ArticlePDF Available

Abstract and Figures

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.
Content may be subject to copyright.
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
157
Crit Care Resusc ISSN: 1441-2772 5 June
2006 8 2 157-171
©Crit Care Resusc 2006
www.jficm.anzca.edu.au/aaccm/journal/publi-
cations.htm
History of Medicine
It would appear that the mouth to mouth method
was not generally known to or practised by medical
men in the 18th century.
Peter Bishop, 1974
A short history of the Royal Humane Society
1
The 18th century in Britain and Europe has been described
as polished and refined, but also dissolute and brutal;
2
it
was not an age of great concern for the poor, the sick, and
the unfortunate of any class. Yet it was a time when the
Age of Enlightenment was developing, with evolution of
man’s concern for his fellow, together with new ideas of the
value of each individual.
In the 17th and especially the 18th centuries, widespread
concern continued to grow in the United Kingdom and
throughout Europe over the large number of deaths from
drowning.
Footnote [FN]1
In the 18th century, that was the com-
monest cause of death from accidents, and said to have
had the same shocking impact as sudden cardiac death did
in the 20th century.
3-4
The Age of Enlightenment fostered, as a noble cause,
attempts at resuscitation for the asphyxiated, especially the
drowned; but often a rescue attempt had to be made in the
face of criticism and derision.
5
Yet, this was the very age
when people were fearful of being buried alive,
6
arising
from general uncertainty over the absolute indications of
death, in the absence of signs of irreversible putrefaction.
These fears worsened with scaremongering from writers
such as Jacques Winslowe — “considered by many to be
the prophet of the resuscitation movement”
7
— warning of
the “danger of precipitate interment”.
Advent of mouth-to-mouth expired air ventilation
during this era
William Tossach delayed documenting his successful inter-
vention of 1732 until 12 years later.
8
Yet, as noted by L Brandt
and his Mainz colleagues, between 1732 and 1744 there
were written exhortations to resuscitate using traditional
empirical methods, initially without specific respiratory
assistance.
6
Such a call came from the anonymous “Phi-
lantrope” in the monthly Mercure Suisse of November
1733, concerning rescue from drowning; and then, in
1740, in a report Avis concernant les personnes noyées, qui
paraissent mortes, ostensibly from the hands of Louis XV
but actually written by physiologist/physicist René de
Réaumur.
FN2
Next, Academicus curiosus”, the anony-
ABSTRACT
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
Crit Care Resusc 2006; 8: 157171
recognised, largely due to Edmund Goodwyn.
History of mouth-to-mouth rescue breathing
Part 2: the 18th century
Ronald V Trubuhovich
FN1. This account will not try to distinguish between the words
“drowned” or “drowning”, when they are used for a fatality, and
“near-drowned” [etc], where that modern day expression would apply.
FN2. And further, P J Bishop’s Short history of the Royal Humane
Society
1
quotes the Society’s 1901 report, for a letter the Society had
received citing the Professor of Philosophy at Neuchâtel 1705–1742,
one Bourquet, as the first to initiate “methods for recovering persons
apparently drowned”. Bishop could not elicit any further details.
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
158
mous translator of the 1742 German (Hamburg) version of
the Avis, now introduced to his account an advocacy of
mouth-to-mouth resuscitation.
6
So even before Tossach’s
paper appeared, the mouth-to-mouth manoeuvre was cer-
tainly known in Europe (see also Part 1
9
). Brandt et al note
further that within a few decades [of these 1740s publica-
tions] the idea of resuscitation of casualties spread all over
Europe”.
6
Midwives,
FN3;10
in their isolation from the medical profes-
sion, were meantime likely to be applying mouth-to-mouth
expired air ventilation (EAV),
11
practised from before 1472
and the time of Paoli Bagellardi
11
when required for neona-
tal resuscitation, as was also outlined in Part 1.
9
But as
Joseph Redding has explained: “... the technique was
considered inelegant and undignified by physicians, who
felt it was beneath their notice and of little concern to
them”.
12
Thus, in 1776, “William Hunter spoke of mouth-
to-mouth inflation as the method practised by the vulgar to
restore stillborn children”.
13
William Tossach and John Fothergill
In 1744 at Edinburgh, William Tossach
8
presented
FN4;14
the
case study of his mouth-to-mouth rescue, witnessed by
many Hundred People, ome of them of Di tinction;
15
he then published it in a small pamphlet. On first reading
Tossach’s account, London physician John Fothergill (1712–
1780), Edinburgh alumnus and Quaker, was immediately
and evangelically enthused by the “Po ibility of aving a
great many Lives” through mouth-to-mouth. He carried
that message to the highly influential Royal Society of
London, extolling mouth-to-mouth as immediately availa-
ble, simple enough for the unskilled to administer, inexpen-
sive and harm-free.
15
In an impassioned address which he
Read 21 Feb 1744–5
FN5;15
to the Royal Society, Fothergill
also contended that malefactors, immediately following
their execution at the gallows, could provide scientific study
opportunities on how to assist others asphyxiated, by
suicidal hanging for instance.
7,15
The Royal Society dis-
missed topics it saw as too far outside its interests. None-
theless, Fothergill tirelessly promoted Tossach’s method, and
other British enthusiasts and European converts followed
his lead. For several decades, he was the advocate and
probably the foremost exponent in Britain, possibly in
Europe, of EAV.
Fothergill’s ideas on resuscitation appeared in Philosophi-
cal Transactions of the Royal Society of London (“Philosoph-
ical”, because scientists were known as natural
philosophers). After dismissing futile measures such as
“bleeding”
FN6
and other measures similarly ineffectual,
Fothergill listed the singular advantages of mouth-to-mouth
EAV over bellows for resuscitation:
15
... but; if any Per on could be got to try the charitable
Experiment by blowing, it would seem preferable to the
other [ie, bellows]:
1 t, As the Bellows may not be at hand:
2dly, As the Lungs of one Man may bear, without Injury,
as great a Force as tho e of another Man can exert;
which by the Bellows cannot always be determin’d:
3dly, The Warmth and Moi ture of the Breath would be
more likely to promote the Circulation, than the chilling
Air forced out of a Pair of Bellows.
Fothergill wrote that it had been suggested to him that “a
Pair of Bellows might po ibly be applied with more
advantage in the e ca e than the Bla t of a Man’s
Mouth”, but he expressed preference for the mouth-to-
mouth method, with its warmed air. Although Elizabeth
France saw Fothergill as fearful of the dangers from bel-
FN3. Maureen McNeil
10
reminds us that, at the beginning of the 18th
century, “midwives were not considered members of the medical
profession in Britain. As more … famous medical men such as William
Hunter and William Smellie took up work in this field, midwifery was
given increased institutional and professional recognition”.
FN4. And then, according to David Schechter, 1969
14
— but to him
alone it seems — Tossach presented his paper [again?] next year,
when Schechter says he addressed the Royal Society of London. But
Ross MacFarlane, Assistant Archivist at the Royal Society, can find
no evidence for this claim (personal communication).
FN5. Re “Feb 21, 1744–1745”, Ross MacFarlane of the Royal
Society explains (personal communication) that the 2 years, 1744
and 1745 (each of which Fothergill supplied — in tandem — for
dating the year of a February 21 reading of his paper
14
), refer to
whichever date is taken as the first day of a new year. In Britain
before 1752, New Years Day was on March 25, so for this paper,
alternative dates are possible and valid — if perhaps confusingly:
one of 21 February 1744 (in Julian, Old Style) and one of 21
February 1745 (in Gregorian, New Style).
FN6. Fothergill described
14
the popular rationale for such a curious
action — as it must seem to us today — thus: “to give vent to the
tagnating Blood in the Vein, in order to make way for that in the
Arteries à tergo, that the Re i tance of the Heart being thus
diminiƒhed, this Mu cle might again be put in Motion”. At times,
attempts at bleeding the victim seem to have been withheld until
there was first some detectable sign of a recovering pulse.
FN7. Surely a 1740 date indicates this “Fothergill” of Fisher’s was
John? (no relation of Anthony’s). I am sceptical that even after
“1740” is corrected to 1745, he could — from his birthdate — be
Anthony
19[no.61]
(bap. 1737-1813). So, I take it that the reference
had to be for the contemporaneous John F. Even so, Fisher’s dating
of 1740 (which can hardly be correct either?) is before Fothergill
could be aware of William Tossach’s rescue, which was not until
1744–5. Fisher’s oft-quoted paper
18
has several errors scattered
among its many pearls, so acceptance of his unreferenced
statements at face value has to be made with great caution. The
only citing Fisher has of Fothergill in his list of references (a list both
long and valuable, but unfortunately incomplete) is for Fothergills
reprint year of 1774. Fothergill’s brother Samuel F, guardian to
John Coakley Lettsom (1744–1815),
20
was of Fothergills own era.
Perhaps Fisher just mixed up John and Anthony.
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
159
lows,
16
he did invent a set of inflating bellows. R J Cary,
without providing evidence, considered bellows “to have
been first used on a human being by Dr John Fothergill of
London, about 1750”.
17
Hart Fisher,
18
also without referenc-
ing, details how the “Anthony Fothergill Method
(1740)”,
FN7;19[no.61]
using cupped hands, avoided actual mouth
contact in EAV: either by applying the technique Fisher
specifies; or by leaving mouth-to-mouth to “charitably
inclined” others. Under “John Fothergill Method (1774)”,
Fisher reports Fothergill, despite his stated preference for
mouth-to-mouth, “not relishing its performance”.
18
Fothergill advocated extending EAV to “ udden deaths
from ome invi ible Cau e ... all the various Ca ualties
[even lightning strike] ... this Ca e ugge t ; viz. The
Po ibility of aving a great many Lives, without ri king
anything. For the drowned, he recommended that, follow-
ing measures delivered “with the utmo t expedition” to
first discharge imbibed water from the body,
FN8;21
a trial of
EAV be attempted. (When Fothergill’s papers were
reprinted in 1774, the editor of Philosphical Transactions
said the value of rolling the patient on a barrel wasnow
deservedly exploded”.
16
) It does not appear that compress-
ing the chest or abdomen with the free hand during
mouth-to-mouth was advocated at this time, although
randomly pressing on the chest was used in lay attempts at
rescue.
In Fothergill’s oft-quoted, mechanistic illustration likening
the absent breathing of the drowned to a stilled pendulum
in a clock in good repair and wound up, both needed just
ome Impul e” to be set in motion.
15
Other early promotions of mouth-to-mouth EAV
Around this time the scholarly physician Richard Mead
(1673–1754),
22
when updating the 1745 edition of his
book A mechanical account of poisons, in several essays,
encouraged resuscitation attempts with “the use of all
means available”, even after drownings of “many
hours”.
19[no.7]
Those means did not include any specific
respiratory assistance, such as mouth-to-mouth. However, a
“very accurate description” of mouth-to-mouth technique
23
appeared in A physical dissertation on drowning (London,
1746/7), by “A Physician,” widely considered to be Row-
land Jackson (1720–1784).
