bluuebunny/crossref_metadata_2025 huggingface dataset:
CONGENITAL AFIBRINOGENEMIA
Authors: FRICK PAUL G. , MCQUARRIE IRVINE
Published: December 2021

A case of congenital afibrinogenemia is described. Despite the absolute incoagulability of afibrinogenemic blood, this type of hemorrhagic diathesis is not accompanied by hemarthrosis.

Systematic studies of this patient's blood revealed that all other known clotting factors are present in normal concentration.

Comparison of the electrophoretic patterns of afibrinogenemic plasma and serum confirmed the fact that except for fibrinogen no other clotting factor is detectable by routine electrophoretic analysis. This is due to the extremely small concentration of these entities when compared with the value of total serum proteins.

On the basis of family studies the hereditary pattern of congenital afibrinogenemia is assumed to be recessive and not sex-linked.

The rate of disappearance of fibrinogen from the blood stream after transfusion of Cohn's Fraction I has been studied. Starting from a level of 161 mg./100 cc., the zero level was reached in 12 days.
USE OF CORTISONE IN MALNOURISHED CHILDREN
Authors: GLASER KURT , FREUNDLICH EMIL
Published: December 2021

Twenty-five case reports of infants with severe malnutrition treated with cortisone are presented and the results of this clinical experimental study are discussed.
ACUTE SUBDURAL HEMORRHAGE AT BIRTH
Authors: SCHIPKE RAYMOND , RIEGE DAVID , SCOVILLE WILLIAM B.
Published: December 2021

The term "acute subdural hemorrhage of the newborn" has been suggested for comparison with subarachnoid hemorrhage of the newborn and chronic subdural hematoma of infancy.

Two cases of subdural hemorrhage in the newborn, treated by subdural drainage, are presented in detail. Five additional cases discovered at autopsy are discussed.

Increased tension of the fontanelle is the most important single sign for directing attention to the possibility of subdural bleeding at birth.

Early recognition as a prerequisite for favorable therapy is emphasized.

Subdural bleeding of clinical significance is best demonstrated by coronal subdural taps.
RETICULOENDOTHELIOSIS AND MYELOPROLIFERATIVE DISORDERS
Authors: SILVER HENRY K.
Published: December 2021

1. The case of a three-year-old boy is presented who had hepatosplenomegaly, bleeding manifestations, reticulocytosis, marked thrombocytopenia and leukocytosis and in whom abnormal cells of various types were found in the peripheral blood. These abnormal cells included nucleated red cells, young myeloid forms as well as immature monocytes. The bone marrow was characterized by a marked increase of nucleated red cells, in all stages of developments, as well as by a moderate increase of mature and immature monocytes.

2. This case appeared to be related clinically to: (1) erythroleukemia; (2) leukoerythroblastosis; (3) monocytic leukemia, both of the Naegeli type and (4) of the Schilling type with leukomoid reaction; (5) leukemic reticuloendotheliosis, and (6) patient No. VII of Downey.

3. The interrelationships between these disorders is discussed.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: LICHTY JOHN A.
Published: December 2021

Previous discussions in this column have reviewed the logic behind health services for children of school age and have discussed the kinds of plans likely to be successful and to be of benefit to the children, the community, and the practicing pediatrician. Several recent reports, notably the First Report of the Expert Committee on School Health Services of the World Health Organization, have called attention to the specific reasons why particular attention needs to be given school children in the broad spectrum of child health services, as well as in the practice of the clinical pediatrician. There are two unusual needs—the ever present process of growth and development with its complications in adolescence, and the stress, strain, and exposure to contagion in the group living characteristic of school life; there are two unusual opportunities—the inherent educational environment with its possibilities for lifelong sound health attitudes and habits, and the existence of the school as a community unit, involving participation by almost the entire population.

There has been repeated emphasis on the need for wholehearted participation by private practitioners in this program, particularly because of the recognized and accepted fact that the most desirable status is for each child to be followed continuously by his own pediatrician.
EDUCATION
Authors: Long C. N. H.
Published: December 2021

WHEN my former colleague and old friend, your president, asked me to speak to you this evening, he suggested two topics that he thought might be of sufficient interest to you to justify my presence at your annual meeting.

His first suggestion was that I present to you some thoughts on medical education. Coming from a school whose attitude towards this is regarded by some as distinctly heterodox, if not downright Unamerican, and also considering that I have recently finished a term as the Executive Officer of this school, I must confess that I felt that the memoirs of an ex-dean, or as President Truman would say a former Dean, while they might be of considerable local interest, would, under the circumstances, be fatiguing but certainly not fascinating or fattening.
TREATMENT OF ASCARIASIS IN CHILDREN WITH A SINGLE DOSE OF PIPERAZINE CITRATE
Authors: Swartzwelder Clyde , Miller Joseph H. , Sappenfield Robert W.
Published: December 2021

A single dose of syrup containing piperazine citrate was almost always completely effective in eliminating light, moderate and heavy infections with Ascaris lumbricoides with the dosage employed. There was no evidence of intolerance to the drug. The worms were still living and intact when eliminated. The preparation of the drug used is a pleasant tasting syrup, facilitating the treatment of small children. This effective single dose therapy, without local or systemic hazards and requiring no fasting or purgation, should be suitable for mass treatment of patients with ascariasis.
ELECTROENCEPHALOGRAPHY—SLEEP FINDINGS IN CEREBRAL PALSY
Authors: Winfield Don L. , Hughes James G. , Sayle William E.
Published: December 2021

EEG sleep records were obtained on 144 children with cerebral palsy (128 spastics and 16 athetoids).

