How to Care for the Insane: A Manual for Nurses

by William D. Granger

We breathe through the mouth and nose. They open into a common passage, the pharynx, which can be seen by looking into the mouth, lying back of the tonsils. Passing downward, it divides by branching into two tubes; one the windpipe, which is in front, behind it is the œsophagus or gullet.

The point of division is just beyond the tongue, and is almost within reach of the forefinger when crowded into the mouth.

The air we breathe passes through the mouth and nose to the pharynx, thence to the lungs by the windpipe. The food we eat passes from the mouth to the pharynx, and thence to the stomach by the œsophagus.

There is at the opening of the windpipe a cover, the epiglottis, which is generally open, but which closes when food is swallowed and helps to keep food from entering. When a substance touches the opening of the windpipe, we instantly cough to expel it.

A person may choke, when the mouth and the pharynx back of it are filled with food; or when a piece is lodged in the wind-pipe, or a large piece in the œsophagus at the point of division, and which crowds upon the windpipe, or covers the opening. Food gets into the windpipe, by being drawn in by a sudden and unexpected inspiration of air. This may happen while eating or in vomiting solid food. With this accidental exception all breathing stops during the act of swallowing.

Some patients, from paralysis, especially paretics, do not feel food when it is lodged in the throat; others, from great dementia, may not know when they are choking, and show no emotional signs of distress. Paretics are particularly liable to bolt their food, and cram the mouth and throat full.

The symptoms of choking are immediate, and if no relief is obtained, the sufferer will die in a few minutes. If the patient knows any thing, he will show immediate signs of distress, violent but ineffectual attempts to breathe, and the face quickly becomes a dark blue color, from the accumulation of carbonic acid in the blood.

Immediate effects should be made to remove the obstruction, and continued until the physician arrives, who is to be sent for at once. Whatever is in the mouth and throat can be easily removed by the fingers; the forefinger should then be crowded down the throat to feel for other obstructions, care being taken not to push a piece of food into the windpipe. If any thing is felt, it can sometimes be pulled out by the fingers, or a hair-pin may be straightened and bent, or a piece of wire, and an effort made to fish it out. When in the gullet and beyond the fingers, it may be pushed into the stomach by a feeding-tube. Artificial respiration may be needed, but attendants must remember it is of no use until the obstruction to breathing is removed.

Marbles, coins, buttons, pieces of pencils, needles, pins, and fish-bones, are frequently swallowed. The physician should be informed at once.

Directions how to Perform Artificial Respiration.—What is to be done must be done quickly; tight clothing about the neck and chest must be removed, and the mouth should be cleaned of dirt, water, or any obstruction to the flow of air. The body is then laid out flat on the back, covered, if possible, with light warm blankets, and some article should be folded and placed under the shoulders, so as to raise them three or four inches. The mouth must be kept open, and the tongue pulled well forward, as it is liable to fall backwards, and cover the opening of the wind-pipe. One person, kneeling behind the head, should grasp each arm at the elbow, and, draw them steadily around so that the arms will meet above the head. A strong pull should be made upon them, and they should be held a few seconds. These movements elevate the ribs and enlarge the chest and produce an inspiration.