A STUDY OF KESPIRATION 225 



Coughing, Sneezing, Choking. In coughing an extra amount 

 of air is first drawn into the lungs and then suddenly expelled 

 through the mouth. We cough when the air passages are 

 irritated by inflammation or by some foreign substance, 

 which the forced expiration often dislodges and removes. 

 Before sneezing there is a deep inspiration, and then the 

 volume of air is usually driven out through the nose. 

 Sneezing is caused by a tickling of the mucous membrane 

 of the nose ; it can be prevented by pressing firmly upon 

 the upper lip beneath the nose. When food gets past the 

 epiglottis into the windpipe, choking results. In cases of 

 this kind the head should be held forward (or downward 

 in case of a child) and sharp blows struck between the 

 shoulders. 



Suffocation. We have learned that the body must be sup- 

 plied continually with oxygen and that its wastes must be 

 constantly removed. If this process is interrupted even for 

 five minutes, fatal results are almost sure to follow. By 

 suf-fo-ca'tion is meant some interference with the process of 

 breathing. Suffocation may be due to inclosure in a small 

 space with a limited supply of oxygen, to the inhaling of 

 illuminating or other gas, or to immersion in water (drown- 

 ing). In any case the patient should be at once brought out 

 into fresh air. If water has entered the air passages, he 

 should be turned face downward and raised by lifting the 

 weight of his body on your hands clasped under his abdomen. 

 In this position the water can flow out of his lungs more 

 easily. If respiration is feeble, cold water should be applied 

 to his face, and his chest should be slapped vigorously. If 

 all these methods fail to restore vitality and if the aid of 

 a physician cannot be immediately secured, artificial respira- 

 tion should be attempted at once. This is accomplished by 

 laying the patient on his back, with a rolled coat or other 

 support beneath his shoulders. His mouth should be open 

 and his tongue drawn out. His arms should then be grasped 

 firmly at the elbows and pulled upward and parallel to each 



