The Industrial Revolution , which began in the middle of the eighteenth century, was facilitated by waterways. In many rivers weirs were constructed to raise water levels both to make them navigable and to provide a continuous supply to turn the water wheels that powered the early manufactories. Where there were no suitable rivers canals were dug so that factories could receive raw materials and deliver products to markets. Inevitably, across Europe, many people fell into the water and this led to two lines of scientific inquiry; how to resuscitate the near drowned and how to be sure someone was dead and could be buried.

The first organization to apply current knowledge to the recovery of drowned persons was set up in Amsterdam in 1767. The initiative was successful and over the next 6 years there were more than two hundred instances where someone who had apparently been drowned was recovered [2]. Similar initiatives were introduced in Venice, Hamburg, and several other European cities but it was less successful in London where there was reluctance to initiate treatments. William Hawes (1736–1808) solved this problem by offering a reward to the first responders and in 1774 helped found the first resuscitation society in London [3, p. 1121] which eventually became the Royal Humane Society.

Experiments on animals demonstrated that artificial ventilation was an important part of resuscitation and either expired-air ventilation (EAV) or positive pressure ventilation using bellows could be used [4] and Hawes and colleagues sought to establish “Receiving Houses” equipped with life-saving apparatus in every parish in England. Best evidence guidelines on methods resuscitative process were developed and circulated. For example, The Humane Society of Philadelphia published “Directions for recovering persons who are supposed to be dead from drowning” in The Medical and Agricultural Register in 1803 [5]. In 1806 the Royal Humane Society in London published The Pocket Companion, a cognitive aid to assist provision of emergency care. Hawes recommended having this card always at hand so that the resuscitative process could be immediately employed and many lives would be saved [6, No. 38].

It was soon recognized that the principles of resuscitation could be applied to conditions other than drowning [2]. In 1781 Hawes began giving a course of lectures on resuscitation, the first time the subject had been a part of medical education. The curriculum included the pathophysiology of unconsciousness from different causes and how to treat suspended animation from drowning, lightening, fumes, intense cold, and stillbirths [3].

By the end of the eighteenth century the bellows had become the preferred mode of artificial breathing [7] but in the nineteenth century the bellows also fell out of favor as a result of complications (including pneumothorax). In 1882 Alexander Graham Bell tested an artificial respirator he had designed using a drowned lamb as a simulated patient. A photograph of a test and a description and sketch of the respirator is in The Alexander Graham Bell Family Papers in Library of Congress [8].

In 1907 the Dräger company began making the Pulmotor, the first resuscitation ventilator (see Fig. 10.1). The company already made breathing apparatus for mine rescue workers and the Pulmotor was designed for resuscitation of miners overcome by gas. Manual methods of artificial respiration had been developed but these were impractical to use underground.

The Third Resuscitation Committee, held in 1918, considered methods of artificial respiration in trauma, poisoning, asphyxia, drowning, electric shock, etc. [9]. The Pulmotor and other mechanical apparatus were demonstrated to the commission along with presentations on manual methods. The commission concluded that in an emergency the pressure-prone method should be started immediately and should be continued whilst waiting for expert help to arrive and during transport of the victim to a hospital. The commission also recommended that medical schools provide resuscitation teaching [9].

After a coal mine disaster in the United States in 1909 claimed more than 250 lives additional mine-safety regulations were legislated. Mine owners were required to provide safety equipment and training for miners in first-aid as well as rescue. Writing in the Coal and Coke Operator in 1909, Eduard Schenck wrote “It is not sufficient to know what is required, or to have suitable contrivances for certain emergencies, but that the men who are to perform duty during such times are experienced in the use of appliances and the execution of the work which is expected of them.” Schenck provided examples from several industries and occupations around the world that used simulation to prepare for adverse events [10]. It is useless, he wrote, to provide rescue and first-aid equipment without regular practice in their use by those who will be required to use them.

In the early twentieth century mine rescue stations that had space for teaching use of equipment and galleries for simulation of mine accidents where teams could be taught and practice extraction and resuscitation of injured workers were developed in the United States [11]. Some, such as the mine rescue station at Benton, Illinois, were sophisticated simulation centers that had training galleries with windows to observe the participants and monitor performance. Teams were paid to undertake at least 2 h of simulation-based training per week and participants were briefed before they entered a scenario which had been carefully planned to make rescuers use a range of skills, work together, and problem solve in stressful circumstances [11].

Benton was not an isolated case but was part of a network of mine rescue training stations across the country. Quality assurance in training was managed by regional, State, and Inter-state meets where individuals and teams demonstrated their rescue and first-aid skills. The performance of individuals was assessed on the provision and quality of care and in team events leadership was also looked for. Checklists of required skills were produced by expert committees and marks were lost during the scenario if an item that was performed poorly or not at all. Typically, most marks were lost for ineffective artificial respiration, failing to stop bleeding, and incorrect treatment and teams lost marks when there was poor leadership [12].

In 1911 many underground workers were overcome by poisonous gases from a fire in a coal mine in Ohio. A trained rescue team extracted the unconscious men and the Chief Inspector of Mine reported “The pulmotor, which is almost human in its workings, was used and several persons revived by it and brought to consciousness” [13].

