SCLERCEDEMA; SCLEREMA CEDEMATOSUM Symptomatology.—The disease usually begins with vague dromal signs, such as lessening of the appetite, slight restlessness and crying; and at the same time the breathing becomes shallow and ular and the heart's action weaker. After a few hours the oedema is seen on the back of the feet, on the cheeks and also on the mons veneris. The cedema spreads upward, leaving the chest free, and is most extensive on the lower extremities. The hands and arms are also attacked but rarely the eyelids and the rest of the face. The penis and scrotum are in like manner swollen. The skin over the affected parts is tense and usually cyanotic in premature children; but in children born at term or when the affection occurs somewhat later, after the physiological exfoliation has terminated, the skin is pale, waxy and at times mottled. An increase in volume is apparent; the consistency in less severe cases is that of butter (Heubner), but in advanced cases the skin is hard and stiff and distinctly gives the sensation of coldness to the palpating finger. The child lies still and apathetic, the temperature in mild cases.
35-34° C. (95°-93.2° F.), sinks in severe cases to 32° C.(89.3° F.) and lower. The excretion of urine is scant and its amount is of some prognostic value. Albumin is usually not present. The body weight does not always diminish, as is usually stated, but on the contrary may even increase.
In the severer eases the children die with gradual weakening of respiration and the heart's action, and with increasing stupor. Death takes place usually after four to five days, in protracted eases after one to two weeks, although eases of lesser severity frequently end in recovery. Actual complications arc rare. Pneumonias occurring ously, diseases of the navel, phigus and sepsis are to be sidered as independent affections.
oc curs only in the newborn. Sel dom congenital, it begins, as a- rule, on the second to fourth clay of life, rarely later, up to the second week. Premature and debilitated children, twins and hereditary syphilitics are especially affected. It is also rather often observed with congeni tal heart disease and nephritis. Less severe forms are very frequently encountered in premature children.
In winter and in localities where the climate is cold, many more cases come under observa tion. The is encountered more frequently in hospitals and dispensaries, that is, it is more common among the poorer class of people than in private practice.
Pathogenesis, disease, concerning the etiology of which much uncertainty exists, is dependent, for its origin, on several factors.
The peculiar anatomical relations in the newborn, and especially in the premature or debilitated newborn, furnish a suitable basis for its occurrence.
On the one hand muscular and circulatory weakness, on the other a, lowering of the oxidation processes and of respiration, are involved in the causation of sclercedema. The influence of cold on the infantile organism becomes the exciting factor.
The nervous theory (Liberali, lIallantvne, O. Somma) and also the theory of an infectious.origin, are more hypothetical and have received no general recognition. Luithlen unqualifiedly denies the existence of sclercedema as an entity; he classes it with the other cedemas of the newborn, with which it shares a common etiological basis, differing only by the superaddition of the elements of cold.
Pathological for an occasional degeneration of the heart muscle (Demme) the usual findings are a venous congestion, especially in the distribution of the versa cava; and then congestion of the lungs, atelectatic areas and small haemorrhages in the lungs and The itself is not necessarily confined to the skin and the subcutaneous tissues but may on the contrary spread to the deeper lying muscles.
Reference is made to the illustration for the histological findings.
The diagnosis is easily made in pronounced cases. The pitting of the skin, on pressure with the examining finger, serves to differentiate the rarely-occurring sclerema, which feels much harder and with which the penis and scrotum are uninvolved.
Acute erysipelas is differentiated by its color, localization and the fever usually accompanying it.
The prognosis is favorable in mild cases, but becomes more dubious the more extensive the involvement; and also when other complications (atelectasis, pneumonia, heart disease) are present.
consists in the prevention of any immoderate chilling, especially with premature and debilitated children, and the instituting of breast-feeding.
treatment consists primarily in the furnishing of artificial heat (couveuse). (See chapter on prematurity and debility.) The stimulation of respiration by means of oxygen inhalation, com bined with artificial respiration, is recommended. Hot baths, 3S-42° C. (100.2-107.3° F.), with massage and passive motion in the bath or after it (Soltmann); inunetions with glycerine to which 10 per cent. of iodide of ammonium has been added are recommended by Baclaloni; diuretics and digalen ,1-1-2 drops internally. hot sweetened coffee (50-100 Gm.), possibly per rectum.
Where there is difficulty in swallowing, gavage and nutrient ene mata. Breast-feeding must be employed if possible.