PRONE AND POSTURAL RESPIRATION 
 
 D R ¥ N I N Cx 
 
 ETC.
 
 Uinca spes est, unicum remedium. 
 
 scevamque exhalat MepJdtim . 
 
 ViRG. ^N. lib. vii, 1. 84.
 
 J 1 
 
 ^ 
 
 &^ 
 
 PHONE AND POSTURAL RESPIRATION 
 
 DROWNING 
 
 OTHER FORMS OF APNCEA OR SUSPENDED RESPIRATION ; 
 
 MAESHALL HALL, M.D. P.R.S. 
 
 OF THE INSTITUTE OF FRAXCE ; 
 
 FOREIGN ASSOCIATE OF THE ACADEMY OF MEDICINE OF PARIS ; 
 
 ETC. ETC. 
 
 EDITED BY HIS SON, 
 
 MARSHALL HALL, Esq. 
 
 LONDON : 
 JOHN CHURCHILL, NEW BURLINGTON STREET. 
 
 MDCCCLVII.
 
 vVA 
 
 THIS LITTLE VOLrME IS DEDICAl ED 
 TO 
 
 GEOEGE WEBSTER, Esq. M.D. 
 
 OF DULWICH, 
 
 IN TESTIMONY OF AX rXIXTERRUPTED FRIEXDSHIP 
 OF THIRTY YEARS ;
 
 AXD TO 
 
 THOSE STUDENTS OF ST. GEOKGE's HOSPITAL* 
 
 \\"H0, 
 
 WITH SUCH ZEAL, ABILITY AND PERSEVERANCE, AVOUKED OUT 
 THE PROBLEM OF 
 
 POSTURAL RESPIRATION ; 
 
 By MARSHALL HALL, M.D. etc. 
 
 August, ISo^ 
 
 * EDWARD LONG FOX, ESQ. (NOW M D. OXON ), 
 CHAULtS HUNTER, ESQ. AUD ROBERT L. BOWLfS, KSQ.
 
 I HAVE made it a sacred duty to assist in editing this 
 my Father's latest work, during the protracted and severe 
 illness, which terminated on the eleventh of this month 
 in his death — in a loss irreparable to the whole scientific 
 world. 
 
 This final leap of an expiring flame is far from being 
 the least brilliant of my Father's gifts to his profession 
 and to humanity. 
 
 My task has been easy. I have had little to do, 
 except to gather together and arrange the papers which 
 have appeared in a pamphlet and in " The Lancet/' and 
 some M.SS. 
 
 I should wiUingly have adopted the title given to the 
 life-restoring process of pronation and rotation of the 
 patient dying of apnoea, by the Editor of that journal, 
 and so cordially adopted by the profession : 
 
 " Any thing more simple, philosophical, or beautiful, 
 could not have been devised. It is proposed to call 
 the plan the ready method of treating the drowned. 
 Infinitely preferable, in our opinion, would be the title of 
 the MARSHALL HALL METHOD. This designation is 
 due to the distinguished discoverer; and the method 
 would thus be benevolently associated with his name to 
 the end of time." 
 
 MARSHALL HALL. 
 
 Blacklands, Galne, Wiltshire. 
 August, 1857.
 
 PREFACE. 
 
 I am unwilling entirely to discard the evidence given 
 by so many who have treated apnoea, of recovery after a 
 very long immersion. And I have endeavoured to 
 imagine an event possible which has been rejected because 
 it has appeared impossible. 
 
 What takes place when all respiration and all circu- 
 lation have apparently ceased ? For from such a state, 
 in new-born infants especially, the patient has recovered. 
 
 Is there a low state of chemical change still per- 
 sistent under the influence of apncea and cold, from 
 which even the adult may be restored under the genial 
 influence of a gentle stream of atmospheric air into the 
 pulmonary air-cells and on the general surface of the 
 body ? 
 
 The damp hay-stack smoulders until some occasion 
 occurs of its low combustion being roused into spark and 
 flame.
 
 Xll PREFACE. 
 
 A.nd a cainllary circulation and its blood-changes 
 may continue, when the heart has already ceased to con- 
 tract, which may render such restoration to life not 
 impossible. A frog in which, from the exclusion of 
 oxygen, the cutaneous circulation has ceased, if observed 
 under the microscope, has been known to become spon- 
 taneously restored on exposure to the atmospheric air. 
 
 Much more might be said on this subject and on low 
 and spontaneous combustion. Meantime, let us persevere 
 with our prone and postural respiration with alternate 
 pressure, and wait and watch and hope ; an efficient 
 artificial respiration has never yet been so promptly or 
 rather instantly applied as it may now be by means of — 
 Pronation and Kotation. 
 
 An investigation is opened to us full of promise of 
 life, even in cases of extremely long duration and un- 
 availing protracted treatment. We must cease to be 
 sceptical. Still-born infants have been restored after 
 a considerable lapse of time.
 
 XHl 
 
 PAUT THE FIKST 
 
 IS NEARLY A VERBATIM REPRINT OF THE ESSAY I'REsENTK 
 TO THE ROYAL HUMANE SOCIETY IN JANUARY 1856. 
 
 PAET THE SECOND 
 
 CONSISTS IN A SIMILAR REPRINT OF PAPERS PUBLISHED IN THE 
 
 LANCET SINCE THAT DATE, WITH OBSERVATIONS 
 
 NOT YET PUBLISHED. 
 
 CASES. 
 
 WITH NOTES ON OBSOLETE MODES OF PRACTICE. 
 
 PART THE THIRD 
 
 CONSISTS IN SEVERAL PHYSIOLOGICAL VIEWS BEARING UPON 
 RESPIRATION AND APNOEA.
 
 PAET FIRST.
 
 THE PNtEOMETEK* 
 
 OR MEASURER OF POSTURAL RESPIRATION. 
 
 Vide p. 61.
 
 PAET FIEST. 
 POSTURAL RESPIRATION 
 
 IN 
 
 DEOWNING, 
 
 ETC. 
 
 § 1. — Introduction. 
 
 In the following pages I propose to treat of Apnoea 
 (from a, priv. and izv^uy respiro), its rationale and treat- 
 ment, in so succinct and plain a manner as to be useful 
 to those most interested in the practical results of such 
 inquiries. I shall keep in view that it is to promote the 
 benevolent objects of the Eoyal Humane Society that my 
 efforts are made. 
 
 My first aim will be to give a clear view of the nature 
 of the effects of suspended respiration ; my second, to 
 state the best means of restoring the patient affected by 
 that suspension. 
 
 The nature of normal respiration is entirely different 
 from that of the apparently respiratory movements in 
 continued apncea. The former is, as will be more 
 distinctly explained hereafter, reflex; that is, it is 
 excited by the carbonic acid exhaled from the blood into 
 
 B
 
 Z POSTUEAL RESPIRATION IN DROWNING 
 
 the air-cells of the lungs, through nerves which proceed 
 to the spinal centre, traverse it in some mysterious man- 
 ner, and proceed from that centre to the muscles of 
 respiration ; the latter are centric, and are caused by 
 the action of the carbonic acid retained in the blood, 
 acting on the spinal centre itself and through certain 
 nerves which proceed from it on the muscles moved, 
 which are also different from the former ones. 
 
 This distinction, which is of the utmost importance, 
 has been established by my own experiments. 
 
 During the circulation, the oxygen inhaled in respi- 
 ration unites with the carbon in the blood, forming car- 
 bonic acid. This carbonic acid is exhaled in respiration 
 in its turn, except in the cases in which the respiration 
 is suspended, as in drowning and other forms of apnoea. 
 
 In apnoea, the carbonic acid retained in the blood 
 first poisons the brain, producing anaesthesia, uncon- 
 sciousness, and immobility; and then the spinal centre, 
 producing the gaspings so characteristic of this condition, 
 and constituting the last external sign of life. 
 
 After this, there is still a slight lingering movement 
 of the heart, on which the feeble hopes of the restoration 
 of the patient repose ; but speedily true asphyxia (from 
 a, priv. and o-^t^w, pulso), or the cessation of all pulsa- 
 tion and circulation, occurs. 
 
 Such is the course of events when the suspension of 
 respiration is complete. It is usually rapid and of short 
 duration. Sometimes, however, the suspension of respira- 
 tion is not absolute ; the patient may rise to the surface
 
 AND OTHEE- FORMS OF APNCEA. d 
 
 and breathe; or there may be a state of syncope, 
 or of slioch, produced by the circumstances of the accident 
 and inducing 2^feelle circulation ; and then the duration 
 of the apnoea, with the hope of restoration, is more 
 protracted, that hope being directly as the persistence of 
 the respiration, and inversely as the rapidity of the cir- 
 culation. 
 
 The further hope of respiration by the means we em- 
 ploy is again directly as we excite or imitate respiration, 
 the restoration of the circulation being promoted by sham- 
 pooing, the warm bath, &c. only as subsidiary and second- 
 ary to respiration. 
 
 We must never forget that the circulation is a self- 
 poisoning, the respiration a f/e-poisoning, process. These 
 are the two principles by which we must be guided in 
 our treatment of apncea. On these topics I proceed 
 to treat more at length in the subsequent sections. I 
 beg my reader to pardon a few repetitions. 
 
 § II, — The Distinction betvjeen Respiration and the 
 Respiratory Movements in Asphyxia. 
 
 Every one is familiar with the effect of dashing cold 
 water on the face, or of descending slowly into the cold 
 bath. The cutaneous nerves of the face or general sur- 
 face are impressed with the cold, and excite, through a 
 reflex action performed through these nerves and the 
 spinal centre, acts of inspiration. 
 
 B %
 
 4 POSTURAL RESPIEATION IN DROWNING 
 
 Every one has experienced the effect on the nostrils 
 of the carbonic acid evolved from the stomach after taking 
 draughts of soda water. 
 
 In ordinary circumstances, it is the carbonic acid 
 gas exhaled from the blood through the fine membranous 
 tissues of the pulmonary air-cells, which, by exciting the 
 fine fibrillse of the pneumogastric nerve spread over those 
 air-cells, proves the constant excitant, through those 
 nerves and the spinal centre, of the normal acts of res- 
 piration. 
 
 To be more explicit, I may add that, in respiration, 
 oxygen gas is inspired ; it is absorbed into the blood, 
 and circulated with it ; in its systemic course it unites 
 with carbon, and forms carbonic acid ; this circulates in 
 the venous blood in its turn, is exhaled from it, proves 
 the excitant of a fresh inspiration in the pulmonary air- 
 cells, and is finally expired into the atmospheric air. 
 
 These acts I have designated reflex or ^Mstaltic, 
 because they are performed along certain «z-going nerves, 
 through the spinal centre, and along certain out-^om^ 
 nerves eventually distributed to the muscles of respira- 
 tion. This ^i^staltic action is the essential character of 
 \}^% physiological acts of respiration. 
 
 All is changed in the case in which the normal acts 
 of respiration are obstructed, as in apnoea. 
 
 When the respiration is entirely suspended, there is 
 no exhalation of carbonic acid, the excitant of respiration ; 
 there can therefore be no r/mstaltic respiration ; but the 
 carbonic acid which ought to be exhaled in the lungs is
 
 AND OTHER FORMS OP APNCEA. 
 
 retained in the blood, poisons it, circulates with it through 
 the system and its various organs, and excites various 
 abnormal conditions and actions. The mode of action 
 is now not ^i^staltic, but centric in the spinal centre and 
 ^cstaltic. The respiratory movements are no longer nor- 
 mal and rhytlunic acts of inspiration and exspiration, but 
 abnormal and irregular ^.rpiratory movements, with a 
 peculiar opening of the mouth, flexion of the body, and 
 frequently with the ejection of foam, followed by in,- 
 spiratory efforts. Such is the character of the respiratory 
 movements in apnoea. They are pathological^ not phy- 
 siological ; and they are, I repeat, centric or ecstaltic 
 from the spinal centre, not ^^^staltic, through it. 
 
 The blood is poisoned by the carbonic acid so re- 
 tained; the organs are poisoned in their turn by this 
 blood-poison. Our most strenuous efforts must be ex- 
 erted to eliminate and remove this poison from the blood 
 and from the system. All other efforts are subsidiary, 
 although auxiliary ; and, if they at all take the place of 
 this, injurious. 
 
 The onli/ mode of thus eliminating the carbonic-acid 
 blood-poison is, to excite, or imitate, Respiration — the 
 one idea which it is the object of these pages to enforce. 
 
 Adopting fully the beautiful device of the Royal Hu- 
 mane Society, I would carry out its meaning still further, 
 and say that so to Moid the latent spark into flame, is 
 our hope, our only hope ; — imica spes est, unicum reme- 
 dium.
 
 D POSTURAL EESPIRATTON IN DROWNING 
 
 To revert to the specific topic of this section, I would 
 again say — and this knowledge is entirely the result of 
 my own labours — that whilst the normal respiratory 
 movements are refiex in their mode of excitement, the 
 movements in apnoea are centric. Of the former cha- 
 racter too is fhepantinf/, wliich may be designated hyper- 
 pnoea, observed in some experimeats to be detailed here- 
 after; and of the latter, the peculiar phenomenon of 
 gasping, which may be termed, from its equivocal cha- 
 racter, pseudo'piKBa,. 
 
 § III. — Belation of Respiration to the Circulation. 
 
 There is the strictest relation between the rapidity of 
 the circulation and that of the respiration. The number 
 of the pulsations of the heart preserves, in all physiolo- 
 gical conditions, the same ratio to the number of respi- 
 ratory movements. If the circulation be augmented, the 
 respiration becomes more frequent ; if the circulation be 
 retarded, the respiration is proportionately slower. 
 
 This ratio between the number and force of the con- 
 tractions of the heart and the number of the acts of 
 respiration is physiological, the result of cause and effect 
 and essential to life and health, in its varied forms 
 and conditions. 
 
 As the blood circulates, it receives the vivifying effect 
 of oxygen, and forms carbonic acid. This carbonic acid
 
 AND OTHEE FORMS OF APNCEA. 7 
 
 is exhaled through the fine membranous tissue of the air- 
 cells, and coming then in contact with the minute origins 
 of the pueumogastric nerve, the internal excitor respira- 
 tory nerve, excites the successive acts of respiration. 
 
 The formation and the evolution of this carbonic acid 
 is greater in proportion to the quickness of the circula- 
 tion ; the rapidity of the respiration is proportionate to 
 the quantity of this carbonic acid so formed and so 
 evolved. 
 
 The circulation is rendered more rapid by muscular 
 effort, and diminished by repose. It is more rapid during 
 walking, less so during quiescence and sleep ; it is re- 
 duced to its minimum, physiologically, during the con- 
 tinued sleep of hibernation. The rapidity of the respi- 
 ration is proportionate to that of the circulation in all 
 these conditions. 
 
 Tlie circulation without respiration would be a self- 
 or hlood- poisoning process ; respiration is ^^-poisoning. 
 By respiration the carbonic-acid poison formed during 
 the circulation is eliminated from the blood and evolved 
 from the system, lis final purpose requires that it should 
 be, what it is, proportionate to the circulation. The 
 carbonic acid, when evolved from the blood, no longer a 
 poison, excites the respiration, which conveys it from the 
 system- — a wonderful adaptation of the means to the end ! 
 
 In the state of hibernation, or extreme quiescence, 
 the velocity of the circulation is reduced to its minimum ; 
 that of the respiration is proportionately reduced. 
 
 In the state of extreme activity, the velocity of the
 
 8 POSTURAL EESPIEATION IN DROWNING 
 
 circulation is augmented to its maximum : wliilst that of 
 the respiration {^proportionately augmented. 
 
 In the intermediate conditions of animal life, inter- 
 mediate phenomena of circulation and of respiration are 
 observed. 
 
 These interesting phenomena are thus readily ex- 
 plained. The excitant of ordinary respiration is the 
 carbonic acid gas, evolved by the blood circulating in the 
 fine membranes of the air-cells, and diffused into the con- 
 tiguous atmospheric air. This evolution of carbonic acid 
 from the circulating blood is proportionate to the rapidity 
 of the circulation ; and since this carbonic acid gas is the 
 excitant of the respiration, the rapidity of the respiration 
 becomes proportionate to that of the circulation in its 
 turn. 
 
 It is demonstrated by chemical analysis that the 
 quantity of carbonic acid evolved is really augmented 
 with the augmented rapidity of the circulation. When 
 the rapidity of the circulation and the quantity of evolved 
 carbonic acid are greatly augmented, the respiration h^- 
 com^^ panting — a phenomenon observed when, without 
 augmented circulation and evolution of carbonic acid, 
 this latter gas is added in a certain proportion to the 
 atmospheric air respired. 
 
 But that carbonic acid which, being evolved, thus 
 performs a most important and vital function, becomes, 
 if retained in the blood, as in suspended respiration, a 
 deadly poison, as I shall proceed to show in the following 
 sections; and as the quantity of the carbonic acid is
 
 AND OTHEE FORMS OF APNCEA. 9 
 
 augmented by every acceleration of the circulation, 
 the rapidity of that process of poisoning in apncea is 
 proportionately great. 
 
 § lY. — The Rationale of the Effects of Suspended 
 Respiration, 
 
 The phenomena of life result from the play of arterial 
 blood on the nervous and muscular tissues. 
 
 ' The blood is supplied by the ingestion of food, and 
 purified by the egestion of the fseces and urine. It is 
 arterialized by the inlialation of oxygen and the exhala- 
 tion of carbonic acid in respiration. 
 
 Respiration consists in these two processes ; both of 
 which are suspended when the respiratory movements are 
 suspended, as in drowning or strangulation. 
 
 These two processes are of very different immediate 
 value to life : the inhalation of oxygen may be long nearly 
 suspended without proving fatal ; the suspension of the 
 exhalation of carbonic acid, even if incomplete, destroys 
 life in a comparatively very short time. These facts are 
 demonstrated by the following experiments : 
 
 Experiment 1. I placed an animal in a limited 
 portion of nitrogen gas, which, from our imperfect mode 
 of procedure, must have become mingled with a small 
 portion of atmospheric air : it continued to breathe with 
 freedom, only beginning io pant as the exhaled carbonic 
 acid began to accumulate.
 
 10 POSTUEAL RESPIRATION IN DROWNING 
 
 In ^perfectly pure nitrogen or hydrogen gas, the 
 animal dies more speedily even than when submerged 
 under water — the oxygen already in the blood being 
 probably exhaled. The spark of life becomes almost 
 instantly extinct, with phenomena which are quite pe- 
 culiar, assuming the form of violent convulsive move- 
 ments. 
 
 One of the most extraordinary results of my expe- 
 riments is this : a mouse will live in an atmosphere of 
 nitrogen and oxygen, in which there is so little oxygen, 
 that a lighted taper is immediately extinguished, flame 
 and spark, — and die in an atmosphere of carbonic acid 
 and oxygen, in which there is so much oxygen, that a 
 taper blown out, leaving a spark, is immediately re- 
 inflamed. It is not the want of oxygen, but the excess 
 of carbonic acid, which proves fatal. 
 
 Tlx;p. 2. We placed an animal in carbonic acid : it 
 began to gas]} almost immediately, and soon expired. 
 
 In the first experiment, the inhalation of oxygen was 
 nearly excluded; in the second, the exhalation of car- 
 bonic acid was intercepted. 
 
 During the physiological condition of the functions, 
 oxygen is continually inhaled, and carbonic acid exhaled. 
 The former unites with the carbon in the blood and forms 
 the latter. The carbonic acid, if retained, becomes a 
 deadly poison. The blood, during its circulation, if 
 respiration be suspended, proves self-poisoning, by the 
 carbonic acid so formed and retained. This process of 
 self-poisoning is rapid in proportion to the rapidity of
 
 AND OTHER FORMS OF APNCEA. 11 
 
 the circulation ; a fact which explains many of the phe- 
 nomena of apncea, and of the effects of our supposed 
 remedies. 
 
 The process of self-poisoning of the blood from the 
 suspension of respiration is readily traceable in experi- 
 ment : 
 
 Exp, 3. We submerged an animal in water, and 
 carefully watched the phenomena : there were, during 
 the Jirsl period of submersion, voluntary efforts to escape ; 
 then, a second period of stillness, or anc^sthesia, ^vithout 
 attempts either to move voluntarily or efforts to respire, 
 the retained carbonic acid poisoning the Irain, and not 
 escaping into the air-cells ; then followed a third period, 
 of gasjnng, which I propose to designate pseudojpncea, 
 conjoining opening of the mouth and expiratory move- 
 ments, with the rejection of foam, resulting from the 
 impression made by the carbonic-acid-poisoned blood on 
 the spinal centre; at length the gaspings cease, the 
 animal seems to be dead, but a lingering cnculation, the 
 value of which is not yet determined by experiment, re- 
 mains, but quickly subsides into true asjohi/xia. 
 
 Exj). 4. Instead of submerging the animal under 
 water, we placed it in a limited portion of atmospheric 
 air (of about three times its own bulk), and observed 
 the following phenomena : the breathing was at the first 
 perfectly natural, unless it was excited by emotion; 
 during a second period it became panting or hyperpncea, 
 the exhaled carbonic acid, when re-respired, acting as an 
 undue excitant of the pneumogastric nerves of the pul-
 
 13 POSTURAL EESPIRATION IX DRO\VXING 
 
 monary air-cells ; this second period passes very gradually 
 into the third, or that oi gasping or pseudopncea, as the 
 carbonic-acid poison formed in the blood excites the 
 spinal centre, a period and a condition further marked 
 by 02^671 mouth, starts, a tottering gait, and paralytic 
 weakness of the posterior extremities, all denoting affec- 
 tion of the spinal centre. 
 
 The third period very gradually passes into the fourth, 
 or true asphyxia and death. 
 
 These phenomena proceed with a rapidity which is 
 inversely proportionate to the age of the animal, to its 
 temperature, to its degree of activity, and to its elevation 
 in the zoological scale. 
 
 The general principle is further illustrated by the 
 phenomena of submersion in animals in a state of hiber- 
 nation : 
 
 Exp. 5. I submerged a bat, which was lethargic 
 in an atmosphere of 36^* Fahr., in water of 40°. It 
 moved about a little, and expelled bubbles of air from 
 its lungs. It was kept submerged during sixteen 
 minutes, and was then removed. It appeared uninjured 
 by the experiment ! 
 
 Exp. 6. I placed a hedgehog which had become so 
 lethargic in an atmosphere of 40° Eahr. as not to awake 
 to take food for several days, under the surface of water 
 at 42° Tahr. It moved about and expelled air from the 
 lungs. It was retained under the water during twenty- 
 two minutes. It was then removed. It appeared unin- 
 jured !
 
 AND OTHER FORMS OF APNCEA. 13 
 
 These animals die as speedily as other warm-blooded 
 animals, if submerged in a state of activity. 
 
 Cases are recorded of the human subject being re- 
 stored after many minutes of submersion. It may well 
 be doubted whether the facts so recorded were correctly 
 observed. But if they were, it must be supposed that a 
 state of syncope, or of shoch, must have obtained at the 
 moment of immersion, and the circulation have been 
 reduced. 
 
 For here it may especially be said — cita mors venit — 
 aut victoria IcBta. 
 
 The great principle in regard to the duration of sus- 
 pended respiration without a fatal issue, is — the degree 
 of slowness of the hlood-poisoning process of the circu- 
 lation. Every thing which, within physiological limits, 
 conduces to this effect, prolongs life. Every thing which, 
 -without respiration, promotes the circulation, such as the 
 warm-hath, frictions, &c. leads to speedier blood-poison- 
 ing and death. 
 
 It must be remembered that the blood is poisoned 
 by carbonic acid, formed by and during the circulation, 
 and that there is one remedy, which consists in the elimi- 
 nation of that poison, and that this is — Besjoiration 
 alone.
 
 14 POSTURAL RESPIEATION IN DROWNING 
 
 § V. — The Effects of Apnoea chiefly the result of the 
 Retention of Carhonic Acid. 
 
 That the effects of apnoea are not the result of the ex- 
 clusion of oxygen, but rather of the retention of carbonic 
 acid, has been already stated in general terms, together 
 with the one sole efficacious mode of treatment deduced 
 from it. I now proceed to detail experiments, at once 
 full of the deepest physiological interest, and confirmatory 
 of this view. 
 
 Exp. 7. — A tame mouse was placed in two ounces of 
 nitrogen gas, not quite pure, as before : it soon began to 
 panty from re-respiring the exhaled carbonic acid, and 
 shortly afterwards to gasp, from the influence of the 
 action of the retained carbonic acid on the medulla ob- 
 longata; and mfive minutes it was dead. 
 
 Exp. 8. — I now placed another tame mouse in ten 
 ounces of the same gas : it remained in it during ffti/ 
 minutes, neither panting nor gasping, its breathing be- 
 coming slower and feebler. It was removed, and seemed 
 not to have suffered materially. The residual gas instantly 
 and entirely extinguished a taper, flame and spark. 
 
 Exp. 9. — In another experiment, I placed a wild 
 mouse mfour ounces of similar gas. It began to pant 
 in three or four minutes, and to open its mouth a little 
 in three or four minutes more. It was then transferred 
 into eight ounces of fresh nearly pure nitrogen. It re- 
 mained in this gas thirti/ minutes, its respiration simply
 
 AND OTHER FORMS OF APNCEA. 15 
 
 and gradually subsiding in depth and frequency to only 
 forty-eight respirations in a minute. We then removed 
 it, in a most feeble condition ; it seemed to recover, how- 
 ever, and the next day was lively ; but it died (of second- 
 ary apncea ?) on the third. 
 
 These experiments are amongst the most remarkable 
 in physiology, and suggest many curious reflections ; 
 nearly all the carbonic acid existing in the blood is ex- 
 haled ; and nearly all oxygen being excluded, little or no 
 further carbonic acid can be formed. Eespiration is 
 reduced to its minimum ; yet the animal lives, the blood 
 not remaining or becoming poisoned by its carbonic 
 acid. It is a condition resembling hibernation. 
 
 I reserve further observations on these and another 
 series of experiments for a memoir which I am preparing 
 for the Institute of France. My present object is to 
 present brief practical views ; my further object is to 
 treat the subject of respiration, and its partial or complete 
 and varied suspension, at greater length and in aU its 
 scientific relations. 
 
 An animal submerged in water dies very speedily, 
 poisoned by the carbonic acid contained in the blood ; 
 and the more speedily, the quicker the circulation and 
 the formation of that carbonic-acid poison. Gasping is 
 the premonitory sign of death. 
 
 An animal placed in a very limited portion of nearly 
 pure nitrogen gas dies in the same manner, but more 
 slowly, a part of the carbonic-acid poison being evolved 
 into that gas, dinA. panting precedes the gasping.
 
 16 POSTUEAL EESPIBATION IN DROWNING 
 
 In a large portion of nitrogen gas^ not quite pure, 
 that is not quite without oxygen, or in a second portion 
 of this gas, the first having received the portion of 
 carbonic acid already formed in the blood, or nearly 
 so, and no further carbonic acid being formed for want 
 of oxygen, the animal, ceasing to experience the organic 
 changes of respiration, and losing its temperature, simply 
 slowly sinks and dies, without the premonitory panting 
 or gasping. 
 
 As natural respiration is the result of excitation of 
 the pneumogastric nerves of the air-cells by the evolved 
 carbonic acid ; panting is the effect of oi'^r-excitation of 
 these nerves by the carbonic acid evolved and by a 
 portion of this gas inspired ; whilst gasping is the con- 
 sequence of the carbonic acid retained in the blood and 
 brought by the circulation into contact with the medulla 
 oblongata and spinalis. None of these events occur in a 
 large or second portion of nearly pure nitrogen. The 
 carbonic acid formed and evolved becomes less and less, 
 with the gradual subsidence, therefore, of the acts of 
 respiration, for want of the evolved carbonic acid excitant. 
 
 The phenomena may be compared to the slow ex- 
 tinction of a taper in a limited portion of atmospheric 
 air. 
 
 These views are confirmed by the following expe- 
 riments in a limited and unlimited portion of oxygen, 
 the difference being the presence or absence of a notable 
 portion of cabonic acid. 
 
 Hxp. 10. — I placed a white mouse in about two ounces
 
 AND OTHER FORMS OF APNCEA. 17 
 
 of pure oxygen gas : it breathed naturally, then panted, 
 then sighed, and then gasped. It was removed in twenty- 
 five minutes, and was slightly convulsed, and still gasped 
 when in the open air ; it tottered in its movements. The 
 residual gas brightened the sj)ark of a taper lighted and 
 blown out ; it therefore contained much oxygen, and the 
 phenomena were exclusively those of carbonic acid. 
 
 ^xj). 11. — I placed a mouse in a large quantity of 
 pure oxygen gas : it remained during three or four hours 
 without manifesting any change, and was then removed 
 apparently little affected. 
 
 § YI. — On the Influence of Temperature y and on the 
 Warm-Bath. 
 
 We owe our knowledge of the influence of tempera- 
 ture in apnoea to the splendid investigations of Ed- 
 wards, and to the more recent experiments of M. Brown- 
 Sequard. 
 
 Within certain limits, which may in general terms be 
 fixed at 60« and 100°, Pahr. the duration of hfe in the 
 case of suspended respiration is inversely as the tempe- 
 rature. 
 
 Above and below those temperatures respectively, 
 heat and cold have each a directly injurious effect. 
 
 In illustration of these facts, I here adduce two inva- 
 luable Talles, giving the results of the experiments of 
 Edwards and of M. Brown- Sequard :
 
 18 POSTUEAL RESPIRATION IN DROWNING 
 
 E&wardis Tahlef^ 
 Influence of temperature. — ^Kittens two days old 
 asphyxiated by immersion in water : 
 
 
 Mean duration of life. 
 
 At 32° Palir. 
 
 4' 33" 
 
 50° 
 
 10' 23" 
 
 68° 
 
 38' 45" 
 
 784" 
 
 34' 30" 
 
 86° 
 
 29' 
 
 106° 
 
 10' 27" 
 
 M. Brown-Sequard* s Table.f 
 Influence of previous temperature. — Rabbits two days 
 old immersed in water of 77° Fabr. being first cooled: 
 
 Mean duration of life. 
 
 To 96° Pabr. 12' 
 
 85° 18i' 
 
 74° 23' 
 
 65° 28' 
 
 It is obvious that the continuous warm-bath, taken 
 alone, must be utterly excluded in the treatment of 
 apnoea — that it can only be considered as admissible 
 when respiration is either not extinct or admits of being 
 excited, or is effectually imitated artificially. 
 
 There is, however, a use, not indeed for the conti- 
 nuous warm-bath, but for the sudden kot-h&th, not 
 
 * Des Agens Physiques ; p. 630 — . 
 t Researches, New York, 1853, p. 47.
 
 AND OTHER FORMS OP APXCEA. 19 
 
 hitherto suggested for adoption in practice : it is when 
 it is of such elevated temperature, and when the patient 
 is in such a condition, as to admit of its being made an 
 excitant of resjnration. 
 
 Its use in this point of view is chiefly useful in the 
 apnoea of still-born infants; and I shall have to treat 
 of it in this relation hereafter. But it cannot be 
 doubted that, if it could be made available at the moment 
 the patient is rescued from the water, a sudden momen- 
 tary plunge into a bath of from 100® to 104° Fahr. 
 would prove the most powerful excitant of inspiration. 
 
 But, even in this case, the application of the hot-bath 
 must be momentary, and alternated with that of the cold 
 bath or douche of the temperature of 50° or 60° Pahr. as 
 an excitant of respiration in its turn. 
 
 This suggestion I made some years ago to my much- 
 lamented friend, Mr. Henry Smith, who, in one case, the 
 only one on record, used it in the case of a still-born in- 
 fant, with complete success. 
 
 "We must cease therefore from the empirical use of 
 the warm-bath. When tliis agent is used, it must either 
 be administered as an excitant, not of the circulation, but 
 of respiration ; or as an excitant of the circulation, res- 
 piration being already restored, excited, or adequately 
 imitated. 
 
 In confirmation of these results, I may here adduce 
 four experiments, performed at the Eoyal Humane So- 
 ciety's receiving house in Hyde Park, and witnessed and 
 recorded by Mr. "Williams, its superintendent :
 
 20 POSTURAL RESPIRATION IN DROWNING 
 
 Tlxp. 12. — A kitten, three days old, 98° Pahr. in 
 temperature, was submerged in water of the same tem- 
 perature. Its last gasp was at the termination of 144 
 minutes. 
 
 Exp. 13. — A kitten of the same age, after exposure 
 alone to the cool atmosphere, was immersed in water of 
 50° Fahr. It survived 23 minutes ! 
 
 Hx/p. 14. — We submerged a puppy, 66 hours old, 
 under water at 100° Falir. It endeavoured to escape ; 
 became still ; then continued to gasp, frequently and 
 quickly, during 19' 35" : we counted 16 gasps. 
 
 Exp. 15. — ^We submerged a puppy of the same litter 
 in water of 50° Fahr. It endeavoured to escape ; became 
 stiU, but in a less marked manner than the former one ; 
 gasped more slowly and at longer intervals during 39' 35" ! 
 In this case we counted 24 gasps. 
 
 Judging from the Tahle of Edwards, the animal would 
 have lived longer still in a temperature of 60° Tahr. ; 
 this temperature acting in prolonging life in apncea, 
 whilst that of 50° destroys life as the direct effect of cold. 
 
 § VII. — The former Modes of Treatment of Asphyxia. 
 
 The modes of the treatment of asphyxia hitherto pro- 
 posed cannot be stated more distinctly than by the sub- 
 joined quotation of the latest Rules proposed by the 
 Eoyal Humane Society :
 
 AND OTHER FORMS OF APNCEA. 21 
 
 " To Restore the apparently Drovmed. 
 
 " 1. Convey the body carefully, with the head and 
 shoulders supported in a raised position, to the nearest 
 house. 
 
 " 2. Strip the body and rub it dry; then wrap it in 
 hot blankets and place it in a warm bed, in a warm cham- 
 ler free from smoke. 
 
 " 3. Wipe and cleanse the mouth and nostrils. 
 
 " 4. In order to restore the natural vjarmth of the 
 body — move a heated covered warming pan over the 
 back and spine. 
 
 " Put bladders or bottles of hot water, or heated 
 bricks, to the pit of the stomach, the arm-pits, between 
 the thighs, and to the soles of the feet. 
 
 " Foment the body with hot flannels. 
 
 " Eub the body briskly with the hand ; do not, how- 
 ever, suspend the use of the other means at the same 
 time ; but, if possible, immerse the body in a warm-bath 
 at blood heat, or 100° of the thermometer, as this- is pre- 
 ferable to the other means for — restoring warmth, 
 
 " 5. Yolatile salts or hartshorn to be passed occa- 
 sionally to and fro under the nostrils. 
 
 "6. No more persons to be admitted into the room 
 than is absolutely necessary." 
 
 These Rules may be summed up in one word — 
 warmth ! The idea is repeated no less than eight times.
 
 22 POSTUEAL EESPIRATION IN DROWNING 
 
 In addition to these measures, others are also recom- 
 mended, and especially Lero/s mode of inducing artificial 
 respiration by means of a bandage, so appHed to the 
 thorax as to admit of being tightened and relaxed. 
 
 § VIII. — Reflections. 
 
 But it will be sufficiently obvious to those who have 
 read the preceding pages with attention, that our main 
 objects in treating asphyxia are two : 1, to eliminate the 
 carbonic-acid poison already formed in the blood; and 
 2, to check as far as possible its further formation. 
 
 The utility of an emetic, as the first means of treat- 
 ment in stomach-poisoning, is not more obvious than the 
 instant institution of artificial respiration, the sole elimi- 
 nator of the blood-poison, in apnoea; and as in the 
 former we would not administer a new dose of the poison, 
 so in the Jatter we must not, if we could, prematurely 
 accelerate the circulation of the blood — that is, ih.Qfor7n' 
 ation of additional poison, by warmth, the warm-hath; &c. 
 
 Without due artificial respiration, every means of 
 augmenting the circulation must be injurious. Excited 
 or imitated respiratory movements are the sole means of 
 ehminating the carbonic-acid poison from the blood — the 
 unicum remedium in apncea; and whatever part the 
 want of oxygen plays in the state of things which exists 
 in apncea, in addition to the excess of carbonic acid, it 
 is still by respiration alone that it can be supplied. The 
 warm-bath and the other measures for restoring the cir-
 
 AND OTHER FORMS OF APNCEA. 23 
 
 culation, without this as the constant and preliminary 
 measure, if they have any influence at all, can only aug- 
 ment the formation of the poison. 
 
