Pathological signs of death from asphyxia are most evident: thin, watery blood; the right ventricle and the large vessels distended, as also the veins leading from the brain and liver; the liver is dark blue in color; petechial and larger haemorrhages under the pleura, pericardium, peritoneal covering of the liver, the pia and other organs; also hremorrhagic-serous effusions into the pleural, peri cardial and peritoneal cavities.
Besides this are the signs of attempts at respiration before de livery; congestive hypenemia of the lungs; ecchymoses under the pleura and pericardium. The respiratory passage (larynx and bronchi) is filled with mucus, amniotic fluid or meconium and one can often trace these masses through to the finer bronchi.
In children who are born asphyctie but have lived, one finds, be sides the more or less extensive atelectases, also air-containing areas; the latter much lighter in color and raised above the atelectatic areas; the atelectases dark and leathery. Amniotic fluid and rneconium are not rarely found in the stomach since swallowing movements may occur with the attempts at ante-natal respiration.
diagnosis of asphyxia is made from the clinical picture and doubt can also arise as to whether in a given case one has to do with a combination with cerebral compression or not; a not un common condition in first-born premature infants.
According to Runge the diagnosis of an asphyxia complicating cerebral compression is justifiable when, with an asphyxia of the first degree, the breathing continues irregular and more infrequent and the pulse rate diminishes in spite of the institution of energetic cutaneous stimuli. In case one suspects an acute anemia search should be made for the cause of such an anemia, e.g., velamentous insertion of the cord.
skilful treatment is employed the prognosis is grave. Usually the asphyetic children of the first degree go over into the second degree, whereas the latter die. With suitable treatment the milder cases usually recover and even the severe cases are not entirely hopeless if peristent treatment be kept up.
The opinion advanced by Schultze and Jacobi concerning the ap pearance of a later idiocy, after severe and protracted asphyxia, and also the reports of Little and Mitchell which refer to the connection between birth trauma and nervous and psychic lesions, are not taken into con sideration prognostically, in individual eases.
Prophylaxis.—This falls within the province of obstetrics. Therapy.—The treatment of asphyxia neonatorum consists in the use of the following measures: 1. In the Clearing out of the Air Passages.—If mucus or amniotic
fluid penetrate into the air passages, one must aspirate through a Ne laton catheter, steadily sucking while advancing the catheter. The method of Ahlfeldt and Pinard, which consists in suspending the child by its legs, for a quarter of a minute, thereby causing the congestive hyperaemia to act in the greatest degree on the respiratory centre, also scents practical. At the same time the mucus should be aspirated. Prochownick recommends rhythmic compression of the thorax while the child is in this suspended position.
2. The Use of Actire Cutaneous Irritants.—Alternating hot and cold douches are most effective. The child is immersed to its neck alternately i n warm water of 40°C. (104° F.) and cold water of 20°C. (6S° F.). The treat ment must always start and end with warm water immersions; besides this, the usual cutaneous irritations by slapping the gluteal region.
3. In every severe case of asphyxia (II degree), uninterrupted, prolonged artificial respiration must be employed. The writer considers Schultze's swinging method to be the most effective of all. In regard to the well-understood technique of this method*, we need only note that after six to eight swinging movements, the child should always be im mersed in warm water of 3S° C. (100° F.), in which one must employ thorough friction, and rapid rhythmical compression of the heart in order to raise the cardiac action to 120-140 a minute. The suspicion, recently raised, that Schultze's method might give rise to rupture of internal organs with consequent hremorrhages, lacks sufficient proof. One should never despair of resuscitating the infant as long as any sign of cardiac action be present and restorative measures must be kept up until the child cries long and lustily (Schultze).
Sylvester's method of artificial respiration also deserves mention; it consists in the strenuous abduction and adduction of the arms and shoulders, thus increasing or decreasing the intra-thoracic capacity.
Laborde's method by traction on the tongue is difficult of execution in the newborn, on account of the smallness of the part to be manipulated.
The method of Pernice, consisting in the use of faradic electricity, has been abandoned, since by it only inspirations can be elicited. Con trariwise, however, the results from the use of oxygen have been rather gratifying.