Establishing a New Method 
of Artificial Respiration in 
Asphyxia Neonatorum 
BY 
J. HARVIE DEW, M.D. 
NEW YORK 
CORROBORATED BY 
Drs. Geo. T. Harrison, Von Beverhout Thompson, 
Wm. A. Ewing, Egbert H. Grandin, Wm. T. 
Lusk, J. Clifton Edgar, Edward A. 
Ayers, and Joseph D. Bryant 
WITH FOUR ILLUSTRATIONS 
[Read before the New York Academy of Medicine, February 2d, 1893. 
Reprinted from the Medical Record of March 11th, 1893] 
NEW YORK 
Press of STETTINER, LAMBERT & CO. 
22, 24 & 26 Reade Street 
1893 ESTABLISHING A NEW METHOD OF ARTIFICIAL 
RESPIRATION IN ASPHYXIA NEONATORUM. 
The best method of practising artificial respiration in as- 
phyxia neonatorum has, within a comparatively recent period, 
been made a subject for discussion by Dr. Lusk's most excellent 
paper read before the Academy in December, 1890, and pub- 
lished in the American Journal of the Medical Sciences for 
February, 1891, and more recently by Dr. W. E. Forest's arti- 
cle in the Medical Record of April 9th, 1892. 
Prof. Lusk offered no new method, but discussed and made 
more prominent the method known as tha* " Schultze, and 
impressed the importance of the use of the catheter for the re- 
moval of mucus and foreign matter from the trachea and larger 
bronchi, and also its use in artificial respiration by direct in- 
flation. 
In the discussion which followed this paper I took occasion 
to state that for many years I had practised a method which I 
regarded as original, and which I believed to be of great practi- 
cal value. 
Dr. Forest, in the Medical Record, finds all of the adopted 
methods in one way or another faulty, and presents one of his 
own (another modification of Sylvester) as " filling the bill." 
Of my statements before the Academy he writes : "Another 
method that has been widely advocated and practised, and yet 
is utterly worthless, is Schroder's. At a recent meeting of the 
New York Academy of Medicine, a physician present [referring 
to myself] claimed that this method was most efficient and put 
it forward as original with himself. In both cases it will be 
seen he was mistaken." 
Dr. Forest then describes " Schroder's well-known method," 
as he terms it, not as Schroder himself describes it, but approxi- 
mately, as I described mine before the Academy in 1890. 
In this paper I desire to show : 1. That Schroder's method 
is no more like mine than mine is like that of Schultze. Also 
that the principle and the object of all three of these methods, 
viz., those of Schroder, Schultze, 'and my own are nearly or 
about the same, while the plan of procedure is entirely different. 
2. That my plan is original, having been adopted indepen- 
dent of any idea secured from text books or elsewhere, and 
that I practised it in 1871, at least three years before Schroder's 2 
first publication of a method, which appeared in 1874, and be- 
fore I had ever known of Schultze or of his method, which 
was published in 1871. 3. That my method is the promptest, 
most powerful, and most efficient for immediate use which can 
be practised with perfect readiness and ease to the operator. 
Schroder, in his work on obstetrics, seventh edition, 1882, 
seems to especially advocate Schultze's method, which should 
be performed by ''grasping the infant in such a manner that 
the operator's thumbs shall rest on either side upon the anterior 
thoracic wall, while the index finger occupies the axilla and the 
remaining fingers are placed diagonally across the back. The 
child is then allowed to hang at arm's length between the knees 
of the obstetrician, its face being turned to the front. The 
child is next swung upward until the arms of the operator reach 
an almost horizontal position." These two movements induce 
inspiration. " The swinging motion is then arrested, flexion 
occurs in the child's lumbar spinal region, its head is directed 
downward, and its lower extremities fall slowly toward the ob- 
stetrician until the whole weight of its body rests upon his 
thumbs " This movement induces expiration. 
