Page:EB1911 - Volume 14.djvu/386

Rh outside air is admitted into the lower chamber at the opposite end, through an aperture (A), and passing over a series of bottles (B) containing warm water, becomes heated. The air is rendered adequately moist by means of a wetted sponge (S) which is placed at the entrance of the lower chamber into the upper. The warmed and moistened air is determined in its direction by the position of the outlet aperture (O), which is situated above and just behind the head of the infant. It contains a helix valve (H) and the rotation of this is an indication that the air is circulating within the incubator.

The child is kept under observation by means of a sliding glass door (G) situated in the upper or roof wall of the incubator. Immediately beneath this, and attached to one of the side walls, is a thermometer (T) which records the temperature of the air in the infant-chamber. The temperature should be maintained at 31° to 32° C. The precise limit of temperature must of course be determined by the condition of the child; the smaller and weaker it is, the higher the temperature must be.

The warm water vessels contain three-quarters of a pint of water and four of them are sufficient to maintain the required temperature, provided that the external air does not fall below 16° C. The vessels are withdrawn and replaced through an entrance to the lower chamber, and which can be opened or closed by a sliding door (D).

The walls of the incubator, with the exception of the glass sliding door, are made of wood 25 millimetres thick.

The apparatus appears to have been successful, if by success is understood the indiscriminate saving of life apart from all other considerations, since the mortality of infants under 2000 grammes has been reduced by about 30%, and about 45% of children who are prematurely born are saved.

Dr Tarnier’s apparatus requires constant attention, and the water in the warm water vessels needs renewing sufficiently often. It is not provided with a temperature regulator and consequently fluctuations of internal temperature, due to external thermal variations, are liable to occur.

In Hearson’s Thermostatic Nurse these drawbacks are to a large extent obviated. This “Nurse” consists fundamentally of an application of the arrangements for heating and moistening the air and for regulating the temperature of Hearson’s chick incubator to Dr Tarnier’s human incubator. As in this latter form, there are two chambers (fig. 14), an upper (A) and a lower (B), connected with each other in the same way as in Tarnier’s apparatus. The upper chamber contains the infant, but the lower is not a heating but a moistening chamber. Through apertures (M) in the bottom of the lower chamber, the external air passes through, and as in the chick incubator it then passes through perforations in the inner cylinder of a water tray (O) and thence over the surface of the water in the tray, through a sheet of wet canvas, to the chamber itself. Hence it passes to the infant chamber and ultimately leaves this through a series of perforations round the top. The air in both chambers is heated by a warm-water tank. This tank forms the partition which divides the incubator into upper and lower chambers and is made of metal. Through the water contained in it, an incoming (R) and an outgoing (R) to the left flue, continuous with each other, pass. These two flues are related to each other as in the chick incubator (see above) and the inlet flue is heated in the same way and the outlet flue discharges similarly. The heat-regulating apparatus is identical with that in the chick incubator, and the thermostatic capsule (S) is placed in the upper chamber, near the head of the infant.

The child is placed in a basket which has perforated walls, and is open above. The basket rests upon two shallow supports (D) situated on the upper surface of the water-tank partition. The child is kept under observation through a glass door in the upper or roof-wall of the incubator.

In Great Britain this apparatus is in use at various hospitals and workhouses throughout the country, and provided there is no great fluctuation of barometric pressure, it maintains a uniform temperature.

Thermo-Regulators or Thermostats. Certain special forms of thermo-regulators, adapted to the requirements of the particular incubators to which they are attached, have already been described. It remains now to describe other forms which are of more general application. Only those kinds will be described which are applicable to incubators. The special forms used for investigations in physical-chemistry are not described. There are various types of thermo-regulators, all of which fall into one of two classes. Either they act through the expansion of a solid, or through that of a liquid. They are so adjusted, that, at a certain temperature, the expansion of the material chosen causes the gas supply to be nearly completely cut off. The gas flame is prevented from being wholly extinguished by means of a small by-pass.

We will first describe those which act through the expansion of a liquid. A very efficient and cheap form is that described by F. J. M. Page in the Journal of the Chemical Society for 1876. The regulator consists of a glass bulb (fig. 15 B), continuous above with a tubular limb (L). At the upper part of the limb is a lateral tubular arm (A) which bends downwards and constitutes the outlet pipe. At the upper extremity of the limb there is a short and much wider tube (T), the lower end of which slides upwards or downwards along it. The upper end of this wider tube is closed by a cork and through a perforation in this a very small glass tube (G) passes downwards into the limb of the regulator to a point a short distance below the exit of the outlet tube. The exact height of the lower aperture of the small tube can be varied by sliding the wider tube up or down along the limb. The by-pass (P) consists of a transverse connexion between the inlet and outlet gas pipes, and the amount of gas which travels through the short circuit thus formed is regulated by means of a stopcock. The by-pass, however, can be formed, as suggested by Schäfer (Practical Histology, 1877, p. 80), by making an extremely small hole in the small inlet tube, a little way above its lower extremity. But unless this hole be small enough, too much gas will be allowed to pass, and a sufficiently low temperature therefore unattainable. The regulator is filled with mercury until the top of the column reaches within in. of the exit of the outlet tube, the bulb is placed in the incubator chamber, and gas is allowed to pass through it. By pushing down the inner inlet tube (G) until its aperture is immersed beneath the mercury, the gas supply is cut off, with the exception of that passing through the by-pass. The stopcock is now turned until only the smallest flame exists. The inlet pipe is then raised again above the mercury, and the flame consequently increases in size. The temperature of the incubator gradually rises, and when the desired degree is reached, the inlet tube is pushed down until the end is just beneath the surface of the mercury. The