At this point the problem of demonstrating a meningococcus septicemia, either as an attendant feature of epidemic cerebrospinal meningitis or independently of it, becomes of great interest. That the meningococcus may be found in the blood in certain cases of epidemic meningitis has been known for some time. Gwyn15 first reported such a finding in a patient of Osler, and since then similar observations have been made by many others, Cochez and Lemaire,16 Jakobitz,17 Martini and Rohde,18 Lenhartz,19 Marcovitz,20 Robinson21 and Duval.22 Elser,23 in forty-one cases found the coccus in the blood in 10.25 per cent. t.; Dieudonné reports positive blood findings in four out of five cases, in one of which the nasal secretion was negative. Especial interest, however, attaches to the presence of the meningococcus in the blood in patients free from meningitis. In 1908 124 reported the case of a girl of 15 years who presented some of the symptoms of cerebrospinal meningitis, but whose spinal fluid remained free from meningococci, while the organisms were found in the blood. At that time I was able to find in the literature three other reports of meningococcus septicemia without meningitis, these being recorded by Salomon,25 Liebermeister26 and Andrewes.27 Netter has since recorded the case of a woman suffering from diarrhea, fever and general malaise, whose blood agglutinated two strains of meningococci, but whose blood culture was not taken. The patient's sister had cerebrospinal meningitis at the time. Cecil and Soper28 have collected from literature four cases of meningococcus endocarditis, two of these being the cases of Westenhoeffer already referred to, and add an observation of their own. The patients of Warfield and Walker29 and Cecil and Soper gave no evidences of meningitis. The occurrence of meningococcus septicemia both in conjunction with the cerebrospinal meningitis and independently of it, lends support to the view that the infection of the meninges is brought about through the blood, the primary focus being in the respiratory tract. 15. Gwyn: Bull. Johns Hopkins Hosp., 1899, x, 112. 16. Cochez and Lemaire: Baumgarten's Jahres., 1902, xviii, 91. 20. Marcovitz: Wein. klin. Wehnschr., 1906, xix, 1312. 22. Duval: Jour. Med. Research, 1908, xix, N. S. xiv, 258. 23. Elser: Jour. Med. Research, 1905, O. S. ix, 89. 24. Bovaird: Arch. Int. Med., 1909, iii, 267. 25. Salomon: Berl. klin. Wehnschr., 1902, xxxix, 1045. 26. Liebermeister: München. med. Wchnschr., 1908, lv, 1978. 27. Andrewes: Lancet, Lond., 1906, lxxxiv-ii, 1172. 28. Cecil and Soper: Arch. Int. Med., 1911, viii, 1. 29. Warfield and Walker: Bull. Ayer Clin. Lab., 1903-6, i-iii, 81. Elser and Huntoon30 summarize the evidence of hematogenous infection in these words: The early appearance of the meningococcus in the blood in a considerable number of cases, the appearance of general sepsis suggested by some patients early in the disease, the lesions in parts far removed from the central nervous system found at autopsy of individuals who succumbed to the disease within twenty-four hours of its inception, and finally the appearance of characteristic lesions in the eye synchronously with manifestations referable to the central nervous system, all point to an early generalization of the meningococci, but are not competent to prove that such an infection antedated the meningeal involvement. The experimental study of this problem has not yet yielded decisive results. Bettencourt and Francao failed to produce meningitis in monkeys either by rubbing cultures of the meningococcus into the nasal mucous membrane or by intravenous injection. Flexners succeeded in producing meningitis in monkeys by intraspinal injection, the resulting meningitis having in this case also the basal distribution thought suggestive of nasopharyngeal infection. Elser and Huntoon, by intravenous injections of Streptococcus mucosus in rabbits succeeded in producing a meningitis which in its onset and the distribution of lesions resembled the meningococcus meningitis. of man. Finally, we may say that the evidence at our command at present strongly suggests that the primary infection in epidemic cerebrospinal meningitis is respiratory, in most cases nasopharyngeal, and that the meningeal infection is