bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPRESSIONS ON PEDIATRIC EDUCATION
Authors: MITCHELL JOHN MCK. , BAIN KATHERINE , HUBBARD JOHN P.
Published: December 2021

Quality is one of the most important components of services rendered for child health. While innate ability and on-the-job learning may result in the production of outstanding achievement on the part of an individual or organization, by and large the quality of a given service may be measured satisfactorily by the fundamental training of those who conduct it.

The conduct of child health services comes far from resting solely in the hands of the physician, still further from those of the pediatrician alone. Nevertheless the physician forms, if not the heart, at least an aorta, through which must flow, if but for an instant, the whole volume of child care. Hence the size and strength of the group which constitute such a vessel become a matter of primary concern in a study having to do with the health of children. With this concept in mind, a Study of Pediatric Education became an integral part of the Study of Child Health Services organized by the American Academy of Pediatrics. In undertaking such a study, there was full realization of the importance of other groups as well as of the inseparable interrelation between medical training as a whole and that for pediatrics. Since it was not possible to cover the entire field, the Study confined itself to a survey of the most important segment; namely, the pediatric training of undergraduate medical students and the graduate training of physicians planning to devote their lives to the care and treatment of children.

The field work is complete. It consisted of visits to and surveys of the pediatric departments of 70 medical schools in the United States and of 9 in Canada, the latter carried out by the Canadian Society for the Study of Diseases of Children. Analysis of the material has just started.

Student Enrollment

The problems of student enrollment are not primarily the concern of those engaged in the teaching of pediatrics nor of an organized group of pediatricians, but they are shared equally with other departments and other medical organizations.
Diseases of the Chest, with Emphasis on X-Ray Diagnosis
Authors: ADAMS JOHN M.
Published: December 2021

This book is particularly suited to general practitioners and the emphasis given to X-ray is well demonstrated throughout. It is primarily an application of the method of X-ray as a clinical instrument to aid the clinician.

The broad aspects of chest disease including anatomy and physiology are developed with a consideration of pathogenesis in various specific conditions. The pneumonias are considered from an etiologic standpoint which is very important if proper understanding and treatment is to be attained. Emphasis is given to the importance of history and the skill required to get a good history. The significance of a good physical examination is not minimized, and the help to be obtained from X-ray is obvious in the book.
Rh . . . Its Relation to Congenital Hemolytic Disease and to Intragroup Transfusion Reactions
Authors: ABELSON NEVA M.
Published: December 2021

Since discovery of the importance of the R antien, more than 700 papers have appeared in the various fields of investigation which this discovery has opened. Many of these papers have been controversial or trivial, and no satisfactory digest of the literature has been available. Therefore, the appearance of a comprehensive, authoritative review of present knowledge and theories concerning the Rh factor is singularly welcome. In this volume the author has included clear, impartial, and well-illustrated discussions of the genetics, nomenclature, and serologic detection of the Rh antigens and antibodies; the clinical and pathologic manifestations of hemolytic disease, and the relation of Rh to transfusion reactions.
Color Atlas of Hematology
Authors: PONCHER HENRY G.
Published: December 2021

There has always been a demand for a practical work book on hematology among students of medicine, practitioners and laboratory technicians that would provide a ready reference source when examining blood films. A number of such books have appeared in recent years and have been well received. Many of those which have been published are now out of date or incomplete in their coverage of the practical aspects of current advances in the field of hematology. This volume was prepared by Doctor Kracke utilizing the plates from his large treatise, "Diseases of the Blood" and incorporating concise clinical descriptions of various disorders of hematopoiesis together with other desirable hematologic findings that makes this a practical, concise and current working manual.
The Spleen and Hypersplenism
Authors: PONCHER HENRY G.
Published: December 2021

Some years ago Doctor Dameshek and his group prepared a reprint of their exhibit on Hemolytic Syndromes presented at the 1942 Convention of the American Medical Association at Atlantic City. This work on The Spleen and Hypersplenism is a comparable publication consisting of a reprint of an exhibit presented at the 100th Anniversary Convention of the American Medical Association in June 1947. Publications of this type have answered an expressed desire on the part of physicians who have attended the scientific sessions of the Convention of the American Medical Association.
History of Nursing
Authors: TOTH BORIE
Published: December 2021

The keynote of the book is found in the preface where it is stated that "the central thesis of the authors is the inextricable interweaving of nursing service with all other branches of human culture." The development of nursing is traced through the record of human history starting with primitive times and ending with the problems facing the world at the conclusion of World War II.

Up to the middle of the 19th century, nursing was under the auspices of religious orders. After the Protestant revolt, nursing as a profession for lay people began to take root.
ACUTE HEMATOGENOUS OSTEOMYELITIS
Authors: SELF EDWARD B.
Published: December 2021

One hundred and thirty-eight cases of acute osteomyelitis admitted to Babies Hospital between 1930 and 1946 are the subject of this report. An unexpected number of cases resulted from infection by hemolytic str. The behavior of hemolytic Staph. aureus is compared to hemolytic str. in osteomyelitis. Mortality is greatest with extreme youth, chronicity least with youth.