 These latter measures must therefore be delayed. 
 T\\Q first, the sole first, remedy is — artificial respiration. 
 
 But the modes hitherto proposed for the institution 
 of respiration are, for reasons which I proceed to give, 
 either inefficient or absolutely injurious. 
 
 These modes of inducing artificial respiration are of 
 two kinds : the first may be compared, in its operation, 
 to the action of \h.Q forcing -pump ; the second, to that of 
 the suction-pump ; and both have been used ^vith a dis- 
 regard to the all-essential consideration of posture. 
 
 To commence my observations on this last point, I 
 must remark that when the subject is kept in the supnne 
 position, events occur which render every attempt at in- 
 ducing respiration absolutely nugatory : the tongue may 
 fall backwards, carry with it the epiglottis and close the 
 glottis or entrance into the windpipe and air-passages f 
 Fluids already in the mouth and fauces, or regurgitated 
 '^rom the stomach, may not only obstruct the air-passages, 
 but be forced or drawn into the windpipe, and so add a 
 new source of apncea ? 
 
 These obstacles are obviated at once by reversing the 
 position from the supine — to the prone ! 
 
 Mr. Wilhams, the Society's Superintendent in Hyde 
 Park, has observed the cheeks to become inflated and air 
 to escape from the intestine, in cases in which artificial
 
 24 POSTURAL RESPIRATION IN DROWNING 
 
 respiration has been attempted by the bellows ; and it is 
 certain that the plan of Leroy can have little efficacy. 
 
 The following experiment has been repeated many 
 times, and has been witnessed by George Webster, jun. 
 Esq. of Peckham, Mr. Williams, and other gentlemen : 
 
 Exp. 16. — The dead subject being placed in the 
 supine position, and pressure made on the sternum and 
 ribs, a little gurgling was heard in the throat ; but, the 
 pressure being removed, there was no evidence of ^%spira- 
 tion. The subject being then turned into the prone 
 position, and pressure being made on the spine and the 
 ribs, and removed as before, there was in general free 
 ^:rpiration and ^Vzspiration, 
 
 One object of the succeeding section will therefore be 
 to describe and recommend the plan of jorowe-respiration, 
 or PRENOPNGEA (from •n^yivfi^, pronus). 
 
 But another objection applies to the mode of inducing 
 artificial respiration having the character of the forcing- 
 pump. 
 
 In order to accompHsh this kind of respiration, a 
 degree of force must be used, sufficient to raise the bony 
 and other structures of the thorax, and depress the dia- 
 phragm — a degree of force which both anticipation and 
 experience prove to be injurious to the delicate structure 
 of the lungs. Legallois and M. Leroy found these struc- 
 tures variously lacerated by this measure in experiments 
 on animals — the air so impelled sometimes passing into 
 the capillary vessels, and sometimes even into the cavity 
 of the thorax !
 
 AND OTHEU FOUMS OF APNGEA. 25 
 
 Two facts are obvious from the considerations laid 
 before the reader in this and the preceding sections : the 
 first, that artificial respiration must precede and accom- 
 pany all other measures for the recovery of the patient 
 affected by the suspension of this vital function; and 
 the second, that some other modes of artificial respiration 
 than those hitherto proposed must be devised, before we 
 can be said to treat the case on scientific grounds, or in 
 a safe and efficient manner. 
 
 I must add, that any measure of inducing the arti- 
 ficial inspiration of air, if used with too great rapidity j 
 is apt to close the larynx by external pressure on its 
 sides : 
 
 Hxp, 15. — ^I removed the larynx and windpipe, and 
 attached the nozzle of the syringe to the lov/er part of 
 the latter : on drawing up the piston, the cordse vocales 
 were seen to be drawn together whenever the piston was 
 moved with some degree of rapidity, and all ingress 
 of air into the windpipe utterly prevented ! 
 
 The obvious conclusion is, that, whenever we attempt 
 artificial respiration, the procedure must be effected with 
 gentleness and slowness. 
 
 § VIII. — New Modes of Treatment of Apnrna. 
 
 The reader of the preceding section will readily anti- 
 cipate the principal points in this. 
 
 The patient is to be taken from his former supine 
 position and laid prone on Msface^
 
 26 POSTURAL RESPIRATION IN DROWNING 
 
 In tills jJositio7t, the tongue falls forwards, draivs 
 with it the epiglottis, and leaves the glottis open, whilst 
 all fluids will flow from the fauces and mouth. The 
 tongue may even be drawn forwards, to secure its 
 removal, and that of the epiglottis, from the rima glottidis. 
 
 In order that the face may not come into contact 
 with the ground, the patient's wrist is to be carried 
 upwards and placed under the forehead. 
 
 It will now also be perceived that the thorax 
 and abdomen will be pressed by a force equal to the 
 weight of the trunk. This pressure will induce e;rpiration. 
 And, additional pressure being now made on the posterior 
 part of the thorax and abdomen, the expiration will be 
 more complete. 
 
 This latter pressure is to be then removed. Its re- 
 moval will be followed by slight i^^spiration. The weight 
 of the body is then to be removed from the thorax and 
 abdomen, by gently turning it 07i the side and a little 
 heyond, placing one hand under the shoulder and the 
 other under the hip of the side moved. In this manner 
 a fair degree of i^^spiration is induced ! And thus, with- 
 out instruments of any kind, and with the hands alone, 
 if not too late, we accomplish that respiration which is 
 the sole, hut sure effective means of the elimination of 
 the blood-poison ! 
 
 Por some experiments on this mode of inducing arti- 
 ficial respiration, which I designate postural respiration, 
 or THESIOPNCEA (from Bea-iq, positio), I am indebted to 
 Edward Long Fox, Esq. of Bristol. They were per-
 
 AND OTHER FORMS OF APXCEA. 27 
 
 formed by that gentleman, with the aid of Mr. Charles 
 Hunter and Mr. E. L. Bowles, at St. George's Hospital. 
 
 JExp. 17. — "The recently dead body was placed in the 
 jprone position; as this was done, considerable expiration 
 took place. Pressure being made on the back and ribs, 
 further expiration took place, but only to a slight extent. 
 On removing this pressure, slight inspiration took place. 
 On turning the body on the left side, violent inspiration 
 took place, which ceased as the body was turned beyond 
 the quarter of a circle. 
 
 " Tlie body was again pronated and again rotated. 
 The expiratory and inspiratory effects were most marked. 
 On one occasion, 120 bubbles of air (in a bent glass 
 tube through which the patient breathed) were distinctly 
 counted during one expiration; and the ins])iration 
 seemed to be quite in an equal degree, although, from 
 its greater rapidity, the bubbles could not be counted.'' 
 
 lExp, 18. — "The body was turned into the prone posi- 
 tion : considerable expiration took place, which was 
 much augmented by the pressure of tJie hands on the 
 back. On removing the pressure, a little inspiration 
 took place. The body being then rotated on the right 
 side, considerable inspii'ation took place, whilst moving 
 through one fourth of a circle; on continuing the ro- 
 tation, inspiration continued until the body was half 
 way between the table and the lateral position, when it 
 ceased." 
 
 Exp, 19. — "The subject, a girl, aged 5 years. On 
 
 c 2
 
 28 P0STUE.1L EESPIRATION IN DROWNING 
 
 pronation of the body, air was expelled in considerable 
 quantity throngh the water in the inverted glass siphon. 
 On rotation, air entered to a corresponding amount. 
 This was repeated 7 or 8 times.'' 
 
 The efftcacy of rotation was again manifested in a 
 subsequent experiment witnessed by Mr. Williams. 
 
 Exp. 20. — In some experimements made at the St. 
 Mary-le-bone Infirmary, already noticed, the dead subject 
 being first placed on the bacJc, and pressure made on the 
 thorax, a little expiratory noise was made; but there 
 was no inspiration on its removal; the subject being 
 turned i?ro7^e on the face, both expiration and inspiration 
 were distinctly observable on making and removing pres- 
 sure along the course of the dorsal spine. 
 
 This manoeuvre must therefore be added to rotation : 
 when the patient is laid quite prone, gentle pressure 
 maybe made on the spine and ribs ; this being removed, 
 the patient may be rotated; and so on systematically. 
 
 These changes should be alternated at the rate of 
 about sixteen times in a minute, and not more, and gently 
 and equably. 
 
 It is scarcely necessary to add that this mode of res- 
 piration must be long and perseveringly pursued ; and 
 now that respiration is being accomplished, every other 
 means of respiration mai/ he superadded. 
 
 Sufacient has been done to show the practical utihty 
 of this, the only certain, safe, and efiicacious mode of in- 
 ducing artificial respiration; but it is obvious that it
 
 AND OTHER FORMS OF APNGEA. 29 
 
 still remains to ascertain the exact value of this and of 
 other measures for succouring the patient affected by 
 apnoea, not by what is fallaciously called experience, but 
 by a series of careful and comjoarative experiments. 
 
 The clothes of the patient may meantime be changed 
 for others warm and dry, which must be contributed by 
 the bystanders. Por I must now observe that I have 
 all along supposed the patient taken out of the water 
 at a distance from medical or other assistance, except 
 that which benevolent persons accidentally near the spot 
 may be able to afford ; for no time must be lost by his 
 removal. 
 
 All who are so present should be instantly employed : 
 the most able in effecting respiration ; of the rest, four 
 should sieze the limbs with their hands and rub them 
 with firm pressure upwards. The warm-bath is not to 
 be compared with this mode of restoring warmth and 
 improving the circulation, if it be pursued with energy. 
 The blood is driven upwards, and though at first venous, 
 mai/ stimulate the heart. 
 
 But I must repeat that aU these modes of procedure 
 must be held as perfectly suhsidiary to the one only 
 remedy, prone and postural respiration. There is one 
 hope, and only one hope ; one remedy : it consists in 
 eliminating the carbonic acid blood-poison from the blood 
 by respiration. 
 
 Having thus given in detail my views of former 
 modes of procedure and of some new ones, I now proceed 
 to place before my readers a recapitulation of the
 
 30 POSTURAL RESPIEATION IN DROWNING 
 
 treatment to be systematically adopted in apncea, in the 
 form of Rules, which, I humbly think, may with great 
 advantage be substituted for those formerly recommended : 
 
 § IX. — New Rules for the Treatment of Asphyxia, 
 
 The Rules for the treatment of asphyxia may be 
 divided into two series : 
 
 1. The essential, or the means to be adopted 
 
 in every case ; 
 
 2. The occasional, or the means to be further 
 
 tried when convenient. 
 
 I. Rules to he adopted in every case : 
 
 I. Send with all speed for medical aid, articles of 
 clothing, blankets; &c. but 
 
 II. Lose not a moment of time ; treat the patient on 
 the spot, in the open air, exposing the face and chest 
 
 freely to the breeze (except in too cold weather) ; then — 
 
 To excite Respiration — 
 
 III, Place the patient gently and for a moment on 
 the face, to allow any fluids to flow from the mouth ;
 
 AND OTHER FORMS OF APNGEA. 31 
 
 lY. Then raise the patient into the sitting posture, 
 and endeavour to excite respiration — 
 
 1. By irritating the nostrils by smiff; hartshorn; &c. 
 
 2. By irritating the fauces by d^ feather ; &c. 
 
 3. By dashing hot and cold water alternately on 
 
 the face and chest. If these means fail — 
 
 To imitate Respiration — 
 
 V. Eeplace the patient on his face, his wrist under 
 his forehead [vide frontispiece), and — 
 
 1. Turn the body gradually, but completely, on 
 
 the side, and a little more ; and then again 
 on the face, alternately ; 
 
 2. "When replaced; apply pressure along the 
 
 back and ribs, and then remove it, and 
 proceed as before ; 
 
 3. Let these measures be repeated gently, 
 
 deliberately, but efficiently, and perse- 
 veringly, sixteen times in the minute. 
 
 YI. Continuing these measures, rub all the limbs 
 upwards, making firm pressure, energetically, 
 
 YII. Replace the wet clothes by such other covering, 
 &c. as can be procured. 
 
 Omit the warm-bath until resj)iration be re-established.
 
 32 POSTURAL RESPIRATION IN DROWNING 
 
 II. Further Rules, to he adopted when convenient : 
 
 I. Apply galvanism ; 
 
 1. Along the diaphragmatic nerve, or 
 
 2. Through the diapliragm and intercostal 
 
 muscles ; 
 
 II. Induce the inhalation 
 
 1. Of oxygen ; 
 
 2. Of dilute pure ammonia. 
 
 On the first part of these Eules no further explanation 
 is necessary. On the second, I now propose to make a 
 few concluding observations. 
 
 Of the value of galvanism I have not formed a very 
 high opinion. If the current be passed along the dia- 
 phragmatic nerve, or through the diaphragm itself, or 
 through the intercostals, respiratory movements may be 
 excited. But I do not know that they would possess any 
 advantage over similar movements induced in any other 
 way. 
 
 It is stiU a question whether the action of the heart 
 may be beneficially excited by galvanism. But the care- 
 ful experiment should be tried. 
 
 The galvanic current passed through the limbs would 
 excite their muscles to contract, and so induce the propul-
 
 AND OTHER FORMS OF APNCEA. 33 
 
 sion of the blood along the veins. Whether this mode 
 of promoting the venous circulation would possess any 
 advantage over the mode by friction and pressure, requires 
 to be determined by experiment. 
 
 I cannot regard the inhalation of oxygen as a very 
 promising measure. Its value requires to be submitted 
 to much further trial and investigation. 
 
 The inhalation of dilute pure ammonia appears to 
 me to have more in it of promise. The blood is over- 
 charged with carbonic acid : the inhalation of ammonia 
 would neutralize this carbonic acid and form the car- 
 bonate of ammonia; the carbonic acid is the blood-poison; 
 the carbonate of ammonia is free from any deleterious 
 quality. 
 
 It cannot be repeated too often or too earnestly that 
 aU these remedies of the second class, if I may so desig- 
 nate them, must be regarded as entirely subsidiary to the 
 constant persistence of respiration. 
 
 The Warm-Bath. 
 
 It will be seen that I have entirely omitted the use of 
 the warm -bath. 
 
 This measure is perfectly useless, not to say injurious, 
 unless artificial respiration be simultaneously administered; 
 and this administration is incompatible with the posture 
 implied by the use of the warm-bath. To use the warm-
 
 34 POSTURAL RESPIRATION IN DROWNING 
 
 lath is, therefore, to renounce the only hojoe, the only 
 
 remedy m apnoea. 
 
 It is true that the warm-bath has been commended 
 by some of the members of the Royal Humane Society ; 
 but it is as emphatically condemned by the Superin- 
 tendent of the Society at Boulogne, by theory, and 
 by experiment. 
 
 Experiment proves, as seen in the Tables adduced 
 (pp. 18), from Edwards and M. Brown -Sequard, that 
 life is more protracted in the case of suspended res- 
 piration at cool temperatures than in temperatures more 
 elevated ; and the experiments given, p. 19, 20, were per- 
 formed at the Eeceiving House in Hyde Park, the first 
 two being witnessed by the Secretary of the Society and 
 by Dr. Christian. 
 
 An animal lives longest without respiration in a tem- 
 perature of about 60° Fahr, With respiration, the 
 temperature may be carefully raised to 98°. 
 
 § X. On the A^mo^a of Still-born Infants, 
 
 The difference in regard to the power of supporting 
 the suspension of respiration in the young animal before 
 and after the commencement of respiration has been 
 noticed by the illustrious Harvey, by Buffon, by LegaUois, 
 by Edwards, &c. The same difference obtains in regard 
 to the very young and the less young of certain species 
 of animals which have breathed.
 
 AND OTHEU FORMS OF APNCEA. 35 
 
 We all remember the celebrated question of Harvey, 
 and the equally celebrated experiment of Buffbn. The 
 foetus breathes less, developes less heat, and supports 
 suspension of respiration better than the infant. It 
 supports apnoea proportionably longer. 
 
 The differences in regard to age in rabbits is shown 
 in the following beautiful Table of Legallois : 
 
 Legalloii Table, 
 
 Influence of age upon the duration of life. Rabbits 
 asphyxiated by immersion in water. 
 
 Gaspings. 
 
 27' 
 16' 
 5i' 
 4' 
 3i' 
 2|' 
 2i' 
 
 The same fact is observed in puppies and kittens. 
 The guinea-pig is, however, an exception to the rule; 
 
 * Legallois observes (Ed Paris, 1812, p. 79) — J'essaye la sensi- 
 bilite en pinQant les oreilles, les pattes et la queue, et j'en note 
 I'extinction au moment ou ces pincements ne determinent plus aucun 
 mouvement." " Assez souvent il existe encore un peu de sensibility 
 a I'anus, quand il n'y en a plus dans ces parties." — Phenomena, in 
 fact, not of sensibility, but of reflex action. 
 
 )ays old. 
 
 Sensibility' 
 
 1 
 
 15' 
 
 5 
 
 10' 
 
 10 
 
 44' 
 
 15 
 
 3' 
 
 20 
 
 2i' 
 
 25 
 
 2' 
 
 30 
 
 W'
 
 36 POSTURAL RESPIRATION IN DROWNING 
 
 the very young of this species holding nearly the same 
 rank in this respect as the adult. 
 
 In regard to the human subject, we learn from the 
 experiments of MM. Andral and Gavarret that the quan- 
 tity of carbonic acid exhaled in respiration «V^creases from 
 the age of eight to that of thirty years ; apncea will of 
 course be the more promptly fatal in the inverse order. 
 After the age of thirty, the quantity of the carbonic acid 
 poison ^^creases. 
 
 The male subject exhales more carbonic acid than the 
 female, the robust than the feeble, and will consequently 
 perish more promptly by the suspension of respira- 
 tion; a result the opposite, I believe, to the popular 
 opinion. 
 
 In treating the still-born, the first great object is, as 
 usual, to excite respiration ; this is most effectually done 
 by plunging it into a cold ( — not a warm bath — ) and a hot 
 bath alternately. This means of exciting respiration in the 
 still-born infant was first put to the test of experiment, 
 at my suggestion, as I have already stated, by my late 
 deeply regretted friend, Mr. Henry Smith. 
 
 The just temperatures of these baths have not yet 
 been ascertained. I would suggest from 50° to 60*^ Fahr. 
 for the cold, and from 98° to 102° Pahr. for the hot 
 bath. The immersion should be momentary ; the alter- 
 nations quick. 
 
 If this means fails,— if irritation of the nostrils, the 
 face, and the general surface, has been tried in vain — not 
 a moment is to he lost, but respiration must be imitated in
 
 AND OTHER FORMS OF APNCEA. 37 
 
 the manner already described — the jr/'o?ie position being 
 first adopted, and then postural-iesT^irdLtioJi being fully 
 and perseveringly instituted. 
 
 § XI. — 0/t Secondary Apncea. 
 
 All is not safe even when the patient seems to be 
 restored from apnoea. 
 
 One of the^puppies of Buffon's experiment died some 
 time afterwards on the same day. 
 
 On one occasion I placed a sparrow and a mouse in 
 the same limited portion of atmospheric air. After a 
 time, the sparrow began to open its mouth and gasp, and 
 was removed ; and after a longer interval, the mouse pre- 
 sented the same phenomena, and was removed in its turn. 
 The bird died the next day ; the mouse on the second 
 following day — of secondary apncea. 
 
 Sir Humphry Davy was seized with alarming sym- 
 ptoms on the evening of the day on which he had 
 attempted to breathe carburetted hydrogen gas. 
 
 On one occasion a soldier was taken out of the 
 Thames in a state of apnoea. Animation was restored. 
 But, many hours afterwards, he was seized with convul- 
 sions and expired. 
 
 From these and other similar facts we must deduce 
 the conclusion, that our watchful care and our remedies 
 must be continued after apparent danger is over. There 
 is still a hidden and remoter danger ; the consequence of 
 the poisoned state of the blood — of secondary apnoea.
 
 38 POSTURAL RESPIRATION IN DROWNING 
 
 The patient should be kept in a cool atmosphere, 
 exposed to the breeze, and be made to take deep and free 
 inspirations voluntarily, and active exercises should, as 
 far as possible, be enjoined, in order that the blood may 
 be purged of its carbonic-acid poison, whilst its circula- 
 tion is promoted. Carbonic acid in the Hood does not 
 excite respiration until it exists in sufficient quantity to 
 induce gasping by acting centrically on the spinal marrow. 
 It is its presence in the air-cells which induces inspiration 
 and panting, as a reflex phenomenon. Its elimination, 
 therefore, requires voluntary, excited, or artificial respira- 
 tory movements. 
 
 But the specific antidote to this blood-poison is — the 
 free inhalation of dilute pure ammonia. This gas actually 
 neutralizes the carbonic poison in the pulmonary blood. 
 
 § Xn. — Recapitulation, 
 
 1. The movements in normal respiration are reflex 
 or d^iflstaltic; 
 
 ^. The respiratory movements in apncea are direct 
 or ecstaltic; 
 
 3. The former are excited by the carbonic acid ex- 
 haled from the blood into the air-cells, in contact with 
 the filaments of the pneumogastric nerve ; and 
 
 4. When this carbonic acid is in excess, it induces
 
 AND OTHER FORMS OF APNCEA. 39 
 
 5. The latter are excited by the carbonic acid retained 
 in the blood and brought into contact with the medulla 
 oblongata and medulla spinalis ; 
 
 6. They take the specific form of gasping, with jerks 
 and tottering movements, and eventually of paraplegia ; 
 
 7. The carbonic acid retained in the blood acts as % 
 most deadly poison ; there is one mode of eliminating 
 this poison, — Eespiration, — and one sure mode of in- 
 ducing respiration — ■pronation and rotation of the body. 
 
 Respiration- is to the Carbonic-Acid Poison in the Blood, 
 what Vomiting is to Poison in the Food. 
 
 8. The quantity of this carbonic-acid poison formed 
 is proportionate to the rapidity of the circulation; to 
 augment the circulation vnthout effecting the elimination 
 of the poison by artificial respiration, as by the warm- 
 bath, is to augment the quantity of the poison, and to 
 accelerate the death of the patient ! 
 
 9. In order to effect artificial respiration, it is essen- 
 tial to place the patient in the prone position; otherwise 
 the tongue and any fluid in the mouth fall backwards 
 and close the glottis or entrance into the windpipe ; 
 
 10. In adopting the prone position, a degree of pres- 
 sure is at the same time made on the thorax and abdomen 
 equal to the weight of the trunk of the body, and ex- 
 piration is produced ;
 
 40 POSTUEAL RESPIRATION IN DROWNING 
 
 11. A little pressure now made along the spine aug- 
 ments the expiration ; 
 
 12. On removing this pressure, inspiration com- 
 mences ; 
 
 13. And by gently rotating the body on the side, 
 further inspiration occurs : 
 
 14. By repeating these manceuvres we produce the 
 most efficient artificial respiration — the only effectual 
 means of treatment ; they have never failed us / 
 
 15. When artificial respiration is thus effected, and 
 the carbonic-acid poison is thus eliminated from the 
 blood, the application of friction with pressure along the 
 veins, and of warmth, may be superadded ; 
 
 16. The warm-hath, excluding prone and postural 
 respiration, should only be administered when the res- 
 piration is either not suspended, or when it is perfectly 
 restored. 
 
 Lastly, I must repeat that the foregoing pages are a 
 mere Abstract of a considerable investigation scarcely 
 more than just begun. Much remains to be done. 
 
 § XIII.— T/^^ Royal Humane Society. 
 
 Such is very nearly the Essay which I presented, 
 first in manuscript and then in print, to the Royal Hu- 
 mane Society, in. January, 1856, and of which the follow- 
 ing notice occurs in the Society's Report : 
 
 " Dr. Marshall Hall, a Member of the Committee,
 
 AND OTHER FOEMS OF APNCEA. 41 
 
 has just presented to the Society a manuscript copy of a 
 ' Treatise on Asphyxia ; being an abstract of an inves- 
 tigation of its nature, carbonic-acid blood-poisoning, and 
 its remedy, prone and postural respiration/ He is also 
 having it printed at his own expense, with a view of 
 supplying the Committee with a sufficient number of 
 copies for the purpose of being sent to all the Medical 
 Assistants of the Society ; for which he has received the 
 thanks of the Committee, for the lively interest he has 
 thereby evinced in the objects of the Society." — Report^ 
 p. 24. 
 
 I earnestly requested that a sub-committee might be 
 appointed to witness the development of the beautiful 
 results of postural respiration — but in vain ! 
 
 Mr. Williams once witnessed an experiment at St. 
 George's Hospital, and I add his account of it ; it was 
 made before the Vimometer used in the subsequent ex- 
 periments was invented. The apparatus consisted of 
 an elastic tube, furnished with an inverted siphon con- 
 taining a little water, to indicate the flow and reflux of 
 the air, induced by rotation and pronation. 
 
 " Attended at St. George's Hospital, to witness some 
 experiments made on the new method of producing 
 artificial respiration without the aid of bellows, pro- 
 posed by Marshall Hall, M.D. &c. 
 
 " The mouth and one nostril were carefully closed by 
 means of sticking-plaster, to prevent the possibility of
 
 42 POSTUEAL RESPIRATION IN DROWNING, ETC. 
 
 air finding its way through them. In the other nostril 
 was inserted a caoutchouc tube, about three feet long, at 
 the end of which was fixed a bent glass tube of the same 
 size, into which was poured a teaspoonful of water. 
 
 " The operator then took hold of the subject (which 
 was lying in the prone position) by the left shoulder and 
 hip, and gently raised it, until the whole body was resting 
 on the right side. This movement caused the air to enter 
 the glass tube, creating bubbles in the water as it passed 
 on into the lungs ; and on the body being slowly replaced 
 on the stomach, the air was freely expelled from the 
 lungs, and caused the same agitation in the water as it 
 made its exit through the glass tube. 
 
 " Judging from the agitation of the water, the quan- 
 tity of air which passed into the lungs must have been 
 considerable, and quite sufficient for the purpose of arti- 
 ficial respiration. 
 
 " The great advantage of inflating the lungs by means 
 of the rotatory movement, or raising the body by the one 
 shoulder and hip, is the readiness with which one person 
 can perform the operation, in the absence of any other 
 assistance. 
 
 " This experiment appeared to be perfectly satis- 
 factory. 
 
 " Herbert Williams, 
 
 " Superintendent R. H. S. Hyde-park Receiving-house. 
 " Feb. 6, 1856."
 
 PART SECOND.
 
 IF OCR PATIENT BE DYING FROM COLD, DO WE NOT CAFTIOtTSLY ADMINISTBR 
 WARMTH? OR IP HE BE READY TO PERISH FROM WANT OF FOOD, DO WE NOT 
 ADMINISTER FOOD ? AND SHOULD HE BB IN PERIL FROM WANT OF AIR, SHALL 
 WB NOT ADMINISTER AIR ? WOULD THE WARM-BATH SUFPL1 THE PLACE OF 
 FOOD? NEITHER CAN IT SUPPLY THE PLACE OF AIE.
 
 PART SECOND. 
 POSTURAL RESPIRATION 
 
 IN 
 
 DROWNING, 
 
 § I. — The 'Royal Humane Society. 
 
 A YEAE has rolled round, and the Eeport of this 
 Society for 1857 contains the following paragraph : 
 
 " The Governors will remember that in last year's 
 Eeport it was announced that Dr. Marshall Hall had 
 presented to the Society a new Treatise on " Asphyxia," 
 of which work he subsequently presented to the Society 
 a sufficient number of printed copies to enable the Com- 
 mittee to transmit a copy to each of the Societ/s Medi- 
 cal Assistants, and which they accordingly did, accom- 
 panied by a circular letter calling on each to give his 
 opinion on the proposed new methods of treatment. 
 Ten replies thereto have been received, including one 
 from Sir Benjamin Brodie, and one from Dr. Christian, 
 M.D. acting Surgeon to the Societ/s Receiving House, 
 Hyde Park ; and from the preponderating opinions ga- 
 thered therefrom, the Committee are advised to pause 
 before adopting this new method recommended by Dr.
 
 46 POSTURAL RESPIRATION IN DROWNING 
 
 Marshall Hall, until it has been proved by the test of 
 successful experience." — Rejwrt, p. 27. 
 
 Any thing more insidious could not be penned ! 
 
 And on what question, in reality, does the Committee 
 pause ? Their patients are dying for want of respiration ; 
 the safe and effectual means of administering this res- 
 piration are placed in their hands ; and they pause as to 
 whether they will allow the patients to use them ! — as to 
 whether they will allow the patient dying for want of air 
 to have air administered to him ! 
 
 The delay is homicidal. 
 
 There is no need of a " successful experience" in a 
 matter so simple ; but if there were, it has been afforded 
 by the cases recorded in the Lancet during the year 
 which has intervened between the dates of the Society's 
 two Reports. 
 
 It is a question for unsophisticated common sense. 
 
 But what are those untoward reports? Why are 
 they not published ? It is surely a question in which 
 the public and the profession are deeply concerned. 
 
 Dr. Christian, acting Surgeon to the Society's Ee- 
 ceiving House, Hyde Park, is mentioned as one having 
 sent in a report. But it was Dr. Christian who proposed 
 first to try " removal, the warm-bath, and galvanism \' 
 and then, when the apncea, however hopeful, tnust have 
 passed into hopeless asphyxia, to institute postural res- 
 piration ! 
 
 Dr. Christian introduces the following new Eule I, 
 without acknowledging its author :
 
 AND OTHER EORMS OP APN(EA. 47 
 
 " Lift the hod/ij out ofthewatet^^ (of the warm-bath), 
 " the necJc and chest being bare, and dash cold water 
 suddenly against the face, neck, and ehest.'^ 
 
 This is the alternate application of heat and cold, which 
 was first proposed by me, and first carried into effect by 
 my friend Mr. Henry Smith, in the treatment of the still- 
 born infant, and given in the Essay presented to the 
 Society, in the following terms : 
 
 " There is, however, a use, not indeed for the warm 
 bath, but for the hot bath, not hitherto suggested for 
 adoption in practice : it is when it is of such elevated 
 temperature, and when the patient is in such a condition, 
 as to admit of its being an excitant of respiration. 
 
 " Its use in this point of view is chiefly useful in the 
 asphyxia of new-still-born infants ; and I shall have to 
 treat of it in this relation hereafter. But it cannot be 
 doubted that, if it could be made available at the moment 
 the drowned patient is rescued from the water, a sudden 
 momentary plunge into a bath of from 100° to 104° Fahr. 
 would prove the most powerful excitant of inspiration. 
 
 " But, even in this case, the appHcation of the hot- 
 bath must be momentary, and alternated with that of the 
 cold-bath of 50° or 60° Falir. as an excitant of respiration 
 ill its turn. 
 
 " This suggestion I made some years ago to my 
 much-lamented friend, Mr. Henry Smith, who, in one 
 case, the only one on record, used it in the case of a still- 
 born infant, with complete success.
 
 48 POSTURAL RESPIRATION IN DROWNING 
 
 " We must cease therefore from the empirical use of 
 the warm-bath. When this agent is used, it must either 
 be administered as an excitant, not of the circulation, but 
 of respiration ; or as an excitant of the circulation, res- 
 piration being already restored, excited, or adequately 
 imitated." 
 
 I dismiss this very painful subject by adducing Dr. 
 Christian's proposition entire, leaving it to the judgment 
 of my readers : 
 
 " Rules for treating Persons Asjphyxiated. 
 
 " 1. Convey the body rapidly to the house, the head 
 and shoulders raised. 
 
 " 2. Place it at once in the warm bath at 100°, up 
 to the neck. 
 
 " 3. Lift the body out of the water, the neck and 
 chest being bare, and dash cold water suddenly against 
 the face, neck, and chest.'' (See above, p. 47, 1. 1.) 
 
 " 4. Pass pure ammonia under the nose. 
 
 " 5. Use artificial respiration, the patient being held 
 in the upright position.'' (How ?) 
 
 " 6. Pass the galvanic current through the chest, 
 including the diaphragm and the muscles of respiration. 
 
 " 7. These methods should occupy but a few mi- 
 nutes ( ! ) ; if they fail, place the patient on the floor" 
 (why on the floor ?), " and use the ^ Ready Method' 
 according to the printed directions, fully and effi- 
 ciently." ( ! )
 
 AND OTHER FORMS OF APNCEA. 49 
 
 But it must be remembered that nearly the first lines 
 of that ready method are — 
 
 " Lose not a moment of time, treat the patient on the 
 spot J in the open air, exposing the face and chest freely to 
 the breeze." 
 
 As to our " experience," I must observe tliat there 
 2LYQfour distinct stages of apnoea : 
 
 1. The first, that in which there are still slight 
 signs of respiration ; 
 
 2. The second, that in which respiration has entirely 
 ceased, but may be excited by proper excitants ; 
 
 3. The third, that in which no excitant can excite 
 respiration ; and 
 
 4. ^\\Q fourth, true asphyxia. 
 
 It is absolutely necessary to keep these distinctions 
 in view, in judging of the efficacy of remedies, in order 
 that we may compare similar cases ; and this has never 
 been done. Our ^^ experience^' therefore is 2, fallacy. 
 
 If this were done, it would still be necessary to com- 
 pare similar cases in sufficient mnnher ; and this has 
 never been done, and indeed probably never will be done ; 
 again therefore our pretended " experience"^ is 2, fallacy. 
 
 And thus it has happened that the continuous warm- 
 bath, which must be injurious, has been supposed to be 
 beneficial ! 
 
 But I proceed to details of far greater weight and 
 importance than this very useless controversy. 
 
 D
 
 50 FOSTUEAL RESPIRATION IN DROWNING 
 
 § II. — More detailed Rationale of Apnoea. 
 
 Before we can be perfectly prepared to investigate 
 the nature of apncea, its effects, and its remedies, we must 
 study the special function which is interrupted. 
 
 Respiration involvesybwr important processes : 
 
 First ; oxygen is absorbed by the blood circulating 
 in the pulmonary blood-channels, — only absorbed, — from 
 tlie w^spired atmospheric air. 
 
 Secondly ; by this oxygen the carbonic acid is dis- 
 placed and evolved from the blood, and removed from 
 the system with the ^^cpired air. 
 
 Thirdly ; aqueous vapour in large quantity is evolved 
 from the pulmonary blood, and exhaled with the same 
 expired air. 
 
 Fourthly ; the expired air has a higher temperature 
 than the inspired air ; caloric is therefore given off by 
 rhe pulmonary blood, the temperature of which is pro 
 tanto diminished : — respiration is therefore a cooling 
 process. 
 
 The panting of the dog from excessive heat is doubt- 
 less a cooling process, and its final object to keep down 
 the temperature. 
 
 The cooling effect of artificial respiration led in certain 
 experiments to erroneous conclusions in regard to the 
 source of animal heat. 
 
 The trachea is not only the way of ingress into the 
 lungs, but the way of egress from the lungs ; it is not
 
 AXD OTHER FORMS OF APNCEA. 5 J 
 
 only the ventilator by which the atmospheric air, and 
 especially its oxygen, is admitted, but the chimney by 
 which the air expired is, with its accession of carbonic 
 acid, conveyed from the lungs, — that carbonic acid which 
 would, if retained, be a real '' choke-damp,'' as it is the 
 blood-poison, and the real cause of death, in apnoea. 
 
 The important function of respiration consists in this 
 inhalation of oxygen and exhalation of carbonic acid. 
 This function is unattended by any important change of 
 temperature. Animal heat is evolved not in the lungs, 
 hut in the general system at large, where the change of 
 oxygen into carbonic acid, the slow combustion of carbon, 
 takes place, during the processes of deposition and ab- 
 sorption in which nutrition consists. 
 
 That nutrition, and with it the evolution of heat, are 
 events which occur in the systemic circulation, are facts 
 principally established in modern times ; but not entirely ; 
 they were not unknown in the time of Harvey. I find 
 the following remarkable passage in a " Discourse"' ap- 
 pended to his English edition of Harvey^s " Anatomical 
 Exercises concerning tlie Heart and Blood,'^ by Dr. James 
 de Back, which appeared in the year 1653, p. 107 : 
 
 " I doe believe, that wherever nutrition is performed, 
 there this function is most manifestly executed, and that 
 the parts, whilst they are nourished, are heated ; there 
 the composition of the blood is dissolved, and is divided 
 very small; there also i\\Q firie particles, freed from their 
 fetters, and being united, do show their force by 
 heating." 
 
