bluuebunny/crossref_metadata_2025 huggingface dataset:
THE ROLE OF OXYGEN IN RETROLENTAL FIBROPLASIA
Authors: Patz Arnall
Published: December 2021

The results of a controlled nursery study, supported by observations of others in both uncontrolled and controlled studies, clearly established the overuse of oxygen in the premature nursery as an important and probably the principal factor in the development of retrolental fibroplasia.

The clinical data is supported by observations in the newborn or young mouse, rat, kitten, and puppy where retinal lesions, identical to those seen in early human retrolental fibroplasia are produced following exposure to an enriched oxygen environment.

Fundamental to all these experiments, and apparently to the pathogenesis of human retrolental fibroplasia, is the uniform ocular susceptibility to oxygen when the retinas are immaturely vascularized, and a resistance to oxygen damage where vascularization is complete.

The animal lesions produced by oxygen are proportional to the concentration of oxygen administered and the duration of exposure, and inversely proportional to the degree of vascularization of the retina. Duration of exposure to oxygen proved to be the most important single factor in these experiments.

The ocular effects of oxygen on the immature retina can be divided into a primary phase of vasoconstriction and obliteration and a secondary phase of vascular proliferation.

These clinical and experimental data justify recommendations for a rigid supervision of oxygen administration to the premature infant to avoid any unnecessary overuse of this potentially toxic agent.
Epileptic Seizures
Authors: DAVIDSON DOUGLAS T.
Published: December 2021

Where can a physician, a social worker, psychologist, or educator find a single not-too-technical book about epilepsy? This 165-page effort fills the bill. Seventeen qualified contributors including Wilder Penfield cover the subject from historical, diagnostic, therapeutic, psychologic, educational and employment asaspects. In this respect the work is unique for a book of its size. Up-to-date bibliographies accompany many of the presentations.

If the pediatrician hooks in vain for a statement as to the relative numbers of patients who require surgical as opposed to medical treatment, or for a discussion of febrile convulsions or genetic considerations, if he suspects that the book's pediatric contributions are lighter than he would like, he will probably forgive these shortcomings because of its many excellent features.
DYSMENORRHEA IN ADOLESCENCE
Authors: Heald Felix P. , Masland Robert P. , Sturgis Somers H. , Gallagher J. Roswell
Published: December 2021

Primary dysmenorrhea is common in adolescence; dysmenorrhea secondary to a cyst or inflammation or other organic pathologic process is rare. During adolescence many girls find it difficult to assume, either physiologically or psychologically, the new demands which the process of maturing into an adult female has put upon them. It is therefore necessary to understand the endocrine and reproductive systems of this age group and also their worries and conflicts. It is important to know that dysmenorrhea does not occur in the absence of ovulation and that cramps can be evidence of underlying tension and worry.

For most girls who have this complaint, a thorough but thoughtful examination, reassurance, a careful explanation of the association between ovulation and menstruation and a little attention to them, will suffice. Others who have the sort of worries and conflicts which plague this age group should be given an opportunity to express their feelings and relieve their tension. In an occasional adolescent, incapacitating menstrual cramps may be the somatic focus of a disorder which will require psychiatric care.

When both the physiologic and the psychologic characteristics of adolescents are kept in mind, the physician can at least do much to insure these patients a more satisfactory adjustment to womanhood and perhaps also to relieve their discomfort. If success does not follow from one's efforts, the assistance of more experienced physicians should be sought.
THE ADRENOGENITAL SYNDROME, SALT-LOSING TYPE
Authors: Faber Harold K.
Published: December 2021

Case reports of two brothers with the adrenogenital syndrome, followed from birth to the ages of 7 and 5 6/12 years, respectively, are presented.

Virilism and addisonian crises were prevented with fair success in both by cortisone and DOCA.

Along with reduction of urinary output of androgens, growth was moderately retarded, but when cortisone dosage was lowered output of androgens increased and marked acceleration of growth, including skeletal maturation, occurred.

An episode of hypertension occurred in each case, but was preceded and followed by periods of normal blood pressure. These episodes may have been due to accelerated release of desoxycorticosterone from implanted DOCA pellets.
CLINICAL CONFERENCE
Authors: Ransohoff Joseph
Published: December 2021

Dr. Ransohoff: I want to draw your attention to a group of infants with chronic subdural hematoma. The distinctive feature of these patients is marked enlargement of the skull. This megalocephaly was of such a degree in eight patients we treated that they were all admitted to the hospital with a tentative diagnosis of internal hydrocephalus. The presence of subdural hematoma was only discovered in these children at the time of tipping the subdural space through the enlarged anterior fontanelle prior to carrying out ventriculography. When air is injected into the subdural space in these patients, roentgenograms reveal fairly normal-sized cerebral hemispheres surrounded by hugely distended subdural spaces. We believe that it is this disproportion between the size of the boney vault and the size of the underlying brain which makes this group a special therapeutic problem (Fig. 1).

