In these cases, the jaundice comes on a few days after birth, and by the end of the week is well marked. The urine is intensely yellow ; but the stools may be of normal tint, although usually costive. The onset of the jaundice is accompanied or quickly followed by fever, which soon be comes high. There is often vomiting of yellow or greenish matter. The child looks excessively ill. His face is livid, with pinched, haggard features, and he refuses the bottle or the breast. His tongue is his hands and feet are purple ; his abdomen swells and is tender ; fluctuation, more or less distinct, is noticed ; and blood or blood-stained pus oozes from the navel. Sometimes the spleen enlarges, and petechim are noticed on the skin. Death may be preceded by convulsions and coma.
When jaundice occurs after the age of infancy, it is due to the same causes which give rise to the symptom in the adult. Of these, no doubt, duodenal catarrh extending into the bile-ducts is, of all others, the most frequent. On this account, the symptom is usually a trifling one, and is quickly recovered from. It is accompanied by some temporary enlarge ment of the liver, which can be felt to project several fingers' breadths be low the ribs ; but except for some delicacy of digestion, little discomfort is experienced. In exceptional cases, the derangement may be the conse quence of plugging of the common duct with inspissated bile, and this accident has been noticed in an infant of three months old. Again, a lumbricus has been known to penetrate into the common duct and produce such impediment to the flow of bile as to give rise to jaundice. Icterus may be also due to acute yellow atrophy of the liver ; but this is fortunately a very rare disease in childhood. Of other causes, atrophic cirrhosis of the liver, phosphorus poisoning, and miasmatic influences have been recorded as producing jaundice in early life.
Diagnosis.-In examining a new-born infant for signs of jaundice, it is often necessary to force the blood out of the skin by firm pressure with the finger before the natural tint of the integument can be observed. In inspecting the eyes for yellow staining it is advisable to use no force in attempting to open the lids with the finger, but rather to wait until the child opens his eyes spontaneously. A baby, when the eyelids are touched, squeezes them together instinctively. In such a case our utmost efforts will often succeed only in exposing the palpebral mucous membrane, and this will quite conceal the globe of the eye from view.
The diagnosis between false jaundice and true icterus neonatorum, if the latter be of the benign variety and little pronounced, is very difficult often quite impossible. In neither case is the conjunctiva stained or the urine yellow. The colour will sometimes help us, for the tint of the jaun
diced skin is often more distinctly yellow than the brownish stain left after severe cutaneous congestion. In all cases where the conjunctivae and urine are tinted, however slightly, we may conclude that the case is one of true jaundice. The condition of the stools is of less moment, for jaundice may be present without the motions being clay-coloured.
In cases where the jaundice persists and becomes deeper and deeper, we have every reason to suspect the existence of some congenital mal formation, especially if- a previous child of the same parents has died shortly after birth with symptoms of icterus neonatorum. If the liver and spleen become enlarged, the temperature remaining low, this suspicion becomes almost a certainty ; and the occurrence of bleeding from the navel is, in such a case, practically conclusive. The partial disappearance of the jaundice is no proof that our apprehensions are unfounded, for the yellow tint of the skin may become distinctly lighter, or even quite disappear be fore the end.
The pycemie form of jaundice is readily detected. The general appear ance of the child, the high temperature, the dry tongue, the swelling and tenderness of the belly, the discharge of blood and pus from the umbilicus, and the early death, sufficiently indicate the nature of the disease.
If the jaundice is accompanied by signs of inherited syphilis, or if, without these, we can discover a history of syphilis in the father, or of previous miscarriages on the part of the mother, the probability of a syphilitic origin to the jaundice must be taken into consideration.
Prognosis.—So as the jaundice is accompanied by no signs of discomfort, little anxiety need be excited by the symptom ; but if diarrhoea or vomiting occur, the injurious effect of exhausting discharges upon a newly born infant must not be overlooked. Little information is to be gained by inspection of the stools, for in cases of serious malformation they may remain normal in appearance for a considerable time. If, in any case, the motions become clay-coloured, and the staining of the skin and urine shows no sign of subsiding, there is cause for apprehension. A slight enlargement of the liver (i.e., a projection of one finger's breadth below the ribs) is immaterial ; but if the organ continue to increase iu size, and if the spleen also begin to swell, the infant's condition is becoming a serious one. It must not forgotten in these cases to examine the anus ; for the appearance of any swelling of the hxmorrhoidal veins, as indicating great obstruction to the portal circulation, is an unfavourable symptom of no little importance.