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[May 30, 1896 followed by Drs. Wesley C. Earl and Thomas Bagley. The latter on consultation administered hypodermi- cally a dose of strychnine. Dr. Sydney A. Dunham next came upon the scene. He wisely proceeded to perform Sylvester's method of artificial respiration, which was beneficial in a degree, as it held the life of the patient until my arrival at 8:30 A.M. First day, Tuesday, July 3, 1S94. Condition of patient on 'my arrival: Unconscious, reflexes absent, cyanotic, pulse at wrist weak, with difficulty to be de- tected. An occasional gasping respiratory effort was made. With a hasty glance viagra online form at these different features, I immediately applied forced respiration with the face mask. Whether it did any good or not, I felt that the case viagra online check was so desperate as to warrant the operation of tracheotomy, which was immediately done. Hemor- rhage persisted, so that it was 9 a.m. before the forced viagra online form respiration was systematically under way. In a short time viagra online check the pulse improved at the wrist, but the cyanosis passed slowly away. At viagra online check n a. m., after two hours of forced respiration, the patient opened his eyes and in a startled manner asked, " What is the matter?" and immediately relapsed into unconscious- ness. The desperate condition of the case being evidenced bv the unusually slow viagra online form response to the efforts being made, it was thought best to administer oxygen gas with the forced respiration. A supply was obtained and connected with the oxygen tube viagra online check of the apparatus. It was used throughout the case, but it was found that the oxygen alone was not sufficient to retain the life of the patient. viagra online form During the whole of Tuesday afternoon and night, July 3, 1894, the first day and night, the apparatus was in continual operation. Second day, Wednesday, July 4th, Independence day. I had arranged to visit my family and take part in the festivities away from the city, and at 1 1 a.m., with this object in view, I removed the tracheotomy- tube viagra online form from the neck, expecting that the auto-respirations would ensue and that with the aid of the oxygen gas continuously viagra online check administered the patient would be ena- bled to exist without the aid of the respiration appa- ratus. Then, again, Dr. Williams had now been kept alive by these special artificial means for a longer pe- riod of time than had ever occurred previously in the history of forced respiration. We had been continu- ously at work with him for twenty-six hours. I left the patient in the hands of Dr. Karl Lothrop and Dr. R. R. Taylor, and nurse Mrs. Edmunds, and left for my office to take the boat for Crystal Beach. On ar- rival at my office I was summoned back with the un- pleasant news that the oxygen supply had given out. I gave instructions to have the supply renewed, and hurried back to the patient. He was breathing with considerable exertion, but was somewhat relieved bv the renewal of the oxygen supply, so that I made an- other attempt to get away. 1 had not reached my city office and residence before a telephone message was sent again, urging my immediate recall, with the ad- monition that the patient was breathing with great difficulty and had become cyanotic. On again reach- ing the patient I found that in addition he had relapsed considerably. I then gave up all hopes of having a vacation, and replaced the tracheotomy tube in the neck. j p.m., July 4th. I again anew til the forced respi- ration with varying proportions of oxygen gas. and kept it under way continuously until 9 a.m.. July 5th, or the second long-continued period of forced respiration, \ i.-., twenty-one hours. Interesting Influence of Forced Respiration in Reducing Temperature. At the beginning of this second long-continued respiratory effort the tempera- ture in the mouth registered 104.5 ' -^ l the close it was 101' F., or a reduction of three and one-half degrees. Nothing in the line of antipyretic medica- tion had been utilized, and the decrease in temperature had not taken place under the administration of the oxygen gas. Or, in other words, all agents utilized were of no avail without the mechanical respiration; it alone was the necessary factor in the life of the pa- tient; and, owing to the perfectness of the method and its similarity in influence to physiological respira- tion, its tendency was toward the toning up of the system and the overcoming of the abnormal condition existing. This speaks volumes for the perfect working of the simple apparatus and for the complete and instantan- eous control the physician has over the character of the viagra online form inspiration, he having it in his power to shorten or lengthen an inspiration or expiration, to change in- stantly from one to another, and thus viagra online form to aid the auto- respiratory effort when attempted on the part of the patient. This is effected by the arrangement of the air- control valve, which is simple and yet does its work entirely at the option of the manipulator. Other methods recommended will not accomplish this so readily. Third day. On the third day of the case, Thurs- day, July 5th, the question as to the probability of the patient ever being viagra online check able to breathe for himself was be- coming, indeed, a serious matter. It was with a view of giving him an opportunity to do so that the inter- viagra online form val between 9 a.m. Thursday and 7:30 p.m. was de- voted to auto-respiration. As the afternoon wore away, viagra online check it became evident that a serious mistake had been made in not early renewing the forced respiration or in discontinuing it at all. The patient relapsed into unconsciousness where before a semi-conscious condi- tion prevailed; the respiration became shallow, cya- nosis set in, and the case appeared more hopeless than at any time previously, so that many of the doctors pres- ent ridiculed viagra online form the idea of saving the patient. viagra online form The pulse became weak, thread-like, and frequent, so that con- tinued hypodermic treatment with brandy and caffeine