bluuebunny/crossref_metadata_2025 huggingface dataset:
PARA-AMINOBENZOIC ACID IN THE TREATMENT OF ROCKY MOUNTAIN SPOTTED FEVER
Authors: ROSS SIDNEY , MCLENDON PRESTON A. , DAVIS HUGH J.
Published: December 2021

PABA was used in 17 cases of Rocky Mountain spotted fever during the summers of 1946 and 1947 with recovery of all patients. Both the morbidity and degree of toxicity were decreased. The earlier the initiation of PABA therapy, the better the response. Favorable therapeutic results can probably be expected if the drug is started before the seventh day. The optimal time for initiating treatment probably is during the fist four days after the onset of the disease. The importance of early diagnosis is emphasized.

There is considerable variation in the PABA blood level achieved with comparable dosage, there being no definite linear or curvilinear correlation between dosage and blood concentration. On the average, a dose of 0.9 gm./kg. body weight in 24 hours in a two-hour divided dosage schedule was found to be satisfactory in children.

PABA has few toxic manifestations. A leukopenia without granulocytopenia was found to occur in some cases. Cephalin flocculation tests showed an increase in positivity during PABA therapy. A reducing substance which produced a green or yellow reduction with Benedict's reagent was found in 55% of the urines examined during PABA therapy. This reducing substance is probably a benzoylglucuronide resulting from the conjugation of PABA with glucuronic acid.
FRACTURE OF THE ANTERIOR SPINE OF THE ILIUM
Authors: GALLAGHER J. ROSWELL
Published: December 2021

Four cases of fracture of the anterior spine of the ilium are reported; and the conditions under which this disorder develops and should be suspected are discussed.

A period of from two to three weeks of bed rest with knee flexed is suggested as the treatment of choice. Surgical intervention or the use of plaster spica was considered unnecessary in these cases.
REPRODUCTIVE HISTORIES OF THE MOTHERS OF 322 INFANTS WITH ERYTHROBLASTOSIS
Authors: POTTER EDITH L.
Published: December 2021

One hundred and seventy-five women observed since 1934 who became immunized to Rh at some time during their reproductive careers had a total of 699 pregnancies prior to January 1, 1948. They had 341 pregnancies preceding the birth of the first infant with erythroblastosis. These resulted in seven stillbirths, 13 neonatal deaths, 65 abortions and 256 surviving children. Forty-four of these abortions followed the birth of the last normal child and preceded the birth of the first child with erythroblastosis. The average number of surviving children born to each patient before the birth of an infant with erythroblastosis was 1.4.

The diagnosis of erythroblastosis was made for the first time in seven women in a first pregnancy and 168 women in second or subsequent pregnancies. Four of the women without earlier pregnancies had had transfusions. Of the 178 affected infants 56 died before birth, 60 died after birth and 62 survived.

Ninety-six women had 179 pregnancies following the birth of an infant with erythroblastosis. These have ended in the birth of 3 Rh-negative, 144 Rh-positive infants with erythroblastosis and 32 abortions. Thirteen of the abortions are known to have been induced. Sixty-nine of the Rh-positive infants were stillborn, 63 died and only 12 survived. Three of the latter are known to have brain damage.

The 322 infants with erythroblastosis included 158 males, 132 females and 32 of unknown sex. Twenty-eight percent of affected males and 23% of affected females survived.

Among 131 infants with erythroblastosis delivered in the Chicago Lying-in Hospital the mortality rates were: 38% for 58 infants whose birth had not been immediately preceded by a transfusion, abortion or erythroblastosis in a sibling; 74% for 27 infants whose birth was immediately preceded by an abortion or a transfusion; 90% for 46 infants whose birth was preceded by that of an infant with erythroblastosis.

Among 18,468 deliveries at the Chicago Lying-in Hospital in the last five years the frequency with which erythroblastosis occurred for the first time varied from once in 2,814 deliveries for women in their first pregnancies to 1:172 in second pregnancies and in 1:55 for sixth pregnancies.

In the last two years no live born infant has died of erythroblastosis in this hospital who has not had an older sibling affected by the same disease.

In evaluating any method of treatment the previous reproductive histories of the mothers of the treated infants must be taken into account. In our hands the previous maternal history has been of more value in prognosticating the fate of an infant born to an immunized Rh-negative woman than have changes in maternal antibody titer or differences in the variety of antibodies present.
PSYCHOTHERAPEUTIC ASPECTS OF PEDIATRIC PRACTICE
Authors: BRUCH HILDE , MCCUNE DONOVAN J.
Published: December 2021

THE profound importance of emotional influences for the healthy or abnormal development of children is now generally recognized. Knowledge of this fact is so widespread, indeed, that one can scarcely open a medical journal or popular magazine without being confronted with it. This cartoon illustrates the fate of maldevelopment. It shows father, mother, sister and brother—all of them at once—under psychoanalytic treatment. The caption explains that a neurosis has its basis in conflicts within the family group. One might well raise the question: "Why did things go wrong to such an extent? Couldn't their pediatrician have advised them so that at least the children would have remained well?" This is a troublesome question from the point of view of both the psychiatrist and the pediatrician.

