of a pair of bellows into one nostril and closing the other. Air was forced into the lungs and then expelled by pressing the chest, thus imitating respiration. Dr Hawes used for his resuscitation work a kind of cradle, in which the subject was placed, and then raised over a furnace. Bleeding, holding up by the heels, rolling on casks, &c. were at various times resorted to. Simple means are often as effective as the official ones. In 1891 a subject was restored in Australia by being held over a smoky fire, which is the native method of restoring life; while a few years back, at an English riverside town, a patient was saved by the placing of a handkerchief over his mouth and the alternate blowing into and drawing air out of the lungs until natural breathing was restored.
One of the oldest methods of resuscitation was that of Dr Marshall Hall (1790–1857), introduced in 1856. In this method the operator takes his place at the patient’s left side, and places a roll of clothing or pillow (which must be the same length as that used in the previous methods), so that it may be in position under the chest when the patient is turned over. The assistant at the head pays particular attention to the patient’s arms, that they may not be laid upon or twisted at the wrists, elbows, hands or shoulders. The patient is then turned face downwards, with the body reclining over the pillow, the operator makes a firm pressure with the hand upon the back, between and on the shoulder blades, he then pulls the patient slowly up on to the side towards himself. Once in position, the operator pushes the patient back again until the face is downward, when the pressure on the back is to be repeated. These three movements must be continued at the rate of about fifteen times a minute, until natural breathing has been restored.
Then came the methods of Dr H. R. Silvester and Dr Benjamin Howard, of New York.
When using the Silvester method, or, for the matter of that, any other method, the first thing to do is to send for medical assistance. Dr Silvester recommended that the patient should not be carried face downwards or held up by his feet. All rough usage should be avoided, especially twisting or bending of limbs, and the patient must not be allowed to remain on the back unless the tongue is pulled forward. In the event of respiration not being entirely suspended when a person is lifted out of the water, it may not be necessary to imitate breathing, but natural respiration may be assisted by the application of an irritant substance to the nostrils and tickling the nose. Smelling-salts, pepper and snuff may be used, or hot and cold water alternately dashed on the face or chest. Provided no sign of life can be seen or felt or the heart’s action heard, promotion of breathing, not circulation must be the first aim and effort. Lay the patient flat on his back, with the head at a slightly higher level than the feet. Remove all tight clothing about the neck, chest and abdomen, and loosen the braces, belts or corsets. The operator taking his place at the head, with an assistant on one side, will turn the patient over until he is lying face downwards, his head resting upon one arm. He should then, after the assistant has given one or two sharp blows with the open hand between the shoulder blades, wipe and clear the mouth, throat and nostrils of all matter that may prevent the air from entering the lungs, using a handkerchief for this purpose. This being done, the patient should be turned upon his back, the tongue pulled forward and kept in position by means of a dry cloth, handkerchief or piece of string tied round the jaw. Every care must be taken not to let it fall back into the mouth and thus obstruct the air passages. When this work has been accomplished (it should only last a few seconds) the operator at the head should lift the patient, handling the head and shoulders very carefully, in order that the assistant may place a roll of clothing or pillow under the shoulder blades. The roll being placed in position, the operator will lean forward and grasp the arms below the elbows. He will then draw the patient’s arms steadily upwards and outwards, above the head, until fully extended in line with the body. Having held the arms in this position for about one second, the operator will carry them back again and press them firmly against the side and front of the chest for another second. By these means an exchange of air is produced in the lungs similar to that effected by natural respiration. These movements must be repeated carefully and deliberately about fifteen times a minute, and persevered in. When natural respiration is once established, the operator should cease to imitate the movements of breathing, and proceed with the treatment for the promotion of warmth and circulation.
Friction over the surface of the body must be at once resorted to, using handkerchiefs, flannels, &c., so as to propel the blood along the veins towards the heart, while the operator attends to the mouth, nose and throat. The friction along the legs, arms and body should all be towards the heart and should be continued after the patient has been wrapped in blankets or some dry clothing. As soon as possible, the patient should be removed to the nearest house and further efforts made to promote warmth by the application of hot flannels to the pit of the stomach, and bottles or bladders of hot water, heated bricks, &c. to the armpits, between the thighs and to the soles of the feet. If there be pain or difficulty in breathing, apply a hot linseed meal poultice to the chest. On the restoration of life, a teaspoonful of warm water should be given; and then, if the power of swallowing has returned, very small quantities of wine, warm brandy and water, beef tea or coffee administered, the patient kept in bed, and a disposition to sleep encouraged. The patient should be carefully watched for some time to see that breathing does not fail, and, should any signs of failure appear, artificial respiration should at once be resumed. While the patient is in the house, care should be taken to let the air circulate freely about the room and all overcrowding should be prevented.
In the Howard method there are only two movements; its knowledge is said to be necessary in case the patient’s arm be in any way injured, or a more vigorous method than the “Silvester” deemed necessary, but care should be exercised not to injure the patient by too forcible pressure. The patient is laid on his back, the roll is larger than that used in the Silvester method, and is placed farther under the back in order that the lower part of the chest may be highest. After adjusting the roll, the operator kneels astride of the patient, while his assistant goes to the head, lifts the patient’s arms beyond the head, and holds them to the ground, cleans the mouth and nose, and attends to the tongue. The operator, with his fingers spread well apart, taking care that the thumbs do not press into the pit of the stomach, grasps the most compressible part of the lower ribs, and with both hands applies pressure firmly by leaning over the patient; then he springs back, lifting his hands off the patient. Artificial respiration is thus effected, and continued at the rate of about fifteen times a minute. When natural breathing has been restored, the treatment is the same as in the Silvester method.
These methods have now been superseded by the Schäfer method, which has been taken up by the Royal Life Saving Society, a body instituted in 1891 for the promotion of technical education in life saving and resuscitation of the apparently drowned. The Schäfer method has much to recommend it, owing to its extreme simplicity and the ease with which the physical operations necessary to carry on artificial respiration may be performed, hardly any muscular exertion being required. It involves no risk of injury to the congested liver or to any other organ, and as the patient is laid face downwards, there is no possibility of the air passages being blocked by the falling back of the tongue into the pharynx. The water and mucus can also be expelled much more readily from the air passages through the mouth and nostrils.
It was due to the happy selection of Professor E. A. Schäfer, as chairman of a committee appointed by the Royal Medical & Chirurgical Society for the investigation of the methods in use for resuscitation of the apparently drowned, that the new method was devised. This committee made many experiments upon the cadaver but failed to arrive at any definite conclusion by that means. The necessity then appeared of thorough investigation of the subject by experiments upon animals, so that the phenomena attendant upon drowning might be better known, and the various methods of resuscitation properly tried. These experiments were made in Edinburgh by Professor