The results agree with those of earlier studies.

Electroencephalographic tracings taken while the patient is asleep are of definite diagnostic value but are of limited prognostic value.

A larger population of athetoids is needed to determine the significance of the continuous high amplitude spindling which was observed. Serial studies should be done on those patients with seizure discharges but without clinical seizures to determine the prognostic significance of such activity in the EEG.
THOMAS COBBET'S DISCOURSE ON THE RAISING OF CHILDREN
Authors: Miller Herbert C. , Miller Mary T.
Published: December 2021

THREE HUNDRED years ago there appeared in New England a book on how to raise children—almost certainly the first of its kind to appear in this country. The fact that it was the forerunner of what in recent years has amounted to a spate of books and articles on the same subject is noteworthy enough. More interesting is the fact that it was written at all. Books on any phase of child life were rarities in those days. Individually, children 300 years ago were undoubtedly as important to their parents as they are today, but children collectively and their special problems had not loomed large in the public conscience. Here, perhaps, for the first time, the American an conscience is speaking out on the subject of children—through a minister whose parishioners approved what they heard from the pulpit and urged that it be set down in print. Because Thomas Cobbet deemed them worthy subjects, we can now catch a glimpse of children of early New England and compare their behavior and what Puritan New England thought about it with children and parents of today. The comparisons are made doubly interesting since our present culture is still heavily indebted to Puritan thought.

Not much is known of Thomas Cobbet, the author.1 He was born in 11 Newbury, England in 1608. He attended Oxford but left on account of the plague. He was a nonconformist and chose to emigrate to avoid persecution. Cobbet arrived in Massachusetts in 1637 with Davenport, and was a colleague to Mr. Whiting of Lynn until 1656 when be became the pastor of the first church in Ipswich, where he remained until his death in 1685.
REPORT OF COMMITTEE ON TUBERCULOSIS
Authors: LINCOLN EDITH M.
Published: December 2021

1. Tuberculin Testing: It was agreed that the Academy ought to emphasize the importance of tuberculin testing as part of a health examination both in clinics and in private offices; that the Patch test is an excellent screening test if properly interpreted. When a history of contact to tuberculosis exists, if the Patch test is negative, further intradermal tests should be done. A negative test with 0.1 ml. of a 1:1000 solution of O.T. or 0.0025 mg. of PPD should be obtained before a contact is declared free from tuberculosis. Tuberculin testing should be begun during the first year of life and should be repeated every 6 months where a possible contact continues.

2. B.C.G. Vaccination: It was agreed that in the United States at present there is no need for vaccination of all negative reactors. It is recommended that B.C.G. vaccination be carried out in individual cases where continued contact is unavoidable an in areas of high incidence if there is provision for follow-up.

3. Examination of Household Contacts: Because in private practice household servants and "baby sitters" a common source of infection, it is urged that pediatricians advise families under their care to have roentgenograms made of all adults who come in close contact with children.

4. Academy Program: To supplement the increasing interest of pediatricians in the treatment of tuberculosis more material on diagnosis and pathogenesis as well as more discussions on treatment should be introduced into Academy programs.

5. Specific Treatment of Primary Tuberculosis: A confusing situation has arisen due to the conflicting opinions of many clinicians on the desirability of treating primary tuberculosis in children without clinical symptoms and even with negative roentgenograms. It should be emphasized that we have no drugs which cure tuberculosis and the use of antimicrobial agents would be largely for the purpose of preventing complications.
THE EFFECT OF INTENSIVE AND PROLONGED THERAPY WITH CORTISONE AND HYDROCORTISONE IN FIRST ATTACKS OF RHEUMATIC CARDITIS
Authors: Markowitz Milton , Kuttner Ann G.
Published: December 2021

Forty patients (39 children and 1 adolescent) with clinical evidence of carditis during first rheumatic attacks were treated with large doses of oral cortisone or oral hydrocortisone for periods varying from 9 weeks to 12 months.

Twenty-nine of these forty patients received treatment within 3 weeks of onset. After follow-up observations ranging from 6 to 22 months, 24 of the 29 patients have no evidence of heart disease. Patients with severe as well as mild carditis responded equally well.

Eleven patients treated later than 3 weeks after onset did less well: only 2 have normal hearts, 8 have rheumatic heart disease and 1 patient died.

The results of this study suggest that cortisone given early in the course of the rheumatic attack in doses sufficiently large to suppress the inflammatory reaction completely and continued until the disease has run its course, may reduce the incidence of residual heart disease. Further studies based on a large series of cases with adequate controls are needed to establish the value of this regimen.