Psychiatrists have been very articulate in talking about the need for better emotional care but frequently the pediatrician has been left in a state of doubt and frustration. There has been too much emphasis on psychiatric methods from the psychiatrist's point of view and too little attention has been paid to the psychotherapeutic possibilities that are inherent in the practice of pediatrics.

The conventional and most fascinating way of demonstrating the importance of psychologic factors is the extensive case history which tells in detail all the vicissitudes of a child's emotional development and how the psycho-dynamics of his inner life are related to the many complaints and symptoms which had been resistant to traditional medical treatment.

The usefulness of such accounts for the pediatrician is their demonstration of what psychiatry can do and what patients might benefit from psychiatric treatment. Yet this treatment is time consuming and it requires special training and experience and it cannot be part of the practice of pediatrics.
PRIMARY DIFFUSE PARATHYROID HYPERPLASIA IN AN INFANT OF FOUR MONTHS
Authors: PHILIPS ROBERT N.
Published: December 2021

A case is reported of primary diffuse hyperplasia of the parathyroids in a 16-week-old infant. The findings included generalized osteitis fibrosa and calcification in the kidneys, lungs, thymus, bronchial cartilage and choroid plexus.
The Postnatal Development of the Human Cerebral Cortex. Volume III; The Cortex of the Three-Month Infant
Authors: BUTLER ALLAN M.
Published: December 2021

This is the third volume of Dr. Conel's unique monographic series which extends his meticulous microscopic study of the development of the human cortex to three months of age. It presents in detail the histologic criteria of development by which comparison may be made of brains of the same or different ages or of various areas within the cortex of one brain. The criteria are: 1. width of entire cortex and of each horizontal layer; 2. number of cells; 3. size of nerve cells; 4. condition of the chromophil substance ; 5. neurofibrils ; 6. size, compactness of structure (including varicosities), and length of processes of nerve cells; 7. pedunculated bulbs; 8. size and quantiy of exogenous fibers; and 9, state of myelination. The manifestations of growth and development of the cerebral cortex by these criteria correlate with observations on the progression of voluntary activity in infants.
Re: Toxoplasmic Encephalomyelitis, Gabriel A. Schwarz, et al., Pediatrics 1:478, 1948
Authors: SCHWARZ GABRIEL A.
Published: December 2021

In our paper on Toxoplasmosis, recently published in Pediatrics, we included a case reported by Drs. Syverton and Slavin in the "Probable" cases in our table on page 488. Dr. Syverton has protested the inclusion of his case in the "Probable" group. The reason his case had been included in probable cases was simply because of his own uncertainty, and consequently ours, as to the relationship of the infecting agent and the symptomatology which the patient presented. Since we are stressing the clinical side, it was our feeling that this case should be clinically considered as a "Probable" case rather than a proven case.
MILK ALLERGY
Authors: Bachman Kay D. , Dees Susan C.
Published: December 2021

During two consecutive calendar years, a series of 403 babies receiving routine well-baby care were followed and records kept of all symptoms and illness occurring during their first 2 years of life.

Gastrointestinal disorders and eczematous rash were the symptoms most frequently encountered which appeared to be due to allergy. Many minor digestive, skin and respiratory symptoms were recorded which did not prove to be allergic manifestations during the 2 years of observations.

Colic was present in 52 well babies, of whom 2 were sensitive to milk.

The incidence of allergy to cow's milk in this series of infants was 4 in 403 or 1%.

Scratch tests were negative in 66 of 72 well babies tested, and no strongly positive reactions were observed. The allergens used were cow's milk, bovine lactalbumin, casein and egg. No correlation could be made between skin tests and clinical symptoms.

Three infants showed a few scattered eosinophils in the stool smear, among 156 from whom stool smears were made. These babies had colic but no symptoms suggestive of allergy later.
FAMILIAL ASPECTS OF OBESITY
Authors: Childs Barton
Published: December 2021

NO SCIENTIFIC investigation is needed to detect the familial nature of obesity, but the extent of the contribution of constitutional, cultural and other environmental components is not at all clear. That it is especially important, however, to understand these etiologic factors is suggested by the failures experienced by those who have undertaken to treat long standing obesity. A firm grasp of the nature of the causes of the condition is the key to prevention, and the time to prevent is childhood.

Before going on to a discussion of heredity in obesity it might be well to state what is possible in genetic studies on human populations. Genetics is the study of heritable variation, and it attempts to describe the degree to which familial like-nesses and dissimilarities result from the action of genes in particular environments. In general, we suppose that gene action is biochemical, and that it is expressed in the control of metabolic reactions in the cells, whether by conferring specificity upon enzymes or by other means.

Several methods for such investigation are available. First we may study discontinuous variation in which differences between individuals are clearly measureable, and a population may be divided into two or several types without misclassification. Such differences are often found to be associated with differences in molecular specificity or quantitative differences in enzyme activity. If these differences are genetic in origin, they are usually found to be due to one or at most a small number of genes, and the intrafamily distribution of the characteristics will follow some mendelian pattern.

A second method involves the analysis of continuous variation. By this is meant differences between individuals which are so small as to make actual measurement of such differences impossible, and covering a wide range or spectrum, so as to form a continuum.
MEASUREMENT OF ACTIVITY OF TRANSAMINASES IN THE SERUM AS AN AID IN DIFFERENTIAL DIAGNOSIS OF JAUNDICE IN THE NEONATAL PERIOD
Authors: Kove Simon , Goldstein Stanley , Wróblewski Felix
Published: December 2021

Measurements of transaminases in the serum have proven of value in the diagnosis of hepatic diseases in adults. It therefore seemed of interest to apply these techniques to the newborn infant.

