Thursday, October 05, 2017

Benjamin Pugh's air-pipe: If you can't get a breech baby out, get the air in

English obstetrician Benjamin Pugh (1715-1798) is best known for inventing curved obstetric forceps and for his 1754 book A Treatise of Midwifery (PDF). He is less well known for innovating two ways to bring oxygen to a breech baby with a trapped after-coming head.

Pugh first created a flexible curved air-pipe, which would be inserted into the baby's mouth to the larynx. He next innovation was to create an airspace by manipulating the soft tissues inside the baby's mouth, with no need for the air-pipe.

Below is an excerpt from Benjamin Pugh: the air-pipe and neonatal resuscitation (PDF) by Thomas F. Baskett in Resuscitation May 2000;44(3): 153-155.


Although it has received less notice [than his curved forceps], Benjamin Pugh made a considerable contribution to neonatal resuscitation. In his Treatise he describes and illustrates his air-pipe (Fig. 2):
‘‘The air-pipe, as a big as a swan’s quill in the inside, ten inches long, is made of a small common wire, turned very close (in the manner wire-springs are made) will turn any way; and covered with thin soft leather, one end is introduced with the palm of the hand, and between the fingers that are in the child’s mouth, as far as the larynx, the other end external.’’
Pugh initially advocated the use of his air-pipe in cases of breech extraction during delay in delivery of the after-coming head. He used the air-pipe in the manner quoted above as ‘‘I found many children were lost in this situation, for want of air…’’ Pugh then described an alternative method which he had developed making the use of his air-pipe rarely necessary:
‘‘You must then introduce the fingers of your left hand into the vagina, under the child’s breast, and put the first and second fingers into the child’s mouth pretty far, so far, however, that you are able to press down the child’s tongue in such a manner that by keeping your hand hollow, and pressing it upon the mother’s rectum, the air may have access to the larynx, you will soon perceive the thorax expand, as the air gets into the lungs.’’
Pugh emphasised the risk of asphyxia to the fetus during delivery of the after-coming head of the breech saying ‘‘…every operator must know there is difficulty, and grave danger of losing the child by its stay in the passage; by my method of giving the child air, I have saved great numbers of childrens’ lives, which otherwise would have died’’. Furthermore, Pugh goes on to give a remarkable early description of mouth-to-mouth respiration.
‘‘If the child does not breath immediately upon delivery, which sometimes it will not, especially if it has taken air in the womb; wipe its mouth, and press your mouth to the child’s, at the same time pinching the nose with your thumb and finger, to prevent the air escaping; inflate the lungs, rubbing before the fire: by which method I have saved many.’’
Image from Baskett 2000


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