Massive doses of penicillin in the earliest stages of the disease constitutes the treatment of choice and emphasis should be on the "treatment of the child," rather than treatment of the bone. Surgery should be postponed in the early stages and used later only to drain abscesses of the soft parts or abscesses of the bone which are well localized and not regressing.

The treatment of chronic osteomyelitis is an entirely different problem. Radical removal of diseased bone and sinuses with primary closure of the wound is the treatment of choice. Immobilization, penicillin, and obliteration of dead spaces by the use of muscle and skin grafts are important adjuncts to success.
Round Table Discussion
Authors: KANNER LEO
Published: December 2021

Chairman Kanner: Every day of man's life constitutes a transition between yesterday and tomorrow, converging in the intrinsic values of the moment. The past and present continue to shape and modify directions and goals, mostly through quiet evolution, sometimes in lively spurts. One of the liveliest spurts occurs during adolescence, at a time when a person is no longer a child and not yet an adult.

Many incisive changes take place in that period. Body growth, in a remarkable upward surge, attains its maximum for the individual. The physique assumes its characteristic configuration. Sexual development reaches procreative capacity. There is striving after emancipation from sheltered existence, a trend toward increasing self-dependence in thought and action. The sphere of interest and participation expands from the confines of home, neighborhood and school to the community at large. The choice of vocation, until then a playfully considered matter, becomes a real issue. Current standards and precepts are submitted to criticism not as yet leavened by the tests of experience. The established order is challenged boldly and then, after some struggle, appropriated gradually with more or less reservation.

Adolescence, in our culture, is a great translator. It translates the language of parental direction, attitudes and behavior into an individualized idiom. This is much less evident in primitive cultures. One might go so far as to say that in primitive societies there is no conceptual equivalent for that which we call adolescence. Childhood ceases abruptly when, through a set of elaborate rites, it is transported into full-fledged adulthood. Tribal ritualism, rather than personal spontaneity determines status and function. In our social structure, a child is given several years in which he is to find his way from a more or less manipulated and regimented existence to the acquisition of initiative in a loosely competitive environment in which the taboos are blurred, the semantics are equivocal, and the variety of occupational, political and theologic choices offers opportunities for perplexities. The adolescent translator's dictionary is full of confusing synonyms and antonyms.

A combination of inner soundness, wholesome parent-child relationship, and guidance from understanding adults, helps most adolescents to emerge safely from the groping and floundering which precede maturing stabilization.
SUBDURAL HEMATOMA, A COMPLICATION OF OPERATION FOR HYDROCEPHALUS
Authors: ANDERSON FRANK M.
Published: December 2021

Report is presented of three infants in whom subdural hematoma developed as a consequence of surgical treatment for hydrocephalus. This complication was not recognized in the first patient, and was unsuccessfully dealt with in one of the others.

Anatomic and physiologic features predisposing to subdural bleeding in hydrocephalic patients are outlined, and methods of prevention, diagnosis, and therapy are described.

Success of operation is jeopardized and likelihood is increased of subsequent blindness, convulsions, and mental impairment in a hydrocephalic infant whose precariously adjusted brain is further damaged by this development.
Round Table Discussion
Authors: LITTLE SHERMAN , NEWCOMB ALVAH L. , KNODE KENNETH T.
Published: December 2021

Chairman Little: This session has a title of "Preventive Psychiatry." I am not sure that it is an entirely correct or happy one. Psychiatry is still a bad word to a good many people, including some physicians, yet it has a real connection with the kind of thing in which we are all interested. What we will discuss is psychiatry in the sense that we are concerned in understanding and helping people, in this case, children. Yet it is not psychiatry in the sense that we are concerned with long term treatment of severe disturbances of adjustment. It is an application of psychiatric knowledge and skill by pediatricians within the framework of pediatric practice. The emphasis is on preventing disturbances in adjustment or on correcting early and relatively shallow-rooted ones.

For a long time many pediatricians have been giving a great deal more than good medical care to sick and well children. On their rounds and in their offices they have consciously and unconsciously helped many children through helping their parents. They help parents by supporting, encouraging and advising them in the difficult job of being parents, and in so doing, they indirectly but concretely help many children. It isn't easy to do this, at least I don't find it so. In the first place, we aren't trained for it. If we develop any skill at it, it comes from experience, which can be painful and slow, and from something that we call intuition. As a matter of fact, our medical training, at least that part of it concerned with our handling of the patient with a medical problem, is often a serious drawback.
FAT DISEASE OF THE LIVER IN INFANTS ON THE ISTHMUS OF PANAMA
Authors: HOWARD FRED H. , MERIWETHER WILLIAM A.
Published: December 2021

