bluuebunny/crossref_metadata_2025_split huggingface dataset:
FREQUENCY AND SIGNIFICANCE OF CARDIAC MURMURS IN THE FIRST YEAR OF LIFE
Authors: Richards Mary R. , Merritt Katharine K. , Samuels Mary H. , Langmann Alfred G. 
Published: December 2021

The frequency of cardiac murmurs in early infancy has been studied in a large series of unselected infants. In the immediate postnatal examination, a murmur was heard in 1.7 per cent. With repeated examinations, however, at 6 and at 12 months of age, the proportion of infants in whom a cardiac murmur was heard at some time rose to 7.0 per cent of 5,017 full-term singlebirth infants and to 9.9 per cent of 364 premature single-birth infants. Non-white infants had a significantly higher prevalence of murmurs than did white infants at both the 6 and 12 month examinations.
Of the 71 full-term infants who had murmurs at the birth examination and were re-examined at both 6 and 12 months, 49 (69 per cent) had no murmurs at either of the later examinations.
Of the 150 full-term infants who had murmurs heard for the first time at 6 months and were re-examined at 12 months, 90 (60 per cent) had no murmur at the 12-month examination.
Of the total number of 353 murmurs heard in full-term infants, 166 were ultimately interpreted to be functional, and 25 to be organic murmurs. The remaining 162 were inconstantly present, and were probably all functional murmurs.
In our experience, a murmur heard at birth carries a 1:12 probability of congenital heart disease; if it is again heard at 6 months, this chance is 1:3; and if the murmur persists to 12 months, the chance is 3:5 that congenital heart disease is present. When a murmur is first heard at 6 months, and persists until 12 months, the probability of congenital heart disease is 1:7; and when a murmur is first heard at 12 months, the probability falls to 1:50.
Premature infants were found to be similar to full-term infants in all respects, insofar as their small numbers made comparisons possible.
Finally, the relative rarity of cardiac murmurs in the newborn period has been demonstrated once more.
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors: Kempe C. Henry 
Published: December 2021

THE SCOPE of the topic is such that one must present many simplifications in a positive manner. As an aid to memory in classifying the ever-increasing number of antibiotics and their antibacterial spectra and dosages, 2 charts have been prepared which are self-explanatory (Tables I and II). In all types of oversimplification one may quarrel with 1 or more points, but the material presented can be of practical value in daily practice.
CHOICE AND DOSAGE OF COMMON ANTIBIOTICS
Antimicrobial drugs are classified as bacteriocidal (those which kill bacterial organisms) or bacteriostatic (those which primarily inhibit bacterial multiplication which, however, resumes upon the removal of the bacteriostatic drug). Bacteriocidal agents actually differ from bacteriostatic agents only in the fact that their action is irreversible. The difference between bacteriostatic and bacteriocidal action appears to be a quantitative rather than qualitative one. Agents may be bacteriostatic at a given concentration and for a given exposure, while increasing concentration or exposure may cause a progressive shift toward bacteriocidal action.
Primarily bacteriocidal agents in current use are penicillin, streptomycin, polymyxin B, bacitracin, and neomycin. Primarily bacteriostatic agents are tetracycline and all related compounds, chloramphenicol, erythromycin, and all sulfa drugs. The dosages of these drugs are given in Table I.
A simple way to recall the antibacterial spectrum of antibiotics: pathogens are divided into rods (most of which are gram negative) and cocci (most of which are gram positive). Bacteriocidal agents which kill rods only are streptomycin and polymyxin B; bacteriocidal agents killing cocci only are penicillin and bacitracin; neomycin is bacteriocidal for a wide variety of rods and cocci.
FEEDING PREMATURE INFANTS—A COMPARISON OF VARIOUS MILKS
Authors: Kagan B. M. , Hess J. H. , Lundeen Evelyn , Shafer Kathleen , Parker Julia B. , Stigall C. 
Published: December 2021

