIC PERFORATION OF THE SMALL INTESTINE IN THE NEONATAL PERIOD
Authors: Hyde George A. , Santulli Thomas V.
Published: December 2021

Five cases of idiopathic perforation of the small intestine in the neonatal period are presented.

Four of the five patients were premature; two survived.

The etiology, pathology, diagnosis and surgical treatment are discussed.
RESECTION AND PRIMARY ANASTOMOSIS IN THE MANAGEMENT OF STENOSIS AND ATRESIA OF THE JEJUNUM AND ILEUM
Authors: Benson Clifford D. , Lloyd James R. , Smith J. Dwight
Published: December 2021

An analysis of 38 cases of congenital jejunal and ileal stenosis and atresia is presented. There was an overall survival rate of 55%. Between the years 1952 and 1959, the survival rate was 62% compared to 33% for the years 1945 to 1951.

Recent concepts of the etiology of these lesions are discussed. Physiologic and anatomic considerations are presented. The authors' program for the surgical management and technical aspects of the operative procedures are outlined.
MACROCEPHALY, PSEUDOPAPILLEDEMA AND MULTIPLE HEMANGIOMATA
Authors: Riley Harris D. , Smith William R.
Published: December 2021

Observations are presented from a family of whom five members exhibited a symptom-complex or syndrome, an entity which is genetically transmitted. The main features are macrocephaly, pseudopapilledema and multiple hemangiomata. To the authors' knowledge this syndrome has not been described previously.
ELLIS-VAN CREVELD SYNDROME
Authors: Alvarez-Borja Arturo
Published: December 2021

Two siblings with Ellis-Van Creveld disease are presented. They both had polydactyly, dystrophy of nails and teeth, and skeletal malformations characteristic of this disease. No evidence of congenital heart disease was present.

The skeletal abnormalities were progressively distalward shortening of segments with characteristic bone malformations previously described in other cases, such as, curving of humeri and of some metacarpal bones; acceleration of the secondary ossification centers and retardation of the primary centers of the hand bones; increased bone age; typical abnormalities in the area of the proximal ends of the tibiae. Unilateral synmetacarpalism was present in one case.

Horizontal clavicles, zones of apparent osteosclerosis intermingled with areas of radiotranslucency, mainly in the distal ends of both tibiae and fibulae, and lack of the third cuneiform bones bilaterally in one case, are believed to be new findings. Lopped ears may be incidental.

The histopathologic picture found in the amputated fingers seems typical of this disease. A brief discussion of it, and a correlation with the radiologic picture is attempted.

These two cases bring more evidence in favor of heredity as a factor in this disease. The mechanism of multiple genes located in different chromosomes is invoked.

Three new skeletal abnormalities are presented.
INFANT FEEDING PRACTICES IN ISRAEL
Authors: Thaustein Jenny , Halevi Haim Shalom , Mundel George
Published: December 2021

Almost 100% of mothers in Israel, irrespective of their cultural background, start breast feeding their infants. This is in accordance with the accepted policy of the medical and nursing professions in Israel.

Complete breast feeding is continued only for a relatively short period. At the end of the second month of life, half the infants already receive complementary food, and only 5% are exclusively breast-fed during their fifth month.

Partial breast feeding is continued in 50% of the infants until the ninth month, and for a small fraction of the sample (mainly Sepharadim and Arabs) this continues until the middle of the second year of life.

The complementary food contains all the essential nutrients for the healthy development of infants, although no quantitative measurements were made in this study. The intakes of protein supplement and vitamins A and D lag behind the recommended schedules, especially among the groups of oriental origin.

There are no striking differences in the pattern of feeding and weaning in the various groups. Apparently the different patterns of feeding "imported" by immigrants from the various countries rapidly become integrated in Israel; there is an impression that a national pattern is evolving. The guidance given by the preventive services for mothers is particularly instrumental in this direction. This guidance is especially evident in the way complementary feeding is introduced and in the way the decision on weaning is made.
THE CORRECTED BROMIDE SPACE (EXTRACELLULAR VOLUME) IN THE NEWBORN
Authors: Fink Chester W. , Cheek Donald B.
Published: December 2021

The extracellular volume of a group of normal infants, in the first day of life, was measured by means of the corrected bromide space, and was found to be 358 ± 6.5 ml/kg of body weight. There was no consistent variation due to the sex or age of the infants.

