APOPLECTIC STATE. 575 



its neck, or is itself in any way compressed, and particularly where 

 any of these accidents occur coincidenlly with a previous pleihoric 

 state. 



Its immediate cause is the compression or engorgement of the 

 brain; which, however, does not prevent a want of the revivification 

 of the blood from being an occasional cause of it, as well as of as- 

 phyxia; and M. Gardien, while opposing the sentiments of M. 

 Chambon, Courraut, and Capuron, is certainly wrong in maintaining 

 that compression of the cord is as incapable of producing the apo- 

 plectic state as it is capable of easily producing asphyxia. 



1228. When a child is born in this state we should make haste to 

 disengorge its vascular system; by acting soon where there is no 

 effusion, the alarming symptoms may generally be soon dissipated. 

 Under the opposite circumstances, death is commonly inevitable; but, 

 as has been remarked by M. Desormeaux, inasmuch as it is impos- 

 sible, a priori, to distinguish a simple congestion from an encephalic 

 hemorrhage, the accouclieur would be reprehensible who should fail, 

 in any case, to bestow upon the child the same care as if the affec- 

 tion were known to be less seiious. 



If the accident have been occasioned by compression by the cord 

 upon the jugular vein, the turns should be quickly cast off, or cut, 

 provided the foetus cannot be otherwise freed from their injurious 

 effects. In other cases it would be equally dangerous to wail for 

 the child to cry before cutting the cord, or to amuse one's-self with 

 immersing the placenta in a warm liquid. The section of the cord 

 is the first and chief remedy to be resorted to. The ligature is not 

 to be applied until after the disappearance of every bad symptom, 

 because the advantage of this section is, that it gives free issue to the 

 blood. To promote the escape of this fluid, it is sometimes requi- 

 site gently to press upon the breast, the abdomen, and the cord it- 

 self. As the blood flows, the cliiUI seems to revive; the livid color 

 of the lips is soon replaced by a purplish or rosy hue; the parts 

 about the mouth, and nose, the rest of the face, and the whole sur- 

 face of the body clear up by degrees; the respiration soon becomes 

 established, and in a few minutes the danger has wholly disappeared; 

 but the circulation is sometimes so much enfeebled and obscure that 

 no blood flows from the umbilicus. In such cases we are obliged to 

 resort to the remedies recommended for asphyxia, that is to say, to 

 frictions, stimulating baths, inflation, electricity, &c.; and as it is ab- 

 solutely necessary for the child to lose blood, provided it be impossi- 

 ble to obtain any from the cord, a leech should be applied behind 

 each ear to disengorge the brain. 



1229. When the integuments have recovered their natural color, 

 50 



