bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE MENTAL PROGNOSIS IN HYPOTHYROIDISM OF INFANCY AND CHILDHOOD
Authors: Smith David W. , Blizzard Robert M. , Wilkins Lawson 
Published: December 2021

A study of 128 children with hypothyroidism is presented. The mental attainments are evaluated in relation to the severity and age of onset of symptoms, and in relation to the age when adequate therapy was instituted. A summary diagram is provided depicting the duration of hypothyroidism in relation to the mental attainments for adequately treated patients.
The best result in severe cretinism, insofar as mental achievement is concerned, is obtained by early adequate therapy. Ten of twenty-two patients in the complete absence of thyroid function treated adequately before 6 months of age, and 12 of 29 patients treated adequately before 12 months of age eventually attained an I.Q. greater than 90. In contrast, none of 50 patients who were inadequately treated, or were treated after 12 months of age, attained such an I.Q.
Mild cretinism, with partial thyroid dysfunction, appears to confer partial protection against mental impairment as 13 of 32 such patients attained an I.Q. of 90 or greater even though not treated early.
Hypothyroidism acquired after 2 years of age apparently exerts little or no serious, irreversible effect on mental development as 13 of 17 patients with acquired hypothyroidism achieved an I.Q. of 90 or greater.
Neurologic sequelae, characterized by spasticity, tremor, and hyperactive deeptendon reflexes, are found frequently in severe cretinism, but not in mild cretinism or acquired hypothyroidism. The severity of neurologic sequelae parallels mental retardation. Early therapy apparently prevents, in part, these sequelae as only 4 of 22 patients with severe cretinism treated adequately in the first 6 months of life had these findings but 22 of 57 patients treated after this age or inadequately treated in the first 6 months, were afflicted with neurologic sequelae.
Early, adequate therapy may fail to establish normal mentality in a certain percentage of patients; 12 of 22 patients treated adequately in the first 6 months of life did not attain an intelligence quotient of 90 or greater. These patients apparently incurred such severe damage to the brain in utero that normal cerebral function could never be established. This surmise is supported by data presented showing a correlation of the severity of retardation of osseous development at birth with the severity of mental impairment.
CLINICAL CONFERENCE
Authors: Engle Mary Allen 
Published: December 2021

Dr. Engle: When pulmonic stenosis occurs as an isolated congenital malformation of the heart, it usually is due to fusion of the valve cusps into a dome with a small hole in the center. In Figure 1 the pulmonary artery has been laid open so that one can see the three leaflets of the pulmonary valve are completely fused, and that there is only a small, central, pinpoint opening which permits blood to leave the right ventricle and enter the pulmonary circulation.
Valvular pulmonic stenosis is much more common than subvalvular or infundibular stenosis, where the obstruction to pulmonary blood flow lies within the substance of the right ventricle. There it may be due to a diaphragm of tissue which obstructs the outflow of the right ventricle, or to an elongated narrow tunnel lined with thickened endocardium, or to a ridge of fibrous or muscular tissue just beneath the pulmonary valve.
The changes in the cardiovascular system which result from obstructed pulmonary blood flow are so characteristic that they permit the ready recognition of this condition. Proximal to the constriction, these changes manifest the burden placed on the right ventricle, which enlarges and hypertrophies. On physical examination this is demonstrated by the precordial bulge and tapping impulse just to the left of the sternum, where the rib cage overlies the anterior (right) ventricle. Radiographically, both by fluoroscopy and in roentgenograms in the frontal and both oblique views, right ventricular enlargement is seen. In the electrocardiogram, the precordial leads show a pattern of right ventricular hypertrophy.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HAVILAND JAMES W. 
Published: December 2021

