IN the 21st Number of the Life-Boat Journal we introduced this important subject to our readers in connection with a new mode of treatment proposed by the eminent physiologist, the late Dr. MARSHALL HALL.

Again, in our 25th Number, we enlarged on the subject, and inserted in juxtaposition the old code of instructions, so well known as those of the Royal Humane Society of London, and that proposed by Dr.

MARSHALL HALL ; the former of which the NATIONAL LIFE-BOAT INSTITUTION had until then circulated, through the medium of its life-boat stations on the coasts of the United Kingdom.

We then stated that the Committee of Management of the Institution felt deeply impressed with the very great importance of the subject, to which their attention had been drawn by one of their most active honorary secretaries ;* and, sensible of the great responsibility incurred by promulgating any system of rules of the efficacy of which the slightest doubt could be entertained, that they had determined to bring the subject so far as possible before the medical world, and to solicit the opinions of all medical men and medical authorities, with a. view to issuing a new Code of Instructions which the Institution might, with confidence, circulate at its stations on our coasts.

In pursuance of this resolution, an appeal was at once made through the medical journals, asking for information, and similar * R. V. Gorhara, Esq., surgeon at Aldborongh, in Suffolk.

appeals were made by letter to all the principal medical associations and hospitals in the United Kingdom, and to a large number of private practitioners, especially in neighbourhoods contiguous to the sea and to inland waters.

Application was also made through some of the Foreign Embassies, for the opinions of the chief medical authorities in foreign countries.

These appeals were in general readily and promptly replied to, and the result is, that the Institution is in possession of such a mass of valuable information and expression of opinion on this interesting and important subject as has probably never previously been collected.

Possessed of this information, the Committee have felt justified in acting on it, and after its being carefully considered in detail, and the several opinions collected compared one with another, they have caused a new code of instructions to be printed, which is now being extensively circulated on the coast of the United Kingdom.

We now place these new Instructions before our readers, together with a summary of the information received, so far as concerns the numbers of opinions that have been collected respecting the two methods, which is all that our limited space will admit of.

From the summary, it will be perceived that the great majority of medical men are in favour of the new method by MARSHALL HALL and by comparing the Instructions with Dr. M. HALL'S plan, it will be seen that his method has been altogether adopted in principle, and with but slight modification in detail and in wording.

It will be well, however, for the benefit of our non-medical readers, that we should, in the first place, explain the difference in principle between the old method of the Royal Humane Society and the new one of Dr. MARSHALL HALL,. The one great distinction in principle is,—that the old method directed all its efforts to the restoration of warmth and re-circulation of the blood, there being no one part of its rules that had reference to the function of respiration; whilst, on the contrary, MARSHALL HALL not only insists on the restoring respiration as of vital importance, but he affirms that every attempt to restore and increase circulation of the blood before respiration has been effected is positively deleterious, and must be liable to cause death. In support of his opinion Dr. M. HALL quotes the fact so well known to all medical men, that the circulation of the blood generates carbon (termed by the faculty blood-poison).

That as carbon or charcoal is a product of ordinary combustion, so carbon is produced by that mysterious animal combustion which maintains the heat of the animal body and supports life; but, that remaining in the blood, that carbon or refuse matter would produce asphyxia, and thereby death.

That accordingly nature, by the beautiful process of respiration, carries out of the system this carbon or waste matter.

