ARTIFICIAL RESPIRATION: IN ASPHYXIA. 1 99 



^[Marshall Hall's Method." After clearing the mouth and throat, place the patient on the 

 face, raising and supporting the chest well on a folded coat or other article of dress. Turn the 

 body very gently on the side and a little beyond, and then briskly on the face, back again, 

 repeating these measures cautiously, efficiently, and perseveringly, about fifteen times in the 

 minute, or once every four or five ' seconds", occasionally , varying the side. By placing the 

 patient on the chest, the weight of the body forces the air out ; when turned on the side,, this 

 pressure is removed, and air enters the chest, j On each occasion that the body is replaced on 

 the face, make uniform but efficient pressure with brisk movement on the back between and 

 below the shoulder-blades or bones on each side, removing the pressure immediately before 

 turning the body on the side. During the whole of the operations let one person attend solely 

 to the movements of the head and of the arm placed under it. "] 



[Sylvester's Method. " Place the patient on the back on the flat surface, inclined a little 

 upwards from the feet ; raise and support the head and shoulders on a small firm cushion or 

 folded article of dress placed under the shoulder-blades. Draw forward the patient's tongue, 

 and keep it projecting beyond the lips ; an elastic band over the tongue and under the chin 

 will answer this purpose, or a piece of string or tape may be tied round them, or by raising the 

 lower jaw the teeth may be made to retain the tongue in that position. Remove all tight 

 Clothing from about the neck and chest, especially the braces." il To Imitate the Movements of 

 Breathing. Standing at the patient's head grasp the arms just above the elbows, and draw the 

 arms gently and steadily upwards, above the head, and keep them stretched upwards 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 

 ibarmth:"] ' \ ' 



Howard advises rhythmical compression of the chest and abdomen by sitting like a rider 

 astride of the body, while Schiiller advises that the lower ribs be seized from above with both 

 hands and raised, whereby the chest is dilated, especially when the thigh is pressed against the 

 abdomen to compress the abdominal walls. The chest is compressed by laying the hands flat 

 upon the hypochondria. Artificial respiration acts favourably by supplying to, as well as 

 removing C0 2 from, the blood ; further, it aids the movement of the blood within the heart 

 and in the large vessels of the thorax. If the action of the heart has ceased, recovery is impos- 

 sible. In asphyxiated newly-born children, we must not cease too soon to perform artificial 

 respiration. Even when the result appears hopeless, we ought to persevere. Pfliiger and Zuntz 

 observed that the reflex excitability of the fcetal heart continued for several hours after the 

 death of the mother. 



Resuscitation by compressing the heart. Bohm found that in the case of cats poisoned with 

 potash salts or chloroform, or asphyxiated, so as to arrest respiration and the action of the 

 heart, even for a period of forty minutes, and even when the pressure within the carotid had 

 fallen to zero, he could restore animation by rhythmical compression of the heart, combined with 

 artificial respiration. The compression of the heart causes a slight movement of the blood, 

 while it acts at the same time as a rhythmical cardiac stimulus. After recovery of the respiration, 

 the reflex excitability and gradually also voluntary movements are restored. The animals are 

 blind for several days, the brain acts slowly, and the urine contains sugar. These experiments 

 show how important it is in cases of asphyxia to act at the same time upon the heart. 



For physiological purposes, artificial respiration is often made use of, especially after 

 poisoning with curara. Air is forced into the lungs by means of an elastic bag or bellows, 

 attached to a cannula tied in the trachea. The cannula has a small opening in the side of it 

 to allow the expired air to escape. 



Pathological. After the lungs have once been properly distended with air, it is impossible 

 by any amount of direct compression of them to get rid of all the air. This is probably due to 

 the pressure acting on the small bronchi, so as to squeeze them, before the air can be forced out 

 of the air- vesicles. If, however, a lung be filled with C0. 2 , and be suspended in water, the C0 2 

 is absorbed by the water, and the lungs become quite free from air and are atelectic {Hermann 

 and Keller). The atelectasis, which sometimes occurs in the lung, may thus be explained : If 

 a bronchus is stopped with mucus or exudation, C0 2 accumulates in the air-vesicles belonging 

 to this bronchus. If the C0 2 is absorbed by the blopd or lymph, the corresponding area 

 of the lung will become atelectic. Sometimes there is spasm of the respiratory muscles, brought 

 about by direct or reflex stimulation of the respiratory centre. 



135. RESPIRATION OF FOREIGN GASES. No gas without a sufficient admixture of O 

 can support life. Even with completely innocuous and indifferent gases, if no be mixed 

 with them, they cause suffocation in 2 to 3 minutes. 



I. Completely indifferent Gases are N, H, CH 4 . The living blood of an animal breathing 

 these gases yields no O to them {Pfliiger). 



II. Poisonous Gases. O-displacing Gases, (a) Those that displace 0, and form a stable com* 



