ASPHYXIA NEONATORUM.

411 His communication would, however,smîfusion of the blood-vessels of the eyewhich attends have been still more interesting had lie stated how amy violent muscular effort, if the jugular other cases of cancer of the stomach he i had veins are at the same time many compressed by a tight observed in the same period and had not operated ccollar. In this connexion, Mr. Collins mentions In the discussion tthe relief that may sometimes be given to a tendency -on for some reason or other. this Prof. Chauffard gave tco subconjunctival haemorrhages by changing the communication, following to his to as scepticism support operative cure of 1llabit of wearing tight collars, also the rationale of cancer in general by recording the case of a woman who 1bandaging the eyes after any eye operation ill ,-olying died at the age of 92, when cancer developed in the Ein opening into the globe. .scar of an operation for cancer of the left breast Had she died at the age more than 50 years earlier. ASPHYXIA NEONATORUM. .of 91, she would havebeen cited as an irrefutable THE methods of peripheral stimulation formerly case of cure of cancer by operation. This point is, perhaps, of academic rather than practical interest ;(employed to encourage respiration in the newly born -most patients operated on for cancer would not be-such as smacking, pinching, and cold-tubbinggreatly perturbed by the prospect of the disease Ihave now been abandoned because it is realised ithat the necessary stimulus is almost certainly recurring 50 years later. chemical rather than physical. But it is still by no means certain exactly what this stimulus may PHYSIOLOGY OF WEEPING. be. Many have held that an increased carbon

encouraging.

especially

dioxide tension of the blood reaching the respiratory IT is well known, at any rate by mothers, that d centre is the operative factor, and on the analogy are infants do not shed tears until they several weeks, o the successful use of carbon dioxide in the treator in some cases months, old. Darwin observed the of n of carbon monoxide poisoning (where the tension fact and comments on it in his book on "The ment o both CO and oxygen in the blood is low) Yandell Expression of the Emotions in Man and Animals." of Ihas consistently and eloquently pleaded Mr. Treacher Collins, in a recent article, explains that Henderson t. value of CO, in stimulating respiration in the this is not because the lacrymal glands are not the n born. From an extensive study of the fcetal developed at birth but because weeping is not a newly reflex action in the ordinary sense, but rather a b blood, however, N. J. Eastman1 now calls the rationale conditional reflex analogous to the secretion of the oof this method of treatment in question. He finds in asphyxiated infants the blood shows a greatly t: salivary gland that may be excited by the sight that 11 increased or even the thought of food. in is a COtension and a serum pll reduced to the Weeping, fact, 1< limits compatible with life, and he argues that late physiological development, both in the indivi- lower t administration of CO2 to stimulate respiration in dual and in the race. In spite of legends about the elephants or crocodiles, it seems to be established ssuch cases is not only valueless but actually harmful. F that no animals except man do actually shed tears. He regards the primary blood chemical change as Mr. Lindsay Johnson experimented on crocodiles by a reduction in the oxygen content of the foetal blood, .squeezing the juice of an onion mixed with common aand emphasises that the chief therapeutic indication is therefore for oxygen. Of the simpler methods of .salt into their eyes but obtained no confirmation of Ìi the myth. The physiological importance of the fi filling the lungs with air, manual artificial respiration a and mouth-to-mouth insufllation are those most first secretion in man is in the that lacrymal place 1" it keeps the surface of the cornea well lubricated readily available ; it should be recognised, however, and free from minute particles of dust, and in the tthat neither is without danger, since ribs may easily b fractured by rough handling and the lung or second place that its most important constituent, be stomach s This acts as a efficient bactericide. ruptured by too vigorous insufflation. very lysozyme, is the function, not of the excessive secretion known COxygen may also be given directly by mask or nasal c and probably the ideal method would be as weeping, but of the ordinary constant secretion catheter, which may be increased by reflex action following a combination of the former with artificial respiration carried out by a Drinker respirator, which was upon any irritation to the cornea. So important does t d in THE LANCET last year (1931, i., 1186). Mr. Collins consider it that he suggests that the described from neonatorum of infants ophthalmia immunity in whom Credé’s treatment has been employed at ERYTHEMA NODOSUM. birth is more probably due to the lysozyme in the THE of erythema nodosum has long to causation secretion than any germicidal property lacrymal in the very dilute solution of nitrate of silver perplexed students of the disease, the main views on p .employed. For although the lacrymal glands of the iiits origin at the moment falling into three groups. young infant do not react psychically they do react IFirst there is the theory of those who, impressed reflexly to any ordinary stimulus and the instillation tby the association with tuberculosis which has been of drops acts as such. Mr. Collins goes on to consider nnoticed by many workers, particularly in Scandinavia, the other protective mechanisms of the eye and regard r the eruption of erythema nodosum as the especially the firm closure of the lids which is often eexanthem of tuberculosis. Then there are those .associated with weeping. This is effected by thevwho, while recognising the association between orbicularis oculi muscle and especially by certain ttuberculosis and erythema nodosum, realise that fibres of it situated near the conjupetival surface of tthis association is by no means constant and are the lid and known as the muscle of Riolan," which ttherefore led to believe that the (lisease is an acute are fourd to be much more highly developed in man s specific fever-" nodal fever." Finally, there are than in ary other mammal. The effect of tight tthose who look on erythema nodosum as an allergic closure of the lids is to protect the ocular blood- Imanifestation which may occur in allergic states vessels from the effect of any sudden increase of blood due Its association to various sensitising agents. c pressure due to extraordinary expiratory efforts withwith tuberculosis they explain by the fact that the :a closed glottis. It is Nature’s corrective to the sudden t tubercle bacillus is a common allergen, a,, evidenced 1

Brit. Jour. of Ophthalmology, Jan., 1932, p. 1.

1

Bull. Johns

Hopkins H osp., January, 1932, p. 39.