When a surgeon drains blood and fluid from the subdural space, he expects the underlying compressed brain to re-expand and obliterate the remaining cavity. If the lesion is of long standing, he may find it necessary to remove the inner membrane of the subdural hematoma, which is covering the surface of the brain, before the expected re-expansion can occur. However, when the cranium has been so enlarged by bilateral subdural collections that it is considerably larger than the normal-sized brain, the brain cannot be expected to re-expand sufficiently to fill the entire cavity.

We became aware of this therapeutic dilemma after applying the usual techniques of treatment to a 3-month-old infant admitted in 1952 with a definite history of trauma. After the removal of about 350 ml of subdural fluid by daily subdural taps, we made bone flaps, bilateral and frontoparietal, and removed the inner membranes of the subdural hematomas, 1 week apart.
Absence of Abdominal Muscles
Authors: GILDEA DOROTHY
Published: December 2021

Opening the June Pediatrics, I noted another article reviewing the clinical and pathologic picture of absence of the abdominal muscles. As this particular review is so current and complete, it would seem repetitious for me to report the several cases I have had. However, the etiology from a genetic standpoint seems most important in the patients here to be reported because this particular mother has had three children born either with complete or partial absence of the muscles of the abdominal wall itself.
Effect of Testosterone on Fetus
Authors: TRIMBLE GEORGE X.
Published: December 2021

Reference is made to the report of a case of female pseudohermaphrodism in an infant after administration of testosterone to the mother during pregnancy, submitted by Doctors Grunwaldt and Bates (Pediatrics, 20:503, September 1957).

I think it would be of interest to note that the question of hormonal production of fetal hermaphrodism was raised in a 1955 case report of such an instance occurring in an infant born of a mother under treatment with male hormone for pruritus during pregnancy.
A SURVEY OF RADIATION EXPOSURE IN PEDIATRIC PRACTICE
Authors: Zavon Mitchell R. , Valaer Peter J.
Published: December 2021

The work habits and equipment of 44 Cincinnati pediatricians who use fluoroscopes in office practice were studied to determine radiation exposure. Several pediatricians shared fluoroscopes, so the study involved 34 machines, representing 14 different makes.

A time-totalizer, made expressly for this study, obtained time-of-use data on 29 of the 34 fluoroscopes.

Sixteen fluoroscopes were used less than 1½ minutes per week. Three exceeded 7 minutes per week, with the maximum being 11¾ minutes per week.

A laboratory coat with 10 pocket chambers was given to each physician for a week to be worn during fluoroscopy. The pocket chambers were located over various areas of the body to determine exposure at each point.

All chambers worn by 31 physicians recorded less than 50 mr. Five doctors had one or two chambers that went beyond the 200 mr scale of the chamber.

Twenty-two fluoroscopes had useful-beam dose rates greater than the presently accepted maximal allowable limit.
HYPOPARATHYROIDISM IN CHILDREN AND ADOLESCENTS
Authors: Soper Robert T. , Mason Edward E. , Buckwalter Joseph A.
Published: December 2021

Eight cases of hypoparathynoidism in patients less than 17 years of age have been presented and discussed. One case was primary in type and seven were secondary to thyroidectomies performed for thyrotoxicosis or carcinoma of the thyroid gland. The similarity of symptomatology, time of onset, treatment and long-term management between cases of hypoparathyroidism in the younger age group and in adults has been emphasized.

Prophylaxis against the development of hypoparathyroidism following thyroid surgeny is the responsibility of the surgeon. When present, the disorder must be recognized early and treated promptly with adequate dosages of appropriate drugs. Conscientious long-term clinical and laboratory follow-up examinations are necessary to avoid the serious complications of chronic hypocalcemia. Tests to quantitate more accurately degrees of parathyroid function are needed in secondary hypopanathyroidsm which is thought to be temporary in nature. Children and adolescents with hypopanathyroidism deserve special care in diagnosis, treatment and long-term management.
Medical Services for Rural Areas
Authors: OVERALL JAMES C.
Published: December 2021

This book is a short report on the difficulties of obtaining medical care in the mountainous areas bordering east Tennessee and Kentucky, and how this problem was handled by the Tennessee Medical Foundation. This region is a thinly-populated, rural, mountainous area where the financial status of the people is probably a greater problem than that of arranging for medical care. This book would be profitable and instructive reading for all who are faced with the problem of furnishing medical care to inaccessible rural areas.
Environment and the Deaf Child
Authors: LIERLE DEAN M.
Published: December 2021

Environment and the Deaf Child is based on material compiled for a doctoral dissertation. The stated purpose of the study is to improve our understanding of the maladjustment of deaf children. The author seeks to determine whether environmental factors play a more decisive role in the adjustive process than do organic or hereditary conditions. To this end the author has included a review of the literature concerning the various views of this problem. Numerous quotations are used and, since they are out of context, it is a little difficult for the reader to be certain of the original author's intent for a given statement.
EDUCATION
Authors: Hill Lee Forrest
Published: December 2021

Should the role of the private hospital in pediatric education be that of service to patients only, or should it attempt a teaching role in addition? The advantages to all concerned—patients, physicians, community—are so great when teaching is in effect that all qualified private hospitals should serve an educational as well as service function. Private pediatric patients are as suitable for teaching as service patients. Residency responsibility can be made adequate. Teaching assumed by a private staff is conducted under a severe handicap as compared to the professional educators in a university, but it can be done well if there is sufficient desire.

