The symptoms met with in drowning are varied. Some, on being precipitated into the water, paralyzed by fear, or stunned by the fall, sink like lead and die without a struggle. Others, still possessed of their faculties, struggle to keep themselves on the surface, but as their strength fails, their motions are made at random, and they clutch at every thing within their reach. From the irregularity of their motions, they rise and sink several times. At every opportunity an attempt is made to obtain a breath of air, but usually water is, introduced with it, which exciting a cough, is expelled from the trachea, the same effort also expelling the air which had been introduced. A fresh demand for air is thus created, and a hurried attempt made to gratify it, but the very eagerness defeats its own object, for water is again introduced. Unless the head is fully raised, some portion of the water passes into the stomach, but the larger portion, together with the air taken in, is expelled by the spasms of the glottis. In this continued struggle the blood rushes to the head, the brain becomes congested, and all effort for life ceases. The victim sinking for the last time, unable to obtain air, whereby respiration may be continued and the blood arterialized, the lungs become filled with venous blood, the strokes of the heart grow weaker and weaker, sensibility gradually departs, and the victim glides quietly and with a feeling of luxury creeping over him into the arms of death.
From what has been already said, it will very readily be seen, that drowning is simply a kind of suffocation, caused not by the presence of water in the lungs or stomach, for there is but very little there, but by the shutting out the atmospheric air from the air-passages of the lungs, thus preventing the oxygenation of blood, and thereby extinguishing the lamp of life.
Let us now inquire into the treatment to be pursued in resusitating persons taken from the water.
If there are no marks of violence sufficient to have caused death, and there is reason to believe the person was alive when immersed, or there is a possibility that life may not be quite extinct, the treatment should at once be judicious, active, and decided, yet there should be the utmost caution in avoiding every thing like rough usage. The mouth and nostrils should be cleaned. The wet clothes immediately stripped from the body, the body wiped dry, and immediately covered with warm dry clothes or blankets. The colder the weather, the more necessary it is that this should be done on the spot, unless there is some place very near at hand, where these matters can be more readily carried into execution. It cannot be too strongly impressed on the mind of those who are first on the ground, and generally non-professional men, to confine themselves rigidly to these plain and simple directions. By doing this they will have paved the way for the more active treatment, which is to follow.
An error in the first steps may prove fatal. There are hundreds lost in the confusion and want of order which prevails at first, that might have been saved, if the attendants would only bear in mind the fact, that every thing which is done, must be done at the right time, and in the right way.
In removing the body, care should be taken that it is not lifted by the shoulders and legs, so that the head would fall backward, or forward, for this would be highly injurious. It should be placed on a door-board, or in a cart, in a recumbent posture with the head and breast raised. On reaching its destination, the body should be placed on a table of convenient height, stripped and covered with warm blankets, the head and chest raised, and the mouth and nostrils kept free and open. Artificial respiration should now be commenced.
The tube of a common pair of bellows can be made, by the assistance of a strip of linen, riband, or tape, to fit accurately into one nostril, while the other is closed by the hand of an assistant, who at the same time closes the mouth. Another assistant (who ought to be placed on the opposite or left hand of the body) is with his right hand to press backwards, and draw gently downward toward the chest the upper end of the wind-pipe, that part which lies a little below the chin, and which from its prominence in men, is vulgarly called Adam's apple; by doing this, the gullet or passage into the stomach will be completely stopped, whilst the windpipe will be rendered more open to let the air pass freely to the lungs. The left hand of the second assistant is to be spread lightly over the pit of the stomach, ready to compress the chest and expel the air again, as soon as the lungs have been moderately filled by the bellows; the first assistant unstopping the mouth or nostril at the same time to let the air escape. The same operation is to be repeated in a regular and steady manner, either until natural respiration begins, or until this and the other measures recommended have been persisted in for three or four hours without any appearance of returning life, unless the stiffness of the limbs and other positive signs of death set in. In the absence of the bellows, until one can be procured, air can be blown into the lungs by applying the mouth of the operator to that of the patient, and expelled from the chest in the manner directed above. To imitate the natural movements in respiration the motions in artificial respiration should be about fifteen times in a minute. While the process of artificial respiration is going on, some of the assistants should be engaged in communicating continued heat to the body. Dry warm blankets, bags of warm grain, bottles of hot water, hot bricks, or blankets wrung out in hot water, are among the means to be used. Should the accident happen in the vicinity where warm water can be readily obtained, a warm bath, moderated to a heat not exceeding 100° would be highly advantageous. Bottles of hot water should be placed at the bottom of the feet, to the joints of the knees and under the arm pits. A bladder, filled with hot water, should be applied to the region of the stomach, and some warm substance, as a heated brick, wrapped in cloths, should be passed over the body, particularly along the back. The application of heat, however, should be gradual. Slight shocks of electricity or galvanism passed through the diaphragm and heart would probably be of advantage, as this agent possesses an immense power over the nervous system. The first evidences of returning life are slight convulsive twitchings in the muscles of respiration, producing gasping or sighing. Our efforts on the approach of these signs should be increased as the life of the patient is still comparatively in our hands and can only be saved by the greatest effort, as it takes some time before the blood can be arterialized, and the mechanism of the body resumes its wonted motion; a little brandy may now from time be introduced in the stomach, and an enema of tepid water given. As the suspension of animation is devoid of pain and attended with a feeling of luxury, so is the return of life agonizing in the extreme, so much so, that the patient often instead of expressing gratitude, curses the officiousness of friends, who have made him suffer such torture.
Even when the breathing has become calm and the circulation apparently restored, there still remains a period of danger, and the patient for a few hours should be closely watched. The treatment we have detailed as necessary in drowning, would also be applicable in asphyxia from strangulation, or in fact from any cause, with those deviations which would naturally suggest themselves to the mind of every intelligent medical man.
The treatment in apparent death from any of the above causes is similar to that indicated in apparent death from drowning.