FEVER IN THE NEWBORN
Authors: E. Cautley
Journal: BMJ (1912)

NEWBOR-"''-5 --I I5 etc.; and also in certain eases' irobilin, aacetone;-diac6tic acid, et When'the intestinal contents' of these patie'nts were administered to rabbits and mice.the animnals-soon died-'whible the contents of normal persons were negative.The 'urinie (catheter specimens) of the cases-which have --ue under my notice was examined; in 11 the reaction for albumen was present, in 4 granular casts :were aobserved, 6 gave the reaction for acetone, and in all cases *'the urea output was diminished.azea lays stress on the severe constipation associated .'ithexcessive vomiting; in my cases I found bad teeth ,,present -in all, in addition to constipation.Williams 3 of Baltimore emphasizes the value of the ammonia coefficient of the 'urine, which is high in the 'toxaemie 'type, but if there are no manifest clhanges in the urine, he holds that the cause of the vomiting is reflex or neurotic.* Behm4 refers the autointoxication to syncytiolysin, and thinks this theory proved by the cessation of vomiting with the cessation of pregnancy.He maintains that the toxins are produced in the periphery of the ovum and not by the metabolism. of the fetus, thus explaining the excessive vomiting of the early months.He supports his 'theory by the excellent results obtained clinically by the administration of rectal salines.Many years ago Smellie5 wrote:Perhaps this complaint is chieflv occasioned by a fullness of the vessels of the uterus, owing to obstructed catameniathe wlhole quantity of which cannot as yet be employed in the nutrition of the embryo; over and above this cause it has been supposed that the uterus, being stretched by the increase of the ovum, a tension of that part ensues, affecting the 'nerves of that viscus, especially those-that arise from the sympathetici maximi, and communicate with the plexus at the mouth of the stomach.Playfair,6 about 150 years later, wrote in a similar strain regarding the cause of excessive vomiting.In' the HIippocratic writings the cause is attributed to' JW a Matthews Duncan7 in 1879 had a fatal case of excessive vomiting, in which, Iiost mortem, was found acute 'yellow atrophy of the liver, which condition he suggested was a factor in the production of the vomiting.'Champetier de Ribes and Bouffe de Sainte'BlaiseI had a' case in which post-mortem haemorrhages atd-areas of cloudiness were found in the liver somewhat 'similar to those foLnd in eclamp'sia.They considered that the excessive vomiting was the result 'of intoxication'due to hepatic insufficiency.,The post-mortemn examination of the fatal case which ,came undler my notice (BRITISH MEDICAL JOURNAL, July 8th, '1911), showed the'liver to be enlarged with fatty inflltra- tion, the spleen slightly enlarged, and the kidneys con- gested.There was a slight congestion of the mucous membrane of the stomach, with a small patch of super- ficial ulceration' near the pylorus.Nothing abnormal was found in the brain.Freund9 thinks the source of the toxins is in the peri- pliery of the ovum or corpus luteum or placenta, but as the toxins, in the great majority of cases do not produce excessive vomiting, he advises looking for-predisposing 'j,auses, such as anaemia, chlorosis, nervous diseases, etc.'bileslo considers that there are three factors in the, 'etiology:, (1) Increased n"ervo'us irritability; (2) a loc,al periphleral source,of irritation; (3) a ready efferent channel for nervous energy (the vagi).Reflex.