24
A B Baker deduces that this
account was “not from personal experience”.
23
Giovanni Tozzetti (1712–1783), named the foremost
Italian resuscitationist of the era,
7
was likely the authority
behind the anonymous 1752 directive, given under Floren-
tine royal decree, pressing citizens to learn resuscitation.
T F Dagi declares that Florence was one of the first cities to
attempt public involvement in such rescues.
7
And he also
finds that a 1773 tract of Tozzetti’s indicates that, in Europe,
physicians learned resuscitation from laymen at the
water’s edge”.
Sometime between 1733 and 1747, surgeon and “man-
midwife” Benjamin Pugh introduced his methods of
resuscitating the apnoeic newborn.
25
In his 1754 Treatise of
midwifery — written after 14 years of obstetric practice,
but failing to gain funding for publication in 1747 — he
described his special air-pipe: “a small common wire,
turned very close (in the manner wire springs are made) ...
covered with thin soft leather.
25
It was to be inserted
through the mouth, blindly by touch, as far as the
larynx
26
or at the larynx,
25
initially for relieving asphyxia
with the after-coming head during difficult breech birth.
G M White stated, however, that the tube was inserted into
the larynx, after which “the operator then blew down the
tube intermittently
27
(ie, supplied mouth-to-tube EAV).
Pugh wrote “... by this method of giving the child air, I have
saved great numbers of children’s lives, which otherwise
must have died.
26
If the clinical problem was solely a
respiratory one, of establishing a clear airway, once Pugh
had developed an alternative relieving technique with
fingers and palm alone, his tube became largely unneces-
sary.
26
(Those incredulous at all this can find more detailed
descriptions in references 25–26.) But, for an apnoeic
newborn, Pugh advocated EAV by mouth-to-mouth:
press your mouth to the child’s, at the same time
pinching the nose with your thumb and finger, to
prevent the air escaping; inflate the lungs, rubbing it
before the fire: by which method I have saved many.
25,26
Obstetrician William Smellie endorsed artificial ventila-
tion in his 1752 midwifery Treatise.
28
Buried within the
book’s 454 pages is the revelation “ and the child has
been ometimes recovered by blowing into the mouth with
a ilver Canula [a female catheter], o as to expand the
lungs. Smellie documented saving newborns with his
mouth-to-tube technique.
25
In 1762, the Authorities of the City of Hamburg
formulated a plan for the drowned, offering rewards.
Herholdt and Rafn’s account states, but the people still
adhered to the Prejudice that it was degrading to touch
those who had died an Unnatural Death”.
29[p.4]
So in 1765,
FN8. David Ramsay,
21
on the first day of the XIXth Century”,
looking back in his 18th century review at the times before the first
humane society, attributed the rationale for this treatment to “the
received theory … that drowned persons died in consequence of
water rushing into their stomachs”.
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
160
the soldiers of the city garrison were ordered to employ “all
possible Diligence” to rescue the drowned, but Herholdt
and Rafn do not say whether that included EAV by mouth-
to-mouth.
Joseph Blacks 1756 documentation of his (1754) discov-
ery that exhaled breath contained “fixed air”, regarded as
“poisonous” and later identified to be the gas carbon
dioxide (CO
2
), led to assertions in 1906 from Robert
Woods
30
that, around this time, “the immediate insuffla-
tion, or mouth to mouth method, was employed exclu-
sively”, and that, from this discovery of CO
2
, deductive
reasoners ... deduced that immediate insufflation was
dangerous ... a grave physiological error”. Woods’s claims
appear unsubstantiated.
Contrary to Woods’s opinion, an “Official ‘Edictby the
Chancery Office of the City of rich”,
31
dated 26 April
1766, described, among other things, details for a mouth-
to-mouth technique, thereby disarming Woods’s above
claim. The Edict’s instructions indicated the limited under-
standing of priorities for resuscitation, but they did exhort
citizens to continue resuscitation attempts as long as “even
for one or two hours”. The initial instructions were for:
1. Changing wet clothes for dry and warm ones;
2. Expressing ingested water, blowing “useful” tobacco
smoke through mouth and nose, and promoting vomiting;
3. Warming the body. Then:
4. In the meantime, one must not neglect to stimulate
the body, particularly the lungs, stomach, and intestines in
all possible ways. Only after a detailed description of
technique for “pre-eminent” tobacco, by smoke or clysters,
both of these “into the lower body”, does Instruction 4
suggest EAV: “If the mouth is open it is appropriate to blow
air into it if someone pinches off the nose, puts his mouth
tightly over the mouth of the drowned then blows hard”. If
all else failed, including jugular phlebotomy (“of great
value”), “have a skilled surgeon open the trachea and have
air blown into the opening”— presumably by mouth-to-
tube EAV.
Later that year, a surgeon at “Corke” (Ireland) did
precisely that: “Mr Glover made an inci ion through the
kin in the windpipe … and blew trongly through a
canula into the lungs” of a man who had been hanged for
29 minutes and “ howed no igns of life”. The robber-
tailor survived “ ome years after, apparently in good
health”.
32
1767, spring: the first humane society,
Amsterdam
5,17,29,33-37
Mouth-to-mouth EAV made a significant advance for
attempted resuscitation of the drowned, when wealthy
philanthropic merchants of Amsterdam formed Europes
first humane society, with 10 directors.
FN9
This was the
Society for the Recovery of Drowned Persons, to inform
the common people and to animate them, as R J Cary
17
phrased it, and rescue those too frequently discovered in
the city’s canals. But whichever measures were to be
applied, before a drowned person could be resuscitated he
or she had to be extracted from the water. Much careful
planning went into the design, manufacture and placement
of rescue equipment;
29[p.22-8]
for example, Brash of Ham-
burg’s successful “seeker”, paired catching forceps, ladders
to lay on the ice, boats, and carrying baskets. Although it
seems that tobacco fumigation was prioritised originally,
2
the Dutch methods
33-36
did include mouth-to-mouth
EAV;
FN10;38
which is hardly surprising considering, as Douglas
Chamberlain states,
36
John Fothergill was influential in the
foundation of the Dutch society. After effecting lung
inflation, the mouth-to-mouth rescuer “produced expira-
tion by compressing the abdomen with his free hand.
33
David Ramsay
21
considered that the Society’s success, with
150 saved in the United Provinces in its first 4 years,
followed from its understanding of the need for a rational
planfor reanimating the collapsed lungs”.
A comment on mid-18th century resuscitation
priorities
2
Looking back at the relative importance given to 18th
century measures employed for the asphyxiated, we would
expect immediate resuscitative aims to be: i) establishing
compensation for deficiency in natural breathing, and
restoring it; and ii) ensuring re-oxygenation of the patient’s
FN9. Some authors foster a legend that the Amsterdam Society’s
1767 inauguration occurred in the same year that René de Réaumur
read a paper to the Académie des Sciences in Paris concerning
some instances of apparent recoveryfrom drowning, after several
resuscitation attempts in Switzerland (likely by de Réaumur’s own
interventions).
12
Elizabeth Thomson
2
states that he presented his
finding “That year (ie, 1767, whereas he had done so in 1740). But
de Réaumur (1683–1757) was already dead. Perhaps she followed
Schechter’s 1969 statement to the same effect,
14
which he supplied
without providing his source for it.
FN10. Evidently a few authors do not accept that, at the start of
their Humane Society, the Dutch had incorporated mouth-to-mouth
EAV into their resuscitative efforts. Peter Karpovich
38
says bluntly,
Mouth-to-mouth insufflation was forbidden”. And although R J
Cary
17
has it thatFurther, if the bellows were not at hand, the trial
was not to be made with the breath of the operator, which ‘has
become obnoxious and unfit to enter any lungs again’”, he does
allow that the Dutch had made some use of mouth-to-mouth.
These writers could not have gone back to the earliest of the Dutch
records for a correct quotation.
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
161
vital organs, prime considerations being to secure airway
patency and to provide artificial ventilation. Physiologic
investigators of the 16th and 17th centuries had already
clearly demonstrated the need for such measures in their
animal experiments. Vesalius — who clearly recognised the
problem of soft tissue obstruction of the airway
12
— had
decreed: “…take care that the lung is inflated at intervals,
the motion of heart and arteries does not stop”.
12
But
common belief and practice in the 18th century still did not
emphasise urgency for re-establishing natural breathing;
rather, the highest priority was for restoring bodily warmth
and dryness. So artificial ventilation had to take its chance
among the resuscitative methods advocated.
In the decades after 1744, attempting to compensate for
inadequate breathing was not topmost in any list of
interventions; in fact, most resuscitative measures were
thought to have equal efficacy.
39
Restoration of breathing
was sited either randomly within such a list, or low down.
Much time was wasted on manoeuvres then thought
necessary for the asphyxiated, but later determined to be
useless (shaking, shouting, thumping or compressing the
chest, tobacco by fumigation or clysters, blood letting,
“barrelling”, inversion, emetics, aromatic stimulants and
smelling salts, intestinal distension, etc, etc — all due for
eventual condemnation by humane societies). Some might
have used hand pressure on the chest to produce an
exhalation, following which, passive recoil of the chest wall
could produce a limited inspiration. The marvel is that there
were so many documented instances, particularly once
humane society records became regular, of asphyxiated
people with seemingly unequivocal signs of lifelessness,
restored to a good recovery after prolonged resuscitative
efforts — without what we would regard as effective
breathing rescue. Accounts and claims of achievements that
the humane societies received were studied carefully — but
of course were not subject to 20th and 21st century-type
audit processes. Some accounts were too far-fetched,
precluding any acceptance.
Benefit from the Amsterdam Humane Society’s promo-
tions was quite early demonstrated in its report of 26
November 1768 of “19 Victims, only in the Dutch prov-
inces, who had been saved by the recommended Measures
within the space of 14 months”.
29[p.3]
And R J Cary
17
can
quote from translated memoirs of the Amsterdam Society,
wherein the detailed reporting of four of the successful
resuscitations from drowning in 1769 has only a single,
brief “respiratory” mention — one, probably not of EAV by
mouth-to-mouth, but of “wind forced into [the] mouth [of
a boy of 14 years], while his nose was held closed and this
was repeated”. However, despite initial endorsement of
EAV by the Amsterdam Humane Society, their preference
was already switching to using bellows, on grounds that the
breath of the operator wasobnoxious and unfit to enter
any lungs again”.
17
Other humane societies
5,17,34-37,40
Many cities, maritime or with rivers, quickly followed the
lead of Amsterdam’s Humane Society and formed similar
learned bodies, first at Rotterdam, then other cities in
Europe and around the world.
FN11
Although a comparable
society for London was not founded until 1774, it was soon
to the fore in systematic research in resuscitation and in
documentation. Humane societies developed to encourage
and teach, and to document, publish and disseminate
knowledge, including information about known resuscita-
tion attempts. (A humane society was not functioning
effectively in the United States until the 1780s.
40
) In many
countries, humane societies established Rescue Stations
and Receiving Houses (there were 11 in London
37
); awarded
medals, gave rewards for genuine saves or valiant attempts,
and compensated helpers.
