Septic Poisoning in Early Life. 
BY 
HENRY DWIGHT CHAPIN, M.D., 
PROFESSOR OF DISEASES OF CHILDREN AT THE NEW 
YORK POST-GRADUATE MEDICAL SCHOOL AND 
HOSPITAL, AND AT THE WOMAN'S MEDICAL 
COLLEGE OF THE NEW YORK INFIRMARY J 
ATTENDING PHYSICIAN TO THE 
DEMILT DISPENSARY. 
HEPRINTKD FROM 
SfVe Neto ¥orh mfleUical Journal 
for June 8, 1889. Reprinted from the New York Medical Journal 
for June 8, 1889. 
SEPTIC POISONING IN EARLY LIFE* 
By HENRY DWIGHT CHAPIN, M. D., 
PROFESSOR OF DISEASES OF CHILDREN AT THE NEW YORK POST-GRADUATE 
MEDICAL SCHOOL AND HOSPITAL, AND AT THE WOMAN'S MEDICAL 
COLLEGE OF THE NEW YORK INFIRMARY ; ATTENDING 
PHYSICIAN TO THE DEMILT DISPENSARY. 
The extreme susceptibility to septic infection exhibited 
in early life is recognized by those who are called to treat 
disease at this time. This tendency is analogous to that 
shown toward the germ-poisons which are supposed to cause 
the various specific diseases. Young protoplasm affords a 
virgin soil for the growth of microbes, and the active circu- 
latory and lymphatic systems will readily carry a develop- 
ing virus to all parts of the organism. A division may be 
made into the septic poisoning occurring in the new-born 
and that which is seen in older infants and young children. 
Infection may even take place before birth by the passage 
of septic matter from the mother to the foetus through the 
medium of the placenta. In such a case the infant may be 
still-born, or succumb a few hours after birth, without pre- 
senting any marked local changes, but followed by a rapid 
decomposition of the body. When a woman is in a septic 
condition the virus may act to the destruction of the foetus, 
* Read by title before the Medical Society of the State of New York 
at its eighty-third annual meeting. 2 
SEPTIC POISONING IN EARLY LIFE. 
just as m the case of a syphilitic woman. As it is not 
common, however, for septicaemia to develop in the mother 
before the birth of the child, the foetus is not so apt to be 
disturbed by septic influences. After birth, the vulnerable 
point for the entrance of septic poison is the umbilicus. 
When the cord is tied, the blood remaining in the umbilical 
vein forms small thrombi, which eventually become calcified, 
thus constituting part of the structure known as the round 
ligament. Owing to its exposed position, pyogenic germs 
may gain access to these thrombi, when suppuration and 
septic infection will quickly follow. Dr. J. L. Smith, in a 
communication on sepsis of the new-born read before the 
Paediatric Section of the Academy of Medicine, divides in- 
fection at the umbilicus into two groups of cases : (1) those 
in which the poison enters the system from an umbilical 
sore and is conveyed by the lymphatics; (2) cases in which 
the septic poison gains access through the umbilical vein. 
As the latter vessel is somewhat pervious and is not in an 
internal and protected position like the ductus arteriosus and 
ductus venosus, the wonder is that infective inflammation 
is not more frequently set up in it. When this accident 
takes place, there will be more or less oozing of purulent 
fluid from the vein, soon followed by symptoms of perito- 
nitis, erysipelas, pleurisy, or other evidences of systemic 
infection. Doubtless in many cases the lymphatics carry 
the infection after the vein has been completely closed by 
an obliterating endarteritis. The umbilical fossa, with its 
denuded epithelium, affords a convenient receptacle and 
favorable spot for the absorption of septic material from a 
diseased mother-from dirty hands, infected linen, sponges, 
or the air. 
There has come under my observation a case where an in- 
fant was born healthy, but the mother contracted septicaemia. 
When the infant was three days old it began to show symptoms SEPTIC POISONING IN EARLY LIFE. 
3 
of peritonitis, although the temperature was not high. At five 
days the general blush of erysipelas appeared upon the surface 
of the body, followed in a few hours by death. At the autopsy 
there was a red discoloration over the body and extremities, 
more noticeable over the legs and thighs and at the axillag. 
The abdomen was tense aud swollen, with no projection of the 
cord above the surface. The peritoneal cavity contained about 
eight ounces of fluid, red in color and holding flakes of lymph 
in suspension. Between the skin and peritonaeum, in the region 
of the cord, was a circumscribed abscess through which the 
vein passed. The sheath of the vein was involved, the inflam- 
mation extending into the peritoneal cavity to the liver, the 
surface of which was covered by a thick layer of lymph. There 
were no signs of suppuration in the vein itself, nor could any 
communication with the surrounding tissues be found. The in- 
flammatory process seemed to be greatest at the navel, extend- 
ing to the liver and then becoming diffused. The intestines 
were matted together by the fibrinous exudation. The lungs 
contained a few patches of broncho-pneumonia, and there was 
considerable bronchitis. 
