PROPOSALS FOR RECOVERING PERSONS APPARENTLY DEAD BY DROWNING, AND SUFFOCATION FROM OTHER CAUSES.
PUBLISHED BY ORDER OF THE GOVERNORS OF THE DISPENSARY.
NEWCASTLE: PRINTED BY S. HODGSON.—1789.
At a Meeting of the MEDICAL SOCIETY, held the 10th of November, the following pages were read and approved of; and a printed copy ordered to be ſent to each Member, with a requeſt that he would offer in writing to the SOCIETY, on Tueſday the 1ſt of December, every objection, alteration, or improvement, which may occur on a careful peruſal.
THE Reports of ſeveral eſtabliſhments on the Continent, as well as of the Humane Society in London, have fully proved, that perſons apparently dead from drowning, or ſuffo⯑cation from other cauſes, may, by proper means, be reſtored to life. But whilſt the ſucceſs which has attended theſe eſtabliſh⯑ments, muſt give pleaſure to every perſon intereſted in the cauſe of humanity; yet it is to be regretted, that the means of reſto⯑ration have not been more publicly underſtood, and more gene⯑rally adopted.
The frequent inſtances of death, by drowning, which have happened upon the river Tyne, and the unſucceſsful attempts of recovery, have afforded the ſtrongeſt proofs, that the methods of reſtoration have not been known to the public, or have not been ſpeedily or properly applied.
In order to give relief to perſons in ſuch unfortunate circum⯑ſtances, in this town and neighbourhood, the Governors of the NEWCASTLE DISPENSARY have eſtabliſhed a department of their Charity, on the following plan, for the recovery of the vital motions, when ſuſpended by drowning; and, to render this de⯑partment more uſeful, they have alſo extended it to the methods of reſtoration in other caſes of apparent death.
6. From various experiments, inſtituted by different members of the SOCIETY, the following appearances have been obſerved to take place in drowning, to which the attention of the reader is requeſted, as not only pointing out the nature of the death, but the methods, which ought to be employed to effect a re⯑covery.
7. When an animal is kept under water, in a few ſeconds it begins to emit its breath forcibly, ſo as to occaſion air bubbles. This emiſſion of air from its lungs is followed with as ſtrong a deſire to draw in air, and in theſe efforts, it commonly inſpires water(a). Its ſtruggles, in a few minutes, become impercepti⯑ble, and it falls down motionleſs. Upon taking it out of the water, provided only eight or ten minutes have elapſed after all its ſtruggles are over, the noſe and mouth appear remarkably pale, the eyes do not protrude, and the pupils, tho' they nearly retain their natural luſtre, are quite dilated; all ſenſe and mo⯑tion, both external and internal, except a ſlight contraction of the right ſide of the heart, are now loſt; and if no means of recovery [7]he made uſe of, the body gradually becomes cold, and with the loſs of heat, the heart loſes the power of contraction.
8. Upon diſſection, no fulneſs in the veſſels within the ſkull, nor any diſeaſe in the brain, or its membranes, are to be found. The lungs alſo appear ſound; are generally about half diſtended, but ſometimes more, when the animal is frequently allowed to come to the ſurface of the water, ſo that he may inſpire. A quantity of frothy fluid(b), conſiſting of mucus, with a little of the water in which the animal was drowned, in every experi⯑ment except one, was ſqueezed from the lungs.
9. The right-ſide of the heart is full of black blood, and the large veins going out from this ſide of the heart, thro' their whole courſe, to the middle of the thighs, the arm-pits, and almoſt to the jaws, are full of blood of the ſame colour. The left-ſide of the heart is almoſt empty, which is alſo the caſe with the whole of the large arteries, except the trunks of the artery, which en⯑ters the lungs, which is commonly filled with blood. The ex⯑ternal blood-veſſels are empty, and the muſcles commonly look as white as if the animal had been bled to death.
