When it is a case of invasion of the lymph and blood channels pro ceeding from the intestine, the onset is less stormy, the Fever is at first only slight, and the movements have a more serous character, pointing to the seat of the lesion being in the small intestine. The character of the movements soon changes, there is more mucus, pus, and blood, which indicate an extension into the large intestine. Cystitis, broncho-pneu monia, and otitis may- follow and be the cause of death.
This may occur from coma or in sudden collapse. The demonstra tion of the organism in the urine, blood, and spinal fluid of the living child is evidence of the general infection. Fleeting or more continued affections of the skin, manifesting themselves as polymorphous erythema, hemorrhages into the skin and visible mucous membranes, symptoms of meningeal irritation, suppurative inflammations of the serous mem branes are signs of the severity and varied localization of the infections. The diagnosis of such infections is based on the characteristic bacterio logic picture, on microscopic examination of the stools, and the possible demonstration of the same organism in the urine, blood, and cerebro spinal fluid. The marked affinity of these streptococci for the organism can be demonstrated by the specific agglutination. Specific treatment by means of the various antistreptococci sera has given no results, and the symptoms must be combated by water, diet, intestinal irrigation, careful nursing, etc., as previously described. On account of the con tagious character of the disease, evidence of which has been frequently brought forward, care must be taken as to the isolation of the cases and proper disinfection of the linen, discharges, and so forth.
Infections with the bacillus pyocyareus, another organism not present in the intestines of normal infants, have likewise been observed. The clinical picture of this infection is not sharply defined. Sometimes it is that of a primary disease of the intestine with secondary toxic symp toms, which cause a sudden rise in temperature, tympanites, severe involvement of the whole organism, and the appearance of bright green discharges in which the preponderance of the pyocyaneus can be observed. Again the infection may be localized to the large intestine, with stools full of mucus with a variety of blue and green colors but still containing a preponderance of pyocyaneus bacilli. General infection does not occur, or at least the examinations of the blood and other fluids have given negative results. The severe general symptoms have been attributed to the production of toxins.
Proteus infection appears with varying pictures of disease, at times as very acute cholera infantuni or as chronic intestinal diseases with a tendency toward atrophy, at times as simple dyspepsia of mild clinical course. Its diagnosis rests upon the demonstration of the exciting
organisms in the stools in large numbers, and its treatment follows the usual rule.
The significance of the dysentery bacillus in a number of severe gastro intestinal diseases was first pointed out by Duval and Basset. Flexner and Holt have collected the results of a joint investigation carried out in America and these have been partly confirmed by Leiner and Jehle. They show that this infection may occur as an acute or subacute, a prim ary or a secondary manifestation. The clinical symptoms may present all variations from the mildest to the severest gastro-intestinal mani festations. The stools are characterized by an admixture, and it is in this mucus that the bacilli are found. The most common clinical type is a catarrh of the large intestine with many mucopurulent and bloody movements, tenesmus, and an acute febrile onset. The treatment con sists iu water diet and prophylactic measures to prevent contact infection. The serum treatment has been applied without apparent results.
There is still to be considered the bacterium coil which for a long time has stood in the foreground as the cause of gastro-intestinal infection.
Further results of research have shown that this ubiquitous organ ism, by its rapid development on the usual culture media, overgrows other varieties of greater etiologic importance, and the facts presented in support of its pathogenicity, such as virulence in animals, agglutina tion, etc., do not wholly bear strict criticism.
We must await further investigation as to the etiologic rele of the anaerobic bacteria.
An observation frequently made is the appearance of an epidemic of gastro-enteric cases and of enteric cases, particularly in institutions, and of the demonstration of contact infection in such eases. At times it is communicated by the hands of the nurses to which infectious material clings, at times by the nipples of the bottles, or it is carried from the anus by napkins, thermometers, etc.
The knowledge of such occurrences has led to stricter supervision of the nursing and has resulted in isolation of the children, careful asepsis and thorough disinfection of the implements used. Finkelstein's rules at the Berlin Municipal Orphan Asylum represent the highest perfection of such care. Results prove that besides digestive causes and contamination of food still other factors are involved, of which the prevention has a significant influence upon the figures representing the frequency of disease and mortality.