Forty-eight cases of fatty liver disease in infancy coming to autopsy over the past 10 years at Gorgas Hospital are reported. The diagnosis of this condition is extremely difficult clinically; liver biopsy is the only certain way of making the premortem diagnosis. In Panama, vomiting, diarrhea and fever are the most frequent presenting complaints. Physical findings of help are the stunted growth, fever, and possibly enlarged liver. Other findings seen commonly in the African cases, such as edema, glossitis and dermatosis, are usually not, seen. The essential pathologic finding is a markedly fatty liver. Pancreatic changes consisting of acinar atrophy were seen in some cases. The cause of the deficiency state appears to be an inadequate protein intake, and will not be simple to deal with, as poverty and ignorance, rather than neglect, would seem to be responsible for this disease. The prognosis is extremely poor, only 11 of the 48 patients surviving for more than 24 hours after medical attention was sought. It is probable that fatty liver disease in infants is relatively common in Panama but almost completely overlooked clinically.
COMBINED PELVIC AND RETROPERITONEAL TERATOMAS IN INFANCY AND CHILDHOOD
Authors: ARNHEIM ERNEST E.
Published: December 2021

The pathologic and clinical features, diagnosis and treatment of combined pelvic and retroperitoneal teratomas in infancy and childhood, based upon a study of 15 cases, are reviewed. One case of malignant combined pelvic and retroperitoneal teratoma with recovery for 4 4/12 years is presented; this is believed to be the first reported cure of this condition.

Combined pelvic and retroperitoneal teratomas were usually noted in female infants under the age of 1 year as large tumors in the pelvis and lower abdomen, with or without extension into the buttocks, often causing urinary or intestinal obstruction, readily diagnosed by rectal and abdominal examination, and revealing areas of calcification or ossification on roentgenologic examination.

In this group of 15, 4 of the teratomas had undergone malignant changes, and 4 had not been operated upon and were described at autopsy.

Successful treatment of combined pelvic and retroperitoneal teratomas was dependent upon early operation, careful operative technic through staged posterior and abdominal incisions, and adequate preoperative and postoperative management. The operative mortality was 20%.

A long term recovery rate of 15% in combined pelvic and retroperitoneal teratomas is in marked contrast to the reported cures with sacrococcygeal teratomas (68%) and retroperitoneal teratomas (42%).
GLYCOGEN DISEASE OF THE HEART
Authors: CHILDS ALFRED W. , CROSE ROBERT F. , HENDERSON PATRICIA H.
Published: December 2021

Two cases of siblings with glycogen storage disease of the heart are reported. The clinical picture was characterized by progressive weakness, areflexia, and susceptibility to secondary infections. There was also progressive hepatomegaly and cardiomegaly.

The pathologic findings correlated well with the clinical and were characterized by marked glycogen storage in skeletal, heart, and smooth muscle, the liver, and nerve cells of the central and autonomic nervous systems. In addition, many other tissues showed some glycogen storage. Storage in the skeletal muscle was so marked as to result in degeneration of the muscle fibers.

The familial aspect of this disease is again noted. Suggestions regarding differential diagnosis are made.
STUDIES OF THE IMMUNOLOGY OF THE NEWBORN INFANT
Authors: OSBORN JOHN J. , DANCIS JOSEPH , JULIA JUAN F.
Published: December 2021

Twenty-three infants from 2 weeks to 6 months old, all of whom had measurable titers of transplacentally-received diphtheria antitoxin, were immunized with a single injection of diphtheria toxoid on alum.

Infants with a low level of passive transplacental antibody were able to respond as well or almost as well as infants who had no passive transfer. The formation of circulating antibody was depressed in infants with a high titer of passively received antibody.

It is suggested that the amount of interference with active immunization is dependent on the relation of the titer of passive transfer and the potency of the antigen. The application of this principle is indicated.
THE PEDIATRICIAN AND THE PUBLIC
Authors: MAGNUSON PAUL B.
Published: December 2021

When I received your kind invitation to give the annual Trimble lecture, I wrote Dr. Compton that I had several pretty sound medical papers worked up on the causes of pain in the lower back—I've been working in that field for more than 40 years—but that the ladies might be much more interested in some information on the President's Commission on the Health Needs of the Nation. So, in deference to the ladies, I am going to talk about the latter topic.

Last November, without a word of warning I got a call from the White House that the President of the United States wanted to see me. I took the train from Chicago that night, and the next morning met with the President. The President laid the cards right on the table. He said he was deeply concerned with the health of the American people in these trying days of all-out-mobilization. He said he had made certain proposals to bring more and better medical care to the people, but these proposals had precipitated an emotional argument which clouded the issue. The President said he was not necessarily committed to any one plan—if any group could come up with a better series of proposals than the ones he advocated, he would be the first to support them if they would insure better health for all the people.

For that reason, he said, he had decided after long deliberation to set up a Presidential Commission to get at the facts. He offered me the chairmanship, and promised me an absolutely free hand in choosing the members of the Commission.
The Changing Health Care Environment: Implications for Residency Training
Authors: Frazier Seth , Hyman Daniel , Altschuler Steven
Published: December 2021

Throughout the United States, the growth of managed care is forcing pediatric providers (physicians and hospitals) to reconstruct and integrate the health care delivery system with a focus away from the academic center and toward the community. Managed care also is forcing new financing approaches geared toward the assumption of economic risk for patient management and utilization of services. Radical changes in pediatric training programs will be necessary to accommodate the strategic and operational changes being pursued in response to these evolving market forces. These changes, while disruptive, will strengthen the breadth and diversity of graduate medical education and will better prepare trainees for the new delivery system in which they will practice. In this article, we examine how the evolution of managed care is redefining the basic financial and organizational framework for pediatric care and the implications of this redefinition for children's hospitals and academic medical center-based pediatric programs. We draw on our experience in the greater Philadelphia market to illustrate the impact of these changes and discuss one pediatric system's response. Finally, we review the educational opportunities provided by these changes.
Community Access to Child Health (CATCH) in the Historical Context of Community Pediatrics
Authors: Hutchins Vince L. , Grason Holly , Aliza Barbara , Minkovitz Cynthia , Guyer Bernard
Published: December 2021

Objectives.

