bluuebunny/crossref_metadata_2025_split huggingface dataset:
REPLACEMENT TRANSFUSION AS A TREATMENT FOR ERYTHROBLASTOSIS FETALIS
Authors: DIAMOND LOUIS K. 
Published: December 2021

THE treatment of hemolytic anemia of the newborn often requires support by compatible blood transfusions. In the years before the discovery of the Rh factor, such blood was usually compatible only according to the A-B-O group, and for convenience the patient's father was often used as a donor. This meant the use of Rh-positive blood. It was found frequently at this time that the infants' blood levels tended to fall rapidly even with repeated transfusions. In many such cases the infused Rh-positive cells are destroyed much more rapidly than are Rh-negative cells as shown by Mollison in England and confirmed by us. It seemed best, therefore, as a first step in improving treatment, to use only Rh-negative blood as a means of achieving the highest blood levels for protection of the patient, and this step was logically inaugurated after 1941.
In the more acute and severe cases of erythroblastosis the infant's anemia often progressed so rapidly in the first 48 hours that several small transfusions proved inadequate. In such patients, by recently developed technics, it has been possible to demonstrate that the serum of the baby still contains free maternal anti-Rh agglutinins and that all of the infant's own red blood cells are often completely coated with this antibody leading probably to a more rapid destruction of the infant's cells. The removal of as much as possible of the baby's own blood should theoretically help diminish the damage resulting from the presence of this free and bound antibody in the circulation and in the tissues. Such reasoning led to the trial of replacement transfusion for the treatment of erythroblastosis. Replacement transfusion is not a new procedure in pediatric practice as many of you know, but to perform it in a newborn infant has added difficulty to an inherently difficult technic.
The earlier method consisted of entering the longitudinal sinus and a peripheral vein, or two peripheral veins, or a vein and an artery. These usually required more or less body exposure for a newborn infant on an operating table, often requiring an hour or more for the procedure and this sometimes caused shock-like symptoms from cold and trauma.
Round Table Discussion
Authors: HARTMANN ALEXIS F. 
Published: December 2021

Acidosis and alkalosis are terms used to describe opposite types of disturbance of acid-base balance of the body fluids. From the chemical point of view acidosis may be defined as the condition in the blood characterized by a reduction of the BHCO3/HHCO3 ratio, and alkalosis as an increase. When BHCO3 is primarily affected, the disturbance is referred to as metabolic in origin; when HHCO3 concentration is the first to be altered, the resulting change is considered to be of respiratory origin. Primary changes of either BHCO3 or HHCO3 usually stimulate compensatory changes in the other which tend to restore the original normal ratio. When compensation for acidosis is incomplete, an increased H+ ion concentration (decreased pH) of the blood results, and such a change is referred to as acidemia. The opposite condition is called alkalemia.
From the clinical point of view a much broader concept of acidosis and alkalosis exists and includes in addition all related changes in metabolism (carbohydrate, fat, protein, water, mineral, enzyme) which may give rise to definite symptoms and signs of illness. Such metabolic changes may be either primary or secondary, and, as either, may be very important in determining prognosis as to life or death.
In practice one is prompted to consider the possibility of acidosis or alkalosis by noting suspicious signs or symptoms and then diagnoses with certainty the presence and extent of change by chemical determinations of serum CO2 content and pH.
The most important signs and symptoms of acidosis are: hyperpnea, which is considered not primary, stupor, dehydration, ketosis and strongly acid urine. Any or all may be absent. The most important signs and symptoms of alkalosis are: depressed respiration, considered compensatory, or hyperventilation, considered primary, tetany, and forceful vomiting, thought to be the result of pyloric or high intestinal obstruction, and strongly alkaline urine. Again any or all such symptoms may be absent. Furthermore, ketosis may be associated with alkalosis; secretion of alkaline urine may give rise to acidosis, and alkalosis may be accompanied by formation of acid urine. Also, it is not unusual to see in the same subject conditions favoring the development of both acidosis and alkalosis, but with the presence of neither.
For absolute diagnosis of acidosis or alkalosis two of the three variables, BHCO3, HHCO3 and pH have to be determined. Since pH and BHCO3 usually move in the same direction, it has been widespread clinical practice to determine only BHCO3 by determining serum CO2 content by the Van Slyke manometric method. In this connection it should be remembered that when so determined about 20/21 of the CO2 comes from BHCO3, the remainder coming from HHCO3 In the past it was customary not to separate BHCO3 and HHCO3, but to record them together as the total CO2 content.
THE VARIABILITY IN MANIFESTATIONS OF UNTREATED PATIENTS WITH PHENYLKETONURIA (PHENYLPYRUVIC ACIDURIA)
Authors: Paine Richmond S. 
Published: December 2021

