AMONGST the most interesting and im- portant subjects which, from time to time, have been treated in The Life-boat Journal, is that of the means to be resorted to for the restoration of the apparently drowned, and it is one in which the NATIONAL LIFE-BOAT INSTITUTION has, for many years, taken the deepest interest. The Institution has spared no pains to elicit the latest experimental and theoretical improvements in those means; and it has spread far and wide the latest knowledge thus obtained by circulating throughout the United Kingdom, in our Colonies, and in foreign countries, a vast number of copies of the printed rules which it has adopted.

On reference to the back numbers of this journal, it will be seen that, in the year 1857, the Institution first issued its own rules. Previous to that time it had provided its Life-boat stations with the rules of the ROYAL HUMANE SOCIETY, but in that year, the eminent physiologist, the late Dr. MARSHALL HALL, pointed out the two serious defects in those rules, that they neither provided for the ejection of any water that had been swallowed, nor for a return of respiration.

The Committee of the Institution, thereupon, appealed to the medical world in this country, and to the public medical authorities on the Continent of Europe, for their opinion on the subject, the result being that the replies were so almost ex- clusively in favour of MARSHALL HALL'S " Ready Method," as he had denominated it, that the Institution had no choice but to adopt the same, although they seriously felt the inconvenience of two systems being promulgated at the same time, as if by two rival bodies, for the information of others than medical men.

The leading features of Dr. MARSHALL HALL'S plan, it will probably be remem- bered by most of our readers, was the alternately placing the body of the patient on its stomach and on one side, with about the same interval between each movement, as the periods of natural in- spiration and expiration. When in the former position the weight of the body and hand pressure on the back, caused the expulsion of any air remaining in the lungs, and that position was also favour- able to the ejection of any water swallowed; whilst, in the latter position, viz., on one side, the natural elasticity of the ribs and surrounding parts caused re-expansion with accompanying inspiration of air.

For a period of seven years those rules were exclusively adopted and recom- mended by the Institution, and with ex- cellent results, but in the year 1863, Dr. H. E. SYLVESTER, of London, proposed a new method of artificial respiration, which he pronounced to be far more effectual than that of MARSHALL HALL, and much more easy of performance; more effectual by causing a deeper inspi-ration, and more easy of performance, as only requiring a movement of the arms of the patient instead of the repeated turn- ing of tho body.

The Committee of the Institution then once more appealed to the medical authorities of the United Kingdom, and to a large number of individual medical prac- titioners, for their opinion of the relative ! value of the two systems. The result on j this occasion was, that a large majority approved of Dr. SILVESTER'S plan on account of its simplicity and easiness of performance. Some, however, of the parties appealed to, and amongst them tho heads of the Naval and Military Medical Boards, recommended a combi- nation of both systems, Dr. M. HALL'S being first resorted to as affording means for the ejection of water from the body, which Dr. SILVESTER'S did not do, it re- quiring the patient to be permanently laid on the back.

Convinced of the great importance of the discharge of water, and having, during the seven years that Dr. M. HALL'S system had been in use, had proofs of its efficacy, the Committee decided to adopt, in future, a combination of the two plans, Dr. M. HALL'S being first used for a period of from two to five minutes; and accord- ingly, in 1864, the Institution issued new rules embodying these alterations. At the same time, however, as stated in an Ar- ticle on the subject in the July number of this journal for that year: " It was not felt that the door would be shut against future change or reconsideration of the subject, should the result of ad- ditional experience, or the farther inves- tigations of scientific men, make it appear desirable to do so." Another period of several years has now again elapsed, during which time numerous instances have occurred of the efficacy of those rules, and proving the importance of the retention in part of the MARSHALL HALL system. In fact, from the circum- stance that when large quantities of water have been swallowed, it is rarely, if ever, all discharged at once, its ejection being often continued, at intervals, for a con- siderable time, it has become a question whether the " Ready Method" of MAR- SHALL HALL should not be returned to at intervals of a fe.w minutes to facilitate its discharge. For there can be little doubt that the presence of a large quantity of water in the stomach impedes the return- ing action of the heart and other vital organs.