No decrease was found in extracellular volume during the period 5 to 15 hours after birth. In the fasting and thirsting newborn one injection of hydrocortisone or desoxy-corticosterone acetate produced no detectable change in the measured bromide space after a mean of 6 and 7½ hours following injection.
GENERALIZED ASPERGILLOSIS IN AN INFANT 18 DAYS OF AGE
Authors: Allan Gordon W. , Andersen Dorothy H.
Published: December 2021

A case of fatal primary aspergillosis in an 18-day-old infant is presented. The clinical course was deceptively benign and death was sudden. Necropsy revealed extensive pulmonary lesions with widely disseminated embolic foci. Aspergillus fumigatus was cultured from the lesions.

The literature pertaining to primary aspergillosis in infancy and childhood is reviewed with special reference to the newborn period.
INTRODUCTORY REMARKS
Authors: Rubin Mitchell I.
Published: December 2021

It May be appropriate to a pediatric audience in a consideration of cellular structure and function to quote from an old nursery rhyme, familiar to most of us:

Little girls are made of

Sugar and spice and all that's nice—

And little boys are made of

Frogs and snails and puppy dog tails.

Actually, we know that this is not the case, and that little boys and girls are made of cells—millions and millions of them. The human infant at birth is said to contain 10 trillion cells. It, therefore, seems reasonable that prior to a discussion of the numerous diseases which affect children ("bundles of cells"), their nutritional and other requirements, that we consider a basic unit of life—the cell.

To the medical student of a quarter of a century ago, and for many years thereafter, the study of the cell held little fascination. Structurally, it was recognized that there was a cell membrane which enclosed a cytoplasmic mass and nucleus, and there were structural substances such as mitochondria within the cytoplasm. The cell as a "chemical factory" was known to biologists, biochemists and geneticists for many years, but this knowledge had very limited influence on medical practice. Physicians thought more in terms of organ function, rather than cell function. This attitude has undergone striking change with the widespread therapeutic usage of vitamins, hormones (particularly the steroid hormones), antibiotics and antimetabolites in clinical medicine.

With the recognition of the unity of nature, the biologic similarity between human cells and single-cell organisms and the biologic information gained in the study of single-cell organisms, there has been kindled a widespread and excited inquiry into the functions of the cells of humans.
THE ENZYMIC AND MORPHOLOGIC ORGANIZATION OF THE MITOCHONDRIA
Authors: Lehninger Albert L.
Published: December 2021

In This Paper I shall describe some of the information we have recently obtained regarding the enzymic and molecular organization of the mitochondria, which as you know are very small particulate organelles in the cytoplasm of all aerobic cells. These bodies have been found to catalyze one of the most fundamental activities of the cell, namely, the transformation of the energy yielded by oxidation of foodstuffs into the so-called phosphate-bond energy of adenosine triphosphate. This process of respiration and phosphorylation is extremely complex and involves the interaction of at least seventy different enzymes and coenzymes in an integrated fashion.

The mitochondria have a characteristic ultrastructure in which these enzymes are embedded, and it is now possible to consider in some detail the intramitochondrial location and function of these important energy-transforming molecules.

First, let us consider the organization of oxidative metabolism in purely biochemical terms. Figure 1 shows the usual text-book representation of the final common pathway of biologic oxidation in animal tissues. You will recall that all three of the major foodstuffs of the cell (carbohydrate, fat and protein) ultimately are degraded in the tissues to a two-carbon unit, namely, acetylcoenzyme A. The acetate group then undergoes oxidation by the Krebs citric acid cycle, and in this process the two carbon atoms of acetate become oxidized to carbon dioxide. The oxidation of acetate is finally completed when pairs of hydrogen atoms are removed from certain of the intermediates of the Krebs cycle by dehydrogenases. These hydrogen atoms, or their equivalent in electrons, pass along the respiratory chain via the cytochromes until they meet molecular oxygen and reduce it to form water.
Congenital Adrenal Hyperplasia Associated with Polycythemia
Authors: Michael Alfred F. , Gold Arnold P.
Published: December 2021

We reported (Pediatrics, 23:727, 1959) a male infant with congenital adrenal hyperplasia complicated by marked polycythemia during the newborn period. This child died at 29 months of age. The purpose of this communication is to relate his further course and the necropsy findings.

