bluuebunny/crossref_metadata_2025 huggingface dataset:
CLINICAL CONFERENCE
Authors: Smith Margaret H. D.
Published: December 2021

Dr. Margaret H. D. Smith: We have been using adrenal steroids in the treatment of tuberculosis in children. We have a relatively small number of cases, not enough to set up a controlled, randomized, case study. We decided a couple of years ago, when we embarked on this study, to treat consecutive cases for certain indications, and see where we got, hoping to find out in the first place whether steroids seemed to do good or whether they seemed to do harm; in the second place, if they did seem to do good, to try and find out what sort of treatment dosage, what treatment schedule, and so forth, might be indicated. We thought then that, if we actually ended up with some sort of positive experience and data, that perhaps we might, under other circumstances, be able to do a properly controlled study. Our observations on the use of steroids in the treatment of tuberculosis have really been patterned on the experience of various European investigators, who started us on our way.

I am not going to say very much about the use of steroids in tuberculous meningitis because that is an indication for the use of steroids which is fairly generally accepted. I think that the data which have been gathered in Italy, in South Africa, and in many other parts of the world, as well as in the few cases that we have had occasion to treat here, make one realize that steroids are a very valuable adjunct in the treatment of tuberculous meningitis.
DUODENAL-MOTILITY PATTERNS IN INFANTS AND CHILDREN
Authors: Barbero Giulio J. , Kim Ih Chin , Davis Jean
Published: December 2021

Intraluminal pressure in the duodenum has been recorded in infants and children utilizing a strain gauge transducer and an open tube method. This method was used in a group of 31 normal children, 11 children with cystic fibrosis of the pancreas and 6 with the celiac syndrome. All the waves of the duodenum could be divided into two main wave forms. The most frequent wave seen was of a duration of less than 8 seconds, classified as a type I wave. Such waves occurred in both rhythmic and non-rhythmic bursts with a consistent frequency of 12 waves/min. The non-rhythmic type I wave was the most common wave form observed in the duodenal motility of children. The second wave form, type III, consisted of an elevation of the base-line longer than 8 seconds in duration with superimposed type I waves and a frequency of 96.8 waves/hr. No significant difference was present in the three groups in both total wave activity and in the incidence of specific wave types.

Duodenal motility resulting from a milk feeding of 60 ml was studied in 16 normal children and 5 with cystic fibrosis of the pancreas. A significant response in total activity resulting from a rise in the number of non-rhythmic type I waves followed milk ingestion. Concurrent with the rise in total activity and non-rhythmic type I waves seen after ingestion of milk, there was a significant decline in the rhythmic type I wave bursts.

The response to 0.1 mg/kg dose of bethanichol chloride injected subcutaneously was observed in 10 normal children. A significant increase in total activity, manifested principally by a rise in the non-rhythmic type I waves, was demonstrated. At the same time there was a significant decrease in the incidence of type I rhythmic wave bursts and type III waves.

The duodenal motility of children had a higher incidence of type I rhythmic wave bursts and frequency of non-rhythmic waves than the duodenal motility reported previously in adults. Under the conditions of this experimental method there was a lower incidence of non-rhythmic type I waves and type III waves in children compared to the results reported in adults.
TREATMENT OF TUBERCULOUS PLEURAL EFFUSIONS WITH PARTICULAR REFERENCE TO ADRENAL CORTICOSTEROIDS
Authors: Smith Margaret H. D. , Matsaniotis Nicholas
Published: December 2021

On the basis of our own experience with tuberculous pleural effusions in children as well as on the more extensive experience of other clinicians working with adult patients, we believe that adrenal corticosteroids, given simultaneously with adequate antituberculous drug therapy, not only exert no deleterious effect on the underlying tuberculous infection, but frequently hasten clinical and roentgenographic improvement.

Six consecutive patients with tuberculous pleural effusions are here presented. Diagnosis was established with the aid of tuberculin test, cultures of gastric washings and pleural fluid, and pleural biopsy. Treatment included administration of INH, PAS and prednisone. The clinical and roentgenographic response was unusually prompt in the five patients with early effusions. On the basis of this experience we recommend the following treatment: INH (20 mg/kg/24 hr) for a period of at least a year, PAS (0.5 gm/kg/24 hr) for the same length of time; and prednisone (1.0 mg/kg/24 hr) for a period of about 4 to 6 weeks, with diminishing doses during the ensuing 2 weeks. The general care should be that given to any child with early active tuberculosis, including bed rest during the febrile period but rarely beyond it. If such treatment can be instituted early, the incidence of pleural adhesions, with ventilatory impairment and development of scoliosis, is probably lessened.

The sixth patient, who was suffering from fibrocaseous pleurisy at the time of admission to our hospital, recovered slowly; in this case adrenal corticosteroid therapy appeared to exert no effect on the course of the disease.
RENAL TUBERCULOSIS IN CHILDREN
Authors: Lattimer John K. , Boyes Truman
Published: December 2021

Genitourinary tuberculosis in children is not easily detected because symptoms are usually minimal, the erythrocyte sedimentation rate is not elevated and the number of leukocytes in the urine may be very few even when the renal destruction is far advanced. The disease is serious because it tends to invade and destroy both kidneys if untreated.

