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The one measure which in practical value far surpassed all others for the restoration of
the dying animal was artificial respiration, and I have no doubt that a great majority of the
deaths which have occurred in man from anæsthesia might have been avoided by the use of an
active artificial respiration. The difficulty with artificial respiration as it has been hitherto
practised upon man, after the Sylvester or other methods, is ifs inefficiency; whereas the
artificial respiration which I used on animals was very active, indeed, much more efficient than
natural breathing in causing circulation of air through the lungs, and therefore in removing
excess of the anæsthetic from the residual air of the lungs and from the blood.
The use of what may be called "forced" artificial respiration by the physiologists,
so naturally suggested a similar practice in man, that the celebrated John Hunter invented
for the purpose an apparatus which consisted of a bellows so constructed that when it was ex--
tended one compartment drew in air from the lungs, while the other drew air from the atmos
-phere; and when it was closed the process was reversed, the fresh air being thrown into the
lungs, the foul air into the atmosphere. In 1867 Richardson, of London, invented an ap
-paratus more elegant and portable, although identical in principle with that of John
Hun-ter's; but I have not found that either Hunter or Richardson treated by forced artificial res-
-piration an actual case of disease or poisoning, In 1875.*
Dr. John Ellis Blake reported a
successful case of aconite poisoning, in which life was apparently saved, although there was no
pulse for over three hours, by artificial respiration, with the use of oxygen. In this case Mar
-shall Hall's method was at first used, but later, a small rubber tube was connected directly with
a copper reservoir of condensed oxygen, the other end of the tube terminating in as mall nozzle,
which was inserted in one nostril. Four hundred gallons of oxygen were thus used, but how
far the force of the compressed gas was employed to dilate the lungs is not very clear; and it
is doubtful whether this case should be considered as one of forced respiration. The first
physician to use forced respiration in actual human poisoning, with a clear idea, of its value
and power, so far as my reading goes, was Dr. George E. Fell.†
It is plain that the bellows constructed by John Hunter and by Richardson are unneces-
sarily complex and faulty in principle. There is no need whatever of drawing the air out of
the fully-filled lungs. Every physiologist knows that when the muscular system is completely
paralysed by curare or even by death, the chest walls have sufficient elasticity to force air out
of the lungs and all ordinary laboratory apparatus for artificial respiration is based upon this
fact. For forced artificial respiration in man an ordinary bellows of proper size is all that is
required for the motive power.
The real difficulty,—
the point to be especially investigated and studied,—is as to the
connection between the bellows and the lungs.
Hunter and Richardson simply placed a tube
in one nostril, closing firmly the other nostril and the mouth of the subject,
Dr. Fell at first used a tracheal tube, the insertion of which, of course, necessitated the
performance of tracheotomy. In one case, however, a simple mask covering the mouth and
nostrils was a perfect success. I have had no opportunity of trying the apparatus on the
* Boston Med. and Surg. Journal, vol. xxi.
† International Medical Congress, Washington, 1887.