bluuebunny/crossref_metadata_2025 huggingface dataset:
CIRCULATORY FAILURE (SHOCK) IN FULMINANT MENINGOCOCCAL INFECTION
Authors: May Charles D.
Published: December 2021

NO OCCASION in medical experience makes the awful meaning of this aphorism more clear than the patient prostrated by the sudden onslaught of fulminant meningococcal infection. Prompt relief is imperative; the patient is in too precarious a state to tolerate a fumbling attack, too feeble to withstand meddlesome and overzealous treatment with drugs of uncertain action; and critical decisions must he made in the presence of extreme anxiety. Here, as in all medical care, the truly practical thing to do can best be determined by adequate comprehension of underlying processes.

The physician is not often faced with a patient overwhelmed by acute infection, but the alarming and distressing prospect makes so lasting an impression that the manifestations are familiar: pallor, cyanosis, disorientation or unconsciousness, cold extremities, rectal temperature greatly elevated, pulse rapid and feeble, cardiac sounds loud, veins collapsed and arterial pressure reduced. These are the signs of failure of the circulation.

In overwhelming infection it is this physiologic disturbance that deserves emphasis and demands first consideration, for it must be corrected promptly to forestall death or disastrous complications. Specific treatment of the infection is important but quite incidental—the patient must be kept alive long enough to reap the benefit of elimination of the causative organism.

To the signs of circulatory failure, add purpuric lesions in the skin, leukopenia progressing to leukocytosis and hyperglycemia, and the syndrome of fulminant meningococcal infection is complete. Viewed in their entirety, the manifestations are those of an intoxication affecting many organs and systems.

It is of particular interest that most often the circulatory failure precipitated by infection is associated with gram-negative, endotoxin-producing organisms. Meningococcus happens to be the most conspicuous offender in infants and children.

Pediatricians have reason for especial concern with this matter; 79% of all the deaths from meningococcal infections in the United States occur in childhood (Table I) and the continuing mortality is largely from the fulminant form, which accounted for 65% of the deaths in a recent series of cases in children.

To gain a clear understanding of the pathogenesis of all the manifestations of fulminant meningococcal infection, it will be necessary to consider the biologic effects of endotoxin, but first the nature of the physiologic disturbance of the circulation will be examined.
EARLY MEDICAL CARE OF DELINQUENT CHILDREN
Authors: Deisher Robert W. , O'Leary Jay F.
Published: December 2021

The purpose of this study was to investigate the role of the pediatrician and other physicians in the lives of a selected group of delinquent children; the types of problems encountered during the preschool period; and the kind of medical care received.

The parents of 102 juvenile delinquents were interviewed at the King County Juvenile Court. By means of a structured questionnaire-type interview, an effort was made to determine: 1) whether these children had developmental problems which could be diagnosed; 2) whether the parent or parents were actively aware of existing problems; 3) whether professional guidance was sought in the attempt to remedy the problem; and 4) what type of patient-physician relationship existed.

The parents were questioned specifically about the type of medical care received by their children, the guidance obtained from physicians, and the active interest displayed by physicians toward developmental problems.

Objective data depicting the formative, early home life of the children were also obtained, including the incidence of working mothers and of fathers who were absent from the home for considerable lengths of time during the child's formative preschool years.

In general it was found that both the parents and the physicians showed little appreciation of emotional and developmental aspects of child development. Moreover, even when such problems were recognized, there was significant tendency to take no definitive therapeutic action to remedy this type of problem.

These parents were apparently satisfied with medical care given for specific illness or injuries. The most prominent deficiency in the parent-child-physician relationship appeared to be related to the lack of interest shown by some physicians in problems of child development, and the lack of time for discussion with the physician about the specific problems present.
THE INFLUENCE OF EXOGENOUS IRON ON FORMATION OF HEMOGLOBIN IN THE PREMATURE INFANT
Authors: Hammond Denman , Murphy Arlene
Published: December 2021

Exogenous iron can be utilized by premature infants at an earlier age than is generally appreciated, at a time when the naturally acquired iron stores are not depleted.

The early administration of iron appears to accelerate recovery from the early anemia of prematurity, so that a significant increase in concentration of hemoglobin is seen by 3 months of age.

Iron administered in the neonatal period can prevent the late anemia of prematurity.

Dietary sources alone appear adequate for prevention of the late anemia in most premature infants receiving diets of superior nutritional quality.
PREVENTIVE IMPLICATIONS OF A STUDY OF 100 POISONINGS IN CHILDREN
Authors: Jensen Gordon D. , Wilson Wesley W.
Published: December 2021

One hundred cases of accidental poisoning occurring in Seattle, Washington, during the summer of 1958 and referred through the Poison Control Center were studied. Although this group probably was not representative of all Seattle children in whom poisonings occurred during this period, the information gained from a study of the circumstances leading to the poisonings has important preventive implications.

