Aside from the first two weeks, the mortality of premature children is hardly higher than that of healthy full-term ones.
According to Budin, 15 per cent. of the premature children died after discharge from his institution and 17.4 per cent. of the full-term ones, after discharge.
Pathological examination of young pre mature children distinctly discloses thcr unr:peness, besides an anoemia of the organs. The organs correspond to the foetal development. The lungs are very anemic and show either partial or total ateleetasis.
The brain, of colloid consistency, permits only of inaccurate differentia tion into white and gray substance, the gyri are imperfectly developed, the pyramidal tracts in the spinal cord are still undeveloped. The kid ney's plainly show renculin formation. The thymus, thyroid, and adrenal are noticeably large. The foetal channels (ductus Botalli, ductus Arantii, and foramen ovale) are still open, showing insufficient involution. The epiphyseal osteogenetic centres are very small and undevel oped. In syphilitic premature children, besides other specific manifestations, one finds the osteo chondritis of Wegner (see chapter on syphilis).
prophylaxis is a twofold one. In so far as it concerns the occurrence of a premature birth, it does not come within the range of this book but rather belongs to the pro vince of the obstetrician or syphilographer. The prophylaxis of the premature child consists in keeping away all external harmful influences; in its positive phase it is curative, in the furnishing of skilled care, warmth and natural food.
Treatment.--The treatment of premature and debilitated children consists (1) in the furnishing of warmth; (2) in careful feeding; and (3) in the avoidance of harmful influences, particularly bacterial. Other measures, especially medicinal, are of much less importance.
1. Furnishing warmth to the body, immediately after birth, is, according to the unani 111011S opinion of all authors on this subject, the first and most important measure in the treatment of the premature child. A bath of 3° C. (9S.6° F.) increased to 40° C. (104° F.), and the careful transportation of the infant into a previously prepared warm room, most surely secure this. A bath of the above-given temperature lasting fifteen to twenty minutes is also the best measure to quickly bring the fallen temperature back to normal, in children that only come under treatment later. Eross rightly states that not all premature
children require artificial warming. However, the small and the dela tated ones do require it in one or another form. The supply of heat should be accurately measured for it has distinct indications and con traindications. In case the three hourly rectal temperatures show a subnormal temperature, artificial warming is demanded. Whereas in private practice one usually must get along with crude appliances, in maternity hospitals and clinics for nurslings one usually finds appa ratus for furnishing warmth (incubators), which with advancing im provement and decreasing cost will be in the near future more widely used in private houses.
The principal requisites of an incubator are (1) simplicity and surety in working, (2) cleanliness, (3) artificial light, ventilation and moistened air*, (4) accurate regulation of the temperature, that is, dosage of the supply of beat. We must admit unfortunately that des pite the greatest care there is hardly an existing model which fulfils all these demands.
Although the problem of the therapy of the premature is in no way fully solved by furnishing a good incubator, and even though its use be confined to those cases where a strict indication is at hand, still the results obtained from its employment are so convincing (compare Berthod, Gagey and others), that the greatest possible perfection in such apparatus seems well worth while.
The opponents of the incubator may content themselves with the dictum of Ddestre, who says, "Tint vaut le milieu, tart vaut la cou veuse." I will omit the historical description of the various models.
An apparatus which is a modification of the French model devised by Finkelstein (Fig. 12), and in use in the City Children's Asylum of Berlin, appears to be both practical and simple. It is made of galvan ized steel tin, with rounded edges. The box, which rests on a stand, is divided into two parts; an upper compartment, partly of glass, which is the receptacle for the child; and a lower compartment, the hot water receptacle, closed by means of a sliding panel. Cold air enters through openings located on the side of the lower part, is there heated, and then passes through the upper compartment, leaving it by means of the air vent. The necessity of regularly the hot water con tainers, makes punctual attendance imperative.