Nephrectomy alone failed to arrest the disease in two of six children with cavitary tuberculosis. Chemotherapy with three drugs arrested the disease in all of the five patients with cavitary lesions treated to date. The follow-up of the cases treated by chemotherapy is shorter than that of the nephrectomy cases.

Ten patients with noncavitary kidney tuberculosis have all had negative urine cultures since multiple-drug chemotherapy. Tuberculosis showed a tendency to lie dormant in the kidneys for long periods (up to 12 years) and then become active again.

Although this series is small and the follow-up is short, the results to date parallel those found in our larger experience with chemotherapy in adults with genitourinary tuberculosis. In general, as in adults, modern triple-drug chemotherapy appears to be about as effective, if not more effective, then nephrectomy, as treatment for this potentially bilateral disease.

As a consequence, at the authors' clinic, nephrectomies are currently being deferred indefinitely, due to the apparent success of chemotherapy. Whether chemotherapy will entirely replace excisional therapy for genitourinary tuberculosis is still problematical, but it has certainly greatly enhanced the outlook for patients with this once lethal disease.
ACIDIFICATION OF THE URINE BY INFANTS FED HUMAN MILK AND WHOLE COW'S MILK
Authors: Fomon Samuel J. , Harris Dorris M. , Jensen Robert L.
Published: December 2021

Acidification of the urine was studied with two groups of infants, each group consisting of four infants between 2 and 6 months of age: Group I received fresh or pasteurized human milk and Group II received whole cow's milk on evaporated milk and water without additional carbohydrate.

The mean titratable acidity of the urine of infants of Group I was 3 meq/m2/12 hr compared with 35 meq/m2/12 hr for infants of Group II. The rates of excretion of ammonia were 7 and 28 meq/m2/12 hr by infants of Group I and II, respectively. After administration of ammonium chloride (4 gm/m2/day) for 2 days, the titratable acidity increased to 6 meq/m2/12 hr in Group I and to 34 meq/m2/12 hr in Group II. The mean rates of excretion of ammonia increased to 21 and 36 meq/m2/12 hr, respectively.

The greater titratable acidity of the urine of infants of Group II is attributed primanly to the greater amounts of phosphate in the urine (mean, 35 mmol/m2/12 hr excreted by infants of Group II compared with 3 mmol/m2/12 hr by infants of Group I). The greater rate of excretion of ammonia by infants of Group II is attributed jointly to the prolonged administration of a diet with relatively great residue of anions and, perhaps, to the greater availability of glutamine and other precursors of ammonia.
EQUIPMENT FOR CATHETERIZATION OF FEMALE INFANTS
Authors: Storts B. P.
Published: December 2021

THE IMPORTANCE of examining the urine of infants, especially females, cannot be overemphasized. It is getting a fresh specimen that sometimes presents the problem. This is true for the pediatrician making a home call and sometimes in office work. The apparatus to be described offers a sort of one-man catheter set that can be used in the home or office. Figure 1 shows that the apparatus can be carried in a medical bag; the 4-ounce, wide-neck bottle makes a small package. The equipment consists of a 4-ounce, wide-neck, Americantype bottle; a two-hole rubber stopper; two pieces of glass rod and a No. 8 soft rubber catheter. The apparatus is assembled, wrapped in a towel and autoclaved. Several of these sets can be kept ready.

It is not often necessary to catheterize male infants. The catherization of female infants can be done in the home with the mother as the only assistant. The vaginal area is cleansed with soap, preferably Phisoderm®. The apparatus does not allow for the escape of the first few drops of urine before collecting; our experience has led us to believe that this is not necessary, if proper cleansing and inspection has been done.

It is well to remember that the urethra of the female infant baby is "C" shaped. The meatus represents the bottom end of the "C." The catheter should be started downward. The thighs should be widely abducted but held fully extended, not flexed on the abdomen. This position will not angulate the "C" curve of the urethra. The specimen is collected in the stoppered bottle which does not require holding. This allows free use of both hands. The specimen is collected in a closed apparatus and offers a fresh specimen for study and culture.
CONSANGUINITY AND THE ETIOLOGY OF CONGENITAL MALFORMATIONS
Authors: Schull William J.
Published: December 2021

Data with reference to the occurrence of major congenital defects among 4,845 children born to related parents residing in Hiroshima, Kure, or Nagasaki, Japan, in the years 1948 to 1954 are presented. It is shown that the frequency of malformed infants varies in relation to the degree of inbreeding in a manner such as to suggest genetic factors in the etiology of some of the reported abnormalities. Elimination of those infants with disorders generally accepted to be hereditary does not obliterate this effect of parental relationship on the frequency of major defect. When one attempts to relate specific malformations to parental consanguinity, one finds that the observed increase in number of malformed infants is not assignable to any one or several uncomplicated malformations but rather appears to be due to an increase in the frequency of children with multiple major defects.
EXCHANGEABLE POTASSIUM IN NORMAL FULL-TERM NEWBORN INFANTS
Authors: Christian Joseph R. , Talso Peter J.
Published: December 2021

Exchangeable potassium was measured in 25 living full-term newborn infants. The range of values was 28.6 to 42.3 meq/kg with a mean value of 35.5 meq/kg.
STUDIES IN FEBRILE SEIZURES
Authors: Millichap J. Gordon
Published: December 2021

In mice, rats, guinea pigs and kittens and in 51 children with recurrent febrile seizures, the height of the body temperature was the important determinant in the induction or occurrence of seizures with hyperthermia. Both clinically and in animal studies, the body temperature at the onset of the convulsion may be used as a measure of the threshold to febrile seizures.

