Treatment of Persons Asphyxiated. RULES. 1.-Treat the patient instantly, on the spot, in the open air, treely exposing the face, neck, and chest to the breeze, except in severe weather, and removing all tight clothing from the neck and chest, especially the brace. The points to be aimed at are first and immediately the restoration of respiration; and, secondly, after respiration is restored the promotion of warmth and circulation. Efforts to accomplish the latter object, beyond removing wet clothing and drying the skin, must not be made until the first appearance of natural respiration. I. TO RESTORE RESPIRATION.-2. Clear the throat, by placing the patient gently on the face with one arm under the forehead; all fluids and the tongue itself then fall forward and leave the entrance into the windpipe free. Assist this operation by wiping and cleansing the mouth. If there be only slight respiration, or no respiration, or if the respiration fail, then 3. To Excite Respiration:-Turn the patient slightly on his side and apply some irritating or stimulating agent, as camphor or ammonia near the nostrils, (not to them) and dash cold water, or alternately cold and hot water, on the face and chest, previously rubbed briskly until warm. If satisfactory respiration commence use the treatment prescribed below to promote warmth and circulation. If there be no success lose no time but proceed 4. To Imitate Respiration (Marshall Hall's method) by replacing the patient on his face, raising and supporting the chest well on a folded coat or other article of dress, and turning the body gently but completely on the side and a little beyond; then again on the face, and so on alternately, occasionally varying the side. Repeat this movement deliberately and perseveringly fifteen times only in a minute. On each occasion that the body is replaced on the face, make uniform but efficient pressure with brisk movement along the spine between and below the scapula, removing the pressure immediately before turning the body on the side; during the whole operation, let one person attend solely to the movements of the head and the arm placed under it. While the above preparations are being proceeded with, dry the hands and feet, and as soon as dry clothing or blankets can be procured, strip the body and cover or gradually reclothe it, but taking care not to interfere with the efforts to restore respiration. Should these efforts not prove successful in the course of from two to five minutes proceed 5. To Imitate Respiration (Silvester's method) by placing the patient on the back on a flat surface, inclined a little upward from the feet; raise and support the head and shoulders on a small firm cushion or folded article of of dress, placed under the scapula. Draw forward the patient's tongue and keep it projecting beyond the lips; an elastic band over the tongue and under the chin will answer this purpose, or a piece of string or tape may be tied round them, or by raising the lower jaw the teeth may be made to retain the tongue in that position. Take your place at the patient's head, grasp the arms just above the elbows, and draw them gently and steadily upward above the head and keep them stretched upwards for two seconds. (By this means inspiration is effected.) Then turn down the patient's arms and press them gently and firmly for two seconds against the sides of the chest. (By this means expiration is effected. Repeat the movements alternately, deliberately and perseveringly about fifteen times in a minute, until a spontaneous effort to respire is perceived, immediately upon which cease to imitate the movements of respiration and proceed II. TO INDUCE CIRCULATION AND WARMTH.-6. Rub the limbs upward with firm grasping pressure and energy, etc.; the friction being continued under the blanket or over the dry clothing, which has been substituted, if possible, for the wet. Promote the warmth of the body by the application of hot flannels, bottles or bladders of hot water, heated bricks, etc., to the pit of the stomach, the armpits, between the thighs, and to the soles of the feet. 7. Meantime, and from time to time, if necessary, to excite inspiration let the surface of the body be slapped briskly with the hand and cold water dashed briskly on the surface, previously rubbed dry and warm. 8. If the patient has been carried to a house after respiration has been restored, be careful to let the air play freely about the room. On the restoration of life a teaspoonful of warm water should be given; and then, if the power of swallowing has returned, small quantities of wine, warm brandy and water or coffee should be administered. The patient should be kept in bed and a disposition to sleep encouraged. CAUTIONS. 1. Avoid the immediate removal of the patient, as it involves a dangerous loss of time-also, the use of the bellows or any forcing instrument; also of the warm bath, except as a momentary excitant. 2. Avoid rough usage, and do not allow the body to remain on the back unless the tongue is secured. 3. Under no circumstances hold the body up by the feet or roll it with a barrel. 