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tion of force in the two halves serves to close it immediately after the first act of aspiration. One need, therefore, suffer no disquieting doubts or uncertainty in regard to the openness of the foramen ovale in the healthy neonatus at term.

In the non-viable child, previous to the seventh month, the valve of Botalli is incomplete and is not a perfect operculum; it cannot thoroughly cover the orifice of the foramen ovale. If the child, therefore, be born without a complete valve, it will probably die from asphyxia, from the mixture of its black and red currents in the systemic ventricle; a child, therefore, whose heart is incomplete is non-viable. Some children born at term appear not to have conformably developed this valve.

A child is rendered non-viable, in consequence of many other faults of development. The astomatous child is non-viable, as is that in which the oesophagus has failed, in part, of its development, rendering the cavity of the stomach inaccessible to aliment. The anencephalous child is non-viable, since important parts of its organization are wholly wanting; the acephalous foetus dies of course. The child is non-viable in which ectopy of important organs, as for example ectopy of the liver and the whole alimentary canal into the root of the umbilical cord, exists; for the cord, being deciduous, must fall off in the course of a few days, leaving the vital organs exposed to inevitable ruin. The child is non-viable in whom large portions of the rectum fail to be developed, although a few examples are met with in which the surgeon, by a dextrous operation, has saved the life of the child laboring under imperforate rectum; probably those that have been thus saved have failed to produce merely a short tractus of that intestine.

Many children perish in the womb from disorders affecting important parts. Doubtless in the early stages of embryonal life, very slight derangements in the structure of the omphalo-mesenteric vessels, or of the duct of the umbilical vesicle, might and do determine the death of the new being. Children also perish in the womb from dis eases affecting parts within the cranium, for the child lives by its nervous mass as truly as the breathing animal does. Diseases of the kidney, and liver, and alimentary apparatus, prove the not unfrequent causes of the death of the child in the womb.

Various affections of the mother produce the death of the child; passions of the mind and physical distempers, to which she is subject, bring it into danger, or destroy its tender existence. Various diseases affecting its umbilical cord; modifications of its placenta, whether as to insufficient magnitude of that organ, or modifications induced by the deposit of calcareous carbonates upon the uterine surface of the

placenta; or the establishment within it of the disease called hydatid degeneration of the organ; or partial detachment of the placenta, serve to destroy the young child before it is born.

The child, when it is driven into the world, is sometimes found unable at once to establish its respiratory life; it lies still and pale, being perfectly motionless; there is little tension of its muscles; if handled, it appears to be flaccid, or, to use a common phrase, limber, like a person who has fainted. If the cord be taken between the finger and thumb, nigh to the navel, the Student will be able to judge whether or not the heart is beating. If the heart is beating, the pulsations will be felt by the finger and thumb by compressing the cord, in which are the two umbilical arteries. If the pulsations are vigorous, and repeated at the rate of about one hundred and forty pulses per minute, no alarm need be felt as to the security of the infant. In a few moments, the diaphragm will receive its nerve-stream; it will descend, compelling the air to enter the lungs, whose embryonal atelectasis is instantly removed by the expansion of the air-cells; the oxygen of the atmospheric air, combining with the blood of the pulmonary circulation, will hasten to the systemic ventricle, which, injecting it into the brain, extricates there a flash of vital force, that irradiates with instant life every nerve fibril in the constitution. This new and powerful infusion of vital force is made manifest by struggles, by cries, by rapid coloration of the surface, and by all the signs that indicate an established respiratory existence. Sometimes the child scarcely cries, or utters a low whining sound. If carefully observed, it will be found to take very short and feeble inspirations. It has not yet had strength of diaphragm to open in full all its air-cells. If the Student should in such a case cause it to cry aloud, by dashing cold water on its breast and face, he might expect a full and powerful act of the diaphragm to open every air-tube and cell of the now perfected lung.

As soon as the child is found fully to have established its respiration, steps should be taken to sever it and remove it from the mother's couch. As before directed, a ligature should be put upon the umbilical cord, at the distance of an inch and a half or two inches from the navel. Tying of the cord is not an indifferent matter, and it is necessary to examine the ligature that may be presented for the purpose before employing it, and it should be strongly jerked between the two hands, in order to test its strength. It ought not to be less than ten or twelve inches in length; a portion of ligature four or five inches long cannot be firmly held, for it becomes slippery in the moistened hands. If it be not of sufficient strength, it may, in tying the first or

second knot, give way, and allow the two hands to separate with violence, which exposes the accoucheur to the risk of tearing the cord out at its root. When the cord is passed around the umbilicus, it should not be tied without taking the greatest care to avoid this sudden separation of the hands that are employed to tie it, upon the pos sible breaking of the ligature. The cord should be ten or twelve inches long, as I have said, so that, being held in the hands and the knot arranged, it can be fastened by separating the radial edges of the hands, rolling them both outwards in supination, without a direct steady pull. I never think to tie an umbilical cord in any other manner than this, and more particularly as my early experience placed me repeatedly in danger of destroying the child, by suddenly jerking its navel-string, from the breaking of improper ligatures placed in my hands.

In applying the ligature to the umbilical cord, either one or two may be employed. If it should be a twin pregnancy, there surely ought to be two ligatures, lest, if there be a common placenta, the second child should suffer a dangerous loss of blood, from the untied end of the cord. In those cases in which the placenta is known to be detached, and pushed into the os uteri, it is better to have only one ligature, for, in that case, the blood of the placenta is discharged in considerable quantities from the cut extremity of the cord, thus serving to diminish the magnitude of the placental mass very considerably, and enabling the woman to thrust it forth with less effort and less pain than would be otherwise required.

