cern us, and that for a special reason. The spasm of the glottis is
produced under the influence of any strong emotion--in anger, for
example, or in fear, in excitement or in crying for any reason. To
control or prevent it we must direct attention not only to the
condition of spasmophilia, but also to the management of the children
who are always excitable and emotional. In these children every burst
of crying, however produced, whether by a fall, by a fright, by the
entrance of a stranger, or by a visit to a doctor, is apt to be
ushered in by a long period of apnoea, due to spasm of the glottis
and of the diaphragm. The first few expirations are not followed by
any inspiration. For several seconds the silence may be complete,
while the child steadily becomes more and more cyanosed, or the body
may be shaken by incomplete expiratory movements and strangled cries
which are suppressed because the chest is already in a position of
almost complete expiration. In the worst cases, when the apnoea
lasts a very long time, there may be convulsive twitching of the
muscles of the face, or the attack may even terminate in general
convulsions. Very occasionally the spasm is actually fatal. In all
fatal cases which have come to my notice the child at the moment of
death had been alone in the room. I have met with no fatal case where
the baby could be picked up and assisted. As a rule, therefore, the
cause and mode of death must be conjectural, but when an infant is
found dead in its cot unexpectedly, it would seem likely that it has
waked from sleep with a sudden start, become excited, and, about to
cry, has been seized by the fatal spasm. In two instances reported to
me a cat had been found in the room with the dead child, and it was
suggested that the animal had lain upon the child's face. Both these
children, however, were vigorous and capable of powerful movements of
resistance. I think it more likely that the cat may have awakened them
in fright, and that the emotional excitement, giving rise to the
spasm, was the cause of the suffocation. That the apnoea in these
extremely rare instances should end fatally produces a difficult
position for the doctor. It need hardly be said that the seizures are
alarming to the parents. For the sake of great accuracy in the
statement of our prognosis are we to add a hundred times to the
mother's alarm by stating the possibility of death? In each case we
must use our own judgment. I believe that