bluuebunny/crossref_metadata_2025 huggingface dataset:
PATHOGENESIS OF HYPOSTHENURIA IN PERSONS WITH SICKLE CELL ANEMIA OR THE SICKLE CELL TRAIT
Authors: Schlitt L. , Keitel H. G.
Published: December 2021

Hyposthenuria was investigated in subjects with sickle cell trait and in patients with sickle cell anemia. The following were observed: 1) in subjects with sickle cell trait both normal and reduced maxima of urinary concentration are found, whereas all untreated patients with sickle cell anemia over 6 months of age have hyposthenuria; 2) hyposthenuria becomes increasingly more severe with advancing age in both sickle cell anemia and sickle cell trait; 3) in a 6-month-old patient with sickle cell anemia and hyposthenuria, the maxima of urinary concentration returned to normal after two transfusions of normal erythrocytes.

Reasons are presented for favoring the hypothesis that hyposthenuria in sickle cell disease is due to renal damage, possibly from intravascular sickling of erythrocytes in renal vessels or from the presence of "free" circulating S-hemoglobin.
CYTOLOGY OF URINARY SEDIMENT IN CHILDHOOD
Authors: Silver Henry K.
Published: December 2021

A method is described for determining the presence of estrogenic stimulation by the cytologic study of desquamated cells present in voided urine.

The advantages of this method for the study of children are described.

The normal findings in the various age groups are presented for both sexes.
THE INTERACTION OF ENZYMES AND HORMONES
Authors: White Abraham
Published: December 2021

The majority of living forms depend for their functioning upon two classes of biocatalysts, the enzymes and the hormones. These biocatalysts permit the diverse chemical reactions of the organism to proceed at 38°C with a specificity and at rates frequently unattainable in vitro at elevated temperatures with similar reactants.

The physiologic importance of enzymes and hormones is evident not only under normal circumstances, but is reflected clinically in the diverse descriptions of errors of metabolism, due to lack or deficiency of one or more enzymes, and the numerous hypo- and hyperfunctioning states resulting from imbalance of hormonal supply.

Inasmuch as both enzymes and hormones function, with rare exception, to accelerate the rates of processes in cells, investigators have sought possible interrelationships and interactions of enzymes and hormones, particularly as a basis for the mechanism of hormonal action. It has seemed logical to hypothesize that hormones, while not essential for reactions to proceed but nevertheless affecting the rates of reactions, may function by altering either the concentration or activity of the prime cellular catalysts, the enzymes. This proposed influence of hormones on enzymic activity might be a primary, direct effect achieved by the hormone participating as an integral part of an enzyme system, or an indirect influence based upon the hormone altering the concentration of available enzyme and/or substrate utilized by a particular enzyme.

It is the purpose of this presentation to describe a relatively few, but better defined, examples of the more direct relationships of enzymes and hormones. Five examples of enzyme-hormone interaction will be presented, based on the criterion that an effect of the hormone has been demonstrated on addition of the hormone in vitro to a purifled, or partially purified, enzyme system.
DIABETES, Robert H. Williams M.D., editor, New York, Paul B. Hoeber, 1960, 793 pp., $20.00
Authors: Klein Robert
Published: December 2021

Each chapter in this book is an essay by one or more of the 54 authors. The expected overlapping and repetitions and the uneven quality make reading very frustrating at the same time that it can be very rewarding. Some of the chapters on the basic alterations in physiology in diabetes mellitus are among the best and certainly the most concise and clear reviews that this reviewer has ever read. But the discussion of the clinical management of children with this disease was disappointing.
NEUROLOGIC LESIONS IN RELATION TO ASPHYXIA OF THE NEWBORN AND FACTORS OF PREGNANCY: LONG-TERM FOLLOW-UP
Authors: Keith Haddow M. , Gage Robert P.
Published: December 2021

Four groups of children were studied over periods of 1 to 14 years. Group 1 included 402 children who had been born after prolonged labor. Follow-up studies were made of 321 of the 402 children. Twelve children (3.7%) were noted to have convulsions, but only one child had a recurring convulsive disorder (epilepsy). The remainder had so-called febrile convulsions. No other persistent neurologic difficulties were found.

Group 3 included 236 children who had asphyxia (anoxia) or delayed respiration at birth. Follow-up data were available on 180 children. The only resulting neurologic difficulties noted were febrile convulsions in two children. None had persistent convulsive disorders (epilepsy).

Group 5 included 124 babies whose mothers had had toxemia of pregnancy. Fourteen were stillborn or died in early infancy. Four of the remaining 110 (3.6%) had a febrile convulsion at some time, but to our knowledge persistent convulsions did not develop.

Groups 2 and 4 were control groups and included a total of 633 children, who were born after relatively short uncomplicated deliveries. Follow-up data were available for 498 of the children; among them 16 children (3.2%) had convulsions at some time, and 13 of the 16 had convulsions at some time between the ages of 8 and 14 years. No other persistent neurologic conditions were found. Four children had recurring convulsive disorders and four others had a single convulsion or occasional convulsion of unknown etiology. Eight others had so-called febrile convulsions. No other persistent neurologic conditions were found.

