Henry Brill

Asphyxial episodes and their prevention in electric and other convulsive therapies

ConclusionsIt is felt that, in convulsive therapy, one should not wait until there is reason for alarm before intervening to end postconvulsive apneas. If respiration has not begun within a few seconds after the fit, it is probably desirable to assist the patient in terminating his anoxia as quickly as possible. The most favorable position for breathing is dorsal hyperextension with the arms drawn up over the head to facilitate the initial movement, inspiration. The simplest effective stimulus is a sharp extension, with the turning of the head on the neck; and this also seems to clear the airway. This procedure retains its effectiveness on repetition. When necessary, full artificial respiration in the dorsal position may be done according to the Silvester method. Further, in difficult cases, one should open the airway with a narrow retractor curved to fit the back of the tongue and inserted between the teeth behind the mouth gag. This should always be done where other procedures are ineffective. Chemical respiratory stimuli do not appear to be of any value here. No observations have been made to indicate that the effectiveness of convulsive therapy is diminished by reduction of anoxia. A case of non-fatal post convulsive respiratory arrest is reported. The personnel which assists with the electric shock treatments can be trained to act as a team which divides the task of carrying out the arm movements, applying chest compression, and maintaining a free airway. These measures can be improvised, but are far more effective when carried out by a group practised in their routine application.It is felt that, in convulsive therapy, one should not wait until there is reason for alarm before intervening to end postconvulsive apneas. If respiration has not begun within a few seconds after the fit, it is probably desirable to assist the patient in terminating his anoxia as quickly as possible. The most favorable position for breathing is dorsal hyperextension with the arms drawn up over the head to facilitate the initial movement, inspiration. The simplest effective stimulus is a sharp extension, with the turning of the head on the neck; and this also seems to clear the airway. This procedure retains its effectiveness on repetition. When necessary, full artificial respiration in the dorsal position may be done according to the Silvester method. Further, in difficult cases, one should open the airway with a narrow retractor curved to fit the back of the tongue and inserted between the teeth behind the mouth gag. This should always be done where other procedures are ineffective. Chemical respiratory stimuli do not appear to be of any value here. No observations have been made to indicate that the effectiveness of convulsive therapy is diminished by reduction of anoxia. A case of non-fatal post convulsive respiratory arrest is reported. The personnel which assists with the electric shock treatments can be trained to act as a team which divides the task of carrying out the arm movements, applying chest compression, and maintaining a free airway. These measures can be improvised, but are far more effective when carried out by a group practised in their routine application.

The Control of Tuberculosis among Patients in Mental Institutions-a 10. Year Report.

Summary1.The results of the first 10 years of operation of a tuberculosis control program among patients in the institutions of the New York State Department of Mental Hygiene are reported.2.This program consists fundamentally of the early detection and early segregation and treatment of cases of tuberculosis.3.There has been a considerable decrease in morbidity and mortality from tuberculosis during the 10 years covered by this report, but the rates in the mental institution population are still higher than in the general population of the state.1. The results of the first 10 years of operation of a tuberculosis control program among patients in the institutions of the New York State Department of Mental Hygiene are reported. 2. This program consists fundamentally of the early detection and early segregation and treatment of cases of tuberculosis. 3. There has been a considerable decrease in morbidity and mortality from tuberculosis during the 10 years covered by this report, but the rates in the mental institution population are still higher than in the general population of the state. The results of the first 10 years of operation of a tuberculosis control program among patients in the institutions of the New York State Department of Mental Hygiene are reported. This program consists fundamentally of the early detection and early segregation and treatment of cases of tuberculosis. There has been a considerable decrease in morbidity and mortality from tuberculosis during the 10 years covered by this report, but the rates in the mental institution population are still higher than in the general population of the state.