THE termination of another summer, with an even longer tale than usual of deaths from drowning, almost instinctively in- duces the reflection as to whether or not the proper measures to adopt in order to restore suspended animation are as gene- rally known as they ought to be, and whether many valuable lives are not annually lost from want of that know- ledge on the part of the rescuers of drown- ing persons or of bystanders present, and from the delay that must too often be incurred before the aid of a medical man can be obtained.

Hundreds of thousands of copies of the Eules for the restoration of the apparently 'drowned, based on those of the late Dr.

MARSHALL HALL, and combined with Dr. SILVESTER'S mode of artificial respira- tion, as issued by the ROYAL NATIONAL LIFE-BOAT INSTITUTION, have been circu- lated throughout the United Kingdom, as have also those adopted by the Royal Humane Society, but, nevertheless, a too frequent ignorance on the matter seems to prevail.

"We have already recurred to this im- portant subject from time to time in the pages of this journal, and may no doubt usefully continue to do so.

Very opportunely a highly-interesting lecture on the resuscitation of the appa- rently drowned was lately delivered at the Training College, at Adelaide, New South "Wales, by the Hon. Dr. CAMPBELL. As it very lucidly and forcibly explains the phy- siology of the subject, and contains some information which we have not seen in any other treatise on it, we reprint the whole lecture as reported in the Adelaide Observer, and add illustrations of the two methods of producing artificial respi- ration referred to by the lecturer, viz., those of Dr. MARSHALL HALL and Dr. SILVESTER, taken from the published Rules of the NATIONAL LIFE-BOAT INSTI- TUTION :— LECTURE AT THE TRAINING COLLEGE, ADELAIDE, NEW SOUTH WALES.

The lecturer remarked that drowning was by no means an infrequent accident. It was always alarming in its nature, and was calculated to create in the minds of ignorant bystanders ex- citement and confusion. It was well to be able to save a life from drowning by dint of courage and skill, but it was an equally meritorious deed to restore life when it was apparently gone. Very few, however, attempted the latter. Medical men were usually sent for, and probably in the mean- time the last chance of restoration was lost. He would now show them that it ought to be esteemed culpable ignorance for any intelligent man or woman to stand by and wait in such a case until the doctor arrived. If instantaneous action was necessary at any time in the history of our life it was when an apparently lifeless body was dragged out of the water and demanded an attempt at re- storation. With the object of giving his audience an intelligent view of the subject of drowning, he drew their attention to the general aspects of respiration, as the function of the body imme- diately interfered with in submersion. Respiration, although seemingly performed with ease and com- fort, and likewise capable of being to some degree voluntarily interrupted, was yet the most imperious function of the body. No one could voluntarily hold his breath' more than one minute, or at the very outside, after long training, two minutes.

Pearl divers could remain two minutes under water, but this was accomplished by the artifice of mechanically compressing the nose and keeping the mouth shut. The necessity of supplying the body with food arose according to habit—only twice or thrice a day—but the hunger of the blood for atmospheric air was constant. Respiration was at the rate of fifteen to eighteen times a minute, or over one thousand times an hour. No rest was given to the lungs, as the interchange of oxygen and carbonic acid was an imperious necessity ol every moment of our existence. The life was certainly in the blood, and if the blood did not carry oxygen on its bosom to every cell of the body life fled away. The accident of drowning or 1.—INSPIRATION.

2.—EXPIRATION.

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

entire submersion in water was a complete inter- ference with this important function. The water effectually prevented the admission of atmospheric air, as well as the exit of carbonic acid. This interference gave immediate rise to circumstances of the greatest danger to life; and the answer to the question how long a person could live under water was answered by the reply to the question how long could the body survive on the oxygen retained in the chest after submersion ? A word of explanation was necessary. The amount of air in the chest under ordinary circumstances was some- where about 230 cubic inches. Thirty inches of this passed actively out and in at each act of in- spiration, and was called "tidal air." This 30 inches, by a forced effort, could be increased to 130, the 100 inches of increase being called "resi- dual air." The remaining 100 inches was known as "complemental air," and was stationary in the chest. This complemental air, though stationary, was yet constantly replaced by the law of the dif- fusion of gases. Now, in drowning, if a person struggled very hard, and consequently expelled not only the 30 cubic inches of tidal air, but also the 100 of residual air, and by the muscular exer- tion involved in the struggle increased the demand for oxygen, then the period during which he would live under water was very brief, probably not more than one or two minutes. If, however, he did not struggle, or by any chance fainted, then, retaining all the available oxygen in the chest, and the waste of the system being at the minimum in con- sequence of fainting, he might live from three to five minutes. Hence the chances of resuscitating a person who faints on submersion are greater than one who does not, and violently struggles, each being the same length of time in the water.