Any abrasion or accidental wound may likewise afford 
an entrance to septic poison at or shortly after birth. The 
forceps may be responsible for the necessary solution of 
continuity. The delicate epithelium of the genital organs, 
without any apparent break, may give access to septic 
matter. 
A female infant came under my observation who was born 
perfectly healthy. The mother had sore throat and some tem- 
perature, but no other evidences of septicaemia. When four 
days old the baby began to fail, and at five days there was some 
swelling of the abdomen and pain on pressure, with a slight rise 
in temperature. On the morning of the sixth day erysipelas 
appeared at the vulva and both groins, spreading up on the ab- 
domen, but not as far as the umbilicus, and down both thighs 
to the knees. Death occurred in the evening. At the autopsy 
there was a bluish-red discoloration of the erysipelatous sur- 4 
SEPTIC POISONING IN EARLY LIFE. 
face, which failed to disappear on pressure, but not reaching 
the navel, which appeared healthy. The peritoneal cavity con- 
tained about four ounces of turbid, yellowish, viscid fluid, hold- 
ing in suspension flocculi of lymph. The parietal and visceral 
peritonaeum was coated with a moderately thick layer of 
fibrin, particularly well marked over the upper surface of the 
liver and over the spleen, but present in the pelvis and every- 
where over the peritonaeum. The cerebro-spinal fluid over 
the occipital lobe and at the base of the brain was stained with 
blood. 
Dr. P. Muller, in Gehrhardt's " Handbucb," states that 
erysipelas or phlegmon, starting from the extremities or 
genitals in the new-born, is probably produced by small 
wounds following birth that furnish points for absorption 
of septic poison. Any possible injury that may be received 
during parturition may thus favor the development of sep- 
tic diseases. After a certain interval of time has elapsed, 
and the infant has passed safely through the vicissitudes 
attendant upon and following parturition, there is still a 
considerable liability to septic poisoning. During early in- 
fancy the genitals and umbilicus are still vulnerable points. 
This was well exemplified in a case I recently saw in con- 
sultation. 
An infant, four weeks old, with a good family history, had 
severe convulsions during three consecutive days, when a slight 
redness and induration appeared over the pubes. There was a 
badly arranged, uncleanly compress over the umbilicus, which 
presented an irritated appearance. The penis and scrotum soon 
became red and oedematous and erysipelas was well marked, 
with a distinct line of demarkation half way between the pubes 
and umbilicus. This was followed by some retention of urine 
and renewed convulsions. The disease gradually abated under 
vigorous treatment, and in a week the infant had recovered. 
In this case the source of infection was the genitals, but, 
if cleanliness and antisepsis had not been employed, the SEPTIC POISONING IN EARLY LIFE. 
5 
umbilicus would soon have become likewise inflamed. Ery- 
sipelas in very young infants is not so very uncommon, and, 
as it is a very dangerous disease, great care should be taken 
to guard against all sources of septic infection. As the in- 
fant grows older, the upper part of the body, particularly the 
scalp and mouth, afford vulnerable areas for sepsis. The 
lymphatics of the head and face are numerous and active, 
and are thus ready to quickly absorb any poison that may 
present itself. The blood-supply to these parts is also abun- 
dant, which favors inflammatory conditions. With refer- 
ence to the action of the absorbed poison, a division may 
be made into local and general sepsis. When suppuration 
is started upon a surface by pyogenic germs-such as the 
Staphylococcus and Streptococcus pyogenes-the lymphatics 
beneath soon participate in the inflammation. Both the 
germs and their products of various poisonous principles 
are absorbed into the lymphatic tracts, and, if they reach 
the blood in sufficient quantity, will cause a general poison- 
ing. Protoplasmatic cells, by their inherent vitality, can 
dispose of and destroy a certain number of germs. If the 
latter are produced quicker or in larger numbers than they 
can be taken care of by the cells of the adjacent lymphatic 
glands, the poison will soon find its way into the system. 
In what may be called local sepsis a certain number of 
neighboring lymphatic glands are irritated and inflamed by 
absorption of the poison, which does not, however, find its 
way into the general circulation in sufficient quantity tc 
produce any very marked symptoms. The commonest ex 
ample of this is impetiginous eczema of the scalp, more 
particularly in connection with pediculi. The pus thus 
produced is unusually irritating, and quickly leads to infeo 
tion of the neighboring lymphatic glands. Its infective 
nature is further shown by pustules on various parts of the 
body, where the poison has been carried by the child's fin- 6 
SEPTIC POISONING IN EARLY LIFE. 
ger-nails. Peculiar pustular eruptions may go through a 
neighborhood by one child infecting another by means of 
the pus accompanying pediculi. This may sometimes be 
mistaken for an epidemic of impetigo contagiosa. 