In Paris, L’Académie des Sciences issued its Edict of
recommendations in 1770;
29
and Lord Cathcart
41
reported
that between 16 June 1772 and 25 March 1773, 23 of 28
people “taken from the Seine” were restored to life.
Simon-André-D Tissot (1725–1797) apparently preferred
mouth-to-mouth with its warm breath (1774) (Fisher
18
does
not reference his source for this statement), although he
later reverted to bellows for inflation of tobacco smoke.
Because cooperation from lay people could be lacking at
accidents, it was towards them — the ones likely to be on
the spot — that humane societies directed their strategies,
offering the encouragement of graded financial rewards for
attempting resuscitation of victims suddenly apparently
dead, especially from drowning. Although it seems that,
originally, tobacco fumigation was prioritised — as can be
confirmed from William Buchan’s 1769 textbook
42
— lay
people were now being encouraged to provide EAV by the
mouth-to-mouth method, although their enthusiasm was
already starting to diminish.
2
And importantly, for a long
time, failure of mouth-to-mouth resuscitations could often
FN11. Many, including Herholdt and Rafn,
29
Carolyn Williams,
5
for
instance, mention Vienna, Saxony, Milan, Padua, East Indies,
America, Algeria and Denmark. Others were established at
Hamburg (1768), Paris (1771), Dresden (1773) and St Petersburg
(1774). By 1780, the United States had its first humane society in
Philadelphia
5,40
(one not really active until 1787), then a humane
society for New York in 1784, and at Boston for Massachusetts in
1786.
40
Glasgow’s humane society was founded in 1790.
34
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
162
be attributable to inability to recognise obstruction of the
airway (but see Edmund Goodwyn, 1782–1788, in the
section Mouth-to-mouth EAV towards the end of the 18th
century in Britain on page 169).
1769: William Buchan (1729–1805)
Only 2 years after the Amsterdam Society’s inauguration,
further dissemination of knowledge about mouth-to-
mouth is demonstrated in the very first edition of William
Buchan’s Domestic medicine (1769).
42
(The 22nd edition
from 1828 appears to be the last British printing available
on Internet sales; one bookseller describes Buchan’s “selling
80 000 copies during his lifetime”). Under “Of Casualties”,
Buchan suggests for “Persons [sic] who have the misfortune
to fall into the water often given up for dead, … re tore
the natural warmth, and renew the circulation and breath-
ing”. So, strip, rub, warm, bleed. Then a paragraph sug-
gests EAV by mouth-to-mouth:
In order to renew the breathing a trong per on may
blow his own breath into the patients mouth with all
the force he can; [But then] … or, what will generally
ucceed better, the smoke of tobacco may be blown
into the lungs, by means of a pipe or funnel …
[presumably, bellows also]. [And it will be] proper to
throw up the moke of tobacco into the inte tines.
But like so many advising from the sidelines, he indicates
no personal experience or evidence for his advocacy —
other than that he has known of “a pig drowned and
re tored to life two or three times ucce ively, by blowing
air into its mouth with a pair of bellows.
Buchan’s respiratory advice by his 8th edition (1784) was
still promoting mouth-to-mouth for EAV.
1774, April 18: a humane society in London
Alexander Johnson,
19[nos.27&29]
insufficiently credited pio-
neer and promoter of resuscitation, summarised the ideas,
methods and annual reports of the Dutch Society for the
years 1767–1771 in his 1773 pamphlet Short account of a
society in Amsterdam instituted in the year 1767 for the
recovery of drowned persons.
6,43
This brought to Britain the
first documentation of the idea for an English humane
society comparable to the Dutch one.
43
The situation in
England around this time is summarised thus: although
occasional reports of successful resuscitation attempts had
appeared in the medical press for several decades, there
was no systematic attempt to introduce such practice on a
regular basis.
As most doctors were largely not involved in such undigni-
fied activities as resuscitation, Johnson wanted knowledge of
it to be taken up at all levels of society, with the ability of “all
classes” to intervene, not just doctors.
19[no.29]
Johnson’s
attempt in 1774 to form The General Institution, his own
humane society, failed.
43
But his précis appeared at the very
time Dr (the Reverend) Thomas Cogan’s Memoirs of the
society instituted at Amsterdam in favour of drowned per-
sons. For the years 1767, 1768, 1769, 1770, and 1771 (a
literal translation of the Amsterdam Society’s proclamation of
1767/1773)was ready for the press”.
19[no.28]
A London
apothecary, William Hawes, had been making rescues from
drowning in the Thames using the Dutch methods, presuma-
bly including EAV by mouth-to-mouth. He rewarded other
rescuers for their reports of life-savings and attempts, but
such were the times, out of his own pocket.
13
When he read
Cogan’s memoir, his enthusiasm was fired to improve the
success rate of recoveries.
After intense efforts by Hawes and Cogan together, and
with the latter’s protégé John Lettsom (another of the
community of Quaker physicians and founder of The
Medical Society of London, in 1773
20
), they organised An
Institution for Affording Immediate Relief to Persons
Apparently Dead from Drowning
43-44
(usually referred to
as The Institute), with its first recorded meeting taking place
on 18 April 1774.
FN12
Posthumous member Dr Oliver Gold-
smith’s name was honoured, but although several 20th
century writers include him as being present, he had died
on 4 April. It contained many benevolent, earnest, lay
enthusiasts as well as doctors, at a time when other doctors
who were previously unwilling would now be forced to take
notice. The Institute’s recorded Case No. 1 was dated 12
July 1774. Then, 4 days later, after plunging onto flagstones
from “a one pair of stairs window, and to all appearance
dead, 3-year-old Catherine Sophia Greenhill was eventu-
ally revived (by apothecary Mr Squires’ electric shocks,
probably a first).
43-44
William Hawes
FN13
was a tireless worker and fund-raiser
for the cause (“demonic … obsessive”!
5
), producing the
society’s annual reports, annual anniversary sermons, fold-
FN12. This was the original title of what would eventually be
chartered as the Royal Humane Society.
1
The Institute of 1774
became “The Society for the recovery of persons apparently
drowned”,
43
then 1776–1787, The Humane Society, which received
royal patronage, according to John Lettsom
44[p.xiii]
in 1784 (but
1785 is given on the society’s website) and the title of The Royal
Humane Society in 1787.
FN13. Hawes petitioned the realm’s Parliament for the provision of
Receiving Houses in every parish in England for drowned and
suffocated persons, and to establish schools where medical
students could be taught the principles of resuscitation.
1
In 1778,
he was appointed Registrar for the Society, editing the society’s
annual reports from 1780 until he died in 1806.
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
163
ing action cards,
19[no.38]
pocket card for on-site referral, etc.
He was ably assisted by the organisational skills of Thomas
Cogan. The Institute took over from Hawes the paying of
rescuers. John Lettsom, Hawes’ successor as writer of the
societys annual reports, 1808–13,
19[no.37]
was “the leading
figure in the established Humane Society until his death in
1815”.
2
But note that successes of the Humane Societys
rescues reinforced the horror in the public mind of being
buried alive and, in that way, also helped keep resuscitation
to the fore in the public mind.
6,37
Humane societies and mouth-to-mouth
resuscitation
Once it became generally appreciated that EAV by mouth-
to-mouth provided a ready means of rescue breathing for
victims, it became the artificial ventilation method advo-
cated in exhortations to the public from civic and other
authorities and, as they became established, by humane
societies. In a list drawn up in 1774 for The Institute, it was
advocated that a rescuer should first dry and warm the
patient, which often necessitated some initial time-wasting
in transporting a victim to a rescue station or local pub, etc.
But in this same list, described as taken from the Dutch
system, artificial ventilation had now attained second
place.
1,13,33
By then the Dutch had come to reject using the
“distasteful” mouth-to-mouth in favour of other artificial
ventilation, preferring bellows, with or without a tube.
However, it was the mouth-to-mouth option of artificial
ventilation that the British Society adopted, despite William
Hunter’s oft-quoted dismissal of it as “vulgar”.
13
As mouth-to-mouth gradually lost favour, other methods
of EAV began to supplant it. John Wilkinson (to whom his
namesake David draws attention in his masterly summary
43
)
suggested in his 1774 book Tutamen nauticum or the
seamans preservation, printed in London, that EAV for
drowned persons be provided by “pipe, funnel, cane or
quill introduced into the mouth. Though these are simple
mouth-to-tube means, J Wilkinson is still in L H Hawkins’s
list of mouth-to-mouth advocates.
45
Bellows were already
being considered at the Humane Society in 1775.
43
Alexander Monro Secundus (1733–1817)
Experiments carried out before August 1774 by Edinburgh’s
famed anatomist/physician Alexander Monro Secundus,
a certaining the be t manner of inflating the lungs of
drowned per ons”, enabled him to establish definitive,
successive techniques.
FN14;46,47
William Cullen, His Majestys
First Physician in Edinburgh and Professor of Physic, wrote
46
of being “informed” that Monro’s preference, when using
his “wooden pipe” to facilitate artificial ventilation, was to
insert the tube into one nostril rather than into the mouth.
Monro could then insufflate the victim’s lungs, either by
blowing “beneficially warmed” expired air down the tube
[mouth-to-tube], or by attaching bellows to the tube.
Meantime, the operator observed the adequacy of inflation
by “the rai ing of the che t or belly”. (Monro’s bellows
apparently had a capacity of c. 1500 mL.)
If ventilation was inadequate, then “introduce directly
into the glottis and trachea a crooked tube (a metal, male
catheter) by employing a blind technique of tactile intuba-
tion which Monro carefully detailed, meanwhile preventing
air from entering the stomach (one of the hazards of the
technique) by pressing the lower … larynx back onto the
gullet”. Inflation, whether by mouth-to-tube or by bellows,
was to be followed by “breast and belly” compression to
actively deflate the lungs. It can be noted, further, that
Monro’s introduction of a method for adult translaryngeal
intubations — named as such here, because at those times
many intubations did not extend into the trachea —
represented a real advance in enabling lung inflation by
those capable of carrying out such manoeuvres, in circum-
stances where that was possible.
His intubation technique is also widely quoted as “men-
tioned by Mr Portal [Baron Antoine Portal (1742–1832)], Mr
le Cat ... [though M Claude-Nicholas Le Cat (1700-1768),
note, may not have performed it] … and others”.
44
And it
furthered the evolution of endotracheal intubation — yet
Richard Lee could declare (in 1972) that Monro’s endotra-
cheal intubation apparently did not find wide applica-
tion.
33
Contrary to Lee’s comment, William Buchan was
invoking Monro’s advice by his 8th edition of Domestic
medicine (1784) [if not earlier?]; as also others later, among
them James Curry (1781),
19[no.57],48
Charles Kite (1787),
44
Edward Coleman (1791 and 1802),
19[no.56]
and Herholdt and
Rafn (1796).
