"It is first and most distinctly seen on the face—especially on thc forehead and about the mouth—and in the chest; later it appears on the seleroties, and last of all on the bands and feet" (Thomson).
In contrast with ordinary obstructive jaundice thc sclerotics are discolored only slightly and late.
The urine is usually normal, not stain ing the napkin; but in severe cases bile pigment is present in it.
Dyspepsia, nausea, vomiting, eructa tions, and flatulence, with sour and green stools, arc constant symptoms of icterus nconatorunt, and occur either simultane ously or soon after the appearance of the jaundice. In many cases fever is present, especially in the evening. The cause con sists in a gastro-intestinal catarrh caused by the irritation produced by the first food, which is often of an unsuitable character. The catarrh extends to the common bile-duct, which becomes ob structed. Quisling (Lancet, 'Ian. 27, '94).
In many eases icterns neonatorum is a, symptom of some transient disorder, while in others it is of grave signifi cance. From 30 to SO per cent. of all infants have it. It usually appears within the first week, usually on the third or fourth day; first on the trunk and face, then on the limbs and con jtmetivt-e. In the milder cases the urine and ftuces are normal. The child's health does not suffer, and after four or five days, or at least one or two weeks, the jaundice disappears. The text-books commonly give two weeks as the duration of severe cases, but cases which lasted for two months and then passed off, leaving the infants appar ently no worse than before the attack, have been personally observed. G. F. Still (Clinical Jour., Afar. 13. 1901).
Diagnosis.—This in uncomplicated cases is easy. The colored stools, the pale urine, and the absence of grave symptoms serve to distinguish it even jaundice, and from syphilitic disease of the liver, and obliteration of the bile duct.
Two children of the same mother died of jaundice. The first pregnancy ran a normal course. The child was healthy during the first four weeks of life, but at that period icterus developed, and con. tinued up to the time of the child's death, which occurred on the first week of the seventh month. The liver was enlarged during life. There NA-as a small abdomi
nal effusion. During the second preg nancy the mother was jaundiced two weeks prior to her confinement. The offspring became jaundiced in the third month. The jaundice fluctuated and at times quite disappeared. The child grad ually failed and died. At the autopsy the liver resembled that of acute yellow atrophy. In the red stage the kidney showed an advanced fatty degeneration. The pulp of the spleen was much hyper trophied. Brandenberg (Centralh. f. in nere Med.; Inter. Med. Mag., Dec., '97).
Etiology. — It is of very uncertain causation; many theories have been ad vanced to explain it. Some have said that the condition is not a true jaundice, but pigmentation due to rapid destruc tion of red corpuscles in the first days after birth. The presence of bile-pig ment and bile-acids in the pericardial fluids of icteric infants and not in others proves, however, the yellow discoloration to be due to bile, and bile is always the product of the liver-cell.
That the blood-destruction leads to a greater amount of pigment in, and in spissation of, the bile followed by partial stasis, and consequent absorption from the biliary radicles, is probably the most reasonable theory. The causes may, how ever, be various, and several may be active in the same case.
Undissolved biliary coloring matter and bile-salts are always to be found in the urine of icteric newborn infants, which proves the hepatogenic origin of the disease. Halberstam (Jahrbiich f. Kinderh. u. phys. Erzie., B. 27, H. 4, '88).
Icterus neonatorum is ascribed by sev eral authors to late section of the cord, whereby a greater mass of blood is thrown from the placenta into the child's circulation, and a great destruction of red corpuscles and coloring matter ensues, followed by ieterus. To test this view, 50 children were at once separated frorn the cord at birth, and 100 later, mostly after separation of the placenta. Of the 50, 36 became icterie and 14 remained unaffected. Of the 100, 71 were observed; out of these, 30 were icteric and 41 re mained well. The intensity of color and length of duration of the jaundice Nvere more marked in those early separated than in others. Schmidt (Archiv f. Gyinik., B. xlv, II. 2, '93).