bluuebunny/crossref_metadata_2025 huggingface dataset:
Policy Statement
Authors:   Medical Home Initiatives for Children With Special Needs Project Advisory Committee
Published: December 2021

The American Academy of Pediatrics proposed a definition of the medical home in a 1992 policy statement. Efforts to establish medical homes for all children have encountered many challenges, including the existence of multiple interpretations of the “medical home” concept and the lack of adequate reimbursement for services provided by physicians caring for children in a medical home. This new policy statement contains an expanded and more comprehensive interpretation of the concept and an operational definition of the medical home.
INTERSTITIAL "PLASMA CELL" PNEUMONIA OF PREMATURE AND YOUNG INFANTS
Authors: DEAMER WILLIAM C. , ZOLLINGER HANS U.
Published: December 2021

An unusual type of infantile pneumonia occurs frequently in certain European countries, but thus far is undescribed in the American literature. It is remarkable clinically in being almost asymptomatic until late in its course, in showing a marked predilection for premature or immature infants, and for being confined to the age period of 6 weeks to 4 months.

Pathologically, it is remarkable for a diffuse interstitial pulmonary infiltration by mononuclear cells which, for the most part, closely resemble plasma cells. An alveolar exudate is also present.

About 22% of patients with clinically recognized cases die of asphyxia. In these cases death appears to be predominantly due to asphyxia.

The most commonly held opinion, in which the authors concur, is that the disease is infectious and probably of viral origin, but as yet there has not been a convincing demonstration of the etiologic agent. Up to the present time no effective therapeutic agent has been found.
BEHAVIOR CHANGES INDICATING EMOTIONAL TRAUMA IN TONSILLECTOMIZED CHILDREN
Authors: JACKSON KATHERINE , WINKLEY RUTH , FAUST OTTO A. , CERMAK ETHEL G. , BURTT MARJORIE MURRAY
Published: December 2021

A study of 140 children was made before and after tonsillectomy to determine the incidence of behavior changes indicative of emotional trauma.

A method of procedure, presented in earlier papers, is briefly described. The difficulties and problems of this type of research are evaluated. The limitations of the research method in proving the presence or absence of emotional trauma are acknowledged.

Findings were: 1. Thirteen children presented behavior changes indicative of emotional trauma. 2. Children treated with consideration for emotional factors gave less evidence of trauma. 3. Children who had suffered previous emotional trauma reacted less well to this experience. 4. Younger children showed more but milder adverse behavior changes. 5. The large majority, 91%, seemed either benefited by or were scarcely affected by the experience.
PEPTIC ULCER IN CHILDHOOD
Authors: GIRDANY BERTRAM R.
Published: December 2021

Peptic ulcer in childhood has been considered a relatively rare disease although sporadic reports of its occurrence have appeared. It has not usually been included in the differential diagnosis of conditions causing recurrent abdominal pain or vomiting in the pediatric patient. These data indicate that peptic ulcer is of frequent occurrence and constitutes an important pediatric problem. Psychogenic elements probably play an important role in the disease. The possible relationship of peptic ulcer to cyclic vomiting is suggested.
ACTH IN THE TREATMENT OF ERYTHROBLASTOSIS
Authors: GEPPERT LEO J. , AKEROYD JOSEPH H. , SIMPSON JOHN W.
Published: December 2021

Twenty erythroblastotic infants were treated with ACTH. Immediately after delivery 12.5 mg. were given and 6.25 mg. every six hours thereafter for a median period of 8.5 days.

These infants showed a delayed adrenal response as measured by a fall in the eosinophile count by the third day.

As indicated by the reversal of the Coombs' test there was a sharp drop in the degree of sensitization of red cells in a shorter period than would have been expected naturally.

The nucleated cell counts decreased to normal ranges by the fourth day chiefly because of the disappearance of erythroblasts.

Red blood cell counts and hemoglobin determinations showed a tendency to rise during the period of ACTH administration and an invariable decrease when ACTH was discontinued.

Hemolysis was certainly not completely prevented since most patients became clinically jaundiced and a concurrent rise in serum bilirubin was demonstrable.

Four infants who had clinical erythroblastosis without demonstrable antibodies (negative Coombs' test) were treated with ACTH and responded in a similar manner.

The Coombs' test became strongly positive in one patient after ACTH was discontinued on the tenth day. Serum bilirubin rose to 12 mg./100 cc. blood and the patient became clinically jaundiced. Fecal urobilinogen increased to 70 mg./24 hours on the fifteenth day. Administration of ACTH was resumed on the seventeenth day followed by a reversal of these processes.

Antibiotic therapy was added to the study regime because of the possibility that ACTH may enhance infection in the newborn infant.

A peculiar local reaction to pork ACTH was not noted with sheep ACTH.

Three patients died, all on the third day. One of these patients was found to have kernicterus at autopsy. No surviving patient has any evidence of kernicterus.

A much larger series will be required to demonstrate any effect on the mortality rate of erythroblastosis.