As part of the evaluation of the American Academy of Pediatrics (AAP) Community Access to Child Health (CATCH), to 1) identify, retrospectively, the actual chronology of activities undertaken through CATCH, and 2) review its antecedents within the AAP, and its predecessor program—Healthy Children.

Methods.

Key informant telephone interviews with 14 national leaders in CATCH were conducted. Relevant program and administrative files and other documents were reviewed. AAP staff assisted the authors in preparing a detailed chronology of Healthy Children and CATCH activities and events from spring 1988 through summer 1996.

Results and Conclusions.

A decade of change in the AAP, under the acronym CATCH began in the late 1980s. The formation of the AAP's Partnership for Children and the Access to Care for Children Initiative, combined with the decision by the Robert Wood Johnson Foundation to transfer the funding of Healthy Children to the AAP, underpinned the changes. The Foundation's decision provided the resources and stimulus for the expansion and increased recognition of Community Pediatrics at the national AAP office, culminating in the establishment of the Department of Community Pediatrics in mid-1994. A national program of pediatrician-led, community-based programs and supportive services was launched, other resources were attracted, and a philosophical shift in defining the role of the pediatrician was put forward. A responsibility toward all children within the community was included in the role of the pediatrician, as well as caring for the individual child within a community context.
EXPERIENCES GAINED IN A THIRTY YEAR STUDY OF PREMATURELY BORN INFANTS
Authors: HESS JULIUS H.
Published: December 2021

IF I were to discuss with you the general subject of the premature infant, I would probably bring you little that is new since most of us have gained similar results through our experiences. However, our greatest contribution lies in the fact that we are presenting a long range life history of our smallest graduates in a broad review of the results to date, leaving a more detailed description of the individual infants for future publication.

Much has been accomplished in our time in lowering mortality and morbidity among premature infants but it must be remembered that in these small infants, even with the best of nursing care and most modern equipment, the death rate cannot be cut beyond an irreducible minimum, largely because of their immature development at birth. I am sure it is obvious to all of us that, if we are going to reduce the number of premature deaths, our hope lies in the first week and especially in the first hours of life of these babies. In the general hospital this will require cooperation betwen the obstetrician, the pediatrician and the nursing supervisors of the two departments.

Our Premature Infant Station was started in 1922 with a capacity of eight cribs, the objective being to provide care for premature infants born in homes or in hospitals not equipped with the necessities for their complete care. The activities of the station have been made possible through the financial assistance and endowment of the Infants Aid Society of Chicago.
NITROGEN UTILIZATION IN CALORIC INSUFFICIENCY
Authors: COX WARREN M. , ELLINGSON RUDOLPH C. , MUELLER A. J.
Published: December 2021

To determine whether a portion of ingested protein can be used for tissue growth when insufficient calories were fed, isocaloric and suboptimal amounts of calories in the form of dextrose or as dextrose and protein hydrolysate (amigen®) were fed to protein-depleted, partially starved, scalded and normal stock rats together with adequate vitamins and minerals. It is concluded that:

1. The greater the need for protein, the greater is the utilization of ingested nitrogen for new protein synthesis under conditions of caloric limitation. Protein-depleted rats are able to build new protein tissue even when basal energy requirements are not completely supplied.

2. Protein depleted, partially starved, scalded and stock animals retain or gain more weight when fed adequate or suboptimal quantities of the hydrolysate-dextrose diet than when fed isocaloric quantities of the dextrose diet.

3. Stock animals with no pre-existing protein loss, and in good nutritive condition, do not utilize dietary nitrogen for tissue building when the caloric intake is suboptimal.

4. When the caloric intake is less than that required to meet the estimated basal energy needs, a diet supplying approximately 20% of the calories as protein supported better growth than those supplying more or less than this amount.
MASSIVE HYDROPS OF THE GALLBLADDER PRODUCING PYLORIC OBSTRUCTION IN A SEVEN YEAR OLD BOY
Authors: LEE C. MARSHALL , ENGLENDER GAIL S.
Published: December 2021

A case of massive hydrops of the gallbladder producing pyloric obstruction in a seven year old boy is presented. Jaundice was not present initially but occurred as a transitory postoperative complication attributed to cholangitis and hepatitis. The merits of cholecystectomy as compared with cholecystostomy in such cases have been briefly discussed.
CLINICAL DIAGNOSIS OF GENERALIZED CYTOMEGALIC INCLUSION DISEASE
Authors: MERCER ROBERT D. , LUSE SARAH , GUYTON DONALD H.
Published: December 2021

A case of generalized cytomegalic inclusion disease is described in which, for the first time, the diagnosis was established during the life of the patient. The clinical syndrome is delineated and the differential diagnosis discussed. It is suggested that the diagnosis of the syndrome can be made clinically in the neonatal period by study of the urine sediment.
TRENDS
Authors: DEISHER ROBERT W.
Published: December 2021

A description has been given of the Child Health Center of the University of Washington, its staff and their functions, as well as the teaching program being conducted for medical students.