The findings of the present study reinforce the conclusions in the previous report from this clinic—that prolonged labor, asphyxia, or delayed respiration at birth did not cause any neurologic abnormality in children who survive the early months of life, and that convulsions of any type are not commoner among children who had difficulty at birth than among children who did not have difficulty at birth.
INSTITUTIONAL CARE OF CHILDREN
Authors: Gula Martin
Published: December 2021

For Two Centuries now, child caring institutions have helped families in caring for their children. Every generation brings its toll of dependent, neglected, disturbed, delinquent, and mentally retarded youngsters to institutional doors.

Such rearing of children away from their families has always been of interest and concern to pediatricians—especially the care of infants and the care of children with severe mental or emotional handicaps. Both these areas are explored in a recent Children's Bureau publication, Child Caring Institutions—Their New Role in Community Development of Services (Publication No. 368, 1958).

Institutional care for well babies is steadily decreasing in our country.
EMOTIONAL AND BEHAVIOR PROBLEMS IN CHILDREN
Authors: Shirley Hale F.
Published: December 2021

The fostering of mental health during the early periods of childhood is an area in which the pediatrician plays a vital role. There are two parts which have particular relevance for the pediatrician. One has to do with counseling around a particular problem or symptom, and the other is concerned with helping parents to understand the various stages of child development in order to prevent some of the difficulties which might otherwise be encountered. These two aspects were considered in this presentation.

COUNSELING IN RESPECT TO A CHILD'S BEHAVIOR

When a mother complains about her child's behavior, how can a pediatrician go about investigating it? What does one look for? And if emotional disturbances are uncovered, what can one do about them? In the field of child psychiatry there is no neat answer to every problem. A behavior problem is not a clinical syndrome any more than a symptom like fever or headache is a disease. Furthermore, the clinical syndromes in the field of child psychiatry are not as yet very well defined. There are variables among the determinants of most human behavior which are hard to identify and to evaluate, and usually there are some that are unknown. This leads to the necessity of tentativeness at first in planning for a child's treatment, and uncertainty, often, as to prognosis.

For anyone, the effectiveness of what is done depends greatly upon how adequate an understanding of the child's environmental background one is able to acquire. Such aspects of the environmental background as the emotional atmosphere of the home, the personalities and emotional adjustment of the parents, the feelings of the parents toward the child and his behavior, and the feelings of the child about the people around him, are all important.
EARLY FEEDING OF DEXTROSE AND SALINE SOLUTION TO PREMATURE INFANTS
Authors: Bauman William Allen
Published: December 2021

Conflicting opinions concerning the optimum age at which to commence feeding premature infants have resulted in either early or late regimens. In order to test the hypothesis that the early administration of fluids to premature babies was beneficial, a controlled study of 50 newborn premature subjects was undertaken. Fluids consisting of 5% dextrose in 0.45% saline were started before the age of 6 hours by constant drip through a nasogastric plastic catheter in 24 subjects selected by a predesigned method using a table of random permutations. The average intake during the test period was 54.5 ml/kg/24 hours. The other 26 control subjects received no fluids until age 36 hours, when both groups were started on formula.

There was no alteration of symptoms of respiratory distress in the group receiving early feedings. One-half of these subjects did not lose weight while being fed the dextrose and saline solution. They promptly lost weight, however, when regular milk feedings were commenced.

The seven infants who died had similar pathologic findings. It was noted that three of the five in the fluid treated group also had pulmonary hyaline membranes. There were no hyaline membranes in the lungs of the two subjects deprived of water.

From this study neither beneficial nor detrimental effects of early feeding could be demonstrated by use of the criteria of dyspnea or mortality. The question of when to start to feed premature babies is still unanswered. There is need for further feeding trials, in which associations among age of commencement, nature of substances fed and the consequent physiologic responses, can be observed.
PATTERNS IN ELECTROLYTE AND NITROGEN BALANCE IN THE NEWBORN PREMATURE INFANT
Authors: Butterfield Joseph , Lubchenco Lula O. , Bergstedt Jens , O'Brien Donough
Published: December 2021

The sodium, potassium and nitrogen balances of 24 small premature infants during the first 3 weeks of life have been determined. During the first week of life there was a sodium deficit of 6 to 16 meq/kg in clinically well infants. Prior to milk feeding there was a loss of potassium and nitrogen, followed by change to retention once milk feedings were started.

See Image in the PDF file

Some sick infants showed a similar pattern; others showed a relative salt retention during illness or during moderate increases in sodium intake.

Three infants were treated with cortisone during the first week of life. Two retained potassium as well as sodium during that time. Another demonstrated an apparent migration of sodium into the cells while receiving the cortisone.

Low and more labile sodium values in serum were noted more often in the ill infants, while higher potassium levels in serum were more frequently encountered in the same infants, although these two phenomena were not necessarily associated.

During the second and third weeks of life, all babies studied began to retain sodium irrespective of the degree of immaturity at birth and the positive nitrogen and potassium balance continued.

