bluuebunny/crossref_metadata_2025_split huggingface dataset:
B. MUCOSUS CAPSULATUS (FRIEDLÄNDER) MENINGITIS; RECOVERY OF A THREE-WEEK-OLD INFANT TREATED WITH SULFADIAZINE AND STREPTOMYCIN
Authors: DANIEL W. A. 
Published: December 2021

B. mucosus capsulatus (Friendländer) meningitis has been a disease entity for approximately 60 years. It occurs chiefly in very young or aged males. The diagnosis in the pediatric age group is especially difficult because of the paucity of symptoms and physical findings referable to the central nervous system or of any primary source of infection. meningitis differs from other types in that the spinal fluid becomes almost gelatinous unless treatment is quickly employed. Less than 50 cases of B. mucosus capsulatus meningitis have been reported, and only five of these have recovered. With the use of streptomycin and sulfadiazine, the mortality rate may be greatly reduced if the cases are diagnosed and treated early in the course of the illness.
A case of B. mucosus capsulatus meningitis occurring in a three-week-old male infant who recovered has been presented.
ADJUSTMENT OF ELECTROLYTES AND WATER FOLLOWING PREMATURE BIRTH (With Special Reference to Edema)
Authors: SMITH CLEMENT A. , YUDKIN SIMON , YOUNG WINIFRED , MINKOWSKI ALEXANDRE , CUSHMAN MARGARET 
Published: December 2021

Many premature infants are born with an edema which is probably the expression of a physiologic mechanism common to all and intensified in some. Clinical observation has shown this to be a disabling condition and prejudicial to survival. Measures which assist its removal, if otherwise safe, may be advantageous even to prematures in whom edema is not severe enough to be visible. Conversely, procedures likely to augment an edema already present might tend to produce it in nonedematous babies.
This investigation has shown an association between manifest edema, an increased breakdown of body protein, and relatively large amounts of Na and K in the urine. All these changes characterize the phase between birth and feeding. Whether or not edema is present, K is rapidly reaccumulated when feeding is begun, and its replenishment reaches an amount considerably above that present at birth. Disappearance of the edema is accompanied by losses of Na and Cl. These alterations occur whether or not water is administered and are ultimately proportional to the amount of edema originally present. Edema usually clears in a day or two but may occasionally persist for a week or more. The time of its disappearance, like the mechanism of its presence, is governed by unknown, perhaps endocrinologic factors. It could not be "washed out" of the body by an increased water intake in the one infant subjected to that procedure. There is every reason to believe its presence would be increased or prolonged by administration of sodium-containing solutions. On the other hand, since K appears to be present in relative insufficiency at premature birth, we propose to investigate the possible advantages of providing added K in early feedings. The clinical implications of the N balances are not clear.
In this clinic, the problem is at present met by allowing no intake whatever for as long as four days after birth, the time being governed by the degree of edema. The excess body water and much of the excess Na are usually removed during this phase. Reduction of body weight by as much as 20% may occur, and the concentration of extracellular fluid becomes significantly increased. On the other hand, danger from aspiration is avoided, and when intake is ultimately begun, the organism is no longer encumbered by edema. Should it be possible in the future to facilitate readjustment of body chemistry by early oral administration of specially designed solutions, the resultant advantages would still have to be weighed against the aspiration hazard.
CLINICAL OBSERVATIONS ON THE USE OF HYALURONIDASE
Authors: BURKET L. CLAIR , GYÖRGY PAUL 
Published: December 2021