 D 2
 
 52 POSTURAL RESPIRATION IN DROWNING 
 
 That the function of respiration is in reality a cooling 
 process, was the doctrine of Galen [Be Utilitate Respira- 
 tionis, ed. Yen. 1597, p. 223). It was also the doctrine 
 of Haller; and it is obviously true. We may inhale 
 the atmospheric air at various temperatures, some of 
 which are below that of freezing water ; we exhale it 
 at the temperature of 92° or 94° Eahr. — a temperature 
 comparatively higher even in summer, and still more con- 
 siderably so in winter. This elevation of temperature 
 in the expired air is effected by a proportionate loss of 
 temperature sustained by the blood circulating in the 
 pulmonary blood-cliannels. Respiration is therefore a 
 cooling process. 
 
 We may thus recapitulate the matter : the oxygen 
 inspired in the lungs is absorbed, and thence conveyed 
 by the arterial blood into the general system, and there 
 supports the slow combustion of the tissues, by which 
 combustion the animal heat is evolved ; the carbonic acid, 
 the ehoke-damp, the blood-poison, formed by this com- 
 bustion, is re-conveyed by the venous blood to the lungs, 
 and thence exhaled into the atmosphere. 
 
 If the mere absorption of oxygen be attended by the 
 evolution of a slight degree of heat, this is probably 
 counterbalanced by the simultaneous escape of carbonic 
 acid, the one losing, the other assuming, simultaneously, 
 the form of gas ; so that the resultant temperature may 
 be unchanged. 
 
 But the evolution of aqueous vapour must also be a 
 cooling process in proportion to the quantity of water 
 passing from the fluid state to that of vapour.
 
 AND OTHER FORMS OF APNCEA. 53 
 
 The cooling effect of the inhalation of a cooler and 
 exhalation of a warmer portion of air constitutes then 
 an obviously cooling process. 
 
 And here I may revert to that marvellous law of the 
 animal economy, according to which the number and 
 extent of the respirations and the rapidity of the circula- 
 tion constantly maintain a due ratio to each other. 
 During repose, and especially during sleep, these are both 
 at a minimum ; during activity and effort of every kind, 
 they are augmented. In both cases the physiological 
 ratio or proportion between them is sustained. 
 
 A singular exception to this rule is observed in the 
 dog, which pants and projects its tongue, as the effect of 
 heat merely, I believe, without proportionally augmented 
 circulation ; the augmented respiration is merely a cooling 
 process. 
 
 If the due ratio between the circulation and the res- 
 piration were broken, one of two events must occur : if 
 the circulation be unduly and disproportionately aug- 
 mented, or the respiration be unduly suppressed, the quan- 
 tity of carbonic acid formed being unexhaled and there- 
 fore retained, the blood becomes poisoned and the patient 
 destroyed; if the respiration were unduly augmented, 
 the temperature of the animal would be lowered, and the 
 patient might die of refrigeration. The former fact ob- 
 tains in every case of apnoea ; it constitutes the death by 
 drowning, strangulation, " choke-damp." The latter 
 fact was actually produced in the splendid experiments of 
 Legallois, in which he used artificial respiration. Undue
 
 5^ POSTUKAL RESPIRATION IN DROWNING 
 
 artificial respiration cools and destroys : the balance of 
 temperature is lost. 
 
 In treating the cases of apnoea and approaching as- 
 phyxia, these principles must be our guide : if we induce 
 too full and too frequent respiration even, the patient 
 will lose his temperature aud be destroyed. 
 
 I have already said and proved that a disproportionate 
 circulation is fatal, — that the tendency of the warm-bath 
 without respiration is deleterious. 
 
 If our attempts at artificial respiration be made in- 
 considerately, — if the induced respiration be too rapid or 
 too great, compared with the remaining degree of the 
 circulation, — we destroy our patient. 
 
 The warm-bath, or any other measure by which the 
 circulation may be sustained, respiration heing deficient, 
 is, I repeat, absolutely destructive. It cannot be re- 
 peated too often, that an animal dies of apnoea the more 
 promptly, the warmer the temperature, the more active 
 the circulation in a word, from whatever cause. 
 
 Our object in treating the drowned patient must be 
 two-fold : to restore the respiration, but to restore it in a 
 degree proportionate to the degree of the circulation ; 
 and to promote the circulation, in its turn, by any means 
 in our power, again augmenting the respiratory move- 
 ments as we may succeed in this second object. 
 
 These are precisely the two objects which I men- 
 tioned in the first part of this volume. It is since that 
 publication that I have ascertained the importance of 
 sustaining a just and due proportion between the two
 
 AND OTHER FORMS 0¥ APNCEA. 00 
 
 functions, the circulation and the respiration, which it 
 must be our constant aim to promote simultaneously and 
 proportionately — either of these, without the other, being 
 actually fatal. Physiology must be our guide. Empi- 
 ricism has proved fruitless — nay, worse than fruitless; 
 it has not even taught us, that to raise the temperature, 
 without inducing effectual and proportionate respiration, 
 is, as I have stated, destructive. 
 
 With tlie postural respiration formerly described must 
 be combined tlie system of energetic frictions of the 
 limbs upwards, with firm pressure, by means of which 
 not only is the venous circulation best promoted, but tlie 
 warmth itself is best restored. 
 
 These things, too, are accomplished by the bystanders, 
 on the spot, without loss of time, therefore, without 
 apparatus of any kind, and even without medical aid. 
 
 Pocket-handkerchiefs should be used as towels, 
 Avhilst each looker-on may supply some garment — the 
 waistcoat, for instance — to lay under and over the patient, 
 the face, neck, and thorax being, however, if the weather 
 be not inclement, freely exposed to the breeze. 
 
 Nothing can be more admirable than the efficiency of 
 postural respiration. Requiring no apparatus, it has 
 solved the difficulty which formerly hung over our efforts 
 to save the half-drowned patient. 
 
 It has already saved many lives ; and it is destined 
 to save many, many more !
 
 56 POSTURAL RESPIRATION IN DROWNING 
 
 § III. — The Apncea of Still-born Infants. 
 
 The newly born infant and the new]y born of many 
 of the mammalia are in a peculiar condition, both in an 
 anatomical and physiological point of view. 
 
 The foramen ovale and the ductus arteriosus being 
 still open"^, the blood of the pulmonary circulation is 
 still diverted from the channels it is destined to pursue, 
 and in this respect it resembles the reptile tribes. 
 
 Respiration, and every stimulus, excejpt temjperature, 
 being absent, the excitability of the spinal system and the 
 irritability of the muscular system exist in the highest 
 condition, according to a law of animal life which I an- 
 nounced some years ago — viz. that these faculties are, 
 throughout the animal kingdom, inversely as the stimv.li. 
 
 The new-born foetus is therefore a creature of high 
 excitability and irritability. But such an animal bears 
 tlie absence of stimuli precisely in the same ratio. Res- 
 piration is the chief of these stimuli ; therefore — to ar- 
 rive at the subject of this section — the new-born foetus 
 can long survive the absence of respiration. 
 
 The condition of apnoea and asphyxia, without the 
 
 * This patent condition of the foramen ovale and ductus arteriosus 
 continues, according to the researches of M. Flourens, during eighteen 
 months of extra-uterine life in the human species. — Sistoire de la JDe^ 
 couverte de la Circulation, pp. 67, 69.
 
 AND OTHER FOUMS OP APNCEA. 57 
 
 absolute loss of life, is therefore of long duration, and 
 the hope of restoring the still-born infant is long pro- 
 tracted ; so must therefore our efforts at resuscitation be. 
 I must here briefly advert to the well-known question 
 of Harvey t, and the not less famous experiment of Buffon, 
 leaving them to my reader's meditation. Harvey asks 
 why the infant which has never breathed bears the sus- 
 pension of respiration longer than the infant which has 
 once respired ? J Buffon had the idea that if the foetus 
 of the class Mammalia was born under water, and res- 
 piration prevented, the foramen ovale and ductus arte- 
 riosus would be prevented from closing, and that in this 
 manner life might be protracted under water. A chimera ! 
 For what respiration would there be, if both placental and 
 aerial respiration were excluded ? But life does not exist 
 without respiration. 
 
 Our efforts to restore the still-born infant consist — 
 1st. In measures to induce efficient respiration ; and 
 2ndly. In measures to maintain the circulation. 
 In order that respiration may be effected, we must 
 adopt the following means : 
 
 t Exercitatio Anatomica Secunda de Circulatione Sanguinis Gui- 
 lielmi Harveii, p. 258. 1751. 
 
 j " Cur foetus in utero non respirans aerem*, usque ad mensem 
 decimum, ob defectum respirationis non suffocatur } Cur natus in 
 septimo, vel octavo, quam primum aerem inspiraverit, inhibita post- 
 modum respiratione, ob defectum aeris suffocatur ?" 
 
 * Did the great Harvey overlook the placental respiration ?
 
 0« POSrURAL RESMHATION IN DROWNING 
 
 1st. The infant must be placed in the joro;^^ position, 
 in order that all fluids, which might obstruct the entrance 
 into the windpipe, may flow away. 
 
 2ndly. Nature's mode of operation being to impress 
 the trifacial and cutaneous nerves, the external excitors 
 of respiration, by the external cold, we must dash a few 
 drops of cold water on the face and the general surface. 
 
 3rdly. We must proceed, having failed to excite res- 
 piration, to imitate the respiratory movements. 
 
 Tliis must not be done by ani/ forcing means ; even 
 the human breath, forced into the infant's lips, may tear 
 the deHcate tissue of the foetal lungs. We must, on the 
 contrary, adopt some measure of drawing the air into the 
 lungs. This is effectually accomplished by first placing 
 the little patient briskly in the prone position, to clear 
 the fauces ; then pressing gently on the back ; and then 
 removing that pressure, and turning it gently on the side 
 and a little beyond ; and so on, perseveringly. 
 
 4thly. Meantime, the limbs are to be rubbed, with 
 gentle pressure, upwards, to promote the circulation, by 
 propelling the venous blood towards the heart. 
 
 5thly. At proper intervals, we must again endeavour 
 to excite the respiration physiologically : 
 
 The infant is to be placed with the face prone, and 
 douched alternately and rapidly with water of the tem- 
 perature of 60° and 100° Fahr. 
 
 High and low temperatures are equally excitants of 
 the reflex function of respiration, and their power, within 
 physiological limits, is in proportion to the difference of 
 those temperatures.
 
 AND OTHER FORMS OF APNCEA. 59 
 
 We must remember that the newly born infant is a 
 creature of high irritability and low stimulus, and that 
 the foramen ovale and ductus arteriosus are open — both 
 events greatly calculated to protract life and hope in the 
 case of apncea ; and we must long, very long, persevere 
 in our efforts to save the still-born. 
 
 The still-born infant has been restored after it has 
 been neglected for hours ! 
 
 There is a remaining consideration. The etfect of 
 apncea is a condition of the blood surcharged with, and 
 poisoned by, carbonic acid : from tliis condition of the 
 blood, a secondary asphyxia and convulsions are apt to 
 occur in the adult. 
 
 The remedy/ and preventive of such secondary asphyxia 
 would be, free exposure to the breeze, with the inliala- 
 tion of very dilute pure ammonia. 
 
 The treatment of the still-born infant may finally be 
 thus briefly resumed in the form of Eules : 
 
 1st. Place the foetus on the face ; 
 
 2ndly. Sprinkle the general siirface briskly with cold 
 water ; 
 
 3rdly. Make gentle pressure on the back : remove 
 it, and turn the infant on the side ; and again place it 
 prone, with pressure ; 
 
 4thly. Rub the limbs, with gentle pressure, upward.^ ; 
 
 5thly. Repeat the sprinkling, only now with cold 
 and hot water (of the temperatures of 60° and 100° Fahr.) 
 alternately; or, 
 
 6thly. Plunge the infant into a hot and cold buth 
 alternatelv at 60° and 100° Fahr.;
 
 60 fOSTURAL RESPIRATION IN DROWNING 
 
 7thly. Continue these measures, or renew them, from 
 time to time, even for hours. The embers of life may 
 not be entirely extinct — 
 
 " Lateat scintillula forsan." 
 
 § lY. — On Trone and Postural Respiration. 
 
 The first important discovery made in the course of 
 this inquiry — and it is vitally important — is, that there 
 is no certain effectual artificial inspiration in the supine 
 position of the patient. 
 
 It may have appeared to succeed, and yet fail : for 
 on making pressure, a slight gurgling ^^piration is fre- 
 quently heard, without any subsequent inspiration, the 
 real vital process. 
 
 It is important to remember that whatever the mode 
 of artificial respiration adopted, in this position — whether 
 the direct application of the mouth, the syringe, the 
 bellows, pressure, &c. — it may and does fail; nay, that 
 it frequently does worse — driving fluids present in the 
 idiViCQs fatally into the windpipe. 
 
 The second is — that the very means which had failed 
 whilst the patient was retained in the supine position, 
 became perfectly available when the body was placed in 
 the PRONE position. 
 
 The rationale of this difference became evident when 
 the position of the tongue and condition of the fauces 
 in regard to fluids came to be observed and considered.
 
 AND OTHER FOEMS OF APNCEA. 61 
 
 The third discovery — and this is also a vital one — is 
 that, in the prone position, rotation to the side, and a 
 little beyond, and rejoronation, are attended by i^^spiration 
 and ^.rpiration. 
 
 Lastly, it was found that gentle pressure along the 
 spine on pronation, and the removal of that pressure be- 
 fore rotation, induced augmented e.2'piration and aspira- 
 tion; so that, by combining these two manoeuvres, heau- 
 tiful life-giving Respiration is induced. 
 
 These results were clearly enough shown in my pam- 
 phlet presented to the Eoyal Humane Society. They 
 have been made still more manifest, and indeed actually 
 measured, by a little apparatus which I have devised for 
 the purpose, and which I have designated \k\RTnmmeter. 
 This apparatus is represented in this neat sketch, for 
 which I am indebted to Mr. Charles Hunter : 
 
 It consists of a long tube of caoutchouc, fitted to 
 another of larger diameter, made of oiled-silk. The 
 former being placed in one nostril, and the other nostril 
 and the mouth being duly secured by adhesive plasters, 
 the process of rotation and pronation, with alternate 
 pressure, is conunenced. 
 
 A Httle fluid being placed in the siphon, the com- 
 mencement and direction of the respiration is seen by 
 the movement of this fluid ; but sliortly it is not only 
 seen, but accurately measured by the graduated oiled-silk
 
 62 POSTURAL RESPIRATION IN DROWNING 
 
 bag, which becomes more or less distended as air passes 
 into or out of it. 
 
 In the midst of these operations, it occasionally hap- 
 pens that a little fluid passes into the tube, with inter- 
 ruption to the free i/^spiration or ^.rpiration. This is at 
 once made manifest by the condition of the siphon. 
 
 The Pnmometer not only detects and measures the 
 degree of the Postural Respiration, but demonstrates the 
 comparative worthlessness of supine- and the extreme value 
 ^A prone- respiration. The very obstructions to respira- 
 tion in the former position, find their efi*ectual and appro- 
 priate remedy in the latter. 
 
 The experiments, which were very numerous, were 
 made at St. George's Hospital, by Mr. Edward Long 
 Fox, Mr. Charles Hunter, Mr. R, L. Bowles, and other 
 gentlemen ; the first being made by Mr. Pox. 
 
 The results were always the same : dubious or null 
 in the supine position ; admirable and never failing in 
 the PRONE position. 
 
 When they were concluded, I proposed to Mr. 
 Hunter and Mr. Bowles to repeat them ; and I subjoin 
 the report drawn up by Mr. Bowles : 
 
 '' Dear Dr. Marshall Hall, — The enclosed experi- 
 ments, to each of which I have appended a few remarks, 
 were made by Mr. Hunter and myself, the object being 
 to confirm or correct those previously made for you by 
 Mr. Fox and ourselves, feeling that, from our former ex- 
 perience, we could now guard against several fallacies 
 likely to arise during the experiments. The mode of 
 procedure was the following :
 
 AND OTHER FOEMS OF APNCEA. 63 
 
 " An India-rubber tube was inserted into one nostril, 
 the opposite one, with the mouth, being closed, and ren- 
 dered air-tight by plasters, bandages, &c. ; the free end 
 of the tube was now attached to a glass siphon, contain- 
 ing a small quantity of water in its bend, and to the op- 
 posite end or this siphon was fastened an oiled-silk bag, 
 made in the form of an intestine, to which it was similar 
 in appearance and cahbre, when inflated. This bag, 
 when full, contained forty cubic inches. The water in 
 the siphon acted as an index of the direction of the air 
 in its passage to or from the bag, or, as we have called 
 it in the experiments, the oiled-silk tube ; it was the 
 amount of air expired into this tube on pronation, &c. 
 which enabled us to compare it with the natural expira- 
 tion of thirty inches ; for when the tube was half filled, 
 which was easily proved by pressing the air towards its 
 closed extremity, we inferred that we had twenty cubic 
 inches in the tube, and so on. We did not pretend to 
 perfect accuracy as to the amount, but it must be an ex- 
 ceedingly near approximation to the truth. 
 
 " I think you will also see, in these experiments, proof 
 that, though the supine position does not in every case 
 prevent the passage of air, it does so in a large proportion 
 of cases ; and if it do so in one case only, that appears 
 to me quite reason enough why that position should be 
 avoided. 
 
 " Believe me faithfully yours, 
 
 " R. Leamon Bowles.'"' 
 
 " Eaton Place South, Eaton Square, 1856."
 
 64 POSTURAL EESPIRATION IN DROWNING 
 
 " SUBJECT I. 
 
 " A male subject, much emaciated, about fifty years 
 of age, and six feet in height ; the body was not quite 
 cold, and cadaveric rigidity had but partially come on ; 
 he had been dead ten hours. The apex of the tongue 
 reached the incisors, and the body of the tongue was at 
 the floor of the mouth, so that a considerable space ex- 
 isted between its surface and the roof of the mouth. 
 Some fluid was seen at the back of the fauces, and, on 
 laying the body on its face, a large quantity of fluids and 
 solids from the stomach made their escape. 
 
 " Eccp. \.' — Semi-rotation, prone and lateral. In 
 the former position, the tube was half filled ; and in the 
 latter, it was instantly emptied. 
 
 " Ex]). 2. — By alternate pressure and relaxation on 
 the thorax (the subject supine) j the same result was ob- 
 tained as in Exp. 1. 
 
 " Exp. 3. — Semi-rotation, prone and lateral, was 
 again had recourse to, and with the same result as before. 
 
 " Exp. 4. — Alternate pressure and relaxation on the 
 thorax in the supine position. This time, not the slightest 
 inspiration or expiration could he oltained, 
 
 " On removing the coverings of the mouth, the 
 tongue was seen to be in the same position as when we 
 commenced; but there was again fluid in the pharynx. 
 
 " Remarks. — This case demonstrates how, in the 
 supine position, fluids in the stomach might interfere 
 with respiration ; for, in Exp. 2, a good result was ob- 
 tained, no fluid being in the pharynx ; but after the fur-
 
 AND OTHER FORMS OF APNCEA. 65 
 
 tber movements of Exp. 3, more fluid, &c. had been 
 ejected from the stomach, filling up the pharynx, and 
 totally preventing the passage of air into or out of the 
 trachea. This case also shows that the epiglottis does 
 not in all cases cover the glottis in the supine position. 
 
 " SUBJECT II. 
 
 " A middle-aged man, very much emaciated, having 
 suffered for a long time from abscess of the brain ; rigor 
 mortis still present; the brain had been removed. 
 
 '^ Exp. 1. — Alternate pressure and relaxation on the 
 thorax, the body supine : no effect. 
 
 " Exp. 2. — On pronation, about one third of the tube 
 — on applying pressure, nearly the whole tube — was 
 filled ; on removing the pressure, the tube was emptied 
 to one third ; and on resuming the lateral position, it was 
 quite emptied. These movements were several times 
 repeated, and invariably with the like series of results. 
 
 " Exp. 3. — Exp. 1 was repeated. No effect was at 
 first produced ; but on pressure being applied by a sud- 
 den jerky some obstacle seemed to be removed, and ex- 
 piration was the result, to such a degree that the tube 
 was nearly filled, as in Exp. 2 ; and on removing the 
 pressure, the corresponding amount was inspired. After 
 this, alternate pressure and relaxation, in the supine po- 
 sition, produced inspiration and expiration with ease. 
 On removing the tube, no obstacle was to be seen in the 
 pharynx. 
 
 . " Remarks. — Exp. 1 proves that in the supine posi-
 
 6Q POSTURAL RESPIRATION IN DROWNING 
 
 tion something does at times prevent respiration in the 
 dead subject ; and although^ in Exp. 3, respiration was 
 produced in this position, it could not be done at the 
 commencement ; some obstacle had first to be overcome, 
 probably adhesion of the epiglottis to the back of the 
 pharynx by viscid mucus, as the following observation 
 would tend to prove : 
 
 "■ On cutting down and removing the right side of 
 the pharynx, with the corresponding halves of the hyoid 
 bone and thyroid cartilage, in another subject, a tolerable 
 view of the position of the parts w^as obtained. The 
 epiglottis was in direct apposition, by its laryngeal sur- 
 face, w^ith the posterior wall of the pharynx, so as to pre- 
 clude the possibility of the passage of air. When, how- 
 ever, the head was allowed to hang backwards over the 
 edge of the table, the bending of the cervical vertebrae 
 caused the posterior wall of the pharynx to recede from 
 the epiglottis, so as to allow the free passage of air. If 
 the tongue had been drawn forwards, would the epiglottis 
 have been removed from the pharynx? or would the 
 prone position cause it to fall forwards ? 
 
 " SUBJECT III. 
 
 " A middle-aged man, very short and emaciated; 
 had suffered from extravasation of urine. There w^as 
 some dulness on percussion on the left side of the chest ; 
 rigor mortis present ; tongue very stiff and moved about 
 with difficulty. Whilst the body was being shifted, we 
 could distinctly hear the rushing in and out of the air.
 
 AND OTHER FORMS OF APNCEA. 67 
 
 " Exp. 1. — Free expiration, filling more than half 
 the tube, from pressure in the supine position. 
 
 " Exp. 2. — The arms were folded beneath the fore- 
 head, and fastened there by bandage. On pronating the 
 body, nearly one third the tube was filled, and on apply- 
 ing pressure, a little more than one third. 
 
 " Exp. 3. — As a considerable portion of the chest 
 was, by the arms being folded beneath the head, raised 
 from the table, a block was so placed that, on pronation, 
 the thorax should rest upon it. No better result, how- 
 ever, followed this than in Exp. 2, except that by pres- 
 sure the tube was now nearly half filled. On resuming 
 the lateral position, the tube was emptied as usual. 
 
 " Exp. 4. — The head was allowed to hang over the 
 edge of the table, as in all pre\aous experiments : and 
 now the tube was more than half filled, as in Exp. 1, on 
 pronation with the addition of a little pressure. 
 
 " Exp. 5. — Pressure in the supine position produced 
 the same result as in Exp. 1. On removing the tube, 
 the fauces were quite clear, and free from fluid. 
 
 " SUBJECT IV. 
 
 " A middle-aged man; had suffered some time from 
 a purulent discharge from the side of the chest, with 
 which cavity the opening was supposed to communicate ; 
 and there was considerable dulness on percussion over 
 the same side of the chest. Eigor mortis less marked 
 than usual ; the tongue had dropped back into the pha-
 
 68 POSTURAL RESPIEATION I.N' DROWNING 
 
 rynx ; but it could not be accurately ascertained whether 
 it quite stopped the way or not ; but 
 
 " Exp. 1. — Pressure on the thorax, the body supine, 
 produced no result whatever, 
 
 " Exp. 2. — ^Proni-lateral movements, with the head 
 on the table : a little more than one third the tube was 
 filled ; increased by pressure to nearly one half. 
 
 " Exp. 3. — Proni-lateral movements, with head hang- 
 ing over the edge of the table : nearly half the tube full, 
 which took place very readily at first, but afterwards more 
 slowly ; on taking out the tube, gritmous fluid from the 
 stomach was found in it. After this was emptied out, 
 the experiment was repeated, and the air now passed in 
 and out as easily as at the first, so that the tube was 
 nearly filled. 
 
 " Exp. 4. — Pressure on the thorax, the body supine : 
 no result, after repeated trials. It being observed that 
 the abdomen was very lax, so interfering with the 
 amount expired, from allowing the diaphragm to descend, 
 a binder was applied ; but a large quantity of the same 
 fluid as before was ejected from the stomach into the 
 tube. The subject was pronated, and the fluid allowed 
 to run out from the tube and pharynx. 
 
 " Exp. 5. — The arms were folded beneath the chest, 
 and the proni-lateral movements employed ; but with 
 very little result ; the effect of the disease of the chest ? 
 
 " Exp. 6. — Pressure in supine position ; no result. 
 On removing the tube, the body of the tongue was far 
 back in the fauces ; but no fluid could be seen.
 
 AND OTHER FORMS OF APXCEA. 69 
 
 '' Remarks, — It was difficult to say whether it was 
 the tongue or fluid in the pharynx that prevented the 
 passage of air when the subject was supine ; but the 
 tongue was much more moveable than in previous cases, 
 and therefore farther back. It was evident, in Exp. 3, 
 that the fluid was the cause of the difficulty.^^ 
 
 These experiments require and merit special study. 
 
 On writing to Mr. Pox, and proposing again to 
 repeat our experiments, this gentleman observed — 
 
 " I cannot see that any thing in point of evidence 
 would be gained by repeating the pronation and rotation 
 experiments. They were conclusive to the minds of all 
 of us who witnessed them. 
 
 " On referring to my notes of the experiments at 
 which I assisted, I find that expiration was immediately 
 produced by pronation of the body, except on one or two 
 occasions, in which the tube became filled with the fluid 
 from the stomach, or the trachea was full of grumous 
 fluid after much disease of the lungs. So that I should 
 say, it was invariably successful, with the glottis and the 
 mouth free." 
 
 Since this period, the efficiency of rotation and pro- 
 nation, in inducing respiration, has been confirmed by 
 many observers, amongst whom I may mention Mr. Paget 
 and Dr. Snow. 
 
 Prom aU the evidence I draw the following con- 
 clusions : 
 
 1. In the majority of cases, it was impossible, by
 
 70 POSTURA.L RESPIRATION IN DROWNINO 
 
 applying and removing pressure to and from the sternum 
 and ribsj to induce effectual ^.rpiration and w?spiration, 
 the body being in the supine position ; 
 
 2. In some cases, the application of the pressure in 
 this position induces a little gurgling expiration, no in- 
 spiration occurring on its removal ; 
 
 3. In one case, in wliich it seemed impossible to 
 induce expiration by making pressure, inspiration became 
 possible after applying pressure with some degree of vio- 
 lence, some obstacle being removed ; was it the tongue 
 which had fallen backwards, and had been replaced by 
 the impulse of the expired air ? 
 
 4. In another case, the epiglottis was found, on 
 examination, pressing against the posterior part of the 
 pharynx, so as to obstruct the entrance into the wind- 
 pipe ; 
 
 5. In nu7nero2is cases, fluids, either present in the 
 mouth, or regurgitated from the stomach, were found to 
 obstruct the entrance into the air-passages ; 
 
 6. We can therefore never be confident of being 
 able to induce respiration in ani/ but the prone position, 
 or position approaching the prone, hi/ any means ! 
 
 7. Nay, one cannot be assured that, in attempting 
 to induce inspiration in the supine position, we do not 
 force foreign matters into the trachea, and so destroy the 
 
 8. The same danger attends all other positions, 
 however slightly inclined towards the supine; 
 
 9. In the prone position, the means recently pro-
 
 AND OTHEU FORMS OF APNCEA. 71 
 
 posed to accomplish respiration — viz. alternate pronation 
 vnih dorsal pressure, and the reraoval of that pressure, 
 and rotation — hate never failed, although our expe- 
 riments have been almost innumerable ; 
 
 10. It is plain that in \ki{t prone position the tongue 
 tends to fall forwards, and aU fluids flow from the pha- 
 rynx and mouth, leaving the entrance into the larynx 
 
 FREE ; 
 
 11. It is demonstrated, by our experiments, that 
 when the subject is laid prone, the counter-pressure on 
 the thorax and abdomen induces expiration, the degree 
 of which is augmented by dorsal pressure, and that these 
 phenomena are reversed on removing that pressure and 
 on rotation ; 
 
 12. Such manoeuvres are equivalent to Respiration, 
 and respiration is the remedy for Apncca : the conclusion 
 is obvious. 
 
 13. All this can be said of no other mode of pro- 
 ceeding hitherto devised ; 
 
 14. In the present state of our knowledge, then, 
 alternate pronation and rotation, and pressure, as just 
 explained, are the remedy for Apnoea. 
 
 15. But these measures must be administered on 
 the instant, on the spot, in the free air ; 
 
 16. All delays — and all other measures hitherto 
 discovered and applied are delays : removal, the warm 
 bath, galvanism — are homicidal! — a verdict which no 
 authority, nothing short of such indubitable experiment, 
 made by competent persons, as has not yet been made, 
 can gainsay.
 
 72 POSTURAL RESPIRATION IN DROWNING 
 
 17. Continued cold^ within pliysiological limits, 
 prolongs life in the circumstances of apncea ; continued 
 warmth shortens it, and is therefore opposed to recovery, 
 notwithstanding the place it has so long held amongst 
 the rules for rescuing the drowmed, &c. 
 
 18. Sudden cold and sudden heat, and especially 
 the two alternately, are, on the contrarj^, excitants ofre- 
 sjnration, and therefore remedies in the early stage of 
 apnma. 
 
 19. In general, nothing can be of more fatal ten- 
 dency than the time lost in removal — the warm bath — 
 galvanism ; 
 
 20. I know of nothing in medicine so near demon- 
 stration as the proofs of the dangers of the former system, 
 and of the simplicity, the safety, and the efficacy of the 
 Eupncea of postural respiration. 
 
 § V. — On the Inhalation of dilute pure Ammonia in 
 Ajmoea. 
 
 I have great reason to believe that there is much 
 promise of good from the inhalation of dilute pure am- 
 monia in apnoea. I detail two experiments very suc- 
 cinctly : 
 
 I placed le mouse in five ounces of atmospheric air : 
 it died m forty minutes. 
 
 I placed a second mouse in the same quantity of 
 atmospheric air, into which pure ammoniacal gas was 
 diffused : it survived ninety minutes !
 
 AND OTHEE FOEMS OF APNCEA. 73 
 
 The difference between these two experiments is that 
 of carbonic-acid blood-poison, retained unchanged, and 
 exhaled or neutrahzed. 
 
 Since these experiments, part of a series, were made, 
 Dr, J. W. Ogle and Mr. Lloyd Bullock have kindly re- 
 peated them, and have arrived at the same conclusions : 
 the addition of. dilute pure ammonia prolongs life in an 
 animal confined in a limited portion of atmospheric air. 
 It is therefore an antidote to the carbonic-acid blood- 
 poison in apncea. Being inhaled, it not only neutralizes 
 the carbonic acid in the air-cells of the lungs, but, being 
 also absorbed, it doubtless neutralizes that other portion 
 of this poison still circulating in the blood, and, through 
 it, in all the organs. 
 
 What a beautiful subject for new experiment ! 
 
 But a special use for the dilute vapour of pure am- 
 monia presents itself in the case in which we have to 
 contend with the vapour of burning charcoal and other 
 forms of carbonic acid. 
 
 Those who descend into such a vapour in wells, the 
 coal-pit, the brewing- vat, for whatever purpose, should 
 wear a mask, exhaling the vapour of dilute pure ammo- 
 nia. Those who have breathed an atmosphere surcharged 
 by carbonic acid, should be succoured by the same agent. 
 The state of the atmosphere too crowded by people, or 
 too much imbued by the results of the combustion of gas, 
 should be corrected by the same means, attention being 
 paid to due ventilation. 
 
 The inhalation of dilute pure ammonia is the special 
 preventive of secondary apnoea.
 
 74 POSTUEAL RESPIRATION IN DROWNING 
 
 § YI. — Of the Inhalation of Oxygen, 
 
 Is oxygen really a remedy in apnoea ? Is it as effi- 
 cacious as atmospheric air? Is oxygen more rapidly 
 absorbed in slow combustion from pure oxygen than 
 from atmospheric air ? This too presents a subject, not 
 for hasty conclusions, but for careful experiment. 
 
 § VII. — The Rationale of the fatal Tendency of the 
 Warm Bath in Apnoea. 
 
 There is a physiological relation between the circu- 
 lation and the respiration, any deviation from which, in 
 either direction, is of a fatal tendency. 
 
 During the systemic (not the pulmonic) circulation, 
 carbonic acid is formed ; in respiration, the oxygen 
 necessary for the formation of this carbonic acid is 
 supplied, and the carbonic acid so formed is evolved 
 from the system. 
 
 The immediate baneful effects of the suspension of 
 respiration arise from the privation of oxygen, and from 
 the retention of the carbonic acid previously formed, 
 which becomes the blood-poison. 
 
 An animal placed in perfectly pure nitrogen or 
 hydrogen gas dies in violent convulsions instantly. And 
 this is doubtless owing to the privation of oxygen ; for
 
 AND OTHER FOUMS OF APNCEA. 7^ 
 
 carbonic acid might be exhaled into nitrogen or hydro- 
 gen gas. 
 
 But an animal dies also in air consisting of such 
 proportion of carhonic acid with oxygen as to prevent 
 the evolution of carbonic acid from the blood, although 
 the quantity of oxygen might be so great that a taper 
 blown out, and burning only as a s^Ktrh, would be 
 instantly re-kindled into flame. 
 
 If, without producing effects so, sudden as those 
 described, we change the relative proportion of the 
 respiration and the circulation, morbid phenomena are 
 produced special to each case. If the circulation be 
 disproportionately augmented, carbonic acid is formed, 
 and being morbidly retained, shghter convulsion and 
 slower death ensue. If the respiration is unduly and 
 disproportionately augmented, the animal is cooled: for 
 mere pulmonary respiration is a cooling process, by the 
 difference of temperature of the i?z spired and expired 
 air ; and in this case also the animal dies, but now from 
 loss of temperature. 
 
 This latter is the case in the patient affected by 
 apnoea, if the respiratory movements be unduly hastened — 
 that is, disproportionately to the rapidity of the remaining 
 circulation. 
 
 On the other hand, if, in apnoea, we excite the 
 circulation without simultaneously and proportionately 
 inducing respiratory movements, we destroy our patient 
 by carbonic acid, formed in the course of that circulation, 
 and uneliminated by respiration. 
 
 E %
 
 76 
 
 POSTURAL RESPIRATION IN DROWNING 
 
 This statement leads me to the proper subject of 
 this paper — the Rationale of the Injurious and Tatal 
 Tendency of the Warm Bath in Asphyxia: for it is 
 injurious, and has, I am profoundly convinced, of itself 
 proved fatal in cases in which the patient, without it, 
 would have spontaneously recovered. Such a case in- 
 deed did occur recently at Boulogne. 
 
 In such a case, it is surely not less essential to the 
 progress of science and our art to remove error than to 
 establish truth. 
 
 Warmth is so obviously a stimulus, and a stimulus 
 is so apparently required for a patient taken out of the 
 cold water in a state of apnoea, that in recommending 
 the warm bath we seem to be addressing ourselves to 
 the common sense of mankind, and it was a step in 
 advance to enteratin a dotibt on the subject. 
 
 But when we begin to experiment — when we learn 
 that an animal deprived of respiration by being sub- 
 merged under water, lives longer in cool water than 
 in warm water, we learn to consider whether, in fact, 
 coolness is not more favourable to life in the apnoea 
 from submersion, than warmth. We recall to mind, too, 
 that animals bear the abstraction of respiration in pro- 
 portion to their coolness : the hibernant animals and 
 the batrachian tribes will scarcely drown at aU. If 
 a kitten be first cooled, or if it be immersed in cool 
 water, it will not drown so soon as it would do if 
 submerged at its ordinary temperature in water of the 
 same temperature — facts established by Edwards, by
 
 AND OTHER FORMS OF APNCEA. 77 
 
 M. Brown-Sequard, and myself, and witnessed by the 
 secretary of the Eoyal Humane Society, and by its 
 superintendent in Hyde-park. 
 
 Thus experiment is made to correct preconceived 
 ideas, however apparently consonant with common sense. 
 
 There are other facts which point to other modes of 
 treatment of the drowned, which the admioistration of 
 the warm bath necessarily excludes. If a poor creature 
 be perishing for want qI foody we cautiously administer 
 footh If a man be, in like manner, perishing for want 
 of air, should we not administer air ? Is not this simple 
 and reasonable ? And in the case of drowning, is not 
 the want of air the first condition to which we should 
 bring succour, and the want of temperature the second 
 or third ? And should we not first administer to the 
 first want ? Then, in the case of drowning, we should 
 administer air first, and warmth in the second place. But 
 may not the warmth administered without air, do great 
 and absolute injury ? It raises the temperature, and in 
 so doing augments the necessity of respiration to life. 
 