The pattern of the experimental febrile seizure was principally clonic in type. It varied with the height of the temperature and with the age and maturity of the animal. Also, the febrile seizure threshold varied with age and maturity. It was independent of the basal temperature of the body. In rats, the threshold was lowest at 3 to 8 days and highest in the adult animal; a small but significant elevation in threshold was observed at birth. In the newborn guinea pig, the threshold convulsive temperature was equal to that of the 20-day-old rat.

The rapidity of rise in body temperature was not a predisposing factor. In animals which convulsed, the susceptibility to febrile seizures was independent of the rate of temperature rise and the severity of the pyrogenic stimulus.

A measure of the febrile seizure threshold as demonstrated in this study has been found of value in studies of the mechanism and prevention of seizures with hyperthermia. Its clinical importance is discussed.
TREATMENT OF DISSEMINATED INFANTILE HISTOPLASMOSIS WITH AMPHOTERICIN B
Authors: Little Joseph , Bruce James , Andrews Harry , Crawford Kenneth , McKinley George
Published: December 2021

Four cases with disseminated histoplasmosis are reported; three were in children under 12 months of age.

All responded gratifyingly to amphotericin B therapy given intravenously.

The value of Heiner's agar-gel technique for histoplasmin precipitin as a diagnostic tool was substantiated.

Further therapeutic trial of amphotericin B in disseminated infantile histoplasmosis seems warranted.
EOSINOPHILS IN THE THYMUS IN HYALINE MEMBRANE DISEASE (RESPIRATORY DISTRESS SYNDROME)
Authors: Black Maurice M. , Baldi Aldo G.
Published: December 2021

An examination was made of the prominence of perivascular aggregates of eosinophilic leukocytes in thymic septa of cases of respiratory distress syndrome (hyaline membrane disease). Similar examinations were also made in cases of stillbirth and perinatal death unassociated with hyaline membrane disease. Moderate or marked thymic eosinophilia was found in more than 70% of 27 cases of hyaline membrane disease. This degree of eosinophilia was encountered in less than 10% of the control group.

Numerous eosinophils were also found in the axillary lymph nodes of four of eight cases of hyaline membrane disease, but in only 2 of 20 control cases.

The data are considered in terms of their relationship to adrenocorticoid levels in the fetus and the pathogenesis of hyaline membrane disease.
OBSERVATIONS ON GROWTH OF FINGERNAILS IN HEALTH AND DISEASE
Authors: Sibinga Maarten S.
Published: December 2021

Using a modification of the Babcock photographic technique, it has been possible to make measurements of the day to day growth of the fingernail in human subjects.

There are marked individual variations in the rate of growth at all ages, but for the same individual and the same nail the rate of growth is relatively constant and can be used to study the effect of various physiologic and pathologic disturbances.

Preliminary observations indicate that nail growth is unfavorably affected in certain disease states, notably measles and nephrosis. Malnutrition and certain dietary restriction were not found to affect this parameter appreciably. Growth of the nails was followed for 10 days after death and was found to be measurable, the rate exceeding that noted during a severe attack of measles.
PROCEEDINGS
Authors: Barclay William R.
Published: December 2021

THE PURPOSE of this presentation is to review very briefly some of the history of the controversial BCG vaccine. This is a living, attenuated, bovine strain of tubercle bacilli. This strain was first isolated in Paris as a very virulent organism for animals, and it was attenuated by serial passage in artificial media for a period of 13 years.

By 1921, Calmette and Guérin were satisfied in their own minds that they had produced an attenuated bacillus, but they delayed the announcement and the distribution of cultures to other laboratories until about 1924. From 1921 to 1928, large numbers of experiments were conducted to try and revert this attenuated bacillus to its original virulent characteristic. All experimental attempts in this direction failed.

In 1930 the vaccine received a setback from which it has never fully recovered, when 240 children received it as an orally administered vaccine at Lubec and 72 of them died. 2 A full-scale investigation subsequently revealed that the BCG strain was not the cause of the disaster. A contaminating strain of bacilli in the culture administered was positively identified by growth and color-producing characteristics.

I think it is improper to speak of "a BCG vaccine." Just as the original vaccine was able to mutate from a fully virulent strain of organisms to an attenuated form, mutations continue to go on producing relative degrees of infectivity or invasiveness. There is no such thing as absolute virulence and absolute avirulence. Rather, there is a continuous spectrum of invasiveness which an organism may exhibit, and an organism may change its characteristics of invasiveness from one culture to another.

