RESPIRA TION. 447 



patient's head, grasp the arms just above the elbows, and draw the arms gently 

 and steadily upward above the head, and keep them stretched upward for two 

 seconds. By this means air is drawn into the lungs. Then turn down the 

 patient's arms, and press them gently and firmly for two seconds against the 

 sides of the chest. By this means air is pressed out of the lungs. Repeat 

 these measures alternately, deliberately, and perseveringly about fifteen times 

 in a minute, until a spontaneous effort to respire is perceived, immediately 

 upon which cease to imitate the movements of breathing, and proceed to 

 induce circulation and warmth." 



A new and effective method has been reported by Galliano : The patient 

 is placed in Sylvester's position; the arms are drawn up above and behind 

 the head, and the wrists tied. This causes the thorax to be expanded. 

 Respiration is accomplished by pressing concentrically with the open hands 

 upon the sides of the thorax and the epigastric region about twenty times a 

 minute. This method is even more effective if in addition the jaw be 

 wedged open, and short, sharp tractions of the tongue be practised immedi- 

 ately preceding each pressure upon the thorax. These operations should be 

 continued for at least one and a half hours, if necessary, and aided by fric- 

 tion, external heat, etc. The periodical traction of the tongue acts as a 

 strong excitant to the respiratory centre. 



I. The Effects of the Respiratory Movements on the 



Circulation. 



The respiratory movements are accompanied by marked changes in the cir- 

 culation. If a tracing be made of the blood-pressure and the pulse (Fig. 78), 

 and at the same time the inspiratory and expiratory movements be noted, it 



Fig. 78.— Blood-pressure and pulse tracing showing the changes during Inspiration (in. > and expi- 

 ration (ex.). 



will be seen that the blood-pressure begins to rise shortly after the onsel of 

 nspiration, commonly after a period occupied by one to three heart-beats, ami 

 leaches a maximum after the lapse of a similar brief interval after the begin- 

 ning of expiration, when it begins to fall, reaching a minimum after the 

 beginning of the next inspiration. During inspiration the pulse-rate ifi more 

 frequent than during expiration and the character <>f the pulse-curve is some- 

 what different. 



The Effects on Blood-pressure. — The changes in blood-pressure are 

 mechanical effects due to the actions of the respiratory movements. When it 



