THE CARE OF THE NEW-BORN INFANT.
as the infant is born, we should satisfy ourselves that the cord is not around the neck or the limbs, and remove from the mouth any mucus which might interfere with respiration. If the cord be not around the neck, the infant is placed between the mother's knees, and the mouth is cleansed by the finger. In case the cord be around the neck or the limbs, it is carefully disengaged, taking care not to make traction on it. If there be any difficulty in disengaging it, the loop should be cut between the fingers and a temporary ligature applied.
[Before further attention is given to the cord, a very important step, in our opinion, is to care for the infant's eyes. These should be at once thoroughly washed with lukewarm water, and: in hospital practice, -as a routine measure, in private practice whenever there is a suspicion of gon orrhea in the mother, a drop of a two per cent. solution of nitrate of silver, should be instilled into each eye, the lids being well separated for this purpose. At this writing, it is unnecessary to refer to the excellent results obtained by this procedure in tho prevention of ophthalmia neo nati. Cred(, to whom we owe the method, proves this amply in his writ ings, and since the adoption of the method at the New York Maternity it is exceptional to meet with a case of ophthalmia.—Ed.] The cord is ligatured as follows: Stout string is necessary in order to thoroughly compress the umbilical vessels. If the cord be thin, nothing more than the ligature is requisite; if, on the other hand, it be thick, then Wharton's jelly should be stripped from the cord, towards the pla centa, before ligating. The ligature should be passed around the cord, and tied in a single knot, and then passed back and be double-knotted. On the placental side a ligature should also be placed, and we cat be tween. On the foetal side the ligature should be applied about one inch from the navel, and, after the cord has been cut, we must make sure that it does not bleed, and that the ligature will not slip. In case the cord bleeds, a second ligature should be applied below the first, as far as pos sible, however, from the navel. The infant should now be wrapped up, and handed to the nurse to be clothed and bathed.
Latterly, the point has been much discussed as to when it was advisa ble to tie the cord. Some authorities counsel ligature immediately on the birth of the infant; others, to wait until pulsation has ceased. Budin has again opened this discussion. Among those favoring the former plan may be mentioned, Cazeaux, Depaul, Verrier, Pinard, and those holding the reverse opinion, are Stolz, Naegel(, Schroeder, Leishmann, Jacque raier. According to Budin, immediate ligature means depriving the in fant of about 80 minims of blood. At least one to two minutes, there
fore, should be allowed to elapse, after the cord has ceased to pulsate, before ligating. At the moment when external life succeeds intra uterine, the lungs dilate, and the air and blood penetrate. The affiux of blood to the lungs is proved by their increase in weight, and the blood, returning by the umbilical vein, passes through these organs into the general circulation. Now, as long as the cord pulsates, as long as the utero-placental circulation lasts, after each beat of the heart, a certain quantity of blood is driven through the umbilical arteries into the pla centa. The foetus sends to the placenta a portion of its blood, and Budin concludes that, even where the infant is born asphyxiated, it is not ad visable to let the cord bleed, but to apply the ligature, and begin artificial respiration. Kohly, Brunon, Helot, in 1876, following the researches of Budin, and adopting his ideas, pronounce in favor of tardy ligature, because the child thus receives more blood. Budin's opinion has given rise to much discussion. Zweifel goes so far as to advise no ligature to the cord until the placenta is expelled. Meyer has found that there was only a difference of 2.69 per cent. in the amount of blood in the placenta after immediate and after tartly ligature, while Z.weifel found a difference of three ounces. Hofmeir finds this result of Zweifel's much exaggerated. He examined ninety cases with reference to this point. In fifty tardy ligature; in forty immediate. He concludes that in case of tardy ligature the infant loses ten per cent. less of its weight than in case of immediate ligature. Porak and Ribemont have lately gone over this question thoroughly, and the general conclusions they have reached, are: 1st. Tardy ligature ensures to the infant an extra quantity of blood, amount ing to about two anJ a half ounces. 2d. The blood contained in the pla cental vessels is necessary to the circulatory system of the infant. 3d. The cause of the entrance of this blood into the foetal circulatory system, is, in particular, thoracic aspiration. The pressure of the uterus is purely an adjuvant and secondary cause. 4th. Immediate ligature, and bleed ing from the cord, should not be practised in case of venous asphyxia of the new-born. 5th. Tardy ligature does not expose the infant to any danger, whether immediate or remote. 6th. The new-born, through tardy ligature, loses less in weight, and regains what it does lose more quickly. 7th. The delivery of the placenta would seem to be facilitated through tardy ligature. 8th. Ligature and section of the cord should never be resorted to until pulsation in it has ceased.