istered to expedite delivery; the infant being born with the face invested with the membranes; the mouth and fauces being filled with viscid mucus, or, as sometimes happens, the tongue falling backwards, and closing up the fauces; or, finally, the infant being exceedingly feeble or exhausted. A suspension of respiration is likewise occasionally observed in cases of very rapid delivery, where the infant is protruded by a quick succession of severe uterine contractions.

Asphyxia may occur immediately after birth, and even after the infant has breathed and uttered some feeble cries, when, from the ignorance, or the wilful neglect of the practitioner or attendants, the necessary measures are not pursued for the preservation of its life; and occasionally, from causes the nature and operation of which it is very difficult to understand.

In some cases the infant, when born, is pallid, with open and flaccid mouth, relaxed limbs, and only a feeble, obscure pulsation, sometimes none at all, at the heart or in the cord. In other cases the face is swollen, livid or purple, with or without pulsation of the heart or of the cord. Occasionally, however, the cord is tense and pulsates strongly, while the pulsation at the heart is slow and feeble.

The state of asphyxia may be more or less complete. The foetus may neither cry nor respire, and present no appreciable motion of the umbilical arteries or heart, being, to all appearances, actually dead; or, while no effort at respiration occurs, the heart and cord may pulsate with more or less vigor, or, again, a few ineffectual respiratory efforts may be made, and even faint cries uttered, and then a complete state of asphyxia ensue.

All the causes to which the suspension of respiration in the new-born infant is to be immediately referred, have not been investigated with sufficient accuracy. Some are, it is true, very evident, being those which directly impede the passage of the air into the lungs, as the existence of a quantity of thick, tenacious mucus in the mouth, fauces, or windpipe; or which prevent the dilatation of the chest and the other respiratory movements, by suspending innervation-as an apoplectic condition of the brain. In cases, however, of not unfrequent occurrence, in which there exists no impediment to the entrance of air into the lungs, and no undue distension of the vessels of the brain, it is difficult to assign the real cause for the non-establishment of respiration. Some have supposed it, in these cases, to arise from a state of extreme debility; others from anæmia; others again from the functions of the placenta having become suspended a short time previous to delivery, thus rendering the blood unfitted for the production of that degree of stimulation of the brain and other organs, which is essential to the proper performance of their functions, rendering certain the death of the infant unless respiration is promptly established by artificial means, and the due vitalization of the blood in this manner effected. The latter opinion, which is that of Velpeau, seems to us the most plausible.

When a new-born infant opens its eyes, moves its limbs, and exhibits a few imperfect respiratory efforts, a smart slap upon the buttocks,

or a few drops of cold water sprinkled upon the chest and abdomen, will very generally cause it instantly to breathe, and to cry out lustily. In all cases, immediate attention should be paid to remove at once any viscid mucus which may exist in the mouth and throat. This may be readily done with the finger, surrounded with a piece of soft linen. The infant should be subsequently placed upon its side, in such a position that, should any of the mucus remain, it may flow from the mouth, while at the same time its entrance into the trachea is prevented. The practice of turning the child upon its face, slapping it between the shoulders, and gently shaking it, as recommended by a few highly respectable writers, "with the view of disengaging any mucus that may be lodged in the trachea," is one neither safe nor useful.

In all cases in which the suspension of respiration is unaccompanied with symptoms of cerebral congestion-a puffy and dark purple or livid appearance of the face-it is not proper to tie and divide the umbilical cord, until its pulsations have ceased, or become quite feeble. The premature application of a ligature to the cord has, we believe, in many instances, given rise to asphyxia.

The dashing of a little cold water or spirits upon the chest and abdomen will, in many cases, almost immediately excite the respiratory action-with loud and vigorous cries-when the cord may be divided, and the infant suffered to remain quiet, until its strength is, in some degree, recruited.

The plan pursued by Velpeau, in imitation of Desormeaux, is a very excellent means of rousing the infant from a state of asphyxia. A portion of some spirituous liquor being held for a moment or two in the mouth, is then spirted with force, in the form of a douche, upon the breast of the child.