Eleven of the forty patients developed serious side effects. In 4 the symptoms were of sufficient severity to necessitate cessation of therapy. In the remainder the untoward reactions were controlled by reducing the dosage of the steroid.
PSEUDOHERMAPHRODITISM WITH MULTIPLE CONGENITAL ANOMALIES
Authors: Schoen Edgar J. , King Alexander L. , Baritell A. LaMont , Knigge William F.
Published: December 2021

The present paper reports a case of probable male pseudohermaphroditism in combination with multiple congenital anomalies. The management of the case and the possible relationship to "Turner's syndrome" are discussed.
EDUCATION
Authors: Work Henry H.
Published: December 2021

AN ORGANIZATION having a therapeutic concern parallel to that of the American Academy of Pediatrics is the American Orthopsychiatric Association. This group, older than the Academy, represents the 3 disciplines, psychiatry, psychology and psychiatric social work which have conventionally functioned in the child guidance clinics. It is the organization which represents in general the field of child psychiatry and which has been concerned over the years with the teaching of the medical psychology of childhood.

Many of the members of this organization, operating in their own disciplines, have participated in the teaching of pediatricians. As long ago as 1941 a symposium entitled "Pediatrics in Child Psychiatry" was held at the annual meeting.
INFANTILE SPASTIC HEMIPLEGIA IV. BIRTH WEIGHTS
Authors: Hood Philip N. , Perlstein Meyer A.
Published: December 2021

This is a study of the birth weights of 190 patients with congenital spastic hemiplegia. Statistical analysis of these birth weights has led to the following conclusions.

The total of 190 patients with congenital hemiplegia had a mean birth weight of 6.4 pounds, significantly lower than the mean of normal infants by 0.7 of a pound. Moreover, there were a significantly greater number of birth weights under 5 pounds in this series as compared with normals.

There was no significant sex difference either between the means or in the incidence of premature or heavy birth weights in this series.

Right hemiplegia births were significantly heavier than left by 0.5 of a pound. Although the ratio of left to right was 1:1 in premature births and in weights between 5 and 8 pounds, the ratio was nearby 1:2 in weights above 8 pounds. It is suggested that preponderance of L.O.A. deliveries may be responsible for the occurrence of more right than left hemiplegias in children of heavy birth weights.

The incidence of premature and heavy birth weights was randomly distributed between convulsive and non-convulsive groups; the difference of 0.4 of a pound between the means in favor of the convulsive group was not significant.

Birth weights in the educable and mental defective groups did not differ significantly.

The frequency distribution of the total group and of most subgroups shows distinctly bimodal curves.

The variance, or degree of dispersion, of birth weights is greater in this series of infants than in normal infants.
SPECIAL ARTICLE
Authors: S. Federico Gómez
Published: December 2021

WHEN the Hospital Infantil was dedicated in Mexico City in April, 1943, we outlined its 3 main objectives:

First: To give medical assistance to the sick child in the most efficient manner, according to our best pediatric knowledge.

Second: To disseminate pediatric information among physicians, medical students and nurses, in the broadest sense.

Third: To encourage pediatric research, keeping in mind that we live in a country of limited economic resources and still undergoing development.

Twelve years have passed. The first objective, medical service to the public was accomplished rapidly. The 575 beds of the Hospital were filled by October, 1943. The second goal was reached in 1945 with the introduction of courses in pediatrics for medical graduates, students and nurses. At present, our teaching capacity is at the maximum. Work on the third objective, pediatric research, could not be started until 8 years after the first 2 goals had been attained because of a number of obstacles. The most important was the lack of funds, since the entire income of the Hospital was needed to provide medical service to the public and to support the teaching program. Another important factor for delaying the research program was the lack of experience of our medical personnel in research technics.

Some early attempts were made to conduct research projects. Young workers sought to do "pure research" while other workers wished to investigate subjects already under study by better organized and more richly endowed foreign laboratories. These attempts did not conform to the principle laid down for all research work in the Hospital Infantil.
SYMPOSIUM ON ENDOCRINOLOGY
Authors: Harrison Harold E. , Ingle Dwight J.
Published: December 2021

The physiological needs for adrenal steroids are increased during severe stress. The amounts required to support life and optimal adaptability (eucorticalism) during severe stress may cause signs of hypercorticalism when administered to similar animals under nonstress conditions. Some of the metabolic and morphologic responses to stress have been thought to be caused directly by the increased secretion of steroids by the adrenal cortices. At least some responses to stress occur full-blown in adrenalectomized animals given normalizing doses of cortical hormones, although the response does not become overt in the animal with adrenal insufficiency. This can be regarded as an example of the permissive or supporting role of hormones. An alternative hypothesis is that stress sensitizes tissues to give a greater response to a fixed titer of cortical steroid. Although there are many examples of pathology caused by the administration of an excess of adrenal steroids and of the modification of a disease by adrenal cortical insufficiency or excess, there is no incontrovertible evidence that dysfunction of the adrenal cortices is a primary cause of any of the "adaptation diseases."
THE PRESIDENT COMMENTS
Authors: BAKWIN HARRY
Published: December 2021

Dr. John Lester Reichert of Chicago has just submitted a most interesting report on his activities as liaison representative of the Academy to the school health section of the American Public Health Association. He mentions that repeated references were made at the meetings to the Academy's interest in school health, to our work on school health policies and to our views on competitive athletics. He received numerous requests for our official statements. Dr. Reichert comments: "I found no serious disagreements with the philosophy of the Academy in the school health section or in any of my other contacts with the American Public Health Association."