29[p.53]
FN14. I have not located any printed documentation by Monro
himself of his methods; but Douglass W Taylor
47
has kindly supplied
me, courtesy of the Otago Medical School Library’s Munro
Collection, with a photocopy from the Dunedin set of Monro’s 1774-
5 lectures. Lecture Number 107 has five pages, anonymously
recorded, on “the method of recovering drowned persons.” In a
personal communication, Professor Taylor advises there is firm
evidence, as is confirmed in the first paragraph of the first Dunedin
page (see Figure 1), that Lecture 107 was delivered in mid-April
1775, 8 months after William Cullen’s letter of August 1774.
46
On
the third page written from this lecture, Secundus now recommends
that “instead of clapping a tube or our own mouth to the mouth of
the drowned person we should blow the air through a tube put into
the nostrils, which is the natural pa sage for it” (Figure 2).
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
164
1774, Aug 8–11: William Cullen (1710–1790) and
[Lord] Charles Schaw Cathcart (1721–1776)
Lord Cathcart had noted the successes of humane societies
in Europe, so sought advice from William Cullen as to what
would be applicable for Scotland.
FN15
Cullen incorporated
the details of the Monro recommendations and methods
for resuscitating the apparently drowned into a 27-page
response, A letter to Lord Cathcart, President of the Board
of Police in Scotland, concerning the recovery of persons
drowned and seemingly dead.
46
Cullen’s letter was dated
“8th Augu t 1774” (not even 4 months after the first
official meeting of The Institute), whereas the year usually
quoted for it is Sir Arthur Keith’s 1909 dating of “1776”,
13
the year during which Medical Tracts published the Cullen
letter in London. This “letter” is justifiably famous, among
many other things, for publicising Monro’s step-by-step
description of how to intubate the trachea. It has also been
criticised because, for the first manoeuvre, it favoured
recovering the heat of the body”, not immediate attention
to ventilation and heart function
13
(compare John Hunter,
1776
49
). William Hawes had also requested such guidance
for The Institute in London, but it appears Cullen sent the
advice only to His Lordship.
The prime objective which Cullen emphasised
46
(in
response to Cathcart’s a king my opinion”) wasTo
re tore the heat of the body [to stimulate what he consid-
ered the “vital principle”], … while … at the ame time,
re toring the action of the moving fibres”, and “While
[doing that] and e pecially after … compleat and fini h the
bu ine by re toring the action of the lungs and heart”.
Artificial ventilation was recommended, not by applying
mouth-to-mouth, but using a Monro method: with a
wooden tube in a nostril and either mouth-to-tube EAV, or
bellows-to-tube artificial ventilation. The Monro technique
for intubation was then described, should that action be
needed. Cullen also strongly supported rectal tobacco
smoke, as many others still did.
Lord Cathcart immediately produced his own paper, The
recovery of persons drowned and seemingly dead,
41
dated
11 Aug 1774, with his recommendation of the sequence of
actions needed for resuscitation. After initial (but time-
consuming) manoeuvres of securing and drying the victim,
then supplying warmth, “the fir t and mo t efficacious
stimulating method was EAV by mouth-to-mouth (which
Cullen chose to omit — or else vetoed). He decreed: “…
blow with force into the lungs, by applying the mouth to
that of the patient … and gently expelling the air again, by
pre ing the che t with the other [hand], imitating the
trong breathing of a healthy per on. There is caution
against abandoning treatment at less than 2 hours. Also,
opening a pa age to the lungs through the wind pipe …
mu t always be left to the judgement of a urgeon.
Figure 1. A page transcribed from Monro
Secundus’s Lecture 107, 1774–1775
The first of five pages transcribed anonymously from Monro
Secundus’s Lecture 107, Oct 1774–Apr 1775 session. Its original
writer is not known (and the transcriber is also unknown), but the
detail suggests the original was in shorthand. Thomas Thorburn, the
known writer of shorthand, wrote the 1773–4 Monro course, but
also attended Monro’s class in 1774–5. As the interpolation has been
identified as in the hand of Monro by Professor D W Taylor, the
original documentation appears both authentic and genuine.
FN15. Lord Cathcart emphasised
41
that no country’s need was
more likely than Scotlands, where drowning danger “calls more
loudly for effectual mea ures.” He saw his advice as applicable to
… per ons drowned, trangled, frozen, or uffocated by noxious
vapours”.
41
M Anne Crowther, in a generous reproduction of the
original papers
46
on a website of the University of Glasgow, re-
emphasises that for Scots no-one is ever far from deep water, and
drowning is always a serious possibility.
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
165
1774: EAV by mouth-to-mouth in Scotland
Lord Cathcarts paper included the Resolution
41
from the
meeting of the Board of Police, Scotland, dated 11 Aug
1774, “That printed copies of the Minutes of this meeting
be fixed upon the church doors, in the market place, and
other proper places, in each pari h within the hire. If, as
is usually written, it had been solely Cullen’s letter that was
to be posted, the Scots populace would not have received
advice to first try mouth-to-mouth EAV, omitted in Cullen’s
letter but included in Lord Cathcart’s paper, as Cullen’s
recommendation for EAV was mouth-to-[nose-]tube alone.
These promotions not only exemplified the enthusiasm for
encouraging resuscitation among lay people, as well as
doctors, it presented mouth-to-mouth EAV to well-nigh the
whole population of Scotland.
A Minute within anExtract” from the Journals of the
Board of Police, Scotland,
50
of the same 11 Aug date,
recorded that Lord Cathcart, and the Earls of Lauderdale
and of Leven, “Ordered” the “ aid paper [Lord Cathcart’s]
and letter [William Cullen’s]” be printed and distributed
countrywide. The Minute also reveals that each Sheriff,
Magistrate and Moderator was directed to keep a Register
of rescue, and to supply a boxed recovery kit with a
fumigator, “FOUR wooden pipes, for blowing into the
no trils”, a pair of bellows, and vials of smelling spirits
(total cost, £1/9/6). It can be noted that Cullen approved
drawing jugular blood from the drowned but only if done
early, while Cathcart’s advice was that phlebotomy
becomes particularly nece ary” as recovery occurs.
1776: John Hunter (1728–1793) and the Humane
Society
49-51
In responding by way of a scientific dissertation to a request
for advice on resuscitation from William Hawes, John
Hunter reported
49
his earlier 1755 experiments on a dog,
employing his double-chambered (inflating/sucking) bel-
lows with the nozzle inserted into a tracheal slit, followed
by comparable Propo als” for the human drowned.
Hunter appreciated that some of them, although apparently
dead, were in a su pended animation” from which they
might recover with proper attention. He recognised the
primacy of the need for artificial ventilation: “privation of
breathing appears to be the fir t cau e of the heart’s
motion cea ing; and therefore, mo t probably, the re to-
ration of breathing is all that is nece ary to re tore the
heart’s motion. But although he describes both “air being
thrown into the lungs”, and “blowing air into the lungs
with bellows, with or without a tube, his proposals do not
mention doing that by an EAV mode, either by mouth-to-
mouth or by mouth-to-tube (whereas J Fothergill’s “blow-
ing” advice meant precisely that). Perhaps he was influ-
enced by brother William’s antagonistic attitude.
13
John Hunter emphasised immediacy:every moment of
which delay [in procuring ‘a i tance] renders recovery
more precarious”; and insisted on gradual warming; perhaps
oxygen too (“dephlogi ticated air … may prove more effica-
cious than common air); and a reversed form of the Sellick
manoeuvre, which Monro Secundus had already described.
46
(The Hunters and Monro had a notoriously uneasy relation-
Figure 2. The third of five pages on drowning
transcribed from Monro Secundus’s
Lecture 107,
1774–1775
The third page from the same source as Figure 1. This page
demonstrates a change in Monros advice on the management of
drowning, from that recommended by William Cullen in his Letter
to Lord Cathcart
46
(which advice derived from Cullen’s reporting his
conversations with Monro, a close colleague for many years).
46
(Both figures reproduced with permission, courtesy of the Health
Sciences Librarian, Medical and Dental Library, University of Otago,
Dunedin, New Zealand.)
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
166
ship, which is intriguing.
51
) John Hunter condemned blood
letting and stimulants, and avoided tobacco fumigation via
the anus. He advised having a resuscitator’s assistant and
exhorted accurate keeping of all case records. The Humane
Society officially endorsed his recommendations (although
not until 1782) and adopted his bellows.
1,13
Alternatives to mouth-to-mouth resuscitation
Aesthetic considerations were often a powerful inhibitor to
applying the direct contact necessary for EAV, and variations
of technique were devised to overcome objections. “Not
relishing its [mouth-to-mouth’s] performance”, John
Fothergill developed inflating bellows for a tracheal tube
(1774).
18
Societies in multiple countries were coming to
favour the indirect methods of EAV, whenever such were
possible.
Possible options were:
to blow into some kind of tube inserted into the patients
mouth (Smellie
28
), nostril (Monro Secundus
46
), or a tra-
cheal slit directly (Vesalius,
FN16;11,19
Glover
32
); or the larynx
(Pugh
26
) or beyond it, into the trachea (Monro
Secundus
46
); or
to squeeze a set of bellows to inflate the lungs, after
either inserting the nozzle directly into the above sites of
entry into the patient: the mouth, a nostril, a tracheal slit
(eg, John Hunter
50
); or connecting the nozzle to a tube
already inserted into one of the above entry sites.
The mouth-to-mouth mode was still a treatment option
for rescuers who were unskilled, failing with, unwilling or
unable to try, instrumentation. Adding both oxygen and
“electricity” was encouraged where that was feasible.
44,46
Otherwise, the age-old efforts and archaic practices listed
earlier, within the section A comment on mid-18th century
resuscitation priorities, were the only means available for lay
folk and unskilled doctors.
7
It is possible that for centuries
household bellows may have, on occasion, been thrust into
the mouth by lay people in desperate attempts at artificial
ventilation, but this does not appear reliably documented.
Arguments against using expired air
After initial enthusiasm for mouth-to-mouth within
humane societies, enthusiasm diminished for rescue breath-
ing in spite of the observable successes which were
achieved — and documented. Its drawbacks were consid-
ered to be:
Perceived inadequacy:
43
This derived from the discoveries
in chemistry: i) by Joseph Black of “fixed air” (later called
carbon dioxide) in 1754, already mentioned; and ii) by
Reverend Joseph Priestley of a new gas (later named
“oxygene” by Antoine-L de Lavoisier), obtained first from
saltpetre in 1771, then as “dephlogisticated air” from red
mercuric oxide on 1 August 1774. (Carl Scheele, discover-
ing “fire air”, or oxygen, independently in 1772 did not
publish that for 5 years.) Once Priestley’s experiments with
mice identified this oxygen as the Vital Element to be
breathed in, some argued that expired air had already had
that principle taken out of it by respiration. As late as 1817,
the Royal Humane Society still believed that its removal left
expired air which “is not pure air but chiefly carbonic similar
to what arises from burning charcoal, it is more likely to
destroy rather than to promote the action of the lungs and
so should be avoided.
45
So K Garth Huston can state that
with the discovery of oxygen, In addition to the indelicacy
of the [mouth-to-mouth] method, it was felt more oxygen
could be given to the patient with a bellows than from
respired air.
