1792: The first attempts at neonatal resuscitation

Fig. 1 -- Represents the box-wood tube.  One end was inserted
into the infants airway.  The caregiver would lace his mouth
over the other end (bottom of the figure in the photo) and provide
breaths to the child.  Bellows may also be connected to the tube.
(14, page 77-78, 196)

Perhaps among the first attempts at artificial respiration were performed on a stillborn child. The mother and father waited patiently for nine months, a perfectly formed child was born, but it wasn't breathing.  Frantic attempts were made to excite breathing.

More often than not such attempts failed, but every so often there was success, which brought great joy and excitement, just enough to motivate the next generation to make such efforts given the same frightful situation.

Some methods used to excite a newborn's first breath included: (1, page 77) (2, page 13)

1. Talking to the baby
2. Rubbing the baby's chest 
3. Shaking the baby
4. Tickling the baby
5. Blowing in the baby's face
6. Warming the baby with warm blankets
7. Applying moderate friciton to the body by rubbing 
8. Slapping the baby on the back or heels
9. Patting the baby on the back
10. Squeezing the rib cage
11. Hugging the baby
12. Performing mouth to mouth respirations, what was called inflating the lungs
13. Inserting a tube into the airway and breathing for the child that way 
14. Suctioning the baby's airway (not available until 1937)
15. Performing gentle chest compressions or abdominal thrusts
16. Tickling the nose with a feather
17. Tickling the arm pits, temples, stomach
18. Dunking the child up to the neck in warm water
19. Other gentle stimilation

Over time, and by trial and error, better methods were developed. By the end of the 19th century a basic form of neonatal resuscitation was taught to medical students, nurses, midwives, and members of societies such as the Humane Society. In fact, the report references and quotes Curry. 

A good example can be found in James Curry's 1815 book "Observatoins on Apparent death:"

WHEN a still-born Child appears in every respect perfect, and especially when, from the circumstances of the labour, there is reason to believe that the Child has not been long dead, measures may be taken for recovery, with very great hopes of success. With this view, the Lungs should be diligently inflated, and the heat of the body kept up, by the application of Warm Flannels, or by putting the Feet and Legs, or the whole Body up to the chin, into Warm Water. Moderate frictions with the Naked Hand, and gentle agitations, may also be used; and Stimulating Remedies applied to the Nose, Temples, and Pit of the Stomach. (1, page 77-78)

If these efforts did not work, then the physician or midwife would move on to the next stage of the resuscitation attempt, which would involve inserting tubes into the airway and breathing for the baby.  An example of this is noted by Curry:

If the Wooden Tube (Fig. 1.) be not at hand, the female Catheter (an instrument which every Practitioner in Midwifery is presumed to carry constantly about with him) will answer tolerably well for inflating the Lungs in this case: in defect of it, a joint of reed, the barrel of a qiull, or a piece of still paper or a card rolled up, may be; —one end being introduced into the Mouth, and the Assistant blowing into the other with his breath,* until the Lungs are expanded; then gently pressing the Chest;—and repeating this, so as to imitate Natural Respiration.

The recommendation by the Humane Society was similar, although the 1823 report of the Society suggested that bellows should be used to breathe for stillborn infants instead of the mouth.

Curry notes that in "some cases which have come within my knowledge prove, that Still-born Children may be recovered even after an hour or more has elapsed." His explanation for this is as follows: 

There are several reasons for believing, that the Vital Principle is not so soon destroyed here, provided the warmth of the body be kept up, as when Respiration has been established for a length of time, and then interrupted: for the new-born Infant which has either not respired at all, or had its breathing suspended very soon after birth, seems in a state of susceptibility somewhat resembling that which annually takes place in certain Animals, as the bat, frog, dormouse, &c, from the influence of the Winter's cold; the one requiring only the restoration of that warmth by the return of Spring, the other the application of Air to the Blood stagnating in its Lungs, to restore the Circulation, and with it the balance of functions necessary to Life. 

His theory is actually quite interesting considering anatomical pathology was only in its infancy during this era.  Over the ensuing years better wisdom improved the steps of neonatal resuscitation.  However, it wouldn't be until the 1980s that the technology was available to save the lives of infants not so perfectly formed.

References:

1. 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)
2. "The Forty Ninth Annual Report of the Royal Humane Society, For the Recovery of  Persons Apparently Drowned or Dead," 1823, London, 

RT Cave Facebook Page
RT Cave on Twitter

1792: Curry confirms importance of breathing during artificial during resuscitation

Dr. James Curry obtained all the data of the various societies and came to a variety of conclusions of which he reported to the medical community in 1792 and 1815.  He confirmed that warming the victim was the single most important part of rescue attempts.  (14, pages 36-7)

This verification, partly due to lack of anatomical and pathological knowledge, further stalled the initiation of providing artificial breaths in many instances, and, perhaps, to the detriment of many victims.  As noted above, there was no rush to perform any of these procedures.  There were, in fact, many reported instances where breaths were note given until one or two hours after the person was pulled from danger.

Although, as Curry explained, once better pathological knowledge of the body was obtained, such that circulation of the vital principles (air, oxygen) is vital to sustenance of life, it was learned that "merely restoring Heat to the body, will not renew all the functions necessary to Life."  (14, page 36-37)

It was thus learned that efforts to imitate natural breathing were of superior importance to warming the victim.  (14, page 36-37)

Breathing, therefore, was ultimately viewed by the Humane Society as the "most important part of the process of Resuscitation. As soon as the temperature of the surface has been somewhat raised by means of artificial warmth, about which no time should be lost, early inflation of the lungs is of great consequence. 

Still, if the body be not above the temperature of the surrounding medium in cold weather, its success is very precarious. The temperature of the surface being once raised, artificial warmth and artificial respiration should be simultaneously employed." (12, page 5)

Curry worded it this way: (14, page 37)

In every case of apparent death, the instituting an artificial breathing, by assiduously inflating the lungs with fresh air, is one of the first and most necessary measures to be taken for recovery. (14, page 37)

So, by the advice of Curry, artificial breathing ultimately became the main priority upon removing the victim from eminent danger.  The other methods were either scrapped or moved down the priority list.

References:  See post "1774:  The birth of the Royal Humane Society"

RT Cave Facebook Page
RT Cave on Twitter