Source: Snow, John. Med. Times and Gazette 14 (April 25, 1857): 421. [ltr to ed., April 1857].
Dr. Marshall Hall's method of artificial respiration
To the 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 respiration 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 Medical Times and Gazette. That it was not efficient in restoring the patient is not to be wondered at, when his own natural respiration, continued for several minutes, had failed to restore the action of the heart. The artificial respiration was resorted to for want of anything 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 distention 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 inhalation of chloroform, the patient continued to breathe after the pulse had ceased, and the artificial respiration was not effectual 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 method 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 interrupted for a short time during the passage of the head, 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. Hall's 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. I believe that inflation of the lungs from mouth to mouth might have restored this child, but, according to my experience, not with the same promptitude.
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 accident which have ended fatally, notwithstanding prompt assistance.
I am, etc.
John Snow, M.D.
18, Sackville-street, April, 1857
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