Schroder next speaks of catheterization for the removal of 
mucus, etc., and in presenting what is termed his method ad- 
vocates it in no terms of special commendation, but apparently 
in the most casual way. He simply says : " If no foreign par- 
ticles have been breathed in, or if they have already been re- 
moved, then one can employ artificial respiration in still other 
ways, thus : While the babe is in a bath one can enlarge the 
thorax, in that one supports the back of the babe while its 
head, arms, and pelvis fall backward ; a forceful expiration is 
then effected by bending up the baby over its belly, thereby 
compressing the thorax." This is literally all that Schroder 
has to say of this method for which he has been given credit. 
Francis Henry Champneys, in his article reporting his ex- 
periments on the cadavera of still-born children, published in 
the " Medico-Chirurgic.il Transactions," dated 1881, condemns 
Schroder's method as worthless. He presents the method as 
follows: "Schroder suggests [please note the fact that 
Champneys does not say that even Schroder himself ever ad- 
vocated or practised this method, but merely that he suggests] 
supporting the child by the back only, letting the arms and 
legs fall backward, which will produce opisthotonos, and then 
bending them in the contrary direction, producing emprostho- 
tonos. The latter to produce expiration, the former inspiration." 
The only description of Schroder's method I have been able 3 
to find in any English or American text book appeared in the 
first edition of Lusk's work on obstetrics, and he has not 
thought it of sufficient value to reproduce it in subsequent edi- 
tions. Yet Dr. Forest says in his article that it "has been 
widely advocated and practised," and at the same time quotes 
Champneys and declares it worthless. 
I do not believe that any one could successfully practise this 
method as Schroder directs, or that it has ever been taught or 
" advocated." 
The plan I have adopted is not so much like Schroder's as 
those of Pacini, Bain, Schiicking, Schuller, and Forest are like 
Sylvester's. 
I mention this fact because there is a most important dif- 
ference to which I desire to call attention. It is that all of 
these methods named have been suggested by, and are simply, 
to a large degree, modifications of that of Sylvester, while my 
plan was suggested by no previously adopted method. At the 
time I began its practice Schroder's method was not in existence, 
or certainly had not been published ; and Schultze's method was 
in its infancy, and entirely unknown to me. 
I cannot now remember exactly when I began to practise this 
method. The first instance I can well authenticate occurred 
in the practice of Dr. George T. Harrison, of this city, who is 
present with us to-night. 
I was called by him to assist in a difficult case of labor which 
he was attending in the old building that stood at the corner of 
Fifth avenue and Fifty-fourth street, on the ground now occu- 
pied by the handsome ''Vanderbilt" residences of Twombley and 
Webb. This was in the latter part of 1871. The infant at birth 
was thoroughly asphyxiated. The work of resuscitation devolved 
on me. It took considerably over an hour to fully establish the 
respiratory process. My method was then practised to relieve 
myself of the fatigue which that of Sylvester imposed, so the 
two methods were alternated during the treatment. I have con- 
tinued its use, almost exclusively, from that time till now. 
Description of Method. 
My directions for its practice are : To grasp the infant with 
the left hand, allowing the neck to rest between the thumb and 
forefinger, the head falling far over backward, straightening the 
mouth with the larynx and trachea, thereby serving to raise and 
hold open the epiglottis (as demonstrated by Benjamin Howard 
in his excellent article, " A New and Only Way of Raising the 
Epiglottis," British Medical Journal, November, 1888). The 4 
upper portion of the back and scapulae resting in the palm of 
the hand, the other three fingers to be inserted in the axilla of 
the baby's left arm, raising it upward and outward. (See Fig. 1.) 
Then, with the right hand if the baby is large and heavy, 
g asp the knees in such a way as to hold them with the right 
knee resting between the thumb and forefinger, the left between 
the fore and middle fingers. This position will allow the back 
of the thighs to rest in the palm of the operator's hand. If 
the infant is small and light, it will be found more convenient 
and easier to hold it in the same way by the ankles instead of 
the knees, allowing the calves instead of the thighs to rest in 
the palm of the hand. 