To establish the normal range of the activity of these enzymes in the serum for the neonatal period, studies were made of glutamic pyruvic transaminase (GPT) in 63 normal newborn term infants for the first week of life. It was found that values for the activity of GPT up to 90 units must be considered physiologic for this early neonatal period. This compares to a physiologic neonatal range of activity up to 120 units for glutamic oxaloacetic transaminase (GOT), found in a previous investigation on these same infants. Thus the range of activity for these two enzymes in newborn infants is somewhat greater than that of adults in whom values up to 45 units for both enzymes are considered normal.

In neonatal physiologic jaundice the degree of hyperbilirubinemia did not affect the activity of GPT, as was also the case, from previous studies, with respect to GOT.

Serial determinations of the activity of GOT and GPT were also made in a small number of infants with jaundice due to pathologic conditions to determine the value of this test in the differential diagnosis of jaundice of unknown origin in the newborn infant. It was found that in hemolytic disease of the newborn, activity of these enzymes usually remains within the normal neonatal range. In very severe hemolysis, activity of GOT may be increased to about 300 to 400 units, temporarily, although activity of GPT remains within the normal neonatal range. In neonatal biliary obstruction there is a sustained increase of activity of transaminase in the serum which may reach values up to about 800 units for the duration of the obstruction, whether it be temporary, as in the "inspissated bile syndrome" or protracted, as in atresia of the bile ducts.

It would appear that serial measurements of the transaminases in the serum may be of distinct diagnostic value in jaundice of unknown origin in the neonatal period, and it is suggested that this procedure be included in the investigation of a clinical problem involving this syndrome.
EXTENSIVE CRANIAL DECOMPRESSION IN THE TREATMENT OF SEVERE LEAD ENCEPHALOPATHY
Authors: McLaurin Robert L. , Nichols James B.
Published: December 2021

Seven patients are presented who were treated for severe lead encephalopathy by massive bilateral cranial decompression.

Of the seven patients, five are alive. One of the fatalities resulted from gastrointestinal hemorrhage 1 week later although it is believed the encephalopathy was controlled.

There is recognized significant mental retardation present in two of the surviving patients although the remaining patients cannot be accurately evaluated at the present age. One of the two showing definite retardation also had craniosynostosis which may itself be associated with cerebral dysfunction.

A plea is made for more widespread use of decompression as a lifesaving measure and it is further suggested that the impairment of mental function following lead encephalopathy may be reduced if cerebral decompression is undertaken when it becomes apparent that the course of the disease is not being altered by medical agents.
USE OF GLUCOSE, INVERT SUGAR AND FRUCTOSE FOR PARENTERAL FEEDING OF CHILDREN
Authors: Lane Harold C. , Dodd Katharine
Published: December 2021

Eighteen children were infused with 10% solutions of glucose, invert sugar and fructose during a period of 6 hours at a rate of infusion of 1.25 gm of sugar per kilogram of body weight per hour. All but two of the children had less glycosuria from intravenous administration of glucose than from the administration of invert sugar or fructose. In 16 children glucose appeared in the urine only during the first 2 or 3 hours of infusion of glucose, but fructose was generally present in the urine during almost all of the 6 hours of infusion of invert sugar or of fructose. Eleven of the eighteen patients had more melituria during the first 2 hours of infusion of glucose than during the first 2 hours of infusion of invert sugar or fructose. This contrasts with the total amount excreted over an 8-hour period.

When glucose was administered, total concentration of sugar in the blood obtained during the first 2 hours of infusions were higher than concentrations obtained during infusions of invert sugar and fructose; subsequently, there was often little difference in total concentration of sugar in the blood during infusion of the three hexoses. Determinations of concentrations of sugars in the blood revealed that the renal threshold for glucose was above 175 mg/ 100 ml of blood, while the threshold for fructose was frequently as low as 10 mg/ 100 ml of blood.

There was no significant difference in total volumes of urine obtained from each patient at the end of 8-hour collection periods after infusions of the three carbohydrates.

The present study suggests that in some children who require intravenous fluid therapy with maximum caloric intake for periods longer than 2 hours glucose is to be preferred to invert sugar or fructose. Whether glucose is the best choice for children after operation or in situations of severe stress remains to be demonstrated.
NEWER DRUGS WHICH INFLUENCE BEHAVIOR
Authors: Steigman Alex J.
Published: December 2021

It has been pointed out that certain chemically related compounds can induce mental aberration in man and animals which other chemicals can correct. These latter chemicals are capable of modifying the inherent aggression of certain lower animals and of inducing serenity in some humans with disturbances of mentation and behavior. The duration of effects, the long-range consequences, the possibility of habituation remain important unknowns.