52
So expired air was rejected.
17
(And inciden-
tally, Huston believed that the discrediting of rectal tobacco
decreased confidence in other techniques which were
beneficial.
52
)
Thus mouth-to-mouth came to be considered out-
moded,
23
and was replaced by artificial ventilation methods
with bellows, and later pistons, among which Nooth’s
pump, a “glass syringe
53
allowing inflation by graduated
volumes,
18
became popular.
Experts such as John Hunter,
49
and later Anthony
Fothergill,
44
Charles Kite,
44
Edmund Goodwyn and others,
were suggesting that any oxygen available be used for
resuscitation.
Aesthetic undesirability:
FN17
A typical further expression
of dislike for EAV came from Benjamin Waterhouses
declaration
2,14
to the Massachusetts Humane Society, as its
1790 annual dinner’s invited speaker: “To blow one’s own
breath into the lungs of another is an absurd and pernicious
practice.
Fear of transmission of infection: Infections were the
most common cause of death at that time, and the
considerable likelihood of contagion was a grim prospect.
Many descriptive slurs on mouth-to-mouth can be found in
the literature from this time. Carolyn Williams cited
5
— as
FN16. Andreas Vesalius (1514–1564), at the very end of De Fabrica
as long ago as 1543, was the first to document EAV in animal
experiments, by a non-mouth-to-mouth method using mouth-to-
tube EAV, supplied down a reed inserted through a slit cut into a
pig’s trachea.
19[no.2]
He may have known that Galen (129–199 AD)
had inflated a dead animal’s lungs with bellows, c. 177.
23
FN17. Descriptive terms found for mouth-to-mouth EAV include:
“vulgar”, “distasteful”, “poisonous”, “unhygienic”,
“unaesthetic”, “unnatural, “indelicate”, inelegant”,
“undignified”, “disagreeable”, “troublesome” and “totyally
impure”.
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
167
a sure sign that an institution [here, mouth-to-mouth
inflation] has arrived on the public scene” — references to it
on the stage: for instance, a character in Richard Cumber-
land’s 1785 comedy, The natural son, complains he has
“contracted a consumption” from it.
Further concerning EAV and humane societies
Progressive disenchantment with EAV in the UK led to the
Humane Society (1782) formally recommending the use of
bellows, inserted into the mouth or a nostril, for artificial
ventilation.
1
Cary reports,
17
with no further detail, that Dr
[Alexander] Johnson’s account of the Amsterdam Society
published about 1785, registers an objection against the
method” [of mouth-to-mouth]. Hawes, on his pocket-card
of c. 1786,
2
did not advocate mouth-to-mouth but EAV:
Apply the pipe of a common sized bellows up the nostril,
and blow with some force, closing the other nostril and
mouth…” with an assistant following on to express an
expiration.
5
(But see below for Hawes’s 1786 contrary
advice to Charles Kite.)
In 1788, the Massachusetts Humane Society recorded
with one short case report: breathe forcibly into the
mouth, and continue this act until he should recover or
become cold.
19[no.74]
And possibly from 1791, the Philadel-
phia Humane Society’s directions
40
for preventing sudden
death were “Close the mouth and one nostril completely.
Blow air through the other into the lungs. If bellows cannot
be had, air may be blown into the lungs through the open
nostril from the mouth of one of the bystanders”.
1787: Charles Kite
44
(1768–1811)
Young surgeon Charles Kite brought significant progress to
the understanding of ventilatory and circulatory aspects of
resuscitation, especially for rescues from drowning, with
which he had become seriously involved at the embarkation
port of Gravesend. His 1786 valved set of inflating/exhaust-
ing bellows,
13
apparently of c. 500mL capacity, was adopted
by the Royal Humane Society, while from his own extensive
experience, his 1787 Essay on the recovery of the appar-
ently dead (dead, principally from drowning) distilled into
274 (+ 6) pages his conclusions on the essential needs,
priorities and techniques in resuscitation. It won him the
Royal Humane Society silver
FN18
medal a year later, at age
20.
In Kite’s analysis, sudden apparent death or su pended
animationwhether from drowning, hanging, noxious
vapours, syncope or lightning-strike (and also for asphyxia
in unborn children surviving the death of the mother) —
came from “apoplexy”, a compre ion or over-fullne s of
the ve els of the brain”, or sometimes from suffocation
about the heart and lungs”. As Kite understood it, “artifi-
cial re spiration will in general an wer the purpo es of
removing the over-di ten ion of the venous sy tem, con-
sequently the compre ion of the brain”, as the aim of
promoting expan ion and contraction of the lungs [was]
to force the blood from the right to the left ventricle of the
heart”. Besides being unequivocal in advocating the central
role of artificial ventilation, he emphasised immediate inter-
vention. Echoing John Hunter’s 1776 advice,
49
he declared,
“... we cannot he itate one moment in pronouncing the
re toring the action of the lungs to be of the very fir t
importance in all our attempts to recover the apparently
dead.
When advising EAV by mouth-to-mouth, Kite quoted the
Royal Humane Society’s advice for an assistant to “blow
into the mouth through a coar e cloth” (although note,
the society had already recommended bellows instead in
1782
1
) — but only as an emergency, not as a continuing
method. (“The difficulty of getting people to continue the
… so extremely di agreeable and trouble ome … opera-
tion … will be ea ily conceived.”) Alternative advice was
for a wooden nose-pipe to be attached, either for EAV or
for valved bellows. Kite suggested inflating the lungs with
the nozzle of the bellows in the mouth or, better, in a
nostril; but if there was an impediment to the proper and
effective inflation of the lungs then try the tube bent like a
male catheter. This was contained in his doctors “respira-
tory” pocket-kit of resuscitation equipment, including a
metal translaryngeal tube and fold-up bellows for inflating,
which he and John Savigny had devised. They also pro-
duced an integrated system of bellows, tubes and exact
connections, for inflating the lungs.
For ideal artificial ventilation, Kite recommended a “medi-
cal director” (for closing the mouth, exerting pressure on the
front of the neck to “prevent the air pa ing into the
tomach instead of entering the lungs”, and providing
expiratory chest compressions), and “a proper per on” as
his assistant, at the victim’s head (for supplying artificial
ventilation by mouth or by bellows to a tube, intra-orally or
intra-tracheally). A “third per on must pre s the belly up o
as to force the air out”. “Tracheotomy is our la t expedient.
Kite also advocated the use of oxygen, described various
stimulants, and endorsed electric shocks, but still accepted
FN18. Only the silver for this magnificent study? Yes, the Royal
Humane Society awarded the 1788 gold medal to Edmund
Goodwyn for his entry, The connexion of life with respiration. The
Medical Society of London assessed eight dissertations on behalf of
the Royal Humane Society.
44[p.vi]
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
168
“occasional” bleeding from the jugular, though at times
appearing ambivalent about its value. His essay’s innovative
features are admirably described: clearly argued principles
of resuscitation, Royal Humane Society data and valuable
analyses of case details, data-gathering charts for future
studies, plus diagrams of their inventive equipment.
3-4,44
Kite quotes his own 1785 “electric shocks” case, as well as
the famous case history of the 1774 resuscitation successful
only after shocks,
5,43
and offers the diagram of his own
simple apparatus for shocking.
3,44
Charles Kite’s time was one when initial lay efforts were,
at best, only warming and heavy stimulation, and still
perhaps the antiquated practice of rectal fumigation with
tobacco smoke. Despite the earlier enthusiasm of John
Fothergill and then the Humane Society, how much mouth-
to-mouth EAV, lay or medical, was performed in England
outside obstetrics does not appear known. It was only
because of clear-sighted early pioneers such as John Hunter
and Charles Kite that many time-honoured but futile rituals
were dropped. It also became obvious that doctors, provid-
ing effective artificial ventilation with bellows, or possibly
able to insert a translaryngeal tube and attach bellows to it,
were often reaching the scene too late to help lay rescuers.
Kite and the Royal Humane Society established strategically
located Rescue Stations at waterside posts, holding practi-
cal aids for artificial ventilation (metal translaryngeal tubes
and bellows), and Receiving Houses, foreshadowed in Kite’s
essay, in London around the Serpentine and for 12 miles
along the banks of the Thames from Westminster. Some of
these were manned, even medically.
Others, such as James Curry in 1791, and the Royal
Humane Society itself in 1806, developed resuscitation
kits
48
with silver airway tubes and bellows, resulting in
numerous life-saving interventions being undertaken, espe-
cially for the apparently drowned.
1796: John Daniel Herholdt (1764–1836) and Carl
Gottlieb Rafn (1769–1808)
Herholdt and Rafn’s Life-saving measures for drowning
persons,
29
a truly remarkable booklet of 112 pages in
Danish, reviewed and summarised those transactions of
humane societies concerned with the recent history of
resuscitation of the drowned published to the time of
writing (1796), together with the knowledge, methods and
available means, especially equipment, then being
employed in rescues in Europe.
For Denmark itself, the authors describe Professor P G
Hensler’s treatise on life-saving measures, printed 1770, as
inspiring the Danish Government to command a copy go to
each Parson, parish Executive Officer, County Lord Lieuten-
ant and Bailiff in the Counties”, etc, (and to their succes-
sors), as well as in the Kingdom of Norway. (The authors’
prime dedication of their book was to Hensler.) Despite all
that, plus the April 1772 Ordinance from the King endors-
ing Hensler, and the May Proclamation from the Danish
Chancellery about preventing and saving from drowning,
Herholdt and Rafn deplore the wide lack of public “Life-
saving Measures” in Denmark. They stated that 45 drown-
ings might occur annually in Copenhagen alone, of which
they estimated that, with proper measures, perhaps two-
thirds could be saved. This book indicated their disgust at
the failure of any authority in Denmark to have established
any proper rescue organisation (and perhaps their protests
led to better organisation?).
The authors declare (page 41),It is clear that the entire
Plan of Treatment must aim at (1) removing all Hindrances
to the Vital Functions [presumably, as they mention on page
42, ‘all the Froth, Slime and Mud’]; starting again, espe-
cially, (2) the Respiration and (3) the Circulation of the
Blood; and (4) restoring the suppressed Energy of the
Nerves. Then they clearly reinforce previous exhortations
from John Hunter and Charles Kite: “Above all, the
Arrested Respiration should be started again … as soon as
possible.
