118 IMMEDIATE AND REMOTE 



during struggling. " \Yhiffs " are far more dangerous 

 than proper anaesthesia. No lifting, or cutting, or 

 painful pressure is permissible until the patient is 

 properly under. There is no danger of an overdose 

 during quiet breathing if the mask is kept half an 

 inch away from the face. 



What is to be done if the calamity is not success- 

 fully averted, and the heart and breathing cease ? 

 The books advise a dozen expedients. A moment's 

 consideration of physiological principles will lead us 

 to put most of them aside. How can amyl nitrite, 

 which is simply a vasodilator, possibly help a heart 

 stopped by the vagus ? Strychnine and brandy are 

 perfectly futile. It is no use giving oxygen to a 

 patient who is not breathing. " Galvanization of 

 the phrenics " is equally likely to galvanize the 

 vagus. 



There are just four measures which matter. The 

 first is to have the head low, so as to keep the vital 

 centres alive. The second is, of course, artificial 

 respiration, which fills the auricles with blood as 

 well as the lungs with air, averts death from asphyxia, 

 and so gives the heart a chance to recover if it can. 

 The third is to stimulate the heart to contract again 

 by manual compression, if possible through the 

 diaphragm. The fourth is to administer as quickly 

 as possible atropine, which must be injected right 

 into the heart by a long hypodermic needle. Atropine 

 is well known to paralyse the terminals of the vagus. 

 Every medical student is taught to resuscitate by 

 its means the frog's heart stopped by muscarin or 

 pilocarpine (which stimulate vagus nerve-endings). 



