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let in the sunlight and ventilate the rooms, while housekeepers as regularly cover them up with curtains and shutters, and, for their pains and lack of knowledge, they often pay for their darkened rooms a mournful penalty. Better far that they worshipped the god of day as the source of life and light and heat. They hunt the sunlight for their tender house plants; why not do the same for themselves and their children? Who woos Hygeia at her favorite shrine receives from her rosy fingers the crimson-tinged cheek and sparkling eye-the reward and badge that distinguish her votaries.
“Then let in the sunlight," writes Prof. Samuel Kneeland, in " Good Health,” “to drive away the mould and mustiness which lurk in your halls and closets, and even in your parlors; far better that the carpets and chairs and curtains should fade, than that the rosy tints of health should disappear from the lips and cheeks of your children. The rays of the glorious sun are necessary for vegetable and animal growth, and, above all, necessary for the healthy growth of the human being. Open, then, your curtains and blinds, and see how quickly the sun will change the atmosphere of your house, bringing light and warmth into musty corners, vivifying the air of every room, reddening the cheeks of the pallid children, and giving to every member of the family a vigor before unknown."
TREATMENT OF THE DROWNED.*
COMPILED BY A. R. BARBEE, M, D., POINT PLEASANT.
Death in drowning under ordinary circumstances results from asphyxia simple or mixed.
When a man falls or is thrown into the water, he soon sinks to a greater or less depth, but almost immediately rises to the surface again ; and if he is a swimmer, makes efforts to save himself, till at length he is reduced to the condition of one who cannot swim at all, with this difference, that he has already exhausted the strength which the other has in reserve for the death-struggles common to both.
Fat people float best, and lean and bony people worst. Women float better than men, their bones generally being of less size, whilst the breasts, if well developed, assist to buoy up the chest. Often, too, at first the clothes of a woman help to keep her afloat.
Infants, owing to the imperfect development and small proportionate extent of their bones, and their frequent fatness, float better than adults. Indeed, frequently it is scarcely possible to make an infantsink in water at all, or if it be made to sink, it rises almost immediately.
Persons with large, well-developed chests float well, on account of the large quantity of air in the lungs and the lightness of the contained viscera.
*For the material of this paper, the compiler is indebted to Dr. Henry B. Baker, Secretary of the State Board of Health of Michigan; the Philadelphia Medical News; Tidy's Legal Medicine, Vol. 2, Philadelphia, 1884; Dulles' Accidents and Emergencies, P. Blakiston, Son & Co., Philadelphia; and rules published by the Life Saving Society of New York.
As regards time, two minutes may be taken as an outside period for the commencement of asphyxia, and five minutes after submersion as the ordinary time when death occurs.
How long after submergence is it possible to restore life? In other words, how long may the heart continue to beat after complete immersion in water ? Dr. Voisin in his report to the Paris Municipality on the treatment of the drowned, records the almost absolute certainty of restoring life within five minutes, whilst he has succeeded in effecting resuscitation up to twenty minutes after submersion. The treatment adopted, to which he ascribes such excellent results, has been the rigorous and immediate use of Silvester's process, the application of warmth to the body by calorific generators, and quietude after restoration.
The indications for the treatment of the drowned are: (1.) To restore animal heat. (2.) To stimulate the action of heart. (3.) To carry on artificial respiration until the natural action is resumed. (4.) To rouse the nervous system.
(5.) To combat the tendency to death from inflammatory or other sequelæ.
The popular method of hanging the body up by the heels, or of rolling it on casks and other rough processes, are to be condemned in toto.
Treatment should be commenced at once, on the spot, in the open air, whilst blankets and dry clothing are being fetched. In order to get rid of water in the mouth, etc., the body may be placed for a few seconds with the head a little lower than the feet, and the face downward, the mouth being kept well open, and the tongue drawn forwards. This done, the body should be turned on the back, and the head and shoulders slightly raised on a board (a door, or shutter serving the purpose well) forming an inclined plane. Whilst all this is going on, the body shouid be stripped and rubbed dry, and the froth from the mouth and nostrils removed. Artificial respiration is now to be employed.
DR. MARSIIALL HALL'S METHOD.
This method consists in turning the body on the side and a little beyond, and then briskly on the face, alternately; each time the body assumes the latter position, gentle but firm pressure being made over the shoulder-blades and the lower ribs posteriorly. The whole amount of air exchanged by this procedure has been found not to exceed fifteen cubic inches, and often to be much less. The method is objectionable for the reason that the first movement which is executed is the one of expiration, thus driving out of the lungs what little air they may contain, and losing a few seconds of time, which might be sufficient, in many instances, seriously to influence the result."*
The following first three rules, with their illustrations, have been copied from the circular of instructions distributed by the State Board of Health of Michigan as a life-saving measure :
RULE 1.-Remove all obstructions to breathing. Instantly loosen or cut
*The Medical News, Philadelphia, August 12, p. 183.
apart all neck and waist bands ; turn the patient on his face, with the head
down hill; stand astride the hips with your face toward his head, and, locking your fingers together under his belly, raise the body as high as you can without lifting the forehead off the ground (Fig. 1) and give the body a smart jerk to remove mucus from the throat and water from the windpipe; hold the body suspended long
enough to slowly count one, two, three, four, five, repeating the jerk more gently two or three times.
