Henry Robert Silvester (1828 – 1908) was an English physician
Awarded him the Fothergill gold medal by the Royal Humane Society for his valuable research and discoveries in the method of inducing respiration in cases of apparent death from drowning or asphyxia, chloroform, and still-birth. More than 500 cases of successful resuscitation using the Silvester method of artificial respiration have been reported.
In the years after its introduction Silvester defended his method of artificial respiration. He criticised the Schafer method in which the rescuer was positioned astride the prone patient saying: ‘The posture of the operator ‘‘athwart the patient’’ in respect of the female patient, was, moreover undesirable’
Silvester gained further notoriety by proposing a technique of hypodermic inflation of air to render men and animals unsinkable…
- Born in 1828 or 1829, the second son of Dr. T. H. Silvester of Clapham
- Medical education at King’s College, London
- 1853 – MRCS Eng
- 1854 – MB, University of London
- 1855 – MD, University of London
- Hunterian scholar in human and comparative anatomy of the Royal College of Surgeons of England
- Physician to the Clapham General Dispensary
- 1861 – honorary medical assistant to the Royal Humane Society
- 1883 – Fothergill gold medal, Royal Humane Society
- Died March 1908 in London
Silvester method (1858)
Silvester questioned the technique of artificial respiration introduced in 1856 by Marshall Hall (1790 – 1857). Silvester inserted fluid into then trachea of fresh cadavers, and using a manometer, demonstrated that the movement of fluid in and out of the trachea, and by inference the movement of air, was limited.
Silvester described his ‘new method of resuscitating still-born children, and of restoring persons apparently drowned or dead‘ in 1858.
I purpose to describe a new method of treating apnoea, and of inducing respiratory movements, by means of which air may be drawn into the lungs of the asphyxiated person without the employment of any apparatus
He pointed out that his technique, unlike that of Marshall Hall, could be carried out with the patient in a warm bath – such as in the case of a stillborn infant
Silvester recommended that one should (I) adjust the patient’s position, (II) maintain a free entrance of air into the windpipe, (III) imitate the movements of deep respiration, and (IV) induce circulation and warmth and excite inspiration. His described his method for artificial respiration as follows:
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. This action enlarges the capacity of the chest by elevating the ribs, and induces inspiration.
Next, turn down the patient’s arms and press them gently and firmly for a few moments against the sides of the chest. This action diminishes the cavity of the thorax, and produces a forcible expiration.
Repeat these measures alternately, deliberately, and perseveringly fifteen times in a minuteSilvester method, 1858
In 1941, Edgar Pask reviewed a range of methods of artificial respiration in the unconscious intubated patient (himself…) including the Silvester method; the Shaefer method; and Eve’s rocking method. Pask concluded that Eve’s rocking method (rocking on a stretcher to 45 degrees either side) was the method which could be most easily and safely applied. This method was duly adopted by the RAF and then the Navy.
In 1950, Gordon et al measured pulmonary air exchange in “recently deceased warm corpses, prior to the onset of rigor mortis and…within one hour of cessation of the heart beat”. They found that the Schafer method averaged 185cc; Eve’s rocking technique 225cc, and the Silvester technique 520 cc.
Key Medical Contributions
Hypodermic Inflation or the Prevention of drowning (1883)
1883 – Silvester demonstrated at the International Fisheries Exhibition the possibility of inflating the subcutaneous space in animals so as to render them sufficiently buoyant to be employed either singly or yoked together to convey persons from a wreck to the coast:
Silvester showed at the Exhibition a small dog, weighing 10 lb., whose subcutaneous tissue he had inflated with air, and which was then able to sustain a weight of 18 lb. in water, in addition to its own weight. Dr. Silvester suggests that a large dog or a calf thus used might be able to bring a number of persons safely to shoreLancet 1883
In August 1883 at King’s College Hospital, Silvester went on to demonstrate that by using a blowpipe, an elastic syringe and an incision at the wrist he was able to “inflate the subcutaneous tissue of the whole body with the result that in a few minutes sufficient air passed under the skin to support a weight in water of between forty and fifty pounds.”