We are now led to return to this sub- ject by the circumstance that Dr. BEN- JAMIN HOWARD, of New York, has now proposed-a new mode of effecting artificial respiration, and has forwarded to the Institution a Prize Essay written by himself on the subject. As Dr. HOWARD'S plan, which he has, in contradistinction to that of MARSHALL HALL, denominated the " Direct Method," appears to us to be even more | simple and easy of performance than Dr; I SILVESTER'S, whilst it has the great ad- | vantage over his of providing in the first ! instance for the discharge of water, we consider it well deserving of the serious consideration of the medical profession, and feel sure that a description of it will prove highly interesting to many of our readers.

I DB. HOWARD entirely coincides with I MARSHALL HALL in considering it of vital ! importance, that, in all cases of suffoca- tion, whether from drowning or other causes, respiration should accompany re- suscitation. At the very commencement of his Essay, he states his opinion on this point in the following explicit and for- cible language: " By whatever form of suffocation death be induced, whether by drowning, smoke, j noxious gases, chloroform vapour, hang- ing, or other mechanical obstruction, the process of death differs from that of or- ganic lesion in this important particular: ! after the signs of life have vanished there is a period during which life still lingers at its seat, its signs being subject to j recall.

" This period is brief. It is usually too i short for the procuring of absent appli-to a place of shelter, involving the risk of forfeiting the possibility of resuscita- tion. For this reason, and because such accidents usually happen at inconvenient places, it is highly desirable that any plan for resuscitation should include the use of such means only, as are every- where, at all times, instantly available.

Fortunately, experience has proved that artificial respiration, for the performance of which such means alone are required, is the only treatment upon which much reliance can be placed. On this point, the opinions of the profession may now be regarded as settled.

The important question, however, still remains to be finally decided: What is the easiest and most effectual way of producing artificial respiration ? 1st. MARSHALL HALL, as we have seen, has proposed a method which involves much personal labour, and requires at least two persons to perform it, as it re- quires the alternate turning of the body of the patient from face downwards to one side, and vice versa. It has, however, the special advantage of affording great facility for the discharge of water from the body, and it has proved efficacious in numerous cases; and, referring to it, Dr. HOWARD himself says: " The foundation- stone of all true progress in the art of resuscitation was first well and truly laid by MARSHALL HALL." And in another paragraph, referring to the rejection of MABSHALL HALL'S system by the ROYAL HUMANE SOCIETY, he says : "We have seen that, in spite of the opinions of many distinguished physi- ologists, the false principle of resuscita- tion by the direct application of heat had become absolutely controlling. A revolu- tion, as complete as it was marvellous, was, however, effected by MARSHALL HALL, who in a few years succeeded in establish- ing the true principle; that which has ever since formed the basis upon which the art of resuscitation has been con- ducted. The principle is, that' Respiration is the one source of vital heat.'" 2nd. Dr. SILVESTER has proposed a method which can be performed by one person, if the tongue of the patient be first secured and prevented falling back so as to close the air-valve in the wind- pipe ; but his plan has the serious defect of placing and retaining the body exclu- sively on its back, and thus affording no opportunity for the discharge of water.

3rd. And now, lastly, Dr. Howard pro- poses the method which we are about to consider.

He first points out what he considers to be the difficulties and shortcomings of the methods of both MARSHALL HALL and SILVESTER, chiefly as regards the indirect- ness and insufficiency of the movements to alternately expand and compress the chest, and their complicated nature, ren- dering their continuous repetition, at the rate of fifteen times in a minute, almost impracticable. He then states that he had for several years taught both methods in his lectures to medical students, and that his repeated failures to produce the desired effects in his attempted demonstrations, and the difficulty he found in making them readily understood and efficiently practised by others, led him to endeavour to strip them of their superfluities, and reduce them to their simplest terms, which resulted in the "Direct Method" that he now proposes.