Therefore, one may read in the literature that a BCG vaccine given in Scandinavia has produced a certain amount of immunity and a certain amount of hypersensitivity, but one cannot expect to exactly reduplicate the same result here; because you just cannot get the same Scandinavian vaccine here and reduplicate that experience. In this country there are several sources of BCG vaccine that a laboratory may acquire or a physician may use.
RADIOLOGIC AID IN REGIONAL AND GENERALIZED EMPHYSEMA OF THE LUNGS IN INFANTS
Authors: Liebner Edwin J.
Published: December 2021

Normally, the bronchi dilate rapidly in inspiration and contract slowly in expiration, thus effecting a form of check-valve mechanism. Intra-and extra-bronchial occlusion, pulmonary infection, developmental bronchopulmonary malformations and pleural communications are pathologic processes which can disturb the check-valve mechanism and produce increased aeration. [See Figure in Source Pdf.]

The main bronchus and artery may be obstructed separately, or as a unit. Angiocardiograms should be analyzed for abnormal patterns, especially obstruction or atresia. A lack of vascular markings in the lungs can suggest pseudo-increased aeration.

On a regional basis, roentgenographic study of the vascular and air patterns can lead to recognition of certain entities. An angiogram in congenital lobar emphysema contrasts the vascular pattern in the involved and the remaining normal and unaffected lobes with pneumatocele, cystic disease, and atelectasis.

Reasons for support of the deficient-cartilage theory as a cause of lobar emphysema are cited, with emphasis on the localization of the emphysema to the anterior or upper lobes.

Bronchiolitis can give total compensatory emphysema, and the reasons given will help to understand the roentgenographic findings. Regional compensatory emphysema of the remaining lung, after total or partial collapse of a lobe by intrinsic or extrinsic factors, is illustrated. Basal pneumothorax is indicated to be a significant postoperative complication.

Although at times great similarity may exist in the appearance of plain films in conditions producing increased aeration of infants' lungs, it is hoped that this review will stimulate deeper analyses and wider recognition of the fundamentals.
THE "FONTANOMETER"
Authors: Davidoff Leo M. , Chamlin Max
Published: December 2021

The "fontanometer" is presented as an adaptation of the Schiotz tonometer to be used for estimating the relative state of intracranial pressure in the young infant. Its standardization and more exact value will be better understood only after a much larger series of eases has been studied, and comparisons are made with direct, simultaneous measurement of intraventricular pressures with a manometer. In the meantime, despite the fact that definite quantitative values cannot be ascribed to the readings at present, the instrument is offered as a simple clinical method of estimating intracranial pressure in the infant without resorting to ventricular on spinal puncture.
PUBLIC HEALTH
Authors: Fleck Andrew C. , Klein Jerome O.
Published: December 2021

On the basis of present knowledge, the various sources and accompanying pathways by which effective contacts between susceptible infants and the staphylococcus take place in the nursery outbreaks are as follows: 1) Direct contact with infective lesions; 2) direct and indirect contact spread from the asymptomatic infant carrier to the susceptible infant within the nursery, particularly under conditions of overcrowding and poor nursery technique.

Personnel carriers, fomites and air-borne droplet nuclei and dust, as sources of outbreaks, do not command a body of convincing epidemiologic evidence at this time.

The epidemiologic investigation of nursery-acquired disease requires that each infant at risk be followed for a minimum of 15 days. The most probable source and route of transmission of the causative organism can be identified. Control efforts should be based on the epidemiologic diagnosis.
PEDIATRICS AND SOCIETY
Authors: Gardner Lytt I.
Published: December 2021

THIS is a progress report to the readers of Pediatrics on the status of Senator Lister Hill's "Health for Peace" bill (Senate Joint Resolution 41). This measure, which would have set up an international institute of medical research, passed the Senate May 20, 1959 with flying colors but finally was snagged in a House subcommittee through the summer of 1959.

The legislation received resounding approval by the Senate, with a vote of 63 to 17. The bill proposed to organize an Institute of International Medical Research within the framework of the National Institutes of Health. A $50,000,000 annual appropriation was planned. Evidence of widespread public support for the measure was observed in the statements of authorities who spoke at the Senate hearings concerning the bill. It is of interest that no one appeared to testify against S.J. Res. 41 during the 6 days of hearings.

At lease two persons participating in the hearings were members of the American Academy of Pediatrics: Dr. Martha M. Eliot, Head, Department of Maternal and Child Health, Harvard School of Public Health and Dr. Sidney Farber (Honorary Associate Member), Professor of Pathology, Harvard Medical School.

Many witnesses pointed out the importance of providing support for the research activities and the training of promising scholars in other lands. On this subject, Dr. Farber had this to say:

In many countries, such as Italy, the amount of research support available is so small that men of great skill and intellect are compelled to carry on only token research concerning problems which are selected because they do not require manpower, equipment, or modern research facilities.
THE BLOOD PRESSURE OF NEWBORN INFANTS: INDIRECT DETERMINATION BY AN AUTOMATIC BLOOD PRESSURE RECORDER IN 20 INFANTS
Authors: Morse Robert L. , Brownell Gordon L. , Currens James H.
Published: December 2021

Systolic and diastolic blood pressures have been determined in 20 infants by the use of an automatic blood pressure-recording machine. The mean systolic blood pressure was 7.1 cm Hg (range 5.8 to 9.5). The mean diastolic blood pressure was 5.2 cm Hg (range 4.2 to 6.4).
MAPLE SYRUP URINE DISEASE: BRANCHED-CHAIN KETO-ACIDURIA
Authors: Dancis Joseph , Levitz Mortimer , Westall Roland G.
Published: December 2021

A case of maple syrup urine disease is presented. The patient lived for 20 months, the longest survival so far reported.