He was admitted to the hospital at 1 day of age to be investigated for adrenal hyperplasia, as his sibling was known to have this disease. The diagnosis was confirmed by finding an increased 24-hour urinary excretion of 17-ketosteroids.
EFFECTS OF ASPHYXIATION OF THE FETUS AND THE NEWBORN INFANT
Authors: Windle William F.
Published: December 2021

There is pressing need of well controlled clinical evaluation of the role of adverse factors in the prenatal, natal and early postnatal periods in the etiology of neurological disorders. This is particularly true of asphyxia neonatorum. Many articles have been written on relationships between apnea, anoxia or asphyxia and manifestations of mental retardation, cerebral palsy, epilepsy and othe neurological, psychological and behavioral defects. The majority of the writers express opinions, but give no evidence that data were collected. Controls are commonly lacking. Often no attempt to measure the variables appears to have been made. A review1 of more than 500 reports, commentaries and testimonials of clinical experiences reveals deficiency in basic information of physiology of the fetus and newborn that is nothing short of appalling.
A COMMUNITY APPROACH TO JUVENILE INTRACTABLE ASTHMA
Authors: Bernstein I. Leonard , Allen John E. , Kreindler Louis , Ghory Joseph E. , Wohl Theodore H.
Published: December 2021

Rehabilitation of children with refractory asthma utilizing the existing facilities of a local institution has proven successful in Cincinnati. A complete description of the origins, aims and services of this program is presented. The local nature of such a program has some distinct advantages over a national institution doing the same kind of work, chief among which is the opportunity for long-term clinical observation and laboratory studies of discharged children. In general this preliminary presentation of our clinical results in 47 patients corroborates the good results previously reported by other centers involved in long-term rehabilitation of children with asthma. Specific factors which may influence or produce clinical remissions in these patients are under current investigation.

In our opinion, it is not only feasible, but also highly desirable, for other urban areas to develop similar treatment centers. It is conceivable that some type of federation, either formal or informal, would be mutually beneficial to all who are involved in this gratifying work, in both local and national centers.
TORSION OF THE APPENDIX TESTIS WITH OBSERVATIONS AS TO ITS ETIOLOGY
Authors: Oeconomopoulos Chris T. , Chamberlain John W.
Published: December 2021

Observations based on 26 cases lead the authors to believe that torsion of the appendix testis is an athletic injury. The condition is often misdiagnosed, resulting in prolonged discomfort and sometimes recurrence of the condition. Surgery is the accepted form of treatment, because it provides prompt relief from the pain, prevents recurrence and, in some cases, is required to rule out torsion of the spermatic cord. The approach to the lesion should be through the inguinal region and not the scrotum.
BLOOD CULTURES FROM THE UMBILICAL VEIN IN THE NEWBORN INFANT
Authors: Lipsitz Philip J. , Cornet JoAnn M.
Published: December 2021

A study was done to investigate the routine use of blood obtained from the umbilical vein for blood cultures in newborn infants. It was found that 45% of such samples will be contaminated with the same organisms as are found on the umbilical stump.

The pathogenesis of the bacteremia indicated by positive cultures from samples of blood obtained from the umbilical vein is discussed.

Positive cultures from the blood samples obtained at the start of exchange transfusions do not necessarily indicate either bacteremia or septicemia.
EFFECT OF SPLENECTOMY ON THALASSEMIA
Authors: Wolff James A. , Sitarz Anneliese L. , Von Hofe Frederick H.
Published: December 2021

The effects of splenectomy in 18 children with thalassemia (Mediterranean anemia) are evaluated.

The subjects varied in age at the time of splenectomy from 1½ to 18½ years and have been followed for 5 months to 28 years since operation. One death occurred at the time of splenectomy, during induction of anesthesia.

All patients, even those who later died, benefited initially from splenectomy. They required fewer transfusions and maintained higher hemoglobin levels subsequently for varying periods of time.