Immersion in the warm bath is also in many cases a very successful means of inducing respiration in the still-born infant. The use of the bath in these cases, however, requires some little management, to derive from it any advantage. The object of the bath is to excite the action of the heart and respiratory muscles. If, within a very short time after immersion, neither respiration nor circulation ensues, the child should be taken out, as the effect of the bath becomes then decidedly injurious. Even when respiration sets in, as it often will, soon after immersion, continuance in the bath should not exceed a few minutes; or we run the risk, by raising the temperature of the infant, of rendering it less capable of enduring the state of asphyxia, while, at the same time, the action of the atmospheric air on the surface of the body, which always exerts a very powerful vivifying influence, is prevented. When the child is removed from the bath, gentle friction should be applied to the surface of its body with a warm dry flannel cloth.

Cold affusion has been resorted to, in cases of suspended respiration in new-born infants, and when judiciously managed, there is no doubt it will often prove a very powerful and successful means of resuscitation. In two cases, related by Dr. Patterson, of Dublin, in which the infant was placed in a tub, and three quarts of water, at a temperature

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of about 60°, were twice dashed over it, strong friction being at the same time applied to the parietes of the chest, active respiration was quickly established; the infant was then removed from the tub, well dried, and wrapt in flannel. In both cases, an entire recovery was effected.

In the Journal für Kinderkrankheiten, it is stated by Dr. Tott, that he has often succeeded in restoring life in cases of asphyxia asthenica infantum, after the failure of the usual means, by causing a person standing on a table to pour cold water from the spout of a tea kettle on the pit of the infant's stomach. In this way, it is added, Professor Hasselberg has saved many lives.

Of all the means that have been employed in cases of suspended respiration in new-born infants, inflation of the lungs is the one upon which, experience has taught us, the most confidence is to be placed, if early resorted to, judiciously practised, and persevered in for a sufficient length of time.

The inflation is best effected by the mouth of the operator applied to the mouth of the infant, the latter being first covered with a thin silk handkerchief, or soft napkin; the child's nostrils should be closed with one hand, while the other is applied upon its thorax. By a moderate but uniform force of insufflation, the lungs will be readily filled with air, when the mouth of the operator is to be withdrawn, and gentle pressure made upon the chest, so as to expel the air which has been introduced; in this manner, artificial respiration should be kept up for some time. If the cord be examined, at a short distance from the abdomen, it will be often found to pulsate soon after the commencement of the operation, or the heart may be felt to beat beneath the ribs. The first symptom of returning life is, generally, a tremulous motion of the respiratory organs; the infant next makes a feeble attempt to inspire, and the cheeks begin to redden. When these phenomena occur, if the inflation is suspended, the infant will frequently be found to make a spontaneous effort at respiration; a deep sigh is the first breath it draws, and in a few seconds it often breathes freely. If now, on suspending artificial respiration, the heart continues to beat vigorously, the cord to pulsate, and the breathing to augment in frequency and depth, it need not be resumed. Should the pulsation stop in the heart and cord, and the breathing cease, or become more feeble, artificial respiration must be immediately resumed and as often as the case requires-at one time, the natural powers of the infant to carry on respiration being tested, at another, the respiration being supported by artificial means. As the efforts at spontaneous respiration increase, ammonia, or Cologne water rubbed upon the hand, and held over the mouth of the infant during inspiration, will assist the recovery, and has a better effect than introducing stimulants into the stomach. A few smart slaps on the gluteal muscles will now generally complete the recovery.

In favor of the efficacy of artificial respiration, in cases of asphyxia occurring at or soon after birth, we have the most incontestable testimony. Blundell trusted to it alone, with the aid of the warm bath. Toogood declares that he never found any other means necessary, and

believes that, if actively employed, and steadily persevered in, it will, in the majority of cases, be successful. We may add our own experience, which is decidedly in favor of this means of resuscitation. But, to be generally successful, it must be persevered in until the natural action of the respiratory organs is fully established, or until the recovery of the infant is shown to be impossible, by unequivocal signs. Toogood continued it for forty-five minutes, in several cases, before respiration was fully established; and in a communication of Sir James Eyre, in the London Medical Gazette, March, 1840, a case is referred to in which the artificial means were persevered in for from thirty to forty minutes, and to two cases in which they were continued by Mr. Terry, of Northampton-in one for one hour and a half, and in the other for two hours and a half, with complete success.

Blundell recommends artificial respiration to be practised by means of a tube introduced into the trachea. We have never had any diffi culty in effecting it by the mouth alone; this is also the experience of Mr. Toogood; and in the communication of Sir James Eyre, already referred to, he remarks, "I uniformly inflate with my own breath; in this matter I perfectly agree with Dr. Cape, in a sensible letter of his which appeared in the Medical Gazette of October 7, 1837."

