by W. D. Bizzell.
American Journal of Obstetrics and Diseases of Women and Children 18:179-181, 1885.
Dear Sirs: --
In the November number of your Journal, I notice the report of a case of "Prolonged Asphyxia in the New-Born Babe," reported by Dr. R. D. Gibson, of Youngstown, Ohio. Having just passed through a somewhat similar experience, I am constrained to report it.
On the morning of October 19th, between twelve and one o'clock, I was summoned to Mrs. P., primipara, age about 22, and of a very nervous temperament. Found the first stage of labor well advanced, head in L. O. A. position, pains only moderately frequent and severe. Reassured the patient, and as is my custom during this stage, lay down on a couch across the hall and told the nurse to wake me when there should be signs of desire to bear down. Was awakened at 3:30 A.M., found considerable progress had been made, though the first stage was not completed till about two hours later.
On account of the nervous irritability of the patient, and loss of courage to bear further pain, from about 4:30 till the completion of labor she was allowed at intervals to inhale chloroform; never, however, to complete insensibility, simply quieting and enabling her to rest between pains instead of giving way to useless complaining and wasting nervous energy as she had been doing without it. In all about 3 vi. was given. The membranes were ruptured about a quarter to seven o'clock, and at a quarter to eight the child was born. Half an hour before the delivery, one drachm of Squibb's fld. ext. ergot was given per os. The child was a moderately sized and externally well developed male. The cord was pulsating slowly and rather feebly. As the child did not cry, or give any token of life, or at least of respiration, I removed it from under the cover, allowing the cold air to come in contact with the cutaneous surface, repeatedly slapped and compressed the chest, passed my finger into the fauces, sprinkled the face and chest with cold water, etc., all to no purpose, as there was not the slightest attempt at respiration.
By this time pulsations in the cord had almost entirely ceased, and the cutaneous surface was becoming deeply cyanosed, although the heart was still beating fairly well. Cut the cord, and after allowing a few drachms of dark blood to escape, tied it. Then placed the child in a tub of warm water and again sprinkled the face, had recourse to Sylvester's and Marshall Hall's methods; these not proving satisfactory used the direct, or mouth to mouth, or a combination of this with movement such as I have nowhere seen described. Putting the child in a warm bath which was kept to the requisite temperature by frequent additions of hot water, and placing the tub, a good-sized foot basin, on a stool, the nurse stood at one end and managed the head, the father at one side close to the nurse seized the two hands of the child. Placing my left hand on the posterior portion of the chest near the lower border of the scapula and my right across the lower sternal region in front, the rhythmic movement was accomplished as follows: The child, immersed in the water to the neck, was quickly lifted up partially out of the water, principally by steadying and lifting with my left hand, so that the lower dorsal vertebrae were arched forward, the head at the same instant being fully extended by the nurse who grasped it on either side. At the same instant the father extended the child's arms by the side of its head. At the very instant these maneuvres were completed, I took a short but deep inspiration, and instantly applying my lips to the child's mouth, with a quick expiration completely filled the child's lungs, instantly the hands were brought down, the head forward and the child's body immersed in the water, the choulders and head fell forward, the child being in a semi-sitting posture, and at the same instant the chest was compressed between my two hands, making the act of expiration quite complete. After resting in the water two or three seconds, the rhythmic movement was again completed. Carried out in this manner, ten complete respiratory acts could be accomplished each minute. Under this treatment, the skin assumed its normal color, the heart's action became strong. At intervals we would suspend our efforts and wait a short while to see what nature would do, but invariably the skin became dusky, the heart's action feeble, and we were compelled to resume our artificial respiration. After two hours and a half of persistent work, there was a feeble gasp, and we hoped that nature would triumph and respiration would be established, but after a few gasps we were compelled to again resort to artificial respiration; but now the heart seemed to give way, the skin grew dusky, and all our efforts to restore the balance in the circulation were unavailing and death occurred. I desire especially to call attention to the combined method of artificial respiration we used with so much satisfaction, also the very long time during which we were able to sustain life.
I did not get a post-mortem, so cannot tell exactly what the trouble was. The parents were cousins, and I am inclined to the opinion that the difficulty was the absence of efficient pulmonary circulation.
W. D. Bizzell.