50 Proceedings of Royal Society of Edinburgh. [sess. 
of performing artificial respiration is that of intermittent pressure 
upon the loiver ribs with the subject in the prone position. It is 
also the easiest to perform, requiring practically no exertion, as 
the weight of the operator’s body produces the effect, and the 
swinging forwards and backwards some thirteen times a minute, 
which is alone required, is by no means fatiguing.* This statement 
also applies to the supine-pressure method when effected slowly and 
without undue violence. But not only is this method less efficient 
than the prone-pressure method, but there are undoubted dangers 
attending it, especially in those cases where the asphyxial condition 
is due to drowning. For in drowned individuals the liver is 
enormously swollen and congested, and ruptures easily, as Dr 
Herring and I found when endeavouring to resuscitate drowned 
dogs by this method of artificial respiration.! And further, 
the supine position is contra-indicated both in drowning and in 
asphyxia generally, since it involves the risk of obstruction of 
the pharynx by the falling back of the tongue, and also fails to 
facilitate the escape of water, mucus, and vomited matter from 
the mouth and nostrils. 
The Silvester method, as compared with the others, has nothing 
in its favour. It has all the disadvantages of the supine position, 
is most laborious, and is relatively inefficient. As regards the 
Marshall Hall method, the most effectual part of that method is 
the exertion of pressure in the prone position ; the rolling over is 
quite unnecessary, and attended by manifest disadvantages. The 
addition to this method which is advocated by Bowles,! consisting 
in raising the one arm over the head after the body is placed in 
the lateral position, has been found, in measurements we have made, 
to introduce no serious augmentation in the amount of air ex- 
changed, but merely serves to render it still more difficult to per- 
form the respiratory movements efficiently at the necessary rate. 
* I have on one occasion continued it for nearly an hour without experi- 
encing the least fatigue, and without the subject having any desire to breathe 
naturally or feeling at all inconvenienced. 
t Report of Committee of Royal Medical and Chirurgical Society, op. cit. 
£ R. L. Bowles, A Method for the Treatment of the apparently Drowned, 
London, 1903. 
( Issued separately January 29, 1904.) 
