UNTIL the year 1857* the ROYAL NATIONAL LIFE-BOAT INSTITUTION circulated at its lifeboat stations the Rules of the Royal Humane Society for the " Restoration of the Apparently Drowned." In that year, however, those Rules having been publicly repudiated by the distinguished physiologist, the late Dr. MARSHALL HALL, whose views were also adopted by numerous other medical men, the Committee of the Institution felt that they could no longer incur the responsibility of issuing rules the correctness of which was thus disputed; and not being a medical body, they decided to ask the opinion of the medical world. They accordingly had the Rules of the Humane Society and those of Dr. M. HALL printed side by side, and the two were forwarded not only to all the public medical bodies in the United Kingdom, and to a large number of private medical men, accompanied with the request that they would favour the Institution with their opinions on the relative value of the two systems; but they also sent them to the different Maritime Governments of Europe, and solicited the opinion of their medical authorities.

The result of this extended inquiry was so almost exclusively in favour of the plan of Dr. MARSHALL HALL, that the Committee of the Institution had no choice but to issue at its stations on the coast a new code of rules in accordance with that system.

The Committee felt the inconvenience of having two conflicting systems before the public, and they would willingly have been spared the apparent interference in a field of labour that had been hitherto exclusively occupied by a sister Society; but as that » Vide NOB. 21, 25, and 29 of the Life-boat Journal.

Society still adhered entirely to its own system, they were compelled to act independently of it.

The leading feature of the Rules recommended and issued by- the Humane Society at that time, was the restoration of warmth to the body, and preference was to be given to the warm bath as the vehicle to restore it over all other means, whenever it was obtainable, the patient being conveyed to the nearest dwelling in the first instance.

The distinguishing principle, on the other hand, of Dr. M. HALL'S system, which he named the "Ready Method," was the restorartion of natural breathing in the first instance before promoting the circulation of the blood; and he proposed a novel mode of artificial respiration.

He also pointed out the importance of treating such cases instantly, on the spot, in the open air, and likewise adopted a different position for the body in the first instance, placing it on the stomach with the face downwards, instead of on the back, as recommended by the Royal Humane Society.

He also highly disapproved of the use of the warm bath except momentarily as an excitant, and then only under the superintendence of a medical man.

In advocacy of these changes, Dr. M. HALL stated: Firstly, that prompt action was of the utmost importance—loss of time being often loss of life. Secondly, that the body should be placed, in the first instance, with the face downwards to admit of the escape of water or other fluids from the lungs, which would otherwise impede or prevent respiration. Thirdly, that if Ihe blood circulated through the body, warmth being imparted to it, without its being reoxidized by contact with fresh air in the hings, on reaching the brain it would necessarily produce asphyxia and death, and that therefore the efforts to restore warmth must not be in advance of those to induce respiration, and that the placing the patient in a warm bath was especially injurious.

To reinduce respiration or natural breathing, Dr. M. HALL then proposed to imitate it artificially by a rotatory motion of the body, the patient being laid on the ground or elsewhere, alternately on the stomach and on one side, the changes of position being repeated every four or five seconds, or about as frequently as the natural expiratory and inspiratory movements take place during life.

On being placed on the ground or other flat surface, he maintained that the weight of the body itself, aided by pressure on the back between the shoulders by the hand of the operator, would, by compressing the j chest, expel all air from the lungs, and that when laid on one side, the natural elasticity of the muscles and framework of the chest would cause it to expand, when a sufficient quantity of air would again enter the lungs in the same manner that air enters the common "bellows" on their interior being artificially expanded.

Again, Dr. M. HALL stated that in the position in which the patient was placed, in accordance with the Rules of the Royal Humane Society, viz., on the back, the tongue would fall back and close the entrance to the windpipe, by which inspiration would be prevented, and that in that position there was no escape for any water that might have .entered the lungs.

These conclusions were arrived at, by Dr. M. HALL, chiefly by experiments on the dead subject and on still-born children, in which latter the phenomenon of suspended animation is analogous in some respects to that resulting from immersion in water.