Comparisons have been drawn among the three large areas of pediatric interest— Nutrition, Infection, Behavior. These have been dominated in a natural evolutionary sequence by the applied rules of hygiene until such time as precise methods and potent specifics were available. The dawn of these methods in the field of Behavior may be at hand. It is unnecessary to point out the fantastic importance of scientific study of behavior, particularly in children whose habits and human values are being shaped by the learning process. The orthodox, conservative, methodical, dispassionate methods of medical research, combining the talents of clinical and basic science, have brought rich rewards to children in the areas of Nutrition and Infection. There is hope that this same approach, if untrammeled by the fanfare of hucksterism—medical or lay, will sometime in the future bring important rewards in the area of Behavior.
INTRACRANIAL COMPLICATIONS OF LEUKEMIA IN CHILDREN
Authors: Sullivan Margaret P.
Published: December 2021

Pathologic findings in the brain and meninges in untreated patients with leukemia have been reviewed. Involvement of the meninges and cerebral parenchyma were not unusual and occurred in acute and chronic disease regardless of cell type.

Despite the frequency of intracranial involvement in untreated patients with leukemia, resultant clinical symptoms were infrequently noted. In the English literature only nine published reports suggestive of increased intracranial pressure in the patient with untreated disease could be found.

A number of leukemic children who have received adrenal steroid hormones and chemotherapy have developed signs of increased intracranial pressure. Approximately one-fourth of the children with leukemia followed at this hospital in the last 18 months have developed this complication. Symptoms and signs are variable but usually include irritability, headache, vomiting, papilledema, separation of sutures, increase in circumference of the head, increased pressure and concentration of protein in the spinal fluid and normal or low concentration of sugar. In rare instances children with this sydrome have also developed hypertension, increased appetite with resultant obesity and various neurologic abnormalities.

The pathogenesis of this syndrome is unknown. The available evidence suggests that such agents as 6-mercaptopurine and Methotrexate® which are known to cross the blood-brain barrier in greatly reduced amounts fail to control the intracranial progression of leukemia even though the disease may be under fair control elsewhere in the body.

The most effective treatment for this complication at the present time is therapy with roentgen rays to the entire skull. Usually a total of 250 to 500 r given in 7 to 10 days will cause symptoms to disappear and spinal fluid findings to improve without adversely affecting the course of the disease in general. There is also some evidence that oral therapy with adrenal steroid hormones is also effective if resistance to this type of therapy has not already developed.
ACUTE DIPHENYLHYDANTOIN INTOXICATION
Authors: Moling John H. , Posch James J.
Published: December 2021

Two case histories of intoxication due to diphenylhydantoin are reported. A review of the literature of previously reported cases is presented. The pharmacology of diphenylhydantoin is briefly discussed.
CAT SCRATCH DISEASE AS A CAUSE OF THE OCULOGLANDULAR SYNDROME OF PARINAUD
Authors: Margileth Andrew M.
Published: December 2021

Ten children with proven cat scratch disease have been observed in the past 3 years. Four of these cases had the oculogandular form of the disease and are presented in detail. The importance of a complete examination of the eyes and of skin testing patients who have preauricular adenopathy with cat-scratch-disease antigen is emphasized. Surgical excision of the primary ocular lesion appears to shorten the course of the disease. Antibiotic therapy was ineffective in comparison with excision of the ocular granuloma.
PHAGOCYTOSIS IN PREMATURE INFANTS
Authors: Gluck Louis , Silverman William A.
Published: December 2021

The paucity of data regarding phagocytosis in the newborn is reviewed. A method of evaluating phagocytosis in the human is presented, in which the proportion of "effective phagocytes" (cells containing 10 or more carbon particles) is scored, rather than the total number of cells engulfing particles. Employing the criteria described, we have found significant differences in phagocytic ability between the blood of premature infants and that of adults or full-term infants. Differences observed between full-term infants and adults in respect to phagocytic capacity of leukocytes were not clearly significant. In general, increasing phagocytosis was observed, approaching adult levels with increase in birth weight. Addition of fresh, normal adult serum to invitro preparations of premature infants' blood significantly enhanced phagocytosis. The substances in serum which stimulated phagocytosis were identified by electrophoresis to be in the fractions generally known as α1-, α2-, and β-globulin.

A possible therapeutic use for adult serum in the premature is postulated and is being studied.
IMMUNOLOGIC STUDIES IN CONGENITAL AGAMMAGLOBULINEMIA WITH EMPHASIS ON DELAYED HYPERSENSITIVITY
Authors: Porter Herbert M.
Published: December 2021

Immunologic studies of a patient with agammaglobulinemia are reported. The delayed type of hypersensitivity was normally produced in response to antigenic stimuli, but circulating antibodies of the gamma globulin fraction of the serum were not. It is postulated that delayed hypersensitivity is responsible for the apparent immunity developed against measles and chicken pox. The tuberculin response is independent of gamma globulin in the serum.