4. Prevent unnecessary crowding of persons around the body, especially if in an apartment or confined space. ASPHYXIA NEONATORIUM. Excite the skin by brandy or the cold (60°) and hot (100°) bath alternately in connection with the above postural respiration, rubbing upward with pressure, etc. The use of Sugar and Lactic Acid in the Animal Economy. By SAMUEL JACKSON, M.D., Emeritus Professor of the Institutes of Medicine in the University of Pennsylvania. The chemical history of the sugars has been very thoroughly worked out by the researches of the chemists. As much cannot be said for its physiological actions and uses in the animal organism, or its relations with vital phenomena. On these subjects much valuable information has been obtained from the investigations of Liebig, Lehmann, and Cl. Bernard. They have not, however, so completely exhausted the facts as to render further observations unnecessary, or to cause additional suggestions to be thought obtrusive. With this view, it has appeared to me that a short review of this subject would not be inappropriate. A brief summary of the principal chemical facts will be required in order to obtain clear ideas of the actions and uses of these bodies in animal organisms. There are several varieties of sugar marked by special characters. Chemists divide them into two kinds or species. The first division or species comprises cane sugar, beet sugar, palm sugar (produced and consumed in India), and maple sugar, with some others of less importance. They are named cane sugars, from their possessing similar chemical properties; and because the Chinese or sugar-cane was the plant from which sugar was first made in China, anterior to our historical era, and at the present day nearly 90 per cent. of the sugars of commerce is furnished by various sugar-canes. The second kind or species of sugar consists of glucose or fruit sugar, which exists largely in sweet grapes, and in raisins or dried grapes, from which it has received the name of grape sugar. It is not peculiar to the grape, but is present in nearly all sweet-tasting fruit. The sugar of honey is identical with glucose, which is also the kind of sugar found in the liver, blood, and alimentary canal of animals, and in the muscles, lungs, amniotic and allantoid fluids of the fœtus in its early stages. The chemical reactions of the two kinds or species of sugar are in strong contrast. The cane sugars are not decomposed by pure potassa and soda; while they are transformed into sugar of the second species or glucose by dilute acids and heat. On the contrary, the alkalies potassa and soda decompose glucose, forming peculiar brown-colored acids; according to M. Peligot, the melassic acid. Trommer ascertained that a solution of glucose to which sulphate of copper and potassa were added and heat applied, decomposed the deutoxide of copper of the sulphate by robbing it of one equivalent of oxygen, the protoxide thus formed, being insoluble is precipitated. This is Trommer's test for diabetic sugar in the urine. Modifications of this test have been made; that of Bareswil is convenient and reliable. It has been adopted by M. Cl. Bernard, who has named it the cupropotassic test for sugar. M. Becquerel ascertained by experiment that the cane sugars have no action on the deutoxide of copper, which is not reduced by them. All the sugars proceed from the transformation of starch. The amylaceous and the saccharine groups of natural bodies are closely allied. They are nearly identical in chemical constitution, consisting of fixed equivalents of carbon (12) with slightly varying equivalents of oxygen and hydrogen in the proportions forming water-that is, from 10 starch, 11 cane sugar, 14 glucose or fruit sugar; or, in other words, they are compounds of a definite proportion of carbon with definite proportions of water. (Payen.) Hence their appropriate chemical name carbo-hydrates. From this sameness of composition, they are readily transformed into one another. Almost any organic matter in a state of change is capable of effecting this transformation of starch. In the seeds of the cerealia and of maize an immense store of starch is annually laid up as aliment for man and animals. Close in contact with the germ in the seed, imbedded in starch, is placed a small albuminoid substance called diastase. As long as the seeds are kept perfectly dry, even for lengthened periods of time, no action takes place; but as soon as they are exposed to moisture and heat, the diastase exerts a catalytic or fermentative action and converts the starch into dextrine and glucose. Being very soluble, they immediately become the organizable substance from which is formed vegetable structure. They are promptly absorbed by the germ, and under its organizing force they are transformed into cellulose, the primary organizable material from which are constructed the primary cells and vessels, and the vegetable tissues and organs. Mialhe has shown that a similar albuminoid (nitrogenized matter) exists in the mixed saliva. Its catalytic power is so great that one part will transform two thousand of starch into glucose. Some physiologists and chemists (Bernard, Robin and Verdeil) do not admit the existence