The Schaefer or prone-pressure method of artificial respiration should be used where possible; however, the Sylvester method may be used advantageously in certain cases.

PRONE-PRESSURE OR SCHAFFER METHOD OF ARTIFICIAL RESPIRATION

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Lay the patient on his belly, one arm extended directly over the head, the other arm bent at the elbow, and the face turned outward and resting on the hand or forearm, so that the nose and mouth are free for breathing. (See fig. 12.)

Kneel, straddling the patient's thighs with your knees placed at such a distance from the hip bones as to allow the palms of your hands to be placed on the small of the back with fingers resting on

FIGURE 12.-First position, prone-pressure method of artificial respiration.

the ribs, the little finger just touching the lowest rib, with the thumb and fingers in a natural position and the tips of the fingers just out of sight. (See fig. 12.)

With arms held straight, swing forward slowly so that the weight of your body is gradually brought to bear upon the patient. The shoulder should be directly over the heel of the hand at the end of the forward swing. (See fig. 13.) Do not bend your elbows. This operation should take about 2 seconds.

Now swing backward immediately so as to remove the pressure completely. (See fig. 14.) 24 After 2 seconds swing forward again. Repeat slowly the double movement of compression and release 12 to 15 times a minute, making a complete respiration in 4 or 5 seconds.

This method has been approved by the following: American Telephone & Telegraph Co., American Red Cross, American Gas Association, Bethlehem Steel Co., National Electric Light Association, National Safety Council, Bureau of Medicine and Surgery, Navy Department, office of the Surgeon General, War Department, U. S. Bureau of Mines, U. S. Bureau of Standards, U. S. Public Health Service.

In actual work the operator's hands may or may not be entirely removed from the patient. In contests for uniformity the operator should entirely remove his hands and assume the position shown in figure 12 between each complete respiration.

Continue artificial respiration without interruption until natural breathing is restored (if necessary, 4 hours or longer) or until a physician declares the patient is dead.

As soon as artificial respiration has been started and while it is being continued an assistant should loosen any tight clothing about

FIGURE 13.-Second position (exhalation), prone-pressure method of artificial respiration.

the patient's neck, chest, or waist. Keep the patient warm. Do not give any liquids whatever by mouth until the patient is fully conscious.

FIGURE 14.-Third position (inhalation), prone-pressure method of artificial respiration.

To avoid strain on the heart when the patient revives, he should be kept lying down and not allowed to stand or sit up. If the doctor has not arrived by the time the patient has revived, he should be given some stimulant, such as one teaspoonful of aromatic spirits of ammonia in a small glass of water or a hot drink of coffee, tea, etc. Resuscitation should be carried on as near as possible to where the patient received his injuries. He should not be moved until he is

breathing normally of his own volition and then only in a reclining position. Should it be necessary, due to extreme weather conditions, etc., to move the patient before he is breathing normally, resuscitation should be carried on while he is being moved.

A brief return of natural respiration is not a certain indication that resuscitation should be stopped. Not infrequently the patient, after a temporary recovery of respiration, stops breathing again. The patient must be watched, and if natural breathing stops artificial respiration should be resumed at once.

In applying resuscitation it may be necessary to change the operator. This change must be made without losing the rhythm of respiration. With this method no confusion results when the operator is changed, and a regular rhythm is maintained.

SYLVESTER METHOD OF ARTIFICIAL RESPIRATION

To use the Syvester method, place the patient on his back. Remove from his mouth all foreign bodies, such as false teeth, tobacco, gum, etc. The tongue must be held out, as otherwise it will

FIGURE 15.-First position (inhalation), Sylvester method of artificial respiration.

fall back and block the windpipe. Grasp it in a dry cloth or with pincers. Have someone hold it out, or, better, hold it out by a bandage or rubber band over the tongue and under the jaw. Place a rolled-up coat, a pad, or something similar under the patient's shoulders. This will straighten his windpipe. Kneel just above the patient's head; catch both his arms at the wrist; draw the arms outward and upward gently and steadily and hold them as far as they will go above the head. (See fig. 15.) This operation requires about 2 seconds and opens and expands the chest to the greatest possible extent. Certain muscles are attached to both arms and ribs, and when the arms are raised these muscles raise the ribs and so enlarge the chest. Bring the arms down till the elbows press against the chest, arms crossed; with a little pressure diminish the size of the elastic chest as much as possible. (See fig. 16.) This movement also requires about 2 seconds. Continue these motions about 12 to 15 times a minute. When done properly, this treatment is hard

work for the operator, and he should be relieved as soon as he grows tired.

Continue any method of artificial respiration, if necessary, for at least 3 hours without. interruption or until natural breathing has been restored or a physician has arrived. Even after natural breathing begins watch carefully to see that it. continues. If it stops, start artificial respiration again. Do not give any liquids whatever by mouth until the person is fully conscious, when aromatic spirits of ammonia (1 teaspoonful in half a glass of water), hot coffee, hot tea, or water may be given slowly. Do not permit bystanders to crowd around the patient. The assistant should not do anything that will interfere with the operator.

OXYGEN INHALER

The administration of oxygen or a carbon dioxide-oxygen mixture to men unconscious from breathing irrespirable or poisonous gases, as previously mentioned, has been found to have decided value. The

Bureau of Mines does not use carbon dioxide-oxygen mixtures in its inhalers; however, it does use inhalers charged with oxygen only as part of its safety car and station equipment. An oxygen inhaler should include:

1. A tank or tanks of compressed oxygen with hand-operated closing valve. 2. A reducing valve to supply a flow of oxygen at a breathable pressure, equipped with a bypass valve or other device for increasing the flow of oxygen when necessary.

3. A breathing bag of about 10 liters (610 cubic inches or about 10 quarts) or more capacity.

4. A breathing tube equipped with a valve that will open automatically and admit outside air in the event the breathing bag becomes empty.

5. A facepiece (mask) equipped with an exhalation valve that also will open and permit excess pressure to escape.

An oxygen inhaler may be used to advantage to feed oxygen to persons who have breathed poisonous gases or in conjunction with administering artificial respiration by either the prone-pressure or Sylvester manual methods. Artificial respiration is used only on

FIGURE 17.-Using an oxygen inhaler in conjunction with artificial respiration.