If we are satisfied that the case is one of congenital deficiency or mal formation, we can have little hope of a favourable issue, although life may be prolonged for several months. The appearance of umbilical hmmorrhage is a very fatal sign, and is usually followed by rapid sinking of the patient.
If the jaundice is due to syphilitic disease, it is hardly likely to end otherwise than unfavourably ; and in cases of umbilical phlebitis and pycemia, we can hold out no hope of recovery.
In older children, icterus, unless it be due to phosphorus poisoning or some profound hepatic lesion, is in most cases a mild derangement which soon passes away.
Treatment.—Ordinary benign jaundice in the new-born baby requires little treatment. Emetics, although strongly recommended by some writers, are in most cases useless, if not injurious. A gentle purge, such as castor oil, followed by two or three grains of bicarbonate of soda with a quarter of a drop of tincture of nux vomica, given three times a day, will soon restore the child's tissues to their natural colour. I now invariably give nux vomica with an alkali in these cases, and believe that in catarrhal jaundice at all ages the former drug has a distinct influence in aiding the child's recovery. If purgatives are prescribed, the aperients used should be those which, like castor-oil or aloes, act low down in the alimentary canal. Senna and other drugs which influence the duodenum and upper part of the bowels may increase the irritation of this part of the intestine, and are unsuitable to cases of jaundice—at any rate to those cases where there is reason to suspect the existence of duodenal catarrh. Mercurials, too, should be given with judgment. It is not advisable to continue acting
upon the liver by repeated doses of mercury. One dose of gray powder or of calomel may be allowed, but the remedy need not be afterwards re peated. With regard to diet :—The infant may still continue to take the breast. If he be bottle-fed, no alteration need be made in his food unless vomiting occur with signs of acid fermentation. If these symptoms of gastric catarrh are noted, the diet must be regulated according to the rules laid down in the chapter on Infantile Atrophy.
If the jaundice be due to malformation, no treatment can be expected to be of service ; but if haemorrhage occur from the navel, attempts should be made to arrest a symptom which experience has proved to be so speed ily fatal. The perchloride of iron may be used locally, followed by a com press ; but in most cases, the surgeon has to fall back upon the operation known as the " ligature en masse." The child should be laid upon his back, and two hare-lip pins must be passed through the integuments at the root of the navel, carefully avoiding the peritoneum. A ligature is then twisted ;tightly round the needles in the form of a figure of eight.
If syphilis be present in the child, treatment for this constitutional con dition should be adopted without loss of time. In cases of pymmic jaun dice, attempts must be made to relieve the distressing symptoms. Warmth should be applied to the belly ; and if there is great tenderness about the umbilicus, extract of belladonna diluted with an equal quantity of glycerine, can be applied to the skin round the navel. Stimulants must be given as required.