Congenital obliteration of the bile ducts is not an extremely rare disease. Over one hundred cases have now been reported. The reporting of further cases would be merely of statistical interest, were it not that certain misapprehensions in regard to this condition are current. These have come to my notice during a recent review of the literature upon this subject, and seem to warrant the reporting here of an additional case and further discussion of the condition. REPORT OF CASE Clinical History.\p=m-\H.H., white, infant boy, was first seen when 7 weeks old in the Dispensary of the Harriet Lane Home. At this time the parents stated that the child's skin had been yellow since birth, that his eyes were yellow, and that the urine stained the napkin. Family History.\p=m-\Motherand father living and well, at 25 and 35, respectively. One other child 1 year old; no children dead; no miscarriages; no his-AMERICAN JOURNAL OF DISEASES OF CHILDREN On March 6 the jaundice had increased. The stools, four to six daily, con¬ tained no bile pigments. The circumference of the abdomen was 37.5 cm. The child gained in weight rapidly-9 ounces in ten days. There was no vomiting. Three days later the jaundice had increased; the temperature was 100.2 F. and the child had signs of bronchitis. He was admitted to the Harriet Lane Hospital, March 9, a well-developed, well-nourished boy. Skin uniformly and deeply bile tinged ; sclerae and mucous membranes showed a distinct but slight icteroid tint. No petechiae. No gen¬ eral glandular enlargement. When sleeping, the child breathed quietly ; pulse rate 120. Liver and spleen palpable two finger breadths below costal margin. Slight signs of bronchitis were present. The examination otherwise was nega¬ tive. The von Pirquet test was negative. Blood showed 4,100.000 red cells, 14,500 white cells, small mononuclears 79 per cent., hemoglobin 80 per cent. (Sahli). Stool unformed, contained mucus and curds and had a slight but definite greenish-yellow tinge ; biliary pigments lacking. Urine stained napkin yellowish green, was dark colored and acid, but not abnormal, save for the presence of bile. The temperature fell to normal after two days. The child was discharged on March 12. The child's heel was punctured for a blood examination and there was great difficulty in stopping the flow of blood, the bleeding continuing for about eighteen hours. On March 20 the child, aged 11 weeks, was taken by his mother to another hospital, and there a small incision was made in the back, for the collection of blood. The child bled from this incision until the evening of the next day. He was brought again to the Harriet Lane Home. Here he was given 10 c.c. of human serum, from his father, subcutaneously, and horse serum was applied directly to the wound. The hemorrhages were not checked until the morning of March 22, thirty-six hours later. A fine silk suture was introduced and the hemorrhage then ceased. On March 24 the child vomited a small amount of bloodstained fluid and the next day the stool contained a large ...
The first electrical diagnoses of tetany in children were made on well marked clinical cases. The electrical values obtained in these were much lower than those found in children free from tetany. It was later discovered that some children who showed no clinical evidences of tetany gave electrical values nearly if not quite so low as those found in cases of clinical tetany. Such children were said to suffer from latent tetany, the diagnosis being based wholly on the electrical reactions.1With this extension of the conception of tetany as an active and as a latent disease of infancy and childhood, the diagnosis of it has, especially with older children, come to rest on a less secure foundation.There have been no electrical standards established for normal children beyond the period of infancy, it having apparently been assumed that the values established for infants are applicable to older children as well. A study of the reactions in older children shows almost at once that this assumption is unjustifiable.Even with infants, also, the determination of what is normal and what is abnormal offers at times great difficulties. Therefore, I have studied the reactions of infants and older children with and without tetany in order to determine the reliability of the electrical diagnosis of this disease and, especially with older children, to establish the stand¬ ards for the normal and the deviations from this which enable us to recognize the presence of tetany.The Development of the Conception of Tetany.-Many of the symptoms which we now recognize as belonging to tetany were first described in infants that were teething.
has described what he believes to be a new endocrinal gland. The structure has been found by him in puppies and in infants under 1 year of age. It occurs in the form of fifteen to twenty solid "epithelial islets," scattered around the parathyroids, thyroid and upper pole of the thymus, occasionally, also, at the lower pole, and more especially in the connective tissue of the superior outlet of the thorax. These structures were found in making serial sections of the neck organs from the tongue downward. The author thinks it is not improb¬ able that the glands have also a wider distribution. In newlyborn infants the largest masses may be seen, at times, as grayish red points that through their richness in vascular capillaries stand out against the suprathymic or periparathyroid connective tissue. The conformation of the islets is said to be microscopically quite characteristic. They consist of a mass of closely packed cells pierced by a rich capillary plexus, and almost always lacking any firm con¬ nective tissue stroma. The masses have no capsule but are separated from the adjacent structures by loose connective tissue in such manner that the individual groups of cells appear, microscopically, as true, sharply defined, islands.
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