Difference of opinion, we believe, still exists as to the precise time and manner in which this change in or purification of the blood takes place. It will not be necessary here to discuss the same: we may, however, shortly explain that the blood is the medium by which the constant waste of all parts of the body is re-supplied, and its substance and bulk maintained, and by which its heat is supported;—that the engine by which this vital fluid is, as by a force-pump, driven through every part of the body is the heart, by the contraction and dilatation of which it is forced through the arteries to every part of the body, whence, at their extremities, it is taken up by the veifls and returned to the heart again;—that the out-going stream, the arterial blood, is red in colour, and contains that heat and nourishment which it is its office to impart to the whole system;—that the returning stream, the venous blood, is black in colour, deprived of its nutritive property, and impregnated with carbon, which, as above stated j hds unfitted it for further use ;—that it is then handed over to another and separate system of arteries and veins for its purification, being at once transferred to the pulmonary arteries, which, by their innumerable ramifications, expose it in the lungs to the freshly-inspired air, when the carbon, combining with the oxygen of the air, forms carbonic-acid gas, which, by each expiration, passes off into the atmosphere, and the blood thus purified is earned back to the heart by the pulmonary veins, whence, again red in colour, renovated and re-vivified—if we may use the term—it once more starts on its ceaseless, unwearied round, and thus the wondrous system of life is maintained for its appointed time.

This digression, to explain the beautiful connection between the functions of respiration and circulation of the blood, was necessary to convey to those who are not already acquainted with the subject, a clear idea of the principle on which Dr. M. HALL'S theory of restoring life in cases of suspended animation from drowning is founded. As he states, the two functions must act together, being mutually dependent on each other. To restore, therefore, the animal heat and quicken thereby the circulation, without the purifying process of respiration, must produce death. As a rather striking illustration of this truth, he quotes the case of the hybernating animals, which are enabled to exist for a long period without breathing, simply because circulation of the blood is also suspended, and life is at a very low ebb. He quotes also the cases of newlyborn infants, and in the cases of still-born infants his method has been most successfully employed. He therefore advances as an axiom on the subject, that the greater the amount of vitality the more necessary is the accompaniment of respiration, whilst it is when at its lowest ebb that life may exist, in abeyance, as it were, for the longest period without respiration.

On reviewing the details of the two methods therefore, the old and new, we find that the former directed the drowned person to be conveyed to the shelter of the nearest dwelling, and then placed in a warm bed, in a warm chamber, and every available means to be then at once taken to restore warmth and promote circulation of the blood, such as friction on the skin, hot bricks or bottles, or bladders filled with hot water, &c., applied to various parts of the body, or, in preference to all, when obtainable, immersion in a warm bath. These means were to be persevered in until life was restored, or the case pronounced altogether hopeless. Such was and we believe is now the system adopted by the Royal Humane Society of London. It appears, however, that many private practitioners have felt the importance of attempting to promote respiration where suspended, which it has been endeavoured to effect by forcing air into the lungs through a common bellows applied to one nostril. Although, however, instances are recorded of recovery following such treatment, and even that of inflation of the chest by the already vitiated air blown from the mouth of a bystander, yet serious risk was incurred of injuring the delicate tissues of the lungs by the use of such means.

It remained for Dr. MARSHALL HALL to discover the far closer imitation of natural respiration which has been already successfully practised in several cases of drowned persons, and in many more instances in the analogous cases of suspended animation in still-born children, which important discovery bids fair to produce a revolution in the treatment of all such cases, and to prove an important benefit to mankind.

Having reference to the above-named important principles, Dr. MARSHALL HALL, then, in the first place, insists that no time be lost; that instead of removing the body to the nearest house, it should be treated instantly, on the spot, in the open air, by which treatment less time is lost and a purer air is inhaled than that within a dwelling.

In the second place, he requires that the body be placed with the face downwards, in which position the tongue will fall forwards, carrying with it the " epiglottis," and so leaving the "glottis" clear and open for the discharge of any fluids which may have passed into the windpipe, and for the ingress and egress of air to and from the lungs. Jo the third and last place, he directs that the process of respiration be imitated by the simple and natural means of changing the posture of the body itself. When placed on the stomach, or with the face downwards, the cavity of the chest is compressed by the weight of the body alone, and Dr. MARSHALL HALL states that experiment with dead subjects has proved that about 20 cubic inches of air will in that manner be exhaled.

Also, that a further steady pressure of the hand on the back, between and below the shoulders, will expel a further quantity of 10 cubic inches, or 30 cubic inches in all.