of diastase as a special organic body. They regard it as an albuminoid or nitrogenized substance, in which a change or molecular action is set up by moisture and heat. Its action, they assert, is the same as that of other animal matter in a state of change or starch. The difference, however, is in time. The action of the mixed saliva is most prompt on prepared starch. When a teaspoonful of hydrated starch is held in a sound mouth with no defective teeth, and well washed, to remove any remains of food from between the teeth, in a few seconds it becomes very fluid (dextrin), in a few more it is sweet, and, if tested at once, sugar is found in abundance. This difference in time, in the activity of the agent, is in striking contrast with that of common organic matter in a state of change when acting on starch. MM. Robin and Verdeil, from similar facts, deny that pepsin is a special agent in the gastric juice; they regard it as organic matter in process of change, which, with an accidulated fluid, will, they assert, digest articles of animal food. A fluid of that composition will dissolve raw or cooked meat, but requires fifteen or twenty hours to effect it. Nor has it been shown that the special peptone or albuminose, the constant product and object of gastric digestion, resulted from the solution of this artificial digestive fluid. This imperfect observation cannot be accepted in the face of the daily experience of healthy digestson accomplished in from, three to four hours. The conversion of starch as an aliment begins in the mouth during mastication, and if in small quantities, is there completed; but when the food is largely amylaceous, the greater portion arrives in the stomach, where the process is continued, but not finished. The unchanged starch passing into the intestines, is brought under the action of pancreatin and the intestinal juice, and is rapidly transformed into glucose. When animals are fed exclusively on starch for some drys, a portion is found in the feces unchanged; the larger part has disappeared in the intestinal canal. (Nehmann.) It has been denied that starch is ever changed into glucose in the stomach, or that it can take place in the presence of an acid. (Fremy and Bohtron.) This fact has been decided as respects the human stomach, by the experiments of Grunewald and Schroeder, who had under their charge a woman with a gastric fistula produced by a wound. They were communicated to M. Longet by M. Shiff, who witnessed the experiment. “Some ounces of hydrated starch were introduced into the stomach through the fistulous opening while fasting. Immediately after some starch was expelled, which was found already to contain sugar. In a quarter of an hour sugar was found abundantly in the stomach, and the whole of the starch was fluid (dextrin).”* M. Bidder asserts that the power of changing starch into sugar in the stomach persists in the presence of free acids; and M. Ernst Schroeder states that the saliva possesses its activity in the stomach, and rapidly transformed swelled starch (turgefactum amylum) into sugar.† This error arose from making the experiment on dogs, in which starch is very imperfectly changed, if at all, by their saliva. Starch does not enter into the natural food of that animal, and it appears as though no provision was made by nature for an office not intended in the natural state. If this view be correct, it is confirmative of the theory that there is a special agent, diastase, in the salivary fluid. Longet expressly objects to the using of these animals in this investigation; he alleges that their saliva has a very low transforming power, and their gastric juice is very acid. The experiments of Lehmann, Bernard, Longet, Corvisart, and others, have established the facts of the transforming power of the pancreatic and intestinal juices, and that dextrin and glucose are the common products into which all the amylaceous and saccharine substances in food are converted in the alimentary canal. Glucose must, then, be regarded as the proper physiological sugar. Bernard has proved its existence in the earliest stages of foetal development, before the formation of the liver, after which it is chiefly developed in that organ. He detected it in the fluids of the amnios and the allantoid. In seeking for the origin of this sugar, or the glycogenic matter which produced it, he observed in the placentas of rabbits and guinea-pigs a whitish sunbstace formed of a mass of cellules filled with sugar-forming substance. These last resembled in this respect the liver-cells of of the adult animal. In pursuing this investication, M. Bernard ascertained that similar epithelial or glandular cellules existed in the placentas of mammifers in the first period of embryonic life, producing a sugar-forming substance. This anatomical element of the placenta, in some animals of this class is mingled with the vascular portion of the organ, but in the ruminants it is separated in the form of epithelial layers on the amnios, In this manner, as Bernard had previously asserted, the fact is established that the production of an amylaceous sugar-making matter is a function common to ani |