John Thomson

Observations on the urine of the new-born infant.

Publications dealing with the physical and chemical characteristics of the urine in the new-born period date from 1864. They are most common in the German literature of last century. In some instances the observations are incomplete while in others they are obviously inaccurate. In general, these shortcomings arise from the difficulty of collecting the specimens of urine. Many ingenious methods of collecting urine from infants and young children are on record and a close search of the literature reveals over forty references to the subject. The apparatus in use in the present investigation consists of two parts, the one a urinal and the other an electrical signalling device.

Osteopetrosis in Successive Generations

Case 1. A full-term male child, weighing 6j lb., the product of a second pregnancy, was born on Aug. 3, 1945. The parents were unrelated. When three months old the child was thought to be blind, and two months later on x-ray examination a diagnosis of osteopetrosis was made. Mental retardation was noted at ten months. At two years two months he was admitted to the Royal Blind School; he was a well built and well nourished child (fig. 1). When two and a half years old he weighed 28 lb., was 33 in tall, had a crown-rump measurement of 19j in., and an arm span of 31 in. The intmeatal measurement was 12j in, the occipito-frontal circumference 19in. The thoracic circumference at the nipple level was 19 in. The head showed slight frontal and more marked parietal bossing. The general outline suggested ft degree of hydrocephalus. The pupils did not react to light and there was bilateral optic atrophy. Nasal obstruction and mouth-breathing were present. Dental eruption had been normal and the teeth appeared in good condition, though the lower lateral incisors and lower right second molar were missing No enlawment of liver, spkee or lymph glands was

Osteomyelitis in the Newborn

The earlier literature on osteomyelitis of very young infants dealt largely with osteomyelitis of the jaw and its probable relationship to mastitis in the nursing mother (Marx, 1920; Bass, 1928; Karplus, 1928; Wilensky, 1932; Poncher and Blayney, 1934). Metastatic osteomyelitis due to umbilical sepsis was mentioned by Fraser (1924) who collected some 30 cases over a period of four years. He said that a fatal result was almost inevitable. Baumgartner (1920) recorded a case of osteomyelitis of the skull, Madier (1922) one of osteomyelitis of a vertebra, and Palew (1931) one of gonoccoccal osteomyelitis. In a study of septicaemia of the newborn infant Dunham (1933) found that osteomyelitis occurred in 10-3°h of the cases and that three out of four such cases died. Mount (1935) reported a fatal case of septicaemia with osteomyelitis of the humerus. Green (1935) recorded a case of osteomyelitis of the humerus, with recovery, where the original lesion may have been a furuncle of the chin at the age of two weeks. The same author with Shannon (1936) published a series of 23 cases of osteomyelitis which occurred before the age of six months. The mortality rate was 45%. They related extra-osseous infection and trauma to the osteomyelitis and stressed skin infection and omphalitis as primary lesions. They considered that osteomyelitis was not a rare disease in infants and emphasized that the treatmnt was that of the general condition rather than of the local one. The poor prognosis given by Fraser and Dunham was not confirnmd by Diliehunt (1935) among whose cases there were two in the neonatal period. He said:

The Volume and Acidity of the Gastric Contents in the Unfed Newborn Infant

The acidity of the gastric contents in the unfed newborn infant was first investigated by Szydlowski (1892a and b). He recorded the presence of free hydrochloric acid. Hess (1913) found free hydrochloric acid in varying amounts in 54 out of 55 infants, and recorded unexpectedly high values. Pollitzer (1921) made similar observations on 100 infants. The pH of the gastric contents was estimated first by Tangl (1906) whose observations ranged from 1 3 to 1I8. Griswold and Shohl (1925) recorded a pH range of 1 7 to 4 4. Ritter (1941) found thepH varied from 1 3 to 4 6, and noted the absence of free hydrochloric acid in four out of 36 infants. Miller (1941) also observed the occurrence of achlorhydria and stated that the incidence of achlorhydria diminished with increasing birth weight. No worker has as yet submitted his observations on achlorhydria and the volume of the free hydrochloric acid in relation to birth weight to a proper statistical test. For this reason it was thought desirable to undertake a new investigation into the incidence of achlorhydria and the free acidity in the newborn.

