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stored, the promotion of warmth and circulation.

The efforts to restore breathing must be commenced immediately and energetically, and persevered in for one or two hours, or until a medical man has pronounced that life is extinct. Efforts to promote warmth and circulation beyond removing the wet clothes and drying the skin must not be made until the first appearance of natural breathing. For if circulation of the blood be induced before breathing has recommenced, the restoration to life will be endangered.

II.—To Restore Breathing.

To clear the throat—Place the patient on the floor or ground with the face downwards, and one of the arms under the forehead, in which position all fluids will more readily escape by the mouth, and the tongue itself will fall forward, leaving the entrance into the windpipe free. Assist this operation by wiping and cleansing the mouth.

If satisfactory breathing commences, use the treatment described below to promote warmth. If there be only slight breathing—or no breathing, or if the breathing fail, then—

To excite Breathing—Turn the patient well and instantly on the side, supporting the head, and—

Excite the nostrils with snuff, hartshorn and smelling salts, or tickle the throat with a feather, &c., if they are at hand. Rub the chest and face warm, and dash cold water, or cold and hot water alternately, on them.

If there be no success, loose not a moment, but instantly.

To imitate Breathing—Replace the patient on the face, raising and supporting the chest well on a folded coat or other article of dress.

Turn the body very gently on the side and a little beyond, and then briskly on the face, back again; repeating these measures cautiously, efficiently, and perseveringly, about fifteen times in the minute, or once every four or five seconds, occasionally varying the side.

[By placing the patient on the chest, the weight of the body forces the air out; when turned on the side, this pressure is removed, and air enters the chest.]

On each occasion that the body is replaced on the face, make uniform but efficient pressure with brisk movement, on the back between and below the shoulder-blades or bones on each side, removing the pressure immediately before turning the body on the side. During the whole of the operations let one person attend solely to the movements of the head, and of the arm placed under it.

[The first measure increases the expiration, the second commences inspiration.]

• The result is respiration or natural breathing; and if not too late, life.

Whilst the above operations are being proceeded with, dry the hands and feet; and as soon as dry clothing or blankets can be procured, strip the body and cover, or gradually reclothe it, but taking care not to interfere with the efforts to restore breathing.

III.

Should these efforts not prove successful in the course of from two to five minutes, proceed to imitate breathing by Dr Silvester’s method, as follows:—

Place the Patient on the back on a flat surface, inclined a little upwards from the feet; raise and support the head and shoulders on a small firm cushion or folded article of dress placed under the shoulder-blades.

Draw forward the patient’s tongue, and keep it projecting beyond the lips; an elastic band over the tongue and under the chin will answer this purpose, or a piece of string or tape may be tied round them, or by raising the lower jaw, the teeth may be made to retain the tongue in that position. Remove all tight clothing from about the neck and chest, especially the braces.

To Imitate the Movements of Breathing.

Standing at the patient’s head, grasp the arms just above the elbows, and draw the arms gently and steadily upwards above the head and keep them stretched upwards for two seconds. (By this means air is drawn into the lungs.) Then turn down the patient’s arms, and press them gently and firmly for two seconds against the sides of the chest. (By this means air is pressed out of the lungs.)

Repeat these measures alternately, deliberately and perseveringly about fifteen times in a minute, until a spontaneous effort to respire is perceived, immediately upon which cease to imitate the movements of breathing, and proceed to induce Circulation and Warmth.

IV.—Treatment After Natural Breathing Has Been Restored.

To promote warmth and circulation—

Commence rubbing the limbs upwards, with firm grasping pressure and energy, using handkerchiefs, flannels, &c. (By this measure the blood is propelled along the veins towards the heart.)