APPARENT DEATH OF THE NEW-BORN INFANT.
1st. If the infant be born feeble, but breathing well, it requires no special attention. If, on the contrary, it breathes with difficulty, its body should be rubbed with a piece of warmed flannel: there should be added to the bath vinegar, wine, eau-de-cologne: the infant should be taken near an open fire—in a word, its skin should be excited in every possible way. Often fumigations with benzoin have given us excellent results.
2d. If the infant be premature, we must redouble our efforts to pre vent its becoming chilled. The infant should be wrapped in cotton, and covered with flannel. The temperature of the room should be maintained at at least 80° F. Hot bottles should be placed around it in its crib, it should be dressed only before a fire, and, above all, it should have a nurse with an abundance of milk, and with projecting nipples. If the infant do not nurse during the first few days, the nurse should draw her milk, and feed it to the infant with a spoon. At the end of several days, the infant will usually take the breast and then it will survive, if it do not become jaundiced, or catch cold, and this it does the more quickly the further it is born from term. In other instances, the function of respiration becomes established but incompletely, cyanosis sets in, and the child dies a few hours after birth.
3d. Finally, we consider the state of apparent death. By this name we mean, with Martel, a peculiar state in which the infant is born, a state characterized by an arrest of the functions of animal life, and apncea, with, it may be, only feebleness, or else cessation of the pulsation of the heart.
Apparent death is met with under two very different forms: 1. The anemic form: 2. The asphyctic or apoplectic form.
Anemic strikes us at once is the pallor, the discoloration of the skin, and of the mucous membranes. The mouth open, the in ferior maxilla falls of its own weight. The muscles of the body generally are in a state of complete relaxation. From the open anus flows the meconium, which soils the body of the infant. The eyes glassy, the pupils more or less dilated, are covered by the eye-lids, which are fre quently a trifle open. The pulsations of the heart are scarcely audible, and are recognized only by gentle trembling over the cardiac region just appreciable to the finger and to the ear—at times, indeed, the pulsations are entirely lacking. The pulsations of the cord, usually absent, are in
certain cases very weak; at long intervals the infant makes no respira tory movement; it looks like a diminutive corpse.
Apoplectic Ibrm.—In this second form, the most common and fortu nately the least fatal, the aspect of the infant is entirely different. Red, livid, almost brownish, especially towards the head, the infant pre sents the traces of congestion, more or less pronounced, and more or less generalized. The lips are swollen, the injected eyes project from the open eyelids, the mucous membrane of the mouth is bluish, the tongue swollen. The body is less relaxed, the limbs in certain cases being nearly rigid. The pulsations of the heart and the cord are less completely abol ished than in the preceding form, and they may be heard over the cardiac region, but they are feeble, irregular, slow, and tend to disappear more and more; the cord is increased in size, the umbilical vein is gorged with blood.
The fcetus, in a condition of apparent death, may then appear under two forms apparently very different, but with this in common, complete ab sence of respiratory movements, with insensibility to external irritants. These two aspects of the new-born infant have been differently under stood by the authorities.
While Naegel(', P. Dubois, Depaul, believe that the first form, the anemic, is met with in premature births, faulty development, serious dis ease of the mother, hemorrhages from rupture of the cord or the placenta, and that the second form, the apoplectic, is met with in case of compres sion of the head, of the cord, pelvic presentations, spasmodic contractions of the uterus, accumulation of mucus in the air-passages, etc., Jacque mier, and we agree perfectly with him, while admitting the influence of these different conditions, considers these two forms as different degrees, more or less advanced, of the same pathological state, asphyxia. This is the opinion of Tarnier, of Budin, of Ribemont, who reject completely, or nearly so, pulmonary and cerebral congestion, and consider these two forms as the result of asphyxia, sudden in the one case, the anemic form, slow and progressive in the other, the apoplectic.