In cases of suspended respiration, occurring in new-born infants, from a congested state of the brain, a somewhat different practice is to be pursued. This form of asphyxia is usually met with in large, robust, plethoric infants, after tedious and difficult labors, where the child has remained for several hours under the direct influence of the uterine contractions, subsequent to the discharge of the waters; where a loop of the cord strictures the neck or thorax; or where the cord is itself compressed by any means during labor. Its immediate cause is the engorgement or compression of the brain; though in all probability it may also frequently result, like the preceding variety, from the want of proper revivification of the blood. It is, in many cases, produced by the too early and injudicious use of ergot.

In the apoplectic form of asphyxia, the countenance, and often the scalp and neck, present a dark red or livid, and bloated appearance, the lips are swollen and purple, the eyes prominent, and the surface of the body warm, red, and somewhat tense.

When an infant is born in this condition, no time is to be lost. The umbilical cord should be immediately divided, and more or less blood, according to circumstances, allowed to flow from it. If the pulsation in the cord has not already ceased, as the blood flows from its cut extremity, very generally, the lividity and turgid state of the face and neck will disappear, and respiration be very promptly established. When the pulsation of the cord is slow and feeble, inflation of the lungs should be resorted to, in addition to the abstraction of blood. The infant may, at the same time, be immersed in a warm bath to the hips, while cold water is applied to its scalp.

In those cases in which the child is born without any indications of life-its face swollen and livid, its body flaccid, and no pulsation is perceptible in the cord, or at the heart-notwithstanding there is but little hope that resuscitation can be effected, it is nevertheless

proper that suitable efforts should be made and persevered in during a reasonable time, for the establishment of respiration.

It is seldom that a sufficient quantity of blood can in these cases be procured from the cord upon its division. We have often, however, found the blood to commence flowing, when the infant is immersed in a warm bath, as directed above, its head being at the same time washed with brandy and water, and its lungs properly inflated. It has been suggested by Dr. Eberle, with the view of soliciting the flow of blood from the cord, to cut the latter short, and apply over the navel a wide-mouthed cupping-glass, furnished with an exhausting syringe. It is supposed that by exhausting the cup, a flow of blood may sometimes be obtained from the divided cord, even after the heart has ceased to act. The suggestion is a very plausible one, and worth a trial. When it is impossible to obtain blood from the cord, Velpeau directs leeches to be applied behind the ear.

In no case of asphyxia in a new-born infant should we hastily pronounce success impossible. Many a foetus, Dr. Blundell remarks, has been laid aside as dead, which by a diligent use of proper means might, in all probability, have been saved.

It is, indeed, amazing the length of time that new-born infants can survive without breathing; not merely for half an hour or an hour, but, as Dr. Maschka has shown (Viertel-Jahrschrift f. Prakt. Heilkunde, 1854) for a much longer period, even under circumstances the most unfavorable. A series of cases in proof of this are collected in the Gazette Hebdomadaire for December 1, 1854.

It often happens that after we have succeeded in establishing respiration, the infant remains for many hours in a feeble condition; the slightest fatigue or agitation being sufficient to extinguish life. It is of the utmost importance, therefore, in all cases in which resuscitation has been effected, that the infant be allowed to remain upon the bed properly wrapped up, in a state of perfect repose, for several hours before any attempt is made to dress it.

2.- Coryza.

Simple catarrh, or inflammation of the mucous membrane of the nares, as it occurs in infants, has received various appellations. It is usually described, however, by medical writers under the denomination of coryza, gravedo, or snuffles, to which, occasionally, the terms malignant or morbid have been added, to distinguish the more aggravated form of the disease, or that in which the Schneiderian membrane becomes covered with a diphtheritic exudation.

Coryza, though always troublesome, is in many cases a disease of little importance, disappearing spontaneously after a few days. It is occasionally, however, productive of considerable suffering and danger. The younger the infant is, in whom it occurs, the more severe and dangerous it in general proves.

The mucous membrane of the nares is particularly susceptible of irritation in the early period of life; and inflammation is excited in it often by very slight causes. It is not uncommon to hear an infant sneeze soon after birth, or even immediately on the air coming in