These methods, we believe, to be all of less value than insulation. According to Depaul, insuffiation has been practised, in case of asphyxia, from great antiluity. It has been condemned by, among others, Du Leroy D'Rtiolles, Piorry. In 1845, Depaul published his first paper on this subject, and, since then, he has not seen fit to modify in the least his conclusions in regard to the usefulness of insuffiation, but still holds that the procedure, when properly performed, is not only advan tageous, but absolutely harmless.
Method of Performing Insictliation.—The oldest and simplest method is that from mouth to mouth. It was Pia who first proposed a tube, one end of which was to be introduced into the mouth, and the other blown through. Chaussier first devised a laryngeal tube, as perfect as possible, and which has been slightly modified by Depaul.
Chaussier's tube is conical, made of metal, about eight inches long, slightly flattened on the sides. The larger end, A (Fig. 248) is rounded and flanged, that the lips may be readily applied. The other end, B, is flattened, and is perforated at C. The tube is curved for ready introduc tion into the larynx. Where the curvature of the tube begins, is a trans verse depression, into which is fitted a sponge. This instrument, then, adapts itself perfectly to the larynx, closes the glottis, so that the insuffiated air cannot readily escape, but must dilate the lungs. Depaul has replaced the lateral openings by a terminal, thus facilitating the entrance of air into the bronchi. He thus describes the manner of using the tube. " The body of the infant should be kept warm constantly. It lies on a pillow, so that the head is higher than the pelvis, and the anterior surface of the neck should project a trifle. Of course all mucus has been re moved from the month and the pharynx. The tube is guided by the finger into the larynx, care being taken not to pass it into the oesophagus. In order to be certain that the tube is in the larynx , feel for it exter nally. On making the insuffiations, to be certain that the air enters the trachea, the lips are to be compressed around the tube, and the nostrils closed." We must blow into the tube with some force, and need not fear rupture of the pulmonary vesicles, or emphysema, since the lungs offer considerable resistance. Ten to fifteen insuffiations a minute are sufficient, and we reinstate expiration by pressure applied by the hands to the tho racic walls. The air issues from the tube, audibly. It is well to with
draw the tube from time to time, in order to cleanse it. When the in suffiated air bubbles as it enters the tube, we know that there is something in it. We, therefore, first aspirate, and then remove the tube. This process of insuffiation should be continued for a variable time, sometimes an hour, or more.
The first result of insufflation is to make the heart-beat precise, strong, and more frequent. The skin of the face, and of the chest, regains its natural tint, then the nostrils move slightly, and at the base of the thorax are noted a few contractions of the diaphragm. Finally the child makes its first spontaneous respiratory act. At first incomplete, and at long inter vals, these inspiratory acts .become, at length, more regular and deeper, but they are separated by incomplete inspirations. Now, ceasing insufflation for the moment, the infant is plunged into a hot bath, whipped, etc., in satiation is resumed, and, at the end of a few minutes, the child regains its color more and more, opens its eyes, inspirations become normal, it cries, and its life has been saved.
At times, however, the inspirations remain incomplete, tremulous, separated by irregular intervals. The child breathes badly, cries badly, and dies at the end of a few hours. By means of insufflation the heart beat may be maintained for a number of hours, but normal respiration never becomes established.
For a number of years efforts have been made to improve on this method of pulmonary insufflation. In 1875 Woillez invented the spiro phore (Fig. 250), and Depaul tried it ten times with nine failures. In 1876, Gairal devised the ierophore (Figs. 251, 252), and in 1877 Pros an insufflator (Fig. 253). In the latter year, Ribemont devised a new laryn tube (Fig. 254), which, according to him, has the following advan tages: 1st. Easier of introduction, on account of its anatomical curve, and because of the knob at the end. 2d. The ease with which, by means of it, we may remove mucus from the larynx. Depaul shows that this tube is not a good one for the following reasons: 1st. Its curvature has been derived from the larynx of a cadaver, which differs markedly from that of the living infant. 2d. Its introduction is no easier than that of Chaussier. 3d. That aspiration through his own tube is far easier, for the reason that the opening is terminal. 4th. Finally, Ribemont's tube, as proven by almost the first case where it was used, may produce em physema.