Dear Dr. Park: It is pretty generally agreed that medical practice in this country has been based on the premise of free choice of physician by the patient, and maintenance of a satisfactory, direct, doctor-patient relationship without the intervention of a third party. At present the opponents of tax-supported, government-controlled medical care are convinced that some form of voluntary, prepaid medical insurance constitutes the best means of protecting our free choice of physician and direct doctor-patient relationship principles.
Some 40 years ago the beginnings of voluntary, prepaid medical care plans were made in this country. These beginnings were made in the Pacific Northwest. They had their origin here because of the peculiar demands of the local, hazardous industries of lumbering, mining and fishing. Contract practice came into being, and received tremendous impetus from the Industrial Insurance Law which was passed in Washington in 1917. Competition for contracts became so intense during the depression period which started in 1929 that vicious methods threatened the structure of medical practice in the State, and it seemed likely that most of the physicians would be relegated to practicing as salaried individuals under a form of health insurance. It was at this time that the various county medical service bureaus in the State of Washington were revived or organized. In Pierce County (Tacoma) a Bureau had been in continuous operation since 1917, and in King County (Seattle) one had been in operation from 1917 to 1925. These bureaus had been organized primarily to contract for work under the State Industrial Insurance Law, and to guarantee a free choice of physician to the workers who belonged to the Bureau. In May 1933 the King County Medical Service Bureau Society was instrumental in organizing the King County Medical Service Bureau to compete with existing contract groups, and to block a proposal by an insurance company for selling insurance and hiring physicians to render necessary medical care.
SEVERE ERYTHEMA MULTIFORME OF THE PLURIORIFICIAL TYPE (STEVENS-JOHNSON SYNDROME)
Authors: SHAFFER BERTRAM , MORRIS PAUL 
Published: December 2021

A case of severe erythema multiforme of the pluriorificial type resulted in total complete blindness due to bilateral involvement of the cornea.
This eruption followed the administration of trimethadione and anterior pituitary extract. The possibility that trimethadione was the cause of the syndrome was considered.
SUBCUTANEOUS ADMINISTRATION OF A SULFADIAZINE-SULFAMERAZINE COMBINATION IN CHILDREN
Authors: SLOBODY LAWRENCE B. , LEHR DAVID , WILLNER MILTON M. 
Published: December 2021

The feasibility of intermittent subcutaneous administration of a sulfadiazine-sulfmerazine combination (2.5% aqueous solutions of the sodium salts in equal amounts) in infants and children was evaluated by means of absorption-excretion and therapeutic studies.
In 60 children with acute infections, intermittent injections of this combination at 12 hour intervals on the basis of 0.13 gm./kg. to 0.2 gm./kg. in 24 hours, gave excellent and well sustained blood and urine levels of sulfonamide and resulted in a highly satisfactory therapeutic response. No local reactions were encountered in more than 500 individual injections.
The incidence of systemic toxicity from the sulfadiazine-sulfamerazine combination was lower than that reported in similar treatment with either compound employed separately. Renal complications, in particular, appear substantially decreased despite the omission of adjuvant alkali therapy. Only one sensitization reaction was observed in this series.
Because of its local irritant effect, the subcutaneous administration of sodium sulfathiazole is not recommended.
Subcutaneous therapy with a combination of sodium sulfadiazine and sodium sulfamerazine has a definite place in the treatment of the infant and small child. The combination seems preferable to single sulfonamides because of a distinctly lower toxicity. These findings confirm our previous studies with oral administration of sulfonamide mixtures.
CHILDHOOD BEHAVIOR SEQUELAE OF ASPHYXIA IN INFANCY
Authors: ROSENFELD GEORGE B. , BRADLEY CHARLES 
Published: December 2021

On the basis of an analysis of the records of 673 children referred for in-patient psychiatric treatment, the majority of those having a history of pertussis in infancy, or asphyxia neonatorum, showed a characteristic behavior syndrome.
The behavior syndrome consisted of the six following traits: Unpredictable variability in mood, hypermotility, impulsiveness, short attention span, fluctuant ability to recall material previously learned, and conspicuous difficulty with arithmetic in school.
Each of these behavior traits occurred from once and a half to twice as frequently in patients with a history of asphyxia in infancy as in a control group.
The syndrome, consisting of at least five of the six traits, occurred more than eight times as frequently in the patients with a history of asphyxia as in a control group.
The syndrome occurred significantly more frequently in children with a history of pertussis when the illness occurred in the first three years of life rather than later.
Since this behavior syndrome presents a serious handicap to successful social adjustment in later childhood, strenuous therapeutic efforts should be made toward eliminating asphyxia as a complication of illness in infancy.
Round Table Discussion
Authors: AIKMAN JOHN 
Published: December 2021

