288 TREATMENT OF THE APPARENTLY-DROWNED. 
respiration suggested by Dr. H. R. Silvester, seem most likely 
to answer in practice :— 
Treat the patient instantly, on the spot, in the open air, 
exposing the face and chest to the breeze, except in severe 
weather. 
1. Zo clear the Throat, place the patient gently on the 
face, with one wrist under the forehead—(all fluids and the 
tongue itself then fall forwards, leaving the entrance into the 
windpipe free). If there be breathing, wait and watch ; if 
not, or if it fail,— 
u. Lo excite Respiration, turn the patient well and in- 
stantly on his side, and excite the nostrils with snuff, or the 
throat with a feather, &c., and dash cold water on the face 
previously rubbed warm. If there be no success, lose not a 
moment, but instantly,— 
ur. Zo imitate Respiration, lay the patient on his back, 
with the head and shoulders slightly elevated ; then let the 
arms be raised and steadily extended upwards, by the sides of 
the head, so as to draw-up the shoulders. In this way, the 
ribs are drawn-up by the muscles passing to them from the 
shoulders, and the cavity of the chest is enlarged. If the arms 
be then carried-down to the sides of the body, the shoulders 
fall, the ribs are lowered, and the sides of the thorax approach 
one another, as in natural expiration,—an effect which 
may be increased by moderate pressure on the front and 
sides of the chest. By an alternation of these movements, 
an artificial Inspiration and Expiration will be effected, 
which, though imperfect, may restore life. 
Iv. To induce Circulation and Warmth, meantime rub 
the limbs upwards, with firm grasping pressure and with 
energy, using handkerchiefs, &c. (by this measure the blood 
is propelled along the veins towards the heart) ; let the limbs 
be thus warmed and dried, and then clothed, the bystanders 
supplying the requisite garments ; avoiding the continuous 
warm bath, and the position on, or inclined-to, the back. 
340. The ordinary movements of respiration belong, like 
those of swallowing, to the class of reflex actions (§ 430). We 
have seen that, in every such movement, a great number of 
muscles are called into play simultaneously; and this is 
effected by means of the stimulus which is sent to them from 
the spinal cord. But this stimulus does not originate there ; 