10. Upon the whole, it appears (8.9.), that no injury is done to the organization of the vital parts; but that the heart and large veins, in its neighbourhood, are diſtended with blood, whilſt every other part ſeems, in a great meaſure, to be drained of that fluid. Nor are theſe circumſtances invalidated by the ap⯑pearances, which have been obſerved in ſome bodies of drowned perſons, who are never opened till many hours after death; for altho', in a few, the veſſels of the brain have been found full of blood, yet, generally, this organ, as alſo the lungs, have been found in a ſound ſtate. Neither does the prominent, or blood⯑ſhot eye, the ſwelled bloated face, or the lividity of the ſkin, which are ſo often obſerved in drowned perſons, who have been long under water, prove any thing more, than that the blood, af⯑ter death, had drained to depending parts.
11. From what has been advanced, in the three preceding para⯑graphs, it appears, that the firſt cauſe of the ſuſpenſion of the vi⯑tal motions in drowning, is the ſtoppage of reſpiration; in conſequence of which the circulation cannot be carried on, and the blood, therefore, is accumulated in the right-ſide of the heart, and in all the large internal veins. With this ſtoppage of the [8]circulation, the brain loſes its energy, the body becomes cold, and with the total loſs of heat, it may be reaſonably ſuppoſed that the principle of life is extinguiſhed(c).
12. From this view of the ſubject, the moſt likely means to reſtore perſons apparently dead by drowning, will conſiſt: 1ſt, in renewing the action of the lungs, without which the accumula⯑tion of blood about the heart cannot be removed; nor the heart itſelf be brought into proper motion: And 2d, in ſupport⯑ing a due degree of animal heat, without which the vital princi⯑ple cannot, with effect, exert its influence.
13. To reſtore the action of the lungs, it is indiſpenſably ne⯑ceſſary that they ſhould be inflated. When the perſon has not been long under water, perhaps blowing air into the mouth or noſe with a wooden pipe may be all that is neceſſary to put them into motion. But in many caſes, it will require great ſkill to in⯑flate them effectually. As the directions for doing this with in⯑ſtruments will be given in another place(d), it would be improper to enlarge on them here. It muſt, however, be obſerved, that the inflation ought not to be done with violence, but ſo as to imi⯑tate natural, eaſy reſpiration. And as, in many caſes, the infla⯑tion ought to be continued for one or two hours, it will be ne⯑ceſſary to employ a pair of bellows. But it muſt be obſerved, as ſoon as the pulſe returns, the inflation ſhould be gradually leſſen⯑ed, and, in a little time, totally laid aſide.
14. By artificial breathing (13.), judiciouſly and aſſiduouſly em⯑ployed, not only the frothy fluid, already taken notice of (8.), which renders the recovery from drowning more uncertain than other caſes of ſuffocation, will be expelled; but the heart will moſt likely be put into motion, by which the accumulation of the blood there, and in its neighbourhood (9.10.), will alſo be re⯑moved, and the circulation reſtored.
15 At the ſame time, that the meaſures recommended (13.) are aſſiduouſly employed, other aſſiſtants ſhould be endeavouring to reſtore, and to keep up a due degree of animal heat. Perhaps the ſpeedieſt method of doing this, (were hot water al⯑ways in readineſs) would be to put the patient into a warm bath. But as this cannot be ſpeedily procured, but more eſpecially, as it interferes with other eſſential applications, the body muſt be [9]gradually brought to a proper heat, by placing it on a warm bed, or mattreſs, and by the uſe of general frictions with warm cloaths(e). The frictions, however, ſhould be at firſt moderate, and perform⯑ed only with a view to reſtore heat, and not force the blood to⯑wards the heart, which in drowned perſons is generally found too much diſtended (9.10.).
16. If the body has been taken out of the water in froſty weather, eſpecially if it has been afterwards long expoſed to the air, the heat, at firſt, ſhould be applied in a very low degree; and if the thermometer be under the freezing point, and the body, when ſtripped, feel cold, and nearly in a condition with thoſe that are frozen; it will, at firſt, be indiſpenſably neceſſary to make uſe of frictions with ſnow, or cold applications, as heat, in ſuch ca⯑ſes, has been found pernicious. In a little time, however, heat muſt be gradually employed.
