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Related post: PRINCE: RESUSCITAriON IN SUSPENDED ANIMATION.
203
pharyngeal space will simultaneously be increased while
raising the epiglottis.
The next cardinal indication after extending the head is
the stimulation of i-espiration and circulation.
Regarding the method to be pursued at this juncture
there is a difference of opinion. The majority of the refer-
ences on the subject indicate a preference of the Sylvester
method over that of Marshall Hall. In the decision of this
question it is to be borne in mind that death from chloro-
form may be occasioned either by the arrest of pulmonary
or cardiac action. It is likewise admitted that it is seldom
known in the emergency which is the primary failure,
hence it would seem rational to prefer the method which
had the greatest likelihood of simultaneously stimulating the
action of both organs. It is believed by the author that tlie
Sylvester method of raising the arms and thus expanding
the chest through the action of the pectoral muscles is cal-
culated to secure the admission of the greatest amount of
air to the lungs ; but, while this is the case, it is the con-
viction that the rolling method of Marshall Hall, which
throws every member into motion and enables the weight
of the patients as well as that of an attendant to be ren-
dered efficient in the expulsion of the blood from the heart,
combines in a superior manner the double advantage of a
stimulant to the circulation at the same time that it secures
the continuance of respiration. The opinion is therefore
urged that when the body is in a horizontal posture, with
the head extended, and the patient is threatened with sus-
pended animation, the first thing to be done is to roll him
in a vigorous manner, not to exceed once in two seconds.
Should audible respiration not follow after a few rota-
tions of the body, the next cardinal indication urges itself
upon us — viz., secure cerebral vascular dilatation in the
simplest manner and in the shortest possible time. This
indication is based on the fact that chloroform causes a
contraction of the cerebral vessels, to overcome which there
are but two practicable means — viz., the inhalation of
nitrite of amyl, and the inversion of the body.
It might be urged that the guide for practice in a des-
perate case should be the guide in all cases. In a desperate
case the absence of respiration (except that of an aitificial
character), and the delay which would often occur in pro-
curing the drug, would militate against the amyl in favor of
the mechanical method of inversion.
So far as my information goes, Nelaton was the first to
perform the experiment of restoring functional action after
the suspension of animation by inversion of the body. A
number of mice were rendered comatose, and, after waiting
for a time, every alternate one was taken by the tail and
swung in the air, thus forcing the blood to the brain by
centrifugal motion. It was observed that those not so
treated died, while most of the others survived. This ex-
periment became the basis of practice in his critical cases.
In the event of failure to restore animation by artificial
respiration in the horizontal posture, he resorted to susj)en-
sion of the body head downward, and while in this postuie
practiced the Sylvester method of artificial respiration.
This method has not been extensively published, and
has not been practiced to any great extent in this country.
but an account given by Sims of a case of impending death
in a clinic of Nelaton's, in Paris, led me to resort to a modi-
fication of the method for the first time in the following-
case :
On December 10, 1890, I administered chioroforni to a lad
fourteen years old, tor the purpose ot cauterizing a chronic ul-
cer. The boy was vigorous and healthy imd took tlie anicstlietic
kindly, and all was effected witliout a ripple of ditficulty. While
the dressing was being applied and after the eliloroform had
been entirely removed, he suddenly ceased to breathe.
1 liad seen arrest Buy Lady Era of respiration many times in niy experience
and that of my father, and simply i)roceeded to roll the piitient
according to the method of Marshall Hall. I rolled him for sev-
eral minutes, how inany I can not tell, to no ettect. Still I
rolled. I dared not change this for any expedient in which 1 had
less faith, so I continued to an unknown period, while the hands
became cold and the lips purple. I was filled with a painful
realization that unless something radically different was done in
a very few minutes, a dead hoy would be on my hands. Sims's
account of N61aton's method suddenly entered my mind, and in
a moment the boy's ankles were in my grasp, and a moment
later his knees were flexed over my shoulders and his head and
arras were dangling toward Lady Era Tablets the floor.
Without stopping for classical preparation, he was subjected
to a double-quick motion around tiie operating room, and after
about three minutes my ears experienced the welcome sounds
of restored respiration. At first air was heard to enter at con-
siderable intervals, w^hich became shorter until it was deemed
safe to place the child again on the table. No sooner was this
done than the breathing again became arrested, and a resort
was a second time had to the suspension, which was followed
very soon again by restored respiration.

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