As soon as the apparently drowned is removed from the water, artificial respiration should be commenced without a moment's delay, Shafer's method being employed. The body should he placed horizontally on the bank, with the back upwards and the left side of the face resting on the ground, no attempt being made to remove the wet clothing or to cause in version by raising the feet. The operator places himself astride the patient's body by kneeling upon the ground and applies each hand with his fingers widely apart over the lowest ribs, the thumbs being planted upon either side of the spine in a parallel direction pointing towards thepatient's head. The operator's elbows being kept extended, he next steadily leans forward so as to throw through his hands the weight of his own trunk upon the lower part of the patient's chest in order to effectually compress the thorax and expel the air contained in the lungs and any water which may have been inhaled. He then rapidly swings his own body backwards without letting go his touch of the patient's chest in order to permit the ribs to resume their normal position and draw in a fresh supply of air as the pressure is suddenly removed. The alternate compression and relaxa tion of the thorax is continued every five seconds without pause between the movements, and the operation is persisted in till natural breathing is established or till the hopelessness of resuscitation is obviously demon strated. The operator need.give no thought to the position of the tongue; this cannot fall backwards and block the air passages, and he should lose no time by inverting the body, as the " face-down " position facilitates the expulsion of water through the mouth.
Life often has been saved after more than an hour's continuous perform ance of artificial respiration when no signs of vitality have been present, and the operator should not desist from his efforts till thoroughly satisfied that the task is absolutely hopeless.
Where the period of complete submersion has been known to extend over several minutes the operation is of no avail. Two minutes of sub mersion have been regarded as fatal, but the writer at a private séance timed a professional swimmer who remained under water in a large glass tank for 4 minutes 5 seconds, his features being under observation all the time.
Whilst resuscitation is being carried out, assistants may be employed in rubbing and applying warmth to the extremities. As soon as sponta neous breathing occurs, the patient should be turned upon his back and the wet clothing replaced by warmed blankets, friction being assiduously carried on over the extremities, always in the direction which promotes the flow of venous blood towards the heart. As soon as possible he should
be removed to a warm bed and hot-water bottles applied to the surface of the body.
Any threatening of stoppage of the breathing must be met by a return to artificial respiration; Laborde's method of rhythmical traction of the tongue is very convenient at this stage should it arise. Some authorities recommend the induced current with one pole applied over the phrenic nerve in the neck and the other over the sixth interspaod between the right axillary and mamillary lines so as to induce vigorous contraction of the diaphragm, the poles being applied at the moment that the artificial inspiratory act is being performed.
Hot drinks containing a moderate amount of alcohol may be ad ministered as soon as the patient is able to swallow, but as a rule stimu lants should be withheld till the patient has been enveloped in warm blankets and placed in bed. A large dose of alcohol administered when the individual's body is still chilled in transit towards the nearest house is liable to cause a further loss of natural heat; the opposite effect follows when the stimulant is given after he has been put to bed and surrounded with warm-water bottles.
Barreiro maintains that in drowning there is an intense congestion of the brain and spinal cord as well as compression of the lung by elevation of the diaphragm owing to the amount of air and water swallowed, and the heart dilates. Blood-letting is part of his routine, and he opens a leg vein so as not to interfere with artificial respiration. For the artificial respiration he places the patient in a sitting posture, with the head and shoulders well raised, so that the weighty abdominal viscera draw down the diaphragm and thus aid the artificial movements which the attendant executes whilst placed behind the patient, supporting his back with one knee. The movements consist of alternate compression and expansion of the thoracic walls by the arms of the patient as in the older methods of resusci tation, whilst an assistant performs rhythmical traction on the tongue.
For the writer's views upon the nature of so-called " swimmer's cramp," which is a common cause of drowning, see p. i9o.
For the practical methods of rescuing drowning persons whilst strug gling in the water the reader is recommended to study the illustrated handbook of instruction which is issued by the Royal Life Saving Society, and which should be in the possession of every physician and swimmer. (It can be obtained by application to the London office of the Society fur is.)