17. Upon the whole, great care and nicety ought to be ob⯑ſerved in the application of heat, which, in every caſe, ought to be proportioned to the powers of life. This is well elucidated by Mr Hunter in the following quotation:—"From obſervation and experiments, it appears to be a law of nature, in animal bodies, that the degree of external heat ſhould bear a proportion to the quantity of life; as it is weakened, this proportion requires great accuracy in the adjuſtment, while greater powers of life allow it greater latitudes. I was led to make theſe obſervations, by at⯑tending to perſons who are froſt-bitten; the effect of cold in this caſe, being that of leſſening the living principle. Heat muſt, at firſt, be gradually applied, and proportioned to the quantity of the living principle; but as that encreaſes, you may encreaſe the degree of heat. If this method is not obſerved, and too great a degree of heat is at firſt applied, the perſon or part loſes entirely the living principle, and mortification enſues. This proceſs invariably takes place with regard to men"(f).
18. Altho' the recovery of drowned perſons depends almoſt entirely upon the methods recommended (13.15.16.); yet when the body is in a condition to be acted upon, cordial and invigo⯑rating medicines, ſuch as throwing brandy and water into the ſtomach and inteſtines, pepper-mint water, aether, or ſpirit of hartſhorn, diluted with water, may prove uſeful auxiliaries(g). But the ſame moderation in their uſe muſt be obſerved, as has been recommended in the application of heat.
19. The means for recovering the motion of the lungs, and animal heat, ſhould often be continued for ſeveral hours; for it [10]appears from the reports of the Humane Society, that, in a very great number of caſes, one, two, and even four hours, were per⯑ſeveringly employed before the firſt ſigns of life appeared(h).
20. Electricity being the moſt powerful of all ſtimulants, it has been recommended by ſeveral ingenious authors(i), and, according to the reports of the Humane Society, has been found ſerviceable in drowning; it ought, therefore, to be tried, when the heart cannot be brought to act by the means mentioned (14.). Shocks, therefore, may be tranſmitted thro' the heart, the head, and the ſpinal marrow; but they ought neither to be employed ſo gently as to produce no effect, nor ſo violently as to do miſ⯑chief.
21. The SOCIETY being of opinion, that bleeding can be ſeldom employed as the means of recovery, refrain from recommending it in the beginning; but when life returns, and the pulſe will bear ſuch an evacuation, it will frequently become indiſpenſably requifite to remove determinations to the head, and to the lungs; which often take place from an irregular diſtribution of the blood to theſe organs.
22. As the remarks, which have been already offered, will ap⯑ply, with a few exceptions, to other caſes of ſuffocation, the SO⯑CIETY ſhall briefly diſcuſs the remaining part of the ſubject.
23. In hanging, the external veſſels, bringing back the blood from the head, are immediately compreſſed, while the blood is ſtill carried on in the internal arteries. The windpipe is ſoon after ſhut by the cord, the ingreſs of air prevented; in conſe⯑quence of this, the face becomes red and livid, and the perſon or animal is ſpeedily carried off by ſuffocation.
24. On diſſection, the blood veſſels of the brain, in ſeveral ani⯑mals that were ſtrangled, appeared turgid with blood, but no o⯑ther diſeaſe was obſerved within the ſkull. The lungs were, in general, quite collapſed, free from frothy fluid, and in every re⯑ſpect ſound. The heart and large adjoining veſſels exhibited ex⯑actly the ſame appearances as in drowned animals (8.9.10.).
25. From this view (23.24.) it would appear, that, together with bleeding from the jugular veins, or cupping in the neck, the other methods of treatment ought to be the ſame as recommend⯑ed for the recovery of drowned perſons.
26. Noxious vapours ariſe from various ſources; from fermen⯑ting liquors, from the fumes of charcoal, of burning quick lime, and of metals during their calcination; from opening vaults, draw-wells, wells of ſhips, and ditches long ſhut up; from the damps in mines, &c.
27. In the coal-pits of this neighbourhood, there frequently ariſe two kinds of noxious air. The firſt, uſually termed the choke-damp, is a natural fixed air, which being ſpecifically heavier than atmoſpheric air, occupies the bottom of the mine. The other is called the fire-damp, which is a natural inflammable air, and being ten times lighter than common air, occupies the top of the mine.
28. From ſome experiments, which would be tedious to re⯑late, it appears that theſe vapours (26.) occaſion a ſuſpenſion of the vital motions, and death, by entering the lungs; and, ex⯑cluding the atmoſpheric air, and in other reſpects (if the fire-damp be excepted) when it takes flame(k), no farther injury is done to the body.