developed through the blood. Protection of the community therefore will demand not only the isolation of those sick with the epidemic disease, but the detection of the many unaffected "carriers." To what extent this may be practicable remains to be seen. In the restricted fields offered by regimental organizations, the German military officers have already applied these methods with apparent success. The efforts to free carriers from their infection (nasopharyngeal) have, so far as I can learn, proved ineffective. Various applications, douches and insufflations have been tried without success. In this regard the experience seems to repeat that with diphtheritic infections of the throat. In time the infection appears to die out in most cases, but treatment does not hasten that desired end. Our present knowledge would suggest the desirability of treating these persons by serum or vaccines. The possibility of protecting the exposed by like means naturally presents itself, but thus far I have not been able to learn of any work along these lines. 137 East Sixtieth Street. 30. Elser and Huntoon: Jour. Med. Research, 1909, xx, 373. 31. Flexner: Jour. Exper. Med., 1907, ix, 142. INDEX OF CURRENT PEDIATRIC LITERATURE HYGIENE Baths, Carbonated and Oxygenated, for Infants.-H. H. Schmid. Educational Hygiene and Prophylaxis.-G. J. Holmes. Jour. Med. Soc. New Jersey, October, 1912. Hygiene, Dental, for Pupils of Public Schools.-S. A. Knopf. New York Med. Jour., Sept. 28, 1912. Medical Inspection of School Children.-S. G. Dixon. Pennsylvania Med. Jour., September, 1912. Medical Inspection of School Children, Object and Intent of.-J. MacDonald. Jour. Med. Soc. New Jersey, October, 1912. School Children of Meadville, Results of Examination of, and Its Importance.— C. C. Laffer. Pennsylvania Med. Jour., September, 1912. Sexual Hygiene, Physician as Teacher of.-A. S. Risser. Jour. Oklahoma Med. Assn., October, 1912. BACTERIOLOGY AND PATHOLOGY Arthritis in Early Life, Defective Development from.-G. Dock. Am. Jour. Med. Sc., October, 1912. Babinski Toe Reflex, Leg Technic for Eliciting. (Neuva manera de investigar el signe de Babinski.)-A. Guemes. Semana méd., July 11, 1912. Chondrodystrophy, Fetal, An Unusual Form of.-G. Dencks. Deutsch. Ztschr. f. Chir., Aug. 15, 1912. Diphtheria Group of Organisms by Biometrical Method.-M. E. Morse. Jour. Infect. Dis., September, 1912. Edema, Chronic, of One Leg in a Child.-E. O. Hughes. Lancet, London, September, 1912. Fistula, Bilateral Congenital, of Lower Lip.-C. B. G. De Nancrede. Ann. Surg., September, 1912. Intestinal Flora of Infants, Influence of Food on.-A. Friedlander and J. V. Greenbaum. Arch. Pediat., September, 1912. Lithiasis in Children in Hungary, Tendency to. (Die infantile Lithiasis in Ungarn.)-J. v. Bokay. Ztschr. f. Kinderh., August, 1912. Lymphatic Diseases of Children.-W. M. Sanger. Jour. Oklahoma Med. Assn., October, 1912. Lymphosarcoma, Retroperitoneal, Treated with Coley's Fluid.-H. K. Hill. Arch. Pediat., September, 1912. Meningococcus in Pus from the Ear. eiter.) -Doering. (Vorkommen von Meningokokken im Ohr München. med. Wchnschr., Sept. 3, 1912. Myxedema and Cretinoid Conditions, the Blood Picture with. (Das Blutbild bei Cachexia thyreopriva.)-T. Kocher. Arch. f. klin. Chir., Oct. 12, 1912. Pseudomeningocele, Traumatic, Case of, Combined with Internal Hemorrhagic Pachymeningitis.-R. Schindler. Jahrb. f. Kinderh., August, 1912. Mongolian Idiocy. Aisenberg. (Ueber Mongolismus bei Kindern.)-W. Shukowsky and R. Jahrb. f. Kinderh., September, 1912. Noma, Bacteriology of. (3 Cas de noma buccal étudiés au point de vue bactério logique.) A. Zuber and P. Petit. Ann. de méd. et chir. inf., Sept. 15, 1912. Sclerema, Adipose, in Patches. Dumas and Debré. (Sclerème adipeux en plaques.)-Triboulet, R. Ann. de méd. et chir. inf., July 1, 1912. Tumor, Malignant, in Abdomen of Child.-P. F. Barbour. Kentucky Med. Jour., Sept. 15, 1912. Twin Monsters. (Ueber Acardie: Zur Frage von den Zwillingsmissgeburten.) — C. F. Heijl. Nord. med. Ark., July 27, 1912. Xiphopagus Operated on Soon after Birth. Surviving Twin in Good Health at Age of Fifty-two. (Nachtrag zu der Mitteilung von Dr. Böhm über einen Fall von Xiphopagen, 1866.)-H. Coenen. Virchow's Arch. f. path. Anat., June, 1912. METABOLISM AND NUTRITION Amaurotic Family Idiocy, Studies in Metabolism of.