From the venous congestion that ensues, the heart also speedily comes to a stand, although not for three to eight minutes after respiration has ceased.

1.—INSPIRATION.

2.—EXPIRATION.

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

It is during this period—that is, between the ces- sation of respiration and the cessation of the heart's action—that resuscitation is possible. If the heart has actually ceased to beat, then resusci- tation is impossible. Certain other circumstances influenced the rapidity oi the drowning process.

The coldness of the water materially hastened the extinction of life; also the amount of water taken into the lungs. If the lungs rapidly fill and become " sodden," by so much is the chance of resuscita- tion diminished. Those were the simple physio- logical facts bearing on this question; and while saying so, the inference from them distinctly was that in any accident from drowning not one moment was to be lost in resorting to artificial respiration. On a person being taken out of the water, the first available spot on which to place the body must be accepted, whether it be a small boat, a jetty, or the beach. Protection muse, if possible, be had; but it was infinitely more important to resort at once to the means of resuscitation. In view of this statement, the culpability of by-standers waiting till the doctor arrives becomes self-evident. The precious seconds have probably all fled by the time he comes upon the scene.

While setting about the application of one of the proper methods of artificial respiration, other matters have to be thought of. First, send for medical help; second, send for blankets; third, send for dry clothes. With respect to the person drowned, before proceeding to artificial respiration see to the following points:— 1. Cleanse the mouth and nostrils.

2. Open the mouth and draw the tongue forward.

3. Retain the tongue forward.

4. Remove all tight clothing on neck and chest.

5. Hang the head over the edge of table or board, and elevate to some degree the feet, to allow any water to flow from the lungs.

6. Place the body flat on its back, and 7. Support the head and shoulders on something of the form of a cushion or pillow.

Having carefully, and with the greatest possible alacrity, attended to these points, then proceed to practise one or other of the following methods of artificial respiration. He said two methods, for there were two. The two methods were known as Dr. Sylvester's, or the physiological, and Dr.

Marshall Hall's, or the "ready" method. The processes in each were different, and, so far as experiments had gone, the results were highly favourable to the first of these methods. Dr. Sylvester's method had resulted in gaining ad- mission to the chest of some forty cubic inches of air as a maximum, while Dr. Marshall Hall's only reached ten cubic inches as a maximum. He then proceeded to show how these were carried out, by placing a young man on the table and going through the several steps of the process. These may be enumerated as follows: 1. Sylvester's method.

a. Grasp the arms above the elbows and raise them above the head.

6. Return them against the side with gentle pressure.

c. Repeat this fifteen times per minute.

This was called the physiological method, because it followed by these movements of the arms the natural movements of the chest in respiration.

The other was: 2. Hall's method, which consisted of— a. Turning the body gently on the side, and a little beyond.

b. Then briskly on the face.

c. Repeating fifteen times per minute.

They did not require to note by a watch the num- ber of repetitions, for by observing the frequency of their own breathing they would find the means of guidance in this respect. Having, by a patient application of these movements, restored to some extent natural respiration, then they must next seek to establish circulation and warmth. But here he must warn them never to take this step until respiration was in some measure present, or the result would be highly inimical to their efforts.

Circulation and warmth would be aided by the application of friction to the limbs and body, dry blankets, hot flannels, hot bottles or bricks to the feet, stomach, armpits, and thighs. Then give some warm drink, a small amount of brandy-and-water, and by soothing and quietness encourage sleep.

Sleep was highly important, not only to restore the disordered brain, but also with the view of warding off the secondary apncea, which might arise even twenty-four hours after the accident. Several minor points of practical import were noted as the lecturer proceeded. Before concluding, he pointed out that the employment of artificial respiration was demanded in other conditions besides that arising from drowning—in fact, in any condition in which the respiration had been inter- rupted, as after the removal of a mechanical obstruction in the windpipe, the effects of a poisonous atmosphere, or the results of a poison swallowed.

We have remarked above that Dr. CAMPBELL'S lecture contains some infor- mation which we had not before seen in.

any previous treatise on the subject, and which we may conclude therefore will be new to many of our readers. For instance, how few persons, except medical men, are acquainted with the rationale of the per- petual action of the heart and lungs, of their mutual relation to each other, and of the entire dependence of life itself on.

the unceasing healthy action of each.

We believe that the ordinary notion of ordinary people is that at every act of respiration the lungs are completely, or almost completely, emptied of air, and that at every inspiration they are re-filled.

