'DROWNING, a form of asphyxia induced by submergence in water or other fluid. As a rule in drowning the body is submerged, but Peterson and Haynes in their recent
Treatment of all cases of drowning should be insistent and prolonged. If there is a great deal of water in the chest, the chances are les sened. Instances have been recorded in which patients have been submerged 20 or 30 minutes and have recovered, but if the body has been beneath the surface for over 4 or 5 minutes the general chances of resuscitation are slight. If attempts at resuscitation are made — and they should always be made unless the body has been under water several hours — the body should be placed face downward, the head and shoul ders depressed, so as to favor drainage of water from the lungs and all efforts should be directed at first toward the restoration of breathing. The
application of hartshorn, smelling salts or snuff to the nostrils, tickling the throat with a feather, dashing cold water and hot water alternately on the chest and face and vigorous friction of the upper part of the body to create warmth are of value, as also wiping and cleansing the mouth; surrounding the patient with hot bottles; and hot rectal irrigations of salt solution or whisky. If these preliminary efforts fail, arti ficial respiration should be resorted to and con tinued for several hours. The patient should be still kept face downward, a folded coat or other article of dress raising and supporting the chest. The weight of the body on the chest forces the air out, then turning the body well over but gently on one side, then turning it on its face again, repeating these movements about 15 times in a minute, occasionally varying the side, at each turn and relief of the chest pressure, air enters the lungs and excites breath mg. This operation should be assisted between each turn of the body by brisk and uniform pressure between and below each shoulder-blade. At the same time, but without interfering with these operations, the hands and feet should be dried, wet clothing removed and the body en veloped in warm blankets or reclothed with dry garments. Should these efforts prove unavailing after from two to five minutes, recourse should be had to Dr. Silvester's method, which consists in placing the patient on the back, on a flat surface inclined slightly upward from the feet, the head and shoulders being raised and sup ported on a small cushion, or folded article of dress placed under the shoulder-blades. The tongue should be drawn forward and fastened by an elastic band, string or tape over the tongue and under the chin, to keep it projecting beyond the lips. Then to imitate the move ments of breathing and to draw air into the lungs, stand at the patients's head, grasp the arms just above the elbows and draw the arms steadily upward above the head, keeping them stretched upward for two seconds. To expel the air from the lungs, turn down the arms and press them firmly for two seconds against the sides of the chest. Repeat these movements deliberately and persistently about 15 times a minute, until a natural effort to breathe is per ceived, when the efforts should be turned toward inducing circulation and warmth, which can be best promoted by briskly rubbing the limbs upward with flannels, etc., thus propelling the blood along the veins to the heart and by the application of hot flannels, hot water bottles, heated bricks, etc., to the pit of the stomach, between the thighs, the armpits and to the soles.
Another method which has the advantage of simplicity and can be applied by one person is that of Dr. Benjamin Howard of New York. The body is placed face downward with a roll of clothing under the stomach, one arm being bent upward so that the hand supports the fore head. To expel the water from the chest, the body is pulled feet downward over the roll of clothing. Then turn the body on the back, with the roll of clothing under the shoulders, so that the head falls back, thus stretching the neck. Kneel over the body, one knee pressed firmly against either thigh. With both hands spread over the lower part of the chest, so that the thumb hooks in under the lowest ribs on each side, press forward steadily with the weight of the body on the arms, thus raising the ribs, en larging the chest cavity and causing the air to enter. When the ribs have been pushed upward to their utmost extent, release them gently by a receding movement, allowing them to return to their original position, thus expelling the air. Repeat this process until respiration is restored, then resort to the methods already mentioned to induce circulation and warmth. No attempts at resuscitation should be abandoned until all efforts seem to be absolutely futile. See AS PHYXIA; PULMOTOR ; RESPIRATION, ARTIFICIAL.