In asphyxia of the newborn mouth-to mouth inflation favored, the infant's nostrils being closed and a moderate de gree of pressure used at first to prevent forcing the epiglottis over the larynx. This is a better method than inflation with a catheter, since most of the air introduced by this instrument returns at its side. O'Dwyer (N. Y. Med. Jour., Mar. 9, '88).
Harvey L. Byrd's method of artificial respiration advocated. The physician places his hands under the middle por tion of the child's back, with their ulnar borders in contact and at right angles to the spine. With the thumbs ex tended, the two extremities of the trunk are carried forward by gentle, but firm, pressure, so that they form an angle of 45 degrees with each other in the dia phragmatic region. Then the angle is reversed by carrying backward the shoulders and the nates. E. L. Crutch field (Med. Bull., Sept., '92).
Following method of resuscitation ad vocated. The infant is grasped with the left hand, the neck resting between the thumb and forefinger (Fig. 1), the head falling far backward. The upper por tion of the back and scapulm will rest in the palm of the hand, the other three fingers being inserted in the left axilla, raising it upward and outward. Next, the knees are grasped (Fig. 2) so that the right one will rest between the thumb and forefinger, the left between the forefinger and middle finger. The back of the thighs will rest in the palm of the operator's hand. Next, the pelvis and lower extremities are depressed (Fig. 3), while the left hand gently bends the dorsal region of the spine backward. To excite expiration the movement should be reversed, the head, shoulders, and chest being brought for ward and the ribs closed upon each other. At the same moment the thighs are brought forward and rested upon the abdomen. Dew (Med. Record, Mar. 11, '93).
Failure to relieve asphyxia is due to obstruction of the glottis by the back ward pressure of the tongue; the tongue should be well drawn forward. Air can then be readily forced into the infant's lungs either by direct application of the accoucheur's lips to the lips of the child or by passing a soft catheter into the child's trachea. This will usually be sufficient for blue or cyanotic infants; for the pale and collapsed ones, pressure over the cardiac region, rapidly and rhythmically, to imitate the normal beart-beat, must also be used. Oeld seldfiger (Amer. dour. Med. Sci., Apr.. '94).
Following procedure is an improve ment over the Schultze method. The child is laid upon a table, its neck sup ported by a roll. The feet are so seized that the thumbs are in contact with the child's soles. the index finger with the back of the feet, the ring-finger resting upon the tendo Aehillis. The remaining fingers are closed. The knees, hips, and spine are then bent in regular motions, the knees touching the breast. Com pression of the abdomen, with expira tion. results; then, by stretching out
the body. inspiration follows. The lar ynx is not compressed, as may be the case by the Schultze method. As an alternative measure, the suspension of the child by the legs is suggested. At the same time the finger may he passed down the throat to facilitate the removal of fluids. provoke vomiting. and this compress the lungs. Such a Meth od tends to prevent aspiration pneumonia. Rosenthal (Univ. Med. Mag., Apr.. '95).
Procedure based on that introduced by Schultze, but less dangerous. The infant is held vertically with the head down: the mouth and pharynx are freed from mucus. The cord is then tied, and the infant is placed in a sitting posture on a table, with the legs extended and separated: the physician takes up a po sition behind the infant, passes one hand into each axilla. the thumbs resting on the seamilpe. and the other fingers ap plied to the front of the thorax; the trunk is then bent forward toward the angle between the separated legs. while. at the same time, the thorax is com pressed by the operator's hands. The lungs are thus emptied. The body is now brought back into a horizontal po sition; the thorax expands, causing marked inspiration. Those movements of flexion and extension are repeated with the same frequency as the normal rhythm of respiration in the newborn. This method used for the past two years, and has never failed. _Even in cases of pronounced asphyxia abort a dozen of those movements have sufficed to revive the infant. Mink.vitch (Semaine Mf'di cale. No. 1902).
Pulmonary Congestion.
Congestion of the lungs typifies that observed elsewhere in the organism, and may, therefore, be divided into two classes: active and passive.
Active Pulmonary Congestion. — SYMPTOMS.—The symptoms vary with the intensity of the congestion and the amount of lung-tissue involved. Dysp ncea, cough, frothy expectoration, local ized pain, wheezing, and accelerated breathing are usually observed; occa sionally the expectoration is tinged with blood. In rare cases there is active pul monary hemorrhage, followed by death (Devergie). All these symptoms, ac cording to Ball, may be found in pul monary congestion of malarial and gouty origin. Death may also occur as the re sult of asphyxia, brought on by the me chanical blocking of the tubes by excess of secretion (Musgrave). The tempera ture rarely surpasses 100° F., and the pulse is tense and bounding. In favor able cases defervescence usually begins twenty-four to thirty-six hours after the onset of the active symptoms.
Both lungs are usually involved, and in mild cases the hyperemia gives rise to appreciable signs only at the base. Fine fremitus may be detected; the breath-sounds are unusually audible, the expiration being prolonged and harsh. Moist subcrepitant lines attend the more severe cases, but these are also most evident toward the bases.