Description of a simple and efficient method of performing artificial respiration in the human subject especially in cases of drowning / by E. A. Shafer.

Sharpey-Schäfer, E. A. (Edward Albert), Sir, 1850-1935.

Date:: 1904

Credit: Description of a simple and efficient method of performing artificial respiration in the human subject especially in cases of drowning / by E. A. Shafer. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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$existing evil, but would at the same time increase the passive congestion of the thoracic viscera. Next with regard to the means to be employed to effect forced inspiration in the apparently drowned. After quoting the instructions given by Professor Schafer, he said that in the unconscious person with the functions of the nervous system in complete abeyance, and the thorax in a condition of expiration, the expansion of the chest walls required for inspiration was dependent alone on the elasticity of the costal tissues, and consequently could take place only feebly and inefficiently unless receiving some active mechanical aid. But when the patient was lying prone, with the weight of his body resting on the most mobile part of his chest, and the diaphragm pressed up by the abdominal viscera against the lungs, and the vital capacity of the chest thereby diminished, he was placed under the most serious embarrassment so far as the entrance of air into his lungs was concerned. In order to obviate this evident disability, the plan of rolling very naturally superseded that of simple compression in the prone position, for, by rolling the body backwards, the natural resiliency of the ribs was allowed fuller play, though on one side of the chest only, and, in consequence, a limited amount of air could be drawn into the lungs. Any advantage possessed by the rolling method over simple compression was, however, neutralised by the danger of fracturing the cervical vertebrae, the fatigue of turning the almost lifeless body alternately on the chest and on the back fifteen times in a minute for some hours, and the employment of only one side of the chest at a time; also the congested condition of the heart and thoracic viscera rendered the pressure in the prone position dangerous in the treatment of cases of drowning; while the free elevation of the ribs on both sides of the chest, which is possible in the supine position of the body, and offered facilities for removing this state of congestion, was not taken advantage of. The next point considered was what was the amount of air respired. It was ascertained by means of experiment that the amount of air inspired by this method was exceedingly small, and compared most unfavourably with the amount obtained in the Silvester method. The greater the amount of air inspired with each effort of the operator, the shorter would be the time required for recovery, and the better would be the prospect of resuscitation, for the greater would be the number of air-cells exposed to the revivifying influence of the oxygen admitted. With regard to the amount of pressure likely to be exerted in following out the instructions given by Prof. Schafer, when carried out by a seafaring population, he said that the pressure on the patient’s chest would not be less than from thirty to forty$