Fig. 9.—Schaefer method of artificial respiration. Inspiration.
The patient is laid on his stomach, arms extended from his body beyond his head, face turned to one side so that the mouth and nose do not touch the ground. This position causes the tongue to fall forward of its own weight and so prevents its falling back into the air passages. Turning the head to one side prevents the face coming into contact with mud or water during the operation. This position also facilitates the removal from the mouth of foreign bodies, such as tobacco, chewing gum, false teeth, etc., and favors the expulsion of mucus, blood, vomitus, serum, or any liquid that may be in the air passages.
Fig. 10—Schaefer method of artificial respiration. Expiration.
The operator kneels, straddles one or both of the patient's thighs, and faces his head. Locating the lowest rib, the operator, with his thumbs nearly parallel to his fingers, places his hands so that the little finger curls over the twelfth rib. If the hands are on the pelvic bones, the object of the work is defeated; hence the bones of the pelvis are first located in order to avoid them. The hands must be free from the pelvis and resting on the lowest rib. By operating on the bare back it is easier to locate the lower ribs and avoid the pelvis. The nearer the ends of the ribs the hands are placed without sliding off the better. The hands are thus removed from the spine, the fingers being nearly out of sight.
The fingers help some, but the chief pressure is exerted by the heels (thenar and hypothenar eminences) of the hands, with the weight coming straight from the shoulders. It is a waste of energy to bend the arms at the elbows and shove in from the sides, because the muscles of the back are stronger than the muscles of the arms.
The operator's arms are held straight, and his weight is brought from his shoulders by bringing his body and shoulders forward. This weight is gradually increased until at the end of the three seconds of vertical pressure upon the lower ribs of the patient the force is felt to be heavy enough to compress the parts; then the weight is suddenly removed. If there is danger of not returning the hands to the right position again, they can remain lightly in place; but it is usually better to remove the hands entirely. If the operator is light and the patient an overweight adult, he can utilize over 80 per cent of his weight by raising his knees from the ground and supporting himself entirely on his toes and the heels of his hands, the latter properly placed on the ends of the floating ribs of the patient. In this manner he can work as effectively as a heavy man.
A light feather or a piece of absorbent cotton drawn out thin and held near the nose by some one will indicate by its movements whether or not there is a current of air going and coming with each forced expiration and spontaneous inspiration.