Any enlarged or inflamed condition of the lymphatic 
glands about the head or neck should lead to a very careful 
examination of the scalp, as a very few pediculi and one or 
two small points of suppuration may give rise to the mis- 
chief. 
I have recently treated a girl of seven years who had been 
perfectly healthy until her mother noticed a swelling beginning 
on the left side of the neck which was thought to be mumps. 
The child looked pale and unhealthy. This continued for three 
weeks, the swelling growing slowly larger, when she was 
brought to the dispensary. A careful examination revealed 
several points of suppuration upon the scalp and a few pediculi. 
As an abscess had formed in the neck, it was opened, and 
appropriate treatment applied to the scalp. The girl recovered 
her usual health when the source of infection was removed, 
and the lymphatic enlargements soon subsided. 
The mouth affords very favorable conditions for the 
growth and development of microbes of all kinds. Where 
suitable cleanliness is not observed there is no cavity of the 
body that can become fouler in a short time. With its many 
crevices and corners ready to lodge decomposing food, a 
free access of air and suitable warmth and moisture, it would 
seem to be a typical place for bacterial culture. Certain 
forms of stomatitis, especially the aphthous and ulcerous, are 
often accompanied by evidences of poisoning. When the 
aphthous patches separate, the small ulcers left afford a fa- 
vorable entrance for septic matter. In these cases the en- 
larged and painful submaxillary glands, with frequently in- 
volvement of the glands of the neck, are evidences of such 
infection. The pain and distress accompanying many cases SEPTIC POISONING IN EARLY LIFE. 
7 
of stomatitis, together with the constitutional symptoms, can 
hardly be explained by a simple inflammation of the mucous 
membrane. We may arrive at a satisfactory account of all 
the disturbance by considering that the neighboring tissues 
are being infiltrated by septic matter. Many cases of local 
sepsis in the mouth are due to diseased teeth. Septic mat- 
ter may be lodged about the roots of the teeth, which, when 
carious, will afford a means of absorption into the blood. 
In some young children the teeth appear to be cut in a de- 
cayed condition. 
I have recently seen an infant of nineteen months in whom 
dentition began at six months. Although otherwise apparently 
healthy, the upper teeth came in black and quickly decayed. 
They produced no disturbance until recently, when the infant 
became feverish and restless and the upper gums and face began 
to swell. An examination revealed small sloughing ulcers 
around the stumps of the lateral incisors, with a general stoma- 
titis. The glands on both sides of the neck were enlarged and 
painful. 
In this case the source of infection was plainly the ulcer- 
ated gum about the decayed teeth. There are other avenues 
that may be noted as affording an entrance to septic matter, 
such as the nose and ears. Certain forms of nasal catarrh, 
and otorrhoea in connection with otitis media purulenta, may 
be responsible for the infection. In any case of lymphatic 
enlargement, with other evidence of local poisoning, the 
original source of suppuration must be carefully sought for. 
Not a few children said to be suffering from the so-called 
scrofulous diathesis are really cases of chronic poisoning by 
pyogenic germs, the true source of which has not been dis- 
covered. I have seen such patients poulticed and given oil 
and iron when an ulcerated surface in the scalp or elsewhere 
had been overlooked and thus allowed to continue absorb- 
ing septic germs. If the source of septic infection is undis- 8 
SEPTIC POISONING IN EARLY LIFE. 
turbed, the poison may be reproduced in sufficient quantity 
to infect the general system. This need not take place at 
once, but after an interval of time the lymphatic tissues may 
lose their power to dispose of the germs, which thus find 
their way into the general circulation in sufficient numbers 
to produce a disturbance in distant organs. It is not always 
easy to draw a sharp distinction between local and general 
sepsis, or to tell when the former ends and the latter begins. 
Any of the causes of local infection may likewise produce 
a general poisoning. Doubtless certain conditions of the 
system will favor such a result. 
A boy of eleven years was brought to me stating he had 
chilly feelings and fever that came on every morning for a 
week. lie complained some of wandering pains in the legs, but 
more particularly of pain and soreness on either side of the 
neck and front of the chest. At the beginning of his illness a 
large boil came on the back of his neck, followed in two days 
by another one, which I opened. Examination revealed en- 
largement of the chains of lymphatics on both sides of the neck 
and considerable soreness to pressure over the pectoral mus- 
cles. Upon investigating the scalp, many nits were found and 
several small masses of pus, with slight ulcerations. Treatment 
directed here relieved his symptoms. 
