Sunday, March 20, 2016

1852: Humane Society recommends new methods of manual breathing

In 1852, scientific evidence provided the proof that stimulating breathing by heating the body, or tickling the nose, was ineffective. It was at this time that artificial breathing became the recommendation for reviving victims of suspended animation. However, the methods of breathing involved "manual handling of the victim." (15, page 2) The new method of breathing was referred to as "manual methods of resuscitation."

The advantage of manual methods is that they did not require any device, nor knowledge at knowing how to operate the device. There, likewise, was no risk at over inflating the lungs. Perhaps the most significant advantage is the manual methods could be started right away, without delay. (15, page 2)
The first of these newer methods were as follows:

Dr. Marshall Hall's Method (Postural Method):  This was introduced in 1856. It involved lying the patient his belly (prone) and pressing on the back to cause expiration.  Then the patient was turned on his
side and his shoulder raised to cause inspiration.  This was repeated until the patient woke up or was pronounced dead.

Dr. Sylvester's Method:  This method was recommended by the Humane Society in 1861. The victim was kept in a supine position.  The operator knelt at the head of the victim, grabbed the victim's arms and lifted them over the victim's head, thus causing inspiration.  The arms were then brought down to the victim's side, thus causing expiration.  This was repeated until the patient is revived or pronounced dead.

Dr. Benjamin Howard's Method:  This method was introduced in 1871.  The patient was placed face down (prone) and the rescuer pressed on the back 2-3 times to remove water from the lungs.  The patient was then placed on his back (supine), and the operator placed both hands firmly on the lower portion of the victim's chest and, with the force of his body, pushed forward to cause expiration.  When pressure was released, the patient took in a breath.  This was repeated until the patient is revived or was pronounced dead. This method was often rejected due to risk of broken ribs and ruptured liver.

As better evidence was obtained these manual methods were improved upon, and in some cases the names were changed to give credit to the modern physician. I will delve into these further in a future post.
In the meantime, once the victim woke up, the following was the general recommendation by Curry, although the recommendation by the Royal Humane Society is quite similar:
When the patient is so far recovered as to be able to swallow, he should be put into to a 'Warm Bed, with his Head and Shoulders somewhat raised by means of pillows. Small quantities of warm Wine-Whey, Ale-posset, or other light and moderately nourishing drink, should now be given from time to time; and gentle sweating promoted, by wrapping the feet and legs in flannels well wrung out of hot water... The patient should on no account be left alone, until the Senses are perfectly restored, and he be able to assist himself; several persons having relapsed and been lost, from want of proper attention to them, after the Vital Functions were, to all appearance completely "established. (14, page 66-68)
Within a year ten victims of the water were revived by the Royal Humane Society, "the youngest of these, a boy of ten, had been under the water for fifteen minutes and had not received any expert assistance for upward of forty minutes."  (1, page 3)
The Lungmotor Company notes:
At the first sermon preached on the Anniversary of the Establishment of the Royal Humane Society, the discourse contained the following statements:
"As we therefore have opportunity, let us do good to all  men."  "Many countries have been supplied with apparatus necessary to restore suspended animation."  The first statement is as applicable today (in 1920) as it was then.
From the establishment of these societies, have grown the government Life Saving Services of the present time, which are doing such heroic work, with the scant measures at their command, to conserve human life.
How little advance in ages has been made in the methods used to resuscitate the apparently drowned, is mutely told in the vast array of figures which mount yearly throughout the world, as the truly horrifying statistics of death, due to this' cause. (1, page 3-4)
As word spread of the benevolence due to the heroic efforts of the Royal Humane Society, and "by its impulse and example it has lead to the formation of numerous similar Associations for the Preservation and Restoration of Life in various places in Great Britain, in her Colonies, in several European nations, and on the American Continent." *

All of the methods used by rescuers were flawed. Mouth to mouth breathing was gross and resulted in cross contamination and the spread of disease. Rubbing a feather across the nose, and blowing smoke up the butt, were ultimately learned to have no effect. Chest compressions, abdominal thrusts, and otherwise altering the victim's body, resulted in broken bones and other injuries.

