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In medicine the term asphyxia is applied to the disturbances of hæmatosis, caused by the more or less complete suspension of the respiratory movements. Now this definition is more suitable than any other to the morbid condition of infants which is observed at the moment of birth, which very distinguished authors describe under the vague term of apparent death, and which other writers often designate under the name of apoplexy, or the apoplectic state of infants.


The asphyxia of infants may result from compression of the cord against the walls of the pelvis during labour; from twisting of the cord obstructing the flow of blood in its interior; from premature separation of the placenta; from laceration of the cord or placenta, and consequent hæmorrhage; from compression of the foetus in consequence of defect in the conformation of the pelvis; from compression of the head by the forceps; from certain effusions of blood in the meninges or in the brain; from obstructions to the entrance of air into the bronchi, in consequence of mucosities of more or less extent accumulated at the back of the throat; and, lastly, from original weakness of the infants, in consequence of their premature birth, and of an alteration in their constitution by serious disease in the mother, or by frequent uterine hæmorrhages in the course of pregnancy.


This stage of asphyxia, or of apparent death, presents the different appearances well described by MM. Paul Dubois, Naegèle, Cazeaux, &c.; appearances which result from the very causes of the disease.

Sometimes the absence of respiration is the result of congestion of blood in the brain, in consequence of an obstacle to the circulation, which thus causes a stasis of blood in the interior of the skin, and the children are livid, purple: this is what I term the apoplectic state of infants, or apoplectic asphyxia.

Sometimes the absence of respiration is the result of the pure and simple compression of the brain by an obstacle in the pelvis, or by the forceps, and the children, half dead, remain pale; this is ordinary asphyxia.

Sometimes this state is caused by hemorrhage of the cord or of the placenta, or by natural weakness, the consequence of diseases of

the mother, or of a premature accouchement, and the appearances are very nearly the same as in the preceding case, with slight shades of distinction.

Two form

of Asphyx

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There are, then, two forms to be distinguished in the asphyxia of infants, the simple ordinary form and the apoplectic form. But u in all these circumstances the primary cause is the same, and this cause is the absence of nervous influence, which impedes the respiratory movements, arrests hæmatosis, and determines death.

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In the apoplectic asphyxia of infants, the surface of the body appears apoplectic

swollen, and is of a violet or rather a bluish black colour; this is more decided on the superior parts of the body, and especially on the face. The muscles are motionless, the limbs preserve their flexibility, the body its heat, and as MM. Cazeaux and Jacquemier have remarked, the pulsations of the cord, of the pulse, and even those of the heart, are sometimes obscure and hardly perceptible.

In the ordinary asphyxia, this colour does not exist; the children, as M. Paul Dubois remarks, present the paleness of death; their skin is sallow, often soiled by the meconium; their lips flaccid, the limbs



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pendant, the lower jaw depressed, the pulsations of the cord feeble, Color pale and nearly entirely absent. The newly-born child which presents these symptoms, has sometimes performed movements, and even cried at the moment of its birth, but it has soon fallen into a state of apparent death.

Between these two principal types there are shades of distinction, and other less decided forms may be observed which establish a sort of transition between apopletic asphyxia and ordinary asphyxia.

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This morbid state lasts a greater or less time, and it may easily be mistaken for death itself, as has several times happened. This may be imagined at the time when the certain signs of death were not well understood; but now, however severe the symptoms may be, there is no room for mistake. Formerly it was not known whether in this condition the pulsations of the heart of the children were maintained or not; now, as I have demonstrated by numerous facts, in my treatise on the signs of death, it is ascertained that the pulsations

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of the heart cannot disappear, and be completely interrupted without s death being the consequence. It follows, then, that in the asphyxia of infants, as in all cases of apparent death, if there is a doubt, it is sufficient, in order to clear it up, to carefully auscultate for five minutes all the parts of the precordial region, to determine if the pulsations of the heart have really disappeared. After a negative exploration, we

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may be assured of death. If, on the contrary, feeble pulsations are distinguished, every means should be put in force, in order to reestablish them, and it is only then that success is possible, as MM. Moreau, ishen Cazeaux, Chailly,* Jacquemier, &c., have fully proved.

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The asphyxia most frequently terminates in recovery. However, a certain number of children die. In these there is always found a more or less decided congestion of the cerebro-spinal apparatus, a congestion which is moreover very common in children who die during birth.


According to Billard, the injection of the meninges, of the spinal cord and of the brain, is so common in the infant that he almost considers it the normal condition, rather than a pathological change. He has observed it in the greater number of the bodies of children who have died of the asphyxia which he calls apoplectic, and often also it is combined with an effusion of blood in the inferior extremity and posterior part of the spinal cord. At the same time Billard observes that he has remarked this change without its having occasioned appreciable symptoms during life.

When the capillary injection is of great extent, as, for example, in the apoplectic asphyxia, an effusion of blood soon takes place on the surface of the meninges, and the blood which is the result of this effusion usually coagulates in large quantity, compresses the brain or spinal cord, and is the cause of the state of stupor and depression which the children present. This hæmorrhage has been observed by M. Cruveilhier in nearly all the children which have died of this asphyxia. It is especially observed towards the posterior lobes of the brain, around the cerebellum and the spinal dura mater. It is also noticed, but rarely, in the ventricles and in the substance of the brain. Billard has, however, reported an example of this kind. The cerebral pulp is usually the seat of a considerable injection, under the form of a spotted or granular redness, chiefly upon the lateral parts of the corpora striata and of the optic thalami.

