If the rescuer be held by the wrists, he must turn both arms simultaneously against the drowning person’s thumbs, and bring his arms at right angles to the body, thus dislocating the thumbs of the drowning person if he does not leave go (fig. 1). If he be clutched round the neck he must take a deep breath and lean well over the drowning person, at the same time placing one hand in the small of his back, then raise the other arm in line with the shoulder, and pass it over the drowning person’s arm, then pinch the nostrils close with the fingers, and at the same time place the palm of the hand on the chin and push away with all possible force. By the firm holding of the nose the drowning person is made to open his mouth for breathing, and as he will then be under water, choking ensues and he gives way to the rescuer, who then gains complete control (fig. 2). One of the most dangerous clutches is that round the body and arms or round the body only. When so tackled the rescuer should lean well over the drowning person, take a breath as before, and either withdraw both arms in an upward direction in front of his body, or else act in the same way as when releasing oneself when clutched round the neck. In any case one hand must be placed on the drowning man’s shoulder, and the palm of the other hand against his chin, and at the same time one knee should be brought up against the lower part of his chest. Then, with a strong and sudden push, the arms and legs should be stretched out straight and the whole weight of the body thrown backwards. This sudden and totally unexpected action will break the clutch and leave the rescuer free to get hold of the drowning person in such a manner as to be able to bring him to land (fig. 3).
There are several practical methods of carrying a person through the water, the easiest assistance to render being that to a swimmer attacked by cramp or exhaustion, or a drowning person who may be obedient and remain quiet when approached and assured of safety. Then the person assisted should place his arms on the rescuer’s shoulders, close to the neck, with the arms at full stretch, lie on his back perfectly still, with the head well back. The rescuer will then be uppermost, and having his arms and legs free can, with the breast stroke, make rapid progress to the shore; indeed a good pace can easily be made (fig. 4). In
this, as in the other methods afterwards described, every care should be taken to keep the face of the drowning person above the water. All jerking, struggling or tugging should be avoided, and the stroke of the legs be regular and well timed, thus husbanding strength for further effort. The drowning person being able to breathe with freedom is reassured, and is likely to cease struggling, feeling that he is in safe hands.
| Fig. 5.—1st Rescue Method. |
When a drowning person is not struggling, but yet seems likely to do so when approached, the best method of rescue is to swim straight up, turn him on his back, and then place the hands on either side of his face. Then the rescuer should lie on his back, holding the drowning man in front of him, and swim with the back stroke, always taking care to keep the man’s face above water (fig. 5). If the man be struggling and in a condition difficult to manage, he should be turned on his back as before, and a firm hold taken of his arms just above his elbows. Then the man’s arms should be drawn up at right angles to his body and the rescuer should start swimming with the back stroke (fig. 6). He should take particular care not to go against the current or stream, and thereby avoid exhaustion. If the arms be difficult to grasp, or the struggling so violent as to prevent a firm hold, the rescuer should slip his hands under the armpits of the drowning person, and place them on his chest or round his arms, then raise them at right angles to his body, thus placing the drowning person completely in his power. The journey to land can then be made by swimming on the back as in the other methods (fig. 7). In carrying a person through the water, it will be of much advantage to keep his elbows well out from the sides, as this expands the chest, inflates the lungs and adds to his buoyancy. The legs should be kept well up to the surface and the whole body as horizontal as possible. This avoids a drag through the water, and will considerably help the rescuer. In some cases it may happen that the drowning person has sunk to the bottom and does not rise again. In that event the rescuer should look for bubbles rising to the surface before diving in. In still water the bubbles rise perpendicularly; in running water they rise obliquely, so that the rescuer must look for his object higher up the stream than where the bubbles rise. It is also well to remember that in running water a body may be carried along by the current and must be looked for in the direction in which it flows. When a drowning person is recovered on the bottom, the rescuer should seize him by the head or shoulders, place the left foot on the ground and the right knee in the small of his back, and then, with a vigorous push, come to the surface.
