"1st. Treat the patient instantly, on the spot, in the open air, freely exposing the face, neck and chest to the breeze, except in severe weather.

"2d. In order to clear the throat, place the patient gently on the face, with one wrist under the forehead, that all fluid, and the tongue itself, may fall forward, and leave the entrance into the windpipe free.

"3d. To excite respiration, turn the patient slightly on his side, and apply some irritating or stimulating agent to the nostrils, as Veratrine, dilute Ammonia, etc.

"4th. Make the face warm by brisk friction; then dash cold water upon it.

"5th. If not successful, lose no time; but, to imitate respiration, place the patient on his face, and turn the body gently, but completely, on the side and a little beyond; then again on the face, and so on, alternately. Repeat these movements deliberately and perseveringly, fifteen times only in a minute. (When the patient lies on the thorax, this cavity is compressed by the weight of the body, and expiration takes place. When he is turned on the side, this pressure is removed, and inspiration occurs.)

"6th. When the prone position is resumed, make a uniform and efficient pressure along the spine, removing the pressure immediately before rotation on the side. (The pressure augments the expiration; the rotation commences inspiration.) Continue these measures.

"7th. Rub the limbs upward, with firm pressure and with energy. (The object being to aid the return of venous blood to the heart.)

"8th. Substitute for the patient's wet clothing, if possible, such other covering as can be instantly procured, each bystander supplying a coat or cloak, etc. Meantime and from time to time, to excite inspiration, let the surface of the body be slapped briskly with the hand.

"9th. Rub the body briskly till it is dry and warm, then dash cold water upon it and repeat the rubbing.

"Avoid the immediate removal of the patient, as it involves a dangerous loss of time; also the use of bellows, or any forcing instrument; also, the warm bath and all rough treatment." dr. Howard's method of resuscitation.

One of the most efficient, as well as the most recent method, is that of Dr. Howard for performing artificial respiration.

Position Of Patient

Face upward, a hard roll of clothing beneath the thorax, with shoulders slightly declining over it. (One twist of handkerchief around the crossed wrists will keep them there.) Rip or strip clothing from waist and neck.

Position Of Operator

Kneel astride the patient's hips; place your hands upon his chest, so that the ball of each thumb and little finger rests upon the inner margin of the free border of the costal cartilages, the tip of each thumb near or upon the xiphoid cartilage, the fingers fitting in the corresponding intercostal spaces. Fix your elbows firmly, making them even with your sides and hips; then -

Action Of Operator

Pressing upward and inward toward the diaphragm, use your knees as a pivot, and throw your weight slowly forward two or three seconds until your face almost touches that of the patient, ending with a sharp push, which helps to jerk you back to your erect kneeling position. Rest three seconds, then repeat this bellows-blowing movement as before, continuing it at the rate of seven to ten times a minute, taking the utmost care on the occurrence of a natural gasp, gently to aid and to deepen it into a longer breath, until respiration becomes natural. When practicable, have the tongue held firmly out of one corner of the mouth with thumb and finger armed with a dry cotton rag.

Action Of Operator 612

Very frequently during the early stages of the administration of an anaesthetic the patient may "forget to breathe," even before the ability to perceive peripheral irritation is lost. Even later in the anaesthesia, when the breathing suddenly ceases, instead of using cold water externally and slapping the patient with wet towels, Dr. H. A. Hare recommends pouring a quantity of ether upon the belly, the shock caused by the cold produced by its evaporation bringing on a very deep inspiration, followed often by the normal respiratory movements.