a child is born apparently lifeless after a tedious labour measures must be at once adopted to promote efficient expansion of the lungs. It is important, however, that whatever is done should be done with due deliberation and care, avoiding unnecessary hurry or vio lence. In a new-born infant the organs are especially tender, and may be fatally injured by heedless energy. Cases have been met with in which the liver and spleen have been ruptured by an over-zealous practitioner in his haste to promote inflation of the lungs. The chest of a new-born infant is in a state of absolute airlessness; and therefore methods of resus citation which depend for their success upon elastic recoil of the chest walls are without any value. So, also, the method of mouth-to-mouth insufilation, pressing at the same time the larynx backwards against the gullet so as to close the latter passage, fails to introduce air into the lungs. Dr. F. H. Champneys, from a series of elaborate experiments upon the bodies of new-born infants, concludes that the best method of resuscitation is that of Dr. Silvester. The child is laid on his back on a table with a pillow under his shoulders, and the operator standing behind the body grasps the arms above the elbows and everts them. He then in successive movements raises the arms upwards by the side of the child's head ; ex tends them gently upwards and forwards for a few seconds ; then turns them down and presses them gently and firmly for a few moments against the sides of the chest. While this is being done the tongue should be held forwards by an assistant. The movements should be repeated fifteen times in the minute, and should be continued for at least half an hour if no satis factory result be previously obtained.
M. Greult advocates placing the infant in water as hot as the hand can bear—which be finds to be about 113° F.—and employing artificial res piration while the child remains in the bath. He relates the case of a primipara who after a tedious labour was delivered by forceps. The infant, when born, was breathless, cold, with scarcely any movement of the heart and but feeble pulsation in the cord. The child was at once placed
in water which felt burning hot to the hand, and artificial respiration was begun. At the end of one minute the skin reddened, and a slight move ment of the chest indicated the beginning of respiration. At the end of two minutes the child began to cry, to breathe, and to move his limbs.
In cases where the infant breathes, but is evidently labouring under imperfect expansion of the lungs, he should be warmly covered or even wrapped in cotton wool, and kept perfectly quiet in a room heated to a tem perature of 70° or 75.° The best position is that recommended by the late Dr. C. D. Meigs, viz., upon the right side with the head and shoulders raised at an angle of 45°. If the patient cannot suck he should be fed with breast milk or some efficient substitute, as directed elsewhere (see page 603). The food must be given with the syringe and elastic tube (see page 15). Stimulants are indispensable. Five drops of brandy can be given in a syringeful of the food every two, three, or four hours, or the child may be fed with white wine whey. If the lividity increases and other unfavour-' able signs are noticed, attempts should be made to force the child to cry or gasp by slapping the chest with the corner of a towel wetted with cold water. Emetics are also useful in freeing the tubes of mucus and forcing the patient to respire deeply. Sulphate of copper (a quarter of a grain in a teaspoonful of water) is the best form in which they can be given. Emetics, however, must not be used if the child is very feeble.
Stimulating embrocations rubbed into the chest are often of service, and immersion in a strong mustard bath (one ounce of mustard to each gallon of water) until the skin becomes very red is a stimulant of very powerful efficacy. The internal administration of stimulants should be continued as long as the child is able to swallow. Unfortunately in bad cases the results of all these measures are far from encouraging.