Ever since Hartmann,1 in 1898, followed by Preysing2 in 1904, noted in infants digestive disturbance associated with disease of the middle ear, the rôle of parenteral infection in gastro-intestinal disturbance has been under consideration.
In 1921, Maurice Renaud,3 in seventy autopsies in cases of diarrhea, found suppuration of the middle ear and mastoid in every case, but did not discover any pathologic condition of the gastro-intestinal tract. Floyd,4 in 1925, reported twenty-six cases, occurring within eighteen months, with symptoms of gastro-intestinal disturbance, toxicity and loss of weight, in infants from 8 to 15 months of age. The earlier cases did not show any response to medical treatment, and autopsy revealed only pus, too thick to flow, in the mastoids. Mastoidectomy in such cases gave good results.
At the St. Louis Children's Hospital, similar cases have been studied in an effort to correlate the clinical observations with