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DIRECTIONS FOR RESTORING THE APPA-
RENTLY DROWNED.1

The leading principles of the following directions for the restoration of the apparently dead from drowning are founded on those of the late Dr. Marshall Hall, combined with those of Dr. H. R. Silvester, and are the result of extensive inquiries which were made by the Royal National Life-Boat Institution of England, amongst medical men, medical bodies, and coroners throughout the kingdom. These directions have been extensively circulated by the Institution throughout the United Kingdom and in the Colonies. They are also in use in the British navy, in the Coastguard service, and at all the stations. of the British army, both at home and abroad.

The actual condition in drowning is due to the same cause as in death by hanging-the non-entrance of air into the lungs. If repeated attempts at breathing be made while the patient is in the water, air will escape from the chest, and water may pass into the air-passages, but this intrusion of water is no necessary condition of drowning. Hence no attempts need be made, as our forefathers taught, to remove the water from the chest, by rolling the body face downwards on a barrel, etc.

The points to be aimed at are-first and immediately the RESTORATION OF BREATHING; and, secondly, after breathing is restored, the PROMOTION OF WARMTH AND CIRCULATION.

The efforts to restore breathing must be commenced immediately and energetically, and persevered in for one

Good Health, July, 1869.

or two hours, or until a medical man has pronounced that life is extinct. Efforts to promote warmth and circulation, beyond removing the wet clothes and drying the skin, must not be made until the first appearance of natural breathing; for if circulation of the blood be induced. before breathing has recommenced, the restoration to life will be endangered.

Send immediately for medical assistance, blankets, and dry clothing, but proceed to treat the patient instantly on the spot, in the open air, with the face downward, whether on shore or afloat, exposing the face, neck, and chest to the wind, except in severe weather, and removing all tight clothing from the neck and chest, especially the braces.

Cautions.-Prevent unnecessary crowding of persons around the body, especially if in an apartment. Avoid rough usage, and do not allow the body to remain on the back unless the tongue is secured. Under no circumstances hold the body up by the feet. On no account place the body in a warm bath unless under medical direction, and even then it should only be employed as a momentary excitant.

To Restore Breathing.

Dr. Marshall Hall's Method.

To Clear the Throat.-Place the patient on the floor or ground with the face downwards, and one of the arms under the forehead, in which position all fluids will more readily escape by the mouth, and the tongue itself will fall forward, leaving the entrance into the windpipe free. Assist this operation by wiping and cleansing the mouth.

If satisfactory breathing commences, use the treatment described below to promote warmth. If there be only

Fig. 1.

slight breathing, or no breathing, or if the breathing fail, then

To Excite Breathing.-Turn the patient well and instantly on the side, supporting the head, and excite the nostrils with snuff, hartshorn, and smelling salts, or tickle

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the throat with a feather, etc., if they are at hand. Rub the chest and face warm, and dash cold water, or cold and hot water alternately on them. If there be no success, lose not a moment, but instantly

DR. HALL'S METHOD. (INSPIRATION.)

Fig. 2.

cautiously, efficiently, and perseveringly, about fifteen times in the minute, or once every four or five seconds, occasionally varying the side. On each occasion that the body is replaced on the face, make uniform but efficient

To Imitate Breathing (see Figs. 1 and 2).-Replace the patient on the face, raising and supporting the chest well on a folded coat or other article of dress. Turn the body very gently on the side and a little beyond, and then briskly on the face, back again, repeating these measures

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pressure with brisk movement, on the back between and below the shoulder blades or bones on each side, removing the pressure immediately before turning the body on the side.

By placing the patient on the chest, the weight of the body forces the air out; when turned on the side this pressure is removed, and air enters the chest. The first measure increases the expiration—the second commences inspiration. The result is respiration or natural breathing; and, if not too late, restoration to life.

During the whole of the operations let one person attend solely to the movements of the head and of the arm placed under it.

Whilst the above operations are being proceeded with, dry the hands and feet, and as soon as dry clothing or blankets can be procured, strip the body, and cover or gradually reclothe it, but taking care not to interfere with the efforts to restore breathing.

Dr. Silvester's Method.

Should the efforts just described not prove successful in the course of from two to five minutes, proceed to imitate breathing by Dr. Silvester's method, as follows: Place the patient on the back on a flat surface, inclined a little upwards from the feet; raise and support the head and shoulders on a small firm cushion or folded article of dress placed under the shoulder-blades. Cleanse the mouth and nostrils, draw forward the patient's tongue, and keep it projecting beyond the lips; an elastic band. over the tongue and under the chin will answer this purpose, or a piece of string or tape may be tied around them, or by raising the lower jaw, the teeth may be made to retain the tongue in that position. Remove all tight clothing from about the neck and chest, especially the braces.

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