bluuebunny/crossref_metadata_2025 huggingface dataset:
RESPIRATORY ACTIVITY AND FUNCTION IN NEWBORN INFANTS DYING WITH PULMONARY HYALINE MEMBRANES
Authors: Miller Herbert C. , Behrle Franklin C. , Smull Ned W.
Published: December 2021

The respiratory activity and function of 10 newborn infants dying with pulmonary hyaline membranes were compared with those of surviving infants who had severe respiratory insufficiency.

Both groups compensated by increasing respiratory rates during the period of respiratory insufficiency. The respiratory rates of the surviving infants rose to higher levels than did those of infants dying with hyaline membranes. Surviving infants were able to compensate satisfactorily even though the tidal volumes were less than normal. Some of the infants dying with hyaline membranes were unable to oxygenate the blood satisfactorily or adjust acid-base balance in spite of the fact they increased their tidal volumes significantly on occasions. Moderate to severe dyspnea was usually present in both groups at birth. Dyspnea usually decreased rapidly and often disappeared entirely in surviving infants during the period the respiratory rates were increasing. Dyspnea generally was maintained from birth onwards in infants dying with hyaline membranes and sometimes increased during the hours preceding their deaths.

Most infants dying with hyaline membranes exhibited signs of respiratory insufficiency from birth to death, such as initial apnea and bradypnea, cyanosis and increasing respiratory rates. Evidence of a symptom-free period after birth was exceptional.

The immediate causes of death in infants with pulmonary hyaline membranes probably are multiple, and include respiratory acidosis, deficient oxygenation and possibly physical exhaustion due to extreme dyspnea.

In comparing respiratory rates of infants with severe respiratory insufficiency, recognition should be given to the fact that infants in the heavier birth-weight groups tend to develop higher respiratory rates than infants who weigh less.
Complications of Hyperbilirubinemia
Authors: NESTEL P.
Published: December 2021

I have read with interest the article "Complications of hyperbilirubinaemia— possible relation to the metabolism of ammonia" by M. K. Gorten et al. (Pediatrics, 21:27, 1958).

It may be of interest that corollary evidence to support the argument put forward by Dr. Gorten is the finding of gross aminoaciduria in infants affected by severe erythroblastosis fetalis (Nestel & Nestel, M. J. Australia, 44:909, 1957). The contention has been that kernicterus may be the result of abnormal nitrogen metabolism secondary to hepatic insufficiency, which invariably occurs in severe erythroblastosis.
CERULOPLASMIN ACTIVITY IN THE SERUM OF CHILDREN WITH SCHIZOPHRENIA
Authors: Bakwin Ruth Morris , Mosbach Erwin H. , Bakwin Harry
Published: December 2021

The ceruloplasmin (monoamine oxidase) activity was measured in time serums of 45 children with schizophrenia, using the technique of Abood. No difference from normal children was found.

It was further shown that ascorbic acid, over a wide range of concentrations, has no influence on the measured values of monoamine oxidase activity, in the technique employed.
FUNCTION OF THE SALIVARY GLAND IN CYSTIC FIBROSIS OF THE PANCREAS
Authors: Barbero Giulio J. , Chernick Warren
Published: December 2021

A significantly greater rate of "unstimulated" parotid salivary flow was observed with 14 children with cystic fibrosis of the pancreas than with 24 normal children. The concentration of sodium and chloride in mixed saliva was significantly elevated in 12 children with cystic fibrosis of the pancreas as compared with 14 normal children. The response to injection of methacholine chloride was greater for both rate of parotid flow and concentration of sodium and chloride with 10 children with cystic fibrosis of the pancreas than with 10 normal children. Concentration of potassium showed no significant difference in either group. The response elicited in the parotid by administration of methacholine chloride indicated a decreased threshold of response and consequent increased sensitivity to parasympathomimetic stimulation in the patients with cystic fibrosis of the pancreas.
ELECTROENCEPHALOGRAPHIC STUDIES OF PATIENTS HAVING POLIOMYELITIS WITH NO CLINICAL EVIDENCE OF ENCEPHALITIC INVOLVEMENT
Authors: Grossman Herbert J. , Gibbs Erna L. , Spies Harold W.
Published: December 2021

Serial electroencephalograms were done with 111 patients having poliomyelitis with no clinical evidence of encephalitic involvement. Using stringent criteria, 48 patients had considerable abnormality of the electroencephalogram. These findings could not be attributed to any complication and were qualitatively and quantitatively similar to those seen in encephalitis.
Aktuelle Probleme der Kindertuberkulose
Authors: SMITH MARGARET H. D.
Published: December 2021

This 76-page, paper-bound book by the leading Swiss student of pulmonary disease in children discusses in nine short chapters the new problems and new horizons opened up by the effective anti-tuberculous drugs now available. Sparingly illustrated, it does not claim to be in any sense a textbook, but simply a series of reports and discussions of recent developments in the bacteriology of tuberculosis (culture media; isoniazid resistance); the changing epidemiologic pattern (including superinfection of infected children); the place of adrenal cortical hormones in treatment; the management of cervical adenitis; the electrolyte disturbances seen in patients with tuberculous meningitis; the changing clinical picture; prognosis and management of bone and joint lesions, and attitudes towards BCG vaccination. Each chapter has a very up-to-date bibliography. The book (one is tempted to say booklet) is so short and to-the-point that it is heartily recommended for anyone who reads German and is interested in some of the fascinating new problems presented by tuberculosis today.
CRANIOFACIAL DYSOSTOSIS: CROUZON'S DISEASE
Authors: Dodge Henry W. , Wood Matthew W. , Kennedy Roger L. J.
Published: December 2021

