The Book of Household Management Part 264

THE MONTHLY NURSE.

2429. The choice of a monthly nurse is of the utmost importance; and in the case of a young mother with her first child, it would be well for her to seek advice and counsel from her more experienced relatives in this matter. In the first place, the engaging a monthly nurse in good time is of the utmost importance, as, if she be competent and clever, her services will be sought months beforehand; a good nurse having seldom much of her time disengaged. There are some qualifications which it is evident the nurse should possess: she should be scrupulously clean and tidy in her person; honest, sober, and noiseless in her movements; should possess a natural love for children, and have a strong nerve in case of emergencies. Snuff-taking and spirit-drinking must not be included in her habits; but these are happily much less frequent than they were in former days.

2430. Receiving, as she often will, instructions from the doctor, she should bear these in mind, and carefully carry them out. In those instances where she does not feel herself sufficiently informed, she should ask advice from the medical man, and not take upon herself to administer medicines, &c., without his knowledge.

2431. A monthly nurse should be between 30 and 50 years of age, sufficiently old to have had a little experience, and yet not too old or infirm to be able to perform various duties requiring strength and bodily vigour. She should be able to wake the moment she is called,--at any hour of the night, that the mother or child may have their wants immediately attended to. Good temper, united to a kind and gentle disposition, is indispensable; and, although the nurse will frequently have much to endure from the whims and caprices of the invalid, she should make allowances for these, and command her temper, at the same time exerting her authority when it is necessary.

2432. What the nurse has to do in the way of cleaning and dusting her lady's room, depends entirely on the establishment that is kept. Where there are plenty of servants, the nurse, of course, has nothing whatever to do but attend on her patient, and ring the bell for anything she may require. Where the number of domestics is limited, she should not mind keeping her room in order; that is to say, sweeping and dusting it every morning. If fires be necessary, the housemaid should always clean the grate, and do all that is wanted in that way, as this, being rather dirty work, would soil the nurse's dress, and unfit her to approach the bed, or take the infant without soiling its clothes. In small establishments, too, the nurse should herself fetch things she may require, and not ring every time she wants anything; and she must, of course, not leave her invalid unless she sees everything is comfortable; and then only for a few minutes. When down stairs, and in company with the other servants, the nurse should not repeat what she may have heard in her lady's room, as much mischief may be done by a gossiping nurse.

As in most houses the monthly nurse is usually sent for a few days before her services may be required, she should see that all is in readiness; that there be no bustle and hurry at the time the confinement takes place. She should keep two pairs of sheets thoroughly aired, as well as night-dresses, flannels, &c. &c. All the things which will be required to dress the baby the first time should be laid in the basket in readiness, in the order in which they are to be put on; as well as scissors, thread, a few pieces of soft linen rag, and two or three flannel squares. If a berceaunette is to be used immediately, the nurse should ascertain that the mattresses, pillow, &c. are all well aired; and if not already done before she arrives, she should a.s.sist in covering and tr.i.m.m.i.n.g it, ready for the little occupant. A monthly nurse should be handy at her needle, as, if she is in the house some time before the baby is born, she will require some work of this sort; to occupy her time. She should also understand the making-up of little caps, although we can scarcely say this is one of the nurse's duties. As most children wear no caps, except out of doors, her powers in this way will not be much taxed.

2433. A nurse should endeavour to make her room as cheerful as possible, and always keep it clean and tidy. She should empty the chamber utensils as soon as used, and on no account put things under the bed. Soiled baby's napkins should be rolled up and put into a pan, when they should be washed out every morning, and hung out to dry: they are then in a fit state to send to the laundress; and should, on no account, be left dirty, but done every morning in this way. The bedroom should be kept rather dark, particularly for the first week or ten days; of a regular temperature, and as free as possible from draughts, at the same time well ventilated and free from unpleasant smells.

2434. The infant during the month must not be exposed to strong light, or much air; and in carrying it about the pa.s.sages, stairs, &c., the nurse should always have its head-flannel on, to protect the eyes and ears from the currents of air. For the management of children, we must refer our readers to the following chapters; and we need only say, in conclusion, that a good nurse should understand the symptoms of various ills incident to this period, as, in all cases, prevention is better than cure. As young mothers with their first baby are very often much troubled at first with their b.r.e.a.s.t.s, the nurse should understand the art of emptying them by suction, or some other contrivance. If the b.r.e.a.s.t.s are kept well drawn, there will be but little danger of inflammation; and as the infant at first cannot take all that is necessary, something must be done to keep the inflammation down. This is one of the greatest difficulties a nurse has to contend with, and we can only advise her to be very persevering, to rub the b.r.e.a.s.t.s well, and to let the infant suck as soon and as often as possible, until they get in proper order.

