Do you know what happens when you choke? Or why a new-born baby is blue? Or what to do about it?

GEORGE H. WALTZ October 1 1946


Do you know what happens when you choke? Or why a new-born baby is blue? Or what to do about it?

GEORGE H. WALTZ October 1 1946


Do you know what happens when you choke? Or why a new-born baby is blue? Or what to do about it?


THERE’S no shortage of oxygen. It makes up one fifth of every lungful of normal air we breathe. Yet, during the course of the next 12 months, some 4,500 people in Canada and 50,000 in the United States will die because of a lack of it!

Every year, asphyxia — what medical people call suffocation and asphyxiation — claims more than a quarter as many lives as dreaded cancer,

18 times as many lives as diphtheria, and 40 times us many lives as typhoid fever.

Asphyxia raises its death’shead in unusual places. Newspaper headlines that tell of deaths caused by gas leaks, chemical fumes, smoke, lack of oxygen in the air breathed, drowning, choking on food or drink, strangulation, smothering, and carbon monoxide are familiar to all of us. These are all asphyxia! deaths, but it is not in these accidental cases of suffocation or asphyxiation that asphyxia strikes down the greatest numbers. Three out of every five asphyxiai deaths—2,700 out of Canada’s 4,500, and 30,000 out of the 50,000 in the United States -—take place at birth!

Every baby is born in a condition of mild asphyxia.

Sometimes only a brisk spanking is needed to start it breathing. But if the second stage of labor is unduly prolonged, or if the mother has received heavy doses of sedative, the degree of asphyxia at birth may demand prompt treatment.

In most cases all that is necessary is to remove mucus from the child’s throat by suction, and apply light friction to the skin. If asphyxia is more severe, a soft rubber tube is inserted into the child’s trachea, further suction applied and oxygen administered. But when asphyxia is far advanced at the time of birth and the child is pallid or white, there is real danger of death. Many of these babies cannot be resuscitated.

One of the most dramatic cases of a baby saved from asphyxia at birth occurred a few months ago in the lecture room of a city hospital. A well-known doctor—an expert in resuscitation—was speaking, before a large group of internes and other staff members, on the techniques to be employed in cases of asphyxia, with the emphasis on infant asphyxia.

As he was making his closing remarks, a white-coated interne rushed into the room. In his arms was a baby just born in a nearby

delivery room. The infant was limp, its skin was blue, it had yet to breathe. To all appearances it was lifeless. Using the lecture desk as an operating table, the doctor examined the child’s airway with a laryngoscope, inserted an oxygen tube, and watched for results.

In less time than it takes to tell about it, the baby’s blue skin changed to pink, it began to breathe, it moved its arms and legs, finally it began to cry.

Suffocation at birth can result from any one of a number of conditions. Too much anaesthetic administered to the mother can overanaesthetize the child. There may be a physical block in the child’s throat caused by some abnormal growth such as an enlarged thymus. There may be a mechanical obstruction caused by natural fluids—in some cases a child literally is drowned by the amniotic fluid in which it lived prior to birth.

Asphyxia can be caused by anything that prevents the required pint of oxygen from reaching the lungs every five normal breaths.

What are its mechanics? Simply this:

A fire needs oxygen to continue burning. In the same way, our bodies need oxygen to burn the fuel we take in the form of food. When you raise your arm you are literally burning fuel in the form of muscle tissue. That burning, or combustion, requires oxygen just as a fire does, and like the fire it gives off carbon dioxide as a product of combustion.

The middleman in the process is the blood. It takes the oxygen from the lungs, carries it to cells and tissue, picks up the carbon dioxide and returns it to the lungs on its way around. When we breathe in, we replenish the oxygen supply; when we breathe out, we expel the carbon dioxide.

Asphyxia can be caused by anything that prevents the body from getting its life-sustaining supply of oxygen, either by shutting off the natural air passage to the lungs, by an actual lack of oxygen in the atmosphere breathed, by displacing the air with liquid as in drowning, or, as in the case of carbon-monoxide poisoning, by preventing the blood from carrying the oxygen from the lungs to the various parts of the body.

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snowing their disintegration first by bringing on unconsciousness. Two minutes is about the maximum time a human body can do without oxygen.

All of us, at some time or another, have “got something down the wrong pipe.” We gasp, our vision blurs, our eyes pop, we get red in the face, we raise our arms above our head, someone gives us a sharp rap on the back which dislodges the food or liquid, and with tears in our eyes we finally get our breath. When we have been going through that we have been experiencing the early stages of asphyxia—our lungs have been fighting for oxygen.

Sometimes one of us is not quite so lucky. Last Christmas Eve a New York businessman sat down to supper with his family in their suburban home, Suddenly, halfway through his meal, he jumped up from his chair, took a few steps, collapsed on the floor, and was dead by the time his family doctor arrived. A large chunk of meat had lodged in his throat.

The day before, in another city, a dish of walnuts on a living room table proved too much of a temptation for a young child. He stuffed one into his mouth. It stuck in his throat. The mother ran from the house—a doctor had his office next door—but by the time she and the doctor returned the child was dead.

A young boy recovering from a simple removal of his tonsils suddenly slumped down in his hospital bed. He was having difficulty breathing. The nurse saw that he was turning blue. Prompt action on the part of the

attending doctor removed a large clot of blood that was slowly but surely bringing on asphyxia.

