Tongue-tie is not met with so frequently as in the old days. If the child can suck and nurses energetically, this complication can be excluded. It may, however, occur. In such a case, the frÆnum is unusually broad and seems to extend clear to the tip of the tongue, which apparently is bound down to the gum and to the floor of the mouth.

The thin membrane may be snipped with the scissors close to the tongue and then torn back with the finger.

Harelip and cleft palate interfere with nursing and require continual attention to keep mucus out of the throat. Brophy has a rubber flap placed over the nipple of the bottle in such a way as to occlude the split tissue and thus enables the child to get nourishment.

These babies must be fed systematically by gavage, if necessary, until the deformity can be repaired.

Hernia at the navel is a common complication of infancy. It is not due to crying, to improper tying of the cord, nor to neglect by the nurse, as frequently charged. It is a congenital fault, wherein the cord opening does not close, and in time, crying and straining will drive the intestines out of the aperture like a pouch. The defect is revealed by the bulging outward of the navel when the child cries. Ordinarily the breach will close of its own accord.

Treatment consists in folding up the skin of the abdomen so that the groove will be over the umbilicus and include it. Then adhesive tape is put on to hold it. The surfaces of skin thus coming in contact should be dusted with rice powder or stearate of zinc. Another method of treatment is to place a wooden button form, round side down, on cotton, over the opening, and bind it on with a zinc adhesive plaster. The dressing should be changed at least once a week.

Inguinal hernia usually heals spontaneously also, but a truss may be required.

HÆmorrhage of the newborn is either accidental or spontaneous. Accidental hÆmorrhage may arise from an imperfectly tied cord, or it may be an effusion, through compression or rupture, into any of the internal organs, such as the brain, lungs, or abdominal viscera. These latter conditions rarely give rise to symptoms, and are seldom recognized during life. There is no treatment.

The intracranial hÆmorrhages are open to diagnosis through the presence of pressure symptoms, but these, too, are impervious to treatment unless a vessel can be tied, like the middle meningeal artery.

Spontaneous hÆmorrhages may develop during the first few days of life from sepsis, syphilis, Buhl’s disease, hÆmophilia, and true melÆna neonatorum. The fragile condition of the blood vessels, the great changes in the blood and circulation after birth, as well as constitutional dyscrasias, are etiological factors of importance. All the causes are not as yet known.

The blood may come from the umbilicus, the mucous membranes of the eyes, nose, mouth, stomach and intestines. It may be effused into the tissues beneath the skin, or into any organ of the body. Marked nosebleed is generally syphilitic in origin.

As a rule hÆmorrhages in the newborn are most common in males, and strongly hereditary.

The tendency to bleed lasts only a few weeks, and if recovery takes place, it is permanent. In some cases, however, where hÆmorrhage has developed in the brain, clots may form in important centers, and the child be permanently paralyzed in speech, sight, hearing, or intelligence.

Symptoms of hÆmorrhage begin during the first week and almost never after the twelfth day. The appearance of blood is the earliest and the most definite sign. The bleeding may come first from the umbilicus, or from the stomach, or from the intestines (melÆna neonatorum). The amount lost is small, but the oozing is continuous. The temperature may be high or subnormal, and may or may not be due to the hÆmorrhage. The skin is pale, the pulse feeble, prostration marked, and weight is lost rapidly. Convulsions are not infrequent.

The diagnosis of the condition is simple. It is only necessary to be certain that the blood is really effused, and not a temporary or accidental event such as the regurgitation of swallowed blood. Black tarry stools will show blood if placed in water.

The prognosis is not good. About two-thirds of these babies die.

The treatment is to stop the hÆmorrhage by ligature, suture, or compression if possible and to alter the character of the blood by adding to its fibrin content. This is brought about, if at all, by the administration of coagulose, coagulen ciba, or by transfusion from an adult—preferably the father.

Paralysis of the face (Bell’s paralysis) may follow the use of forceps. The prognosis is favorable. Paralysis of the nerve in the neck (musculospiral) is sometimes known as Erb’s paralysis. It happens in consequence of difficult breech deliveries or of vertex labors when much force is required to extract the shoulders.