See Image in the PDF file

It is conjectured that the sodium diuresis observed during the first week of life may represent a physiologic reduction of the total body water.
RENAL DIABETES INSIPIDUS
Authors: Schoen Edgar J.
Published: December 2021

In a family with renal diabetes insipidus, members of four generations were studied; the history of five generations was available. In this kindred the disease appeared to be transmitted as a sex-linked dominant gene attached to the X chromosome, with variable penetrance in the female heterozygous carriers.

Renal diabetes insipidus was present in three male children and two men; six additional males died of unknown causes in infancy or early childhood. In males the medical problem is early recognition to avert death or serious brain injury secondary to dehydration.

Of five female heterozygous carriers studied, three demonstrated persistently normal urinary concentration following thirsting. Two evidenced marked diminution in renal concentrating ability and could be considered to have mild renal diabetes insipidus. History suggested that one other female member of the kindred had manifest disease. In the female the medical problems are diagnosis in the occasional female with manifest disease and detection of the heterozygous carrier prior to the birth of her child. In this kindred we found the urinary concentration test a reliable detector of the female heterozygous carrier only if the results were abnormally low.
Intussusception in Infants and Children, Mark M. Ravitch, M.D. Springfield, Illinois, Charles C Thomas Publisher, 1959, 121 pp., $9.00
Authors: Pickett Lawrence K.
Published: December 2021

This is the first book to be published in a new series entitled "Pediatric Surgical Monographs" edited by Mark M. Ravitch, M.D. This first volume is authored by Dr. Ravitch on a subject that has been one of his major interests.

Dr. Ravitch has done an excellent and complete job, covering all aspects of the problem of intussusception. He has emphasized early in the book the rarity of the condition, since many busy children's hospitals have relatively few cases each year.
MIXED GROUP PRACTICE
Authors: Burke Donald M.
Published: December 2021

In Order to deal with the question1 in an intelligent manner it will be necessary to define both "new pediatrics" and "mixed group." It will be further illuminating to ask why the question should be asked: Can the new pediatrics be practiced?" It seems fair to state in answer that the question is asked chiefly because of the discrepancy between the type of patient who is seen in pediatric residency and the type of patient encountered in everyday pediatric practice. It should be pointed out that implicit in this discrepancy is a known change in the character of pediatric practice in general; the pediatrician of today sees few of the diseases considered both common and serious in the practitioner's office a generation ago.

The ex-resident entering practice today may find that the knowledge gained from the more difficult periods of his residency training is not put to frequent use. He might further find that he is at a loss to cope with some of the many questions a mother can ask regarding her child, which do not seem related to the child's organic illness; her attention may be focused on something which appears minor in the eyes of the pediatrician. He finds himself often in the position of health counselor and practitioner of preventive medicine rather than a physiologist delving into the newly-known metabolic disturbances or the fine techniques of cardiac catheterization. He must learn the truth of Dr. Wyman C. C. Cole, Sr.'s statement that, "We must think of the pediatrician as the child's physician, not merely as one who treats the diseases of childhood."2
REPORT ON 1960 WRITTEN EXAMINATION
Authors:   The Examinations Committee
Published: December 2021

THE EXAMINATION

The Examinations Committee of the American Board of Pediatrics has decided not to change the general format of its 1961 written examination from that used over the past several years. A detailed account of this format was published in Pediatrics, 22:1001, 1958. Candidates who will take the examination in January 1961 are advised to read this previous publication.

The written examination of January 8, 1960 was taken by 520 American candidates and by 126 foreign candidates. In accordance with policy decided upon a year ago (Pediatrics, 24:848, 1959), the passing grade was selected after study of the marks achieved by the American candidates only.
NEWS AND ANNOUNCEMENTS
Authors: Fischer Carl C. , Polk D. Stewart
Published: December 2021

Bronx Pediatric Society

The Bronx Pediatric Society will meet on Wednesday, December 14, 1960 at 8:30 pm at the Morrisania, Bronx. Dr. Edmund P. Fowler of the College of Physicians and Surgeons, Columbia University, will present the James Harkins Memorial Lecture, Problems in Pediatric Otobogy.

American Psychosomatic Society

The American Psychosomatic Society will hold its 18th Annual Meeting at Chalfonte-Haddon Hall in Atlantic City on April 28, 29, and 30, 1961.

The program committee would like to receive titles and abstracts of papers for consideration.
The Dyslipidoses, Raúl Fleischmajer. Springfield, Thomas, 1960, 509 pp., $16.00
Authors: Landing Benjamin H.
Published: December 2021

This book begins with a general survey of the biochemistry and metabolism of fatty acids, glycerolipids, phospholipids, sphingolipids and cholesterol. A number of diseases involving "synthesis, transport or deposit" of these lipids are then reviewed, not including disorders of metabolism of steroids other than cholesterol, nor the carotenoids. The descriptions of clinical and pathologic aspects of the various diseases of lipid metabolism vary from good to excellent, and the author demonstrates both judgement and willingness to take a stand in some of the more controversial fields, such as the glycogen storage diseases.
Modern Problems in Pediatrics, Volume VI: Renal Function and Kidney Disorders in Childhood, edited by A. Hottinger and H. Bergen. New York, S. Karger, 1960, 560 pp. (tri-lingual edition), $27.00
Authors: Scaglione P. R.
Published: December 2021

