Blue Diseasi(Cyanosis) is due to an arrest of development interfering with proper aeration of the blood. While the child is still in the womb its own lungs are inactive and unex panded. The aeration of the blood of the child is effected indirectly through the blood of the mother. The blood of the child passes in the vessels of the cord to the placenta, which con nects the child to the mother, and is there puri fied by exchanges with the blood of the mother. Returning from the placenta the blood of the child passes to the upper chamber of the right side of the heart, partly directly and partly through the liver. In the adult the right and left sides of the heart are separated by a com plete partition, but in the fcetus an opening exists through which the pure blood can pass directly through the right upper chamber to the left, and from the left side it is then dis tributed through the body. After birth this opening should close, and then the blood requires to pass from the right side through the lungs, where it is purified, before it reaches the left. In rare cases this opening remains unclosed, and thus while part of the blood passes through the lungs to the left side, part escapes directly from right to left without previously passing through the lungs, and thus without aeration. The blood is, therefore, constantly deficient in oxygen, and the blue ness arises in consequence. The child's skin, its cheeks, lips, hands, and feet are markedly livid, the fingers and toes are clubbed and the nails are incurved. It breathes rapidly and is liable to attacks of breathlessness. In marked cases death usually occurs in a few day's, in slighter cases life may be prolonged for some years. All that can be done is to keep the child quiet and to protect from cold.
— This condition is due to shortening of the bridle of the tongue. When it is present the child cannot push the tongue out over the lips; and it interferes with the suckling. It is easily set right by turning up the tongue and dividing the front of the bridle by means of a blunt-pointed pair of scissors. This should only be done by a medical man, for if the scissors be directed upwards, one of the blood-vessels running along the under surface of the tongue may be injured.
Cataract.—Children are sometimes born with white spots in the lens of the eye, inter fering with sight, or the whole lens may be white, rendering seeing impossible. This is due to some defect of nourishment iu the womb. The child should be taken early to an oculist, as an opeiation is frequently neces sary very early to prevent changes arising in the eye that would interfere with the useful nese of an operation at a later period. (See p. 482.) Congenital Dislocation at the Hip.—This is a condition in which, probably through faulty growth of the head of the thigh-bone, and the socket in which it should lie (see p. 63), the head of the thigh-bone lies outside the socket. The condition may not be discovered till the child begins to try to walk. It occurs usually on both sides, though it may be only on one. If both sides are affected, the child's back is arched forwards, the abdomen is prominent, the buttocks broadened, and the child waddles.
If it is only on one side, the child walks with a rolling limp, and one leg is shorter than the other. This condition should always be one to make sure of, should a child make no attempt walk, or should fail, at the usual time.
It can be remedied by operation.' Professor Lorenz, of Vienna, treats such cases by manipu lation and then fixing up the limb in plaster for a time.
Congenital Absence of Bile-duets is a defect of development in infants, attended by jaundice, which is sooner or later fatal, at the latest within eight or ten months. It is due to the canals which should convey the bile from the liver to the bowel (see p. 201) being defec tive, so that bile is kept back in the liver. One result is that the motions are clay-coloured, and there is constipation. The child's skin is deeply jaundiced, and the urine highly coloured with bile. The liver and spleen are enlarged, and blood is apt to escape from various situa tions. The child becomes very emaciated but with prominent belly. Vomiting and convul sions are apt to occur, and death usually arises from exhaustion.
Congenital Obstruction of Stomach Out junction of the stomach and the first part of the small intestine is called the pylorus. This junction may be unduly narrow at birth, making it difficult for the food to escape into the bowel. The technical word for narrowing is stenosis, and when it is at this place the stenosis is called pyloric, thus obstruction at the outlet of the stomach dating from birth becomes, in technical language, congenital pyloric stenosis. It is a very rare condition, so far as the record of cases goes, but the writer fears many cases may be ascribed to other causes.
Its chief symptoms are two—(1) persistent vomiting and (2) constipation. The child may appear perfectly healthy at birth, and may thrive, whether fed artificially or at the breast, for two or three weeks. But after two, three, or four weeks vomiting begins. It occurs daily, now and again, at first, but increases till it is after every meal. Change of food, sedative medicine, and so on may seem to diminish it for a brief period, but it recurs, and persists in spite of everything, so that the child rapidly becomes emaciated and exhausted. After the vomiting has begun, constipation becomes noticeable ; when the bowels are moved, only bile-stained mucus is passed and little or no faecal matter of the usual colour. When the child's belly is examined, a prominence is likely to be observed in the upper portion, between the navel and the end of the breast-bone, and a wave-like movement may sometimes be seen to pass over this region, due to excessive action of the stomach in the effort to force its contents through the narrow outlet. Symptoms of such persistent vomiting should lead to immediate appeal to a surgical expert, for in extreme degrees of narrowing there is no hope of saving the child's life except by an operation.