bluuebunny/crossref_metadata_2025_split huggingface dataset:
MANAGEMENT OF THE PATIENT WITH CLEFT LIP AND CLEFT PALATE
Authors: MacCollum Donald W. , Richardson Sylvia Onesti 
Published: December 2021

Although some aspects of the management of a child with a cleft lip or cleft palate or both are controversial, it is generally agreed that the best possible care of these youngsters involves the co-operation of a multi-professional group including at least a surgeon, dentist, speech therapist, pediatrician, orthodontist, and the parents as well. It is not necessary for the group to be centralized in location, although this is helpful to the patient. However, each member of a group must be aware of the potentialities and procedures of the other members and should have a knowledge of the terminology and basic principles of the other disciplines represented. As his duties of total care are ever present and continuous, the pediatrician is in a strategic position to help the parents to understand and to implement the consecutive phases of therapy in the home.
The rationale and a general description of one type of cleft lip—cleft palate program as it is carried out at the Children's Medical Center in Boston is presented. During the last 15 years, 2,635 operations for closure of the lip and palate have been performed in the Plastic Surgery Unit. The authors' policy is to repair a cleft lip at 6 to 8 weeks of age and to repair the palate within the first 2 years of life, preferably at about 14 months of age.
Included is a summary of a study made at this Center to evaluate the long-range results of early palatal closure and over-all care of a group of 164 children operated upon between the years of 1942 and 1952.
The conclusions of this study corroborate the authors' previous clinical impression that the results of early palatal closure have been so satisfactory that continuation of the policy seems warranted.
Supportive care is described in some detail because of the authors' wish to emphasize its importance and to provide for the pediatrician a practical guide which long experience has proven to be successful.
GESELL TESTS ON AFRICAN CHILDREN
Authors: Geber Marcelle , Dean R. F. A. 
Published: December 2021

The results of a series of Gesell tests on African infants and children are presented.
The most remarkable finding was the precocity of the younger infants. The motor development was greatly in advance of that of European infants of the same age, but was not an isolated phenomenon; it was paralleled by advanced adaptivity, language and personal-social behaviour.
The precocity was usually lost in the third year, but was retained by some children who had the advantages of a kinderganten.
The results of the Gesell tests were confirmed by a study of newborn African infants, whose state of development was also precocious by European standards.
The findings are discussed in relation to some details of the African environment, and especially to some local customs which may affect early development. Emphasis is placed on the potential value of finding means by which the early precocity could be maintained.
THE HOME CARE OF SEVERELY RETARDED CHILDREN
Authors: Holt K. S. 
Published: December 2021

A study is reported of the practical and emotional problems found in 201 families with mentally retarded children in Sheffield, England.
The families were selected for study solely because they had a retarded child, so that the observations might give a true measure of the incidence of the various disturbances.
The main practical problems were nursing care in 14 families (7%), constant supervision in 63 families (31%), and frequent attention at night in 31 families (15%). These problems caused the exhaustion of the mother in 19% of the families and of the father in 5%. The siblings suffered from attacks by the mentally retarded child in 12% of the families, and through helping in 5%. The parents' activities were limited: in 41% of families they were never able to go out together and in 17% they never had a holiday. The retarded child was the cause of extra expense in 59 families (29%).
The emotional problems observed were disappointment, guilt, shame and a sense of inadequacy. These reactions led to quarrelling between the parents in 6% of the families. The parents had separated in 5% of the families but usually there were other causes behind these separations. In 10% of the families the siblings showed resentment, and in 5% they were ashamed of the retarded child. The emotional factors led to social isolation in 63% of the families.
The place of home care for retarded children is discussed. It is suggested that this can be helped by careful counselling and guidance for the parents, by attention to the needs for practical help, and by reducing the still prevalent stigma against mental defect.
THE DEVELOPMENT OF ENZYME SYSTEMS DURING EARLY INFANCY
Authors: Driscoll Shirley G. , Hsia David Yi-Yung 
Published: December 2021