IN 1912 Crouzon presented his classic paper to the Medical Society of the Hospitals of Paris. It was a report on two patients, a 29-year-old mother and her 3-year-old son, with strange malformations of the face and head to which he gave the name "hereditary craniofacial dysostosis." In general Crouzon listed the following factors as characteristic of the disease: 1) cranial malformation that is a combination both of a skull in the shape of a boat (scaphocephaly) and in the shape of a wedge (trigonocephaly); 2) malformation of the face resulting in an arched nose resembling a parrot's beak and marked protrusion of the mandible beyond the maxilla (prognathism); 3) bilateral exophthalmos with external strabismus; and finally 4) a hereditary and familial occurrence of these malformations. In addition to these four main characteristics of the syndrome, the child described in Crouzon's paper also had suffered from epilepsy and urinary incontinence. In discussing the possible etiology of this disorder, the author favored the hypothesis that it represented a hereditary malformation of embryonic origin.

Since this original report, Crouzon and others have had the opportunity to see and report on additional cases of this strange malady. Atkinson reviewed the literature in 1937 and found that, to that time, 86 certain cases of this condition had been reported. In 28 of the 86 cases occurrence of the disorder in other members of the afflicted member's family was not mentioned. Vogt described this condition associated with syndactylism, and in 1942 Arce and Arce reviewed the roentgenologic findings in eight cases of pathologic synostosis of the vault, including Crouzon's disease.

Parks and Costenbader presented the cases of three patients having Crouzon's disease, one of whom had undergone operation, and Pinkerton and Pinkerton reported four cases of craniofacial dysostosis in a family of seven.

Three members of the family reported by the Pinkertons, including the father, were normal. Four others in this family, including the mother, had Crouzon's disease. One of those affected was a 3½-year-old girl with marked visual impairment and ophthalmoscopic evidence of chronic increased intracranial pressure. Cranial surgery was recommended in this instance but was refused.
Hemophilic Arthropathies
Authors: FERGUSON ALBERT B.
Published: December 2021

The book, Hemophilic Arthropathies by Henry H. Jordan, is of value from two aspects. It is inadvertently an autobiography of a sincere student of a disease and as such portrays the man and his emotional involvement with his patients. The book also touches a much neglected aspect of the disease and here the major contribution deals with the details of plaster and brace care for these patients. Patients with extremity involvement in hemophilia having total or marked disability when first seen included 47 of a total of 56 patients. Of 21 who were bed-ridden 19 are now ambulatory. Such a result obviously represents a dogged devotion to a very difficult problem for both the patient and the orthopedic surgeon.
INCREASED AMINO-ACIDURIA IN INFANTS WITH KWASHIORKOR FED NATURAL AND SYNTHETIC DIETS
Authors: Schendel Harold E. , Antonis Arnold , Hansen John D. L.
Published: December 2021

There appears to be a temporarily increased (three-to eightfold) amino-aciduria in kwashiorkor, which is rapidly reduced with treatment. This increased excretion was apparent when the data were expressed as a function of body weight or excretion of creatinine, as a percentage of intake or as amino-acid index. Further, this increase is due to the increased output of 17 amino acids rather than any single acid.

Secondly, there is a grossly increased amino-aciduria in both normal infants and infants with kwashiorkor fed two synthetic amino-acid formulae, theoretically adequate: this appears to be due to a large extent to those acids present in the formula as the DL-isomers, although excretion of D-acids was also higher in the patients with kwashiorkor than in controls.
CONGENITAL ADRENAL HYPERPLASIA ASSOCIATED WITH POLYCYTHEMIA
Authors: Gold Arnold P. , Michael Alfred F.
Published: December 2021

A patient with congenital adrenal hyperplasia is presented with the heretofore undescribed association of polycythemia.

It is hoped that this report will stimulate further interest in the hematologic study of patients with congenital adrenal hyperplasia during the immediate neonatal period.
A PATCH TEST FOR CHLORIDE IN SWEAT AS A SIMPLE SCREENING METHOD FOR DETECTING CYSTIC FIBROSIS OF THE PANCREAS
Authors: Gluck Louis
Published: December 2021

A simple patch test, designed as a screening test for cystic fibrosis of the pancreas, is reported in preliminary form. In trials carried out with 207 patients it has proved accurate and reliable.

A brief resume of the physiology of sweating, especially as pertinent to diagnostic methods in pediatrics, is also presented.

Studies are in progress aiming toward further refinement of this method.
Letters to the Editor
Authors: ABLER CHARLES
Published: December 2021

Congratulations on your stimulating editorial "Can the New Pediatrics be Practiced?" I ask your indulgence to rephrase it to "Can the New Medicine be Practiced?" because my remarks embrace the entire field.

Progress in medical knowledge has occurred, will continue to occur, and consequently has and should continue to improve available medical care. As a necessary corollary there must occur better training of physicians. This makes it necessary to re-orient the classification of physicians along the following lines, to optimally utilize the skills of the better and highly trained physicians that this newer medical knowledge demands:

1) General practitioners in the younger age group—old terminology = pediatricians.