29. The bodies of animals, ſuffocated in theſe vapours, exhi⯑bit the following appearances:—The limbs remain flexible for a long time; the eyes retain their luſtre; the temperature of the body, and even a heat higher than the healthy ſtandard, in ſome inſtances, continue ſeveral hours after death. This is particu⯑larly the caſe with animals ſuffocated in the ſteams of charcoal; and in them the blood remains fluid, and even highly florid. In animals ſuffocated in fixed, and in inflammable air, altho' the limbs continue flexible, the blood was not florid. The veſſels of the brain were found turgid in animals ſuffocated in theſe va⯑pours; the lungs were ſound; the heart and adjoining veſſels were equally turgid as in thoſe which were drowned or hanged.
30. The moſt effectual means of recovering the vital actions, when ſuſpended by noxious vapours, conſiſt in inflating the lungs as ſoon as the body is removed to the open air; in ſprinkling the face, and, when the heat is above the ſtandard of health, even the whole body, with cold water. In perſons ſuffocated by the fumes of charcoal, advantages have ariſen from rubbing the body with ſnow. But here the heat ſhould be only diminiſhed in pro⯑portion to the powers of life; and, therefore, if the body become cold, equal advantage will accrue from the gradual application of warmth. The ſtate of the veſſels of the brain (29.) would ſeem to require bleeding; and accordingly it has been recommend⯑ed(l). [12]Blood may therefore be taken from the jugular veins, or from the neck (25). In all other reſpects, the methods of treatment will be the ſame as in thoſe who are drowned.
31. Children, from inattention or other cauſes, are frequent⯑ly ſmothered in beds. When not overlaid, the functions of life are ſolely ſuſpended by breathing confined air. From experi⯑ments upon brutes, it appears that, in this caſe, the lungs are collapſed, and, except the accumulation of blood in the heart, and large veſſels in the neighbourhood, no injury is done to the reſt of the ſyſtem. If the means of recovery, therefore, be not too long delayed after the lungs and heart have ceaſed to act, there will be great hopes of reſtoring the patient. If the body be too hot, as is commonly the caſe, it ſhould be expoſed, at firſt, to a current of air. The lungs ſhould be immediately in⯑flated; and, afterwards, in every other reſpect, it ſhould be treated conformably to what has been recommended in ſuffoca⯑tion from drowning.
32. In ſuch ſtill-born children as come into the world, in other reſpects, with a healthy appearance, great hopes may be enter⯑tained from inflating the lungs, if too much time have not been loſt. But this proceſs ought to be continued aſſiduouſly for ſome hours, by blowing air thro' a quill, or any ſmall tube inſerted into the mouth. The temperature of the body ſhould at the ſame time be kept up by a due degree of warmth; and the blood propelled from the ſurface to the heart by proper frictions.
CONTAINING RULES to be obſerved by the SPECTATORS in endeavour⯑ing to recover perſons apparently dead by drowning.
33. As ſoon as the body is taken out of the water, a perſon muſt inflate the lungs of the patient, by blowing into the mouth, or, (which is better) into one noſtril, thro' a wooden pipe(m), a roll of cap-paper, or any thing elſe that will effectually convey the breath up the noſtril; whilſt the other noſtril, together with the mouth, is cloſely ſhut, that no air may paſs otherwiſe than by the pipe. At the time of blowing thro' the pipe, another perſon, in order to prevent the air getting into the ſtomach, muſt [13]gently preſs the projecting part of the windpipe backwards. When the lungs are filled, the perſon muſt remove his hand from the mouth, and preſs the belly and breaſt, ſo as to let the air paſs out. When by theſe means the lungs have emptied themſelves, the blowing thro' the pipe is to be repeated in the ſame manner, ſo that natural breathing, as far as poſſible, may be imitated. If the lungs cannot be, by theſe means, diſtended, it moſt pro⯑bably will proceed from ſome ſtoppage about the opening into the windpipe, which will in all likelihood be removed by pulling the tongue forwards.
33. At the ſame time that air is blowing into the lungs, other by-ſtanders ſhould be employed in ſtripping off all the wet cloaths, and in rubbing the body dry with flannel, or ſuch cloths as can be procured. The body ſhould then be wrapt in a warm blanket, or in the ſpare garments of any of the ſpectators.