It is essential that the pediatrician participate, at the planning level, in programs of school health. How best to conduct such programs has by no means been worked out.

The school health examination, as carried out under modern conditions is a great improvement over previous practices where children were herded together and given a hurried once-over. Nevertheless, the new examination is not, in my opinion, good enough. It is not a substitute for the examination by the private physician. By its very nature it cannot be.

A patient comes to a private physician of his own free choice. He comes because he has confidence in his doctor, and he is consequently ready and willing to accept suggestions.

An examination in the private physician's office is given and interpreted in the light of the physician's previous experience with his Patient. This often extends back to the birth of the child and includes a knowledge of the parents and siblings, the home, and so on. The private physician is not interested primarily in detecting "defects."
RENAL DISEASE IN INFANTS AND CHILDREN
Authors: Rubin Mitchell I. , Calcagno Philip L.
Published: December 2021

THE PRESENTATION emphasized the physiologic basis for the clinical symptoms occurring in the common causes of renal failure in childhood. The discussion was divided into the following categories: normal renal physiology in the developing child, clinical symptomatology of renal failure, certain aspects of glomerulonephritis and other hematurias and the management of renal failure and fluid therapy in a variety of pediatric conditions in relationship to renal functional disturbances occurring in them.

RENAL PHYSIOLOGY

The quantitative differences in functional capacity between the developing child and the adult were presented. Values comparable to the adult, on a surface area basis, for glomerular filtration rate, renal plasma flow and maximal tubular excretion of para-aminohippurate are reached in some infants by 6 months of age and in most infants by 2 years. The individual variability in functional maturation was stressed. The young infant concentrates his urine to about half that of the adult, and his tubular response to intravenously administered pitressin also appears to be less than that of the adult. Full maturity of this function may be attained as early as the second month of life. The young infant has no difficulty in diluting urine, for as early as the second week of life he can excrete a urine comparably dilute to that of the adult under similar circumstances. Renal regulation of acid-base balance is thought to be less proficient in the very young infant. The premature infant for instance excretes less urinary ammonia in response to an acid load than does the older child.
Biologische Daten Für den Kinderarzt
Authors: FOMON SAMUL J.
Published: December 2021

This excellent and comprehensive compilation of biologic data concerning the pediatricage period is without counterpart in the English language. Translation would be most desirable, but the numerous tables and graphs and the extensive bibliography will be useful even to those unfamiliar with the German language.

The first volume includes anthropometric data relating to fetal and post-fetal growth; the skeletal system; hematologic, chemical and immunologic considerations of the blood; the circulation; the respiratory system; nutrition, including foods and accessory foodstuffs; digestion and intestinal bacteria.
SYMPOSIUM ON JUVENILE DELINQUENCY
Authors: Little Sherman , Beck Bertram M.
Published: December 2021

A CAREFUL review of the research literature bearing on delinquency makes it evident that delinquency is a pathology transmitted from the community to the family and thence to the individual youngster.

The relative importance of family and community and individual factors vary, however, with a particular child. In some instances the delinquent act is almost a direct outgrowth of community conditions; in such cases family influence is of importance only insofar as it has failed to prepare a youngster to deal with the environmental situation confronting him. In other instances the delinquent act is directly related to the nature of the parent-child relationship; in these cases community conditions are of importance only insofar as they have been stimulating or precipitating factors or have influenced the parental capacity.

Observations of communities with low delinquency rates, combined with refined statistical analyses of the correlation between delinquent behavior and factors usually thought to be productive of delinquency, reveal that in communities that have social stability, little population movement, homogeneity of population, and the kind of interaction between people that represents a sense of belonging to the community, there is very little crime and delinquency. This is true even when such communities are marked by a great concentration of poverty, bad housing, a population of minority group members, and the absence of health and welfare agencies. On the other hand, a socially disorganized neighborhood, peopled by residents who do not possess a sense of community comradeship and participation, will be productive of delinquency even though it may have good housing and superior economic status.
JUVENILE DELINQUENCY
Authors: Rabinovitch Ralph D.
Published: December 2021

IN PSYCHIATRY, as in any other branch of medicine, diagnosis and as full as possible an understanding of etiology and pathology are prerequisites to the prescribing of a treatment program. Unfortunately, in problems of delinquency, often the factors at play are more complex than in most diseases and, therefore, treatment needs are also more complex amid less clearly defined. Delinquency, of course, is not a diagnosis but a symptom. The delinquent act is like fever or a swelling; the factors underlying it are multiple and varied.

