Examination of the literature dealing with true melena neonatorum shows that there is no agreement in regard to its etiology. It has long been known that duodenal ulcers may be found in infants who have died from melena. Shukowsky,1 in 1907, estimated that ulcers of the gastro-intestinal tract, including the esophagus, stomach, duodenum and lower intestine, have been demonstrated in 45 per cent. of such infants. Theile2 found records of sixty-four cases of ulcer of the gastro-intestinal tract occurring with melena neonatorum; thirty-one were in the duodenum and twenty-nine in the stomach. He does not give the percentage of cases of melena neonatorum without lesions.
Undoubtedly, duodenal ulcer is much more common than has generally been accepted, and more common than Shukowsky's estimate of 45 per cent. As I have pointed out,3 they are easily overlooked at necropsy because they may be very small, and obscured by