Eighty-two of the children were between 1 and 3 years of age. Aspirin caused 24 poisonings. In 19 of these cases it had been left out by another family member, and only three children found aspirin in the medicine cabinet. The medicine cabinet was the source of the poison in only 4 of the 100 cases. Poisonous berries and toadstools caused 14 poisonings and represent an important local hazard, particularly as most parents were not aware that the berries were harmful.

Whereas only 22 of the patients had previously suffered accidents, 25 had been poisoned before, several more than once. In 32 cases there had been recent or concurrent illness in some member of the household.

Three circumstances were found to occur commonly, and singly or in combination accounted for 86 of the poisonings: 1) In 26 cases some person other than the parents (siblings, other children, neighbors, relatives, friends) played an important part either by making it possible for the patient to reach the poison or by failing to put it away. 2) In 31 cases the parents did not think that the child could climb, open doors, unscrew caps, or perform other tasks necessary to get the poison. 3) In 53 cases the poison was not in its usual location, either because it was in use, because persons other than the parents had left it out, or because the parents themselves were careless. As most of these parents appeared to have some degree of safety consciousness and at least tried to provide a safe place in which to keep potential poisons, they would probably profit from specific advice based on the most common circumstances under which poisonings occur.
INTRAVENOUS FLUID THERAPY FOR INFANTS AND CHILDREN
Authors: Bruck E. , Aceto T. , Lowe C. U.
Published: December 2021

The physiologic basis, culled from the germane literature, and the practical application of a simple program of parenteral fluid therapy are presented. A polyionic solution is described whose salt and sugar concentrations are such that administration of a volume sufficient to meet the water requirement of a patient simultaneously provides adequate electrolytes and calories. The advantages of basing calculations for fluid therapy on body surface area are discussed. The program has been found to be effective for many types of metabolic disturbance and a variety of morbid conditions.
Cooperative Programs of Training and Research in Mental Retardation
Authors: KUGEL ROBERT B.
Published: December 2021

Professional workers in the field of mental retardation and interested lay persons have been aware of the gulf that has existed between institutions for the mentally retarded and colleges and universities. In the past 5 or 6 years there has been a resurgence of interest in the problems of mental retardation in almost all professional groups. As part of this resurgence, the American Association on Mental Deficiency Project on Technical Planning in Mental Retardation was established with headquarters in Columbus, Ohio. At the recommendation of the Advisory Council it was felt that a study should be made to find out more about this traditional gulf or cleavage that is said to exist between the "ivory tower" and the "brick tower." This monograph is a report of this study. It has also been the aim of this study to promote more effective working relations and to stimulate more complete programs of professional training and research in mental retardation.
IRON DEFICIENCY ANEMIA PRODUCING EVIDENCE OF MARROW HYPERPLASIA IN THE CALVARIUM
Authors: Britton Howard A. , Canby John P. , Kohler Colette M.
Published: December 2021

Five cases of iron deficiency anemia associated with diploic hyperostosis are reported.

The changes are sufficiently pronounced to be identical with the "hair on end" appearance usually associated with the chronic hemolytic anemias.

It is suggested that untreated, chronic iron deficiency anemia in prematures and twins, and even in full-term infants fed diets poor in iron can produce diploic hyperostosis.
ILLNESSES IN CHILDREN INFECTED WITH AN ADENOVIRUS ANTIGENICALLY RELATED TO TYPES 9 AND 15
Authors: Cramblett Henry G. , Kasel Julius A. , Langmack Marcia , Wilken Francis D.
Published: December 2021

During the investigation of an outbreak of febrile illness among children on a toddler ward within a hospital, a virus was recovered from specimens of the patients in HeLa cell cultures. The virus was found to have antigenic properties of both adenovirus types 9 and 15. The virus was neutralized by type 15 antiserum consistently. However, by hemagglutination characteristics and by hemagglutination-inhibition tests, the virus appeared to be type 9.
MANAGEMENT OF BURNS IN CHILDREN
Authors: Farmer A. W.
Published: December 2021

Burns are one of the common injuries of childhood.

Prevention is better than cure.

Most burns are minor in extent and require local treatment only.

All second and third degree burns in children involving over 10% of the body surface should be regarded as major injuries, requiring emergency care.

With adequate resuscitative therapy death during the phase of secondary shock is unusual except for massive burns.

The trend in burn therapy is for early surgical debridement, followed by early restoration of skin cover, in order to by-pass serious complications due to infection and nutritional changes.

It is most important to protect the extensively burned patient from exposure to additional illnesses, and to restore the surface as early as possible.
PROGRESS IN TREATMENT OF TUBERCULOSIS
Authors: Lincoln Edith M. , Cruz Pio G. Vera
Published: December 2021

The results of specific therapy in 420 children with tuberculosis have been reported in terms of immediate survival, and after periods of follow-up observation ranging from 3 to 15 years.

While the over-all result of specific therapy is excellent in contrast to the results obtained before the era of antimicrobial therapy, much remains to be accomplished.