I shall try, somewhat in summary form, to describe treatment needs in terms of basic causes of delinquency. Our material is drawn from experience in a large public clinic in a medical school that serves the State of Michigan, and provides opportunity for intensive inpatient as well as outpatient study.

First, however, a note of caution: That juvenile delinquency has increased in recent years, especially acts of violence or destruction, is indicated by the statistics at hand. Reading many popular accounts today, one might well get the impression that all teen-agers have "gone to the dogs," that, as a group, they are marauding vandals without capacity for feeling or responsibility. This is, of course, far from the truth. Delinquency is a major social problem but our understanding of it is not helped if in our concern for the more dramatic we exaggerate and lose perspective. The tendency in recent years has been to describe the teen-ager in terms of only negatives. Some writers have gone so far as to stretch absurdity to the point of representing the most vicious, sadistic crime of the year as typical adolescent behavior.
Letters to the Editor
Authors: BLUESTONE SEYMOUR S.
Published: December 2021

Dr. Harry Bakwin's letter (Pediatrics, 17: 405, March, 1956), in which he quotes Dr. Charles May's challenge to the concept of the "team approach" and adds his confirmatory comments, should be elaborated. I have great respect for both our president and our editor. Nevertheless, while their statements as worded cannot be directly contradicted, their message is reversed in meaning when their statements are properly qualified.

Dr. May raises the question of nomenclature. Certainly, as he says, every department within a medical center is a team.
The Pediatric Years
Authors: LESSER ARTHUR J.
Published: December 2021

One of the contributions of this book lies in the fact that it gives recognition to the increasing role of many professional nonmedical people working under medical direction in the health supervision and medical care of children. As more attention is being given to the chronic diseases and handicapping conditions of childhood, the contributions of physical and occupational therapists, nurses, nutritionists, medical social workers, special education teachers, rehabilitation counselors, health educators and others take on increasing importance.
Viral and Rickettsial Diseases of the Skin, Eye and Mucous Membranes of Man
Authors: FABER HAROLD K.
Published: December 2021

This compact volume covers a remarkably large segment of virology, since it deals with not only those diseases which are limited to the body surfaces but also many of those systemic disorders in which the surfaces are incidentally involved, e.g., the common acute exanthemata, typhus, etc. Both authors are eminently qualified for the task, Dr. Blank being a dermatologist of note, and Dr. Rake an acknowledged authority in general virology whose original contributions in herpes, the common cold, influenza, etc., are outstanding. Both men are connected with the Squibb Institute for Medical Research.
BRAIN TISSUE IN THE NOSE AND THROAT
Authors: Low Niels L. , Scheinberg Labe , Andersen Dorothy H.
Published: December 2021

Including the present cases, at least 38 cases of tumors in the nose and throat consisting of brain elements have been described during the last 55 years. They are congenital anomalies which probably represent completely or partially severed remnants of the anterior cerebral vesicle. Our 3 patients illustrate different clinical pictures which may be presented by these tumors. When a tumor is encountered near the nose or in the pharynx, this anomaly should be kept in mind because of the occasional connection with the brain or meninges and the consequent risk of meningitis.
OBITUARY
Authors: ABT ARTHUR F.
Published: December 2021

THIS is not only an obituary; it is the saga of an era of medicine, of which one of the last great Oaks was Isaac A. Abt. The parents of Isaac A. Abt were Levi and Henrietta Hart Abt. They migrated to this country from Germany shortly after the unrestful period of 1848.

Upon his arrival in this country at the age of 19 years, Levi Abt with his mother made his way, through the aid of friends, to Illinois and set out with a pack on his back peddling from farm house to farm house with zeal and energy. In point of time it was about 20 years after Chicago was incorporated as a municipality.
Prenatal and Paranatal Factors in the Development of Childhood Behavior Disorders
Authors: WORK HENRY H.
Published: December 2021

For years the subject area of this monograph has been an intriguing one to pediatricians. Many of us have shared the feeling of the authors that there might well be a continuum of pathology following pregnancy and birth which would include children whose only disturbance would be that of behavior problems.

The evidence in this extremely well controlled study does suggest that "abnormalities of the prenatal and paranatal periods were found to be significantly associated with behavior disorders in children." The authors feel, particularly in respect to a group of children with hyperactive behavior disorders, that these are part of a continuum of abnormalities ranging from foetal death through cerebral palsy and epilepsy.
Caution in Oxygen Therapy to Prevent Retrolental Fibroplasia
Authors: KINSEY V. EVERETT
Published: December 2021

The recommendation that oxygen be restricted in the care of premature infants to that amount indicated by clinical symptoms, and then that it be given only in concentrations below 40%, is being made by more and more medical and lay agencies. I am in full accord with this recommendation, and following it has unquestionably reduced the incidence of retrolental fibroplasia (RLF) to a significant and encouraging extent.