Although one doubts that this volume "will . . . further advance . . . our insight into ‘Kidney Problems during Infancy,’ " it does present a trilingual collection of reasonably up-to-date and informative papers on some physiologic and pathologic aspects of pediatric nephrology. The essays are written, with one exception, in the native language of various authorities drawn from English, French and German-speaking countries. Summaries, whenever present, are not offered in each of the three languages.
The Child in Hospital: A Study of His Emotional and Sosical Well-Being, Hedley G. Dimock. Philadelphia, F. A. Davis Company, 1960, 236 pp., $4.50
Authors: Work Henry H.
Published: December 2021

One often gets the feeling that our British and Canadian colleagues are considerably ahead of us in planning for the care of children who need to be hospitalized. This text offers a new organization of a great deal of recent work on this particular subject. It is a book written for pediatricians, hospital administrators and nurses.

More comprehensive than Robertson in his recent book, the author includes a considerable biography as well as an excellent description of the relatedness of ward activities, staff activities and actual patient needs.
BACTERIAL ENDOCARDITIS IN CHILDREN WITH HEART DISEASE
Authors: Blumenthal Sidney , Griffiths Sylvia P. , Morgan Beverly C.
Published: December 2021

We have reviewed the literature and our experience with 58 patients with bacterial endocarditis superimposed upon pre-existing heart disease, observed during the 30-year period, January 1930 through December 1959. There has been no change in the relative incidence of bacterial endocarditis in children with heart disease observed at the Babies Hospital since the introduction of antibiotics. Twenty-one patients (0.49/1,000 admissions) were observed from 1930 through 1943 and 37 patients (0.52/1,000 admissions) from January 1944 through December 1959. In the majority (40) infection was superimposed upon a congenital malformation of the heart, while in 17 there was evidence of rheumatic heart disease. In one, a rheumatic infection complicated a congenital anomaly.

The history usually revealed unexplained fever and fatigue in a child known to have heart disease. Additional symptoms often reflected the nature of the underlying cardiac pathology. Patients with tetrad of Fallot developed symptoms secondary to hypoxia which in some instances was later shown to be attributable to vegetations at sites resulting in obstruction to pulmonary blood flow.

The pathogenesis of bacterial endocarditis is defined in terms of bacteremia superimposed upon abnormal endocardial or endothelial surfaces; the further role of hemodynamic trauma secondary to congenital or acquired lesions is discussed.

The results of bacteriologic studies were as vital in confirming the diagnosis and planning treatment as in the management of patients with meningitis. Blood cultures were usually positive in the first sample obtained (86%) and always by the sixth. Bacterial endocarditis is uncommon in the presence of sterile blood cultures providing an adequate number (six), each of sufficient quantity (10 ml), are obtained sufficiently long after antibiotics have been discontinued and providing they are incubated in aerobic and anaerobic media for 3 weeks.

In children, the most important prognostic features were (1) recognition of the disease, (2) the nature of the infecting organism, and (3) adequate antibiotic treatment. In seven instances in our experience the correct diagnosis had not been considered prior to necropsy examination. Among the patients with bacterial endocarditis treated with antibiotics, recovery occurred in each of the 20 due to viridans streptococci, in 1 due to gamma-streptococci, and in 3 of the 8 due to Staphylococcus aureus.

The principles of management are discussed and suggestions outlined for antibiotic therapy of children with bacterial endocarditis. Penicillin alone is recommended for infection due to viridans streptococci, if the organisms are highly sensitive, whereas for infection due to Staphylococcus coccus aureus a combination of chloramphenicol, erythromycin and penicillin is advocated as initial therapy. The importance of the use of antibiotics in therapeutic dosage for prophylaxis in patients with heart disease prior to dental manipulation or other surgical procedures is stressed.
IDIOPATHIC HYPERGLYCINEMIA: A NEW DISORDER OF AMINO ACID METABOLISM
Authors: Nyhan William L. , Borden Margaret , Childs Barton
Published: December 2021

The amino acids of blood and urine have been investigated using chromatography on cation exchange columns in the study of a patient with idiopathic hyperglycinemia. Marked increases in concentrations of glycine, serine, alanine, isoleucine and valine were found in the plasma. These changes were not reflected in increased excretion of these amino acids in the urine (with the exception of glycine). Restriction of the dietary intake of protein resulted in a decrease in the concentrations of glycine and other amino acids in the blood and urine, and there was a concomitant decrease in the frequency and severity of episodes of acute illness.

The oral administration of leucine was found to induce a decrease in the levels of a number of amino acids in the patient and in controls. Continued decrease during the 3 hours of observation was noted for serine, isoleucine and valine. A mild but progressive decrease in threonine concentration was observed in the controls, while in the patient the concentration increased after the administration of leucine. Decreased levels at 1½ hours, returning toward the fasting levels at 3 hours, were observed for alanine, taurine and glycine. These apparently normal responses to leucine loads were not mediated through increase in the urinary excretion of the amino acids involved, and the data are interpreted to indicate entry of these amino acids into cells.
LIMITS OF VARIABILITY OF CONCENTRATION OF SODIUM IN SERUM OF NORMAL CHILDREN
Authors: Joseph John B. , Bergstrom William H.
Published: December 2021

The mean concentration of sodium in serum of a group of normal children in Syracuse, N.Y., in midsummer was 146 meq/l.

