Chapter II: Boats, Rafts, and Make-Shift Floats (5)

"In the first place, it may be observed that for several hours after the submersion all hope of recovery should not be given up, unless it is declared by a medical man of experience that life is extinct. The signs by which this opinion may be formed are pretty clear to him, but by an ordinary spectator they are liable to be mistaken, since they are all more or less comparative in their nature. When, however, for half an hour there is not the slightest evidence of breathing, or of the action of the heart--when the eyelids are half closed, with the pupils turned upwards and dilated, the jaws clenched, and the fingers semi-contracted--there is little doubt about the result, especially if the tongue is partially protruded, and the lips and nostrils are covered with frothy mucus. The temperature of the body is often not a reliable sign, because that is kept up by artificial means; but if, in spite of these, and in addition to the existence of the above symptoms, the coldness of the surface is very manifest, even if there is no medical authority for the relaxation of all efforts at restoration, it can serve little purpose to persevere. Still it is better to err on the safe side, and in this country there is seldom a long interval of doubt.

"But supposing a body to be brought out of the water, it becomes a question, What shall be done? Shall it be taken to the nearest house, or at once be treated on the spot? The answer is, proceed at once in the open air, whether on shore or afloat, and lose not a moment in the attempt to _restore breathing_, and _keep up the temperature of the body by the application of dry heat_. The first of these is the main object, and the second must be for a short time sacrificed to it, but only for a few minutes, after which the two objects must be jointly pursued. These efforts must be continued energetically till they are either found to be successful, or declared to be useless. Should the breathing be restored, the circulation should next be encouraged by rubbing the limbs in the direction of the heart, with firm and steady pressure, and with the aid, if possible, of warm flannels or silk handkerchiefs, protected by a blanket over all. Beyond these general directions, however, it is necessary to give others more minute, and this will be best done in the words used in the printed directions of the Royal National Lifeboat Institution, which are given in a succinct tabular form, and should be hung up in every public place near which accidental drowning is at all likely to occur." These directions are as follow:

TO RESTORE BREATHING. TO PREVENT ANY FURTHER _To clear the Throat._ DIMINUTION OF WARMTH.

1. Place the patient on the floor or N.B.--These efforts must ground with his face downwards, and one be made very cautiously, of his arms under the forehead, in which and must not be such as position all fluids will escape by the to promote _Warmth_ and mouth, and the tongue itself will fall _circulation rapidly_; for forward, leaving the entrance into the if circulation is induced windpipe free. Assist this operation by before breathing has been wiping and cleansing the mouth. restored, the life of the patient will be endangered. 2. If satisfactory breathing commences, No other effect, therefore, adopt the treatment described below to should be sought from promote warmth and natural breathing. If them, than the prevention there be only slight breathing, or no of evaporation, and its breathing, or if it fail, then-- result, the diminution of the warmth of the body. _To excite Breathing_-- 1. Expose the face, 3. Turn the patient well and instantly neck, and chest, except on the side, and-- in severe weather (such as heavy rain, frost, or 4. Excite the nostrils with snuff, snow). harts-horn, smelling salts, or tickle the throat with a feather, &c., if they 2. Dry the face, neck, are at hand. Rub the chest and face warm, and chest, as soon as and dash cold water on it. possible with handkerchiefs or anything at hand; 5. If there be no success, lose not a and then dry the hands moment, but instantly and feet.

_To imitate Breathing_--

6. Replace the patient on the face, raising and supporting the chest well on a folded coat or other article of dress.

7. Turn the body very gently on the side and a little beyond, and then briskly on the face, back again; repeating these measures deliberately, efficiently, and perseveringly about fifteen times in the minute, or 3. As soon as a blanket once every four seconds, occasionally or other covering can be varying the side: obtained, strip the body; but if no covering can [_by placing the patient on the chest, be immediately procured, the weight of the body forces the air out; take dry clothing from when turned on the side, this pressure is he bystanders, dry and removed, and air enters the chest._] re-clothe the body, taking care not to interfere with 8. On each occasion that the body is the efforts to restore replaced on the face, make uniform but breathing. 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:

[_the first measure increases the expiration, the second commences inspiration._]

[stars] The result is--_Respiration_ or _Natural Breathing_; and, if not too late, _Life_.

_Cautions._

1. Be particularly careful to prevent
persons crowding round the body.

2. Avoid all rough usage and turning
the body on the back.

3. Under no circumstances hold the body
up by the feet.

N.B. The directions are printed in parallel columns to avoid confusion, and to insure that the efforts to obtain both objects shall be carried on at the same time.