Bednar’s disease is characterized by the appearance of two ulcers on the hard palate, one on either side and just above the spot where the last tooth will erupt. It is most liable to occur in sickly infants and supposedly arises from the abrading of the mucous membrane by a rubber nipple or through the rough cleansing of the mouth. It is very resistant to treatment. The child must be put in good condition by attention to the nourishment and the spots touched with tincture of iodine on an applicator.
The exudative diathesis is indicated superficially by a definitely bounded red patch on either cheek, which is not relieved, or only temporarily, by the common ointments and powders. The mother says the “face is chapped,” or that the baby has a “milk eczema.” Otherwise the skin is pale.
These children are frequently fat, but the tissue is flabby. The urine is sometimes ammoniacal. There is no marked disturbance of temperature. Fretfulness and constipation are the principal symptoms.
The condition is due to too much fat in the food. A skimmed-milk diet is best for a time. The fat can be added gradually until the limit of tolerance is found.
If chalky masses appear in the stools, the fat must be reduced again. Occasionally the child must be taken off the milk entirely, and a soup or gruel diet substituted.
For local application, the following formula is sometimes beneficial: (Grulee.)
| ℞ | Naphthalene | ℥i | |
| Starch | ʒiv | ||
| Zinc stearate | ʒiv | ||
| M. | |||
| Sig. Apply frequently. | |||
The “cradle cap” is a frequent sign of the exudative diathesis in its milder stages.
The term is applied to a yellowish-gray patch over the large fontanelle. The mother calls it “dirt,” which she finds hard to remove and it always recurs. The mass is composed of dry scales, which gradually change into an eczema. Vaseline or sweet oil left on over night makes the removal of the scales quite easy the next day. If a raw surface is left, zinc ointment should be applied. The diet must be changed as previously described.
Erythema, especially of the diaper region, is sometimes a manifestation of congenital syphilis. It is usually limited to the inner side of the thighs, the perineum, scrotum or vulva, and buttocks. It must be associated with other and more characteristic signs, however, such as snuffles, cachexia, etc., before it becomes diagnostic of syphilis. Most erythemas of this area are due to irritation from moist or soiled diapers, but other factors may be important. Bluing in the diaper, gastrointestinal troubles, and circulatory disturbances are contributing causes. The local treatment is the same as for intertrigo. If the child is syphilitic, systemic measures must be instituted.