Constipation in the newborn may come from many causes. The amount of food may be so inadequate that no residue is left, and the bowels move only once in forty-eight hours. Over-stimulation of the bowel by castor oil or colonic flushings in the early weeks of life to correct colic may diminish its sensitiveness and produce atonic constipation. In the artificially fed infant too much fat in the food is a very common cause of the trouble.

Treatment.—Correct the amount of fat in the milk. If the child is breast-fed, the mother’s diet should be non-nitrogenous and vegetables should preponderate. Drugs should not be given until all else has been tried. Gluten suppositories will furnish a mild irritation to the rectum. Orange juice and prune juice may be given, or Mellin’s food or oatmeal water added to the milk. Milk of magnesia ½ to 1 teaspoonful, or Husband’s magnesia, in same dosage, may be given daily. Senna is also efficacious.

Diarrhoea is generally significant of an error in diet which is usually a plain indigestion, though there may be too much sugar in the food.

The stools are more frequent and always softer than usual, possibly fluid.

Diarrhoea means increased intestinal action due to irritation from something. It may be due to indigestion, to the presence of hard curds, to acidosis, or it may accompany almost any disease of infancy as a symptom merely. The odor is due to gases formed in the canal by bacterial action. There is but little odor in fermentation, but much in putrefaction. Mucus appears either as balls or strings. The balls come from the small intestine, strings from colon. Blood indicates ulceration at some point in the bowel, or an erosion just above the sphincter.

Fatty curds may be either white, granular, sand-like masses, or small, soft, and yellow. The protein curd is large and smooth, or white and bean-like. Both occur only when the artificially fed infant is given raw milk (Brenneman). If the milk is boiled for two minutes these masses will not form.

The cause must be determined. The frequent stools, however, are exhausting, and may have to be checked with opiates or mechanical astringents.

When due to indigestion, all food by mouth may be stopped for two or three days and only barley water administered.

In a breast-fed child, diarrhoea is sometimes checked by diluting the milk with a little barley water, given just before nursing. With these infants, not much change in the sugar content can be made by alterations of the maternal diet, but where artificial food is used, the amount of sugar is easily reduced to a satisfactory degree.

Colic is a cramp-like pain of the bowels. Previous to the attack the child is restless, expels some gas, and has the “colic smile,” which leads the mother to believe the child is quite well. When the attack comes on, the thighs are flexed on the abdomen, and the legs on the thighs. The child has a sharp cry, that is nearly continuous, but in some way related to the nursing period, for the attack comes on a few minutes, and sometimes an hour, after taking the breast. The belly is rigid, the arms wave aimlessly. Diarrhoea may be present, and the movements are accompanied by much flatus. Distention is nearly always present. When the belly is tapped it gives a drum-like note and the child belches gas, sometimes accompanied by milk, which seems to relieve.

Treatment.—Colonic flushings to relieve the bowel of irritating curds. The child may be laid face down with a bag of hot water under the belly. Mixture of asafoetida gtts. xx to xl, or whiskey and hot water should be given for the attack, followed later by a full dose of castor oil. The diet should be rigorously investigated.

Vomiting may or may not be serious. The child may nurse too rapidly or too much, and the over-distended stomach simply empties itself. Many infants “spit up” their excess of milk, and thus relieve themselves. This is a simple regurgitation, usually of unchanged milk, though it may be acid from admixture with the gastric juice.

Vomiting, in a breast-fed child, may come during an attack of colic when the eructations of gas appear. It may be a symptom of gastrointestinal intoxication, of too much fat in the food, too short intervals between feedings, or too much sugar in the food.

Projectional vomiting awakens suspicion of a pyloric stenosis or meningitis, and must be reported to the physician at once.

Vomiting which occurs within twenty minutes after feedings is not serious ordinarily, even though gas and large curds are expelled, but all vomiting later than this, is significant of a pathology.

Treatment.—Regulation of the hours of feeding is most important, and next, the character of the food. If the child vomits an hour or so after nursing, it may be that the milk is too rich (fat). Try a longer interval, or give an ounce or so of cereal water before putting the child to the breast.

Prematurity exposes the child to three distinct dangers, which arise, respectively, from atmosphere, food, and infection. Very few children born before the seventh month survive. A child born at the eighth month, or with a weight of three pounds, or more, can be saved almost always. The premature child up to the time of birth, has been protected very carefully against temperature variations by the liquor amnii, and when suddenly precipitated into a new environment, which its vitality barely tolerates, the consequences are serious.