Early diagnosis of tuberculosis must be stressed, still better methods of treatment of some forms of tuberculosis must be evolved, and the search for antimicrobial agents which may truly eradicate the disease must be pursued.

Finally, in order to evaluate properly the results of specific therapy for tuberculosis, patients must be kept under observation for many years.
Letters to the Editor
Authors: FINBERG LAURENCE
Published: December 2021

We would wholeheartedly agree with the comments made by Dr. Bongiovanni. Perhaps though, his last sentence should be amplified further and emphasized a bit. We should not like to leave the reader with the impression that following acute ingestion of salicylate one can be adequately reassured by finding a single level of salicylate in the blood below 35 mg/100 ml; the dose ingested, the amount removed by emesis on lavage, and the time of determination all bear critically on the interpretation of the level.
CHLORAMPHENICOL TOXICITY IN THE PREMATURE INFANT
Authors: Lambdin Morris A. , Waddell W. W. , Birdsong McLemore
Published: December 2021

A study of deaths occurring during prophylactic administration of chloramphenicol to premature infants is presented.

The potential toxicity of this agent in this age group is implied strongly, if not proven.

It is noted that the revised dose of chloramphenicol for the premature infant now advised is 25 mg/kg/24 hr., and for the full-term newborn is 50 mg/kg/24 hr.

These data point out the necessity of more careful evaluation of drugs prior to their release for administration to infants, especially to the premature infant.
"SPORADIC" HYPOPHOSPHATEMIA AND VITAMIN D-RESISTANT RICKETS
Authors: Winters Robert W. , McFalls Vernon W. , Graham John B.
Published: December 2021

A 7-year-old female child presenting with hypophosphatemia associated with a severe degree of vitamin D-resistant rickets of the "simple" type is described. Genetic studies of 30 close relatives on both sides revealed no other persons with the disease; chemical studies of 13 relatives showed no instances of occult hypophosphatemia. No clinical or biochemical features other than the unusual severity of the bone disease were uncovered which unequivocally distinguish this patient from the more common sex-linked dominant form of the disease.

There are a number of possible explanations for the occurrence of such "sporadic" cases of vitamin D-resistant rickets. The possibilities of either homozygosity for an unrecognized autosomal recessive form or of a new mutation are regarded as being more likely than phenocopy or acquired disease, but no one explanation can be accepted to the exclusion of the others at this point. It is emphasized that important results can be anticipated from a collation and study of a group of fully validated "sporadic" cases of the disease. The authors would like to propose one of us (J.B.G.) to serve as a clearing house for information regarding any similar "sporadic" cases known to other investigators in the hope that a suitably large group can be collected for analysis.
The Placenta and Fetal Membranes
Authors: BLANC WILLIAM A.
Published: December 2021

This book is the result of a well planned effort sponsored by the Association for the Aid of Crippled Children.

In the first part (124 pages), 8 reviews accompanied by a bibliography bring up-to-date some of the basic aspects of research on the placenta. All of them are excellent and have been written by outstanding scholars. Amoroso reviews extensively the comparative aspect of hormonal functions and Dempsey emphasizes some facets of the histophysiology of the placenta.
AMINO ACID EXCRETION IN URINE OF NORMAL INFANTS AND CHILDREN
Authors: Berry Helen K.
Published: December 2021

Glutamic acid, serine, glycine, threonine, alanine, glutamine, lysine and tyrosine are excreted in the urine by normal infants. The urinary excretion of glycine and alanine, particularly, decreases with age, and probably this is related to development of renal function. The amount of histidine excretion is probably related to intake of dietary protein in most instances.

The role of proline and hydroxyproline in the urine of young infants is not explained.

Other amino acids may be excreted in small quantities, less than 25 µg/mg of creatinine. The presence of taurine,β-amino-isobutyric acid, leucine, valine, or Unknown No. 35 in larger quantities in the urine, is significant. In the young, apparently "normal" child the excretion of these substances in large amounts may indicate the presence of a metabolic disturbance even though no clinical symptoms are evident.

Use of the term "amino-aciduria" should be employed with great caution. The effects of drugs on amino acid excretion have not been established. The assessment of the significance of amino-aciduria, once established, whether generalized or specific, must await further investigation of metabolic interrelationships.
BIOPSY OF BONE MARROW WITH THE SILVERMAN NEEDLE IN CHILDREN
Authors: Pearson Howard A. , McFarland William , Cone Thomas E.
Published: December 2021

Biopsy of the marrow of the posterior iliac crest with the Silverman needle is a simple and safe procedure in infants and children. Using this technique, accurate marrow evaluation has been possible in six instances of "dry tap," and in each case the marrow was abnormal.

