bluuebunny/crossref_metadata_2025 huggingface dataset:
RAPE: Offenders and Their Victims, by John M. MacDonald, M.D. Springfield, Illinois: Charles C Thomas, 1971, 342 pp., $14.00
Authors: Starbuck George W.
Published: December 2021

The author has accumulated many vividly recorded cases of rape from Biblical days to recent times. He has confined his writing to the victim and offender, before, during, and after the act, with unnecessarily numerous examples. What he did not emphasize enough is prevention and treatment. These are as important as what he did stress, i.e., facts and advice about prevention; but these have been repeated from generation to generation, again and again, and add little to our pool of knowledge.
STUDIES OF THE SUDDEN INFANT DEATH SYNDROME IN KING COUNTY, WASHINGTON. III. EPIDEMIOLOGY
Authors: Bergman Abraham B. , Ray C. George , Pomeroy Margaret A. , Wahl Patricia W. , Beckwith J. Bruce
Published: December 2021

Excluding the first week of life, sudden infant death syndrome (SIDS) is the greatest single cause of death during the first year of life and second only to accidents as the greatest killer of children under age 15. All cases of SIDS occurring in King County, Washington (170) during a 44-month period were studied. Birth certificate data from all children born in the county during the same period were utilized for comparison. Findings include a characteristic age distribution (peak at 2 to 3 months), preponderance in males, low birth weight babies, and in lower socioeconomic class families.

"Seasonality" and apparent "time clustering" were present in the infants. All SIDS infants died during sleep in a silent fashion. Forty-four percent of the babies had an upper respiratory infection in the 2-week period prior to death. The epidemiologic findings point to viral infection as playing a major contributory role in SIDS.
I: From the Introductory Remarks
Authors: Spock Benjamin M.
Published: December 2021

What to me as a pediatrician is most fascinating about Erik Erikson is the contrast between his achievements and his own childhood and formal education. You know that he has been Professor of Psychology at the University of California at Berkeley, and for the last 10 years University Professor at Harvard. As you may also know, a University Professor is someone whose knowledge is considered so profound and so broad that he can't be confined to any one University department. Erik Erikson has also been a distinguished psychoanalyst who has expanded significantly the concepts given us by Freud. Yet if he had been your patient in his youth, you would have shaken your head gravely. And if you had been considering him for admission to medical school or to the American Academy of Pediatrics, you would have found him completely lacking in formal qualifications.

He was born of Danish parents who separated during his infancy. His mother then took him to live with friends in Germany, where she eventually married her son's doctor. Thus Erik, by adoption, became the son of a pediatrician. He always teases us about this fact.

All through school he was a notoriously poor student, except in art and in ancient history. Instead of going on to the university, when he graduated from high school at the age of 18, he became a wanderer. As what we would call today a "hippie" or "alienated person," he wandered for a year through the Black Forest and up to Lake Constance doing nothing that would be called work or study, at least by American standards.
Acidosis and Failure to Thrive in Infants Fed Nutramigen
Authors: Healy Cornelius E.
Published: December 2021

Nutrition in a seriously ill neonate may determine whether or not the infant survives. Nutramigen offers a theoretical feeding advantage in that formula is partially digested so that the work of digestion is lessened. Nutramigen substitutes sucrose for lactose, a solution of amino acids for milk protein, and corn oils for butterfat. It also offers essential vitamins and minerals. Many physicians use this preparation as a food for seriously ill infants and a transitional feeding following diarrhea. It is also used for feeding in milk allergy and in galactosemia.

We have noted a puzzling syndrome in some seriously ill neonates over the past several years.
THE IMPORTANCE OF FATHERS IN THE REARING OF CHILDREN—TWO EIGHTEENTH CENTURY VIEWS
Authors: C. T. E.
Published: December 2021

The two quotations below,1 the first from the writings of Dr. William Buchan (1729-1805) and the second from those of Dr. C. August Struve (1767-1807) were probably read with incredulity by eighteenth century fathers, most of whom considered the affairs of the nursery entirely the domain of women.

The mother is not the only person concerned in the management of children; the father has an equal interest in their welfare, and ought to assist in every thing that respects either the improvement of the body or mind. It is a pity that men should be so inattentive to this matter; their negligence is one reason why females know so little of it. Women will ever be desirous to excel in such accomplishments as recommend them to the other sex; but men generally keep at such a distance from even the smallest acquaintance with the affairs of the nursery, that many would reckon it an affront were they supposed to know any thing of them. Not so, however, with the kennel or the stables: a gentleman of the first rank is not ashamed to give directions concerning the management of dogs or horses, yet would blush were he surprised in performing the same office for that being who derived its existence from himself, who is the heir to his fortunes, and the future hope of his country.

I by no means wish to insinuate that the troubles and cares of education during the first periods of life should be exclusively imposed upon mothers.
Letter to the Editor
Authors: Brent Robert L.
Published: December 2021

The suggestion of the Infectious Disease Committee of the American Academy of Pediatrics virtually to eliminate vaccinia immunization in this country is an important decision. Frequently important decisions are made unilaterally without laying the legal and political groundwork for an orderly transition from the old to the new status.

