THE TREATMENT OF EXOPHTHALMIC GOITRE

Abstract

11 he found death to be due to asphyxia, while in the remaining 20 cases the skull was not dissected, so that no actual diagnosis was made. Browne, on the basis of an examination of 200 stillbirths in the Edinburgh Maternity Hospital, showed that cerebral haemorrhage was ten times more common in breech than in vertex cases. The moral to be drawn from these observations is that intracranial injuries resulting from the rapid extraction of the after-coming head are a considerably greater source of danger to the child than is asphyxia from delay in the birth of the head. It is generally accepted that the foetus can exist for at least ten minutes without receiving fresh supplies of oxygen. Bourne, in his valuable little book, Recent Advances in Obstetrics and Gynaecology, refers in this connexion to the apnoeic condition of children born after a prolonged period of " twilight sleep," and who, if left severely alone but merely kept warm, remain motion less for perhaps ten minutes or a quarter of an hour while the heart beats quite regularly, and then quietly and gradually establish respiratory movements. As one who uses " twilight sleej} " to a large extent, I have had a great many instances of this, and I can confirm it abso lutely. But the application of the matter at present is that it emphasizes the need for care and deliberation in the extraction of the head, and the danger of " hurry."