Seven infants with mild erythroblastosis were not treated because the potential dangers of ACTH were considered to carry more risk than their state of the disease.

Several modifications of the treatment regime used in this study are suggested.
STUDIES ON ERYTHROBLASTOSIS DUE TO ABO INCOMPATIBILITY
Authors: HSIA DAVID YI-YUNG , GELLIS SYDNEY S.
Published: December 2021

Detailed clinical and laboratory data have been presented on 21 infants with erythroblastosis due to ABO incompatibility. A careful survey in one newborn service over a six-month period showed that there were 11 cases of erythroblastosis due to ABO incompatibility as compared to 7 cases of erythroblastosis due to Rh incompatibility, suggesting that the disease occurs with greater frequency than has been hitherto reported.

No one test is available which can in every case be absolutely diagnostic of the disease. The criteria useful in suggesting the diagnosis are listed. Practically, the presence of a major blood group incompatibility between infant and mother with a negative Coombs' test, clinical jaundice in the first 24 hours, and a serum bilirubin level of more than 10 mg./100 cc. at 24 hours or less is sufficient to make the diagnosis in the absence of manifest infection.

The same criteria for treatment as applied to Rh erythroblastosis should be applied to erythroblastosis due to ABO incompatibility in the light of our present knowledge.
ROLE OF IRRADIATION THERAPY IN THE TREATMENT OF NEUROBLASTOMA
Authors: KEEGAN MAJOR JAMES M. , BURNETT HARRY W. , MARSHALL FLORENCE N.
Published: December 2021

The cancericidal effect of irradiation on neuroblastoma is demonstrated in a case report.
HEMATOPOIESIS IN PREMATURE INFANTS WITH SPECIAL CONSIDERATION OF THE EFFECT OF IRON AND OF ANIMAL-PROTEIN FACTOR
Authors: Wolff James A. , Goodfellow Alice M.
Published: December 2021

Normal values in the first 3 months of life have been determined for hemoglobin, erythrocytes, reticulocytes, platelets, leukocytes and differential counts for premature infants with birth weights less than 1200 gm., and for those between 1200 and 1500 gm. at birth. No significant difference was found in the degree of depression of levels of hemoglobin and erythrocytes when values in the 2 weight groups were compared.

Two reticulocyte peaks occur during the first 3 months of life. The first peak is present immediately after birth. The second peak, at about the eighth week, coincides with the occurrence of the greatest degree of anemia.

Neither iron therapy nor treatment with animal-protein factor containing vitamin B12 and Aureomycin®, started before the end of the third week of life, had a statistically significant effect on the early phase of the anemia of prematurity.

Untreated premature infants and those given animal-protein factor were anemic at the end of the first year of life. Subjects given iron therapy had normal hemoglobin values at one year of age.

Blood transfusion is rarely necessary in the treatment of the anemia of prematurity.
DEMONSTRATION OF ANTIBODIES AGAINST ENTEROPATHOGENIC ESCHERICHIA COLI IN SERA OF CHILDREN OF VARIOUS AGES
Authors: Neter Erwin , Westphal Otto , Lüderitz Otto , Gino Rosalie M. , Gorzynski Eugene A.
Published: December 2021

A study on the presence of Escherichia coli 0111, 055, and 026 hemagglutinins and agglutinins in the sera of children and adults selected at random yielded the following results.

The E. coli hemagglutination test proved to be far more sensitive for the detection of these antibodies than the conventional bacterial agglutination test.

A relationship was found to exist between the presence of E. coli hemagglutinins and the age of the individuals; these antibodies were found in over 90 per cent of human sera selected at random from individuals 12 years of age and older, and less than 14 per cent of sera from infants up to the age of 3 months.

Placental transfer of E. coli hemagglutinins was demonstrated in only 3 out of 26 cases, and in these instances the maternal antibody titers were from 4 to 16 times higher than those of the cord blood.

These E. coli hemagglutinins were demonstrated also with red blood cells modified with purified lipopolysaccharides, indicating that they react with the somatic antigens of these serogroups of E. coli.

The specificity of the hemagglutinins was established by absorption tests, utilizing red blood cells modified by one or the other of the lipopolysaccharides.

E. coli 0111, 055, and 026 hemagglutinins were demonstrated in 2 commercial gamma globulin preparations, indicating that these antibodies are not restricted to a population in a small geographical area.

