The red corpuscles bear no etiological relation to icterus neonatorum. The number of erythrocytes during the first week of life is independent of the occur rence of jaundice. The fluctuations in particular are more dependent upon the changes in the volume of plasma. The "resistance" of the red corpuscles is the same at the time of birth as in the adult, and it is not altered in consequence of jaundice. Knopfelmacher (Wien. klin. Woeh., .No. 43, '96).
Icterus neonatorum is due to patho logical causes supervening during the first moments of extra-uterine life, and not to physiological conditions attending the birth of the child.
On examining the liver in fatal eases venous stases and retention of bile in the bile-duets was always present. The re tention of bile is favored by anything which tends to prevent the full expansion of the lungs, or interferes with the free action of the heart, both of which condi tions so frequently follow after a difficult labor. The jaundice develops most fre quently about the third day, never ap pearing as early as the first, and rarely delayed as late as the fifth day. The duration of the illness is from six to four teen days, and occurs, according to the author's investigations, 395 times out of 1000 newborn children. The icteric tint is first obscrA-ed on the nose and cheeks, and occasionally the face alone Is jaun dietth the rest of the body remaining of a normal color. The color of the urine is um hanged in mild eases. but in severer mucks bile pigment is present. There is eft( 11 profound alteration of nutrition aud shining of the pulse-rate during an t t ai k. Verniel Presse MC.d. Ilelgc., .1une 1, '981.
Weil's Disease (Acute Infectious Jaundice).
lif 1SS6 Weil described " peculiar rm of acute infectious disease charac terized by jaundice. swelling of the ,Tleen. and nephritis.- This has been ri.cog.nized by Cerman writers as a new disease. But others have looked upon it only as what has long, been described as "acute infectious jaundice," a name that serves sufficiently to designate it.
Symptoms.—The disease presents the symptoms that characterize acute infec tions generally. It sets in suddenly, usually with chill, followed by fever, pain in the back and limbs, loss of appe tite. thirst, general malaise, headache, giddiness, and usually diarrhon. The symptoms increase for a clay or two, the temperature rising rapidly to 104° or . 105° F., weakness increases, and there is mild delirium. Janndice appears 011 the
second or third day, with marked en largement and tenderness of the liver • and swelling. of the Tleen. The urine becomes albuminous and shows the other signs of acute nephritis. There is marked derangement of the digestion—furred tongue, nausea, and sometimes vomiting. The symptoms begin gradually to subside by the fifth to the eighth day. The per- ; sistent hig.h temperature falls, g,radually reaching the normal by the tenth or twelfth day. The jaundice abates with the other symptoms.
Epidemic of icterus occurring especially among children noted. Reports of 518 cases collected in Saxony during the autumn of 1889. The initial stage lasted three or four days and was characterized by fever, vomiting, constipation, and congestion of liver and spleen. The icterie stage appeared one or two days after defervescence and lasted about eleven days. Seventy-three per cent. of the children living in the region where the epidemic prevailed were attacked. Thirteen deaths were reported to the writer. Catarrhal conditions of the stomach did not predispose to the disease, while disorders of the respiratory tract, stud especially influenza, dicl. It appeared to be both contagious and miasmatic. :Meinert (La Semaine :Med., Aug. 27, '90).
Small epidemic of icterus among chil dren attending the same school, but liv ing in houses far apart. The attack com menced suddenly, with vomiting, pros tration, headache, vague gastric pains, and, in the course of three or four days, intense ieterus. The whole process lasted ten to twelve days. Denton (Revue de la Suisse Rom., Oct., '90).
An infectious icterus resembling ty phoid in its clinical appearance. The phenomena are ushered in with pain in the head and limbs, the temperature gradually rising till it reaches 102.2° to 103° F., which height continues five to eight days. On the fourth or fifth day icterus appears, the spleen is enlarged, and the margin of the liver is prominent and painful. The tongue is coated. The urine contains albumin from the begin ning, but becomes dark on the fourth day, although the freees are normal and some times colorless. The duration of the dis ease is between two and three weeks. It usually terminates in recovery. Two fatal cases, however, are on record. The necropsies revealed great reddening and swelling of the solitary follicles. Hoep pener Pled. Press and Circular, July 23, '93).