One hundred six cases of phenylketonuria have been surveyed in 11 institutions in New England and Eastern Canada.
Data not previously available (and of some degree of uncertainty as to reliability) are presented as to the ages at which patients with phenylketonuria achieve the ability to sit unsupported, to walk independently, and to say recognizable words. A small number of patients achieve these steps at reasonably near the normal age and the degree of variability is such that early developmental timetables should not be overemphasized in interpreting possible effects of any treatment of the disease.
Both eczema and seizures are proportionately more frequent in severely retarded patients with phenylketonuria than in those with lesser degrees of intellectual defect. If present at the time an experimental treatment is instituted, they would provide more objective evidence of possible benefit. Electroencephalograms were abnormal in 79% of patients for whom tracings were available and would provide one means of evaluating plans of treatment even in the absence of seizures.
While the majority of these patients have blue eyes and blond hair, there is enough evidence to suggest a tendency to darkening of the hair with age that this also should be used with caution in evaluation of treatment.
Frequencies of various neurologic manifestations are presented, including unusual hand posturing, tremor, hyperreflexia, clonus and spasticity. These are all variable enough that a reasonably positive diagnosis [See FIG. 2. in Source Pdf.] by physical examination is not possible, and further, they are not well adapted to evaluation of treatment.
The distribution of intelligence quotients in patients with phenylketonuria appears to follow a continuous curve and to include a small number of persons with borderline normal or better intelligence. In assessing the effect of any treatment, it is unwarranted to ascribe to that treatment the attainment of borderline normal intellectual levels that may be reached by small numbers of patients, especially if originally tested in infancy or early childhood.
The effect of any therapy can be adequately evaluated only by comparing changes in a number of treated patients with phenylketonuria, with changes in comparable control patients, selected on the basis of intelligence, age, physical accomplishments, and status with respect to hair color, eczema, convulsive seizures and electroencephalographic findings.
THE VALUE OF MICROSCOPIC EXAMINATION OF THE STOOL FOR EXTRACELLULAR STARCH IN THE DIAGNOSIS OF STARCH INTOLERANCE
Authors: Davidson Murray , Bauer Charles H. 
Published: December 2021

Among 203 casually passed stool specimens obtained from children with no apparent gastrointestinal disease, 43% contained some extracellular starch by microscopic examination.
By prematurely emptying the rectum with a small enema, the amount of extracellular starch found microscopically could be increased.
If the colon is "sterilized" with neomycin, the content of microscopic extracellular starch of casually-passed stools will likewise be increased.
It is concluded that the presence of some microscopic extracellular starch in the stool is normal, and that in diarrheal states not related to starch malabsorption the content of extracellular starch would be increased.
It is suggested therefore, that the iodine test for extracellular starch in stools is not a useful tool, and that the diagnosis of starch malabsorption cannot be made on the basis of an "increased" content of extracellular starch demonstrated by this technic.
VISCERAL SQUAMOUS CANCER IN CHILDREN
Authors: Moore Condict 
Published: December 2021

Cases of squamous carcinomas, excluding carcinoma of the skin, reported in children have been reviewed. The disease is a medical curiosity.
Most squamous carcinomas in children have occurred in the mouth and pharyngeal region.
There is no evidence that these squamous cancers do not respond to the same methods of treatment and to the same degree as do the squamous cancers in adults.
A case is reported of a patient with squamous carcinoma of the tongue, treated by surgery, who is living and well nearly 2 years after therapy.
EXPERIENCES WITH MEPROBAMATE IN CEREBRAL PALSY
Authors: Charash Leon I. , Cooper William 
Published: December 2021