This method required some skill, practice and equipment. So Silvester set about trying to find a simple alternative method to create subcutaneous emphysema and therefore buoyancy in the imminent drowning scenario.
The intention of the proposed operation is to cause the skin of the neck and upper part of the chest to be sufficiently distended with air to support the weight of the body when immersed. The inflation being effected by the person himself by means of his lungs without the intervention of appliances.
The operation consists in making a small puncture [for] the passage of an ordinary blowpipe in the mucous membrane of the inside of the mouth, the object being to open a communication for the passage of air from the cavity of the mouth into the subcutaneous spaces of the neck. The situation chosen for the puncture is in the angle formed between the gum of the lower jaw and the side of the under lip or cheek, about opposite the first molar tooth of the lower jaw. The point of the instrument perforating should be passed down a short distance between the skin of the side of the face and the superficial fascia of the neck, its point being guided by the finger placed on the outside of the face and neck, taking care not to puncture either the skin or the superficial fascia.
In order to inflate the skin of the neck and chest, the patient should close the mouth and nose, and make a succession of forcible expiratory efforts, when the air contained in the cavity of the mouth will pass freely into the subcutaneous tissue of the neck. These expiratory efforts, inspiration being effected through the nostrils, should be continued until the skin is fully distended with air, which will pass readily to both sides of the neck and down the chest as far as the nipples; and this is all that is required to render the body buoyant in water.
The amount of air which the skin of the average neck is capable of holding without undue distension has been measured, and found to be enough to support ten pounds, and this is amply sufficient to support the body immersed in water. The time required for inflation is found to be less than three minutesSilvester 1885
Moist medical dressings (1874)
Hitherto surgical lint in its several forms has been applied wetted with various fluids to the surface of the human body, and in order to prevent evaporation a sheet of gutta percha tissue has been laid over its surface and there loosely retained by a bandage.
The object of this Invention is to unite the gutta percha tissue or other non-porous material inseparably with the lint so as to retard evaporation from the lint and keep it in a moist condition for an indefinite time. The compound may be medicated and colored, and the lint may be 5 composed of textile fabric, as of cotton, flax, or oakum, or other material, as felt or cloth.
I claim the use of this Invention for all purposes to which it may be applicable.Silvester, Dressing patent 1874
- Silvester H. Dr. Marshall Hall’s “ready method”. The Medical Times and Gazette 1857; 15: 503
- Silvester HR. A new method of resuscitating still-born children, and of restoring persons apparently drowned or dead. In: Transactions of branches. BMJ 1858; s4-1: 576-579
- Silvester HR. The true physiological method of restoring persons drowned or dead, and of resuscitating still-born children. 1858
- Silvester HR. The discovery of the physiological method of inducing respiration in cases of apparent death from drowning, chloroform, still-birth, noxious gases, etc. 1863
- Silvester HR. The Physiological Method of Treating Consumption. Br Foreign Med Chir Rev. 1863 Jan; 31(61): 170.
- Silvester HR. The discovery of the nature of the spleen: from an investigation of the lateral homologies of the liver, stomach, and intestinal canal. 1870
- Silvester HR. Patent: An Improvement in Appliances for Water Dressing for Medical and Other Purposes. 1874
- Silvester HR. Hypodermic Inflation. In: Annotations. Lancet 1883; 122(3123): 29
- Silvester HR. On life-saving from drowning by self-inflation. Lancet 1885; 125(3201): 11
- The late Dr. Henry Robert Silvester. Lancet 1908; 171(4412): 878
- Silvester traced. Br Med J 1952;1:393
- Bibliography. Silvester, Henry R. WorldCat Identities
- Hewlett FW. Silvestor Method. In: Anaesthetics and their administration. 1907: 556-557
- Baskett TF. Resuscitation great: Silvester’s technique of artificial respiration. Resuscitation. 2007 Jul;74(1):8-10.
Doctor currently working in South Wales, training in anaesthetics. Graduated Leeds University with MB ChB with BSc in microbiology in relation to medicine. Special interests in emergency medicine, critical care and anaesthetics