Mine rescue and resuscitation in the United Kingdom and parts of Europe was at a similar stage of development to that in the United States. Mine Recue Work and Organization by Bulman and Mills published in 1921 described the training required for rescue and resuscitation and included designs for mine rescue simulation facilities. Training exercises were made very realistic by making the air of the training gallery unrespirable [14]. Mine rescue team members were trained and assessed on their use of oxygen-reviving apparatus. In these scenarios victims are either other miners or “dummy patients” weighing at least 150 lbs [14].

The mine rescue teams in Borna, Germany practised transporting accident victims using mannequins made from wood and leather that they called “Kumpels” (buddies) [15]. A more sophisticated mannequin with a lung simulator was made to practice resuscitation using the Pulmotor, see Fig. 10.2. This simulator had a body constructed from spiral springs, flexible joints, and a wooden head model used by the Wig-makers’ Guild. An airway was drilled in the head and connected by rubber hoses to the lung which was protected in a wooden box that had a sliding glass window to see and access the controls. The rescuer needed to manage the airway correctly to be able to provide artificial respiration [15]. For added realism, the limbs were weighted and articulated so that they would fall during transport unless appropriately secured.

Railways were another source of industrial injury and the need for appropriate education of emergency personnel in use of first-aid equipment was well understood [16]. A mannequin was used to teach first-aid to railway workers in the late nineteen th century [17].

Newspapers reported many cases of resuscitation using the Pulmotor , or the copies that were generally referred to as pulmotors, and it became synonymous with successful resuscitation. In an item about an actor signed by Harry Cohn at Columbia Pictures in Picture Play Magazine in 1934 it was observed that the careers of Jean Harlow and Lee Tracy having been revived by the “Cohn pulmotor” [18]. When the outcome of resuscitation with pulmotors was investigated it was found that many of the reports had been exaggerated [19].

The Pulmotor had a positive pressure inspiratory phase to expand the lungs but it also had a negative pressure expiratory phase and it was found that negative pressure applied to the lungs had deleterious effects [20]. Also, the manufacturer recommended firm pressure be applied to the neck to direct oxygen and air into the lungs but this was not always done well and the stomach was inflated instead of the lungs. The need for this precaution during positive pressure ventilation by the mouth had been observed by Munro in the eighteenth century and was reported in a letter on resuscitation published in 1884 [21]. Cullen described how when bellows were when was applied to a person’s mouth “the air is ready to pass by the gullet into the stomach; but this may be prevented, by pressing the lower part of the larynx backwards upon the gullet. To persons of a little knowledge in anatomy, it is to be observed, that the pressure should be only on the cricoid cartilage.”

Several manual methods of artificial respiration were developed in the nineteenth and first half of the twentieth centuries. In these methods pressure was applied to the chest and parts of the body were moved to cause air to enter the lungs. Edward Sharpey Schafer’s “prone pressure ” method was originally developed at the end of the nineteenth century and was used with modifications for around 50 years. In 1945 Harry Church patented a resuscitation simulator to help students learn how much pressure was needed, where it should be applied and how often to apply it, important features of this method [22].

Many patient simulators have been developed to learn and practice effective methods of cardiopulmonary resuscitation developed after the Second World War. Most of these incorporated design elements similar to those in Church’s simulator. The most widely known of the manikins would have to be Laerdal’s Resusci-Anne. Simulators to practice extrication and trauma care have also been developed. Around a 100 years after mine rescue simulations were used competitively to lift standards the Society for Simulation in Healthcare introduced a competitive event known as “SimWars ” at the annual conference.

Epidemics of what was probably diphtheria have been a significant cause of mortality, particularly in children, since at least the sixth-century CE [24]. Until the nineteenth century infections were classified by the symptoms they produced and there was much overlap between diseases. The first symptoms of diphtheria are malaise, sore throat, and mild fever but after 2–3 days a thick layer of dead mucosal cell debris, known as a pseudo-membrane develops in the pharynx, larynx, and trachea. The illness, which was also called putrid or malignant sore throat in the nineteenth century, is caused by Corynebacterium diphtheria and the pseudo-membrane is a result of a toxin released by the bacterium. The airways are narrowed by which makes the victim feel as if they are being strangled and children, because their airways are already small, are particularly at risk of complete airway obstruction and death from suffocation.

In the seventeenth century there were severe epidemics of diphtheria in Italy and Spain where in 1613 it caused so many death the year became known as “anno de los garotillos” (year of strangulations). [24] In the first half of the eighteenth century there were epidemics of diphtheria in Britain and France and in the second half there were epidemics in North America. The French physician Pierre-Fidèle Bretonneau performed a post mortem on sixty victims of the disease during an epidemic in Tours, France from 1818 to 1820 and having separated it from other illnesses gave it the name diphtheria [25]. Bretonnaeu also developed the first “successful” method of treatment for the airway obstruction, tracheotomy [26]. The first patients, one in 1818 and another in 1820, both died but a third patient in 1825 lived. In 1855 Bretonneau’s pupil, Armand Trousseau (1801–1867), published the results from a series of cases at the Hôpital des Enfants-Malades (Hospital for Sick Children) in Paris. Just 47 (22 %) of 216 patients survived but even that was thought to be good result as it was expected that all would have succumbed without the tracheotomy [26, 27].