464 SECTIONAL TRANSACTIONS.—I. 
Excess of CO, causes paralysis of centre; small amount stimulates it. Afferent 
nerves for reflex stimulation of centre: pulmonary branches of vagi; superior 
laryngeal ; nerves to carotid sinus ; afferent nerves of respiratory muscles ; cutaneous 
nerves. 
Methods of artificial respiration. History of the subject. Importance of selecting 
a method independent of apparatus and simple of application. Measurement of 
efficiency. Description of prone pressure method. Cinematograph illustration. 
Adgantages of the prone pressure method. It is (1) efficient, (2) simple, (3) involves 
no fatigue, (4) only one operator necessary, (5) no obstructions possible from tongue 
or soft palate or mucus. Jn supine position all of these tend to block the air passages 
and prevent air from entering the lungs; this especially in conditions of unconscious- 
ness such as accompanies drowning, seen to a less extent during the unconsciousness 
of sleep, snoring being caused by obstruction of the tongue and soft palate to the 
passage of air into the lungs when a person is in the supine position. It immediately 
stops on his turning to one side. 
Instances of fatal results in cases of drowning from turning patient from prone to 
supine position. Danger of calling in an uninstructed medical man. Artificial 
respiration not taught in most medical schools. Most medical students and doctors 
have never practised it. It could and should be included as part of physical drill in 
all schools. Already well taught in army, navy, police force, and to boy scouts and 
girl guides. 
Prone pressure method rests on physiological basis ; when the centre in the bulb 
is no longer completely paralysed by excess of CO, owing to renewal of air in the 
lungs from the movements of the chest it responds to each pressure with an inspiration ; 
in other words, each expiration causes a respiratory movement. This is the well- 
known Hering-Breuer phenomenon. In this way the method assists recovery of 
natural respiration, and may be regarded as physiological, although the direct action — 
of the operator is in the first instance to produce éxpiration. 
Adrenaline should he given if possible, and as soon as possible, to aid recovery of 
heart and of arterial tone. This is the natural function of adrenaline, which is 
constantly being secreted into the blood under normal circumstances by reflex stimula- 
tion of a centre in the bulb. Like the other centres there (respiratory, cardiac, vaso- 
motor) this centre is stimulated at the beginning of asphyxia, but is paralysed later 
by excess of COs, so that adrenaline is no longer secreted. To combat this loss it 
should be administered in asphyxia ; best by injecting it directly into the heart, in a 
dose of about 20 minims of 1 in 1000 solution, which may be repeated if necessary. 
Asphyxia neonatorum usually caused by obstruction of vessels in umbilical cord 
by compression of the contracted uterus if the cord is round the neck of the fcetus. 
It must be treated on a different principle because the lungs are empty of air and 
need to be filled. This is accomplished, if possible, by inducing natural respiration 
by stimulation of skin by cold or otherwise, but if the respiratory centre is paralysed 
by excess of CO, it will not respond. Failing this, inflation can be effected through a 
cannula passed into the trachea; mouth to mouth inflation is difficult, since air 
driven into the mouth is apt to pass into the wsophagus and stomach. If the lungs 
are inflated respiration can be carried on by intermittently blowing air in and allowing 
it to escape or alternatively by employment of pressure on the chest or abdomen, 
preferably in the prone position. In cases of asphyxia neonatorum adrenaline should 
always he injected at once into the heart. 
ee ae ee 
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Prof. YANDELL HENDERSON. 
It is not enough to resuscitate a man from drowning or asphyxia or other accident, 
or from surgical anesthesia, if he is to die a few days later from secondary pneumonia. 
Inhalation of carbon dioxide is the most effective means of stimulating respiration, 
when depressed or stopped, to renewed and increased activity. It has also proved to 
be a highly effective preventive—indeed it is essentially the specific preventive—-of 
the collapse of the lungs which leads to pneumonia. These two advantages have now 
been demonstrated by experience in large numbers of cases of carbon monoxide 
asphyxia, drowning and other accidents. For the asphyxia of the new-born this 
inhalation is replacing the old brutal and often ineffective methods of swinging, 
spanking and dipping. In surgical clinics this treatment is already widely used to 
counteract failure of breathing under anesthesia to restore a normal circulation, 
and especially to prevent post-operative pneumonia. p 
ter, aced: 