The total standard deviation for within-individual variation was 4 meq/l, comprising a laboratory error of ±2.5 meq/l and a "true" within-individual variability of ±3.2 meq/l.

No significant difference between individuals was demonstrated.

Within 90% confidence limits, the maximum chance difference between two successive concentrations of sodium in the serum, whose mean falls within the normal range for means of two samples was found to be 11 meq/l.

Within 95% confidence limits, the maximum chance difference between any two values, duplicate or successive, due to laboratory error was 6.9 meq/l.

The implications of these findings for the interpretation of sodium levels in serum of patients are discussed.
Pathology of Infancy and Childhood
Authors: BLANC WILLIAM A.
Published: December 2021

Dr. MacGregor, one of the greatest and most respected pioneers of pediatric pathology, has written a much expected book. It is not primarily designed as a specialized monograph, but as an aid to the general pathologist unfamiliar with pediatric problems. Much of the material to be found in the three other textbooks on pediatric pathology is now available in a compact and well-illustrated manual. The material is enthusiastically presented; the author uses the first person, a refreshing change in an era of impersonal—if clear—stylistic approach.
NEPHROTIC SYNDROME IN EARLY INFANCY AS A MANIFESTATION OF CONGENITAL SYPHILIS
Authors: Papaioannou Angelos C. , Asrow Gertrude G. , Schuckmell Natalie H.
Published: December 2021

The case of a 10-week-old infant with a nephrotic syndrome due to congenital syphilis is presented.

Negative prenatal history for venereal disease may be misleading. Therefore, a renewed emphasis of congenital syphilis as an etiologic factor of the nephrotic syndrome in early infancy is proposed.

Protein in serum fractionation by paper electrophoresis may be of assistance in the differentiation of a primary or secondary renal disease.

Early diagnosis of congenital syphilis as a cause of the nephrotic syndrome and specific antisyphilitic therapy will result in prompt remission of the clinical manifestations of this disease.
CONCENTRATION OF COPPER IN SERUM OF CHILDREN WITH SCHIZOPHRENIA
Authors: Bakwin Ruth Morris , Mosbach Erwin H. , Bakwin Harry
Published: December 2021

Levels of copper in serum were measured in the blood of 91 schizophrenic children using the technique of Angel et al. No difference from the levels in control children was found.

Children 5 to 17 years of age have significantly higher levels of copper in serum than normal adults.
PARASITISM BY CAPILLARIA HEPATICA
Authors: Calle Simón
Published: December 2021

A case of genuine infection with Capillaria hepatica in a child is presented. This is the eighth case to be reported, the fourth to be diagnosed by liver biopsy, and the second case in which the patient is still living.

The literature dealing with the subject is reviewed with a brief summary of the cases on record.

The nature of infection by Capillaria hepatica, its pathogenesis, its etiology and its significant pathologic anatomy are discussed in the light of recorded studies in man and in animals serving as natural hosts of the parasite.
THE CARDIAC SILHOUETTE IN NEWBORN INFANTS: A CINEMATOGRAPHIC STUDY OF THE NORMAL RANGE
Authors: Burnard E. D. , James L. S.
Published: December 2021

The mediastinum and heart of the newborn baby was studied by a cinematographic method and compared with the roentgenogram. In cinematographs of the resting baby the transverse diameter of the heart shadow varied only slightly with respiration and cardiac cycle. The deduction that the roentgenogram of the quiet baby would give a reliable estimate of the size of the shadow was borne out by reasonable agreement in the measurement of transverse diameter by the two methods.

The heart of the crying baby was broadest during the inspiration before a cry. Even so, transverse diameter was rarely greater than when the baby was at rest.

The roentgenographic changes on crying were studied in relation to respiratory mechanics. They could be well explained by effects, on venous return to the heart, of conditions which resembled the Mueller and Valsalva maneuvers. Two varieties of appearance were mentioned where the phase of the respiratory cycle could be wrongly inferred in the roentgenogram from the state of lung aeration and level of diaphragm. An interpretation based on them, of changes in size of the silhouette in relation to deep breathing in the newborn infant, would be misleading. Explanation of big differences in terms of anatomic change alone without reference to the large contrasting effects of the Mueller and Valsalva may have helped discredit the roentgenogram of the heart in the newborn infant.

Evidence for the prevailing opinion that variations in the thymus interfere to an important degree with the conventional measurement of transverse diameter of the heart is open to question. Reasons are given for the opposite view.
BRAIN ABSCESS IN CONGENITAL HEART DISEASE
Authors: Matson Donald D. , Salam Maria
Published: December 2021

In any patient with congenital cardiovascular disease, particularly if he is cyanotic, the development of focal neurologic abnormalities or evidence of increased intracranial pressure must be considered as indicative of the possible presence of a brain abscess until proved otherwise. This is true whether or not there is any suggestion of septicemia, meningitis or focal infection elsewhere in the body. Cultures of the blood and cerebrospinal fluid are usually negative.

