ON

ARTIFICIAL RESPIRATION IN STILL

BORN CHILDREN.

THE AMOUNT OF VENTILATION SECURED BY DIFFERENT METHODS.

AN EXPERIMENTAL INQUIRY.

BY

FRANCIS HENRY CHAMPNEYS, M.A., M.B. OXON., M.R.C.P., F.L.S.,

ASSISTANT LECTURER ON MIDWIFERY, ETC., AT, AND ASSISTANT OBSTETRIC PHYSICIAN TO, ST. GEORGE'S HOSPITAL.

(Received October 4th-Read November 23rd, 1880.)

is

Preface.

The question whether a new-born child shall live or die a matter of so great importance that no apology is needed for such an investigation as is here detailed; the answer to this question not uncommonly depends upon the success or failure of artificial respiration.

In spite of the importance of the subject, nothing is accurately known with regard to it, and even good textbooks on midwifery pass over it superficially.

It is not proposed to deal at once with the whole matter, which is far too large for summary treatment; this object

will probably be better attained by dividing the subject and treating each division in detail.

The present inquiry deals solely with the question, "What relative amount of air is each of the various methods capable of introducing into the lungs of a newborn child which has never breathed ?" This ques

tion is as yet unanswered; for the various committees which have investigated the main question have hitherto confined their attention to adults, and even the interesting experiments of Behm, which were performed on six new-born children, dealt with children which had not breathed in three cases only, in one of which the experiments failed-a point which seems to have affected his results.

The present investigation, being solely experimental, elucidates many points in the physiology of the respiration of new-born children.

These experiments, dealing as they do with children in whom (for instance) the circulation is not proceeding, no doubt require translation into terms of children in whom the circulation has not yet ceased.

On the other hand, they eliminate the influence of reflex action, a most important matter where methods are to be rigidly tested, and practically of great moment where the children are in the stage of pale (flabby) asphyxia, in which reflex action is abolished, and which includes all cases of real difficulty.

This question of the stage of asphyxia is a point on which far too little stress has been laid, the facts being that almost any form of irritation may be sufficient to excite inspiratory efforts in a case of the first (livid) stage of asphyxia, whereas in the second (pale) stage, not only can reflex action not be relied on, but all forms of irritation are simply useless and waste time.

It is curious to read the correspondence which has followed the introduction of each new method of artificial respiration, the writers kindly hastening to contribute their mite of evidence in favour of the method, in the form of cases absolutely without any trustworthy details

of the stage of asphyxia, and therefore absolutely worthless.

It may be perfectly true that a child can be recovered in select cases either by slapping the nates or by Silvester's method, but to put the two methods together is unphilosophical and likely to obscure rather than to elucidate the question. On the other hand, it is certain that in the only important class of cases slapping and all other forms of irritation are simple waste of time.

Many of the accounts with which the papers have been repeatedly inundated, relate to cases which would probably have recovered if simply let alone.

In order to establish a numerical superiority with regard to any one method according to this system, it would only be necessary to apply it to all children born (an argument which applies to the frequent use of the forceps).

The desiderata of a method of artificial respiration are summarised by Behm as (a) ventilation of the lungs, (b) excitation of the circulation, (c) removal of foreign bodies from the air passages. Of these, only the first is here

considered.

It has been thought best to give a description of each method from the original source, as even the common methods are most inaccurately known.

It is not, for instance, an edifying spectacle to see one surgeon leaning his whole weight on a patient's abdomen at the same time as another surgeon elevates the arms, in the belief that Silvester's method is being pursued.

No details which secure even a small excess of ventilation of the lungs are unimportant, and a consideration of such details is included in this inquiry.

The number of bodies experimented on is twenty-six of which twenty have been used for the investigation of this portion of the subject.

The experiments were begun January 5th, 1878, and ended July 5th, 1880.

All the bodies used were those of children who had

never breathed, both in order to keep within the law and also to procure uniform material for investigation.

It will be pointed out that the chest of a child which has breathed differs essentially from one which has never breathed.

It must be observed that a source of error exists in the order followed in the experiment, the subsequent experiments usually succeeding better than the earlier ones, from increasing ventilation of the lungs.

This error has been eliminated as much as possible by varying the order, and by repeating experiments after the lungs have been shown to have become expanded.

Another error exists in the stretching of the pectoral muscles which is liable to occur in Schultze's and Silvester's methods, especially the modifications of the latter.

The following methods have been employed:

1. Marshall Hall.

2. Howard.

3. Silvester.

4. Pacini.

5. Bain.

6. Schücking.

7. Schüller.

8. Schroeder.

9. Schultze.

They may be classified according to the principle on which they depend.

Classification of methods of manipulation according to their mode of action with regard to ventilation of the lungs.

1. Marshall Hall (Lancet,' 1856, March 1, p. 229, "On a New Mode of Effecting Artificial Respiration," by Marshall Hall, M.D., F.R.S., and April 12th, p. 393, Asphyxia, its Rationale and Treatment.") "Let the patient be placed in the prone position, the head and neck being preserved in their proper place. The tongue