34. If, upon a ſhort trial, theſe methods do not ſucceed in re⯑ſtoring the breathing, the body ought to be immediately carried to the neareſt Receiving-houſe, or, if it be at any diſtance, to the neareſt building. In removing the body, great care ſhould be taken to keep it in an eaſy poſture, with the head and ſhoulders a little raiſed. It will be beſt conveyed in the arms of two per⯑ſons, while a third takes care that the neck be not too much bent forwards, or to one ſide. If the body be taken out at a conſi⯑derable diſtance from any houſe, it ſhould be laid in a cart upon ſtraw, on one ſide, with the head and upper parts raiſed; and, in this poſition, a briſk motion will do no harm.
35. The body being now conveyed to a houſe, it ſhould be placed upon a warm bed or mattreſs, and covered with a warm blanket. The head and cheſt ſhould be conſiderably raiſed, but not ſo much as to ſlide down, in which poſition the body ſhould be kept during the whole of the future attempts of recovery. It will now be again indiſpenſably neceſſary to renew the endea⯑vours to reſtore life, by blowing air into the lungs, as directed in Rule I; and by reſtoring a moderate degree of heat, by gently rubbing the body with warm flannels, or other warm cloths; and by applying bottles full of warm water, wrapped up in flan⯑nel, to the feet.
36. The means of cure recommended in Rule I. and II. and more particularly mentioned in the end of Rule IV. muſt be con⯑tinued for a long time: Perſeverance is abſolutely neceſſary; and it is often only after two, three, or four hours of uninterrupt⯑ed labour, that the firſt ſigns of life appear.
[14]37. Altho' the above methods of cure ought to be immedi⯑ately begun by any of the by-ſtanders of diſcernment, and have been often attended with the happieſt effect; yet, as the appli⯑cation of the means requires ſkill and dexterity, and as it is fre⯑quently abſolutely neceſſary to employ inſtruments to inflate the lungs; one or two of the MEDICAL ASSISTANTS ſhould be called in without delay. The loſs of every moment, or the miſappli⯑cation of the means, is attended with the utmoſt danger to the unfortunate object, who is approaching nearer and nearer to a ſtate from which he cannot recover.
CONTAINING A Deſcription of a Pocket CASE of INSTRUMENTS for the Recovery of Perſons apparently dead, with the Methods of USING them.
38. Many ingenious inſtruments have been recommended by authors, and adopted by different eſtabliſhments in their endea⯑vours to recover the apparently dead; but the MEDICAL SOCI⯑ETY have preferred the improvements lately made upon them by Mr SAVIGNY of London, both on account of the utility of the inſtruments, and their being contained in a caſe, which is ex⯑tremely portable. Some management, however, is required to adjuſt the inſtruments to the different purpoſes; but a careful inſpection of their component parts(n), and attention to the following directions, will render their application eaſy.
39. When air from the lungs of a healthy perſon is to be uſed, the ivory mouth-piece is to be ſcrewed on one end of the flexible tube of red leather, and the ivory nozle upon its other ex⯑tremity, by which means, a blow-pipe is compleatly formed; which is to be inſerted into the noſtril; and to be managed in the ſame manner as the wooden pipe (33.). But as atmoſpheric air(o) ſhould be, in moſt caſes, preferred for inflating the lungs properly, the following adjuſtment of the inſtrument will be required: The conical part of the hollow ſcrew, by means of the braſs winch, is to be firmly ſcrewed into the muzzle of any common pair of bellows (p): The ivory mouth-piece of the flexi⯑ble [15]tube, is then to be removed, and the other end of the conical ſcrew to be fitted in its place. The inſtrument being thus com⯑pleted, "a proper perſon, ſtationed at the head of the body, is to paſs the tube into the noſtril, and ſuſtaining it there with the fore-finge, he is to compreſs the other noſtril with his thumb, and the mouth with the remainder of the ſame hand, that no air may paſs out. With the other hand, he is to make a ſuitable preſſure upon the prominent part of the windpipe, to pre⯑vent air paſſing into the ſtomach. The medical director is then to work the bellows, which ought, at one play, to throw in a ſufficient quantity of air to fill the lungs. When they are pro⯑perly diſtended, the hand ſhould be removed from the mouth, and the lungs are to be aſſiſted in emptying themſelves by com⯑preſſing the belly and cheſt. The ſame proceſs is to be repeated for ſome time, that, as far as poſſible, the manner of natural reſ⯑piration may be imitated." If the air do not paſs into the lungs ſo as to diſtend them compleatly, it probably ariſes from the a⯑perture of the windpipe being ſhut, which may generally be re⯑medied by bringing the tongue forwards.