The potential diagnostic usefulness of the E. coli hemagglutination test deserves further investigation.
EXPERIENCE WITH NEEDLE BIOPSY OF THE LIVER IN INFANTS AND CHILDREN
Authors: Bruton Ogden C. , Metzger Joseph F. , Sprinz Helmuth
Published: December 2021

Fifty Patients, varying in ages from 19 days to 10 years, were studied by needle biopsy of the liver. Histological study of the tissue helped (1) to establish the status of the liver in Banti's syndrome prior to surgery, (2) to establish the diagnosis in some patients with enlargement of the liver, (3) in the differential diagnosis of jaundice occurring in the neonatal period, (4) to establish the extent of liver involvement in certain systemic diseases, and (5) to determine, periodically, the status of the liver for prognostic purposes. Examples of each of these categories are given. The technique is discussed and the ease with which the procedure may be performed without general anesthesia in infants who have not yet reached the "fear reaction" age is pointed out. Fifty-nine biopsies were performed and there were no complications. The only contraindication to the procedure is thought to be an increased bleeding tendency which, in the judgment of a mature operator, might significantly increase the possibility of hemorrhage. It is felt that needle biopsy of the liver is a useful adjunct for diagnosis and study in infants and children, and when used with discretion is safe enough to merit favorable consideration.
SPECIAL ARTICLE
Authors: Faber Harold K.
Published: December 2021

THE INVITATION with which you have honored me on this memorable occasion has given me a tempting opportunity to discuss certain problems with which my associates and I have been engaged for nearly a quarter of a century, and to correlate the results of some 25 separate studies on the various aspects of pathogenesis, published, mainly in the Journal of Experimental Medicine, during that time. Most of these have dealt with the beginnings and evolution of the disease up to the onset of paralysis, in search of answers to such questions as: How and where does the virus enter the body? Where do the initial lesions occur? What are the sources of viral excretion? How is viremia produced? By what routes is the central nervous system invaded? What is the explanation of silent infections? What are the defenses, natural and artificial, against the disease? And, finally, can a unitarian concept be sustained of the pathogenesis of poliomyelitis in terms of the relation between host and virus?

Before discussing these questions, certain prefatory remarks are in order about the host-cell affinities of poliomyelitis virus. While it is interesting and in various ways very important that these can be radically altered in vitro by Enders' methods of tissue culture, and in vivo by pretreating animals with cortisone or ACTH, as shown by Schwartzmann and Aronson, nevertheless such results should be applied with the greatest caution to the pathogenesis of the human disease, in which cytopathic changes in such extraneural tissues as kidney, muscle, skin and testis, when they occur at all, are exceptional and not part of the characteristic pathologic picture.
THE ROLE OF EDUCATION IN ACCIDENT PREVENTION
Authors: Dietrich Harry F.
Published: December 2021

The basic problem in childhood accident prevention is one of education involving physicians, parents and children. The physician must learn more about the causes of accidents, he must also perfect his techniques of teaching parents how to assume their role in accident prevention.

The ultimate responsibility for juvenile accident prevention falls on the parents, but this should be conveyed to them in a non-frightening manner and with an assurance of possible achievement. This is possible with a theory of accident prevention which embraces a reciprocal relationship between protection and education related to age.

It is essential that parents realize the importance of parental example in the education of their children. The most stimulating educational device is supervised participation. If parental example is good and supervised experience is imaginatively conceived, then and then only can didactic instruction of the child be effective.

Finally, attention is called to the fact that here presented is a paper on accident prevention in childhood which is devoid of statistics.
Letters to the Editor
Authors: GARDNER LYTT I.
Published: December 2021

I am enclosing a copy of the very recent Sanitary Code in this state designed to exercise some control over the dangerous use of shoe-fitting fluoroscopes. It seems to me that this safety regulation might be of general interest to pediatricians. It represents to my knowledge the first organized attempt to protect both the child and the shoe salesman.
PUBLIC HEALTH, NURSING, MEDICAL SOCIAL WORK
Authors: Wallace Helen M. , Blumenthal Sidney , Losty Margaret A. , Gossett Helen
Published: December 2021

A study of convalescent care in 6 general institutions in and around New York City has revealed serious gaps in the services designed to meet the needs of children. Major gaps were found in such areas as medical service, social service, therapy, nursing service, recreation, and physical facilities. Questions are raised concerning the future role, if any, convalescent institutions might play. The need for intensive studies of convalescent institutions is apparent, if the available community funds are to be used to moot the present and future needs of the most children.
Varicella and Cortisone
Authors: HAGGERTY ROBERT J. , ELEY R. CANNON
Published: December 2021

In the past 2 years we have seen 2 patients at the Children's Medical Center, who, while receiving cortisone therapy, developed varicella and died following a state of shock within a few days after the appearance of the vesicles. Post-mortem examinations of these patients revealed hemorrhagic vesicles throughout all viscera. In 1 case the virus of varicella was grown from vesicle fluid, heart blood, and lung. Since fatalities from varicella in childhood are so rarely encountered, even by physicians with vast experience in the field of infectious diseases, and since the clinical course of the infection in these two patients was so fulminating, the possible relationship of cortisone administration was raised.
A STUDY OF PLASMA VALUES OF SODIUM, POTASSIUM, CHLORIDE, CARBON DIOXIDE, CARBON DIOXIDE TENSION, SUGAR, UREA AND THE PROTEIN BASEBINDING POWER, pH AND HEMATOCRIT IN PREMATURES ON THE FIRST DAY OF LIFE
Authors: Pincus J. B. , Gittleman I. F. , Saito M. , Sobel A. E.
Published: December 2021

Seventy-three premature infants were studied on the first day of life before fluid therapy or feedings were begun. These were divided into 3 groups according to weight. A fourth group was included in this study as a "control."