The make-up of the clientele in a private hospital simulates more closely that of private practice than does that of some university centers. Inability of a private hospital to carry out basic research is its most serious defect in the role of education. However, the type of research best suited to the first 2 years of residency training is clinical and this type can be readily pursued in a private hospital.

While outpatient experience is difficult to arrange in a private pediatric hospital, it is essential and can be accomplished with co-operation from the staff. Private hospitals which possess personnel and facilities justifying designation as pediatric centers are likely to have sufficient referrals of unusual and difficult cases to insure adequate inpatient teaching on the less common disorders.

When private hospitals undertake teaching programs, standards of pediatric care are raised in the hospitals and in the communities they serve.

Provision of general physicians for children is a unique system obtaining only in America. It has given American children a high standard of medical care. Many more physicians of this type are needed to meet the demand. How many more is unknown, but perhaps two or even three times as many as are available. Until the demand has been met, properly qualified private pediatric hospitals should establish or continue educational as well as service programs.
CONGENITAL ABNORMALITIES OF AMINO ACID TRANSPORT IN RENAL TUBULES
Authors: Lowe Charles U.
Published: December 2021

VARIETIES of syndromes have been described in which an abnormal amount of organic acid appears in the urine. In many of those syndromes which have been carefully studied, amino acids appear to constitute the major portion of organic acids. This probably is the result of the development of adequate methodology for the determination of amino acids. Nevertheless the author proposes classifying these diseases as organic acidurias, since it is his belief that there are organic acids, other than amino acid, present in the urine of these patients.

Although the central theme of the Symposium of which this paper is a part is genetic defects, in the classification which is to be presented for consideration, some syndromes are included which are not genetic in origin. This is done for the purpose of completeness and to suggest the relationships between the syndromes with a genetic background and those in which the organic aciduria results from some nongenetically controlled aberrations.

These syndromes may be roughly divided into two groups: Those in which the concentration of amino acids in the blood is elevated and those in which it is normal. The problem of classification of these syndromes has recently been reviewed in detail. In the group of syndromes with normal concentrations in the blood, further subdivision is necessary into four apparently different groups. In Table I are listed the diseases falling into these various categories.

Among the diseases characterized by elevated concentration of organic acids in the blood, one may observe that only phenylpyruvic oligophrenia represents a congenital anomaly.
Deafness, Mutism and Mental Deficiency in Children
Authors: YANNET HERMAN
Published: December 2021

The causes for the failure of adequate speech development in children include deafness of varying degrees and types, mental deficiency, infantile autism, auditory aphasia, and serious emotional disorders related usually to social deprivation. Since the therapeutic approach as well as the prognosis varies greatly in these different conditions, early differential diagnosis is of paramount importance.

This book, actually a rather short monograph of some 80 pages (approx imately 20,000 words), summarizes the various clinical features and diagnostic procedures involved in the differential diagnosis.
INCIDENCE OF STIGMATA OF MONGOLISM IN CHILDREN WITH ACUTE LEUKEMIA
Authors: Sutow Wataru W.
Published: December 2021

The present study failed to demonstrate increased frequencies in occurrence of certain stigmata of mongolism in 59 children with acute leukemia. The stigmata investigated were brachycephaly, dermatoglyphic patterns, hypoplasia of middle fifth phalanx and congenital cardiac anomalies.
The Concept of Development
Authors: SENN MILTON J. E.
Published: December 2021

The pediatrician is reminded frequently of the necessity of being familiar with concepts and characteristics of human growth and development. In his training, his practice and his Board examinations he faces a variety of problems which test his knowledge in these areas. Too often he feels uncomfortable in his attempts at formulating solutions to these problems. His discomfiture and lack of skill are frequently due to the fact that in his training he has little direction and guidance in ways of coping with questions of growth and development.
CLOACA WITH NON-ADRENAL FEMALE PSEUDOHERMAPHRODISM
Authors: Sieber William K. , Klein Robert
Published: December 2021

Two infants have been described who exhibited previously unreported urogenital anomalies. Both patients were female pseudohermaphrodites of non-adrenal origin who had persistent cloacae.

The etiology of the anomalies is unknown. This rare combination of anomalies was recognizable clinically. If the diagnosis is made promptly, surgical correction may possibly prevent serious renal damage.
SALIVA, TEARS AND DUODENAL CONTENTS IN CYSTIC FIBROSIS OF THE PANCREAS
Authors: Sant'Agnese Paul A. di , Grossman Herman , Darling Robert C. , Denning Carolyn R.
Published: December 2021

Analyses of the concentrations of chloride and sodium in mixed saliva support the conclusion that patients with cystic fibrosis of the pancreas show higher mean values than do control subjects. Salivary potassium does not vary significantly in the two groups.

Concentrations of chloride and sodium in tears were also found to be significantly increased as compared with controls. Potassium concentrations in tears are similar in the two groups.