The use of hyaluronidase was observed in 116 infants and children in such procedures as hypodermoclysis, phthalein excretion test and urography. Eight tenths of a milligram (0.8 mg.) of the dry substance dissolved in 1 ml. of distilled water was used as a standard amount of the enzyme for all procedures.
Hyaluronidase provided an effective expedient to fluid diffusion in subcutaneous therapy. From clinical observations, the speed of flow in any one case is dependent upon: 1. general development of the patient, 2. state of hydration of the patient, 3. activity of the patient, 4. position of the needles in the skin, 5. original speed of the flow and 6. type and amount of fluid given.
There was no significant change either in dye excretion or total renal fluid excretion when hyaluronidase was used in the phthalein excretion test.
Hyaluronidase reduced the amount of dye necessary when given subcutaneously to secure adequate visualization in urography.
Repeated urinalyses in many of the procedures showed no evidence of renal pathology.
There were no instances of thermal reaction, spread of infection, or reactivation of infection that could be attributed to the use of the enzyme.
TRENDS IN HEALTH LEGISLATION AND ADMINISTRATION
Authors: WALL JOSEPH S. 
Published: December 2021

THE handwriting is on the wall for all to see. The people of the country have elected a President who has repeatedly during his years in office and during his campaign speeches proclaimed his intention to extend social security and to establish a national health program based upon compulsory health insurance. Heretofore he has been obstructed by a Republican Congress: now, as Republican Speaker Joseph Martin has succinctly pointed out, it cannot be doubted that the President can get through any legislation he really wants.
One of the President's close advisors is Mr. Oscar Ewing, Administrator of the large and powerful Federal Security Agency, which we can predict with reasonable assurance will soon be elevated to cabinet status. The creation of a cabinet department encompassing government activities in medicine and public health, education and social welfare gained considerable momentum in the 80th Congress. Furthermore, it is expected that the Hoover Commission created by the Republican 80th Congress will include in its report on organization of the government's executive branch the formation of such a department. A new name has already been suggested for this branch of the government: The Department of Human Resources.
Mr. Ewing has, on many occasions, made his position very clear. In a speech delivered three days after the election he reviewed the recently published report entitled "The Nation's Health," a report which followed the National Health Assembly in point of view of time but did not in all respects follow the recommendations made by those attending the conference. In his November 5th address he stated:
COMBINED IMMUNIZATION AGAINST DIPHTHERIA, TETANUS AND PERTUSSIS IN NEWBORN INFANTS
Authors: DI SANT'AGNESE PAUL A. 
Published: December 2021

A comparison was made of antibody production by newborn infants and by older children following prophylactic inoculation against diphtheria, tetanus and pertussis. In all instances the same triple combined antigen ("Alhydrox") was used, and the same routine was followed. First injection of vaccine was administered to all newborn infants at seven days of age. Most of the "older" children were between six and 12 months of age at first injection.
Incidence and severity of systemic reactions to administration of the triple combined antigen increased with subsequent injections in newborn infants; the reverse was true of the "older" children. No such difference was found between the two age groups in local reactions to inoculation. Five sterile abscesses were observed in the newborns; none in the "older" children.
Pertussis agglutinin titers achieved after immunization were consistently higher (even after booster dose) in "older" children than in infants injected in the newborn period.
"Older" children produced significantly higher diphtheria antitoxin titers after prophylactic injection than the newborn infants. After administration of a booster dose, however, diphtheria antibody production in the two age groups was comparable.
No difference was found at any time in tetanus antitoxin levels achieved after inoculation by the newborn infants and the "older" children.
It was concluded that during the first year of life the capacity to produce antibodies in response to an antigenic stimulus increases with advancing age. It was felt, however, that in some instances the immunologic handicap due to tissue immaturity can be overcome if a sufficiently great antigenic stimulus is given.
Evaluation of antibody titers achieved by newborn infants after prophylactic injection of triple combined antigen reveals that the results of immunization against tetanus and diphtheria were satisfactory. The results of inoculation against pertussis were considered to be unsatisfactory, mainly because the proportion of infants who produced "protective" agglutinin titers fell far short of the 90% which is the maximum that can be expected.
A conservative approach to the problem of active immunization in early infancy is urged. It is suggested that until further work is done, routine prophylactic inoculations not be started before the age of three months.
ANTEPARTUM DIAGNOSIS OF CONGENITAL ANOMALY OF THE HEART
Authors: BERREY BEDFORD H. , HELMAN RICHARD G. 
Published: December 2021