On the other hand, if, before proceeding to the severance of the child, the uterus is found to be still very large, in consequence of containing the placenta in its cavity, it is better to apply a second ligature; by doing this, the Student would restrain the evacuation of the placental blood, and thereby keep the organ fuller, more plump and solid, which would enable the uterus more readily to slip it off from the utero-placental superficies than it could do if the placenta, by the evacuation of all its blood, should become flaccid, like a wet soft sponge.

The child, being removed, should be washed and afterwards dressed. It should be washed in tepid water at all seasons of the year. The body of the new-born child is usually covered with a flaky, unctuous matter or induitus that is insoluble in water, and is not removable by means of soap; it readily incorporates, however, with oil or lard, or the yelks of eggs. One or two yelks of eggs, beaten up and rubbed over the whole surface of the child, suffice to make an emulsion with the white induitus of the child, which is afterwards readily washed

away by means of soap and water; or the whole child should be carefully and thoroughly anointed with a handful of lard, which also incorporates readily with the viscous matter in question, and which is readily washed off afterwards. If the attending nurse is inexperi enced, the Student should direct her to use, not a piece of linen or muslin, but a portion of soft flannel, as the wash-rag for the purpose of cleansing the child's body: either linen or muslin slides over the surface and fails to pick up every portion of the induitus, whereas every particle of it is taken up by means of a wash-rag made of the bit of flannel.

In cold weather, the child should be washed in a warm room, and sufficiently near to the fire; but its surface burns readily; let the Student take heed, therefore, that its body is not exposed to be blistered, as I have seen it blistered, by being held too near an open fire or grate.

As soon as the child is thoroughly washed, a piece of linen, four inches wide and eight inches long, should be doubled to make a square disk; in the centre of this disk, a slit should be made with a pair of scissors-it is best not to cut a round hole in it. Through this slit let the remnant of the navel-string be passed, so as to let the double disk of linen lie upon the belly of the infant; the cord should be laid down flat upon this disk, pointing upwards towards the scrobicle: the linen should next be turned up so as to cover it, the right side of the piece should be turned over the cord towards the left, and the left side of the piece should be turned over covering the right, which will effectually envelop the navel-string, which is all the dressing it can require. The object of this dressing is to receive the discharges which exude from the navel-string, and prevent the cord from adhering to the child's dress, to which, without some such precaution, it would soon become glued, and thus be liable to be torn off earlier than the period at which the natural process would otherwise detach it; there is no other use in dressing the navel-string of which I am aware.

As soon as the cord is thus dressed, the belly-band, which is usually made of a strip of flannel four or five inches in width, should be put over it, and the end, carried around the body, may be pinned either at the back of the child or at the side. After this, the child should have a shirt large enough to come down nearly to the hips. If it is too long, it will be constantly wetted with the urinary discharges. Next comes the petticoat, which is usually, in this country, made of flannel, and which has or has not, according to the taste of the mother, a shoulder strap, but which always has a proper waistband. Some persons do not employ the petticoat, but a good many women still use here the barra

coat from the Portuguese, barra, an ell of cloth. It is a yard of flannel, more or less, of which one end is fastened around the waist, and the other brought up and pinned in front, so as effectually to cover up the lower extremities of the child-a convenient and facile mode of dressing it in cold weather.

The last covering is the frock. I should hardly deem it necessary to mention it here, were it not, in the first place, that I am writing for Students, who ought not to go to the lying-in room without being provided with some information upon particulars which, though they be of minor importance, are not without their influence upon the comfort and safety of his patient and upon his own success and reputation. But, more than this, I mention it, because I desire here to enter my solemn protest against the folly, the stupidity, and I might say the iniquity of the fashion which induces so many persons, possessing in other respects good sense and good education, to dress their new-born children less wisely than an Osage Indian mother, or the most savage Esquimaux. A child that is born does not surely belong, to its parents until it has attained its sixth year; it seems to me that such a child is but a loan on condition of becoming property, provided it be wisely and safely conducted up to the sixth year of its age; for, onehalf of the annual product of child-birth perishes in six years. It can not be that this amazing mortality is an inevitable concomitant of the state of existence, but it must be a result of ignorance and carelessness as to the hygienical conduct of the neonatus and the young child. It is true that a multitude of children are brought into the world endowed with such a feebleness of constitution, or such hereditary depravation of it, as to render protracted existence and maturity impossible; but the population abstracts would find an immense augmentation were a sound discretion to preside over the hygienical manage ment of newly-born children. Now in the United States, from Carolina to Maine, and from the Atlantic board to the western limits of Missouri, Iowa, and Wisconsin, little children are dressed in frocks without sleeves, or having only pretended sleeves, which are really nothing more than shoulder straps, and that, while the backs and bosoms also expose nearly the whole of the thorax. There would be no objec tion to such habits for children born between the 10th of June and the autumnal equinox; it would even be advisable so to dress the summer children, in a climate notorious for its intense light and heat; but to dress the children in the same manner, whether born in June or February, is an imprudence which no power but that of Fashion could compel sensible women to commit. But Fashion has a power that often transcends the dictates of wisdom and of common sense.

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