Amongst these children ecchymoses in the lung, in the thymus, and decided congestions of the various abdominal viscera are sometimes observed.


As may be observed, the asphyxia of newly-born infants is a very dangerous and very serious state, which should be promptly treated, and by the various means which are suitable to the different indications which the situation of the child demands.

• Traité pratique de l'art. des accouchements.

In the first form which I have admitted, that is to say in the apoplectic asphyxia, the engorgement of the brain and other organs Race must be relieved. The umbilical cord should be cut, and two or three mucosities spoonfuls of blood allowed to flow. The respiration begins to establish itself if there are no obstructions in the mouth, which should be always and Allen well examined. The finger should be insinuated in order to remove lord te the mucosities which may be found there accumulated. The purplish blue tint of the skin gradually disappears, at first in the lips and bed. face, and soon afterwards in the rest part of the body.

If the blood cannot flow from the cord, the child should be put V.S. Nee

into a tepid bath to encourage the flow, and if that does not succeed,

a leech should be put behind each ear, over the mastoid process, and Esturthe bite should not be allowed to bleed after the fall of the animal.

In the second form, that is to say in ordinary asphyxia which is exempt from apoplectic symptoms, the loss of blood is useless, and the umbilical cord should not be allowed to bleed; if the children are anæmic this would be an operation replete with danger. In these cases the ligature should be placed upon it and the cord divided in the usual manner.

In the two forms of the asphyxia of new-born children, all possible means should be used to stimulate the action of the respiratory Shoals movements. To effect this, all the exterior excitants have been employed. Frictions, baths, douches, &c., have in turn been put into priile coti practice. The child should be placed in a tepid bath or in a bath prepared with the decoction of aromatic plants, or still better in warmed linen or before a clear fire. It should be gently rubbed with! a portion of flannel or with the fingers; this failing, it should be smacked on the buttocks with the hand, and this flagellation always produces a good effect. The frictions may be either dry or performed by means of a flannel impregnated with irritant liquids, such as vinegar and brandy. These liquids are also made use of to excite the

nostrils or the interior of the mouth. The employment of ammonia

is often attended with danger.

The precaution should also be taken, from the commencement of the operation, to inspect the interior of the mouth in order to remove by the finger the mucosities which may be there present.

When all these means are of no avail, some douches with vinegar or with brandy and water should be made over the chest; the attendant fills

stappens, the Colle

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his mouth and forcibly projects this liquid on the walls of the chest, at .. the same time exerting lateral pressure on this cavity to replace the ton

action of the paralysed muscles. Some persons recommend the appli

cation of the mouth over that of the child, and to blow into the back of the throat. It is much better to practise the insufflation by means of a bent tube introduced into the larynx.

This operation


should be performed with the greatest precaution; care should be taken not to make a mistake in the situation and not to blow into the oesophagus, and also not to dilate the lungs beyond measure, and determine pulmonary emphysema. To effect this, the laryngeal tube of Chaussier, the form and general disposition of which are very appropriate, should be used, as Dugès, Madame Lachapelle, and more recently M. Depaul, recommend.

The index finger of the left hand is carried on the epiglottis and serves as a guide to the laryngeal tube which the right hand pushes towards the aperture of the larynx, so as to penetrate their passing in front of the epiglottis. As the instrument may be in the oesophagus, lateral motion should be given to it to discover if it drags the larynx along with it. Besides, if it is in the oesophagus from the first insufflation, the rising of the epigastrium by the gas is observed, which should then be immediately arrested.

It is useful to press a little upon the larynx with the instrument in order to depress the oesophagus, or to close the nostrils and the lips with the fingers, then from ten to twelve insufflations should be performed in a minute, at the same time slightly pressing upon the chest to assist the egress of the air. These insufflations may be prolonged for a quarter of an hour, half an hour, or as long as it is imagined that on auscultation the unfrequent pulsations at the precordial region can be distinguished. When the beatings of the heart have completely disappeared, and when the ear applied to the chest for some minutes can distinguish nothing, all further efforts become useless, for there is no example of a parallel case in which reanimation of the child has succeeded; this is also the advice of those experienced accoucheurs whose observations have been previously quoted.

Electro-puncture of the diaphragm and of the intercostal muscles has also been recommended. This means may be useful, and has succeeded in a great number of cases.

It is especially important to prolong the attempts with the greatest perseverance. We should not soon give up, but as I have previously remarked, should continue our exertions for an hour or more, so that we should only leave the child when we are assured of the complete and certain disappearance of the movements of the heart, or in other words when it is impossible to restore it to life.

[The following illustration is quoted from a paper (Journal fur Kinderkrankheiten ; Ap., p. 397) by Dr. Marchant (de Charenton), in answer to the question proposed by the author, as to how long asphyxia can continue without producing death. Dr. Grénet de Barbezieux relates in the Presse of November 29, 1851, the following circumstance: In the year 1844 I delivered a lady in Paris of a child presenting all the characters of five months' gestation. The skin was colourless, the infant motionless, shrivelled, and flabby, and evinced no signs of the establishment of respiration and circulation. Nevertheless, I attempted its resuscitation,

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