ASPHYXIA.

1130 the prisons zealously endeavour to reform the adultt is the keynote of treatment. It cannot be too widely criminal. But the future is with the prevention off known that death from electricity is usually no moredelinquency rather than with the treatment of crime,, than apparent death. Artificial respiration should the causes of which are often to be found at a very7be begun immediately and continued for several early stage in the life of the individual. The mental1 hours, for no form of asphyxia yields such a good health of all children, therefore, should become the recovery-rate. Lay workers are instructed to con. tinue their efforts for four hours ; recovery is common intelligent care of each community; all character deviations and mental abnormalities should be early after three hours and has even occurred after eight. detected and early corrected to avoid the waste of Electricity may act primarily on the circulation, so good citizens and the tremendous expense of criminal,1, that respiration continues for a few minutes after repair that is our present portion. In that prophy.’ the shock and then ceases ; in such patients the heart laxis lies the hope-indeed, the purpose-of the is probably in fibrillation and the prognosis is bad. mental hygiene and child guidance movements. Generally, however, the current paralyses therespiratory centre while leaving the circulation normal, and the patient may recover his breath after hours of apncea. All the evidence warns us against ASPHYXIA. declaring patients dead unless heart sounds and THERE are three principal causes of acute asphyxia : pulse are entirely absent after a long period of prone drowning, electric shock, and the inhalation of pressure respiration ; they turn cyanotic and regain poisonous gas or vapour. The increasing ease with colour as treatment proceeds. To combat the rise which town populations can reach bathing-places of intrathecal pressure which sometimes occurs, makes the tale of drowning accidents longer every Prof. S. JELLINEK recommends lumbar puncture.3 summer; the second risk is increasing with the Asphyxia caused by carbon monoxide poisoning growing industrial and domestic use of electricity, introduces an entirely different factor, as Prof. and the third has become much greater since motor HAMILTON HARTRIDGE pointed out in a lecture vehicles came into popular use. It is, therefore, reported on p. 1137 of our present issue. The becoming more and more necessary for the ’prac- asphyxia resulting from inhalation of coal-gas, titioner to be certain in his mind of the methods motor-car fumes, or the effluent from badly ventilated he will employ when confronted with asphyxia. gas and anthracite stoves, is chiefly due to the affinity Artificial respiration immediately occurs to the mind of the monoxide for haemoglobin, so that oxygen of doctor and first-aid worker alike, and the Schafer is excluded from the blood. This chemical effect prone-pressure method1 has proved so successful calls for oxygen inhalation to assist the starved of recent years that it has almost superseded all tissues. As the respiration is depressed in the late others. The patient’s air-passages are cleared as stages, 5 per cent. of carbon dioxide should be added well as possible, and he is laid prone on the floor with to stimulate the respiratory centre. Prof. HARTRIDGE, one arm bent and the other extended, and the face also suggested the exhibition of sodium cyanide turned to the side. The operator kneels astride the for this purpose. Artificial respiration should, if thighs and places his hands on the lower ribs. He possible, be performed with the oxygen-carbon compresses the thorax by leaning forward on his dioxide mask in place,o1 and it is important that the straight arms, and releases the pressure by swinging oxygen be administered as early as possible, for the back. Inspiration and expiration should last about damage done by oxygen-want is, as we have said, two seconds each. So much every first-aid worker proportional to time, and it is possible that knows, but while artificial respiration is undoubtedly a patient may recover from the asphyxia and yet be the corner-stone of treatment for asphyxia the doctor permanently crippled in cerebral function. It should, is properly expected to offer more skilled help than however, be remembered that high concentrations the layman, and there are other very important of oxygen are dangerous to the lungs if given confacts to be remembered. ! tinuously for long periods, and the oxygen should be Drowning, to quote a recent and able summary replaced by air and carbon dioxide as soon as the of the position by Dr. C. K. DRINKER,2 is, as far as is real All carbon monoxide urgency has known, a relatively simple form of asphyxia, and should have left the blood after an hour and a half. when the mouth and nose have been cleared of Another useful way of supplying oxygen to the obstruction the Schafer method is all that remains tissues is by transfusion, but this must be done to be done. Nerve cells die at different rates when early. Finally, a valuable hint, that does not always. deprived of a regular supply of oxygenated blood. occur either to doctor or layman, is that the nearest The smallpyramidal cells of the cerebrum die, he gas-works will probably provide trained help and says, in eight minutes, while the spinal cord and suitable inhalation apparatus more efficiently and sympathetic ganglia may last for an hour. Complete promptly than any hospital. immersion in a healthy person does not cut off the oxygen supply completely, and the chances of recovery depend on the great viability of the medullary THE EVOLUTION OF A HERESY. centres. It is necessary, of course, to lose no time before starting rescue measures, but a healthy THE heresy of one generation becomes the orthodoxy individual has a good chance if artificial respiration of the next. Prof. ERNST KRETSCHMER, known in is commenced, even after 15 minutes. Dr. DRINKER this country by the translation of his work on does not recommend drugs for drowning, or indeed and Character," contributes an important " Physique for any form of asphyxia. Alpha-lobelin he stigma- article to the Deutsche Medizinische Wochenschrift of Caffeine tises as inefficacious and dangerous. 13th on Further Developments of PsychoApril sodiobenzoate may have some effect if given intratherapeutic Technique, especially of Psycho-analysis. venously, and can do no harm, but the doctor may He begins by noting that whoever, as a bystander, safely leave his hypodermic case at home. seek to form a judgment from the theoretical electric shock is the cause of the asphyxia, perseverance might ,

directly

passed.

When

1 Harvey Lectures, 1907-1908.

J. B. Lippincott Company. 2 Jour. Amer. Med. Assoc., 1928, xc., 1263.

New

3 Wien. Klin. Woch, 1928, May 3rd, p. 622. 4 Booklet of American Gas Association, Lexington-avenue, York.