288 TREATMENT OF THE APPARENTLY-DROWNED. 



respiration suggested by Dr. H. E. 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. 



i. To 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, 



ii. To 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, 



in. To 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 j 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 ; 



