bluuebunny/crossref_metadata_2025_split huggingface dataset:
HEMATOLOGIC ADJUSTMENTS TO CYANOTIC CONGENITAL HEART DISEASE
Authors: RUDOLPH ABRAHAM M. , NADAS ALEXANDER S. , BORGES WAYNE H. 
Published: December 2021

Several infants and children with cyanotic congenital heart disease and polycythemia, but without a corresponding increase in hemoglobin, have been encountered.
The presence of a normal hemoglobin level in cyanotic children is not sufficient evidence of absence of anemia.
These children responded well to iron therapy; they showed a rise of hematocrit and developed normal red cells in excessive amounts. Clinical improvement paralleled the rise of hematocrit.
A rise of hematocrit above 75% resulted in return of symptoms, possibly due to marked increase of blood viscosity.
Studies on newborn infants with congenital heart disease show an absence of the usual postnatal erythrocyte decrease in very cyanotic infants but revealed a tendency to the development of "relative anemia" after the third or fourth month of life.
SPECIAL REVIEWS
Authors: ROGERS KENNETH D. , WISHIK SAMUEL M. 
Published: December 2021

Over the last decade or more, pediatricians have become increasingly aware that operative procedures can carry with them psychologic trauma for the child. While it is not to be implied that every operation is a life-shaking experience upon which hinges the future happiness and security of the child, we do know that operations and their attendant events are well remembered by all of us, that they are found to be part of the "meaningful content" of psychiatric exploration, and that the onset of night terrors, disobedience, enuresis, excessive dependence reactions and similar disorders often follow operations. Unquestionably, the exact effect of these experiences on children varies both with the type of experience and with the basic security of the child. Although neurotic symptoms may have their origin in traumatic hospital experience, it is more likely that unfavorable reactions to hospitalization are caused by an activation or reinforcement of anxieties or neurotic trends already present.
Unfortunately, there has been a wide discrepancy between the acceptance of these ideas and the modification of present presurgical and surgical managment of the child to conform with them. The reasons are not hard to find, for the child patient has paid the price of specialization in medicine by having his pediatrician discover a condition, the surgeon elect to operate, the hospital nurse and physician manage the preoperating room experience, the anesthetist perform the potentially most upsetting procedure of the whole experience, and all these persons and others manage his postoperative hospital course.
FUNNEL CHEST
Authors: BILL ALEXANDER H. 
Published: December 2021

Funnel chest as seen in childhood seldom produces disability.
A review of the literature reveals a growing number of cases of funnel chest in adult patients in whom varying degrees of cardiac disability have been described.
In a questionnaire answered by 25 American physicians, the majority feel that among adult patients with severe funnel chest there are some who suffer from cardiac or respiratory disability. There was a feeling that many of these patients undergo psychologic trauma.
Twenty-three of the 25 feel that operative correction of a severe degree of funnel chest should be undertaken in childhood.
A series of eight cases operated upon by the author is reviewed. Of these cases the outcome has been the most successful in children operated upon by radical surgery between 2 and 6 years of age.
The author believes that, for children with a severe grade of funnel chest, surgery should be recommended when they are between 2 and 6 years of age.
COMMITTEE ON ACCIDENT PREVENTION
Authors:   COMMITTEE ON TUMOR REGISTRY,   COMMITTEE ON ACCIDENT PREVENTION
Published: December 2021

The Committee on Accident Prevention has submitted the following statement:
Precautions in the Use of Fluoroscopy
General
No unnecessary examination should be made.
A history of any previous x-ray exposures—by fluoroscopy or roentgenography—should be obtained.
Carry out at no more than 3, but preferably 2 milliamperes.
Record the durations of each examination and the site examined on the child's history.
Equipment
Filters 2-3 mm. aluminum are to be used.
The longest possible target—table top distance—preferably 18" should be used.
Calibration of output (r) of machine should be made not less than once a year unless the tube has been changed or other repairs made.
Machines should have a timing switch which cuts off automatically after 5 minutes.
The machine and controls should be of shockproof type.
Method
Accommodate before fluoroscopy (use red glasses—10 minutes before entering fluoroscopy room).
Wear protective apron and gloves.
Use the minimal field compatible with the requirements of the examination.
Never increase milliampere settings to "see better."
GROWTH IN HEAD WIDTH DURING THE FIRST TWELVE YEARS OF LIFE
Authors: MEREDITH HOWARD V. 
Published: December 2021

