THE CLINICAL SIGNIFICANCE OF ABNORMAL RESPIRATION AND DEGLUTITION ...... THE RELATIONSHIP BETWEEN THE INFECTION IN THE CHILD AND CLINICAL TUBERCULOSIS IN THE ADULT. FRANCIS MARION POTTENGER, A.M., M.D., RECENT ADVANCES IN OUR KNOWLEDGE OF MEASLES. JOHN F. ANDERSON AND THE DIAGNOSTIC VALUE OF THE CUTANEOUS TUBERCULIN TEST OF V. PIRQUET. F. L. WACHENHEIM, M.D., NEW YORK... APPARATUS FOR COLLECTING INFANTS' BLOOD FOR THE WASSERMANN REAC- TETANUS AS A COMPLICATION OF BURNS. CHARLES NEWBERGER, B.S., M.D., AN UNUSUAL LESION OF THE RIGHT CRUS IN AN INFANT OF FOUR MONTHS. FREDERIC J. FARNELL, M.D., and Henry W. BURNETT, M.D., PROVIDENCE 43 STANDARDIZATION OF BLOOD-PRESSURE READINGS BY MEANS OF AN AUTOMATIC DEVICE FOR READING SYSTOLIC AND DIASTOLIC PRESSURES IN CHILDREN. B. RAYMOND HOOBLER, M.D., New York.. TUBERCULOSIS OF THE MESENTERIC GLANDS IN INFANTS AND YOUNG CHILDREN. ITS EFFECT ON ABSORPTION. FRITZ B. TALBOT, M.D., BOSTON.. PROGRESS IN PEDIATRICS-INDEX OF CURRENT PEDIATRIC LITERATURE.. 49 AUGUST, 1912. NUMBER 2 HISTORY OF THE CLASSIFICATION OF GASTRO-INTESTINAL DISEASES IN ANCIENT AND MODERN TIMES. ISAAC A. ABT, M.D., CHICAGO.......... STUDIES IN THE BACTERIOLOGY OF THE ACUTE INTESTINAL DISEASES OF Abstract: Infant Feeding and Disorders of the Digestive System: Résumé of the Literature of the Past Six Months. Maurice Ostheimer, SEPTEMBER, 1912. NUMBER 3 SOME FUNDAMENTAL PRINCIPLES IN STUDYING INFANT METABOLISM. FRANCIS G. BENEDICT, PH.D., and FRITZ B. TALBOT, M.D., BOSTON...... CONGENITAL OBSTRUCTION OF THE POSTERIOR URETHRA: REPORT OF A CASE IN A BOY AGED FIVE YEARS. J. H. Mason Knox, Jr., M.D., and T. P. 316202 THE HYPODERMIC USE OF HEMATINICS IN THE TREATMENT OF ANEMIA IN CHILDREN, WITH REPORT OF CASES. H. LOWENBURG, A.M., M.D., PHILA- OCTOBER, 1912. NUMBER 4 BLOOD-CULTURES DURING LIFE IN INFANTS AND YOUNG CHILDREN, WITH DESCRIPTION OF A NEW TECHNIC. MARTHA WOLLSTEIN, M.D., AND EDWARD MORGAN, M.B., NEW YORK.. THE PANCREATIC FERMENTS IN INFANTS. ALFRED F. HESS, M.D., NEW YORK.. 205 INFANTILE ECZEMA AND INDIGESTION. PRELIMINARY CLINICAL STUDY WITH ILLUSTRATIVE CASES. HARVEY P. TOWLE, M.D., AND FRITZ B. TALBOT, STUDIES IN METABOLISM OF AMAUBOTIC FAMILY IDIOCY. HENRY HELMAN, M.D., SAMUEL BOOKMAN, PH.D., AND BURRILL B. CROHN, M.D., NEW YORK 234 PROGRESS IN PEDIATRICS: A SUMMARY OF THE RECENT LITERATURE ON ORTHO- NOVEMBER, 1912. NUMBER 5 THE INFLUENCE OF HIGH PROTEIN FEEDING ON THE GENERAL METABOLISM, ON THE INTESTINAL FLORA AND ON THE BODY TEMPERATURE OF INFANTS. L. A BRIEF REPORT OF AN EPIDEMIC OF SORE THROAT WITH INVOLVEMENT OF THE CERVICAL LYMPH-NODES. JOHN RUHRÄH, M.D., BALTIMORE....... EFFECTS OF COLD AIR ON BLOOD-PRESSURES OF CHILDREN AND YOUNG ADULTS IN VARIOUS STAGES OF TUBERCULOSIS. B. RAYMOND HOOBLER, A.M., DECEMBER, 1912. NUMBER 6 A GRAPHIC CHART METHOD OF STUDYING AND TEACHING THE PRINCIPLES OF American Journal of VOL. 4 JULY, 1912 No. 1 LEUKOCYTIC "INCLUSION BODIES" WITH SPECIAL REFERENCE TO SCARLET FEVER * JOHN A. KOLMER, M.D. PHILADELPHIA In November, 1911, Döhle1 described certain "bodies" within the cytoplasin of the polymorphonuclear leukocytes in blood smears from thirty patients with scarlet fever. In a number of controls similar "bodies" were found in a patient with pneumonia and two patients with malignant neoplasms. As far as he knew these "bodies" had not been described before and to them the term "inclusion bodies" (Leukocytenenschlüsse) was applied. In March, 1912, Kretschmer2 confirmed these findings and considered their presence in scarlet fever of diagnostic value. The latter also found these "bodies" in smears from patients with pneumonia and tuberculosis and two with diphtheria with streptococcus empyema. More recently Nicoll and Williams3 reported a study of fifty-one cases of scarlet fever, finding the "bodies" in forty-five cases. Similar "bodies" were found in three out of twenty-five controls. The presence of such "bodies" within the polymorphonuclear leukocytes of cases of scarlet fever are mainly of interest from the standpoint of differential diagnosis and of their possible relation to the etiology of this infection. Döhle suspected their relation to streptococcus infections. and if these "bodies" are to be found in a large percentage of scarlet fever cases and are absent in non-scarlatinal conditions, they would be of considerable aid in differentiating true scarlet fever from cases of serum sickness with scarlatiniform rashes, rötheln, various toxic erythemata, etc. Accordingly the object of this study was twofold: 1. To investigate the nature of the "bodies." 