Because of the ease of performance, with no more preparation than for ordinary marrow aspiration, and because of the rapidity with which a truly adequate marrow biopsy specimen can be made available for histologic study, we believe that the Silverman-needle biopsy is the method of choice for biopsy of time marrow in children.
MID-FACIAL CONTOUR IN PATIENTS WITH CLEFT LIP AND CLEFT PALATE
Authors: Hagerty Robert F. , Hill Milton J.
Published: December 2021

Ninety-nine cases of cleft palate were studied with conventional and soft tissue cephalometric roentgenograms. The Type III cases (clefts of the entire palate, alveolar ridge and lip) were studied in detail and statistically evaluated. No gross differences were seen in bony growth of the postoperative and unoperated cases of cleft palate of this group. In the postoperative cases of cleft palate, where the lips had been repaired at an average age of 3 months, there was a significant lingual version of the incisor teeth, posterior displacement of the upper lip, and exaggerated fullness of the lower lip. This was not seen in the unoperated cases of cleft palate, where the lips were closed at an average age of 2 years. These contoural abnormalities are believed to be related to a tight, early, lip closure and not to the effects of palatal surgery. In general, facial contoural abnormalities in cases of cleft lip and cleft palate after conventional surgery are believed to be more the direct result of a tight lip following unsatisfactory surgical repair, resulting in a collapse of the supporting incisor teeth, than the result of interference with maxillary growth centers by palatal surgery. It is believed that surgical techniques developed in recent years will be most effective in helping to eliminate such results.

In view of the foregoing, it would appear that conventional palatal surgery can be carried out before the end of the second year of life without detriment to the facial contour, and with maximal opportunity for the development of good speech. It is most important to effect a loose lip-closure to obtain a more normal facial contour.
SINUS ARRHYTHMIA
Authors: Reeve Richard , DeBoer Kee
Published: December 2021

Though there are many comments on respiratory sinus arrhythmia in articles and textbooks, there have been surprisingly few data collected. We have presented data from 4,096 electrocardiograms of 199 healthy individuals on pulse rate, range (max. difference in cycle length), and frequency index (range/mean cycle lengthx100).

Pulse rates for this group, though not as low as those taken under basal conditions,32 show generally lower values with a greater variation than those often reported.30,31 The girls have higher pulse rates than the boys as a group after the age of 6 years.

Sinus arrhythmia defined as a range of 0.16 seconds or more is present under a year of age in both sexes. The range increases to a maximum between 8 and 12 years and only the 75th and 90th percentiles for boys show a definite decrease after this. Of 81 individuals from whom we have records from the ages of at least 8 years through 17 years, only one boy and one girl do not at some time show a range of 0.16 seconds or more.

The values for the frequency index (defined in text) we obtained were higher than those of Landtman.19 The girls show higher values than the boys after the age of 12 years for the 75th and 90th percentiles because of their higher range and higher pulse rate.

From a study of individuals over a number of years, we find that there is a strong negative association between range and pulse rate and a definite though less strong negative association between range and P-R interval. Siblings show marked similarities in their group position for pulse rate, sinus arrhythmia (range), and P-R interval.

The influence of variation in tidal volume and respiratory rate on sinus arrhythmia (range) was investigated. The results show that there is usually an increase in range with increase in tidal volume but a variable response to respiratory rate changes. Rapid respiratory rates decrease sinus arrhythmia (range) probably by the increase in pulse rate from the greater work involved, though changes in CO2 tension of the blood might also be important.

From studying the effect of breath-holding on sinus arrhythmia we find that slowing usually occurs 3 to 6 heart beats after the increase in rate which is associated with inspiration, and occurs with expiration only by coincidence. The amount of slowing is not related to the time of expiration.
A STUDY OF NONFATAL ACCIDENTS IN CHILDREN UNDER SUPERVISION IN CHILD HEALTH STATIONS OF NEW YORK CITY DEPARTMENT OF HEALTH (1952-1959)
Authors: Jacobziner Harold , Rich Herbert , Merchant Roland
Published: December 2021

Accidents are the leading cause of death and disability in young children. Data are presented on 5,000 nonfatal accidents in which 4,791 children under supervision in New York City child health stations were involved. Based on a health examination by the physician, a physician-parent conference, and/or nurse-parent conference, it is our impression that these children are not in the main dissimilar in growth and development and intelligence from the group not involved in accidents.

Age and sex are important factors in the occurrence of nonfatal accidents. The highest frequency was at ages 12 to 17 months. A statistically significant preponderance in male children was also noted. No conclusions are drawn as to color; the high incidence in the nonwhite and Puerto Rican population is not a racial characteristic, but a reflection of overcrowding and substandard housing. Of all accidents 56.6% were of a serious nature. The frequency of home accidents is very high in the first 2 years of life.

Type of accident varies with age. Falls and burns were the two leading causes of accidents. The head was frequently involved in falls and the upper extremity in burns. The relationship of congenital malformations and behavior disorders to accidents could not be determined in this study. The majority of the reported accidents were judged preventable.

Accordingly, education is assumed to be crucial in accident prevention, with the physician playing a dominant role. However, it is to be emphasized that accident prevention requires a team approach from all facets of the community. Further systematic and intensive research is needed about many phases of accidental occurrences and particularly about the human facets, including the cultural and social as pects.