2) General practitioners in the older age group—old terminology = internists.
Exchange Transfusion for Hyperbilirubinemia in Premature Infants
Authors: BOGGS THOMAS R.
Published: December 2021

Dr. Gerald H. Holman's conclusions as presented in his article (Studies on physiologic hyperbilirubinemia of Negro and white premature infants. Pediatrics, 22: 1115, 1958) should not go unchallenged. I am referring specifically to his statement: "routine exchange transfusions for elevated concentrations of bilirubin (in premature infants) does not seem warranted."

Failure to be strongly critical of such a notion in the light of current knowledge might well result in the loss of ground gained in our efforts to prevent kernicterus, with resultant death and cerebral palsy. It is unfortunate that through publication in Pediatrics this idea gains some measure of sanction and support.
Letters to the Editor
Authors: HOLMAN GERALD H.
Published: December 2021

I welcome this opportunity to further discuss the criteria for the use of routine exchange transfusions in the premature infant with hyperbilirubinemia.

Although it is well established that kernicterus due to "physiologic hyperbilirubinemia" can and does occur in the premature infant, its exact incidence in untreated premature infants is not known. Figures vary from 1 to 5% of all prematures. Even less understood, is the incidence of kernicterus in premature infants whose serum bilirubins reach 18 mg/100 ml or higher. Meyer states that 60% of prematures whose bilirubin reaches 18 mg/100 ml or higher will develop kernicterus.
Toxicity of Phenothiazine Compounds
Authors: GOLDSMITH RICHARD W.
Published: December 2021

I have been very interested in the recent exchange of letters (Pediatrics, 22: 1201, 1958) regarding the toxicity of the phenothiazine compounds. I have witnessed many cases of typical toxicity to phenothiazine drugs and have made several observations which I would like to record.

The symptoms are completely listed by Dr. Bowen's letter. The patients referred to in the following paragraphs illustrate the majority of these symptoms. It is my impression that these symptoms are distinctly not convulsive in nature, but rather are manifestations related to the extrapyramidal tract.
VITAMIN SUPPLEMENTS
Authors: MAY CHARLES D.
Published: December 2021

THE selection of the supplementary vitamins that may be needed should be one of the simplest things the physician has to do in prescribing the diet for an infant or child. At least one would be inclined to believe scientific nutrition must have progressed this far. And yet confusion and wasteful error characterize the customary use of vitamin supplements in academic centers as well as by practitioners. Why?

The remarkable variety of commercial preparations of vitamins now available makes a choice difficult. Without elementary knowledge of the vitamins needed to maintain the health of normal infants, in contrast to the unusual requirements in disease, it is easy to yield to the temptation to give every infant and child a superabundance of vitamins in an all-inclusive supplement—just to be sure.

Such casualness amounts to lavish generosity.
A PRACTICAL METHOD FOR THE MEASUREMENT OF SYSTOLIC BLOOD PRESSURES OF INFANTS
Authors: Rice H. V. , Posener L. J.
Published: December 2021

A new, indirect method of determination of systolic blood pressures applicable to small infants has been described. It has been shown to be consistent, reproducible, and to correlate closely with the standard auscultatory method. The appartus used is compact, portable, inexpensive, provides quick results and does not irritate or injure the patient. It lends itself readily to the recording of systolic pressures.

Limited results obtained by the new technique were presented and compared with those obtained by other methods.

Further data for statistical purposes are being compiled.
ORTHODONTICS AND THE PEDIATRICIAN
Authors: Cohen Melvin I.
Published: December 2021

The orthodontist carries out specific dental health procedures on a patient at an age level when the pediatrician has the over-all health responsibility. It is therefore desirable that there be a proper understanding and communication between these groups. This paper attempts to present material from the field of orthodontics to aid the pediatrician in his understanding of this dental specialty.
OFFICE EVALUATION OF VISION IN CHILDREN
Authors: Costenbader Frank Duncan
Published: December 2021

I AM PLEASED to be included on a panel discussing the special senses in conjunction with intelligence and certain skills. It would seem that in so grouping these subjects, the eyes, the ears and the other senses have no longer been considered isolated phenomena but as parts of an integrated whole.

It seems important at this early point in the discussion to emphasize the fact that the term "vision" is frequently misused, usually only connoting visual acuity. It should be emphasized that vision in its broadest sense includes visual acuity, the extent of the fields of vision, the normality or abnormality of binocular vision, and the adequacy of the visual associations such as recognition, identification and memory. It seems superfluous to point out that excellent visual acuity, if seen through a gun barrel, is by no means satisfying. Also, that a full, wide field of vision, when the object of interest is blurred, is most unsatisfactory. Having two eyes, each of which is a perfect unit, but not seeing together well and comfortably, is most annoying and handicapping. Finally, referring back to the brain a perfect visual image, which cannot be properly recognized and identified and then correlated with similar images previously received, is a totally frustrating experience.