The deltoid, biceps, and other muscles are affected so that the arm can not be raised. The failure to raise one arm will be the symptom that will attract the attention of the nurse. Some cases recover in a month or so, either spontaneously or by the aid of electricity. If not, the injured nerve must be cut down upon and its continuity restored.

Ophthalmia neonatorum is an infection of the eyes of the newborn by the gonococcus. The infection occurs as the child passes through the vagina or vulva, or when an unclean finger is put into the eye.

The reaction is violent. The discharge at first is thin, then thick, pus. If untreated, the eyesight may be lost by ulceration. In the asylums twenty-five per cent of the inmates are blind from this infection; and as late as 1896, seven per cent of the blindness in the state of New York could be traced to this avoidable disease.

The preventive treatment consists in the frequent douching of the vagina before labor with potassium permanganate solution 1:5000, or chinosol 1:1000. After labor, a drop or so, of 1 per cent solution of nitrate of silver is dropped into each eye and not neutralized.

After the infection has occurred, iced compresses are applied to the eye, night and day, and a solution of argyrol 15 to 20 per cent instilled into the outer corner, twice a day. In female infants with ophthalmia, the vagina must be watched for discharge which does not fail to appear in most cases. Argyrol (20 per cent) should be injected with a medicine dropper and left to drain out spontaneously. All dressings used about the child should be destroyed, and the nurse should use the most scrupulous cleanliness and care of her own person.

Separation of the cord may be delayed in puny babies and in cases where the cord is large and thick.

Some of these cases are doubtless due to a patency or fistulous condition of the urachus. Usually the separation may be hastened by touching the constrictured part with silver nitrate. Or, if the cord does not separate before the second week, it may be desirable to cut off the hanging fragment and touch the base with silver nitrate or dust with alum powder.

Granulations may protrude like a mulberry from the stump of the navel (“proud flesh”). These are touched with nitrate of silver stick.

Menstruation may appear occasionally from the vulva of the newborn. It is really a hÆmorrhage, a menstrual flow, which is associated with uterine activity, but rarely significant. There is no treatment. It disappears spontaneously.

The breasts of the newborn may fill with milk and become indurated and tender. Nothing should be done to them. Let them alone and the swelling will subside in a few days and the milk (“witches’ milk”) disappear.

Icterus may develop from the third to the sixth day. The child becomes yellow and stays yellow for a week, when the color gradually leaves. It is thought to be due to the liberation of some embryonic residue in the foetus, but nothing is known certainly. For the simple form no treatment is required. Recovery is prompt and uneventful. However, jaundice is associated with other conditions that prove fatal, hence every icterus should be watched carefully until it disappears.

Child’s Nails.—The nails are frequently rough and ragged at ends and sides. They should be smoothly trimmed lest they become infected at the junction with the skin and give rise to paronychia. If infection does occur, the skin and flesh may be pushed back with a sterile applicator, and the point touched with peroxide of hydrogen. A syphilitic history may be traced in some of the babies.

Thrush is a form of contagious soreness, characterized by white flakes or patches on the mucous membrane of mouth or anus which look like milk, but can not be wiped off.

It is due to a vegetable fungus and occurs most frequently among anÆmic or poorly nourished babies or those suffering from harelip. It is associated with symptoms of indigestion.

It may always be prevented by keeping the mouth and nipples clean, as directed on another page, and by keeping the bottles and rubber nipples in a solution of boric acid when not in use. When the disease appears, the mouth must be swabbed three or four times a day with an applicator soaked in saturated solution of boric acid. This is curative.

AphthÆ or stomatitis is the name given to whitish vesicles, followed by superficial ulcers that occur upon the inside of mouth and lips of the infant. It is rare in the newborn child. Boric acid solution is cleansing, and stick alum, frequently applied, will effect a cure.

Wheals, urticaria or “stomach spots” appear as generally distributed small spots about the size of a split pea, with a white center and a red periphery. They appear about the third day and last twenty-four hours.