These infants have a poor heat production, and the natural warmth of the body must be preserved. This is best done by incubators, which supply air and moisture in stable and appropriate amounts. Chilling of the child for even a few moments may be fatal. A room may be fitted up to produce the necessary conditions of light, air, heat and moisture. The child, wrapped in sheets of cotton, except the face, is then covered with a blanket, and surrounded by a temperature varying from 88° to 95° F., which is gradually lowered to 80° F. as the child gains strength. An occasional whiff of oxygen, as prescribed for an atelectatic child, is sometimes advantageous.

Bathing.—Premature infants must not be bathed, but the skin should be cleansed with cotton and warm sweet oil or albolene. All unnecessary handling is to be avoided.

Food.—Breast milk is the secret of success with these cases. Since most of the infants are too weak to take the nipple, the breasts must be pumped, and the child fed with spoon or pipette.

The interval between the feedings depends a little on the amount taken, but it should not be less than one and one-half hours, nor more than two hours. As the child gains, the interval may be lengthened to three hours. Lack of sufficient nourishment is shown by cyanosis and loss of weight, and overfeeding, by vomiting and diarrhoea.

The child must be fed by hand until strong enough to nurse the breast. In certain cases of prematurity, as well as in diseases like pneumonia, scarlet fever, and diphtheria, the child must be fed by gavage. Nutritive inunctions of benzoated lard or cod-liver oil are also valuable, not only for the passive exercise supplied, but for the absorption of a certain amount of the unguent.

Marasmus means wasting, but the term is applied to infants that steadily lose weight. The bodies of infants are so largely composed of fluid, that loss of weight occurs quite easily and rapidly. Loss of weight may be sudden or gradual. It comes on rapidly after acute diarrhoea, either with or without vomiting, or it may follow persistent vomiting without diarrhoea.

Malnutrition from defective feeding is the most common cause of wasting in infants. This may be from lack of sufficient food or lack of proper ingredients, as well as irregularity of intervals, and disease. Rickets, congenital stenosis of the pylorus, congenital syphilis, and tuberculosis are all possible factors in the etiology.

In any case, no treatment can be instituted until these conditions have been confirmed or excluded.

Pyloric stenosis (the account follows Grulee) may be a thickening of the muscular coat of the outlet of the stomach (pylorus) or a spasmodic contraction. The condition is most frequent in males and in the first born.

Symptoms usually begin before the second week. There is constipation with small ribbon-like stools, and the urine is scanty. The most marked sign, however, when it is present, is the excessive, uncontrollable vomiting, which ordinarily occurs fifteen to thirty minutes after eating, but may be delayed for several hours. The vomiting may be of the common type, but more frequently it is projectile in character, like that seen in meningitis. The contents of the stomach are violently expelled, sometimes several feet. Physical examination may reveal the stomach bulging under the arch of the ribs and peristaltic waves moving back and forth across its surface. The pylorus itself may sometimes be felt as a lump or tumor.

Prognosis.—About fifty per cent die.

Treatment.—Dietetic and surgical. Grulee recommends small amounts of food, poor in fat, be given at short intervals. If this fails, operation is required.

Pneumonia in the newborn most frequently results from the aspiration of mucus out of the maternal passages as the child is born. This may happen when the cord is compressed, or at any time when a partial asphyxiation impels the child to try to breathe.

It may also come on when a feeble child has been chilled by a prolonged first bath.

The disease develops about twenty-four hours after birth in a child apparently well. The temperature rises, respiration becomes rapid, and cough develops. The child is fretful, restless, refuses the nipple, and gasps for breath. It may become cyanotic. The prognosis in newborn infants is very serious.

Treatment is stimulation. A mustard bath will benefit where the respiration is rapid and the child blue. Tincture of digitalis may be administered in drop doses every three or four hours. Carbonate of ammonia, ¼ gr., in mucilage of acacia, half a dram, may be given for cough.

Child must be fed on mother’s milk pumped from breast.

Snuffles may be due to improper clothing, to drafts of air, or to syphilis. If due to cold, camphorated oil may be rubbed on the nose and the passages kept clean with an applicator soaked in albolene. If this fails, a small pellicle of anÆsthone may be placed in each nostril, and the child laid upon its back until the ointment melts and runs back into the pharynx.

Furuncles (boils) may be numerous. They come from irritation of the skin by atmosphere, soap, water, and clothing, whereby infection enters. This is especially liable to occur in the hair.