Since the introduction of this -method for restoring suspended animation, a great number of medical men have most successfully used it in the treatment of still-born children, and some striking cases have occurred of restoration from drowning through its adoption ; but opportunities for its practical use in the latter case by medical men are comparatively infrequent.

As, however, in the year 1857 the efficiency of the system previously in general use for the restoration of partially drowned persons W;as disputed, so again, in the year 1862-3, Dr. SILVESTER, of London, proposed a new method of artificial respiration, which he pronounced to be far more effectual than .that of Dr. MARSHALL HALL, and much more easy of performance; more effectual as producing a deeper inspiration and expiration, and thus more completely inflating the lungs; and more easy of performance, as only requiring a movement of the arms of the patient instead of the repeated turning of the body, which, in the case of a heavy person, if continued for a lengthened time, would be a laborious operation to those performing it.

As the Humane Society had done, so he also placed the patient on the back, but with the head higher than the feet, whilst the tongue was to be drawn forward by the hand, and prevented from falling back again by an elastic band passed over it and round the chin, or by other artificial means.

To effect the respiratory movements he then proposed to raise the arms of the patient from the sides, perpendicularly, to above and before the head, which movement, by the action of the pectoral and other muscles raising the framework of the chest to the greatest expansion of which it is capable, would occasion an indraught of air or inspiration equal to that inhaled naturally by a deepdrawn breath, a yawn, or a sigh. And then, by letting the arms fall gradually back to the sides, and pressing the elbows forcibly against them, the chest and lungs would bo again collapsed and be emptied of air. These movements were to be repeated, like those of Dr. MARSHALL HALL, about every four or five seconds, in imitation of natural breathing.

The Royal Humane Society, which up to 1863 had still adhered to their old plan, despite Dr. MARSHALL HALL'S attacks on it, in that year altered their Rules, and thus admitted the importance of restoring respiration as well as warmth; but selected Dr. SILVESTER'S proposed method of effecting i't.

Once more, then, the Committee of the NATIONAL LIFE-BOAT INSTITUTION found themselves in the same dilemma as in the year 1857. Two different, if not rival systems, were again before the public: both could not be the best, and they had to choose between them. Feeling the great importance of the subject, they therefore decided again to seek the opinion of the medical world, and, accordingly, they had the two plans, viz., that of Dr. M. HALL and that of Dr. SILVESTER, as now adopted by the Royal Humane Society, printed side by side, and sent copies of them to the chief medical bodies in the United Kingdom, and to several hundred medical men, accompanied by a letter requesting them to favour the Institution with their opinion on the relative merits of the two plans.

The replies received were carefully considered and compared one with another, and the result was, a modification of the previous Rules adopted by the Institution, a portion of Dr. SILVESTER'S system being engrafted on them.

As above remarked, both these systems could not be the best; it was however possible that a portion of each might be so, and the balance of opinion, collected in the manner above related, was in favour of that hypothesis.

The greater number of those appealed to pronounced in favour of Dr. SILVESTER'S plan of imitating respiration, as being, in their opinion, more simple and easy of performance than that of Dr. M. HALL : many of these, however, objected to the use of the warm bath, and some of them, whilst approving of Dr. SILVESTER'S manipulation, objected to the placing the body on the back in the first instance, as preventing the escape of any fluid which might have passed down the wind-pipe and into the lungs. Some expressed themselves as altogether in favour of Dr. M. HALL'S plan, stating that they had arrived at that opinion from practical experiment; whilst some again recommended that Dr. HALL'S plan should first be tried, and if not followed shortly by success, "that Dr. SILVESTER'S should then be resorted to.

To the last of the above conclusions the Committee finally arrived, believing that the first treatment of the body, as recommended by Dr. HALL, was more favourable to the freeing the lungs of water and other extraneous matter that might have penetrated them. Moreover, up to the very time of making this change, successful cases of treatment by Dr. HALL'S plan were being reported, which still further strengthened the Committee of the Institution in their belief that it would not be prudent altogether to discontinue its use. Whilst, however, coming to that resolve, it was not felt that the door would be shut against future change or reconsideration of the subject, should the result of additional experience or the further investigations of scientific men make it appear desirable to do so.