An English translation of the book was achieved in 1960,
under Editor-in-chief Henning Poulsen, for a handout cele-
brating the 10th anniversary of the Scandinavian Society of
Anaesthesiologists. He states in his foreword, “The mouth-
to-mouth method is carefully and vivedly [sic] described on
pages 59-62 in a section entitled: … Insufflation of Air into
the Lungs [in fact, these translated words are on page 45
of the English version; “pages 59–62” refers to the Danish
version] … and it emphasises the advantages [does it
really?] and disadvantages of this method. Certainly, Her-
holdt and Rafn establish the physiological soundness of
mouth-to-mouth for EAV, but to this reader their endorse-
ment of the method seems lacking in enthusiasm. After
description of a sternal compression technique (producing
an expiratory assist, which would be followed by elastic
recoil action of the rib cartilages to spontaneously draw in
an inflation with “Pure Atmosphere”), which has only a
“weak” effect but is more efficacious in children, the
authors then succinctly describe a mouth-to-mouth tech-
nique, one with an expiratory assist manoeuvre also. Criti-
cism of mouth-to-mouth follows on page 46, as a system
hardly to be recommended:
But as the Insufflation of Air by mouth is a very Toilsome
and Loathesome Act, and since accordingly an otherwise
laudable delicacy of feeling usually prohibits both the
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
169
Physician and other People of Propriety from using this
method, especially in Adults or People of advanced years
who have been drowned, it is of little use [my empha-
sis]. So far we have heard of only a few examples where
well-known men have overcome the unpleasant feeling
associated with this act and in Honourable Enthusiasm
used their own mouths for that purpose ….
This method is admittedly less disgusting when one
blows through a Pipe-stem or another small Tube which
is inserted into the Nostrils or the Mouth.
And: It is a far better means to bring Pure Atmosphere
which has not been fouled by other people’s breathing
into the lungs of the Drowned Person.
Artificial ventilation by other than mouth-to-mouth is
then described in detail: by “ordinary bellows”, nozzles,
and tubes. The authors debunked “blood letting”.
Mouth-to-mouth EAV towards the end of the 18th
century in Britain
By his experiments from about 1782, but published 4 and 6
years later, Edmund Goodwyn
50
(1756–1829) had increased
the chances of mouth-to-mouth success in EAV, by discov-
ering that the tongue could fall back and obstruct the
airway in an unconscious victim lying supine. He also
advocated supplying oxygen (as did Anthony Fothergill;
44
there were multiple differences of opinion among the
resuscitation promoters Goodwyn, Kite, Fothergill, Edward
Coleman and others). But mouth-to-mouth was declining
once the Humane Society formally recommended the use of
bellows (1782) as the best means of carrying on artificial
respiration” — although Sir Arthur Keith stated in his
review of the history of the Royal Humane Society for his
Hunterian Lectures of 1909
54
that, in many of the cases
recorded then, no mention is made by the rescuer of having
used bellows.
Writers on resuscitation history usually describe a decline
in applying mouth-to-mouth for EAV by the end of the 18th
century. With the system of careful documentation of
rescue attempts filed in the Royal Humane Society records,
one might hope it was possible to ascertain the actual
degree of its employment in London and its surrounds.
Keith’s review
54
was possibly the first detailed study to be
carried out systematically since Charles Kite studied time
lengths of immersion in 1787.
44
Perhaps P J Bishop’s 1974
study for the Royal Humane Society’s 200th anniversary
Short history
1
is the next published source available.
Keith’s table for succeeding periods of the “chief means
employed” lists for the years:
1774–1793, “Warmth, Fumigation, Inflation”, with
43.7% unsuccessful. For this period, Sir Arthur says
... artificial respiration, if applied at all, took the form of
mouth-to-mouth inflation.
FN19
1796–1811, “Warmth, Inflation(bellows)”, with 54.8%
unsuccessful.
To judge from how Sir Arthur expresses it, “bellows
obviously qualifies “inflation”, which is reinforced by the
juxtaposition of the two words in his text. That would seem
to indicate there was no mouth-to-mouth at all in the Royal
Humane Society records for 1796–1811. But it is surely
surprising to be asked to accept that it was not employed in
a single one of 2470 successful cases? Sir Arthur points out
that using bellows had the least success of any “period” he
lists between 1774 and 1907.
Obstetricians continued intervening for the apnoeic new-
born, for whom James Elam (1954) could still assert that
EAV “continued to be used without the official endorse-
ment of medical organisations” after the Royal Humane
Society abandoned its practice”.
55
Conclusion
Mouth-to-mouth rescue breathing was (?re-)introduced to
adult resuscitation in the 18th century after apparently
minimal employment, apart from that by midwives for
neonates. In a developing Age of Enlightenment, humane
societies, the first one founded in Amsterdam (1767),
initially adopted it for respiratory resuscitation. Arthur
Keith showed mouth-to-mouth for EAV still flourishing in
Britain until 1793, but official endorsement had been lost
there for a decade. By the end of the century, enthusiasm
for it was well past its peak, principally for aesthetic
reasons, and lung inflation manually with designed bel-
lows was favoured. Translaryngeal tubes, usually metal,
were developed once Monro Secundus described his
tactile intubating technique for doctors. Absence of spe-
cial equipment on-site or medical help readily to hand
precluded such use, and a victim’s life might then depend
on whether a lay attendant was prepared to apply rescue
breathing by mouth to mouth. However, the turn of the
century still featured its practice in midwifery, and this
theme and others will be pursued in Part 3.
Diversions, as postscripts
1. Intensivists may be interested to note that a non-resuscita-
tive, intensive-care-type intervention was demonstrated before
FN19. Whereas, for the year 1773 in France, Sir Arthur says that
only 11% were unsuccessful byinflation” alone!
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
170
the 18th century ended. Versatile surgeon Pierre-J Desault is
credited with maintaining a nasotracheal catheter in place for
glottic swelling for a day and a half. Although this has been
described as occurring in 1802,
56
or in the early 19th century,
57
it had to be before the time of his death in 1795. I have failed
to locate a full case account in English. Desault treated “several
cases of oedema of the glottis by successful blind endotracheal
intubation”.
58
2. I find remarkable the number of Scotsmen to the forefront
in resuscitation during this period (several of them were
Quaker physicians). The list appears to include: William
Tossach, William Buchan, William and John Hunter, Alexander
Monro Secundus, William Cullen, Lord Cathcart, Edmund
Goodwyn, Edward Coleman and David Ramsay. This feature
must also reflect the excellence of Edinburgh’s 18th century
medical school, which was also attended by resuscitation
supporters, the Northerners, John and Anthony Fothergill, and
Irishman, Oliver Goldsmith).
3. Kites massive Essay seems to me a staggering achieve-
ment, with all the experience and judgement needed to
write it — yet he did it as a 19-year-old.
Acknowledgements
I wish to acknowledge the immense help received from many
people enabling the completion of this article: my wife, Elizabeth;
librarians at the Philson, ANZCA, Otago Medical School, E & M
Davis, Wellcome, British, and Auckland City Libraries (however
would we manage without librarians?); Barry Baker; Tony Newson;
Douglass Taylor; Marianne Forbes; Ross MacFarlane (of RSL); Rich-
ard German; David Wilkinson; Anne Crowther; C-J Simmons; and an
ever-tolerant editor, Vernon van Heerden, and his staff.
Author details
Ronald V Trubuhovich, Honorary Specialist Intensivist
Department of Critical Care Medicine, Auckland City Hospital,
Auckland, New Zealand.
Correspondence: rvt.met@pl.net
References
1 Bishop PJ. A short history of the Royal Humane Society to mark its
200th anniversary [monograph]. London: Royal Humane Society,
1974: text 10pp; illustr. 6pp.
2 Thomson EH. The role of physicians in the humane societies of the
eighteenth century. Bull Hist Med 1963; 37: 43-51.
3 Eisenberg MS. Charles Kite’s essay on the recovery of the appar-
ently dead: the first scientific study of sudden death. Ann Emerg
Med 1994; 23: 1049-53.
4 Alzaga AG, Varon J, Baskett P. Charles Kite: the clinical epidemiol-
ogy of sudden cardiac death and the origin of the early defibrillator.
Resuscitation 2005; 64: 7-12.
5 Williams C. “Inhumanly brought back to life and misery”: Mary
Wollstonecraft, Frankenstein, and the Royal Humane Society.
Women’s Writing 2001; 8: 213-34.
6 Brandt L, El Gindi M, Duda D, Ellmauer S. The development of
organised emergency medicine in the 18th century. In: Atkinson RS,
Boulton TB, editors. The history of anaesthesia. Carnforth, UK:
Parthenon Publishing Group, 1989: 382-5.
7 Dagi TF. Exhortations to resuscitate in the 18th century: civic duties
in poetry and prose. In: Atkinson RS, Boulton TB, editors. The
history of anaesthesia. Carnforth, UK: Parthenon Publishing Group,
1989: 359-67.
8 Tossach WA. A man dead in appearance, recovered by di tending
the lungs with air. Med Essays & Obs Soc Edinb 1744; v (part 2):
605-08.
9 Trubuhovich RV. History of mouth-to-mouth rescue breathing. Part
1. Crit Care Resusc 2005; 7: 250-7.
10 McNeil M. Under the balance of science, Erasmus Darwin and his
age. Manchester: Manchester University Press, 1987: 238-9.
11 Baker AB. Early attempts at expired air respiration, intubation and
manual ventilation. In: Atkinson RS, Boulton TB, editors. The history
of anaesthesia. Carnforth, UK: Parthenon Publishing Group, 1989:
372-4.
12 Redding JS. Historical vignettes concerning resuscitation from
drowning. In: Safar P, Elam J, editors. Advances in cardiopulmonary
resuscitation. New York: Springer-Verlag, 1977: 276-80.
13 Keith A. Three Hunterian Lectures on the mechanism underlying
the various methods of artificial respiration practised since the
foundation of the Royal Humane Society in 1774. Lecture 1. Lancet
1909 Mar 13; 173 (4463): 745-9.
14 Schechter DC. Role of the humane societies in the history of
resuscitation. Surg Gyn Obstet 1969; 129: 811-5.
15 Fothergill J. Ob ervations on a ca e published in the la t volume of
the Medical e ays, Etc. of recovering a man dead in appearance,
by di tending the lungs with air. Edinburgh, 1744. Phil Trans Roy
Soc 1744-45:(see FN5); 43: 275-81.
16 France EM. Some eighteenth century authorities on the resuscita-
tion of the apparently drowned. Anaesthesia 1975; 30: 530-8.
17 Cary RJ. A brief history of the methods of resuscitation of the
apparently drowned. Johns Hopkins Hosp Bull 1913 Aug; 270: 243-
71.
18 Fisher HE. Resuscitation. In: Glasser O, editor, & associates. Medical
physics. Chicago: Year Book Medical Publishers, 1944: 1241-55.
19 American Society of Anesthesiologists. Resuscitation: an historical
perspective. A catalogue of an exhibit at the Annual Meeting of the
American Society of Anesthesiologists in San Francisco, October 11-
13, 1976. Park Ridge, Ill: Wood Library-Museum, 1976 [hereafter
referred to as ASA Exhibit Catalogue, 1976; ref.19.] Thus: Fothergill A.
Cited in ASA Exhibit Catalogue [ref. 19]; no.61: p.23. (Copies are
still available from the Wood Library-Museum, $US10.)
20 Cramond T. Beneficence, temperance and medical science. Aust N
Z J Surg 1997; 67: 512-9.
21 Ramsay D. A review of the improvements, progress and state of
medicine in the xviii
th
century. Charleston, SC: Young, 1801. In:
Brunhouse RL. David Ramsay, selections from his writings. Edited
with introduction and notes. Philadelphia: American Philosophical
Society, 1965: Transactions, new ser; 55[pt4]: 196-217, see p.201-2.
