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On artificial respiration
... Of four patients he mentioned, two died despite his use of "Sylvester's" method. 65 His paper seems to be quoted frequently, presumably for its foresight rather than useful data. Secondly, Charles Leale described his single but noteworthy case of MMV in 1909. ...
The start of the 19th century saw the enthusiasm of the previous one for mouth-to-mouth ventilation (MMV) dissipated. To inflate the lungs of the asphyxiated, the Royal Humane Society in the United Kingdom had recommended bellows since 1782. Principal determinants for change were aesthetic distaste for mouth-to-mouth contact and the perceived danger of using expired air, although MMV survived in the practice of some midwives. Following the 1826-9 investigations of Jean-Jacques Leroy d'Etiolles then François Magendie, all positive pressure ventilation methods were generally abandoned, after 1829 in France, and 1832 in the UK; but not chest compressions. During the next quarter century, rescuers lost understanding of the primary need for "artificial respiration", apart from researchers such as John Snow and John Erichsen, until Marshall Hall's "Ready Method" heralded the second half-century's various methods of negative pressure ventilation. Some of those methods continued in use until the 1940s. Sporadic anecdotal cases of MMV rescues were documented throughout. In the 20th century, inadequate mechanical inhalators were also tried from 1908, while obstetricians devised indirect methods of expired air ventilation (EAV). Anaesthetists in the 1940s, such as Ralph Waters, Robert Dripps, and the pair, Robert Macintosh and William Mushin, described the usefulness of MMV, and James Elam was "re-discovering" it. Following World War II, "Cold War" concerns stimulated research at the Edgewood Medical Laboratories in Maryland in the United States into the possibilities of MMV, and Elam et al confirmed and expanded on brief experiments at Oxford (United Kingdom) on the efficacy of mouth-to-tube EAV. Studies, 1957-9, by Archer Gordon, Elam and especially Peter Safar resulted in the resolution of previous airway problems, established the primacy of MMV, and incorporated it into an integrated system for basic cardiopulmonary resuscitation. Ready adoption of MMV in the US was followed by worldwide spread, especially after endorsement from the 1962 international symposium at Stavanger in Norway. However, already there were occasional rumblings of reluctance to perform MMV. In this article, I consider MMV also in the context of other ventilatory modes for resuscitation.
... Occasional recommendations for mouth-tomouth ventilation continued through the nineteenth and early twentieth centuries, 5 but it was well out of fashion and virtually forgotten. William Hunter considered it to be 'a method practised by the vulgar', 6 and even Herholdt and Rafn considered in their ...
Surf Life Saving Australia, which began in the early 1900s, initially adopted the indirect resuscitation methods used by the Royal Life Saving Society. As new indirect methods became available, both organisations adapted their resuscitation techniques and followed international developments closely. In the 1950s, accumulating evidence suggested that direct methods of resuscitation, such as mouth-to-mouth ventilation, might be more efficacious. Subsequently a number of investigations were carried out in Sydney at the Royal Prince Alfred Hospital on anaesthetised and paralysed patients. These experiments were recorded for an ABC documentary and reported at the International Convention on Life Saving Techniques held in Sydney in March 1960. Following the convention, Queensland Surf Life Saving conducted training sessions in cooperation with anaesthetists Roger Bennett and Tess Brophy (later Cramond), at St Andrew's Hospital in Brisbane. Two volunteers were anaesthetised and paralysed on two separate weekends to allow over one hundred people to gain experience in expired air and bag-mask ventilation. One of the volunteers in these training exercises kindly provided much of the material that led to this paper, providing a first hand account of the experiments and an invaluable insight into the cooperation between anaesthetists and volunteer rescue associations.
Basic airway management modern history starts in the early 18th century in the context of resuscitation of the apparently dead. History saw the rise and fall of the mouth-to-mouth and then of the instrumental positive-pressure ventilation generated by bellows. Pulmonary ventilation had a secondary role to external and internal organ stimulation in resuscitation of the apparently dead. Airway access for the extraglottic technique was to the victim's nose. The bellows-to-nose technique was the "basic airway management technique" applicable by both medical and nonmedical personnel. Although the techniques had been described at the time, very few physicians practiced glottic (intubation) and subglottic (tracheotomy) techniques. Before the anesthetic era, positive-pressure ventilation was discredited and replaced by manual negative-pressure techniques. In the middle of the 19th century, physicians who would soon administer anesthetic gases were unfamiliar with the positive-pressure ventilation concept.
The development of the ABCDE mnemonic is a useful device to help health professionals remember priorities in dealing with acutely ill patients. While its meaning has developed over the decades, the assessment algorithm it represents demonstrates an effective, highly organized, yet simple method of ensuring that the priorities of checking the airway, breathing, circulation, for any disabilities and exposure for full examination are followed. Various initiatives helped to extend these basic principles of resuscitation to ensure quick, appropriate and effective treatment to all patients undergoing acute in-patient care.
In Britain, the great boost to performing mouth-to-mouth resuscitation for the "suddenly apparently dead" came from William Tossach's 1744 documentation of his own successful case, and then from promotion by John Fothergill and other enthusiasts. Some civic authorities on the Continent were exhorting citizens to employ it from as early as the mid-18th century. The first humane society was founded in Amsterdam in 1767 and initially promoted expired air ventilation (EAV) by the mouth-to-mouth method. Other humane societies were soon established throughout Europe, especially in maritime cities with frequent drownings. The founding of London's humane society in 1774, initially known as "The Institute," was followed by earnest efforts to promote mouth-to-mouth EAV in England, and soon after in Scotland, but not until the 1780s in North America. Disenchantment with the mouth-to-mouth method as less desirable (for various reasons) led to decline in its general use. In 1782, what later became The Royal Humane Society in London changed its expressed preference for artificial ventilation by mouth-to-mouth to manual artificial ventilation using inflating bellows, although mouth-to-mouth was a method of resuscitation which could be attempted by any rescuer. The need to apply artificial ventilation immediately was not really recognised before John Hunter's recommendation to London's Humane Society in 1776. Charles Kite spelt out clearly the principles of resuscitation in 1787-8, though he gave some priority to warming. It seems that only in the latter part of the 18th century was the importance of airway obstruction recognised, largely due to Edmund Goodwyn.
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