Yet all of these methods gave the rescuer hope, and the victim a fighting chance (albeit a weak one). When a person was reanimated, this provided the feeling of joy necessary to continue the movement. With each rescue attempt data was obtained, and the experts were able to use this data to come up with better methods.

Even with modern guidelines and methods survival rates for those in "suspended animation" continues to be low. However, as data continues to come in, these guidelines, and the methods used, are updated on a regular basis. Children and adults of all ages are properly trained so that when they are witness to an accident they feel competent to help that person, as opposed to standing by feeling helpless and disconsolate.

For all the wisdom we have today about saving such lives, we must give particular thanks to the members of the Royal Humane Society. It was by their efforts that a general feeling of benevolence spread across the globe, inspiring a movement that continues to save lives to this day.

*For example, in 1786 the Humane Society of Massachusettes was formed. (13, page 3) In 1824 the Royal National Lifeboat Association was formed.  (9, page 171), 

  1. "Drowning: Historical-Statistical Methods of Resuscitation," no author nor editor listed, Published by Lungmotor Company, Boston, Massachusetts, 1920
  2. "Pulmotor advertises gas company," Gas Age, volume 29, 1922, New York, Robbins Publishing Company Inc. 
  3. Cannon, Walter Bradford, George Washington Crile, Joseph Erlanger, Yandell Henderson, "Report of the Committee on Resuscitation from Mine Gases," Technical paper number 77, Department of Interior, Bureau of Mines, Joseph A. Holmes, Director, 1914, Washington, Government Printing Office
  4. "Schaefer Method of Resuscitation," The Colliery Engineer, August, 1913, Volume XXXIV, August 1913 to July 1914, Scranton, PA, International Textbook Co., page 53 (no author or editor listed)
  5. Hughes, Martin, Roland Black, "Advanced Respiratory Critical Care,"  2011, New York, Oxford University Press; material from section 3.1: "Invasive Ventilation Basics: Development of Invasive Ventilation (history)."
  6. Agasti, T.K. "Textbook of Anesthesia for Postgraduates," 2011, New Delhi, Jaypee Brothers Medical Publishers, page 590
  7. Safar, Peter, "Exhaled air ventilation and cardiopulmonary resuscitation," published in the following: Gordon, Archer S, "Cardiopulmonary Resuscitation: Conference Proceedings," May 23, 1966, Washington D.C., National Research Council
  8. Donahue, Mary, "History of Lifesaving," DeAnza Collegge,, accessed 8/10/13
  9. "Resuscitation of the apparently drowned," The Dominion Illustrated Monthly, February, 1893, Montreal and Toronto, Vol. II, NO. 1, pages 171- 175
  10. Eisenberg, Mickey S., "Life in the Balance: Emergency Methods and the Quest to Reverse Sudden Death," 1997, New York, Oxford University Press
  11. Knott, Arthur Reynolds, "Lie Saving and Artificial Respiration," 2nd edition, 1915, no city or publisher noted in book
  12. "The Forty Ninth Annual Report of the Royal Humane Society, For the Recovery of  Persons Apparently Drowned or Dead," 1823, London, 
  13. "History of the Humane Society of Massachusetts," 1845, Boston, Samuel N. Dickinson, Printer
  14. Curry, James, "Observations on Apparent Death from drowning, hanging, suffocation by noxious vapours, fainting-fits, intoxication, lightning, exposure to cold, & etc., and an account of the means to be employed for recovery. To which are added the treatment proper in cases of poison, with caution and suggestions respecting various circumstances of sudden danger," 2nd edition, 1815, London (the 1st edition was published in 1792)
  15. Meltzer, S. J., "History and analysis of the methods of resuscitation," Medical Record: A Weekly Journal of Medicine and Surgery, July 7, 1917, Volume 92, Number 1, New York, 
  16. Meltzer, ibid, page2; the reference alluded here is to an article by Arthur Keith, Lancet, 1909, 1, page 745, 825, 895,
  17. Rush, Benjamin, "Medical inquiries and observations," volume 1, 2nd edition, 1805, Philadelphia, chapter one: "An inquiry into the natural history of medicine among the Indians of North America, and a comparative view of their diseases and remedies with those of civilized nations, read before the American Philosophical Society, held at Philadelphia, on the 4th of February, 1774," pages 1-68
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