The overlap in concentrations of chloride and sodium in both saliva and tears is considerable in the two groups of subjects, thus detracting seriously from the value of these determinations in differentiation of cystic fibrosis from other diseases. This is in contrast to the consistent difference, with virtually no overlap, found in the concentration of chloride and sodium in the sweat of patients with cystic fibrosis as compared with other conditions, and the consequent use which is made of the "sweat test" as a reliable diagnostic procedure.

Parotid secretory rates have been found to be significantly increased in patients with cystic fibrosis over those of controls.

Amylase and lysozyme activity in parotid and mixed saliva were no different in patients with cystic fibrosis and controls.

Concentrations of chloride, sodium and potassium in duodenal fluid were found to be essentially the same in patients with cystic fibrosis as in controls, differing only mildly from concentrations of these ions in plasma. Among patients with cystic fibrosis, wide variations in the proteolytic activity of the duodenal fluid were not accompanied by corresponding variations in the concentration of chloride, sodium and potassium.

In the generalized disease termed cystic fibrosis of the pancreas there are thus three defects in secretion of exocrine glands which require explanation: an abnormality in mucus secretion; abnormally high electrolyte concentrations in sweat, saliva and tears; and an increased rate of secretion of the parotid glands.
MEDICAL AND HOSPITAL CARE DURING PREGNANCY AND EARLY INFANCY
Authors: Boek Walter E. , Yankauer Alfred , Lawson Edwin D. , Wolcott Minnie C.
Published: December 2021

This article has presented data from interviews with 1,433 mothers residing in 15 areas distributed around upstate New York. Data on medical and hospital care during pregnancy and early infancy were compared by social class level of families.

Mothers in the lower classes differed from those in the higher classes in such behavior as seeking care from a physician later in pregnancy, fewer of them using specialists for prenatal and postnatal care, staying a shorter time in the hospital after delivery, having lower medical costs, carrying less insurance, claiming less ability to pay expenses of pregnancy and childbirth, smaller proportion obtaining postnatal medical examinations, more taking baby to physicians for illness rather than for check-ups, and a lower percentage having had the child immunized and vaccinated.

A direct trend was observed in breast feeding. The higher the social class the more breast feeding. First babies were breast-fed more than other babies except for those in the lowest class. More mothers in the lowest class used separate sterilization for bottles, nipples, and formula, fewer were feeding vitamins, and fewer used commercially prepared formulas for the infants.
Letters to the Editor
Authors: REISMAN MARTIN
Published: December 2021

In reference to the recent report by the Committee on Nutrition on the feeding of solid foods to infants (Pediatrics, 21:685, 1958), several additional points might be raised. It is noted that no harmful results have been reported thus far in the early feeding of solids. However, the Committee after comprehensive review of the problem concludes that "no nutritional superiority or psychologic benefit results from introduction of solid foods into the infant diet prior to 2½ to 3 months of age."

It would seem that some "psychologic benefit" might be postulated, if not for the baby, then for the parents. The prolonged emptying time of the stomach and satiety that accompanies the introduction of solids is frequently the means by which the doctor and parents are first able to initiate a more reasonable feeding and sleeping program, most specifically, allowing the infant and parents to sleep through the night.
STUDIES ON THE ALLERGENICITY OF COW'S MILK
Authors: Ratner Bret , Dworetzky Murray , Oguri Satoko , Aschheim Lydie
Published: December 2021

As demonstrated by parenteral sensitization and challenge in anaphylaxis experiments with guinea pigs, a particular heat-denatured milk was shown to have lost the allergenicity of the alpha-lactalbumin fraction, partially lost that of the beta-lactoglobulin fraction, and retained the allergenicity of the alpha-casein fraction.
Device for Urine Collections
Authors: GROSSMAN ELMER R.
Published: December 2021

The recent appearance of several articles showing more or less complex devices for collecting urine from baby boys prompts me to describe a simple and effective technique; this system was devised and used for 2 years at Travis Air Force Base Hospital and has been used on the infants' ward at the University of California Medical [See FIG. 1. in Source Pdf] Center for 1½ years. The components can be found in any hospital; the apparatus can be assembled and affixed in 10 minutes; it does not leak; no skin irritation has been noted, even with 4-day collection periods; and it can be washed, stored and re-used indefinitely. (See Fig. 1.)
Tracheotomy: A Clinical and Experimental Study
Authors: FERGUSON CHARLES F.
Published: December 2021

This little book is the most comprehensive treatise on all of the aspects of tracheotomy the reviewer has yet come across. Its bibliography alone comprises 293 references. It deals with nearly every type of ventilatory distress, and in addition to a standard section on the classic indications for tracheotomy from the mechanical point of view, it approaches the problem from the physiologic viewpoint with an up-to-date discussion of the syndrome of secretional ventilatory obstruction.