THE recognition of congenital anomalies of the heart of the fetus has received scant mention in medical literature. Because such a condition was observed and correctly diagnosed antepartum, this report of the case should be of interest.
Hyman states that the condition may not be noted because enough time is not devoted to adequate fetal cardiac auscultation. Other aspects of the routine examination are regarded as more important and to detect the presence or absence of the sounds of the fetal heart usually suffices.
The incidence of congenital heart disease declines with advancing age, especially the more severe lesions which are incompatible with life beyond the first weeks or months following birth. Clinical evidence of congenital heart disease has been noted in 0.3% of newborn infants and in from 0.05% to 0.15% of school age children. Maude Abbott, in 3,633 autopsies of all age groups, recorded 43 cases (1.2%) with congenital anomalies of the heart.
Perusal of medical literature of the past hundred years shows that Massman, in 1854, was the first to record the recognition of an unusual fetal cardiac murmur; he suspected a congenital anomaly of the heart, and this diagnosis was confirmed at autopsy. Barth, in 1880, likewise described a case which was confirmed at autopsy.
Padgett, in 1894, the first American to record such a diagnosis, believed that he heard the murmur of mitral valvular disease in a fetus and his suspicion was substantiated at autopsy. Others reporting similar cases included Bellot and Andry and Lacroix.
Hoehne, from a study of his own case and seven others collected from the literature, proposed three criteria for the diagnosis of fetal congenital cardiac lesions: 1. There is a murmur rough in character, of constant duration and intensity, but not synchronous with the maternal pulse. 2. For the most part, there is a constant defect in both heart sounds; usually the first and occasionally only the first sound is heard. 3. The murmur is heard over the entire abdomen of the mother with greatest intensity in the area where the fetal cardiac sounds are heard best.
During studies of routine fetal phonocardiograms in 31 cases, Sampson and others reported one case of fetal congenital anomaly of the heart. Dipple made a comprehensive review of the literature and added two cases of his own, each having an interventricular septal defect, a patent foramen ovale and a patent ductus arteriosus.
MULTIPLE HEMORRHAGIC HEPATOMA (L'ESPERANCE)
Authors: RATHMELL THOMAS K. , MAINS M. PAUL 
Published: December 2021

A case of multiple hermorrhagic hepatoma of the liver in an infant of five months is reviewed with illustrations of the gross and microscopic pathology.
Hepatomas of infants differ somewhat from those seen in adults.
In the light of our findings, descriptions of bone in hepatic neoplasms should be accepted with reservations.
OBSERVATIONS ON 117 PATIENTS OPERATED ON FOR CONGENITAL PULMONARY STENOSIS
Authors: DAMMANN J. F. , GIBSON STANLEY , POTTS WILLIS J. 
Published: December 2021

Operations were performed on 117 patients with congenital pulmonary stenosis or atresia.
Diagnosis in the patient with a typical tetralogy of Fallot is not difficult. Variations from this typical picture, noted on physical examination, roentgenogram and fluoroscopy, are discussed.
Six patients with tricuspid atresia are reviewed with particular reference to differential diagnosis.
One patient with pulmonary valve stenosis and a patent foramen ovale is presented.
An aortic-pulmonary anastomosis was accomplished in 105 patients with 10 deaths, a mortality rate of 9.5%. Twelve patients were explored with a mortality of 50%. The over-all mortality was 13.8%. The causes of death are reviewed.
Results have been slightly less satisfactory in older patients with a right aortic arch than in those patients with a left aortic arch.
Excessive cardiac enlargement has occurred in a few instances.
CHANGE IN THIOCYANATE AND SODIUM24 SPACES DURING GROWTH
Authors: FELLERS FRANCIS X. , BARNETT HENRY L. , HARE KENDRICK , MCNAMARA HELEN 
Published: December 2021