Of the 18 patients, 7 have died; all but 2 of these developed chronic congestive heart failure late in the course of the disease. Pericarditis was suspected in life and proven at necropsy in three subjects. No definite proof of the relationship of splenectomy to the incidence of penicarditis has been shown.

In this small series of patients no significantly increased incidence of severe infection was observed postoperatively.
Lack of Inhibition of Choline Esterase in Serum by Nupercaine in Cystic Fibrosis
Authors: Weber Ione , Hayden George A. , Kim Ih Chin , Barbero Giulio J.
Published: December 2021

When it was reported1 that a genetic factor was involved in the degree of inhibition of choline esterase activity in the serum by Dibucaine (nupercaine), a study was undertaken to determine whether or not this familial characteristic could be demonstrated in patients with cystic fibrosis and their relatives, as contrasted with the general population.

The ages of the 31 patients with cystic fibrosis ranged from 18 days to 9 years. The relatives comprised: 28 mothers, ages 20 to 49 years; 23 fathers, ages 23 to 54 years; 10 siblings, ages 2½ to 20 years; and 43 other relatives, ages 5 to 72 years.
MORTALITY OF EXCHANGE TRANSFUSION
Authors: Boggs Thomas R. , Westphal Milton C.
Published: December 2021

We have presented the experience of an exchange transfusion service in performing 1,139 procedures over a 7-year period. The design and practices of this service have been described in order to provide the background necessary for a critical analysis of our results. Since no definition exists for "Mortality of Exchange Transfusion," we have suggested one.

The outstanding features of this experience were:

1. The umbilical vein approach proved to be an extremely easy technique by which to initiate an exchange transfusion.

2. The great majority of the procedures were completed as planned.

3. In all but a very few exchange transfusions, a volume of donor blood at least 1.5 times the infant's blood volume was infused. We could show no correlations between the volume of donor blood employed in an initial procedure and the need for a repeat exchange.

4. Most of our exchange transfusions were completed in less than 1 hour; many in less than 30 minutes. We were unable to demonstrate a higher morbidity or mortality in infants being subjected to a faster as opposed to a slower procedure.

5. The best definition of the mortality rate of exchange transfusion appears to be the number of infants dying during or within 6 hours of a procedure expressed as a percentage of the number of infants transfused and again as a percentage of the number of exchange transfusions performed.

6. The incidence of death during or within 6 hours of an exchange transfusion appeared to be more closely related to an infant's clinical status at the beginning of a procedure then to the procedure itself. Most of the deaths occurred among critically ill infants with Rh-hemolytic disease. Vigorous infants, full-term or premature, regardless of diagnosis, tolerated exchange transfusions well. Our mortality rate in vigorous infants was very low.
HYPOGAMMAGLOBULINEMIA
Authors: Dolan Thomas F. , McCullough Norman B. , Gibson Lewis E.
Published: December 2021

An unusual patient, characterized by recurrent infections, hepatosplenomegaly, low levels of gamma-globulin in the serum (400 mg/100 ml) and lymphocytosis, is described.

The patient had pneumonia due to Nocardia asteroides followed by chronic Salmonella newport infection of 16 months' duration, kept in check by continuous antibiotic therapy. No antibodies were produced against specific antigenic challenges. The relationship of this case to those of congenital and acquired agammaglobulinemia is discussed.
THE PRACTICE OF PEDIATRICS
Authors:   The Editor
Published: December 2021

Early in 1959 an editorial in Pediatrics (23:253, 1959) entitled "Can the new pediatrics be practiced?" referred to some obstacles facing pediatricians now entering general practice. It seemed that the scope of pediatrics and the knowledge of children had been extended enough in recent years to justify the term new pediatrics, and that these advances were becoming difficult to apply in a hurried general pediatric practice. The question was raised as to whether it was not somewhat urgent to take more deliberate steps to make it easier and more inviting to practice pediatrics as a truly sophisticated specialty—to take cognizance of the improved capabilities of pediatricians and to foster recognition of the comprehensive service they can render when the working conditions are favorable. Furthermore, it was emphasized that there appeared to be need for concern about the future appeal of the practice of pediatrics rather than with the fate of pediatrics as a branch of medical science, and that this distinction was fundamental to intelligent discussion.

