The newborn, moreover, as also the older child, is exposed to infec tion from other children, especially infants suffering from septic or inflammatory disease; the infection being carried by physicians, atten dants and on utensils. The frequent occurrence of veritable epidemics of sepsis of the newborn in maternities can be easily understood.
Susceptibility.—Infants possess seemingly a relatively low resis tance to septic infection; the younger the child the less the resistance and the less mature the child at birth the less its resistance. Thus the premature infant is especially menaced by septic infection. It is also a very striking fact that infants seem to become septic less often when at home than in institutions. This reminds us of the behavior of puerperal fever; yet, whereas, puerperal fever belongs to the rarities in well conducted maternities, sepsis neonatorum is still not an uncommon occurrence and epidemics of this disease are a menace to every hospital for the care of infants. The low protective power which the nursling develops against septic disease is partly attributed to the undeveloped condition of its organs. Thus the lymph-nodes, which play a prominent part in the defence against sepsis, are of little or no importance to the nursling and the absence of even regional lymph-node enlargement is the rule in sepsis neonatorum. Further, we must consider the unde veloped condition of the skin, \\•lia seems especially adapted for pro tection against infection (according to Hulot the stratum corneum is scantily developed in the newborn). The epithelium of the gastro intestinal tract is also said to be, in contradistinction to the adult. per vious for bacteria even without any lesion. For certain animals it has been firmly established that the intestinal mucosa of the newborn is not impervious to the passage of certain bacteria; whereas this is not the case in the adult animal; to what extent this holds good in human beings has not been established. The middle ear is also not fully devel oped, the tympanic cavities being filled an embryonal tissue re sembling the jelly of Wharton in its structure. We can attribute the susceptibility of the young infant to septic infection principally, perhaps, to its insufficiently or scantily developed capacity for manufacturing protective substances (Halban, Landsteiner).
The well-established observation that artificially fed infants often succumb to septic infection, whereas breast-fed children are relatively seldom attacked (which holds good for the nursling after the end of the second month) must have direct relation to the food. Explanatory of this, we can refer to Moro's investigations concerning the transmission of alexins from the mother's milk, rich in these substances; as cow's milk is much poorer in alexins WC could thus explain the increased protection of breast-fed children. The belief is also advanced that the cells of the artificially nourished child are so taxed by assimilation of the foreign or aspecific ("artfremd") food that they can elaborate less protective sub stance against possible infection.
In the nursling, during the first clays of life, the umbilical cord and the wound left after its separation are especially liable to infection. Infection of the newborn is further facilitated by the physiological des quamation of the skin and mucous membranes. After consideration of all these conditions it seems clear that the newborn, particularly the premature newborn is especially susceptible to general septic infection.
The susceptibility for sepsis is doubtless increased by the presence of other diseases, among which hereditary syphilis and intestinal affec tions are most important in infants.
Portals of Entry. The newborn infant may be born septic. The virus can pass to the fugal circulation through the placenta, when bac teria, which have broken through the placental vessels, circulate in the mother's blood. Such cases have been verified not only for the pyogenic cocci but also for other bacteria, e.g., bacillus typhosus, diplococcus etc. The newborn can also become septic through aspira tion of infected liquor amnii, as when the bag of waters ruptures too early. The newborn can further be infected during its passage through the birth canal.
Dubrisay reported a case of purulent vaginitis in the mother: sepsis of the child; death 11 hours after birth with pleurisy and pneumonia. Congenital and placental infections and sepsis acquired during the birth are frequent experiences.