For a long time the opinion of Sir Benjamin Brodie concerning the presence of water in the lungs of the drowned was accepted, who says "that the admission of water into the lungs is prevented by a spasm of the muscles of the glottis cannot, however, be doubted, since we are unable to account for it in any other manner."
Later experiments made by a committee of the Royal Medico-Chirurgical Society, of London, demonstrated, on the contrary, that "in drowned animals not only were all the air passages choked with frothy fluid, more or less bloody, but that both lungs were highly gorged with blood, so that they were heavy, dark colored, and pitted on pressure, and on being cut exuded an abundance of blood-tinged fluid with many air bubbles in it." Dr. R.L. Bowles[1] also holds that the lungs of the drowned contain water, and supports his views by a list of cases. In his words, "These examples show very conclusively that in cases of drowning in man, water does exist in the lungs, that the water only very gradually and after a long time is effectually expelled, and that it is absolutely impossible that any relief should be afforded in that way by the Silvester method." Dr. Bowles believes that the method of Dr. Marshall Hall is superior to any other in this class of cases. He thinks that on account of the immediate adoption and continued use of the prono-lateral position, this method is more to be trusted than any other for keeping the pharynx clear of obstruction. "It also empties the stomach and gradually clears the lungs of the watery and frothy fluids, and will surely and gently introduce sufficient air at each inspiration to take the place of the fluid which has been expelled." In the light of even my limited experience I cannot but feel that Dr. Bowles' opinion concerning the Silvester method would admit of some modification. This is often the case with very positive statements concerning medical matters. In my own case the Silvester method answered well, but I was much impressed with Dr. Bowles' claims for the Marshall Hall method, and should bear them in mind were I called upon to attend another case of drowning.
I think it must be admitted that pulling the tongue forward as a means of opening the glottis, which has become a standard treatment in asphyxia, is unscientific, and not warranted by the results of experiments made to determine its value.[2]
Dr. Bowles also believes that "the safety of the patient is most perfectly secured by keeping him on one side during the whole treatment, one lung being thus kept quite free." With the account of my case I have brought forward such views of other writers as it seemed to me would be of practical service and throw light on a subject which is of great importance, since the yearly record of mortality from drowning is by no means inconsiderable. I think, however, that a knowledge of what ought to be done in cases of drowning should be much more generally diffused than is the case at present. It should be one of the items of school instruction, since no one can tell when such knowledge may be of immense importance in saving life, and the time lost in securing medical aid would involve a fatal result.
It is also very desirable that all doubt should be removed, by the decision of competent medical authorities, as to which "ready" method or methods are the best, since there are several in the field. With this should be decided what is the best means for securing patency of the air passages, and, in short, a very careful revision of the treatment now recommended for drowning, in order that there may be no doubt as to the course which should be adopted in such a serious emergency.—Medical Record.
Resuscitation of the Apparently Drowned, by R.L. Bowles, M.D., F.R.C.P., Medico-Chirurgical Transactions, vol. lxxii., 1889.