While much still remains unknown, a great body of knowledge has already been accumulated, and much more could be accomplished now if current existing knowledge were much more widely applied. It is strongly recommended that accident prevention become part of the physician's daily practice, and that it be included as an integral part of well-child supervision. Any program of accident prevention must be predicated on two essentials: 1) Get the facts; 2) Act quickly on the facts obtained.
PRACTICE OF PEDIATRICS
Authors: Knudson Alfred G. , Natterson Joseph M.
Published: December 2021

A program for the participation of parents in the hospital care of fatally ill children is described. Such a program is practical and, in fact, serves useful purposes for patients, parents and staff.

The ill children are spared to a large extent from the great difficulty of separation from the parents. This has a maximally beneficial effect upon children less than 6 years of age. For the child 6 to 10 years of age, fear of procedures and of bodily harm seem to take precedence over separation fear, so that parent participation is less helpful. Parent participation is least helpful for the children over 10 years of age, where fear of death itself is the primary problem. There is apparently a maturation of death fear, whereby it evolves from separation fear and mutilation fear.

Parents, particularly mothers, are enabled to cope with their own separation anxiety and guilt feelings by participating in the hospital care of the child. This is especially important initially in the course of the child's illness, when the mother's reactions are conspicuously characterized by denial, guilt and hysterical emotionality. Later, when the mother's behavior becomes more rational, her desire to participate is balanced against her desire to support the rest of the family. There is apparently a phasic response in the mother, with an initial emotional and denying reaction and a later more rationally adaptive reaction.

Staff personnel, particularly nurses, are largely relieved of the burden of assuming a role of psychologic parentage. An opportunity to identify with a research program is afforded, thus providing constructive purpose. Compensation is also provided by the gratitude of parents who have come to know the staff and to appreciate their efforts and by the satisfaction of aiding in the psychologic rehabilitation of parents.
In Reply: Management of Otitis Media
Authors: Ferguson Charles F.
Published: December 2021

Dr. Chamberlin's letter brings up an obviously controversial subject. It does not, however, seem surprising that the articles he refers to are by otolaryngologists, since it is the otolaryngologist who sees the complications of otitis media, not only intracranial in origin, but also the complications of resultant hearing impairments, which I mentioned in my article. It is certainly true that most cases of otitis media will respond to antibiotic therapy given properly by the pediatrician, and many cases of bulging ear drums, as I stated in my article, will subside without myringotomy.
Phenylketonuria without Mental Retardation
Authors: Caudle Harold V.
Published: December 2021

Mental retardation has been generally considered a sine qua non of phenylketonuria (phenylpyruvic oligophrenia) but recent reports have described normal intelligence in some children so afflicted.1,2 It is the purpose of this letter to report an untreated child with phenylketonuria and above-normal intelligence.

See table in the PDF file

The patient, a 3½-year-old white boy, was the product of a normal pregnancy, delivery and neonatal period. His birth weight was 3,263 gm. Growth and development were normal, and at 2½ years he weighed 12.8 kg and was 91 cm tall.
AUSCULTATION OF THE HEART IN INFANTS AND CHILDREN
Authors: Castle Robert F. , Craige Ernest
Published: December 2021

We have attempted to describe the auscultatory features of a variety of physiologic and pathologic states of infancy and childhood. The phonocardiogram has been used for illustrative purposes and, indeed, often proves invaluable in the demonstration of the subtleties of cardiovascular sounds. It is our hope, however, that this review will be of some use to the physician whose sole sound analyzing instrument is his brain, for we believe that the key to successful auscultation is an understanding of basic cardiac physiology and pathophysiology and that in a great majority of cases the configuration of sounds and murmurs on the phonocardiogram is fully predictable on the basis of the clinical examination.
ISOLATION OF THE RESPIRATORY SYNCYTIAL VIRUS FROM A PATIENT WITH PNEUMONIA
Authors: Rowe Daniel S. , Michaels Richard H.
Published: December 2021

A virus with the characteristics of the respiratory syncytial virus was isolated from the throat of a 6-month-old infant with pneumonia. The illness was accompanied by an eightfold increase in complement-fixation antibody to the Long strain of the respiratory syncytial virus and a sixteen-fold rise in the homologous neutralizing antibody, indicating that the pneumonia was accompanied by infection with this virus. The relationship between this infection and the patient's pneumonia is possibly etiologic.
COLLECTING CHILDREN'S BOOKS: A REWARDING PASTIME
Authors: Kerlan Irvin
Published: December 2021

Collecting children's books is an appealing and absorbing hobby which has personal attraction for the physician who engages in this pleasant pursuit. As in all fields of collecting, whether it be stamps, coins, old automobiles, guns or antiques of any kind, there is great delight and satis faction in developing a special area of interest.

Books are of particular appeal since they afford pleasure on reading and in the case of children's books offer an additional reward through their visual and tactile attraction. As one accepts the infectious preference of selecting first editions of the books that one recalls from one's childhood, and which gave endless hours of enjoyment, one is soon energetically on his magic carpet to a land of old friends and new acquaintances.

