signifies the extinction of life by a total immersion in water.

In some respects, there seems to be a great similarity between the death occasioned by immersion in water, and that by strangulation, suffocation by fixed air, apoplectics, epilepsies, sudden faintings, violent shocks of electricity, or even violent falls and bruises. Physicians, however, are not agreed with regard to the nature of the injury done to the animal system in any or all of these accidents. It is indeed certain, that in all the cases above mentioned, particularly in drowning, there is very often such a suspension of the vital powers as to us hath the appearance of a total extinction of them; while yet they may be again set in motion, and the person restored to life, after a much longer submersion than hath been generally thought capable of producing absolute death. It were to be wished, however, that, as it is now universally allowed, that drowning is only a suspension of the action of the vital powers, physicians could as unanimously determine the means by which these powers are suspended; because on a knowledge of these means, the methods to be used for recovering drowned persons must certainly depend.

Dr de Haen, who has written a treatise on this subject, ascribes this diversity of opinion among the physicians to their being so ready to draw general conclusions from a few experiments. Some, having never found water in the lungs, have thought that it never was there; and others, from its presence, have drawn a contrary conclusion. Some have ascribed the death which happens in cases of drowning to that species of apoplecty which arises from a great fulness of the stomach. But this opinion our author rejects, because in 13 dogs which he had drowned and afterwards dissected, no signs of such a fulness appeared. Another reason is drawn from the want of the common marks of Drowning of apoplexy on the dissection of the brain, and from the actual presence of water in the lungs. He is of opinion, that the death of drowned persons happens in consequence of water getting into the lungs; and stopping the blood in the arteries. He then discusses the question how far the blowing of air into the lungs is useful in recovering drowned people. If their death is to be ascribed to the water entering their lungs, this practice, he observes, must be hurtful, as it will increase the pressure on the blood-vessels, or may even force the water into them; which, on the authority of Lewis's experiments, he alleges is possible. But, in spite of this reasoning, he affirms, that from experience it has been found useful. He allows, that the practice of suspending drowned people by the feet must be hurtful, by determining the blood too much to the head; but he observes, that remedies in some respects hurtful may be used when the advantages derived from them preponderate; and is of opinion, that the practice above mentioned may be used by agitating the viscera against each other, and thus renewing their motions. Cutting the larynx in order to admit air more freely to the lungs, he reckons to be of little or no use; but acknowledges, however, that it may sometimes prove beneficial on account of the irritation occasioned by the operation.

Dr Cullen, in his letter to Lord Cathcart concerning the recovery of persons drowned and seemingly dead, tells us, that "From the dissection of drowned men, and other animals, it is known, that very often the water does not enter into the cavity of the lungs, nor even into the stomach, in any quantity to do hurt to the system; and, in general, it is known, that, in most cases, no hurt is done to the organization of the vital parts. It is therefore probable, that the death which ensues, or seems to ensue, in drowned persons, is owing to the stopping of respiration, and to the ceasing, in consequence, of the circulation of the blood, whereby the body loses its heat, and, with that, the activity of the vital principle."

In the Phil. Trans. vol. lxvi. Mr Hunter gives the following theory. The loss of motion in drowning seems to arise from the loss of respiration; and the immediate effect this has upon the other vital motions of the animal, at least this privation of breathing, appears to be the first cause of the heart's motion ceasing. It is most probable, therefore, Mr Hunter observes, that the restoration of breathing is all that is necessary to restore the heart's motion; for if a sufficiency of life still remains to produce that effect, we may suppose every part equally ready to move the very instant in which the action of the heart takes place, their actions depending so much upon it. What makes it very probable, that the principal effect depends upon throwing air into the lungs, is, that children in the birth, when too much time has been spent after the loss of that life which is peculiar to the foetus, lose altogether the disposition for the new life. In such cases there is a total suspension of the actions of life; the child remains to all appearance dead; and would die, if air was not thrown into its lungs, and the first principle of action by that means restored. To put this in a clearer light, Mr Hunter gives the result of some experiments made on a dog in 1755.—A pair of double bellows were provided, which were so constructed, that by one action air was thrown into the lungs, and by the other the air was sucked out which had been thrown in by the former, without mixing them together. The muzzle of these bellows was fixed into the trachea of a dog, and by working them he was kept perfectly alive. While this artificial breathing was going on, the sternum was taken off, so that the heart and lungs were exposed to view. The heart then continued to act as before, only the frequency of its action was greatly increased. Mr Hunter then stopped the motion of the bellows; and observed that the contraction of the heart became gradually weaker and less frequent, till it left off moving altogether; but by renewing the operation, the motion of the heart also revived, and soon became as strong and frequent as before. This process was repeated upon the same dog ten times; sometimes stopping for five, eight, or ten minutes. Mr Hunter observed, that every time he left off working the bellows, the heart became extremely turgid with blood, and the blood in the left side became as dark as that in the right, which was not the case when the bellows were working. These situations of the animal, he observes, seem to be exactly similar to drowning.