Fig.1. 
The next step is to depress the pelvis and lower extremities, 
so as to allow the abdominal organs to drag the diaphragm 
downward, and with the left hand to gently bend the dorsal 
region of the spine backward. This enlarges the thoracic cav- 
ity and produces inspiration. (See Fig. 2.) 
Then, to excite expiration, reverse the movement, bringing 
the head, shoulders, and chest forward, closing the ribs upon 
each other, and at the same moment bring forward the 
thighs, resting them upon the abdomen. This movement 
arches the lumbar region backward, and so bends the child 
upon itself as to crowd together the contents of the thoracic 
and abdominal cavities, resulting in a most complete and 
forcible expiration. (See Fig. 3.) 5 
While this movement is a powerful one, the operator can, by 
his manipulations, accomplish it without shock and render it 
as gentle as he pleases. 
Fig. 2. 
Fig. 3. 
Champneys' Experiments. 
It is evident from Dr. Forest's article in the Medical Record. 
already alluded to, in which he condemns Schroder's method as 6 
worthless, that the plan I propose will be denounced by some 
one, and for the same reasons that Champneys assigned in dis- 
cussing Schroder's method. 
I therefore think it best to state that Champneys' experi- 
ments were made by securing one end of a tube in the larynx 
of a still-born cadaver, while the other end was immersed in a 
fluid. He then endeavored, by exciting the inspiratory act, as 
directed in the different methods of artificial respiration, to de- 
termine by the ascent of the fluid how much air each one of 
them was capable of sucking in. 
His experiments led him to the conclusion that the methods 
of Schultze and Sylvester will suck in the greatest amount; 
that the modifications of the Sylvester method are the next 
most powerful, and that those of Howard, Marshall Hall, and 
Schroder excite no perceptible suction, hence are worthless. 
These experiments were all made on the cadavera from 
twenty-four to thirty-six hours after birth, when rigor mortis 
had, or certainly had had time to become as fully established 
as is usual in such cases. Under these circumstances it seems 
to me easy to understand that the active and forcible procedures 
incidental to the Schultze and Sylvester methods would exhibit 
a decided suction, while the much more passive movements of 
the Howard and Marshall Hall methods, and the plan " sug- 
gested" by Schroder, would draw in no appreciable amount of 
air. I cannot see how any other results could have been ex- 
pected. 
Only think ! Take an infant thirty-six hours dead, with the 
muscles, ligaments, cartilages, and even the bones to a certain 
extent stiffened, or deprived of their elasticity, place a tube in 
its larynx as stated, and then with a hand supporting its back 
allow the head and shoulders to gravitate to one side, its pel- 
vis and legs to the other. Now, how much air do you suppose 
is going to be sucked in ? I should certainly answer none, even 
if I had never heard of Champneys and his experiments. 
Finding by this exceedingly passive movement of producing 
opisthotonos in the cadaver that no air was drawn in, Champ- 
neys at once proceeded to account for the failure by stating that 
thismethod (Schroder's) is based upon the a priori reasoning 
that the capacity of a flexible cylinder increases when it is 
curved, and concludes as follows : " But the principal reason 
lies in the fact that in children who have never breathed the 
position of the thorax is one of expiration and not of inspira- 
tion, the thoracic walls are completely collapsed, and there is no 
thoracic cavity or cylinder to deal with. There is nothing to 7 
procure descent of the diaphragm, and the thoracic cavity can- 
not be expanded in any direction by such means." 
Some of the features of the plan I have adopted are more like 
to Schroder's than to any other thus far published. This fact, 
and the comments that have been made, have led me to direct 
your attention thus especially to what Schroder's so-called 
method is, and to what has led Champneys to condemn it. I 
do not think these conclusions will apply at all to my method, 
and I hope you will all agree with me when I present to you the 
following 
Explanation of Method. 
At birth an asphyxiated infant is perfectly limp and flexible. 