There were increased amounts of leucine, isoleucine and valine in plasma and urine, indicating a block in the metabolic degradation of these amino acids.

There was an accumulation in the urine of the respective keto acids, but not of the aldehydes or of the simple acids. This locates the block at a step common to all three amino acids, that of oxidative-decarboxylation.

The alpha-hydroxy-acid derivatives of these amino acids are probably present, but the evidence is still incomplete.

Animal experiments indicate that oxidative decarboxylation of the branched-chain amino acids is a metabolic step which is found generally in tissues, including leukocytes but probably not erythrocytes.
Immunity and Virus Infection
Authors: PLOTKIN STANLEY A.
Published: December 2021

This volume is a collection of papers given at a symposium on immunity and virus infection held in May, 1958 by the Vanderbilt University School of Medicine on the occasion of a visit by Sin MacFarlane Burnet.

The book opens with a thought-provoking discussion by Burnet of three theories of antibody production: the direct template theory of Haurowitz and Pauling; the indirect template theory of Burnet and Fenner; and the clonal selection theory of Jerne as modified by Burnet. The direct template theory states that antibody is formed by moulding against antigen; the continued production of antibody, therefore, depends on the persistence of the antigen.
THE REDUCTION OF INTUSSUSCEPTION BY HYDROSTATIC PRESSURE
Authors: SANTULLI THOMAS V.
Published: December 2021

THE ARTICLE by Robins and Plenk which appears in this issue of Pediatrics is representative of the experience on the operative and non-operative forms of treatment of intussusception in childhood which is being reported by many others. Although the series is too small to draw any valid conclusions, the authors have attempted to show that reduction by barium enema will save about a half of these patients a surgical procedure, and they have called our attention to the advantages and disadvantages of hydrostatic reduction.

The treatment is still controversial and there is uncertainty regarding the proper role, if any, of hydrostatic reduction of intussusception. Some of the proponents of the surgical treatment still maintain that operation is the only form of treatment for all cases of ileocolic intussusception, while other authors are equally adamant in the use of hydrostatic pressure as the primary method of reduction.
THE INFLUENCE OF SODIUM GLUCURONATE ON HYPERBILIRUBINEMIA OF THE NEWBORN—FURTHER OBSERVATIONS
Authors: Schwob Marianne , Perry Ralph , Boyer Audrey , Holt L. Emmett , Hallman Niilo , Backman Alf , Hjelt Lars
Published: December 2021

A blind control study of intravenous administration of sodium glucuronate solution has been carried out in hyperbilirubinemia of the newborn, using glucose and saline solution as the control. The results with both solutions were virtually identical. In a substantial proportion of the cases a conspicuous decrease in bilirubin in the serum was obtained. In other cases little or no effect was seen. The most likely explanation of the results is that expansion of the extracellular space occurred, a result that may be more frequent when there has been an unusually great loss of weight after birth. It thus appears that sodium glucuronate solution has nothing specific to offer in treatment of hyperbilirubinemia of the newborn.
Incidence of Retrolental Fibroplasia
Authors: ZACHARIAS LEONA
Published: December 2021

With the marked drop of incidence rate of retrolental fibroplasia, interest in this disorder has virtually disappeared. Except for the reports of certain state agencies for the blind, almost no data on incidence of retrolental fibroplasia are being published and probably very few are being collected. Our research group at the Massachusetts Eye and Ear Infirmary, however, has been working since 1954 on a 5-year follow-up study of mild and severe retrolental fibroplasia at the Boston Lying-in Hospital and has, as part of that study, followed the changes in incidence during the period when restrictions on the use of supplementary oxygen were being introduced into premature-infant care.
CYCLIC VOMITING
Authors: BARBERO GIULIO J.
Published: December 2021

RECURRENT vomiting in children has always been a difficult problem for diagnosis and treatment. The syndrome termed "cyclic vomiting", defined by Gee in 1882 as recurrent bouts of unexplained vomiting in children, has lacked careful documentation of clinical course and eventual prognosis. The report by Hoyt and Stickler on cyclic vomiting in this issue of Pediatrics presents a long-needed retrospective follow-up of patients previously labeled with this term.

It is encouraging to learn that this syndrome usually terminates by puberty. It is also helpful to obtain specific information concerning the incidence of migraine and headaches in these children, since a prevailing impression among many clinicians has been of the very high frequency of migraine in the families of such children and of the eventual development of migraine in the later life of these children.
COMPARISON OF THE IN-VITRO METABOLISM OF TETRAHYDROCORTISONE IN THE LIVER OF THE FETAL, NEWBORN, PREGNANT AND NON-PREGNANT ADULT RAT
Authors: Greenberg Robert E. , Gardner Lytt I.
Published: December 2021

In the study of corticosteroid metabolism means must be utilized to separate the initial sequential process of reduction of the A ring of the phenanthrene nucleus from the subsequent conjugation mechanism at the 3-hydroxyl position. Utilizing the in-vitro system described by Brown et al., the metabolism of tetrahydrocortisone by liver slices from adult female, pregnant, post-partum fetal and newborn rats was studied.