Thus, for a child "to see well" he must see clearly the thing he looks straight at, he must see widely the things about him, as well as the object of interest, he must have his two eyes properly co-ordinated, and he must be able to recognize, identify and associate this image with related images and activities of the past.
Perspectives in Virology
Authors: PARROTT ROBERT H.
Published: December 2021

Perspectives in Virology is a compendium of scientific and philosophic discussions conducted at a symposium to honor Dr. F. R. Beaudette. The list of participants in itself is an honor to his memory but the content of the papers and discussions are a real tribute to the broad stature which modern virology is beginning to enjoy.

The papers wander from such basic subjects as the chemical nature of tobacco mosaic virus through discussions of new viruses in man to an intensely interesting and entertaining dissertation on the role of viruses in tulip breaking. One might gather from the above that this is not particularly a textbook with broad coverage such as would be appropriate for the day-to-day needs or studies of the student or practicing pediatrician.
THE "DRAW-A-MAN" TEST AS A PREDICTOR OF SCHOOL READINESS AND AS AN INDEX OF EMOTIONAL AND PHYSICAL MATURITY
Authors: Coleman J. M. , Iscoe Ira , Brodsky Marvin
Published: December 2021

In summary, the results of this study seem to justify an affirmative answer to each of the original questions forming the basis of this study, provided the physician is alerted to the precautions and reservations mentioned. With these in mind, the "Draw-A-Man" test would seem to be a useful instrument, suitable for the use in a busy office practice. The utility of this technique as a screening procedure certainly seems warranted.
VACCINATION AGAINST TUBERCULOSIS
Authors: SMITH MARGARET H. D.
Published: December 2021

WHILE DEATHS from tuberculosis have decreased sharply in this country, the number of new cases has not, so that there is still leeway for improvement in the control of this disease. Safe, effective immunizing agents have contributed immeasurably toward the control of other communicable diseases. What is the situation in 1959 with respect to vaccination against tuberculosis? This Commentary and the paper by Barclay in this issue of Pediatrics consider this question.

Already in Koch's day the search was on for a vaccine against tuberculosis. Tuberculin, as well as tubercle bacilli killed or attenuated in various ways and strains of tubercle bacilli derived from cold-blooded animals, proved disappointing. Calmette and Guérin, working with a virulent bovine strain of tubercle bacillus isolated in 1902, found that it lost virulence when sub-cultured at frequent intervals on special media. By 1922, the "BCG" strain appeared stable and was administered orally to infants. Soon afterwards, despite pleas from prominent French clinicians of the day, mass vaccination was undertaken without adequate controls, and the vaccine fell into disrepute.
EYE HEALTH PROGRAM IN PUBLIC SCHOOLS
Authors: Lawson Lawrence J. , McGuigan Robert A. , Fricke Irma B.
Published: December 2021

The efficiency of the Snellen tests as used in the Evanston (Illinois) Public Schools was studied and compared with other published reports. The results are satisfactory and we concur with the published reports of the National Society for the Prevention of Blindness, which recommends the use of the Snellen distance test plus teacher observation. A program of eye health is discussed as part of the total medical health school program. An eye health program cannot depend upon equipment alone!
"A Physician Looks at Psychiatry"
Authors: GRUNEBAUM HENRY
Published: December 2021

I was disturbed some months ago by Dr. Harry Bakwin's review of Dr. Jacques May's book "A Physician Looks at Psychiatry." (Pediatrics, 23:758, 1959). I did not write because of the hope that more experienced child psychiatrists than myself would do so. It does, however, seem to me that the review does psychiatry a disservice.

Dr. Bakwin comments "when Dr. May and his wife consulted psychiatrists hopefully anticipating kindly understanding and wise insight, they were met, instead, by aloofness and distrust. They were the culprits . . . the irresponsible persons who through deceit, rejection, and an insincere emotional veneer had injured their children . . . they were the guilty ones." Now this is almost a direct quote from Dr. May's book so one must presume that Dr. Bakwin agrees that this experience is typical of patients coming to child psychiatrists.
TRANSMISSION OF HOSPITAL STAPHYLOCOCCI AMONG NEWBORN INFANTS
Authors: Hurst Valerie
Published: December 2021

A newly opened nursery became contaminated with staphylococci resistant to antibiotics as soon as infants and nursing personnel were transferred to it from another nursery. The phage patterns and antibiotic sensitivity of the staphylococci recovered from the air were identical to those colonizing the infants and were different from those carried in the noses and throats of the personnel. Plate counts of staphylococci present in the nursery air were approximately threefold higher than those obtained in adjacent areas inhabited by nursery personnel and not by the infants.

The carrier rate, as determined by cultures of nose and throat, of infants discharged from the new nursery did not differ from that of infants discharged from the old nursery, despite greater space, more individualized nursing care, masking of the nurses, and air-conditioning. As newly born infants derive their staphylococci primarily from older infants, hospital nurseries may have to be replaced by rooming-in units specifically designed to meet present-day epidemiologic problems.
Letters to the Editor
Authors: STANTON ROBERT E. , JOOS HOWARD A.
Published: December 2021

We appreciate Dr. Kove's interest and comments. Of course, our results refer only to single determinations, and they are interpreted only as such. No serial observations are reported on interpreted. The conclusion is valid that single determinations of S-GOT will not differentiate hepatic diseases. Dr. Kove's own published data confirm the observation that single determinations at variable points during the course of an illness do not reliably differentiate the cause of jaundice.

