The author's incubator (Fig. 13) with its latest improvements, can, similarly, be erected very cheaply in either house or clinic. It is divided into a compartment for the child; the heat and moisture gen erator; a water container and heat box. The accompanying diagram makes a detailed description unnecessary. The cubic contents of the incubator is 0.09 cbm., and 4.97 cbm. of air pass through it in the course of an hour, consequently the air changes fifty times hourly.
13esides Schlossmann's electric heated incubator, the one of lluti nel also deserves mention. In view of the danger of infection which has often been attributed to the conveuse, the latter is made of varnished fayence, shaped like a bath tub. The rest of the apparatus_ is very simi lar to the Finkelstein one; the heating appliance being changed every two to three hours.
Several institutions (Children's Hospital, Gratz, St. Anna Children's Hospital. Vienna, and elsewhere) have incubator rooms (sec Fig. 14). These are far superior to the simple incubators and according to the judgment of experienced clinicians are well adapted for use in insti tutions; they can even at times be improvised in private practice, if one has an abundant supply of heaters at command.
The room in which a premature child is kept, with or without a couveuse, should be of an even tempera ture. from about 22°-25° C. (71.5°-77° F.). and should conform to the inexpensive require ments of modern hy giene, at least as far as cleanliness, ventilation. and sunshine are con cerned. The air in the room should be kept sufficiently moist. The temperature in the in cubator must be kept from 26°-2S° C. (79°– S2° F.), at the start; only very small, prema ture children require a higher temperature. It hardly seems practical to keep the tempera ture of the incubator constant, at 25° C. (7° F.) as recommended by Pinard.
If the body temperature is not raised by the above-mentioned temperature of the incubator, the humidity of the air must be increased by placing hot, moist towels in the incubator—"couveuse humide recommended by von Bonnaire and Gagey, by means of which these authors have attained surprising results.
With the slightest signs of overheating (restlessness. sweating,
increased respiration, cyanosis) the body temperature must be reduced, if necessary by removing the child from the incubator.
Hutinel and Delestre make use of the incubator for as short a time as possible, and after maintaining an even temperature from one to two days, recommend the removal of the child from the incubator. Like wise, every acute infection furnishes a contraindication to the use of the incubator. One can use as a substitute for the incubator treatment, heated tubs, hot water bottles, thermophores in the form of heat-pillows (highly praised by Heubner), as well as the electro-thermostat lately put on the market.
In using the above-given meth ods, the breathing air does not be come heated, while, on the other hand, an over-heating of the child, by insufficient radiation of the heat, can readily take place. Neverthe less, the simplest. way is by placing two to four hot water bottles in the bed which must be refilled every two hours. The rectal temperature must be taken regularly so that any stasis of heat, which may cause serious trouble, can be detected.
The U-shaped hot water bot tle, which appears in the accom panying illustration Fig. 15, has proved itself very useful because frequent refilling is unnecessary.
2. Feeding and its technique are particularly important in the ther apy of premature and debilitated children. Above all things mother's milk is desirable. It must. be considered a grave error, if, through any negligence, the opportunity to obtain mother's milk is lightly passed by. This applies in a still greater degree for debilitated chidren (espe cially with hereditary syphilis), whose prognosis actually depends on their being nursed at the breast (Heubner).
The greatest. difficulty is the inability of the premature child to nurse and in private residences it is especially a very difficult task to accustom the child to the breast; in primiparx with poorly secreting breasts or retracted nipples, this is next to impossible. Only the great est patience in expressing and pumping the milk by means of a strong breast-pump, to avoid caking, or still better, the comcomitant nurs ing of a stronger, older infant, will bring the breast into operation.