LOCAL DISEASES OF THE STOMACH AND INTESTINES IN EARLIEST CHILDHOOD THIS affection is extraordinarily rare in childhood and particularly This affection is extraordinarily rare in childhood and particularly so in infancy. It offers great difficulties in clinical diagnosis, when, as is frequently the case, especially in round ulcer in this period of life, bloody vomiting, and stools containing blood which has its origin in the upper bowel, are both lacking. Moreover, the vague, indefi nite pain, not always localized in the gastric region, as well as the vomiting of the food and progres ive loss of weight, are considered to be due to some process in the lower. abdomen, as fcr instance appendi citis. On this account most of the eases reported (these have been col lected by Rehn and Bechthold), were not diagnosed during life; indeed, in the instances observed by Bechthold, the condition u-as not recog nized after laparotomy and was first discovered at autopsy. The small amount of hydrochloric acid, produced in the infant s stomach, the rarity of hyperacidity at this age, the rapid emptying of the food contents into the small intestine, and the absence of mechanical dis turbances, render the relative scarcity of cases readily understood. Without claiming to have made an exhaustive examination, I was able to find only twenty-one eases, the youngest of which was a child of two and one-half months.
The course of the disea.se was but seldom so typical that the clini cal diagnosis could be made with certainty; for the most part, appen dicitis was thought of, and, on this account, laparotomy (with favorable result in a ease reported by Watson—Cheyne).
The diagnosis of the condition presents no difficulties when there is blood vomitus or tarry stools, and ono must also consider the possi bility of ulcer of the stomach when gastralgia and symptoms of peri tonitis are present; in an observation published by Frommer, the possibility of association of ulcer of the stomach with severe aphthous stomatitis was suggested, but, nevertheless, as already said, in tno,st instances one can only conjecture.
There is seldom any definite indication for treatment. Explora tory laparotomy is indicatecl when the symptoms are severe, especially in cases of recognized peritonitis. When the clinical diagnosis of a ease. of ulcer of the stomach is a possibility, it should be treated at once by securing absolute rest for the stomach, external applications of cold and rectal feeding. Gelatin injections may be given, such as are ser viceable in meltena. A 2 per cent. solution carefully sterilized (because of the danger of tetanus infection) should be injected, in quantities of 15-20 c.c. (3-5 dr.) into the subcutaneous tissue of the breast or thigh (in small children in two places), and the injection repeated in a few hours in case the bleeding does not stop. Careful diet and the use of alkalies (bismuth, alkali waters, etc.) are said to gradually- assist the healing process.
Ulcers of the duodenum arc even less frequent and their diagnosis is only conjectural. They- play a certain role in the etiology of melama neonatorum; but in later life they are most exceptional. I am able to refer to but one observation, that of Vandetpoel. This was a ten months old child which suddenly- developed bloody stools and hwmatemesis, at the end of a chronic catarrhal colitis. The autopsy showed, as the cause, an ulcer the size of a bean lying close below the pylorus, in the posterior wall of the duodenum; the base of the ulcer was formed by the head of the pancreas grown fast to the duodenum.