As in any field, one should be familiar with the heritage of the developments of the area to have a preferred advantage, and in some instances such background may serve as a specialized area of interest. In the case of children's books, although illuminated manuscripts and the first printed books are not usually regarded as children's fare, we do find that in the Seventeenth Century there were books published for children. Collecting the highspots of the great books for children through the centuries opens many vistas of awareness in already charted fields. To be sure, the price of one's selections may be appreciable, yet it differs no wise from the proportionate values placed on all rare and scarce materials.

Although John Newbery, an apothecary in London in the 1740's, set about to make books for children and is avidly recognized as the first exclusive publisher of children's books, Thomas Boreman, also in England, made a few books for young readers in the years just before Newbery.
THE BLOOD PRESSURE OF NEWBORN INFANTS IN ASPHYXIAL STATES AND IN HYALINE MEMBRANE DISEASE
Authors: Neligan Gerald A. , Oxon. D. M. , Smith Clement A.
Published: December 2021

The early changes in the systolic blood pressures in six clinical groups of newborn infants have been studied. Readings of the sphygmomanometer used have been compared with "direct" measurements during cardiac catheterization, and the results are reported.

In 36 normal mature infants the systolic pressure fell by a mean of 25 mm Hg from the initial value recorded within the first 5 minutes after delivery, to the lowest value, reached as a rule between 1 and 4 hours after delivery. In 18 clinically asphyxiated mature infants, the mean fall (38.5 mm Hg) was significantlygreater because the initial level was significantly higher (by 15.1 mm Hg) than the comparable initial level in the infants who breathed promptly. Three episodes of apnea during anesthesia have also been observed in two infants aged less than 48 hours, and on each occasion there has been an abrupt rise in the systolic pressure, with or without a corresponding bradycardia.

In a group of premature infants studied from within the first half-hour after delivery, the seven of them diagnosed as hyaline membrane disease had a significant hypotension between 5 minutes and 4 hours after birth, as compared with the lowest systolic pressures found at corresponding times in the 10 infants who remained well. Among infants of diabetic mothers, a similar relative hypotension was observed in the four severe cases of hyaline membrane disease as compared with blood pressures of the 11 who remained well and the three who were mildly affected. A group of 13 mature infants delivered by elective cesarean section, for indications other than maternal illness of any kind, showed no significant differences in the course of their lowest systolic pressures as compared with the group of mature infants delivered from below. Neither the cause nor the significance of the hypotension seen in hyaline membrane disease is yet sufficiently clear to allow recommendation as to treatment.
RADIOACTIVE-IODINE CONCENTRATION IN THYROID GLANDS OF NEWBORN INFANTS
Authors: Ogborn Richard E. , Waggener Ronald E. , VanHove Eugene
Published: December 2021

The thyroid function of 28 newborn in fants was studied by the uptake of I131 by the thyroid gland.

The range of I131 uptakes was from 6.3 to 36.4% with a mean of 20.3% (standard deviation is 8.5%). Fourteen of the cases were within one standard deviation of the mean and all cases were within two standard deviations.

In this study sex and weight were not found related to thyroid function.
Ciba Foundation Study Group No. 4: Virus Virulence and Pathocenicity, G.E.W. Wolstenholme, and C.M. O'Connor, Eds. Boston, Little, Brown and Co., 1960, 114 pp
Authors: Cramblett Henry C.
Published: December 2021

This book contains the papers presented by various investigators in the Ciba Foundation Conference concerned with virus virulence and pathogenicity. The participants were investigators noted for their excellence in virologic research.

The various factors known to effect virulence and pathogenicity of viruses in in-vitro culture systems as well as in vivo in humans are well elucidated. Although the influenza virus was used as the model for a major portion of the discussions, other viruses were also considered.
STENOSIS OF A BRANCH OF THE RENAL ARTERY CAUSING HYPERTENSION IN A CHILD
Authors: Lambeth Charles B. , Derrick John R. , Hansen Arild E.
Published: December 2021

Marked hypertension is known to have persisted for a 2½-year period in a 5-year-old child. The symptoms of polydipsia and polyuria with enuresis as well as hyperactivity had been noted. The only physical findings were hypertension and its associated retinopathy.

Attempts at translumbar aortography resulted in a large hemorrhage into the left pleural space. Two years later, however, a successful retrograde renal arteriogram revealed a stenosis of the superior branch of the right renal artery. Removal of this obstruction and re-anastomosis of the vessel resulted in the return of the blood pressure to normal as well as the complete relief of the symptoms. In the pediatric age group this is believed to be the first report of such a lesion treated successfully with vascular surgery.

