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the windpipe), and keep it projecting a little beyond the lips. Let another assistant grasp the arms just below the elbows and steadily draw them upwards by the side of the patient's head to the ground, the hands nearly meeting (which enlarges the capacity of the chest and induces inspiration). While this is being done, let a third assistant take a position astride the patient's hips, with his elbows resting upon his own knees, his hands extended ready for action. Next, let the assistant standing at the head turn down the patient's arms to the side of the body (see Fig. 21), the assistant holding the tongue changing hands if necessary to let the arms pass.

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Just before the patient's hands reach the ground, the man astride the body will grasp the body with his hands - the balls of the thumbs resting on either side of the pit of the stomach, the fingers falling into the grooves between the short ribs. Now, using his knees as a pivot, he will, at the moment the patient's hands touch the ground, throw (not too suddenly) all his weight forward on his hands, and at the same time squeeze the waist between them as if he wished to force something in the chest upwards out of the mouth; he will increase the pressure while he slowly counts one, two, three, four (about 5 seconds), then suddenly let go with a final push, which will spring him back to his first position. This completes the expiration.

At the instant the pressure is taken from the waist, the man at the patient's head will again draw the arms steadily upwards to the sides of the patient's head, (the assistant holding the tongue again changing hands to let the arms pass if necessary), and will hold them there while he slowly counts one, two, three, four (about 5 seconds).

Repeat these movements deliberately and perseveringly 12 to 15 times in every minute, thus imitating the natural motions of breathing.

70. If natural breathing is not restored after a trial of the bellows movement for the space of about 4 minutes, turn the patient a second time on his stomach, as directed in Art. 68, rolling the body in the opposite direction from that in which it was first turned for the purpose of freeing the air passages from any remaining water. Continue the artificial respiration from 1 to 4 hours, or until the patient breathes, according to the instructions given in Art. 69; and for a while, after the appearance of returning life, carefully aid the short gasps until they have deepened into full breaths. Continue the drying and rubbing, which should have been unceasingly practiced from the beginning by assistants, though care should be taken not to interfere with the means used to produce breathing. The limbs of the patient should always be rubbed in an upward direction toward the body with firm, grasping pressure and energy, using the bare hands, dry flannels, or handkerchiefs, and the friction should be continued under the blankets or over the dry clothing. The warmth of the body can also be promoted by the application of hot flannels to the stomach and armpits, and bottles or bladders of hot water, heated bricks, etc. to the limbs and soles of the feet.

71. After-Treatment. - Externally: As soon as breathing is established, let the patient be stripped of all wet clothing, wrapped in blankets only, put to bed comfortably warm (but with a free circulation of fresh air), and left to perfect rest.

Internally: Give whisky or brandy and hot water in doses of a teaspoonful to a tablespoonful, according to the weight of the patient, or other stimulant at hand, every 10 or 15 minutes for the first hour, and as often thereafter as may seem expedient.

Later manifestations: After reaction is fully established, there is great danger of congestion of the lungs, and if perfect rest is not maintained for at least 48 hours, it sometimes occurs that the patient is seized with great difficulty of breathing, and death is liable to follow unless immediate relief is afforded. In such cases apply a large mustard plaster over the breast. If the patient gasps for breath before the mustard takes effect, assist the breathing by carefully repeating the artificial respiration.

IN CASE NO

MODIFICATION OF TREATMENT TO BE USED

ASSISTANCE IS AT HAND

72. To Produce Respiration. - If no assistance is at hand and one person must work alone, place the patient on his back with the shoulders slightly raised on a folded article of clothing; draw forward the tongue and keep it projecting just beyond the lips; if the lower jaw be lifted, the teeth may

Fig. 22

be made hold the tongue in place; it may be necessary to retain the tongue by passing a handkerchief under the chin and tying it over the head.

Grasp the arms just below the elbows and draw them steadily upwards by the sides of the patient's head to the ground, the hands nearly meeting (see Fig. 22). Next lower the arms to the side and press firmly downwards and inwards

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on the sides and front of the chest over the lower ribs (see Fig. 23), drawing toward the patient's head. Repeat these movements 12 to 15 times every minute, etc.

INSTRUCTIONS FOR SAVING DROWNING PERSONS BY

SWIMMING TO THEIR RELIEF

73. When you approach a person drowning in the water, assure him with a loud and firm voice that he is safe.

Before jumping to save him, divest yourself as far and as quickly as possible of all clothes; tear them off, if necessary; but if there is not time, at all events loosen the feet of your drawers, if they are tied, for if you do not do so, they will fill with water and drag you.

On swimming to a person in the sea, if he is struggling, do not seize him, but keep off for a few seconds until he gets quiet-for it is sheer madness to take hold of a man when he is struggling in the water - if you do, you run a great

a risk. Then get close to him and take a fast hold of the hair of his head, turn him as quickly as possible on his back, give him a sudden pull, and this will cause him to float; then throw yourself on your back also and swim for the shore, both hands having hold of his hair, you on your back and he also on his, and of course his back to your stomach. In this way you will get sooner and safer ashore than by any other means, and you may in this manner swim with two or three persons; experiments have been made where this was done with four persons, the rescuer swimming with them a distance of more than 40 yards. One great advantage of this method is that it enables you to keep your head up and also to hold up the person's head you are trying to save. It is of primary importance that you take fast hold of the hair, and throw both the person and yourself on your backs. After many experiments, it is usually found preferable to all other methods. You can in this manner float nearly as long as you please, or until a boat or other help can be obtained.

74. It is believed there is no such thing as a death grasp; at least it is very unusual to witness it. As soon as a drowning man begins to get feeble and to lose his recollection, he gradually slackens his hold until he quits it altogether. No apprehension need therefore be felt on that head when attempting to rescue a drowning person.

After a person has sunk to the bottom, if the water be smooth, the exact position where the body lies may be known by the air bubbles, which will occasionally rise to the surface, allowance being made of course for the motion of the water, if in a tideway or stream, which will carry the bubbles out of a perpendicular course when they are rising to the surface. Oftentimes a body may be regained from the bottom, before too late for recovery, by diving for it in the direction indicated by these bubbles.

On rescuing a person by diving to the bottom, the hair of the head should be seized by one hand only, and the other used in conjunction with the feet in raising yourself and the drowning person to the surface.

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75. If in the sea, it may sometimes be a great error to try to get to land. If there be a strong “outsetting” tide,

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