After a very complete and interesting historical review of this ancient operative procedure, the author tabulates in various forms a series of 310 tracheotomies performed on 300 patients at the Brooke Army Hospital, Fort Sam Houston, Texas from 1947 to 1955.
Letters to the Editor
Authors: SHAW EDWARD B.
Published: December 2021

I am appreciative of Dr. Bowen's comments regarding my previous letter regarding side effects from the use of phenothiazine compounds and I am in general agreement with him. It was not the purpose of my communication to characterize phenothiazine drugs as necessarily dangerous nor to single out one of them as most to be feared. The real danger lies in what might be done by the physician who has no knowledge of the possibility of these side effects when confronted by symptoms which appear alarming, ". . . in no single case did the physician who prescribed the drug or the physician who first saw the resultant seizures have any knowledge of this relationship."
Fatality From Intravenous Nitrofurantoin
Authors: SWEET AVRON Y.
Published: December 2021

Recently one patient died and another came near death because of severe metabollic acidosis following the administration of Furadantoin® Intravenous Solution. (The brochure accompanying the medication does not indicate that metabolic disturbances might result from its use.) Both patients were adults with severe and extensive paralysis due to poliomyelitis and marked respiratory paralysis as well. Both had renal calculi and urinary tract infections with bacteria which were resistant to all but the more toxic antibacterial agents.
IDIOPATHIC PAROXYSMAL MYOGLOBINURIA
Authors: Segar William E.
Published: December 2021

A case of idiopathic paroxysmal myoglobinuria is reported. This is a disease of unknown etiology, characterized by severe muscle pain and weakness or complete paralysis and by the excretion of burgundycolored urine. The urine is free of erythrocytes but gives a strongly positive benzidine reaction. There is no discoloration of the plasma. A definite diagnosis can be made by spectroscopic examination of the urinary pigment and identification of the absorption bands characteristic of myoglobin.

The underlying pathologic process and clinical manifestations are discussed.

This report describes the treatment of a 15-year-old boy who recovered despite the development of both respiratory paralysis and acute renal failure, complications which are responsible for the mortality rate of 30% from this disorder.
INHERITANCE OF SUSCEPTIBILITY TO CONGENITAL DEFORMITY
Authors: Runner Meredith N.
Published: December 2021

Fasting for 24 hours during the ninth day of pregnancy resulted in 22% of the fetuses having either cranioschisis or deformed ribs or both at 18 days post coitum. The fasting treatment affected neither the frequency of pregnancies following matings nor the incidence of prenatal mortality.

Fetuses were protected from the fasting effect by relatively small quantities of a variety of nutrients, i.e., glucose, ketone-body or amino acids administered by stomach tube during the fasting period. The array of protective compounds suggested that they acted by supplying substrate for the citric acid cycle.

Four teratogenic treatments (insulin, iodoacetate, x-methylfolic acid and fasting) produced similar abnormalities of development. A metabolic scheme is presented to suggest that each of these agents may interfere with reactions in the citric acid cycle.

Administration of nutrients during the fasting period and use of teratogenic agents have provided circumstantial evidence that carbohydrate metabolism may be selectively critical for morphogenesis of embryonic neural tube and for differentiation of precartilaginous mesenchyme.
PATHOGENESIS OF LESIONS IN THE NERVOUS SYSTEM IN HYPERNATREMIC STATES
Authors: Finberg Laurence , Luttrell Charles , Redd Henry
Published: December 2021

In an attempt to verify the possible causal relationship of hypernatremic dehydration and damage to the central nervous system and to study the mechanisms involved, kittens were made hypernatremic by injection with hypertonic solutions of sodium. Many of the clinical manifestations referable to the nervous system as seen in patients with hypernatremic dehydration were produced. Gross anatomic changes consisting of intracranial hemorrhages, such as are sometimes seen in patients, were also present in the animals. A study of the inorganic chemical composition of the tissues revealed a difference in the pattern of osmotic adjustment between cells of brain and of muscle. This is interpreted as a relative excess from development of idiogenic osmols within brain cells. It is suggested that this difference may in part account for the marked manifestations related to the nervous system seen in the animals and, by analogy, in patients.
Myasthenia Gravis
Authors: BRAY PATRICK F.
Published: December 2021

The need for a monograph on the subject of myasthenia gravis has been considerable because the clinical management of this multifaceted problem requires precise knowledge of therapeutic details together with a reasonable knowledge of the disturbed neuromuscular physiology. The author has laid emphasis in this text on the practical clinical matters of diagnosis, drug treatment and general management. His personal experience with 350 cases of myasthenia gravis seen at Mt. Sinai Hospital in New York City provides the groundwork for his discussion.

The incidence of this condition is not well known, but the author and other workers feel that for every known patient with myasthenia, one or two patients with the disease remain undetected.
"FAST" HEMOGLOBIN COMPONENT FOUND IN UMBILICAL-CORD BLOOD OF THAI BABIES
Authors: Tuchinda Soodsarkorn , Vareenil Chitra , Bhanchit Partraporn , Minnich Virginia
Published: December 2021

Four hundred and fifteen specimens of cord blood collected from the Thai population were examined; 22 contained an electrophoretically "fast"-moving component of hemoglobin, an incidence of 5.2%. No other abnormal hemoglobin was found in the specimens of cord blood.