Dr. CAMPBELL, however, tells us, that but 30 cubic inches of air out of about 230 cubic inches which the lungs contain thus pass out and in during the process of breathing, which quantity of 30 cubic inches is termed "tidal air;" that half the remainder, which can be expelled by mus- cular effort, is called "residual air," and that the remaining 100 inches, stationary in the chest, is termed " complemental air," whilst the length of time during which a person might live under water would de- pend greatly on the extent to which the residual air had been exhausted through violent struggling or other effort, the maximum time being when, consequent on fainting, the body had become alto- gether inert.

Again, the Doctor informs us that the heart does not entirely cease to beat until from three to eight minutes after respira-tion has ceased, and that it is during that interval —i.e. between the cessation of respiration and the ceasing of the heart to beat—that restoration under proper treatment is possible, and that it is im- possible when the heart has absolutely ceased to beat.

From the above two important and highly interesting facts it will be apparent how essential it is that every effort should be made by rescuers of drowning persons to shorten the period of immersion as much as possible, and to restore breathing when immersion has ceased.

Another point to which we would draw attention is that of the admission of water to the lungs. We notice that Dr. CAMP- BELL speaks of the lungs as being filled, or sodden with water. On the other hand we believe that other medical men and physiologists have concluded that but little water swallowed ever finds access to the lungs, involuntary spasmodic action, such as we experience on even a drop of any fluid or the smallest particle of solid matter finding its way into the windpipe, causing the valve termed the epiglottis, which had been momentarily at fault, to be instantly on the alert and close the passage.

We will leave this question at issue to be settled by the learned themselves, con- tent, on our part, to point out the vital importance of the discharge of water from the "stomach" when, as is frequently if not generally the case, it has been swal- lowed in large quantity; well-authenti- cated instances having been recorded when life was rapidly ebbing, and reaction only took place on relief being afforded to the vital organs by vomiting the water by which their action had been almost sup- pressed.

It will be noted that Dr. CAMPBELL advocates the Silvester system of pro- ducing artificial respiration in preference to the " ready method" of MARSHALL HALL, on the ground that it introduces a larger amount of air to lung action. The question, however, naturally arises whe- ther, when life is at its lowest ebb, and circulation of the blood scarcely com- menced, any large amount of air is re- quired to re-oxidize it in the lungs. If we run or take other violent exercise the action of the heart and consequent circu- lation of the blood are rapidly increased; but nature instantly provides a remedy, and quicker breathing affords the requi- site increased supply of air to the lungs to oxidize and vitalize the augmented flow of arterial blood. Inversely, then, it may be presumed that a greatly diminished cireulation and presentation of blood at the lungs would require a proportionally less quantity of air to oxidize it.

Apart, however, from the question whe- ther so great an advantage is obtained as Dr. SILVESTER supposes from the larger amount of air which he supplies to the lungs, the chief objection that we enter- tain to his system per se is, that he takes no sufficient steps to secure the discharge of swallowed water, whilst MARSHALL HALL'S method effectually does so, and hence we advocate the combination of the two systems as adopted by the NATIONAL LITE-BOAT INSTITUTION.

It will be noticed that Dr. CAMPBELL does not ignore the necessity of encourag- ing the escape of fluid, whether from the stomach or chest, but that he adopts a different means for doing so than MAR- SHALL HALL, placing the body on a board, table, or boat, &c., with the head project- ing beyond its margin, and with the feet or legs slightly raised. Dr. CAMPBELL does not say if the body is to be turned face downwards; but unless it be so we con- sider that the merely placing it in a slightly-inclined position, as recommended by Dr. SILVESTER, would not afford suffi- cient mechanical aid to'expel water from either the stomach or chest.

The plan of Dr. BENJAMIN HOWARD, of New York, contained in his "Direct Method," which we published in the eighty- seventh number of this journal, is, we think, much more likely to do so. He places the body face downwards, with a large bundle of tightly-rolled clothing under the stomach, and applies heavy pressure on the back. We think that MARSHALL HALL'S plan, returned to at intervals, in combination with that of Dr. SILVESTER, is better than either.

Where, however, doctors differ, laymen may well hesitate to dogmatize. We will not therefore pronounce absolutely which system for restoring suspended animation, or whose plan for encouraging the dis- charge of water, is altogether the best; but we will observe that Doctors CAMP- BELL and HOWARD, equally with MARSHALL HALL, insist—1st, on the vital import- ance of acting instantly on the spot, delay in the majority of cases meaning death;— 2nd, that renewed circulation of the blood must in nowise take precedence of renewed respiration; and—3rd, that it is often essential to recovery that water swallowed in large quantity, or inhaled, should be discharged through the mouth.

We would say, then, to every reader of these lines, should opportunity offer, and a drowning person's life at any time de- pend on your aid, remember those three axioms; carry them into effect to the best of your ability; and, if not too late, you may, with God's blessing, have the supreme satisfaction of restoring a fellow- creature to renewed existence.