Anaesth Intensive Care 2016 | 44:4
Cover note
The rocking method of artificial respiration
Lionel McDonald demonstrates the ‘Eve Rocker’. Image courtesy of Surf Life
Saving New South Wales.
Formerly I regarded the breathing thorax as a concertina-
bellows; my present work suggests that it resembles rather
a cylinder and piston. In older men the cylinder wall is
often rigid and scarcely used in respiration at rest. Hence
in artificial respiration it seems much better to exploit
the piston action of the diaphragm rather than to try to
compress the rigid walls of the cylinder.
Frank Eve, 19321.
By the early 1900s, several methods of artificial respiration
employing intermittent compression of the thorax had been
described. These included the techniques of Marshall Hall2,
Henry Silvester3, Benjamin Howard4, and Edward Schäfer5.
First described in 1903, Schäfer’s ‘prone pressure method’5
required the operator to kneel beside, or straddle, the hips
of the prone patient. Air was forced out of the patient’s lungs
when the operator pushed on the lowest posterior ribs. The
pressure was then relaxed, during which time air was drawn
into the lungs by elastic recoil5. More easily learnt and less
exhausting to perform than other techniques6,7, Schäfer’s
method became the dominant technique in English-speaking
countries during the first five decades of the 20th century8,9.
In November 1932, Frank Eve, Consulting Physician at
Hull Royal Infirmary and Senior Physician to the Victoria
Hospital for Children, Hull, reported a novel method of
manual artificial respiration1. Eve ‘stumbled’10 upon his idea
in January 1932, when asked to see a two-year-old girl with
post-diphtheritic paralysis of the diaphragm. He found the
patient propped up in bed, deathly pale and rapidly dying
Cover note
of a ‘death rattle’1 secondary to mucous surging to and fro
in her trachea. Tilting the girl head-down, Eve was able to
drain the secretions from her airway, but realised that this
position would have a detrimental effect on her lung function
if maintained continuously. It then occurred to Eve that if a
slow seesaw movement were provided, the weight of the
girl’s abdominal contents might push and pull her diaphragm
up and down like a piston. Accordingly, a rocking chair was
obtained, and the child tilted through 30 degrees from the
horizontal on each side. The technique proved clinically
beneficial and was performed continuously by her parents
10–12 times a minute until the diaphragmatic paralysis
resolved several days later. Portable chest radiographs taken
with the rocking chair in the head-up and head-down position
showed considerable excursion of the child’s diaphragm.
Eve trialled his technique for a second time in August
19321. The patient was a previously fit 24-year-old athlete
with acute respiratory failure secondary to Landry’s paralysis.
A mattress was lashed to a special stretcher, which was placed
on a trestle and the patient’s weight balanced over the pivots.
While the patient eventually succumbed to heart failure, Eve
felt the apparatus ‘did what it was asked to do’1 and believed
his technique might be applicable to resuscitation after
drowning, electric shock and gas poisoning1.
One year later, Eve and Esther Killick, from the Department
of Physiology, University of Leeds, published the results of
experiments comparing the Silvester, Schäfer and rocking
methods of artificial respiration11. Using healthy subjects
who had voluntarily suspended their breathing, the pair
demonstrated that lung ventilation produced by the Silvester
method was inadequate. Meanwhile Schäfer’s method and
the rocking technique produced tidal volumes of 350–550,
and 450–600 ml, respectively. Killick and Eve also found that
the technique allowed warmth to be applied to the victim,
and, as the least strenuous and simplest method of artificial
respiration, could be maintained for long periods, using
untrained operators. In practice, they recommended that
Schäfer’s method should be used without delay until a rocking
stretcher with blankets and hot water bottles could be found.
In time other case reports emerged. In 1934, Surgeon
Lieutenant Keevil of the Royal Navy described the successful
use of Eve’s rocking method in a case of respiratory failure
secondary to a ruptured cerebral abscess12. Using a
service stretcher secured to a trestle, Keevil recorded that
breath sounds could be clearly heard emanating from the
patient, which came as a ‘striking contrast to the silence
which accompanies the Schäfer method’12. Four years
later, a purpose-built tiltable hospital bed, made by the Tor
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Equipment Co. at Eve’s suggestion8, was used to manage a
nine-year-old boy admitted to Grimsby Corporation Hospital
with poliomyelitis13.