Eleven of the babies with abnormal hemoglobin were examined; hematologic findings were within normal limits. Five were followed for 2½ to 8 months; the abnormal component disappeared within 76 to 101 days. One of these children subsequently developed hemoglobin E. Another baby, 2 days of age when first seen, had the "fast" component of hemoglobin in the blood. She was the only child in the group who had marked hepatomegaly, splenomegaly, reticulocytosis, and nucleated erythrocytes in the peripheral blood. These abnormalities subsequently disappeared, but at 112 days a small amount of the "fast" component of hemoglobin persisted and hemoglobin E had appeared.

The blood of 412 mothers revealed an incident of 10% hemoglobin E, the only abnormal hemoglobin detected by paper electrophoresis.

The concentration of hemoglobin A2 was determined on the blood drawn from nine parents of babies with abnormal "fast" hemoglobin; the value was normal in all instances. Microcytosis and increased resistance of the erythrocytes in hypotonic saline solution, however, was found frequently among the parents of affected babies.

The abnormal "fast" component of hemoglobin was identical with "Barts" hemoglobin. Its characteristics suggest that it may be an abnormal fetal hemoglobin.
COMPARATIVE HEMATOLOGIC RESPONSE TO IRON FORTIFICATION OF A MILK FORMULA FOR INFANTS
Authors: Marsh A. , Long H. , Stierwalt E.
Published: December 2021

Seventy-four full-term and 42 premature infants were studied from birth to 9 months of age in relation to intake of iron. All were maintained on a vitamin-supplemented milk diet, and approximately a third had iron supplementation of 12 mg in 32 fluid ounces of milk intake.

Significant differences between groups as regards growth, development or number of illnesses were not apparent.

The infants fed supplemental iron had higher values for hemoglobin, hematocrit and serum iron, after 3 to 3½ months of age, and these values continued to be significantly higher throughout the 9-month period of observation.

Among the infants who received no iron supplement, 2 full-term and 16 premature infants developed evidence of anemia, which responded quickly when the infants were changed to the iron-fortified formula.

No signs of toxicity or difficulty were noted in the iron-supplemented group, nor of lack of acceptability by the infants of any formula used in the study.
ARTERIOVENOUS ANEURYSM OF THE CEREBELLUM IN A PREMATURE INFANT
Authors: Baird W. F. , Stitt D. G.
Published: December 2021

A case of cerebellar arteriovenous aneurysm occurring in a premature white female infant is presented. Signs of cerebellar irritation were present before death. An actual arteriovenous shunt could not be demonstrated microscopically; also cardiomegaly, a common consequence of such a lesion, was absent.
PATTERNS OF SKELETAL DEVELOPMENT IN THE HAND
Authors: Pyle S. Idell , Reed Robert B. , Stuart Harold C.
Published: December 2021

The first purpose of this presentation of patterns of skeletal development in the hand has been to demonstrate that essentially normal children, although passing through very similar steps or stages of skeletal development in the hand, do so in a variety of ways in respect to the rates of their progress through these stages or by age periods. The second objective has been to show the kinds of patterns which emerge and the relative frequency with which certain of these are encountered. This has been done by studying the consistency manifest by children in their rate of progress over the whole of childhood as well as by major subdivisions of the developmental period.

This Study shows that few children are very irregular in progress or change frequently to any substantial degree in their rate of progress, but many make one or two substantial shifts in rate from one period to another. The most common, marked and understandable shift is the single one occurring roughly between childhood and adolescence. The years close to the dividing line between these two age periods, therefore, are the ones in which change in rate of skeletal development (hand) may be expected most commonly. The changes in rates occurring at other ages, as portrayed in patterns under III or IV (Figs. 15 to 20), are not readily explained on the basis of other features of development. Factors found associated with these different patterns of skeletal development in the children concerned, relating to nutrition, illness experiences, growth in height and other aspects of development will be considered in later reports on interrelationships.

Aside from a preliminary report from this laboratory the only other report known to the authors which dealt longitudinally with patterns of skeletal development was published by Kelly in 1937. This concerned children 6 to 18 years of age and used an index derived from measurements of several bones or epiphyses in the hand and wrist; six patterns were derived from these indices and described as convex, linear, concave, convex-concave, linear-convex and concave-convex. Because of the fundamental differences in the data used in this Study, it is not possible to compare Kelly's results with those being reported.
Laboratory Manual of Pediatric Micro-Biochemical Techniques
Authors: KAPLAN S. A.
Published: December 2021

This manual contains methods of chemical analysis of over 100 substances in biological fluids and should, therefore, provide a complete ready-reference source for clinical chemistry laboratories. The range of methods of chemical analysis which are given, extends from routine analysis, such as for bicarbonate, chloride, glucose, etc., to some rather more complicated and specialized techniques, such as for catecholamines, 17-hydroxycorticoids, mucopolysaccharides, etc. There is hardly a test which will be performed in the routine hospital laboratory which is not covered by this manual.
C-REACTIVE PROTEIN IN THE SERUM IN NEPHROSIS AND ACUTE GLOMERULONEPHRITIS
Authors: Valyasevi Aree , Sloan Joseph M. , Barness Lewis A.
Published: December 2021

C-reactive protein in the serum and the erythrocyte sedimentation rate were followed serially in 13 patients with acute nephritis and in 9 patients with the nephrotic syndrome.

