Volume 58 · Issue 01 · 1940

Interest in the pathogenesis and mechanism of generalized convulsions has shown a prodigious growth during recent years, as indicated by the large number of papers published on the subject. Two quite unrelated factors may be considered to have been responsible for this. The first in order of time (though perhaps not in importance) was a belated recognition of the possibility that solution of the perplexing problem of epilepsy might be accelerated by an elucidation of the neural and physiochemical, mechanisms involved in a generalized convulsion. The second factor was the introduction of convulsive shock therapy for schizophrenia (1). The experimental investigations reported in the present paper were undertaken with the conviction that any addition to our knowledge concerning the mechanism of insulin convulsions should contribute to a clearer under: standing of the functional disturbances which characterize chronic idiopathic epilepsy in children.

In the course of the preceding study concerning the effects of various procedures on the serum electrolytes and on the occurrence of insulin convulsions in the normal dog, it was found that convulsive reactivity was markedly decreased by reducing the oxygen or by increasing the carbon dioxide tension of the atmosphere (1). When no insulin was administered, breathing a gaseous mixture composed of 88 to 95 per cent nitrogen and 12 to 5 per cent oxygen caused significant reductions in the potassium and inorganic phosphorus as well as in the carbon dioxide tension of the serum, but no other electrolyte changes.

It is a well known fact that whooping cough contributes very greatly to the excessive morbidity and mortality among infants and young children. When the disease is well established, very little can be done in the way of amelioration of symptoms or shortening of its course. It is, therefore, very important to determine whether one may rely upon the current method of active immunization against this all- too-common contagious disease of childhood.

In their field work in the First Health Area of Peiping, Guy and Yeh (1) experienced difficulty in obtaining a soybean emulsion with sufficient protein concentration when one part of bean was used with eight parts of water according to Tso's method (2). While the difficulty of insufficient protein concentration may be overcome by using a higher concentration of bean in proportion to water, the composition of the emulsion is still liable to daily variation even if it is made according to a fixed procedure under strict supervision (3). Their mixture made with a soybean meal (4) of course obviated this difficulty. The present metabolic experiments were undertaken to study further the roasted soybean as an infant food. They were carried out on two young infants whose dietary histories were known to us from the time of their birth. On an older child, similar studies were made to determine the possible effect of irradiation of the roasted soybean meal on the calcium and phosphorus balances.

The incidence of acute encephalitis in epidemics was not known in the Chinese medical literature until 1936, when Su (1) reported from Amoy one series of five patients seen in July, 1935, and another of four patients seen from January to February, 1936. One of them recovered and the rest all died. In the summer of 1938 ten cases of acute encephalitis were seen in the Pediatric Service of this hospital within a short period of 24 days. In six cases opportunities were available for the collection of convalescent sera and the determination of their neutralizing power against two strains of encephalitis virus. It is the purpose of this paper to report the clinical and serological findings in these cases.

The course of mumps is usually smooth and many clinicians hardly confine their patients with mumps to bed. However, mumps is a generalized disease, even though in most cases the parotid gland involvement constitutes the only symptomatic manifestation. It is unnecessary to dwell upon the orchitis, a well known accompaniment of mumps. It is usually observed only after puberty has been reached; in younger children it occurs but seldom. On the average one-third of the adult patients with mumps show symptoms of orchitis, fortunately often only unilateral. In some epidemics orchitis, however, is much more frequent.

Since it is known that 95% of the creatine in the body is present in the muscles, its importance in muscle physiology has been inferred. But it was not until after the discovery of the physiology of phosphocreatine by Fiske and Subbarow (1) that its role began to be clearly understood. It is now known that phosphocreatine breaks down during the contraction of muscle, and its resynthesis depends on the energy furnished by the degradation and oxidation of muscle glycogen. Therefore, a lack of available muscle glycogen may lead to creatinuria due to the failure of phosphocreatine resynthesis. Indeed, the occurrence of creatinuria has been demonstrated in fasting (2, 3), in convulsions, in carbon monoxide poisoning, on the administration of adrenalin, caffeine, and diuretin, in phosphorus or phlorizin intoxication (4), and in diabetes (5). That the creatinuria on thyroid administration is associated with a profound depletion of the glycogen stores in the muscle has been demonstrated by Abelin and Spichtin (6). Conversely insulin has been found to reduce creatine in the blood of diabetics (7). According to Brentano (8) the degree of creatinuria depends not so much on the absolute amount of glycogen in the muscles as upon the extent and rapidity with which it is reduced.

The presence of leucocytosis and lymphocytosis in the blood in pertussis has been well known since the early report of Fröhlich in 1897 (1). Subsequent observations of Meunier (2), Cabot (3), Churchill (4), Crombie (5), Barach (6) and others showed that the increase in the total number of leucocytes occurred almost universally and elevation of the percentage of the lymphocytes occurred in from 80 t0 90 percent of the cases. These authors considered these hematological findings to be of great diagnostic value, especially during the early stage of the disease. However, recent studies of Sauer and Hambrecht (7) and that of Dolgopol (8) demonstrated that such a characteristic blood picture usually occurred only when the clinical symptoms of the disease have well developecl. Nevertheless, there remains the undeniable value of the blood picture in the diagnosis of the disease, as when the patients are brought to the hospital for treatment, they are mostly in the late catarral or early paroxysmal stage and the leucocytosis and the lymphocytosis of the blood may serve as confirmatory evidences for the clinical diagnosis.

The attention of those interested in medical education is called to the recent publications by the Council on Medical Education and Hospitals of the American Medical Association entitled "Medical Education in the United States 1934-1939" and "Graduate Medical Schools in the United States 1937-1940., The former report begins with a valuable introduction giving a brief historical summary of the development of medical education in the United States and then proceeds to deal in general terms with the objections, policies, organization, administration, clinical facilities, teaching personnel and educational programs of some sixtysix American Medical Schools. The latter report deals with the continuation study for practising physicians.

From the fall of 1934 to spring of 1937, through the courtesy of Dr. J. L.Li, Superintendent of the Hunan Maternity Hospital, we had the opportunity of organizing a Well-Baby Clinic in that hospital. The chief purpose of this clinic was to take care and follow up babies delivered in the hospital and in the field by their staff. There were over l,300 babies registered in those two and half years. At each visit, they received regular examinations, advices on feeding and care and prophylactic inoculations. The majority of them were frequently brought to the clinic.

A survey of tuberculosis infection among infants and children was started in Shanghai several years ago. The results of the early part of the work was jointly presented with Drs. Lai, Kao and Chien in 1934. Since then the tuberculin tests have been continually done on school children as well as in the out-patient clinic.