The transition is already underway to make the U.S.A. a population susceptible to smallpox. Should we not consider more carefully:

(1) The present policies in Russia, China, and other nations with regard to their plans for creating a susceptible population.
Letter to the Editor
Authors: Nathenson Gerald , Golden Gerald S. , Litt Iris F.
Published: December 2021

We share the concern of Doctors Schiff, Chan, and Stern and Doctors Cohen, Neumann, and Ganapathy regarding the displacing effects of sodium benzoate contained in parenteral diazepam on the bilirubin-albumin complex. Though binding capacities of addicted infants receiving diazepam have been normal when measured by the hydroxybenzenazo benzoic acid method, recent evidence indicates superiority of sephadex G25 filtration over dye binding techniques, since the sephadex method directly measures the amount of bilirubin displaced. It would be important to know whether parenteral diazepam produces free bilirubin, in vivo, particularly when administered intramuscularly.
"GREEN STOOL SYNDROME" OF THE NEWLY BORN INFANT
Authors: GREENBLATT I. J. , BLOCH HARRY , TURIN R. D. , STERNBERG S. DAVID
Published: December 2021

A syndrome in newborn infants consisting of green stools, normal number of bowel movements, without pyrexia, dehydration, vomiting or death, is described.

No etiologic agent was uncovered but metabolic changes as evidenced by low prothrombin and absence of urobilinogen in the feces and urine were seen.

The appearance of normal bacteriologic flora of the feces as evidenced by culture, smear and the presence of urobilinogen, and normal prothrombin activity following treatment suggest that a penicillin-sensitive agent which exerted antibiotic effects on the normal intestinal flora was present.
ANALYSIS OF PREMATURE MORTALITY RATES
Authors: PLATTNER EDWARD B. , STEIN ALBERT F. , GERBER HAROLD X.
Published: December 2021

During the years of 1941 to 1946, 2,910 premature infants were admitted to the Premature Station of the Children's Division of Cook County Hospital. Of this number 17.9% died. The influence of birth weight on survival rate was demonstrated.

There were more female premature infants than males (1.23:1).

The female infants had a higher survival rate than the male infants (15.3% mortality rate for females as compared with 21.9% for males).

There were more nonwhite than white premature infants in this series. The nonwhite infants had a mortality rate of 15.7% whereas the white infants had a mortality rate of 20.6%. Possible explanations for this difference included racial factor and the factor of transportation of a prematurely born infant from one place to another.

Of the infants born at Cook County Hospital where the factor of transfer was nonexistent, nonwhite infants had a mortality rate of 16.3%; the white infants, 21.1%. Female infants survived better than did the male infants (female mortality rate, 13.4%; male mortality rate, 22.2%).

Of the infants transferred to Cook County Hospital, the white infants survived better than the nonwhite (21% as compared with 25.3%). The female infants in this group likewise showed greater survival ability as compared with the male infants (20.2% for females; 24.1% for males).

There was no month of the year in which prematurity was consistently higher than the other months.

The death of prematurely born infants likewise is not influenced by the month of the year. The mortality rate is related to the number of admissions and not to month or season.
CURRENT PROBLEMS IN DEATHS OF PERSONS UNDER 20 YEARS OF AGE
Authors: BAUMGARTNER LEONA , PESSIN VIVIAN
Published: December 2021

In the past 10 years mortality rates for persons under 20 have declined less rapidly than in that of the previous decades. Nevertheless, the application of new and well recognized procedures in the prevention of deaths due to pneumonia, influenza, appendicitis, diarrhea and contagious diseases, and tuberculosis have led to striking reductions in deaths due to these causes. Because of these reductions, other causes of death have assumed new importance. Thus, in children over one year of age accidents are today the leading cause of death. Heart disease, tuberculosis and cancer claim a high percentage among those from 10 to 20, while contagious and respiratory diseases are still important in children under 10.

In infants, the deaths occurring before, at or near birth are of chief importance, with those associated with premature birth assuming an importance that demands active and immediate attention. Despite the gains made, deaths associated with childbirth (i.e., fetal and neonatal deaths) stand second today in claiming lives of all ages in New York City. Only heart disease has a larger mortality. The time has come for physicians to take cognizance of these facts and to see that all mothers and babies get the kind of care which good pediatricians and obstetricians know can be given. In addition, there is a pressing need for an intensified research program to the end that deaths in infancy and those due to accidents and heart disease can more effectively be prevented.
CHEMOTHERAPY OF TUBERCULOSIS IN CHILDREN
Authors: LINCOLN EDITH M. , KIRMSE THOMAS W.
Published: December 2021

Streptomycin is the most effective tuberculostatic agent. It is unsuitable for prolonged therapy because of its potential toxicity, especially for the vestibular branch of the VIII C nerve, and because of the tendency of the tubercle bacillus to become resistant after relatively short periods of treatment.

Experience only will prove ultimately which lesions respond best to streptomycin therapy. Because of its limitations its use as a sole chemotherapeutic agent should be restricted to cases which can be benefited or cured by short courses of therapy not exceeding six weeks. It is of great value in controlling tuberculosis for short periods of time so as to permit surgical procedures and collapse therapy. Streptomycin is contraindicated in forms of tuberculosis such as primary infections and minimal chronic pulmonary tuberculosis which usually respond without chemotherapy. It should not be used in an attempt to prevent complications; meningitis and other less serious complications may develop during treatment.