PEDIATRIC literature and clinical experience contain abundant indications of physiologic immaturity in newborn infants, especially in those born prior to term. Functional immaturity of brain, liver, kidney, immune response and blood coagulation are among the well-recognized peculiarities of the newborn period. Exaggerations of these usually mild, transitory phenomena may contribute to grave disorders and possibly prove to be lethal. In addition to apparent derangements of particular systems or organs, there are occasional infants, notably the delicate offspring of diabetic mothers, whose general response and appearance suggest immaturity disproportionate to size and gestational age. In this group, general metabolic disturbances are suspected which await biochemical localization and characterization. Conventional post-mortem examinations may be discouragingly unrevealing in these babies. For example, one of the most commonly encountered problems is that of infants dying following unexplained respiratory distress. Pathologically, only so-called "hyaline membranes" with atelectasis have been found. This pattern can be noted in at least half of all infants of diabetic mothers and prematures and occasionally in a full-term baby, and constitutes one of the most baffling problems in clinical pediatrics today.
In contrast, the increasing availability of biochemical methods of study are providing a rapidly growing fund of information concerning the normal fetus and newborn. From studies on the chemical embryology of other species and from limited similar work with human material, characteristic patterns of chemical differentiation are emerging. Extension of such observations may be expected to permit the establishment of new metabolic parameters by which to assess the developing fetus and infant.
A COMPARISON OF THE TERATOGENIC EFFECTS OF FIVE POLYFUNCTIONAL ALKYLATING AGENTS ON THE RAT FETUS
Authors: Murphy M. Lois 
Published: December 2021

Five alkylating agents and x-rays, administered to pregnant rats on the twelfth day of gestation and which were killed on the twenty-first day, produced malformations in the fetuses.
The dosages producing four measured effects on the pregnant rats and their fetuses for each of the five alkylating agents and x-rays were found to resemble each other more than in a comparison of six antimetabolites in a previous study.
There is a similarity of the malformations produced by these agents, but some distinct differences in gross soft-tissue and skeletal abnormalities are described.
PEDIATRIC UROLOGY
Authors: Michie Alexander J. 
Published: December 2021

THE MAJORITY of the concern in pediatric urology is centered around infections and anomalies, the former occupying the greater portion of the practicing pediatrician's problem in this field. Therefore, discussion was aimed mainly at pyelonephritis, with queries on other facets of genito-urinary pathology being mentioned.
A review of the literature reveals that pyelonephritis is the commonest cause of death in uremia. While it kills twice as many patients as glomerulonephritis, it occupies only about a third of the literature given to these two problems. The statistics of a number of widely accepted authorities reveals that of all the patients admitted to hospitals, 1% have a urinary tract infection and 5% of all patients treated by pediatric services have a urinary tract infection. Pyelonephritis is more common in the female than in the male in the ratio of 9:1. In the female it is more common in the years from 0-12 and from 25-70 years of age. Very few males have pyelonephritis except those with congenital anomalies, and in the older age group those with gonorrheal obstructions and prostatic enlargement. The manifestations of congenital obstructions to urine flow usually present themselves in the ages from 0-6 years.
CAUSES OF PYELONEPHRITIS
Natural Causes
The Short Rrethra of the Female: In females under 8 or 9 years of age, the urethra is about 1 cm long and some females have such a short urethra that it is essentially only a urethral sphincter. In 10 females less than 10 years of age, all 10 had dye in their bladders, after they sat down and stood up 20 times in 6 inches of dyed water. What is not understood is why more females do not get infection, if this is the answer to more frequent infections in females than in males.
Overdistention of the Bladder: Marked overdistention of the bladder causes vesicoureteral reflux. This condition is more common in adolescents who do not have enough social experience, i.e. those who would not feel free to excuse themselves from company in order to urinate.
Involuntary Residual Urine: In the male patient who has severe paraphimosis and dysuria, an increase in residual urine is often found. Also following circumcision, the skin of the glans penis often exfoliates, leading to urethral meatal ulceration causing dysuria which is followed by a residual urine.
DISCIPLINE
Authors: Kenward John F. 
Published: December 2021