The family tree of first cousins with congenital agammaglobulinemia is presented and supports the concept that the disease is a sex-linked recessive trait appearing only in male children.
METABOLISM OF AMINO ACIDS
Authors: Snyderman Selma E.
Published: December 2021

There has not as yet been widespread application of the large amount of information which has been accumulating in the field of metabolism of amino acids. There are several ways in which this information could be utilized. Both the prevention and treatment of kwashiorkor might be efficiently accomplished by the supplementation of existing diets with the specific amino acids in which they are deficient. A study of the requirements and of the patterns of excretion of amino acids in various disease states might demonstrate either a qualitative or quantitative difference in requirements of amino acids produced by the pathologic state. Lastly, it is quite possible that a study of metabolism of amino acids in as yet unexplained syndromes might reveal hitherto unrecognized metabolic aberrations.
DETERMINATION OF SOME STREPTOCOCCAL ANTIBODY TITERS AND ACUTE PHASE REACTANTS IN PATIENTS WITH CHOREA
Authors: Harris T. N. , Friedman Sidney , McLean David C.
Published: December 2021

Forty-three patients with chorea were examined by a number of laboratory tests: These consisted of two streptococcal serologic titrations, antistreptolysin-O and antihyaluronidase, and three acute phase tests, the erythrocyte sedimentation rate, and the concentrations of C-reactive protein and mucoproteins in the serum. The patients were divided into two groups, those with apparently "pure" chorea, who did not show any other clinical evidence of rheumatic fever in conjunction with an episode of chorea, or at any other time to our knowledge, and those with some other evidence of rheumatic fever. In the case of each of these tests the frequency distribution of values found in the rheumatic chorea group was different from that of the "pure" chorea group, the former having a higher center and range of distribution. Also, the results of both the acute phase tests and the streptococcal serologic tests gave evidence of contamination of the "pure" chorea group with rheumatic subjects.

The data suggest that there are, in fact, two such clinical groups of patients with chorea, and that laboratory aid toward the differential diagnosis between them would be applied in the same way as in other differential diagnoses involving rheumatic fever.
CLINICAL CONFERENCE
Authors: Schulman Irving
Published: December 2021

Dr. Schulman: The case we would like to discuss is one chosen for its own intrinsic interest and also because it provides a good opportunity to illustrate some of our newer knowledge of coagulation in general, and hemophilia in particular.

The patient is a 4-year-old boy who was referred to this hospital for investigation of a hemorrhagic diathesis. His birth was normal and at the age of 7 days he was circumcised without difficulty. At 1 year of age he developed bleeding from a traumatic laceration of the left upper eyelid, which persisted for 5 days. At the age of 3 years he apparently fell and bit his tongue. This led to persistent bleeding for a period of 14 days, despite the administration of three transfusions. At 3 6/12 years of age, an upper central incisor became loose, resulting in bleeding for 3 days. At 4 years he suddenly developed a painful swelling of the right knee, which increased in severity for 5 days. Joint aspiration yielded 20 ml of blood. At no time did this boy have any other manifestations of bleeding. There had been no nose bleeds.

The members of the family are indicated in Figure 1. This patient has two brothers who are unaffected and three sisters who are also unaffected. The mother and father are unaffected. However, the mother's paternal uncle had a severe hemorrhagic disease and, in addition the mother's sister has two sons who also have bleeding manifestations. The disease, then, apparently occurs only in males. It skips a generation and is apparently transmitted by females. This is the classic sex-linked, recessive inheritance which we have come to associate with hemophilia.
Salmonella Osteomyelitis and Abnormal Hemoglobin Disease
Authors: HAMMOND DENMAN
Published: December 2021

In the September, 1957, issue of Pediatrics (20:439, 1957) appeared an article by Henry K. Silver et al., in which a case was reported as the first instance of salmonella osteomyelitis in a patient with hemoglobin C-D disease. This report will perhaps attract more interest as the first recorded case of hemoglobin C-D disease, with or without associated complications.

Documentation of the hemoglobinopathy as C-D disease is reported to have been concluded from paper electrophoretic patterns of hemoglobin C trait in one parent, a pattern similar to hemoglobin S trait in the other parent and a pattern similar to hemoglobin S-C disease in the patient, with failure to demonstrate sickling in either parents or child.
HYPERTENSION AND HYPERCALCEMIC NEPHROPATHY DUE TO VITAMIN D INTOXICATION
Authors: Way William G. , Morgan David L. , Sutton Lee E.
Published: December 2021

A case is presented of hypercalcemic nephropathy secondary to vitamin D intoxication in a child 26 months of age.

The patient exhibited hypertensive encephalopathy. The management of severe hypertension in this case is discussed in detail.

Severe renal impairment was present and regressed as the patient improved.

The pathogenesis and treatment of vitamin D intoxication is discussed.
PRESENT PROBLEMS PERTAINING TO PATENCY OF THE DUCTUS ARTERIOSUS
Authors: Engle Mary Allen , Holswade George R. , Goldberg Henry P. , Glenn Frank
Published: December 2021

The incidence of marked retardation of growth in children with patency of the ductus arteriosus was reviewed in an operative series from the New York Hospital and from the literature. Retardation in growth was present in approximately one-third to one-half of the children.

Almost all of the patients in the New York Hospital series with serious growth impairment remained retarded following otherwise successful surgery on the ductus at ages 3 to 14 years. Periods of postoperative observation ranged from 1 to 10 years, averaging 4 years.

Possible reasons for persistent impairment of growth are considered.

