THE CASE of a 23-month-old girl, who died after an acute illness of a week, was studied in this hospital. The interrelationship of somatic disease and the pathological functioning and pathological anatomy of the central nervous system has been a topic of emphasis in the laboratory of neuropathology of this Institute.There is the principle that the kind, predilection, and distribution of lesions of the central nervous system are to be understood through the subtlety of the interrelation of multiple factors. This idea contrasts with the previous belief in the specificity of changes in the central nervous system. The emphasis on the interrelationship of somatic disease and changes in the functioning and anatomy of the central nervous system has given increasing meaningfulness to this principle.The neuropathological findings observed in this case seemed most consistent with a pathogenesis of bacterial toxins derived from a bacterial growth in the circulating blood, namely, a septicemia. The history of paint eating, in the abnormal amounts of lead in the blood and feces, pointed to an exogenous toxin, namely, lead, in the pathogenesis of the neuropathological findings. This discrepancy could be understood if certain assumptions were made. Suppose that the abnormal concen¬ tration of lead in the blood inactivated antibodies, so that the usual resistance to bacterial invasion and growth were diminished ; then brain change could be due to bacterial toxins rather than to lead intoxication.* In vitro experiments indicate that lead does inactivate antibodies and, hence, diminishes body defenses to bac¬ terial invasion and growth.
REPORT OF A CASEHistory.-A 23-month-old child, with normal delivery and in good health, who had displayed a two-month pattern of chewing painted objects, suffered an acute illness of nine days' duration. The onset was characterized by vomiting and a temperature of 100 F. Vomiting became spasmodic. The fever continued. Lethargy and closure of the left eyelid gradually appeared. The patient was admitted as a brain tumor suspect to the Neurosurgical Service of Rhode Island Hospital 30 hours before death.There was lethargy, left-lid ptosis, a "cracked pot" sound, and bilateral papilledema. Con¬ vulsive movements of the arms and head appeared 21 hours before death and continued episodically until death. Eight hours before death, the spinal fluid pressure was 400 mm. of water, and the total protein 393 mg. per 100 cc. The blood count was as follows : 7 gm. of hemoglobin per 100 cc. ; 5,140,000 red blood cells per cubic millimeter, and 15,250 white blood From the Institute of Pathology, Rhode Island Hospital.References 1 and 2.