Its muscles are like so many wet rags and offer no resistance till 
stretched out to near or about the limit of their elasticity. In 
the Sylvester method the ribs are not lifted till the pectoral 
muscles have been put well upon the stretch, for the accomplish- 
ment of which the arms must be forcibly pulled upward. 
When this is done the chest cavity is increased laterally, and 
the diaphragm is flattened out, pressing the abdominal organs 
to some extent downward, thus serving, in a measure, to in- 
crease the cavity vertically. This produces the suction which 
every one recognizes, and which has made this method, up to 
date, the most universally known and adopted. 
My method accomplishes exactly the same results in a differ- 
ent way. To understand how it is done, let us consider for a 
moment the anatomical structure of the chest walls. These 
walls are supported by, and have their fixed point in the attach- 
ment of the ribs to the dorsal vertebrae. They are composed 
mainly of the ribs, their cartilages, the sternum, and the inter- 
costal and pectoral muscles. 
The muscles, as stated, offer no resistance and no assistance, 
except for traction. 
The ribs constitute not only the most prominent structure in 
the formation of the chest walls, but their movements are essen- 
tially important in any effort artificially or naturally to draw 
air into the lungs. It is upon their peculiar arrangement, for- 
mation, and attachments that the active inspiratory movement 
of my method depends. 
They are twelve in number on each side, and are separated 
from each other at well-defined distances. They vary in both 
length and shape from the first to the twelfth. They can be 
made to very closely approximate, if not to overlap each other, 
and are capable of as wide a separation as the elasticity of the 8 
intercostal muscles will permit. They terminate at the sternum 
in flexible cartilages, which vary in length and render them 
very movable. 
Posteriorly they have almost a fixed attachment. Their heads 
are closely bound by a strong ligamentous union to the bodies 
of the dorsal vertebras, while their tubercles, located nearly an 
inch from their heads, are bound with equal firmness to the 
lateral processes of the same vertebrae. Only a slight rotatory 
motion exists at this articulation, which, together with the 
peculiar shape of the ribs and the flexibility of their anterior at- 
tachments, enables the normal inspiratory act to be performed, 
the ribs at each effort being drawn upward and outward. 
Now comes the important fact I wish to impress. It is, that 
in my method of artificial respiration, owing to the firm attach- 
ment of the ribs to the bodies and processes of the vertebrae, as 
soon as the dorsal region is curved backward and the relative 
position of the bodies and transverse processes is changed, the 
ribs and their intercostal muscles open out like the segments of 
a fan. and, at the same time, owing to their peculiar shape, all of 
the bodies of the longer ribs are forced outward and the dia- 
phragm is flattened. Thus, both the lateral and vertical diame- 
ters of the thoracic cavity are increased. 
How much air is actually drawn in and how much reflex ac- 
tion is excited by the inspiratory effort of this or any other 
method in the first few movements it is difficult, from a clinical 
standpoint, to determine, but after keeping up the operation 
for a few moments, in any favorable case, it will be easy to 
recognize unquestioned evidences of suction. 
The infant whose photograph I herewith exhibit was born a 
little before, and died a short while after, 7 p.m. I was not 
present at its birth, but reached the bedside a few minutes after 
death. The photographs were taken at 11 a.m., sixteen hours 
after death. I then performed my method of artificial respira- 
tion, and was able to force air in and out of the lungs with each 
movement. The evidence was made positive by a very audible 
sound, excited by the escape of air at each expiratory effort. 
It is very frequently, if not usually the case, when resuscitat- 
ing an infant, that a decided grunt is heard with the expiratory 
movement after once the introduction of air has been established. 
The expiratory movement in this method is one of its most 
perfect and advantageous features. Indeed, I believe that a 
complete expiration is, for at least two reasons, of equal, if not 
greater importance than that of inspiration: 1st, because if 
one cubic inch, or any given amount of air is drawn in, it is 9 
most desirable that all of it shall be forced out in the movement 
that follows; 2d, because the expiratory effort in artificial res- 
piration should not serve only for the expulsion of air, but 
should at the same time be a means of improving and hasten- 
ing the general circulation. 
