Page Fourteen P H Y S I O T H E R A P Y O cto b e r, 1 9 5 5 RESPIRATORS USED IN POLIOMYELITIS By D R . H. H. M A L H E R B E Poliomyelitis Research Foundation. TYPES A V A ILABLE: 1. T ank (“ Iron Lung” ) negative pressure respirator. 2. Cuirass o r shell negative pressure respirator. 3. Interm ittent positive pressure respirator, used with tracheotom y. 4. R ocking bed. 5. Electrophrenic respirator. C H O IC E O F R ESPIR A T O R F O R A PA R T IC U L A R C A SE: This depends on a num ber o f factors, all o f which have to be considered. Patients requiring respiratory aid fall-in to tw o classes: wet o r dry. Wet Cases: (a) Purely bulbar, with only paralysis o f pharyngeal muscles preventing swallowing o f secretions. Such a patient should be treated w ith positioning and suction alone, w ithout mechanical respitratory aid. (b) Purely bulbar, but w ith paralysis o f abductors o f vocal cords as well. This patient requires tracheotom y, with or w ithout mechanical respiratory aid. (c) B ulbospinal, involving muscles o f the pharynx and also intercostals o r diaphragm . This patient requires tracheotom y and mechanical aid. The respirator used may be either tank o r positive pressure applied to tracheotom y tube. D ry Cases: B ulbar region o f brain not affected to the extent o f paralysing pharynx o r abductors o f larynx; and the inter­ costal myscles or diaphragm are chiefly affected. Such a patient does not require tracheotom y and can be treated in a tank, cuirass, o r rocking bed, depending on the degree o f respiratory distress. USES O F E A C H T Y PE O F R E SPIR A T O R : 1. T ank: This is very efficient, and is most widely used in the U nited States. M odels are also available for children under 2 years o f age. Wet and dry cases can be treated in th e ta n k ,. but th e m anagem ent o f a tracheotom y opening close to a collar requires special skill. M odern types have a positive pressure dom e for tem porary use over the head when the tank is opened. The overall results when tank respirators are used for wet cases equal those obtained when positive pressure machines are used, but the cost o f a tank is ab o u t three times th a t o f a positive pressure machine. 2. C uirass: F its over the chest and upper abdom en. Is only 60_ 70% as efficient as a tank, but is suitable when extreme efficiency is not required: e.g. fo r a m oderate degree of respiratory failure, o r for a patient recovering and due for weaning from a tank. Light models are made which perm it th e patient to sit up and be moved from room to room . These are most suitable for patients able to go home, but who require some form o f respiratory aid. 1 3. Interm ittent Positive Pressure R espirators: These were developed in 1952 in D enm ark and have rem ained the more com m on type in use in Scandinavia. A ir is supplied through a tracheotom y opening. Some types have a negative pressure phase to draw th e air from the lungs, as well as the positive pressure phase to push it into th e lungs. N ursing problems are eased by this method, as the patient’s body is not enclosed; but careful supervision is necessary. The machine is usually cheaper than the tank, and can be m ore readily m anufactured if an epidemic involving a high proportion o f respiratory cases occurs. 4. Rocking B ed: This is based on Eve’s method o f artificial respiration, the weight o f the viscera moving the diaphragm as the patient is rocked. This method is suitable for dry patients with slight respiratory distress, and is much used in the U nited States for weaning patients from a tan k ; o r for use at night when the patient is able consciously to breathe during the day, but requires assistance when asleep. I t is also o f use in preventing urinary and circulatory stasis. 5. Electrophrenic Respirator: Electrical stim ulation to the phrenic nerve causes the diaphragm to contract. This is not suitable for prolonged use, but is occasionally o f value when a patient who retains some power to breathe has difficulty in synchronizing his own efforts with the tank in which he has been placed. This respirator is used as a tem porary m easure only. PH Y SIO T H E R A PY T he physiotherapist has an im portant p art to play in keeping the lungs clear ,the circulation moving, and the muscles in condition. In the wet type o f case, all depends upon m aintaining a clear airway, and correct physiotherapy is essential for patients in o r out o f th e respirator. In dry cases, most machines in use to-day allow full access to the body and the physiotherapist’s task is considerably lightened and consequently increased in im portance, as m ore can be achieved to prevent deformities and o ther sequelae in respirator patients. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 0 (to b e n J9 5 5 ^ P H Y S I O T H E R A P Y Page Fifteen P E T E R R O T H E N B E R G E L E C T R I C A L A N D I N D U S T R I A L I N S T R U M E N T S E L E C T R O - S U R G I C A L R E P A I R S P E C I A L I S T S 98c M O O I STREET, JO H AN N ESBU RG P.O. B O X 3 9 0 4 P H O N E 2 3 - 0 7 3 0 U P LA N D S O R T H O PA E D IC H O M E F O R C R IPP L E D C H IL D R E N . PH Y SIO T H E R A P IST required. N on-residential post. Salary scale £450 by £30 to £690, plus U niform Allowance £20 per annum . Comm encing salary according to experience. Provident F und. A pplication forms from th e Secretary, N atal Provincial Cripples C are Association, P.O. Swart- kopskloof, N atal. ADVERTISING SPACE AVAILABLE SITUATION L OCU M P H Y SIO T H E R A PIST required to assist in Private Practice as from O ctober o r N ovember, 1955 for the summer months. D irect enquiries to : 13, Bright Street, Somerset West, Cape. + + + BRANCH NEWS S O U T H E R N TRANSVAAL The A nnual G eneral M eeting of the Southern Transvaal branch took place on A ugust 16th, 1955, at the G eneral H ospital, Johannesburg. The following Office Bearers were elected for the year 1955-56. President: Miss J. B lair; Vice-President: Miss L. D yer; Treasurer: Miss E. A lberts; Secretary: Miss C. B aker; additional m em bers: M r. A. R othberg, Miss F. Hossy, Mrs. M. Levy. M r. E. K ruger, Miss S. Levilt, Mrs. M. Shand and Mrs. W hittington. Delegates e’ected to represent the B ranch at Conference are: Miss 1.. D yer, M r. A. R othberg, Miss E. Alberts, Mrs. M. Levy, M rs. E. K ruger, Miss F. Hossy, Miss E. Botting, Miss C. Whiting, Miss A. Zuithoff, Miss S. Levitt, Miss C. Baker, Miss P. Paton and M rs. M . Horsley. D eliverance • • • from pain . . . . the humanitarian function of of the practitioner . . . . now accomplished with greater speed, more economy and with a higher degree of safety than ever before. Full details and clinical notes on the use of R E N O T I N in the treatment of Migraine, Neuritis, Lumbago, Sprains and M yalgia may be obtained from E xclu sive D istrib u to rs f o r Southern A fric a PHARMACEUTICALS LTD. P.O. BOX 7793 JOHANNESBURG R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )