SECTIONAL TRANSACTIONS.—I. AGS 
Respiration is closely associated with the tonus of the muscles, especially of the 
thorax. Depressed breathing and low tonus permit collapse of parts or all of a lung. 
From this collapse, if infection is present, pneumonia develops. If respiration and 
muscle tonus are stimulated by inhalation of carbon dioxide, the lungs are kept open 
_ and the development of pneumonia is prevented. 
Dr. C. K. Drinker. 
Since 1925 the author has had part charge of organising and conducting the 
emergency and educational work of the New York Consolidated Gas Company against 
carbon monoxide poisoning. The number of calls for treatment of asphyxia responded 
to by the emergency crews of the company averages 1,722 a year. Of this number 
78 per cent. are due to carbon monoxide. The author outlines the training given 
all the employees of the gas company and the especial training of the emergency 
crews. The paper describes practical experience with the treatment of poisoning by 
inhalation of carbon dioxide and oxygen mixtures, the outcome of cases, and finally 
discusses the absence of sequele representing neurological damage. 
Sir Francis BE. Saipway. 
Many deaths are preventable ; accidents arise from lack of knowledge of methods 
of resuscitation, from delay in their application. 
Resuscitation may be defined briefly as the restoration of the nervous and muscular 
activities of the body. These activities depend largely upon an adequate supply of 
oxygen and the removal of excess of carbon dioxide. The exchange of gases may be 
interrupted in the following ways: (1) temporary paralysis of the nervous system 
owing to lack of oxygen or the action of anesthetics; (2) paralysis of the muscles 
of respiration, generally secondary to paralysis of the nervous centres; (3) failure 
of the circulation of the blood. 
Treatment is based upon the foregoing conditions. 
Artificial respiration combined with oxygen and a small percentage of carbon 
dioxide will supply the needs of the nervous system and reduce the amount of the 
anesthetic which is depressing the nervous centres ; further, the alternate expansion 
and contraction of the lungs produce a mechanical effect by pumping the blood, 
and a respiratory reflex, the Hering-Breuer phenomenon, if the medulla is excitable. 
The pumping action of the heart can be improved by the supply of oxygen and 
carbon dioxide, and also by the mechanical effect of the artificial respiration. In 
case of failure of the heart to beat, puncture of auricle to be employed without delay ; 
intracardiac injection of drugs unnecessary and may be harmful. Massage of heart 
may be attempted if abdomen is already open. Artificial respiration must be started 
Simultaneously with cardiac resuscitation. Time of survival of cortical cells dis- 
cussed. 
In the case of a child apparently still-born there are the following points to 
‘emember : its nervous system and its heart are more resistant to lack of oxygen than 
is the case in the adult; its lungs resemble a solid organ, and require inflating with 
air. Mouth to mouth inflation ‘supplies sufficient oxygen and carbon dioxide, but 
its use is to be confined to emergencies as the air is more likely to inflate the stomach. 
Warmth increases the excitability of the nervous system and the metabolism. In 
more serious cases (white asphyxia) artificial respiration by the method of Schafer, 
ud ministration of carbon dioxide and oxygen, cardiac puncture may be necessary. 
Respiratory centre of child may be depressed by drug given to mother to alleviate 
ains of labour. . 
_In considering the methods of treatment the advantages and disadvantages of 
e Sylvester and Schafer methods of artificial respiration must be weighed in relation 
he nature of operation. The value of carbon dioxide as a stimulant to the 
ery centre, prevention of necessity for resuscitation rather than cure, are 
idered 
Prof. J. A. Gunn. 
The survival-time of tissues, especially of the central nervous system, after stoppage 
f the circulation. 
1931 HE 
