ASPHYXIA.
This is the result of many widely differing causes, and the treatment of the primary affection will he found under such headings as Drowning, Laryngitis, Glossitis, Bronchitis, Sunstroke, Poisoning by Chloroform and Gas, Air Passages, Foreign Bodies in, &c. The main indication is for artificial respiration after the obstruction in the air passages has been removed. The various methods of carry:ng this out are fully described under Drowning.
In asphyxia caused by heart and lung disease, where death is threaten ing from the overburdening of the right auricle and ventricle, a prompt and free incision into a vein at the elbow will often save life. The vene section may advantageously be followed up by Oxygen inhalations, and these in the suffocation caused by acute bronchial affections may remove the asphyxia without blood-letting if used as soon as cyanosis appears. The method of injecting Oxygen hypodermically has given good results. :\ small quantity may be injected direct from the cylinder every hour or less. Saline purgatives in less urgent cases act like a small venesection, and Ozonic Ether may be given with advantage.
In the strangulation caused by hanging the obvious procedure will be instantly to cut down the victim, remove all constrictions about the neck, and begin artificial respiration, which should be kept up for a long period, working with deliberate and slow exertions till after signs of returning animation show themselves. If air cannot be made to enter the chest tracheotomy may be required. Oxygen, if at hand, should always he employed. Laborde's method of making forcible and rhythmical traction on the tongue is a valuable method of exciting the respiratory centre.
To relieve the asphyxia of newly born infants all mucous discharge should be removed from the mouth and pharynx, and by dashing alter nately cold and warm water on the chest and face, respiration is usually excited. If these measures and artificial respiration fail the lungs should he inflated through a large catheter, or in desperate urgencies by the physician blowing in air from his mouth. Where the upper air passages are blocked a catheter should be inserted into the glottis till its point is about 31 inches from the teeth, when a forcible blast of air sent through the instrument will force any blood or mucous discharge upwards into the mouth. The catheter should be passed as the child lies on its back with the head hanging over the edge of a table.
In the traumatic asphyxia and cyanosis produced by thoracic com pression, where the patient has been squeezed in a surging crowd, or buried under the weight of fallen earth or masonry, the first step should be the administration of remedies to combat shock. Artificial respiration should not be attempted in the presence of broken ribs and other serious structural injuries.
Along with the treatment of asphyxia or strangulation by the different methods of artificial respiration Laborde's plan may be combined and electrical stimulation used at the same time, but these should only be employed in a rational manner with due consideration of their simul taneous effects upon the natural rhythm of the respiratory movements.