NOTE

ON THE MEANS OF RESUSCITATING STILL-BORN

CHILDREN.

IN ADDITION to the measures recommended for this purpose at p. 107, viz. tickling the mouth and fauces, rubbing and gently slapping the chest, and allowing the funis to bleed, we are advised by most obstetric authors to employ the warm bath and artificial inflation of the lungs. Recent enquiries, however, have thrown considerable doubt upon the propriety of adopting either of these measures. According to Dr. Edwards's experiments, the warm bath must act injuriously, by excluding the atmospheric air, which he found to play a most important part in the removal of asphyxia. Again, the observations of MM. Leroy and Majendie prove that brisk inflation of air into the trachea killed rabbits, foxes, goats, sheep, and other animals, even when the force employed was that of an expiration from the human lungs,' and that from the records kept in the city of

Paris of the results of means employed for the recovery of persons drowned, the greater prevalence of the practice of insufflation has been coincident with a decrease of the number restored to life. Mr. Porter, who performed experiments similar to those of Leroy, and with like results, before he knew of the investigations of that gentleman, mentioned to me the fact that insufflation of cold air from a bellows, in the event of the person's resuscitation, seldom fails to produce dangerous bronchitis. From a consideration of these circumstances, I would recommend heat to be applied to a still-born infant, by holding it before a fire upon a person's lap; the chest and abdomen to be well rubbed with warm, dry flannel; and the nostrils and fauces to be tickled with a feather dipped in spirits. The lungs may be filled once or twice, by the operator applying his lips, with a bit of silk or muslin intervening (for the sake of cleanliness) to those of the child, and gently breathing into its mouth. While doing this, the nostrils must be held between the finger and thumb of one hand, and the fingers of the other should be placed upon the pit of the stomach, so as to prevent the air from passing into that organ. When the chest has been distended, it may be compressed gently with the hand, so as again to

* Review of Dr. Kay's work on Asphyxia in Med. Chir. Rev. for July, 1834.

empty it, and the inflation may be repeated once or twice. It should not, I think, be done much oftener, and always with the greatest gentleness. The trachea pipe, which certain teachers have recommended to be carried by every accoucheur, should, in my opinion, never be resorted to.

EDITOR'S NOTE.

In cases of suspended animation at birth our treatment must be regulated by the cause of this condition. Thus, if the child's skin be blue, its lips and face livid and congested, a very few drops of blood allowed to escape from the cord may relieve the embarrassed circulation. But if, as more generally happens, the child be born in a state of syncope and anania, friction with spirits over the chest, and still more so over the spine, the warm bath, alternated with cold aspersion in some cases, and either the Marshall Hall or Silvester methods of exciting respiration, which must be too familiar to the reader to need any description, should be at once resorted to and steadily persevered in for a long time. The Silvester method, with friction over the thorax and spine, and the warm bath, are the means I place most reliance on.-T. M. M.

S

OBSERVATIONS

ON CHLOROFORM.

SINCE the earlier edition of this work was published, the practice of inducing freedom from pain in surgical operations, in painful diseases, and in childbirth, by the inhalation of ethereal vapours, has been introduced into medicine. This process of Anæsthesia was at first effected by means of sulphuric ether, and considerable success followed the employment of that agent. Its utility in the practice of surgery led to its introduction into the lying-in room, and many women were saved the terrible pains of child-birth through its means. In the year 1848, another substance was suggested by Professor Simpson, of Edinburgh, as a substitute for ether. He was not satisfied that sulphuric ether was the best ingredient for producing anæsthesia; and after a long and laborious investigation of the properties of a great variety of fluids of the class of ethers, he came to the conclusion that Chloroform possesses various important advantages over them all, especially in obstetric practice; and that, in particular, it is far more

portable, more manageable and powerful, more agreeable to inhale; is less exciting than ether, and gives us far greater control and command over the superinduction of the anesthetic state. Dr. Simpson's discovery of the valuable properties of chloroform as an anesthetic agent was followed by its universal adoption. No other is employed in surgery or midwifery; and although many practitioners of eminence have not yet overcome their scruples respecting the practice, yet a large number have embraced the doctrine, that anæsthesia in midwifery is justifiable and safe. Indeed, considering that eight years have not yet elapsed since the promulgation of this discovery, the number of its adherents is a matter of surprise, particularly when we reflect upon the slowness with which the greatest discoveries have been received by mankind: witness the circulation of the blood, and vaccination. When chloroform is used to allay the pain of a surgical operation, it is usual to carry its effects to the full amount of insensibility. This is of great importance to the operator as well as to the patient, for the sudden movements, both voluntary and involuntary, which most persons make when under the knife of the surgeon, are thereby prevented, and the end is accomplished with ease to both parties. Some advocates for the employment of chloroform in cases of parturition, recommend the effects to be