The diagnosis of sepsis !mist in general be considered as difficult. Bacteriological examination of the blood furnishes the most reliable re sults. Inasmuch, however, as it is always necessary to draw off consid erable quantities of blood and as this can only be done unimpeachably 'by puncture or incision of a vein and not from the ball of a finger or toe, it is evident that this examination can only be carried out in a small percentage of infants during life. Added to this is the fact that bacteria are not found in the blood in life in a considerable percentage of cases of sepsis. It is recommended to make the blood examination during the death agony or immediately post mortem, a method of procedure which can usually be carried out with infants. Sometimes the bacteria may be found in numbers in cover-slip preparations from the blood of the cadaver. In some cases information may be furnished by puncture of organs which are the seat of metastatic inflammations and the bacterio logical examination of the body fluids, only rarely the bacteriological -examination of the urine which is drawn by catheter.
In the majority of cases, however, we must get along without bac teriological examinations of the blood (lumbar puncture furnishes no certain evidence, since bacteria are found in the cerebrospinal fluid in the absence of sepsis, under certain conditions). Then the diagnosis must be made from the clinical information. When the primary focus is demonstrable, when the infants have fever, and metastases or haemor rhages show themselves, we are probably justified in making the diag nosis. The examination of the retina, recommended by Herrenheiser and Fischl, may be of value diagnostically. However, we must not lose sight of the fact that in the newborn retinal haemorrhages may also be caused by birth trauma. In some cases it is impossible in the absence of bacteriological anatomical evidence to decide whether or not we are dealing with sepsis. In acute cases sepsis must be differentiated from acute gastro-enteritis and pneumonia, and in children only a few days old, from atelectasis and cerebral or meningeal haemorrhage; the cases running a subacute or chronic course must often be differentiated from chronic nutritional disturbances carrying secondary diseases in their train.
The prognosis is very serious; the more acute the course of the dis ease, the younger and more immature the affected infant and the more organs evidently involved, the more unfavorable the outlook.
Prophylaxis and Treatment.—Since sepsis occurs especially where children are eared for in numbers, as in institutions, it behooves us to employ all those means which have been so effective in the prevention of puerperal fever. The strictest asepsis in the care of the newborn is
enjoined. The care of the child from the moment of birth should not be assigned to the same attendant caring for the puerperal woman. The umbilical dressing must be aseptic, the oral cavity should not he cleansed; the clothing of the infant should be sterilized and the hands of the atten dant clean and disinfected when changing the clothes. All utensils should be individual for each child and should be kept sterile (bath-tub, basins, cotton, thermometer, etc.). In hospitals the isolation of all nurslings is of special value (the box system of Grancher, or, still better, isolation cells or rooms). For the breast-feeding of infants, the breast should be carefully cleansed before each nursing and in artificial feeding the strictest asepsis of food, bottles and nipple must be carried out. lleubner has recommended that in institutions the feeding of children should not be entrusted to the attendants in charge of the cleansing of the children.
In the care of premature children, kept in incubators, it becomes unqualifiedly necessary to strive for strict disinfection of the incubator and a sufficient supply of clean air.
The treatment of the developed disease is purely symptomatic. Together with the combating of the individual symptoms one must de vote attention to the care of the skin and the nourishment; artificially fed children should be furnished with human milk since through this the chances of recovery are increased. All abscesses must be opened and treated according to surgical principles. Bandages should be limited as much as possible in order that healthy areas of the skin may not be involved through the bandage. The heart's action should be carefully supported; one may employ strong tea, small doses of digitalis (0.05 Gm.
gr.) pro die in infusion) or digalen c.c. (nt 7) internally daily, caffein (caffein sodium salicylate 0.05 to 0.1 Gm. (1 gr.-1 gr.) pro die) or camphorated oil 0.3 to 0.5 c.c. (DI 4—S) subcutaneously (possibly two to three times daily). The subcutaneous injection of physiological saline solution (nine-tenths of 1 per cent.) in amounts 20-50 Gm. (5-12 drains), according to age, is recommended by many. Just as with adults, col loidal silver may be tried and especially per rectum or by intravenous injection of 0.1 Gm. gr.) (Finkelstein). The use of specific immune sera has up to the present time shown no beneficial results.