22 Mead RA. A mechanical account of poisons, in several essays,
London 1745. Cited in: ASA Exhibit Catalogue 1976 [see ref. 19];
no.7: p.8.
23 Baker AB. Artificial respiration. The history of an idea. Med Hist
1971; 15 (4): 336-51.
24 Jackson R. A physical dissertation on drowning: in which submer-
sion, commonly call’d drowning, is shown to be a long time
consistent with the continuance of life….to which is subjoined, the
proper measures for recovery and relief; … by a physician, London,
1746. Cited in: ASA Exhibit Catalogue 1976 [see ref. 19]; no.8: p.8.
HISTORY OF MEDICINE
Critical Care and Resuscitation Volume 8 Number 2 June 2006
171
25 Baskett TF. Benjamin Pugh: the air-pipe and neonatal resuscitation.
Resuscitation 2000; 44: 153-5.
26 Wilkinson DJ. Benjamin Pugh and his air-pipe. In: Boulton TB,
Wilkinson DJ, editors. Essays on the history of anaesthesia. London:
Royal Society of Medicine Press, 1996: 1-3. [Internat Congr and
Symp Series, 213.]
27 White GM. Evolution of endotracheal and endobronchial intuba-
tion. Brit J Anaesth 1960; 32: 235-46.
28 Smellie W. A treatise on the theory and practice of midwifery.
London: D Wilson nr Strand at Plato’s Head, 1752: p.226. [Facsimile
edition. Birmingham, Al, USA: Classics of medicine library, 1990.]
29 Herholdt JD, Rafn CG. An attempt at an historical survey of life-
saving measures for drowning persons and information of the best
means by which they can be brought back to life again. Copenha-
gen: Tikiobs/Geest, 1796. (English version translated by Hannah
DW, Rousing A. Poulsen H, editor, 1960.)
30 Woods RH. On artificial respiration. Trans Roy Acad Med Ir 1906;
24: 137-41.
31 Official “Edict” by the City of Zurich, Switzerland, 1766 AD. On the
methods of resuscitation to be employed on drowned or asphyxi-
ated persons. With a brief introduction by Arno B Luckhardt. Bull
Inst Hist Med 1938; 171-8.
32 Johnson A. From Dr Alex John ons authentic ca es. A hanged man
restored to life. Scot’s Magazine 1774 Sep; xxxvi: 450-1.
33 Lee RV. Cardiopulmonary resuscitation in the eighteenth century. A
historical perspective on present practice. J Hist Med All Sci 1972;
27: 418-33.
34 Sternbach GL, Varon J, Fromm R Jr, Baskett PJF. The resuscitation
greats. The humane societies. Resuscitation 2000; 45: 71-5.
35 Baskett PJF. J D Herholdt and C G Rafn: two unsung heroes from
Denmark. Resuscitation 2003; 58: 283-8.
36 Chamberlain D. Never quite there: a tale of resuscitation medicine.
Resuscitation 2004; 60: 3-11.
37 Eisenberg MS. Life in the balance. Emergency medicine and the
quest to save life. New York: Oxford University Press, 1997: 59-61.
38 Karpovich PV. Adventures in artificial respiration. New York: Associ-
ation Press (of the YMCA), 1953: 17.
39 Payne JP. On the resuscitation of the apparently dead. An historical
account [Arnott Demonstration]. Ann Roy Coll Surg 1969; 45: 98-107.
40 Huston KG. Origins of resuscitation in the USA. In: Atkinson RS,
Boulton TB, editors). The history of anaesthesia. Carnforth, UK: The
Parthenon Publishing Group, 1989: 352-9.
41 Cathcart CS. Paper presented by Lord Cathcart and referred to in
the preceding Minute. Edinburgh: [Board of Police of Scotland?]
1774 Aug 11: 1-7. Available at: http://special.lib.gla.ac.uk/teach/
Cullen/letter.html (accessed Feb 2006): 33-45.
42 Buchan W. Domestic medicine or the family physician, a treatise on
the prevention and cure of diseases by regimen and simple
medicines with an appendix containing a dispensatory for the use
of private practitioners. 1st ed. Edinburgh: Balfour, Auld, Smillie,
1769: 621-624.
43 Wilkinson DJ. The development of resuscitation in the United King-
dom. In: Atkinson RS, Boulton TB, editors. The history of anaesthesia.
Carnforth, UK: The Parthenon Publishing Group, 1989: 348-51.
44 Kite C. An essay on the recovery of the apparently dead. Including:
Dr Lettsom’s Address on the delivery of the medal, p.xiii. London: C
Dilly in the Poultry, 1788: 274 + 6. [Excerpts in: Armstrong Davison
MH. Endotracheal and other modern methods in the eighteen
century. The evolution of anaesthesia. Altrincham, UK: John Sher-
ratt & Son, 1965: 216-22.]
45 Hawkins LH. The history of resuscitation. Brit J Hosp Med 1970;
Oct: 495-500.
46 Cullen WA. A letter to Lord Cathcart, president of the Board of
Police in Scotland, concerning the recovery of persons drowned
and seemingly dead. London, Edin. 8th Augu t 1774. [Also,
London: J Murray, 1776.] Available at: http://special.lib.gla.ac.uk/
teach/Cullen/letter.html (accessed Feb 2006): 1-27.
47 Taylor DW. The manuscript lecture-notes of Alexander Monro,
secundus (1733-1817). Med Hist 1978; 22 (2): 174-86.
48 Brandt L, Duda D, El Gindi M. The first instruments for resuscita-
tion. In: Atkinson RS, Boulton TB, editors. The history of anaesthe-
sia. Carnforth, UK: The Parthenon Publishing Group, 1989: 375-82.
49 Hunter J. Propo als for the recovery of people apparently drowned.
Phil Trans Roy Soc 1776; 66: 412-25.
50 Cathcart Lord, Lauderdale Earl of, Leven Earl of. Extract from the
Journals of the Board of Police, concerning recovery of persons
drowned and seemingly dead. Edinburgh: Board of Police of
Scotland, 1774 Aug 11. Available at: http://special.lib.gla.ac.uk/
teach/Cullen/letter.html (accessed Feb 2006): 29-31.
51 Moore W. The knife man. The extraordinary life and times of John
Hunter, father of modern surgery. London: Bantam Press, 2005: 95-
6, 103-4, 110-1, 117-20.
52 Huston KG. Introductory notes. In: ASA Exhibit Catalogue, 1976: 1-
3 [see ref.19].
53 Zuck D. Dr Nooth and his apparatus. Brit J Anaesth 1978; 50: 393-405.
54 Keith A. Three Hunterian Lectures on the mechanism underlying
the various methods of artificial respiration practised since the
foundation of the Royal Humane Society in 1774. Lecture III. Lancet
1909 Mar 27; 173 (4465): 895-9.
55 Elam JO, Brown ES, Elder JD. Artificial respiration by mouth-to-
mask method. N Engl J Med 1954; 250: 749-54.
56 Waters RM, Rovenstine EA, Guedel AE. Endotracheal anesthesia
and its historical development. Anesth Analg 1933; 12: 196-203.
57 Alberti PW. Tracheotomy versus intubation, a 19th century contro-
versy. Ann Otol Rhinol Laryngol 1984; 93: 333-7.
58 Mushin WW, Rendell-Baker L. Origins of thoracic anaesthesia
(1953). Park Ridge, Ill, USA: Wood Library-Museum, 1991
(reprinted): 43.
... Prana vayu is compared with the atmospheric oxygen that was called amlajan, meaning the base constituents of acids is necessary to carry out the vital functions of life. e facts as described by ayurvedic scholars in earlier days in the Gupta period depict a clear and categorical feature mentioned in the process of respiration in human subjects [3,[6][7][8][9][10][11][12][13]. ...
... e resuscitation was performed by the surgeon William Fossach [6]. He presented the case of mouth-to-mouth rescue [7]. In the late eighteenth century, Baron Antoine Portal gave a proposition for typical cases related to respiratory disorders, to inflate the lungs of the neonatal subjects with air. ...
... e Scottish surgeon John Hunter (13 February 1728-16 October 1793) propagator of such instrumental strategies in medical treatment and finally arduously fabricated human bellows equipped with pressure relief valves. He subsequently gave recommendations to the Royal Human Society for the urgent requirement of using mechanical ventilation on an emergency basis for resuscitation [3,7,33]. In addition to that, he stated that in order to decrease inflation of the stomach mild pressing of the larynx against the vertebrae will be an effective strategy measure [2,7]. ...
Article
Full-text available
The outbreak of novel COVID-19 has severely and unprecedentedly affected millions of people across the globe. The painful respiratory distress caused during this disease calls for external assistance to the victims in the form of ventilation. The most common types of artificial ventilating units available at the healthcare facilities and hospitals are exorbitantly expensive to manufacture, and their number is fairly inadequate even in the so-called developed countries to cater to the burning needs of an ever-increasing number of ailing human subjects. According to available reports, without the provision of ventilation, the novel COVID-19 patients are succumbing to their ailments in a huge number of cases. This colossal problem of the availability of ventilator units can be addressed to a great extent by readily producible and cost-effective ventilating units that can be used on those suffering patients during an acute emergency and in the absence of conventional expensive ventilators at hospitals and medical care units. This paper has made an attempt to design and simulate a simple, yet effective, mechanized ventilator unit, which can be conveniently assembled without a profuse skillset and operated to resuscitate an ailing human patient. The stepper motor-controlled kinematic linkage is designed to deliver the patient with a necessitated discharge of air at optimum oxygen saturation through the AMBU bag connected in a ventilation circuit. With the associated code on MATLAB, the motor control parameters such as angular displacement and speed are deduced according to the input patient conditions (age group, tidal volume, breathing rate, etc.) and thereafter fed to the controller that drives the stepper motor. With a proposed feedback loop, the real-time static and dynamic compliance, airway resistance values can be approximately determined from the pressure variation cycle and fed to the controller unit to adjust the tidal volume as and when necessary. The simplistic yet robust design not only renders easy manufacturability by conventional and rapid prototyping techniques like 3D printing at different scales but also makes the product easily portable with minimal handling difficulty. Keeping the motto of Health for All as envisioned by the WHO, this low-cost indigenously engineered ventilator will definitely help the poor and afflicted towards their right to health and will help the medical professionals buy some time to manage the patient with acute respiratory distress syndrome (ARDS) towards recovery. Moreover, this instrument mostly includes readily available functional units having standard specifications and can be considered as standard bought-out items.
... In 1767, the first rescue organization named "Amsterdam Rescue Society" has been established in the Netherlands (Bierens, 2017). They have started rescuing drowned people in Amsterdam and saved 150 victims since the past 4 years (Trubuhovich, 2006). ...
... The chief aspects of CPR procedure were chest compression and mouth-to-mouth breathing (rescue breathing). These two skills have been part of the CPR procedures since the beginning (Trubuhovich, 2006). In the guidelines 2000, chest compression was more highlighted than rescue breathing. ...