THE WET-NURSE.

2435. We are aware that, according to the opinion of some ladies, there is no domestic theme, during a certain period of their married lives, more fraught with vexation and disquietude than that ever-fruitful source of annoyance, "the Nurse;" but, as we believe, there are thousands of excellent wives and mothers who pa.s.s through life without even a temporary embroglio in the kitchen, or suffering a state of moral hectic the whole time of a nurse's empire in the nursery or bedroom. Our own experience goes to prove, that although many unqualified persons palm themselves off on ladies as fully competent for the duties they so rashly and dishonestly undertake to perform, and thus expose themselves to ill-will and merited censure, there are still very many fully equal to the legitimate exercise of what they undertake; and if they do not in every case give entire satisfaction, some of the fault,--and sometimes a great deal of it,--may be honestly placed to the account of the ladies themselves, who, in many instances, are so impressed with the propriety of their own method of performing everything, as to insist upon the adoption of _their_ system in preference to that of the nurse, whose plan is probably based on a comprehensive forethought, and rendered perfect in all its details by an ample experience.

2436. In all our remarks on this subject, we should remember with gentleness the order of society from which our nurses are drawn; and that those who make their duty a study, and are termed professional nurses, have much to endure from the caprice and egotism of their employers; while others are driven to the occupation from the laudable motive of feeding their own children, and who, in fulfilling that object, are too often both selfish and sensual, performing, without further interest than is consistent with their own advantage, the routine of customary duties.

2437. Properly speaking, there are two nurses,--the nurse for the mother and the nurse for the child, or, the monthly and the wet nurse. Of the former we have already spoken, and will now proceed to describe the duties of the latter, and add some suggestions as to her age, physical health, and moral conduct, subjects of the utmost importance as far as the charge intrusted to her is concerned, and therefore demanding some special remarks.

2438. When from illness, suppression of the milk, accident, or some natural process, the mother is deprived of the pleasure of rearing her infant, it becomes necessary at once to look around for a fitting subst.i.tute, so that the child may not suffer, by any needless delay, a physical loss by the deprivation of its natural food. The first consideration should be as regards age, state of health, and temper.

2439. The age, if possible, should not be less than twenty nor exceed thirty years, with the health sound in every respect, and the body free from all eruptive disease or local blemish. The best evidence of a sound state of health will be found in the woman's clear open countenance, the ruddy tone of the skin, the full, round, and elastic state of the b.r.e.a.s.t.s, and especially in the erectile, firm condition of the nipple, which, in all unhealthy states of the body, is pendulous, flabby, and relaxed; in which case, the milk is sure to be imperfect in its organization, and, consequently, deficient in its nutrient qualities.

Appet.i.te is another indication of health in the suckling nurse or mother; for it is impossible a woman can feed her child without having a corresponding appet.i.te; and though inordinate craving for food is neither desirable nor necessary, a natural vigour should be experienced at meal-times, and the food taken should be antic.i.p.ated and enjoyed.

2440. Besides her health, the moral state of the nurse is to be taken into account, or that mental discipline or principle of conduct which would deter the nurse from at any time gratifying her own pleasures and appet.i.tes at the cost or suffering of her infant charge.

2441. The conscientiousness and good faith that would prevent a nurse so acting are, unfortunately, very rare; and many nurses, rather than forego the enjoyment of a favourite dish, though morally certain of the effect it will have on the child, will, on the first opportunity, feed with avidity on fried meats, cabbage, cuc.u.mbers, pickles, or other crude and injurious aliments, in defiance of all orders given, or confidence reposed in their word, good sense, and humanity. And when the infant is afterwards racked with pain, and a night of disquiet alarms the mother, the doctor is sent for, and the nurse, covering her dereliction by a falsehood, the consequence of her gluttony is treated as a disease, and the poor infant is dosed for some days with medicines, that can do it but little if any good, and, in all probability, materially r.e.t.a.r.d its physical development. The selfish nurse, in her ignorance, believes, too, that as long as she experiences no admonitory symptoms herself, the child cannot suffer; and satisfied that, whatever is the cause of its screams and plunges, neither she, nor what she had eaten, had anything to do with it, with this flattering a.s.surance at her heart, she watches her opportunity, and has another luxurious feast off the proscribed dainties, till the increasing disturbance in the child's health, or treachery from the kitchen, opens the eyes of mother and doctor to the nurse's unprincipled conduct. In all such cases the infant should be spared the infliction of medicine, and, as a wholesome corrective to herself, and relief to her charge, a good sound dose administered to the nurse.

