Katharine Dodd

Stomatitis and diarrhea of infants caused by a hitherto unrecognized virus

Summary 1. A stomatitis of infants and children often accompanied by diarrhea is reported. The disease occurs most frequently in infants under 6 months of age. 2. A hitherto unrecognized virus has been isolated from the mouths and from stools of infants with the disease by inoculation of the scarified rabbit cornea. The virus has been propagated and maintained in serial transfer through forty passages in the eyes of young rabbits. 3. The specific causal relation of the virus of stomatitis and diarrhea of infants to the disease has been demonstrated by the appearance of neutralizing antibodies in the convalescent serum of individuals recovering from the condition. Further supportive evidence that this virus is the cause of the stomatitis was obtained from an accidental laboratory infection with filtered material from infected rabbit corneas. 4. The evidence thus far indicates that the virus is highly contagious. 5. The stomatitis has been found to occur sporadically in adults and such persons may serve as sources of infection for susceptible infants. Adults have been found to harbor and spread the virus when they themselves demonstrate no evidence of infection.

The correction of distorted fluid equilibrium in the presence of vascular injury

Summary Restoration and maintenance of a normal amount of fluid and electrolytes in the body and a normal partition of the total body water comprise an important part of adequate supportive treatment. A normal partition of extracellular water in the blood stream and interstitial spaces is only possible when an adequate amount of plasma protein is present in the blood stream. In nutritional hypoproteinemia or following a loss of plasma protein through injured capillaries there is a distortion of fluid distribution in that too little is retained in the blood stream and too much accumulates in the tissue spaces. Thus edema of the tissues and dehydration of the blood may occur simultaneously. When plasma protein is deficient, the administration of fluid alone fails as a means of restoring an adequate volume of blood. Indeed such measures often result in a greater loss of protein through injured capillaries. A useful early sign that fluid administration is leading to this undesirable result is the observation of a gain in weight accompanied by a progressive rise in the concentration of hemoglobin and a decrease in the concentration of plasma protein. Proper supportive treatment for such patients must include a replacement of plasma protein as well as of fluid and electrolytes. Better results in terms of retention of the replaced protein and hence of the replaced fluid in the blood stream are obtained when early liberal transfusions of plasma are combined with a conservative administration of fluid.