This observation is the basis for a recommendation of early operation for patients with patent ductus arteriosus who become retarded in height and weight. It is anticipated that this will afford a better chance of reversibility of the abnormal growth pattern, if the retardation has not persisted too long during the period of most rapid growth.
INCIDENCE OF CRANIAL NERVE PARALYSIS IN POLIOMYELITIS IN RELATION TO PRESENCE OR ABSENCE OF TONSILS
Authors: Top F. H.
Published: December 2021

Evidence is presented from data covering the period 1940 to 1952 which corroborates the conclusion of previous studies that prior tonsillectomy probably adversely affects the occurrence of brainstem paralysis (bulbar and bulbospinal) in poliomyelitis. Neither this study nor any preceding studies relating to this problem have proved the contention. On the basis that the hypothesis is correct, an attempt is made to find an answer by studying the incidence of the common paralysis of cranial nerves (VII, IX and X and XI) in bulbar and bulbospinal cases of poliomyelitis on the basis of presence or absence of tonsils.

Rates of incidence of paralysis of cranial nerves, not adjusted for age, indicate a decidedly higher proportion of paralysis of the facial nerve (VII) among nontonsillectomized patients whereas tonsillectomized persons are preportionately more affected by palatal and pharyngeal paralysis (nerves IX and X). Paralysis of the facial nerve appears from two studies to occur more commonly at earlier ages, particularly in the age group 0 to 4 years. However, age adjustment did not erase, although it did somewhat lower, the TR/TP ratio. This finding lends credence to a real difference but can only be applied to this study, as Paffenbarger in a smaller study found no significant difference in frequencies of paralysis of the facial nerve between groups with tonsils removed and tonsils present, and Southcott, also in a small study, found paralysis of the facial nerve more common among tonsillectomized patients with bulbar (includes bulbospinal) involvement. The differences noted for palatal and pharyngeal paralyses (nerves IX and X) in the unadjusted rates as between tonsillectomized and nontonsillectomized patients remain statistically different and in some instances significant when corrections for age are made.

The results of this study are suggestive but give no entirely satisfactory explanation for the differences noted. Various explanations previously offered are cited and briefly discussed. Perhaps more definitive studies in animals along the approach suggested by Southcott will prove more fruitful, namely, labelling virus by some radioactive element in order to trace the route it takes to the central nervous system.
THE RELATION OF HEPATIC FIBROSIS TO CONCENTRATION OF BILIRUBIN IN THE SERUM IN CONGENITAL ATRESIA OF THE BILIARY TRACT
Authors: Christy Raymond A. , Boley Joseph O.
Published: December 2021

Thirty-seven infants with proven congenital biliary atresia were studied. The concentrations of bilirubin in the serum were so variable in the first 2 to 3 months after birth as to make the diagnosis of congenital atresia of the bile ducts on the basis of single or serial determinations of bilirubin in the serum exceedingly difficult. The amount of fibrous tissue did not correlate significantly either with the age of the infant or with the concentration of bilirubin in the serum. The amount of fibrosis in the liver was so great in certain infants by the time they were 2 months of age that early exploration according to the technique of Swenson would appear to be advisable.
IMPROVED LOCAL TOLERANCE TO BENZATHINE PENICILLIN G
Authors: Krugman Saul , Ebin Eva V.
Published: December 2021

Four types of penicillin for intramuscular injection were compared for incidence of local reaction: (1) suspension of benzathine penicillin G, 600,000 units in 1 ml; (2) benzathine penicillin G, 600,000 units, with 5 mg of prednisolone, in 1 ml; (3) benzathine penicillin G, 600,000 units, plus aqueous procaine penicillin, 600,000 units, in 2 ml; and (4) aqueous procaine penicillin, 1,200,000 units in 2 ml.

A total of 320 children were evaluated at 24 hours, and the following percentages of severe local reaction were recorded for the four penicillin preparations listed: (1) 54%; (2) 9%; (3) 11.5%; and (4) 4%. The incidence of mild local reactions was the same following all four preparations, 11 to 12%.

The local tolerance to benzathine penicillin G, 600,000 units, was significantly improved by combining it with either 5 mg of prednisolone, or an equal dose and volume of aqueous procaine penicillin.
THE PLACE OF METHACHOLINE (MECHOLYL®) IN THE MANAGEMENT OF PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
Authors: Husson George S.
Published: December 2021

Methacholine has a distinct place in the management of paroxysmal supraventricular tachycardia.

It is recommended as the drug of choice when a patient is moribund and a fastacting drug is indicated.

Certain indispensable precautions are outlined for its use.

The interaction of methacholine and popularly used drugs such as quinidine and digitalis is discussed.

The observations on an infant with recurrent supraventricular tachycardia, successfully treated with methacholine on several occasions, are presented.
INFANT FEEDING PRACTICES IN HOSPITAL MATERNITY NURSERIES
Authors: Meyer Herman F.
Published: December 2021

THE VARIED practices in the routine feeding of infants in newborn nurseries in the United States are important to record as historic and scientific evidence of the customs of our times. This survey concerns some of the more important of these practices as they were applied in 1956 to 2,244,667 infants in 1,904 hospitals in the United States.

There is indeed a paucity of information on a national scope as to the infant feeding and other practices in maternity nurseries. As part of a comprehensive study of Child Health Services conducted in 1946-47 by the American Academy of Pediatrics with the co-operation of the United States Public Health Service and the United States Children's Bureau, it was found that 38.1% of infants discharged from 2,513 hospitals during one specified week were breast-fed; 27% were breast and bottle-fed; and 34.9% bottle-fed only. In this same study it was found that of the various feeding mixtures, 73.2% of infants received evaporated milk; 10.7% fresh milk; and 16.1% prepared milk preparations.

