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man of truth and honor, who has practiced midwifery for half a century, should convince every right-minded man, that there is no need that country physicians should take the precautions against germs, so strongly urged by the advocates of listerism. But Dr. Green is sustained by other good men whom I have named and thousands of others whom I could name. No, I need say no more, for if one were to rise from the dead and give like testimony, the antiseptic enthusiasts and laboratory practitioners would still discredit the testimony of the bed-side practitioner.

TWO INTERESTING CASES OF FORCED RESPIRATION. FELL METHOD.

BY GEORGE E. FELL, M.D.,

OF BUFFALO, N. Y.

Sunday morning, March 1, at 3:20 A.M., I was called to the residence of Dr. Harrington, on Franklin St., and there found a young lady who had taken a large dose, about fifteen grains, of morphine. At 3 A.M., Mr. Harrington, Sr., had noticed stertorous breathing. He arose, looked at the patient, but concluded that it was nothing more than a very deep slumber. The condition continuing, however, he called Dr. Harrington, who examined the patient, finding her in a comatose condition, cyanotic; pupils markedly contracted; and a bottle of morphia upon the table. She had written two or three letters which clearly indicated the cause of the trouble.

I immediately proceeded to forced respiration with the face-mask, which resulted in overcoming the cyanosis and producing an improvement in the heart action. We continued forced respiration with the face-mask until 6:30 A.M., when it was observed that the cyanosis was again

increasing, and the condition of the patient growing more and more desperate. No evidences of consciousness were present. By shouting into the ear, ocular reflexes were noticed in a contracting of the orbicular muscles. There ap

peared to be no hope of recovery at this time.

With Dr. Harrington's assistance we made tracheotomy, and inserted the tracheotomy tube, as arranged for forced respiration, into the trachea. Connection was then made with the apparatus, and forced respiration kept up. The improvement on the employment of forced respiration per tracheotomy, over that produced by the face-mask, was evident. The chest movements were greater, and the results were more satisfactory in many respects. However, of so serious a nature was the condition of the patient at this time that not one present expected other than a fatal termination. No pulse existed at either wrist; auscultation could detect no heart movement, either on the part of Dr. Harrington, myself, or the students present. Two conditions, however, appeared to indicate that life was not extinct. The pupils continued contracted, and cyanosis did not supervene. The glassy stare of the eyes was present, and outside of the two favorable indications mentioned, it appeared that death could not be far off. At this point Dr. Harrington's father made the remark that if this young lady was made to live, it would be indeed a "miracle." However, I kept up the forced respiration, saying that I would do so a little

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while longer, "just for the fun of it." In a short time auscultation on the part of Dr. Harrington gave us the satisfactory information that the heart was beating. In the course of a few hours these reflexes were more and more marked, and consciousness supervened. Forced respiration was continued through the forenoon, and until quite late in the afternoon, making some twelve to fourteen hours of continual forced respiration before the patient could be allowed to breathe for herself.

She has made a good recovery.

In this case artificial respiration would at no time have been of any avail to the patient. Oxygen gas used.

Sunday, March 15, at 11:30 A.M., I was called to attend Joseph Altiere. A prescription containing phenacetin, morphine and cocaine, in small quantity, had been prescribed by the attending physician, for neuralgia of the stomach. The patient had taken repeated doses, without regard to instructions upon the prescription, until a large poisonous dose of these very dangerous drugs had been taken. At 11:30 A.M., forced respiration with the face-mask was commenced, and quickly overcame the marked cyanosis, which was intensified, undoubtedly, by the phenacetin. With the face-mask forced respiration was kept up all the afternoon, the patient at times becoming conscious. The cyanotic condition seemed, however, to increase, owing to the base of the tongue falling back and occluding

the larynx. A ligature was placed through the tongue, and the organ was pulled well up, with the result that the lungs were more readily inflated.

In this case oxygen gas was administered, in connection with the forced respiration apparatus, it being supplied in greater or less quantities, as seemed to be desirable. At times the amount of air passing to the stomach and the bowels was so great as to markedly distend them, thus interfering to a certain extent with the inflation of the lungs by the forced respiration, and indicating one of the difficulties to be met with in forced respiration with face mask. In the afternoon the patient became comatose, and responded very little to the respiratory work. During the evening it was evident that the patient was not progressing satisfactorily, the influence of the poisons being peculiar in their action, there not appearing to be any elimination of the drugs-although the catheter was used as often as was necessary, and the antidotes which seemed to be indicated, and stimulants, such as digitalis and alcohol, injected hypodermically. At 10 P.M., Sunday night, I made tracheotomy, and forced respiration was then kept up by the direct method. The result, as in the former case, indicated the very great readiness with which the method could be used in the inflation of the lungs, and the patient was apparently holding his own. I left for home at 11 P.M., trusting that the patient would be in good condition in the morning.

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