Promizole® was found to be ineffective in the treatment of tuberculous meningitis; five out of seven cases of acute generalized miliary tuberculosis treated with promizole® have survived 2½ to almost five years and are free from miliary tuberculosis.

Combined therapy with streptomycin and promizole® was undertaken in order to utilize the advantages of the rapid action of streptomycin with the prolonged bacteriostatic action of the sulfone which can be given safely and effectively for a period of years. By combining the two drugs it was hoped to delay the emergence of resistant organisms and to secure an enhanced effect from both streptomycin and promizole®.

Ten children with miliary tuberculosis have been treated by combined therapy. One patient died after six days of treatment and another of a relapse from meningitis 11 months after the initial diagnosis of miliary tuberculosis. No relapse of miliary tuberculosis has occurred in patients treated with promizole® whether or not it was combined with streptomycin.

Eighteen cases of tuberculous meningitis have been treated with streptomycin by the intramuscular and intrathecal routes and with promizole® orally. Thirteen cases survived from 5 to 23 months. There have been no severe neurologic sequelae. All the survivors are apparently normal mentally.
PAPULAR URTICARIA
Authors: BLANK HARVEY , SHAFFER BERTRAM , SPENCER MALCOLM C. , MARSH WILLIAM C.
Published: December 2021

Papular urticaria (lichen urticatus) is a chronic disease which in the great majority of cases occurs during the warm seasons on exposure to fleas and bedbugs.

Skin tests indicate many such patients are abnormally sensitive to these insects.

In the three year study reported, it was demonstrated that 86% of the patients could be cured in two weeks with a 5% DDT dusting powder and DDT household spray, whereas with former methods of therapy, only 21% were cured in 11 weeks of treatment.
TREATMENT OF HEMOPHILUS INFLUENZAE b MENINGITIS
Authors: MCMORROW KATHRYN J. , TOP FRANKLIN H.
Published: December 2021

The present series consists of 67 patients, 17 of whom died, giving a gross fatality rate of 25.4%. Nearly one half of the cases were under 2 years of age and accounted for 65% of the deaths. By disregarding patients who died within 36 hours of admission and patients first admitted to the hospital after 21 days, the corrected fatality rate for the group below 2 years is 18.2%.

Death occurred in the four patients admitted and first treated at the end of the third week of illness. Both deaths in the group under 2 years who received sulfadiazine, serum and streptomycin occurred in patients who had been ill three weeks before receiving treatment.

The prognosis is likely to be unfavorable in the age group under 2 years if treatment is delayed beyond the 14th day.

The fatality rate for patients who received sulfadiazine and serum was the same in this series as for patients who received streptomycin in addition.

Serotherapy proved ineffectual in the age group under 2 years when delayed beyond the 14th day of illness. With respect to prognosis, the intravenous route for administration of serum offers no advantage over the intramuscular route.
CLINICAL STUDIES OF THE EFFECTS OF 3,5,5, TRIMETHYLOXAZOLIDINE-2-4-DIONE (TRIDIONE®) ON THE HEMATOPOIETIC SYSTEM, LIVER AND KIDNEY
Authors: DENHOFF ERIC , LAUFER MAURICE W.
Published: December 2021

Six children receiving tridione® showed : 1. A constant syndrome of : a decline in bone marrow megakaryocyte and nucleated red blood cell elements; a low peripheral blood platelet count; and prolonged clot retraction time. 2. An occasional association of: peripheral leukopenia, toxic signs in the red blood cells and lymphocytes, and an abnormal cephalin flocculation response.

In one case the bone marrow megakaryocyte response occurred alone and was temporary; in another it was temporary but associated with a persistent decline in marrow nucleated red blood cells; and in a third case both the megakaryocyte and nucleated red blood cell depression were only temporary, despite continuation of the medication.

Withdrawal of medication caused a return to normal values, most rapid and marked in the bone marrow.

Tests for clot retraction time and platelet counts at regular intervals in addition to complete blood counts seem indicated in all patients receiving tridione®. When available, bone marrow studies, especially of megakaryocytes, would also be of value.
RETROLENTAL FIBROPLASIA
Authors: HEPNER W. R. , KRAUSE ARLINGTON C. , NARDIN HELEN E.
Published: December 2021

Ninety-two per cent of the 66 cases of retrolental fibroplasia seen at the University of Chicago were born prematurely. No patients found to have retrolental fibroplasia were born at the Chicago Lying-in Hospital before 1937. The incidence of retrolental fibroplasia at the Chicago Lying-in Hospital from 1937 through 1945 was 6.8% of all survivals weighing less than 1600 gm. at birth; from 1946 through 1948, the incidence was 30.4% in the same weight group. The ratio of surviving infants born weighing less than 1600 gm. to the total number of surviving infants born at the Chicago Lying-in Hospital remained relatively constant from 1937 through 1948.

The etiology of retrolental fibroplasia cannot yet be explained by prenatal bleeding or specific infection. Cutaneous angiomas cannot be said to have etiologic significance in retrolental fibroplasia since the incidence of cutaneous angiomas is no greater in infants with the disease than in premature infants in general. No relationship between the use of sulfonamide drugs and the development of retrolental fibroplasia can be established in this series of patients.