40. But if farther impediments occur to the inflation of the lungs, the ivory nozle (39) muſt be removed, and the ſilver in⯑ſtrument in the form of a catheter ſcrewed on the tube of red lea⯑ther, in its place. The inſtrument being thus completed, "the medical director ſhould place himſelf on the right ſide of the pa⯑tient; and introducing the fore-finger of his left hand, at the corner of the patient's mouth, he ſhould puſh the point of it be⯑hind the epiglottis, and uſing this finger as a directory, he muſt enter the tube, with the other hand, at the left corner of the mouth, till the end of the inſtrument has paſt beyond the point of his fore-finger; and the inſtrument is then to be ſuffered to fall rather than to be puſhed into the glottis." The bellows are then to be worked as in the former proceſs (39).
41. If the methods propoſed (39.40.), fail of inflating the lungs, an opening into the wind-pipe may be made; and cer⯑tainly ought to be tried as a laſt reſource. The ſilver inſtru⯑ment ſhould be introduced into the opening, fitted with the bellows, and to be worked in the ſame manner as recommended (40.); by which means air will be certainly thrown into the lungs.
42. The next inſtrument recommended is the elaſtic tube of black leather, for conveying medicines into the ſtomach. The ſmall end muſt be carefully introduced down the gullet, into the ſtomach; and any liquid cordial, ſuch as ſpirits, aether, volatile liquor of hartſhorn, or oil of peppermint, properly diluted with water, muſt be poured in ſmall quantities into the other end of the tube; and if the liquor do not deſcend readily, blowing upon it will make it paſs into the ſtomach.
43. The next inſtrument is a large bladder, which may inſtant⯑ly [16]be connected with a proper pipe, contained in a diviſion of the caſe. A clyſter prepared with brandy, gin, or the oil of pep⯑permint, largely diluted with warm water, muſt be injected.
44. Altho', from the ſympathy which ſubſiſts betwixt the ſtomach and whole ſyſtem, and the irritability remaining long in the inteſtines, much benefit may ariſe from the proceſſes (42.43.) as auxiliaries; yet no means, unleſs for a very ſhort ſpace, muſt interfere with the more important articles of inflating the lungs, and reſtoring animal heat.
45. The laſt inſtrument(q) is a thermometer upon Mr HUN⯑TER'S principles, which is extremely well calculated for aſcertain⯑ing the natural heat remaining in the body; and for regulating the application of artificial heat. The freezing point is marked on the ſtem by a ſcratch on the glaſs, and the diviſions upon an ivory ſcale embracing the glaſs; are eaſily ſeen thro' the ſtem.—By applying this inſtrument to the body, and finding the temperature conſiderably below 98o, artificial heat ſhould be gradually applied till it be uniformly heated to 98o, or 100o. But if the external parts of the body be ſo chilled, that the ther⯑mometer ſinks below 32o, cold applications will be at firſt ne⯑ceſſary; and in this caſe the heat ſhould be afterwards increaſed ſlowly and gradually.—The inſtrument may likewiſe be eaſily introduced into any cavity, ſo as to aſcertain the degree of internal heat; which remains, in general, for ſome hours after the external ſurface is cold. Therefore, if it be puſhed three or four inches up the rectum, the preſence or abſence of life may be aſcer⯑tained by the riſe or fall of Mercury in the tube.
46. In compoſing the preceding pages, many authors have been conſulted; but the SOCIETY cannot conclude without ex⯑preſſing their great obligations to the following: Dr CULLEN, Dr MONRO, Dr HAWES, Mr HUNTER, Monſ. PORTAL, Dr GOODWIN, and Mr KITE; the two laſt of whom received the Prize Medals of the HUMANE SOCIETY, for the beſt original eſſays on ſuſpended animation.