A group of 40 patients with cerebral palsy of various types and degrees of severity has been studied carefully while receiving meprobamate therapy. In 11 of these patients (27.5%), the medication caused a definite deterioration in clinical status. In all cases this proved to be reversible after discontinuation of the medication. In 12 patients (30%) there was no change in the clinical status despite the fact that the medication was given over a period of at least 2 months to the point of inducing drowsiness. Seventeen patients (42.5%) experienced initial improvement of a subjective and objective nature, but this was sustained in only four patients (10%) and in these it was purely subjective. In no case was there any permanent objective evidence of improvement.
Of the 14 patients in whom the medication was abruptly discontinued, five (35.5%) developed prominent withdrawal symptoms. The remaining 26 patients, from whom the medication was gradually withdrawn over a period of 2 to 3 days, did not demonstrate these manifestations.
It is not the intention of the authors to discredit the use of chemical agents in cerebral palsy. The search will surely go on and there may be optimism that research will eventually produce an agent with some specificity for cerebral palsy.
EPIDEMIOLOGY OF A STREPTOCOCCAL OUTBREAK IN A SCHOOL: ATTEMPT AT CONTROL BY MASS PROPHYLAXIS WITH PENICILLIN V
Authors: Poskanzer David C. , Feldman Harry A. , Mou Thomas W. , Kuroda Kenzo 
Published: December 2021

An attempt was made to abort an epidemic of streptococcal infection in a rural school including kindergarten through third grade by the use of mass, oral penicillin V prophylaxis for 10 days. Half of the classes received 200,000 units of penicillin V once daily and the others received two doses daily. In both instances, there was a decline in the carrier rates but neither regimen was entirely satisfactory. Unusual resistance to penicillin could not be demonstrated in streptococci isolated after the treatment period.
Carrier studies were conducted in 124 families of children in the school sample. Prior to the prophylaxis regimen the carrier rate for Group A streptococci was 7% for adults more than 24 years of age and 24% in their children in the school being studied. Forty families which did not have children in the school also were cultured. None of the adults more than 24 years of age in this group was found to have streptococci in contrast with 4% of adults (cultured the same day) in the school-associated families. These observations tend to support the hypothesis that the school is the focus of infection and that families with children in school have a higher rate of infection than families without children in school. However, in both groups of families the adults appeared to be relatively resistant to infection.
Within the school, the focus of infection appeared to be the individual classroom rather than the grade level. Rates of positive cultures for Group A streptococci in different classrooms within the same grade ranged from 0 to 71%.
Numerous isolations of Group C streptococci were made in the school population. The age distribution paralleled the age distribution of the children from whom Group A organisms were isolated. In addition, titers of antistreptolysin-O in persons from whom Group C organisms were isolated were similar to those in persons with Group A strains. It is suggested that Group C infections may have contributed to the course of the epidemic.
FOOD ALLERGY AND FOOD INTOLERANCE IN RELATION TO THE DEVELOPMENT OF GOOD EATING HABITS
Authors: Pratt Edward L. 
Published: December 2021

The clinician caring for infants and children does not wish to interfere unnecessarily with their diets and thereby jeopardize their nutrition and their development of good eating habits. Yet serious illness may be completely relieved by eliminating an offending ingestant, so the physician does not wish to overlook this therapeutic measure. If he turns to recent medical reports for help, he is confused and bewildered by the varying definitions and by the lack of critical judgment applied to the cases reported. When a patient improves after removing a food from his diet, is it the result of the quantity, quality or pharmacologic properties of the food or because of the psychologic associations with the food? If a purified fraction of the food, administered—withheld—readministered under controlled conditions appropriately produces symptoms, is this an example of intolerance or allergy?
The need is urgent for extensive investigations of the basic mechanisms and for sound clinical studies in the fields of food intolerance and, particularly, of food allergy. Continuation of noncritical attitudes towards food allergy can only further debase this subject and may well lead to neglect of its true value, to the detriment of the patients. "If the gravity of decisions in medical research are greater than in other research, so much greater is the need to plan the investigations for the avoidance of bias and for the elimination of subjective judgments about alternative explanations of the results."
At the present time, one must conclude that the physician should respect the importance of promoting good eating habits and that, while he should readily suspect foods as a cause of symptoms, he will accept this situation only after carefully designed studies of the patient demonstrate it. Otherwise: "Cava medicum, nocere atque sanare potest!" (Beware of the physician: he can harm as well as heal!)
REMARKS AT THE PRESENTATION OF THE PORTRAIT OF JOHN HOWLAND
Authors: Gamble James L. 
Published: December 2021