We agree with Dr. Kove that the stage of disease should be taken into account in interpreting S-GOT.
FETAL BLOOD STUDIES
Authors: Battaglia Frederick , Prystowsky Harry , Smisson Clayton , Hellegers Andre , Bruns Paul
Published: December 2021

The normal relationship between fetal and maternal plasma of total osmotic pressures and concentrations of sodium and potassium were determined in women with uncomplicated pregnancies at full term. The total osmotic pressure of fetal plasma was found to be 3.6 mOsm/kg of water higher than the maternal, probably not representing a physiologically significant difference. No significant difference in sodium concentrations of plasma was found. The potassium concentration in the fetal plasma was 0.7 meq/l higher than in the maternal plasma. The administration of 5% glucose or 20% mannitol intravenously to pregnant women prior to delivery was shown to have a prompt effect upon the total osmotic pressure and concentration of sodium and total protein of fetal plasma.
VENTRICULAR SEPTAL DEFECT
Authors: Morgan Beverly C. , Griffiths Sylvia P. , Blumenthal Sidney
Published: December 2021

Seventeen patients had a history of congestive heart failure in infancy out of a total of 125 cases of ventricular septal defect reviewed. The initial episode of cardiac decompensation occurred in the first 6 months of life. Ten of the patients had evidence of unremitting failure and died in the first year of life, while seven survived infancy. Exacerbations of decompensation after infancy were rare; patients who survived the first year of life did not succumb to complications of the defect in childhood.
THE OCCURRENCE OF CYANOSIS IN CHRONIC HEPATIC DISEASE
Authors: Groth John F. , Friedman Sidney
Published: December 2021

The clinical, laboratory and pathologic findings are described in a 9-year-old male with cirrhosis of the liver who demonstrated chronic cyanosis and clubbing.

The possible mechanisms of cyanosis in patients with chronic hepatic disease and portal hypertension are discussed. The development of portopulmonary anastomoses with flow of blood in the direction of the pulmonary veins as a result of portal hypertension is considered the most plausible mechanism.
TOTAL, UNCOMPLICATED, ANOMALOUS PULMONARY VENOUS CONNECTION
Authors: Sherman Frank E. , Bauersfeld S. Richard
Published: December 2021

Anatomic observations on 13 necropsy specimens of total, uncomplicated, anomalous pulmonary venous connection are presented.

These cases accounted for 0.8% of all deaths and 3.9% of congenital cardiac deaths in a consecutive necropsy series.

Neill's embryologic classification is recommended because it is suitable for clinical purposes. The pulmonary venous return in one of the cases drained directly to the right atrium (type 1); in six it drained via a left superior vena cava (type 3A); in three it drained via the coronary sinus (type 3B); and in three the pulmonary venous return drained via the portal system (type 4A).

Findings common to all cases were: 1) interatrial communication; 2) enlarged right heart; 3) small left heart; 4) increased pulmonary circulation; and 5) normal aorta.

Anatomic findings are related to their surgical implication. The disproportion in size and implied functional capacities of the right and left sides of the heart is stressed, and the authors agree with previously recommended surgical correction in multiple stages.

Factors favoring surgical correction are: 1) The anomalous channel is so located that anastomosis with the left atrium is anatomically feasible. 2) The small left heart contains a reasonable, if not normal, number of myocardial fibers that should be capable of hypertrophy and increased function. 3) This anomaly is uncomplicated by other cardiac or extracardiac anomalies in most instances. All cases in this report were uncomplicated. 4) Pulmonary vascular changes in these infants are without scarring. 5) Myocardotomy in most instances can be limited to the atrial wall.

Factors unfavorable to surgical correction are: 1) Age at death in this series varied from 15 days to 14 months. The risk of cardiac surgery in infants is well-known. 2) The anomalous veins are scarred vessels, and may predispose to thrombosis. 3) The size of the anastomosis is limited by the small size of the left atrium.

Anomalous pulmonary venous connection must be excluded in all cases of left-to-right shunt at the atrial level. Anatomic variations that might lead to a proper diagnosis are summarized for the various types included in this study.
A STUDY OF 44 CHILDREN WITH THE SYNDROME OF RECURRENT (CYCLIC) VOMITING
Authors: Hoyt C. Sherman , Stickler Gunnar B.
Published: December 2021

The case records of 44 patients less than 15 years of age seen at the Mayo Clinic from 1945 to May, 1957, who had the syndrome of recurrent vomiting, were studied. A questionnaire sent at the time of this study—from 2 to 14 years after the original examination—to determine if possible the prognosis and cause, elicited a response from 38 patients or their parents. Of the 38 patients, 30 had no cyclic vomiting at the time of follow-up. Of the remaining 8 patients, there was less than a 5-year follow-up in 7.

