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Michael Underwood, 1799, Treatise on the Diseases of Children

Volume II.

Introduction

on

Apparently Still-Born Infants

Having in the Preface touched upon all such topics as might be deemed necessary to an Introduction to the subsequent parts of this work, the reader is reminded, that the present Exordium is dedicated to the consideration apparently still-born children, and to point out the most likely means of their animation. And what I have here to offer is the result of an experience that has been attended with more success than might have been expected.

I have, indeed, both at the Lying-in-hospital, and elsewhere, met with many instances of children born with very little, and others without even the smallest appearance of life, some of whom have remained entirely destitute of it, for more than a quarter of an hour, and yet have been happily restored. I pretend to little or no skill in this business not generally practiced, and can scarcely guess to what to attribute this success, unless it may be an unwearied assiduity and perseverance in my attempts, whensoever there are no certain signs of death, till I conceive nothing is possibly to be expected from them. And this has so often succeeded, that I have been tempted to think its importance may, possibly, not have been sufficiently attended to by every practitioner. I rest this presumption, not only upon some fortunate events where I have had little or no previous ground for hope, but where other practitioners had, in some instances, abandoned it. A certain steady perseverance in our attempts to preserve life, as long as the least hope may remain, is, indeed, not only a duty we owe to the Public, but one successful attempt is an abundant recompence for many failures; especially, as I imagine we shall rarely fail whenever there may be the least positive ground for hope of a favourable issue.

As to the Means, they consist only of warmth, clysters, stimulants, and especially blowing forcibly into the trachea.

The ordinary stimulants are the smoke of lighted brown paper, or tobacco; juice of onions; frictions with hot cloths, and brandy; cold brandy poured on the thorax, and on the funis umbilic, where it is inserted into the belly; striking the nates, and the soles of the feet; stimulating the nose, and pharinx with a feather, (drawing out the mucus that may present;) with every other similar mean calculated to excite a strong effort, especially that of crying; to which our attempts more particularly tend. On this account, I believe, no great benefit is to be expected from stroking the blood along the funis, or immersing the placenta in warm water; the fetal life being extinct, the recovery of the child will depend on the blood passing freely through the lungs, which it cannot do till the child is brought to breath freely and forcibly; the continuance of which also is never secure, till it begins to cry. To these ends, I have depended above all upon blowing into the trachea, through the mouth, which I am satisfied, may be more effectually done by the mouth of the assistant being placed directly upon the child's, than by means of a blow-pipe; (although the air is, indeed, certainly less pure;) at the same time, preventing the return of the air before it has entered the lungs, by the fingers of one hand placed at the angles of the mouth, and those of the other on each side the nose. But I have sometimes imagined, that I might attribute much of my success not only to the continuance of this, but to the manner of doing it, by attempting to imitate natural respiration, by forcing out the air I have thrown in, by a strong pressure against the pit of the stomach; thus blowing in, and alternately pressing out the air, for a long time altogether, omitting it only now and then, to make use of some of the aforementioned means: which latter, however, can do very little to insure the life of the child, until it begins not only to gasp, and that with shorter intervals, but also to breathe in a somewhat uniform manner. At this time, should the child not be disposed to cry, which is frequently the case, I think nothing is so likely to succeed as a tobacco, or other very stimulating clyster, or putting a little Scotch-snuff, or other pungent powder, up the nose, which latter if they induce sneezing, will soon be followed by a strong cry, and the child be with certainty restored.

Amongst other means, that of warmth was recommended; to which end, the infant should be entirely covered with very hot cloths, which should be renewed as fast as they become cool; or the body may be immersed in a tepid bath of salt and water, or milk, and be well rubbed all over: the cord may likewise be suffered to bleed a little, especially if the face and body do not soon acquire the normal natural color -- but this ought seldom to be done, or the funis be divided as long as any pulsation is to be felt in it.

To these means may be added the cautious use of electricity, which appears as likely to be successful in these, as in most other cases to which it has been applied: but I have never been in a situation to make trial of it, or I certainly should, as I once knew a child happily recovered by it, after being laid out for dead, for near two hours, in consequence of a fall from a two-pair of stairs window.

But should these several means fail; as a last resource, a very different kind of stimulant may be tried, and instead of laying the infant aside in a warm flannel, it should be exposed to sudden and severe cold, which I remember once to have succeeded after the life of the child had been despaired of.

I shall just add, that, amongst other symptoms of some supposed irrecoverable injury a child may have sustained in the birth, is that of a disoloured and often fetid, or bloody water forcing out of the nose, after the lungs have been two or three times artificially inflated. Under these circumstances, however, I many years ago succeeded in two or three instances so far as to animate children sufficiently both to breathe and to cry; but they afterwards lay in a moaning state for four or six hours, and then expired. To succeed thus far, indeed, if I am rightly informed, may prove of importance, where the course of a family estate may be pending on a living child. I have, however, lately been fortunate enough to succeed completely, under the most unfavorable circumstances, and after a great quantity of discolored mucus, and something like meconium, was forced up from the throat and nose, and the child, an unusually large one, is still living.

It will be presumed, I dare say, that the above scrupulous attention is not designed to be inculcated in every instance of apparently still-born infants, but principally where the death of the child may not only be certainly ascertained, but there has previously been reason to expect it would be brought alive into the world. -- The great importance, however, of the subject, it is hoped, will be sufficient apology with most readers for the length of these directions; and as the attempt to restore infants to life has always been a most pleasing employment to myself, the desire of being an occasion of inducing others to a perseverance in the use of the like means, emboldens me to risk the censure of any who may deem it prolix or superfluous.


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Created 12/1/1998 / Last modified 12/3/1998
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