The student working in such a Center is better able to integrate some of the basic principles of pediatrics, public health and psychiatry, thus making these areas more acceptable and interesting.

The teamwork displayed by the staff who represent a variety of professional approaches is often remarked on by students. They seem to realize at last the functions of a public health nurse, a social worker, nutritionist, and others as represented by the Child Health Center staff and to recognize that they as physicians can benefit in terms of better understanding of their own patients from similar relationships with people from other fields. Perhaps even more significant, they begin to realize the other important phases which should be considered in following the growth and development of each child other than the physical.

It has been indicated that for the medical student to derive maximum benefit from a Child Health Conference experience, his time must be allotted carefully to various phases of the program in operation. Then each student's time must be planned so that certain pertinent information is obtained on experience furnished. To cover the many aspects desired we are fortunate to have an organization such as the Child Health Center in which staff members from several different special fields cooperate in teaching the growth and development of a total child. It is suggested, however, that even with a less elaborate child health conference plan many of the same points can be made if sufficient time is given for the students and a smaller, but interested staff is provided.
SPECIAL ARTICLE
Authors: GAMBLE JAMES L.
Published: December 2021

Dr. O'Shaughnessy promised to submit a "detailed report in which the mode of analysis and so forth will be minutely described." This he presently did. Meanwhile a general practitioner in the small city of Leith in Scotland who read his Lancet faithfully saw at once the therapeutic implications of Dr. O'Shaughnessy's observations. The name of this enterprising doctor was Thomas Latta, and to him belongs the credit of being the first to employ intravenous injection of a solution of sodium salts to replace losses incurred by diarrhoea. His first patient was an old lady severely sick with the cholera. The dramatic outcome of this historic adventure in therapy is recorded in a beautifully written report which Dr. Latta sent to the Lancet, May 23, 1832. He tells us that "she had apparently reached the last moments of her earthly existence and now nothing could injure her—indeed so entirely was she reduced that I feared that I should be unable to get my apparatus ready ere she expired. Having inserted a tube into the basilic vein, cautiously—anxiously I watched the effects: ounce after ounce was injected but no visible change was produced. Still persevering, I thought she began to breathe less laboriously. Soon the sharpened features, and sunken eyes and fallen jaw pale and cold, bearing the manifest impress of death's signal began to glow with returning animation, the pulse which had long ceased returned to the wrist, at first small and quick, by degrees it became more distinct, fuller, slower, firmer and in the short space of half an hour when six pints had been injected she was free from all uneasiness, actually became jocular, and fancied that all she needed was a little sleep; her extremities were warm and every feature bore the aspect of comfort and health."
OVARIAN MATURATION AND CYST FORMATION IN CHILDREN
Authors: POLHEMUS DONALD W.
Published: December 2021

The results of study of a number of ovaries removed from infants and children at autopsy are presented. Follicle maturation and cyst formation were found to be extensive even in earliest infancy. The relationship of these findings to present knowledge and current theories regarding histogenesis of cysts is discussed.
STUDIES OF THE NATURAL HISTORY OF HERPES SIMPLEX INFECTIONS
Authors: BUDDINGH G. JOHN , SCHRUM DAVID I. , LANIER JAMES C. , GUIDRY D. JOSEPH
Published: December 2021

In a detailed study of 12 individuals with primary herpetic stomatitis the virus was recovered from the mouth and stools during the acute stage, convalescence, and for varying periods of time thereafter. The average time period during which virus could be recovered from these sources was 23 days after the onset of the disease. Virus could not be recovered from the blood or spinal fluid, but patients were not available for study before the third day of the disease.

Neutralizing antibodies to herpes simplex were first demonstrated in the serum from the fourth to seventh day of the disease. The antibodies attained a maximum level during the second or third week. Considerable differences in individual antibody levels were noted. The maximum antibody concentration was not maintained and dropped to relatively low levels over varying periods of time in each patient studied.

Herpes simplex virus was recovered from the mouths of many individuals presenting no clinical evidence of herpetic infection. The virus was recovered from 7% of 571 normal individuals of various ages. It was recovered from 1 infant out of 97 under 6 months of age, from 20% of 72 children of 7 months to 2 years, from 9% of 199 children 3 to 14 years of age and from 2.5% of the 185 adults. The incidence of normal carriers was found to be highest (26%) in Negro children in the 7 months to 2 year age group.

Neutralizing antibodies were demonstrated in the serum of 43% of white and 71.4% of Negro children in the 7 month to 2 year age group. The serum of 84.7% of white and 86% of Negro children in the 3 to 14 year age group contained antibodies to herpes. In adults 90% of white and 96% of Negro individuals had antibodies to herpes in the serum. Natural active immunity appears to be established at an earlier age in the segments of the population in which the highest carrier rate was demonstrated.

