will fall forwards, and leave the entrance into the windpipe free. . . Let the body be now turned gently on the side (through rather more than a quarter of a circle), and the pressure on the thorax and abdomen will be removed, and inspiration will take place! The expiration and inspiration are augmented by timeously applying and removing alternately pressure on the spine and ribs."

(P. 394.) "Replace the patient on his face, his arms under his head, that the tongue may fall forward and leave the entrance into the windpipe free, and that any fluids may flow out of his mouth; then 1. Turn the body gradually but completely on the side, and a little more, and then again on the face, alternately (to induce respiration and expiration). 2. When replaced, apply pressure along the back and ribs, and then remove it (to induce further inspiration and expiration), and proceed as before.

2. Howard (Lancet,' 1877, August 11, p. 194). P. 196: "Seize the patient's wrists, and having secured the utmost possible extension with them crossed behind his head, pin them to the ground with your left hand so as to maintain it. The rest consists in throwing the weight of the body on the lower ribs, and then suddenly relieving the pressure (this of course requires modification in a foetus). It can be practised before division of the funis or after."

3. Silvester ('The True Physiological Method of Restoring Persons apparently Drowned or Dead, and of Resuscitating Stillborn Children,' by Henry R. Silvester, B.A., M.D. Lond., 1858). "1. To adjust the patient's position. place the patient on his back with the shoulders raised and supported on a folded article of dress. 2. To maintain a free entrance of air into the windpipe (by drawing the tongue forwards). 3. To imitate the movements of deep respiration raise the patient's arms upwards by the sides of his head, and then extend them gently and steadily upwards and forwards for a few moments. Next turn down the patient's arms and press them gently and firmly for a few moments against the sides of the chest."

In Fig. 4, p. 17, the operator grasps the arms above the elbows. The arms are not everted.

Also The Discovery of the Physiological Method of inducing Respiration in cases of Apparent Death from Drowning, Chloroform, Still-birth, Noxious Gases, &c.,' 3rd ed., 1853.

The directions are the same as above, except that (p. 20) the feet are to be secured; the arms are to be kept "stretched steadily" (upwards) for "two seconds" instead of "a few moments." The operator grasps the arms above the elbows, but in the figure he has seized them distally to the elbows (figs. 24 and 25).

Pacini (Di un nuovo metodo di praticare la Respirazione artificiale,' Firenze, 1867). The feet of the patient being fixed the operator stands with the head against his own abdomen, and then with his hands takes a firm hold of the upper part of the arms, applying the forefingers behind and close to the armpit, while the thumb is in front of the head of the humerus. Holding the shoulders thus, he pulls them towards him, and then lifts them in a perpendicular direction.

5. Bain ('Med. Times and Gazette,' 1868, December 19th, p. 708). 1st method. The fingers are placed over the front of the axillæ, the thumbs over the ends of the clavicles; the operator then draws the shoulders upwards, and then relaxes his traction.

2nd method. The shoulders are raised by taking hold of the hands and raising the body about a foot off the table, the position of the arms being at about an angle of 45° beyond the head.

6. Schücking (Berl. Klin. Wochenschr.,' 1877, No. 2, p. 19). The same as Silvester, except that the arms are drawn upwards and outwards.

7. Schüller (Berl. Klin. Woch., 1879, June 2nd, p. 319). The operator, standing either at the left side or at the head of the patient, raises the edges of the ribs with his fingers placed beneath them, and then depresses them. The knees should be kept bent to relax the abdominal

walls. The manipulation flattens and depresses the diaphragm.

8. Schroeder (Lehrbuch der Geburtshülfe,' Bonn., 1874, p. 673) suggests supporting the child by the back only, letting the arms and legs fall backwards (which will produce opisthotonos), and then bending them in the contrary direction (producing emprosthotonos). The latter to produce expiration, the former inspiration.

9. Schultze (Der Scheintod Neugeborener,' Jena, 1871, p. 162). The navel string being tied, the child is seized with both hands by the shoulders in such a way that both thumbs lie on the anterior wall of the thorax, both index fingers extend from behind the shoulders into the axillæ, and the other three fingers of both hands lie obliquely along the posterior wall of the thorax. The head is prevented from falling by the support of the ulnar sides of the two hands.