This paper brings together the research findings on biparietal diameter from more than 50 investigations. It constitutes a synthesis of present knowledge pertaining to the head breadth of physically normal, North American infants and children.
There are sections on the following topics: methodologic considerations, means for head width, variability in head width, findings from longitudinal data, and the relation of head width to other variables. Included in the section on variability is a table of norms and comments on its clinical use.
Representative generalizations are:
1. The average North American white child attains 30% of adult head width by the middle of prenatal life, 60% by birth, 80% by 6 postnatal months, 90% by 3 years and 95% by 9 years.
2. Throughout the period from birth to 12 years, the 2 sexes differ systematically: head width distributions for North American white girls have slightly lower means and smaller standard deviations than comparable distributions for boys.
3. At 1 year of age, the limits of normal variation in head width are 11.4 cm. and 14.8 cm. for North American white boys, 11.1 cm. and 14.3 cm. for North American white girls. The normal limits at age 10 years are 12.9 cm. and 16.3 cm. for boys, 12.7 cm. and 15.9 cm. for girls.
4. North American Negro school children have narrower heads than North American white school children, and North American Japanese school children wider heads than North American white school children. The mean biparietal diameter of children of Mexican descent approximates that of American Negro children.
5. The association between width of head and length of head is low—of the order r = .25. A similarly low relationship exists between width of head and width of hips, but the relationship between width of head and width of face is appreciably higher.
PEDIGREE DEMONSTRATING A SEX-LINKED RECESSIVE CONDITION CHARACTERIZED BY DRAINING EARS, ECZEMATOID DERMATITIS AND BLOODY DIARRHEA
Authors: ALDRICH ROBERT A. , STEINEBERG ARTHUR G. , CAMPBELL DONALD C. 
Published: December 2021

Genetic analysis of the family of an individual suffering from what appeared to be secondary thrombocytopenic purpura indictated that:
1. Sixteen of 40 male infants died.
2. Ten of these, including the proband, were known to have suffered from draining ears, eczematoid dermatitis and bloody diarrhea.
3. The pattern of deaths agrees with the assumption that a sex-linked recessive gene is responsible for the primary deviation which leads to the death of these infants.
PULMONARY FUNCTION IN CYSTIC FIBROSIS OF THE PANCREAS
Authors: WEST JOHN R. , LEVIN SHELDON M. , SANT'AGNESE PAUL A. 
Published: December 2021

Studies of pulmonary function in patients with chronic pulmonary disease associated with cystic fibrosis of the pancreas have revealed a pattern of dysfunction which may be said to be characteristic of this disease, but which is subject to great variation in severity.
Both ventilatory insufficiency (leading to dyspnea) and disturbances in gas exchange (leading to arterial hypoxia and carbon dioxide retention) may occur. The former would seem to be largely the result of factors which bring about a diminished ventilatory capacity, among which an increased resistance to air flow within the tracheobronchial tree, due to obstruction of the larger and smaller bronchi by accumulated secretions and purulent exudate, is probably most important. Defective gas exchange seems to stem largely from disturbances in the normal relationships of alveolar ventilation to perfusion. This seems in large part due to uneven distribution of tidal air to the alveoli as a result of bronchial obstruction, although concomitant variation in the distribution of blood probably occurs also.
In general, the severity of the impairment of pulmonary function closely parallels the chronicity and severity of the characteristic secondary bronchial and pulmonary infections. The treatment of these constitutes, logically, the major effort in therapy.
STUDIES OF THE IMMUNOLOGY OF THE NEWBORN INFANT
Authors: DANCIS JOSEPH , KUNZ HANS W. 
Published: December 2021