 In the fir8t place, if any effect be produced by the 
 warm-bath, the circulation is accelerated. But to accele- 
 rate the circulation without inducing, at the same time, 
 efficient respiration^ is to augment the formation of 
 carbonic acid — the llood-poisoUf — without its elimi- 
 nation from the system, and it induces, consequently, 
 a fatal result; 
 
 Secondly, all excited respiration through the medium 
 of the cutaneous excitor nerves is excluded, the uniform
 
 78 POSTURAL RESPIRATION IN DROWNING 
 
 temperature of the warm bath excluding the excitants 
 of those nerves arising from the alternate application of 
 heat and cold to the surface ; 
 
 And thirdly, imitated respiration is excluded by the 
 very sustained position of the patient, excluding, as it 
 does, alternate pronation and rotation, and pressure 
 applied and removed — those changes of position and com- 
 pression which induce respiratory movements. 
 
 So that the warm bath is not only positively 
 injurious by poisoning, but negatively, by excluding 
 the de-poisoning process. 
 
 Lastly, the warm bath excludes those frictions of 
 the limbs upwards, with pressure, which really consti- 
 tute the most effectual means of promoting the circu- 
 lation and warmth. 
 
 Nor is it unimportant to save the time expended in 
 preparing the warm bath, or in carrying the patient to it. 
 
 And it is scarcely a minor point to direct all our 
 thoughts and energies, undiverted, to the important 
 remedies exclusively. 
 
 In conclusion, the warm bath is of doubly fatal 
 tendency: it is so in itself positively; and it is so 
 negatively, by excluding every real remedy. 
 
 All have heard of the Grotto del Cane, The poor 
 dog is put into carbonic acid, and taken out affected by 
 apnoea. It is plunged — not into a warm lath — but into 
 the shallow water of the adjoining lago Agnano, and taken 
 out — restored ! 
 
 I cannot conclude this section better than by ad-
 
 AND OTHER FORMS OF APXCEA. 79 
 
 ducing the penultimate paragraph of Edward's ad- 
 mirable work : 
 
 "We have seen," says this profound physiologist, 
 " how fatal heat is in asphyxia (apnoea), or in cases of 
 restricted respiration." " If the application of heat be 
 continuous, it will prove fatal. In some cases it may be 
 useful, if it be of short duration : when an animal is 
 plunged into water at 104° Tahr. its movements are 
 much more energetic, but less numerous, than at inferior 
 temperatures. There are circumstances in which a 
 momentary application of heat may be employed to 
 ^excite movements of the thorax. The immersion of a 
 great part of the body in hot water is frequently an 
 efficacious means for animating the still-born infant. But 
 as soon as such movements are produced, or if they do 
 not occur, we must renounce a mode of proceeding of 
 which the prolonged use would be fatal !""^ 
 
 § YIII. — The Banger of all Attempts at Artificial 
 Respirationf except in the Prone Position. 
 
 I have shown, in the last section, not the inutility 
 only, but the danger of the loarm bath in the treatment 
 of apnoea or asphyxia. I now proceed to demonstrate 
 the danger of all attempts at the induction of artificial 
 
 * Des Agens Physiques, p. o29-o30.
 
 80 POSTURAL RESPIRATION IN DROWNING 
 
 respiration — the special remedy against apnoea, — except 
 in the prone position. 
 
 If the patient, in apnoea, be moved and placed in 
 the supine position, in which no attempts at artificial 
 respiration can be effectually made, what is the condition 
 of the rima glottidis or entrance into the windpipe ? Is 
 it free, so that air may be pressed or drawn into it ? 
 And if apparently free, does it remain so at the moment 
 when an effort to force or draw air into it is made ? 
 
 1. Is the tongue so securely situated, all muscular 
 energy having ceased, as neither io fall backwards, nor 
 to be drawn backwards, and so close or obstruct the 
 orifice and entrance into the windpipe ? 
 
 2. Is there no accumulation of mucus, or other 
 animal fluids, or of fluids from regurgitation from the 
 stomach, which may also obstruct the glottis ? nay, more, 
 which may be forced or drawn into the windpipe, 
 inducing a second and fatal suffocation ? 
 
 No one can say, a priori, that one, or even both, of 
 these events may not occur. These are not only possible, 
 but probable, — not onl)/ probable, but inevitable under 
 certain circumstances. 
 
 There is one fact of the utmost importance. When, 
 from any circumstances, the nervous and muscular powers 
 are in abeyance, nothing is so common as regurgitation 
 from the stomach, from change of position, compression, 
 &c. Under such circumstances, compression of the sides 
 of the thorax would certainly be apt to produce this 
 effect. Now, in the supine position, the matters so
 
 AND OTHER FORMS OP APNOEA. 81 
 
 regurgitated would remain in the fauces, obstruct the 
 glottis, or, when the pressure was removed, be drawn 
 into the windpipe ! Leroy's mode of attempting to effect 
 artificial respiration, of which a sketch is given by the 
 Royal Humane Society in its Reports, is utterly ineffectual; 
 but if effectual, would be replete with danger. The only 
 certain safeguard against such a fatal accident is — the 
 PRONE position. In this position, the tongue tends to fall 
 forwards, and all fluids flow from the fauces and the 
 mouth, or are expelled by the first induced expiration. 
 
 All this is reasonable, a priori. But we must not 
 rest here. Our appeal must be to factSj not to mere 
 notions. The facts must be ascertained by careful 
 examination of the dead subject. 
 
 1. What is the position of the tongue when the 
 body has been roughly moved about and laid in the 
 supine position, all cadaveric rigidity of the parts being 
 overcome by previous movement of this organ backwards 
 and forwards ? 
 
 2. What is the further position of the tongue in the 
 supine position, at the moment of attempted inspiration, 
 first, by means of the bellows, or, secondly, by the removal 
 of the pressure on the ribs or sternum, and the consequent 
 dilatation of the thorax ? 
 
 These facts may be ascertained by removing the 
 tissues on one side of the neck, so as to give a lateral 
 view of the tongue, glottis, epiglottis, and pharynx, and 
 by replacing those tissues by a portion of transparent 
 glass of the proper size and form, properly placed and 
 carefully maintained in its position.
 
 82 POSTURA.L RESPIRATION IN DROWNING 
 
 The first part of tliis examination has been abeady 
 made : — The subject being placed in the supine position, 
 and the lateral parts of the neck being removed, so as to 
 admit of observing the relative position of the internal 
 organs — the tongue, the epiglottis, the glottis, the 
 pharynx, — it was seen that obstruction to the entrance 
 of air actually did take place. 
 
 I now propose to place a piece of transparent glass 
 so as accurately to close the cavity and allow of the 
 observation, first, of the effect oi position, the supine and 
 the prone comparatively, and then of any attempt to 
 induce inspiration, 
 
 A similar examination of this internal cavity in 
 reference to fluids present in it — and we never can know 
 when such fluids are present — is unnecessary : fluids will, 
 in the supine position, gravitate to the lowest parts of 
 a cavity, and will be drawn into an open orifice, such as 
 the glottis, under the influence of air forced or inhaled 
 into it. And such an event not only renders all attempts 
 at i^^spiration nugatory, but induces a permanent, because 
 material, obstruction of the entrance in the windpipe. 
 
 In confirmation of these views, I revert to experi- 
 mental y«<?^5 already given. 
 
 '^ The following experiment has been repeated many 
 times, and has been witnessed by George Webster, jun. 
 Esq. of Peckham, Mr. Williams, superintendent of the 
 Royal Humane Society, Hyde-park; and other gentle- 
 men : 
 
 The dead subject being placed in the supine position, 
 and pressure made on the sternum and ribs, a little
 
 AND OTHER FORMS OF APNCEA. 83 
 
 gurgling was heard in the throat; but, the pressure 
 being removed, there was no evidence of i^^spiration." 
 
 Now let us contrast with these abortive attempts to 
 induce artificial i//spiration in the supine position, the 
 beautiful and life-giving results — f/zspiration and ^.rpira- 
 tion — of alternate rotation from the prone position and 
 repronation. I continue the quotation : 
 
 "The subject being then turned into the prone 
 position, and pressure being made on the spine and the 
 ribs, and removed as before, there were free e:rpiration 
 and zMspiration." 
 
 Far more marked is the effect of pronation and 
 rotation : 
 
 " The subject was turned into the prone position : 
 considerable expiration took place, w^hich was much 
 augmented by pressure of the hands on the back. On 
 removing this pressure, a little inspiration took place. 
 The body being then rotated on the right side, consider- 
 able inspiration again took place, whilst moving through 
 one fourth of a circle; on continuing the rotation, 
 inspiration continued until the shoulder was half-way 
 between the lateral position and the table, when it 
 ceased.'" 
 
 I conclude the momentous subject by several 
 aphorisms in regard to the treatment of apncea : — 
 
 1. The effects of suspended respiration can only be 
 removed by the renewal of respiration. 
 
 2. Artificial respiration can only be certainly, 
 effectually, and safely performed in the prone position ;
 
 84? POSTUHAL EESPIRATION IN DROWNING 
 
 3. In the supi7ie position the larynx is apt to be 
 obstructed by the falling back of the tongue and 
 epiglottis, or by the accumulation of fluids already in the 
 pharynx or regurgitated from the stomach. 
 
 4. These fluids may be fatally inhaled into the 
 windpipe when aspiration is mechanically effected. 
 
 5. All other measures are subsidiary, even the 
 rubbing the limbs with pressure upwards ; and all which 
 exclude respiration are, ipso facto, destructive; the warm 
 hath is of douhly fatal tendency, — first, by excluding 
 pronation and rotation, and secondly, by promoting the 
 formation and the circulation of the blood-poison — 
 carbonic acid. 
 
 § IX. — 0)1 the Prognosis in Apncea. 
 
 The prognosis in apnoea (or asphyxia) depends upon 
 three elements : 
 
 First, the physiological constitution of the patient ; 
 
 Secondly, the stage of the apnoea (or asphyxia) ; 
 
 Thirdly, the promptitude with which the chief reme- 
 dies, respiration, or pronation and rotation, are adminis- 
 tered. 
 
 The physiological constitution of the new-born infant 
 is that of low stimulus and of high irritability. The re- 
 spiration is, in fact, the respiration, so to speak, of the 
 fish tribes — the placenta representing the branchiae ; and
 
 AND OTHER FORMS OF APNffiA. 85 
 
 even of the lowest of these, the extent of surface of the 
 placenta, compared with the magnitude of the animal, 
 being considered. 
 
 But the duration of life in apnoea is in the inverse 
 proportion of the quantity of respiration ; that is, the 
 less the degree of respiration, the longer its suppression 
 can be sustained without the extinction of life. The 
 same hibernant animal lives a longer or a shorter time 
 submerged under water, just according to the degree of 
 hibernation, with its low respiration, in which it may be 
 placed, and dies more promptly as that hibernation is 
 exchanged for activity with its high respiration. 
 
 The degree of respiration is always linked with pro- 
 portionate circulation — as effect is linked with its cause — 
 or as supply is linked with demand. The quicker the 
 circulation, the quicker the formation and elimination of 
 carbonic acid, or the ^(^(?6>r/-poison, but the ordinary excitant 
 of respiration, the degree of necessity for its elimination, 
 being in the same proportion. Hence the destructive 
 tendency of the warm hath, in the ordinary sense of 
 this phrase ; for I do not now speak of the sudden and 
 momentary hot lath (which may prove an excitant of 
 respiration), but of the ordinary continued warm bath, 
 which, if it accomplish any thing, augments the circula- 
 tion, respiration being still in abeyance ; with this aug- 
 mented circulation, there is augmented formation of the 
 blood-poison, carbonic acid; and this being retained, 
 proves a *' choke-damp," and, in a word, destroys hfe. 
 Now the warm-bath at the Royal Societ/s receiving-
 
 86 POSTURAL EESPIRATION IN DROWNING 
 
 house lias been a warm bath, and has usually been con- 
 iinued during twenty minutes. 
 
 But to return to the practical object of this section, 
 which will be found, as ever, to coincide with ^/^eory — (so 
 commonly and ignorantly decried), — the new-born infant 
 is a creature of the lowest degree of respiration. Its life, 
 and the hope of its restoration in apnoea, is — the longest, 
 I believe that, in almost every case of the apncea of the 
 still-born, the success of the postural respiration will be 
 complete. For the same reason, the application of this 
 method should be the most persevering . 
 
 In regard to the stages of apnoea (or asphyxia), I 
 may observe that there are most distinctly /bwr ; 
 
 The first is that in wliich the breathing is not quite 
 extinct ; 
 
 Tlie second, that in which the respiration has ceased, 
 but may be excited by those means which I have so dis- 
 tinctly pointed out on various occasions; 
 
 The third, that in which respiration has not only 
 ceased, but is in-excitable, and in which therefore our 
 liope of resuscitation is in imitating or inducing the re- 
 spiratory movements — that is, in pronation and serai- 
 rotation ; 
 
 ^\\Q fourth and last stage is that of true asphyxia — 
 that in which not only all respiration, but all pulsation 
 has ceased, and with it almost all hope. Sir B. C. 
 Brodie says, emphatically — " If that action of the heart 
 hy which the circulation is maintained should cease, it 
 can never he restored. This I positively assert, after
 
 AND OTHER FORMS OP APNCEA. 87 
 
 made it the subject of a very careful hivestiga- 
 
 In the cases of the drowned or the strangulated, the 
 patient may come under our notice in any one of these 
 stages, or in any prior, posterior, or intermediate con- 
 dition. 
 
 The course of tJiis apnoea or asphyxia is extremely 
 short : four or five minutes of complete submersion is 
 supposed to be hopelessly fatal. In a given case, the 
 hope is precisely commensurate with the promjptitude with 
 which this treatment is appKed. Certainly the plan or 
 rules recently proposed to the Eoyal Humane Society 
 to be adopted before postural respiration — that is, the 
 time lost — would extinguish all chance, all hope, and 
 therefore all fair and honest trial of that method ; and I 
 trust that Society will, for its own honour and credit, 
 reject all such insidious proposals. 
 
 The moment we see the drowned patient, we should 
 observe, for a moment, whether there be respiration, and 
 if so, vmit and still <9^5^;t^ carefully ; if breathing con- 
 tinue, be careful of interfering ; and, constantly watcliing, 
 direct the wet garments to be removed, and the limbs to 
 be rubbed, dried and clothed as promptly as possible, 
 every one contributing some article of clothing. 
 
 But if the breathing has ceased, if there be real 
 apnoea, then, without any delay of any kind, we should 
 enforce at once the best measures ; and those are already 
 
 * Lectures on Pathology and Surgery; 1846; p. 81.
 
 88 POSTURAL RESPIRATION IN DROWNING 
 
 demonstrated to be those already described, unpost- 
 poned. 
 
 I regard the new Eules lately proposed to the Humane 
 Society as unfair towards the new method, and as fatal to 
 the patient. I believe it to be absolutely impossible that 
 any asphyxiated patient should so survive i\ie preliminary 
 measures proposed in those Eules, as to be subsequently 
 recovered, or recoverable, by that method, or ani/ method. 
 
 The prognosis in cases of drowning, &c. is made up 
 then of three elements : 1. the constitution of the pa- 
 tient; 2. the stage of the affection; 3. i]\Q promptitude 
 of the treatment ; to which, of course, must be added the 
 adequacy of the remedies. 
 
 In concluding, I wish briefly, but distinctly, to restate 
 the chief practical points embraced in those remedies : 
 
 1. It is obvious to all unsophisticated persons that 
 the effects of 
 
 Suspended RespiratioUj 
 by whatever cause, are only to be removed by the 
 Restoration of Respiration. 
 
 2. It is proved by experiment on the dead subject 
 that respiration is effected by the 
 
 Pronation, and 
 
 Rotation of the body, with pressure duly applied and 
 removed. 
 
 3. The special remedy for apnoea, then, is this 
 
 Postural Respiration.
 
 AND OTHER FORMS OF APXCEA. 0^ 
 
 § X. — 0?i Narcotic Poisoning. 
 
 Many years ago, a lady drove to my door (in Man- 
 ehester Square) from Avenue Road, in the utmost con- 
 sternation, having shortly before swallowed an ounce and 
 a half of Battle/s solution of opium, in mistake for a 
 senna draught. 
 
 I instantly applied the stomach pump with my own 
 hands, and her life was saved ! 
 
 I have often asked myself the question — What should 
 I have done, had I not had the stomach pump in all 
 readiness, and had I not been able to induce vomiting ? 
 Until this hour, I knew not how satisfactorily to answer 
 this fearful question. 
 
 There are two stages in narcotic poisoning, in each 
 of which postural movements are, in the absence of the 
 stomach pump, our /lope. 
 
 The first is that in which our object is to remove the 
 poison from the stomach by the induction of mechanical 
 vomiting, but in which, from the degree of narcotism, all 
 physiological remedies fail. 
 
 The second, that in which our object and hope are, 
 to continue respiration until the elimination of the poison 
 from the system may be accomplished. 
 
 In the former case, the patient should be laid on a 
 table, with the head projecting beyond its edge, if pos- 
 sible ; and, being placed on the side, the finger of one 
 person is to be introduced into the faucesj whilst the
 
 90 POSTURAL RESPIEATION IN DROWNING 
 
 body is briskly and repeatedly rolled into the prone posi- 
 tion, and pressure or a smart blow on the back applied 
 by another. 
 
 If there be the slightest degree {^^ scintilkdd^) of ex- 
 cito-motor power remaining, the cardia, already some- 
 what relaxed from torpor, will be still further relaxed, 
 physiologically, whilst the glottis^ the safety valve of the 
 trachea, is closed, and the tliorax and abdomen being 
 compressed by a force equal to the superincumbent weight 
 of the body, to which further force may be added by 
 means of pressure made along the spine, mechanical 
 vomiting will be produced, and the poison expelled. 
 
 This desirable effect will be produced in cases in 
 which the narcotic torpor is too great to admit of excit- 
 ing the very complex act oi phi/siological vomiting. 
 
 But now let us suppose that the narcotism is too 
 deep for the success of this manoeuvre, — that the second 
 case is before us. Then our hope consists in continuing 
 respiratory movements until the poison is eliminated from 
 the blood and the general system. In one word, our 
 hope is in prone and postural respiration, such as I 
 have recommended it for apnoea. 
 
 I suppose that volition has ceased, and that the pa- 
 tient can no longer be made to move or walk about ; that 
 all good physiological respiration has ceased, or is about 
 to cease; then — then one hope still remains — postural 
 respiration — and the other measures comprised in the 
 treatment of apnoea; and I need not say how long and 
 perseveringly this method should be continued.
 
 AND OTHER FORMS OF APNOEA. 91 
 
 § XI. — The Laryngismus of Chronic Laryngitis, 
 
 Chronic laryngitis is liable to extreme and dangerous 
 spasmodic exacerbations, assuming the form of laryngis- 
 mus. 
 
 In a very early volume of the Medico -Chirurgical 
 Transactions, I pubHshed a case of Chronic Lar}Tigitis 
 in which tracheotomy was instituted to protect the patient 
 from the immediate danger from these paroxysms of 
 laryngismus, whilst mercury was freely administered as 
 the cure of the laryngitis. 
 
 Such is always the place occupied by tracheotomy. 
 It is itself a cure for no disease. 
 
 It is in such a paroxysm as I have described that 
 postural respiration might save the patient, if most time- 
 ously applied. And unless tracheotomy be instituted, 
 due warning of the imminent danger of these paroxysms, 
 and of the remedy, should be given to the friends of the 
 patient. 
 
 I see this subject recently noticed by Dr. Eben. 
 Watson, in his very able and valuable work on the " Local 
 Medication of the Larynx^^ (p. 82). 
 
 § XI. — The Laryngismus of Convulsion and ofEjpilepsy. 
 
 There are tivo cases of sudden death in convulsion 
 and epilepsy : one of these is syncope ; the other, laryn-
 
 92 POSTURAL RESPIRATION IX DROWNING 
 
 These events are not uncommon even, in that con- 
 vulsive affection designated laryngismus stridulus; and 
 I have met with an instance of the same kind in a little 
 girl, aged ten, afflicted with epilepsy; and another in 
 a youth, a medical student. 
 
 The fit of pertussis, so apt to pass into convulsion, 
 may also terminate in fatal apnoea, laryngismus being the 
 intermediate connecting link in both cases, and timeous 
 postural respiration the remedy in the latter. 
 
 In the laryngismus of these cases, the spasm, with its 
 apnoea, may continue so long that, when it has ceased, 
 the pneumogastric may no longer be excitable by the 
 contact of the carbonic acid in the lungs, and the 
 apnoea may issue in fatal asphyxia. It is at such a 
 moment that postural respiration would probably rescue 
 the patient from his danger. 
 
 The caution and proper instructions should be given 
 to every one having charge of the infant affected by 
 laryngismus stridulus, and to every parent having an 
 epileptic son or daughter. Fortunately the remedy is at 
 hand, and most easy of application. 
 
 I may take this occasion to place on record the sur- 
 mise that, in many cases of epileptic laryngea, the blood 
 remains over-charged with carbonic acid ; this may be 
 the source of the dark epileptic complexion ; the remedy 
 is the inhalation of dilute pure ammonia.
 
 AXD OTHER FORMS OF APNCEA. 93 
 
 § XIII. — The Laryngismus of Stryclinme. 
 
 Judging from many experiments, I believe that 
 strychnine destroys life in three ways : 
 
 1. By inducing laryngismus and apnoea; 
 
 2. By inducing exhaustion of the nervous power, 
 the effect of spasm and pain ; and 
 
 3. By a secondary asphyxia. 
 
 The^f<9^ object in the treatment is, of course, to get 
 rid of the poison. Emetics must be given. But if these 
 fail, the hopeful remedy is, to place the patient prone, 
 and, in the interval between the spasms, to tickle the 
 fauces with a feather or other object. 
 
 The second — the important remedy, is — tracheotomy. 
 In my experiments, I gave the same poisonous dose of 
 the acetate of strychnine to each of two dogs, and per- 
 formed tracheotomy in one ; and left them undisturbed 
 for the night. The one in which tracheotomy was per- 
 formed lived ; the other infallibly died I Tracheotomy 
 disarms laryngismus of danger — of its apnoea. 
 
 The third remedy is the postural method, with two 
 objects : the first, to administer respiration as the remedy 
 for the effect of the laryngismus, &c., and its apnoea or 
 suspension of respiration ; the second, adding tickling to 
 the fauces, again, to empty the stomach ; a third may be, 
 even when all spasm has ceased, to continue the alternate 
 pronation and rotation, that is — respiration, — in the hope 
 that life may be continued until the poison may be elimi- 
 nated from the system, as well as mechanically regurgi- 
 tated from the stomach.
 
 94 POSTURAL EESPIEATION IN DROWNING 
 
 § XIY. — The Laryngismus of Cliohing. 
 
 Death in choking is the result of a diastaltic or 
 reflex spasmodic closure of the glottis. 
 
 Nothing can be done in this stage of the accident, 
 except, 
 
 1. To endeavour, by introducing the finger into the 
 fauces, to induce vomiting ; 
 
 2. To introduce something like a hoiigie into the 
 oesophagus (a firm scroll of linen being the readiest); or, 
 
 3. To adopt a measure which I adopted on an emer- 
 gency, with immediate success, some years ago : 
 
 A little boy, eating some fowl in haste, attempted to 
 swallow too large a morsel^ and was choked ; I ran to 
 him, placed him between my knees, one knee (the right) 
 pressing firmly on the stomach, the other on the back ; 
 I then placed one hand (the left) on the back part of the 
 thorax, whilst I gave a firm blow with the other on the 
 sternum. In an instant I had the joy of seeing the morsel 
 of chicken expelled with force to a considerable distance ; 
 and all was safe ! 
 
 But supposing all these efforts to fail. What is then 
 to be done ? 
 
 In the midst of the apnoea induced by the closure 
 of the glottis, the excito-motor power at length fails, and 
 the larynx is no longer spasmodically closed ; and now 
 postural respiration may be adopted, with the effect of 
 sustaining respiration and life, until such a bougie is
 
 AND OTHER FORMS OF APNCEA. 95 
 
 made as shall be effectual in pushing down the morsel 
 of food or other object in the pharynx or oesophagus. 
 
 Kfirm scroll of cotton or hnen^ when imbued with 
 grease, made from a sheet, a window-blind, or curtain, 
 may be made, not in too great haste, and be boldly 
 passed into the cesophagus. 
 
 The morsel of food is generally lodged in the phar}iix, 
 or u][jper part of the oesophagus, and, when forced lower 
 down ceases to excite reflex action of the larynx ; and 
 breathing is, therefore, possible. 
 
 A thin bent tallow-candle, or a piece of firmish cord 
 (taken from the window-frame), might answer the purpose 
 of the bougie. 
 
 Postural respiration procures us the time necessary for 
 obtaining any of these means, and for giving full directions 
 to the assistants. In performing it, a little brisk move- 
 ment and even a smart blow may be adopted too in prona- 
 tion, and in making dorsal pressure, which may, if not at 
 first, eventually, dislodge the foreign body. 
 
 I need scarcely suggest that this last measure should 
 also be enforced in cases of a foreign body inhaled into 
 the larynx both hefore and after tracheotomy, with the 
 addition of a firm blow with the open hand, on the 
 back.
 
 96 POSTURAL RESPIRATION IN DRO\VNING 
 
 § XV. — On the Time the Patient may he suhnerged. 
 
 Many exaggerated accounts are on record in regard 
 to the length of time during which a patient may be 
 submerged, and yet recover. 
 
 The general principle has already been stated : the 
 higher the temperature, the more rapid the circulation, 
 the quicker the respiration, — and the greater the 
 necessity for air; the sooner, therefore, the apnoea will 
 become fatal asphyxia. 
 
 If a person be running, and fall into the water, 
 that fatal asphyxia will soon take place. 
 
 Skaters, warm with skating, speedily perish, though 
 life will be prolonged by the coldness to which they are 
 exposed. 
 
 Those who are without active exercise on the ice, and 
 therefore cold, will live longer if submerged in the 
 water. 
 
 But the duration of apnoea is longest in those who, 
 from any cause, experience a considerable reduction of 
 the pulse and of the temperature, of course within 
 physiological hmits : a degree of syncope occurring as 
 the person is submerged — from fright, for example — will 
 enable him to sustain the privation of air longer than 
 those whose circulation is vigorous. If a degree of shock 
 be sustained from the fall or plunge into the water, the 
 same effect may be produced. 
 
 It is in such circumstances that the long period of
 
 AND OTHER FORMS OF APNCEA. 97 
 
 immersion said to have been sustained, must, if true, 
 be explained. 
 
 Sometimes the immersion is not constant or complete ; 
 as, ^Yllen the patient rises to the surface, or the water is 
 shallow ; and then life will, of course, be protracted. 
 
 In general, apnoea is more speedily fatal in summer 
 than in ^vinter, in the young and robust than in the 
 feeble, in the active than in the inert. I think it must 
 be admitted that very young children live longer, when 
 deprived of air, than adults. 
 
 These facts are confirmed by physiological considera- 
 tions, to be briefly detailed in Part the Third of this 
 little work. All, indeed, is physiology. 
 
 Two things are obvious, and of great practical value : 
 the first, that whilst we should not lose a moment in 
 adopting the postural respiration, we should not be 
 deterred from persevering by the apparent hopelessness 
 of the case, or the too ready desponding observations of 
 the bye-standers. We know not what event may have 
 occurred to reduce the circulation and the consequent 
 necessity for respiration. 
 
 All physiology, all experiment, the whole of the 
 works of Edwards and of M. Brown- Sequard, my own 
 investigations, all support these views, of which the 
 hibernant animal and the batrachian, present the most 
 marked illustrations. The differences amongst our 
 patients may be small ; but they are not the less real. 
 
 These considerations lead, especially, io perseverance, 
 in our breath-giving, life-giving, postural manceuvres —
 
 98 POSTURAL RESPIRATION IN DROWNING 
 
 and the embers of life may be smouldering when we 
 
 thmh them extinct. 
 
 § XVI. — Formula for Frone mid Postural Respiration, 
 
 I conclude Part Second by adducing the latest Rules 
 for the treatment of apnoea, in their most simple but 
 distinct forms, and suited to general, not to say univer- 
 sal, application. 
 
 They have never failed to produce good respiration, 
 in cases in which the pharynx and larynx have been free 
 from matters regurgitated from the stomach or expelled 
 from the lungs ; and these failures only apply to our ex- 
 periments with the Pnoeometer, not to our efforts to save 
 the patient ; for, in the prone position, even such events 
 find their instant remedy. 
 
 I believe I may assert that this mode of artificial 
 respiration will succeed in every case of apnoea ; it will 
 fail, I fear, whenever that aptoea has, by delay or other- 
 wise, passed into asphyxia. 
 
 The first object is to clear the Throat ; 
 
 The second, to Excite respiration physiologically ; 
 
 The third, to Imitate respiration ; and I have a 
 remark to make — not, I think, made before : it will be 
 observed that the process of imitated respiration begins, 
 not with inspiration, but with ^;rpiration, this being the 
 eft'ect of Wx'd prone position with dorsal pressure. 
 
 In the first place, it is obvious that in this manner
 
 AND OTHER FORMS OF APNCEA. 99 
 
 we second the rule for clearing the throaty the effect of 
 mere position, by adding one which may clear the trachea 
 by inducing expiration ; it may be Irish respiration ; and 
 if, instead of pressure on the back, we apply a smart 
 llowy it may do more still. 
 
 In this, I believe, we imitate Nature too : the compres- 
 sion of the infant's thorax and abdomen as it passes, after 
 the birth of the head, through the vagina, must act in 
 the same manner, /r^^f producing /bm6/^ e:cpiration, and 
 so expelling all mucus from the air passages. 
 
 A similar event, issuing in good, has been seen to result 
 from effecting e^zjpiration by a strong effort of suction 
 by the mouth apphed to the mouth and nostrils. 
 
 The late Mr. Eeid invented a double-acting syringe, 
 the objects of which were, first, to induce ^^piration and 
 then ^?^spiration. I do not know whether it was ever 
 nsed. It may, I believe, still be seen in Eegent Circus, 
 Piccadilly. 
 
 Prone and postural respiration happily takes the 
 place of all such manoeuvres and instruments. 
 
 These measures are portrayed in the most simple 
 manner in the following table : 
 
 F 2
 
 100 POSTURAL RESPIRATION IN DROWNING 
 
 RULES 
 
 FOR PRONE AND POSTURAL RESPIRATION. 
 
 I. Rules to he ajoplied in every Case. 
 
 1. Treat the patient instantly, on the s^ot, in the 
 ojoen air, exposing the face and chest to the breeze (except 
 in severe weather). 
 
 L^To Clear the Throat— 
 
 2, Place the patient gently on the face, with one 
 ist under the forehead ; 
 
 [all fluids and the tongue itself then fall forwards, leaving the entrance 
 into the wind-pipe free.] 
 
 If there be breathing — wait and watch ; if not, or if 
 it fail, — 
 
 //. — To Excite Respiration — 
 
 3. Turn the patient well and instantly on his side, 
 and — 
 
 4. Excite the nostrils with snuff, the throat with a 
 feather, &c. and dash cold water on the face previously 
 rubbed warm. 
 
 If there be no success, lose not a moment, but in- 
 stantly —
 
 AND OTHER FORMS OF APNCEA. 101 
 
 III. — To Imitate Resjpiration — 
 
 5. Eeplace the patient on his face^ raising and sup- 
 porting the chest and abdomen tvell on a folded coat or 
 other article of dress ; 
 
 6. Turn the body very gently on the side and a 
 little heyond, and then briskly on the face, alternately ; 
 repeating these measures dehberately, efficiently, and 
 perseveringly fifteen times in the minute, occasionally 
 varying the side ; 
 
 [when the patient reposes on the cJiest, this cavity is compressed by the 
 weight of the trunJc, and expiration takes place; when he is turned on the 
 side, this pressure is removed, and inspiration occur si. 
 
 7. When the prone position is resumed, make 
 equable but efficient pressure, with brisk movement, 
 along the back of the ckest ; re?noving it gently im- 
 mediately before rotation on the side ; 
 
 [the first measure augments the expiration, the second commences in- 
 spiration. 1 
 
 *»* The result is — Respiration ; — and, it not too late, — Life 
 
 IK — To induce Circulation and Warmth — 
 
 8. Eub the limbs upivards, with firm grasping 
 pressure and with energy, using handkerchiefs ; &c. 
 
 [by this measure the blood is propelled along the veins towards the hearth' 
 
 9. Let the limbs be thus dried and warmed, and 
 then clothed, the bystanders supplpng coats; &c. 
 
 10. Avoid the continuous warm-hath, and the position 
 on or inclined to the hack.
 
 103 POSTURAL EESPIRATION, ETC. 
 
 II. Rides for the Treatment of the Still-born. 
 
 I. The first object is to clear the Throat and nostrils 
 of mucus. 
 
 1. This is best done by the prone position, pressure 
 along the back, &c. 
 
 2. By seizing it, as it appears, by a piece of soft 
 hnen. 
 
 II. The second object is, to imitate Nature, and 
 Excite respiration ; 
 
 1. The alternate hot and cold douche, or 
 
 2. The alternate hot and cold bath, or 
 
 3. Excitants apphed to the nostrils or the skin, are 
 the most efi'ectual measures. 
 
 III. The third, the all-important measure, is, to 
 Imitate respiration by 
 
 Alternate rotation, and pronation with pressure ; 
 
 IV. Next follow friction along the limbs upwards, 
 with flannel; 
 
 V. The continuous warm bath, as distinguished from 
 the sudden alternate hot and cold baths, is to be carefully 
 avoided, as causing loss of time and the neglect of all- 
 important remedies. 
 
 YI. Yery dilute vapour of pure ammonia should be 
 inhaled into the lungs.
 
 CASES.
 
 Recently a melancholy event occurred at Scarborough : 
 
 A gentleman^ bathing in the sea, was, as is supposed, seized with 
 cramp, and was only rescued from the water as life seemed about to 
 become extinct. The patient, instead of being treated instantly, on the 
 spot, was " conveyed," as formerly directed, to the bathmg-house : on 
 the way, he breathed several times ; on his arrival, he seemed irre- 
 coverably dead! 
 
 1 add another anecdote, not less deplorable : 
 
 A young person was bathing at Bov.logne-sur-mer , and ivas rescued 
 when nearly drowned. Breathing was partially restored, when the 
 superintendent of the " Societe Mumaine et des Nauf rages," as related to 
 me by himself, ivas very reluctantly indticed to place the patient in a warm 
 hath. The breathing ceased, and in this bath the patient expired !
 
 CASES. 
 
 I. CASES OF DROW^'ING. 
 
 Case I. — By Br. Alexander , of Bundonald, Kilmarnock, 
 
 The first case which occurred, and in which postural 
 respiration was instituted, was that of Dr. Alexander ; and 
 it is full of instruction. 
 
 Though improving under the influence of this treat- 
 ment, it was thought proper to try the effect of the warm 
 bath ; the child grew worse ! 
 
 The postural respiration was resumed, and it was 
 restored ! 
 
 In a letter Dr. Alexander observes : " As I have 
 been the first to put your admirable method into practice, 
 probably I have been the first to notice the injurious 
 effects of the warm bath/^ " I believe the child would 
 have died in it, had it not been removed." 
 
 Dr. Alexander's case of the resuscitation of a still- 
 born infant is also the first saved by the postural method 
 of respiration. 
 
 To the Editor of The Lancet. 
 
 " Sir,— When Dr. Marshall Hall first published in 
 your columns, on April 12th, 1856, his Ready Method of 
 treating asphyxia, I felt so convinced of the soundness
 
 106 POSTURAL RESPIRATION IN DROWNING 
 
 of the views then promulgated, that I resolved to test them 
 practically on the first occasion which should present 
 itself. I had not to wait very long for an opportunity 
 of doing so. 
 