The operator stands with somewhat separated legs, and bends slightly forwards, holding the child as above described at arms' length, hanging perpendicularly (1st position, inspiratory).

Without pausing, he swings the child upwards from this hanging position, at arms' length. When the operator's arms have gone slightly beyond the horizontal, they hold the child so delicately that it is not violently hurled over, but sinks slowly forwards and forcibly compresses the abdomen by the weight of its pelvic end (1st movement, expiratory).

At this moment the whole weight of the child rests on the operator's thumbs lying on the thorax (2nd position, expiratory).

Any compression of the thorax by the hands of the operator must be carefully avoided. The body of the child rests during the first position with the floor of the axilla on the index fingers of the operator exclusively, and no compression should be exercised on the thorax in spite of the support offered by the hands to the head, nor should the thumbs compress the thorax in front.

When the child is swung upwards, the spinal column should not bend in the thoracic but only in the lumbar region, and the thumbs should not at this time strongly press the thorax, but should only support the body as it sinks slowly forward.

The raising of the body as far as the horizontal should be effected by a powerful swing of the arms (of the operator) from the shoulders; but from that point the arms should be raised more and more slowly, and, by means of a delicately-adjusted movement of the elbow-joints and scapula on the thorax, the pelvic end of the child should. fall gradually over. By this gradual falling over of the child's pelvis over the belly, considerable pressure of the thoracic viscera is exercised both against the diaphragm and the whole thoracic wall. At this point the inspired fluids often pour copiously from the respiratory openings.

After the child has slowly but completely sunk over, the operator again lowers his arms between his separated legs. The child's body is thereby extended with some impetus; the thorax, released from all pressure (the operator's thumbs lying now quite loosely on the anterior wall of the chest), expands by means of its elasticity; but the weight of the body hanging, as it does, on the index fingers of the operator by the upper limbs, and thus fixing the sternal ends of the ribs, is brought into use for the elevation of the ribs with considerable impetus; moreover, the diaphragm descends by virtue of the impulse which is communicated to the abdominal contents. By this means a deep inspiration is quite passively produced (2nd movement, inspiratory).

After a pause of a few seconds, in 1st inspiratory position, the child is again swung upwards into the previous position (1st movement, 2nd position, expiratory), and while it sinks slowly forwards it brings its whole weight to bear on the thumbs, which rest on the anterior thoracic wall, and mechanical expiration again ensues. At this point any inspired fluids always pour copiously from the mouth. and nose, and generally meconium from the anus.

VOL. LXIV.

4

The proceeding is repeated eight or ten times a minute, but more slowly when the inspired fluids flow from the mouth and nose.

Description of apparatus.

Tracheotomy was performed, and a canula tied into the trachea, this canula being in connection with an india-rubber tube, interrupted by a T-piece closed by a clamp, for the purpose of admitting air when desired. (When this clamp was opened the manometer is said to have been readjusted.) The other end of this tube was connected with a V-tube filled with water to a marked point, about half-way up. Inspiration, therefore, produced a rise of the water in the limb of the tube to which the india-rubber tube was attached, and expiration a corresponding fall. The readings in inches refer to the height of the fluid in this limb above the zero or line of original level (the actual height of the column of fluid being double this), and not to the cubic amount of air inspired.

The V-tube was not long enough to register more than six or seven inches above the line of zero; when the effect exceeded this, the manometer was readjusted half way, the subject being held in statu quo.

These facts do not vitiate the comparison of the relative inspiratory value of each different method, but they would have to be remembered in calculating the absolute inspiratory value.

Each inch in length of the manometer tube held about 2 c. c.

The results in the same body only are compared.

EXP. 1.-Male child, at eighth months. Craniotomy, January 5th, 1878, 9 p.m.; experiment, January 9th, 10 a.m. (83 hours). Trachea divided, canula tied in, tube connected with water manometer.

1. Lungs not inflated.