ROYAL NATIONAL LIFE-BOAT INSTITUTION.

Supported solely by Voluntary Contributions.

DIRECTIONS FOR RESTORING THE APPARENTLY DROWNED.

THE leading principles of the following Directions for the Restoration of the apparently Dead from Drowning are founded on those of the late Dr. MARSHALL HALL, combined with those of DB. H. R. SILVESTER, and are the result of extensive Inquiries which were made by the Institution in 1863-4 amongst Medical Men, Medical Bodies, and Coroners throughout the United Kingdom. These Directions have been extensively circulated by the INSTITUTION throughout the United Kingdom and in the Colonies. They are also in use in Her Majesty's Fleet, in the Coast-guard Service, and at all the stations of the British Army at home and abroad.

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 downward, 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, especially 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.

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 perserveringly, 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 bat 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.

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.

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 CIRCULATION AND WARMTH.

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, fee. [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, fee., 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 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 lite 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 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 a momentary excitant.

By order of the Committee, ROYAL NATIONAL LIFE-BOAT INSTITUTION, RICHARD LEWIS, London, May, 1871. Secretary.