| Fig. 6.—2nd Rescue Method. |
| Fig. 7.—3rd Rescue Method. |
When the rescuer reaches land with an insensible person, no time should be lost in sending for a medical man, but in the meantime an attempt to induce artificial respiration may be made. The first recorded cases of resuscitating the apparently drowned are mentioned in the notes to William Derham’s Physico-Theology, as having occurred at Troningholm and Oxford, about 1650. In 1745 Dr J. Fothergill read a paper on the subject before the Royal Society. It dealt with the recovery of a man dead in appearance by distending the lungs by Mr William Tossack, surgeon in Alloa, in 1744. In 1767 several cases of resuscitation were reported in Switzerland, and shortly after a society was formed at Amsterdam for recovery of the apparently drowned, and to instruct the common people as to the best manner of treating them when rescued, and to reward the people for their services. In 1773 Dr A. Johnson suggested the formation of a similar society in England, and Dr Thomas Cogan translated the memoirs of the Amsterdam society. Dr William Hawes secured a copy and tried to form a society. There was, however, a strong prejudice against the idea, but he publicly offered rewards to persons who, between Westminster and London Bridges, should rescue drowning persons and bring them to certain places on shore in order that resuscitation might be attempted. In this way he was instrumental in the saving of several lives, and paid the rewards out of his own pocket, until his zeal brought him sympathy and the Royal Humane Society was founded. This was in 1774. The system then in vogue was a means of inducing artificial respiration by inserting the pipe of a pair of bellows into one nostril and closing the other. Air was forced into the lungs and then expelled by pressing the chest, thus imitating respiration. Dr Hawes used for his resuscitation work a kind of cradle, in which the subject was placed, and then raised over a furnace. Bleeding, holding up by the heels, rolling on casks, &c. were at various times resorted to. Simple means are often as effective as the official ones. In 1891 a subject was restored in Australia by being held over a smoky fire, which is the native method of restoring life; while a few years back, at an English riverside town, a patient was saved by the placing of a handkerchief over his mouth and the alternate blowing into and drawing air out of the lungs until natural breathing was restored.
One of the oldest methods of resuscitation was that of Dr Marshall Hall (1790-1857), introduced in 1856. In this method the operator takes his place at the patient’s left side, and places a roll of clothing or pillow (which must be the same length as that used in the previous methods), so that it may be in position under the chest when the patient is turned over. The assistant at the head pays particular attention to the patient’s arms, that they may not be laid upon or twisted at the wrists, elbows, hands or shoulders. The patient is then turned face downwards, with the body reclining over the pillow, the operator makes a firm pressure with the hand upon the back, between and on the shoulder blades, he then pulls the patient slowly up on to the side towards himself. Once in position, the operator pushes the patient back again until the face is downward, when the pressure on the back is to be repeated. These three movements must be continued at the rate of about fifteen times a minute, until natural breathing has been restored.
Then came the methods of Dr H. R. Silvester and Dr Benjamin Howard, of New York.
When using the Silvester method, or, for the matter of that, any other method, the first thing to do is to send for medical assistance. Dr Silvester recommended that the patient should not be carried face downwards or held up by his feet. All rough usage should be avoided, especially twisting or bending of limbs, and the patient must not be allowed to remain on the back unless the tongue is pulled forward. In the event of respiration not being entirely suspended when a person is lifted out of the water, it may not be necessary to imitate breathing, but natural respiration may be assisted by the application of an irritant substance to the nostrils and tickling the nose. Smelling-salts, pepper and snuff may be used, or hot and cold water alternately dashed on the face or chest. Provided no sign of life can be seen or felt or the heart’s action heard, promotion of breathing, not circulation must be the first aim and effort. Lay the patient flat on his back, with the head at a slightly higher level than the feet. Remove all tight clothing about the neck, chest and abdomen, and loosen the braces, belts or corsets. The operator taking his place at the head, with an assistant on one side, will turn the patient over until he is lying face downwards, his head resting upon one arm. He should then, after the assistant has given one or two sharp blows with the open hand between the shoulder blades, wipe and clear the mouth, throat and nostrils of all matter that may prevent the air from entering the lungs, using a handkerchief for this purpose. This being done, the patient should be turned upon his back, the tongue pulled forward and kept in position by means of a dry cloth, handkerchief or piece of string tied round the jaw. Every care must be taken not to let it fall back into the mouth and thus obstruct the air passages. When this work has been accomplished (it should only last a few seconds) the operator at the head should lift the patient, handling the head and shoulders very carefully, in order that the assistant may place a roll of clothing or pillow under the shoulder blades. The roll being placed in position, the operator will lean forward and grasp the arms below the elbows. He will then draw the patient’s arms steadily upwards and outwards, above the head, until fully extended in line with the body. Having held the arms in this position for about one second, the operator will carry them back again and press them firmly against the side and front of the chest for another second. By these means an exchange of air is produced in the lungs similar to that effected by natural respiration. These movements must be repeated carefully and deliberately about fifteen times a minute, and persevered in. When natural respiration is once established, the operator should cease to imitate the movements of breathing, and proceed with the treatment for the promotion of warmth and circulation.