Article
Full-text available
This review aims to determine the changes made in the cardiopulmonary resuscitation (CPR) guidelines from 2000 to the present. The study was mainly undertaken by using International Guidelines from American Heart Association. The main change of CPR was chest compression skill. The guidelines have improved high-quality CPR through the change of chest compression skill. The latest adult CPR guidelines are as follows: (a) push chest quickly (100-120/min), (b) compress appropriately (5-6 cm), (c) relax chest fully (complete chest recoil), (d) avoid interruption of compression, and (e) avoid hyperventilation. The understanding of the latest CPR skills will be helpful in improving survival rate from sudden cardiac death.
... He also built the first human low-pressure chamber and described his experiences when the pressure was reduced to the equivalent of an altitude of ∼2400 m [12]. Until the mid-18th century, some authorities were encouraging the use of mouth-to-mouth method [13]. The method was criticized due to use of expired air and aesthetic distaste [14]. ...
Article
Full-text available
Health systems, which have been under great pressure with the COVID-19 outbreak, encountered problems in accessing some urgently needed medical resources. One of these resources has been the medical ventilators needed in acute respiratory distress syndrome developing with COVID-19. As a result of the calls made, many manufacturers have modified their facilities to produce med- ical ventilators and the problem has been solved to a great extent. While we focus on the urgent requirement for ventilators in these troubled days of COVID-19, we do not seem to be worth discussing their technical developments. How did the countries perform in the development of novel respiratory technologies in the pre-COVID period? While patents are seen as a measure of inventive activ- ity, we attempt to draw a general picture of patents granted in the field of medical respiratory technologies. Our study examines 27 397 respiratory patents listed in the Derwent Innovations Index database at the last 50 years and focuses on the last decade for further evaluation. In addition to the analysis of patent numbers, we identified the core ventilation technologies of the last two decades with the topic modeling technique and compared them. We used the claims section of the patents collected. It is seen that focus of ventilation patents granted between 2001 and 2010 was on oxygen, flow generation, and pressure sensors while it shifted to the pipes, measurement methods, and plates between 2011 and 2022.
... In 1732, the first mouth-to-mouth ventilation case was reported on a coal miner. This latter revival was performed by the surgeon William Fossach [12]. He presented in 1744 at Edinburgh the case study of his mouth-to-mouth rescue [13]. ...
Article
Mass casualty incidents such as those that are being experienced during the novel coronavirus disease (COVID-19) pandemic can overwhelm local healthcare systems, where the number of casualties exceeds local resources and capabilities in a short period of time. The introduction of patients with worsening lung function as a result of COVID-19 has strained traditional ventilator supplies. Mechanical ventilator is a medical device which is usually utilized to ventilate patients who cannot breathe adequately on their own. Among many types of ventilators Bag Valve Mask (BVM) is a manual ventilator in which a bag is pressed to deliver air into the lungs of the patient. In present work, a mechanical system along with speed controller has been developed to automate the operation of BVM. The constructed prototype contains crank, powered by servo motor, supported by wooden frame. To bridge the gap during ventilator shortages and to help clinicians triage patients, manual resuscitator devices can be used to deliver respirations to a patient requiring breathing support. With principal dimensions of 0.54*0.64 m2 , bvm weighs 0.9 kg and DC power convertor for supplying power for a continuous operation, the prototype can be moved easily. The dimensions of the frame are selected as such to be compatible with the physical dimension of Ambu bag. The performance of the device was tested using Airflow meter which illustrates that the Tidal Volume vs. Time graph of the automated system is similar to the graph produced by manual operation of the BVM, but with a mean deviation of 0.182 Litres with manual operation and 0.1 Litres with prototype. For patients who require ventilatory support, manual ventilation is a vital procedure. It has to be performed by experienced healthcare providers that are regularly trained for the use of bag-valve-mask (BVM) in emergency situations. Keywords: Mechanical Ventilator, Automated BVM, BPM, COVID-19, Ventilator design, Airflow meter
... In 1732, the first mouth-to-mouth ventilation case was reported on a coal miner. This latter revival was performed by the surgeon William Fossach [12]. He presented in 1744 at Edinburgh the case study of his mouth-to-mouth rescue [13]. ...
Article
Mass casualty incidents such as those that are being experienced during the novel coronavirus disease (COVID-19) pandemic can overwhelm local healthcare systems, where the number of casualties exceeds local resources and capabilities in a short period of time. The introduction of patients with worsening lung function as a result of COVID-19 has strained traditional ventilator supplies. To bridge the gap during ventilator shortages and to help clinicians triage patients, manual resuscitator devices can be used to deliver respirations to a patient requiring breathing support. For patients who require ventilatory support, manual ventilation is a vital procedure. It has to be performed by experienced healthcare providers that are regularly trained for the use of bag-valve-mask (BVM) in emergency situations. We will present, a historical view on manual ventilation’s evolution throughout the last decades. Artificial ventilation has developed progressively and research is still going on to improve the actual devices used. Throughout the past years, a brand-new generation of ventilators was developed, but little was done for manual ventilation. Manual ventilation through BVM can be replaced by automatic ventilation which illustrates that the Tidal Volume vs. Time graph of the automated system is similar to the graph produced by manual operation of the BVM and to the graph produced by a human subject. The use of an automatic manually operated device may improve ventilation efficiency and decrease the risk of pulmonary overdistention, while decreasing the ventilation rate.
... Here, the difficult route and fizzled intubation envelop a range including difficult cover ventilation, difficult laryngoscopy, difficult intubation and failed intubation. The most feared circumstance is that we can't ventilate-respiratory events [12][13][14]. The acclimated specifications of the equipment manage a level of weight that probably won't be all around endured, and causes consequent slash and hampers the desired result. ...
Conference Paper
Full-text available
Endotracheal tube (ETT) is a widely used lifesaving tool in case of moderate to severe medical predicaments. It enables an alternative means of mechanical ventilation for tranced or comatose patients. The gadget also helps in ventilation in case of giving general anaesthesia during major surgical procedures. Along the symbiotic use of the system comes the delicate maintenance and adequate monitoring of the instrument. One of the important features of the system is the air-filled cuffs or simply the air balloons that are availed to sustain the optimal intrinsic conditions of the pharmacological actions desired for the patient. The mechanism is to prevent aspiration of secretion of nasal mucosa. Because these secretions can cause aspiration pneumonia which is a life-threatening complication of these morbid patients. However, this requires periodic monitoring of pressure levels and facile adjustments to avoid aspiration, which might be even fatal. The subtlety of the course of action is often overlooked and negligence gives rise to unsought fatality in some patients. To reverse the course of this mishap, we came about our vocational modification to the conventional endotracheal tubes and air cuffs. The embodiment of automation ensures the inviolability as well as omission of professional lapse. The automatic apparatus facilitates the automatic detection of the pressure distortion and alarms the designated healthcare expert as a forewarning and hence the patient is bypassed any associated threat.
Article
Aim: To examine the level of knowledge on new psychoactive substances (NPS) among health care profesionals (HCPs) working within the Emergency Medical Services (EMS) system in Poland, and to assess how they would like to improve it. Material and methods: The study involved 602 HCPs working within the EMS system and was carried out using a survey questionnaire. Both online and paper-copy surveys were utilized. The collected data were statistically analyzed using the STATISTICA 12.5PL computer program (StatSoft, Inc., USA). Results: Most responders perceived themselves as having a “sufficient” (49%) or a “weak” level (40.5%) of knowledge of NPS, while only 10.5% as “good”. The Internet was a main source of information on NPS. In the 4-year period covered by the study, only less than 22% of HCPs took part in any training courses on NPS. Most participants expressed a need to learn more about “pharmacological treatment”, “legal provisions” and “qualification for hospital treatment”. Conclusions: An inadequacy in essential knowledge of NPS by HCPs working within the EMS system highlights the need for education on these novel molecules.
Article
Cardiopulmonary resuscitation (CPR) is lifesaving procedure and a basic link in modern cardiac resuscitation. Research has associated patient survival to the quality of CPR performed. The variations in performance quality and patient survival described in the literature highlight opportunities to improve outcomes. To maximize survival from cardiac arrest, educational efforts must focus on optimizing CPR quality. (RQI) ®—The Resuscitation Quality Initiative is one method to accomplish this in the radiology department.
Chapter
The history of pediatric critical care is laid out within this chapter. It demonstrates how the development of medicine for critically ill infants and children has been advanced by those who were willing to push boundaries. Critical care required the development of medical technology that some questioned as being cruel and certainly experimental. Others pushed against stigmas of who was worth saving. Certainly issues of resource allocation, and where and by whom care should be delivered, has been present since the beginning. Understanding the history of pediatric critical care, and understanding that questions of ethical permissibility have been present since the beginning, helps create a framework for understanding the ethical questions and dilemmas of today.
Article
Full-text available
While thorough investigation of many aspects of contemporary scientific developments and Mary Shelley's personal history have provided illuminating contexts for the study of Frankenstein, the activities of the Royal Humane Society, and other bodies and individuals who pioneered and publicized resuscitation techniques, have been comparatively neglected. Here we find a richly documented, highly conspicuous area of scientific endeavour, which generated much excitement in life and literature from the last quarter of the eighteenth century onwards. There are three major points of contact with Frankenstein: Victor Frankenstein's revival of dead tissue to make his creature; the frequent occurrences of unconsciousness and asphyxia, both in the novel and in Mary Shelley's family during the period leading up to its composition, and the widely differing degrees of competence and success with which they are treated; and the possibility that resuscitative techniques were used to revive Mary Shelley's mother, Mary Wollstonecraft, after a suicide attempt. The impact on Frankenstein of Mary Shelley's lifelong distress at the role she played in bringing about her mother's death in childbirth has been thoroughly canvassed by other critics, notably Anne Mellor, but the thought that Mary Shelley, who was herself conceived after her mother's second suicide attempt, might be, in a sense, a child of the dead adds a further turn to the Gothic screw. This study traces a hitherto unexplored intersection between Mary Shelley's first novel and her family history, as well as showing how it launches a formidable attack on the shady ethics and inconsiderate arrogance of some early resuscitators.
Chapter
Several thousand people die each year in this country as the result of drowning. Most of them are young and in good health. No single disease accounts for as many deaths in people under age 24, yet relatively little is known about this costly killer. For centuries the search for a solution to this problem was frustrated by lack of understanding of the principles of resuscitation.
Having been requested by a principled member of the society, lately established for the recovery of persons apparently drowned, to commit my thoughts on that subject to paper; I readily complied with his request, hoping, that, although I have had no opportunities of making actual experiments upon drowned persons, it might be in my power to throw some lights on a subject so closely connected with the inquiries which, for many years, have been my favourite business and amusement. I therefore collected together my observations and experiments relative to the loss and recovery of the actions of life, and shewed them to a Society of which I am a member; who approved of them as new and curious, and unanimously recommended their being submitted to the judgement of this learned Body. The practice is new, and has furnished as yet few important and clear facts.