2442. Respecting the diet of the wet-nurse, the first point of importance is to fix early and definite hours for every meal; and the mother should see that no cause is ever allowed to interfere with their punctuality. The food itself should be light, easy of digestion, and simple. Boiled or roast meat, with bread and potatoes, with occasionally a piece of sago, rice, or tapioca pudding, should const.i.tute the dinner, the only meal that requires special comment; broths, green vegetables, and all acid or salt foods, must be avoided. Fresh fish, once or twice a week, may be taken; but it is hardly sufficiently nutritious to be often used as a meal. If the dinner is taken early,--at one o'clock,--there will be no occasion for luncheon, which too often, to the injury of the child, is made the cover for a first dinner. Half a pint of stout, with a Reading biscuit, at eleven o'clock, will be abundantly sufficient between breakfast at eight and a good dinner, with a pint of porter at one o'clock. About eight o'clock in the evening, half a pint of stout, with another biscuit, may be taken; and for supper, at ten or half-past, a pint of porter, with a slice of toast or a small amount of bread and cheese, may conclude the feeding for the day.

2443. Animal food once in twenty-four hours is quite sufficient. All spirits, unless in extreme cases, should be avoided; and wine is still more seldom needed. With a due quant.i.ty of plain digestible food, and the proportion of stout and porter ordered, with early hours and regularity, the nurse will not only be strong and healthy herself, but fully capable of rearing a child in health and strength. There are two points all mothers, who are obliged to employ wet-nurses, should remember, and be on their guard against. The first is, never to allow a nurse to give medicine to the infant on her own authority: many have such an infatuated idea of the _healing excellence_ of castor-oil, that they would administer a dose of this disgusting grease twice a week, and think they had done a meritorious service to the child. The next point is, to watch carefully, lest, to insure a night's sleep for herself, she does not dose the infant with G.o.dfrey's cordial, syrup of poppies, or some narcotic potion, to insure tranquillity to the one and give the opportunity of sleep to the other. The fact that scores of nurses keep secret bottles of these deadly syrups, for the purpose of stilling their charges, is notorious; and that many use them to a fearful extent, is sufficiently patent to all.

2444. It therefore behoves the mother, while obliged to trust to a nurse, to use her best discretion to guard her child from the unprincipled treatment of the person she must, to a certain extent, depend upon and trust; and to remember, in all cases, rather than resort to castor-oil or sedatives, to consult a medical man for her infant in preference to following the counsel of her nurse.

THE REARING, MANAGEMENT, AND DISEASES OF INFANCY AND CHILDHOOD.

CHAPTER XLII.

Physiology of Life, as ill.u.s.trated by Respiration, Circulation, and Digestion.

2445. The infantine management of children, like the mother's love for her offspring, seems to be born with the child, and to be a direct intelligence of Nature. It may thus, at first sight, appear as inconsistent and presumptuous to tell a woman how to rear her infant as to instruct her in the manner of loving it. Yet, though Nature is unquestionably the best nurse, Art makes so admirable a foster-mother, that no sensible woman, in her novitiate of parent, would refuse the admonitions of art, or the teachings of experience, to consummate her duties of nurse. It is true that, in a civilized state of society, few young wives reach the epoch that makes them mothers without some insight, traditional or practical, into the management of infants: consequently, the cases wherein a woman is left to her own unaided intelligence, or what, in such a case, may be called instinct, and obliged to trust to the promptings of nature alone for the well-being of her child, are very rare indeed. Again, every woman is not gifted with the same physical ability for the hara.s.sing duties of a mother; and though Nature, as a general rule, has endowed all female creation with the attributes necessary to that most beautiful and, at the same time, holiest function,--the healthy rearing of their offspring,--the cases are sufficiently numerous to establish the exception, where the mother is either physically or socially incapacitated from undertaking these most pleasing duties herself, and where, consequently, she is compelled to trust to advent.i.tious aid for those natural benefits which are at once the mother's pride and delight to render to her child.

