Some writers, especially Grandidier and Ritter, have attributed the bleeding to a condition allied to hmophilia • and certainly in cases where death results from profuse capillary haemorrhage in the new-born child, some special and unusual tendency to bleed from slight causes must evi dently prevail. In one of four cases published by Dr. Halliday Croom, marked hemorrhagic tendency existed in the father. In another, although no family predisposition could be detected, the child himself had an evi dent tendency to bleed, for the pressure of the forceps with which the infant was delivered had produced an extensive ecchymosis on either side of the head. In a child possessing this unfortunate tendency, any cause which interferes with the establishment of respiration will increase the pressure on the veins, and may thus determine an effusion of blood from the capillary system. Still, with regard to this supposed constitutional in firmity, it must be remarked that melmna neonatorum is said not to have been especially observed in families subject to true luemophilia ; and that of infants who survive, few show in after life any particular tendency to In older children gastro-intestinal hemorrhage may be due to either general or local causes.
Of the general causes, heemorrhagic puipura is perhaps the most com mon. In this disease the bleeding occurs not only from the stomach and bowels, bUt also from the nose, mouth, and kidneys, and into the subcu taneous tissue. The tendency to hmorrhaire is only a temporary phe nomenon, and ceases when by treatment or otherwise the condition of the patient has become improved.
In limmophilia the tendency is permanent, and persists to the end of life. As in the former 'ease, the bleeding is not confined to the gastric or intestinal mucous membrane, but may occur from any mucous surface and into the subcutaneous tissue.
In the malignant forms of all the eruptive fevers general haemorrhage may also occur. In such cases the symptom indicates a profound con tamination of the system, and is of most unfavourable augury.
The usual form of gastro-intestinal haemorrhage met with in the child arises from purely local causes. Ulceration of the bowels, such as occurs in typhoid fever, in cases of long-standing intestinal catarrh, and as a con sequence of tubercular or scrofulous disease, is a common source of bleed ing. The same symptom is seen in the ulceration arising from dysentery. In intussusception a prominent 'feature is the passage or blood and blood stained mucus from the bowel. The irritation of worms will sometimes induce bleeding from the mucous membrane ; and intest,:; nal derangements which give rise to straining, especially if the bowel prolapse, are a common cause of admixture of blood with the stools.
There is one other cause of haemorrhage which must be mentioned. This is polypus of the rectum. Polypi are said not to be uncommon under the age of ten years, and to occur more frequently in boys than in girls. These fibro-cellular growths spring from the sub-mucous tissue, and are covered by the mucous membrane. They are more vascular in the child than in the adult, with a greater tendency to bleed, and are attached by a slender pedicle which readily gives way. The polypus varies in size from a pea to a marble, and may be sometimes seen within the bowel, if near the sphincter, looking like a bright red cherry. It bleeds easily, both dur ing the passage of a stool and also independently of defcation, and if its seat is near the outlet, the effused blood may be mixed with mucus.
Symptoms.—In the case of the new-born baby, the hmnorrhage which is special to this period of life begins usually within a few days of birth— in the majority of instances within the first twenty-four hours. It may; however, be delayed. Of fifty cases collected by Dr. Groom, the bleeding took place :—in thirty, between the first and sixth day ; in eight, between the sixth and eighth ; in fo;ur, between the eighth and twelfth ; and in eight, between the twelfth and eighteenth day. The blood is sometimes ejected from the stomach as well as passed from the bowels. Sometimes, however, melaena occurs without hmmatemesis ; and less commonly, hmma temesis without melmna. Of eight cases seen by Lederer, four had haemorrhage from both stomach and bowels ; three from the bowels alone ; and one exclusively from the stomach.
The appearance of the blood may be preceded by great restlessness and pallor, a sunken belly, and sudden prostration. When the blood appears externally the infant seems to suffer no pain. He passes apparently an ordinary stool ; but this, on inspection, is found to consist either of dark treacly matter from admixture with meconium, or of dark pure blood. If, at first, .dark and contaminated with the contents of the bowels, the blood soon becomes red and unaltered. In quantity it is often sufficient to soak the linen and the diapers. The defections succeed one another rapidly, and after each passage the child is left cold and motionless, and seem ingly exhausted. In rare cases, if the discharge is sudden and copious, he may be convulsed. After a time he revives somewhat, and cries feebly ; but if the flow be profuse, soon falls into a collapsed state. He lies quietly, with pallid face, cold extremities, an almost imperceptible pulse, and a sunken fontanelle.