Slow, Chronic Asphyxiation.—Slow, chronic asphyxiation is not infrequent. Its symptoms are often difficult to detect. Poisoning is manifested by weakness, cephalalgia, vomiting, pallor, general anemia, lassitude, and local paralysis. If any of these symptoms appear in the men who work in the vicinity of the producers, immediate steps should be taken to prevent the possibility of carbon monoxide asphyxiation.
First Aid in Cases of Carbon Monoxide Poisoning
It has already been stated that the oxygen of the air has no oxidizing effect upon blood contaminated by carbon monoxide. Only a liberal current of pure oxygen can oxidize the combination formed and render hematosis possible. This liberal current can be obtained from an oxygen tank of the portable variety, provided with a tube carrying at its free end a mask which
is held over the mouth and the nostrils. The absorption of gas takes place by artificial respiration, which is effected in several ways. The most practical of these are the Sylvester and Pacini methods.
Sylvester Method.—The patient is laid on his back. His arms are raised over his head and then brought back on each side of the body. This operation is repeated fifteen times per minute approximately. The method is very frequently employed and is excellent in its results.
The Pacini Method.—Four fingers are placed in the pit of the arm, with the thumb on the shoulder. The shoulder is then alternately raised and lowered, producing a marked expansion of the chest. This method is the more effective of the two. The movements described are repeated fifteen to twenty times each minute very rhythmically.
One or the other of these two methods of treatment should be immediately applied in serious cases. Certain preliminary precautions should be taken in all cases, however. The patient should be carried to a well-ventilated and moderately heated room, stripped of his clothes, and warmed by water-bottles and heated linen. Reflex action should be excited, the peripheral nervous system stimulated in order to contract the heart and the respiratory muscles, and the precordial region cauterized. In addition to this treatment, the region of the diaphragm should be rubbed and pinched, the skin rubbed, cold showers given, flagellations administered, urtications (whipping with nettles) undertaken, the skin and
the mucous membranes excited, the mucous membrane of the nose and of the pharynx titillated with a feather dipped in ammonia, alcohol, vinegar, or lemon juice. Rhythmic traction of the tongue is effective when carried out as follows: The tongue is seized with a forceps and kept extended by means of a coarse thread. It is then pulled out from the mouth sharply and allowed to reenter after each traction. These movements should be rhythmic and should be repeated fifteen to twenty times a minute.
All these efforts should be continued for several hours. When the patient has finally been revived, he should be placed in a warm bed. Stimulants such as wine, coffee, and the like should be administered. If the head should be congested, local blood-letting should be resorted to and four or six leeches applied behind the ears. It should be borne in mind that the various steps enumerated are to be taken pending the arrival of a physician.
Impurities of the Gases