The following are the new Rules issued and recommended by the Institution, to which it desires to draw the attention of medical men, and of all who may have opportunities to assist in the restoration of the " apparently drowned." They have been illustrated by drawings to make the mode of treatment more intelligible to those uninitiated in it:— I.

Send immediately for medical assistance, blankets, and dry clothing, but proceed to treat the Patient instantly on the spot, in the open air, with the face downwards, whether on shore or afloat; exposing the face, neck, and chest to the wind, except in severe weather, and removing all tight clothing from the neck and chest, especial)/ the braces.

The points to be aimed at are—first and immediately, the RESTORATION OF BREATHING ; and secondly, after breathing is restored, the PROMOTION OF WARMTH AND CIRCULATION.

The efforts to restore Breathing must be commenced immediately and energetically, and persevered in for one or two hours, or until a medical man has pronounced that life is extinct. Efforts to promote Warmth and Circulation beyond removing the wet clothes and drying the skin must not be made until the first appearance of natural breathing.

For if circulation of the blood be induced before breathing has recommenced, the restoration to life will be endangered.

II.—TO RESTORE BREATHING.

To CLEAR THE THROAT.—Place the Patient on the floor or ground with the face downwards, and one of the arms under the forehead, in which position all fluids will more readily escape by the mouth, and the tongue itself will fall forward, leaving the entrance into the windpipe free. Assist this operation by wiping and cleansing the mouth.

If satisfactory breathing commences, use the treatment described below to promote Warmth. If there be only slight breathing—or no breathing—or if the breathing fail, then— To EXCITE BREATHING—Turn the Patient well and instantly on the side, supporting the head, and— Excite the nostrils with snuff, hartshorn, and smelling salts, or tickle the throat with a feather, &c., if they are at hand. Rub the chest and face warm, and dash cold water, or cold and hot water alternately, on them.

If there be no success, lose not a moment, but instantly To IMITATE BREATHING—Replace the Patient on the face, raising and supporting the chest well on a folded coat or other article of dress.

1.—Inspiration, Turn the body very gently on the side and a little beyond, and then briskly on the face, back again; repeating these measures cautiously, efficiently, and perseveringly about fifteen times in the minute, or once every four or five seconds, occasionally varying the side.

[By placing the Patient on the chest, the weight of the body forces the air out; when, turned on the side, this pressure is removed, and air enters the chest.] On each occasion that the body is replaced on the face, make uniform but efficient pressure with brisk movement, 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.

2.—Expiration.

The foregoing two Illustrations show the position of the Body during the employment of Dr. Marshall Haffs Method of Inducing Respiration.

m.

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.

1.—Inspiration.

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.

To IMITATE THE MOVEMENTS OF BREATHING.—Standing at the Patient's head, 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.) Repeat these measures alternately, deliberately, and perseveringly, about fifteen times in a minute, until a spontaneous effort to respire is perceived, immediately upon which cease to imitate the movements of breathing, and proceed to INDUCE Cnt- COLATION AND WARMTH.

2*—-Expiiation.

The foregoing two Illustrations show the position of the Body during the employment of Dr. Silvester's Method of Inducing Respiration.

IV.—TREATMENT AFTER NATURAL BREATHING HAS BEEN RESTORED.

To PROMOTE WARMTH AND CIRCULATION.— Commence 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 blanket 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.

On the restoration of life, a teaspoonful of warm water should be given; and then, if the power of swallowing have returned, small quantities of wine, warm brandy and water, or coffee, should be administered. The Patient should be kept in bed, and a disposition to sleep encouraged.

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, APPEARANCES WHICH GENERALLY ACCOMPANY DEATH.

Breathing and the heart's action cease entirely; the eyelids are generally half-closed; the pupils dilated; the jaws clenched; the fingers semi-contracted; the tongue approaches to the under edges of the lips, and these, as well as the nostrils, are covered with a frothy mucus. Coldness and pallor of surface increase.

CAUTIONS.

Prevent unnecessary crowding of persons round the 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 a warm bath, unless under medical direction, and even then it should only be employed as a momentary excitant.