If the thoracic cavity is thoroughly but gently compressed, 
the heart and large blood vessels will be unloaded in the direc- 
tion of least resistance. This, of course, must be forward and 
in the right direction, as the cardiac aortic and pulmonary 
valves will open for its forward and close upon its backward 
flow. The accomplishment of this result with each expiration 
cannot be otherwise than most beneficial to the sluggish cir- 
culation of an asphyxiated infant. The Schultze method fills 
this requisite, as pointed out by Dr. Lusk in his article upon 
this subject ; but the action is too violent and cannot be regu- 
lated with gentleness. The Sylvester method and its modifi- 
cations, the mouth-to-mouth insufflation, and inflation by cath- 
eterization, are all deficient in this particular : they, each of 
them, depend for their expiratory movement on lateral pres- 
sure over the lower ribs, upon the epigastrium, or both to- 
gether. This plan of expiration is objectionable because : 1 
It does not expel all of the air from the lungs, if any has 
been drawn in. 2. It causes the centre and posterior portion 
of the flabby diaphragm to descend, thereby increasing the 
vertical diameter of the chest cavity. 3. It produces but slight, 
if any, pressure upon the heart and large blood vessels which 
occupy the mediastinum; certainly not sufficient pressure to 
be of any material benefit to the circulation. 
In the expiratory movement of my method, when the 
shoulders and chest are brought forward, and at the same mo- 
ment the thighs are made to rest upon the abdomen, includ- 
ing the epigastric region, the pressure upon the contents of 
the thoracic cavity can be made as forcible as the operator 
thinks best. The ribs are crowded upon each other, closing 
up the intercostal spaces, and the organs of the abdomen are 
pushed upward upon the diaphragm so as to diminish the ver- 
tical diameter as much as it is possible to do. By these com- 
bined forces the expulsion of air is complete, and the desired 
effect upon the heart and large blood vessels is most favorably 
secured. 
A Method Must be Selected. 
Every obstetrician who finds that he has delivered an as- 
phyxiated infant proceeds at once to excite the respiratory act. 10 
by reflex stimulus. To do this he moves the infant from side 
to side, spanks it, sprinkles water upon it, and possibly dips 
it alternately into hot and cold water ; but when the asphyxia 
is too profound to be thus relieved he is forced to resort to 
some one of the many methods of artificial respiration. 
Of the established methods Sylvester's and the plan of mouth- 
to-mouth inflation are probably by far the most universally 
adopted, next that of Schultze, then catheterization and insuf- 
flation, and finally the individual plans not commonly known. 
One or more of these methods must be resorted to by every 
practitioner. Hence it is a matter of unquestioned import- 
ance to be able to select the best among them, not only for 
individual use but for instruction in our schools of medicine. 
As previously stated, the Sylvester and the mouth-to-mouth 
plan offer good inspiratory but very imperfect expiratory move- 
ments. The Schultze method, though very efficient, is often 
inconvenient, is too chilling to the infant, and in many instances 
is too violent in its movements. Catheterization and insuffla- 
tion is not easy, and is, as a rule, unsafe in inexperienced hands. 
Of the individual and private methods I have nothing to say 
except of the one under consideration. 
In maternity hospitals where the obstetrician is offered 
every facility, and in the homes of the wealthy where there are 
so many conveniences, the difference between the methods of ar- 
tificial respiration may not be a question of so much import- 
ance ; but in that very much larger class of cases occurring in 
the homes of the middle and poorer people, where there are 
but few conveniences, he must always endeavor to select the 
most ready and favorable plan for immediate use. 
In any prolonged case of asphyxia the operator will become 
greatly fatigued in constantly pursuing any one of the meth- 
ods proposed, and will find great relief in practising first one 
plan and then another. 
Advantages of this Method. 
