754 REPORT—1904. 
nerve fibrillz, ze. the true nerve-element, grew down from the developing 
neuroblast, 
The following Papers were read :— 
1. On Methods of Artificial Respiration. By Professor E. A. ScuArer, F.2.S. 
It is essential that any method of artificial respiration which is to be employed 
with the view of resuscitating persons asphyxiated by drowning or otherwise should 
be simple in application and capable of producing an efficient exchange between 
the lungs and atmosphere. Artificial respiration may require to be performed by 
a single individual, and the muscular exertion needed should not he great. The 
methods (Silvester and Marshall Hall) which are commonly recommended for use 
in this country fulfil none of these conditions. They are troublesome and com- 
plicated and require a large amount of muscular exertion on the part of the operator. 
In addition to this they are inefficient, z.e., they do not effect a sufficient exchange 
of air between the lungs and atmosphere. This should average between 4,000 and 
5,000 cubic centimetres per minute. The proof of the first statement is to be 
found in the experience of anyone who has tried to perform artificial respiration 
by these methods; the proof of the second is contained in the data given in the 
table which accompanies this communication. A further convincing proof is to 
be found in the fact that it is impossible to maintain the respiratory exchanges of 
a normal individual who submits to allow himself to be ‘ respired’ by either of these 
methods, z.e., he is unable to refrain from himself actively respiring on account of 
the air-exchange being insufficient. 
The only method of artificial respiration which is perfectly simple to apply, 
and which effects a sufficient exchange of air per minute, is that of intermittent 
pressure upon the lower part of the thorax. The introduction of this system, 
although it had been suggested by Erichsen and others, is due to Dr. B. Howard 
(1869). By Howard’s method the patient in a case of drowning is first turned face 
downwards and the back is pressed upon two or three times to force out water from 
the lungs, after which he is turned face upwards. The operator is then directed to 
grasp the lower part of the chest and to press gradually forward with all his weight 
for three seconds, then with a push to jerk himself back and wait three seconds, 
repeating this eight to ten times a minute. 
This method is simple, can be performed by one operator, and is fairly 
efficient so far as air-exchange is concerned (see table). The drawbacks are 
(1) that the tongue in the face-up position tends to fall back and block the pas- 
sage of air through the pharynx; (2) that there is risk of rupturing the liver (which 
is enormously swollen in asphyxia); (3) that there is risk of breaking the ribs if 
the operator is heavy and powerful, and if the patient be advanced in years. 
These drawbacks are avoided by keeping the patient in the face-down (or 
prone) position during the whole operation. The tongue then tends to fall 
forwards, and the weight of the operator’s body being communicated through his 
hands, which are placed over the lower part of the back (lowest ribs), compresses 
the thorax and abdomen in such a way that the pressure is diffused over a con- 
siderable area, and is less localised than by the method described by Howard. 
This produces greater efficiency and reduces the risk of injury to ribs or viscera to 
aminimum., The muscular exertion required is only that needed to swing the 
upper part of the body backwards and forwards on the hands about twelve or 
thirteen times a minute, the operator kneeling by the side of or across the patient. 
The pressure is gradually applied and gradually released. The amount of air 
exchanged by this method per minute (see table) is greater than that yielded by 
any other which has been tried, and may even exceed the ordinary rate of 
exchange of the individual. It is perfectly simple and easy of application by boy, 
woman, or man. It ought therefore to be practised in cases in which artificial 
He es is required, in preference to methods which are both complicated and 
inefficient. 
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