Now we have an opportunity to consider the opinions of leaders within the American Academy of Pediatrics in the following series of papers. These were presented at the 1960 Spring Session of the Academy in a panel discussion organized by a prominent official of the Academy to deal with the question posed by the editorial a year previously.

Some of the participants took serious exception to the term new pediatrics. Less seriously, one gains the impression they might have preferred Ye Olde Pediatrics to describe the prevailing practice, to go with their suggestion it simply needs to be made "better."
INTRODUCTORY
Authors: Fischer Carl C.
Published: December 2021

In A Final act of what I can only interpret as retribution for the tasks imposed upon them, your Program Committee drafted its chairman to set up the concluding program of this session in a form of a panel on the topic, "Can the New Pediatrics be Practiced?"

Fortunately, no restrictions as to content or participants were given and for this, at least, my thanks to the committee.

Periodic episodes of self-examination by various segments of the medical profession have been among the more salutary advances of Medicine for generations, but increasing emphasis upon the change in pediatric practice seems to date back only about 3 years to a Letter to the Editor of the Journal of Pediatrics by Dr. Frank L. Tabrah in December, 1957. This letter quoting an article of the November, 1956 issue of Medical Economics, stated among other things that "1/3 of the pediatricians in practice were dissatisfied" and contained such challenging statements as, "well-babies still frequent the pediatrists' office, but it is inconceivable that any physician with intelligence and interest in the unusual, can long survive the routine of playing grandmother for years on end in a well-baby practice. Few men will knowingly accept such a career—in time the specialty may lose the top quality men it has attracted in past years, pediatric medical office practice is not enough; there are too many private pediatric practices being started today that will be abandoned from sheer boredom." Dr. Tabrah's letter was followed by a reply by one of our panelists, Dr. Lee Hill, and in the same issue by an article entitled "Pediatric Rewards" by Dr. A. H. Parmelle, Sr.
REPORT OF SUBCOMMITTEE ON ACCIDENTAL POISONING
Authors:   Subcommittee on Accidental Poisoning, Press Edward , Adams William C. , Chittenden R. F. , Christian Joseph R. , Grayson Robert , Stewart Colin C. , Everist Bruce W.
Published: December 2021

BACKGROUND MATERIAL

Boric acid (H3BO3, boracic acid, orthoboric acid) is a colorless and odorless compound occurring as crystals, granules or a white powder. It is usually prepared by action of sulfuric acid on borax (sodium borate).

Boric acid is used medicinally in ophthalmic solutions, and the powder or solution as an acidifying agent in treating the irritation produced by ammonia from the urine in diapers of infants, and in dermatology in ointments either alone or in combination with other medicinal agents. It has also been employed in gargles, mouth washes and as a preservative.

Commercial uses of boric acid are varied, but often include its use in the preparation of face or body powders in which it is added to tale. It is stated that boric acid has a suppressant effect on molds or mildews, or assists in enabling the powder mixtures to flow more freely from the containers.

The usual ointment contains 10% boric acid; the standard medicinal solution contains not less than 4.25% boric acid.

The United States Food and Drug Administration, on January 30, 1954, issued a statement to the effect that borated talcum powder containing 5% or less of boric acid is safe for use as a dusting powder on babies. The implication here is that powder using more than 5% boric acid would not be safe.

Fatalities among adults from the ingestion of boric acid have been reported from as little as 1 teaspoonful of boric acid. Another report indicates that 2 ounces of a 5% solution of boric acid were fatal to an infant.
Tooth Discoloration in Cystic Fibrosis
Authors: Zegarelli E. V. , Denning C. R. , Kutscher A. H. , Tuoti F. , di Sant'Agnese P. A.
Published: December 2021

In recent years, attention has been focused on grossly observable, often severe discoloration of teeth of a gray-black or brown character in patients with cystic fibrosis of the pancreas. Quite often, this discoloration appears to be localized, but not definitively, to the middle and cervical thirds of the clinical crowns of teeth.