RULE 2.—Place the patient face downward, and maintaining all the while your position astride the body, grasp the points of the shoulders by the clothing, or, if the body is naked, thrust your fingers into the armpits, clasping your thumbs over the points of the shoulders, and raise the chest as high as you can (Fig 2) without lifting the head quite off the ground, and hold it long enough to slowly count one, two, three. Replace him on the ground, with his forehead on his flexed arm, the neck straightened out, and the mouth and nose free. Place your elbows against your
knees, and your hands Fig. 3.
upon the sides of his chest (Fig. 3) over the lower ribs and press downward and inward with increasing force long enough to slowly count one, two. Then suddenly let go, grasp the shoulders as before and raise the chest (Fig. 2); then press upon the ribs, &c. (Fig. 3). These
alternate movements should be repeated ten or fifteen times a minute for an hour at least, unless breathing is restored sooner. Use the same regularity as in natural breathing.
RULE 3.–After breathing has commenced, restore the animal heat. Wrap him in warm blankets, apply bottles of hot water, hot bricks, or anything to restore heat. Warm the head nearly as fast as the body, least convulsions come on. Rubbing the body with warm cloths or the hand, and slapping the fleshy parts may assist to restore warmth, and the breathing also. If the patient can surely swallow, give hot coffee, tea, milk, or a little hot sling. Give spirits sparingly, least they produce depression. Place the patient in a warm bed, give him plenty of fresh air; keep him quiet.
DR. SILVESTER’S METHOD.
By this method it is possible to introduce into the lungs from nine
to forty-four cubic inches of air. The feet being well fixed, grasp the arms at the elbows, draw them above the head, and keep them in this position on the stretch for about two or three sec
onds. Then reFig. 1. verse the manoeuvre for about the same length of time, pressing the arms firmly against the sides of the chest. This twofold or alternate movement should be repeated about fifteen or sixteen times. a minute, till a spontaneous effort at respiration occurs. The inexperienced operator
Fig. 2. is apt to make these movements too rapidly. Meanwhile the bystanders or assistants can remove the wet clothes, place hot bottles or tins to the feet, and apply hot flannels or hot bricks wrapped up in flannel over the region of the stomach, to the armpits, etc. The body should be lightly covered with blankets, and the lower extremities rubbed, etc.
DR. HOWARD'S DIRECT METHOD.
This system accurate.
has many advantages in practice, and is scientifically
(1.) Instantly turn the patient face downward, with a large, firm roll of clothing under the stomach and chest. Press with your weight two or three time, for four or five seconds each time, upon the patient's back, so that the water is pressed out of the lungs and stomach, and drains feebly downwards out of the mouth. Then (2) quickly turn the patient face upwards, the roll of clothing being now put under his back just below the shoulder-blades, the head hanging back as low as possible. Place the patient's hands together above his head. Kneel with patient's hips between your knees. Fix your elbows against your hips. Now, grasping the lower part of the patient's chest, squeeze the two sides together, pressing gradually forward with all your weight for about three seconds, until your mouth is nearly over the mouth of the patient; then with a push, suddenly jerk yourself backwards. Rest about three seconds, then begin again, Repeat these bellows-blowing movements, so that the air may be sucked into the lungs about eight or ten times a minute. Remember, the above directions must be used on the spot, the instant the patient is taken from the water. A moment's delay, and success may be hopeless. "As soon as the water is pressed from the lungs, all clothing should be ripped away from the chest and throat. In making the pressure, either for the removal of water or for breathing, increase it gradually and thoroughly, and suddenly let go with a jerk. With women and children use less force. Do not stop these movements under an hour, unless the patient breathes. Be careful not to interrupt first short natural breaths. If they be long a part, carefully continue between them the bellows-blowing movements as before.
In some cases respiration may be promoted by ammonia being applied to the nose, tickling the throat with a feather, dashing hot and cold water on the face and chest, and galvanizing the phrenic nerve. To do this, one pole should be applied to the region of the stomach, and the other to the nape of the neck, or just above the middle of the collar-bone. Some advise both poles to be applied above, one on each side of the neck.
When the patient can swallow, a teaspoonfulor two of warm brandy and water should be given..
Artificial respiration should be kept up until the lips and extremities are of good color.
To prevent a relapse, the patient should be closely watched. (Tidy's Legal Medicine, vol. 2, Phila., 1884.)
Two THINGS TO BE DONE.
RESTORE ANIMAL HEAT. Avoid DELAY.--A moment may turn the scale for life or death. Dry ground, shelter, warmth, stimulants, etc., at this moment are nothing, artificial breathing is everything,—is the one remedy,-all others are secondary.
Do not stop to remove wet clothing before efforts are made to restore breathing. Precious time is wasted, and the patient may be fatally chilled