The bacteriostatic activity of the serum of infants was compared by an in vitro test with that of older children and adults in an attempt to explain the increased susceptibility to septicemia of the former.
The serum of newborn infants at birth has a bacteriostatic activity against E. coli comparable to that of older individuals. This property is lost during the first weeks of life. It reappears in some infants in a few months and is usually present after one year of age.
The bacteriostatic activity of premature infant serum follows closely that of the full term infant.
The complement activity of 9 of 11 sera from premature infants fell within the range found in normal adult sera. Experiments using guinea pig serum as a source of complement also indicate that the poor bacteriostatic activity of premature infant serum is not the result of deficient complement ent activity. This is probably also true of the full term infant.
Experiments with gamma globulin indicate that a deficiency in this serum fraction is at least partly responsible for the poor bacteriostatic performance of premature infant serum.
Concurrent bacteriostatic tests with E. coli, Neisseria catarrhalis and Salmonella derby suggest that the ability to inhibit one organism is usually paralleled by the ability to inhibit the others.
The possible nature of the bacteriostatic substances is discussed.
RETROPERITONEAL MYXOLIPOMA
Authors: PINTO V. CARVALHO , MATTOS A. GOMES , PIMENTA E. , MORAES R. VILHENA , ALTENFELDER P. 
Published: December 2021

A case of a fatty tumor of the retroperitoneal space, with the histologic diagnosis of myxolipoma, is presented. The boy was 7 years old and weighed 24.2 kg.; the tumor weighed 12.8 kg., or more than half the child's weight.
The clinical history suggests that the tumor appeared at the age of 1½ years and developed without any complications of the renal and intestinal functions. There was predominance of the myxomatous tissue and the removal of the whole tumor was possible. It was located between the mesenteric leaves and for its removal, 50 cm. of the ileum had to be resected. The complete extirpation was performed and the child is in good physical condition six months after the operation.
AN EVALUATION OF CHLORAMPHENICOL THERAPY IN TYPHOID FEVER IN CHILDREN
Authors: FRIEDMAN ABRAHAM 
Published: December 2021

In the light of the author's experience with chloramphenicol therapy of typhoid fever in 122 children, the following conclusions appear to be valid:
I. Prolonged chloramphenicol therapy is unnecessary, undesirable and sometimes even harmful. The course of therapy should be limited to the period of fever and continued for just one or two days after the temperature has become normal. This view is based upon the following considerations:
A. The finding that relapses were just as frequent on longer courses as on shorter ones.
B. Prolonged courses of chloramphenicol expose the patient more intensely to the hazard of severe and sometimes fatal gastrointestinal disturbances.
C. Prolonged courses may expose the patient more seriously to severe and sometimes fatal bone marrow depressions.
D. This conclusion is of special importance where the availability of the drug and the expense involved are factors to be taken carefully into consideration.
II. Except in hypertoxic forms of typhoid, chloramphenicol therapy should be instituted as early as possible and should not be delayed for any reason. This view is based upon the following considerations:
A. On the one hand, when chloramphenicol is started early, during the first week of illness, the relapse rate is higher in comparison to the relapse rate when therapy is started later.
B. On the other hand, complications and mortality rates are considerably higher when therapy is postponed to the second week or later.
C. Weighing these two hazards against each other, it appears that the latter outweighs the former and that it would certainly be wiser to take the risk of a relapse than of a severe complication or a fatality and therefore therapy should be started in every case as early as diagnostic considerations permit.
III. In hypertoxic forms of typhoid, chloramphenicol therapy should be withheld at the beginning, trying supportive therapy, including blood transfusions. Later chloramphenicol may be started but with small doses only, perhaps 12.5 mg./kg./day. If no deterioration in the general condition takes place it may then be increased, say 3 to 4 days later, to 25 mg./kg./day and 3 to 4 days later again, to 50 mg./kg./day, provided the general condition of the patient does not deteriorate.
IV. If in spite of special care in instituting chloramphenicol therapy in hypertoxic forms of typhoid an intestinal perforation-like syndrome develops, chloramphenicol therapy should be stopped immediately and general supportive measures instituted as soon as possible. The same applies when the intestinal perforation-like syndrome develops suddenly in a patient not previously severely toxic.
V. Gastrointestinal disturbances during chloramphenicol therapy should be taken seriously, and any degree of severity in such disturbances warrants the immediate cessation of chloramphenicol with the immediate institution of corrective measures to combat the electrolyte disturbances which might have resulted.
JUVENILE THYROTOXICOSIS
Authors: ALLEN RICHARD F. , ROSE EDWARD , ROSE ELIZABETH KIRK 
Published: December 2021