 "On the 31st of May, 1856, 1 was sent for express to 
 visit a female child, aged two and a haK years, said to 
 have been drowned in a tubful of soap-suds. I had a 
 distance of fully two miles to ride, and started with a 
 feeling that my labour would be all in vain. Half an 
 hour must at least have elapsed from the time the child 
 was discovered in the water until I reached the spot. On 
 arriving, I found the child stripped of her clothes, wrapped 
 in a piece of flannel, reclining on her mother^s knee, and 
 people assiduously applying warm flannels to various parts 
 of the body, accompanied with frictions. The child 
 occasionally gave a sort of gasp or sob, with a slight 
 quiver of the body ; the eyes were projected and fixed, 
 and the pupils dilated : the pulse could not be felt. 
 
 "The postural movements, with upward frictions, as 
 recommended by Dr. Marshall Hall, were immediately 
 commenced, and after forty minutes' continuance, respi- 
 ration became more regular, but not so satisfactory as I 
 could wish. The child began to moan occasionally, and 
 attempted to cry ; the pulse could be distinctly felt, though 
 irregular ; but the eyes continued in the same immoveable 
 state, with dilated pupils, as when I arrived. In addition 
 to the postural movements, &c. &c., cold water was 
 dashed over the head, face, and various parts of the body. 
 
 " The child was then placed in a tub of hot water to
 
 AND OTHER FORMS OF APNCEA. 107 
 
 the middle of the body, a cloth wet with hartshorn applied 
 over the region of the heart, and cold water poured upon 
 the head. Instead, however, of improving, the breathing 
 became more irregular, and spasmodic in its character. 
 
 " The child was therefore, after being five minutes in 
 the bath, removed, and the postural movements repeated 
 and persisted in for half an hour. The breathing again 
 became more regular and natural, the pulse more distinct 
 and firmer, yet the eyes continued iu the same state as 
 before. 
 
 " It was then evident that, besides the carbonic acid 
 which might be retained in the blood, there was conges- 
 tion of the brain, or some other state aHied to it, which 
 might be relieved by cautious depletion. A leech was 
 fortunately got and applied to the head, with most decided 
 relief, and, after a visit of two hours and a half duration, 
 I had the pleasure of leaving the child in the enjoyment 
 of a sound sleep, and in two days of seeing it quite well, 
 after two or three doses of aperient medicine. 
 
 '' I could not find out how long the child had been 
 under the water ; all I could ascertain was, that it might 
 have been one minute, but could not be more than five. 
 
 "In the case of a still-born child, from breech presen- 
 tatiouj on May 4th, ] 856, 1 had the satisfaction of seeing 
 the postural movements successful in restoring animation, 
 after htm^ persisted in for twenty minutes before the child 
 gave any signs of life. 
 
 "In a similar case, after a natural presentation, on the 
 28th Jan., I failed in restoring animation, though the
 
 108 POSTURAL RESPIRATION IN DROWNING 
 
 Ready Method was tried for thirty -five minutes. I might 
 have continued the movements longer, but the mother 
 required my attention for some time, and I deemed it 
 vain afterwards to repeat them. 
 
 "Until your last number appeared, I had no idea that 
 any man or body of men, gifted with common sense, 
 would have had any doubts of the propriety of following 
 out the treatment recommended by Dr. Marshall Hall, in 
 all cases of asphyxia, from whatever cause. I have there- 
 fore contributed my mite to the list of cases already pub- 
 lished, confirming the soundness of the views entertained 
 and the treatment recommended by Dr. Marshall Hall, 
 and trust that every medical man will see it to be his 
 duty to follow out the Eeady Method on every suitable 
 
 Case II. — By Br. Hadden, of Skibbereen. 
 
 The second case of success in treating the drowned 
 by postural respiration is by Dr. Hadden, of Skibbereen. 
 I give it in Dr. Hadden^s own words, and add two ex- 
 tracts from a correspondence with that able physician : 
 
 " Skibbereen, Co. Cork, July 31, 1856. 
 
 " My dear Sir, — I think it right to inform you that 
 within the last few days I have had an opportunity of 
 trying your new method of inflating the langs, and I am 
 liappy to say the result has been most successful.
 
 AND OTHER FORMS OF APNCEA. 109 
 
 " The case was that of a boy, about thirteen years of 
 age, who, when bathing, got a cramp in the right leg, 
 and, after struggling for a considerable period, sank ex- 
 hausted. He remained under water for many minutes, 
 and when brought to land appeared quite dead. 
 
 " I happened to be passing at the time, and imme- 
 diately put your plan into operation, and after continuing 
 it for more than a quarter of an hour, he began to show 
 some symptoms of returning animation. 
 
 " His recovery is the most remarkable I have ever 
 witnessed, and must have been impossible, if treated 
 according to the methods heretofore in use. 
 
 " With much respect, I am, dear Sir, very truly yours, 
 '' David Haddhin, M.D." 
 
 " Dr. Marshall Hall." 
 
 " Skibbereen, Aug. 12, 1856. 
 " My dear Sir, — I must rely altogether on the state- 
 ments of others as to the exact time during which my 
 l)atient was under water ; but, from a variety of circum- 
 stances, I believe he could not have been less than from 
 fifteen to twenty minutes completely submerged after he 
 had risen to the surface for the last time. The account 
 is, that he breakfasted at nine o^ clock, and immediately 
 afterwards went to bathe, in company with another boy, 
 about his own age= He had not been long in the water 
 when he complained of cramp in his leg, and called for 
 help to his companion, who immediately went to him, 
 but had not strength to render him effectual assistance.
 
 110 POSTURAL EESPIRATION IN DROWNING 
 
 and with difficulty escaped being dragged to the bottom 
 by him. The alarm was then given, and assistance pro- 
 cured from a distance of at least an eighth of a mile ; but 
 when this arrived, the body could not be seen. A man 
 undressed, and dived in the place where the boy was last 
 observed, and, after much trouble, succeeded in bringing 
 him to the surface. 
 
 " I was driving near the place at ten o'clock, and saw 
 the body taken out of the water ; and so completely was 
 animation suspended, that even his own father, with 
 other bystanders, thought it quite useless to adopt any 
 remedial measures. However, I immediately spread a 
 woollen cloak on the ground, placed the body in the prone 
 position, and commenced the rotatory movements, having 
 given directions that a careful person should support the 
 head, while others were employed drying and rubbing 
 the legs and entire surface. The sun was very hot at the 
 time, and I left the body uncovered, to facilitate the 
 rubbing. I also held liquor ammonia under the nostrils, 
 and rubbed it over the region of the heart. 
 
 " For fifteen minutes, every exertion appeared useless. 
 There was then a kind of respiration established. The 
 breathing soon became loud, and accompanied by a kind 
 of moan, which continued for several hours. At eleven 
 o'clock, there was an attempt at vomiting, which was 
 near frustrating all our exertions, as a portion of food got 
 into the larynx, and had almost produced sufibcation. 
 At half-past eleven, he was taken home. From that 
 time, there was some return of consciousness ; but during
 
 AND OTHER FORMS OF APN(EA. Ill 
 
 the entire day he had considerable pulmonary and cere- 
 bral congestion ; and this was followed by a severe attack 
 of fever, which continued for ten days. 
 
 " I am happy to say he is now completely recovered. 
 " I am, dear Sir, very truly yours, 
 
 " David Hadden." 
 
 " To Marshall HaU, Esq, M.D. &c. &c." 
 
 " Skibbereen, Sept. 24th, 1856. 
 
 " My dear Sir, — The idea I had formed of the case 
 was, that vital action had commenced with the deep in- 
 spiration and convulsive movements of the diaphragm 
 and abdominal muscles, converting the respiration, which 
 had previously been inaudible and purely passive and 
 mechanical, into active and independent breathing; the 
 pneumogastric (stimulated by long-continued artificial 
 respiration) being evidently the excitor. The trifacial 
 could not have had any influence in the first instance, as 
 the ammonia was not used until after the effort at 
 vomiting. 
 
 " I have lately used the rotatory movements with 
 success in the treatment of a still-born infant; but I 
 thought it necessary to increase the weight of the body 
 by gentle pressure, when in the prone position, and smart 
 slapping over the nates to excite vital action. 
 
 " I am, dear Sir, most truly yours, 
 
 " David Hadden." 
 
 " To MarshaU HaU, M.D. F.R.S."
 
 112 POSTURAL HESPIEATION IN DROWNING 
 
 Case III. — By Br. A. Leg at, of South Shields. 
 
 I have peculiar pleasure in recording, as the third case 
 of the success of postural respiration, the following most 
 interesting one by Dr. A.. Legat, of South Shields : 
 
 " Having had occasion to visit a lady, three or four 
 miles distant, on the third instant, as I drove to the door 
 I was requested to go immediately to the coach-house to 
 see " an extreme case." On entering the harness-room, 
 I saw, stretched on his lack, before a warm fire, partially 
 enveloped in blankets, a muscular-looking young man, 
 surrounded by four or five others, one of whom was sup- 
 porting his head. The lips and face were blue, the sur- 
 face quite cold, and the body so rigid that the right hand, 
 which rested over tlie pubis, and the left arm, bent at 
 right angles over the chest, could not without difficulty 
 be changed from their position. No respiration could 
 be detected, and there was no pulse. A slight quivering 
 was observed throughout the body for an instant, and in 
 this movement seemed the only hope that life might be 
 restored. Exactly an hour had elapsed snice he was 
 taken out of the sea, and at that time he spoke a few 
 words. Blankets were taken down to the beach. He 
 was well rubbed. An attempt was made to administer 
 brandy, which it would appear he could not swallow, and 
 he was then carried about four hundred yards to the 
 room where I found him. He had been lying here about
 
 AND OTHER FORMS OF APNCEA. 113 
 
 half an hour^ during which time he hod not spohen, and 
 for the last ten minutes of it he had been in the condi- 
 tion above described. Those around told me " they 
 feared it was too late to be of use to him.'" 
 
 I felt there was no time to be lost. The window of the 
 room was ordered to be thrown open, and placing my watch 
 on the floor before me, for the purpose of correct obser- 
 vation, I knelt down, and, with my right hand on his left 
 shoulder and my left on the side of his chest, commenced 
 the movements described by Dr. Marshall Hall. He was 
 rolled gently over on his face (the mouth and nostrils 
 being kept carefully free), and then back again on his 
 side " and a little beyond,^^ every four or five seconds. 
 
 About seven minutes had elapsed when I heard more 
 than one of the bystanders say, " it was of no use •" but 
 the movements were steadily persevered in, accompanied 
 with occasional slappings with the open hand over the 
 back of the chest, and nibbing of the limbs upwards by 
 two assistants. In twelve minutes I first detected indi- 
 cations of returning respiration, and in six minutes more, 
 accurately noted, the breathing was natural. I then 
 made him swallow a little brandy, and saw liim again in 
 half an hour, before I left, perfectly safe. 
 
 " Remarks. — Three months have just elapsed since 
 the short, but excellent rules, from the able pen of Dr. 
 Marshall Hall, for the restoration of the drowned, appeared 
 in The Lancet, and now the second instance of remarkable 
 recovery by their means is recorded. I could conceive 
 no case which could put this new method more severely
 
 114 POSTURAL RESPIRATION IN DROWNING 
 
 to the test than the present one. Every attention had 
 been paid to the man from the moment he was removed 
 from the water — warm blankets, continued rubbing of 
 the body, the application of mustard, the administration 
 of brandy, removal to a warm fire, &c. ; and yet, not- 
 withstanding all this, instead of getting better, he grew 
 worse, and must inevitably in a few minutes more have 
 been beyond all reach of art. And why ? Because his kind 
 and attentive neighbours, although doing their best for 
 him, had been pursuing a plan opposed to his re- 
 covery. 
 
 Three causes evidently operated against the poor man : 
 1st. the attempt to give brandy, which he could not 
 swallow j 2ndly. the carrying him nearly four hundred 
 yards ; and 3rdly. the placing him ^lpon his hack ; all of 
 which, in his enfeebled condition, must have tended to 
 reproduce and prolong the asphyxia. An hour elapsed, 
 postural respiration was tried, under these disadvantages, 
 and in eighteen minutes the respiration was free ! 
 
 " It would be well if the Eoyal Humane Society would 
 withdraw their old " Eules," so liberally scattered about, 
 and replace them with the concise and simple instructions 
 of Dr. Marshall Hall. Ordinary intelHgence and perse- 
 verance, with a knowledge of such rules, I feel certain, 
 would be the means of saving very many lives. 
 
 " I beg also to suggest to my professional brethren 
 this plan for the purpose of resuscitating patients thrown 
 into a critical condition from the administration of chlo- 
 roform. The present method of seizing the tongue with
 
 AND OTHER FOEMS OF APNCEA. 115 
 
 the forceps to pull it forward will be unnecessary, and com- 
 mand over the respiratory organs will be found to be 
 surprisingly great." 
 " November, 1856." 
 
 Case 1Y. — Imjproperly treated— fatal. By Br. A. Begat, 
 
 I am indebted for a second case to Dr. A. Legat — 
 full of the deepest interest and instruction. 
 
 The nttle patient was five years old. He gasped 
 when first rescued from the water, and would surely have 
 been restored by instant postural respiration. Instead 
 of this, the warm-bath was used; the child was lost; 
 at last postural respiration loas tried ; but the state of 
 apnoea had passed into fatal asphyxia ! — a sad commen- 
 tary on a proposition noticed in the foregoing pages. 
 
 " South Shields, June 4th, 1857. 
 
 " Dear Sir,- — As I believe you will be glad to hear 
 some particulars of a case where the " Eeady Method" 
 has been tried by me a second time, although unsuccess- 
 fully owing to previous loss of time in improper treat- 
 ment, I beg to forward you the following notes : 
 
 " When visiting a patient on the evening of the 4th 
 ultimo, a messenger requested me to go with him imme- 
 diately to see a child supposed to be drowned. The 
 house was not a quarter of a mile distant, and as my 
 conveyance was at hand, I saw the little patient within a 
 couple of minutes.
 
 116 POSTURAL EESPIRATION IN DROWNING 
 
 " The room was a small one, and crowded witli 
 neighbours. The child was undressed, the lower extre- 
 mities in warm water, and warm wet blankets were placed 
 over the body, which was quite flaccid. The face and 
 lips very livid, the tongue slightly protruding beyond the 
 teeth ; a little frothy mucus surrounded the nostrils ; and 
 the pupils were considerably dilated. There was no 
 respiration, or pulse. 
 
 " He was carried to the door instantly, and treated 
 after your excellent method. I began the movements 
 precisely at eight, p. m. — continued them steadily for 
 about twenty-five minutes, when Mr. Young, another 
 medical man, arrived. We persisted steadily for one 
 hour and five minutes, when it became so dark, we judged 
 it excusable to desist. 
 
 " During the movements, small quantities of fluid, 
 with some half-digested food, came from the stomach, 
 
 " What had occurred before I saw the boy, I learned 
 subsequently. There was a variety of statements on 
 this point ; but the following one, made by the father, 
 seemed most consistent and correct. The little fellow, 
 five years of age, left his nurse about half an hour before 
 I saw him, accompanied with another child, went to a 
 pond about 100 yards off, and fell in almost immediately. 
 He was supposed to have been in the water fifteen or 
 twenty minutes — was taken out by his father, who said 
 he gave two little gasps — and was conveyed to the house, 
 and placed at once in the warm bath. This occupied but 
 a short time ; but in the meanwhile the little patient was 
 irrecoverably dead !
 
 AND OTHEE FORMS OF APNCEA. 117 
 
 ^' Who can doubt that the boy would have been res- 
 cued by the " Eeady Method/' used instantly by the side 
 of the pond, wliere he gasped ? 
 
 " Believe me, dear Dr. Marshall Hall, yours very 
 truly, 
 
 '' A. Legat." 
 
 *' Dr. MarshaU HaU, F.KS." 
 
 Case Y. — By Ernest P. TFilkms, Usq. of Newport. 
 
 My fifth case is by Mr. Wilkins, of Newport. Though 
 briefly detailed, it is also full of interest : 
 
 " Newport, Isle of Wight, March 18th, 1857. 
 
 " My dear Sir, — I have adopted your discovery in 
 several cases with perfect success. 
 
 '^ A female, aged thirty-two, in a moment of rage, 
 threw herself from a bridge into our river. I was not 
 perfectly satisfied that the asphyxiated condition in which 
 I found her arose from drowning— although it might 
 have done so — because the depth of water was not above 
 the knees. Some of the parties who picked her up said 
 she was not long enough in the water to be drowned ; 
 others said she was drowned. I attributed the apnoea to 
 the shock to the nervous system produced by the fall 
 from the height, from fifteen to twenty feet ; she pitched 
 on the nates ; or to the exposure to cold, it being a bitter 
 night, and she was dragged a long distance in the water
 
 118 POSTURAL RESPIRATION IN DROWNING 
 
 to reach the landing place. It might perhaps arise from 
 combined causes. 
 
 " I was soon on the spot, and in the language of the 
 bystanders found her dead — in other terms, asphyxiated. 
 I commenced your Eeady Method, and continued it for 
 upwards of an hour, with perfect success, to the amaze- 
 ment of her friends who assisted me. 
 
 " The other cases were suspended animation from 
 childbirth, of which so many cases are on record. 
 
 " I shall be happy to reply to any questions on the 
 foregoing case, if you may desire further information. 
 
 " Believe me, with sincere respect, faithfully yours, 
 " Ernest P. Wilkin s." 
 
 " Dr. MarshaU Hall." 
 
 Case VI. — Bi/ Mr. Richard Ellis, of Bishops-AuMand, 
 Bur ham. 
 
 My sixth case is from the able pen of Mr. Eichard 
 EUis, of Bishops-Auckland. It must be a severe case 
 in which convulsion occurs, and great confidence in the 
 means is shown by its second judicious repetition : 
 
 " To the Editor of The Lancet. 
 
 " Sir, — On the evening of the 1st of this month, 
 about seven o'clock, I was called to see a boy who, I was 
 told, had just been taken out of a deep pond, situated in 
 a brickfield near this town. I arrived at the patient's
 
 AND OTHER FORMS OF APNCEA. 119 
 
 house just as they were in the act of carrying liim in, 
 apparently lifeless. He was a thin, delicate child, be- 
 tween seven and eight years of age, and he presented tlie 
 following unpromising symptoms : — Eespiration entirely 
 suspended; action of the heart inaudible; coldness of 
 the entire surface of the body ; pulse imperceptible at the 
 wrist ; great lividness of the face, and turgescence of the 
 superficial veins of the neck. I immediately had the wet 
 clothes removed, and placing the body on a blanket 
 spread on the floor, proceeded to carry into execution 
 the plan recommended by Dr. Marshall Hall for restora- 
 tion in such cases, turning the patient on his side and a 
 little beyond, making pressure pn the spine, and exposing 
 the face and chest to a current of cool air. When I had 
 continued these movements repeatedly each minute for 
 about half an hour (at the same time using friction of 
 the body perseveringly), I was deHghted to hear one or 
 two gasping attempts at respiration ; and in about another 
 half hour, the circulation became so far restored as to 
 admit of his being removed to bed. Here, however, he 
 had a severe attack of convulsions, which continued so 
 long as to compel me to repeat the postural movements 
 for some minutes. The temperature of the body now 
 increased rapidly ; and at the end of two hours from the 
 time of my first seeing him, he became so far restored as 
 to swallow a little, and to be conscious of the presence of 
 his friends. The reaction and consequent fever were 
 moderate, and the boy has now quite recovered from the 
 effects of his accident.
 
 120 POSTUEAL RESPIRATION IN DROWNING 
 
 " From inquiries which I have made since^ it appears 
 certain that the child was submerged for at least Jive 
 minutes, as he had to be extracted from the mud in the 
 bottom of the pond by means of a ladder. 
 
 " I remain, Sir, your obedient servant, 
 
 " Richard Ellis, L.R.C.S. Edin/' 
 
 " Bishops -Auckland, Durham, June, 1857." 
 
 Case YIT.~Ow board the Dreadnought, ly 
 F, M. Corner, Esq. 
 
 " Henry Bullivaul, setat. eleven, fell from a boat into 
 the Thames, immediately became submerged, and was 
 carried by the tide a distance of about one hundred yards, 
 when he became entangled in the moorings of the Dread- 
 nought, ten feet beneath the surface. Allowing the 
 shortest time of submersion, he was under water five or 
 six minutes ; and in three minutes more he was on board 
 the hospital. 
 
 " I saw him directly, and found respiration ceased and 
 his face and lips livid, and he was to appearance dead. 
 I did not examine for the pulse, regarding that of little 
 moment, but at once resorted to the " Ready Method ;" 
 at the same time having his clothes removed, and the 
 body rubbed dry. After two or three rotations, there 
 was an inspiratory effort, succeeded, shortly, by others, 
 at intervals of about half a minute. He soon breathed 
 regularly, but faintly, and at long intervals ; and during
 
 AND OTHER FORMS OF APNCEA. 121 
 
 the intervals I performed artificial respii-atioii^ and occa- 
 sionallj applied strong ammonia to the nostrils, and 
 slapped the chest smartly with my flat hand; all, 
 I am satisfied, with benefit. In about ten minutes 
 he was sensible, spoke, and took a few teaspoonfuls of 
 brandy and water, shortly followed by vomiting of appa- 
 rently Thames water. He now breathed tolerably well, 
 and only complained of cold ; and a hot bath being ready, 
 I placed him in it for two or three minutes, giving him 
 a little brandy. After this, he was wrapped in blankets, 
 a mustard cataplasm applied to the front of the chest, and 
 left. 
 
 " P. M. Corner." 
 
 II. CASE OF SUFFOCATION. 
 
 Case YllI — Of a Man overwhelmed hj the fall of Earth ; 
 communicated by James F. West, Esq. 
 
 " The attention of the profession having been recently 
 called to the mode of performing artificial respiration 
 suggested by that distinguished physiologist. Dr. Marshall 
 Hall, I think it may not be uninteresting to publish the 
 details of a case which, from the severity of its nature, 
 must be considered as an ample test of its merits, as a 
 mode of relieving suspended animation in cases of 
 asphyxia. 
 
 The patient was completely asphyxiated, having 
 been covered by a mass of earth for three-quarters of 
 
 G
 
 122 POSTURAL EESPIRATION IX DROWNING 
 
 an hour ; yet perseverance in this method of treatment 
 sufficed to restore him to a state of safety in a compara- 
 tively short space of time. Prom the notes of the case 
 I have made the following abstract : 
 
 " James S , a stout, plethoric, healthy man, 
 
 thirty-eight years of age, was admitted into the Queer/s 
 Hospital, Birmingham., under the care of Dr. Heslop, at 
 a quarter to one o^ clock in the afternoon, on April 28th, 
 in an almost inanimate state, breathing convulsively and 
 stertorously, the respirations being not more than four or 
 five in a minute, with a scarcely perceptible pulse, the 
 face pale, and the general surface of the body cold and 
 bloodless. 
 
 The history of the case, as obtained from his fellow 
 labourers, was, that while he was engaged, about 
 midday, in constructing a sewer, the earth around him 
 gave way, and he was completely buried to the depth 
 of about ten feet. Twenty minutes elapsed before the 
 soil was removed from around his head, and at least three 
 quarters of an hour before the whole of the body was 
 extricated. A cab having been at once obtained, he was 
 conveyed to the hospital. No appearance of injury on 
 any part being apparent, and there being no such evi- 
 dence as bleeding from the nose or ears to warrant a sus- 
 picion of fracture of the base of the skull, but the sym- 
 ptoms being rather such as might be accounted for by 
 the circulation of non-arterialized blood, I determined to 
 put in practice the Marshall HaU method of artificial 
 respiration. With the assistance of my friend Mr. Mould,
 
 AND OTHER FORMS OF APNCEA. 123 
 
 by whom the most valuable aid was rendered during the 
 entire operation, the man was stripped, cold water was 
 dashed on his head and face, and the postural movements 
 commenced. Hot flannels were applied to the lower 
 extremities, and friction towards the centre of the circu- 
 lation unremittingly kept up. During the first quarter 
 of an hour, but little improvement was visible ; perfect 
 coma existed ; not a sound escaped his lips, and there 
 was not the slightest muscular movement ; hut during the 
 second quarter, a marked amelioration of the symptoms 
 took place. The livor gradually left the lips, and the 
 countenance resumed a more natural aspect ; the pupils, 
 wliich were at first much though equally contracted, be- 
 gan to dilate ; the pulse, though still intermittent, became 
 more frequent and regular ; an attempt at vomiting was 
 made, but nothing but a little water containing gritty 
 matter was thrown up ; and lastly, he began to move his 
 arms spasmodically, and by the action of the muscles of 
 forced inspiration to endeavour to dilate his chest. At 
 the end of three quarters of an hour, the pupils were in- 
 tensely dilated ; the skin had become warm ; inarticulate 
 sounds began to escape his lips ; and the muscular move- 
 ments were stronger and more frequent. 
 
 The breathing, which was still laborious and ster- 
 torous, almost ceased, when the patient was laid on his 
 back, and the artificial respiration discontinued. 
 
 " The Read?/ Method loas unceas'ingly kept njjfor an 
 hour and a half; and at the end of that period the re- 
 spiration was performed naturally, though slowly, and 
 
 G 2
 
 124 POSTURAL EESPIRATION IN DrvOWNING 
 
 with some difficulty. The skin was hot, the face flushed, 
 the vessels of the conjunctiva injected, the veins of the 
 head and neck turgid; the pulse had risen to 70, but 
 was perfectly regular. 
 
 " The patient was then placed in bed, and held in 
 the recumbent posture by two assistants, as he was very 
 violent, and restraint was imperatively called for. Vene- 
 section to the amount of twelve ounces was now per- 
 formed ; the blood, which came in a good stream, was 
 quite black, but became florid on exposure to tlie air. 
 The respiration was much relieved by this procedure, and 
 subsequently took place with greater regularity, less 
 stertor, and diminished efl'ort. He still continued to 
 writhe about in bed; but his efforts were much less 
 violent : warmth was kept up by hot blankets, &c. To- 
 wards eight, p, M. the breathing again became slow and 
 laboured, and the pulse fuller and more frequent. By 
 the advice of Dr. Heslop, twelve leeches were applied to 
 the temples, and the bleeding encouraged by hot fomen- 
 tations. Respiration was now performed very cjuietlj 
 and regularly ; the pulse was natural ; but there was no 
 sign of consciousness, and he lay apparently in a state of 
 stupor, muttering incoherently at intervals, and picking 
 the bed-clothes. About nine p. m. he passed a stool in- 
 voluntarily. At eleven p. m, an enema, containing half 
 an ounce of turpentine, two ounces of castor oil, with 
 half a pint of gruel, was administered, and followed by a 
 copious evacuation. 
 
 " The patient slept pretty soundly during the re-
 
 AXD OTHER FORMS OF APNCEA. 125 
 
 mainder of the night, and on awaking, about eight in the 
 morning, he recognized his wife, who was standing bj 
 his bedside, though he was unable to answer questions 
 pertinently, and remained in a state of semi-conscious- 
 ness during the rest of the day. He continued heavy 
 and lethargic, complaining considerably of headache, dur- 
 ing the two following days ; and he was not perfectly 
 rational till Saturday, May 2nd, when, his state being 
 such as to warrant his discharge, he was permitted to 
 leave the hospital/' 
 
 IIT. CASES OF STILL-BORN- INFANTS. 
 
 Case IX. — By Marshall Sail Higginhottom, Esq. 
 of Nottingham, 
 
 The following case possesses a peculiar value, on 
 account of the accuracy with which it was observed ; and 
 especially from the fact, first noticed by the author, of 
 bubbles of mucus blown out and drawn into the nostrils 
 — a sort of natural Pnceometer. It was particularly 
 noticed afterwards by Mr. Charles Yaudin and Dr. Ni- 
 cholls. It is of great moment to be able to observe that 
 there really are expiration and inspiration in pronation 
 and rotation ; for it is of vital importance to know that 
 the air-passages are/r^^ ; 
 
 " Carltoa Street, Nottingham, Dec. 21st, 1856. 
 
 " ^ly dear Uncle, — ^ ^ ^ ^ Early this morning I 
 attended a lady in her confinement. The presentation
 
 126 POSTURAL RESPIRATION IN DROWNING 
 
 was a breecli one, and there was much and unavoidable 
 pressure upon the umbiHcal cordj which ceased to pulsate 
 a quarter of an hour before the child was born. When 
 born, the child was quite livid, without perceptible move- 
 ment of the heart, and indeed to all appearance dead; 
 and, under ordinary circumstances, I should not have 
 entertained the slightest hopes of its resuscitation. 
 By adopting your method, I had the great satisfaction of 
 seeing it fully restored to life in about twenty minutes, 
 when it cried lustily — the nurse and friend being amazed 
 at the result. Being the only son in a large family of 
 daughters, the parents' delight was proportionately great. 
 I explained to the father that he had to thank you for a 
 living son. •5«- -^ -^ -^ 
 
 " Believe me, my dear Uncle, your affectionate 
 nephew, 
 
 " Marshall Hall Higginbottom." 
 
 " Dr. MarshaU HaU." 
 
 " Carlton Street, Dec. 25th, 1856. 
 
 " My dear Uncle, — I lose no time in sending you a 
 more particular account of the phenomena observed in 
 the case of the still-born infant which I mentioned to 
 you. 
 
 " The child was livid, and the lips purple, and there 
 was no perceptible action of the heart. 
 
 " Upon commencing the postural treatment, I noticed 
 that with each induced expiration a quantity of air, de- 
 noted hy buhbles of tenacious frothy mitcus, issued from
 
 AND OTHER FOUMS OF APNCEA. 127 
 
 nostril, the huhhles receding on induced inspiration. 
 I saw the necessity of this mucus being removed eacli 
 time, in order to allow the free entrance of air, respira- 
 tion being apparently carried on entirely through the 
 nostrils ; for although there was mucus also between the 
 lips, it was not at all disturbed during the postural 
 changes. 
 
 '^ Continuing the treatment for about ten minutes, 
 the mucus ceased to flow, and a very slight action of the 
 heart became perceptible. This ceased, if there was any 
 remission of the treatment ; but returned when the pos- 
 tural proceedings were renewed. 
 
 " In fifteen minutes the action of the heart became 
 stronger, and dashing cold water upon the face and chest 
 now produced a forcible inspiration ; after which, and for 
 the first time, respiration appeared to be carried on 
 through the mouth. 
 
 " The countenance, which had gradually become less 
 livid, now assumed a natural appearance, and in twenty 
 minutes the child was quite restored, and cried vigor- 
 ously. 
 
 " Your affectionate nephew, 
 
 " Marshall Hall Higginbottom.'^ 
 
 " Dr. MarshaU Hall."
 
 128 POSTURAL EESPIRATION IN DROWNING 
 
 Case X. — By Charles Vaudin, Esq. of St. HeUer's, 
 Jersey. 
 
 " 60, ^ew Street, St. Helier's, Jersey, Feb. 10th, 1857. 
 
 '' Dear Sir, — Truly has it been said that medicine in 
 judicious hands is the handmaid of Nature. 
 
 " As truly may it be said that your thoughtful and 
 ingenious application of great principles and natural laws 
 to the treatment of diseases and accidental exigencies 
 must be ranked amongst one of the greatest discoveries 
 of modern medical science ; for they have, since the short 
 period of their first promulgation, been the means of 
 saving many lives that would have been otherwise lost. 
 
 " The enclosed I have thought worthy of record, as 
 exemplifying in a remarkable degree the truth of the 
 princijolej as well as the success, of the " Marshall Hall 
 Method." 
 
 " The desire of adding testimony to a great truth, 
 which, like all others, is too slow in being received and 
 appreciated, and the wish of seeing honour given to whom 
 it is due, are the only apologies I have to offer for ad- 
 dressing you. 
 
 " Believe me to be. Sir, yours very truly, 
 
 " Charles Yaudin, M.R.C.S. &c." 
 
 " Dr. Marshall Hall." 
 
 " Mrs. D , a lady of exceedingly delicate consti- 
 tution, aged twenty-six, was taken in labour of her second
 
 AXD OTHER POKMS OF APXCEA. 129 
 
 child on the second of January, at seven a. 5r. She had 
 suffered trifling pains two days before, and had not felt 
 the motion of the child since they commenced. I saw 
 her at nine, and found her then suffering from frequent 
 but ineffectual pains. The vagina and external parts 
 were hot and dry ; the os uteri dilated to the extent of a 
 shilling; its lips thin, dry, and umielding; membranes 
 entire; and head presenting. A careful stethoscopic 
 examination of the abdomen failed to detect any sounds 
 of the foetal heart. The pelvis was small, but not de- 
 formed. 
 
 " At seven a. m. on the 3rd, I delivered her of a 
 delicate male child. Around its neck were two folds of 
 the funis, in which I could not detect the slightest pul- 
 sation. It was cut and lightly ligatured. The surface 
 was flaccid, cold, and very livid ; the lips blue ; the palms/ 
 soles, and a small surface over the nates, were quite sod- 
 den, and partially exfoliated. Entire absence of all 
 reflex action. The pupils were insensible to light, the 
 nose to ammonia, and there was not the slightest appre- 
 ciable motion in the prsecordial region. The usual reme- 
 dies, except sufflation and the hot bath, were tried with- 
 out success. Suspended animation could hardly be more 
 pronounced or akin to death. 
 
 '' The " Marshall Hall Metliod" I persevered in for 
 twenty-six minutes, accurately noted by my watch before 
 me. The postural movements were made upon warm 
 blankets frequently changed. Then the funis began to 
 bleed ; about one drachm of blood was lost, and it was
 
 130 POSTURAL RESPIRATION IN DROWNING 
 
 secured. The countenance had before this undergone a 
 marked change, had become mottled and red. My ob- 
 servations of the respiratory action coincided exactly with 
 Mr. M. H. Higginbottom^s ; viz. " with each induced 
 expiration, a quantity of air, denoted by bubbles of a 
 tenacious frothy mucus, issued from each nostril, the 
 bubbles receding on induced respiration." I could now 
 distinctly discover a slight fluttering action of the heart. 
 After twenty- nine minutes, and following an induced ex- 
 piration, I noticed a tremor of the skin and muscles over 
 the epigastrium, followed by a sudden voluntary inspir- 
 ation, the chest becoming forcibly distended and fixed, 
 renderinsj its diaphragmatic boundary tense, and, as well 
 as itself, resonant as a drum all over. The chest re- 
 mained in this fixed position for nearly two minutes, the 
 intercostal muscles being very prominent, the postural 
 motions still going on, and I began to think all my efforts 
 ended here, when the child made a voluntary expiration, 
 attended by a cry ; the movements and frictions were 
 made with redoubled energy, and I soon had the gratifi- 
 cation of hearing the infant (;ry loudly enough, and 
 breathe alone, as well as empty its bladder vigorously, 
 thirty-three minutes having elapsed. The door and a 
 window of the room were kept open, and the process 
 carried on near the former, to ensure a supply of fresh 
 air. The child has been subsequently dry nursed, and is 
 doing well."
 
 AND OTHER rORlIS OF APNCEA. 131 
 
 Case XI. — By Dr. Nicholls, of Wiveliscomhe, Somerset, 
 
 " "Wiveliscombe, Somerset, Feb. 6th, 1857. 
 
 " Dear Sir, — With much pleasure and satisfaction I 
 send you a very short account of a case of asphyxia in a 
 new-boin infant, treated by youj invaluable plan. 
 
 " On Tuesday, Tebruary 3rd, at four p. m. I was 
 called some miles, through frost, snow, &c. to a poor 
 woman who had been in labour three days, and who, 
 strange to say, out of eight labours, has five times had 
 arm presentations, and twice placenta prsevia. I found 
 part of the placenta and both arms presenting, and, after 
 very great exertions, delivered her by turning of an appa- 
 rently dead child. Por three or four minutes I was so 
 much engaged with the mother, who was in a state of 
 great prostration, that the child was not attended to. I 
 then treated the child on your plan, although with very 
 faint hopes of success ; but after rather more than half 
 an hollies exertions, much to my satisfaction, and to the 
 nurse's and mother's astonishment, circulation and respir- 
 ation were as strong as I ever saw in a new-born child. 
 I feel quite sure that hot water, friction, brandy, &c. 
 would have been useless in this case. 
 
 " Mr. M. H. Higginbottom's case was very much 
 like mine ; as I noticed the frothy mucus which came 
 from the nostrils ; and this gave me great trouble, as the 
 nurse would give me no help in a case which she thought 
 hopeless. I may add that I saw the little patient this
 
 132 POSTURAL RESPIRATION IN DROWNING 
 
 morning, and she is as strong as any child of three days 
 old. 
 
 " The weather was very cold, and I quite think with 
 you that cold protracts latent vitality, and gives you a 
 greater chance in these cases. 
 
