Resuscitation After Shock.

(By Arthur J. Vogan, F.R.G.S., recipient R.H. Society’s reward; oldest St. J. of J.

Ambulancer in Australasia.)

AS I have had my advice sought re garding the new process of resusci tation from drowning, by friends in Fiji, perhaps the following notes may be found useful to those living outside the orbit of salvation of the ordinary medi cal man.

I trust that such wonderful and de voted men as Dr. Williams, of Samarai; and Dr. A. C. Neff, of the leper station at Makogai; and other professionals who had rendered me hospitality and assist ance, will forgive me, as a very humble member of the healing art and pardon my presumption.

Suicide by gas-poisoning is greatly on the increase in the large centres of population in America and England; but, fortunately, is beyond the reach of the owners of copra plantations and pearl-traders. Similar effects arise at times from excessive stimulation under that now “forbidden” condition of the mind about which Mr. Dexter disagrees with me.

Drowning, the excessive effects of using the poisonous betel-nut (“areca mentality”?)—which arrested the pro gress of Island self-culture; shock, from shark bites, or fish-spines; bush-fire, fume-effects, etc., can all be now more effectively treated, than when I learned ambulance work many years ago.

We hear about the administration of oxygen; but it has too often been given in a perfunctory way (frequently too late) and timid kind of inadequate way, owing mainly, in hospital, to the ex pense! There is no danger whatever in breathing pure oxygen for hours con tinuously—working hard all the time, as In the case of mining rescue-parties.

At a meeting of the British Associa tion in 1931, the subject was dealt with by the President, Dr. Dale, and four main, available lines of resuscitation were described: namely, artificial respi ration, carbon-dioxide and oxygen, inha lation, cardiac puncture, and cardiac massage. The two latter do not concern us amateurs!

Sir Edward S. Schafer, the inventor of the latest resuscitation process, which has taken the place of the Sylvester method, which I learned in the ’seven ties and ’eighties, showed that the result of a Royal Commission proved that the prone position now called “Schafer’s method” was far preferable.

In this, pressure of about sixty pounds weight is brought to bear on the small of the back —thus compressing the ab dominal viscera;- and pushing the dia phragm upwards like the plunger of a pump. The old way, which I have found successful, was by the well-known hold ing of the forearms, whilst kneeling astride of body, lying on its back, with tongue tied down to jaw, and, after stretching arms above head, bringing the elbows down on to floating ribs so as to compress them. Alternating pump ing action every five seconds, or so.

But careless action might rupture or gans; and the new way is better —but like most BEST things, requires more attention and greater skill! In England and America it is taught to Army and Navy, the police, and boy scouts, girl guides, etc.

But having “caught your hare”, to use the old cookery expression, and seeing with delight the first tentative volun tary attempts of your unconscious pa

tient to breathe again, your thoughts turn naturally to what will now follow: “Post hoc propter hoc!” There is the dreaded pneumonia, and after nervous effects, that may wipe out what your amateur resuscitation has recovered.

One turns, then, to the new carbon dioxide treatment called practically the administration of “Dicarbox” gas, which obviates most of the dreaded after effects. Twenty-five years ago Profs.

Haldane, Priestly, and Douglas, of Eng land, working in conjunction with Pro fessor Yandell Henderson, of Yale Uni versity, realised that the inhalation of cardon dioxide gas prevented the func tional depressions arising after shock, surgical operations, and acute poisoning and disease. Their discovery reminds those of us who are of the old school of the famous saying of the great Swiss physiologist Miescher, about the year I found the first gold discovered in New Guinea, in historic times (1885): —“Over the oxygen supply of the body carbon dioxide spreads its protecting wings.”

At first the practical problem of ad ministering C.D. was not simple. As I heard Sir Michael Foster say: “It is rarely possible to carry a physiological discovery bleeding from the laboratory to the bedside.” Haldane first showed that the compound which carbon mon oxide forms with the haemoglobin (col ouring matter of blood) is dissociable, and that haemoglobin is restored to nor mal condition under the mass action of oxygen. Professor Henderson then found that if carbon dioxide was administered (5 to 8 per cent.) respiration was greatly stimulated. When a mixture of oxygen and C.D. was administered, after a short but intense asphyxia, the effects were truly extraordinary.

It is now administered under the prone position of Professor Schafer, and the apparatus has each year been sim plified and lightened so that it can be

carried into the intricate passages of mines, or earthquaked ruins of towns.

The chances of resuscitating folk “found drowned”, or “dead drunk”, or poisoned with fumes, is to-day fifty per cent, greater than when I was young and beautiful.

We owe this to these wonderful men of whom our democracies know nothing.

Our mobs make heroes of cricketers, and little gods of other professional players, of games for money; but our hospitals are rendered inefficient because the people cannot spare for them funds they waste upon “pat-ball” games.

Any further information regarding the above subject required by my Island friends will be forwarded. This article has been written to supply one of my numerous correspondents with what, no doubt, many are in need of.