The common denominator among patients with congenital heart disease and brain abscess is a central right-to-left shunt, which in the present series has always been accompanied by cyanosis, polycythemia and clubbing. In children under 2 years of age cerebral infarction due to thrombosis is much more common as a cause of neurologic complication than is abscess.

In the presence of abscess, the condition is usually of 7 to 10 days' duration and of gradually increasing severity. The cerebrospinal fluid shows some increase in pressure and may frequently show mild increase in protein content or leukocyte count. Roentgenograms of the skull are normal, unless the abscess is of long-standing duration. Contrast studies such as angiography or pneumoencephalography may be urgently indicated if clinical localization is doubtful. Electroencephalography has consistently shown focal abnormality in the form of high-voltage slowing. Treatment consists of repeated aspiration in deep-seated and poorly encapsulated lesions supported by intensive antibiotic therapy, or aspiration followed by total excision in superficial and well-encapsulated abscesses.

To prevent neurologic complications in this type of anomaly optimum treatment is obviously prophylactic total anatomic correction of the right-to-left shunt. If a brain abscess has occurred and has been successfully treated, the earliest possible anatomic correction of the cardiac anomaly is still indicated.

This paper records the experience of one neurosurgical service with 13 cases of brain abscess in patients with cyanotic congenital heart disease in a 13-year period. Six of the 13 patients in this series had successful surgical treatment. While these results are poor, they have improved remarkably with earlier recognition and treatment. It is of utmost importance, therefore, that all physicians be aware of the frequency of brain abscess in congenital heart disease and suspect it early so that treatment can be carried out before there is irreversible brain damage.
STANDARDS, STETHOSCOPES, STEROIDS AND STATISTICS
Authors: Feinstein Alvan R.
Published: December 2021

The different results of recent studies of the treatment of rheumatic fever seem to be due not to therapeutic effects but to the inclusion in compared groups of different percentages of patients with inherently different cardiac prognoses. The homogenization of heterogeneous groups has occurred either through insufficient attention to the details of cardiac classification or through inadverent use of different criteria for the classification. The situation has been aptly described by Hill, who wrote, "the essence of a successful controlled clinical trial lies in its minutiae—in a painstaking, and sometimes very dull, attention to every detail." Until the deficiencies in some of these "minutiae" are remedied, many contentions remain unproved.

Massive penicillin treatment, as compared to none, has not demonstrably reduced heart disease. Since massive treatment was not tested against an ordinary streptococcal-eradicating dose of penicillin, the advantages claimed for massive treatment, even if valid, would not pertain to use of the latter regimen. With regard to anti-inflammatory therapy, steroids have been unequivocally superior to salicylates only in temporarily suppressing the acute, overwhelming carditis of a small percentage of patients who are moribund, but even here, steroids have not affected ultimate cardiac status. Such severely ill patients are uncommon. For most patients with rheumatic carditis, the three most satisfactory trials of steroids versus salicylates have indicated a two-to-one vote against any superiority for steroids. In the minority report, the patient population differed significantly from that of the other two reports, and its different results probably arise from this feature. It still remains to be shown convincingly that steroids, salicylates, or both produce more permanent cardiac benefit in most instances than symptomatic therapy alone.

For the practicing clinician, the preceding discussion is intended as a guide for use in reviewing the evidence and making his choice of treatment. For the investigator who performs therapeutic trials, it is intended to indicate the subtle details which are required for a successful study. For both, it should recall the old admonition of an investigative clinician: "Unless prognosis springs from solid diagnostic roots, the tree is unstable."
Letters to the Editor
Authors: SILVERMAN WILLIAM A.
Published: December 2021

The recommendations for the design of newborn nurseries recently made by the Committee on Fetus and Newborn resulted from the efforts of members of the Committee and well-qualified consultants to evaluate the present state of knowledge concerning the problems in the control of infections in newborn infants. During the deliberations the Committee was painfully aware of the fact that, with respect to many aspects of this subject, there was a dearth of acceptable experimental evidence. Under these circumstances the group was obliged to make educated guesses.

Doctor Harvie points out that the recommendations of the Committee leave "an impression of finality."
Accidents from Doors
Authors: BASS LEE W.
Published: December 2021

The screen door shown in the Figure is the cause of frequent preventable accidents occurring especially during the summer months. The accident usually involves a young child who is running out the doorway and as the door slams shut, puts a hand out to stop it. If enough force is exerted, the hand, arm or possibly head and neck will crash through the thin glass. The results may be either mild or severe lacerations of the arm; most of the trauma may be incurred when the child withdraws the arm back across the jagged glass. Laceration of the neck area may be life threatening.

The doors are built with two or three sections and the sections are filled with either glass or screen fillers.
The Pathology of Cerebral Palsy
Authors: LOW NIELS L.
Published: December 2021

Anyone writing about cerebral palsy, whether he is dealing with clinical, therapeutic or pathological aspects, is beset with the same difficulties: He is not writing about a disease, not even about one well defined syndrome. Therefore, he must write about a vague subject and must by necessity treat many unrelated disorders.

