OF STILL-BIRTH.
The child may be born still, from its not having passed to its full period, or from various causes it may not have vital stamina enough to enable it to live. In some cases the child is born without any manifestations of life whatever appearing. The face is swollen and livid, the body flaccid, and the navel-string does not pulsate.
In such cases we should not at once wholly despair of life, although there is not usually much to hope for; yet, inasmuch as cases of this kind are now and then recovered, they ought not to be immediately abandoned without making suitable efforts for the resuscitation of the vital powers.
A frequent cause of the absence of respiration in the new-born infant is, separating the umbilical cord too soon after birth. Such is the opinion of Denman, Burns, Baudeloque, Dewees, Elberle, etc., etc., and there can be no doubt that many a child has been destroyed by this inconsiderate practice. By all well-qualified and skillful practitioners it is laid down as a rule, “that the cord is not to be tied until the pulsations in its arteries have ceased;” and this any person of ordinary understanding, and without medical knowledge, can easily ascertain, by simply taking the cord between the thumb and forefinger.
In consequence of the neglect of this rule, Doctor Dewees tells us that he had reason to believe he had seen several instances of death, and this of a painful and protracted kind. “And that this is probably one of the causes of the many deaths, in the hands of ignorant midwives and practitioners,” this author observes, “we have too much reason to suppose.” The practice with many is, to apply a ligature to the cord the instant the child is born, without any regard whatever to its pulsation, or the state of the child’s respiration.
Treatment.—In the cases of asphyxia, to which I have referred, various methods of treatment have been adopted, some of which are, no doubt, valuable, while others are meddlesome, and worse than useless.
If the child is livid and dark-colored, it has been recommended to abstract blood. This is best done at the umbilical cord; that is, by separating it. If the blood will not flow, it is recommended to strip some blood from it. It is, however, admitted that, in general, very little, if any, can be obtained in this way.
It has also been recommended to apply a cupping-glass to the umbilicus, so that by exhausting the air from the part the blood may be brought into motion, and thus made to flow, and this even after the heart has ceased to act. I know of no author, however, who has succeeded in this method.
The object of abstracting blood in any of these various ways is to set the vital fluid in motion, and to relieve the congested parts. But it appears to me that there is a far better method than this, and that is simply by friction with the wet hand. The child has in no case too much blood; it is only in the wrong place. The wet hand does not at all injure the skin; the cold water—for cold only should be used here—acts as a stimulus to the vital power, and the motion of the hand and the pressure will set a hundred-fold more blood in circulation than the mere separating of the umbilical cord could do. Hence it is that I would depend much upon friction, and very little, if any, upon the abstraction of blood. This latter practice is destined to become as obsolete in time, as that of bleeding in a severe injury or shock of the system—a method which has deservedly gone out of date among all scientific practitioners of the medical art.
In conjunction with the measure which I have just recommended, there is another of importance, which should be faithfully made; and that is, an effort to excite the respiratory function by artificial inflation of the lungs, and compression of the chest with the hands, so as to imitate in a measure the natural acts of inspiration and expiration. In doing this the operator must apply his mouth to that of the infant—the latter having been first freed of the mucus that attaches to it—at the same time closing its nostrils, and endeavor by a moderate but uniform force of expelling the air from the mouth, to fill the lungs of the child. As the air is thrown into the lungs, the chest of the child must be allowed to expand as much as it will; and then, as this act is discontinued, the chest should be compressed a little, carefully, so as to imitate the natural motion of these parts.
Authors disagree as to the amount of force allowable in forcing air into the lungs of a new-born child. Some have recommended a “forcible insufflation,” while others contend that such a practice is fraught with danger to the child. It appears from a series of experiments that have been made in France on animals, and from observations relative to the human subject, that no very great force of insufflation is necessary to rupture the delicate air-cells, and cause a fatal emphysema of the pulmonary structure. In sheep, and in the dead human subject, the air-cells were ruptured by a force of insufflation not greater than that which may be made by a person of ordinary respiratory vigor, without any very violent effort.
To obviate the unfortunate accident of rupturing the air-cells of the lungs, the air should be thrown into the respiratory passage through a silk handkerchief folded double, or a fine napkin laid over the mouth of the infant.
In all cases of retarded, impeded, or suspended respiration immediately after birth, care should be promptly paid to the removal of the viscid mucus, which is usually to be found lodged in the mouth and throat of new-born infants. In some instances the quantity of mucus is so great, and its quality so tough, that it is believed the child could not possibly breathe if the obstruction was not removed from the parts. In all cases, therefore, if there appears to be any difficulty whatever in regard to respiration, it is best to remove this mucus by means of the finger, surrounded by a handkerchief or piece of soft linen. If there is reason to believe that the mucus is also lodged in the throat and beyond the reach of the finger, it has been recommended that the child should be turned with its face downward, and the body raised higher than the head. In this position, the child’s back, between the shoulders, is to be patted with the hand, and its body gently shaken, so as to disengage any matters that may be lodged in the trachea, and permitting it to flow out of the mouth by making this the depending part. At the same time, if the back is rubbed with the hand wet in cold water, the stimulating effect will aid in the expulsion of the offending cause from the throat.
Infants are sometimes born in a state of asphyxia, when, instead of lividity and swelling of the countenance, there is the opposite extreme, the face and surface of the body, generally, being pale, exhibiting a want of vitality. In such cases, it is of the utmost importance that the cord be not divided too hastily; on no account, indeed, should this be done until the pulsation has ceased. The viscid mucus should at once be removed from the mouth and fauces by the methods before mentioned; and it has been recommended to apply brandy, spirits of camphor, hartshorn, etc., to the mouth and nostrils, with the view of exciting the respiratory function. It is doubtful, however, if such articles do any permanent good whatever, and they are certainly liable to harm. At any rate, it is better, I am confident, to sprinkle cold water upon the surface, and to make friction with the cold wet hand. This will set the blood in motion, and aid the vital powers incomparably more than the stimulants mentioned.
It is also advisable in these cases, if respiration is particularly tardy, to inflate the lungs carefully, according to the method before recommended. But the applying hot brandy, flannels wrung out of hot spirits, etc., which have often been used on such occasions, are worse than useless, and ought never to be resorted to.
Infants, in this condition, should not be given up too hastily. Numbers of cases have happened in which a half hour or more has elapsed before respiration has been established. Even a much longer period than thirty minutes has transpired in some cases before the breathing has been established.
The time will come, probably, when electricity will become so well understood as to enable us to make it a valuable agent in cases of still-birth and suspended animation. In the present state of knowledge, however, it is better, I think, to depend on the stimulus of cold water, frictions, and the other means to which I have already referred. But great care is necessary in the management of all such cases; and I have no doubt that many more infants have been killed by too meddlesome and injudicious management, than have been saved by the use of artificial means. The tendency in cases of this kind always has been to do too much. It is one of the greatest acquirements in art to learn when not to do.