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There have been many excellent reports on the demineralization of bone in association with chronic diffuse nephritis (renal rickets), but the condition is still imperfectly understood. To quote Hunter,1 "the theory that phosphate retention, due to the renal defect, is primarily responsible for the changes in the bones is clearly unsatisfactory." The dwarfing, polyuria and polydipsia, which are not infrequent and which strongly suggest an endocrine factor, are likewise unexplained. A lemon yellow tint to the skin, anemia and weakness of the musculature are commonly associated with chronic nephritis, but these conditions are also found in hyperparathyroidism. The case summarized in the following report is of interest because of the opportunity it afforded to study some of the metabolic and pathologic factors in detail. REPORT OF A CASE History.—D. R., a boy aged 14 years, was referred to the pediatric service in April 1932 with the following history:

INTRODUCTION MORPHOLOGIC observations pertaining to the skeletal systems of normal and athyroid infant macaque monkeys are presented in the present communication, and certain correlations are made with preceding clinical, biochemical, and radiological observations on growth and metabolism in those animals.*Investigation of skeletal development in human cretinism is limited by multiple intrinsic and extrinsic factors which cannot be controlled. Experimental observations based on subprimates cannot always be applied to humans; therefore, it is logical to use a catarrhine laboratory animal in such studies. With selection of the primate Macaca mulatta for study, many intrinsic and extrinsic factors are subject to control.1The present study has been confined to early infancy, when growth and development is not only rapid but strikingly constant among normal colony members.† Control of extrinsic factors was facilitated by animal quarters which provided constant temperature, humidity, and physical environment. In addition, disease and nutritional deficiencies were

As one of a series of integrated reports regarding the role of thyroid in growth and metabolism of normal and I131 thyroid-ablated infant rhesus monkeys,1 this communication presents quantitative aspects of iodine metabolism.Earlier reports of thyroid function in rhesus monkeys are limited to observations on thyroidectomized mature animals,2 except in the study of Fleischmann and(Footnotes continued on next page)co-workers,2a where two 8-month-old animals were also observed. Of the reported studies,2 none have dealt with iodine metabolism per se, nor have they been concerned with the role of thyroid in growth and development. In all cases, thyroidectomy was achieved either by prolonged administration of thiouracil3 or by surgical means—the latter frequently being complicated by severe and often fatal hypoparathyroidism.4 When thiouracil was used, large doses (0.8 gm. per day) were found necessary to produce hypothyroidism and thyroid hyperplasia in adult animals,

IT IS THE purpose of this paper to integrate roentgenologic features of skeletal growth and development in normal and athyroid infant rhesus monkeys with previously reported studies of growth and metabolism in the same animals.1In the present study, skeletal growth and maturation were evaluated by serial roentgenograms. The roentgenologic features of thyroid deficiency in humans are well described.2 These features, however, have not previously been investigated in subhuman primates. METHODS AND MATERIALS Animals.—Six infant rhesus monkeys whose lineage was carefully recorded were obtained for our studies from the indoor macaque colony of Dr. van Wagenen at Yale University.1aAnimals D-766 and C-794 were used as controls throughout the study, while Animal B-767 was used as a third normal control until the age of 162 days at which time it received a thyroid-ablating dose of 1.5 mc. of I131.1b Animal B-767 was thereafter included in

LONG-TERM investigations designed to characterize the metabolic and endocrine features of growth and development in the human infant have been limited by a multiplicity of uncontrollable protean factors, included among which are heredity, a relatively slow rate of maturation, and our inability to prescribe the total environment of any child and his respective family. Use of primates other than man, while a recognizable escape from such limitations, has not been previously practicable due to the following considerations: (1) the need of a well-standardized primate colony on which sufficient growth and developmental data had been collected to warrant application of small numbers to such investigations; (2) the unavailability of techniques mandatory to successful management of member animals under experimental conditions; (3) the need for research tools, such as the application of tracer techniques and ultramicrochemical analyses, which were usually not within the practical domain of laboratories conducting such studies.One of