Keep the boils washed with boric acid solution and open them as soon as the focus, or head, appears.

Phimosis is such a close adjustment of the prepuce to the glans penis that it can not be retracted. In some cases there may be obstruction to the outflow of urine, but generally a tiny portion of the glans can be seen. The prepuce may or may not be redundant. This condition makes cleanliness impossible and balanitis may result.

On account of the straining required to urinate, prolapsus ani, hernia, and hydrocele of the cord sometimes develop. Symptoms may arise from preputial adhesions, as well as phimosis. Frequent or difficult micturition, nocturnal incontinence, priapism, pruritus, and masturbation may develop out of the irritation, as well as nervous manifestations, such as insomnia and night terrors.

The condition should be recognized and corrected in infancy. If the adhesions are dense, an incision can be made down the dorsum of the prepuce, the tissue forcibly separated from the glans, and the flaps cut off. Stitches may be required. In other cases circumcision may be necessary.

Paraphimosis.—When a prepuce with a small orifice is forcibly retracted over the glans, it occasionally happens that it cannot be pulled forward again. If allowed to remain this way, the parts will swell, and the penis become strangulated as if with a ligature.

The danger arises from the stoppage of the circulation, which may be followed by ulceration and gangrene.

Reduction must be brought about by manipulation, if possible, but where this fails, the constricting band must be cut through and sedative applications used.

Balanitis is inflammation of the prepuce from the decomposition of smegma, which collects under a tight foreskin. The condition is quickly relieved by cleanliness and a few applications of vaseline or zinc oxide ointment. Circumcision should not be done until the inflammation has subsided.

Circumcision, either as a physical necessity or as a religious rite, is frequently performed.

The nurse prepares a table with sterile linen, a basin with antiseptic solution and sponges, sterile towel, and sterile vaseline, with a roll of gauze bandage an inch wide.

The object of the operation is to remove the prepuce and leave the glans exposed.

The instruments needed are a pair of sharp scissors, a pair of dissecting forceps, two pairs of artery forceps, small, full curved needles, and fine catgut.

The nurse gives the child some gauze to suck, which has been soaked in brandy and sugar-water, brandy one dram to an ounce of water. Then taking her place at the child’s head, she flexes the thighs back upon the abdomen, and widely separates them. The field of operation is thoroughly washed with soap and warm water, the prepuce is then retracted and the smegma wiped away. Then the body and limbs should be covered with clean linen, except the penis, or a sterile towel may be used with a hole in it through which the penis is drawn. The redundant tissue is removed and fine catgut sutures put in.

The operation being completed, the wound is covered with sterile vaseline and wrapped with a sterile gauze bandage, leaving the end of the glans exposed.

The gauze and vaseline are changed whenever saturated with urine. Healing ought to be complete by the seventh day. The nurse should examine the dressing at frequent intervals during the first twenty-four hours, since serious hÆmorrhages may occur from vessels that have not been included in the sutures.

Priapism is a condition of functional fullness and firmness of the penis that is more than ordinarily constant. Its importance lies in the fact that it may be a symptom of spinal irritation, balanitis, worms, or phimosis.

Spina bifida is the most common congenital deformity. It is characterized by a fluid tumor, which protrudes from an opening in the vertebral column. It may appear anywhere along the spine, but is found most frequently in the lumbar or cervical region. The deformity is supposedly due to an arrest of development. It is nearly always fatal inside of two weeks, though cases have been known to reach mature years.

There is no treatment except protection from injury.

Hydrocephalus is sometimes, but not necessarily, associated with spina bifida.

The ventricles of the head are filled with cerebrospinal fluid, and the fontanelles are widely separated. The cause of the anomaly is unknown.

This condition may render labor difficult or impossible until the diagnosis is made and the skull perforated. Rupture of the uterus may result from the futile efforts to expel the child. If born alive, the child nearly always dies, or if it grows up, the intelligence is imperfect in most cases.

Anencephalus is a monster, having a body, but only a part of a head. The eyes protrude, the tongue may hang from the mouth, and the brain is under-developed.

Sudden death of infants that are apparently healthy comes with a shock to the physician as well as the parents, and in some instances, no plausible reason can be assigned for it. Apoplexy, pneumonia and stoppage of the trachea by milk curds may explain some cases. Suffocation by lying on the face in wet bedding, or overlying by the mother will account for others. Internal hÆmorrhage into lungs, pleura, stomach, or brain is also known to be causative.