Inspection when born.—As soon as the child is born its mouth and nose should be cleared from mucus, if that has not been done already; and if it has not breathed, means should be resorted to immediately to make it do so. Sometimes the whole head is covered with a thin membrane, called the caul, or veil, which is most probably only a portion of the Amnion, and which may cause suffocation. I remember a case of this kind in my own practice, in which the caul was unnoticed at first, and the child came near dying from it. Nothing could be seen, and as it bent before the finger, when pressed into the mouth, it was totally unobserved. The nurse however, called out that the child did not breathe, and a close examination as to the cause soon revealed why. On passing the finger under the edge of the membrane, which was round the neck, it came off like a cap, and the child cried immediately.
Washing the child.—The cleansing of the child may usually be safely committed to the nurse, or other female attendants, though some of them have very absurd and injurious practices in this respect. Thus I have known them rub the whole body over with whiskey, or raw spirits, before washing it, which must cause great coldness from its evaporation, and also great irritation. The only thing required is perfect cleanliness, and this should be effected in the quickest and simplest manner. Some very mild soap, and moderately warm water, is all that is really needed, though a little sweet oil, or fresh lard, or butter, rubbed on first, appears to facilitate the operation. The drying should be done as quickly as possible, after all the mucus is washed off, and with great care; the napkin being as soft as it can be, and never rubbed hard, for it takes but little force to remove the skin. Many persons take great trouble, and are a long time over this infantile wash without succeeding well with it. They are deceived by the tough mucus slipping under the hand, but still clinging to the body, where they leave it even after using the napkin; it then dries on and forms a hard skin, very difficult to remove, and very irritating. This can be avoided with care, and by using the oil first, which appears to soften the mucus. Some persons use flour, or Indian meal, and others starch, but none of these are so good as the simple means we have described.
Dressing the child.—After the washing and drying is completed the child must be dressed, and this is a process in which comfort and utility is frequently sacrificed to mere fashion and prejudice, as it is in adults. The article next the skin should be of soft line linen, which may be followed by others of warmer material, according to the temperature. They should all be perfectly loose in their make, and quite soft to the feel. As far as possible they should all be fastened with strings, rather than pins. These metallic points are troublesome to fix, and often injure the child, in spite of every precaution. They are also apt to be referred to as the cause of the child crying, and thus prevents other causes being sought for, which frequently exist.
Some people put a thick flannel cap on the head, over a linen one, but others leave this part altogether uncovered, which I think is the best plan. At most there should only be the linen covering; the head being better rather cool than otherwise.
The dressing of the cord is the next duty, and this is done by taking several pieces of soft linen, oiled a little, and cutting a small round hole in the middle of each, through which the cord is passed. The linen then lies flat on the abdomen of the child, and the cord on the top of that, the holes being just large enough for it to pass easily through. Five or six pieces are usually put on, but very frequently only one is used, and is found quite sufficient. It should be very fine, and soft. When this is done another layer is laid over the cord, and then a bandage of soft linen, about four or five inches wide, is passed two or three times over it, and round the body. This completes the dressing, and the child may now be wrapped up warmly and laid down to sleep—remembering, as Dr. Chailly remarks, that if it be laid on a chair, or sofa, it may be accidentally sat upon and killed, an accident which has happened.
ACCIDENTS WHICH MAY HAPPEN.
Before these dressings are needed however, there are frequently other things of more importance to be attended to. If the labor has been long, or the presentation unfavorable, the child may be born apoplectic, from the pressure it has received. The face will be puffed up, and of a blue color; the body will be swollen, and the limbs without motion, while the pulsation will scarcely be felt, either over the child's heart or in the cord. It will feel warm, and the limbs will be quite flexible, but still there will be no signs of life. In this case it should be exposed naked to the cool air, and even blown upon; and if that does not resuscitate it the cord may be cut through below the ligature, so as to let out two or three tea-spoonfuls of blood. After this it generally revives, and begins to move, while its face assumes a natural color, and the swelling goes down. The mouth and throat should also be carefully cleaned with a quill feather, of all mucus.
A more frequent accident is Asphyxia, or want of breathing, in which case the surface of the body is cold and pale, and no breath whatever is drawn, though the heart beats quite naturally. Very weak children, or those born before their time, are most likely to become asphyxiated, or those delivered by instruments. The first thing to be done is to carry the child to the open window, if it be not exceedingly cold, and expose its head and chest to the air, while the rest of the body is wrapped up warm. This will often make it gasp, but if it does not a little cold water may be dashed on its face and chest, and the throat may be tickled with a feather. The breech may also be smartly slapped, and the chest well rubbed with the cold hand. When it begins to breathe a little it may be put into a warm bath up to the middle, and a warm injection may be given to it. In most cases these means will speedily bring it round, but if they do not the attendant should place his mouth close over that of the child and breathe into it, so as to fill the lungs, and then press down the chest to empty them again, repeating the process several times. This may be called artificial breathing, and if it succeed once only there is a probability of its effecting the desired object. The breath however, must not be blown in too hard, or it may injure the child's lungs, nor too rapidly. Sometimes a tube is used, which is passed down into the throat; but it is troublesome, and not much better than the mouth, if any at all. These efforts may be repeated twenty or thirty times if necessary, or even more. In some cases it is requisite to continue using some, or all of these means, for an hour or two without intermission, before the child begins to breathe freely. I knew an instance even, where the nurse continued to do so for five hours, and at last fully recovered the child, though all present, including the doctor, had given it up. She said she did not despair while it continued warm, though it was doubtful whether the heart beat or not. This may show that the attempt should not be abandoned too soon.
In cases of asphyxia no blood should be lost at all, but on the contrary the cord should be carefully examined to see if it is tied fast; the bleeding from it frequently aggravating the evil.
Congenital weakness.—Some children are born extremely weak, and remain constantly debilitated and cold. This is very apt to be the case when they are born before the full term, or when the mother is diseased. They should be carefully wrapped in cotton, or very soft flannel, and kept warm by bottles of warm water. Many instances are on record of these weak children becoming afterwards extremely robust, so that they need not be regarded with unmixed apprehension, nor neglected from a supposition that they must die.