Dr. HOWARD remarks, that " the one object of both methods is compression and expansion of the chest." How, then, can that object be most directly and easily performed, with the least amount of fatigue to the performer of the operation. He then points out, in his preliminary obser- vations, that the lungs have no positive action of their own, but that they are exceedingly elastic, expanding and con- tracting with the expansion and contraction of the chest, and always completely filling it; that there are sets of move- ments belonging to different parts of the chest, producing the different forms of breathing designated, respectively, the superior costal, the inferior costal, and the abdominal types; that the provision for free and extensive movements is confined exclusively to the lower part of the chest; that while all the ribs above have but little cartilage, and are united directly with the sternum (the breastplate of the chest), all those below the seventh to the twelfth ribs have a very extensive supply of cartilage, and are not joined directly to the sternum, but are so free anteriorly as to be not inaptly called the floating ribs (vide Fig. I.); that the entire floor or base of the chest is composed of the musculo- membraneous diaphragm, which by its contractions produces that type of breath- ing called abdominal, because of the motions it communicates to the abdomen by the alternating pressure it exercises OB its contained viscera.

He then proceeds to state, that the superior and inferior types of costal breathing are neither of them essential to life; and that health as well as life may be maintained by abdominal respiration alone, provided the person remain in repose; the superior costal type being only used for forced inspirations, such as may be required in unusual exertions.

Lastly, that in accordance with the anatomy of the parts, ordinary breathing usually combines the inferior costal and the abdominal types, the parts of the thorax called by them into action com- prising all which afford the greatest motion, change of thoracic capacity, and exchange of air in the lungs; all which holds equally whether the force causing the motions of those parts be vital, and from within, or mechanical, and from without.

In imitating natural inspiration, then, by substituting mechanical for the vital force, it is to those parts such force should be applied, and in such a way as most nearly to produce the motion ob- served in healthy breathing.

He then proceeds to describe Ms method as follows:— THE DIRECT METHOD.

Rule I. Arouse the patient.—Unless in danger of freezing, do not move the patient an inch; but instantly expose the face to a current of fresh air, wipe dry the mouth and nostrils, rip the clothing, so as to expose the chest and waist, and give two or three quick smarting slaps on the stomach and chest with the open hand.

If the patient does not revive, then proceed thus:— RULE II. To draw off water, &c., from the stomach and chest. (Vide 3?ig. II.)— Turn the patient on his face, a large bundle of tightly-rolled clothing being placed beneath his stomach, and press heavily over it for half a minute,' or so long as fluids flow freely from the mouth.

EUIE HI. To prodduce "breathing. (Vide Fig. III.)—Place the patient on his back, the roll of clothing being so placed be- neath it as to raise the pit of the stomach above the level of any other part of the body. If there be another person present, let him, with a piece of dry cloth, hold the tip of the tongue out of one corner of the mouth, and with the other hand grasp both wrists and keep the arms forcibly stretched back above the head.

(This position prevents the tongue from falling back and choking the entrance to the windpipe, and increasing the promi- nence of the ribs tends to enlarge the chest; it is not, however, essential to success.) Kneel beside, or astride, the patient's hips, and with the balls of the thumbs resting on either side the pit of the stomach, let the fingers fall into the grooves between the short ribs, so as to afford the best grasp of the waist. Now, using your knees as a pivot, throw all your weight forward on your hands, and at the same time squeeze the waist be- tween them, as if you wished to force everything in the chest upwards out of the mouth; deepen the pressure while you can count slowly one, two, three, then suddenly let go with a final push, which springs you back to your first kneeling position. "Remain, eteet m ova knees while you can count one, two; then repeat the same motions as before, at a rate gradually increased from four or five to fifteen times in a minute, and continue thus this bellows movement with the same regularity that is observable in the natural motions of breathing which you are imitating.

Continue thus far from one to two hours, or until the patient breathes; for awhile after carefully deepen the first short gasps into full breaths, and con- tinue the drying and rubbing, which should have been unceasingly practised from the beginning.

RULE IV. After treatment. Externally.

—As soon as the breathing has become established, strip the patient, wrap him in blankets only, put him in a bed com- fortably warm, but with a free circulation of fresh air, and leave him to perfect rest.

Internally.—Give a little hot brandy and water, or other stimulant at hand, for every ten or fifteen minutes for the first hour, and as often thereafter as may seem expedient.

The advantages which Dr. HOWARD claims for his method, as compared with those of MARSHALL HALL and Dr. SIL- VESTER, are summarised by him as fol- lows :— I. It combines the merits of the other methods, and has the following besides: 1. To the greatest " thoracic expan- sion " it adds a " compression " not found in any previous method, and so. yields a greater exchange of air in the lungs.