Dr. Towbin has organized his text well, and he has divided the material into clear and practical chapters. A valiant effort is made to correlate etiology with pathology. The author has emphasized that one single causative factor, anoxia, can cause different pathologic responses but also that different etiologic factors can cause a similar pathologic end-result. Although case histories are given to support anoxia as the presumed etiology in many cases, definite proof that anoxia caused the damage is lacking.
STUDIES IN THE PHYSIOLOGY OF SWEATING IN CYSTIC FIBROSIS
Authors: Sibinga Maarten S. , Barbero Giulio J.
Published: December 2021

With repeated methacholine (Mecholyl) chloride stimulation, experimental sweat gland fatigue was induced in 21 control subjects and 19 patients with cystic fibrosis of the pancreas. The relationship between rate of secretion and concentration of sodium in sweat was studied in these experiments. A concept of two different types of sweat gland fatigue was developed, based on the anatomic parts of the sweat gland.

Sweat glands of patients with cystic fibrosis are subject to fatigue much like normal glands. An earlier decline in sweating rate during the experimental sweat gland fatigue was observed in patients with cystic fibrosis, showing a greater sensitivity to intense stimulation.

Although greater variability in concentration of sodium was observed in patients with cystic fibrosis undergoing a sweat gland fatigue experiment, the over-all fatigue response in both groups was comparable. Tubular function was not interpreted to be abnormal, but an abnormality in the coil seems to be a possible site for the secretory defect in cystic fibrosis. Under intense stimulation the sweat of patients with cystic fibrosis varies with factors that operate in the normal sweat gland. Sweat glands of patients with cystic fibrosis, however, are more unstable in relation to concentration of sodium than are normal sweat glands.
BODY WATER COMPARTMENTS IN CHILDREN: CHANGES DURING GROWTH AND RELATED CHANGES IN BODY COMPOSITION
Authors: Friis-Hansen B.
Published: December 2021

During growth of infants and children, certain characteristic changes are found. A rapid decrease of the relative volumes of total body water and of extracellular water occurs during the first year of life, followed by a smaller decrease of volume of extracellular water later in childhood. At the same time an increased heterogeneity of the extracellular water takes place. On the other hand, the volume of intracellular water increases a little during the first months of life and remains more or less constant from then on. Formulas and nomograms from which these body water compartments can be predicted are presented. Finally, data on the corresponding changes in the total body water and in body specific gravity are discussed.
PRESIDENT'S MESSAGE
Authors: Wheatley George M.
Published: December 2021

SEVERAL months ago I had the privilege of visiting Winnipeg, in Saskatchewan, Canada, at the invitation of the Academy Chapter there, to address the 52d annual meeting of the Children's Hospital. My talk at the meeting was an effort to answer the question: "What lies ahead for children's hospitals?" I know that many pediatricians and others, much more experienced in this complex subject than I, are seeking the answer. Perhaps exposing you to some excerpts from my Winnipeg talk will stimulate discussion of the future of this important factor in child health.

The progress made in the care of children in general hospitals and the strengthening of pediatric service in university medical centers raises the question: "Do we need special hospitals for children?" Dr. J. W. Gerrard, Professor of Paediatrics at the University of Saskatchewan, in a recent letter to me sums up the case for children's hospitals very well. He says:

1. Children's hospitals set the standards of treatment, care and investigations for routine pediatric problems. There is no doubt, for example, that acute infantile gastroenteritis is handled very much more efficiently in a children's hospital by pediatricians than in a general hospital where children are cared for, possibly by pediatricians, but more probably by general practitioners. Not only will the treatment be better in the children's hospital, but the children's hospital will be to an advantage because its services, and in this particular, its biochemical services, will be tailored to meet the needs of children; analyses will be carried out on small amounts of blood, not on the large quantities required by laboratories dealing mainly with adults.

2. A children's hospital is advantageous because not only do perplexing problems, but skilled pediatricians as well, tend to gravitate towards it, and there is always the opportunity, should the need arise, to call in colleagues in consultation.

3. In a children's hospital, common problems tend to be grouped together, e.g., children with leukemia, heart disease, nephrosis and so on, providing the opportunity for pediatricians to specialize in a particular field; they then gain experience which helps to raise the standards of treatment and research in these fields.

4. A children's hospital provides students and interns with a chance to review all or most pediatric problems within a relatively short span of time, so that when they go out into practice they will be able to recognize the rare and the strange, for they will be seeing diseases which they have already had a chance to study and treat.

5. Children's hospitals provide excellent centers for the dissemination of new knowledge to those in practice, particularly at so-called "refresher courses," and in this way keep those in practice up to date.
DIAGNOSTIC INERTIA
Authors: MCKAY R. J.
Published: December 2021

In this issue of Pediatrics the article entitled "A New Design for Patient Care and Pediatric Education in a Children's Hospital: An Interim Report," by Green and Segar, represents a challenging approach to problems that are of increasing concern to pediatric educators and pediatric services of medical centers throughout the United States. It should be emphasized that the authors' plan is a proposed solution to the problems involved, and that the question as to whether it will constitute an answer will have to await analysis not only of their results but of the results of other approaches to the same problems.
PRIMARY FAMILIAL XANTHOMATOSIS WITH INVOLVEMENT AND CALCIFICATION OF THE ADRENALS
Authors: Wolman M. , Sterk V. V. , Gatt S. , Frenkel M.
Published: December 2021

THIS PAPER deals with the description of clinical, pathologic, histochemical and biochemical findings in two cases of generalized xanthomatosis with calcification of the adrenals. The infants were siblings of a previously described patient,1 and and the findings warrant the conclusion that the disease process was identical in all three.