An ocular disease of postnatal origin may be separated from the composite group. With this postnatal disease retinal detachment is the basic sign, prematurity is universal, and associated central nervous system and somatic defects are less common. A large increase in incidence of this postnatal disease occurred with a change in neonatal management. During the same period, no change in the incidence of the disease of prenatal origin was apparent.

The change in neonatal management that could be related to the rise and fall in incidence was the use of a multiple vitamin preparation containing a synthetic emulsifying agent. An attempt to correlate the first appearance of or the changes in incidence of the disease at the University of Chicago was the first use of vitamin A or modification of the dosage of vitamin A was unsuccessful.

It is suggested that the title retrolental fibroplasia be reserved tentatively for those infants who have bilateral retinal separation as a complication of extreme prematurity until an etiologically appropriate name may be proposed.
CONGENITAL MEGACOLON
Authors: RITTER JOSEPH A. , HAWTHORNE HERBERT R. , METZGER HARRY N.
Published: December 2021

Congenital megacolon of the obstructive type, currently attributed to agenesis of the intramural plexuses in the contiguous distal segment, is amenable to surgical treatment.

Resection of either the distal neurogenically obstructive segment or the dilated proximal segment, contrastingly different procedures, results in anatomic and functional improvement.

Three cases, herein reported, treated by resection of the dilated segment, demonstrate that the preferential choice of resection of the neurogenically obstructive segment may be on an equivocal physiologic basis.

The new operations developed for eliminating the neurogenically obstructive segment appear to be an advancement in surgical technic.
OBSERVATIONS ON PITUITARY-ADRENAL RESPONSE TO EPINEPHRINE
Authors: WHITE FORREST P. , SUTTON LEE E.
Published: December 2021

The eosinophil depression test used as a test for normally functioning anterior lobe of the pituitary gland and adrenal gland cortex in response to stress is consistent and valid in infants and children.

The pituitary-adrenal stress mechanism as judged by the eosinophil depression test appears to be well developed in the full term infant at birth. Newborn term infants showed normal responses.

Premature infants with few exceptions failed to show a normal response to the test, indicating an immaturity in their resistance to stress as mediated by the anterior lobe of the pituitary gland and adrenal cortex.

Older infants and children responded normally in 12 of 14 cases. Of the two exceptions, one was a child with eczema who had an intense eosinophilia and the other a child with diabetes insipidus.

Many clinicians have long held the belief that adrenal cortical hormones should be given to premature infants who do not respond to routine care or who are subjected to infection, operation or other conditions of unusual stress. There is a need for further study of the therapeutic value of adrenal cortical hormones in premature infants with inadequacy of resistance to stress.
DETERMINATION OF THE OXYGEN CONTENT OF CAPILLARY BLOOD IN CONGENITAL HEART DISEASE
Authors: HULTGREN HERBERT N. , HACKETT ADELINE J.
Published: December 2021

A previously described technic of collecting and analyzing capillary blood for oxygen content has been modified slightly and applied in the study of children with congenital heart disease. Samples obtained and analyzed in this manner differed in oxygen content from simultaneously drawn arterial samples by no more than 0.4 volumes per cent. The value of the technic in the study of congenital heart disease has been illustrated.
ERYTHROBLASTOSIS FETALIS
Authors: VAUGHAN VICTOR C. , ALLEN FRED H. , DIAMOND LOUIS K.
Published: December 2021

1. Twelve years' experience with 539 cases of erythroblastosis fetalis has been reviewed.

2. It is not possible to show beyond the statistical limits of chance that any change in mortality of erythroblastosis fetalis in relation to therapy in live born infants has occurred in this time.

3. It is probable that the early induction of labor has caused an increased risk to live born babies during part of this period, when erythroblastosis fetalis has been complicated by immaturity, particularly before 38 weeks' gestation.

4. Caution is urged in assaying the value of any therapeutic measure, the use of which in erythroblastosis fetalis may result in a selected body of clinical material.
DOSAGE OF DRUGS IN INFANTS AND CHILDREN: I. ATROPINE
Authors: UNNA KLAUS R. , GLASER KURT , LIPTON EARL , PATTERSON PAUL R.
Published: December 2021

The susceptibility of apparently healthy children of all age groups to atropine by oral and subcutaneous administration was studied in carefully controlled experiments on 129 children. The minimal effective dose (MED) of atropine was determined by its effect in suppressing sialorrhea elicited either mechanically by chewing gum and/or pharmacologically by subcutaneous injection of methacholine.

Variations in individual susceptibility to atropine are large in all age groups and independent of the route of administration (oral, hypodermic.)

The average MED/kg. body weight following oral administration is somewhat smaller in infants of 1 to 12 months and children from 12 to 36 months (0.16 and 0.14 mg./kg., respectively) than in older children in the age groups of 3 to 6 years and 6 to 12 years (0.22 and 0.20 mg./kg., respectively). Comparable results are obtained by hypodermic administration.

The ratio between the MED by mouth and the MED by hypodermic injection is approximately 3:1 in all age groups.

