A case of peculiar crowing inspiration in a new-born child / by Hugh Miller.

  • Miller, Hugh, active 1881.
Date:
[1877?]
Catalogue details

Licence: Public Domain Mark

Credit: A case of peculiar crowing inspiration in a new-born child / by Hugh Miller. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    2/8 page 2
    without any known exciting cause for inducing it. The spasmodic pains were arrested by morphia suppositories, and after two days they ceased to trouble her. Henceforth, the gastric disorder was kept in check by pepsin and bismuth, while the irritation of the bladder was somewhat relieved by her taking tartarated iron. At full term, her labour began ; its onset was marked by the usual irregular and fitful pains, which in about two hours were succeeded by the regular bearing down ones, and the labour, which was natural, was completed within the usual period of a healthy multipara, and with no effort beyond that usually employed. The child, a male, was fully matured ; it appeared to be well nourished, and was of the average size. From the first, its respiration was defective. It did not cry, and the attempts at inspiration were irre- gular, short, and very feeble ; they might be described rather as a gasp than as an inspiratory effort. Slapping the nates, and the alternate application of hot and cold water to the skin, increased the frequency of the child's efforts to breathe. A little blood was allowed to escape from the navel, with no beneficial result; then the use of hot and cold baths was resorted to. The child was plunged in one of them to the neck, kept for a few minutes in it, and then quickly transferred to the other. This treatment was found of most advantage ; the skin began to show patches of a natural colour; after a time, the breathing was more regular, and at length evidence of life was given by crying. Then, through the application of a sponge squeezed out of hot water alternately with one from cold water, and applied to the throat, in- creased facilities for breathing were given. It was evident, however, that, under the most favourable circumstances, the crowing spasmodic inspiration would continue. The lividity of the skin also was still pre- sent to such an extent as to indicate very defective aeration of the blood. At the end of two hours, I ceased using the sponges. I then placed it in warm cotton-wool, and gave it a few drops of brandy, with warm water, which was swallowed readily. Dr. Foulis, surgeon to the Throat Dispensary, who was sent for, now came in, and the child re- mained under his constant observation until it died. His statement of the case is, that the baby suffered from a continual impediment to the inspiration, in the form of a crowing long-drawn effort, ending usually with an abruptness which seemed to point to some obstacle in the glottis. Occasionally, there occurred a sort of collapse, with cyanosis and cessation of the breathing, which lasted for a minute at most, and was rallied from slowly under the use of alternate applications of hot and cold sponges to the chest. The inhalation of minute quantities of ether was tried, but, though it seemed to relieve the spasm, yet it did so rather by producing a sort of stupor than by any real benefit to the breathing. The only treatment which seemed of real use was holding the lower jaw forward by means of the fingers placed behind the angles, and so pushing it forwards. This effectually relieved the breathing for the time, and restored the colour of the lips and face to the natural rosy tint; the crowing inspiration returning immediately on the relaxa- tion of the forward pressure. Later on, however, the dyspnoeic attacks became more frequent, and the child died nineteen hours after the birth. Milk and a very little brandy were administered every two hours or so, in small quantities, and the swallowing did not seem to be much impaired except during the last hours of life. That same evening we examined the body. We found a degree of venous congestion in the skin and organs generally. The thymus gland was, if anything, undersized. One third part only of the lung was ex-
    digitised image 1
    digitised image 2
    digitised image 3