Dr Edmund Goodwyn, in a treatise lately published on this subject, has endeavoured to ascertain the effects of submersion upon living animals in a more accurate manner than had hitherto been done. His first care was to determine the symptoms which took place before death; and to observe these, he procured a large glass bell in which the animals were to be immersed. Having inverted, and filled this with water, he put into it several cats, dogs, rabbits, and smaller animals, confining them among the water till they were apparently dead. In these experiments he observed, that immediately after submersion the pulse became weak and frequent; there was an apparent anxiety about the breath, and struggling to relieve it. In these struggles the animal rose to the top of the water, throwing out a quantity of air from the lungs. After this the anxiety increases, the pulse becomes weaker, and the struggles more violent; he rises again to the surface, throws out more air from the lungs, and in his efforts to inspire, a quantity of water commonly passes into the mouth. The skin about the face and lips then becomes blue, the pulse ceases, the sphincters are relaxed, and the animal falls down without sense or motion. On dissecting the bodies of drowned animals, our author met with the following appearances: 1. The external surface of the brain was darker, but the vessels of it were not more turgid than usual, nor was there any appearance of extravasation. 2. The pulmonary arteries and veins were filled with black blood, and the lungs themselves contained some frothy liquor. 3. Notwithstanding these symptoms, the right auricle and ventricle were still contracting and dilating; the left sinus venosus and auricle moving feebly, but the left ventricle at rest. 4. The right and left auricles of the heart, the right ventricle, and the left sinus venosus, were filled with black blood; but the last ventricle only half filled with the same, and a quantity of the same black blood was also contained in the smaller branches of the arteries proceeding from the left ventricle.

This investigation was followed by a most careful DRO

DRO

drowning, and ingenious inquiry concerning the causes of the symptoms already related. To find out whether or not the entrance of water into the lungs was the cause, or whether water really entered the lungs in these cases or not, he drowned several animals among ink; and by inspecting their bodies, found, that though water really did enter, it was in such small quantity that it could not be supposed capable of producing such violent effects. To ascertain this, however, more exactly than could be done by the ink, he drowned other animals in quicksilver; which, by reason of its not being miscible with the animal fluids, could be more accurately collected. By these it appeared that no more than five drachms of the fluid in which a cat was immersed entered her lungs in the time of drowning; and to determine whether or not this could be the occasion of the animal's death, he made the following experiment: Having confined a cat in an erect posture, he made a small opening in the trachea, by cutting one of the cartilaginous rings; and through this opening he introduced two ounces of water into the lungs. The only consequences were a difficulty of breathing and weak pulse; but these soon abated, and it lived several hours afterwards without any apparent inconvenience. On strangling it he found two ounces and a half of water in the lungs. On repeating the experiment with other fluids, he found the difficulty of breathing and alteration in the pulse somewhat greater; but in these instances also they abated in a few hours; and when the animals were strangulated, the lungs were found to contain four ounces of fluid.

From all these experiments Dr Goodwyn draws the following conclusions: 1. "A small quantity of fluid usually passes into the lungs in drowning. 2. This water enters the lungs during the efforts to inspire; and mixing with the pulmonary mucus, occasions the frothy appearance mentioned by authors. 3. The whole of this fluid in the lungs is not sufficient to produce the changes that take place in drowning. And hence it follows, that the water produces all the changes that take place in drowning indirectly, by excluding the atmospheric air from the lungs." This naturally leads to an investigation of the uses of respiration, and the effects of the air upon the blood and lungs in that action, which our author traces with great accuracy and very convincing experiments. He begins with attempting to determine the quantity of air drawn in at each inspiration, with the proportional quantity left after expiration. The experiments by which he endeavoured to ascertain these quantities seem to be more uncertain than the others, as indeed there are not data sufficient for them. From such as he had an opportunity of making, however, the following conclusions were deduced: 1. "The lungs contain 109 cubic inches of air after a complete expiration; and this quantity receives an additional quantity of 14 cubic inches during each inspiration. 2. The dilatation of the lungs after expiration is to their dilatation after inspiration as 109 to 123. 3. The blood circulates through the pulmonary vessels in all the degrees of natural respiration. 4. The circulation through them, after expiration, is sufficiently free to keep up the health of the system."