The following chemical constituents of the plasma were measured: sodium, potassium, chloride, CO2 content, total protein, urea and sugar. The blood pH and the hematocrit were also determined. The protein base-binding power was calculated. The observations were made on capillary blood obtained by heel puncture. Ultramicro-methods were used for the estimation of the various chemical constituents.

The mean concentration of potassium is significantly higher in the lowest weight group; the protein and correspondingly the base-binding power of the protein is also significantly lower in this group. The mean values for sodium, chloride, CO2, pH, sugar and urea did not vary significantly with the birth weights of the infants. While the lowest pH values were encountered in the lowest weight group, the mean did not significantly differ from group to group. The mean concentration of urea was higher in the lowest weight group but did not significantly vary with the birth weight of the infants. The mean concentration of glucose in the plasma was lowest in the lowest weight group. The hematocrit values were uniformly above normal in all groups, but the mean did not vary from group to group.
A DIFFERENCE IN MORTALITY RATE AND INCIDENCE OF KERNICTERUS AMONG PREMATURE INFANTS ALLOTTED TO TWO PROPHYLACTIC ANTIBACTERIAL REGIMENS
Authors: Silverman William A. , Andersen Dorothy H. , Blanc William A. , Crozier Douglas N.
Published: December 2021

A controlled clinical trial was designed to test the relative effectiveness of two prophylactic antibacterial regimens administered to premature infants in the first 5 days of life. Infants who received penicillin/sulfisoxazole (diethanolamine) died at a significantly higher rate than those who received oxytetracycline. The incidence of kernicterus was significantly higher among infants who received penicillin/sulfisoxazole (diethanolamine).
TREATMENT OF ACUTE LEUKEMIA
Authors: Burchenal Joseph H. , Murphy M. Lois , Tan Charlotte T. C.
Published: December 2021

IN TREATMENT of acute leukemia in children, as in treatment of any form of cancer, early diagnosis is of great importance. Although in contrast to many other tumors in children, leukemia is never curable even when detected at the early stages, the sooner treatment can be initiated, the more chance there is of having sufficient time to achieve a beneficial effect. The most important single factor in making the diagnosis of leukemia is a high degree of suspicion. Patients with pains in the bones and joints, with any hemorrhagic tendency, with increased susceptibility to infection or with an unexplained anemia or fever should have an immediate determination of total and differential leukocyte count, hemoglobin, and platelets. If any abnormality is found or if the symptoms persist, a bone marrow aspiration is essential. If these procedures are utilized, it is the rare case in which the diagnosis cannot be made with relative ease.

In most cases of acute leukemia, there is almost complete replacement of the normal elements in the marrow by leukemic cells. Depression or absence of erythropoietic activity in the marrow and possibly decreased life span of the circulating erythrocytes leads to severe anemia with the accompanying symptoms of pallor, easy fatigability, and dyspnea on exertion. The decreased megakaryocytic activity in the bone marrow and the decrease of platelets in the circulating blood lead to petechiae, ecchymoses, and other hemorrhagic manifestations.

In the peripheral blood the total leukocyte count may be high, normal, or low but, as most of the cells are abnormal in type, the patient is less able to combat infection.
EDUCATION, COMMUNICATION, AND PROMOTION
Authors: MAY CHARLES D.
Published: December 2021

THE PRESENT era has had various titles thrust upon it: atomic age, era of psychiatry, age of democracy, etc. Future historians may judge our times to be better characterized as the Age of Promotion. Means of reaching an audience have achieved awesome efficiency. A cult of Public Relations is flourishing.

This makes it imperative that the significant differences between Education, Communication and Promotion be realized. Full realization of the differences may make indiscriminate use of these terms less likely. Consideration of the very different concepts represented by Education and Promotion may alert us to the dangers in confusing the separate processes, however carelessly or deceptively they may be labeled.
PULMONARY ARTERIOVENOUS ANEURYSM IN CHILDHOOD
Authors: Husson George S.
Published: December 2021

A case of a 2 6/12-year-old male with pulmonary arteriovenous aneurysm successfully treated by lobectomy is presented.

The importance of this syndrome as a pediatric problem and the necessity for early diagnosis and surgical treatment is discussed.

A review of the salient features of this syndrome is presented.
A CONTROLLED STUDY OF THE USE OF THE BLOXSOM AIR LOCK
Authors: Reichelderfer Thomas E. , Nitowsky Harold M.
Published: December 2021

A controlled study of the response of premature infants and infants delivered by nonelective cesarian section to exposure in the air lock was undertaken. Seventy-two infants were placed in the air lock and 71 received the routine care in an incubator. There were no significant differences noted in over-all mortality rates, in mortality rates during the first day of life or in the incidence of relief of respiratory distress between the group of infants exposed in the air lock and those placed in the Isolette®.