2446. In these cases, when obliged to call in the services of hired a.s.sistance, she must trust the dearest obligation of her life to one who, from her social sphere, has probably notions of rearing children diametrically opposed to the preconceived ideas of the mother, and at enmity with all her sentiments of right and prejudices of position.

2447. It has justly been said--we think by Hood--that the children of the poor are not brought up, but _dragged up_. However facetious this remark may seem, there is much truth in it; and that children, reared in the reeking dens of squalor and poverty, live at all, is an apparent anomaly in the course of things, that, at first sight, would seem to set the laws of sanitary provision at defiance, and make it appear a perfect waste of time to insist on pure air and exercise as indispensable necessaries of life, and especially so as regards infantine existence.

2448. We see elaborate care bestowed on a family of children, everything studied that can tend to their personal comfort,--pure air, pure water, regular ablution, a dietary prescribed by art, and every precaution adopted that medical judgment and maternal love can dictate, for the well-being of the parents' hope; and find, in despite of all this care and vigilance, disease and death invading the guarded treasure. We turn to the foetor and darkness that, in some obscure court, attend the robust brood who, coated in dirt, and with mud and refuse for playthings, live and thrive, and grow into manhood, and, in contrast to the pale face and flabby flesh of the aristocratic child, exhibit strength, vigour, and well-developed frames, and our belief in the potency of the life-giving elements of air, light, and cleanliness receives a shock that, at first sight, would appear fatal to the implied benefits of these, in reality, all-sufficient attributes of health and life.

2449. But as we must enter more largely on this subject hereafter, we shall leave its consideration for the present, and return to what we were about to say respecting trusting to others' aid in the rearing of children. Here it is that the young and probably inexperienced mother may find our remarks not only an a.s.sistance but a comfort to her, in as far as, knowing the simplest and best system to adopt, she may be able to instruct another, and see that her directions are fully carried out.

2450. The human body, materially considered, is a beautiful piece of mechanism, consisting of many parts, each one being the centre of a system, and performing its own vital function irrespectively of the others, and yet dependent for its vitality upon the harmony and health of the whole. It is, in fact, to a certain extent, like a watch, which, when once wound up and set in motion, will continue its function of recording true time only so long as every wheel, spring, and lever performs its allotted duty, and at its allotted time; or till the limit that man's ingenuity has placed to its existence as a moving automaton has been reached, or, in other words, till it has run down.

2451. What the key is to the mechanical watch, air is to the physical man. Once admit air into the mouth and nostrils, and the lungs expand, the heart beats, the blood rushes to the remotest part of the body, the mouth secretes saliva, to soften and macerate the food; the liver forms its bile, to separate the nutriment from the digested aliment; the kidneys perform their office; the eye elaborates its tears, to facilitate motion and impart that glistening to the orb on which depends so much of its beauty; and a dewy moisture exudes from the skin, protecting the body from the extremes of heat and cold, and sharpening the perception of touch and feeling. At the same instant, and in every part, the arteries, like innumerable bees, are everywhere laying down layers of muscle, bones, teeth, and, in fact, like the coral zoophyte, building up a continent of life and matter; while the veins, equally busy, are carrying away the _debris_ and refuse collected from where the zoophyte arteries are building,--this refuse, in its turn, being conveyed to the liver, there to be converted into bile.

2452. All these--and they are but a few of the vital actions constantly taking place--are the instant result of one gasp of life-giving air. No subject can be fraught with greater interest than watching the first spark of life, as it courses with electric speed "through all the gates and alleys" of the soft, insensate body of the infant. The effect of air on the new-born child is as remarkable in its results as it is wonderful in its consequence; but to understand this more intelligibly, it must first be remembered that life consists of the performance of _three_ vital functions--RESPIRATION, CIRCULATION, and DIGESTION. The lungs digest the air, taking from it its most nutritious element, the _oxygen_, to give to the impoverished blood that circulates through them. The stomach digests the food, and separates the nutriment--_chyle_--from the aliment, which it gives to the blood for the development of the frame; and the blood, which is understood by the term circulation, digests in its pa.s.sage through the lungs the nutriment--_chyle_--to give it quant.i.ty and quality, and the _oxygen_ from the air to give it vitality. Hence it will be seen, that, speaking generally, the three vital functions resolve themselves into one,--DIGESTION; and that the lungs are the primary and the most important of the vital organs; and respiration, the first in fact, as we all know it is the last in deed, of all the functions performed by the living body.

THE LUNGS.--RESPIRATION.