On the basis of observation with this child, as well as data from the literature, it is concluded that hypertension in children is almost never essential and every effort should be made to determine the cause. Children with enuresis, or polyuria and polydipsia, should have careful blood pressure determinations.
A METHOD FOR CONTINUOUS URINEAND STOOL COLLECTION IN YOUNG INFANTS
Authors: Hepner Ray , Lubchenco Lula O.
Published: December 2021

Metabolic investigations of premature and young infants have been hampered by difficulties in making quantitative urine and stool collections. Many studies have been limited to male infants and the duration of study has often been short, or interrupted by the development of skin irritation. Fragile or desperately ill patients who might benefit from investigation often are not studied because of the difficulties and hazards involved in available methods.

A special pan designed after the type used in animal metabolic cages has been adapted for urine and stool collections from infants in incubators. This device has made possible the continuous collection of urine and stool for as long as 8 to 13 weeks. This metabolism pan has also permitted investigations of female infants as well as males and, further, has been found to be satisfactory and valuable in the treatment of the very small, sick or postoperative patient.

See image in the PDF file

Figure 1 is a sketch of the stainless steel pan and complete equipment with the infant in place. The pan is a shallow funnel with connecting tubing extending into a bottle below. The nylon netting is shown stretched tightly over the top of the pan and held in this position by metal rods, threaded through seams in the nylon and clamped in place outside the pan.

The baby is placed prone or on his side on the netting with a bib under his head and a piece of nylon netting pinned loosely over his back or shoulders.
VIRAL INFECTIONS OF INFANCY AND Childhood, Harry M. Rose, M.D. New York, Paul B. Hoeber, Inc., 1960; Number 10, Symposium of the Section on Microbiology, The New York Academy of Medicine, 244 pp., $8.00
Authors: Sprunt Katherine
Published: December 2021

Viral Infections of Infancy and Childhood is a collection of papers presented at a symposium at The New York Academy of Medicine in March 1958. The authors are well known virologists or pediatricians from various parts of the United States, England and Europe. The topics were obviously selected for their special interest and timeliness; some present new concepts and others are devoted to a much needed review of present-day developments in special areas. Where necessary the papers have been brought up-to-date by footnotes and addenda.
THE PEDIATRICIAN AS CONSULTANT IN A GENERAL PRACTICE AREA
Authors: Lee W. J.
Published: December 2021

As long as births on this continent increase faster than the proportionate output of medical graduates, there will never be a sufficient number of trained pediatricians, "comprehensive" or otherwise, to attend the entire childhood population—even if this situation were ideal, and there are arguments against it being so—unless, of course, the proportion of pediatricians among total practitioners increases tremendously, which is improbable. The pediatrician-to-child population ratio is estimated to be 1 to 7000.1 In 1957, the United States had approximately one Board Certified pediatrician for every 40 physicians of all categories, and there appears to be no breaking of ranks by the generalists. The more comprehensively a pediatrician practices (that is, with close supervision of the child and extensive counselling of the family) the fewer patients will he be able to see and the more expensive will his services become. (It could be that this mode of pediatric candidate, as others have suggested.) Thus for practical reasons of availability and economy the less trained general practitioner must continue to assume the greatest share of the work, and he would still turn to the specialist pediatrician for particular help, as seems to be indicated from the foregoing presentation. If improved quality of child care is the aim of medical educators, then that emphasis should be placed as much on the training of the general practitioner as on that of the pediatrician,7 and the latter should look more to the field of consultation for his contribution to the nation's health.

The author readily admits that his way of practice is not without shortcomings and difficulties, part of which derive from the fact that he holds a minority view among his peers. Some of the problems can be surmised from between the lines of the material presented, but they need not be dwelt upon because they do not detract from the main theses of the study. A specialist with referrals justifies his status; without them his valuable knowledge and skills tend to rust from disuse. That the pediatrician consultant must minimize the scope of his counselling work need not mean that he stands unconcerned about general well-being of children and other pertinent issues; in such matters he can and should participate at the voluntary community level and thus play his distinctive part on the wider scene. By interposing himself between the grass roots and the ivory towers he becomes a key link in the chain of medical services to the child, and at the same time he assures himself of a satisfying professional existence.
GROUP PRACTICE
Authors: Lee Henry F.
Published: December 2021

As the member of this panel who represents pediatric group practice, I believe it is for me to suggest how such group practice may aid or abet or, at least, fit into the concept of the "Newer Pediatrics."

I do not believe that there is truly a "New Pediatrics." I think we are simply attempting to define something that has been around a long time, but which has been successfully applied by only a fraction of practicing pediatricians.

Almost a year ago I gave a talk to a group of residents who had requested my thoughts on the meaning of the term, "Newer Pediatrics." I am not sure that I made myself entirely clear to them, which implies that I was not wholly clear myself as to all the implications in this concept. However, permit me to read to you the last paragraph of my talk. Further reflection has given me no cause to change the content.