WE OWE Edwards A. Park a large debt for the sketch of John Howland illustrated by anecdotes displaying his personality which he gave us in his John Howland address.
Howland was a New Englander to the core and a loyal son of Yale of the Class of '94. His medical career began in New York where, after 3 years as a student in New York University Medical School and a 2-year internship at the Presbyterian Hospital, he became associated with L. Emmett Holt, Sr. and decided to enter the then opening field of pediatrics. His fine abilities as a physician were rapidly recognized. He also began his investigative career in New York.
In the year 1910 at the age of 39 he was appointed Professor of Pediatrics at the Medical School of Washington University in St. Louis, which had just been reorganized on a full-time basis. He was disappointed by the inadequacy of the equipment there and unwilling to wait several years for the building of the projected new hospital. He resigned after 6 months and returned to New York.
This hiatus in his careen in academic medicine was a short one. In the year 1912 he was called to the chair of Pediatrics at the Johns Hopkins Medical School to succeed Von Pirquet who had returned to Germany to accept the professorship at Breslau. This was a much coveted post. Also, I have been told, he was much aggrieved over having contracted trichinosis from eating Baltimore sausages.
During the 2 years that Von Pirquet was in Baltimore, the Department of Pediatrics had no quarters of its own and was obliged to use space borrowed from the Medical Outpatient.
The Mentally Ill Child
Authors: KUGEL ROBERT B. 
Published: December 2021

The subtitle of this book, A Guide for Parents, indicates the group for whom the authors wrote. Unfortunately such books written by professional workers often are presented in such a way that the content is either too simple or too complex so as to be of very little use to parents. Such would seem to be the situation with this book.
The title gives one the impression that this book might deal with some of the problems which confront parents of emotionally disturbed children.
MULTIPLE SCLEROSIS IN CHILDREN
Authors: Gall John C. , Hayles Alvin B. , Siekert Robert G. , Keith Haddow M. 
Published: December 2021

Forty cases of disease of the central nervous system, characterized by several episodes and disseminated lesions, with onset in childhood and clinically typical of multiple sclerosis, were studied.
The disease as it occurs in children does not appear to differ clinically from the disease as observed in adults, in respect to mode of onset, symptoms, physical findings, and changes in the spinal fluid. In the Mayo Clinic series, however, almost twice as many girls as boys were affected.
A pediatrician confronted with a child showing evidence of scattered neurologic deficits that remit, particularly a disturbance of vision and co-ordination, should consider the possibility of multiple sclerosis.
STUDIES OF DISTAL COLONIC MOTILITY IN CHILDREN
Authors: Davidson Murray , Bauer Charles H. 
Published: December 2021

Three patients with fecal impaction and soiling are described. In each a short area of achalasia proximal to the anus was demonstrable by motility studies.
Surgical resection of the achalasic segment resulted in improvement in all, although ganglia could be demonstrated in this segment in each child.
The relationship of this syndrome to congenital aganglionic megacolon and to psychogenic obstipation is discussed.
EXPERIMENTAL SALICYLATE POISONING: OBSERVATIONS ON THE EFFECTS OF CARBONIC ANHYDRASE INHIBITOR AND BICARBONATE
Authors: Kaplan S. A. , del Carmen F. T. 
Published: December 2021