Liver slices from premature and newborn rats exhibited an intact although quantitatively reduced ability to metabolize tetrahydrocortisone, when compared to the normal adult rat. Liver slices from pregnant and post-partum rats similarly metabolized less tetrahydrocortisone, suggesting that similar factors might be affecting the conjugating mechanism in all four groups.

It is probable that incomplete development of enzymatic mechanisms in the young animal might be anticipated to be more pronounced and significant in terms of the highly specific enzymes and hydrogen donors involved in the initial reduction of the A ring of the steroid nucleus.
IMMUNOLOGIC RESPONSES OF PREMATURE AND FULL-TERM INFANTS TO INFECTION WITH CERTAIN VIRUSES
Authors: Eichenwald Heinz F. , Kotsevalov Olga
Published: December 2021

Observations are reported on a number of newborn and premature infants naturally infected with adenovirus types 1, 2, and 3, and ECHO virus types 9, 18, and 20 during their first few weeks of life.

Serial serologic studies revealed that these babies generally responded promptly with antibody formation and that this was independent of age and birth weight, but did vary with the particular type of virus involved. The presence of homologous passively acquired antibody did not appear to interfere with the formation of active immune bodies. However, the response to the various viruses differed sufficiently that it was not possible to arrive at general conclusions on the basis of information derived from any single agent.
PRIMARY HYPEROXALURIA
Authors: Shepard Thomas H. , Krebs Edwin G. , Lee Lou-sein W. , Johnson Mary Louise
Published: December 2021

Dietary and metabolic studies carried out on a patient with primary hyperoxaluria are reported. There was no appreciable change in the urinary excretion of oxalate when he was given a diet low in oxalate, or ascorbic acid, magnesium or riboflavin. A diet high in protein and low in carbohydrate was associated with increased excretion of oxalate, whereas increased catabolism of protein induced by cortisone and the postoperative state did not appreciably change the urinary excretion of oxalate.

Evidence that the source of increased accumulation of oxalate might be related to the glycine-glyoxylate-oxalate pathway is the observation that the increased urinary excretion of oxalate in the mother was slightly depressed by the administration of sodium benzoate. Glycine (10 gm) did not cause an appreciable increase in oxalate in the urine but may have been associated with formation of bladder stones in the patient.

The ratio of oxalate to nitrogen in the urine remained relatively constant during wide fluctuations in excretion of nitrogen.
CHANGING CONCEPTS IN OTOLARYNGOLOGY FOR THE PEDIATRICIAN
Authors: Ferguson Charles F.
Published: December 2021

DURING the past two decades since the advent of chemotherapeutic and antibiotic drugs, the field of otolaryngology has undergone tremendous changes. This is true not only of the specialty as a whole, but also particularly of that portion in which the pediatrician is primarily concerned. It behooves him, as well as the otolaryngologist, to become increasingly aware of formerly hopeless congenital anomalies now amenable to treatment. In addition he must still maintain a high diagnostic acumen and not allow it to become dulled by the promiscuous use of the newest medications for every minor symptom. Too often there is the temptation today to over-treat a simple illness, only to find that a new complication has arisen, which may prove of more concern than the original, self-limited condition. Although it should be axiomatic even today, it must again be emphasized that accurate diagnosis should always precede therapy.

The average present-day physician, whatever his field of endeavor, unfortunately is becoming increasingly strong on therapy, and too often weak in diagnosis. The constant barrage of beautifully colored propaganda from highly competitive drug houses does not help to relieve this growing imbalance, and constantly tempts him to give every medication an early trial before a careful diagnosis can be established. The effect of such a situation, particularly in the field of otolaryngology, cannot be denied.

According to Hansel whose contributions to our understanding of obscure conditions of the nose and throat are monumental, the three most important problems in otolaryngology today are allergy, infection and immunity.
Letters to the Editor
Authors: LAMBDIN MORRIS A.
Published: December 2021

My reaction to the remarks of Dr. St. Geme, which concern the "gray syndrome," was one of agreement. I was pleased that the problem had been so clearly outlined and could again be brought to the attention of all concerned with care of the newborn infant. We here have not observed all of the symptoms and signs as outlined by Dr. St. Geme, which have been variously quoted to be the result of excessive amounts of chloramphenicol.
POST-SPLENECTOMY INFECTION IN INFANTS AND CHILDREN
Authors: Robinson Tom W. , Sturgeon Phillip
Published: December 2021

Fatal or life-threatening infection occurred in 13 members of a post-splenectomy population of 110 individuals followed for a median period of 6 years. Division of the population into two groups, one group predisposed to infection by the basic disease and/or the treatment which led to splenectomy and another non-predisposed group, revealed a distinct difference in the hazard.

The non-predisposed group of 63 individuals had only one severe infection; this experience does not suggest risk of a very high order.