2. No time is wasted and no harm is done by superfluous motions.

3. Obstructive fluids are removed by drainage as well as by ejection. This is not done by any other method.

4. It can be applied on the spot, forth- with, wherever the patient's chest can be reached by the operator.

II. It is more effective; because 1. The respiratory motions are seen and felt, and can be accurately regulated by the hands of the operator.

2. Any other means, such as friction, electricity, insufflation, inhalation with oxygen, warm bath, &c., may be used simultaneously with the " Direct Method," without causing interruption or incon- venience.

III. It is more easy to be understood; because, 1. There is but one movement.

2. The object of the movement is self- evident.

IV. It is more easy to be performed; because, 1. The chief source of compression is the weight, not the strength, of the operator.

2. The attitude of the operator is convenient.

3. The movement is simple and limited.

4. Each movement is followed by a period of complete rest.

After careful consideration of Dr.

HOWARD'S method, in conjunction with those of Dr. SILVESTER and MARSHALL HALL, we feel convinced that as regards the ease with which it can be performed it is superior to both, whilst it has the special advantage over Dr. SILVESTER'S, that it affords an opportunity, at the outstart, for the discharge of water. We consider, however, that Dr. HOWARD is mistaken in supposing that it is sufficient to afford an opportunity for water to escape at the commencement of the treat- ment, since numerous reported cases prove that it is frequently discharged at repeated and varying intervals.

We also think it questionable whether there is so great an advantage as both Dr. HOWARD and Dr. SILVESTER claim for their methods over MARSHALL HALL'S, in the circumstance that they inject and eject a greater quantity of air through the lungs. If the blood supplied to the brain by the heart be of full amount, a proportionate amount of air will be re- quired to oxidize and vivify it; a fact which nature teaches us by the circum- stance of our involuntary quicker breath- ing when, by running or other unusual exertion, we have quickened the circula- tion of our blood. Not only, however, is such the case, and therefore, when the heart has almost ceased to palpitate, and , the blood supplied to the lungs is small i in amount, may a small amount of air be sufficient to oxidize it; but is it not worthy the consideration of medical men, whether, just as a candle or a spark may be extinguished by the powerful current of air which will excite a furnace to a white heat, it may not be possible that the feeble flame of life, then nickering in the heart, may not be extinguished by a too fierce blast of air in the lungs; and whether the success, which has un- doubtedly in numerous well-attested cases resulted from MARSHALL HALL'S " Keady Method," may not be to some extent attributed to the gentle fanning of the vital spark, which is effected by that original and ingenious plan.

Those, however, are points which must be decided by future experience, and the further consideration of the medical world; which experience and considera- tion will, no doubt, be awaited by the NATIONAL LIFE-BOAT INSTITUTION before it again alters its Rules for the Restora- tion of the Apparently Drowned.

We append the figures (vide Figs. 4, 5, 6, and 7) illustrating the methods of Dr. MARSHALL HALL and Dr. SILVESTER, as at present adopted by the Institution, in order that a general idea may be formed of Dr. HOWARD'S proposed system, in juxtaposition with others.

DK. HOWARD'S SYSTEM.

Fig. I. Showing the character and position of the human ribs. Those on one side, as when the lungs are inflated; FlQ. 1.

and those on the other, as when artificially compressed by the operator.

Fig. II. Showing the first step taken, by which the chest is emptied of air, and the ejection of any fluids swallowed is assisted. Fig. HI. Showing the position and during artificial expiration and inspira- action of the operator, in alternately pro- tion of air.

MARSHALL HALL'S SYSTEM.

l.-INSPIRATiON.

Fio. 4.

•-'.—EXPIHATIOX.

FIG. 5.

Ihe last two Illustrations (Figs. 4 and 5) show the position of the Body during the employment ofDr Marshall Salfs Method of Inducing Respiration. Fig. HI. Showing the position and during artificial expiration and inspira- action of the operator, in alternately pro- tion of air.

MARSHALL HALL'S SYSTEM.

l.-INSPIRATiON.

Fio. 4.

•-'.—EXPIHATIOX.

FIG. 5.

Ihe last two Illustrations (Figs. 4 and 5) show the position of the Body during the employment oF Dr Marshall Hall's Method of Inducing Respiration.