In a series of experiments on dogs it has been shown that injection of the carbonic anhydrase inhibitor acetazoleamide (Diamox®) is followed by an increase in the renal excretion of salicylate. However, the increased excretion of salicylate is achieved only at the expense of paralyzing the powers of the kidney to deal with metabolic acidosis. As a result, administration of acetazoleamide increases the mortality of animals which have received large doses of salicylate. It is therefore strongly recommended that acetazoleamide not be used in the treatment of patients poisoned with salicylate.
On the other hand our animal experiments suggest that administration of sodium bicarbonate to patients with salicylate poisoning is not harmful even when given early in the course of the development of symptoms. As a result, we have been administering amounts of bicarbonate calculated to raise the concentration of bicarbonate in the plasma by 5 to 10 mEq/l, repeated not more than once every 12 hours.
The mechanism of production of acidosis in salicylate poisoning is discussed in the light of present knowledge of the inhibitory effects of salicylates on certain steps of intermediary metabolism of carbohydrates and fats. The means by which acidification of the urine (in an attempt to compensate for the existing metabolic acidosis) further impairs the excretion of salicylates is also discussed.
HISTAMINE AND RELATED COMPOUNDS IN URTICARIA PIGMENTOSA: ANALYSES OF TISSUES HAVING MAST-CELL INFILTRATION
Authors: Gardner Lytt I. , Tice Artelissa A. 
Published: December 2021

Tissue from the liver and spleen of a child with urticaria pigmentosa have been analyzed chemically for histamine and related compounds. Both tissues were infiltrated with mast cells. Trichloroacetic acid extracts of tissue from the liver of the child with urticaria pigmentosa were chromatogaphed on paper. Histamine was demonstrated as a double-spot formation similar to that described by previous workers who have chromatographed histamine-rich tissues. The histamine was present in the tissue in several hundred times the normal concentration, and exceeded the values for human tissue reported in the available literature. No serotonin could be detected in these human mast cells, a finding in contrast with previous reports of increased serotonin content in rodent mast cells, and in agreement with the findings of Sjoerdsma et al. who could find no serotonin in skin from a patient with urticaria pigmentosa. Our studies suggest that the decarboxylation of 5-hydroxytryptophan to serotonin does not take place in the human mast cell. Instead the accumulation of compounds such as 5-hydroxytryptophan, kynurenine or hydroxylated kynurenine may take place. There was no increase in xanthine oxidase activity.
Acetone extracts of tissue from the liver were made and the residues chromatographed. In addition to histamine, there were noted three substances of unknown structure resembling tryptophane and/or its metabolites. Chemical evidence suggesting the presence of large amounts of a substance resembling mucoitin sulfuric acid (? heparin) in this tissue was obtained. The possible relationship of such compounds to the biochemical error in urticaria pigmentosa is briefly considered. There are at present no data to indicate whether the enzymatic defect is primary to the intermediary catabolism of histamine or of heparin.
ECZEMA VACCINATUM
Authors: Reynolds Audrey H. , Joos Howard A. 
Published: December 2021

Nine cases of eczema vaccinatum are presented, including two fatalities. Seven were caused by contact of a child with eczema with a recently vaccinated sibling.
Suddenly appearing umbilicated vesicles superimposed upon atopic eczema are almost diagnostic of eczema vaccinatum or eczema herpeticum. These do not occur with mere secondary bacterial infection.
Hyperimmune vaccinal gamma-globulin is now available for specific therapy.
Eczema vaccinatum is frequently iatrogenic and uniformly preventable.
The following steps are recommended for prophylaxis: 1) No child with atopic eczema or other skin disorder should be vaccinated. 2) No child should be vaccinated if any member of his family has eczema or other skin disorder. 3) Parents of children with eczema should be notified at the onset of the disease of the danger from vaccination contact. 4) If a sibling of a child with atopic eczema is vaccinated, he must be completely separated from that child for at least 21 days. 5) Forms used by state and local health departments for parents' consent to vaccination should include an appropriate warning of the contraindications. 6) Eczema vaccinatum should be a reportable disease. 7) Patients recently vaccinated must be excluded from pediatric wards containing patients with atopic eczema, other diseases of the skin, burns or healing surgical incisions. 8) Vaccination may be recommended at 2 months of age, especially for babies from strongly allergic families.