Chairman Aikman: Pediatrics and medicine in general are so full of emergencies that it is difficult to know which ones to consider. At times the line between medicine and surgery is not sharply drawn. The problems are different in various parts of the country due to social conditions, the local poisonous plants, insects, food poisonings, diseases and lastly customs of the people. The problems of Texas are in many ways different from those of New York. The ease with which emergencies develop make the physician humble, and the solutions of these problems require ingenuity, resourcefulness, and courage. Knowledge regarding these matters is almost impossible to secure on a minute's notice, especially outside of the hospital.
No emergencies present more variety and interest than the poisoning accidents of children. Here we have unusual, dramatic, and even fantastic problems presented for immediate solution and treatment. The constant introduction of new poisons into agriculture and industry is astonishing. Unfortunately, there is considerable lag before the danger of new chemicals is detected and effective measures for treatment found. The magnitude of the problems can be appreciated when we know that the California Agricultural Code has jurisdiction over nearly 5,000 materials introduced for pest control of all kinds. A large part of these may become a problem when brought in the reach of and in contact with the runabout child. The National Safety Council reports that poisoning was the third most important cause of accidental deaths in the home in 1944. Deaths from falls were 16,900, mostly in the aged; burns 6,300, about 30% in children less than five years of age; and 2,090 deaths were from accidental poisoning, 680 of these occurred in children under five years of age. In 1929 there were 530 deaths but in 1937 only 440 deaths were reported, 217 of which occurred during the second year of life. The increase in 1944 is probably due to the larger birth rate and to unsatisfactory living conditions.
Poisons will produce nearly every symptom from mild skin rashes to convulsions, coma and death. Poisoning may easily be mistaken for disease and the number of cases overlooked has been estimated as high as 80%. It has recently been pointed out that salicylate and especially aspirin may add confusing symptoms to those of the disease being treated. The amount of accidental poisoning in small children is impossible to determine because only the reporting of fatal cases is required.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: EMERSON HAVEN 
Published: December 2021

OF ALL the specialties of medical practice none has contributed more than pediatrics to the two basic purposes of public health service; namely, the building of healthy minds in healthy bodies, or the guidance of growth and development of children; and the control of preventable diseases, especially those of nutrition and the acute communicable diseases of childhood. The obstetricians and general practitioners have done almost as much in their spheres of influence to advance the safety and length of life.
In spite of the contributions of physicians in general, and of certain specialties in particular, there is a widespread indifference to and practical ignorance of the administrative structure upon which almost all the voluntary efforts and independent professional resources of our communities must rest for practical and continuous constructive results.
For the moment we shall ignore the potential accessary benefits which may in the decades ahead accrue from the World Health Organization, in which our country is quite certain to participate. We rècognize that our federal and state governments are not authorized by law to conduct the health departments of cities, counties, towns, villages or any other jurisdictions of local government except to meet an emergency resulting from neglect and incompetence of local authority and in view of the fact that the federal and state health administrations can and should supplement but not replace local health services.
IMMUNOLOGIC AND BIOCHEMICAL STUDIES IN INFANTS AND CHILDREN, WITH SPECIAL REFERENCE TO RHEUMATIC FEVER
Authors: DEGARA PAUL F. 
Published: December 2021

Agglutinative antibodies for three different strains Str. hemolyticus, beta, group A, were studied in 497 sera from 372 children. A high titer was found in approximately 9% of well children.
There was no significant difference between rheumatic and non-rheumatic subjects in the incidence of high agglutinin titers for Str. hemolyticus.
Following infections, presumably streptococcal in origin, approximately 46% of the children examined had high agglutinin titers for Str. hemolyticus.
In active rheumatic fever, agglutinins were present in high titers in nine out of 11 patients who had experienced an antecedent illness, presumably streptococcal in origin. Of 23 patients with no history of such an infection, only three had streptococcal agglutinins.
INFECTIOUS CROUP. II. "VIRUS" CROUP
Authors: RABE EDWARD F. 
Published: December 2021