I claim for my method the following facts and advantages : 
1. That it is most efficient in all cases where artificial res- 
piration, in asphyxia neonatorum, is indicated. 
2. That years of experience have served to prove to others, as 
well as myself, its unquestioned value. 
3. That it can be practised with ease and readiness to the 
operator. 
4. That its movements are easy and can be quickly resorted 
to at any moment and anywhere. 11 
5. That while its inspiratory movement will be found, by 
experience at the bedside, to be as efficient as that of other 
methods, the expiratory movement is far more complete and 
satisfactory than in any of them. 
6. That nearly, or about all, of the air drawn in can be ex- 
pelled. 
7. That, owing to the force and at the same time to the ab- 
solute control which the operator has over the expiratory move- 
ment, he is able to compress the contents of the thoracic cav- 
ity to just exactly that degree deemed by him wisest and best, 
thereby favoring and hastening the general circulation-. 
Fig. 4. 
8. That this method can be employed before the cord is cut, 
when "it seems important to save as much blood as possible to 
the infant. 
9. That the operator can sit or move from place to place 
about the room, greatly to his relief from fatigue, still continu- 
ing the respiratory movements. 
10. That, if thought best, the movements can be kept up 
while the infant is immersed up to its chin in hot water. 
11. That by elevating the buttocks and depressing the head 
and shoulders, the expulsion of mucus can be effected, as in the 
Schultze method. (See Fig. 4.) 
12. That for alternating with Sylvester's and other methods 
it possesses peculiar advantages, affording great relief to tire- 
some positions in protracted cases. 12 
13. That it possesses all of the advantages of the Schultze- 
method and none of its disadvantages. 
14. That the method is prompt, reliable, easy toperform, and 
perfectly safe. 
252 West Fifty fourth Street. 
CORROBORATIVE EVIDENCE 
PRESENTED IN THE DISCUSSION OF THE PAPER BEFORE THE 
ACADEMY OF MEDICINE, AS GATHERED FROM ITS 
RECORDS, AND FROM NOTES TO THE AUTHOR. 
Dr. George Tucker Harrison. 
I can fully corroborate the statements made by Dr. Dew in 
the paper we have just heard, as to the inestimable value of the 
method devised by him for the resuscitation of the asphyxiated 
new-born child. 
This I am enabled to do, not only by seeing its efficiency 
demonstrated on subjects manipulated by himself, but by clini- 
cal evidence garnered in my own practice. 
In the treatment of the severer cases of asphyxia neonatorum 
three indications are to be fulfilled. The air passages must be 
freed from all foreign substances, air must be carried to the 
lungs, and the dormant energy of the heart and circulation 
must be awakened. These three indications are all fulfilled 
by the use of Dew's method. Some insist that the aspiration 
of foreign substances in the air passages by catheterization 
should precede the resort to any method of artificial respiration. 
In my experience I have not found this necessary in cases in 
which either Dew's or Schultze's method was practised. 
With reference to Schultze's method, it should be said that it 
also fulfils all the indications of treatment in a most exact 
manner. It cannot be denied, however, that this disadvantage 
will always be attached to it-viz., that in the hands of a be- 
ginner, or awkward practitioner, dangerous injuries may be in- 
flicted upon the child. 
[Here the doctor related a number of cases of injury gathered 
from different sources illustrative of the danger, and, continu- 
ing, said :] 
Such accidents are never likely to occur in the hands of an 
expert in obstetrics, but in the hands of the general practitioner 
they have occurred and may occur again. 
In this regard Dew's method has the great merit that no such 13 
accidents are to be feared. There is no reason why these two 
methods should not be used alternately in a case of great se- 
verity. As a rule, however, the adoption of Dew's method will 
supersede the necessity of a resort to any other. 
Dr. Von Beverhout Thompson. 
It gives me pleasure to indorse Dr. Dew's method of artificial 
respiration, which I have practised since the winter of 1871, 
when I saw him perform it for the first time. 