The cause of the syndrome of recurrent vomiting, while possibly psychogenic, is not known definitely. It usually terminates before puberty. There may be some relationship to migraine which also may be a syndrome and not a definite disease entity. Electroencephalographic study of 15 of the patients did not suggest any relationship to a convulsive disorder.
The Child with Abdominal Pains
Authors: BARBERO GIULIO J.
Published: December 2021

This little volume is a classic monograph on the problem of abdominal pain in childhood. It is beautifully written, with brevity and clarity. Dr. Apley demonstrates so well how careful examination of a complex clinical area may be subjected to critical analysis. In almost all instances he has based his concepts on some type of analysis of clinical material liberally reinforced by the use of control measurements. Of particular interest are the studies on "abdominal epilepsy" and emotional disturbance in the problem of recurrent abdominal pain of childhood.
MYASTHENIA GRAVIS IN THE NEWBORN
Authors: Greer Melvin , Schotland Marilyn
Published: December 2021

A case of possible myasthenia gravis diagnosed in the newborn period has been presented. The manifestations included those of both the "neonatal" and "congenital" varieties. The symptoms were those of the neonatal variety and were transient, but the mother did not have myasthenia. A sibling who died previously at 3½ months of age may have had the same disease.
The Pediatric Residency
Authors: Kanof Abram
Published: December 2021

While in the art gallery one may stoutly insist that he knows what he likes, it appears from the article of Deisher et al. (Pediatrics, 25:711, 1960) that in the practice of pediatrics one likes what he knows. I do not agree, however, that the fault is in the medical school training; rather, it lies in the inadequacies of the pediatric residency program.

What happens to the enthusiastic senior choosing pediatrics as his field, to change him after 10 years of practice into a physician nagging about the really petty complaints in Table V of Deisher's article?
RENAL TUBULAR DYSFUNCTION COMPLICATING THE NEPHROTIC SYNDROME
Authors: Stickler Gunnar B. , Hayles Alvin B. , Power Marschelle H. , Ulrich John A.
Published: December 2021

Observations on two girls in whom an unusual type of chronic renal insufficiency developed many months after the onset of nephrotic syndrome are reported. Each patient became free of edema in spite of persistent massive proteinuria. Growth was retarded and rickets and attacks of tetany developed.

The chemical disturbances of the blood were characterized by hypocalcemia, hypokalemia, azotemia and metabolic acidosis. Hyposthenuria, proteinuria, amino-aciduria, and minimal erythrocyturia, cylindruria and glycosuria were present.

Healing of the rickets and cessation of attacks of tetany followed the administration of vitamin D and calcium salts. Prednisone was administered to one patient and thereafter proteinuria decreased and renal tubular function improved. Both girls are relatively asymptomatic 11 and 9 years after the onset of nephrotic syndrome, although they are rather small and still have evidence of renal disease.

It is possible that cells of the renal tubules have been damaged as a result of prolonged massive proteinuria.
ACTIVITY OF ACID PHOSPHATASE IN THE SERUM OF NORMAL INFANTS AND CHILDREN
Authors: Laron Zvi , Epstein-Halberstadt Batia
Published: December 2021

Normal values for activity of acid phosphatase in the serum of infants and children are presented. The total acid phosphatase activity is high in the serum of newborn infants, declines slightly during the first 2 weeks of life, remains at a medium level up to the age of 13 and then further declines until it reaches a low level found in adults, around the age of 17 years.

The activity of tartaric acid-inhibited acid phosphatase in serum is similar in all ages.

A disparity between acid phosphatase activity in the serum of mothers and their infants is described.
THE RELATION BETWEEN CELL STRUCTURE AND CELL FUNCTION
Authors: Lowe Charles U.
Published: December 2021

The Day is past when the cell can be considered a bag containing a nucleus and a host of enzymes swimming freely within the cytoplasm. It is now clear that the cell is a highly organized, carefully integrated and delicately controlled synthetic and catabolic organ with well defined particulate structures to which many specific functions may be assigned.

The nucleus contains two specialized structures, the genetic material or the chromosomes, and the nucleolus. The chromosomes are strands of desoxyribopolynucleotide (DNA) and histone-like proteins which are invisible as organized structures until mitosis is well established (Fig. 1). The DNA consists of double strands of polynucleotide with specific configuration wound in the form of a helix. The chromatin during mitosis can be visualized as multiple indented strips, which have sufficient individuality as to appear unique. Each chromosome strand is made up of many molecules; a locus on a chromosome with specific genetic potential has been termed a cystron, and a structurally related group of cystrons form a chromomere. The individual cystrons have not been clearly visualized but it seems reasonable to suppose that each represents a single molecule. Why particular genetic material is associated with specific chromosomes is not known.

The number of chromosomes appears to be characteristic of the species, and within a given organism all resting nuclei, except those of the germ cells, contain the same number of chromosomes and the same amount of DNA. Certain nuclei, for example a small number of hepatocytes, contain multiples of diploid DNA.

The lateral portion of each chromosome has in association with it a ribose polynucleotide (RNA or PNA), and that region is a site of rapid synthesis of this substance.
Intraspinal Tumors of Childhood
Authors: MATSON DONALD D.
Published: December 2021

This is a comprehensive monograph dealing with mass lesions of the spinal axis in childhood. Although the title reads "Intraspinal Tumors of Childhood," the authors have included their experience with 64 tumors and 8 non-tumors; the latter include vascular anomalies, herniated intervertebral disks, a dermal sinus and an extradural cyst. They state in their introduction that the latter are included because they gave symptoms closely simulating those of tumors of the spinal cord. Although this book is 560 pages in length, much of the text is taken up with detailed case histories, not only of the 72 patients in the author's series but also of many from the literature. The book is profusely and beautifully illustrated with clinical, roentgenographic, operative, and gross and microscopic pathological photographs.
Physiology of Prematurity
Authors: DANCIS JOSEPH
Published: December 2021

The Fifth Conference on Prematurity is reported in the manner already familiar to readers of publications of the Josiah Macy, Jr., Foundation. The editing succeeds again in maintaining clarity of expression without losing the feeling of spontaneity.

