Three Hunterian lectures on the mechanism underlying the various methods of artificial respiration practised since the foundation of the Royal Humane Society in 1774 : delivered in the Theatre of the Royal College of Surgeons of England on March 1st, 3rd, and 5th, 1909 / by Arthur Keith.

  • Arthur Keith
Date:
1909
Catalogue details

Licence: In copyright

Credit: Three Hunterian lectures on the mechanism underlying the various methods of artificial respiration practised since the foundation of the Royal Humane Society in 1774 : delivered in the Theatre of the Royal College of Surgeons of England on March 1st, 3rd, and 5th, 1909 / by Arthur Keith. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    28 move when the operator standing at the patient’s head applies his strength. The manipulation carried out by the operator maybe described as a “ passive shrugging of the shoulder ” ; the shoulders are seized with the thumb in front of, and the fingers behind, the head of the humerus ; as the operator pulls and lifts the shoulders towards the patient’s ears the pectoral muscles passing to the front of the chest and the latissimus dorsi passing to its side become stretched and cause an inspiratory movement of the ribs—chiefly the upper. Expiration is caused by the recoil which follows relaxation of the shoulders. The Pacini method is also laborious and the passive expiratory recoil requires to be aided by active pressure to be really effective. In the following year (1868) Dr. W. P. Bain on returning from Italy made Pacini’s method known in England. He modified the manner in which Pacini grasped the shoulders so that the movements of the clavicle might be made more effective. He also introduced a method which is deserving of attention because it represents the effective part of one of the most ancient methods of resuscitation and one which I find from the records of the Royal Humane Society is still much in use—viz., that known as “agitation of the body.” From 1774 onwards the Royal Humane Society had condemned agitation or manipulation of the body by the limbs. Bain observed that when he seized the hands of a dead subject— which lay on its back on the floor—and attempted to lift it by drawing the arms towards him an inspiratory move- ment occurred varying in amount from 80 to 300 cubic centi- metres. He found that most effect was produced by standing at the head of the passive subject and then pulling and lifting the body by the hands towards him. The feet of the subject require to be held or fixed. The method is laborious and needs the application of pressure to the chest to make expiration effective. The second Resuscitation Committee was instituted to inquire into the merits of the Pacini-Bain method but it never really proceeded to work. Howard’s Method. In 1871 Dr. Benjamin Howard0 of New York introduced another method of artificial respiration. In teaching the police of New York he found that the methods of Marshall Hall and of Silvester were too complicated to be clearly understood and readily applied by non-professional assistants. His aim was to discover a method which was at once simple and effective; as a preliminary measure the body of the patient is turned face downwards and is compressed to expel 9 The Direct Method of Artificial Respiration (Prize Essay), Trans- actions of the American Medical Association, 1371: The Lancet August 11th, 1877, p. 194. ’
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