Our Experience combined with that of others reporting cases in this category, provides a total splenectomy population of 205 with but two severe infections. It is evident that splenectomy carries a very low risk of post-operative infection when done over the age of 6 months for the generally accepted indications of splenic rupture, congenital spherocytic anemia, and idiopathic thrombocytopenic purpura.

In the 47 individuals in this study predisposed to infection by their underlying disease, the incidence of severe post-operative infection was approximately 25%. No relation to age at time of splenectomy was evident. Ten of the 12 infections occurred within 12 years of operation. No attempt has been made to assess how great an increase, if any, this represents over a non-splenectomized control population similarly predisposed to infection.

Our Experience, in addition to that of others, in the group predisposed to infection by their underlying disease, makes a total splenectomy population of 85; 23 (27%) of this group suffered severe post-operative infections.
INFANTILE AMAUROTIC FAMILY IDIOCY
Authors: Aronson Stanley M. , Valsamis Marius P. , Volk Bruno W.
Published: December 2021

The clinical, biochemical and pathologic findings regarding two Negro infants with infantile amaurotic family idiocy have been

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PNEUMOPERITONEUM IN PREPARATION FOR CORRECTION OF A LARGE ABDOMINAL HERNIA IN AN INFANT
Authors: Pines Bernard
Published: December 2021

The preoperative use of artificial pneumoperitoneum was found to be a valuable aid in the possible solution to the problem of definitive operative closure of massive ventral abdominal hernia in the young patient. The method of its use in a 22-month-old child is described in detail.

The rationale for the use of this procedure is discussed generally.
RELIABILITY OF BILIRUBIN DETERMINATIONS IN ICTERUS OF THE NEWBORN INFANT
Authors: Mather Alan
Published: December 2021

In view of the increasing necessity for close collaboration between the clinical laboratory and the pediatrician who is faced with multiplying problems in management of diseases of the newborn, it may not be amiss for a clinical chemist to point out some of the limitations to the assistance he is called upon to render in chemical evaluation of jaundice.

Granting that symptomatic battles against increasing levels of bilirubin in the serum constitute the clinical objective in these cases, there appears to be a growing sensitivity of the pediatrician in his reaction to smaller and smaller changes between consecutive bilirubin assays.
GENETIC CONTROL OF CELLULAR BIOCHEMISTRY
Authors: Bonner David M.
Published: December 2021

The Present Paper deals with the cell, but we should not forget that the problems of the cell are at the same time the problems of the whole organism. I would like to consider briefly the gene and the cell, i.e., the relationship of genetic material to metabolism. I would like to consider this problem not only in terms of the cell, but in terms of man as well, since the field of biological research is not a field solely of academic interest. The problems of gene action and of the genetic control of metabolism are fields which are rapidly developing as fields of major importance to medicine, and, in fact, the impact of genetics may be perhaps felt most keenly in the years ahead in the field of pediatrics.

In discussing the genetic control of cellular metabolism, one might first ask: What is meant when we speak of the genetics of a cell or of man? Basically, we are concerned with the nature and action of the material which is transmitted from cell to cell or from organism to organism, and which determines the traits of the succeeding generation. It has been clearly shown that the genetic material of the cell resides in its chromosomes, and that chemically, it is a polydeoxyribonucleotide, designated DNA for short.1,2

What makes one think that genetic material controls cellular metabolism? In recent years, the cytology of human cells has enjoyed a great resurgence of interest. It is now possible to grow human cells in tissue culture, and by this means human chromo somes can be studied with great care and precision.
UNCLASSIFIED MYCOBACTERIA
Authors: Blatman Saul , Middlebrook Gardner
Published: December 2021

The importance of the "Unclassified Mycobacteria" as agents of human disease is becoming increasingly evident.1 Those who have previously considered many strains of Mycobacteria to be nonpathogenic are now investigating their role in cervical adenitis, in pulmonary disease resembling tuberculosis, and as the etiologic agents in certain types of skin granulomata. In pediatrics the problem of cervical adenitis has been a particularly difficult one, and perhaps some of the perplexities of "tuberculous adenitis" can now be solved.2-4

Some investigators chose to label this group of acid-fast organisms as the "Atypical Mycobacteria"; Middlebrook and his coworkers use the term "Unclassified Mycobacteria," because as Mycobacteria they are not atypical; they are simply as yet poorly studied and unclassified.
PEDIATRICS IN THE REPUBLIC OF KOREA
Authors: Berglund Eldon B.
Published: December 2021

In The spring of 1959, Dr. John Anderson, Professor of Pediatrics at the University of Minnesota, asked me to go to Korea as adviser in pediatrics to Seoul National University. The University of Minnesota has a contract with the United States Operations Mission (USOM) to help rehabilitate Seoul National University in the schools of Agriculture, Public Administration, Engineering and Medicine. This contract has been in effect since 1954, has involved the spending of several millions of dollars, the sending of medical advisers from Minnesota to Seoul and of medical participants, as they are called, from Seoul National University (SNU) to the University of Minnesota.
PYURIA IN INFANCY OFTEN INDICATES A MALIGNANT PROCESS
Authors: MARSHALL VICTOR F.
Published: December 2021

IF PYURIA in infancy is directly related to a high incidence of continuing renal hazards, an increasing rate of disability and a tendency to a shortened life, it can be considered often as a sign of malignancy. Follow-up studies of many if not most patients who had pyuria in infancy and childhood demonstrate all too well these malignant features.