Results of treatment are presented in 30 thyrotoxic children whose symptoms appeared prior to age 15 years.
Fifteen patients received thyroid irradiation with or without stable iodine and 15 received prolonged treatment with antithyroid compounds, with or without stable iodine.
Among the 24 patients in whom the final results of treatment could be fairly assessed, satisfactory remissions were obtained in 17 (70.8%). Approximately similar results were obtained in those who were irradiated and in those who received antithyroid compounds.
Satisfactory remissions were obtained in 5 of the 6 patients subjected to thyroidectomy.
Two cases of unusual interest are described. Reasons for the present conservative policy in the treatment of juvenile thyrotoxicosis are stated.
THE PEDIATRICIAN AND THE PUBLIC
Authors: PARK EDWARDS A. 
Published: December 2021

The British National Health Service is a highly original system. Its organization is as democratic as our public school system and free from political control. It is the most interesting and exciting social experiment of my life which means a great many years. It is time that we give up one-sided consideration and turn to study it fairly, for whatever direction medical care takes in this country it is possible to learn enormously from the experiences of the British system. I believe that it has some serious defects but that in spite of them it has been a prodigious success in supplying the needs of the people.
I think that in assessing the value of the British National Health Service we Americans fall into two errors. In the first place we compare the best which we have in this country with what we happen to run across and in some instances with the selected worst in Great Britain. The second error, which is the more important, is that we think primarily in terms of the physicians, i.e., ourselves. We involuntarily put ourselves in the place of the British physician and ask how we would like to be restricted as they are. The primary aim of medical service is the patient and, in the aggregate, the preservation of the health and welfare of the nation. In developing any system of medical care, it is necessary to consider first the welfare of the people, but it is a fundamental mistake not to consider adequately the welfare of the physician.
I think that the error in the organization of the National Health Service was in considering almost exclusively the needs of the people and giving very little attention to the needs of the physician, who have been moved about and their activities limited and defined too much as if they were chess men on the board. From this error, it is the people who will ultimately suffer.
THE EFFECTS OF HYPOXIA ON THE RESPIRATION OF NEWBORN INFANTS
Authors: MILLER HERBERT C. , BEHRLE FRANKLIN C. 
Published: December 2021

The effects of administering atmospheres containing 10 and 12% oxygen to healthy newborn infants of different ages have been studied.
Infants under 24 hours of age tended to hypoventilate throughout the period of hypoxia. Infants six to 11 days of age hyperventilated for the first two or three minutes and then showed a decrease, although not so marked as observed in the infants under 24 hours of age. Infants 16 to 48 days of age showed the most marked increase in ventilation, but even in these infants it was poorly maintained as compared to responses seen in adults.
Hypoxia produced a slowing of the respiratory rate in all infants except the very oldest. Tidal air was increased at first and then decreased. The increases in tidal air accounted for most of the increase in minute volume seen in the older infants.
Hypoxia increased the incidence of periodic breathing in the two older groups of infants, but had very little effect on infants under 24 hours of age.
Respiratory patterns did not appear to be altered by the hypoxic conditions employed in this study.
It has been postulated that the comparatively weak response to hypoxia made by infants immediately after birth possibly is dependent on relatively poor chemoreceptor reflexes and that the latter increase in strength during the first weeks of postnatal life.
It has also been suggested that the relative inability to induce periodic breathing in infants under 24 hours of age as compared to those several weeks old is further evidence indicating that metabolism of the medullary respiratory centers is to a larger extent anerobic than at the later periods of postnatal life.
NON-SURGICAL TREATMENT OF UNILOBAR OBSTRUCTIVE EMPHYSEMA OF THE NEWBORN
Authors: KORNGOLD HERBERT W. , BAKER JOHN M. 
Published: December 2021