A complete report as to incidence of breast feeding in maternity nurseries in the United States, comparable to the data obtained by Bain in 1948, will be made in another paper.

METHODS

A questionnaire containing 21 interrogations was submitted to the nursery supervisors of the 2,981 hospitals having birth rates of 300 infants or more in 1955. The return of 63.9% of these questionnaires implies considerable enthusiasm and interest among supervisory personnel of maternity nurseries. Many pertinent comments were made and varied opinions relative to these procedures were volunteered.

A unique feature of the report is that the results are presented not only in terms of hospitals, but also in numbers of infants involved.
TRANQUILIZING DRUGS IN PEDIATRICS
Authors: Bradley Charles
Published: December 2021

The availability of so-called tranquilizing drugs as adjuncts to the therapy of emotionally disturbed children is of such recent origin that few reviews of their use in this regard have as yet appeared. The present article discusses a tentative classification of these substances, their general effects, probable mode of action and potential hazards. Included is a brief review of the literature concerning the use of the following preparations as tranquilizers for children: chlorpromazine, reserpine, azacyclonol, hydroxyzine and meprobamate. Indications for their use are briefly outlined, as are some of the principles of their effective administration. Emphasis is placed upon the fact that tranquilizing drugs may be useful for the relief of symptoms, but that in the total treatment of emotionally disturbed children all other available means of psychologic management should also be employed.
Methemoglobinemia Due to Benzocaine
Authors: GOLUBOFF NATHAN
Published: December 2021

I noted with interest the report on "Methemoglobinemia Due to Benzocaine" (Pediatrics, 20:915, 1957), apparently caused by an ointment containing benzocaine. I had expected that sooner or later such a case would be reported.

Dr. Wolff referred to a case I reported previously: "Methemoglobinemia in an Infant —Associated with Application of a Tar-Benzocaine Ointment" (J. Pediat., 47:22, 1955).

At the time this was reported I was uncertain as to whether the 2½% tar or the 5% benzocaine in the ointment was the toxic factor, and could find no case of methemoglobinemia caused by either substance in ointment or otherwise.
THE RELATION OF VITAMIN K TO HYPERBILIRUBINEMIA
Authors: Asteriadou-Samartzis Elizabeth , Leikin Sanford
Published: December 2021

The concentration of bilirubin in the serum in a group of 119 premature and full-term infants was studied after the administration of water-soluble vitamin K and vitamin K1. It appeared that large doses of water-soluble vitamin K produced a higher concentration of bilirubin than was found in the control infants. Vitamin K1 administered intravenously did not have a hyperbilirubinemic effect.

The mean concentration of bilirubin on the fifth day for infants given 25 mg of vitamin K1 orally approximated that of the untreated control group. However, the regression line of body weight versus concentration of bilirubin for this group showed a tendency towards hyperbilirubinemia in infants of less than 2500 gm (5 lb).
RECURRENT PHEOCHROMOCYTOMA
Authors: Cone Thomas E.
Published: December 2021

A recurrent pheochromocytoma developing de novo in the neck of an 8-year-old white boy 2¼ years after the successful surgical removal of a right suprarenal pheochromocytoma is presented.

The patient remained in excellent health for approximately 2¼ years after the removal of the original pheochromocytoma. He then developed a firm, slowly enlarging mass in the right side of the neck after an attack of tonsillitis. This mass proved to be a functionally active pheochromocytoma.

No previous report of a recurrent pheochromocytoma developing at a different site many months after the successful surgical removal of the primary pheochromocystoma could be found in the American literature.
METABOLIC STUDIES OF NORMAL FULL-TERM INFANTS FED PASTEURIZED HUMAN MILK
Authors: Fomon Samuel J. , May Charles D.
Published: December 2021

Six normal full-term infants were fed human milk during all of the first 6 months of life and three normal full-term infants were fed human milk during portions of that period. Data are presented concerning growth in length and weight. The mean concentration of total protein in the serum was 5.2 gm/100 ml and that of urea nitrogen was 6.3 mg/100 ml. Data from 74 nitrogen balance studies of the nine infants are presented.

The mean volume of intake of pasteurized human milk during the balance periods performed in the first 1½ months of life was 218 ml/kg/day, decreasing to 140 ml/kg/ day between 4½ and 6 months of age. Assuming a mean concentration of 67 cal/100 ml of the pooled human milk, the mean caloric intake of the infants during the first 1½ months of life was 147 cal/kg/day, decreasing to a mean intake of 94 cal/kg/day between 4½ and 6 months of age. The mean intake of protein during the first 1½ months of life was 2.4 gm/kg/day, decreasing to 1.5 gm/kg/day between 4½ and 6 months of age.

The mean retention of nitrogen at 1 month of age (calculated from the regression equation) was 180 mg/kg/day, gradually decreasing to 47 mg/kg/day by 6 months of age. These retentions are considerably less than those reported for infants receiving the higher intakes of protein (generally more than 3.5 gm/kg/day) provided by many formulas of cow's milk.