Premature infants of birth weight between 1,000 and 2,000 gm. were given isocaloric feedings at the rate of 82 calories per kilogram body weight per day between the seventh and twenty-eighth days of life using: 1) human milk characteristically low in ash content; 2) modified human milk with slightly increased protein and ash content and slightly lowered fat content; 3) a cow's milk mixture which simulates human milk in protein, carbohydrate and fat and provides a moderate ash content, and 4) a one-half-skimmed cow's milk mixture providing high protein, low fat and high ash. These milks produced increasing weight gains in the order in which they are named.
The increased weight gain over that provided by isocaloric amounts of human milk appears to be directly related to the increase in ash intake rather than to the percentage of protein, carbohydrate or fat. Comparable analysis of data from another study in which 120 calories per kilogram body weight were fed supports this observation.
Several recent studies have demonstrated the relative immaturity of renal function in the premature infant under 1 month of age, with a resultant tendency to retain water on high mineral intakes. The increase in weight gain in relation to the increase in intake of ash may be a reflection of the poor renal function of young premature infants and their relative inability to excrete the increased solute load, with resultant obligate water retention.
These data suggest a probable difference in character of weight gain during and after the first month of life in premature infants on diets of mineral concentration higher than that of human milk. This difference should be reflected in body composition, determination of which might well be an interesting subject for future investigation. Further study may demonstrate that weight gain has serious limitations as a criterion for normal development of the premature infant during the first month of life.
MASSIVE BLEEDING FROM DUODENAL ULCER IN INFANCY TREATED BY GASTRECTOMY
Authors: Neilson J. R. , Black J. H. 
Published: December 2021

1. An infant of 18 months with massive bleeding from a duodenal ulceration has been treated by gastrectomy after failure of conservative medical and surgical methods of treatment.
2. A 33-month follow-up shows excellent progress.
3. It is hoped that future reports, especially of follow-up surveys, will aid us in the choice of a method of treatment in those patients where radical care seems indicated.
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors: Lowe Charles U. , Danowski Thaddeus S. , Ebert Richard 
Published: December 2021

Chairman Lowe: We have planned a program which will begin with a presentation of certain theoretical concepts of parenteral fluid therapy and will finish by offering what we believe to be practical concepts.
Dr. Danowski will present a physiological and biochemical background, including the use of water and the necessity for certain electrolytes in a parenteral fluid program.
Dr. Ebert will discuss the use of blood, plasma and blood substitutes and describe the place of each in therapeutics.
I, in turn, will attempt to utilize their remarks, to draw them together and thus provide a practical program of parenteral fluid therapy.
We are interested, particularly, in providing a basis for therapy of patients who have undergone surgery. I think you are all aware that many of the pediatric problems in parenteral fluid therapy which plagued pediatricians 10 and 15 years ago are no longer serious problems. I have in mind, particularly, diarrheal disease. But we are faced with a real challenge in terms of therapy for the infant or child who is to undergo surgery or who has undergone surgery. So, we will attempt to emphasize this aspect.
A STOPCOCK FOR USE IN EXCHANGE TRANSFUSIONS
Authors: Sobel Irwin Philip , Horowitz Leon 
Published: December 2021

EXCHANGE transfusions through the umbilical vein may be performed in several ways. In the open method, a nurse draws donor blood through a two-way stopcock which is connected to the bottle by autoclaved polyvinyl tubing. The syringe filled with donor blood is handed to the operator or his assistant who injects it directly into the umbilical vein catheter. The advantages of this multiple syringe method are simplicity, speed and minimal opportunity for the formation of blood clots in the system. The disadvantage is the danger of the formation of an air embolus, because during the changing of syringes the umbilical vein catheter is in direct communication with the air. In the closed method, the operator draws donor blood from the bottle and injects it into the umbilical vein catheter by means of 2 three-way stopcocks fastened in tandem. The advantages of this single syringe method are the completely closed system and the avoidance of changing of syringes. The disadvantages are: 1) the keys of the 2 three-way stopcocks can be arranged in 9 different positions; 2) the chances of clotting are increased because of the use of 2 stopcocks, and 3) a direct connection between the blood in the bottle and the umbilical vein is possible. The stopcock to be described was designed to incorporate advantages of both methods while avoiding their disadvantages.
The female end of the stopcock (see Fig. 1) is connected to the bottle of donor blood by means of autoclaved polyvinyl tubing; the male end is inserted into the umbilical vein catheter; and the sidearm is fitted onto the syringe.[See Fig 1 in Source Pdf]
RENAL HYPERCHLOREMIC ACIDOSIS WITH NEPHROCALCINOSIS AND RENAL RICKETS IN A SIX-YEAR-OLD BOY
Authors: Jurow Seymour S. , Warthen Robert O 
Published: December 2021

