MECONIUM AND FECES OF THE BREAST-FED INFANT The first evacuation of the bowels occurs only a few hours after birth, or, if the labor is protracted, it may occur during birth. This is a dark brown, mostly odorless, homogeneous tarry mass called meco nium (see Plate 4). Its sources are swallowed amniotic fluid, secretions from the intestinal tract of the embryo, and intestinal epithelial cells. Microscopically, lanugo, cholesterin, fat globules, platelets of epidermis, epithelial cells, and peculiar greenish yellow, oval or rounded bodies, so-called meconium corpuscles, are found. The opinions concerning the origin of the latter are not quite uniform, but it is probable that they are derived from epithelial cells of various origin, which while passing through the intestines shrink, break up into small pieces, and become strongly stained with bile.
The total amount of meconium is about 00 to 00 Gm., (2-3 ounces) and infants taking the breast well dispose of most of it in small sepa rate portions on the first day and in the first half of the second day. But, particularly in cases of pronounced underfeeding, meconium may occur in the feces as late as the fourth clay. Camerer observed with the first excretion of meconium a small grayish white glassy mass. This is composed mostly of mucus, detritus, and epithelioid cells. Its presence may be of some sigificance forensically, since it proves that no meconium had been voided previously.
According to the investigations of Zweifel, F. Millet) and others the meconium contains 70 to SO per cent. water. The dry residue con tains about 5 per cent. nitrogen, 15 per cent. ether extract, and 4 to 5 per cent. ash. ITydrobilirubin is absent: the presence of bilirubin, bili verdin, glycocholic acid, taurocholic acid, and cholesterin can be demon strated.
In most cases the character of the feces changes in the course of the second day (see Plate 4). The discharge from the intestines acquires a lighter color and becomes softer, and after a short time the pure milk stool makes its appearance. Tts color is light yellow to golden y ell o w, the consistency is pasty. the odor is agreeable and the reaction is acid. The composition is not quite uniform, but nearly always numerous small white pieces, gas hubbies, and mucus. particularly during the first week,
are imbedded in the yellow mass. During the first week the daily pass ages number two to four, later one to two. When a normal amount of food is introduced about 2 to 3 Gm. feces are excreted for each 100 Cm.
mother's milk, and about 4 Gin. solids for 100 Gm. milk solids. In cases of overfeeding the resorption is not so good. During the first week fresh milk stools contain twenty to t wenty-five per cent. dry residue, later fifteen to twenty per cent.; of this ten per cent. are inorganic sub stances,-- one-third of which are calcium salts, - and ninety per cent. organic suhstances (mainly bacteria). Beside the ash, the dry residue contains about twenty to -thirty per cent. fat, soap, and free fatty acids, and four to five per cent. nitrogen.
The microscopical examination of the fresh milk stool reveals the presence of numerous bacteria. fat globules of varying sizes, crystals of fatty acids, salts of fatty acids (soaps).—partly in crystalline form partly amorphous, —crystals of cholesterin and hilirubin, more or less changed epithelial cells, and masses without structure. The small whitish clumps, which can he seen macroscopically, have long regarded as casein. But most of these consist of calcium soaps anti fat globules, and sonic of them are made up of bacteria. probably knitted together by a proteid-containing substance.
The quality of the feces does not change materially under normal conditions during time whole period of lactation (see Plate Fre quently in the first months, apparently 'rmerfectly healthy infants have passages which are not uniform in consistency, and which present the appearance of chipped beef and are slimy or watery. As a rule, tiles( manifestations disappear quickly without any therapeutic measures. But these cases very probably represent light pathological conditions, which may be due to changes in the quality of the food (according to Gregor variations in the fat content of the milk), or may be caused by light digestive disorders otherwise not demonstrable.