The study of these cases and review of pertinent literature indicates that primary xanthomatosis (idiopathic lipidosis with deposition of cholesterol and triglycerides) is a metabolic disease entity that is independent of the granulomatous process called histiocytosis X, or eosinophilic xanthomatous granuloma. It will be shown in the discussion that primary xanthomatosis may occur in various forms, and that the form described in this paper is a rare but distinct clinical and pathologic type. This type differs in the distribution of lesions from other types of primary xanthomatosis, such as the type of cerebral xanthomatosis described by van Bogaert, Scherer and Epstein, and the type associated with involvement of bones that sometimes produces the Hand-Schüller-Christian syndrome.

For reasons that wiil be clarified in the discussion, the term "Hand-Schüller. Christian disease" is not adopted in this paper. The term "Hand-Schüller-Christian syndrome" indicates a well-known syndrome with exophthalmos, diabetes insipidus and peculiar bone changes. The term "primary xanthomatosis" describes a primary (i.e., idiopathic) storage process in which triglycerides and cholesterol are deposited in various tissues.

CASE REPORTS

Case 1

Family History: The two infants described in this article and the infant previously described1 were female siblings born to closely related parents. The father and mother, both Persian Jews, were cousins.
INTELLIGENCE OF CHILDREN WITH DIABETES MELLITUS
Authors: Ack Marvin , Miller Irving , Weil William B.
Published: December 2021

I.Q. tests were administered to 38 pairs of diabetic and nondiabetic children. In each family the nondiabetic child was a randomly selected sibling of the diabetic child. No relation was found between I.Q. difference (diabetic I.Q. - sibling I.Q.) and duration of illness. Children in whom diabetes began before the age of 5 years had significantly lower I.Q.'s than their nondiabetic siblings. There was no statistical difference between the diabetic and his sibling when the disease began after 5 years of age. A suggestive relationship (but not statistically significant) was found between the number of episodes of hypoglycemia and acidosis and the magnitude of the I.Q. difference between diabetics and siblings for those with onset of disease before 5 years of age.
SUPERIOR HEMORRHAGIC POLIOENCEPHALITIS (WERNICKE'S DISEASE) OCCURRING IN AN INFANT—PROBABLY DUE TO THIAMINE DEFICIENCY FROM USE OF A SOYA BEAN PRODUCT
Authors: Cochrane W. A. , Collins-Williams Cecil , Donohue W. L.
Published: December 2021

A 7½-month-old male infant at necropsy revealed pathologic findings compatible with those of superior hemorrhagic polioencephalitis (Wernicke's disease). A retrospective dietary history indicated that the child had received a soya bean product because of atopic and gastrointestinal allergy; this resulted in a deficient intake of vitamin B1. The symptoms and signs of thiamine deficiency in infants are briefly reviewed. It is recommended that all physicians consider the importance of vitamin supplementation when prescribing restricted or special diets for young infants and children.
HYDROCEPHALUS AND OBSTRUCTION OF THE SUPERIOR VENA CAVA IN INFANCY
Authors: Hooper Reginald
Published: December 2021

The clinical manifestations of obstruction of the superior vena cava are discussed, and the infrequent occurrence of this condition in childhood is noted. A case is reported in which obstruction of the superior vena cava caused early enlargement of the head, and the condition was diagnosed when the child was referred for management of hydrocephalus. Increased intracranial venous pressure causes cerebrospinal fluid to be produced in excess of absorption. When this occurs in early childhood, enlargement of the head occurs without manifestations of cerebral dysfunction.

The management of this condition and the intracranial complication is discussed.
PREDUODENAL PORTAL VEIN
Authors: Boles E. Thomas , Smith Blanca
Published: December 2021

A preduodenal portal vein is a rare vascular anomaly that is the result of a variation in the normal developmental pattern of the embryonic precursors of the portal vein, the right and left vitelline veins and their three anastomotic channels. Such an anomalous vein is a hazard in operations on the duodenum or biliary tract because of the dangers of inadvertent division or ligation. The anteriorly placed portal vein may also interfere with the customary placement of anastomosis in instances of congenital duodenal obstruction. There is a remarkably frequent association of preduodenal portal vein with situs inversus of varying degrees and with malrotation.
DOUBLE URETERS IN INFANCY AND CHILDHOOD
Authors: Ratner Irving A. , Fisher John H. , Swenson Orvar
Published: December 2021

The embryology, pathology, diagnosis and treatment of double ureters is presented and correlated with the authors' experience with 62 clinical cases from 1950 to 1960. A method of treatment is suggested based upon the principle of conservation of renal tissue; the results of this treatment are indicated.