No evidence was adduced for the effectiveness of the air lock as a resuscitator in this group of infants.
A PLAY PROGRAM AND ITS FUNCTION IN A PEDIATRIC HOSPITAL
Authors: Tisza Veronica B. , Angoff Kristine
Published: December 2021

The Boston Floating Hospital created a Play Program as part of the mental health activities in the service of a comprehensive approach to pediatrics. The organization and the functioning of the program are described in detail and the necessity of good communication and co-operation among the different groups in the hospital is emphasized. Some of the observed reactions of the patients and their families to various phases of the program are recorded and illustrated by short case histories. The feeling is expressed that the non-directive technique of the playroom teachers and the wide range of choice in play activities offered to the children helps them in gradually mastering anxiety over the illness, procedures, restrictions and the separation from the parents. It is pointed out that the "play group" is an integral part of the broadly organized Child Psychiatry Unit of the Boston Floating Hospital.
FLUORESCEIN CIRCULATION TIMES IN DIPHTHERIA
Authors: COBB SIDNEY , HODES HORACE L.
Published: December 2021

The circulation time has been studied in 35 cases of diphtheria with repeated measurements. It is a useful guide in judging the severity of myocarditis, and it suggests that digitalis can relieve the failure of diphtheritic myocarditis.
THE INCIDENCE OF BREAST FEEDING IN HOSPITALS IN THE UNITED STATES
Authors: BAIN KATHERINE
Published: December 2021

Data comprising the first nation-wide survey of the incidence of breast feeding in hospitals in the United States are presented.

More than two-thirds of all hospitals of 25 or more beds admitting women for delivery are included in the study. Coverage was equally good for all regions, for urban and rural communities, and for small, medium size, and large hospitals.

For the United States as a whole, one-third of the infants were weaned at the time of discharge from the hospital and two-thirds were on breast or mixed feedings.

A smaller percentage of breast feeding occurred in hospitals in or near metropolitan areas, as contrasted with areas removed from metropolitan centers. A lower percentage of breast feeding occurred in medium-sized hospitals as contrasted with small or large hospitals.

There are striking regional differences, in the northeast the percent of infants on bottle feeding only—at time of discharge—being 61%, as contrasted with an incidence of 18%, in the southwest and southeast.

Among infants discharged from hospital under eight days of age the incidence of breast feeding was higher than among those who remained longer.
Communication from THE COMMITTEE ON FETUS AND NEWBORN
Authors: CLIFFORD STEWART H.
Published: December 2021

State committees on fetus and newborn have been appointed in 47 states, in four Canadian Provinces and in Hawaii. All of these committees are now confronted with the problem of organizing an active program.

All state programs must have the active cooperation of the state and county medical associations. Following are excerpts from a letter from Dr. Milo Brooks showing how the Southern California Committee has informed their County Medical Association of the program and made a strong bid for its support and cooperation:

". . . The two groups (the Academy and an independent Los Angeles group, previously organized) have now blended into one organization, and with the cooperation of the Bureau of Maternal and Child Health of the State of California Department of Health, the Obstetrical and Pediatric Sections of the Los Angeles County Medical Association and the American Academy of Pediatrics have prepared a tentative program composed of the best features of premature programs now functioning in other cities and states.

"We . . . need (your) cooperation and support . . . and, therefore, humbly make the following requests for:

(1) Approval of the . . . committee as now constituted, or a committee as selected by the Los Angeles County Medical Association, as an advisory committee to work with the city and county Health Departments in the organization and operation of a premature program for Los Angeles County.

(2) Appointment (if the present committee is acceptable) of a representative, preferably a member of the section on General Practice, to the committee.

(3) Presentation of the following recommendations to the Los Angeles City Health Department Commission, and the Los Angeles County Health Department:

a. To recognize the need for better facilities for the care of premature infants born in Los Angeles County.

b. To approve and list centers for premature care and/or assist hospitals to establish or enlarge and equip a premature center.

C. To establish post-graduate nurses' training in the care of premature infants.

d. To permit the Los Angeles County General Hospital to accept any premature infants born outside the hospital within the limits of their capacity.

e. To supply the physical necessities for transporting prematures to adequate facilities when aid is requested by the physician in attendance, i.e. nurses, ambulances, oxygen, incubators, etc.

f. To supply funds for a secretary, or other personnel, which is needed for the proper funcioning of the program.

g. To make prematurity a reportable condition when adequate facilities become available to care for all premature infants born at home or in hospitals where facilities are inadequate.

h. Investigate premature infants' deaths.
Symposium ON CONGENITAL HEART DISEASES
Authors: GIBSON STANLEY
Published: December 2021