The last part of our author's inquiry, viz. concerning the chemical changes produced in the air by respiration, and the effects of the air upon the blood itself falls naturally to be considered under the article Respiration: so that here we shall only observe in general, that his experiments evidently show that the disease produced by drowning arises entirely from the exclusion of the atmospheric air or its dephlogisticated part; for which reason he recommends inflating the lungs with that kind of air in preference to any other.

From these different views of this matter, physicians have differed considerably in their account of the methods to be followed in attempting the recovery of drowned persons. De Haen recommends agitation of all kinds; every kind of stimulus applied to the mouth, nose, and rectum; bleeding; heat, both by warm clothes and warm water; blowing air into the trachea; stimulants, such as blisters, warm ashes, &c. applied to the head, ankles, thighs, pit of the stomach, and other parts.

Doctor Cullen's observations on this subject are as follow.—"With respect to the particular means to be employed for the recovery of drowned persons, it is to be observed, in the first place, That such as were recommended and practised, upon a supposition that the suffocation was occasioned by the quantity of water taken into the body, and therefore to be evacuated again, were very unhappily advised. The hanging up of persons by the heels, or setting them upon the crown of the head, or rolling the body upon a cask, were generally practised, upon a supposition altogether false; or upon the supposition of a cafe, which, if real, is apprehended to be irrecoverable. At the same time, these practices were always attended with the danger of bursting some vessels in the brain or lungs, and of rendering thereby some cases incurable that were not so from the drowning alone. All such practices, therefore, are now very properly disapproved of and forbidden.

"In those cases in which the body has not been long in the water, and in which therefore the natural heat is not entirely extinguished, nor the irritability of the moving fibres very greatly impaired, it is possible that a good deal of agitation of the body may be the only means necessary to restore the action of the vital organs; but in other cases, where the heat and irritability have ceased to a greater degree, it is to me very doubtful if much agitation can be safe, and if any degree of it can be useful, till the heat and irritability are in some measure restored. In all cases, any violent concussion cannot be safe, and, I believe, is never necessary. It may be proper here to observe also, that in transporting the body from the place where it is taken out of the water, to the place where it may be necessary for applying the proper means of its recovery, all postures exposing to any improper compression, as that of the body's being carried over a man's shoulder, are to be avoided. The body is to be kept stretched out, with the head and upper parts a little raised; and care is to be taken to avoid the neck's being bent much forward. In this manner, laid upon one side, and upon some straw in a cart, it may be most properly conveyed; and the agitation which a pretty brisk motion of the cart may occasion, will, in most cases, do no harm.

"From the account I have given above of the cau- Drowning, ses, or of the appearances, of death in drowned persons, it is evident, that the first step to be taken for their recovery is to restore the heat of the body, which is absolutely necessary to the activity of the moving fibres. For this purpose, the body, as soon as possible, is to be stripped of its wet clothes, to be well dried, and to be wrapped up in dry, and (if possible) warm, coverings: and it is to be wilhed, in all cases, as soon as the report of a person's being drowned is heard, that blankets should be immediately carried to the water side; so that as soon as the body is got out of the water, the change of covering just now mentioned may be instantly made; or, if the body has been naked when drowned, that it may be immediately dried and defended against the cold of the air. Besides covering the body with blankets, it will be further of advantage, if it can be done without loss of time, to cover the drowned body with a warm shirt or waistcoat immediately taken from a living person.

"When, at the time of a person's being drowned, it happens that the sun shines out very hot, I think there can be no better means of recovering the heat, than by exposing the naked body, in every part, to the heat of the sun; while, at the same time, all other means necessary or useful for the recovery of life are also employed.

"When the heat of the sun cannot be employed, the body should be immediately transported to the nearest house that can be got convenient for the purpose: the fittest will be one that has got a tolerably large chamber, in which a fire is ready, or can be made; and, if possible, the house should afford another chamber, in which also a fire can be provided.

