Volume 50 · Issue 04 · 1936

Acute intestinal intoxication was defined by Brown and Boyd as an acute metabolic disturbance with a predominance of gastro-intestinal symptoms occurring in infants and young children during the hot weather. It is characterized by its sudden onset with collapse, vomiting, usually diarrhea, frequently hyperpnoea, moderate leucocytosis, various degrees of pyrexia and dehydration.

Renal rickets or renal dwarfism is a condition characterized by retarded growth, skeletal deformities and osteoporotic changes. Clinically the patients usually show polyuria, retarded development, wasting pallor, secondary anemia and acute symptoms of uremia from time to time especially during infections.

It is generally considered that scarlet fever is an uncommon disease in South China (1). This is certainly in conformity with our experience in Canton. Only ten cases have been encountered during my five years practice in this city. The patients were school children and young student who had not been outside of the province.

Definition Still-birth (23) may be defined as the birth of a viable foetus, 35 cm or more in length, or whose period of uterine life as calculated from the date of the mother's last menstrual period is equal to 28 or more weeks, and which at birth died without having attained pulmonary respiration.

There are four reasons for writing the present paper; first to ascertain the incidence of various diseses among infants and children in Moukden, second, to further the study of children's diseases, third to assist in the task of the prevention of diseases in children, fourth, to compare the incidence of diseases among children in Moukden with other parts of the world, such as Europe and America.

Cerebro-spinal meningitis is a disease of growing importance in the Far East. I. Imura (1) reported in 1932 for Japan that, from 1918 to 1928 inclusive, 9705 cases had been notified. A seemingly marked increase occurred in Japan (2), from 241 cases in 1931, to 359 cases in 1933 and 1,225 cases in 1934. In China, Urbanek (3) in 1911, reported 5 cases in Chinkiang. In 1917 a few cases have been reported in Changsha by Hume (4).

Meningitis in form of epidemics is comparatively of recent occurrence in China. It first appeared in Hongkong in 1918 (1). Since then sporadic cases have been observed every year in a few sea-ports. The next important epidemic occurred in 1919-1920 (2) in Luchowfu, Anhwei province. In general, the disease tends to spread into the inland regions. After the third important epidemic in Shanghai in 1929 (3) and the fourth one in Canton in 1932 (4), an epidemic occurred in 1934 in Hengchow, south Hunan, was reported by Brown and Broady (5), which was believed to be the first epidemic of the disease ever occurred in the province of Hunan.

It is important for physicians and particularly pediatricians to recognize the clinical picture of tuberculous meningitis. In the first place this disease is very frequently met with. It is by far the most common form of meningitis seen in young children except during epidemics of meningococcus seen in young children except during epidemics of meningococcus meningitis.

In making a review of our clinic and hospital histories for the organisation of a Children's Chest Clinic, the following data were collected. Since there are few published reports concerned with tuberculosis in Chinese children, it is dasirable to record what data we have. As an accurate index of the incidence of tuberculosis in a community, it is necessary to have tuberculin testing on a large scale. Reports such as those herewith submitted are of value until more comprehensive surveys can be made.

It was demonstrated that the globulin fractions derived from human placentas contained antibodies that would neutralize diphtheria toxin, blanch scarlet fever rashes, protect monkeys from poliomyelitis, and prevent measles in susceptible children (1). Subsequent studies have been made on the clinical use of the placental globulin extracts in the prophylaxis of measles(2,3) That such extracts are easily available and that the expense involved in their production is low have made it possible to prevent or modify measles on a large scale. But the method of preparation by ammonium sulphate precipitation requires a long time for the process of dialysis, and the final product being in liquid form shares the disadvantage of any serum in that its potency decreases considerably during storage.

The term "cancrum oris" is used to designate a spontaneoua process of gangrenous necrosis which starts on the mucous membranes of the oral cavity and may spread rapidly to the neighbouring structures. It has been described under various names such as nowa, water-cancer, scorbutic cancer, gangrena oris, gangrenous osteogingivitis and gangrenous stomatitis. When the word "noma" is used, it includes lesions of similar nature which appear on the vulva, prepuce, anus and other regions.