In order to document and analyze data concerning this peculiar tooth discoloration. a study of a group of patients with cystic fibrosis was undertaken.
A PEDIATRIC CLASSIC
Authors: M. C. D.
Published: December 2021

It is not from a desire to be tantalizing that only three pages of this classic of pediatric investigation are shown here (Figs. 1-3). The title page reveals it was so lengthy a paper (actually 62 pages) that a "Contents" was believed to be necessary. Although the article is based on observations from only four subjects, the studies are known to have extended over 2 years.

The investigations were so thoughtfully planned that they have served as models to subsequent generations of workers in the field. The data are presented within the framework of a clear exposition of concept and subjected to a searching analysis and logical interpretation. It would be a reckless editor who would seek to improve on the characteristic style or dare to strike out a single paragraph.

The first public appearance of one of Gamble's famous diagrams is shown on the page 633 of his paper; that it is the product of his own draftsmanship is easily recognized by those who ever watched him prepare charts for lectures or papers in his laboratory study.

Dr. Gamble was 40 years old when this paper appeared, but it was his first important contribution. There was still time for a long series of equally fundamental papers. Take heart you despondent quartogenerians and stir among the scoffing youngsters!
THE EFFECT OF ALTERATIONS IN EXTRACELLULAR FLUID ON THE COMPOSITION OF CONNECTIVE TISSUE
Authors: Weil William B. , Wallace William M.
Published: December 2021

Variations in the volume and composition of the extracellular fluid were produced by adrenal insufficiency, dehydration and intraperitoneal perfusion with a chloride-free solution. Direct analysis of blood, skin and tendon were performed to determine the extent to which loose and dense types of connective tissue varied with the changes in the plasma ultrafiltrate. Less than 10% of the sodium and chloride in tissue is associated with connective tissue solids in such a way as not to be readily diffusible.

On the basis of these studies, a structure for connective tissue has been postulated with three divisions: A rapidly-equilibrating phase, a noncellular connective tissue solids phase and an intracellular phase. The noncellular solids, acting as polyelectrolytes, could bind ions to a variable extent depending on acid-base and fluid tonicity changes.

The reduced rate of equilibration of dense connective tissue with extracellular fluid produces a phenomenon which would appear as "storage" in certain situations.

Thus by binding and by delayed equilibria, connective tissue has a small capacity to act as a storage area for extracellular electrolyte, but in general, the fluid and salt of connective tissue is in direct diffusion equilibrium with plasma ultrafiltrate.
THE EFFECT OF POTASSIUM DEFICIENCY ON THE KIDNEY
Authors: Holliday Malcolm A. , Segar William E. , Bright Nancy H. , Egan Thomas
Published: December 2021

Evidence is presented that the histologic lesion and the defect in urinary concentrating capacity seen in potassium deficiency are a consequence of the potassium deficiency per se and their progression is a function of the duration of the potassium deficiency, not of its severity.

Prolonged potassium deficiency results in irreversible scarring of the kidney and in an irreparable defect in the urinary concentrating capacity.

Dilution of urine in potassium deficiency is minimally impaired at a time when a defect in urinary concentrating capacity is present.

A relation between the histologic lesions in the collecting tubules of the potassium deficient animals and the defect in the urinary concentrating capacity of these animals is discussed.
RELATIONS OF INTRACELLULAR IONS TO METABOLITE SEQUENCES IN MUSCLE IN KWASHIORKOR
Authors: Metcoff Jack , Frenk Silvestre , Antonowicz Irena , Gordillo Gustavo , Lopez Elizabeth
Published: December 2021

A biopsy was obtained at the time of admission and subsequently from eight children with severe kwashiorkor. The biopsies were analyzed for electrolyte content and for the quantities of certain intermediates (pyruvate, lactate, citrate and alphaketoglutarate). The results in five children who recovered are compared with those from three children who died. Significant reductions occurred in intracellular potassium, phosphate, magnesium and pyruvate, but lactate and alpha-ketoglutarate were increased.

When the intracellular electrolytes were related to a specific intermediary metabolite (on the premise that the ion served as an activator or inhibitor in an enzymatic sequence leading to the production or the utilization of that intermediate) the changes assumed greater significance. A more dynamic interpretation of the data was provided by comparing ion:metabolite ratios of the initial with those of the second biopsy in patients who either recovered or died. Death from kwashiorkor was associated with a marked reversal in the sodium: pyruvate ratio and the apparent inorganic and organic phosphate to pyruvate ratios within the cell. These changes are consistent with some defect in the formation of pyruvate from phosphoenolpyruvate in a potassium-, magnesium-, phosphorus-dependent system. The citrate, magnesium and "true" inorganic phosphate to alphaketoglutarate ratios also were reversed in children who died compared to those who recovered. Such changes indicate a possible inhibition in the usual citric acid cycle pathway along which alpha-ketoglutarate is metabolized.