"When the drowned body is brought into such house, and care is at the same time taken that no more people are admitted than are absolutely necessary to the service of the drowned person, every endeavour must be immediately employed for recovering the heat of the body, and that by different measures, as circumstances shall direct.

"If, in the neighbourhood of the place, there be any brewery, distillery, dyery, or fabric which gives an opportunity of immediately obtaining a quantity of warm water and a convenient vessel, there is nothing more proper than immersing the body in a warm bath. Even where a sufficient quantity of warm water cannot be had at once, the bath may be still practised, if the accident has happened in or very near a town or village, where a great many fires may be at once employed in heating small quantities of water: for in this way the necessary quantity may be soon obtained. To encourage this practice, it is to be observed, that one part of boiling water is more than sufficient to give the necessary heat to two parts of spring or sea water, as it is not proper to apply the bath at first very warm, nor even of the ordinary heat of the human body, but somewhat under it; and, by the addition of warm water, to bring it gradually to a heat very little above it.

"If the drowned body be of no great bulk, it may be conveniently warmed by a person's lying down in bed with it, and taking it near to their naked body, changing the position of it frequently, and at the same time chafing and rubbing with warm cloths the parts which are not immediately applied to their warm body.

"If none of these measures can be conveniently practised, the body is to be laid upon a bed before a moderate fire, and frequently turned, to expose the different parts of it; and thus, by the heat of the fire gradually employed, and by rubbing the body well with coarse towels, or other cloths well warmed, pains are to be taken for restoring its heat. This will be promoted by warm cloths applied and frequently renewed under the hams and armpits; and by hot bricks, or bottles of warm water, laid to the feet.

"In the practice of rubbing, it has been proposed to moisten the cloths applied with camphorated spirits, or other such stimulating substances; but I think this must prove an impediment to the rubbing; and I would not recommend any practice of this kind, except, perhaps, the application of the vinous spirits of sal ammoniac to the wrists and ankles only.

"For recovering the heat of the body, it has been proposed to cover it all over with warm grains, ashes, sand, or salt; and where these, sufficiently warm, are ready at hand, they may be employed; but it is very seldom they can be obtained, and the application might often interfere with other measures that may be necessary. All therefore that I can propose with respect to the use of these, is to observe, that bags of warm and dry salt may be amongst the most convenient applications to the feet and hands of drowned persons; and the quantity necessary for this purpose may be got pretty quickly by heating the salt in a frying pan over a common fire.

"While these measures are taking for recovering the heat, means are at the same time to be employed for restoring the action of the moving fibres. It is well known, that the intestines are the parts of the body which, both from their internal situation and peculiar constitution, retain the longest their irritability; and therefore, that, in drowned persons, stimulants applied may have more effect upon the intestines than upon other parts. The action, therefore, of the intestines is to be supported or renewed as soon as possible; as the restoring and supporting the action of such a considerable portion of moving fibres as those of the intestines, must contribute greatly to restore the activity of the whole system.

"For exciting the action of the intestines, the most proper mean is, the application of their ordinary stimulus of dilatation; and this is most effectually applied, by forcing a quantity of the air into them by the fundament. Even the throwing in cold air has been found useful; but it will certainly be better if heated air can be employed: and further, if that air can be impregnated with something which, by its acrimony also may be powerful in stimulating the intestines.

"From all these considerations, the smoke of burning tobacco has been most commonly applied, and has upon many occasions proved very effectual. This will be most properly thrown in by a particular apparatus, which, for other purposes as well as this, should be in the hands of every surgeon; or at least should, at the public expence, be at hand in every part of the country where drownings are likely to happen. With regard to the use of it, I have to observe, that till owning, the tobacco is kindled in a considerable quantity, a great deal of cold air is blown through the box and tube; and as that, as hinted above, is not so proper, care should be taken to have the tobacco very well kindled, and to blow through it very gently, till the heated smoke only passes through. If upon certain occasions, the apparatus referred to should not be at hand, the measure however may be executed by a common tobacco pipe, in the following manner: A common glyster pipe, that has a bag mounted upon it, is to be introduced into the fundament, and the mouth of the bag is to be applied round the small end of a tobacco pipe. In the bowl of this, tobacco is to be kindled; and, either by a playing card made into a tube and applied round the mouth of the bowl, or by applying upon this the bowl of another pipe that is empty, and blowing through it, the smoke may be thus forced into the intestines, and, in a little time, in a considerable quantity.