Of the three etiologic types of infections croup the most frequently occurring type in this study was so-called "virus" croup.
The pathology of so-called "virus" croup is distinct from that of croup due to H. influenzae type B and C. diphtheriae. It is similar to viral influenza in man and viral laryngotracheitis in chickens.
Clinically "virus" croup is a progressive disease with downward spread of the infection in the respiratory tract. The inflammation can extend to various regions resulting in the clinical forms of the disease known as laryngitis, laryngotracheitis, or laryngotracheopneumonitis. The mortality increases as the disease spreads down the respiratory tract.
There is no well-founded specific treatment for "virus" croup. However, sulfadiazine should be given to all infectious croup patients until cultures of the rhinopharynx and blood assure the absence of H. influenzae type B. Continued chemotherapy should be given all patients severely ill with the disease.
The most frequent and severe complication of "virus" croup is some form of extraalveolar thoracic air. The most common cause of death is respiratory embarrassment.
Round Table Discussion
Authors: SAKO WALLACE 
Published: December 2021

Four monthly doses of an alum-precipitated mixture of diphtheria toxoid and H. pertussis vaccine administered after the third or fourth month of life should confer immunity to diphtheria and pertussis.
Three monthly or bimonthly doses of an alum-precipitated "triple" mixture of diphtheria toxoid, H. pertussis vaccine, and tetanus toxoid administered after the sixth month of life should confer immunity to diphtheria, pertussis, and tetanus.
Alternate gluteal regions are the sites of choice for alum-precipitated antigens in children under three years.
When performed three months or more after the final dose of mixed alum-precipitated antigens the positive pertussis agglutinogen skin test and the negative Schick test for diphtheria were adequate evidence of immunity.
Before a previously immunized child attends kindergarten or school, one stimulating dose of alum-precipitated mixed antigen is recommended.
Probable exposure to a disease of a previously immunized child warrants very prompt administration of one stimulating dose of the respective fluid antigen.
Skin Manifestations of Internal Disorders (Dermadromes)
Authors: DI SANT' AGNESE P. A. 
Published: December 2021

This book represents the most recent attempt to provide a systematic description of the skin manifestations of internal disorders. The author has coined and used throughout the volume the term "dermadrome" to designate the dermal component of a syndrome. Thus for instance the characteristic exanthem is the "dermadrome" of scarlet fever, erythema multiforme and skin nodules the "dermadromes" of rheumatic fever.
The dermatologic symptoms are detailed under the heading of the various diseases. This facilitates reference within the text for those not conversant with all the intricacies of dermatologic classification.
Author and publisher have done a commendable job in presenting the material in clear and readable form.
Re: Multiple Cystic Tuberculosis of the Bones, McLemore Birdsong, M.D., and Camillus S. L'Engle, Jr. Pediatrics 1:767, 1948
Authors: SMYTH FRANCIS SCOTT 
Published: December 2021

The report by Birdsong and L'Engle in the June issue of Pediatrics, leaves me unconvinced. It is difficult to explain the finding of tubercule bacilli by the authors. One would like verification by guinea pig inoculation. This would seem a desirable check, since, peculiar for tuberculosis that was not as yet terminal or overwhelming (tuberculous meningitis), the tuberculin skin test was negative.
The reproductions of the X-ray films of skull and pelvis are strikingly similar to those of the Hand-Schüller-Christian, Letterer-Siwe disease. I do not believe the absence of foam cells in the biopsy rules out xanthomatosis.
THE DISTRIBUTION OF GROUP B COXSACKIE VIRUSES IN A CHILDREN'S INSTITUTION
Authors: Rivadeneira Juan C. , Robbins Frederick C. , Crea Maria , Eiben Robert M. 
Published: December 2021

