Martel, on the other hand, believes that these two forms are entirely different. If the same cause originally produces them, the result is not the same. "Apparent death in the new-born may follow on asphyxia or enfeeblement of the heart. In case of asphyxia, apparent death has super vened progressively, but rapidly; in case of cardiac feebleness, asystole, it has, on the contrary, supervened slowly.
" In asphyxia, the blood circulates in excessive amount in the peripheral vessels, but it does not contain sufficient oxygen. On account of this de ficiency in oxygen, the medulla cannot functionate at the hour of birth.. Nevertheless, carbonic dioxide, through transient irritation, produces a few respiratory movements, but these are of short duration. In heart failure, apparent death is present, because the heart is unable to project into the body the amount of blood necessary for the interchange of gases which takes place within the tissues; hence, if oxygen is absent, it is be cause the blood cannot reach the periphery, the capillaries are empty and contracted, the heart is unable to fight against their elasticity, and the central organs are gorged with blood. The first inspiration cannot be made, because the medulla lacks the quantity of blood necessary for its normal function." It is impossible for us to reject congestion as a factor as entirely as do Budin and Ribetr ont. If their opinion be correct for pulmonary con gestion, it appears to us incontestible that we are de'aling with something different in case of congestion of the nervous centres.
At the autopsy of children born apoplectic, we find .the venous vessels of the brain and its membranes, the rachidian plexuses, the veins of the neck and of the chest, and the cavities of the right heart, gorged with venous blood. There are hemorrhages at the base of the brain, extending even into the ventricles, and we find local congestions in the lungs, the diaphragm, etc. If, on autopsy of anemic infants, the capillaries, and the peripheral parts of the body, are empty, the large cerebral vessels are gorged with blood, even as in the preceding form. It is apparent then, that we do not accept the opinion of Budin and Ribemont in the treat ment of apparent death of the new-born, and we make a sharp distinction between the cases when the fcetus is blue, apoplectic, and those where it is pale, anemic, in syncope.
1st. The Infant is blue, apoplectic. — The first thing to do is to remove immediately every obstacle to respiration. The infant is placed on its back, the head resting on a pillow, and by means of a finger, or a feather, the nostrils and the pharynx are cleansed of obstructing mucus. Now cutting the cord, allow it to bleed until the infant has lost one to two tea spoonsful of blood. If the blood do not flow readily, before tying the cord place the infant for a few minutes in a hot bath. The blood soon flows: the cord is tied, the infant wrapped in hot cloths, and rubbed vigorously. The cyanotic tint, ordinarily, disappears rapidly, to give place to the normal, and a few frictions, slapping of the feet, or a second bath, causes the child to respire more or less freely. If this does not
suffice, we must proceed to artificial respiration or insuffiation.
If the infant be anemic, we must have care that it does not lose the least quantity of blood. On the contrary, we must tie the cord at once and with care, plunge it alternately in a hot and then in a cold bath, pour cold water from a height on the epigastrium, whip it with a wet cloth, tickle the nostrils with a feather, and, if this does not suffice, quickly resort to artificial respiration.
It is our belief that insuffiation is a much more efficacious means, but there are a number of other measures which are of value. For instance, the following procedure has often served us well. The infant, wrapped in hot cloths, and its head on a pillow, is placed on its back with the arms alongside the body. Seizing each arm, they are quickly lifted towards the head, and then rapidly pressed down against the thorax. These movements, repeated alternately, dilate the thorax, and thus assist the entrance of air into the lungs. Marshall Hall's method is warmly recommended by Naege1(., Grenser and Spiegelberg. Schultze endorses the following methods: " The accoucheur, standing with the body slightly bent forward, the legs moderately separated, the arms extended towards the ground, seizes the infant by the index fingers passed from behind forward into the axillw. (Figs. 246, 247.) The thumbs rest gently over the clavicles, and the remaining fingers are applied against the posterior surface of the clavicle, in the direction from above downwards. The infant's head is supported against the wrists. This position is that of inspiration. The accoucheur, thus holding it, suddenly throws the infant forward and up ward. When the accoucheur's arms are a trifle above the horizontal line, the motion is gently stopped, so as not to jerk the child, and the foetal lumbar spine is flexed, the abdomen being forcibly compressed by the weight of the pelvic extremity. The result of this passive expiratory movement, is an abundant flow of mucous from the respiratory passages. The position of the child is now gently changed to that which it occupied at the outset, and the thorax, freed from all pressure, enlarges by its own elasticity, and the diaphragm sinks with the retreat of the pelvic viscera. Thus, by a purely passive process, is produced a deep inspiration. After a few seconds, the manoeuvres are repeated. The air enters the glottis audibly. When spontaneous effort at respiration is made, the above method is to be desisted from, in order that the spontaneous respiratory process may not be interfered with by the artificial." Boer, Desormeaux, Stoltz, and others, advise recourse to electricity, in the shape of galvanism, or electro-puncture. Leroy has been able, by passing a galvanic current through the diaphragm, to produce in animals asphyxiated by drowning alternate contraction and relaxation of this mus cle, and to provoke, finally, the return of respiration, and of life. Lauth, finally, has advised the use of the induced current.