Neuro-muscular Incoordination at the Cardia in the Newborn

Hurst (1915) coined the word achalasia, i.e. absence of relaxation, to describe a neuro-muscular incoordination in the alimentary tract. Previously, Rolleston (1896) had suggested such an incoordination to explain some cases of dilatation of the oesophagus. The condition was then known as cardiospasm, a word introduced in 1882 by Mikulicz (1904). Earlier it was known as simple or idiopathic dilatation of the oesophagus and had been described by Hannay (1833). While most of the writings on the subject refer to later childhood and maturity, the presence of the condition in infancy has long been recognized. Rotch (1896) described simple dilatation of the oesophagus in a girl who died aged ten weeks. Luschka (1868) recorded what he considered to be congenital dilatation of the oesophagus, and Zenker (1878) reported the appearance of dilatation of the oesophagus above the cardia in a premature infant of seven months gestation, who died at the age of seven days as a result of haemorrhage from the umbilicus. Recognition of the condition in the neonatal period has been rare, though many of the cases diagnosed at a later age gave a history of vomiting from birth or soon after (Langmead, 1919; Morgan, 1911). Tyson (1926) was the first to record a case of achalasia in the neonatal period. He called it phrenospasm. Birnberg (1929) published three cases of cardiospasm. Segar and Stoeffler (1930) recorded two cases. Olmsted (1931), Bogert (1933), and Vinson (1945) reported one case each. Aikman (1933) recorded four cases. The main features of these cases, all of which were diagnosed radiologically, are given in Table 1. A case of uncontrollable vomiting from the second day of life onwards and recorded by Garrahan and Muzio (1932) has not been included in this table. There is some doubt about the diagnosis of this case and no supporting radiological evidence appears to have been obtained at the time of the illness. In an extensive search of the literature no cases other than these were found. This relative infrequency with which the condition in the newborn infant has been recorded, is justification for recording the following three cases of neuro-muscular incoordination. The first two cases appear to be typical of achalasia of the cardia, but the third case is different and requires separate discussion.

Urea clearance in the immediate post-natal period.

In the growing volume of leature concerng renal function in the newbor infant there is as yet Sittle mention of urea clarance in the immeiiate post-natal period: that is in the first three or four days of life. Barett (1940) made observations on mulinc in infants of five to nine days old. The invettigations of McCance and Young (1941) ie made on infants of seven to fourteen days old. They also made observations on three infants aged six to thirte days: these infants had meningocoeles. Experimental studies wer made by Barett, Periley, and McGinnis (1942) on a twenty-four hour old infant who had an extoversion of the urinary bladder. The conditions of the experment were abnormal. The work of Gordon, Harrison, and McNamara (1942) deal with full-term infants of eight to sixty-five days and premature infants of sen to seventy-three days old. Dean and McCance (1947) have carried out some most inting exprmnental studies on infants of two, three, and four days old In t m stance, the infants suffered from inoperable meningomyelocoeks. They were studied under conditions which do not normally pertain at this age period. The observations now recorded were made on healthy spontaneously delivered full-term male and fenale infants. In each case the mother had a normal pregnancy and puerperium. No clinical anmality was detected in these infants during ter stay in hospitaL The infants are divided into three groups each of which, with the method used and the data obtained, are described seriatim. The groups are referred to as groups I, II, and m.

Urinalysis in dehydration fever.

JOHN THOMSON, M.D., D.P.H., D.C.H. (From the Department of Child Life and Health, University of Edinburgh) Introduction In the course of carrying out a series of observations on renal output and the composition of the urine in the newborn period, two cases of dehydration fever were observed. The observations recorded in these two cases deviate so far from the normal, Thomson (1944), that their separate recording is desirable. Case Records Baby M.-Baby M. was born spontaneously at 1.45 p.m. and weighed 9 lb. 2j oz. It was the first baby of a young mother aged 22 years. The weight curve was within normal limits and the number of stools passed was not excessive. Under test feeding conditions the baby was put three times to the breast in the first twenty-four.hours, but it obtained no measurable amount of fluid. During this period two separate half-ounce feeds of 5 per cent. glucose in normal saline were given at 12 midnight and 6 a.m. Subsequently the baby was put to the breast at three-hourly intervals, always under test feeding conditions, and was given no further extra fluids except one ounce of sterile water at 3 p.m. during its fourth twenty-four-hour period. A record of the test feeds was kept (table l).