For the present and future happiness of the child, and certainly for the well-being of those about him, the child must learn some obedience. The majority of parents know this, but from time to time may be discouraged and doubtful about their program of discipline. The pediatrician can do a great deal to help. In usual pediatric practice he can do, and does, much to preserve and create optimal conditions for discipline. With parents who are doubtful and unsure, he can counsel, guide and support them in establishing and carrying out a consistent program. When difficulties arise, he often can detect the cause and either correct it, or refer the family for more intensive treatment. Since discipline is primarily a family duty and privilege, he should not dictate policy or program, but he can help the parents see the need for obedience and how to achieve it.
Learning obedience does not mean that subjugation to an authority is a final end in itself. On the contrary, it is a means to an end. Good discipline, by helping the child to learn obedience, protects the child from dangers within and without, relieves him of the burden of making decisions for which he is not ready, and allows him to develop independence of thought and action within a secure framework. Good discipline does not have as its primary purpose the comfort of adults, although this is a secondary gain. It does not intend to make conformity a way of lifeand "adjustment" mandatory.
THE INFLUENCE OF THE NUMBER OF BREAST FEEDINGS ON MILK PRODUCTION
Authors: Egli G. E. , Egli N. S. , Newton Michael 
Published: December 2021

Previous research on the relationship of the number of feedings of milk production was reviewed. Studies on animals and on women in early lactation and late lactation indicate that milk production increases when numbers of feedings are increased.
The present study concentrated on the middle period of lactation. The number of feedings was altered experimentally, and the resulting changes in milk production were observed. The subjects for the experiment were a breast feeding mother and baby 5½ months post-partum.
When the number of feedings and the total nursing time were decreased, significantly less milk was obtained by the baby. When the number of feedings and the total nursing time were again increased experimentally the amount of milk obtained by the baby did not change for 48 hours, but then rose to the control level observed at the beginning of the study.
The findings of this research support the previous observations in the field. Mothers who wish to increase their milk supply should be urged to feed their infants two or three extra times each day.
THE ALDRICH SYNDROME
Authors: Kildeberg Poul 
Published: December 2021

After a brief survey of our present knowledge of Aldrich's syndrome a case of this strange illness is reported. The clinical picture—with eczema, thrombocytopenic bleedings and recurrent infections–and the almost complete lack of natural isoagglutinin in the patient's serum conforms with the descriptions given by other authors. However, persistent distressing vomiting, at least partially due to a relative stenosis of the pyloric canal, was a prominent feature in our case. It was not possible to establish the sex-linked, recessive inheritance originally demonstrated by Aldrich et al.; in fact, no other members of the patient's family have with certainty suffered from the disease.
The possibility of an inborn error of immunoprotein metabolism is discussed, and the close genetic, clinical and serologic similarities in Aldrich's syndrome and various forms of congenital immunoparesis are emphasized. Analyses of the patient's proteins in serum, including immunoelectrophoresis disclosed a generalized hyperimmunoglobulinemia various abnormalities of the gamma globulins and an excess of three specific alpha2-globulins. The genetic serum type was found to be Gm(a÷).
CLINICAL MANIFESTATIONS OF DUPLICATION OF THE BOWEL
Authors: Mellish R. W. Paul , Koop C. Everett 
Published: December 2021