The spaces occupied by one or more of the four substances, thiocyanate, sodium24, mannitol and inulin, were determined in 36 subjects ranging from premature infants to adults.
No conclusions could be drawn concerning the spaces occupied by mannitol and inulin, since, under the conditions of the observations in our human subjects, neither of these spaces reached a constant value.
There is a definite decrease in the spaces occupied by thiocyanate and sodium24 as growth proceeds. If the changes in the spaces occupied by these two substances reflect corresponding changes in extracellular fluid volume, they indicate that young infants have an extracellular volume which is 57 (sodium24) to 78 (thiocyanate)% greater than that of the adult.
The decrease in the spaces occupied by thiocyanate and sodium24 occurs at two distinct periods of growth: primarily during early infancy and also during adolescence.
TRENDS IN HEALTH LEGISLATION AND ADMINISTRATION
Authors: WALL JOSEPH S. 
Published: December 2021

ON March 21 the Hoover Commission's final report on the reorganization of the Government's medical and hospital services was submitted to the Congress. The report prepared by the bi-partisan l2-man Commission is not in accord with the proposal to create a cabinet department of welfare which would include the present functions of the Federal Security Agency—a proposal which is incorporated into a House bill (H. R. 782) and, as stated in this column a month ago, has been approved by the House Committee to which it was referred. In contrast to H. R. 782, the Hoover Commission recommends a new cabinet department to direct the welfare and educational program of the Federal Government and a new and separate United Medical Administration. The UMA would be responsible directly to the President and should, according to the Commission, be headed by "the ablest medical and health administrator whose services can be obtained by the government," with three assistant administrators and an advisory board composed exclusively of Federal officials. It is noteworthy that the qualifications recommended for the person who should head the UMA does not specify that he should be a doctor of medicine.
The cabinet department, for which no name has as yet been proposed, would have jurisdiction over the Bureau of Old Age and Survivor's Insurance, the Bureau of Public Assistance, the Children's Bureau, the Bureau of Education, the Bureau of Vocational Rehabilitation, the American Printing House for the Blind, the Columbia Institution for the Deaf and the Bureau of Indian Affairs.
JET INJECTION IN PEDIATRIC PRACTICE
Authors: HUGHES JAMES G. , JORDAN ROBERT G. , HILL FONTAINE S. 
Published: December 2021

The technic of jet injection is described. It represents the first fundamental change in the basic principles of injection in almost 100 years.
The method is relatively painless, is practically innocuous to tissue, and has technical simplicity.
Information is presented dealing with depth of penetration of substances injected, pain response of children, local effects on tissues, blood levels of penicillin and of streptomycin given by jet injection, and clinical response of patients given penicillin by this technic.
Discussions are given concerning the need for chemical inertness of the metal used in the metapule, viscosity of material which can be injected and the possibility of inadvertent intravenous injection.
The proper instrument for children under 10 years of age is one of 75 pounds spring pressure, and for children 10 years of age or older 100 pounds spring pressure. With these strengths it has consistently been possible to secure intramuscular injections in the deltoid and triceps areas, and subcutaneous injections in the lateral thigh area. Injections over large veins should obviously be avoided.
Jet injection offers promise in the field of pediatrics chiefly because of its relative painlessness. It may prove of value in mass immunizations, not only because of pain prevention and technical simplicity, but also because the transmission of viral agents from one subject to another by contaminated needles would be avoided.
Further investigations are indicated, for the relief of pain is one of the foremost functions of a physician.
PHONOCARDIOGRAPHIC DIFFERENTIATION OF THE MURMUR OF MITRAL INSUFFICIENCY FROM SOME COMMONLY HEARD ADVENTITIOUS SOUNDS IN CHILDHOOD
Authors: HARRIS T. N. , FRIEDMAN SIDNEY , HAUB CARL F. 
Published: December 2021