Neutralizing antibodies were demonstrated in the serum of 76% of white infants and in 90% of Negro infants 6 months of age and under. The placental transmission of neutralizing antibodies was demonstrated. Approximately the same level of antibody was found to be present in the maternal serum and in the serum obtained from the placenta.
ENDOCARDIAL FIBROELASTOSIS
Authors: DENNIS JAMES L. , HANSEN ARILD E. , CORPENING THOMAS N.
Published: December 2021

Based on the study of 149 case reports it appears that endocardial fibroelastosis is an entity which manifests itself in three distinctive types of clinical pattern. These have been designated fulminating, acute and chronic types of disease, according to the age group, type of onset, symptomatology and course of illness. Utilization of this clinical classification to make the differential diagnosis of idiopathic cardiomegaly is described. Pathologic findings are summarized and tabulated. Pathogenesis is speculative but developmental defect resulting from persistence and overgrowth of the primitive lining of the left bulbus cordis best explains the site and character of the lesion.
ABSORPTION OF VITAMIN A ALDEHYDE BY CHILDREN
Authors: KATSAMPES CHRIS P. , MCCOORD AUGUSTA B. , HAMBURGER ROBERT N. , CLAUSEN SAMUEL W.
Published: December 2021

Vitamin A aldehyde is readily absorbed and converted into vitamin A alcohol by the normal human subject. It is therefore a good source of vitamin A for man. Inasmuch as patients with fibrocystic disease of the pancreas show poor absorption of vitamin A acetate and much better absorption of vitamin A aldehyde and vitamin A alcohol, while children with celiac disease show poor absorption of all three forms of vitamin A, the vitamin A aldehyde absorption test is a new aid in establishing the differential diagnosis of these two diseases. The absorption of vitamin A aldehyde by patients with various other diseases usually parallels their absorption of the acetate and the alcohol.
SPECIAL ARTICLE
Authors: POWERS GROVER F.
Published: December 2021

Dr. Daniel C. Darrow, Hamden, Conn.: To me has fallen the pleasure and honor of presenting the second John Howland Medal to Grover Francis Powers. What I can say adds nothing to a life work which merits the highest recognition which American pediatricians can bestow on a colleague. Nevertheless those who have not had the opportunity to know and work with him would like to know something of the man.

He was reared and lived in Lafayette, Indiana, until he was graduated from Purdue. He received his medical degree at Johns Hopkins in 1913 and spent seven years at the Harriet Lane Home. During these years his friends and associates were the remarkable group of men who flocked to the first department of pediatrics in the United States which recognized that study of disease is the most important function. John Howland was assisted by Edwards A. Park, McKim Marriott, Kenneth Blackfan, James L. Gamble, Fred Tisdale, Graham Ross, Wilbur Davidson, Benjamin Kramer, Sam Clausen and others. What extraordinary careers stemmed from this outstanding opportunity to study diseases of children! Powers was influenced most by John Howland, McKim Marriott, Edwards Park, Kenneth Blackfan and Sam Clausen. Of his classmates George Washington on Corner was closest. Of all this galaxy of stars, Grover Powers became the greatest as pediatrician—as master of the science and art of the care of sick infants and children. It is, therefore, enlightening to see what the relatively pure pediatrician can achieve as professor of pediatrics.

He brought to pediatrics a good mind which would have assured success in a number of fields.
ASSOCIATION OF ESCHERICHIA COLI SEROGROUP 0111 WITH TWO HOSPITAL OUTBREAKS OF EPIDEMIC DIARRHEA OF THE NEWBORN INFANT IN NEW YORK STATE DURING 1947
Authors: NETER ERWIN , KORNS ROBERT F. , TRUSSELL RAY E.
Published: December 2021

Escherichia coli serogroup 0111 was isolated in 1952 as the predominant coliform organism from 5 fecal specimens obtained from 7 infants who were suffering from epidemic diarrhea of the newborn infant during two serious hospital outbreaks of this disease in 1947. The specimens had been preserved at a temperature of -40° to -70° C. for five years. The association of certain serogroups of E. coli and epidemic diarrhea of the newborn infant is discussed.
RECENT STUDIES ON IMMUNIZATION AGAINST POLIOMYELITIS
Authors: SALK JONAS E.
Published: December 2021

The simple fact is: That an experimental method for inducing measurable amounts of antibody for the three known poliomyelitis viruses, employing a killed-virus vaccine is available, and it now becomes possible to determine whether—and to what extent—the incidence of naturally occurring paralysis may be influenced.