Since it would appear that the diagnosis of patent ductus arteriosus can be made accurately in such a high percentage of cases and that the surgical treatment of this lesion is highly successful with a low mortality and morbidity rate, we believe surgery is advisable in all cases with this lesion excepting the 35-year-old or older group who have no progressive cardiac hypertrophy and no incapacitation by virtue of their fistula. The optimum age for operation is three years. The vast majority of the patients have a ductus that can be divided and the advantages of division over ligation have been pointed out. Patent ductus arteriosus complicated by subacute bacterial endocarditis should have surgery following intensive penicillin therapy.
ADOPTIONS
Authors: Karelitz Samuel
Published: December 2021

Any practice or social institution which is increasing at a rapid rate deserves review by the professions involved and by the public, to see where it is going and how it is getting there. This question of adoption is a vast national problem and one that concerns medical and legal practitioners, the courts, public health, public or private social agencies. Adoptions in the United States have increased 80% in the last 10 years, and the increase appears to be continuing. The reasons for this phenomenon are probably many and mixed. Underlying them is the widespread interest in family life, in wanting children and more children as evidenced by the increase in the birth rate and in the size of families. Even college graduates, traditionally the low birth-rate group, are having bigger families today.

As a background for the more specific papers to follow, I should like to present an over-all view of the extent of the problem and some of the major issues involved.

There is no over-all national pattern of adoption procedure in the United States as defined by law or as carried out in practice. Just as laws vary from state to state—on marriage, divorce, taxation, or civil rights— so laws relating to adoption vary. Much of our legal machinery, furthermore, is concerned with the process of legalizing the status of the child, of finishing the job and tying the knot, and not with the core of the problem—the placement of a child for adoption. There are great differences in social agencies. Their practices as well as their philosophy are undergoing study and reappraisal all the time—and especially now.
Youth. The Years from Ten to Sixteen
Authors: WORK HENRY H.
Published: December 2021

For any one book considerable controversy may exist in relation to its ultimate use, to the organization of the content, or to the range of its intended readers. This book will be regarded with considerable difference of opinion as it attempts to embrace the highly vital knowledge in the area of total growth of children from the ages of 10 to 16 as well as to serve as a guide for parents during this period.

The lay press has been glowing in its response to this final addition to Dr. Gesell's trilogy on growth.
A Short History of Helping Babies Breathe: Why and How, Then and Now
Authors: Niermeyer Susan , Little George A. , Singhal Nalini , Keenan William J.
Published: December 2021

Helping Babies Breathe (HBB) changed global education in neonatal resuscitation. Although rooted in the technical and educational expertise underpinning the American Academy of Pediatrics’ Neonatal Resuscitation Program, a series of global collaborations and pivotal encounters shaped the program differently. An innovative neonatal simulator, graphic learning materials, and content tailored to address the major causes of neonatal death in low- and middle-income countries empowered providers to take action to help infants in their facilities. Strategic dissemination and implementation through a Global Development Alliance spread the program rapidly, but perhaps the greatest factor in its success was the enthusiasm of participants who experienced the power of being able to improve the outcome of babies. Collaboration continued with frontline users, implementing organizations, researchers, and global health leaders to improve the effectiveness of the program. The second edition of HBB not only incorporated new science but also the accumulated understanding of how to help providers retain and build skills and use quality improvement techniques. Although the implementation of HBB has resulted in significant decreases in fresh stillbirth and early neonatal mortality, the goal of having a skilled and equipped provider at every birth remains to be achieved. Continued collaboration and the leadership of empowered health care providers within their own countries will bring the world closer to this goal.
A PSYCHOSOMATIC STUDY OF EIGHT CHILDREN WITH SYDENHAM'S CHOREA
Authors: Chapman A. H. , Pilkey Loraine , Gibbons Mary Jane
Published: December 2021

A psychosomatic study was made of eight children with Sydenham's chorea. The children ranged in age from 7 to 16 years. Three patients had a history of rheumatic fever and three had no evidence of rheumatic disease; in two patients the evidence for rheumatic fever was equivocal, one probably having had it and the other probably not.

The eight children were found to be emotionally quite disturbed. Their personality structure was characterized by a triad of (a) marked passivity, (b) schizoid withdrawal from people, with two of the children being frankly schizophrenic, and (c) much underlying anxiety. Obsessive, phobic and depressive features were separately present in some of the children. In five cases the onset of Sydenham's chorea closely followed an episode of marked emotional stress, and in two others the correlation of chorea with emotional stress was equivocal.

The literature was reviewed, and it was pointed out that in over half of all reported cases of Sydenham's chorea evidence of rheumatic fever could not be found.

It is felt that Sydenham's chorea can be understood only as a psychosomatic illness potentially caused by a number of agents acting individually or jointly, and varying in their respective importance from case to case. Severe personality disorder and rheumatic fever are two such etiologic agents which may be operative in Sydenham's chorea. The importance of further psychosomatic study and experimental psychotherapy in the comprehensive medical study and management of children with this disorder is emphasized.
ABDOMINAL MASSES IN THE NEWBORN INFANT
Authors: Longino Luther A. , Martin Lester W.
Published: December 2021

Information concerning 32 infants with abdominal masses noted during the first day of life is presented. The most common mass was a hypoplastic, multicystic kidney which was the final diagnosis in 13 of 32 cases.