A case of hyperchloremic acidosis, nephrocalcinosis and renal rickets occurring in a 6-year-old boy is presented.
Many cases of this disease and its variants begin in childhood and awareness of the conditions may help to bring patients to treatment earlier.
An associated, but probably unrelated, mild hemolytic anemia and splenomegaly of unknown etiology is described.
A SURGICAL TREATMENT PROPOSED FOR EITHER ENDOCARDIAL FIBROELASTOSIS OR ANOMALOUS LEFT CORONARY ARTERY
Authors: Paul Raphael N. , Robbin S. Gwin 
Published: December 2021

A new surgical approach is suggested for the treatment of endocardial fibroelastosis and anomalous left coronary artery.
The recommended procedure (poudrage) has been shown in some cases to produce an effective collateral circulation to the myocardium in patients with coronary heart disease.
Four patients have been presented, 3 of whom have survived approximately 1 year with clinical improvement. During most of this time the patients have not been receiving digitalis.
Of the 3 living patients, in 1 the diagnosis of anomalous left coronary artery is suggested on the basis of history of "anginal attacks" and electrocardiograms suggestive of anteroseptal myocardial infarction. The other 2 patients do not fulfill the criteria for anomalous left coronary artery but are clinically endocardial fibroelastosis.
One patient died following surgery and necropsy failed to demonstrate any cause of death other than the underlying condition itself.
The need for further follow-up is recognized. With utilization of this procedure in more patients the relative merits or faults may be brought out. However, it appears, that its use may be recommended in these conditions because they are statistically incompatible with life for any appreciable time and the procedure is relatively free of risk even in the case of diagnostic error.
STUDIES OF FIBROCYSTIC DISEASE OF THE PANCREAS (MUCOVISCIDOSIS): CHYMOTRYPSIN ACTIVITY OF DUODENAL FLUID
Authors: Richmond Reid C. , Shwachman Harry 
Published: December 2021

A study of the chymotrypsin activity of duodenal fluid, using the method of Ravin, Bernstein, and Seligman, is presented. The method is applicable to routine assay and is a reliable reflection of pancreatic function. In addition, this assay is specific for chymotrypsin activity in contrast to the customary tests for protease activity, which use casein or gelatin as substrates. In 40 patients with complete pancreatic insufficiency due to fibrocystic disease of the pancreas the chymotrypsin activity of the duodenal fluid was not measurable (i.e., less than 5 µg. of β-naphthol liberated from the substrate).
The chymotrypsin activity in 53 patients with normal pancreatic function and without symptoms referable to fibrocystic disease of the pancreas varied from 11 to 65 µg. of βd-naphthol except for the lowest value in this control group of 8 µg.
In another group of 62 children with sufficient symptoms to call for duodenal fluid assay (failure to gain, abnormal feces or repeated respiratory infections) the range of chymotrypsin activity was similar to that of the control group. The duodenal fluid assay and clinical course excluded fibrocystic disease of the pancreas in this group.
The chymotrypsin assay is useful in the study of patients with partial pancreatic insufficiency from progressive loss of pancreatic function as the disease progresses.
In view of occasional diagnostic failures, based on assay of a single enzyme, it is important to determine the total enzyme activity of duodenal fluid for proper complete evaluation of pancreatic function.
OBITUARY
Authors: HUGHES JAMES G. 
Published: December 2021