Of all the methods described, recommended, and practised, 
in my opinion his is the simplest and the best. 
To prove that inspiration and expiration take place, you will 
observe, if there is mucus in the nose or mouth, that when the 
body of the child is doubled up it will be forced out, and when 
the body is stretched backward it will be sucked in. You can 
also distinctly hear the air passing in and out of the lungs when 
the movements of this method are made. 
I have seen a good many infants saved by Dr. Dew's method, 
who, as I believe, had they been treated by any other method, 
would have died. 
Dr. William A. Ewing. 
In the resuscitation of asphyxiated new-born infants I have, 
for more than twenty years, practised the method described by 
Dr. Dew, and have found it more satisfactory than any other 
known to me. I first saw the method practised by Dr. Dew, 
and, so far as I know, it was original with him in all its most 
practical features. 
Dr. Egbert H. Grandin. 
From practical experience I am able to testify to the worth 
of the method proposed by Dr. Dew for the resuscitation of 
asphyxiated infants. 
I was not familiar with this method until Dr. Dew called my 
attention to it in March, 1892. I then directed the house staff 
in the maternity hospitals with which I am connected to test it 
thoroughly. 
The reports made to me are all in its favor, even as my own 
personal experience would lead me to expect. 
The method appeals to me in particular on account of its 
simplicity, imitating, as it does, so closely the natural respira- 
tory act. Before resorting to this or any other method the 
upper air passages must be cleared of mucus, etc. It is also 
advisable to distend the infant's lungs by mouth-to-mouth 
.insufflation. 14 
This having been done, and it requires but a minute, the 
infolding and outfolding of the child alternately surely dimin- 
ishes and increases the thoracic capacity, empties the great blood 
vessels of their engorged venous supply, and relieves the right 
heart; in short, not alone is the respiratory act established, but 
a distinct suction effect is excited on the thoracic circulation. 
For venous asphyxia, therefore, this method commends itself 
to me as the best of any described. It has absolutely no resem- 
blance to the so-called Schroder method, and it does not subject 
the infant to the risks which Schultze's method does. 
In cases of the anaemic form of asphyxia, hot saline rectal 
irrigation should be an adjuvant. 
The nearest approach to Dew's method is the one described 
by Dr. Harvey L. Byrd, of Baltimore (now deceased), in 1870, 
and published in the Baltimore Medical Journal tor the same 
year. Nevertheless entire credit should be given to Dr. Dew 
for originality of conception, and he deserves the thanks of the 
profession for the care which he is taking to popularize what, 
to repeat, I consider the best of all methods of resuscitation in 
asphyxia neonatorum. 
Dr. William T. Lusk. 
I was shown by Dr. Dew some three or four days ago photo- 
graphs of his methods, and have had time to think them over. 
I believe his method possesses more advantages than any of 
the three or four most familiar to the profession. 
I think, however, that we should not lose sight of the fact 
that there are no two cases exactly alike, and remember that a 
method suitable in one case may not be so well suited to another. 
I think Dr. Dew's method deserves the merit of being placed at 
the head of the list, but that it is one which should exclude all 
others I shall have to question. 
[Dr. Lusk next emphasized the importance of clearing the air 
passages of mucus, etc., by mouth-to-mouth suction, the use of 
the finger in the pharynx, catheterization, etc., and thought 
that when the heart has begun to beat perceptibly artificial 
respiration should be performed. He explained the circulation 
of the new-born and the advantages of Schultze's method in 
facilitating and aiding it, and in establishing respiration, aud 
then continuing he said:] But the objection to the Schultze 
method is that if the heart's action is very feeble and the swing- 
ing movements are repeated, in a brief period of time the heart 
will cease to beat altogether and life becomes extinct. 
It is therefore of much importance that we should have a 15 
method like that of Dr. Dew's, which disturbs the child but 
slightly. 
