SEPSIS IN INFANCY The lack of unanimity concerning the septic diseases, renders it advisable at the outset to fix distinctly just what is understood by the term "sepsis." From a great number of definitions which up to the present have not fully succeeded in classifying the subject, we prefer that of Len hartz, and will, therefore, understand with him "under the caption sepsis, all general diseases caused by the pyogenic cocci and other equiv alent bacteria." Whereas, rather inappropriately, the septic processes without abscess formation are to he termed sepsis, the ancillary term with metastases" is to be employed when reference is made to what has heretofore been known as pyfemia (metastasizing sepsis). We, however, only speak of metastasizing sepsis when proof is present either during life or at necropsy that the abscess has not been formed by di rect contiguity through the lymph- and tissue-spaces, but has occurred through the medium of the circulation. Kocher and Tavel speak of bacterimnia when bacteria have gained entrance and circulate in the vascular system, and of toxwmia when only products of bacterial metabolism have been absorbed into the circulation. On account how ever of the varying symptoms of sepsis in the first months of life, often difficult of interpretation, we must limit the designation sepsis without exception to those disease pictures in which proof has been furnished of the presence of bacteria in the blood. When in a given case no proof is adduced or can be furnished of the presence of bacteria in the circula tion, we are only justified in classifying it under the head of sepsis when it agrees in symptom-complex, course, and possibly in anatomical find ings, with those disease pictures in which general bacterial infection has been demonstrated.
The question to what extent we are justified in attributing the symptom-complex of sepsis to a mere toxminia must he held in abeyance. It is to he expected that improvement in our bacteriological technique will enable us to reserve the designation sepsis for that symptom-com plex with which the entrance of pyogenic organisms into the circulation has been demonstrated. This proof can already be furnished in most eases, if not during life at least at necropsy.
Cause of Sepsis.—Sepsis in the infant, as in the adult, may he caused by a variety of bacteria. First and foremost the so-called pyogenie cocci are to be named. The staphylococcus pyogenes albus and aureus,
the streptococci (among which the intestinal streptococcus of Escherich occupies a prominent place), the diploeoccus pneumoniie (Fraenkel Weichselbauin), bacillus eoli eommunis, bacterium laetis aerogenes, bacillus enteritidis Gartner and related strains, bacillus pyocyaneus, the proteus group, more rarely the gonococcus, the influenza bacillus of Pfeiffer and possibly the bacillus of Friedlander and the meningoeoccus of Weichselbaum.
Varieties of Sepsis.—Sepsis may be primary, or secondary to a pre existing disease. It is usually caused by a single organism and only occasionally, although seemingly more often in the infant than the adult, there is a polymicrobie infection.
We must differentiate a hetero- and auto-infection just as in the adult. According to Kocher and Tavel we speak of hetero-infection when the cause of the disease comes from without and of auto-infec tion when it is already present in the organism under normal conditions, before the disease. The majority of infections are hotero-infections. The infant with its special susceptibility has ample opportunity for contamination with infectious agents; especially those from the air: also through its clothes and further through its food, which in infancy is usually milk. Mothers' milk is much better protected against infec tion than cow's milk. We know, however, that the milk of healthy as well as septic mothers contains bacteria. The bacteria enter the lacteal duets from without; according to Basch and Weleminsky bacteria never invade the milk from the circulation unless there has been some distur bance of the structure of the breast (e.g., htemorrhage). Pyogenic bacteria are regularly found in the milk of animals. The infant is also exposed to infection from the water used in cleansing its mouth and perhaps even from the water of the bath; this latter source of infection has hardly been established and has been at all events much over-estimated in importance. The newborn, moreover, is exposed to infection from the lochia, which normally contains pathogenic bacteria; this infection either takes place directly during the passage of the child through the birth canal, or indirectly, through carrying the lochia to the body of the child by mother or nurse or on instruments or bandages.