322 RESPIRATION 



be taken to eliminate the conditions producing tissue asphyxiation, i.e., 

 to re-establish both respiration and circulation. Artificial respiration in one 

 form or another is the first aid to be given in drowning, and in other types of 

 asphyxiation, since the technique is equally effective after the lungs are 

 emptied of fluid. The method at present most relied upon is that of Schafer 

 which includes both the artificial respiration and indirect heart massage. 

 The procedure to be followed in Schafer' s method in condensed statement 

 is given as follows by Dolley: 



" The patient is rolled upon his belly, the face turned to one side, and the 

 arms are extended as straight forward as possible. The extension of the 

 arms is a very important improvement, introduced by the Commission, on 

 the original Schafer method. The operator kneels straddling the patient's 

 thighs and facing his head; he places his palms on the muscles of the small 

 of the back with the fingers spread over the lowest ribs. Then holding his 

 arms straight, he swings forward so that his weight is gradually brought to 

 bear upon the subject. This should take from two to three seconds, and must 

 not be violent. It compresses both the chest and the abdomen. The result 

 is that not only is the chest compressed from front to back, but the pressure 

 on the abdominal viscera tends to force the diaphragm upward. The air is 

 forced out of the lungs, expiration. The operator then immediately swings 

 back to his starting position. Through their elasticity the chest walls ex- 

 pand and air is inspired. A two-second interval should follow the forced 

 expiration so that the rate is from twelve to fifteen a minute. The method 

 not only accomplishes safely and easily ventilation of the lungs, but it must 

 affect a fair amount of compression and relaxation of the heart, especially 

 in young or thin individuals. This so-called indirect heart massage, which 

 will be more emphasized later, is a valuable stimulant to a failing heart." 

 Artificial respiration should be kept up for from two to four hours. A 

 slight but temporary circulation of the blood may produce a partial oxidation 

 which only very slowly recovers sufficient vital activity to bring the nerve 

 centers up to the automatic and reflex level of activity required. 



Some cases of so-called drowning are in reality death from cardiac failure. 

 Any hope of resuscitation in this type depends upon vigorous indirect 

 cardiac massage. This is accomplished more effectively in the above method 

 of artificial respiration by allowing the palms of the hands to slide around 

 to the sides of the body, presssing near the ends of the free ribs. In this 

 position it is easy to give pressure with the finger tips under the ribs and 

 against the heart. In extreme, and perhaps in surgical cases, direct massage 

 may be given. 1 



1 Fuller discussion of the conditions involving drowning and the procedure look- 

 ing toward recovery are available in the following references: C. C. Guthrie, Blood- 

 vessel Surgery, chapter on Resuscitation, page 300. Report of the Commission on 

 Resuscitation from Electric Shock, W. B. Cannon, Chairman. Medical Handbook 

 for the Use of Lighthouse Vessels, etc., published by the U. S. Public Health and 

 Marine-Hospital Service. D. H. Dolley, On Resuscitation, Bulletin of the University 

 of Missouri, Medical Series, No. 4. 