Over the past few months, however, I have learned that a number of pediatricians have gained the impression that there is appreciably less risk of developing RLF if oxygen is administered at less than 40% concentration.
Medical Research, a Midcentury Survey: Volume I. American Medical Research: In Principle and Practice; Volume II. Unsolved Clinical Problems: In Biological Perspective
Authors: GARDNER LYTT I.
Published: December 2021

The American Foundation was established in 1924 by Edward Bok, and has had as its goals the objective study of various public questions and the publication of the findings. It has had as projects the study of the judicial settlement of international disputes, the relations of record between the United States and the Soviet Union, the problems involved in methods of distributing and financing medical care, and finally a midcentury survey of medical research. The latter has just been published in two volumes, one of which takes up the principle and practice of American medical research, and the second which discusses unsolved clinical problems.
". . . AND WITH NO LANGUAGE BUT A CRY"
Authors: SHAW EDWARD B.
Published: December 2021

IN THIS issue is reported a panel discussion on the subject of colic. The difficulties of this subject are implicit with the consideration of a symptom rather than of a disease entity—it is as though one chose to speak of cough or rash or any other symptom.

This symptom complex has little academic standing for the more one is cloistered from the plaints of parents in the evening hours the less important it appears. Every pediatrician who is interminably consulted by the parents of a thriving baby who simply cries, and cries, and cries, suffers along with the distracted mother and the unhappy father and must wish most sincerely that he had a good, and preferably a single, answer to this all too common complaint.
PHYSIOLOGY OF THE SWEAT GLAND IN CYSTIC FIBROSIS OF THE PANCREAS
Authors: Gochberg Sumner H. , Cooke Robert E.
Published: December 2021

Electrolyte concentrations of total body sweat were determined in nine patients with cystic fibrosis of the pancreas and in six controls. The sodium concentration in the patients averaged 79 mEq/l; the controls averaged 18 mEq/l. There was no difference between the two groups in rate of sweating, skin and rectal temperature, ratio of urea in sweat to urea in plasma and lactic acid concentration of sweat.

A possible mechanism for the altered composition of sweat is suggested in terms of the present knowledge of sweat physiology.
CHEMOPROPHYLAXIS OF ENTEROBIASIS
Authors: Jung Rodney C. , Emerson Samuel M. , Sewell Bennett
Published: December 2021

The efficacy of piperazine citrate used therapeutically and prophylactically against enterobiasis was studied in a home for boys aged 4 to 14 years all infected with pinworm.

Syrup of piperazine given in a dose of 5 ml three times daily for 1 week failed to cure 5 of 24 boys but given for 14 days it failed in only 1 of 25. Tablets of piperazine given in a dose of 500 mg three times a day for 1 week failed to cure 4 of 23 boys. Of 28 children receiving no treatment 25 were positive during the test period.

Syrup of piperazine given weekly in a single dose of 15 or 45 ml apparently prevented reinfection in 11 of 23 and 12 of 19 boys respectively. All of 22 controls who received no prophylactic medication became reinfected.

The reduction of reinfection among those receiving prophylactic piperazine consisted of a decrease not only in the number of individuals reinfected but also in the intensity of the reinfections that occurred. No signs or symptoms of intoxication due to piperazine were noted.
COLIC IN INFANTS—GENERAL CONSIDERATIONS
Authors: Rambar Alwin C.
Published: December 2021

MANIFESTATIONS

Infantile colic is an ill-defined condition which seems to consist primarily of pain associated with symptoms ranging in degree from general fussiness to paroxysms of agonized crying. The symptoms usually start after feeding and are worse late in the day. Besides the typical unhappiness, as exemplified by clenching the fists and flexing the legs, the infant often makes sucking movements and appears to be searching for food. Usually these infants have a great deal of gas, manifested by excessive belching, flatus, and rumbling. The passage of gas is occasionally followed by temporary relief, supporting the theory that distended loops of intestine from collected air causes colic. It is most common in the first born, usually starting at 2 to 4 weeks of age, and lasting through the third or fourth month.

It is difficult to say what percentage of infants have colic since a certain amount of fussiness is natural, and crying that may be considered normal in one household, might be regarded as intolerable in another. Certainly colic is not "the almost infallible occurrence" that Brenneman once described, although Wessel found that only 50 of 98 infants lie studied were considered contented babies. From my own experience in both private practice and clinic work, I have gained the impression that the incidence of colic is higher in the private group.

ETIOLOGY

There is little agreement as to the cause of colic, but a basic immaturity of the intestinal tract, a constitutional predisposition to hypertonicity, hunger, improper feeding technique, allergy on a reaction to tenseness in the home, are commonly described as etiologic factors.
FAMILY TENSION AS A CAUSE OF COLIC IN INFANTS
Authors: Cobb John C.
Published: December 2021

A study of colic in infancy was undertaken as part of the Yale Rooming-In Project. The longitudinal records of 98 infants who were study subjects were analyzed with respect to incidence, duration, and severity of colic. Forty-eight of the infants were classified as fussy or colicky and 50 as contented.