"If none of these means for throwing in the smoke can be employed, it may be useful to inject warm water to the quantity of three or four English pints. This may be done by a common glyster bag and pipe, but better by a large syringe; and it may be useful to dissolve in the water some common salt, in the proportion of half an ounce to an English pint; and also to add to it some wine or brandy.

"While these measures for recovering the heat of the body and activity of the moving fibres are employed, and especially after they have been employed for some time, pains are to be taken to complete and finish the business, by restoring the action of the lungs and heart.

"On this subject, I am obliged to my learned and ingenious colleague, Dr Monro, who has made some experiments for ascertaining the best manner of inflating the lungs of drowned persons. By these experiments he finds it may be more conveniently done by blowing into one of the nostrils, than by blowing into the mouth. For blowing into the nostril, it is necessary to be provided with a wooden pipe, fitted at one extremity for filling the nostril, and at the other for being blown into a person's mouth, or for receiving the pipe of a pair of bellows, to be employed for the same purpose. Doctor Monro finds, that a person of ordinary strength can blow into such a pipe, with a sufficient force to inflate the lungs to a considerable degree; and thinks the warm air from the lungs of a living person will be most conveniently employed at first; but when it is not soon effectual in restoring the respiration of the drowned person, and that a longer continuance of the inflation is necessary, it may be proper to employ a pair of bellows, large enough at once to contain the quantity of air necessary to inflate the lungs to a due degree.

"Whether the blowing in is done by a person's mouth, or by bellows, Dr Monro observes, that the air is ready to pass by the gullet into the stomach; but that this may be prevented, by pressing the lower part of the larynx backwards upon the gullet. To persons of a little knowledge in anatomy, it is to be observed, that the pressure should be only upon the cricoid cartilage, by which the gullet may be straightened, while the passage through the larynx is not interrupted.

"When, by blowing thus into the nostrils, it can be perceived, by the raising of the chest or belly, that the lungs are filled with air, the blowing in should cease; and by pressing the breast and belly, the air received into the lungs should be again expelled; then the blowing and expulsion should be again repeated; and thus the practice is to be continued, so as to imitate, as exactly as possible, the alternate motions of natural respiration.

"It is hardly necessary to observe, that when the blowing into the nostril is practised, the other nostril and the mouth should be accurately closed.

"If it should happen, that in this practice the air does not seem to pass readily into the lungs, Dr Monro informs me it is very practicable to introduce directly into the glottis and trachea a crooked tube, such as the catheter used for a male adult. For this he offers the following directions: The surgeon should place himself on the right side of the patient; and, introducing the fore finger of his left hand at the right corner of the patient's mouth, he should push the point of it behind the epiglottis; and using this as a directory, he may enter the catheter, which he holds in his right hand, at the left corner of the patient's mouth, till the end of it is passed beyond the point of his fore finger; and it is then to be let fall, rather than pushed into the glottis; and through this tube, by a proper syringe applied to it, air may be with certainty blown into the lungs. I observe, that some such measure had been proposed by Mons. le Cat in France; but I have not learned that it has ever been put in practice, and I am afraid it may be attended with several difficulties, and must be left to the discretion of surgeons who may be properly provided and instructed for this purpose.

"For throwing air with more certainty into the lungs, it has been proposed to open the windpipe in the same manner as is done in the operation which the surgeons call bronchotomy, and by this opening to blow into the lungs; and when the blowing into the nostril does not seem to succeed, and a skillful operator is at hand, I allow that the measure may be tried; but I can hardly suppose that it will be of any advantage when the blowing in by the nostril has entirely failed.

"It is to be hoped, that by blowing into the lungs one way or other, even a quantity of water which had been taken into the lungs may be again washed out; and the fame seems to be the only effectual means of washing out that frothy matter which is found to fill the lungs of drowned persons, and which proves, if I mistake not, the most common cause of their mortal suffocation. This practice, therefore, is to be immediately entered upon, and very assiduously continued for an hour or two together.

"I have now mentioned the measures chiefly to be pursued and depended upon for the recovery of drowned persons; but must still mention some others that may prove considerable helps to it.