The mass proved to be a malignant tumor in four instances (an incidence of 13%).

Preoperative intravenous urogram should be made in every instance, even the obvious hydrometrocolpos may present a marked secondary hydronephrosis. In the other cases, one can rarely be certain that the mass is not of renal origin.

Of the 30 infants undergoing surgery, there were three deaths, either from the surgery or in the immediate postoperative period—a mortality rate of 10%.

The presence of an abdominal mass in the newborn infant, the same as for older patients, constitutes an indication for early surgical intervention. Delay on the basis that the baby is too small or too young cannot be justified.
ALLERGY—THE UNANSWERED CHALLENGE IN PEDIATRIC RESEARCH, EDUCATION AND PRACTICE
Authors: Crook William G. , Harrison Walton W. , Crawford Stanley E.
Published: December 2021

THE NEGLECT OF TRAINING IN ALLERGY

Perhaps the most remarkable thing about allergy is its relative neglect in the field of medical research, education and practice. This phenomenon has been recognized by a number of leaders in the field. "Allergy is sadly neglected in the medical schools of this country. Some department heads look upon it as scarcely more scientific than witchcraft. . . . There is no question that medicine either ridiculed or ignored. . . . The chances are overwhelming that as a resident—(the physician) had no exposure whatever to an allergy service or guidance from one trained in allergy."

A review of the program of the Society for Pediatric Research for the past several years shows that, while there were many papers on varied subjects, few of them dealt with allergy.

THE PROBLEM OF THE PRACTICING PEDIATRICIAN

Our discussion of this subject is presented from the point of view of practicing pediatricians who have struggled with the problems of allergy in a general pediatric practice for some 9 years. During this period, the recognition and management of children with allergic disease presented such a problem that we had to take a more active interest in it as a matter of "self defense." In comparing our training with that of other pediatricians, we feel that our exposure, and the quality of the instruction given us in managing the allergic child, was well above the average. Nevertheless, we still were inadequately prepared to meet the needs of countless hundreds of our patients.

A recent study of the incidence of allergic disease in our practice during the year 1954 showed that 14% of an unselected, consecutive group of children coming to our general pediatric clinic had major, unquestioned allergic disease, including asthma, hay fever, allergic rhinitis and eczema. An additional 18% had findings which warranted a classification of "probably allergic."
CLINICAL CONFERENCE
Authors: Silverman William A.
Published: December 2021

Dr. Silverman: I shall present the history of an infant who was admitted to our premature nursery on May 9, 1956. This Puerto Rican male infant was born during the thirty-sixth week of an uneventful pregnancy. An antenatal serologic test for syphilis was negative. Delivery was spontaneous. Birth weight was 1070 gm. Physical examination on admission to the nursery revealed the liver to be 1 cm below the right costal margin and the spleen was firm, 1 cm below the left costal margin. Nothing else worthy of comment was noted and the infant was managed in a routine manner. The immediate newborn period was entirely uneventful, specifically neither petechiae nor unusual degree of icterus were noted. The ocular fundi were examined, as a matter of routine, during the third and fifth weeks of life and they were described as normal.

During the sixth week of life, when the infant weighed 2080 gm, it was suddenly noted that the abdomen was quite distended. Examination at this time disclosed marked hepatosplenomegaly, both organs were firm. Again neither icterus nor petechiae were noted. There appeared to be some difficulty in swallowing. Roentgenograms of the chest at this time were normal and of the skull revealed intracranial calcification which was displayed in a pattern that seemed to outline dilated lateral ventricles. Lumbar puncture yielded cerebrospinal fluid which was negative except for protein of 198 mg/100 ml. The urine and cerebrospinal fluid were examined for the cells characteristic of cytomegalic inclusion disease and none were found.

Funduscopic examination at this time disclosed an area of chorioretinitis in the right eye. It was presumed at this time that the infant had toxoplasmosis.
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

Present knowledge of nutrition is admittedly incomplete. Accumulation of further knowledge by controlled observations is to be encouraged.

The present divergence of opinion regarding the appropriate time for the introduction of solid foods into the diet of the infant is recognized.

No nutritional advantage or disadvantage has as yet been proven for supplementing adequate milk diets with solid foods in the first 3 or 4 months of life. No harmful results have been reported thus far, but potential danger exists that earlier supplementation of the milk diets of infants with solid food of inferior nutritional content may, because of satiety, result in a decreased intake of milk.

High-protein feedings unaccompanied by sufficient water intake, as may occur with a meat supplement, can compromise the young infant's fluid and electrolyte balance.

Strained meat has been shown to be the equivalent of milk as a source of protein, and to be well tolerated by both premature and full-term infants. Claims for the advantages of the early introduction of meat are conflicting and do not permit the drawing of definite conclusions.