The determination of the susceptibility of children of various ages of atropine fails to adduce evidence supporting the assumption of an increased resistance to atropine or of a physiologic vagotonia in infants.

The relation of the MED of atropine in apparently healthy children to the doses recommended in pediatric therapy is discussed. The calculation of the dosage of atropine by body weight is recommended.
STUDIES ON THE GELATIN-LIQUEFYING PROPERTIES OF CERTAIN BACTERIA
Authors: JOHNSTONE DOUGLAS E.
Published: December 2021

The gelatin film test for the demonstration of gelatin-liquefaction of bacterial cultures and stool suspensions is described. This test may aid in the identification of gelatin-liquefying bacteria, particularly members of the Pseudomonas and Proteus groups.

One hundred and seventy-nine strains of bacteria were tested. Positive results were obtained with Ps. aeruginosa, P. ammoniae and some strains of P. morgani. Negative results were obtained with 24 hour cultures of Staph. aureus hemolyticus and Esch. coli.

This test may be positive in dilutions of 24 hour broth cultures of gelatin-liquefying bacteria as high as 1:100,000 with an average of 1:200. The average number of such bacteria found necessary to give a positive gelatin film test is 960,000/2 drops of test solution (varying from 80,000 to 360 million). Bacteriologically sterile Seitz filtrates of gelatin-liquefying bacteria also gave positive gelatin film tests in high dilutions.

A mixture of gelatin-liquefying bacteria with saline suspensions of feces gave positive tests.

Stool cultures of four and duodenal cultures of three proved cases of cystic fibrosis of the pancreas revealed heavy growth of gelatin-liquefying bacteria. All these specimens gave positive gelatin film tests.

The presence of aureomycin in the stool (in concentrations of up to 1 mg./cc.) does not inactivate bacterial gelatinase.

The fact that bacteria present in the gastrointestinal tract may give a positive gelatin film liquefaction test makes mandatory the re-evalution of the positive feces "x-ray" tests for the diagnosis of cystic fibrosis of the pancreas. To avoid false positive gelatin film tests, the results of the test should be correlated with the presence or absence of gelatinliquefying bacteria.
AORTIC-PULMONARY COMMUNICATION DUE TO LOCALIZED CONGENITAL DEFECT OF THE AORTIC SEPTUM
Authors: GIBSON STANLEY , POTTS WILLIS J. , LANGEWISCH WILLIAM H.
Published: December 2021

Four patients who had findings suggestive of a patent ductus arteriosus were explored. In none was a patent ductus found.

Evidence is offered in support of an aortic-pulmonary communication due to a localized defect in the aortic septum as accounting for the clinical symptoms and signs.
DUODENITIS IN CHILDHOOD
Authors: GILLESPIE JAMES B. , DUKES RICHARD E.
Published: December 2021

Six cases of duodenitis in childhood are reported and the literature is briefly reviewed. Recovery was prompt and uneventful in all but one patient in this group. In the single instance chronic duodenitis existed for a period of four years despite a medical regime considered adequate. The possible presence of an inflammatory lesion of the duodenum should be considered in any child with vague or ulcer-like abdominal complaints. A clinical diagnosis can only be suspected and roentgen studies of the stomach and duodenum are indicated in cases of obscure gastric discomfort.
Round Table Discussion
Authors: SMITH CLEMENT A. , HEATON CLAUDE , HARSHBERGER JANE Y. , SPOCK BENJAMIN , NATHANSON IRA T. , BAIN KATHERINE , KIMBALL E. R.
Published: December 2021

Chairman Smith: In their approach to breast feeding, as to religion, pediatricians might be classified in 3 groups. There are the firm believers, with serene faith that all women ought to nurse their babies because "breast feeding is best feeding." At the other extreme, certain agnostics hold that it makes no important difference whether a baby is breast fed or given a formula. Much the most numerous are the third group, who would be glad to have a faith to stand up for if the rational basis of such a faith were revealed to them. These conscientious physicians, anxious to give sound scientific advice, find themselves falling back among traditions and impressions, in the absence of modern factual knowledge. Much new data concerns only premature infants, for whom it is quite possible that Nature did not design human milk. Obviously we need facts. Are the antibodies in human milk significant? Does it protect against neonatal diarrhea? Does suckling cause uterine involution? What constitutes optimum growth in infancy? Does it result with artificial feeding?

Without the answers to these and other questions the subject escapes into psychologic and emotional fields since it cannot be properly tackled in physiologic territory. Indeed whether a mother will nurse her baby is now usually decided psychologically rather than physiologically. If 72% of New Hampshire babies leave the maternity hospital on bottle feeding only, compared to 10% of those in South Carolina, the psychology of South Carolina women, and of their doctors, must differ from that of those in New Hampshire.
THE PEDIATRICIAN AND THE PUBLIC
Authors: GOLDMANN FRANZ
Published: December 2021

1. Payment for the services of physicians conducting diagnostic clinics is made most frequently by allowing flat rates, either per unit of time or per clinic session, somewhat less frequently by using the part-time salary system, and only rarely on the basis of the fee-for-service system.

2. Payment for specialist consultations outside of clinics is based on the fee-for-service system and the part-time salary system in this order of frequency.