-H. Heiman, S. Bookman and B. B. Crohn. AM. JOUR. DIS. CHILD., October, 1912. Beriberi, Infantile.-V. L. Andrews. Philippine Jour. Sc., April, 1912. Dextrins and Maltose in Infant Feeding.-T. S. Southworth. Arch. Pediat., September, 1912. Feeding in Infancy, Value of Early Mixed.-G. M. Decherd. Texas State Jour. Med., September, 1912. Feeding Principles, Present-Day.-F. H. Glazebrook. Jour. Med. Soc. New Jersey, October, 1912. Feeding Young Children, Present Status of.-E. S. Everhard and G. Felker. Infant Foods, Commercial. (Kindernährmittel im Handel.)-H. Kühl. Arch. f. Kinderh., Aug. 3, 1912. Infants with Serious Losses of Weight, Treatment of. (Behandlung von Säuglingen bei schweren Gewichtsverlusten.)-K. Stolte. Monatschr. f. Kinderh., 1912, xi, No. 4. Metabolism, Calcium and Phosphorus, on Cow's Milk. (Ueber den Kalk und Phosphorsäurestoffwechsel des Säuglings bei Knapper und reichlicher Ernährung mit Kuhmilch.)-G. Wolff. Jahrb. f. Kinderh., August, 1912. Metabolism, Infant, Some Fundamental Principles in Studying.-F. G. Benedict and F. B. Talbot. AM. JOUR. DIS. CHILD., September, 1912. Milk, Albumin. (Erfahrungen mit Eiweissmilch.)-J. Cassel. Arch. f. Kinderh., Aug. 3, 1912. Milk, Condensed Breast, in Infant Feeding. (Verwendung konservierter Ammenmilch zur Ernährung von Säuglingen.)-J. Peiser. Deutsch. med. Wchnschr., Sept. 12, 1912. Milk, Desiccated, in Infant Feeding. (Le lait sec dans l'alimentation des nourrissons.)-E. C. Aviragnet, L. B. Michel and H. Dorlecourt. Arch. de méd. d. enf., September, 1912. Milk Sugar, Nutritive Value of. (Der Nährwerth des Milchzuckers.)-M. Calvary. Ztschr. f. Kinderh., August, 1912. Milk Supply from Tuberculin Tested Cows, Successful Efforts of a Small City to Secure.-C. H. Wells. Am. Jour. Pub. Health, September, 1912. Nutrition, Human, Study in.-A. O. Shaklee and D. de la Paz. Bull. Manila Med. Soc., August, 1912. Pancreatic Ferments in Infants.-A. F. Hess. AM. JOUR. DIS. CHILD., October, 1912. Pasteurization of Milk, Effect of, on Babies.-J. L. Morse. Boston Med. and Surg. Jour., Oct. 10, 1912. Rachitis, Research on (Was lehrt mein Rachitismaterial?)-R. Fischl. Ztschr. f. Kinderh., August, 1912. Salt Fever. (Ueber das sogen. Kochsalzfieber.)-S. Samelson. Monatschr. f. Kinderh., July, 1912. Scorbutus, Experimental. (Experimentelle Erzeugung der Moller-Barlowschen Krankheit und ihre endgültige Identifizierung mit dem klassischen Skorbut.) -K. Hart. Virchows Arch. f. path. Anat., June, 1912. Scurvy, Infantile, and Modern Conditions.-W. P. Northrup. Arch. Pediat., September, 1912. Sugar, Experimental Research on Dogs in Regard to Action of. (Untersuchungen am Hunde über die Wirkung des Rohr und Milchzuckers.)-P. Heim. Monatschr. f. Kinderh., July, 1912. DISEASES OF THE NEWLY-BORN Dropsy, Congenital. (Hydrops universalis neonati mit komplizierender kongenitaler Mitralstenose.)-E. Ludwig. Cor.-Bl. f. schweiz. Aerzte, Sept. 1, 1912. Fistula, Congenital, in the Neck, Operative Cure of.-G. De Francisco. Riforma med., Aug. 10, 1912. Hemorrhage, Meningeal, in Newly-Born. (2 observations d'hémorragie méningée chez le nouveau-né; guérisen après ponction décompressive par voie lombaire au par voie cranienne.)-R. Gilles. Rev. mens. de gynec. d'obst. et de pediat., August, 1912. Hemorrhage, Meningeal, in New-born Infant, Case of, with Recovery.-M. H. Krohn. Denver Med. Times and Utah Med. Jour., September, 1912. Toxemia, Intestinal, in New-born Infant.-J. L. Morse. AM. JOUR. DIS. CHILD., October, 1912. New-born Infant, Care of: Progress in Pediatrics.-H. Hempstead. ACUTE INFECTIOUS DISEASES Cerebrospinal Fluid in Infectious Diseases. (Ded Liquor cerebrospinalis bei Infektionskrankheiten, insbes. im Zusammenhang mit der Wassermannschen Reaktion bei Poliomyelitis acuta epidemica.)-H. Schottmüller. München. med. Wehnschr., Sept. 10, 1912. Chorea and Infections. (Chorée et infection.)—J. Roux. Ann. de méd. et chir. inf., June 15, 1912. Diphtheria.-S. G. Wilson. New Orleans Med. and Surg. Jour., October, 1912. Diphtheria Bacilli in the Urine. (Absonderung von Diphtheriekeimen durch den Harn.)-H. Conradi and Bierast. Deutsch. med. Wchnschr., Aug. 15, 1912. Diphtheria, Bacteriology of.-R. W. Ashley. Northwest Med., September, 1912. |