For eases of cardiac failure the heart muscle should be grasped and compressed intermittently by pushing the hand backward beneath the xiphoid cartilage. Iliffe (Brit. Med. Jour., Feb. 6, '92).
Case in a boy aged 15 years. After tracheotomy and prolonged attempts to establish artificial respiration, an open ing was made the anterior wall of the thorax on the left side and the peri cardium exposed. Rhythmical compres sion of the heart excited slight move ments of this organ, and pulsation was observed in the large blood-vessels of the thoracic cavity, but the respiration, in spite of strenuous and prolonged efTorts to restore the action of the lungs, was not renewed, and after an interval of half an hour, during which cardiac massage was energetically and persistently practiced, the movements of the heart ceased. Aglinzeff (Centralb. f. Chin, No. 21, 1901).
Case of chloroform narcosis in a man 24 years old. Ten minutes later the trachea was opened and air was blown into the lungs, but without result. Prus's cardiac massage was then decided upon. An incision was made in the skin and muscles parallel to the third and fifth ribs and left sternal edge. The third and fourth ribs were cut close to the sternum, and two and a half inches were resected in the flap. In doing this the left pleural cavity was accidentally opened. The hand was then introduced. and the heart, with the periearditun still intact, was grasped. No movements were felt, but rhythmical compressions were systematically practiced, partly by grasping the organ and partly by pressing it against the back of the ster num. After a short time slight contrac tions were felt, which gradually in creased, and at the end of one-half hour spontaneous respirations were initiated. At the end of three hours breathing was deep and without effort. Four hours from the commencement of in halation respiration became difficult, and after a few minutes ceased. The heart continued to beat from midday S p.m. The temperature of the body was fairly maintained, falling slightly; after eight hours it was 9S° F. Freyberger (Hospitalstidenae, viii, No. 47; Treatment, Jau. 4, 1901).
Strychnine.—The value of strychnine as an antidote to chloroform, when given hypodermically, is insisted upon by inany, and the experience of the past few years seems to corroborate this opin ion. Its main object is to sustain vitality
until sufficient elimination of the ana2s thetic has taken place. It must be used energetically and administered hypo dermically.
The great value of strychnine as a stimulant to the respiratory centre dur ing chloroform poisoning in keeping life going while the vapor is being exhaled; but the drug must be used boldly.
The use of the electrical current in act ing upon the respiratory centres at once, and by increasing the current rapidly, keeps the respiratory mechanism during the dormant stage of strychnine after injection.
With these two agents to hand one ought to be able to treat any ease of chloroform poisoning. S. T. Reid (Brit Med. Jour., NOV. 20. '97).
Hydrocyanic Acid. — This agent has been suggested by Hobday recently, but its use is not to be recommended until its merits will have been demonstrated.
Electricity. — According to H. C. Wood, attempts to excite contraction of the diaphragm by electric stimulation of the phrenie nerve are fraught with danger, the overflow of the current being likely to lcad to cardiac inhibition. Rockwell, however, has reached the con clusion that the inhibiting fibres going to the heart are less affected by electric ity than the accelerator nerves. The beneficial effects of the faradic current are due, not to any action it has on the heart's rhythm, but to its stimulating influence over respiration.
The strength of the current employed to produce this effect on respiration is much less than need be if a cardiac stimulation is aimed at, and the appli cation of one pole over the pit of the stomach and the other under the angle of the lower maxillary near the anterior border of the sterno-mastoid is often fraught with excellent results.
failure of respiration un der an antesthetic may sometimes be overcome and spontaneous respirations initiated by pouring a quantity of ether upon the bared abdomen. The cold thus produced will, says Hare, often prove successful in restarting breathing.