19th century pioneers of intensive therapy in North America. Part 1: George Edward Fell.
For three decades after Marshall Hall's 1856 strictures against "forcing methods" and bellows for artificial ventilation (AV), human "forced respiration" (equivalent to intermittent positive pressure ventilation) was virtually abandoned. Various arm-chest manoeuvres often proved inadequate to save life. After doctor and engineer George Fell, of Buffalo (New York) (1849-1918), failed to save the life of an opiate-poisoned patient using Silvester's popular method, he resolved to try his animal laboratory AV method (bellows and tracheotomy). Following his first success in a landmark case (1887), he better adapted the apparatus for human use and soon succeeded with further difficult cases, but was unable to raise enthusiasm for his "Fell method" of AV. His reports of successful rescues to prestigious Washington Congresses met derision (1887) and indifference (1893), although by then they detailed 28 "human lives saved", mostly after opiate poisoning, and a switch from tracheotomies to face masks (simpler, but with a few complications). Continuing with rescues throughout the 1890s, Fell personally achieved recoveries after AV for as long as 73.5 hours (1896), and over 78 hours (1899). He argued for his method repeatedly with many talks, much documentation, and pleas for its use in other ventilatory crises. Despite his endeavours and successes, Fell was unable to secure widespread uptake of forced respiration, but others adopted his principles. Joseph O'Dwyer modified Fell's face mask-tracheotomy system by incorporating an intralaryngeal tube, and this "Fell-O'Dwyer apparatus" was used for neurosurgical cases (1894), also revolutionising intrathoracic surgery (1899).
Department of Critical Care Medicine, Auckland Hospital, Auckland, New Zealand. rvt.met@pl.net
Ronald V
RV
Trubuhovich
D001045:Aphorisms and Proverbs as Topic; D002170:Canada; D003422:Critical Care / Q000266:history*; D049672:History, 19th Century; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000266:history; D012121:Respiration, Artificial / Q000266:history* / Q000295:instrumentation; D012151:Resuscitation / Q000266:history; D014140:Tracheotomy / Q000266:history