An increased incidence of allergy has not been demonstrated from solid foods fed in the early weeks of life.

Digestion, absorption and utilization of solid foods appears to be adequate even in the first days of life. Other physiologic mechanisms indicate nature's provision for their administration at a later date.

No psychologic advantage can be attributed solely to early feeding of solid foods.

Caution should be exercised in attributing any beneficial effect observed while feeding a food to a single constituent of so complex a mixture as a natural food.
Letters to the Editor
Authors: GRUNWALDT EDGAR
Published: December 2021

Dr. George X. Trimble's letter (Pediatrics, 20:919, 1957) in regard to our article on pseudohermaphrodism (Pediatrics, 20:503, 1957) has just come to my attention.

I would like to point out that, in the two previous cases reported in the German literature by Zandler and Müller and Hoffman et al., the testosterone was not administered to the mother until too late in pregnancy, embryologically speaking, to cause pseudohermaphrodism. Both these infants were born suffering from the effects that testosterone will produce in any female.
Speech Correction at Home
Authors: CURTIS JAMES F.
Published: December 2021

As stated in the introduction, the purpose of this book is to present in "simple nontechnical language selected information concerning speech problems" and to describe "how friends and family members may help persons with trouble in oral communication to overcome their handicaps."

This purpose is, indeed, an important one and there will probably never be a surplus of good materials which can be placed in the hands of parents and friends of persons with speech handicaps. However, there is a real question in this reviewer's mind if this need may not be better met, in most instances, by materials which deal specifically with the particular handicap of concern at the moment, rather than by a book which attempts in a relatively few pages to cover a number of types of problems.
CARE OF THE PREMATURE INFANT
Authors: Silverman William A.
Published: December 2021

It is accepted that the umbilical cord should be clamped early in known and suspected cases of erythroblastosis. When isoimmunization is not a factor, some advocate late clamping to effect a physiologic transfusion. Others say this produces excessive blood volume, which may be a causative factor in the respiratory-distress syndrome. Studies by umbilical-vein catheterization thus far have failed to show an association between high venous pressure and increased mortality.

Aspiration of the stomach is being performed routinely in many centers. No convincing controlled studies are available to show that this procedure has lowered mortality or morbidity.

Resuscitation of the newborn continues to be a problem. The trend is toward more vigorous measures more promptly applied, to produce and maintain an airway, and thus facilitate initial expansion of the lungs. Nasopharyngeal suction is adequate in most instances. Infants who do not breathe spontaneously may benefit from direct laryngoscopy, clearance of the airway and artificial respiration. Morphine antagonists may be given if narcosis is evident following use of narcotics during delivery.

Initial heat loss is greater in prematures than in full-term newborns. The rate of fail of body temperature is maximal during the first hour of life when the infant is exposed to labor-room temperatures while being resuscitated. Swaddling, effective against heat loss, has the disadvantage of interfering with direct observation of the infant. The answer to this problem may be infra-red heat lamps built into one corner of the labor room. The use of glucose has been mentioned but not enough information is available.

There is a growing trend toward the omission of silver nitrate for prophylaxis in the eyes in newborns.
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

The great mass of information on the beneficial influence of thiamine in markedly deficient animals is probably not applicable to any but the most severely deprived humans. No secure data are at hand that thiamine administration to humans "stimulates" appetite; this does not conflict with the well-recognized fact that the vitamin is essential for body processes.

The evidence for appetite-stimulating or growth-promoting effects of vitamin B12 is not convincing. Whatever the specific medical or nutritional indications for vitamin B12 may prove to be, in children, it is clean that this vitamin does not encourage appetite so as to cause increased growth in children. Admitting that the design of experimental work with humans is fraught with difficulties, the lack of scientifically acceptable control subjects makes much of the evidence advanced in support of specific effects of vitamin B12 unacceptable.

The impression should not be conveyed to the physician that "growth failure" is commonplace and that all flagging appetites are due to inadequate intake of either on both of these vitamins. On the basis of current knowledge, claims for any effect of these vitamins in either stimulating appetite or promoting growth are not justified. Present evidence is insufficient to show any effect of vitamin B1 and vitamin B12 on stimulation of appetite or growth except in deficiency states.

This discussion in no way detracts from the metabolic significance or usefulness of these two important vitamins. It is clear that, at present, we do not yet fully understand appetite or all the factors which affect growth. Humility should govern the attitudes of manufacturers and physicians alike when it is urged that growth-promoting substances be given to large groups of children.
Letters to the Editor
Authors: DEAN R. F. A.
Published: December 2021

Thank you for sending the copy of Dr. Cobb's letter regarding the article by M. Geber and myself.

The quotients we gave were calculated by Gesell's formula, as Dr. Cobb suggests. If he prefers to use age from conception rather than age from birth, he must of course make the same correction for data on white children as he has made for the data on our African children. He will arrive at a different set of numbers, but the precocity of the African children will remain.