3. Payment for treatment by physicians, both specialists and general physicians, is made most frequently on the basis of the fee-for-service system and less frequently on the basis of the part-time salary system.

4. In at least eight states, the part-time salaries paid to the physicians cover a varying combination of the following types of professional service: diagnostic clinic sessions, consultations outside of clinics, and treatment, including preoperative and postoperative care as well as operative procedures.

5. Dentists, including orthodontists, are compensated on the basis of the fee-for-service system in the great majority of all states.

6. Pediatricians receive fees most frequently and flat rates or part-time salaries less frequently. Orthopedic surgeons are paid on the basis of the flat rate system, the fee-for-service system, or the part-time salary system in this order of frequency.

7. Reimbursement of travel expenses incurred in connection with both service at diagnostic field clinics and consultations outside of clinics is a widely accepted principle.

8. There is little, if any, information on such questions as the reasons for the choice of certain methods of payment, the basis for the determination of specific rates of compensation, the number of diagnostic clinic sessions actually held per month or year, the average number of hours, excluding travel time, actually spent on one clinic session, the amount of work and time actually contributed by the physicians receiving part-time salaries, or the type and amount of service rendered by physicians compensated on the basis of the fee-for-service system. In the absence of such information no conclusions can be drawn on the relative merits of the various payment methods employed and especially on the adequacy of the compensation received by the participating physicians and dentists, the effect on the quality of service, and the administrative implications.
BLOOD CARBONIC ANHYDRASE ACTIVITY IN NEWBORN INFANTS AND THEIR MOTHERS
Authors: ALTSCHULE MARK D. , SMITH CLEMENT A.
Published: December 2021

Each ml.of erythrocytes of newborn infants exhibits carbonic anhydrase activity which, on the average, is approximately 40% of that found in the erythrocytes of adult subjects. The deficiency appears to vary with the maturity of the organism, either in or ex utero. It is not as great as that described by earlier workers who used methods of less validity. Moreover, the relative polycythemia of the newborn infant counteracts this deficiency, and accordingly the blood of these infants may exhibit carbonic anhydrase activity within or a little below the normal adult range. Transfusion into infants of adult blood increases the carbonic anhydrase activity.

Mothers in whom blood hemoglobin levels are low show similar degrees of lowering of blood carbonic anhydrase activity.

The functional significance of the changes found in the newborn infant is not known.
TOTAL BLOOD EOSINOPHIL COUNTS IN THE NEWBORN PERIOD
Authors: MEDOFF HAROLD S. , BARBERO GIULIO J.
Published: December 2021

A total of 262 eosinophil counts were done on a series of 57 infants. The mean level was 267 at birth and 483 at 1 month of age.

The eosinophil count rose significantly in the first week of life in 75% of 44 infants. Eighty-two per cent of 28 infants showed a significant rise in eosinophils from 5 to 30 days of age.

The marrow of newborn infants was relatively rich in myelocytic and rubrocytic elements and low in lymphocytes. At 30 days of age the marrow showed a significant and reciprocal change in the relative proportions of these elements.

The infant's eosinophil pattern in the first week after birth was variable and erratic. It differed quantitatively and qualitatively from that of his mother.
STUDIES OF ACID BASE EQUILIBRIUM IN PREMATURE INFANTS
Authors: REARDON HELEN S. , GRAHAM BRUCE D. , WILSON JAMES L. , BAUMANN MARY L. , TSAO MAKEPEACE U. , MURAYAMA MAKIO
Published: December 2021

A study of the acid base balance of arterial blood in 92 premature infants, aged 1 to 65 days and 1.1 kg. to 2.3 kg. in weight, has been presented. The temporal artery blood was analyzed for pH, plasma CO2 content, chloride, total protein, total base. Alveolar carbon dioxide tension (pCO2) and "R" were calculated. Acid base analyses on the femoral artery blood of 16 adolescent well boys were used as controls. The study reveals the following salient facts:

There is a wide variation in the blood chemical findings between normal, well premature infants. In addition, repeat determinations upon the same infants revealed a more labile blood chemical picture than is found in older infants or adults.

No premature infant had all fractions of the acid base balance within the adult normal range.

The mean values for pH, CO2 content and protein were reduced in premature infants, while the mean values for total base, chloride, phosphate and "R" were elevated as compared to the values for the adult controls. The mean value for carbon dioxide tension was normal.

Sixty-seven per cent of the premature infants had the chemical findings of an uncompensated metabolic acidosis; 13% had a normal pH and CO2 content; 10% had a respiratory acidosis, 7% had a respiratory alkalosis and 3% were unclassified.

There was no statistical correlation of acid base values to birth weight or age or weight at the time of chemical sampling.

There was no difference of acid base values in infants who had been transfused by blood or plasma and those infants who had never been given blood or plasma transfusions.

By clinical examination alone, the nature of the acid base variations could not be anticipated in what we generally consider as well premature infants. There was no correlation between the variations of the acid base disturbance and the prognosis for life in these babies.

The fact that most premature infants have an increased hydrogen ion concentration and an unstable acid base balance may be additional reasons why premature babies so easily develop severe acidosis when any stress occurs, whether it is improper feeding, infection, etc.

