Osteomyelitis in the newborn.

The earlier literature on osteomyelitis of very young infants dealt largely with osteomyelitis of the jaw and its probable relationship to mastitis in the nursing mother (Marx, 1920; Bass, 1928; Karplus, 1928; Wilensky, 1932; Poncher and Blayney, 1934). Metastatic osteomyelitis due to umbilical sepsis was mentioned by Fraser (1924) who collected some 30 cases over a period of four years. He said that a fatal result was almost inevitable. Baumgartner (1920) recorded a case of osteomyelitis of the skull, Madier (1922) one of osteomyelitis of a vertebra, and Palew (1931) one of gonoccoccal osteomyelitis. In a study of septicaemia of the newborn infant Dunham (1933) found that osteomyelitis occurred in 10-3°h of the cases and that three out of four such cases died. Mount (1935) reported a fatal case of septicaemia with osteomyelitis of the humerus. Green (1935) recorded a case of osteomyelitis of the humerus, with recovery, where the original lesion may have been a furuncle of the chin at the age of two weeks. The same author with Shannon (1936) published a series of 23 cases of osteomyelitis which occurred before the age of six months. The mortality rate was 45%. They related extra-osseous infection and trauma to the osteomyelitis and stressed skin infection and omphalitis as primary lesions. They considered that osteomyelitis was not a rare disease in infants and emphasized that the treatmnt was that of the general condition rather than of the local one. The poor prognosis given by Fraser and Dunham was not confirnmd by Diliehunt (1935) among whose cases there were two in the neonatal period. He said: