Drowning.

By H. H. BLANKMEYER, M. D., HONEY GROVE, TEXAS

In the Chicago Medical Times, November, 1906, I read Professor H. K. Whitford's article on Drowning, introduced there by Dr. Ellingwood, which to me was very interesting. You know it is, as he there states, a commonly accepted fact:

1. That a drowned person under water five minutes cannot be restored to life;

2. That a drowned person going into the water alive has his lungs filled with the fluid;

3. That a person drowned must not be resuscitated by the use of heat.

To all three of these accepted ideas he takes a most emphatic opposite stand, and with convincing argument he argues that a person can be restored to life even if apparently dead an hour or more, and all this time under water, so long as decomposition or breaking down of tissue has not taken place, and he quotes cases that he has actually resuscitated, while two other doctors failed, and all three patients were drowned at the same time and in like manner. He argues that a person going into the water alive does not get any water into his lungs while drowning, because as soon as two or three drops touch the epiglottis it will spasmodically contract and close the entrance of the trachea, which, as you know, is the passage to the lungs.

Therefore, a person taken from the water with water in his lungs was most likely dead or unconscious before entering the water, and therefore the generally accepted evidence that the person entered the water dead, if the lungs are found free of water, according to Dr. Whitford, is false. He argues that today men are serving penitentiary sentences upon the circumstantial "water in the lung theory" who may be innocent of murder.

The water you have seen come from the mouth of a drowned person when rolled over a barrel or held with feet elevated was from the stomach, not from the lungs.

Dr. Whitford argues that to resuscitate a drowned person heat should be used and not withheld. In drowning, the body becomes chilled, and naturally the blood thickens and the capillaries become clogged; therefore, it would be the height of folly to cause artificial respiration and try to make the heart force congealed blood to flow through frozen capillaries. Get the capillaries and blood into condition first and then perform artificial respiration. Don't that seem reasonable? What engineer would ever think of making steam and power if he knew the pipes were filled with mud and ice before he would get such mud or ice in condition that it would move and allow the steam to circulate?

"Here is the main point of this paper that I wish to bring forward." If Dr. Whitford is correct in his views—and I like them better than any I have ever heard—haste is not necessary in restoring a drowned person.

The actual method of artificial respiration is not the essential feature. You all know or have heard of the Paris or Laborde method of drawing out the tongue and jerking it rhythmatically.

The Sylvester method is to draw the tongue forward, move the arms from side of body upwards until they nearly meet over the head and then slowly bring the arms down until the elbows meet over the abdomen; repeat this movement sixteen or eighteen times per minute.

Marshall Hall's method is to place the body face downwards, with forehead on forearm; stand astride the body and grasp it about the shoulders, raise the chest as high as possible without removing head from arm, holding it about three seconds; then place body upon the ground again, press lower limbs downward, then upward, gradually increasing force, for ten seconds. Suddenly let go and repeat lifting as before.

Dr. H. K. Whitford's common sense, practical method is to restore the normal temperature of the body first. This he writes, is best accomplished in a bath tub with the stopper so arranged that the water will gradually and slowly escape, allowing more hot water to be added from time to time, and thus keeping the water at one temperature. While the patient is in the tub the stimulation can be increased by pouring the hot water from a height of five or six feet on the body, avoiding the face and spine. If a bath-tub is not handy, use blankets soaked in hot water, repeating as often as necessary to get body and circulation back to the normal. If you are where hot water or blankets are not to be had, then do the best you can with friction to get normal temperature of the surface and capillaries. When you have caused as much stimulation as you can toward normal circulation, then draw the tongue forward with tongue forceps, or by the use of your finger and give free passage of air through the treachea to the lungs. Then, cause artificial respiration by any method best known to you, and if the blood current has been properly prepared it will not take more than five or ten minutes' work at artificial respiration to accomplish happy results.

Eclectic Medical Journal.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.