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Meliena Neonatorum

blood, hemorrhage, gastro-intestinal, newborn, disease and tract

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MELIENA NEONATORUM The name melama neonatorum is not applied to any one disease as an entity. It rather serves to cover a symptom-complex, the loss of blood from the gastro-intestinal tract, either from the stomach by vom iting, or from the rectum, or both. One is justified in expunging mehrna from the category of diseases of the newborn. However, inasmuch as loss of blood from the gastro-intestinal canal often forms the most marked and at times the. only demonstrable symptom in certain mala dies of the newborn, we give this symptom-complex special considera tion. We will endeavor, therefore, to give a brief description of this symptom-complex and its consequences and, by comparing its clinical picture with the hitherto known anatomical findings, to show the method by which the examining physician can make a diagnosis of the under lying disease. We must again emphasize the statement that a diag nosis of mehena is unjustifiable and that endeavor must be made in every instance to discover the disease responsible for the lnemateinesis or the hemorrhage in the intestinal canal. There are three varieties of mebena,—spurious, symptomatic and true. Spurious melfena desig nates the loss of blood from the gastro-intestinal tract when the hemor rhage does not really originate in the mucosa of the gastro-intestinal tract. This we know that epistaxis frequently causes the vomiting of blood in the newborn. The epistaxis, moreover, is often overlooked, because the blood instead of escaping from the anterior naves runs back ward into the pharynx and and thence into the stomach. In such cases one is occasionally able to see streaks of fresh blood on the posterior pharyngeal wall (Swoboda). This epistaxis in children, how ever, depends upon various pathological processes in the nasal mucosa syphilitic rhinitis, ulcerations with septic processes, nasal diphtheria (observed in syphilitic children, Swoboda). In still other cases the blood comes from the mucosa of the lips or mouth. Ylcers whose seat of predilection is the angle of the mouth, Bednar's aphtMe and stoma tides, especially such as tend to necrosis, must be taken into considera tion. In other cases spurious mehena is due to wounds of the buccal

mucosa; such wounds may be caused during delivery by the finger of the accoucheur; or later, in the bloody separation of an adherent frnum of the tongue, an operation which vas formerly extensively performed.

It could only be under the most complicated conditions that a pul monary hemorrhage in the newborn would lead to the vomiting of blood. However, pulmonary hemorrhages have been observed in the newborn (Billard, Barthez and Rilliez, and recently by Esser), but to my knowledge h{ematemesis is not mentioned in the report of these cases, all of which ran an extremely rapid course without cough. How ever in older children the passage of blood from the stomach or intes tines may occasionally be observed with pulmonary hemorrhage.

Not infrequently the hemorrhage does not originate in the child P,t all but in the mother. Fissures of the maternal nipple bleed during the act of nursing and the newborn swallows maternal blood, which at times is vomited or colors the feces black. In such cases however, there can be but a scanty admixture of blood. In some cases spurious mekrna is attributed to the swallowing of blood during birth, for example, with premature detachment of the placenta. In case spurious mehena can be excluded, one then has to deal with a hasmorrhage originating in the blood vessels of the gastro-intestinal tract. We speak of symptomatic whom when the gastro-intestinal hemorrhage forms only one symptom of a demonstrable general disease; of true melmna when the hemorrhage and its consequences dominate the entire disease picture. It is self evident that a strict alignment into one of the above classes is often impossible.

We shall discuss, first, the cause of such a hemorrhage and then the diseases and conditions that can be considered responsible for its etiology.

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