416 APPENDIX O. 



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tiling necessary is to relieve the Blood of carbonic acid. If he 

 have been insensible but a few moments, a smart slap on the 

 shoulders, a dash of water in the face, or tickling the throat, may 

 excite a gasp, and if he gives one he will give another in time, 

 and nothing more need be done; he will soon be restored. The 

 first step in respiration is to place him on the back, with the 

 shoulders, head, and hips a little raised above the loins. The 

 second stop is to secure a free passage for air through the larynx, 

 by seizing the tongue between the fingers, covered with cloth to 

 hold it firmly, and extending it, thus raising the epiglottis, at the 

 same time pressing down the Adam's apple, or larynx, away 

 from the epiglottis. If this does not prove sufficient, let an in- 

 cision admitting the little finger be made in the windpipe just 

 below the larynx (it cannot do harm), and kept open in any 

 convenient way. The third step is to expel air from the lurgs 

 by raising the loins as high as possible without lifting the hips, 

 and then allowing them to sink, which will cause inspiration. 



Let these motions for expiration and inspiration be repeated 

 as often as a person would naturally breathe. Continue the pro- 

 cesses of warming and artificial respiration for not less than 

 three hours, unless signs of animation are previously shown. A 

 case is known where two and one half hours elapsed, and the 

 person now lives; and another, has been observed where, two 

 hours after falling into the water, a person first gave sins of life. 



In case of suffocation by *'moke, gases in a well, etc., the 

 same state exists as in drowning, and the sair.e course is needed. 



If a house is on fire, there will be a strata of pure air near 

 the floor, that may be breathed ; and if a person must go through 

 smoke, he should close the nose that he may not strangle, and 

 if he must brenthe before the smoke is passed, let him put his 

 face to the floor before freeing his nose. Smoke will not pass 

 through a wet handkerchief or other cloth of several thicknesses, 

 but air will. Therefore, if convenient, use it. 



If a person is choked, the food should be drawn out from, or 

 pushed down, the throat, and if a person does not then gasp, he 

 is t-> be treated as drowned. 



Hard substances swallowed are very apt to be refused by the 

 oesophagus, naturally adapted only to receive soft substances, 

 and in its effort to reject them they are sometimes crowded for- 

 ward, under the epiglottis, rind into the larynx, strangling by 

 detention there, or, carried through it, obstruct the pipe below. 

 In the former case, the windpipe must be opened; then proceed 

 as in case of the drowned : in the latter case, the substance must 

 be drawn out, a thing usually difficult to do. Young children 

 should not have, nor older persons hold, in the mouth small hard 

 substances. 



In ulcerations of the throat, or when the nicer breaks, or in 

 case of croup in the larynx, opening the windpipe is sometimes 

 advisable, and the only thing that can save life can do no harm, 

 and should always be assented to nnd encouraged when advised 

 by the physician. 