All that should be inferred now is that studies are progressing satisfactorily; there have been no set-backs nor anything but revelations that shed more light on the course ahead. We must continue to regard the experimental developments to date as providing immunologic markers along the way that tell us whether we are on the right road. That there is more to do now than before indicates that we have not stumbled down a by-way but have selected a road, with many lanes, that seems long indeed. Our problem is to select not only the fast lane but the one that is safest and most certain.
HORMONE PATTERNS IN PATIENTS WITH CONGENITAL ADRENAL HYPERPLASIA
Authors: KELLEY VINCENT C. , ELY ROBERT S. , RAILE RICHARD B.
Published: December 2021

Measurements of plasma 17-hydroxycorticosteroid concentration and urinary 17-ketosteroid excretion were made in children with congenital adrenal hyperplasia. These results have been compared with blood ACTH titers in the same children. Prior to cortisone therapy endogenous ACTH concentrations and 17-ketosteroid excretion were abnormally high whereas circulating 17-hydroxycorticosteroid concentrations were exceptionally low. During the period of cortisone therapy these values approached normal. Adrenal unresponsiveness to ACTH was evidenced in patients with congenital adrenal hyperplasia by their failure to produce elevations of circulating 17-hydroxycorticosteroid concentrations in response to ACTH injection.
INCONTINENTIA PIGMENTI
Authors: BAMBRIDGE HONOR
Published: December 2021

The salient features of the disease complex formerly known as incontinentia pigmenti are discussed and a brief review of the literature is given.

A further case is reported, that of a six months old female infant who has a characteristic history of inflammatory vesicular lesions present shortly after birth, and fading to leave a brownish marbling of the skin and warty areas on the phalanges. Other defects manifest in this infant include microcephaly, mental retardation, spastic tetraplegia (Little's disease), epileptiform seizures, vulval hirsutism and congenital dislocation of the right hip joint.
POLIOCIDAL ACTIVITY OF SOME COMMON ANTISEPTICS WITH SPECIAL REFERENCE TO LOCALIZED PARALYSIS
Authors: FABER HAROLD K. , DONG LUTHER
Published: December 2021

Evidence herein presented that poliomyelitis virus may, in rare instances, be introduced into the body by penetrating local trauma (tonsillectomy, injections) emphasizes the importance not only of proper sterilization of instruments, needles and syringes but also of preparing the surface to be traumatized with an antiseptic capable of quickly destroying poliomyelitis virus, preferably within half a minute.

Of the local antiseptics tested, mild (2%) tincture of iodine was found to be highly effective; tincture of merthiolate moderately so; tincture of metaphen and 2% hexachlorophene only slightly effective; and ethyl alcohol (70%) and tincture of zephiran, ineffective, all within the stated time limit. The mild tincture of iodine is therefore recommended for routine use.

Antiseptic should also be applied to the stopper of the vial before withdrawing material for injection.

While the preventive prophylactic value of local antisepsis against poliomyelitis is undoubtedly limited, its routine use is clearly indicated and might prevent some occurrences of localized paralysis.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HUBBARD JOHN P.
Published: December 2021

My attention, rather belatedly, has been called to a rather startling evidence of confusion oven the terms social medicine and socialized medicine in the tribute paid to our beloved and highly esteemed friend, Dr. Joseph Wall. I refer to the "In Memoriam" at the bottom of page 232 of the August 1953 issue of Pediatrics. Here one notes the following:

"It would be impossible to evaluate his service to the Academy, and the medical profession generally. To him `social medicine' was as the setting sun to medical freedom. He fought `socialized medicine' in no unmistakable terms. The encroachment of Government in medicine, and pediatrics in particular, found a worthy opponent. He was never dismayed by the might of social interests, nor faltered in aggressive attacks on their activities."

Certainly no one could question Dr. Wall's vigorous attacks upon the encroachment of "socialized medicine." At the same time he would be the last one to wish to have "socialized medicine" confused with social medicine. He was, in fact, a leader among us in broadening the Academy's izonhorizon in the social implications of health services for children and the whole structure of community organization in behalf of improving child health.
EDUCATION
Authors: GIANNINI MARGARET JOAN , SNYDER ELKAN , SMITH HAROLD MICHAL- , SLOBODY LAWRENCE B
Published: December 2021

A simple home training program for retarded children has been presented in brief. This program has been used with 58 children for over nine months and has proved to be of value to the child and parents.
TRANSIENT COMPLETE ATRIOVENTRICULAR HEART BLOCK OF UNKNOWN ETIOLOGY
Authors: TRAISMAN ALFRED S. , TRAISMAN HOWARD S.
Published: December 2021

Complete atrioventricular heart block in a nine year old male, of unknown origin, with accompanying Adams-Stokes syndrome rome has been presented. An interesting aspect of this case is that the complete atrioventricular dissociation reverted to sinus rhythm with first degree atrioventricular block, and a right bundle branch block pattern. Clinically, the boy is well and engaging in normal activity.
OBSERVATIONS ON TOTAL BODY CHLORIDE IN CHILDREN
Authors: CHEEK DONALD B.
Published: December 2021

The distribution of bromide has been used to measure total body chloride in 50 infants and children. Total chloride has been found to follow the differential growth equation. An index of extracellular water has been obtained and followed with the progress of age. It has been found that infants in early life have 40% more chloride per unit weight than adults. Total chloride/kg. shows a rapid proportionate decrease during the first year of life.
DEFICIENCY IN GAMMA GLOBULIN WITH EDEMA AND HYPOPROTEINEMIA
Authors: FRIED CHARLES T. , HENLEY WALTER L.
Published: December 2021

A case of edema, hypoproteinemia and deficiency in gamma globulins is reported.
THE WEAPON OF TRUTH
Authors: BEAVEN PAUL W.
Published: December 2021

The first general meeting of the Academy of Pediatrics was held in Atlantic City in 1931. A year previously a meeting had been held in Detroit, at which time officers were elected and a constitution was adopted. The meeting at Atlantic City was a report of committees appointed the year before. This was followed by a business meeting. During this session Dr. Henry Gerstenberger, newly appointed head of the Committee on Hospitals, made a formal recommendation from his group. One of the first acts of the Academy, he stated, should be an evaluation of the current methods of teaching pediatrics in medical schools. The recommendation was also that an analysis should be made of the care of children in hospitals and other children's institutions. Such a survey should be repeated periodically.