 " I am, dear Sir, yours very truly, 
 
 " James Nicholls, M.D." 
 
 ♦' MarshaU Hall, M.D. F.R.S." 
 
 Case XII. — B;y J. T. Savory, Esq. of Wendover, 
 
 " To the Editor of The Lancet. 
 
 " Sir, — If you think another case of asphyxia, suc- 
 cessfully treated by the " Marshall Hall method," worthy 
 of notice, please to give it a corner in your widely circu- 
 lated journal. 
 
 " At three o^clock- a. m. on December 29th, I was 
 called to a case of placental presentation. On arriving 
 at the house of my patient, I found her in an alarming 
 state of syncope, from excessive hsemorrhage. I imme- 
 diately attempted delivery by turning ; the child (a boy) 
 being large, I had a good deal of difficulty in liberating 
 the head from its pelvic prison, some considerable time 
 and much exertion on my part being required, the mother 
 having no uterine pains to assist in the expulsion. 
 
 " When the child was born, I observed it was per- 
 fectly asphyxiated ; but my chief anxiety being to do all 
 I could for the mother, my. attention was not directed to
 
 AND OTHEE FOEMS OF APXCEA. 133 
 
 the infant for several minutes. It then appeared quite 
 inanimate. However, thinking it a good opportunity to 
 try " Dr. Marshall IlalFs method" in cases of asphyxia, 
 I proceeded according to the plan laid do^^qi by him, and 
 after persevering unremittingly for a quarter of an hour, 
 the child gave a slight and short inspiration; and in 
 three minutes more, another inspiration took place; after 
 this, the infant breathed once in a minute for a short 
 time, and then more frequently and deeply ; at length he 
 opened his eyes ; and at the expiration of half an hour, 
 he breathed freely, and cried as strongly as a healthy 
 child. 
 
 '^ Two female friends of the patient were present, and 
 they frequently expressed a positive opinion that it would 
 be perfectly useless to continue any attempts at resusci- 
 tation, the nurse at the same time exclaiming, " Ah, Sir, 
 you may turn and twist that child about as much as you 
 like, but you will never bring it to life." Their surprise 
 was great indeed when at length the child began to show 
 signs of animation. 
 
 " I take to myself no credit in the treatment of this 
 case, being merely an humble follower of the scientific 
 and valuable directions given by Dr. ^larshall Hall. 
 
 " I am, Sir, your obedient servant, 
 
 " J. T. Savory." 
 
 " "Wendover, January, 1857."
 
 134 POSTURAL RESPIRATION IN DROWNING 
 
 Case XIII. — By J. C. diappell, Esc[. George Street, 
 Hanover Square, 
 
 The interest attached to the present case is in the 
 fact of the infant being born prematurely, at six months 
 and a half. It was restored to Ufey even although scarcely 
 likely to live : 
 
 " The child was stiU-born ; no pulsation at the wrist 
 or beating of the heart to be detected. I pursued your 
 plan steadily for fifteen minutes (the nurse evidently 
 thinking me a lunatic) ; at the end of which time, I found 
 the heart beat, and, in five minutes more, heard as loud 
 a cry as could be expected from a 6i-months' child. 
 The infant still lives ; but that it may be reared, appears 
 very improbable. 
 
 " I found no difficulty whatever in appljdng the 
 postural changes to the infant in question ; in fact, its 
 diminutive size rendered the operation easier j a second 
 person performed the frictions upwards. 
 
 " I commenced by clearing the mouth and fauces of 
 mucus, which abounded and afterwards came away in 
 considerable quantities. The child, at its birth, had a 
 dusky hue. Tor thirteen or fourteen minutes, I found 
 no sign of vitaHty ; but in one or two minutes more, I 
 felt a slight quiver under my right hand (which grasped 
 the left side of the chest), and almost simultaneously 
 heard a mucous rattle in the throat ; an instant after, I
 
 AND OTHEIl FOEMS OF APNCEA. 133 
 
 could discern pulsation of the heart. I again cleared 
 the mouth and throat of mucus, continued the postural 
 movements, and, at the expiration of four or five minutes 
 more, tlie infant gave a cry as loud as could be expected, 
 considering it was at most a seven months' child." 
 
 ADDITIONAL CASES. 
 
 Case XIV. 
 
 " Bognor, Sussex, January, 1857. 
 
 " Dear Sir, — Having read in The Lancet your valu- 
 able method for the restoration of the drowned, I resolved 
 to try it in the first case of suspended animation which 
 might come under my care. 
 
 " On the 26th of December last, I was called to 
 
 attend Mrs. , in labour with her first child ; and on 
 
 making an examination, I found the operation of turning 
 was required, which I performed. When the child was 
 born, I found it was perfectly asphyxiated. I imme- 
 diately commenced your resuscitation process, and having 
 continued it for about ten minutes, the nurse observed 
 (to use her own words), " Ifs no use your trying any 
 longer. Sir; it\s dead enough." 
 
 " Being determined to give the process a fair trial, 
 I continued it for about twenty minutes, when the child 
 gave evidence of life, and shortly after cried out ; respir- 
 ation was established. The child lived fourteen days, 
 and died from debility, the woman not having gone her
 
 136 POSTUEA.L RESPIRATION IN DHOWNING 
 
 full time ; wliicli tends to strengthen the superiority of 
 your process over every other for the restoration of still- 
 born children. 
 
 " I make no apology for sending you this case, be- 
 lieving that you will be pleased with the successful treat- 
 ment of it, for which 1 am indebted to you. 
 
 " I am, Sir, your obedient servant, 
 
 " Charles Osborn, M.E.C.S." 
 
 " MarshaU Hall, Esq. M.D." 
 
 Case XY. 
 
 " To the Editor of The Lancet. 
 
 " Sir, — Considering it the duty of all who have tried 
 with success Dr. Marshall Hall's method for recovering 
 new-born infants in whom all respiration has ceased, to 
 communicate the result of their experience to the public, 
 I am induced to forward the following case : 
 
 " Last Sunday morning, I was called to attend Mrs. 
 
 M , in labour. After a short time, the child was 
 
 born, and duly handed over, alive and apparently well, 
 to an attendant. For some time I was rather anxiously 
 engaged with my patient, who was very much disposed 
 to haemorrhage (from which she suffered seriously after 
 her last labour). Having seen every thing right and 
 safe with her, I was attracted by the quietness of the 
 infant, when, upon looking at it, I found all respiration 
 had ceased. I instantly commenced Dr. Marshall HalFs
 
 AND OTHER FORMS OF APNCEA. 137 
 
 methoci, with the happy result, in ten minutes, of deUver- 
 ing up to the friends the infant ahve and crying. 
 
 " Apologizing for trespassing on your columns, I aiii, 
 Sir, your obedient servant, 
 
 '' H. S. Chavasse." 
 
 " Sutton Coldfield, Jan. 19tli, 1857." 
 
 Case XVI. 
 
 " Winslow, Bucks. January 30, 1857. 
 
 " Sir, — A case occurred in the practice of Mr. Denne, 
 in this town, last night, illustrating the great advantages 
 of your Ready Method. In a case of confinement, after 
 a very lingering time, the delivery was completed by 
 forceps. When the child was born, there was an im- 
 mense scalp-tumour, and the usual symptoms of pro- 
 longed asphyxia were present — so much so as to cause 
 a doubt in my mind whether even your Ready Method 
 would perforin almost a miracle, and resuscitate the 
 child. 
 
 " However, I placed the child in the prone position, 
 and then commenced turning it with the right hand on 
 the side of the chest, the left supporting the head. The 
 movement was repeated about once in a second (such as 
 is marked by the penduhim of a large clock), and after 
 its repetition about twenty-three times, I had the satis- 
 faction of hearing a cry, at first faint, but not by any 
 means so afterwards:
 
 138 POSTURAL RESPIRATION IN DROWNING 
 
 " The time which elapsed from the first movement to 
 the cry was about seven or eight minutes ; and I may 
 add, that the cord was cut prior to the child being 
 touched, and that no other means whatever were tried 
 but the rotatory motion. The astonishment of the women 
 around the bed was excessive, and they firmly believe 
 that a method will be found almost to return the dead to 
 life. The child is alive and well, and adds another name 
 to the list of lives that have been, and will be, saved by 
 the Eeady Method. 
 
 " I have the honour to be. Sir, your obedient servant, 
 
 " Thomas Newham.'' 
 
 " MarshaU Hall, M.D." 
 
 Case XVII. 
 
 " To the Editor of The Lancet. 
 
 " Sir, — Within the last three weeks, I have had two 
 opportunities of trying the Eeady Method in the asphyxia 
 of newly born infants. One was a case of turning, on 
 account of arm-presentation ; the other was a presenta- 
 tion of the breech. In both instances, the heart's action 
 was barely perceptible ; no pulsation could be felt in the 
 cord, and no inspiratory effort could be detected. After 
 rotating the trunk five or six times, inspiration com- 
 menced, and in a short time respiration became fully 
 established, so that the children were able to cry vigor- 
 ously. I purposely abstained from using any other means
 
 AND OTHER FOUMS OF APNCEA. 139 
 
 of resuscitation. My experience of these two cases would, 
 as far as it goes, lead me to consider Dr. Marshall HalFs 
 method as far more prompt and effectual than any of the 
 means which we had previously been accustomed to use. 
 " I am, Sir, your obedient servant, 
 
 " J. G. SWAYNE, 
 
 " Physician- Accoucheur to the Bristol General Hospital, 
 and Lecturer on Midwifery at the Bristol Medical School." 
 
 " Clifton, March, 1857." 
 
 Case XYIII. 
 
 " Gainsborough, Feb. 7th, 1857. 
 
 " Sir, — I have much pleasure in adding another to 
 the list of lives saved by your valuable discovery. The 
 facts of the case are as follow, and in some respects simi- 
 lar to one reported in to-day's Lancet : 
 
 " I am assisting a practitioner in this town, and on 
 Thursday evening last, the 5th instant, I was called to a 
 woman in labour at the workhouse. On my arrival, at 
 half-past eight p. m. I found the head presenting, and 
 with it a loop of the funis, the pulsation of which had 
 entirely ceased. I found it impossible to replace it, and 
 in half an hour the woman was delivered of a child appa- 
 rently quite dead. The usual means failing to restore it, 
 I at once commenced the Eeady Method. After ten 
 minutes^ trial, the child gave a feeble gasp, and it con- 
 tinued to do so at every ten or twelve turns. The inter-
 
 140 POSTURAL RESPIRATION IN DROWNING 
 
 vals between these respiratory movements soon became 
 shorter and shorter, and in half an hour it breathed of 
 its own accord. It appeared, however, in a semi-comatose 
 state for some time, and was three hours before it became 
 warm and could move its limbs. Even then, the heart 
 beat very feebly, and at only half its normal frequency at 
 birth ; and it did not entirely recover until six o'clock 
 the following morning. At the present time the child is 
 doing well, and is as likely to live as any other new-born 
 infant. 
 
 " Should you desire more minute particulars, I shall 
 be happy to furnish them, and am. Sir, yours faithfully, 
 " Edward Capron, M."R.C.S. & L.S.A." 
 " Marshall HaU, M.D. F.E.S." 
 
 Cases XIX and XX. 
 
 "17, Paddington Green, Feb. lOth. 
 " Dear Sir, — I take the liberty of communicating to 
 you two cases in which your Eeady Method was em- 
 ployed with perfect success. In the first case, the child 
 had been born suddenly ; for nearly ten minutes before 
 my arrival, tlie umbilical cord was twisted round its neck, 
 and the soiled clothes of the mother completely smo- 
 thered it. The usual remedies of dashing cold water, &c. 
 failed to restore it, and after five minutes your Ready 
 Method was employed. In a few minutes the child 
 gasped, and eventually slowly recovered.
 
 AND OTHER FORMS OF APXCEA. 141 
 
 " The second case was a nates presentation in a 
 primipara : the head occupied seventeen minutes in 
 passing; there was great li\ddity in the face and neck, 
 and no pulsation could' be detected in the heart or cord. 
 Perseverance with the Keadv Method for several minutes 
 was crowned with success. The child is now nearly two 
 months old. 
 
 ^' 1 certainly think that in the " olden time" these 
 cases would have been turned over to the sexton. 
 
 " I am yours obediently, 
 
 '' J. S. Beale. 
 
 " Dr. Marshall Hall." 
 
 Case XXI. 
 
 " Detroit, Michigan, U. S. April 1st, 1857. 
 
 ^' On the ISth of January last, I was called to a 
 young married woman, in her second conhuement. The 
 presentation was a footling one; and previous to the 
 birth of the child, all circulation in the funis had ceased 
 for over twenty minutes, from the pressure exerted upon 
 it between the parts of the mother and the head of the 
 foetus. Upon expulsion there was com])lete asphyxia. 
 The face, lips, &c. were perfectly blue, and there was not 
 the slightest sign of animation. Without waiting to cut 
 or tie the funis, I immediately adopted the postural 
 method recommended by you, inducing artificial respira- 
 tion, causing that act to be performed about twenty to
 
 142 POSTUEAL RESPIRATION IN DEOWNING 
 
 twenty-two times in the minute. In less than one 
 minute, the blueuess of the face and extremities had sen- 
 sibly diminished ; in two minutes, it had nearly gone ; 
 in two minutes and a half, a slight etfort at natural re- 
 spiration, accompanied by a sob, took place ; and in less 
 than three minutes and a half, respiration was fully esta- 
 bHshed, the child crying lustily. Only one hour elapsed 
 from the time I entered the house till mother and infant 
 (a fine, stout boy) were both comfortable and doing welL 
 " I conceive it to be the duty of every one who has a 
 case of this kind to report it to you, so that an accumu- 
 lation of proof of the efficacy of this beautiful life-giving 
 process may at once be made universally known to the 
 professional as well as non-professional world. 
 
 " William Cowan, ]\Lr.P. & L.G." 
 
 Case XXII. 
 
 " Hamilton, Canada, West, March 20th, 1857. 
 ^' Sir, — On the 24th of August last, soon after read- 
 ing your first paper in The Lancet, I had an appalling 
 case of placenta prsevia. Haemorrhage continuing after 
 the birth of the child, extraction of the placenta neces- 
 sarily preceded attention to the infant, who was about 
 being removed as dead by the nurse, who had tied and 
 cut the cord. It occurred to me, fortunately, to try your 
 method, believing it applicable to the case of apnoea before 
 me; and after persevering for at least ten minutes,
 
 AND OTHER FOEMS OF APXCEA. 143 
 
 respiration was fairly established, to the astonishment 
 and delight of all present, and the child is now a fine 
 thriving boy. Since then, in two cases of still-born 
 children, though not so hopeless, I have easily succeeded 
 in restoring animation by the same method. 
 
 " H. Cragie." 
 
 '' Be Marshall Hall." 
 
 Case I. — Of Banger from Chloroform — restored 
 hy Charles Hunter J Esq., of St. George's- 
 
 Life, in the following case, was preserved by Mr. 
 Hunter^s promptness and energy. I cannot say how 
 deeply I feel indebted to that gentleman for this and 
 many other instances of his invaluable aid in this inquiry. 
 
 "On the 28th of January, 1857, I was asked to 
 assist at the operation of tenotomy, in a little boy about 
 four years old. Chloroform was administered, and every- 
 thing went on well. The operation was concluded ; they 
 had ceased giving cliloroform, when suddenly the child 
 became perfectly pallid, and apparently lifeless ; res])ira- 
 tion had ceased. AYarm water, cold water, slapping on 
 the face, were had recourse to ; none of these excited 
 respiration in the least. Pressure on the sides of the 
 chest was tried, the child remaining in the supine posi- 
 tion. This attempt to produce artificial respiration was 
 no more effectual than the previous efforts to excite re- 
 spiration had been.
 
 144 POSTURAL RESPIRATION IN DROWNING 
 
 " The child was now quickly placed in the p^one po- 
 sition, and slight pressure was made on the back ; then 
 rotation on to the side and a little beyond was effected. 
 A gasping movement of the mouth followed. The pro- 
 nation and semi-rotation were repeated three or four 
 times, when respiration was distinct; but being still 
 feeble, semi-rotation and pronation were continued a few 
 more times, with much improvement in the respiration. 
 The inhalation of ammonia with a httle sprinkling of 
 water were employed; the latter now excited inspiration. 
 They were repeated occasionally till the child showed that 
 it had regained the full power of its lungs by crying, and 
 it was then given into the mother's arms. 
 
 " In this case it may be remarked that the Ready 
 Method was not adopted at the very beginning ; it might 
 not have been necessary, and we should not have been 
 able to prove that it was. The case was, however, far 
 otherwise.. To the pale and apparently lifeless child 
 various excitants of respiration w^ere applied without 
 effect; also artificial respiration was employed in the 
 sujpine position, by the lateral compression of the thorax. 
 This was not attended by the slightest success, and why ? 
 Dr. Marshall Hall has shown that the tongue may fall 
 back, and that fluids may accumulate in the pharynx and 
 obstruct the orifice of the larynx in this position. If the 
 patient is to breathe again, the only remedy is to cause 
 the fluids to flow out, and the tongue to fall forwards ; 
 and this, it appears to me, can only be efi'ected by the 
 prone and postural method.
 
 AXD OTHER FORMS OF APNCEA. 145 
 
 " I once saw a patient in one of the London hospitals 
 die under chloroform, before the operation for which it 
 was the preparation could be commenced. In that case, 
 I saw excitants of respiration employed ; I saw meclia- 
 nical attempts made to restore respiration in the supine 
 position, by lateral compression and relaxation of the 
 thorax. Up to this point, the case closely resembles the 
 preceding one. Both failed thus far. The patient, a 
 Vv'oman, died (the Ready Method was not tlien known). 
 Galvanism was applied, and there was nothing else to 
 try. But in the case of the little boy it was known — it 
 was tried — he was saved. 
 
 " I will only add this : chloroform constantly makes 
 patients sick during and after its administration. Tsow, 
 whether matters are really vomited or not, may it not be 
 that attempts at artificial respiration in the supine posi> 
 tion (in asphyxia from chloroform) have sometimes failed 
 because of the obstruction of the larynx and glottis by 
 the regurgitation of fluids from the stomach into the 
 pharynx? May not even the spasmodic cough which 
 occurs be due to irritation from the presence of these 
 '' foreign matters ?" Is not, therefore, the Beady Method 
 specially indicated in these cases ? for how can any posi- 
 tion but the prone remove these life-destroying liquids 
 and morsels ? 
 
 " I once attempted to resuscitate a still-born child. 
 I had a hot-bath ready, and dipped the infant in and out. 
 I tried other means of inducing respiration. Knowing 
 at that time no better way of effecting this, I applied my 
 
 H
 
 146 POSTURAL RESPIRATION IN DROWNING 
 
 mouth to its mouthy whilst it was in the supine position. 
 I inflated the lungs certainly by the force I employed ; I 
 tried also lateral compression and relaxation of the thorax. 
 Every time I ceased inflating the lungs, thick grumous 
 fluid freely escaped from the mouth. My efforts were 
 useless, and I now believe I blew much fluid with air 
 into the lungs, existing as it did in the pharynx and 
 mouth. 
 
 " In cases of drowning, in still-born infants, in cases 
 where chloroform has caused asphyxia, fluids more or 
 less tenacious, according to circumstances, do, then, 
 obstruct the glottis ; and in such cases no attempt to 
 restore respiration can be effectual till the prone position 
 has removed the obstruction." 
 " Feb. 1857." 
 
 Case II — Of Banger from CJiloroform, 
 1)1/ JFm. Curran, Esq. 
 
 " To the Editor of The Lancet. 
 
 "Sir, — Admiring the zeal and perseverance with 
 which The Lancet continues to advocate that interesting 
 discovery of Dr. Marshall Hall, which is, I believe, from 
 its simplicity and readiness, likely to supersede the means 
 hitherto employed for the relief of apnoea, and which, in 
 consequence, has been so appropriately termed the 
 "Marshall Hall Method," I wish to communicate a 
 notice of the following case, in which it was practised
 
 AND OTHER FORMS OF APXCEA. 147 
 
 with immediate benefit^ and to recommend its adoption 
 under similar circumstances. 
 
 '''Tiios. r , aged 54, labourer, a thin, spare man, 
 
 of weakly habit, languid circulation, and having well- 
 marked arcus senilis of both eyes, was brought to this 
 hospital on the 6th of April, having just sustained com- 
 pound fracture of one toe (which was soon after removed), 
 and such contusion and injury of the other, especially of 
 the large one, as to impair its vitality, and lead to the 
 supervention of sloughing and partial denudation of bone. 
 
 '' Gangrene destroj^ed the whole of the upper hori- 
 zontal half of the great toe. Mr. de Meric, therefore, 
 had to operate in such a way as to turn up the extremity 
 of the lower horizontal half towards the dorsum of the 
 toe to a point where some skin had been left, a portion 
 of the plantar aspect becoming anterior and superior, the 
 toe being thus newly capped after the removal of the last 
 phalanx. The patient was put under the influence of 
 chloroform in the ordniary way, and kept in a state of 
 unconsciousness for about, or perhaps somewhat longer 
 than, the usual period, without manifesting any peculiar 
 susceptibility, or other symptom of a suspicious nature, 
 until after the toes were dressed and preparation made to 
 remove him to bed. At this time, the breathing rather 
 suddenly fell, and became almost imperceptible; the 
 chest-play was so limited and imperfect, and the 
 pallor of countenance so expressive of prostration and 
 approaching syncope, as to require douching, sufflation, 
 pressure over diaphragm, and other means. These not
 
 148 POSTURAL RESPIRATION IN DROWNING 
 
 influencing the respiration, Mr. de Meric seized him by 
 the body, while I held the head, and turning him alter- 
 nately on his side and chest, soon produced the desired 
 result ; the very first turn being accompanied with a puff, 
 which gradually became more whiffing and prolonged, 
 was followed by a muffled groan, and ultimately termi- 
 nated in deep and tranquil breathing. 
 
 " The change was so rapid and obvious as to attract 
 our immediate attention, and impress us with the con- 
 viction of its extreme value and necessity in cases of 
 tlireatening asphyxia from chloroform, drowning, or other 
 analogous cause. 
 
 " I am. Sir, very respectfully, 
 
 '' Wm. Curran.'-' 
 
 " Royal Free Hospital, May, 1857." 
 
 Note III. — Case of Danger from Chloroform. 
 
 "Chloroform was administered to a man affected 
 with strangulated hernia, to prepare him for the opera- 
 tion; asphyxia was produced; neither respiration nor 
 pulse was perceptible ; pronation and rotation, frictions 
 of the limbs upwards, the inhalation of the vapour of 
 ammonia — all the measures comprised in the 'Eeady 
 Method,^ in a word, were effectually administered ; the 
 patient recovered, and so recovered that the operation 
 was performed."
 
 AND OTHER FOEMS OF APNCEA. 149 
 
 Note on the Fatal Case of Chloroform, 
 ly Janies Paget, Esq. 
 
 I do not think medical records contain anything 
 more admirable for prompt candour and intrinsic value 
 than Mr. Paget's case of a fatal result from the adminis- 
 tration of cliloroform. The case is as follows : — (1 have 
 marked in italics those words to which I would draw 
 particular attention.) 
 
 " The patient was a boy, nine years old, of delicate 
 constitution, and of nervous, timid disposition ; but with 
 no indication of any organic disease, except that for 
 which the operation was to be performed — namely, a 
 tumour of the scapula ; for which it was proposed to 
 remove the greater part of that bone. 
 
 " At half-past eight, A.ir., on February 28th, after 
 the patient had passed a night of sound sleep, the chlo- 
 roform was first administered in a room adjoining tliat in 
 which the operation was to be performed. He was 
 alarmed at the thought of being put to sleep, and of 
 what would then be done, and was very averse from 
 taking cliloroform ; but he was persuaded to inhale it ; 
 and, though not without resistance, yet with less than is 
 commonly made by patients of the same age, he was 
 brought under its full influence in about tliree minutes. 
 He sat in bed during the first few inspirations, and after 
 these, was recumbent. It was obseved that two or three, 
 deep inhalations were quickly followed by complete insen-
 
 150 POSTURAL RESMIUTION IN DROWNING 
 
 sibility; and the next few inspirations were stertorous. 
 He was at once carried, in the horizontal posture, into 
 the room, and laid on tlie table arranged for the oper- 
 ation. 
 
 " Three or four minutes passed while we were ar- 
 ranging his position and his dress, and while I was 
 pointing out to those who were to assist me the proposed 
 plan of operation. During this time the influence of the 
 chloroform so far passed ofp, that he became sensible, 
 displaced his coverings and pillows, said something ex- 
 pressive of discomfort, and vomited a small quantity of 
 frothy fluid, (He had taken no food since the previous 
 night, when he had had a good supper.) A very small 
 (juantity more of chloroform was slowly inhaled, and he 
 became again nearly quiet, and was again placed on his 
 side. I was on the point of commencing the operation ; 
 but as he again, by movements, indicated some degree of 
 sensibility, and changed his posture, about forty drops 
 more of chloroform were poured on cotton wool, in- 
 closed in a fold of lint — an inhaler, with the chloroform 
 on sponge having been previously used. The lint was 
 lield, about half an inch from the face, by Mr. Thomas 
 Smith, my usual assistant in operation. The patient 
 inhaled lightly for a few times, then made one long 
 inspiration, and appeared to pass at once into deep sleep. 
 Except that he thus appeared to come suddenly under 
 the full influence of chloroform, no external change was 
 visible ; but a few seconds later, his pulse, wliich had 
 been carefully watched, and had been to this time normal.
 
 AND OTHER FORMS OF APNCEA. 151 
 
 suddenly began to beat very quickly ; then it ceased for 
 two or three seconds ; then beat rapidly for several 
 times, with a kind of flickering movement; and then 
 ceased to be perceptible. 
 
 " Just before this change of the pulse was observed, 
 the chloroform had been withdrawn. The one deep in- 
 spiration was followed by a few stertorous breathings; 
 but after these, he breathed naturally, his complexion and 
 features showed no change, he seemed only calmly asleep, 
 and in this state he continued hreath'ing naturally ^ and 
 with no change in his appearance, but pidseless for at 
 least a minute. Then his breathing became less frequent, 
 and seemed as if it might soon cease ; his face grew pale, 
 and his lips very slightly livid. 
 
 " With the help of cold water sprinkled on his 
 chest and face, and cold air blo^vn on his face and throat, 
 he was raised from this state of defective breathing in 
 about two minutes, and again breathed deeply and freely, 
 though slowly (probably about t\Telve times in the 
 minute). He thus breathed ioY two or three mhiutes, 
 and during this time the lips, and the pale or slightly 
 livid parts of the face, became pink again, and though 
 no pulse could he felt at the wrists, the heart was heard 
 acting. During this time also, some wine and brandy 
 WTre poured into the mouth, and passed down the 
 cesophagus, but without any evident movements of swal- 
 lowing. His breathing again became gradually infrequent 
 and feeble. Cold air and sprinkling with water, frictions 
 and percussions of the chest, scarcely increased the
 
 152 POSTL^RAL TtESPIRATION IN DROWNING 
 
 breatliing, and in less than two minutes it ceased. Arti- 
 ficial respiration, by the method of Dr. Marsliall Hall, 
 was immediately employed, and many times during the 
 first five minutes of its employment the artificial inspira- 
 tion obtained, when turning the body over to its side 
 was followed by a distinct, and sometimes even a full 
 muscular inspiration. But at the end of about five 
 minutes these signs of life ceased, fseces escaped, and no 
 more indications of life appeared, though the artificial 
 breathing, the friction of the limbs, and other means for 
 resu'=Jcitation, were continued for twenty or more minutes." 
 
 On reading this interesting case, I wrote to Mr. 
 Paget, and, amongst others, my letter contained the 
 following paragraph : 
 
 " My own idea is, that the case was not at all one 
 of pure a/pnoRQ, or likely to be benefited by the induc- 
 tion of respiration. The stertor and other defects in 
 ])reathing were obviously the effects of narcotism of the 
 medulla oblongata. The absence of pulse, or suspended 
 circulation, the breathing continuing, establishes asphyxia 
 not the result of apnoea. Of these and of final sinking 
 the patient seems to have died, the apnoea being the 
 general result — the effect, not the ca^tse, of dying." 
 
 Mr. Paget^s reply corroborates my view : 
 
 " I fully agree with you as to the cause of death in 
 the case I have recorded. If the poor boy^s danger had 
 been due to asphyxia (suffocation), T feel nearly sure 
 that he would have been saved by your method of arti- 
 ficial respiration. I was struck with its e(\\}idX facility and
 
 AST) OTHEll FORMS OF APN(EA. 155 
 
 as the remedy of ordinary asphyxia ; but I 
 felt, while using it, that the case was one in which it could 
 do no more than secure that respiration should not be 
 wanting if the heart should recover its power. My 
 beUef is, that from the time of the cessation of the pulse, 
 though the heart could for some minutes be heard acting, 
 there was no current of blood, no true circulation ; and 
 that the boy ceased to breathe because his blood ceased 
 to move." 
 
 These documents establish several new facts : first, 
 that the efficiency of jy^stural movements for inducing 
 respiration is perfect ; secondly, that, as there may be 
 asphj-xia the effect of apncea, so there may be apnoea the- 
 effect of asphyxia ; thirdly, that in the former case only, 
 it is to be feared, can artificial respiration be of anv 
 efficacy. 
 
 March 17th, 1857. 
 
 Note on Br. Snoiv's Experiments. 
 
 " To the Editor of the Lancet. 
 
 '' Ste, — Subsequent to my note on Mr. Paget's in- 
 teresting case, I have had my attention particularly 
 drawn to Dr. Snow's paper on "The Cause and Pre- 
 vention of Death from Chloroform.^' I especially allude 
 to the paper printed from the London Journal of Medicine 
 for April, May, and June, 1852. 
 
 "I have no hesitation in affirming that the first
 
 154 POSTUEAL IIESPIRATION IN DROWNING 
 
 three pages of this paper are amongst the most able and 
 valuable in physiology, and I beg to be allowed to re- 
 produce them in the pages of the Lancet : — 
 
 " 'Chloroform, like other medicines which relieve or 
 prevent pain, is capable of causing death if its action be 
 carried too far. When a certain quantity of it is present 
 in the blood, sensibility is so far diminished that surgical 
 operations may be performed without pain; whilst a 
 certain additional quantity has the effect of diminishing 
 sensibility to such an extent, that the necessity for 
 breathing (?) is no longer felt, the i-espiratory movements 
 cease, and the circulation of the blood is by this means 
 ?oon arrested. In some cases, as we shall see, sufficient 
 chloroform is absorbed to arrest the action of the heart 
 by its own influence. 
 
 (c ( ^Yhen animals, such as dogs, cats, rabbits, and 
 guinea-pigs, are made to respire air containing from tbree 
 to five per cent, of chloroform till they cease to breathe, 
 — a process wdiich generally occupies ten or fifteen 
 minutes, — the heart can be heard to beat, by means of 
 the stethoscope applied to the chest, for a minute or 
 longer after the breathing has ceased; and it often 
 ]iappens that, about the time when the hearths action fails, 
 the animal makes two or three gasping inspirations, 
 which have the effect of restoring the contractions of the 
 heart, which recommence with great rapidity. If the 
 animal has been withdrawn from the chloroform, these 
 gasping insi)irations have generally the effect, when they 
 occur, of thoroughly re-establishing both the breathing
 
 AXD OTHER FOIl^IS OF APXCEA. 155 
 
 and circulation ; but if it is made to breathe the chlo- 
 roform during these gasps, the action of the heart is 
 again arrested, and the natural breathing does not 
 return. 
 
 "'When the same kind of animals are made to 
 respire air charged with upwards of eight per cent, of 
 vapour of chloroform, death occurs with great rapidity, 
 and in a different manner from that just described. The 
 action of the heart ceases about the same moment as the 
 breathing. In three instances, indeed, it has ceased 
 before the breathing, and although gasping inspiration.s 
 have several times occurred after the chloroform was 
 withdrawn, it has rarely happened that these inspirations 
 have had the effect of restoring the hearf s action. 
 
 " 'I have observed the manner in which the breathing 
 and circulation ceased in twenty-nine instances, with tlie 
 stethoscope applied to the chest of the animal, when tlie 
 quantity of chloroform in the air they breathed was known; 
 but the following three experiments will sutfice to show 
 the different ways in which death occurs under the 
 influence of chloroform, according as its vapour is more 
 or less diluted with air. I may here remark, that the 
 results of the experiments mentioned in this paper can be 
 applied with great propriety to elucidate what occurs in 
 the human subject, both on account of the exact simi- 
 larity between the effects of chloroform on the lower 
 mammalia and on man, when confined within safe bounds, 
 and also from the close resemblance of the phenomena 
 caused by the less diluted vapour, to what has been 
 described as occurring in the accidents to patients.
 
 156 POSTURAL EE5PirtATI0N IN" DROWNING 
 
 " ' Experiment 1. — A young but full-grown cat was 
 ])laced in a glai>s jar, of the capacity of 1600 cubic inches^ 
 and a fluid drachm of chloroform was introduced, by a 
 portion at a time, through a tube in the cover of the jar. 
 As twenty-five minims of chloroform produce twenty-six 
 cubic-inches of vapour, the atmosphere which the cat 
 had to breathe contained nearly four per cent, of vapour, 
 and the jar was moved about to ensure the uniform 
 mixture of the vapour with the air. In five minutes the 
 cat became insensible, and lay breathing naturally. In 
 about ten minutes more tlie breathing became very feeble, 
 and it ceased altogether in about another minute, or 
 sixteen minutes after the cat commenced to breathe the 
 chloroform. It was immediately taken out and laid on 
 ;i table, and the stethoscope was applied to the chest. 
 The heart could be heard beating distinctly at first, but 
 the pulsations became slower and feebler, and in about a 
 juinute they could be no longer heard. Just at tliis 
 time, however, the cat took a gasping inspiration, and 
 immediately the heart was heard to beat in a most rapid 
 manner. The gasps were repeated, and the action of 
 tlie heart, became less rapid, but stronger. In a little 
 time both the breathing and the action of the heart be- 
 came natural, the cat remaining, however, insensible for 
 some minutes. 
 
 "'Experiment 2. — A cat, of about the same size as 
 the last, was put into the same jar, and the same quantity 
 cf chloroform was introduced. It was removed at the 
 and of four minutes, when it was so far insensible as to
 
 AND OTHER FORMS OF APNCEA. 157 
 
 offer no resistance. Being laid on the table, it was made 
 to breathe air charged with ten per cent, of vapour of 
 chloroform from a bladder. Twenty-five minims of 
 chloroform were put into the bladder, which held 260 
 cubic inches, and it was filled up with the bellows. A 
 portion of another bladder, which was attached to the stop- 
 cock, was made to surround the head of the cat, and it 
 consequently breathed to and from the bladder. In half 
 a minute it was quite insensible ; in about half a minute 
 more, the breathing became difficult, and the sounds of 
 the heart less distinct. The breathing became gradually 
 slower, and ceased altogether between three and four 
 minutes after the respiration from the bladder commenced. 
 The sounds of the heart were rather frequent, and scarcely 
 audible, just before the breathing ceased, and they could 
 not be heard afterwards. The chest was opened tliree- 
 quarters of an hour after death : the lungs were of a 
 pale-red colour, everywhere permeated with air, and a 
 small quantity of fluid blood flowed from them on making 
 an incision ; the right cavities of the heart were quite 
 full of blood, and the left cavities contained a small 
 quantity. 
 
 " Experiment 3. — A cat was made insensible in the 
 same manner as the two previous ones. As it made 
 strong efforts to get out of the jar, and consequently 
 breathed more deeply, the chloroform took effect sooner ; 
 and it was removed and laid on tlie table, in a passive 
 state, at the end of two minutes and a half. The respi- 
 ration and sounds of the heart were quite natural. The
 
 158 POSTURAL RESPIRATION IN DROWNING 
 
 nose of the animal was placed in the mouth of a metal 
 vessel, lined with bibulous paper, and used as a chloro- 
 form inhaler ; the inhaler contained chloroform, and was 
 surrounded with water of the temperature of 110° Fahr.; 
 the stethoscope was kept applied to the chest whilst the 
 chloroform was exhibited. After four or five inspirations 
 from the inhaler, the heart suddenly ceased to beat, the 
 breathing still going on ; the inhaler was removed as 
 soon as I was satisfied that the action of the heart had 
 ceased, and there were two or three rather convulsive 
 respirations afterwards, and then tlie breathing stopped ; 
 but, between one and two minutes later, there were two 
 or three feeble inspirations, accompanied with motion of 
 the nostrils, but no returning action of the heart could 
 be heard. The chest was opened ten minutes after 
 death : the lungs were quite pale throughout ; there 
 was a little clear serum in the pericardium ; the heart 
 appeared quite motionless when first observed, but, after 
 exposure to the air for a short time, there were some 
 slight contractions of a few fibres of the right ventricle; 
 the right auricle and ventricle were filled with blood. 
 