This conference is devoted to the premise that the best approach to the problem of prematurity is to eradicate it. Accordingly the stress is on factors leading to the termination of pregnancy with the inference that these may eventually be controlled. The major presentations are concerned with the effect of oxytocin on the activity of the pregnant uterus (Caldeyro-Barcia), the effect of progesterone on the isolated uterine muscle cell (Csapo), the role of the "incompetent cervix" in causing prematurity (Reid), and the relation of asymptomatic bacteriuria in the pregnant woman to prematurity and perinatal death (Kass).
ALLEGED ANAPHYLACTIC REACTIONS TO HUMAN GAMMA-GLOBULIN
Authors: Glaser Jerome , Wyss-Souffront William A.
Published: December 2021

In the case of reactions following the injection of therapeutic agents, the possibility must be considered that the reaction may have occurred as a result of the contamination of the medication by some extraneous allergenic material. It is highly advisable that the manufacturers of biological products for injection avoid the possibility of contamination of these products by silk, penicillin and possibly other substances that may act as powerful sensitizers and allergens. All individuals sensitive to penicillin should receive injections from syringes not previously used for the injection of penicillin. It would be even better to set aside syringes and needles to be used only for the injection of penicillin and to be sterilized separately; if the sterilizing is done by boiling, a separate sterilizer should be used for that purpose only. If a patient dies suddenly following an injection, and the cause of death appears to be allergic shock, or if it is not obvious, blood should be drawn (most easily done by cardiac puncture) as soon as possible and the serum preserved under refrigeration for possible future passive transfer and other tests, as recommended by Lund and Hunt.

There is no incontrovertible evidence that acute anaphylactic reactions have occurred in man due to the injection of human gamma-globulin per se. The possibility that this may occur, however, cannot be completely excluded. It is of the utmost importance if such reactions are suspected that every effort be made to discover the responsible allergen.
MICROMETHOD FOR DETERMINATION OF CONCENTRATION OF ANTIBIOTICS IN SERUM FOR APPLICATION IN CLINICAL PEDIATRICS
Authors: Fujii R. , Grossman M. , Ticknor W.
Published: December 2021

A micromethod is described for determination of concentration of antibiotics, utilizing agar diffusion, beta-hemolytic streptococci as the test organism, and blood hemolysis as an indicator. The method can be performed with 0.1 ml of serum and does not require rigorous sterile technique for the filling of capillary tubes or for the collection of blood. Duplicate determinations of 61 serum specimens were made, comparing the concentrations of erythromycin propionate lauryl sulfate obtained by the standard Rammelkamp twofold tube dilution method with those obtained by our micromethod. Only 1 of the 61 specimens analyzed showed more than one twofold dilution difference between the two methods. This micromethod appears to be suitable for the determination of actual concentrations of any antibiotic that is effective against beta-hemolytic streptococci, with only minor variations in the performance of the test. It might also be modified for antibiotics that are not effective against beta-hemolytic streptococci by using another test organism and, for example, a dye indicator.
Vulvitis
Authors: CHUSID EMANUEL
Published: December 2021

I have encountered in the past 2 or 3 months several young girls with a nonspecific vulvar irritation, manifested by pain, itching, burning and sometimes dysuria. In each of these children this was directly attributable to bathing in bubble bath or detergent—the symptoms disappearing upon the cessation of the use of these products. Matey, a well-advertised bubble bath for children in this area, seems to have been the most frequent irritating substance.
SWEAT CHLORIDE CONCENTRATION IN CHILDREN WITH ALLERGY AND WITH CYSTIC FIBROSIS OF THE PANCREAS
Authors: Andrews Billy F. , Bruton Ogden C. , Knoblock Edward C.
Published: December 2021

Sixty-six children were evaluated for chloride excretion in sweat obtained by iontophoretic inducing of sweating with pilocarpine. These children were divided into five groups: (1) children with cystic fibrosis, (2) siblings of patients with cystic fibrosis, (3) allergic children, (4) asthmatic children with emphysema, and (5) normal controls. Children with allergy were not found to have chloride values greater than values for normal controls. The values for 2 patients in the total allergic group of 38 did compare with values of siblings of patients with cystic fibrosis.
CONGENITAL HEMOLYTIC DISEASE RESULTING FROM A-O ISOIMMUNIZATION
Authors: MITCHELL NATHAN , MOSS ARMAND H. , REDNER BERNARD , LEVY HAROLD , GREENBLATT I. J.
Published: December 2021

Three instances of fatal hemolytic disease of the newborn have been observed in group A infants born of Rh positive mothers belonging to group O. Markedly elevated anti A agglutinins were demonstrated in the mother's serum following delivery of the child. (1:10,120 in Case 1, 1:5,000 in Case 2, and 1:6,000 in Case 3. All these titers fell within three weeks.) All infants were Rh positive and no Rh or Hr antibodies were found in the mothers' serum. Jaundice became apparent in all infants within 24 hours of birth. There was a moderate anemia, and varying numbers of nucleated red blood cells were found in the peripheral blood. One infant died on the third day of life, the second on the fifth, and the third on the sixth. In all cases the typical changes of hemolytic disease of the newborn were present at autopsy and in all extensive kernicterus of the basal ganglia, hippocampal nuclei, periventricular pontine nuclei, cerebellar dentate nuclei and medullary olives were found.

