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The purpose of this communication is to direct attention to the usefulness of dioctyl sodium sulfosuccinate (Aerosol O. T.), developed some 15 years ago, in the treatment of severe fecal impaction and lesser degrees of constipation. As one of the very first of the synthetic wetting agents it was originally popularly described in Life magazine without implication of medical usefulness, and readers may recall that its remarkable properties were illustrated by the cover picture of a duck sinking in water to which a small concentration of this material had been added. The effectiveness of this material for treating constipation is consequent to its ability to allow a hard fecal mass to be penetrated by water or by mineral oils so that it becomes effectively softened. Its action thus seems to be the simple physical effect one would expect From the Department of Pediatrics, University Hospital. The food absorption studies were

There are probably now in the United States at least 500 patients with poliomyelitis, more or less permanently confined to the tank respirator, widely identified in Europe, as well as in America, by the name of "iron lung." The purpose of this paper is to point out that with skillful and energetic treatment, carried out decisively toward a single purpose, it is almost never necessary for a patient to be confined in such a device indefinitely. All but a very few victims of respiratory paralysis from this disease can be made mobile and free from a tank respirator within a few months, and except for occasional brief periods of aid, can do things for themselves. Since the invention of the tank respirator by Philip Drinker and others in 1930, this device has come to stand in the public eye as a symbol of poliomyelitis, carrying with it vague feelings of

The customary procedure of using height and weight to calculate the assumed surface area of the body, and then using the result to calculate various metabolic needs of the body, is based on confused logic and inadequate observation. A simple rule of thumb based on weight alone is here shown to be sufficiently accurate, especially since temporary adjustments are dictated by clinical judgment in correcting such conditions as initial dehydration. The rule for infants less than one year of age calls for 60 ± 15 ml. of water per pound (132 ± 33 ml. per kilogram); for children from 1 to 5 years, 50 ± 15 ml. per pound (110 ± 33 ml. per kilogram); for children above 5 years, approximately 40 ± 15 ml. per pound (88 ± 33 ml. per kilogram).

The question of the relationship of tonsillectomy to poliomyelitis has become more than a scientific one of virology or epidemiology and now involves problems dealing with the philosophy of medical practice. The pediatricians find themselves in a position similar to that of the otolaryngologists, since they are faced with the idea, supported in this case not by theory at all but only by statistics, that the routine immunization procedures that they have carried out may bring about an increase or, at least, a localization of paralysis. There is among their members, therefore, the same attitude that some otolaryngologists have shown: one almost of resentment that any such question should arise and interfere with their routine. Both these problems, like many others in the practice of medicine, resolve themselves into a matter of weighing one estimated risk against another. Any scientific discussion of this problem demands the knowledge and training of

The problem of control of so-called "epidemic diarrhea" in nurseries for newborn infants and in nurseries for sick infants is quite unsolved. The causative organism is not surely known, and its mode of transmission from patient to patient is undetermined. Whatever is revealed by future studies, it is obvious that prevention of the spread of enteric organisms will always be of prime importance. The care of fecal excretions and the laundering of diapers is a very great problem in any nursery or infant ward, and the usual programs, if safe, are both expensive and elaborate. The problem of the preliminary removal of the gross fecal material from diapers before laundering is itself disagreeable, expensive, and dangerous, since all manual techniques involve some degree of splashing and increased risk of spreading disease by droplets, even if carried out at some distance from the nurseries. The number of diapers that must be

Complete mental and physical rest is the accepted primary aim in the treatment of acute myocardial infarction, particularly during the initial stages of the condition. Controversy has arisen during recent years, however, regarding the mode of management for these patients that would be most effective in achieving this goal. Customarily in the past, immediate restriction to bed followed by prolonged periods of strict bed rest has been the therapy of choice, since the concept handed down through the years has been that bed rest if absolutely enforced would afford the most complete rest to the myocardium.1These ideas have in recent years been contested and are now refuted by some observers.2 Many outstanding authorities on the treatment of heart disease are becoming increasingly aware of the several disadvantages and harmful effects observed when patients are kept recumbent or rigidly restricted to bed for long periods during the treatment

• A total of 21 surgical operations have been done in 17 patients who were dependent on respiratory aids to varying degrees. Psychological preparation was essential. Some patients who were able to get along with the chest respirator or the rocking bed preoperatively were nevertheless transferred to a tank respirator after surgery and continued in it for hours or days after the operation. During the operative procedure and until the patients were placed in a respiratory aid after surgery, an anesthesiologist controlled their respirations. Patients who had been accustomed to the chest respirator had to be kept in a tank respirator after laparotomy until the abdominal incision was no longer sensitive. Three case histories illustrate the principle that surgery is not contraindicated even in patients with chronic poliomyelitis with partial quadriplegia and vital capacities as low as 190 cc.