Preliminary data on concentrations of phosphoenolpyruvate, isocitrate and oxalacetate within the muscle cell and on the activities of pyruvic kinase also are presented.

The data are consistent with the hypothesis that the cellular swelling (in muscle) often characteristic of kwashiorkor leads to reduction in concentration of essential intracellular ions with inhibition of intermediary energy metabolism, thus leading to death. Since intracellular ions may function as activators or inhibitors for specific enzymes, it is suggested that changing quantities of a particular ion may be referred to the quantity of metabolite forming substrate or product of the specific enzymatic sequence. Altered ratios of ions to appropriate metabolites emphasize the possible significance of intracellular electrolytes in the biological system.
ANABOLIC DRUGS TO PROMOTE GROWTH
Authors: BONGIOVANNI ALFRED M.
Published: December 2021

A PHYSICIAN is faced with a particularly troublesome problem when a child who is believed to be too short for his age is brought before him for treatment and an underlying disease is not to be found. So urgent may be the concern of the parents that some sort of hormone treatment may seem imperative to allay the anxiety. The temptation will be great "to do something" to promote growth and force the child into a "normal" size for his age. A quick concrete attack seems so much easier than prolonged discussions of the benign nature of the physical problem and the attendant psychologic consequences.
Anomalien der Harnwege im Kindesalter und Ihre Chirurgische Behandlung
Authors: McGOVERN JOHN H.
Published: December 2021

This is a well-illustrated review of various congenital genitourinary anomalies. The details of the urologic investigation as presented in the first chapter would more likely interest radiologists and urologists than pediatricians. Cystourethrography is not sufficiently emphasized. Not only is the examination rather easily performed but abnormalities are frequently so disclosed: for example, 10 to 15% of children with recurrent infection have shown vesicoureteral reflux and hydronephrosis, often when the intravenous pyelogram was normal.

Some of the etiologic concepts suggested are at variance with current knowledge; for example, vesicoureteral reflux is said to be normal under some circumstances; also, megaureter is alleged to be secondary to aganglionic segments of the ureter.
STUDIES ON THE CIRCULATION IN THE NEONATAL PERIOD
Authors: Rudolph A. M. , Drorbaugh J. E. , Auld P. A. M. , Rudolph A. J. , Nadas A. S. , Smith C. A. , Hubbell J. P.
Published: December 2021

Hemodynamic measurements by means of cardiac catheterization were obtained in 38 infants in the first 30 hours after birth. Nineteen of these infants were considered to have normal circulatory and respiratory systems. Nine had mild respiratory distress, and 10 had severe respiratory distress.

The circulatory systems of infants with mild respiratory distress did not appreciably differ from the normal. Some infants in both these groups showed evidences of patency of the ductus arteriosus with a small left-to-right shunt for the first 10 to 15 hours after birth.

The infants with severe respiratory distress had widely patent ducti, with large left-to-right shunts and, in some instances, right-to-left shunts. The pulmonary arterial and systemic arterial pressures were lower in these infants as compared to the normal and those with mild respiratory symptoms. These characteristics of the severely distressed infants could be related to the disease process, but may be due to prematurity alone.