Formerly I resorted to Sylvester's method, and from time to 
time reinforced it, but now I am sure that I shall try the method 
of Dr. Dew, and I do not believe that it will do any harm once 
in a while to give the child two or three swings; first, for the 
purpose of forcibly ejecting mucus from the air passages, and, 
second, because I believe it gives an impetus to the heart, 
when once the heart's action is started, which cannot be accom- 
plished as well by any other method. 
Dr. J. Clifton Edgar 
said in part : I desire to thank Dr. Dew for so practically de- 
scribing his method and comparing it with others. There is one 
point that I did not understand Dr. Dew to bring out, which 
in conversation with him some few days since he spoke of, and 
that was the advantage of this method in that it could be 
readily used between the thighs of the mother before tying the 
cord, in those instances of asphyxia neonatorum termed "pal- 
lida," where we delay the separation of the cord for the purpose 
of securing the last half-ounce or ounce of blood obtainable. 
The method, Mr. President, is undoubtedly a good one, because 
it is both an easy and a safe method. 
Dr. Edward A. Ayers. 
I have practised Dr. Dew's method for six or seven years. I 
was first led to use it, as it was the only method which per- 
mitted placing the child in hot water during the manipulations. 
To get the needed stimulus of cold water, I usually dip the child 
for an instant in a cold bath placed conveniently at hand. 
That the method so clearly described by Dr. Dew is efficient 
I have had abundant opportunity of observing. 
By bringing the pelvis and knees well up against the ensiform, 
or as near as needed, and flexing the head and chin well on to the 
sternum, a very thorough expiration can be secured, clearly 
evinced by the noise, and by the expulsion of fluids from the 
nose and mouth. Inspiration can be proven in the same man- 
ner. 
The longest time occupied in resuscitation was thirty-eight 
minutes. Dew's method enables me to sustain artificial respi- 
ration, and at the same time keep the child in hot water-a 
factor which frequently makes all the difference between suc- 
cess and failure. Byrd's method, somewhat similar to Dew's, is 
not so efficient and does not permit us to manipulate the child 
under water. 16 
Dew's method is most useful, according to my experience, in 
the pale babies; those suffering from weak heart action, rather 
than from congestion and stagnation of the blood currents. 
Schultze's method in this class so chills that the child die 
from loss of heat before artificial respiration gets a fair chance. 
The latter method is more efficient for removing mucus and 
blood. 
Every method has its especial value, but from my observa- 
tions, which have been obtained from about fifteen hundred 
cases of confinement, I believe, as Dr. Lusk has said, that this 
method (Dr. Dew's) should stand at the head of the list. 
Dr. Joseph D. Bryant. 
I am fully convinced of the following facts : 
1. That extension of the dorsal and cervical spines, in the 
living or the dead subject, increases the capacity of the thorax, 
and therefore causes the entrance of air into that cavity, other 
things being equal. 
2. That flexion of the spine and the forcing of the abdominal 
contents against the diaphragm and thoracic viscera diminishes 
the capacity of the thorax, and therefore causes expulsion of air 
through the trachea. The same movement, no doubt, also 
stimulates the action of the heart by direct contact with it of 
unusual pressure agencies. 
3. That whether or not this method of procedure be better 
than others of greater repute, in a practical sense, is a matter 
which can be better decided by those who are constantly em- 
ploying artificial respiration in their every-day experiences than 
by myself. 
Dr. D. H. Stewart. 
There seems to be some doubt as to what Schroder's method 
is. With Dr. Dew's permission I will demonstrate it on his 
cadaver. 
There is nothing new about it. It was described as early as 
1868. You take the child in either hand-right or left (Schro- 
der, I believe, begins with the left)-lay it on its back in your 
hand, the legs and arms hanging down and the chest as in 
opisthotonos, and that is the position of inspiration ; then on 
its chest and stomach on the other hand (emprosthotonos), and 
that is the position of expiration. 
You keep on reversing the child, changing from hand to 
hand. That, at least, is the way it was explained to me last 
summer in Germany. 
It is a valueless method, I believe.