2453. The first effect of air on the infant is a slight tremor about the lips and angles of the mouth, increasing to twitchings, and finally to a convulsive contraction of the lips and cheeks, the consequence of sudden cold to the nerves of the face. This spasmodic action produces a gasp, causing the air to rush through the mouth and nostrils, and enter the windpipe and upper portion of the flat and contracted lungs, which, like a sponge partly immersed in water, immediately expand. This is succeeded by a few faint sobs or pants, by which larger volumes of air are drawn into the chest, till, after a few seconds, and when a greater bulk of the lungs has become inflated, the breast-bone and ribs rise, the chest expands, and, with a sudden start, the infant gives utterance to a succession of loud, sharp cries, which have the effect of filling every cell of the entire organ with air and life. To the anxious mother, the first voice of her child is, doubtless, the sweetest music she ever heard; and the more loudly it peals, the greater should be her joy, as it is an indication of health and strength, and not only shows the perfect expansion of the lungs, but that the process of life has set in with vigour. Having welcomed in its own existence, like the morning bird, with a shrill note of gladness, the infant ceases its cry, and, after a few short sobs, usually subsides into sleep or quietude.

2454. At the same instant that the air rushes into the lungs, the valve, or door between the two sides of the heart-and through which the blood had previously pa.s.sed-is closed and hermetically sealed, and the blood taking a new course, bounds into the lungs, now expanded with air, and which we have likened to a wetted sponge, to which they bear a not unapt affinity, air being subst.i.tuted for water. It here receives the _oxygen_ from the atmosphere, and the _chyle_, or white blood, from the digested food, and becomes, in an instant, arterial blood, a vital principle, from which every solid and fluid of the body is constructed. Besides the lungs, Nature has provided another respiratory organ, a sort of supplemental lung, that, as well as being a covering to the body, _in_spires air and _ex_pires moisture;--this is the cuticle, or skin; and so intimate is the connection between the skin and lungs, that whatever injures the first, is certain to affect the latter.

2455. _Hence the difficulty of breathing experienced after scalds or burns on the cuticle, the cough that follows the absorption of cold or damp by the skin, the oppressed and laborious breathing experienced by children in all eruptive diseases, while the rash is coming to the surface, and the hot, dry skin that always attends congestion of the lungs, and fever._

2456. The great practical advantage derivable from this fact is, the knowledge that whatever relieves the one benefits the other. Hence, too, the great utility of hot baths in all affections of the lungs or diseases of the skin; and the reason why exposure to cold or wet is, in nearly all cases, followed by tightness of the chest, sore throat, difficulty of breathing, and cough. These symptoms are the consequence of a larger quant.i.ty of blood than is natural remaining in the lungs, and the cough is a mere effort of Nature to throw off the obstruction caused by the presence of too much blood in the organ of respiration.

The hot bath, by causing a larger amount of blood to rush suddenly to the skin, has the effect of relieving the lungs of their excess of blood, and by equalizing the circulation, and promoting perspiration from the cuticle, affords immediate and direct benefit, both to the lungs and the system at large.

THE STOMACH--DIGESTION.

2457. The organs that either directly or indirectly contribute to the process of digestion are, the mouth, teeth, tongue, and gullet, the stomach, small intestines, the pancreas, the salivary glands, and the liver. Next to respiration, digestion is the chief function in the economy of life, as, without the nutritious fluid digested from the aliment, there would be nothing to supply the immense and constantly recurring waste of the system, caused by the activity with which the arteries at all periods, but especially during infancy and youth, are building up the frame and developing the body. In infancy (the period of which our present subject treats), the series of parts engaged in the process of digestion may be reduced simply to the stomach and liver, or rather its secretion,--the bile. The stomach is a thick muscular bag, connected above with the gullet, and, at its lower extremity, with the commencement of the small intestines. The duty or function of the stomach is to secrete from the arteries spread over its inner surface, a sharp acid liquid called the _gastric_ juice; this, with a due mixture of saliva, softens, dissolves, and gradually digests the food or contents of the stomach, reducing the whole into a soft pulpy ma.s.s, which then pa.s.ses into the first part of the small intestines, where it comes in contact with the bile from the gall-bladder, which immediately separates the digested food into two parts, one is a white creamy fluid called chyle, and the absolute concentration of all nourishment, which is taken up by proper vessels, and, as we have before said, carried directly to the heart, to be made blood of, and vitalized in the lungs, and thus provide for the wear and tear of the system. It must be here observed that the stomach can only digest solids, for fluids, being incapable of that process, can only be _absorbed_; and without the result of digestion, animal, at least human life, could not exist. Now, as Nature has ordained that infantine life shall be supported on liquid aliment, and as, without a digestion the body would perish, some provision was necessary to meet this difficulty, and that provision was found in the nature of the liquid itself, or in other words, THE MILK.

