Scientific American Supplement No. 819, September 12, 1891

by Various

I immediately directed that the patient should at once be placed upon the ground, which was sloping, and arranged his rubber boots under the back of the head and nape of the neck, so that the head should be slightly elevated and the neck extended, while the head was turned somewhat upon the side, that fluids might drain from the mouth. The day was clear and moderately warm. Respiration had ceased, but no time was lost in commencing artificial respiration. The patient had on a shirt and pantaloons, which were immediately unbuttoned and made loose, and placing myself at his head, I used the Silvester method, because I was more accustomed to it than any other. It seems to me more easy of application than any other, and I have often found it of service in the asphyxia of the newly born.

The patient's surface was cold, there was extensive cyanosis, and his expression was so changed that he was not recognized by his fellow townsmen, but supposed to be a stranger. The eyelids were closed, the pupils contracted, and the inferior maxilla firmly set against the superior. One of the men who had brought him ashore had endeavored to find the heart's impulse by placing his hand upon the chest, but was unable to detect any motion.

I continued the artificial respiration from 9.45 until 10, when I directed one of his rescuers to make pressure upon the ribs, as I brought the arms down upon the chest. This assistance made expiration more complete. When nature resumed the respiratory act I am unable to say, but the artificial breathing was continued in all its details for three-quarters of an hour, and then expiration was aided by pressure on the chest for half an hour longer. Friction upward was also applied to the lower extremities, and the surface became warm about half an hour after the beginning of treatment.

About twenty minutes after ten, two hypodermic syringefuls of brandy were administered, but I did not repeat this, since I think alcohol is likely to increase rather than diminish asphyxia, if given in any considerable quantity. A thermometer, with the mercury shaken down below the scale, at this time did not rise. At 11.8 the pulse was 82; respiration, 27; temperature, 97.

After a natural respiration had commenced, the wet clothing was removed, and the patient was placed in blankets. Ammonia was occasionally applied to the nostrils, since, although respiration had returned, there was no sign of consciousness; the natural respiration was at first attended by the expulsion of frothy fluid from the lips, which gradually diminished, and auscultation revealed the presence of a few pulmonary rales, which also passed away. There were efforts at vomiting, and pallor succeeded cyanosis; there were also clonic contractions of the flexors of the forearm. The pupils dilated slightly at about one hour after beginning treatment. Unconsciousness was still profound, and loud shouting into the ear elicited no response. Mustard sinapisms were applied to the præcordium, and the Faradic current to the spine.

Coffee was also administered by a ready method which, as a systematic procedure, was, I believe, novel when I introduced it to the profession in the Medical Record, in 1876. I take the liberty of referring to this, since I think it is now sometimes overlooked. It was described as follows:

"A simple examination which any one can make of his own buccal cavity will show that posterior to the last molar teeth, when the jaws are closed, is an opening bounded by the molars, the body of the superior, and the ramus of the inferior maxilla. If on either side the cheek is held well out from the jaw, a pocket, or gutter, is formed, into which fluids may be poured, and they will pass into the mouth through the opening behind the molars, as well as through the interstices between the teeth. When in the mouth they tend to create a disposition to swallow, and by this method a considerable quantity of liquid may be administered."

After I had worked with the patient in the open air, for four and three-quarter hours, he was carried to a cottage near by and placed, still unconscious, in bed. There had been an alvine evacuation during the time in which he lay in the blankets.

Consciousness began to return in the early part of the following morning, and with its advent it was discovered that the memory of everything which had occurred from half an hour previous to the accident, up to the return of consciousness, had been completely obliterated. With this exception the convalescence was steady and uncomplicated, and of about a week's duration. From a letter which I recently received from my patient, I learned that the lapse of memory still remains.

My experience with this case has taught me that, unless the data have been taken very accurately, we cannot depend upon any statements as to the time of submersion in cases of drowning. My first supposition was that my patient had been from thirteen to fifteen minutes under water, but a careful investigation reduced the supposed time by one-half. This makes the time of submersion about six minutes, and that which elapsed before the intelligent use of remedies about three minutes longer.