The cause of the acidosis in premature infants has not been established. The theory that premature infants have a partial anaerobic metabolism with a decreased production of carbon dioxide is tenable but not established.
GASTRIC ULCER OF THE PYLORUS SIMULATING. HYPERTROPHIC PYLORIC STENOSIS
Authors: COLE ARTHUR R. C.
Published: December 2021

A brief review of the natural history of peptic ulcer in infancy and childhood is given. The symptomatology, differential diagnosis and diagnostic procedures are presented. The diagnosis of peptic ulcer should be considered more often in infancy and childhood and the proper diagnostic procedures instituted.

A case of gastric ulcer simulating hypertrophic pyloric stenosis is presented. A summary of 31 cases with peptic ulcers found at autopsy at the Babies Hospital from January 1, 1924 to January 1, 1950 is given.

From a summary of coexistent disease found in the autopsy cases at the Babies Hospital and reports from the recent literature, it would appear that diseases of the central nervous, gastrointestinal and respiratory systems are commonly present in cases which have shown peptic ulcer at autopsy.
Round Table Discussion
Authors: REILLY WILLIAM A. , WILKINS LAWSON H. , DEAMER WILLIAM C. , MOTEL WILLIAM G. , DIETRICH HARRY F.
Published: December 2021

Chairman Reilly: The first topic that I want to discuss with you is thyroid extract, its indications and usage. This sounds like a hackneyed subject but still there is a great deal of misusage and misinformation about thyroid.

The first thing about thyroid that might be of use to you is its preventive usage. In pregnancy it is probably advisable in the endemic areas where goiter and iodine deficiency occur to give some iodine. I am going to be very dogmatic and didactic and hope that our fellow participants will disagree, if they care to. A good many physicians feel, and I agree, that the pregnant woman should be given a little thyroid substance if it is properly indicated.

Now for the therapeutic use of thyroid. First, the indications are as follows: It is unnecessary to state to you gentlemen that you do not have to use thyroid extract for thyrotoxicosis. I have seen that happen very recently in a child with a great thyroid overactivity and carditis; some one administered a tremendous amount of thyroid inducing further decompensation of the heart. The prime indication for thyroid therapy is real hypothyroidism. Other conditions that still might be indications for thyroid are nephrosis, eczema, ichthyosis, obesity and perhaps prematurity. I am going to be very dogmatic about mongolism. Thyroid extract in mongolism has no use unless the mongol has hypothyroidism. I want to decry the use of thyroid in mongolism, although I have no better therapy. However, I do give it a trial, if for no other reason than to demonstrate to the parents that thyroid will not benefit their child.
Drs. Ehrlich and Tait Reply
Authors: Ehrlich Mary A. , Tait Charles A.
Published: December 2021

We are pleased to respond to Dr. Gluckman's thoughtful comments regarding our article, which is concerned with applying the objective methods of acoustic impedance measurements to pediatric clinical populations.

Dr. Gluckman specifically asks if acoustic impedance measurements are practical for evaluating the "struggling, toxic infant with acute otitis media, or the infant who is frightened and struggling and has serous otitis media." Impedance measurements are objective because no behavioral responses are required of the patient.
Surgical Correction in Infancy To Reduce Mortality in Transposition of the Great Arteries
Authors: Kawabori Isamu , Guntheroth Warren G. , Morgan Beverly C. , Mohri Hitoshi , Dillard David H.
Published: December 2021

The mortality for infants with transposition of the great arteries (TGA) prior to the introduction of medical and surgical septostomy was over 80% by 6 months of age. The mortality has fallen recently, due to balloon atrial septostomy (BAS), but still exceeds 25% by 6 months of age in major centers. The cumulative mortality rises to 40% by 1 year of age with or without additional surgical atrial septectomy.

In our center, 12 patients with an average age of 3 months were operated on for interatrial baffle correction of their TGA under surface-induced deep hypothermia. BAS had been done preliminarily in those patients without an adequate atrial communication. Ten of these 12 patients (83%) survived. These patients have been followed up from one month to eight years with an average follow-up of over four years. Surgical correction during infancy offers a better survival rate for infants with TGA than does medical management, with or without palliative surgery.
On Tympanostomy Tubes: Rationale, Results, Reservations, and Recommendations
Authors: Paradise Jack L.
Published: December 2021

The eardrums of millions of infants and children throughout the world contain foreign bodies, surgically implanted as prostheses. Myringotomy combined with placement of an indwelling tympanostomy tube (or grommet) has gained widespread acceptance among otolaryngologists as the treatment of choice for persistent middle ear effusion1 and for certain related otologic conditions. But otolaryngologists by no means stand alone: many if not most of the operations currently performed were initially recommended by pediatricians.

It is difficult to determine how many such operations are currently performed on pediatric patients in this country, since most operations take place in outpatient settings and therefore escape systematic reportage. A reasonable estimate, however, would be 1 million procedures per year or, because most of them are bilateral, two million tubes inserted.