"One of these is, the opening the jugular veins, to relieve the congestion which almost constantly occurs in the veins of the head, and is probably a frequent cause of the death of drowned persons. For relieving this congestion, the drawing some blood from the jugulars, very early, may certainly be of service; and it will be particularly indicated by the livid and purple colour Drowning, colour of the face. It may even be repeated, according to the effect it seems to have in taking off that suffusion; but when the drowned person is in some measure recovered, and some motion of the blood is restored, it will be proper to be very cautious in making this evacuation, and at least to take care not to push it so as to weaken too much the recovering, but still weak, powers of life.

"Another measure for recovering the activity of the vital principle, is the application of certain stimulants to the more sensible parts of the body, such as holding the quicklime spirit of sal ammoniac to the nose, or putting a little of it upon a rag into the nostrils. It has been usual to pour some liquids into the mouth; but it is dangerous to pour in any quantity of liquid till it appear that the power of swallowing is in some measure restored.

"When a surgeon is at hand, and is provided with proper apparatus, a crooked pipe may be introduced into the gullet; and by this a gill or two of warm wine may be poured down into the stomach, and probably with advantage. But when no such apparatus is at hand or surgeon to employ it, and the power of swallowing is still doubtful, the trial of pouring liquids into the mouth should be made by a small quantity of warm water alone; and when, from such trial, the power of swallowing shall appear to be recovered, it may then be allowable to favour the further recovery of the person, by pouring in some wine or brandy.—In short, till some marks of the recovery of swallowing and respiration appear, it will not be safe to apply any stimulants to the mouth; excepting that of a few drops of some acrid substance to the tongue, and which are not of bulk enough to slide back upon the glottis: I can think of no stimulant more conveniently and safely to be applied to the mouth and nostrils than a moderate quantity of tobacco smoke blown into them.

"Though I do not imagine that drowned persons are ever hurt by the quantity of water taken into their stomach, yet, as a stimulus applied to the stomach, and particularly as the action of vomiting proves a stimulus to the whole system, I can have no objection to the French practice of throwing in an emetic as soon as any swallowing is restored. For this purpose, I would successively throw in some tea-spoonfuls of the ipecacuanha wine; and when it does not interfere with other necessary measures, the fauces may be gently irritated by an oiled feather thrust into them.

"With regard to the stimulants, I must conclude with observing, That when a body has lain but for a short time in the water, and that therefore its heat and irritability are but little impaired, the application of stimulants alone has been often found effectual for the recovery: but, on the contrary, when the body has lain long in the water, and the heat of it is very much extinguished, the application of any other stimulants than that of tobacco smoke to the intestines can be of very little service; and the application of others ought never to interfere with the measures for recovering heat and the motion of respiration.

"With respect to the whole of these practices, I expect, from the principles upon which they are in general recommended, it will be understood that they are not to be soon discontinued, though their effects do not immediately appear. It is obvious, that, in many cases, it may be long before the heat of the body, and the activity of the vital principle, can be restored, although in a longer time it may very possibly be accomplished. In fact, it has often happened, that though means employed for one hour have not succeeded, the same continued for two or more hours, have at length had the wished-for effects. It should therefore be a constant rule, in this business, that the proper means should be employed for several hours together; unless it happen that, while no symptoms of returning life appear, the symptoms of death shall, at the same time, go on constantly increasing.

"In the whole of the above I have kept in view chiefly the case of drowned persons; but it will be obvious, that many of the measures proposed will be equally proper and applicable in other cases of suffocation; as those from strangling, the damps of mines, the fumes of charcoal, &c.; and a little attention to the difference of circumstances will lead to the measures most proper to be employed."

Mr Hunter, in the before-mentioned paper, differs pretty considerably from De Haen and Dr Cullen. He observes, that when assistance is soon called after immersion, blowing air into the lungs will in some cases effect a recovery; but when any considerable time has been lost, he advises stimulant medicines, such as the vapour of volatile alkali, to be mixed with the air; which may easily be done, by holding spirits of hartborn in a cup under the receiver of the bellows. And, as applications of this kind to the olfactory nerves tend greatly to rouse the living principle, and put the muscles of respiration into action, it may probably, therefore, be most proper to have air impregnated in that manner thrown in by the nose. To prevent the stomach and intestines from being too much diluted by the air so injected, the larynx is directed to be gently pressed against the oesophagus and spine.