The process of making cheese, or fresh curds and whey, is familiar to most persons; but as it is necessary to the elucidation of our subject, we will briefly repeat it. The internal membrane, or the lining coat of a calf's stomach, having been removed from the organ, is hung up, like a bladder, to dry; when required, a piece is cut off, put in a jug, a little warm water poured upon it, and after a few hours it is fit for use; the liquid so made being called _rennet_. A little of this rennet, poured into a basin of warm milk, at once coagulates the greater part, and separates from it a quant.i.ty of thin liquor, called _whey_. This is precisely the action that takes place in the infant's stomach after every supply from the breast. The cause is the same in both cases, the acid of the gastric juice in the infant's stomach immediately converting the milk into a soft cheese. It is gastric juice, adhering to the calf's stomach, and drawn out by the water, forming rennet, that makes the curds in the basin. The cheesy substance being a solid, at once undergoes the process of digestion, is separated into _chyle_ by the bile, and, in a few hours, finds its way to the infant's heart, to become blood, and commence the architecture of its little frame. This is the simple process of a baby's digestion:-milk converted into cheese, cheese into _chyle_, chyle into blood, and blood into flesh, bone, and tegument-how simple is the cause, but how sublime and wonderful are the effects!

2458. We have described the most important of the three functions that take place in the infant's body-respiration and digestion; the third, namely, circulation, we hardly think it necessary to enter on, not being called for by the requirements of the nurse and mother; so we shall omit its notice, and proceed from theoretical to more practical considerations. Children of weakly const.i.tutions are just as likely to be born of robust parents, and those who earn their bread by toil, as the offspring of luxury and affluence; and, indeed, it is against the ordinary providence of Nature to suppose the children of the hardworking and necessitous to be hardier and more vigorous than those of parents blessed with ease and competence.

2459. All children come into the world in the same imploring helplessness, with the same general organization and wants, and demanding either from the newly-awakened mother's love, or from the memory of motherly feeling in the nurse, or the common appeals of humanity in those who undertake the earliest duties of an infant, the same a.s.sistance and protection, and the same fostering care.

THE INFANT.

2460. We have already described the phenomena produced on the new-born child by the contact of air, which, after a succession of muscular twitchings, becomes endowed with voice, and heralds its advent by a loud but brief succession of cries. But though this is the general rule, it sometimes happens (from causes it is unnecessary here to explain) that the infant does not cry, or give utterance to any audible sounds, or if it does, they are so faint as scarcely to be distinguished as human accents, plainly indicating that life, as yet, to the new visitor, is neither a boon nor a blessing; the infant being, in fact, in a state of suspended or imperfect vitality,--a state of _quasi_ existence, closely approximating the condition of a _still-birth_.

2461. As soon as this state of things is discovered, the child should be turned on its right side, and the whole length of the spine, from the head downwards, rubbed with all the fingers of the right hand, sharply and quickly, without intermission, till the quick action has not only evoked heat, but electricity in the part, and till the loud and sharp cries of the child have thoroughly expanded the lungs, and satisfactorily established its life. The operation will seldom require above a minute to effect, and less frequently demands a repet.i.tion. If there is brandy at hand, the fingers before rubbing may be dipped into that, or any other spirit.

2462. There-is another condition of what we may call "mute births,"

where the child only makes short ineffectual gasps, and those at intervals of a minute or two apart, when the lips, eyelids, and fingers become of a deep purple or slate colour, sometimes half the body remaining white, while the other half, which was at first swarthy, deepens to a livid hue. This condition of the infant is owing to the valve between the two sides of the heart remaining open, and allowing the unvitalized venous blood to enter the arteries and get into the circulation.

2463. The object in this case, as in the previous one, is to dilate the lungs as quickly as possible, so that, by the sudden effect of a vigorous inspiration, the valve may be firmly closed, and the impure blood, losing this means of egress, be sent directly to the lungs. The same treatment is therefore necessary as in the previous case, with the addition, if the friction along the spine has failed, of a warm bath at a temperature of about 80, in which the child is to be plunged up to the neck, first cleansing the mouth and nostrils of the mucus that might interfere with the free pa.s.sage of air.