It is manifestly impossible to review the entire field of these affections, as the premature infant may have all the diseases of full term children. Several affections, however, are peculiarly severe in the premature infant. First. Sepsis occurs in a great many, and usually comes from the bowel, either as an intoxication or a general infection. Broncho-pneumonia is another fatal complication, and is not usually suspected because the infant shows such feeble signs of life. A subnormal temperature and cyanosis, with loss of weight, are sometimes the only symptoms, and they might be explained by other things. Second. Ophthalmia neonatorum, when it occurs, takes on a very virulent form, perhaps due to the warm air making conditions favorable to the growth of bacteria.

It is particularly difficult to treat because of the weakness of the infant and the smallness of the part. General sepsis may occur from the eye, and in all ways, the prognosis is bad. Third. An affection which has been observed not infrequently at the incubator station of the Maternité in Paris, but with which we have had no experience, is an ulcerative rhinopharyngitis, due to decomposition of food which the baby regurgitates into the nares. Profuse discharge, soon purulent, ulceration of the mucous membrane even to the bone, with the development of saddle nose similar to that of syphilis, are reported [8]. Sometimes this causes a broncho-pneumonia and general sepsis. The treatment is one of local cleanliness and antisepsis, which, however, is not easy to practice. Fourth. Attacks of syncope are not unusual with premature infants. They simply forget to breath. Cyanosis soon becomes marked, and unless properly treated, death ensues. The child is limp and there is no attempt to respire. Post mortem, no mechanical cause for the death is found. There is another form of cyanosis which comes on suddenly, too, where the infant chokes, becomes cyanotic, and may die of asphyxia unless the cause be removed. This cause may be an overloaded stomach, especially with artificial feeding, when vomiting relieves the condition; second, an undigested curd regurgitates into the pharynx, and the infant is too weak to remove it. This shows the importance of having a light incubator and watching the baby. Finally, these attacks may be due to a developmental anomaly of the stomach or of the chest. The treatment of the first condition, syncope is stimulating. First see that there is free ventilation in the incubator and that the infant has not a subnormal temperature. A hot bath with a little wine or mustard in it should be given. The nourishment must be certain, but not too free. A little coffee or whiskey may be given, and inhalations of oxygen. These are of signal benefit. The treatment of the second condition consists of removing the obstruction, regulation of the diet, less and more dilute mothers’ milk and the usual curative methods of asphyxia post partum. Fifth. Atelectasis pulmonum. This affection is not infrequent with premature infants, and is due to several causes. Syphilis, as a white hepatization, or catarrhal pneumonia; developmental anomalies, e.g., diaphragmatic hernia, insufficient development of the lungs, compression of the trachea by a struma, injury to the respiratory center from compression, and, most often, to insufficient primary inflation of the lungs. The child is reddish blue, unconscious, grunts or moans with each expiration; later, the extremities become almost black and edematous. The child dies usually, in four to forty hours, intense cyanosis and jaundice being present toward the last. At each inspiration, one can see the chest sink in at the base. The treatment consists in obtaining sufficient inflation of the lungs, and then the incubator. One must not be misled by the child’s breathing, or even by its crying lustily; if each expiration is attended by a grunt or moan, and if the normal pink, or dusky red, does not come into the skin, the child is in danger. Its lungs are atelectatic and must be filled out, or the infant is lost. The best way to obtain this is to put a catheter into the trachea and blow air into the lungs. The other methods of artificial respiration are not efficient. The infant should be made to cry every two hours. Oxygen has a marked effect in these cases, but will not save them unless the lungs are finally inflated. There is now no doubt of the incubator saving infant life, especially premature children, and the percentage of these is not small. At the Chicago Lying-In Hospital 28 babies have been placed in the incubator in two years. Any premature infant that has a spark of life, is given the benefit of every means we have to save it. Of these 28, 8 died in a few hours, usually being frozen or in convulsions on arrival at the hospital; 3 had hemorrhagic diathesis; 2 died of atelectasis pulmonum; 1 lived 4 days, and 14 were reared and discharged well. Of the 14 that died, 2 were in the sixth month, 4 in the seventh month, and 8 in the eighth month. Of the 17 children that could be saved, 14 were saved. The later results are also of interest. Ahlfeld found that 90 per cent of infants brought prematurely by artificial induction of labor, were alive and well at the end of the dangerous first year. Voorhees shows relatively as favorable results. Paul Bar cites the case of an infant of six months’ pregnancy, weighing two pounds and ten ounces, born in 1894. At the age of four years she weighed thirty five and a half pounds and was thirty nine inches high, a bright, intelligent little girl. I present here a photograph of an infant born six months and fourteen days after conception. She weighed three and a half pounds at birth, and now is a normal child in every particular. Capuron tells of the case of Furtuni Liceti, born in the fifth month, who lived to be twenty four years old. Moore gives a trustworthy account of an infant that at birth weighed one and a half pounds and was nine inches long; at fifteen months this infant weighed eighteen pounds and was healthy. Spaeth [16] says he has known a child of six months’ pregnancy, surpass in eventual development his brothers born at term, and, to cap all, Victor Hugo was a premature infant, so weak and puny that the accoucheur said the child could not live. In his own words, Victor Hugo says he “came into the world colorless, sightless, voiceless and so poor a weakling, that all despaired of him, save his mother.” It was six weeks before he was able to travel [17]. Therefore, it cannot be said that the effort to save these infants is not worth making. On the contrary, every protection should be thrown around their delicate lives.