THE AMERICAN Academy of Pediatrics has suffered a great loss in the death of one of its past presidents, Dr. Edward Clay Mitchell of Memphis, who died February 1, 1955, at the age of 73 after an illness of 15 years. He was one of the pioneer pediatricians of the South and exercised a tremendous influence in helping establish pediatrics as a major specialty not only in this area but nationally. He will be long remembered by his many friends because of his active participation in the progress of pediatrics and also because of his strong personality and good fellowship. Most of all he will live in the memory of many parents and their children, now grown, whom he treated through the years with such high professional ability and such personal interest.
Dr. Mitchell was born in Corinth, Illinois, the son of a surgeon, and his grandfather and other members of the family were doctors. His brother, Dr. John M. Mitchell of Evanston, is a member of the American Academy of Pediatrics. He attended West Point for 3 years and later graduated in medicine from Northwestern University. His postgraduate training in pediatrics was at the Michael Reese Hospital in Chicago, and in Vienna.
The years at West Pont undoubtedly left a lasting impression on Dr. Mitchell, for he was noted for his erect carriage, almost military bearing, and his strong qualities of leadership. He maintained an open mind and paid courteous attention to suggestions, but he was a most decisive person and a man of action. When he was in charge of anything there was seldom any doubt as to who was the leader and he tackled all assignments with amazing energy.
When his formal medical training was finished, Dr. Mitchell established a thriving pediatric practice in Memphis in 1908, where he was almost the first person to limit his work to the care of children.
THE BREAST MILK BANK AS A COMMUNITY PROJECT
Authors: Kimball E. Robbins , Jones Elizabeth , Lewis Myrtle E. , Kolb Ethel R. 
Published: December 2021

1. The management of breast feeding is outlined.
2. The organization of our breast milk bank as operated by Evanston Hospital and Junior League volunteers is described.
3. The establishment of a breast milk bank has enabled us to increase the number of premature infants fed breast milk threefold. Their weights and length of hospital stay are presented.
ERYTHROMYCIN IN THE TREATMENT OF DIPHTHERIA AND DIPHTHERIA CARRIER STATE
Authors: Beach M. W. , Gamble W. B. , Zemp C. H. , Jenkins Margaret Q. 
Published: December 2021

The treatment of acute diphtheria has not been drastically changed by the use of antibiotics. Antitoxin remains the primary form of therapy. However, the eradication of virulent diphtheria bacilli from the upper respiratory tract of patients with the active disease and of carriers is of considerable importance in the control of the disease.
Streptomycin is effective in vitro and in infections produced experimentally but it has not been clinically evaluated in acute diphtheria or in the carrier state.
Chlortetracycline, chloramphenicol, and oxytetracyline, although active against the causative organisms, have not had sufficient clinical trial to permit evaluation in the control of diphtheria and the carrier state.
Penicillin eradicates C. diphtheriae from the nasopharynx in 75 per cent of patients within a period of 3 to 4 days.
In this study erythromycin eradicated the C. diptheriae from the nose and throat in all of the cases in an average of 2 days in the active cases and in an average of 3 days in the carrier state.
In the treatment of diphtheria erythromycin appears on the basis of the present and of previous studies to be the most promising antibiotic developed to date.
Erythromycin is advocated as an adjunct to and not as a substitute for antitoxin in the treatment of acute diphtheria.
STATISTICAL REPORT ON INCIDENCE AND DURATION OF BREAST FEEDING IN RELATION TO PERSONAL-SOCIAL AND HOSPITAL MATERNITY FACTORS
Authors: Jackson Edith B. , Wilkin Louise C. , Auerbach Harry 
Published: December 2021

The incidence of breast feeding at the New Haven Hospital (University Service) and the discontinuance of nursing during the puerperium is reported for a 10-year period (1942 through 1951), with a review of the literature over this decade.
The incidence of breast feeding at the New Haven Hospital declined sharply from 81.9 per cent in 1942 to 48.9 per cent in 1946, with a tendency to level off after a slight rise in 1947.
There was a significant increase in per cent of mothers who stopped breast feeding in the hospital at a time (1942 through 1944) when a significant decrease in per cent of mothers starting to breast feed was occurring. On comparing the proportion of discontinuance between rooming-in and nursery (non-rooming-in) mothers (1947 through 1949) a statistically significant difference was found between the two groups, the rooming-in group showing less cessation of nursing during the hospital period.
In follow-up studies of the duration of breast feeding of the rooming-in and nursery mothers (1947 through 1949) the average duration between the two groups shows a significant difference in each of the years studied; the 3-year averages for the two groups likewise show a statistically significant difference, the rooming-in mothers nursing longer. The average duration within either group does not differ significantly from year to year.
On relating incidence and duration of breast feeding to difficulty of labor, as rated from hospital records during 1949, it was found that time incidence of breast feeding decreases with the increasing difficulty of labor.
THE VALUE OF PEDIATRIC-PSYCHIATRIC TEAMWORK IN THE TREATMENT OF RHEUMATIC FEVER
Authors: Green Maurice R. , Wile Renée 
Published: December 2021