1. The reported 22 cases of unilobar obstructive emphysema in infancy are reviewed. Eighteen of these cases were successfully treated by lobectomy or segmental resection. No cause of the obstruction was found in over 50% of the cases reported.
2. Two cases of unilobar obstructive emphysema in the newborn are presented. These patients were successfully treated by selectively decompressing the emphysematous lobe.
3. The non-surgical method of treatment is advocated in the newborn when lobar emphysema is newly established and reversible. It may be of value when surgery is indicated to improve the patient who is a poor risk.
4. The mechanism, by which selective decompression alleviates the partially obstructed bronchus, is open to conjecture. However, we postulate that the bronchus, is kinked by an overdistended emphysematous lobe and that retained viscid secretions augment the bronchial obstruction in the new born.
COMPARISON OF SKELETAL MATURATION WITH DENTAL STATUS IN JAPANESE CHILDREN
Authors: SUTOW WATARU W. , TERASAKI TARO , OHWADA KENJI 
Published: December 2021

1. Data obtained from simultaneous skeletal maturation assessments and dental status evaluations on each of 1,360 Japanese children (678 boys and 682 girls) ranging in age from six to 14 years have been presented.
2. Statistically significant differences in number of permanent teeth were demonstrated between the skeletally above average and skeletally below average children, skeletally advanced children having the greater number of teeth. At individual age levels, consistent significant differences were not found.
3. Comparisons of the terminal (extreme) segments indicated statistically demonstrable differences in a greater number of individual age groups, especially among girls.
4. At each age level, the girls had a greater mean number of erupted permanent teeth than the boys.
EDUCATION
Authors: PARMELEE A. H. , SWENGEL ETHEL , ADAMS JHON M. 
Published: December 2021

A course in the medical school curriculum has been described. We have pointed out the integration with the basic sciences, growth and development and preventive medicine, and we have emphasized the relationship of the psychologic, economic and sociologic aspects of the patient's environment to disease.
The principle of self-education is emphasized throughout the four-year experience of the student. The close guidance of the student is provided by the active participation of the faculty of the School of Medicine and many additional people in the University and community.
The experiences of the student in the first two years of the course have been reviewed in an attempt to evaluate their achievements.
The total curriculum time of the Family Medicine Course for the four years is 116 hours. This represents approximately 23½% of the total curriculum time of the Medical School.
THE INCIDENCE OF CONGENITAL MALFORMATIONS: A STUDY OF 5,964 PREGNANCIES
Authors: MCINTOSH RUSTIN , MERRITT KATHARINE K. , RICHARDS MARY R. , SAMUELS MARY H. , BELLOWS MARJORIE T. 
Published: December 2021

I. The plan is described of a prospective study of the outcome of 5,964 pregnancies, with special emphasis on the relationship of factors in fetal environment to the incidence of abortions, stillbirths, neonatal mortality and congenital malformations.
II. Data are presented on the overall incidence of congenital malformations according to sex, race, weight at delivery, maternal age and order of birth.
A. The incidence of congenital malformations among 5,739 products of conception weighing over 500 grams was 7.5%. The rate was 7.0% among infants born alive and surviving the neonatal period, 13.6% among antepartum deaths, 23.3% among intrapartum deaths, 29.6% among neonatal deaths and 70.6% among deaths occurring between the ages of one and 12 months.
B. The following relationships in incidence rates among live-born infants surviving the neonatal period were found.
1. The rate among males (8.4%) was half again as high as among females (5.5%).
2. Non-white infants had a higher rate (7.8%) than white infants (6.3%).
3. Infants weighing 2,500 grams or less had a higher proportion with defects (9.7%) than did those weighing over 2,500 grams (6.7%), although this difference occurred entirely among females.
4. Maternal age had no effect on the incidence of congenital malformations.
5. White infants of lower birth order had a lower rate (5.3%) than did those of higher birth orders (8.2%). No difference according to birth order was observed among non-white infants.
III. A system of classification of malformations is described and discussed. Incidence rates by organ system groups are presented.
A. Less than one-half of the malformations found among live-born infants were suspected or noted at birth.
B. Malformations of musculo-skeletal system and skin were more frequent than malformations of other systems. Incidence rates by organ system groups are directly related to problems of diagnosis.
C. Of the malformed live-born infants, 14.8% had more than one malformation and in 9.1% more than one system was involved. Of the malformed stillbirths and neonatal deaths, 66.0% had more than one malformation and in 51.1% more than one system was involved.