Because I had formed the clinical impression that allergy was an important contributing factor in the causation of colic, careful family histories were taken for all of these infants with particular attention to allergic disease in any member of either parent's family. An adequate family history was obtained in 95 of these infants. These data were analyzed both according to the incidence of allergic disease and according to the severity of allergic disease in family members.

Among the relatives of the 45 "fussy" or "colicky" infants 7.3 per cent had severe allergy, 17.7 pen cent had mild allergy and 74 per cent had little or no allergy. Among the relatives of the 50 contented infants 7.6 per cent had severe allergy, 14.7 per cent had mild allergy and 77 per cent had no allergy. The family histories included a total of 957 relatives.

The 45 families of the babies who were fussy or colicky were divided as follows as to amount of allergy among the relatives. In 7 families there was much allergy, in 30 families there was some allergy and in 8 families there was little or no allergy. The [See Table I in Source PDF] families of the 50 contented infants were divided as follows, in 7 families there was much allergy, in 33 there was some allergy and in 10 there was little on no allergy.
Handbood of Poisons
Authors: PRESS EDWARD
Published: December 2021

The number of potential poisonous substances in our current environment is increasing rapidly and this lithographed, soft-covered, handbook promises to be very useful in the clinical treatment of poisoning. The manual is one of the most diversified and inclusive compendiums in the field. It includes not only the usual industrial, pesticide, household chemical, and medications customarily covered in works of this type but also has sections on poisonous plants, reptiles, insects, arachnids, and fish that are quite extensive and up-to-date.
Kindersterfte in Nederland (Child Mortality in the Nttherlands)
Authors: JACOBZINER HAROLD
Published: December 2021

This book presents an excellent analysis of child mortality in the Netherlands. It traces the evolution of the decreases oven the past 75 years and predicts future trends. Since 1900 infant mortality decreased by 85% in the Netherlands. The preschool mortality showed a decline of 91% and mortality among the school age child was reduced by 83%. Child mortality was thus reduced at all age groups.

The problem of infant mortality in the Netherlands like in the United States, is mainly the problem of the newborn, the bulk of the deaths in the infant group being due to perinatal mortality.
Annual Review of Medicine, Vol. 7
Authors: BEAN WILLIAM B.
Published: December 2021

The increase in the number of medical facts is equivalent to a decrease in time. On all sides physicians are beset by the problem of how to keep up with reading the flood of so-called "literature." For those who wish to keep up a speaking acquaintance with general medicine there are very few methods better than a careful study of the Annual Review of Medicine. For here we do not have just a list of articles published during the recent past but a thoughtful and studied critique in which evaluation, opinion, and some synthesis are available.
Fluid Balance Handbook for Practitioners
Authors: LOWE CHARLES U.
Published: December 2021

Problems in parenteral fluid management of patients ill with a variety of diseases have received considerable attention during the past few years. Not only are clinicians considerably more aware of the therapeutic problems presented by these patients, but management of such individuals in small community hospitals has become practical through wide dissemination of general principles of therapy. Several major monographs devoted to this subject, have appeared recently, but most of them have been written to appeal not to the practitioner but to the physician practicing in an academic environment.
PEDIATRIC CARE AND DELINQUENCY
Authors: MCLENDON PRESTON A.
Published: December 2021

THE Committee on Juvenile Delinquency of the Academy realizes that medical responsibility for the care of children rests largely in the hands of the pediatrician and the general practitioner. Both groups render service to the ill child and advise parents concerning the rearing of their children. The distinction lies in the volume of services rendered, and the quality of service as determined by the ability of the individual physician. In any case, the physician who considers the evaluation of asocial attitudes to be a part of his responsibility has an excellent opportunity to appraise and interpret misbehavior. Also, physical problems are admittedly related to emotional disturbances in total "pediatric" evaluation.
SOCIAL CULTURE AND NUTRITION
Authors: Jelliffe D. B.
Published: December 2021

Examples of malnutrition related to protein deficiency, including kwashiorkor, nutritional marasmus and "nutritional growth failure," are commonly seen in early childhood in rural West Bengal. While this was mainly due to poverty, and especially the economic inability to buy animal protein foods, together with repeated attacks of enteritis and constant intestinal parasitism, in addition, it was found that certain aspects of the local domestic culture pattern acted as "cultural blocks" between the child and the theoretically available sources of protein. Results of a survey of local methods of infant feeding are summarized and some of the important cultural blocks outlined, including delays in the traditional rice-feeding ceremony, reasons for unwillingness to introduce mixed feedings in the second 6 months of life, failure to use or produce certain foods (with especial relation to the four types of food classification found in the village), general dietary restriction during illness and specific blocks with regard to individual sources of protein. The importance of having health measures based on an understanding of the local domestic culture pattern is emphasized.
A PEDIATRIC-PSYCHIATRIC VIEWPOINT ON OBESITY
Authors: Lourie Reginald S.
Published: December 2021

FROM the viewpoint of the pediatric psychiatrist, the problems of obesity, as seen clinically, can be thought of as having three layers. The first is constitutional, better described as physiologic, which may be broken down into genetic and structural elements. The second is psychologic, consisting of the values that food intake or the obesity itself come to have. The third layer is made of the cultural and social reactions to food and fat. These attitudes encountered inside and outside the home intermesh in their effects with the physiologic and psychologic levels. These, in turn, are also interwoven, until one cannot separate one layer from the other. However, when individual cases are scrutinized they reveal the pathology at one layer or the other to predominate and indicate where efforts to modify the abnormality might best be directed. Incidentally, the same levels operate on the other side of the coin, anorexia.