The object of this paper is to present a useful outline of pediatric-psychiatric teamwork on a pediatric ward, for children suffering from rheumatic fever.
In general, reactions of anxiety, rebelliousness, and depression were displayed by the children under treatment. Upon observation, their negative behavior seemed to be related to feelings of loneliness, guilt, and fear. This created certain difficulties for the children and staff members, and their problems were worked out in joint conferences of pediatric and psychiatric personnel.
Much thought was given to the problems presented by those children who found it most difficult to accept being bedridden. Various suggestions were made and steps taken to solve these difficulties on an individual basis for each child. An entertainment and occupational therapy program was found to be a most valuable aid in easing the situation for both patients and personnel.
Examples are given to illustrate how children, who appear similar at admission, can present very different problems. Case histories cited also show the importance of the family's cooperation for the child's full recovery and rehabilitation, both physically and mentally.
The contribution of each member of the team is discussed, and the value of treating sick and emotionally disturbed children through a pediatric-psychiatric program of care is demonstrated.
Aspects of Synthesis and Order in Growth
Authors: FORBES GILBERT B. 
Published: December 2021

This book, a collection of papers delivered at a recent symposium of the Society for the Study of Development and Growth held at Dartmouth, does not present the subject in the classical pediatric manner. Rather, it is a consideration of the problems of growth and differentiation first at the molecular level and later from the standpoints of enzyme function, genetic action, and the more fundamental aspects of biosynthesis and growth determinants.
The biologist and the botanist have been quick to take up the newer tools of immunochemistry, tracer techniques and enzyme chemistry in an attempt to further elucidate the problems of growth and development at the cellular level.
Diagnosis of Congenital Heart Disease
Authors: LURIE PAUL R. 
Published: December 2021

This is not a textbook, nor an encyclopedic reference, but rather a full report of the intensive diagnostic study of a series of 396 cases of congenital heart disease by a group whose reputation is wide and well deserved. The introduction states that of 342 cases subjected to full study, only 5 resulted in uncertain diagnoses. This seems incredible until one sees the superb quality of their angiocardiography, the outstanding feature of the book.
The authors combined several technical developments in this achievement; biplane 12/second roll-film changer, exposure times as short as 0.003 second on infants and selective injection of the contrast material into the chamber established by immediately prior catheterization being most crucial.
STUDIES OF DISTAL COLONIC MOTILITY IN CHILDREN
Authors: Davidson Murray , Sleisenger Marvin H. , Almy Thomas P. , Levine Samuel Z. 
Published: December 2021

A suitable technic for measuring gastrointestinal pressures and motility in children is described and critically evaluated.
Data from 40 normal children are presented. These data show characteristic and different patterns in closely related segments of the distal colon, with a tendency to broader wave forms in the lower rectum. The possible physiologic implications are reviewed.
Comparison of the data is made with data available from adults and, although the findings agree, differences in classification and interpretation are made.
The potential usefulness of the technic for pharmacologic studies is discussed.
THE GENERATION OF THROMBOPLASTIN AND LEVELS OF PLASMA THROMBOPLASTIN COMPONENT IN THE BLOOD OF INFANTS
Authors: McElfresh Arthur E. , Sharpsteen J. Randolph , Akabane Taro 
Published: December 2021

Infants less than 6 months of age have decreased thromboplastin generation, resulting in part from a deficiency of plasma thromboplastin component. Some factor or factors other than a low level of plasma thromboplastin component may contribute to this deficiency.
By the age of 1 year the majority of infants generate thromboplastin normally, and have normal levels of plasma thromboplastin component.