Page:Encyclopædia Britannica, Ninth Edition, v. 7.djvu/496

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and air enters the chest. ) On each occasion that the body is replaced

on the face, make uniform but efficient pressure with brisk move ment 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. During the whole of the operations let one person attend solely to the movements of the head and of the arm placed under it. (The first measure increases the expiration the second commences inspiration. ) The result is respiration or natural

breathing, and, if not too late, life.
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.

III. Should these efforts 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. 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 round 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.

FIG. 3. Inspiration (Dr Silvester s method).

FIG. 4. Expiration (Dr Silvester s method).

To imitate the movements of breathingStanding at the patient's

licad, grasp the arms just above the elbows, and draw the arms gently and steadily upwards above the head, and keep them stretched upwards for two seconds. (By this means air is drawn into the lungs.) Then turn down the patient s arms, and press them gently and firmly for two seconds against the sides of the chest. (By this means air is pressed out of the lungs.) Eepeat these measures alternately, deliberately, and perseveringly, about fifteen times in a minute, until a spontaneous effort to respire is perceived, imme diately upon which cease to imitate the movements of breathing,

and proceed to induce circulation and warmth.

IV.—Treatment after Natural Breathing has been restored. To promote warmth and circulationCommence rubbing

the limbs upwards, with firm grasping pressure and energy, using handkerchiefs, flannels, &c. (By this measure the blood is propelled along the veins towards the heart. ) The friction must be continued under the blankets or over the dry clothing. Promote the warmth, of the body by the application of hot flannels, bottles, or bladders of hot water, heated bricks, &c., to the pit of the stomach, the arm pits, between the thighs, and to the soles of the feet. If the patient has been carried to a house after respiration has been

restored, be careful to let the air play freely about the room.

General Observations.—The above treatment should be persevered in for some hours, as it is an erroneous opinion that persons

are irrecoverable because life does not soon make its appearance, persons having been restored after persevering for many hours. The appearances which generally accompany death are the follow- ing : breathing and the heart s action cease entirely ; the eyelids are generally half closed, the pupils dilated ; the tongue approaches to the under edges of tiie lips, and these, as well as the nostrils, are covered with a frothy mucus ; coldness and pallor of surfaco

The following cautions should be attended to: Prevent unneces

sary crowding of persons round th 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 i warm bath unless under medical direction, and even then it should only

be employed as a momentary excitant.

Dr Silvester s method is more generally practised that that of Dr M. Hall, its special advantages being that it com mences by imitating inspiration, and more completely distends the chest. But we are of opinion that the combina tion of the two methods as recommended above should undoubtedly be practised in every case.

It has frequently been pointed out that in fatal cases of drowning the right auricle of the heart is very much dis tended ; and it has been plausibly urged by Professor Struthersof Aberdeen (Edinburgh MedicalJoiirnal, 1857, p. 418) that the movements of respiration may be successfully imitated, and air may enter the lungs, and yet the patient may not recover in consequence of the stoppage of the action of the heart. He recommends that blood should be drawn from the external jugular vein, so as to relieve the engorged auricle, which, from its distension, is paralyzed. The abstraction of a small quantity of blood is all that is required to effect this from half to one or two table-spoonfuls. Finally, as a last resource, galvanism must be had recourse to. Both this and the blood-letting must be practised by a qualified medical man ; but it is important to know that the methods of Dr Hall and Dr Silvester can easily be learned by any one, and that, if early and perseveringly applied, they are attended with a large measure of success. The treatment must be continued for at least eight hours, should there be an absence of extreme pallor, and while any heat of the body remains.

The question of the treatment of the drowned cannot be regarded as definitely settled, and the plans of Hall and Silvester have from time to time been subjected to criti cism. Among the latest suggestions is that of Dr B. Howard of America, who, by means of what he terms his " direct" method, which mainly consists in pressure of the chest from above (the patient being placed on his back), claims that air is more easily introduced into the lungs, and that the expansion and contraction of the chest are more perfectly attained (see Lancet, August 11, 1877). At the meeting of the British Medical Association at Man chester 1877, Dr Howard practically demonstrated his plan on the living subject, and there can no doubt that involuntary respiration was readily produced. Further evidence, however, is necessary from actual cases of sus pended animation.

See the treatises on Medical Jurisprudence by Devergie, Orfila,

Caspar, Taylor, Guy, and "Voodman and Tidy; article " Apnoea," by G. Barley, M.D., in vol. v. of Holmes s Surgery, 2d edition, pp. 889; and Report on Asphyxia by Committee of the Royal Medical and Chirurgical Society of London, in vol. xlv. of Transactions,


(h. d. l.)

DROZ, François-Xavier Joseph (1773-1850), a French writer on moral and political subjects, was born on October 31, 1773, in the city of Besangon, where his family had furnished men of considerable mark to the legal profession. His own legal studies led him to Paris in 1792 ; he arrived on the very day after the dethronement of the king, and was present during the massacres of September ; but on the declaration of war he joined the volunteer bataillon of the Doubs, and for the next three years served in the army