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 in a child over a year old
the risk is almost negligible.

Fortunately in all save the rarest possible instances the apnoea
yields and a deep inspiratory movement follows. As the air rushes past
the glottis, which is still partially closed, a sound recalling the
whoop of pertussis is heard. Often this recurs throughout all the
burst of crying which follows, and each inspiration is accompanied by
a shrill stridulous sound. With the re-establishment of respiration
the cyanosis rapidly fades, to be succeeded in some cases by pallor
and perspiration.