Three men recently climbed down inside a large water tank to paint its interior. When they failed to appear at the usual quitting time for lunch, another workman peered down over the top rim. All three lay unconscious on the floor of the tank. They were dragged out, but not before one of them had succumbed to asphyxia. Paint fumes had displaced the air at the bottom of the tank and robbed the men of the oxygen they needed for life.

Faulty Exhaust Fatal

One day last winter a farmer on his way to his roadside mailbox noticed a coupé as it passed on the straight road that edged his farm. Suddenly, and for no apparent reason, the car left the road and rolled to a stop in the ditch. Since the driver of the car immediately made efforts to drive the car back onto the road, the farmer paid no more attention and returned to his house. A few hours later the driver was found dead at the wheel of his car, which was still resting in the ditch.

Police investigating the case decided to make a test. One of the investigators donned a gas mask, arranged a sensitive carbon-monoxide indicator on the seat beside him, and proceeded to duplicate the events leading up to the accident. He drove down the straight road, swerved into the ditch just as the original driver had done, and then attempted to get the car back on the road.

A strange story was told by the indicator. During the straight-away drive it detected enough carbon mon-

oxide in the air in the closed car to cause drowsiness. When the motor was being raced to get the car out of the ditch, it indicated more than enough of the deadly, odorless gas to kill a man.

A careful inspection of the car revealed a makeshift repair of a leaky exhaust pipe that all but funnelled the exhaust gases directly into the front seat.

In this case the car was not wrecked and it was possible to track down the cause of death. How many more “Driver Falls Asleep, Runs Into Brick Wall” accidents can be listed wnder the same cause? It’s hard to say in specific numbers. Generally there’s not enough left of the car to permit a thorough test, but statistics brought to light by recent surveys present an alarming hint.

Of 2,000 war-worn cars tested, the closed interiors of 120, when the motors were running, showed enough carbonmonoxide to cut down the driver’s reactions and his mind-to-muscle coordination to a dangerous point. In another survey, again, of 2,000 random cars, 28%, or 480, were found to have leaky mufflers and exhausts; while an analysis of the exhaust gases showed that 60% of the 2,000 were spewing carbon-monoxide concentrations of between 6 and 13%—rather a startling figure when you consider that 15% is dangerous. Literally, a hatful of carbon monoxide in the interior of your car is enough to make you sleepy; two hatfuls may kill you!

According to one reliable estimate, 1 million of the annual nonfatal automobile accidents in the United States can be chalked up to the effects on the reflexes of the drivers of carbon-

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monoxide gas escaping from leaky exhausts.

With most private cars now operating on borrowed time, motors are less efficient, and as the efficiency goes down the amount of carbon monoxide in the exhaust gases goes up. Don’t take chances when you drive. Don’t drive with all your windows closed. Don’t drive if you begin to feel drowsy. And do have your car’s muffler and exhaust pipe checked for dangerous leaks.

What Can You Do?

I Is there anything that the layman I can do to help the asphyxia victim? Naturally, the first thing to do is to summon medical aid, but some knowledge of the causes may often mean the difference between life and death before the doctor arrives.

Asphyxia is a progressive process—there are degrees of asphyxia. The first degree, which doctors call the “depression stage,” is a sort of unconsciousness. The victim can swallow, his heart action is fairly normal, and he can be roused to consciousness easily, even though he may drop off again, in this degree of suffocation the best thing for the patient is AIR— keep him warm, loosen any tight clothing like a necktie, and give him plenty of chance to breathe. Chances are he will come around before the doctor arrives.

The second degree, or spastic stage,

I is complicated by the fact that besides ! total unconsciousness from which he I cannot be roused, the victim will have spasms or convulsions. His body will flex, his jaws will clench, the muscles of the throat, neck, and mouth will become rigid, and there will be bleeding from the nose or mouth, and possibly vomiting

Because the convulsions, bleeding, and vomiting tend to obstruct breathing even further, a person in the spastic stage very often progresses to the third, or flaccid, stage. About the only thing that the layman can do during the spastic stage is to try to relax the victim and to apply prone-method artificial respiration (as taught by the Red Cross and St. John Ambulance Association) in an attempt to force air into the lungs. Again, give the victim plenty of air.

In the final degree, or flaccid stage, the victim will be completely limp. He will be unconscious. There will be no convulsions, the muscles will be relaxed, the skin will be cold and clammy, and breathing will become less and less frequent. Unless medical aid reaches this person in the form of oxygen applied directly to the lungs, death is sure to follow.

During this stage, inspection of the victim’s throat will be comparatively easy and, if no doctor is at hand, some attempt should be made to determine what is blocking the victim’s throat and to remove it with your fingers if possible.

If the person is choking on a piece of food or on liquid, give him sharp blows on the back—do anything that will compress the lungs and perhaps dislodge the block.

If a victim becomes unconscious, whether from suffocation (drowning or gassing) or something lodged in his throat, try artificial respiration, if you know how, and keep him warm. If you don’t know artificial respiration do everything possible to give him air put a pencil or some handy object between his teeth to keep his mouth open, place him on his side, and push his head back to lift his chin as far as possible. Above all, call a doctor. it