Thirty-eight cases of duplication of the gastrointestinal tract are presented. The embryogenesis of duplications is briefly considered.
Duplications may arise at any point along the alimentary tract but are most frequent in the abdominal cavity. Heterotopia of the mucous membrane is often present. When acid secreting mucosa lines the lesion, hemorrhage or erosion may result. Anatomically, duplications can be classified into spherical or tubular forms. The spherical seldom communicate with the normal bowel lumen, whereas the latter may open into the intestine at some point.
The anatomic distribution, sex, racial incidence and age of onset are summarized.
Other visceral anomalies are frequently associated. Vertebral anomalies often are discovered with thoracic duplications.
Diverse symptoms and signs may lead to the finding of a duplication. In this series respiratory difficulty predominated in five patients, abdominal pain in six patients, an abdominal or anal mass in seven patients, an acute abdominal problem in seven patients and on ten occasions duplications were discovered when patients underwent investigations or operative procedures for other problems.
Thirty-six of the 38 patients had surgical procedures. Interference was deemed unnecessary in one patient. Among the 36 surgical cases, 35 survived and have had no susequent difficulties.
There were two deaths in infants with multiple anomalies, in whom the duplications was an incidental finding in one and a necropsy finding in the other.
THE EARLY SYMPTOMS OF PHENYLKETONURIA
Authors: Partington Michael W. 
Published: December 2021

The early clinical histories of 36 patients with phenylketonuria were studied. It was found that more than half the patients had suffered from symptoms of one sort or another in the early weeks of life. These symptoms began months before any sign of mental defect was evident to the parents. The main symptoms found were vomiting (17 patients), irritability (12 patients) and infantile eczema (6 patients). Some patients had more than one symptom. Three children had pyloric stenosis.
The findings are discussed. It is suggested that in these patients vomiting and irritability in early life may be due to a "toxic" effect of phenylalanine or its derivatives on the brain. It is recommended that all infants having these symptoms, as well as those with infantile eczema, a peculiar smell, seizures, suspected or actual mental retardation or a retarded (or phenylketonuric) sibling, should be tested for phenylketonuria.
SPECIAL ARTICLE
Authors: Goddard Katharine E. , Broder George , Wenar Charles 
Published: December 2021

A study of reliability of elementary facts in the developmental histories of pediatric patients in a clinic population is reported. The results show that mothers do not report gestation time reliably, that many mothers are incorrect when they state that forceps were not used in the delivery, that few mothers can report accurately the immediate difficulties at the delivery of their infant. Feeding histories revealed many discrepancies in duration of nursing and knowledge of formula composition. Many mothers forget or overlook a significant number of illnesses. On the other hand, the mother's evaluation of difficulty of labor and delivery agrees with that of the physician; facts concerning weight at birth, and at subsequent yearly intervals, and details of motor development are reported with accuracy.
The significance of reliability is stressed in interpreting the relevance of factual developmental data to differential diagnosis in deviant behavior, perinatal studies, etc., and further areas of investigation of reliability are suggested.
HUMAN BODY COMPOSITION
Authors:   Committee on Nutrition, Blumberg Richard W. , Forbes Gilbert B. , Fraser Donald , Hansen Arild E. , Smith Nathan J. , Sweeney Michael J. , Fomon Samuel J. 
Published: December 2021

Although it is self-evident that the study of human nutrition has as its goal the optimal nutrition of man, the nutritional status of the body best suited to optimal performance, i.e., optimal nutrition, has unfortunately not yet been satisfactorily defined. Body composition of animals may be measured by direct chemical analysis and correlated with dietary intake and with the various aspects of performance; studies of body composition of living man, on the other hand, must rely on indirect measure ments.
The following two reports, which give an account of the current status of the attack on the difficult task of measuring body composition in living man, are sponsored by the Committee on Nutrition to call attention to the resurgence of effort in this field during recent years. A fuller knowledge of the gross composition of the human body and its relation to preceding diet will constitute a significant step towards realization of the ultimate goal of nutritional science. Even then, a particular body composition will be of importance primarily in terms of functional performance. The availability of newer techniques should do much to stimulate physicians and nutritionists in defining body composition as an essential step in arriving at a more exact definition of optimal nutrition.
THALIDOMIDE AND PHOCOMELIA
Authors: Taussig Helen B. 
Published: December 2021