They may be mistaken for insect bites and they may, or may not, be accompanied by temperature, which is probably only a coincidence.

The wheals disappear spontaneously without treatment.

Bednar’s disease is characterized by the appearance of two ulcers on the hard palate, one on either side and just above the spot where the last tooth will erupt. It is most liable to occur in sickly infants and supposedly arises from the abrading of the mucous membrane by a rubber nipple or through the rough cleansing of the mouth. It is very resistant to treatment. The child must be put in good condition by attention to the nourishment and the spots touched with tincture of iodine on an applicator.

The exudative diathesis is indicated superficially by a definitely bounded red patch on either cheek, which is not relieved, or only temporarily, by the common ointments and powders. The mother says the “face is chapped,” or that the baby has a “milk eczema.” Otherwise the skin is pale.

These children are frequently fat, but the tissue is flabby. The urine is sometimes ammoniacal. There is no marked disturbance of temperature. Fretfulness and constipation are the principal symptoms.

The condition is due to too much fat in the food. A skimmed-milk diet is best for a time. The fat can be added gradually until the limit of tolerance is found.

If chalky masses appear in the stools, the fat must be reduced again. Occasionally the child must be taken off the milk entirely, and a soup or gruel diet substituted.

For local application, the following formula is sometimes beneficial: (Grulee.)

The “cradle cap” is a frequent sign of the exudative diathesis in its milder stages.

The term is applied to a yellowish-gray patch over the large fontanelle. The mother calls it “dirt,” which she finds hard to remove and it always recurs. The mass is composed of dry scales, which gradually change into an eczema. Vaseline or sweet oil left on over night makes the removal of the scales quite easy the next day. If a raw surface is left, zinc ointment should be applied. The diet must be changed as previously described.

Erythema, especially of the diaper region, is sometimes a manifestation of congenital syphilis. It is usually limited to the inner side of the thighs, the perineum, scrotum or vulva, and buttocks. It must be associated with other and more characteristic signs, however, such as snuffles, cachexia, etc., before it becomes diagnostic of syphilis. Most erythemas of this area are due to irritation from moist or soiled diapers, but other factors may be important. Bluing in the diaper, gastrointestinal troubles, and circulatory disturbances are contributing causes. The local treatment is the same as for intertrigo. If the child is syphilitic, systemic measures must be instituted.

Intertrigo, or chafing, is a form of eczema due to moisture, bluing in the diapers or uncleanliness. The child should be cleaned with oil instead of water, and well powdered with stearate of zinc or zinc ointment may be used. Talcum powder which contains boric acid is contraindicated.

Pemphigus neonatorum is an eruption of blisters or blebs which seem to follow infection from the maternal passages or to be communicated by other babies who have the disease.

From three to fourteen days after birth, the blebs develop on the abdomen, neck or thighs, and show a tendency to spread to other parts of the body. The vesicles vary in size from one-fourth of an inch to two inches in diameter, and contain a serous, purulent, or bloody fluid. Other signs of general sepsis may appear.

In diagnosis care must be used to exclude syphilis, which also exhibits blebs, but usually on the soles of the feet or the palms of the hands. Besides, a nonsyphilitic child is generally better nourished. The prognosis is unfavorable if the child is weakly, if the blebs spread rapidly over a large area, or if the infection attacks the umbilicus.

Treatment.—A rigid quarantine must be enforced. In the hospital no new cases can be admitted. The alimentation must be increased, the blisters evacuated, and the surfaces cleaned and covered with a 25 per cent ointment of ichthyol, or an ointment of ammoniated mercury 2 per cent.

Strophulus, red gum, or miliaria rubra are names applied to an inflammation of the sweat glands when their secretion is retained. It is a “sweat rash” characterized by an eruption of scattered red papules or small vesicles which commonly appear on the cheeks or neck of young infants, or where skin surfaces come in contact. It is due to excessive clothing or heat. It is really a prickly heat. The treatment consists in the removal of the cause, and a generous use of stearate of zinc powder or rice powder.