Page:The New International Encyclopædia 1st ed. v. 17.djvu/77

KESPIRATION. just above the elbows, and raised gently and steadily upward and forward to their full extent, and at the same time rotated slightly outward. This position is maintained for two or three sec- onds and secures iitsiiiriilioit. The arms are now lowered and pressed lirmly ayainst the sides of the chest for two or three'seconds, thus bringing about expiration. These movements are repeated in alternation with regularity and precision, at the rate above mentioned. Sylvester's method is the one generally employed to resuscitate the drowned. ]?eforc proceeding with artificial respiration in these eases certain preparations have to lie made. To drain oft' water from the stomach and chest, the patient is stripped to the waist and placed face downward with the pit of the stomach raised above the level of the mouth by a roll of clothing or other material placed transversely beneath the trunk. Pressure is then made upon' the patient's back. The tongue must be held out, the larynx kept open, and the mouth and throat cleared of mucus. In cases of drowning efforts to resuscitate should be continued for at least an hour, apjiarently inanimate individuals having been broiglit to life at the end of that time, after having been immersed half an hour or longer. Attempts to restore respiration should be supplemented by friction, the administration of stimulants, and the application of heat to the abdomen and lower extremities, Schultz's method, applicable especially to the resuscitation of newly born infants, is as follows: The operator stands behind the patient. The shoulders arc grasped, with an index finger in each armpit, the thumbs over the shoulders, and the rest of the fingers resting obliquely over the back. The whole weight of the child's body is now allowed to hang from the shoulders. This lifts the ribs, expands the chest, and produces mechanical inspiration. Expiration is produced by swinging the child forward at arms' length to a point where the lower limbs and pelvis top- ple over toward the operator, thus bringing about extreme flexion of the tnuik, and forcing the ab- dominal viscera against the diaphragm. This motion is then reversed, and the process repeated at the rate of eight or nine times a minute. In the method of Byrd-Dew the neck is sup- ported by one hand, the thighs upon the other, the chilli lying upon its back. The head is al- lowed to fall backward so that the glottis may remain freely open. The body is then alternately extended and flexed, which movements determine respectively inspiration and expiration. Fell's method of artificial respiration consists in pushing a tube into the larynx and trachea, and forcing warmed air into the lungs by means of a bellows. Expiration is secured by pressure on the sides of the chest. Gibbons's method, which is applied by its author to cases of apparent death from electric- ity, consists of inserting one end of a tube into a nostril of the inanimate person and then, after closing the other nostril, working two bellows alternately so as to exhaust the air in the lungs and then supply fresh air under pressure. Laborde's method depends on rhythmical trac- tion of the tongue. This organ is seized, as far hack as possible, between (the thumb and index finger wrapped in linen, and alternately pulled forcibly forward and relaxed. This method is supposed to excite lireathing by reflex action. A practicable and very useful method especial- 61 RESPIRATORY SYSTEM. ly for young children is nioutli-tu-nioulli insuffla- tion. A piece of gauze is lai<l over the nioulli of the child and air breathed directly into its lungs from those of the operator. RESPIRATORY SOUNDS. Sounds pro- duced during inspiralic]]! ami expiration us per- ceived by auscultation, either by placing tlii' ear upon the chest or tbrough the medium of the stethoscope (q.v.). When the ear is placed upon the chest of a' healthy ailult, a soft. ru><tlin{; sound is heard, comparable to the sighing of a gentle breeze anuing the leaves. This soun<l is louder and more marked during the inspiratory act, which is in health longer than expiration in the ratio of G:.5. To this sound the name rcsiciihir tniirmiir has been given. Certain areas of the chest, here the large bronchi are man^r the surface, viz. over the steru n, the juietion of the first costal cartilage with the sternum, and a diamond-shaped space at the back in the middle line, the sound beconu's tulmlar, and higher pitched, and expiratiiJU and inspiration are of equal length. This is called bronchial breathing and is significant of disease when it occurs else- where than over the areas above indicated. Where these two sounds shade into each other, bronclio-vesicular breathing is heard. In pathological conditions of the lungs, the vesictilar murmur imdergoes many important modifications. It is. for example, diminished or completely obliterated in pleurisy (q.v.) with eli'usion and in pneumothorax ; it becomes lovuier and higher in pitch over consolidated luns; tissue such as occurs in pneumonia and pul- monary tuberculosis (q.v.). One of the earliest physical signs of phthisis is a ]n-olonged respira- tory murmur, and this alteration of the n<u-nial rhythm is also characteristic of asthma and em- physema (q.v.). Interrupted breathing, some- times called cog-wheel rcHjiirtition, is heard in healtliy but nervotis individuals, but in disi'a.se it is caused by the breaking of the column of air passing through the bronehials by tenacious nnicus, or by the expansion of ditlerent lobes at diftcrent times. Certain adventitious sounds to which the ge- neric name rules is applied are heard in disease, and are nrodueed either in the bronchial tubes or air vesicles. Dry rales are whistling, squeak- ing sounds, caused by the passage of air through bronchial tubes narrowed in places by swelling of the lining mucous membrane, as in bronchitis, or by spasm, as in asthma; or by tough, adherent nuicus. Moist nlles are ]iroduced by the expan- sion of previously closed air cells, or by the pas- sage of air through fluid in the bronchial tubes or in a cavity. These are heard in tuberculosis, the resolving stage of lobar pneumonia, pulmo- nary oedema, etc. Melaliic tinlcliny is a sliarp» quick .sound resembling that produced by strik- ing a glass vessel with a pin. Its presence gives, evidence of the luesenee in the lung of a cavity of considerable size containing air. and surround- ed bv firm walls. . frirtion xoiiiid is |)ro<lueed by the rubliing together of the visceral and parietal layers of the pleura when roitgh from intlani- mation, and is in<licative of ideurisy. Consult Loomis's Plu/sical Diaffiwsi.t (Kew York, 1!)02). See At'scuLTATioN. RESPIRATORY SYSTEM, Compar.tivb . .tomv or TiiK. The system of organs th.-vt iiave the function, in the animal body, of taking in oxj-gen from the surrounding mediums (water