While this business is going on, an attendant should prepare bed clothes, carefully brought to a proper degree of heat. Heat our author considers as congenial with the living principle; increasing the necessity of action, it increases action: cold, on the other hand, lessens the necessity, and of course the action is diminished: to a due degree of heat, therefore, the living principle, he thinks, owes its vigour. From experiments, he says, it appears to be a law in animal bodies, that the degree of heat should bear a proportion to the quantity of life; as life is weakened, this proportion requires great accuracy, while greater powers of life allow it greater latitudes.

After these and several other observations on the same subject, our author proceeds to more particular directions for the management of drowned people.

If bed clothes are put over the person, fo as scarce to touch him, steams of volatile alkali, or of warm balsams, may be thrown in, fo as to come in contact with many parts of the body. And it might probably be advantageous, Mr Hunter observes, to have steams of the same kind conveyed into the stomach. This, we are told, may be done by a hollow bougie and a syringe: but the operation should be very speedily performed, formed, as the instrument, by continuing long in the mouth, might produce sickness, which our author says he would always wish to avoid.

Some of the warm stimulating substances, such as juice of horseradish, peppermint water, and spirits of hartshorn, are directed to be thrown into the stomach in a fluid state, as also to be injected by the anus. Motion possibly may be of service; it may at least be tried: but as it hath less effect than any other of the usually prescribed stimuli, it is directed to be the last part of the process.

The same care in the operator, in regulating the proportion of every one of these means, is here directed, as was formerly given for the application of heat. For every one of them, our author observes, may possibly have the same property of destroying entirely the feeble action which they have excited if administered in too great a quantity: instead, therefore, of increasing and hastening the operations on the first signs of returning life being observed, as is usually done, he desires they may be lessened; and advises their increase to be afterwards proportioned, as nearly as possible, to the quantity of powers as they arise.

When the heart begins to move, the application of air to the lungs should be lessened, that, when the muscles of respiration begin to act, a good deal may be left for them to do.

Mr Hunter absolutely forbids bloodletting in all such cases; for as it not only weakens the animal principle, but lessens life itself, it must consequently, he observes, lessen both the powers and dispositions to action. For the same reason, he is against introducing any thing into the stomach that might produce sickness or vomiting; and, on the same principle, he says, we should avoid throwing tobacco fumes, or any other such articles, up by the anus, as might tend to an evacuation that way.

The following is a description of instruments recommended for such operations by our author.

First, A pair of bellows, so contrived, with two separate cavities, that, by opening them when applied to the nostrils or mouth of a patient, one cavity will be filled with common air, and the other with air sucked out from the lungs, and by shutting them again, the common air will be thrown into the lungs, and that sucked out of the lungs discharged into the room. The pipe of these should be flexible; in length a foot, or a foot and a half: and, at least, three eighths of an inch in width. By this the artificial breathing may be continued, while the other operations, the application of the stimuli to the stomach excepted, are going on, which could not be conveniently done if the muzzle of the bellows were introduced into the nose. The end next the nose should be double, and applied to both nostrils.

Secondly, A syringe, with a hollow bougie, or flexible catheter, of sufficient length to go into the stomach, and convey any stimulating matter into it, without affecting the lungs. Thirdly, A pair of small bellows, such as are commonly used in throwing fumes of tobacco up by the anus.

Notwithstanding the differences in theory, however, between the physicians above mentioned, it is certain, that within these few years great numbers of drowned people have been restored to life by a proper use of the remedies we have enumerated, and societies for the recovery of drowned persons have been instituted in different places. The first society of this kind was instituted in Holland, where from the great abundance of canals and inland seas, the inhabitants are particularly exposed to accidents by water. In a very few years 150 persons were saved from death by this society; and many of these had continued upwards of an hour without any signs of life, after they had been taken out of the water. The society was instituted at Amsterdam in 1767: and, by an advertisement, informed the inhabitants of the United Provinces of the methods proper to be used on such occasions; offering rewards at the same time to those who should, with or without success, use those methods for recovering persons drowned and seemingly dead. The laudable and humane example of the Dutch was followed in the year 1768 by the magistrates of health in Milan and Venice; afterwards by the magistrates of Hamburg in the year 1771, by those of Paris in the year 1772, and by the magistrates of London in 1774.

The following directions are given for the recovery of drowned persons by the society at London.

I. As soon as the patient is taken out of the water, the wet clothes, if the person is not naked at the time of the accident, should be taken off with all possible expedition on the spot (unless some convenient house be very near), and a great coat or two, or some blankets if convenient, should be wrapped round the body.