Although a positive C-reactive protein test was always associated with evidence of infection, obvious infection in a few instances was not accompanied by a positive test.

Determination of C-reactive protein is valuable in determining the presence of infection in patients with acute nephritis and the nephrotic syndrome, especially in the latter where hormone therapy may mask many signs of infection.
VIRUSES OF THE ACUTE COMMUNICABLE DISEASES
Authors: Robbins Frederick C.
Published: December 2021

THE GROUP of acute and extremely common communicable virus infections has been greatly enlarged in recent years since the recognition of the Coxsackie and ECHO viruses. The clinical manifestations of infections with this large group of agents are gradually being sorted out, and include aseptic meningitis, pleurodynia, herpangina, diarrhea, various minor illnesses and a variety of exanthems. The observation that several of them produce diseases with rash has greatly complicated the diagnostic problems of the pediatrician. This group of illnesses is of great interest and importance, but will not be discussed here. Rather, the scope of this presentation will be limited to three infections, namely, measles (rubeola), rubella, and those due to the viruses of varicella and herpes zoster. The purpose is to review briefly the present status of our knowledge concerning them and to point out some of the problems yet to be solved. No attempt will be made at exhaustive coverage.

MEASLES

Experimental Considerations

As the result of the work of Enders and his associates, it is now possible to study the virus of measles in the laboratory, and control of this disease by active immunization would appear to be a real possibility within the near future. From the historic point of view measles has been the subject of a great deal of attention from the clinician, epidemiologist and virologist. The early workers, such as Anderson and Goldberger in 1911, Blake and Trask in 1921, and others at about the same time, were able to produce measles in monkeys by inoculating them with blood and other materials from patients.
CELIAC DISEASE AND WHEAT SENSITIVITY
Authors: Weijers H. A. , van de Kamer J. H.
Published: December 2021

Celiac disease is considered "an inborn error of metabolism," which becomes mainly manifest after the consumption of wheat (rye, barley, oats). Wheat gluten, especially its gliadin fraction, is shown to be the harmful substance.

The cause of the action of gliadin is sought for in the glutamine-containing peptides, which, due to an enzymatic defect in the cells of the intestinal wall, would not be split normally into amino acids but would get into the blood, thus exerting an abnormal influence on the metabolism.

The abnormal elevation of the gliadinloading curves is probably based on the presence of these peptides in the blood.
COMPREHENSIVE PEDIATRICS: POSTGRADUATE TRAINING FOR PRACTICING PHYSICIANS
Authors: Rose John A. , Ross Donald C.
Published: December 2021

It is the opinion of the authors that the "new pediatrics" (comprehensive pediatrics) can be practiced, but at the present time many practitioners are not equipped to do so. This is because hospital structure has in the past effectively protected the physician in training from many of the emotional aspects of practice. Often it is only when he is in practice that he feels the full impact of these.

A pilot postgraduate program for practicing physicians and evaluation of its results are described. It is the belief of the authors that the success of such a program is largely dependent on the careful planning and preparation of every step: public relations, selection of material, mode of presentation, group participation, etc.
Letters to the Editor
Authors: SILVER HENRY K.
Published: December 2021

I am in agreement with Dr. Wiener that efforts should be made to expedite, simplify, and increase the safety of the technique used in terminal "sterilization" or to find a suitable substitute. When it is necessary to store formula, terminal "sterilization" is the only safe method of processing milk mixtures and mothers should have the information needed to carry out the method properly and should understand why it is necessary. In our experiments, we showed that proper technique includes adequate cleaning of all equipment.
Congenital Cardiovascular Anomalies in Twins
Authors: G. S.
Published: December 2021

This paper reports on a very carefully conducted clinical investigation of the etiologic factors involved in cardiovascular anomalies in twins. The author studied 37 pairs of twins in whom congenital heart disease was known to be present in at least one member of the pair. The patients were selected from several clinics in New York City; only those pairs of twins were chosen for whom the zygosity could be definitely determined and the presence or absence of a cardiovascular anomaly established. There were 26 pairs of dizygotic twins and 11 pairs of monozygotic twins in the study. Two pairs in each group were concordant (both co-twins affected) for the presence of cardiovascular anomalies; all other pairs were discordant (only one twin had congenital heart disease). The relative etiologic significance of genetic and environmental factors is discussed in the light of these observations.
Principles of Human Pathology
Authors: BLANC WILLIAM A.
Published: December 2021

This textbook can be highly recommended as an introduction to pathology for students and as a practical desk reference book or "refresher" or both pediatricians and general practitioners. It is packed with information and pictures, contains very little loose talk and still preserves an air of informality which makes for easy reading. The authors have successfully integrated anatomy and physiology with clinical and morphologic data.