Two cases of clinical poliomyelitis occurred within a week among 400 children in an orphanage. The first case was paralytic and was due to type 1 poliomyelitis virus. The second case was nonparalytic and only Coxsackie B virus, type 4, was isolated from his feces. This is thought to have been the causative agent of his disease.
At the time the two cases occurred, the stools of 153 well children, including the intimate associates of the patients, and 43 of the 55 adults in the orphanage, were tested in tissue culture for virus. Twenty-four agents, cytopathogenic for monkey kidney cells, were isolated from the children and none from the adults. The viruses isolated proved to be Coxsackie B2 and B4, except for two that were antigenically related to ECHO virus, type 14.
Antibody studies indicated that during the succeeding 2 months 24% of 50 children, not demonstrated to have been excreting virus at the time of sampling, developed neutralizing antibodies against Coxsackie B4 virus and 6% against B2. It was estimated that approximately 130 children were infected with Coxsackie B4 with only 1 clinical case of aseptic meningitis.
Serologic evidence indicated that approximately one third of the children had been infected with the virus related to type 14 ECHO virus, but that only one child developed a new infection during the 2 months of the study.
As no evidence could be found of inapparent poliomyelitis infection in the orphanage, it would seem likely that the isolated case of poliomyelitis became infected during a previous hospital admission, 11 days before he developed symptoms of poliomyclitis. During 2 days of contact he did not appear to have disseminated the virus to his associates in the orphanage.
These data would suggest that types 2 and 4 Coxsackie B viruses probably do not cause pleurodynia because no cases with the symptoms of this disease occurred in spite of the high rate of infection with these agents.
OBESITY
Authors: Gordon Harry H. , Hill Lee Forrest 
Published: December 2021

OBESITY may be encountered at any age in pediatric practice. In infancy it seldom causes concern either to parents or the physician. Parents, in fact, are inclined to view with approval and no little pride the overweight infant who eagerly consumes barge quantities of food. Such accomplishments are looked upon as indications of health at its best.
The physician's lack of concern stems from his knowledge that the obesity of the first year of life is almost certainly transitory and will diminish with the increased activity and lessened appetite which can confidently be expected during the second and preschool years. Stuart feels that the chief significance of obesity in the young infant with an excessive appetite appears to be the indication that the infant readily responds to a positive caloric balance by storing fat. "This," he states, "may be a portent of obesity to follow in adolescent or adult life, if the habit of overeating is developed and maintained." It would seem, therefore, that an indication clearly exists for the institution of parental education in the basic principle of good nutrition even at this early age.
Obesity in the preschool years is relatively uncommon. Thinness rather than obesity is the characteristic of this age period. During the early school years susceptible children, rather insidiously at first, begin to show the trend for excessive fat deposition. Its peak incidence occurs roughly between the years of 8 and 14. Many of these children will, during the next few years, gradually lose their obesity and emerge as young adults with quite acceptable figures (Fig. 1). Whether this comes about as a voluntary reduction in caloric intake or is the result of a readjustment in physiology of the body is not quite clear.
EXPERIMENTAL STUDIES ON THE PATHOGENESIS OF KERNICTERUS
Authors: Ernster Lars , Herlin Lennart , Zetterström Rolf 
Published: December 2021

The effect of bilirubin on cellular energy metabolism has been studied in vitro. Bilirubin inhibits oxidative phosphorylation in isolated rat-liver and brain mitochondria, with a depression of the underlying respiration as a concomitant phenomenon. The latter effect can be prevented by the addition to the mitochondrial suspensions of diphosphopyridine nucleotide and cytochrome C.
In experiments with rabbits in vivo it has been shown that the penetration of bilirubin from blood into central nervous system is greatly enhanced by intracisternal treatment with p-chloromercuribenzoate, an agent which inhibits the function of the blood-brain barrier system. The increase of the concentration of bilirubin in the cerebrospinal fluid upon treatment with p-chloromercuribenzoate is parallelled by an equal increase of the total protein content.
The bearing of these findings on the pathogenesis of kernicterus, and some of the clinical implications are discussed.