The mean gain in weight for each gram of nitrogen retained by the infants was 42.1 gm.
BREAST FEEDING IN THE UNITED STATES: EXTENT AND POSSIBLE TREND
Authors: Meyer Herman F.
Published: December 2021

The per cent of infants in the United States leaving hospital maternity nurseries with breast feeding decreased from 38%, in 1946, to 21% in 1956. There is evidence in each category of states and regions of the United States that there is less breast feeding of hospital newborn infants than there was a decade ago. If confirmed 10 or 20 years hence by comparable surveys, it could be said that a trend existed toward less breast feeding in this country. The presented data suggest an inclination or slant toward that direction.

The results of statistical data shown in the two surveys discussed in this report, and the results anticipated in future surveys, are a reflection of an important change in our cultural pattern. Any variation either way in the incidence of the ancient practice of breast feeding of newborn infants is anthropologically important in regard to the culture of the present time.
CORONARY THROMBOSIS AND MYOCARDIAL INFARCTION IN A 4½-YEAR-OLD BOY
Authors: Kambolis Katherine P. , Lebhar Neil F. , Barnett Roy N.
Published: December 2021

A case of fatal massive myocardial infarction in a 4½-year-old boy is presented. The underlying thickening of the coronary artery, aneurysm formation and thrombosis are believed to be of inflammatory origin.
Letters to the Editor
Authors: LAHEY M. E.
Published: December 2021

You have asked that I comment on Dr. Ulstrom's better regarding certain statements appearing in the April report of the Committee on Nutrition. By complying, I find myself in the somewhat ambiguous position of agreeing in part with the Committee and in part with Dr. Ulstrom! The reason for this ambiguity is that both Dr. Schubert and I believe that the syndrome under consideration probably does not constitute a single entity. It seems to us (and I believe this opinion is shared also by Drs. Cartwright and Wintrobe) that two separate and probably fundamentally different entities are represented within the case material described.
THE POSSIBLE ROLE OF THE PHYSICIAN IN CAUSING HYPERNATREMIA IN INFANTS DEHYDRATED FROM DIARRHEA
Authors: FINBERG LAURENCE
Published: December 2021

THE OBSERVED incidence of hypernatremia in dehydrated infants has been much higher during the past decade than ever before. It therefore behooves us to see whether this increase is real, and whether current feeding or therapeutic practices are contributing to the problem. The greater hazard to life and health found accompanying this type of dehydration, over the more usual type (where concentration of sodium in the plasma is within the normal range), gives heightened stimulus to this quest.

The paper appearing in this issue of Pediatrics by Colle et al. presents data on one aspect of pediatric management that seems clearly implicated, namely, the administration of feedings containing large amounts of solutes to infants who have diarrheal disease.
THE DEGREE AND DURATION OF POLIOMYELITIS VIRUS EXCRETION AMONG VACCINATED HOUSEHOLD CONTACTS OF CLINICAL CASES OF POLIOMYELITIS
Authors: Davis David C. , Lipson Martha J. , Carver David H. , Melnick Joseph L. , Robbins Frederick C.
Published: December 2021

A study of the fecal excretion of poliovirus was made among household contacts of poliomyelitis patients in an attempt to determine whether or not prior administration of Salk vaccine had influenced susceptibility to gastrointestinal infection. No signfficant difference in excretion of virus was found between children who had received one or two doses of vaccine and those who had not been previously vaccinated.
A DEFECT OF GLUTATHIONE METABOLISM IN ERYTHROCYTES FROM PATIENTS WITH A NAPHTHALENE-INDUCED HEMOLYTIC ANEMIA
Authors: Zinkham W. H. , Childs B.
Published: December 2021

Four patients are reported who suffered hemobytic anemia after exposure to naphthalene. These were all Negroes; three were male and one female.

All the patients were shown by determinations of concentrations of glutathione in whole blood and the glutathione stability test to possess erythrocytes with a defect of glutathione metabolism.

One of these patients was a newborn infant to whom naphthalene and its metabolites must have been delivered through the placenta, since both he and his mother had profound hemolytic anemia, but she alone ingested moth balls.

In-vitro tests are reported showing the effects of naphthalene and its metabolites on the reduced glutathione of the erythrocytes of the patients. Naphthalene itself is innocous while alpha-naphthoquinone and alpha-naphthol lowered the concentration of reduced glutathione of the erythrocytes in lower dilutions than did beta-naphthoquinone and beta-naphthol.

Repeated stability tests done with the erythrocytes of the infant and covering a period of more than 3 months gave support to the hypothesis that the defect in glutathione metabolism expresses itself only in older erythrocytes.
STUDY OF FAT ABSORPTION UTILIZING I131-LABELED CORN OIL IN INFANTS AND CHILDREN WITH AND WITHOUT STEATORRHEA
Authors: Spector Samuel , Matthews LeRoy W. , Lemm Frances J. , Erp Ymkje Van , Cline Jean
Published: December 2021

A method for measuring the absorption of I131-labeled fat is presented.

In normal infants the degree of fat absorption, by the method presented, appears to be a function of age.

In infants and children with cystic fibrosis of the pancreas the test provides a means of studying the lipolytic function of the pancreas and the efficacy of the addition of pancreatic extracts to the diet.

The test provides a means of recognizing the presence and severity of the celiac state where it is a factor in malnutrition.