THALIDOMIDE [alpha (N-phthalimido) glutarimide] is a synthetic drug with the structural formula shown in Figure 1. Thalidomide was invented by the firm of Chemie Grünenthal as a sedative, but when tested on animals was found to be ineffective. Chemie Grünenthal was, however, so certain that thalidomide must have some quieting effect on the central nervous system that it was then tested on man for its effect on epilepsy, and promptly reported to be useless as an anti-convulsant but an excellent sedative. By 1957, thalidomide, marketed under the trade-name of Contergan, was widely used as a sedative and for mental patients. It was considered "safe" to keep in the home because an overdose caused a sound sleep but never produced fatal poisoning. Thalidomide was added to other preparations for conditions where sedation would be beneficial, such as headaches (Algosedive, which is aspirin, phenacetin, and thalidomine), migraine, cough, asthma, gastrointestinal disturbances, grippe, arthralgia, and arthritis. A preparation with a small amount of thalidomide was sold as a tranquilizer.
The rights to market the drug were sold to a number of foreign pharmaceutical firms, and the drug was exported to many other countries. Thus, to my certain knowledge, more than a dozen preparations have been placed on the market in a minimum of 16 countries, excluding the United States, where it was distributed to over 1,000 physicians for investigation. Table I gives a list of these drugs which the author has been able to check. Evidence is steadily accumulating which indicates that both the number of preparations and the number of countries is far in excess of the above figures.
MULTIPLE ANTIGEN IMMUNIZATION OF INFANTS AGAINST POLIOMYELITIS, DIPHTHERIA, PERTUSSIS, AND TETANUS
Authors: Barrett Clarence D. , McLean I. William , Molner Joseph G. , Timm Eugene A. , Weiss Charles F. 
Published: December 2021

This study was designed to determine the earliest age in infancy at which immunization against poliomyelitis, diphtheria, tetanus, and pertussis can be started using a multiple antigen containing component antigens against all four diseases. Subjects ranged in age from 1 day old through 6 months old at time of initial injection. All were given a series of four injections of 0.5 ml of DPT-polio antigen 4 weeks apart followed by a fifth dose (0.5 ml) of the same material 6 months later. A control group received 0.5 ml of a DPT antigen at monthly intervals for their first four doses, but were given a DPT-polio injection (0.5 ml) for their fifth dose.
Although it is evident that there is a progressive response in relation to age of the infant at time of initial inoculation, in respect to poliomyelitis and pertussis immunization, it was apparent that the capacity of the 3-month-old infant to respond to active immunization closely approximates that of the 6-month-old. Ninety per cent showed definite evidence of an immune response to all three poliovirus types despite extremely high levels of preprimary maternal antibody in the majority of 3-month-old infants under study.
Pertussis antibody response, as measured by agglutinin titers, was as good in the 3-month-old as in the 6-month-old infants. The response in the 2-month-old infants was relatively poor at the postprimary stage but was equivalent to that of the older infants at the postbooster interval. There was no indication that response to pertussis immunization was impaired by the inclusion of pertussis antigen in the quadrivalent antigen under study.
Diphtheria and tetanus antitoxin titers were excellent regardless of age at initial inoculation.
The results indicate that four doses of DPT-polio combined antigen given at monthly intervals will overcome the interference of high levels of maternal antibody in respect to poliomyelitis immunization and that the primary series of injections may be started as early as the third month of life. It is important, however, that this primary series of inoculations be followed by a booster dose of the same antigen preparation in about 6 months in order to reinforce the basic immunity.
PEDIATRIC CARDIOLOGY, AND THE SUB-BOARDS
Authors: NADAS ALEXANDER S. 
Published: December 2021

MUCH HAS BEEN WRITTEN about the "crisis" in Pediatrics in recent years. The pages of this journal were filled at one time with discussions on the New Pediatrics, and still a sporadic Letter to the Editor reveals the soul-searching of a colleague. It may perhaps be timely to comment upon formal subspecialization, a type of New Pediatrics, representing a career opportunity for a limited number of physicians.
My remarks will obviously pertain principally to the Sub-board of Pediatric Cardiology, though I understand that they are more or less pertinent to the Allergy Sub-board as well.
The first question to be answered is, why is a Sub-board necessary?