 " ' The air in the inhaler which this cat breathed, 
 probably contained between twenty and thirty per cent, 
 of vapour of chloroform.^ 
 
 " It is obvious that death from chloroform results 
 from two causes, and assumes two forms : wlien the pro- 
 portion of chloroform in the atmosphere breathed is 
 hmited to from three to Jive per cent, the fatal result 
 Leghis with defective respiration, or ajorioea, and proceeds
 
 AND OTHER FORMS OP APNCEA. 159 
 
 to asphyxia, and the Eeady Method is the ready remedy; 
 but when the proportion of chloroform amounts to uji- 
 ivards of eight per cent, death assumes at once the form 
 of asphyxia, with either simultaneous or suhseqiient apnoea, 
 and there is, it is to be feared, no remedy. 
 
 " This conclusion, which Dr. Snow drew from his 
 admirable experiments, I drew independently from an 
 attentive perusal of the accurate details of Mr. Paget's 
 interesting case."*' 
 
 In looking over Dr. Snow^s other papers, I have 
 been much amused, on reading a page in The Lancet of 
 1841-42, for October and November, pp. 133 and 212, 
 to see the same war waged with the Eoyal Humane 
 Society, in regard to the use of the icarm bath in 
 aspliyxia, as is being again waged in tlie present day. 
 
 Dr. Snow showed, from the experiments of Edwards, 
 that the warm bath must prove deleterious. Mr. WooUey 
 contended then, as now, and with as little reason, and 
 with the same discordance with physiological truth, tliat 
 the warm bath should be used. Unfortunately, the 
 remedy — the " Eeady Method " was not then discovered; 
 and as no method Qipromptlu producing artificial respira- 
 tion — the sole life-giving process — was then known, 
 error has continued to prevail over truth. The warm 
 bath is not only not remedial — it is positively destructive ; 
 as the merest tyro may know for himself, who will care- 
 fully repeat a few telling experiments. 
 
 One statement by Mr. Woolley is a little remarkable :
 
 160 POSTURAL EESPIRATION IN DROWNING 
 
 " he had not found artificial respiration of benefit after 
 tlie warm bath failed to restore life " (p. 213) : neither 
 would he or any one else find respiration of benefit after j 
 not the warm bath only, but "removal, the warm bath 
 and galvanism/^ had been tried in vain. 
 
 The lapse of fifteen years has not detracted from the 
 accuracy and value of Dr. Snow's views. 
 
 We may now safely draw the following conclusions in 
 the present state of science : 
 
 1. The warm bath in apnoea and asphyxia is a phy- 
 siological and practical error. 
 
 In one case, at Boulogne, the patient having begun 
 to breathe, was destroyed by being put into the warm 
 bath. 
 
 2. In the absence of artificial respiration, the remedies 
 are — free exposure of the surface to the breeze, and 
 frictions of the limbs upwards, with pressure. 
 
 3. But the true remedy in apnoea is Respiration ; and 
 this is happily instantly accomplished by — the " Eeady 
 Method/' or, as 1 presume /must now call it — the 
 Marshall Hall Method. 
 
 April, 1857. 
 
 Postural Resjnration observed ly Br. Snow. 
 
 " To tlie Editor of The Medical Times and Gazette. 
 
 " Sir, — I shall be obliged if you will allow me to state 
 that I believe Dr. Marshall Hall's method of artificial
 
 AND OTHER FORMS OF APNCEA. 161 
 
 restoration was quite efficient, as a method of artificial 
 respiration in the case of death during the inhalation of 
 amylene, which I related in the last number of the Me- 
 dical Times and Gazette. That it was not efficient in 
 restoring the patient is not to be wondered at, when liis 
 own natural respiration, continued for several minutes, 
 had failed to restore the action of the heart. The arti- 
 ficial respiration was resorted to for want of any thing 
 else which could afford a chance of benefit. I asked Mr. 
 Fergusson^s advice respecting the propriety of opening 
 the jugular vein, with a view to relieve the probable dis- 
 tension of the right cavities of the heart; but as the veins 
 of the neck were shrunk, and did not contain any blood, 
 he did not think it would be of any use to open them. 
 In Mr. Paget^s recent case of death during the inhala- 
 tion of chloroform, the patient continued to breathe after 
 the pulse had ceased, and the artificial respiration was 
 not efi'ectual in restoring him. 
 
 " When the failure of the pulse is the consequence 
 of the absence of breathing, as in drowning, artificial 
 respiration is the proper remedy ; and I believe the me- 
 thod of Dr. Marshall Hall to be a very efficient one. I 
 had, a few days ago, the opportunity of seeing its good 
 effects on a child born in a state of partial asphyxia. 
 The child presented by the shoulder, but was easily turned 
 by Mr. Edward Tegart, while the mother was under the 
 influence of chloroform. Being a large child, however, 
 the circulation between it and the placenta was inter- 
 rupted for a short time during the passage of the head.
 
 162 POSTURAL RESPIRATION IN DROWNING 
 
 and when born, although there was a slow pulsation in 
 the funis, it breathed only by distant gasps ; its muscles 
 were completely relaxed, and it was so insensible, that 
 dashing cold water on it had no effect on the respiration. 
 The gasping was becoming less frequent, and the pulse 
 was failing, when Mr. Tegart and I began Dr. Hallos 
 method. I could hear the air entering the larynx at every 
 turn of the child. Its own inspirations soon became more 
 frequent; it became of a florid colour, in place of the 
 livid one it had previously presented ; its muscles began 
 to be tense and active, and in a very short time it was 
 crying vigorously. 
 
 " In any case of accident from chloroform, or any 
 other narcotic vapour, if the respiration were suspended 
 by the over-action of the medicine on the brain, and the 
 heart were not entirely paralysed, artificial respiration 
 would, I believe, restore the patient. Such is the result 
 of my experiments on animals ; but where the heart itself 
 is the organ chiefly or solely affected, artificial respiration, 
 although affording a chance of benefit, is likely to be of 
 little avail ; and these apparently are the cases of acci- 
 dent which have ended fatally, notwithstanding prompt 
 assistance. 
 
 " I am, &c. 
 
 '' John Snow, M.D." 
 
 " 18, Sackville Street, April, 1857."
 
 AND OTHER FORMS OF APXCEA. 163 
 
 Postural Resjriration observed hy J)r. McCormac. 
 
 " Belfast, September 20, 1856. 
 
 " My dear Sir, — In my experiment as to the induc- 
 tion of postural respiration, I followed strictly your most 
 valuable suggestions. The body was that of a vigorous 
 man, not long dead. The right shoulder and side were 
 made the axis of rotation. I inclined the body forward, 
 in the prone position, as you direct, then raised it on the 
 side and beyond to an angle of about 130°. I continued 
 this alternating motion for some time ; but I did not 
 measure (I had no immediate facilities for doing so) the 
 amount of inspiration and expiration produced. It was 
 very satisfactory to me, however, to observe the gush of 
 air, as it entered and left the nostrils, where the transit 
 was more ob\aous than by the mouth. 
 
 " I had often witnessed the bubbling transit of air 
 thus, during the movements to which the remains of the 
 dead are necessarily subjected, but was far from drawing 
 from it the important practical inference which you have 
 done. 
 
 " I shall try your method of postural respiration at 
 the earliest opportunity, not only in the case of the 
 drowned, hut in other cases of asphyxiated persons — per- 
 sons asphyxiated from or by irrespirahle or poisonous 
 gases, the undue inhalation of chloroform, and by strong 
 drink; in all of which, your method, I conceive, is
 
 164 POSTURAL RESPIRATION IN DROWNING 
 
 calculated, presumably, to realise the most beneficial 
 results. 
 
 " Permit me, my dear Sir, to subscribe myself yours 
 most faithfully, 
 
 "Henry McCormac." 
 
 " Dr. Marshall Hall." 
 
 Case of Narcotic Poisoning, in a child thirteen months old; 
 hy Charles Blades, Esq. of Tattershall. 
 
 The following case is full of the most thrilling in- 
 terest. Its simple details and the perseverance with 
 which the treatment was pursued are admirable : 
 
 " To the Editor of The Lancet, 
 
 " Permit me, through your journal, to record the 
 following case of narcotism, illustrating as it does Dr. 
 Marshall HalFs Eeady Method in cases of poisoning. 
 
 " On the 11th ultimo, at two p. m. I was called to 
 see a child, aged thirteen months, which had had poppy- 
 water given to it the previous evening. I found it in a 
 state of perfect unconsciousness ; there was no respira- 
 tion ; no pulse could be detected. I immediately adopted 
 the Ready Method, persevering in it for several hours ! 
 and was well rewarded for my trouble, by first detecting, 
 through the fontanel, a slight motion of the brain, then
 
 AND OTHER FORMS OF APNCEA. 165 
 
 around the umbilicus, and ultimately by the child's com- 
 plete recovery. 
 
 '' The successful result of this case is due to Dr. Mar- 
 shall Hall's plain and practical instructions in postural 
 respiration, published in your valuable journal. 
 
 " I am, Sir, your obedient servant, 
 
 " Charles Blades.'' 
 
 " Tattershall, Feb. 1857." 
 
 " Tattershall, Feb. 28th, 1857. 
 
 " Dear Sir, — I have much pleasui'e in complying with 
 your request for further details of my case of poisoning. 
 
 " On making inquiries of the relatives of my little 
 patient, I learnt that it had been for the last few days 
 suffering from a cough, and that they had given it a sufii- 
 cient quantity of poppy- water to compose it to sleep. 
 It slept all night and the following morning without in- 
 termission, when, about twelve o'clock a. m. on attempt- 
 ing to give it some broth, it was seized with a fit, to 
 relieve which it was placed in a warm bath, but was soon 
 removed from thence, apparently lifeless. 
 
 '' On my arrival at the house, a little before two 
 o^loch p. M» I found the child lying in its grandmother's 
 arms, in a state of insensibility ; the eyes were closed, 
 the pupils contracted ; no pulse and no respiration could 
 be detected. 
 
 " I immediately placed it in the prone position, with 
 one hand under its foreliead, the other under the chest. 
 I commenced turning: the bodv on the side and a little
 
 166 FOSTURAL RESPIRATIOX IN DROWNING 
 
 beyond, and tlien on the face, alternately, repeating these 
 measures tlnrteen or fourteen times in a minute ; at the 
 same time, the attendants were desired to rub the limbs 
 upwards simultaneously. 
 
 " I had not continued my attempts at resuscitation 
 more than a few minutes, when a slight motion of the 
 brain became perceptible, and gasping movements of the 
 mouth followed. 
 
 " Although no decided amendment displayed itself 
 for some time, yet I was fully convinced that the efficient 
 maintenance of the respiratory process was of the first 
 importance, not only to the continuance of the circula- 
 tion, but also as being the chief means by whicli the 
 .poison is eliminated. I therefore persevered in the pos- 
 tural movements until half-past six the same evening, 
 before I could pronounce my patient out of danger. 
 
 " Apologizing for not replying to your note earlier, 
 I remain your obedient servant, 
 
 " Charles Blades.' 
 
 " Dr. Marshall Hall." 
 
 POSTSCRIPT TO THE CASES. 
 
 § I. — Two Cases hy Br. Lawrence, of Carmarthen. 
 
 I cannot refrain from inserting the two following 
 cases from the pen of Dr. Lawrence, of Carmarthen, 
 although they were not treated by postural respiration. 
 Each contains an idea of deep interest.
 
 AND OTHER FORMS OF APNCEA. 167 
 
 The ohject of the suction in the first case was obviously 
 tliat of the prone position — ^^ to clear the throat /' how 
 far less effectual for that object I need scarcely point out. 
 In the supine position, part of the fluids of the throat, 
 though drawn out of their first position, would be apt to 
 flovj hacJc again when the act of suction ceased ; indeed, 
 the subsequent i;«spiration might draw it into the larynx. 
 
 It is singular enough that it is the very opposite to 
 the " mouth to mouth^^ insufflation recommended in 
 some cases of apnoea, as in that of the still-bom infant. 
 
 The late Mr. Eeid devised a syringe with a double 
 action, thinking to draw out and force in the air alter- 
 nately. 
 
 To be effectual, both of these objects should indeed 
 be combined, together with the further precaution of en- 
 tirely removing the danger of the fluids again falling 
 back, or being drawn back, into the larynx. Kow all 
 these objects are admirably comhined in ^rone and pos- 
 tural respiration alone. 
 
 The second case illustrates the subject of laryngis- 
 mus and. its apnoea, and shows the value of mere pressure 
 made on the chest, of the efficiency and safety of which, 
 when ' the throat is clear ^ no one can doubt ; however 
 otherwise full of danger. 
 
 But I proceed to give the interesting cases them- 
 selves : 
 
 '*■ Seventeen or eighteen years since. Dr. G. a surgeon 
 of Tenby, was bathing in the sea, and had a stick in his 
 mouth, decoying a young Newfoundland dog into the
 
 168 POSrURAL EESPIRATION IN DROWNING 
 
 "IS 
 
 water. After being some time in the sea, he was ob- 
 served, by a mason on the top of a house in the town, 
 and by a gentleman on the Castle Hill (looking out by 
 St. Catherine's Eock, where there is a strong current at 
 the return of the sea), with the stick under his chin. It 
 had fallen from his mouth and kept him above water. 
 (A young clergyman was carried off and drowned at this 
 spot a few years ago.) The mason ran down, gave the 
 alarm, and brought him out quite lifeless. He was taken 
 to the Bath Eooms, and I was early in attendance. I 
 immediately began friction, warm applications, plenty of 
 fresh air by keeping all persons at a distance but my 
 assistants. I pressed on the chest, sides, &c. to exhaust 
 and inflate the lungs, and followed out a treatment tlie 
 same as Dr. M. Hall recommends, with two exceptions, 
 which I think are very important ones, and such as I 
 shall bear in mind at any future period : that of turning 
 on the face, and not using the warm bath too earlf/. I 
 did place my patient in a warm bath as soon as he began 
 to respire, in the case of Mr. G. 
 
 " I offered half a sovereign to any person who would 
 suck at his nose or mouth. A man came forward and did 
 it. Mr. G. soon afterwards drew one inspiration ; the man 
 of course spat out much fluid which he drew from the 
 lungs. The gentleman from the Castle Hill, an agent 
 to the late Lord Milford, seeing the eff'ect, paid the man 
 the half-sovereign ! 
 
 " This treatment w^as suggested to me by two cases 
 which I read in the papers many years ago, one of which
 
 AKD OTHER FORMS OP APX(EA. 169 
 
 I ciit out, and I enclose to you"^ ; in the other, after 
 failure of the medical man, a chimnev-sweeper^s boy came 
 forward and said " he would restore the patient." He 
 began the suction, and the patient recovered !" 
 
 " The second ease was one of asphyxia in a child of 
 my own. He was attacked with hooping-cough, the 
 severest case I think I ever saw, at two or three months 
 old. In a fit of coughing, the spasm was so severe and 
 of so long duration, that breathing ceased. His face 
 gradually became blue, his jaw and hands fell, and death 
 appeared to have taken place. A medical friend, who 
 was attending my child with me, left my house; some 
 little time elapsed, when I roused myself, ordered a warm 
 bath, and began frictions and alternate pressure on the 
 sides, chest, &c. &c. to inflate and exhaust the lungs; 
 
 * " Extraordinary Mode of Resuscitation." — A youth, named 
 Henry Rice, having fallen into the hasin, City Road, a quarter of an 
 hour elapsed hefore he could he got out. The hoy was conveyed to 
 the "Wenlock Arms, and two surgeons immediately attended, who, after 
 an hour's exertion, were unsuccessful in their attempts to restore the 
 youth to life. A drunken man in the tap-room, waking from his sleep 
 and learning that the medical men had failed in their attempts, stag- 
 gered into the room and said he would restore the boy ; and applying 
 his mouth to that of the youth (at the same time including the nostrils) , 
 by strong suction, as if drawing the breath from the patient, actually 
 renovated the lad in a few minutes, to the astonishment of all present. 
 This was the ninth person whom this individual had restored to life 
 in a similar manner. This extraordinary case has excited much spe- 
 culation and has led to the conjecture that an instrument might be 
 made to answer the means adopted in these instances of resuscitation, 
 which would be highly beneficial in every point of view." 
 
 I
 
 170 POSTURAL RESPIRATION IN DROWNING 
 
 and in about ten minutes the child took one inspiration, 
 and then gradually recovered. It was most pleasing to 
 see the gradual blue cloud of the face pass off, and 
 the natural colour return. My medical friend had ex- 
 pected my child was dead ; and when I requested him to 
 call the next day, he did not believe it was to see the 
 child, or that the child could be restored. He witnessed 
 one or two similar attacks, and my successful efforts at 
 recovery. I changed the air as early as possible, an 
 immediate improvement took place, and my child re- 
 covered, and is now alive." 
 
 § II. — On obsolete Modes of Treatment. 
 
 Amongst the obsolete modes of treatment pointed out 
 by the Royal Humane Society, one deserves especial 
 notice and consideration : 
 
 " Do not roll the hody on casks" 
 
 There is in this obsolete rule an error and a truth, 
 equally unknown to those who first proposed it. Their 
 idea was that water had been imbibed into the lungs or 
 into the stomach, and the manoeuvre proposed was in- 
 tended to allow of its flowing away. This is the error. 
 Had the idea been fixed upon the condition of the pha- 
 rynx and larynx, obstructed, not with water merely, but 
 with mucus and fluids regurgitated from the stomach, it 
 would have been just and true, and the jprone position 
 of the patient, when placed on the cask, would have been
 
 AND OTHER FORMS OF APNCEA. 171 
 
 the true and just means of removing those fluids, and of 
 " clearing the Throat I" 
 
 But the patient was " rolled'^ on the cask ; that is, 
 I suppose, being placed in a position perpendicular to 
 the axis of that vessel, he was moved so as to augment 
 and diminish the pressure of his body on the thorax and 
 abdomen, alternately. But this is precisely the effect of 
 ' pronation and rotation !' 
 
 The only observations which this paragraph calls 
 forth, are— first, that the idea of getting rid of water is 
 founded in error ; secondly, that the result of the pos- 
 tural changes was not — postural Respiration. It re- 
 mains as a medical fallacy and curiosity — a specimen of 
 what passes for ' experience/ 
 
 The idea of disgorging water supposed to have been 
 imbibed into the lungs and stomach, prevailed in the 
 profession. I have been shown the following paragraph by 
 Smollett, who, it must be borne in mind, was a physician : 
 
 " In crossing the river, my 'squire and his horse were 
 swept away by the stream ; and, with some difficulty, I 
 have been able to drag him ashore, though I am afraid 
 my assistance reached him too late ; for since I brought 
 him to land, he has given no signs of life. 
 
 " Here he was interrupted by a groan, which issued 
 from the chest of the 'squire, and terrified the spectators 
 as much as it comforted the master. After rome recol- 
 lection, Mr. Pillet began to undress the body, which was 
 laid in a blanket on the floor, and roUed from side to 
 side by his direction. 
 
 i2
 
 172 POSTURAL EESPIRATION IN DBO^l^NING 
 
 " A considerable quantity of water being discharged 
 from the mouth of this unfortunate 'squire, he uttered a 
 hideous roar, and opening his eyes, stared wildly around ; 
 then the surgeon undertook for his recovery." ^ 
 
 No one will imagine that the true effect of tliis pro- 
 cedure was suspected even, by its authors, 
 
 I cannot doubt that the two truths unconsciously 
 hidden under these propositions saved many lives. They 
 were, in fact, clumsy, unsuspected modes of ' clearing the 
 Throat,' and of ' imitating Respiration' — in a word, of 
 ' prone and postural respiration,' whilst intending to 
 remove water from the bronchia and stomach, which 
 never existed there ! 
 
 But, at least, this measure, clumsy and erroneous as 
 it was, was preferable to the ' warm bath' by which it 
 was superseded. 
 
 When recently at Eolkestane, and enquiring about the 
 treatment of the drowned, one boatman said his mode 
 was to roll the patient over and over on the ground. 
 Respiration would doubtless be the unlooked-for result 
 of such a manoeuvre. 
 
 But the real object of these proceedings was, like 
 that of suspending the patient by the feet, to empty the 
 lungs and stomach of water! Good might, in some 
 cases, come out of this ignorance. 
 
 In conclusion, I may observe — 
 
 1. That suctio7i would, in general, be followed by 
 
 * Smollett's Launcelot Greaves, chap. ii.
 
 AND OTHER FORMS OF APNO^A. 173 
 
 little result, since the frothy mucus drawn into the 
 mouth during this operation would be probably drawn 
 back by the succeeding i?2spiration, the subject being in 
 the supine position. 
 
 2. All attempts at respiration, whether hy forcing 
 or by suction, would be attended, with the choking of the 
 air-passages by the fluids in the pharynx, the sujpiiie 
 position being equally observed. 
 
 More than these few observations, the subject of ob- 
 solete modes of treatment of the drowned scarcely deserves, 
 so entirely practical is the design of this little volume. 
 
 I trust I may at length add to the list, the warm 
 bath, the most fatal of aU, by the loss of precious time, 
 and of the sole real remedy, which it entails, not to repeat 
 the positively injurious tendency of this mistaken remedy. 
 
 I conclude that — 
 
 1. In all former postural measures— as holding the 
 patient up by the feet, the rolling on a cask, &c. — the 
 idea and the motive were to empty the lungs and the 
 stomach of water imbibed during the period of sub- 
 mersion. 
 
 I need not say that the whole proceeding was an 
 error, 
 
 2. That by accident resjnration might thus be pro- 
 duced, with its happy results. 
 
 3. That all attempts at artificial respiration in the 
 supine position could only be successful by a similar 
 happy accident — the tkroat chancing to he free.
 
 174< POSTURAL RESPIRATION IN DROWNING, ETC 
 
 4. That mouth to mouth suction or forcing might 
 be successful ; but might also be ineffectual in one case, 
 ^n^ fatal in another. 
 
 In a word, nothing is certain, nothing is safe, except 
 in the prone position. 
 
 The warm bath least of all.
 
 PAET THIED.
 
 The Begins Frofessor of Medicine y Br. Ogle^ of Trinity College^ 
 Oxford, has issued an address to the members of Convocation, in which 
 he states— '■'■ The Vice-Chancellor of the University having ruled that 
 no one may read an address in Convocation, and my health preventing the 
 more obvious alternative which presents itself, I am constrained to make 
 known by this mode of communication the views which I entertain re- 
 specting the statute. Be Frofessore A^iatomice et Aldriehidno^ and which 
 I deem it my duty to put forth : 
 
 "I UNHESITATINGLY, CX Cathcdrd, ASSERT, THAT TO SEVER THE 
 STUDIES OF ANATOMY AND PHYSIOLOGY FROM THAT OF MEDICINE, 
 IS VIRTUALLY TO REDUCE THE LATTER SCIENCE TO A MERE EM- 
 PIRICISM."
 
 § I. — Edwards de VInfluence des Agens Phi/siques siir 
 la Vie. 
 
 Every one who presumes to give an opinion on the 
 subject of apnoea or asphyxia, must begin by a profound 
 study of this incomparable work ; a work to which the 
 discerning author devoted six years, experimenting on 
 every tribe of animal, at all seasons of the year. 
 
 There are three distinct chapters on apnoea. There 
 are the same number on the influence of temperature in 
 apnoea. 
 
 The general conclusions are these : — 
 
 1. The higher the temperature, within physiological 
 limits, the sooner the animal perishes if deprived of air. 
 
 2. The lower the temperature, also within physio- 
 logical limits, the longer the animal survives the priva- 
 tion of air. 
 
 That is the physiological limit of temperature, beyond 
 which, positive destructive effects are observed. 
 
 Every means, therefore, of raising the temperature 
 of the patient afflicted with apnoea, and not breathing, as 
 the continuous warm bath, and the several others recom- 
 mended by the Eoyal Humane Society, are deleterious. 
 Whilst every means of maintaining a cool temperature, 
 and especially the free exposure of the face, chest, and 
 surface generally, to the mild, cool breeze, is beneficial.
 
 178 POSTURAL RESPIRATION IN DROWNING 
 
 These are the important conclusions to which com- 
 parative experiment has led the physiologist. It is 
 opposed to the fallacious "experience" of those, the 
 objects of whose observations never can be comparative, 
 so compHcated is the question of apnoea, and so various 
 the condition of the patient. 
 
 ^Nothing can be more glaring than the one glaring 
 fallacy of substituting warmth for air, when the patient 
 is dying for want of air ! 
 
 The truth is, the propriety of the warm bath in 
 apnoea is a vulgar error ; an error which physiology in 
 the volume of Edwards ought long ago to have corrected. 
 
 Who will pretend, after this, that medicine is not 
 physiological, and fail to agree with the opinion recently 
 expressed by Dr. Ogle, the Eegius Professor of Medicine, 
 of Trinity College, Oxford ? 
 
 " The Vice-Chancellor of the University having ruled 
 that no one may read an address in Convocation, and my 
 health preventing the more obvious alternative which 
 presents itself, I am constrained to make known by this 
 mode of communication the views which I entertain 
 respecting the statute, De Professore Anatomise et Al- 
 drichiano, and which I deem it my duty to put forth. 
 I unhesitatingly, ex cathedra, assert, that to sever the 
 studies of anatomy and physiology from that of medicine, 
 is virtually to reduce the latter science to a mere em- 
 piricism." 
 
 An opinion which I have long advocated. Yet little 
 minds still speak of " theory" as inferior to what they 
 term "experience,"
 
 AND OTHER FORMS OF APNCEA. 179 
 
 Above all things, let us be frank, candid, just. 
 
 To revert to Edwards' work : warmth, previous to 
 the privation of air, is deleterious ; cold, beneficial. Ani- 
 mals die sooner of apnoea in summer than in winter. 
 
 There is still another interesting fact, which bears 
 upon the same subject : 
 
 Some very young animals, as the rabbit, the dog, the 
 cat, which are born feeble, and with the eyes closed, soon 
 lose their temperature, if separated from their mother and 
 placed singly ; others, as the guinea pig, born less help- 
 less, and with the eyes open, placed in similar circum- 
 stances, sustain their own temperature. The former 
 sustain comparatively a long privation of air, submerged 
 in water o£ the same temperature, even to half an hour ; 
 the latter soon perish, scarcely survi\dng the privation of 
 air three or four minutes. 
 
 Animals perish from apnoea the more speedily, the 
 greater their relation to heat, whatever that relation may 
 be, external or internal. 
 
 Every ray of light on this subject converges to the 
 same focus. 
 
 § IL — Relation hetiveen the Dynamics and Stimuli in the 
 
 The dynamics in the animal economy are two : that 
 seated in the spinal system; and that seated in the 
 muscular system. The former is excitor ; the latter, the 
 excitability — the irritability of Haller.
 
 180 POSTURAL RESPIRATION IN DROWNING 
 
 The stimuli of the animal economy are also, prin- 
 cipally, two : air and food. 
 
 Life consists in a series of actions and re-actions of 
 these several agents and re-agents; the dynamics and 
 the stimuli bear an inverse ratio to each other: in 
 the cases in which the dynamics are low in degree, 
 the stimuli are uniformly high ; and in the case in which 
 the dynamics are high, the stimuli are low. Out of the 
 varied condition of these, relative and absolute, the varied 
 forms and conditions of animated beings take their 
 origin. 
 
 Take an animal of high respiration, as the bird : the 
 stimuli, air and food, are extremely high, the dynamics 
 proportionately low. Choose, on the othei; hand, an 
 animal said to be of cold blood : its respiration and the 
 quantity of its food are extremly low, the dynamics high. 
 
 The dynamics in nerve and muscle, and the quan- 
 tities of air and food, are inversely proportionate to each 
 other, respectively .- 
 
 The temperature is proportionate to the stimuli, air 
 and food, and inversely proportionate to the dynamics. 
 
 The whole animal kingdom is subject to this law. 
 It is the Law of Life. 
 
 In the human subject, activity, which is a condition 
 of augmented stimuli, is attended by exhausted dynamics. 
 Repose, and especially sleep, have the contrary effect. 
 
 The embryo may be compared to the reptile in regard 
 to the dynamics and stimuli. 
 
 The application of these principles to the subject of
 
 AND OTHER FORMS OF APNCEA. 181 
 
 this volume is direct : the animal bears the privation of 
 stimuli, air and food, in the inverse proportion to the 
 quantity of stimuli : the bird perishes from apncea, or 
 from the want of food, sooner than the animal lower in 
 the scale ; the infant that has breathed, sooner than the 
 new-born infant. 
 
 The animal reduced in temperature bears the priva- 
 tion of air and food better than the animal warmed by 
 clotliing and exercise. 
 
 In the concluding part of this volume, I propose to 
 return still more particularly to the interesting subject of 
 the Law of Life. 
 
 § \l\.—ne Nature of Lfe. 
 
 Lfe is a slow comlustion. In all circumstances, 
 materials which are capable of union with oxygen, and 
 this gas, are brought into contact and union throughout 
 the duration of the vital processes. The want of food 
 (the fuel) and the want of oxygen (the supporter of com- 
 bustion) are equally the cause of the extinction of this 
 chemical vital process, whether it exist in the form of 
 flame, spark, or combustion in a still lower form. 
 
 Without fuel, or, still more to our present purpose, 
 without the supporter of combustion (oxygen), how can 
 mere external heat be efficient in producing the life-con- 
 stituting process ? The essential point is to bring the 
 combustible into due contact with the supporter of com- 
 bustion ; this accomplished, external temperature may ac- 
 celerate a process which it cannot, j!?^r se^ imitate or endure.
 
 182 POSTURAL RESPIRATION IN DROWNING 
 
 These facts must never be overlooked by tlie physi- 
 cian who is called to treat a case of failing vital combus- 
 tion : gently to fan the smouldering embers into the real 
 process of combustion, which is Life, is our only hope ; 
 I say, " gently to fan," for too much respiration soon 
 may cool the doubtful embers, and extinguish life ! 
 
 Who would dream of resuscitating dying embers by 
 warmth ? Surely either food or air is the restorative. 
 And let it be remembered that the two -things are not 
 analogical merely, but identical — for Life is a slow com- 
 bustion. In apnoea, therefore, in which, not fuel, but air, 
 is wanted, let us fan into flame the " vital spark." 
 
 It has long been a question with me, whether slow 
 combustion is in every case ascertained in pure oxygen 
 gas, and whether it is especially in the case of respira- 
 tion? a question to which I have already attended, 
 and which I propose to submit to the only true test of 
 comparative experiment. 
 
 The discovery that life is a true combustion has been 
 traced, in modern times, by Lavoisier and by Liebig. It 
 constitutes a great epoch in physiology. 
 
 A few days only before his most cruel death, Lavoisier 
 Avrote these memorable words : 
 
 '^ Ou pent done dire avec les anciens que le flambeau 
 de la vie s'allume au moment ou Fenfant respire pour la 
 premiere fois, et qu'il ne s'eteint qu^a la mort." 
 
 The spark, if not the flame of life, begins in utero, 
 sustained by the placental nutrition and respiration, food 
 and air.
 
 AND OTHER FORMS OF APNCEA. 183 
 
 § IV. — On the Condition of the Circulation in Apnosa, 
 
 What signs have we in cases of apnoea of a little 
 remaining pulsation of the heart and of circulation ? We 
 are, in general, too much engaged with the treatment of 
 the patient to observe the symptoms with accuracy. The 
 best plan would be to let the treatment devolve on one 
 person, and observation on another, when the circum- 
 stances permit. 
 
 1. The first object to examine is the e^e, especially 
 the cornea; 
 
 2. The second involves the lips and the face, the 
 nails and the hands ; 
 
 3. The third, the condition of the arteries and veins, 
 especially the pulse and the brachial veins, the carotids 
 and the jugulars ; 
 
 4. The fourth is the heart itself, carefully applying 
 the ear during a pause between the respirations ; 
 
 5. In hopeless cases, an incision may be made into 
 the integument, to see if blood will flow ; choosing some 
 part which still retains its warmth. 
 
 A¥e should watch for lividity, for flaccidity, and 
 endeavour to discover whether, the hand and arm being 
 put into hot water, a brachial vein will tumefy if under 
 the influence of a ligature applied round the arm. 
 
 We should watch for effects of our efforts to produce 
 postural respiration, especially in change of colour in the 
 lip and face.
 
 ]84 POSTUEAL RESPIRATION IN DROWNING, ETC, 
 
 Whatever intimation of a persistence of circulation 
 may be obtained from these sources, we know that, so 
 long as gasping or convulsive movement may continue, 
 we have evidence of a morbid condition or change in the 
 blood, in the vessels, or in the tissues of the medulla 
 oblongata or meduUa spinalis. 
 
 In experiments, in the midst of all these observations 
 the carotid may be laid bare, as was done by Legallois, 
 and the degrees of repletion and colour may be fuUy 
 observed : they present the criterion of the power of the 
 heart to propel blood..^ 
 
 There is another source of knowledge in regard to 
 the persistence of the circulation, in that of the temper- 
 ature. But observations are wanting on this point. 
 The axilla and the rectum might be made the subject of 
 tliis inquiry. 
 
 Any indication of remaining circulation should stimu- 
 late us to steady perseverance in the postural respiration. 
 If the recorded facts of long -sustained apnoea are incre- 
 dible, those of the effects of perseverance hi recent efforts 
 to restore the patient are not less so. 
 
 I here terminate this little work. If spared, I pro- 
 pose to resume it hereafter. Meantime I cannot resist 
 the temptation of introducing a Lecture given four years 
 ago at the request of the authorities of the Smithsonian 
 Institute at Washington. The physiologist will per- 
 ceive its strict bearing on the vital question of Apnoea. 
 
 * " Sur le Principe de la Vie."— 1812. p. 71.
 
 ZOONOMIA; 
 
 OR 
 
 THE LAW OF ANIMAL LIFE ; 
 
 A LECTURE, 
 DELIVERED AT THE SMITHSONIAN INSTITUTE, WASHINGTON, D.C. L'. 
 ON MARCH 8, 1853.
 
 Gentlemen, 
 
 I congratulate myself on the opportunity afforded 
 me, by your kind invitation, to unfold a principle in 
 physiology on which I have long meditated and expe- 
 rimented, and which I have ventured to designate The 
 Law of Animal Life. 
 
 Many have been the attempts to define life. All have, 
 I think, proved abortive. I shall not, in my turn, ven- 
 ture to attempt that in which so many have failed. My 
 object will be rather to describe than to define. 
 
 Life, then, may be justly viewed as consisting in a 
 comprehensive system of action and re-action; of the 
 action of certain physical and chemical influences, and 
 the re-action of certain vital powers in organized beings. 
 
 Throughout the animal, and indeed the vegetable, 
 kingdoms, the primary organic agents and re-agents are 
 pollen and ova. Life first consists in the riciprocal action 
 of these upon each other. Such is the very type and 
 essence of life in its earliest dawn. Harvey said, Omne 
 vivum ab ovo. He might, with equal truth, have said, 
 Omne vivum a jpolline ; and, with still greater truth, 
 Omne vivum a polline, et ovo. 
 
 Each of them — the pollen, the ovum — was originally 
 a creation. Their mutual and reciprocal action is a 
 phenomenon which the Creator has impressed on this 
 portion of His works as the fiat of His will.
 
 188 ZOONOMIA; OR, THE LAW OF ANIMAL LIFE. 
 
 That this action is perfectly reciprocal is proved by 
 the resemblance of the new being or offspring — be it 
 animal or vegetable — to botk parents. The event is at 
 present as inscrutable in its nature and essence, as it is 
 interesting to the physiologist and philosopher as a sub- 
 ject of observation and new inquiry. 
 
 Why t/ds seed of the Triticum Indicum, or Indian 
 corn, on which pollen has fallen, should, if planted 
 in soil, and exposed to the genial influences of heat and 
 moisture, become a noble and useful plant ; and why this 
 other, to which, from its mode of growth and treatment, 
 no pollen has been allowed to have access, shall, under 
 similar circumstances and influences, undergo decay and 
 decomposition, who can tell ? Why tUs egg, which has 
 been fertilized by pollen, should, under similar genial in- 
 fluences, become a bird, and eventually soar into the 
 regions of the atmosphere ; and why this other, unaffected 
 by pollen, should pass into a state of putrefaction, who 
 can declare ? Who will attempt to explain why those 
 "divinse particulse aurse,'' which exist in the form of 
 pollen, can alone vivify these ova ? Who can say w/mt 
 there is in these ova, and wkaf there is in the appropriate 
 pollen — for the two are equally essential — which develop 
 growth, and form, and life ? 
 