The possible role of left ventricular failure associated with a large left-to-right ductal shunt is discussed. A generalized lack of vasoconstrictor tone could possibly be responsible for systemic and pulmonary arterial hypotension as well as for the widely patent ductus arteriosus.
Tumors of the Female Sex Organs, Part 2, Tumors of the Vulva, Vagina and Uterus
Authors: BLANC WILLIAM A.
Published: December 2021

This volume has been written in the tradition of the AFIP fascicles. It should be very useful to the pathologist. The text is concise, and the illustrations are abundant and of excellent quality. There is little of interest for the pediatrician in this particular fascicle. The problems of the sarcoma botryoides in infants are presented quite briefly, and the literature remains strictly pathological, without reference to recent, somewhat less gloomy, articles by surgeons.
IN-VITRO EVALUATION OF EFFECT OF ENZYMES ON TRACHEOBRONCHIAL SECRETIONS FROM PATIENTS WITH CYSTIC FIBROSIS
Authors: Chernick Warren S. , Barbero Giulio J. , Eichel Herbert J.
Published: December 2021

A standard procedure was established for the in-vitro screening of potentially therapeutic enzymes in cystic fibrosis. The procedure involved the use of two criteria for the evaluation of the effectiveness of a given enzyme, i.e., the release of components from the tracheobronchial secretions absorbing at 270 mµ and the change in viscosity of the secretions.

Of various proteolytic, fibrinolytic and nucleolytic enzymes subjected to the screening procedure, pancreatic dornase had the most marked action on a 1% homogenate of the secretion in saline solution. Trypsin and chymotrypsin were considerably less effective, and the other enzymes had little or no effect.

Tracheobronchial secretions from cystic fibrosis were found to inhibit the activity of trypsin when assayed with casein, but not that of pancreatic dornase when assayed with deoxyribonucleic acid.

A direct correlation has been shown between the degradation of deoxyribonucleic acid and the decrease in viscosity of the tracheobronchial secretions from cystic fibrosis, when acted upon by pancreatic dornase.

Cytochemical smears of the secretions from cystic fibrosis exhibited dissolution of the fibril structure after treatment with pancreatic dornase.

The data afford further evidence for the contention that the fibrous network observed in the tracheobronchial secretions of patients with cystic fibrosis consists primarily of deoxyribonucleoproteins which contribute to the over-all viscosity of these secretions.
INTRACELLULAR ORGANIZATION OF ENZYME SYSTEMS
Authors: Villee Claude A.
Published: December 2021

A review is presented of the morphologic picture made available by recent advances in electron microscopy and of the biochemical localization of enzymes made possible by ultracentrifugation, which have led to a picture of the segregation of function accompanying a segregation of structure within the cell. The localization of enzymes in certain parts of the cell provides additional methods of controlling enzyme rates and insures that reactions will occur in a certain sequence. The product of one reaction is made directly available as the substrate for the next reaction in the sequence, and the enzyme for this next step is located immediately adjacent in the membrane. The localization of enzymes within lipoprotein membranes may permit reactions to occur in a nonaqueous phase, reactions that could not be carried out in a completely aqueous system.

Although much remains to be done in this rapidly developing field, it is now clear that catalysts are organized spatially within the cell and that the fine structure of this organization extends to molecular dimensions, paralleling the intricate morphologic fine structure that has been revealed by electron microscopy.
THE TREATMENT OF ACUTE RHEUMATIC FEVER
Authors: Dorfman Albert , Gross John I. , Lorincz Andrew E.
Published: December 2021

A controlled study of therapy on 131 patients with first attacks of acute rheumatic fever of 18 days or less duration was conducted. All patients were given a basic regimen of bed rest and initial penicillin therapy followed by sulfadiazine prophylaxis. The effect of the basic regimen was compared with hydrocortisone, salicylates, and a combination of these two agents. Both aspirin and hydrocortisone favorably affected certain acute manifestations; the effect of the latter was more striking. Treatment with hydrocortisone appeared to result in a decrease in apical systolic murmurs at the end of 1 year, as compared with treatment with aspirin or no specific anti-rheumatic therapy. No advantage of combined therapy was found. It is recommended that acute rheumatic fever with carditis be treated with hormones; but in the absence of carditis, salicylates should be employed.
Mental Retardation in Infants and Children
Authors: KUGEL ROBERT B.
Published: December 2021

In the forward Frederic A. Gibbs states "Changed attitudes toward feeblemindedness allow the present text to start from a simple, logical, and completely realistic premise, viz., that mental retardation is due to brain disorder." Hopefully, many more physicians accept this statement as correct, but it is unfortunately clear that there are still many physicians who have not yet accepted the fact that mental retardation is a reasonable and profitable area of concern and investigation. The authors carefully and persistently present the mass of information now available to support Gibbs' statement.