INTRODUCTION Reviewing the literature on blood studies one is struck by the comparatively few extensive investigations which have been carried on with the blood of the new-born. The morpohologic variations in hemoglobin and cells have received more consideration than any other phase of the problem. The chemistry of the blood of the new-born has been given little attention. Sedgwick's1 findings stand out as the most extensive and illuminating, and Slemon's2 investigations on maternal and fetal blood are fundamental, furnishing conclusive evidence of the mechanistic function of the placenta. Coagulation has been given little real attention and except for isolated studies on individual cases of hemorrhages of the new-born few, beside Rodda,3 have attempted to analyze the factors entering into this problem.We have, therefore, attempted to bring together all these phases—morphology, chemistry, coagulation and pigment metabolism—into a combined study of the blood of the normal new-born

THE following case reports and comment are presented to call attention to a possible new syndrome with the hope that further observations and interest will clarify the present uncertainty of its nature. REPORT OF CASES Case 1.—S. W., a 5 month old girl, was admitted to the University of California Hospital in April 1938. Both parents and a sibling were in good health. The patient had been born at term with a normal delivery and weighed 6 pounds 14 ounces (3,120 Gm.). She had been given feedings of evaporated milk formulas, with orange juice and cod liver oil in addition. There had been no previous illnesses, but she was said to have fallen from her crib at 2 months of age.Six weeks prior to admission to this hospital she became extremely irritable, especially when handled about the face or given the bottle. She was able to take feedings once

The material for this study was drawn from the children's allergy clinics of Washington University School of Medicine (St. Louis) and the University of California Medical School (San Francisco).1 While attention was especially directed toward the rôle of allergy, other factors were not overlooked. The infants were studied on repeated visits to the clinics and the following data obtained: name, age, sex, race or color, family history, age at onset, age when first seen, skin test reactions, with response on subsequent visits, the nature of the allergens found positive and the relation to clinical manifestations. In addition the rôle of season, the effect of increasing age, the presence of infections and the response to therapy were noted. While conclusions may be difficult to draw in all instances, an attempt will be made to discuss the various observations.Of a total of 160 patients ranging from 3 weeks to 4

Since the introduction of chemically acidified milk by Marriott,1 numerous suggestions and modifications have been made regarding its use, but evaporated milk acidified with lactic acid has stood the test of repeated trials. There is still some skepticism, however, regarding the rôle of the acid. Marriott considered acid milk valuable because of further alteration of the milk curd and improved gastric digestion when the buffer salts of the milk are neutralized by acidification. Brennemann2 reported his gradual adoption of Marriott's formula for acid milk after a clinical trial in the Children's Memorial Hospital in Chicago and his conclusion was: "The result was all that has been claimed and all that could be hoped for, and again such as I had never seen before with any other food." As to the theoretical rôle of the acid, he believed that the effectiveness of the formula was due to the finer

TO THE EDITOR:— I have read with interest the report of Helwig, Schutz and Kuhn in The Journal of February 26. Since they refer to some of our experimental studies (Smyth, F. S.; Deamer, W. C., and Phatak, N. M.: Studies in So-Called Water Intoxication, J. Clin. Investigation12:55 [Jan.] 1933), I feel justified in voicing an opinion regarding their interpretation. In the acute water intoxication induced experimentally by us in dogs, vomiting, not diuresis, was the more characteristic result. Water was given by gavage; no parenteral fluids were administered. In such cases the course was brief, the electrolyte loss was largely gastric hydrochloric acid, the result a relative alkalosis from acid deficit.In contrast with these observations, the clinical picture described by Helwig and his co-workers is much more confused. The prolonged course with possible starvation, anesthesia, ketosis (or infection?) added potential acid fractions. No determinations of total

To the Editor:—I note with interest the letter from Dr. Merl G. Colvin in The Journal, February 21, in which he proposes the establishment of an International School of Medicine. The problem of our responsibility and opportunity in meeting the needs of the foreign countries interest me greatly. The role of medicine and the health sciences is an extremely important one in the concept of present world affairs. The war has left us with a responsibility and an opportunity formerly expected of Europe, and, as Dr. Colvin's letter implies, this small world's health vitally affects our own health and economy. Too often in the past, however, foreign students whose countries present a different economic and social picture from ours have been sent to our schools, which of necessity educate and train men for situations as they exist in this country. Many have returned to their own countries, where they

Several letters to the editor are presented in response to articles published in previous issues including "Why India Fights India," by Robert Aura Smith in the December 6, 1947 issue, "Dirtiest Duty in the Coast Guard," by Alden Hatch in the November 29, 1947 issue and "Why Not Leave the South Alone," by Reuben Davis in the November 22, 2006 issue.