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produced a very small amount of the second antibody inaddition to the predominantly large amount of the mainantibody; but the conclusion seems valid that " when ananimal is stimulated with two contrasting antigens,individual cells tend to form one species of antibody ".There remains the problem of why this is so. Is it aninterference phenomenon, and can a cell deal with only asingle antigen at a time ? Or is a cell genetically restrictedto the kind of antigen to which it can form antibodies ? Inorder to answer such questions it may be necessary to goback to a previous stage in the process-that of the initialstimulus to antibody formation.

1. Safar, P., Lourdes, A. E., Elam, J. O. New Engl. J. Med. 1958, 258, 671.2. Gordon, A. S., Raymon, F., Sadove, M., Ivy, A. C. J. Amer. med. Ass.

1950, 144, 1447.

ARTIFICIAL RESPIRATION

IT has been proposed that an old method for artificialrespiration, and a variant of it, should be used for emer-gency resuscitation. Safar et al. maintain that, used

properly, mouth-to-mouth insufflation is far better thanany of the push-pull methods: certainly the figures givenfor the ventilation achieved suggest that their techniqueis efficient. They criticise the method originally used fortesting and comparing the different manual methods ofartificial respiration. They point out that in all instancesthe patients, though anxsthetised and curarised, were alsointubated, thus ensuring a clear airway. When they testedmethods such as the arm-lift/back pressure (Holger-Nielsen) on patients who were not intubated the volumeper respiration was low-not much above that whichwould wash out the dead space. Without intubation, andeven in the prone position, the toneless soft palate andpharynx partly block the airway and severely limit possibleventilation. Even with intubation Safar et al. did notsucceed in moving more than 700-260 c.cm. of air witheither the Holger-Nielsen or the Silvester method. Thisis far below the ventilation regularly attained in the

investigation of Gordon et al.,2 but the reason for thisdifference is not clear.

Safar et al. tested the mouth-to-mouth method with the

subject on a hard table and on the floor. They point outthat one advantage of the method is that the operator hasboth hands free to hold the lower jaw forward and to keepthe mouth open, thus ensuring a clear airway; at the sametime the hands can be used to close the patient’s nostrils.The operator places his own mouth well over that of thepatient and, at first vigorously, and later less vigorously,blows out his own expired air until the patient’s chestexpands. The operator then removes his mouth andallows expiration to occur naturally by elastic recoil. It isclaimed that this method can be used by anyone onanyone, that it can be maintained for long periods withoutfatigue or dizziness, that it easily achieves a ventilationof 1000-1500 c.cm. at 12-20 respirations a minute, andfinally that it is easily taught and learnt. Occasionally airmay enter the patient’s stomach; but it can be removed bycompression of the abdomen, and it does not interferewith the respiratory process. The main objection to themouth-to-mouth method is aesthetic, and to overcome thisSafar et al. have designed a simple S-shaped tube whichcan rapidly be inserted down to the pharynx; the operatorcan then expire through the outer end of this tube, givingoropharyngeal respiration. The ventilation by using thetube is just as good as in the direct mouth-to-mouthmethod. Insertion of the tube is said to be easy, to besoon learnt, and to involve negligible delay in starting

resuscitation. Further, the tube is small and light and caneasily be carried in the pocket. Mouth-to-mouth resusci-tation can be used on patients of all ages, but Safar et al.emphasise that for infants the operator must not expirevigorously lest he rupture alveoli; little more than an

expiratory puff is required.Safar et al. state that they tried the Holger-Nielsen

method after inserting their pharyngeal tube and foundthat ventilation was extremely poor unless the lower jawwas held forward-obviously an impossible manoeuvrefor a rescuer working single-handed. It is difficult toreconcile this and some other criticisms of the Holger-Nielsen and Silvester methods with the successes knownto have followed their use,3 and even that of the far lessefficient Schafer method. It is also difficult to see howdizziness is avoided if the operator is hyperventilatingsufficiently to supply "virtually room air" to the patient.If the operator does not hyperventilate the method is opento objection by those who believe that 4-5% C02 shouldnot be supplied to one who is anoxic and probably hyper-capnic. Nevertheless, though most people cannot be

expected always to carry an oropharyngeal tube and musttherefore stick to the Silvester or Holger-Nielsen methods,all workers who are likely to be faced by emergenciesmight well learn and test this simple method, and, if theyfind it good, use it. All the speakers in an AmericanSymposium on this method 4 spoke favourably of it.

Certainly no unreasonable conservatism should beallowed to prevent progress in saving life or preventingthat death in life-the decerebrate state resulting fromanoxia.

3. See Lancet, 1952, i, 548.4. J. Amer. med. Ass. 1958, 167, 317-341.

BIRTHDAY HONOURS

THE award of the Order of Merit to Sir MacfarlaneBurnet, the distinguished virologist and immunologist,will be widely and warmly welcomed. Burnet graduated inmedicine in the University of Melbourne, where he is nowdirector of the Walter and Eliza Hall Institute of Medical

Research, and he devoted two periods to study and researchin this country, in 1926-27 at the Lister Institute and in1932-33 at the National Institute for Medical Research at

Hampstead. But he has spent most of his life, in biologicaland medical research of one kind or another, in Melbourne,where he has built a school which attracts workers fromall over the world. He has done much fundamental workon bacteriophages, and recently he has made equallydetailed researches into the influenza viruses, and theirmethods of penetrating cells and multiplying therein. Inthese two fields he has profoundly influenced scientific

thought. He is probably better known, however, for hisability to generalise in matters of wide biologicalsignificance.

Doctors in the Dominions figure prominently elsewherein the Honours List. Thus Dr. C. R. Burns and Prof. F. H.Smirk, of New Zealand, are appointed K.B.E. ; and Prof.J. C. Eccles, Mr. B. T. Edye, and Brigadier K. B. Fraser,of Australia, and Colonel A. G. Curphey, of Jamaica, arecreated knights. Of the honours to doctors in this country,the appointment of Mr. J. D. McLaggan as K.c.v.o. andthe knighthood conferred on Brigadier J. S. K. Boydand Mr. E. W. Riches will give special pleasure to many.We congratulate these and the others named in the liston p. 1332.

Sir ARNOLD STOTT, consulting physician to the WestminsterHospital, died at his home in Surrey on June 15 at the age of 72.