From the practical point of view, let us consider the natural history of obesity and the clinical varieties one sees in practice, and let us see how the three-layer concept fits. First, as pointed out by Gordon, there is a tendency to be complacent or even pleased with obese infants. At level one, the physiologic, such constitutional factors as those present in the neonate born with an excessive quantity of pepsinogen secreted by the gastric mucous membrane could have the effect of producing as Mirsky points out, a relatively intense or even continuous hunger, and make greater demands on its mother for nursing.
Liver: Structure and Function
Authors: NAJJAR VICTOR A.
Published: December 2021

This book is primarily devoted to a consideration of the structure and physiologic function of the liver in normal and abnormal states. In Part I a fair amount of pertinent biochemistry of the liver is included. Separate chapters are devoted to proteins, fats, some liver enzymes, micronutrients and bile pigments. The more prominent sections are devoted to the structure of the vascular and biliary systems. Part II deals mainly with the various pathologic states in liver disease as manifested by structural and functional alterations. Part III is mostly clinical in tone, with emphasis on technics for evaluating liver pathology including biochemical, radiologic and biopsy methods. Parts IV and V are concerned exclusively with a thorough presentation of diffuse and focal diseases of the liver.
The Riddle of Stuttering
Authors: JOHNSON WENDELL
Published: December 2021

Dr. C. S. Bluemel has been a practicing psychiatrist for nearly half a century. His major identification has been with the Mount Airy Sanitarium in Denver. For personal as well as professional reasons, he began at the turn of the century to occupy himself with what he calls "the riddle of stuttering," and in 1913 he published his first major work, Stammering and Cognate Defects of Speech. This book was particularly notable for its historical treatment of the subject, and in the final chapter of this most recent book he presents again, though briefly, the history of theory and practice regarding stuttering as fan back as ancient Greece and Rome.
PEDIATRIC DERMATOLOGY
Authors: Perlman H. Harris , Falk Alfred B.
Published: December 2021

THIS DISCUSSION of dermatologic therapy contrasted the opinions of an empiricist, Dr. Perlman, with those of a nihilist, Dr. Falk. Both speakers based their comments upon personal experience. Participants were forewarned that these remarks would frequently be contrary to classic dermatologic teaching.

Histologic examination reveals that the infant's skin lacks a well-developed stratum corneum. This keratinized outer layer of the epidermis is loosely organized and lace-like, thereby providing a poor defensive barrier against the entrance of bacteria. Poor cornification also explains the frequency of weeping, exudative dermatoses during infancy. Fungus infections of the skin are rare during infancy because the loose stratum corneum does not provide a favorable surface for superficial growth of fungi. The delicacy of the infant's skin and its scanty protective cornification make it particularly vulnerable to damage by overtreatment. Indeed, 40% of the dermatoses seen by dermatologists today are due to the effects of overly-enthusiastic topical therapy.

Dermatologic problems commonly seen by pediatricians were discussed under the following general headings:

(1) Eczematous dermatoses: contact dermatitides, dermatitis venenata (poison ivy), diaper dermatitis, intertrigo, infectious eczematoid dermatitis, atopic dermatitis, atopic erythroderma, nummular eczema and circumscribed neurodermatitis.

(2) Pyodermas: dermatitis exfoliativa neonatorum (Ritter's disease), impetigo contagiosa, ecthyma, erythema streptogenes, dermatitis gangrenosum infantum and periporitis staphylogenes.

(3) Maculopapular squamous dermatoses: pityriasis rosea, seborrheic dermatitis (cradle cap), psoriasis, parapsoriasis, lichen planus, pityriasis rubra pilaris, lichen nitidus and lichen striatus.

Comments regarding the diagnosis and treatment of certain of these conditions, which seemed to be of special interest to participants in the round table discussion, follow.

DERMATITIS VENENATA (POISON IVY)

The irritant principle of poison ivy is a dihydric phenol, urushiol, a catechol-like substance which is contained in every portion of the poison-ivy plant, including leaves, stem, flowers and fruit.
The Family Book of Child Care
Authors: HARPER EDWIN A.
Published: December 2021

This book is much more than a manual covering the routines of child care from conception to puberty. It is a comprehensive treatise upon family living with emphasis upon the child. In addition to advice about feeding, bathing, training, etc., there are practical chapters on "How to Have a Comfortable Home," "Money is a Part of Child Care," "Family Life and Moral Values," "Emotions are Fundamental," and "Work and Play: A Foundation for Happiness." As the preface states: "This book is written for mothers and fathers who expect to enjoy raising a family; it is written for the couples who are making bigger families popular again."