"I conceive of the ‘Newer Pediatrics’ as being an approach to practice which requires the pediatrician not only to be well grounded in the diagnosis and treatment of disease, but to be sensitive to the psychological and emotional aspects of illness and general growth and development; furthermore, it requires that he be able, either by his own ability, or by using the abilities of his specialized colleagues, to make available to the families in his practice pediatric care which encompasses these factors in a fashion satisfactory to himself, to his patients, and to their families.
PSYCHOLOGIC ASPECTS IN PRACTICE
Authors: Cecil Henry S.
Published: December 2021

For Some Time at the Children's Hospital of Philadelphia we have been concerned about the changing nature of pediatric practice. It seems apparent that the shifting morbidity and mortality patterns of childhood increasingly demand that the pediatrician assume an expanded responsibility in the psychosocial aspects of care. With this in mind we have focused our attention on the training needed to develop in the pediatrician the requisite skills to meet the demands of this expanded responsibility.

Many factors have contributed to changing needs of children seen in office practice. Increased knowledge of nutrition, electrolytes, immunizations and the antibiotics have influenced the entire spectrum of child hood illness. The population growth has brought increasing numbers of children to the pediatrician, and mobility of young families has led to isolation of parents from the support in child rearing formerly offered by close contact with their own families. Increasingly they turn to their physician for this support.

With the declining incidence of acute infectious disease, many children who would have died of congenital defects and metabolic disorders are now surviving. These cases are usually marked by high degrees of family disturbance and breakdown.

In addition, there has been a rising incidence of serious developmental disorders in very young children and an increasing parental concern about the supervision of emotional growth and development.

These and other factors have been well discussed by Richmond in a recent article in Pediatrics.1

Thus, the problems presenting themselves today both in office and in hospital practice, while they may be organic in symptomatology, are complicated by severe emotional components in increasing numbers.
CONCLUSIONS
Authors: Fischer Carl C.
Published: December 2021

After reviewing the presentations of the four panelists and the informal question and answer period that followed, the following conclusions would seem to represent the consensus insofar as the panel is concerned:

(1) The practice of pediatrics as a specialty would seem to be here to stay—at least insofar as can be presently judged.

(2) The term "new" pediatrics is a misnomer in that many pediatricians have been practicing it for many years. Our present interest, then, lies not so much in a "new" or comprehensive pediatrics—but in better ways to accomplish it.

(3) Our undergraduate and postgraduate training must be brought up to date in order to better equip the pediatrician of the future for the comprehensive practice of pediatrics as it exists in his community.

(4) This does not necessarily mean more time or more formal training but rather better use of all available facilities, including participation in as well as full awareness and understanding of the emotional and social factors in the lives of the "little people" under their care.
Phenylketonuria in Jews
Authors: Laron Zvi , Yonis Zeev
Published: December 2021

Until 1954, 513 cases of phenylketonuria were recorded in the literature.1 Since then many more cases have been reported, both from America and Europe. Interestingly, only one of the reported patients had Jewish ancestors;2 another Jewish patient is mentioned in a personal communication.3 Considering the rarity of this metabolic disorder in Jews, a preliminary report on several cases of phenylketonuria we have discovered in a family of Iraqui Jews seems justified.

In June 1958, a 21/2-year-o1d boy with mental and motor retardation was referred to our clinic for evaluation.
In Reply: Epidermolysis Bullosa Letalis
Authors: Roberts Maureen , Howell Dennis , Bramhall James L. , Ruebner Boris
Published: December 2021

Doctor Mautner is correct in claiming to have described the first indisputable case of epidermolysis bullosa letalis under the name of pemphigus hereditarius (Monatschr. f. Kinderheil., 22:15, 1922). We certainly did not intend to deprive him of the credit for this achievement. In our article, however, we did not claim that epidermolysis bullosa letalis was first described by Herlitz. We merely credited Herlitz with first defining this condition as an entity, since he recognized it as one of the variants of epidermolysis bullosa and coined the term epidermolysis bullosa hereditria letalis.
LEADERSHIP
Authors: Wheatley George M.
Published: December 2021

Last month i closed with a reference to leadership. The thought running through my mind was that each of us owes something to our specialty—a kind of tribute to those who have gone before us and who gave of themselves to build the specialty of pediatrics. Ordinarily we think of this "debt" being paid off by the scientist in the laboratory and the clinician at the bedside. And, of course, their contributions have been and continue to be tremendous. But, I submit, everyone who is a pediatrician owes something to further the advance of pediatrics. The hallmark of our specialty from its beginning has been involvement in community service. Many pediatricians not only apply the new knowledge of disease prevention, nutrition and child care to the rearing of children in private practice, but by advice and personal service participate in community health projects to extend these new concepts to all children. Not only have these contributions of individual pediatricians aided greatly to establish pediatrics as a specialty, but have helped enormously to give it a privileged place in public opinion. Every practitioner can exercise this kind of leadership in his or her community.

This same dedication by many pediatricians has made the Academy a leader among medical organizations. The Academy exemplifies a new kind of medical society—an organization concerned not only with clinical problems but the social needs of patients. The Academy, I believe, was the first medical organization to recognize the value of co-operative relationships with nonmedical groups. One of its first committees was called the Committee for Cooperation with Nonmedical Groups.