Pyuria is not a disease entity. Pyelitis and cystitis are essentially descriptive diagnoses and accordingly lead to empiricism in therapy. However, descriptive diagnoses and empiricism in therapy have been important early steps out of the morass of uncertainty. Refinements in description, multiplication of facts gleaned from investigation, and therapeutic results tend to identify cause.
THE ADRENAL GLAND IN THE HUMAN FETUS
Authors: Lanman Jonathan T.
Published: December 2021

The work of recent years has clarified the function of the human fetal adrenal gland to a point where a reasonable explanation of its several peculiarities appears possible. We believe that the fetal adrenal is a steroidogenic organ with a high biogenetic capacity. Its steroid products are qualitatively similar to those of the adult gland, but certain quantitative differences may be present. There is indirect evidence that relatively little aldosterone is produced or required by the fetus. The placenta serves to regulate electrolyte homeostasis in the mammalian fetus.

We believe that the primary adrenotropin stimulating the fetal adrenal is ACTH from the fetal pituitary and that the enlargement of the fetal adrenal reflects the intensity of the stimulus. Since there is some evidence that in the fetus, as in the adult, adrenal steroids control a feed-back mechanism operating between the pituitary and adrenal, we believe that strong ACTH stimulation reflects an increased fetal demand for corticosteroidogenesis. This increased demand could be secondary to either defective production of steroids by the fetal adrenal or increased metabolism of steroids by the fetus. A likely, though unproved, mechanism is destruction of corticosteroids in the placenta. We believe that species differences in fetal adrenal size, and the atrophic adrenals in human anencephalic monsters, reflect variations in the intensity of fetal pituitary ACTH stimulation, and that the poorly differentiated glomerular zone common to all mammals reflects the lack of stimulation by the tropic hormone for aldosterone. There is at present no evidence that the apparently active human fetal adrenal gland plays a critical role in normal fetal development.

We have attempted to indicate those numerous areas where appropriate data with which to test our interpretation of fetal adrenal physiology are not presently available. It would be surprising if our concept survives these tests entirely unmodified. We hope, however, that this interpretation may indicate profitable areas for further work, and that it is sufficiently well founded on observation and experimentation that its basic concepts will prove to be reliable.
PRESIDENT'S MESSAGE
Authors: Wheatley George M.
Published: December 2021

ONE OF THE IMPORTANT AREAS of child health which pediatrics has tended to overlook is the medical care of the adolescent. Here is a group of the population in the age group 15-19 numbering in the United States 12,847,000 as of July 1, 1959 exclusive of the Armed Forces, and in Canada 1,375,700 as of June 1, 1960. Except for a few outstanding school health services and adolescent clinics, their health needs have received relatively little study by any medical group.

This is not a new thought. I can recall hearing the care of the adolescent discussed at Academy meetings for many years, usually in the corridors. At some luncheon, probably the School Health Committee's, perhaps 15 years ago, a resolution was passed which declared the pediatrician's responsibility for child health extended to about age 20. Periodically pediatric authorities have called attention to the need to work with this age group. The latest mention of this is in the Presidential address of Dr. Samuel Levine of the American Pediatric Society, who called for "a special effort to understand the puzzling problems and potential of adolescents."

Several years ago at the request of the Executive Board, I tried to discover the attitude of pediatricians toward the care of the adolescent. It was not a scientific study, but correspondence with perhaps 50 wellknown practitioners and teachers. The replies were on the whole enthusiastic, and recommended Academy action to give more recognition to this age group in our program. They gave suggestions and descriptions of ways in which individual physicians were serving this age group.
PROCEEDINGS
Authors: Belford William W.
Published: December 2021

AFTER SOME 30 years a member of the Academy and 6 years on the Executive Board, I come to this occasion very much aware of the great honor given me. Those before me have given us their concepts and philosophy of pediatrics and of the American Academy of Pediatrics, and what it has done. I am very humble in my comments about things as they appear to me.

In the lives of all of us there is always something to be done—unfinished business. There is unfinished business for the American Academy of Pediatrics too. The last 10 years seem to have increased the number of factors and items of this unfinished business. There is so much to be done for the welfare of children! It is encouraging, though sometimes confusing, that so many groups are interested in the welfare of children besides pediatricians.

It is good that the Fellows of the Academy takes part in the activities of these other organizations, for many of these lack pediatric guidance. The Academy's official liaison representatives to these groups are appreciated and we give them our thanks for their unselfish and outstanding efforts. It is evident that this phase of the work in child care will increase, and pediatricians must have an increasing role in the work of these organizations which are interested in various aspects of child health and welfare. The National Council of Organizations for Children and Youth now numbers 596 organizations as members.

The recent White House Conference on Children and Youth was a huge affair! It was quite evident that there was a vast amount of knowledge unusued though known to one group but not realized or suspected to be available by others.