A point of interest in this case was that the boy's parents 
were both rheumatic and for the past two years he had suf 
fered from rheumatic pains in the legs and elbows. During 
one of these attacks a year ago he complained of pain over 
the heart, and his parents were told that the rheumatism 
had attacked this organ. Examination revealed a distinct 
presystolic murmur. The chilliness, with fever coming on 
every morning, simulated a malarial attack, but a study of 
the case showed that the present illness was neither due to 
a mild attack of rheumatism nor to malaria, but to septic 
infection from small ulcers on the scalp. Sometimes it is 
impossible to discover the original source of trouble. SEPTIC POISONING IN EARLY LIFE. 
9 
An Italian baby, two weeks old, with health y-looking par- 
ents, was brought to the Demilt Dispensary with an abscess 
over both wrists, which I opened, letting out a fair quantity of 
pus. Healing took place, but in about two weeks a swelling 
was noticed in the right thigh which increased until in several 
days fluctuation was marked. It was then opened and washed 
out, considerable pus being evacuated. The abscess extended 
down to the bone, and it was found necessary to insert a drain- 
age-tube. In a few days a good-sized abscess formed on the 
back of the neck which was opened and drained. At about 
this time the baby began to cough, and fine rales were heard in 
the left lung and base of the right lung. Some dullness on 
percussion was soon noted on the left side, and a diagnosis of 
pneumonia made. As this was about clearing up, a patch of 
erysipelas appeared on the upper third of the left thigh. For- 
tunately, the infant nursed well throughout its illness and tol- 
erated large quantities of stimulants and tinct. ferri chlorid. A 
gradual recovery took place without other septic symptoms. 
The abscess in the thigh discharged for about two months, but 
examination of the pus failed to disclose tubercle bacilli, and 
eventually it healed up completely. 
An interesting case has been related to me by Dr. News 
where septicaemia had its origin in a naevus. 
A delicate female infant bad a pulsating naevus about an 
inch long by half an inch in diameter upon the cheek. When 
it was seven weeks old the doctor was called and found the in- 
fant very ill, with a high temperature and quick pulse. On the 
following day the naevus turned black and had a reddened, 
swollen base. A general eruption, somewhat resembling mea- 
sles, also appeared upon the body. Death took place upon the 
following day. The doctor afterward learned that an old 
woman had professed that she could cure the naevus by treat- 
ing it with a piece of placenta. A trial was allowed, and she 
had been vigorously rubbing the placenta into the naevus for 
several days before the appearance of septic symptoms. 
The contagious diseases of children, particularly scar- 
latina and diphtheria, present the gravest forms of sepsis. 10 
SEPTIC POISONING IN EARLY LIFE. 
In these diseases a distinction can be made between the 
specific and the septic blood-poisoning. The secondary in- 
fection that produces the latter form of poisoning may ensue 
from the severe angina of scarlatina or from the decompo- 
sition and absorption of diphtheritic false membrane. In- 
flammation of the lymphatic glands of the neck with a 
phlegmonous cellulitis will often be present in such cases. 
There is nearly always a high temperature and great pros- 
tration. I have recently treated a case of scarlatina in a 
young child where the temperature remained about 106° 
F. for a week on account of sepsis. As this form of septic 
infection is well recognized and described fully in the text- 
books, further description is here needless. 
Treatment.-The true line of treatment will be to pre- 
vent in every way the entrance of septic germs at any of 
the vulnerable points. Scrupulous cleanliness, which is 
practical antisepsis, should be observed from the time of 
birth. If the mother is in a septic condition, the greatest 
care must be taken not to infect the infant, principally by 
destroying the poison at its source by thorough disinfec- 
tion. The umbilical cord and the navel wound should re- 
ceive attention from the physician, instead of being rele- 
gated entirely to nurses. The cord is sometimes cut with 
scissors that are not over-clean. If the attendant is not 
sure of the scissors, they had better be passed through the 
flame of a spirit lamp, and thus rendered aseptic. The cord, 
after being thoroughly cleansed, should have a dry dress- 
ing, such as borated cotton, applied, as its speedy mummi- 
fication is desirable. If suppuration begins about the 
navel, frequent washings with solutions of carbolic acid or 
bichloride of mercury must be employed. In older infants 
or young children suffering from evidences of septic poison- 
ing, a most careful search must be made for any point 
where such material might be absorbed. The scalp, mouth, SEPTIC POISONING IN EARLY LIFE. 
11 
and teeth should be carefully inspected, together with any 
other possible vulnerable point. When lymphatic enlarge- 
ments are discovered, instead of using poultices and thus 
hastening the breaking down of tissue, it would seem bet- 
ter treatment to try and discover the focus of irritation, 
and, by destroying its source, prevent suppuration. If the 
poisoning has become general, free stimulation and support 
will be indicated. At the same time every effort must be 
made to cut off the source and entrance of septic germs. 
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