2. To determine their diagnostic value in scarlet fever after the examination of a large number of cases of scarlet fever, diphtheria, serum sickness and various infections, especially those of streptococcus origin. *From the Laboratory of the Philadelphia Hospital for Contagious Diseases. *Read before the Philadelphia Pediatric Society, June 11, 1912. 1. Döhle: Leukocytenenschlüsse bei Scharlach. nale, 1911, lxi, part 2, p. 63. Centralbl. f. Bakteriol. origi 2. Kretschmer, M.: Die Diagnostische Bewertung von Leukocyteneinschlüssen bei Scharlach. Berl. klin. Wehnschr., March, 1912, No. 11. 3. Nicoll, M., and Williams, A.: Inclusion Bodies in Scarlet Fever. Arch. Pediat., 1912, xxiv, No. 5, p. 350. "INCLUSION BODIES" These "bodies" are characteristically found in the protoplasm of the polymorphonuclear leukocytes of scarlet fever patients near the margin of the cell and are not connected with the nuclei. They present no fixed morphology but occur characteristically as rod and coccus forms. Due care must be exercised not to mistake the neutrophilic granules for round "inclusion bodies." Both forms may be present in any stage of scarlet fever and in the same smear. Early in scarlet fever most of the polynuclear cells will be found to contain one or more of the "bodies." The number of leukocytes showing their presence and the number of "bodies" per leukocyte vary according to the severity of the infection and diminish as convalescence is established. After the sixth day in mild scarlet fever they may require careful search before being found. The rod or bacillary type is most distinct in outline but all are more or less hazy in the best stained preparations. TECHNIC For examination, ordinary blood smears are prepared on perfectly clean slides. Thin smears are especially desirable. The "bodies" are readily stained by the Giemsa, Manson, Leishman, Wright and Jenner stains. Ordinary methylene-blue will bring them out. They do not stain with eosin and hematoxylin. In order to determine whether or not they are composed of chromatin, specific differential stains were employed to differentiate between chromatin and plastin. With the Giemsa stain the "bodies" are colored a faint bluish-green; with methyl-green and pyronin they present a fairly well-defined reddish color and with malachite-green and pyronin likewise a reddish color. They do not stain with iron hematoxylin. These stains would indicate conclusively that the "bodies" do not contain chromatin and are not protozoan in nature. They are probably composed of plastin, represent a degenerative process of the cytoplasm and are probably composed of spongioplasm. The fact that they are found in streptococcus infections would indicate their relation to the streptococcus. However, the systematic examination of the blood of eight rabbits receiving a single injection of streptococci from scarlet fever, puerperal sepsis and tonsils did not show the presence of these "bodies." SCARLET FEVER Blood smears from 216 patients with scarlet fever were examined, the majority being cases of mild or moderate severity. A few were of the severe anginose types of scarlet fever. Cases were examined from the first day of the rash to the fifty-second day after the rash had appeared. The results of examination of 200 cases are expressed in Table 1. It will be noted that "inclusion bodies" are to be found in a large percentage of scarlet fever cases during the first few days of the infection. After the sixth day they become quite few in number and may be more difficult to find. Döhle did not find any after the sixth day but his series |