All foreign bodies should be removed from the mouth and pharynx. If the patient have been in water he should be suspended head downward, in order that the water may escape by gravity from the lungs. In all of these methods rhythmical traction upon the tongue will be found a valuable aid in the procedure.
Sylvester’s method utilizes the arms as levers by which to expand the thorax, by means of the muscles which pass between them and the chest. The patient is laid on his back, the shoulders somewhat elevated and the head thrown backward. The forearms are seized just below the elbows and carried upward over his head, by which movement the chest is expanded; here they are held about two seconds, and then brought down to the side of the chest and actual compression of the thorax made with them, for the same period of time. When the chest is compressed, an assistant may also press the liver upward and thus help to empty the lungs. The intent is to make from sixteen to eighteen of these movements in a minute. In children the movements are made more rapidly, and in infants considerably more. It is usually necessary that traction be made upon the feet to prevent pulling the body upward when the arms are moved to expand the thorax. If the manipulations can be carried out upon a table whose feet can be somewhat elevated this will also help, as the blood is thereby induced to enter the cranium.
Marshall Hall’s method is to roll the patient from his back on to his side, the uppermost arm being utilized to make pressure upon the side of the thorax in order to expel air. Then the body is rolled over on to the back, by which movement the chest is expanded. This method is not nearly as efficient as that mentioned above.
Fig. 45
Fell’s apparatus for forced or artificial respiration.
In case of drowning Howard’s method is quite applicable. The maneuvers are as follows:
1. Turning the patient upon the face, with a large firm roll under the stomach and chest, and protecting his mouth from the surface upon which he is lying, press with full weight two or three times, for four or five seconds, each time upon his back, so that the water is expelled from his lungs and stomach.
2. Then quickly turn him face upward with the roll beneath his back, with his head hanging downward and his hands above his head. The operator then kneels astride over the patient, with the hips between his knees, and grasps the lower part of the patient’s chest firmly, bracing his own hands with his elbows firmly against his own hips. With his full weight he then makes pressure upon the patient’s chest, compressing it laterally for two or three seconds, gradually leaning forward while doing this, and then with a sudden jerk pushing himself backward. The intent here is to imitate the ordinary respiration rate as above, or perhaps a little less often. This may be continued for a half-hour or even for an hour, sometimes with eventual success.
There should be also massage of the heart, in addition to traction upon the tongue. Artificial assistance should not be discontinued until the patient is breathing regularly and sufficiently without help. In [Fig. 45] is represented the Fell apparatus for making forced artificial respiration, this being a great improvement on the so-called mouth-to-mouth inflation. The essential feature of it is a bellows, by which the air is forced into the lungs, through a mouth-piece made to fit tightly over the face, or through a tracheotomy tube. In accident cases other measures, such as artificial warmth, etc., should be employed.