II. The patient is to be thus carefully conveyed in the arms of three or four men, or on a bier, to the nearest public or other house, where a good fire, if in the winter season, and a warm bed, can be made ready for its reception. As the body is conveying to this place, a great attention is to be paid to the position of the head; it must be kept supported in a natural and easy posture, not suffered to hang down.

III. In cold or moist weather, the patient is to be laid on a mattress or bed before the fire, but not too near, or in a moderately heated room; in warm and sultry weather, on a bed only. The body is then to be wrapped as expeditiously as possible with a blanket, and thoroughly dried with warm coarse cloths or flannels.

IV. In summer or sultry weather too much air cannot be admitted. For this reason it will be necessary to set open the windows and doors, as cool refreshing air is of the greatest importance in the process of resuscitation.

V. Not more than fix persons are to be present to apply the proper means; a greater number will be useless, and may retard, or totally prevent, the restoration of life, by rendering the air of the apartment unwholesome. It will be necessary, therefore, to request the absence of those who attend merely from motives of curiosity.

VI. It will be proper for one of the assistants, with a pair of bellows of the common size, applying the pipe a little way above one nostril, to blow with some force, in order to introduce air into the lungs; at the same time the other nostril and the mouth are to be closed by another assistant, whilst a third person gently presses the chest with his hands, after the lungs are observed to be inflated. By pursuing this process, the noxious and stagnant vapours will be expelled, and natural breathing imitated. If the pipe of the bellows be too large, Drowning. the air may be blown in at the mouth, the nostrils at the same time being closed, so that it may not escape that way; but the lungs are more easily filled, and natural breathing better imitated, by blowing up the nostril.

VII. Let the body be gently rubbed with common salt, or with flannels, sprinkled with spirits, as rum or geneva (A). A warming pan heated (the body being surrounded with flannel) may be lightly moved up and down the back. Fomentations of hot brandy are to be applied to the pit of the stomach, loins, &c. and often renewed. Bottles filled with hot water, heated tiles covered with flannel, or hot bricks, may be efficaciously applied to the soles of the feet, palms of the hands, and other parts of the body. The temples may be rubbed with spirits of hartshorn, and the nostrils now and then tickled with a feather; and snuff, or eau de luce, should be occasionally applied.

VIII. Tobacco fumes should be thrown up the fundament: if a fumigator be not at hand, the common pipe may answer the purpose. The operation should be frequently performed, as it is of importance; for the good effects of this process have been experienced in a variety of instances of suspended animation. But should the application of tobacco smoke in this way not be immediately convenient, or other impediments arise, oysters of this herb, or other acid infusions with salt, &c. may be thrown up with advantage.

XI. When these means have been employed a considerable time without success, and any brewhouse or warm bath can be readily obtained, the body should be carefully conveyed to such a place, and remain in the bath, or surrounded with warm grains, for three or four hours.

If a child has been drowned, its body should be wiped perfectly dry, and immediately placed in bed between two healthy persons. The salutary effects of the natural vital warmth, conveyed in this manner, have been proved in a variety of successful cases.

X. While the various methods of treatment are employed, the body is to be well shaken every ten minutes, in order to render the process of animation more certainly successful; and children in particular are to be much agitated, by taking hold of their legs and arms, frequently and for a continuance of time. In various instances agitation has forwarded the recovery of boys who have been drowned, and continued for a considerable time apparently dead.

XI. If there be any signs of returning life, such as sighing, gasping, or convulsive motions, a spoonful of any warm liquid may be administered; and if the act of swallowing is returned, then a cordial of warm brandy or wine may be given in small quantities, and frequently repeated.

XII. Electricity may be tried by the judicious and skilful, as its application neither prevents nor retards the various modes of recovery already recommended; but, on the other hand, will most probably tend to render the other means employed more certainly and more expeditiously efficacious. This stimulus bids fair to prove an important auxiliary in cases of suspended animation; and therefore deserves the ferious regard and attention of the faculty.

The methods which have been fully described, are to be employed with vigour for three hours, or upwards, although no favourable circumstances should arise; for it is a vulgar and dangerous opinion to suppose that persons are irrecoverable, because life does not soon make its appearance; an opinion that has configned to the grave an immense number of the seemingly dead, who might have been restored to life by resolution and perseverance.

Bleeding is never to be employed in such cases, unless by the direction of one of the medical affilants, or some other gentleman of the faculty who has paid attention to the resuscitating art.