The chapters on infection and infectious diseases, kidney, and surgical pathology in general are excellent.
THE PRACTICE OF PEDIATRICS
Authors: Deisher Robert W. , Derby Alfred J. , Sturman Melvin J.
Published: December 2021

In order to gather more information about the current trends in pediatric practice in one locality, a study was done in 1958 to ascertain what the pediatricians in the State of Washington were doing; whether they were satisfied with their practice; and if their training had adequately prepared them for practice. Information about the nature and extent of pediatric care done by the general practitioner, which was available from a 1957 study in the State of Washington made it possible to compare certain aspects of pediatric care as practiced by the general practitioner with those same aspects of pediatric care as practiced by the pediatrician.

Some attempt was made to try to compare the findings of this study with relevant information given in other studies.

In general, it was found that in the State of Washington well-child care and the treatment of upper respiratory infections occupies much of the pediatrician's time. Time spent in well-child care was approximately equal to that spent in sick-child care—a contrast to the experience of the present-day general practitioner and to pediatric practice in former times. Treatment of certain kinds of diseases has ostensibly increased somewhat in the past two decades, and treatment of accidents is now part of pediatric care. Some conclusions about the adequacy of medical school training are also presented.
PULMONARY PHYSIOLOGY IN CHILDREN
Authors: Cook C. D. , Barrie H. , DeForest S. A. , Helliesen P. J.
Published: December 2021

Measurements of lung volumes, compliance and resistance, and effective respiratory muscle strength have been carried out in a series of patients with idiopathic scoliosis, scoliosis secondary to poliomyelitis and scoliosis secondary to abnormalities of the vertebral column.

The patients with idiopathic scoliosis showed, in general, moderate reductions in vital capacity, while those with poliomyelitis and associated paralysis showed more marked decreases. Residual volume on the average was essentially unchanged in both groups. Compliance was only moderately but consistently reduced in both groups while flow-resistance was only slightly to moderately increased. In the group of patients with idiopathic scoliosis, effective respiratory muscle strength was normal for given lung volumes but inspiratory strength was subnormal. Serial studies show that after fusion, the patients tended to have a further decrease both in respiratory muscle function and in lung volumes. The frequently serious pulmonary dysfunction accompanying the scoliosis secondary to vertebral abnormalities is illustrated.
OBSTRUCTION OF THE INFERIOR VENA CAVA IN CHILDHOOD
Authors: Kaufman Stephen
Published: December 2021

FORTY-THREE cases of obstruction of the inferior vena cava in childhood have been found in a search of the English literature, more than one-half of them collected by Pleasants in 1911 (Table I). Of the total cases, 13 survived the disease; 9 of these were congenital in origin. Only three had demonstration of the obstruction by venography; of these, two were congenital and did not reveal any deep collateral circulation. The most common factors in the etiology were infection, congenital obliteration of the inferior vena cava with anomalous drainage, and thrombus or invasion of the vessel by a malignant tumor (Table II). Sequelae varied with the particular etiology of the obstruction, the acuteness of onset, the location, and the rapidity of its progression (Table III).

CLINICAL MANIFESTATIONS

The most common symptoms of this condition are found to be inconstant pain generally referred to the lumbar area, edema of the legs when the iliac veins are also obstructed, and the presence of superficial collateral circulation. Ascites, jaundice hemorrhoids and splenomegaly are uncommon and dilated superficial veins do not appear unless other deep veins are also obstructed. Marked albuminuria or oliguria which was not present previously may suggest the progression of the process to involve the renal vein. Almost complete anuria may supervene before adequate collateral circulatory adjustment takes place.

When the lower third of the inferior vena cava is obstructed, collateral circulation is usually evident in the groin, abdomen and flank. Albuminuria is rare, edema of the abdominal wall is unusual, and edema of the legs is usually absent unless there is concomitant obstruction of the iliac vein.
The Treatment and Prevention of Reading Problems: The Neuro-psychological Approach
Authors: GORDON SOL
Published: December 2021

Dr. Delacato, a Philadelphia educator and specialist in remedial reading with an established reputation has written a challenging book which postulates a neurologic basis as the etiology of reading and speech problems. Unfortunately, the rigors of scientific method are not employed in validating his serious views on this subject.

In evaluating 45 retarded male readers, Dr. Delacato found such factors as emotional mal-adjustment, social immaturity, rigid parents lax parents, severe emotional conflicts at home poor attitude toward school, lack of motivation to be uncommon characteristics of this group.
CYSTINOSIS
Authors: Karpinski Felix E.
Published: December 2021

Three cases of cystine storage disease occuring in one family are presented. In all three patients the diagnosis of cystine storage was established in vivo with the demonstration of cystine crystals in aspirated specimens of bone marrow and confirmed by paper chromatography of the urine in the two deceased siblings. The genetic aspects of the disorder are briefly discussed.

Bone marrow examination, properly performed, is suggested as a satisfactory procedure for the demonstration of cystine storage.
Der Liquor Cerebrospinalis im Kindersalter
Authors: ZELLWEGER HANS
Published: December 2021

In the first section of this book techniques and hazards of obtaining cerebrospinal fluid as well as the physiology of the production and absorption of cerebrospinal fluid, the significance of the barriers between blood, brain and cerebrospinal fluid are reviewed. Cytology and chemistry of the cerebrospinal fluid are extensively discussed. Non-routine methods like electrophoresis and chromatography of proteins respectively, and amino acids are given equal consideration.