 Look at these ova and at these seeds. On this ovum, 
 and on this seed, no pollen has ever been shed. They 
 will, though placed in circumstances the most favourable 
 for development, only pass the more readily into decay. 
 But this other ovum, this other seed, on which pollen.
 
 zoonomia; or, the law of animal life. 189 
 
 life-giving pollen, has shed itself, will, under similar cir- 
 cumstances, germinate and pass into life, the whole sub- 
 sequent being becoming expressly imbued with the 
 equally inscrutable properties of the pollen, and of the 
 ovum or seed. 
 
 What is the condition of this pollenized, this fructified 
 ovum or seed, before active life begins ? Is life in abey- 
 ance ? Or is it in actual existence, only in its lowest and 
 imperceptible form ? Have eggs and seed a temperature 
 of their own, above that of the medium in which they are 
 placed ? And what is the condition of this offset of an 
 animal or animalcule (as the planaria), or of this plant ? 
 Both will continue to live independently of the original 
 stem. Both may be multiplied and propagated by new 
 and similar offsets. Both are, as I have stated, equally 
 imbued with the properties of both the original pollen 
 and ovum. All tliis is mysterious, inscrutable in its 
 essence, constituting one of the arcana of organic nature, 
 which may long, may for ever, be hidden from us. 
 
 But the laws of life, and those of the material and 
 inorganic world may be detected ; and their detection 
 and investigation are amongst the most legitimate, inte- 
 resting, and important objects of philosophical inquiry. 
 At present, I beg only to state, that whilst pollen places 
 the ovum or seed under vital influences, its absence 
 allows them to become the prey of mere physical or 
 chemical agencies alone. 
 
 The further essential and distinctive characteristic of 
 organized beings^ that in which they differ from the
 
 190 ZOONOMTA; OR, THE LAW OF ANIMAL LIFE. 
 
 objects of the inorganic world, is — membrane. Through 
 this membrane, a special function of transition takes 
 place, constituting endosmosis and exosmosis, or imbi- 
 bition and exudation.- 
 
 If this membrane be injured or broken down, the 
 materials of organized being are again immediately sub- 
 tracted from the laws of organization, and delivered over 
 to the ordinary principles of chemical action — decay or 
 eremacausis — from which that membrane had preserved 
 them whilst it placed them under the dominion or modi- 
 fication of vital influences. Examples of this fact are 
 afforded by bruises of animal or vegetable tissues, which, 
 if slight, are repaired by the vital powers ; but if severe, 
 lead to death or decay. How extraordinary are the 
 changes which almost immediately take place in bruised 
 flesh, or in a bruised orange or apple ! 
 
 But I must hasten from these preliminary views, and 
 pass on to the more express subject of this lecture. All 
 living being, from the serpent to the eagle, possess in 
 common, peculiar dynamic properties ; in all, these pro- 
 perties respond to appropriate external and internal 
 stimuli. On the reciprocal play, action, and re-action, 
 of these forces and agents, life, with all its varied pheno- 
 mena, in all its varied forms, essentially depends. 
 
 These dynamics and these stimuli bear a relative 
 proportion to each other. This proportion is inverse; 
 the higher the dynamic, the lower the stimuli, and vice 
 versa. Such is — the Law of Animal Life, 
 
 In the animal kingdom, two forms of dynamics exist.
 
 zoonomia; or, the law of animal life. 191 
 
 The first has its seat in the nervous system, or, more 
 definitely, in the spinal and ganglionic sub -systems : I 
 venture to designate it by the term neuro-dynamic. The 
 second has its seat in the muscular system ; it may be 
 designated myo-dynamic. The stimuli exist in greater 
 numbers, for they consist in physical and chemical agents 
 of the external world, such as air, food, water, heat, hght, 
 the galvanic influence, &c. 
 
 I must introduce the subject of the vital dynamics by 
 showing those who are not familiar with physiology an 
 experiment full of the deepest interest. I place before 
 you a frog, prepared for the purpose; and you will 
 observe how the most elevated principles of philosophy 
 may be illustrated by what you may deem the humblest 
 objects of creation. The physiologist knows and feels 
 that his science, elevated as it is, is included in the most 
 insignificant insect that lives — -the caterpillar or the 
 butterfly. 
 
 The nervous system consists in three sub-systems ; 
 the first is that of which the brain, or cerebrum, is the 
 centre, and sensation and volition the special functions. 
 I have removed this centre and these functions from this 
 frog by removing the head, and with it, the very centre 
 of the system, or sub -system, itself ; the creature is thus 
 entirely deprived of sensibihty ; the idea of suffering is 
 excluded. It is also deprived of voHtion ; all spontaneous 
 movements are impossible. 
 
 Yet there is a source and power of movement remain- 
 ing ; for you observe the effect of irritation of the integu-
 
 192 zoonomia; or, the law of animal life. 
 
 meiit covering the toe or foot. This power resides in 
 the spinal marrow, or spinal centre, and certain nerves 
 proceeding to it and from it, termed therefore eisodic or 
 in-going, and exodic or out-going. I have designated 
 this power neuro- dynamic ; it was formerly termed the 
 vis nervosa; its English appellation would be nerve- 
 power. 
 
 The nerves which proceed to the centre of this spinal 
 system arise from the skin. I have removed the skin 
 from the left foot, and you will observe that the same 
 irritation which, applied to the right foot, induced con- 
 traction of the muscles, is inoperative when applied to 
 this denuded limb; in effect, the origin of the eisodic 
 nerve has been removed with the integument. 
 
 But I now irritate the spinal centre itself; you 
 observe the convulsions produced. 
 
 Lastly, I irritate these, the lumbar nerves ; they are 
 exodic, and proceed to the muscles ; again the limbs are 
 violently agitated by movements. 
 
 Here, then, are phenomena arising out of irritation 
 of the nerves, eisodic and exodic, and the centre of the 
 spinal system. They attest the neuro-dynamic power of 
 those several nervous tissues. 
 
 But there is still a third sub-system of the nervous 
 system ; it is termed the ganglionic, and it is connected 
 with all that is interior or within us. I have here placed 
 aside the viscera of the frog, and with them the ganglionic 
 sub-system belonging to them — the heart, the stomach, 
 the intestines, &c. If you were nearer you would see the
 
 ZOONOMIA; or, the law of AXIMAL Lli'E. 193 
 
 heart pulsate, and the stomach and intestines move by 
 what is termed peristaltic action. These phenomena are 
 effected through the medium of the ganghonic portion of 
 the nervous system in which the neuro-dynamic must also 
 reside. 
 
 But, besides the power residing in the nervous tissues, 
 there is, as above stated, another dynamic. Its seat is 
 the muscular tissue, for which reason it may be desig- 
 nated the my -dynamic. You observe the effect of a yerv 
 slight galvanic influence passed along this muscle ; the 
 muscle is immediately vigorously contracted. This is the 
 vis muscularis of physiologists, the miiscle--^Q>ys^Y, 
 
 These vital dynamics, and the physical and chemical 
 stimuli to which I have alluded, bear an inverse ratio to 
 each other. This is the case both primarily and second- 
 arily — the first by creation; the second, by a natural 
 operation and effect ; for if stimulus be diminished, the 
 dynamic becomes augmented ; and if the stimulus be 
 augmented, the dynamic becomes exhausted, and, in some 
 degree, proportionately reduced, as natural events, causes 
 and effects. 
 
 Thus the effect of hibernation, during which the 
 stimuli of air, food, temperature, and nutrition are re- 
 duced to their minimum, is to lead to augmented 
 dynamic and excitability, and to what may very appro- 
 priately be designated vernation, or the activity of spring; 
 whilst the effect of the augmented stimulus in the 
 summer months, that is, of augmented air, food, temper- 
 ature, and nutrition, is to exhaust or lessen the dynamic
 
 194 zoonomia; or, the law of animal ltfe. 
 
 of nervous and muscular fibre, however they may augment 
 general activity and power of mass, and prepare the way 
 for the next winter sleep. 
 
 By creation and the operation of natural causes, then, 
 the inverse ratio, between dynamics and stimulus, in 
 animated creation, is — the Law of Life. 
 
 The attempt to invert this law in either direction, and 
 equalli/ in either direction, is to destroy life. Unduly to 
 augment the stimulus when the dynamic is high, or un- 
 duly to diminish the stimulus when the dynamic is low, 
 is equally to interrupt the vital actions. 
 
 I will again illustrate my subject by a reference to 
 the interesting case of hibernation : — If you take a bat 
 from its winter quarters, from its state of hibernation, in 
 which its respiration is at the minimum and its dynamic 
 at the maximum, and make it fly about, and so augment 
 the vital stimulus of respiration, it infallibly dies I If, 
 on the other hand, you take the same creature in its 
 condition of summer activity, and of high respiration and 
 low dynamic, and deprive it of air by immersion in water, 
 or in an irrespirable gas, it dies too. Invert in either 
 way the inverse ratio of dynamic and stimulus, and the 
 result is fatal. 
 
 Low dynamic req^iires high stimulus ; high dynamic, 
 low stimulus. The higher the d}Tiamic, the more capable 
 is the animal of the further abstraction of stimulus, and 
 vice versa. If, instead of taking a bat from its summer 
 activity, you take it in its state of hibernation, and now 
 immerse it in water for ten minutes or even longer, it is
 
 zoonomia; oe, the law of animal life. 195 
 
 altogether uninjured. The bat, taken in its state ol 
 activity, and submerged in water, dies in two minutes 
 and a half. 
 
 Thus, the hibernating animal dies if its respiration 
 be augmented, whilst it can bear its suspension; the same 
 animal, in its state of vernation, or of activity, can bear 
 its respiration to be augmented, but dies speedily if it be 
 suspended ! 
 
 I will illustrate this view by another order of facts : 
 The tadpole of the frog breathes in water, and feeds on 
 water-plants ; the same tadpole, become a frog, breathes 
 in atmospheric air, and feeds on insects. It has become 
 a higher breather — a higher feeder. In the former state, 
 the dynamic, in the latter the stimulus, is comparatively 
 greater. The tadpole would die if taken out of its ele- 
 ment, the water ; the young frog would drown if com- 
 pelled to remain in it ! 
 
 These facts are the results of innumerable experiments. 
 I shall take occasion to revert to them hereafter. 
 
 Besides being inverse, to which there is no exception, 
 the ratio between dynamic and stimulus may be higher 
 or lower. It is in this maimer that we are enabled to 
 explain the modes of life. As life in general is a result 
 of stimulus into dynamics, we should, without a provi- 
 sion of this kind, see all animals equally active or inactive. 
 Either the reptile would not creep slowly, or the bird 
 tribe would not soar into the atmosphere. But we 
 observe, in fact, that when the stimulus is ^/i^propor- 
 tionately low, the animal is of low activity; and that
 
 196 ZOONOMIA; OR, THE LAW OF ANIMAL LIFE. 
 
 when it is ^disproportionately liigli, the animal is in the 
 enjoyment of an intense degree of activity. 
 
 Throughout animated nature, as I have already stated, 
 in all the varied forms and modes of life, from the eagle 
 to the serpent, the dynamic and the stimuli are in an in- 
 verse ratio to each other. Such, as I have observed and 
 often repeated, is the Law of Life. In the bird tribes, the 
 quantity of air and food imbibed is extreme, the degree 
 of dynamic very low ; in the reptile tribes, the quantity 
 of stimulus is low, and the degree of dynamic high. 
 
 The following formulae may serve to express this 
 general fact : 
 
 Stimulus ... 8 ... 4 .. 2 ... 1 
 Dynamic ...1...2...4...8 
 
 The degree of activity, or of inactivity, in all these 
 cases may be supposed to remain the same; but to 
 explain the greater activity of the bird, and the inactivity 
 of the reptile, a modification of the formulae is required, 
 which may be thus expressed : — 
 
 Stimulus ... 1 ... 2+2 ... 4+8 ... 8+24 
 Dynamic ... 8 4 2 1 
 
 In this manner, whilst the inverse ratio between the 
 stimulus and the dynamic, generally speaking, remains, 
 that of the former may augment more rapidly, as we pass 
 into the more active forms of living beings, than that of 
 the latter diminishes ; and thus the bird and the insect 
 fly, whilst the reptile and caterpillar creep. With higher 
 stimulus, the animal becomes more bird-like; with lower 
 stimulus, it becomes more reptile.
 
 zooxomia; or, the law of animal life. 197 
 
 "With augmented air and food, other organs, besides 
 those of respiration and digestion, become stimulated to 
 greater action. There is especially a correlation between 
 the rapidity of the action of the heart and of the acts of 
 respiration, arising in a peculiar and reciprocal manner 
 out of the play of stimulus and of the neuro-dynamic, 
 which resides in the spinal and ganglionic sub-systems 
 and the myo-dynamic in the muscles wliich are respectively 
 under their dominion, and out of the law which binds 
 them together, which deserves to be distinctly described. 
 The blood flowing through the lungs exhales carbonic 
 acid ; this is the internal excitor of inspiration, acting on 
 the fine branches of the pneumogastric nerves spread over 
 the lining membrane of the lungs ; the more rapid the 
 circulation, the greater the quantity of carbonic acid 
 exhaled, and consequently the more rapid the respiration. 
 But this respiration brings the oxygen of the atmosphere 
 into contact with the pneumonic blood in its turn, 
 through the same pulmonary membrane ; this oxygen is 
 absorbed by the blood, passes into the circulation, and 
 stimulates the heart to augmented action, and augments 
 the rapidity of the circulation. This last induces, in its 
 turn, a greater exhalation of carbonic acid in the lungs, 
 again augmenting respiration, &c. In proportion to the 
 the augmented stimulus, the dynamic is diminished. 
 
 The changes which take place in regard to the ratio 
 of dynamic and stimulus are of two kinds: — 1, Structural; 
 2, Physiological. The former, in metamorphosis, is 
 usually, if not always, upwards, to a state of higher
 
 198 ZaONOMIA; OR, THE LAW OF ANIMAL LIFE. 
 
 activity, — aud to a state of higher stimulus with dimi- 
 nished dynamic ; the latter takes place in both directions, 
 being to one of higher stimulus in vernation, and to one 
 of higher dynamic in hibernation. Activity on the one 
 hand, and repose, and especially sleep, on the other, 
 induce similar, though less-marked, effects. 
 
 I think I have said enough to convince you, gentlemen, 
 that there is, in this Law of Life, a most interesting and 
 important fact — a vast generalization. This generaliza- 
 tion embraces three great objects — 1, The scale of ani- 
 mated being ; 2, The metamorphosis, and, perhaps, mere 
 development; 3, Physiological changes. I know of 
 no law so general, so expansive. 
 
 I may now observe that it is of deep interest to trace 
 the criteria of the ratio between dynamic and stimulus. 
 
 1. Galvanism is a test of neuro- and myo- dynamic, 
 just as nerve and muscle in the animal in which these 
 dynamics are high — as the frog — become galvanoscopic, 
 or a test of galvanism. 
 
 2. In the animal in which the stimulus is high, the 
 temperature and its measurer, the thermometer, become 
 a test of its degree, and of course of the inverse condition 
 of the dynamic. 
 
 3. The degree of activity, or of inactivity, denotes 
 the relative condition of the two elements of the Law of 
 Life. 
 
 4. It has already been noticed, that, in proportion to 
 the dynamic, and in the inverse proportion to the stimulus, 
 the animal possesses the power of bearing the subtraction
 
 ZOONOMIA ; OR, THE LAW OF ANIMAL LIFE. 199 
 
 of stimulus, the privation of air and of food, and is, in 
 more senses than one, endowed with tenacity of life. 
 
 The length of time during which an animal can bear 
 the privation of air, or breathe a given Hmited quantity 
 of air, is proportionate to the dynamic. 
 
 5. The quantity of respiration affords a measure of 
 the stimulus. This is ascertained in various ways — 1, 
 By the structure and extent of the lungs^ ; 2, By the 
 number of the respirations ; 3, By the quantity of oxygen 
 imbibed, and of carbonic acid exhaled. 
 
 In proportion to the su)face of the luugs on which 
 the methaematous or blood-changing channels are spread, 
 in proportion therefore to the complexity of the structure 
 of the lungs is the quantity of respiration. The fish 
 has a mere gill ; the batrachiau has a vesicular lung, 
 with or without subdivisions or intersections, as we 
 observe in the triton, or in the frog or toad respectively; 
 the lung of the serpent, the tortoise, the tribes of the 
 mammalia, and of the birds, becomes more and more 
 complex and extended ; in the insect and in the bird, 
 the respiration is extended over the system, not being 
 limited to one organ; in the insect, indeed, each articu- 
 late segment is furnished with an analogue of the medulla 
 oblongata, as a central nervous organ of the respiration. 
 The dynamic exists in an inverse proportion. 
 
 6. The quantity of food assimilated or respired is a 
 stimulus in itself, and, in its proportion to respiration, 
 becomes a measure and criterion of the degree of dynamic 
 inversely. In speaking of the quantity of stimulus, as
 
 200 zoonomia; or, the law of anIxMal life. 
 
 represented by the food, we must also bear in mind the 
 quality as well as the quantity of that food, and its 
 convertibility into calorifacient and nutrient principles. 
 Insect food is, perhaps, of all kinds of food, the most 
 stimulant, whilst vegetable food is the least so. It must 
 also be a question how much of the food is really made 
 available, and how much is excreted, unrespired, unas- 
 similated. 
 
 7. We have in the circulation a criterion of the kind 
 and character of life ; slow and with few methsematous 
 vessels in tlie animal of low stimulus and high dynamic, 
 it becomes quicker with more crowded vessels as the 
 stimulus is greater. The structure of the lung and the 
 degree of rapidity of the movement of the blood-globules 
 must be carefully noted ; as the former becomes more 
 complicated, and the latter augmented, the quantity of 
 stimulus is higher, and, I need scarcely say, the degree 
 of dynamic lower. 
 
 There is, indeed, no subject so replete with interest 
 as the circulatory apparatus — pneumonic and systemic — 
 in themselves, in the different orders of animated being, 
 and in reference to the Law of Life. The entire apparatus 
 consists of — 1, The minute arteries ; 2, The minute veins; 
 and 3, The intermediate blood channels, or, as I have 
 proposed to denominate them — from the important fact 
 that aU the changes which take place in blood take place 
 in them — the methsematous, or blood-changing, channels. 
 These vessels are specifically distinct, a distinction on 
 which I have insisted on anotlier occasion.
 
 ZOONOMIA.; OR, THE LAW OP ANIMAL LIFE. 201 
 
 I must now, gentlemen, in the last place, bring before 
 you certain results of that Law of Life which I have 
 thus very inadequately sketched. In doing this, I shall 
 be compelled to repeat some of the preceding remarks ; 
 but I prefer this to the alternative of leaving my sketch 
 incomplete. 
 
 The first remark I have to make in regard to the 
 results of the Law of Life, relates to the temperature of 
 animals of high dynamic and of low respiration, and con- 
 sequently of low temperature. Such animals are said to 
 be of cold blood. This expression is inaccurate; no 
 animal is positively of cold blood. The species of lowest 
 temperature is still of a temperature higher than that 
 which would subsist absolutely without respiration, and 
 its blood is only low in temperature, without being as 
 cold as the surrounding medium. 
 
 Even amongst fishes, some are high, others low, 
 feeders and breathers, with a corresponding temperature. 
 The trout can only live at the surface of a limpid stream, 
 breathing highly oxygenated water, and feeding on the 
 insects immediately on that surface; the carp, on the 
 contrary, lives and breathes lowly, at the lowest parts of 
 stagnant pools. The trout is comparatively a fish of 
 higli stimulus — food and respiration — and temperature, 
 and uf low dynamic ; the carp of high dynamic and low 
 stimulus. The trout dies almost immediately, if taken 
 out of its crystal element ; the carp will live for days in 
 wet moss — that is, out of its own element, abundantly
 
 202 ZOONOMIA ; OR, THE LAW OF ANIMAL LTFE. 
 
 supplied with moisture, or in a limited portion of water 
 ill supplied with mixed atmospheric air. 
 
 As we rise in the scale of animated beings, from the 
 fish to the reptile, from this to the mammalia, and from 
 these to birds, the respiration, and, with this, the tem- 
 perature, also rises, the dynamic proportionately falling ; 
 the temperature of the fish and reptile is slightly above 
 that of the medium in which they dwell respectively; 
 that of the mammalia is about 98o ; that of the bird 
 tribes, about 102° Fahr. 
 
 The temperature accurately coincides with the quality 
 and quantity of food and the quantity of respiration, and 
 is, in efPect, the development of an internal stimulus from 
 stimulant ingesta. 
 
 With temperature, there is also, probably, the evolu- 
 tion of the galvanic agency. 
 
 The galvanic apparatus, the thermometer, the quality 
 of food, the quantity of oxygen, the power to bear the 
 abstraction of these stimuli, or, in certain circumstances, 
 their addition : all these are criteria of the place a given 
 animal, in a given condition, ought to occupy in the zo- 
 ological or physiological scale. 
 
 Growth, development, metamorphosis, nutrition, in 
 ovo and extra ovum, are other results of the play of vital 
 powers, dynamic and stimulus. With each of such 
 changes in form, a change in kind of life, or a metabiosis, 
 occurs. 
 
 Of these, hints have been dispersed in the preceding
 
 ZOONOMIA ; OR, THE LAW OF ANIMAL LIFE. 203 
 
 remarks. If T have succeeded in giving you, Gentlemen, 
 an adequate idea of them, and of the other topics involved 
 in the development of the Law of Life, I shall feel much 
 gratified. Pray accept my best thanks for your kind 
 attention throughout this imperfect lecture.
 
 205 
 
 POSTSCEIPT. 
 
 Case of Browning, 2'^^'^^'^'^^^^^ Suhmeniony Restoration ; 
 ly Edward CooJc, Esc[. Guildford. 
 
 Fielder Underwood, set. 16, an intelligent lad 
 and a good swimmer, while in the act of winding up 
 one of the sluice doors of the Mill- Mead Lock, Guildford, 
 was suddenly immersed in the water, by the handle 
 slipping off. The accident occurred on the 9th of July, 
 at 6.15, p. M. The water was pouring with great force 
 through the sluice hole into the lock, and he was conse- 
 quently carried under the sluice door and jammed there. 
 A man who was standing on the opposite side of the 
 lock immediately ran round to his assistance, and suc- 
 ceeded in getting hold of the boy's hand, although he 
 was immersed in a depth of from four to five feet of water ; 
 but, although he apphed aU the strength in his power, 
 he could not extricate him, in consequence of the lower 
 extremities of the boy being drawn firmly under the sluice 
 door, and jammed there by the force of the current of 
 water in the river above. 
 
 L
 
 206 POSTSCRIPT. 
 
 The man, finding that his efforts to release the lad 
 were of no avail, ran to a house two hundred yards dis- 
 tant for another handle (the handle having fallen into 
 the water with the boy). The road he had to traverse 
 was a difficult one ; part of the way consisted of a 
 narrow passage and a court-yard, he having to open a 
 gate to get into it ; and when he arrived at the house, 
 the woman who occupied it was up stairs. She imme- 
 diately came down and conducted the man through the 
 house into a back yard, where he found a handle, with 
 which he hastened back to the lock, and, with great pre- 
 sence of mind, at once determined not to wind up the 
 door under which the boy was pressed, lest he should 
 be carried by the current into the semicircular sluice 
 canal, but to wind up to its full height the sluice 
 door of the opposite side, in order to fill the lock as 
 speedily as possible, and take away the great pressure 
 of water which kept the poor boy a prisoner under 
 the sluice door. He therefore, instead of running 
 a little distance round, attempted to throw the handle 
 across the river to a man on the opposite side ; but in the 
 attempt he failed, and the handle fell into the water. 
 Anotlier was then sought after, by running and shout- 
 ing to some millers one hundred and fifty yards 
 distant. The handle was obtained, and the one sluice 
 door was wound up to its full height; and while the 
 lock was filling, some persons imagined that they saw 
 the boy's body in the agitated water which was in the 
 lock ; they thought that the boy had been carried through
 
 POSTSCEIPT. 207 
 
 the sluice canal ; and hooks were immediately obtained, 
 but what they imagined was the boy's head turned out 
 to be a tuft of weed. They then directed their search in 
 the water above the lock, and found the body wedged 
 under the sluice door ; and, although the lock was filled 
 with water, and the pressure of water thus removed, they 
 found that it was necessary to apply the handle to wind 
 up the sluice door which was pressing upon him ; and 
 when that was done, they immediately lifted the body 
 out of the water by means of grappling hooks. 
 
 I have been particular in narrating all these minute 
 circumstances, in order that an idea may be formed of the 
 time the boy was under the water ; for he was entirely 
 submerged from the moment that he fell in till the mo- 
 ment he was taken out. Now it takes three minutes and 
 a half to fill the lock with water when both sluice doors 
 are open to their fullest extent. AYhen the accident 
 occurred, but a small quantity of water had ran into the 
 lock, and one door was wound up one third and the other 
 one half its height ; the latter was partially blocked up 
 by the boy^s body, and the former could be wound up 
 entirely only when the handle from the mill was ob- 
 tained ; therefore the time which elapsed from the period 
 of time that he was immersed till he was removed was 
 considerable, and due to the follo\\-ing circumstances : 
 
 Istly. The attempt to rescue the boy in the first 
 instance. 
 
 2ndly. The time lost in the efforts made to obtain 
 the handles, and the accidental loss of one them.
 
 208 POSTSCRIPT. 
 
 Srdly. The endeavour to find the boy in the lock — 
 due to an impression that he had been carried through 
 the sluice canal. 
 
 The majority of those who saw the accident, and were 
 present during the whole period of submersion, were of 
 opinion that he was in the water more than ten minutes. 
 From the time it occupies to fill the lock, combined with 
 other circumstances, / infer that he must have been sub- 
 merged from seven to eight minutes, and certainly not 
 less than seven. 
 
 I arrived on the spot immediately after he was taken 
 out of the water. The surface of the body was cold, the 
 lips and cheeks blanched ; there were no signs of respira- 
 tion ; the heart was still ; the body was to all appearance 
 inanimate — lifeless. The muscles were very relaxed. I 
 immediately obtained the assistance of several of the by- 
 standers, and first stripped the body of its clothing. I 
 placed one man at each leg, one at the back, and one at 
 the head to guide it right in the rolling, and another to 
 administer a solution of heartshorn occasionally to the 
 nostrils. I drew the tongue well forward, and saw that 
 the throat was unobstructed. I then proceeded to act 
 according to the rules of the Marshall Hall Method — my 
 kind assistants rubbing the surface of the extremities 
 back, &c. while I rolled the body from fifteen to eighteen 
 times per minute. This was done on the grass, within 
 fifteen yards of the spot where he was taken out. After 
 from five to seven yninutes, the first gasp or inspiration 
 was noticed ; the next, in about half a minute ; and then
 
 POSTSCRIPT. 209 
 
 occurred about once in twenty seconds, more or less, 
 and with some irregularity for from fifteen to twenty 
 minutes; and after that time, the respirations became 
 more frequent. At the end of thirty -five minutes or so, 
 he breathed without my assistance, and the pulse could 
 be felt at the wrist ; but pulsation was felt in the femoral 
 artery in Scarpa's triangle some minutes before it was 
 felt at the wrist. After having thoroughly ascertained 
 that he could breathe, I had him wrapped up in a blanket 
 and conveyed home, where he was put to bed. The 
 surface of the body was still cold ; he was unconscious, 
 and could not be roused by loud talking, &c. The pupils 
 were much dilated. Respirations, 25, short and op- 
 pressed. Pulse weak, 50. Hot- water bottles were 
 applied to his legs and feet, and a free current of air 
 admitted through the room. At half-past seven p. m. 
 Mr. Sells saw him, and recommended the application of 
 a mustard cataplasm to the chest and abdomen. The pulse 
 had risen in volume and frequency, being 64, and the 
 respirations from 30 to 82, still very much oppressed ; 
 and on oscultating the chest, rough mucous crepitation 
 and bronchial wheezing could be heard. The mustard 
 plaster appeared to give him great pain ; it remained on 
 ten minutes, and made the skin red. 
 
 Mr. Sells again saw him with me at half-past nine 
 p. M. The pulse had increased to 104, and the res- 
 pirations to 52 ; excessive reaction had taken place, the 
 surface of the body was very hot and dry, he was still 
 unconscious, the dyspnoea very great. We made an
 
 210 POSTSCRIPT. 
 
 attempt to give him a little water out of a teaspoon, but 
 he made no effort to swallow. 
 
 At midnight he swallowed a teaspoonful of warm tea, 
 and said that it was " too sweet ;" these being the first 
 words he uttered after the occurrence of the accident ; 
 he slept till five a. m. 
 
 10th. At half-past six a. m. the skin was hot and 
 dry, pulse 88, weak ; respirations, 32 ; much oppressed, 
 has not answered to any questions put to him. At half- 
 past seven a. m. bowels relieved, and a large quantity of 
 urine passed. Half-past nine, a. m. ; is perfectly con- 
 scions, and cheerful ; has no knowledge of the accident, 
 and disbelieves its occurrence ; he does not even recollect 
 going to the lock. Complains of soreness and stiffness 
 of the limbs. The surface of the extremities is still cold, 
 but the surface of the other parts of the body is hot and 
 dry. Hot flannels appHed to the legs and feet ; pulse 
 90, weak; tongue, white; six grains of calomel to 
 be taken directly. At noon, vomited a small quantity 
 of what appeared to be pure bile, persjnres freeli/ , pulse 
 90, stronger; eat a small quantity of hght pudding; 
 breathing much easier. 
 
 11th. Was purged freely several times by the calo- 
 mel; enjoyed a good night's rest; pulse 80, soft and 
 rather weak; respirations 25, deeper, and more natural; 
 the temperature of the lower extremities was lower than 
 of other parts of the body, and warmth was still applied ; 
 has no headache ; complains of feeling stiffness in the 
 limbs.
 
 POSTSCRIPT. 211 
 
 A grain of calomel was given at niglit, and a senna 
 draught the following morning. 
 
 12th. Stomach irritable ; vomited after taking the 
 pill and draught ; tongue less wliite ; pulse 84, stronger. 
 To have light diet. 
 
 July 13th. Health improved in all respects, and 
 considers that he is *' himself again." 
 
 Edwaed Cook, 
 
 Assistant to Messrs. Stedman, Sells, and Stedman, 
 Surgeons, Guildford. 
 
 1 trust that this important case, with its details, will 
 lead to a renewed and more careful observation of the 
 length of time during which the human subject may be 
 deprived of respiration, without extinguishing all hope of 
 restoration.
 
 INDEX. 
 
 PART FIRST. 
 
 SECTION PAGE 
 
 I. — Introduction 1 
 
 II. — The Distinction between Respiration and the Respi- 
 ratory Movements in Apnoea 3 
 
 III. — Relation of Respiration to the Circulation 6 
 
 IV. — The Rationale of the Effects of Suspended Respiration 9 
 V. — The Effects of Apnoea chiefly the result of the Reten- 
 tion of Carbonic Acid 14. 
 
 VI. — On the Influence of Temperature, and on the Warm- 
 Bath 17 
 
 VII. — The former Modes of Treatment of Asphyxia 20 
 
 Reflections, 22 
 
 VIII . — New Modes of Treatment of Apnoea, 25 
 
 IX. — New Rules for the Treatment of Asphyxia 80 
 
 X. — On the Apnoea of Still-born Infants 34 
 
 XL — On Secondary Apnoea 37 
 
 XII. — Recapitulation 38 
 
 XIII.— The Royal Humane Society 40
 
 214 INDEX. 
 
 PART SECOND. 
 
 SECTION PAGE 
 
 I. — The Royal Humane Society 45 
 
 II. — More detailed Rationale of Apnoea 50 
 
 III.— The Apnoea of Still-born Infants 56 
 
 lY. — On Prone and Postural Respiration 60 
 
 V. — On the Inhalation of dilute pure Ammonia in Apnoea 72 
 
 VI. — Of the Inhalation of Oxygen 74 
 
 VII. — The Rationale of the fatal tendency of the Warm 
 
 Bath in Apnoea 74 
 
 VIII.— The Danger of all Attempts at Artificial Respiration, 
 
 except in the Prone Position 79 
 
 IX. — On the Prognosis in Apnoea 84 
 
 X. — On Narcotic Poisoning 89 
 
 XI. — The Laryngismus of Chronic Laryngitis...-. 91 
 
 XII. — The Laryngismus of Convulsion and of Epilepsy .... 91 
 
 XIII. — The Laryngismus of Strychnine 93 
 
 XIV. — The Laryngismus of Choking 94 
 
 XV. — On the Time the Patient may be submerged 96 
 
 XVI. — Formulae for Prone and Postural Respiration 98 
 
 CASES. 
 
 I. CASES OF DROWNING, 
 
 CASE 
 
 I — By Dr. Alexander, of Dundonald, Kilmarnock 105 
 
 II.— By Dr. Hadden, of Skibbereen 106 
 
 III.— By Dr. A. Legat, of South Shields 112 
 
 IV. — Improperly treated — fatal. ByDr. A. Legat 115 
 
 v.— By Ernest P. Wilkins, Esq. of Newport 117 
 
 VI.— By Mr. Richard Ellis, of Bishops-Auckland, 
 
 Durham 118 
 
 VII. — Onboard the Dreadnought, by F. M. Corner, Esq... 120
 
 INDEX. 215 
 
 II. CASE OF SUFFOCATION. 
 
 PAGE 
 
 Case of a Man overwhelmed by the fall of Earth ; com- 
 municated by James F. West, Esq 121 
 
 III. cases of the STILL-BORN. 
 
 I. — By Marshall Hall Higginbottom, Esq. of Notting- 
 ham 125 
 
 II.— By Charles Yaudin, Esq. of St. Heliefs, Jersey..,. 128 
 
 III — By Dr. NichoUs, of Wiveliscombe, Somerset 131 
 
 IV.— By J. T. Savory, Esq. of Wendover 132 
 
 V. — By J. C. Chappell, Esq. George Street, Hanover 
 
 Square, 134 
 
 additional cases. 
 
 YI to XIY 135 to 142 
 
 IV. cases of danger from chloroform. 
 I. — Case of Danger from Chloroform— restored by 
 
 Charles Hunter, Esq. of St. George's 143 
 
 II. — Of Danger from Chloroform, by Wm. Curran, 
 
 Esq 146 
 
 Note. — Case of Danger from Chloroform 148 
 
 Note on the Fatal Case of Chloroform, by James Paget, 
 
 Esq 149 
 
 Note on Dr. Snow's Experiments 153 
 
 Postural Respiration observed by Dr. Snow 160 
 
 Postural Respiration observed by Dr. McCormac 1 63 
 
 V. case of narcotic POISONING. 
 
 Case of Narcotic Poisoning in a Child thirteen months old ; 
 
 by Charles Blades, Esq. of Tattershall 164 
 
 postscript to the cases. 
 
 I. — Two Cases by Dr. Lawrence, of Carmarthen 166 
 
 II. — On obsolete Modes of Treatment 170
 
 216 INDEX. 
 
 PAET THIRD. 
 
 SECTION 
 
 I.— Edwards de I'lnfluence des Agens Physiques sur 
 
 la Vie 177 
 
 II. — Relation between the Dynamics and Stimuli in the 
 
 Animal (Economy 179 
 
 III.— The Nature of Life 181 
 
 IV. — On the Condition of the Circulation in Apnoea 183 
 
 ZOONOMIA ; OR THE LAW OF ANIMAL LIFE; 
 
 A Lecture, delivered at the Smithsonian Institute, Wash- 
 ington, D. C. U. S. on March 8, 1853 184 
 
 POSTSCRIPT. 
 
 CASE OF DROWNING. 
 
 Case of Drowning, Protacted Submersion, Restoration ; by 
 
 Edward Cook, Esq. Guildford 205 
 
 RECENTLY PUBLISHED BY THE AUTHOR, IN PARIS, 
 
 COUP D'CEIL DU SYSTEME SPINAL. 
 FINIS. 
 
 PRINTED BY J, MALLETT, WARDOUR STREET, LONDON.
 
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