That by then placing the body on one side, from the natural elasticity of the framework which encompasses the lungs, a complete expansion of the chest cavity again takes place, and, following a natural law, the outer air once more rushes into, and refills the lungs to the amount of the 30 cubic inches previously expelled. By this truly simple and beautiful operation, an artificial respiration is completely established, the alternate acts of which may be repeated at intervals, the length of which are at the command of the operator. Dr. HALL recommends their being repeated at intervals of four seconds, or fifteen times in a minute. A complete expiration and inspiration thus occupying a period of eight seconds.

Whether this particular rate of alternate movement of the body be the most suitable, or whether it should be the same in all cases, and in all stages of suspended life by drowning, will no doubt be shown by the light of further experience.

During the time that the efforts above described are being made to restore the breathing power, Dr. HALL recommends that means be adopted to increase warmth, and restore the circulation of the blood, by Wction, drying the body and clothing it, or ay any available means except the continuous warm bath, which is known to impede breathing. He however urges, as of the utmost importance, that these efforts to restore heat, &c., must not go ahead of the respiratory action, which itself generates teat by the chemical change it produces in the blood.

On perusing the summary of the opinions given by three hundred medical men, and by medical bodies within the United Kingdom, which we now place before our readers, it will be observed that, owing to the short time since its promulgation, only seven have tested the correctness of Dr. MARSHALL HALL'S plan, by actual experiment on drowned persons; but that the greater number of 22 have done so in the cases 01 asphbdated or still-born children. Although the operations have been successful in all the reported cases of both kinds, yet it must be admitted that the proof of experience, especially as regards drowned persons, is as yet but of a limited character. Since, however, the great body of those medical practitioners who have theoretically expressed their ap- proval of Dr. HALL'S method, have pronounced their opinions in a most emphatic manner, as founded 'on physiological facts and reasoning, and have stated their intentions to adopt it in future cases; and seeing, from the comparatively small number of persons drowned within reach of the aid of medical men, that a long period would necessarily elapse before any rules founded on long experience could be adopted, we feel sure that the Committee of the NATIONAL LIFE-BOAT INSTITUTION have acted rightly in pronouncing and promulgating rules on this subject for the guidance of uninstructed persons, founded on the opinions thus expressed by so large a number of the members of the distinguished medical profession of this country; backed as those opinions also are by the continental authorities who have kindly favoured the Institution with their opinions on the relative merits of the old and new methods.

Referring to the opinions of foreign authorities, it may be stated that although Dr. MARSHALL HALL is known to them by his writings, and has a European celebrity as a physiologist, they do not appear to have heard of his proposed system for restoring drowned or other asphyxiated persons. They have therefore only pronounced theoretically on the subject; affirming the correctness in principle of his method, and generally adding that if his manner of restoring respiration by postural action only, should be proved by experience to be as effectual as the Doctor anticipated, it would be an invaluable acquisition to medical knowledge.

With reference to the opinions received from the Board of Public Health at Paris, we may observe that whilst that Board approves of the principles advocated by Dr. MARSHALL HALL, it states that the necessity of restoring respiration has been .for a long time known and acted on by their medical authorities, but their mode of effecting it differed from that of Dr. M. HALL'S.

Opinions of medical men and medical bodies in the United Kingdom on the comparative-merits of the two methods of restoring drowned persons, viz.—That of the Royal Humane Society and that proposed by Dr. MARSHALL HALL.

Total number of replies received . . 300 of whom 11 sign as representing medical bodies.

Total number of the above which are altogether in favour of Dr. M.

HALL'S plan 254 Number in favour of the plan of the Royal Humane Society. . . . 10 Number who recommend the addition of some of the Royal Humane . Society's rules to those of l r. M.

HALL 20 Number whose replies are undecisive. 12 Number who decline to offer an opinion 4 Number who have successfully practised Dr. M. HALL'S plan on drowned persons 7 Number who have successfully practised Dr. M. HALL'S plan on stillborn children,—some of them in several instances 22.