The finding of free circulating antibodies in the infant's blood obtained postmortem is of particular interest. These anti A agglutinins were active only in albumin-plasma dilutions. The retention of the agglutinating property of this antibody in both infant and mother even after addition with A and B blood group specific Witebsky substances indicate that it is probably an immune antibody.

It is believed that A-O isoimmunization has been proved in these three cases.
TRENDS IN HEALTH LEGISLATION AND ADMINISTRATION
Authors: WALL JOSEPH S.
Published: December 2021

IN THIS column in April, we reported that a new School Health Services Bill was being drafted in the Health Sub-Committee of the Senate Committee on Labor and Public Welfare. On March 25, this Bill came out of Committee and was introduced into the Senate by Senator Thomas (Democrat, Utah) as S. 1411. Sponsoring this Bill with Senator Thomas was the entire membership of the Health Sub-Committee, with the addition of Senator Saltonstall, who introduced the School Health Service Bill (S.1290) a year ago in the Eightieth Congress.

In the opinion of several of those who are close to the Washington scene, this School Health Services Bill is one of the health measures most apt to meet with favorable and early action in the current session of Congress. While the battle rages over a comprehensive health program, a health measure which is less contentious may be enacted. Following all the electioneering promises it would be surprising if this session of Congress were to close without some health legislation which can be held up as accomplishment. S. 1411 is scheduled for early action in the Senate; in the House there have been several additions to the roster of the sponsors of School Health Services legislation. Indeed, this Bill, with some modifications, may have been acted upon favorably in both Houses by the time this report is published. If enacted, the measure will have farreaching influence upon health services for children of school age, and therefore warrants close attention by pediatricians, general practitioners, health officers and others specially concerned in this area.
Who Will Advise Mothers?
Authors: TERRELL C. O.
Published: December 2021

Dr. John N. Kennell, in a Letter to the Editor, emphasized the findings of the study being conducted at Western Reserve on the emotional needs of mothers. He asks the question, "Who is going to give a mother the individualized quidance about child rearing that she wants? Do we pediatricians want to do this? Can we do this? All Pediatricians? A few pediatricians?"

These problems are not compartmented so that they can be taken in and out of pediatrics.
CONGENITAL MITRAL STENOSIS
Authors: Elliott Larry P. , Anderson Ray C. , Amplatz Kurt , Lillehei C. Walton , Edwards Jesse E.
Published: December 2021

The clinicopathologic findings were studied in four cases of congenital mitral stenosis, all occurring with associated malformations; these included coarctation of the aorta (two instances), ventricular septal defect (one case), and patent ductus arteriosus (one case). A high incidence of associated malformations of the aortic arch system was also common in cases reported in the literature. Our four cases of congenital mitral stenosis and most of the 57 cases reported in the literature presented a clinical profile which may lead the clinician to suspect congenital mitral stenosis, either alone or in association with an additional malformation These features include (1) a history of recurrent pulmonary problems suggesting pulmonary edema; (2) systolic or diastolic murmurs, occurring together or individually, heard loudest at the apex; and (3) electrocardiographic and roentgenologic evidence of enlargement of left atrium or left and right atria in combination, and hypertrophy of the right ventricle. (Left ventricular hypertrophy suggests an additional malformation.) The diagnosis can be strengthened further by (1) demonstration by cardiac catheterization of an elevated pulmonary arterial "wedge" pressure; (2) demonstration of a pressure gradient across the mitral valve; and (3) evidence obtained by selective angiocardiography of an obstructive lesion at the mitral valve. Leftsided cardiac catheterization is advisable to identify or exclude co-existing anomalies. A surgical potential exists for patients with congenital mitral stenosis.
MISCELLANEOUS REVIEW
Authors: CLEMENT DAVID H.
Published: December 2021

Some Practical Considerations of Economy and Efficiency in Infant Feeding. American Journal of Public Health, 52:125-142, 1962. (Reprinted for the U. S. Department of Health, Education, and Welfare; Children's Bureau.)

A Joint Committee of the Food and Nutrition Section and the Maternal and Child Health Section of the American Public Health Association has written this useful review. Compressed into its 17 pages is a great deal of pertinent information from man widely scattered sources and of special interest to physicians and nurses engaged in infant feeding practices among families where economy is important.

Infant feeding practices have been reviewed with special regard to cost, convenience, and safety. But there are many facts of interest to the private practitioner whose patients may be free of financial worry.

Impressive is the statement that in 1957 some 13,500,000 United States children were in families whose total income was less than $3,000 a year. In 1956, one of five dwelling units in small cities or rural areas had no running water inside the structure.

The cost of breast feeding in relation to bottle feeding depends upon the cost of the additional nutrients eaten by the mother. With a truly low-cost diet (which impressed this reviewer as so unpalatable as to be unrealistic the cost was calculated at 15ø a day, whereas with a moderate cost diet it was 40ø a day. An evaporated milk formula was estimated at 15ø a day and pasteurized whole milk at 25ø a day. The safety of breast milk was accepted as vastly superior to formulas.