482 PEDIATRICS 



bolic processes, those mysterious processes, which even though they 

 are not life itself are at least the source of its strength and the most 

 immediate expression of its activity. Although this matter is so 

 very important, for the study of growth and of the dyscrasias 

 occurring so frequently in childhood, it has only been in recent years 

 that we have busied ourselves with the systematic investigation of 

 this subject, urged on by the Breslau school (Czerny). In spite of 

 the careful investigations performed by Camerer and Heubner in 

 the realm of energia only the first steps have been taken toward the 

 clearing-up of these questions, their study is made very hard by the 

 unusual technical difficulties and the vulnerability of the infantile 

 organism. 



The science, however, which has had the greatest influence upon the 

 development of pediatrics is that which hardly twenty-five years ago 

 proceeded from the modest workshops of Pasteur and Koch, and 

 has won in this short time so overwhelming an influence on medical 

 thought and research. The reason why bacteriology is of such great 

 importance to pediatrics is that in no other period of life do the 

 infectious diseases take so great a part. Most striking from this 

 standpoint is the earliest infancy, the pathology of which is dominated 

 by the septic diseases produced by the widespread bacteria of sup- 

 puration. The nature of these diseases was in most cases first recog- 

 nized by the demonstration of these easily cultivated disease-breed- 

 ers; in this field Hutinel and Fischl have rendered the best services. 

 Investigation in the realm of the true epidemic diseases, the acute 

 exanthemas and the infections of mucous membranes, has been less 

 successful, but the example of the diphtheria bacillus, discovered 

 by Loffler, shows how great a furthering of clinical and therapeutic 

 knowledge is to be expected from the discovery of the disease-pro- 

 ducers. Also the discovery that not a few infections which were 

 formerly observed only in adults, e. g., tetanus, typhoid, cerebro- 

 spinal meningitis, dysentery, etc., occur also in early childhood, was 

 first made possible by the bacteriologic demonstration of the micro- 

 organisms concerned. 



Bacteriologic diagnosis received an important enrichment by 

 the use of the reaction products of the organism called forth by the 

 disease-process, e. g., the agglutinins of typhoid (Gruber, Widal). 

 This method may serve not only for diagnostic purposes, but also 

 for the discovery of unknown disease-producers, e. g., colon infec- 

 tion and dysentery. Jehle has demonstrated in my clinic the agglu- 

 tination of pneumococci by the serum of pneumonia patients al- 

 ready in the first days of the disease, and lately it has been made 

 possible to isolate the streptococcus of scarlatinal angina, which 

 is agglutinated by scarlatina immune serum in very high dilution. 



Apart from this, we receive through it an unsuspected look into 