Dr. Gerstenberger emphasized his suggestion by stating that only projects of this nature could justify a new pediatric society. He and his committee felt strongly that this new organization should not be just scientific and social, for other pediatric societies fulfilled that need. It should have as a goal the greater welfare of all children. This point also was the theme of the presidential address of Dr. Isaac Abt at this same meeting.

The suggestion of a Child Care Survey was referred to the Committee on Child Health Relations and to the Committee to Cooperate with Governmental and Non-medical Agencies. No continuing program ever followed this suggestion. Events described here show that it was a task no new organization could successfully have undertaken.

In 1935, four years later, Dr. Clifford G. Grulee, Secretary of the Academy, submitted what might be called a modification of the suggestion made by Dr. Gerstenberger.
CLINICAL AND LABORATORY DIFFERENTIATION BETWEEN HERPANGINA AND INFECTIOUS (HERPETIC) GINGIVOSTOMATITIS
Authors: PARROTT ROBERT H. , WOLF STANLEY I. , NUDELMAN JESSE , NAIDEN EULAINE , HUEBNER ROBERT J. , RICE E. CLARENCE , MCCULLOUGH NORMAN B.
Published: December 2021

Thirteen cases of herpangina and 12 cases of gingivostomatitis were studied as to etiology and clinical picture. In almost all cases the clinical impression was confirmed by virus isolation. Tests done to establish other possible etiologic agents for these diseases were either negative or not statistically significant. The importance of these findings as they apply to diagnosis and treatment is discussed.
THE ATHETOID SYNDROME IN CEREBRAL PALSY
Authors: LAMM STANLEY S. , KOVEN LEO J.
Published: December 2021

Athetosis in infancy and childhood is primarily the result of anoxia associated with the birth of the infant. A secondary factor is icterus and Rh incompatibility, especially in the deaf athetoid. The family background, and period of pregnancy appear to play no role in the etiology of athetosis. The order of pregnancy is highly significant, the risk of pathology being enhanced with the first delivery. The finding that anoxia plays the paramount role, is consistent with proven pathological studies which have revealed changes in the brain associated with anoxia.

The incidence of athetosis may be lessened if the primary factors which lead to anoxia, Rh incompatibility and icterus, are avoided or controlled.
PAROXYSMAL FUSSING IN INFANCY, SOMETIMES CALLED "COLIC"
Authors: WESSEL MORRIS A. , COBB JOHN C. , JACKSON EDITH B. , HARRIS GEORGE S. , DETWILER ANN C.
Published: December 2021

The literature on "infantile colic" or "paroxysmal fussing" is reviewed.

The frequent occurrence of a regular evening fussy period in two groups of infants is reported as indicative that this is a normal physiological event of the first few weeks of life.

The longitudinal records of 98 infants who were study subjects of the Yale Rooming-In Project were analyzed with respect to incidence, duration, and severity of "paroxysmal fussing." Forty-eight of the infants were classified as "fussy" and 50 as "contented."

The "fussy" babies typically began to have their paroxysms in the second week of life and ceased to have them at about eight weeks. Almost all of them were more fussy in the evening hours than in the morning. The rationale of various methods of treatment is discussed.

The "fussy" group was similar to the "contented" group as regards details of feeding, birth weight, weight gain, sex, educational level of the mother, and family history of allergy.

Of the 48 "fussy" infants, family tension was judged to be an important contributing cause in 22 cases, allergy in six cases; both allergy and family tension together in nine cases; in 11 cases there was no apparent cause.

"Paroxysmal fussing" or "infantile colic" is possibly one of the earliest somatic responses to the presence of tension in the environment. The particular degree to which any infant reacts is probably determined by constitutional factors.
IMPAIRMENT OF SWEAT SECRETION IN MALNOURISHED INFANTS
Authors: KAHN E. , RAND M. D. , WALKER A. R. P.
Published: December 2021

Severely malnourished African infants are often feverish during hot summer weather. To elucidate the cause of this phenomenon, malnourished infants and controls were studied under standard conditions of heat stress with regard to sweat secretion and rise of body temperature. There was a marked impairment in the function of the sweat glands in the malnourished infants and the mean body temperature rose higher than that of the controls. The derangement of the sweat secretion was not related to the extent of the nutritional oedema. There was no close correlation between impairment of sweat secretion and rise in body temperature. The possible reasons for these observations are discussed. It is suggested that dysfunction of the sweat glands in severe malnutrition is caused by a poor peripheral circulation.