Phonocardiographic tracings were recorded in children with known insufficiency of the mitral valve, children with a variety of systolic murmurs without blowing quality and children with no audible cardiac murmurs.
The murmurs of valvular insufficiency produced tracings with a completely patternless and disorganized wave form. The other nonblowing murmurs all yielded tracings of uniform sine-wave character, regardless of their acoustic quality. Of these, the majority were "twanging-string" murmurs, the loudest of these with a distinct buzzing quality; the others were "snorting," "scraping" or "grating" in quality. Clinical observations indicated that these nonblowing murmurs were not indicative of cardiac disease.
The murmurs of mitral insufficiency were significantly longer than the nonpathologic murmurs, but the latter showed, on the average, fully as great amplitude on the tracings. Physical and clinical implications of these findings are discussed.
PERCUTANEOUS RENAL BIOPSY IN CHILDREN
Authors: Dodge W. F. , Daeschner C. W. , Brennan J. C. , Rosenberg H. S. , Travis L. B. , Hopps H. C. 
Published: December 2021

Since 1951, when the percutaneous renal biopsy was introduced as an adjunctive method for study of patients with renal disease, reports of some 4,000 kidney biopsies have appeared in the literature. Only about 250 of these, however, have been performed in children.
A biopsy specimen containing 5 to 10 glomeruli has been reported to be adequate for interpretation and to be representative of the total renal parenchyma in 84% of the cases with diffuse renal disease.
Using a biopsy technique similar to that described by Kark, we have obtained an adequate specimen in 92% of 205 kidney biopsies performed in 168 children with diffuse renal diseases.
Seven deaths have been previously reported in the literature. The circumstances surrounding the death of these seven patients and of the one death that occurred in our series are described. Perirenal hematoma has had a reported incidence of 0.4%. It has been our experience, as well as that of the other investigators, that if blood boss is replaced, the patient has an otherwise uneventful course and the mass subsequently disappears. Gross hematuria has had a reported incidence of 5.2%. Microscopic hematuria, lasting for 6 to 12 hours after biopsy, has been found to be the rule rather than the exception.
The complications which have occurred have been associated with bleeding, and therefore a careful history concerning bleeding tendency and a study of the clotting mechanism is essential if the risk of needle renal biopsy is to be minimized. In addition to a bleeding tendency or defect in clotting mechanism, most investigators are agreed that the presence of only one kidney or an uncooperative patient are absolute contraindications to renal biopsy.
The renal biopsy is primarily, at present, an additional and most useful investigative tool in the elucidation of the pathogenesis, natural history (by serial studies) and effectiveness of specific therapy upon the various renal diseases. It is of practical clinical importance in the selection of those patients with the nephrotic syndrome in whom glucocorticoid therapy is likely to be beneficial or the patient with anuria whose renal lesion is probably reversible with time; and, as a guide to the effectiveness of therapy in patients with pyelonephritis or lupus nephritis. It is not a technique that can be recommended for general or casual use.
A classification of the pathohistobogic findings of diffuse glomerulonephritis, patterned after Ellis, is presented and discussed. This classification will be used in the description and discussion of various renal diseases and systemic diseases with associated nephritis in the three subsequent papers.
ELECTROCARDIOGRAPHIC FINDINGS IN HEALTHY PREMATURE INFANTS
Authors: Levine O. Robert , Griffiths Sylvia P. 
Published: December 2021

The electrocardiographic findings in 87 healthy premature infants, ranging in age from 1 day to 1 month, are presented. The data illustrate the problems inherent in establishing "normal" standards in the neonatal period since exceptional figures are encountered for most of the parameters measured. Analyses of time intervals and amplitudes are therefore tabulated by frequency distribution, range and median values.
The general configuration of the electrocardiogram closely resembles that observed in full-term infants of comparable age. In both, the precordial pattern is that of right ventricular preponderance. The electrocardiogram of the premature infants differs chiefly in the lower voltage of all the major complexes in the limb leads.