History-Beriber, known in China as Chiao-ch'i, had existed in this country probably long before history. The disease was mentioned in the Nei-Ching (内经) (1), about 4630 years ago, but it was not separated from other maladies. In most cases, the disease began insidiously and ran a long courese. Its slow progressive nature was particularly discussed by the physicians during the period from 206-196 B. C.

Tetany is known to occur at times in cases of renal insufficiency. We had the opportunity to observe such a case recently. The rarity of the condition justifies the following report.

It is now generally conceded that the roentgenological examination of the skeletal system is an important adjunct to the diagnosis of congenital syphilis, particularly in early infancy. In the presence of specific roentgenographic changes of the bones, a diagnosis of congenital syphilis can be made even if the serologic test is negative.

Anyone who has had experience in the treatment of syphilitic children knows with what difficulty and sacrifice a social worker, a bread-winner, a busy mother or a case-taker brings the child to the clinic weekly over a long period. When acute symptoms have disappeared persistent importunity is often required to get the child continue the treatment.

Splenomegaly in infants and children often presents an interesting problem for differential diagnosis. As a cause of the sign, a variety of entirely unrelated conditions may be mentioned. Among the common groups of such conditions are acute and chronic infections, parasitic diseases, blood disorders, mechanical pressure on the venous flow, tumors and certain diseases of unkown nature. While one should consider as many causes of splenic enlargement as possible in the handling of an unusual case, a knowledge of the incidence of the common diseases or conditions with which splenomegaly is often associated in infancy and childhood would be of distinct help in the daily pediatric practice.

In response to the request of the Editors of the Chinese Medical Journal, I consider it a great pleasure to present the following statement on behalf of the National Child Welfare Association of China showing its brief history, program, projects and personnel as well as its activities for the year ended December 31st, 1935.

Tho Aim of Well Baby Clinic work is to direct the hygiene, feeding, prophylactic inoculations and training of an infant so as to give him opportunity for normal development during the first years of life. It is the almost universal practice in United States hospitals and is becoming more generally practised in England and Europe to have a pediatrician take charge of the infant at birth. This assures early examination by a physician trained for the care of infants and gives the mother the advantage of startiuS from the beginning with the physician who is to help her with the care of her infant. The Child Health Nurse should visit the mother while she is still in hospital. Before leaving hospital, each mother should receive explicit directions for feeding her infant, for his daily routine and for the care of his skin and clothing. Appointment should be made for the mother and infant to return to Well Baby Clinic the first week after leaving hospital.

The social work we do for children in the Peiping Union Medical College follows the general organization of the hospital. There is a social worker in the Pediatric Clinic, another working in co-operation with the Home Finding Society, and a third in the Surgical Clinic for women and children.

Althought the child welfare movement as we know it in this country is mainly of the twentieth century, its foundations were well and truly laid in the nineteenth, writes Mrs. H. A. L. Fisher to "The Times."

While the control of smallpox by inoculative measures has long been successfully practised, it is only in the last few years that any satisfactory result has been obtained in the control of some other communicable diseases. In view of the recent progress in thin field of medical research and practice, a brief review on the present status of prophylaxis against four major communicable diseases of childhood-diphtheria, scarlet fever, measles and whooping cough-might be of interest. Considering the voluminous literature on these subjects, the reviewer does not intend to present anything original or comprehensive but hopes that it might be treated as a working guide for the busy practitioner or health officer who may not have the leisure of sorting out from tho detailed published reports facts useful to their practical problems.

During the last few years considerable progress has been made in our knowledge of vitamin C, with the isolation of the pure vitamin and its subsequent synthesis by chemical methods, so that its chemical and physical nature is now well established. Concerning its physiological action and its relation to disease, a voluminous literature has accumulated, and much has been accomplished toward an understanding of these subjects. Some of the recent findings are reviewed herewith.

The word "approach" in the title of this contribution is used in the military sense of a system of entrenchments enabling those concerned in endeavouring to solve tho problems to get nearer to their objective. Such an approach is rather a system of approaches. The method of making these is in some instances clearly defined by practices tested by time and approved by scientific investigations. The tactics to be adopted are in other respects not yet defined or understood. This is particularly so when attempts are made to employ means largely successful in other countries to the problems in China where many special circumstances have to be considered.

