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To the Editor:—
The treatment of coma in insulin shock resembles surgical narcosis in several respects, one of them being the danger of aspiration of mucus due to increased secretion of saliva and the absence of pharyngeal reflexes. It is an established fact, known for generations, that aspiration in surgical narcosis is best prevented by placing the patient in a flat position, head turned, so as to permit the saliva to flow out of the mouth.In view of that fact, it seems strange that the half upright position has been recommended for comatose insulin shock patients in some recent publications (Wilson, Isabel G. H.: A Study of Hypoglycaemic Shock Treatment in Schizophrenia, Board of Control, H. M. Stationery Office, 1937. Cameron, D. E., and Hoskins, R. G.: Experiences in the Insulin-Hypoglycemia Treatment of Schizophrenia, The Journal, October 16, p. 1246) and doubtless in earlier papers from which they are
Robinson GW, Lamm H. SUGGESTIONS FOR THE POSITION FOR COMATOSE INSULIN SHOCK PATIENTS. JAMA. 1937;109(22):1834. doi:10.1001/jama.1937.02780480066026