A Report from a Committee of the Medical Research
Council summarising the state of development of apparatus
for artificial respiration published in 1939 recommended the
use of tilting stretchers based on Eve’s principle for ‘short
emergencies’14. Such devices included the Riley Rocking
Resuscitator Stretcher, developed through collaboration
between Eve, Mr W. Riley of the Wakefield Mines Rescue
team, and the manufacturing company, Messrs Siebe
Gorman and Co. These stretchers were noted to be ‘fool
proof’14, making them particularly valuable for industrial
establishments and similar situations where the incidence
of respiratory accidents was high. Commenting only briefly
on the Tor tiltable hospital bed, the Committee wrote: “if
experience proves that sick people can tolerate this unusual
method of artificial respiration…the bed may fulfil most of the
requirements for prolonged artificial respiration in general
hospitals”14.
The onset of the Second World War brought with it an
increased risk of drowning for Naval servicemen. In 1942
Surgeon Lieutenant Gibbens of the Royal Naval Volunteer
Reserve reported that many otherwise uninjured men were
rescued after only a short immersion at sea, and yet did not
survive. Gibbens attributed this failure to the Schäfer method,
which he viewed as inefficient, complicated, and tiring, such
that it was rarely carried out thoroughly or for long enough15.
Working with Surgeon Lieutenant de Launay8, Gibbens went
on to devise several techniques for rapidly instituting Eve’s
rocking method on board ships. These techniques were
officially endorsed by the Navy and propagated in the 1943
publication, First Aid in the Royal Navy16. Eve subsequently
helped develop manual methods for rocking victims in small
rescue boats17, and by 1946 the rocking technique was
adopted by the US Coast Guard as complementary to the
Schäfer method18.
Many voluntary organisations, such as Surf Life Saving
Australia, also approved its use in the 1940s, teaching it
alongside the Schäfer method. Like other methods of manual
artificial respiration, Eve’s rocking technique was eventually
replaced by mouth-to-mouth respiration in the 1960s.
P. J. Featherstone
Addenbrooke’s Hospital, Cambridge, UK
C. M. Ball
Department of Anaesthesia and Perioperative Medicine,
Alfred Hospital and Monash University, Melbourne, Victoria
Cover note
References
1. Eve FC. Actuation of the inert diaphragm by a gravity
method. Lancet 1932; 220:995-997.
2. Hall M. Asphyxia, its rationale and its remedy. Lancet
1856; 32:393-394.
3. Silvester HR. A new method of resuscitating stillborn
children, and of restoring people apparently drowned or
dead. Br Med J 1858; 2:576-579.
4. Howard B. Plain rules for restoration of persons
apparently dead from drowning, as taught under the
auspices of the Metropolitan Board of Health of the City
of New York. New York: E. B. Treat and Co. 1869.
5. Schäfer EA. Description of a simple and efficient method
of performing artificial respiration in the human subject,
especially in cases of drowning, to which is appended
instructions for the treatment of the apparently drowned.
Med Chir Trans 1904; 87:609-623.
6. Killick EM, Cowell EM, Crowden GP. Principles of artificial
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E and S Livingstone.
9. Comroe Jr J H. ‘…In comes the good air.’ Pt. I. Rise and fall
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809.
10. Eve FC. Resuscitation of the drowned today. JAMA 1944;
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11. Killick EM, Eve FC. Physiological investigation of the
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12. Keevill JJ. Note on the diaphragm-gravity method of
artificial respiration. J Roy Nav Med Serv 1934; 20:367.
13. Kerr JA. Poliomyelitis treated by tilting stretcher. Lancet
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14. Medical Research Council. ‘Breathing machines’ and their
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15. Gibbens GH. Artificial respiration at sea. Br Med J 1942;
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16. First Aid in the Royal Navy. His Majesty’s Stationery Office.
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17. Eve FC. Resuscitation in rescue boats. Br Med J 1945;
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18. Shloss L. Fifty chances a day to save a life! Popular Science
1946; July:103-106.
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