Hence, as a matter of practical safety, although it is not necessary, as a rule, to apply a ligature to the umbilical cord, even when we cut it very near the abdomen of the child, we had better do it, as no harm can come from the procedure; it is possible for it to do good, even to save the life of the child; properly applied, it is not possible for it to do harm.
As to the point at which we divide the cord—whether at a half an inch or an inch and a half from the abdomen—every one must be his own judge. It is an old woman’s notion, both in this country and in the old, which was derived from the physiology of the ancients, and which requires that the cord should be cut very near the umbilicus if the child was a girl, and very far from it if it is a boy; such a mode of cutting being supposed to exert a great influence upon the development of the generative organs.
Notwithstanding the objections of some of the old women, I have separated the cord very near—say within half an inch of the abdomen. This is a much neater and more cleanly mode than it is to leave two or three inches of a dead substance to putrefy upon the child; besides, the more cleanly the part is kept, the more quick does the healing process take place.
“As to the ligature itself,” says Velpeau, “De la Motte advises us to apply it at the distance of one inch, Deventer, Levret, and the moderns, at the distance of two fingers’ breadths, others at three, four, five, six, and even twelve inches from the abdomen. Some persons have recommended the application of two, and in such a way that the one nearest the abdomen should not be so tight as the other. Sometimes it has been recommended to draw it very tightly, at others very loosely. One person is content with a single turn, and a single knot; and another thinks there should be two turns, and a double knot; a third, like Planck and M. Desormeaux, makes first one turn and one knot, and then bends the cord into a noose to tie another knot upon it.”
“A majority of the Philadelphia accoucheurs,” says Professor Meigs, of that city, “in tying the navel-cord, pass two strong ligatures each twice around it, securing them with two knots; the one an inch and a half, and the other two inches and a half from the abdomen, and divide it between the two with a pair of sharp scissors. This is a cleanly practice in all cases, and prudent, if not essential, in twins;” cleanly, that is, because, as the professor means the second ligature—that is, the one that is nearest the mother—prevents the blood coming from the placenta, and soiling the bed; the same principle I usually adopt, only the first ligature is placed half an inch, instead of an inch and a half from the abdomen. Sometimes, however, as in the night, it is perhaps better to leave the cord an inch or two long, and the next day tie it nearer the body. The ligature, since we use it at all, should be drawn very tightly; the cord being a dead animal substance after birth, very soon shrinks; hence if the ligature is not very tightly drawn, it may slip off in a day or two. In tying the ligature, we should be careful not to pull at the child, for in so doing we might cause a rupture, or a tendency to such an occurrence.
In making the division—which is usually done with a pair of good shears or scissors—we must be careful to avoid cutting off a finger, toe, or the private member. The infant, in its struggles, is very apt to get some of these parts in the way just as one is making the cut.
As to the kind of ligature: some think they must always have a narrow tape; and hence we often find, in attending a case, that the mother has already prepared herself with this material. But a common round thread is to be preferred; we can draw this more tightly than we can a flat ligature. A strong linen thread, doubled and twisted if we think it necessary, I consider the best. “Some would not dare to use any thing except tape,” says Velpeau; “whereas wiser persons make use of whatever they can find at hand.”
One circumstance should be particularly noticed in regard to tying the cord. It is said that it is possible for umbilical hernia to take place before the child’s birth. In such case a portion of its intestine must have protruded into cord. Hence, in such case, if we were to tie a ligature about the cord near the body, and where the intestine is—a fact that we can know by the cord being bulged out, or enlarged at the part—and should cut it off so as to sever the intestine, we should inevitably kill the child. Few practitioners have ever seen such a case; but inasmuch as it is said that such hernia may possibly exist, we should always watch for it. It would be easy to detect, but if one should have any doubt as to whether there is hernia or not, he may apply the ligature an inch or two from the child’s body, and thus make sure of doing no harm.
It is important to remember, that at the time of, and before making the separation, the child should be so placed as to allow the most free respiration; it has just begun to breathe for the first time in life; it is just as important that it has good air as it is for any of us. Many a tender infant has been injured at the very beginning by being smothered among the bed-clothes as soon as born. People everywhere, think it will take cold as soon as it is exposed to the air; but think, you who understand the anatomy and physiology of the human system, how exceedingly delicate the fine internal net-work of its little lungs is! And think you that the external skin is less able to bear the new impression of the atmosphere than the lungs are?
As to difficulties at the child’s navel, I have never had them. It is certainly a very simple thing to leave it altogether to itself, with the exception, the second day and onward, of laying upon it a soft, clean, wet compress, of four or five thicknesses, so that it remains constantly moist. This water-dressing, often renewed, and kept thoroughly clean, heals the navel more quickly than can be done in any other known way.