During the past five years a study of food consumption in China has been carried on in connection with the study on land utilization in China under the direction of Dr. J. L. Buck by the Department of Agricultural Economics of the University of Nanking. Food consumption data were gathered as a part of the land utilization study in view of the findings of a previous Chinese Farm economy investigation that the diet of the farm family consists to a very large degree of foods produced on the farmer's own farm and thus that the crop program bears a direct relation to the nutrition of the family.

A well balanced and abundant diet is the first prerequisite of health and vigor. It is more important than shelter, clothing, cleanliness, or protection from communicable disease. It is the fundamental requirement, without which no individual can be well. Food is closely related to environment, and the optimal constitution of a diet varies not only with growth and age and occupation, but with many other factors such as climate and sunlight.

Some time ago the Editor of this Journal deplored the lack of accurate investigations on famine diseases so momentous in the face of China's periodic calamities. Since nutritional deficiencies are, in a broader sense of the word, "famine diseases" too, it was thought worth reporting our experiences with super-caloric feeding at the Shanghai Conference of the C.M.A. in 1932.

Soybeans and soybean products constitute the chief source of protein food of the Orient. The soybean is capable of being converted into numerous products which can be substituted in the human diet for cow's milk, cheese, eggs and meat. It is now known that the soybean is a highly nutritious and adequate food. While the variety of cereals and oils consumed varies much in different sections of China, almost everywhere the chief protein supply is from soybeans.

An adequate child hygiene program includes activities directed toward maintaining the health of both mother and child from the prenatal period to the end of adolesence. In China, for convenience in administration, the "maternity and child health" work extends only through the pre-school period. While school health work is considered a separate though related field.

Child health work in the First Health Area, Municipality of Peiping, is that phase of health activity concerned with the individual from conception up to school age and, as such, it may be more properly called maternity and child health work. In 1929 Dr. Marion Yang* reported in this Journal the early activities of this service. After the lapse of seven years further progress has been made and it seems worthwhile to trace tho development to date.

Infant mortality is usually expressed in terms of infant death rate, i.e., as the number of deaths of infants under one year of age per 1,000 living births. Owing to the different sanitary, educational, and economic conditions prevailing in different places, there is considerable variation in the infant death rate. Even in the same place, different family conditions give rise to different rates.

The infant mortality rate of an area is a good index of the local health conditions. In our recent inquiry of 862 families in Kao-Chiao, a district of Greater Shanghai, it was found that out of 2,227 live births, 444 or 199.4 per mille children died under one year of age. A further analysis of the data discloses the following facts.

Recently, there came under our observation a case of gonococcus arthritis in a girl of 4 years old. The diagnosis was definite and recovery was complete. The rarity of this disease in childhood warrants the reporting of this case.

In general, the treatment of cutaneous disease is made unnecessarily complicated. This is due chiefly to two reasons; (1), a failure to recognize the nature of the pathologic changes underlying the production of a lesion, and (2), a failure to understand the limitations of the available remedial agents. A cumbersome and antiquated terminology does much to confuse the physician, and names, never fully understood come to mind instead of a recognition of the lesion in the simple anatomical terms of disease.

Phlyctenular kerato-conjunctivitis (hereinafter designated as P. C.) is the commonset eye disease that the pediatrician sees in his practice. It may, therefore, be appropriate to outline briefly the procedures which have proved useful in the treatment of P. C.

To go abroad to take up post-graduate courses is always an expensive undertaking. It is more so if students have but vagus idea of where and to whom to go. They often find out too late that most of the distinguished specialists shoot across their clinics like a meteor and are inaccessible to students and that the majority of the well-known clinics are not the place for the unprepared.

In bringing out this Special Number on Paediatrics, the Chinese Medical Association desires, through its official organ, the Chinese Medical Journal, to associate itself with the nationwide movement to celebrate 1936 as the children's year. For as Dr. H. H. Kung, the President of the National Child Welfare Association of China, rightly puts: "There is no country to-day that does not realize the importance of child welfare, for the intelligence and good citizenship of the youths of to-day are measured by the amount of energy and time that is spent in their education and welfare when they are children, and no modern nation can afford to overIook this fact." And let us add that no nation consisting of C 3 individuals, crippled in body and maimed in mind, can ever hope for equality in the comity of powers ruling the world.