Among the conditions for which the operation is performed, undoubtedly the most common is chronic secretory otitis media. Here there are three interrelated objectives: to remove the effusion, to relieve any associated hearing loss, and to institute and maintain middle ear ventilation. Less commonly the operation may be undertaken for one of various other reasons: to try to reduce the frequency of episodes of acute otitis media2,3; to relieve persistent underaeration of the middle ear when associated with conductive hearing loss or other symptoms2; or to prevent the development of adhesive otitis media or cholesteatoma when atelectasis or, especially, retraction pockets of the eardrum are present.2,4-6

The idea of using an indwelling tube to artificially ventilate the middle ear dates from 1868, when the great Viennese otologist, Politzer, introduced a ventilating eyelet made of hard rubber.7
SCIENTIFIC LITERATURE
Authors: Comroe J. H. , H. R. J.
Published: December 2021

Another problem deserving of thoughtful discussion by mature scientists is what to do about current scientific literature. Should scientists be encouraged to include in their articles speculation (labelled as such) on possible uses of their findings in their own or other fields, instead of studiously avoiding it; could this have an important impact on the research of "me-too" scientists who are superb technically but not imaginative or creative? Is there a way of promptly calling to the attention of biomedical scientists important new techniques or concepts that they normally would come across for years?
STATISTICS
Authors: Prescott R. J. ,   Student
Published: December 2021

. . .Perhaps the medical profession should take a close look at its attitude towards statistics. The medical statisticians are thin on the ground, and it would be unrealistic to expect all papers with some statistical content to be refereed by them, even if this was thought desirable. Another way to tackle the problem is through undergraduate and postgraduate medical education. Since most medical students will not become research-workers, it is debatable whether the computational complexities of a test form a relevant part of their medical education. However, all doctors should keep up to date with developments reported in the journals, and to do so adequately they must learn to judge published work critically. It is this aspect of statistics which appears to be in most need of emphasis in undergraduate medical education.

For the aspiring researcher, the most important statistical skills to be learnt at postgraduate level are the design of experiments, surveys, and clinical trials. Without them the techniques of statistical analysis, which also need to be learnt at this time, may have poor material to work on.

Unless moves of this sort occur the present situation is likely to continue. Many research-workers will spend much of their time on work which is doomed in advance to be of no medical or scientific merit; valuable research facilities will be inefficiently used; the literature will continue to produce articles where the conclusions do not follow from the data. Worst of all, such articles will continue to be believed.
CARRIER PIGEONS AND THE COUNTRY PRACTITIONER (1900)
Authors: C. T. E.
Published: December 2021

Seventy-five years ago telephone service was not yet available in many parts of the United States. The editorial below offered a practical solution for the physician who practiced in areas where phone service was not available. The solution will surprise many of our younger physicians.

The perfection and cheapness of the long distance telephone and its consequent instillation in many country neighborhoods have done much to lessen the anxiety, if not the labor, of the country doctor. As the greater part of our country, however, is as yet unprovided with telephone service, a practical suggestion in regard to the use of carrier-pigeons which we find in the recent number of the Gazette des Hòpitaux may prove of value to some of our readers. The writer, after having trained a number of pigeons, leaves one or two at the house of the patient to be dispatched with a message should an emergency arise, or to state the morning and evening condition in a critical case. This means of communication gives the patient a sense of security and often serves to lessen the labors of the physician. So well satisfied is the doctor with this that he has established a station in each of the villages in his neighborhood so that he may be promptly summoned for new cases. He finds that he can leave two pigeons, always of the same sex, in a post for about a week. The longer the birds have been absent, the more quickly do they return.
Legal change for child health: Report on a conference
Authors: Seidel Henry M.
Published: December 2021

"Physically and politically powerless, children have always gotten the short end of the stick. In earlier times, the surplus, especially females, were legally and deliberately killed; in the Middle Ages and until recently children were chattels; in Dickensian England they starved in workhouses or were exploited as beggars a la Oliver Twist...."

Louise Raggio, Conference Participant

The building Frank Lloyd Wright called Wingspread served as the setting for a discussion concerning the relationship of the health of the young to their legal needs and the role of the pediatrician in these regards. Men and women from medicine, the law, and social work shared their points of view, seeking a firm definition of advocacy for children, attempting to highlight some manageable priorities among the legal needs so that pediatricians might move to a partnership with others in the community which might facilitate access to a better life for all children and youth.
Thrombocytopenic Purpura Associated With Exanthema Subitum
Authors: Nishimura Kozo , Igarashi Masanori
Published: December 2021

Postinfectious thrombocytopenic purpura in children is well known, and several viral infections have been incriminated, including rubella, measles, measles vaccination, chickenpox, mumps, smallpox vaccination, infectious mononucleosis, hepatitis, cytomegalovirus infection, and upper respiratory tract infection, as reviewed by McClure in the January 1975 issue of Pediatrics (page 68). It seems that thrombocytopenic purpura following exanthema subitum is not known in the English literature. We would like to present a brief summary of five such cases we have reported previously.1
Nature and Nurture in Childhood Weight
Authors: Philippe Pierre
Published: December 2021

The genetic and mesologic fractions governing the variability of biological characters such as blood pressure and weight must be determined in order to establish how these characters function. If it is true that hypertension as well as obesity are extreme deviations of a natural variability of these biological parameters, knowledge of the genetic and mesologic processes could guide the treatment.

Biron et al.1 from the University of Montreal showed that family similarities in children's weight from ages 1 to 21 are linked to primarily genetic factors.