252 



NATURE 



\yuly 20, 1876 



showed that as with a fire that is well-nigh burned out 

 we can restore action by laying new fuel lightly on the 

 remaining flame, and then by gentle blowing can communi- 

 cate the flame to the new fuel, so in artificial respiration the 

 same delicacy of procedure will reproduce the vital flame. 



In the absence of experimentation these facts could 

 never have been learr ed. It was necessary to see the 

 effects of various methods under various conditions, and 

 under various circumstances in order to arrive at certain 

 conclusions. A century of observations on men subjected 

 to accidents that destroy life would not have taught so 

 much as was learned in a few hours from the observations 

 on the inferior animals. 



Artificial Circulation. — The inquiry on the subject of 

 artificial circulation proved that the attempt to establish 

 the circulation by injection into the vessels, or by forcing 

 the blood over the lungs, or by drawing it over in com- 

 bination with artificial respiration, failed by reason of the 

 coagulation of blood which followed such attempts. Some 

 countenance was given, by the experiments, to the attempt 

 to encourage a current of circulation by the process of 

 raising and depressing the body so as to place the head 

 at one moment below the level and at another moment 

 above the level of the body ; but on the whole the effort 

 to restore the circulation through the lungs was most 

 expedient by the simple plan of artificial respiration 

 carried out as above stated. 



Use of Galvanism. — The research instituted to test the 

 value of galvanism as a means of restoring animation 

 had a most important practical bearing. By regulating 

 the intermittent current with a metronome I found it 

 possible to make the respiratory muscles, of an animal 

 recently dead act in precise imitation of life. I also 

 found that the heart could be excited into brisk contrac- 

 tion by the same means. But the result came out that 

 by this method the muscles excited by the current 

 dropped quickly into irrevocable death through becoming 

 exhausted under the stimulus, and that in fact the 

 galvanic battery, according to our present knowledge of 

 its use in these cases, is an all but certain instrument of 

 death. By subjecting animals to death from the vapour of 

 chloroform in the same atmosphere, and treating one set 

 by artificial respiration with the double-acting pump, and 

 the other set by artificial respiration excited by galvanism, 

 I found that the first would recover in the proportion of five 

 out of six, the second in proportion of one out of six. 

 Further, I found that if during the performance of mecha- 

 nical artificial respiration the heart were excited by gal- 

 vanism, death was all but invariable. The explanation of 

 these experimental truths is illustrated by a simple simile. 

 If an animal reduced in power to the last degree from want 

 of food be carried to a place of succour, it may recover ; 

 but if it be stimulated or forced to walk to the place it will 

 possibly die on the way. So with a man or animal under 

 prostration from shock or narcotism ; if the surgeon uses 

 his own force for the restoration of the enfeebled muscles 

 of the man before him he may restore the muscles to 

 power ; but if he uses up the last remaining force in the 

 rnuscles of his patient by stimulation he will kill them out- 

 right. Considering that in the large number of instances 

 of sudden death by accident, the first thing " tried " for 

 restoring life is the galvanic battery, the information on 

 the subject thus yielded by experiment, and which could 

 have been got in no other way, is a result which, though un- 

 expected, is none the less valuable. Indeed the peculiarity 

 of experimental pursuit is that something unexpected in 

 result is always learned, and is almost always useful. 



Injection of Stimulants. — The effect of injecting am- 

 monia, and other stimulants into the heart for the pur- 

 pose of exciting the walls of the heart into contraction, 

 ■was found to be as faulty as the application of galvanism 

 for the same purpose. It produced a final contraction 

 which was fatal. 



Use of External Warmth. — The research on the action 

 of warmth on animals under suspended anirnation was 



singularly interesting. I found that when an animal under 

 a narcotic is still breathing, however faintly, the restoration 

 of the animal warmth is often alone sufficient to r°store life. 

 This came out of the observation of the action of narcotics 

 in reducing temperature, and in my first researches on 

 chloral hydrate I showed that of two animals under the 

 same lethal dose one was safe to recover in a warm air, 

 while the other in a cold air would die. These facts relate 

 to animals which are still breathing though all but dead. 



On the other hand, I discovered that if an animal had 

 actually ceased to breathe, the most certain way of 

 ensuring its death is the exposure of it to heat ; the most 

 certain way of retaining it in a condition for possible 

 recovery and of retaining its muscular irritability under 

 stimulus is the exposure of it to cold. Heat I found excites 

 the final muscular contraction and causes coagulation of 

 the fibrine of the blood ; cold suspends both. Thus in a 

 warm-blooded animal exposed, after its death from chloro- 

 form, to extreme cold in a dry air, I found every muscle 

 in the body that I could reach vigorously active under 

 re-applied warmth and galvanism three hours after 

 death ; while in fish and batrachians I found it possible to 

 restore life altogether after they had been accidentally 

 inclosed, that is to say, frozen up in ice. As we arrive at 

 clearer knowledge of the means of restoring animation 

 in man, these facts will have a bearing of the extremest 

 value. Already they indicate that in the death of the human 

 subject by drowning and cold, attempts to restore life are 

 demanded even hours after the occurrence of the accident. 



Lastly, on this head, the experimentation taught me 

 that while in the process of resuscitation it is very bad 

 practice to immerse the body in a heated medium like hot 

 water, it is of the utmost importance to establish the 

 artificial respiration with a warm and dry air. Such an 

 air prevents condensation of water in the bronchial tubes, 

 quickens the process of oxidation of blood, and allows the 

 body to become warm from its own natural centres of vital 

 heat. 



Practical Applications. 



The experimental inquiry herewith briefly stated is too 

 new to have brought forth much fruit. The grand practical 

 results for which it was pursued have to follow in course of 

 years. Some results have, however, already been realised. 



Immediately after chloral hydrate came into use, the 

 dangers from its use were found to be imminent. I was 

 able to point out even before such dangers had occurred 

 that the cause of danger was reduction of animal tempera- 

 ture from the agent, and that in treating a person poisoned 

 with chloral two things were required, viz., to maintain a 

 high atmospheric temperature, and to give warm food. 

 Twice I have been summoned to these accidental poison- 

 ings, and in both instances I have saved life by these simple 

 and purely scientific modes of cure. Probably after a 

 number of deaths of men from chloral, it might have been 

 learned that the cause of death was the reduction of animal 

 heat. The fact gained instantly by observation on the lower 

 animals supplied the knowledge in advance of the accident. 



In two instances in the human subject in which after 

 the performance of the operation of tracheotomy, life has 

 become suspended from obstruction to the entrance of air 

 into the lungs below the artificial opening, the obstruction 

 has been removed, and afterwards by means of artificial 

 respiration carried out with the instrument I have described 

 above, fife has been restored after all the ordinary evidences 

 of death were manifested. In one of these examples of 

 restored life the recovery was complete and the patient is 

 now as well as ever he was. But for the long period of 

 eleven minutes he lay in all the character of death, 

 depending solely for returning life on the surgeon who 

 supplemented his respiratory power and who gently 

 fanned back into life a flame which had ceased for ever 

 if scientific experimentation on the lower animals had not 

 shown the possibility of its return by the hand of science. 

 {To be contimied) 



