Page:Encyclopædia Britannica, Ninth Edition, v. 7.djvu/495

475 475 from that of the same process in other forms of death, lu ordinary cases, the first signs of putrefaction manifest themselves in the lower parts of the abdomen. The rest of the trunk is attacked, then the extremities, and lastly the face. In drowning, on the contrary, the first part of the body to show evidence of decay is the face ; and in the course of a few hours, so rapid is the advance of the putre factive process, that it becomes utterly impossible to recognize the features. Hence it is that it has been chiefly in cases of drowning that difficulties have arisen as to identification, in consequence of that part of the body by which persons are most readily recognized undergoing alteration so rapidly. Devergie, who, from his official con nection with the Morgue at Paris, enjoyed unusual facilities for watching the various stages of putrefaction in the drowned, has carefully described them, and we now proceed to give a resume of his observations. The 1st stage includes a green discoloration of the skin, first noticed on the face and neck, which gradually extends over the body. The 2d is the evolution of gas, distending the abdomen, and causing chose changes to which we have already adverted. The 3d is that of brown putrefaction, which affects all the parts of the body previously coloured green. The 4th is that of putrilage. The discoloured parts soften, liquefy, and dis appear. Under such circumstances the body rapidly decays, and the bones fall asunder. On the other hand, in cool weather the process of liquefaction is arrested, and the soft parts become solidified, owing to their conversion into adipocire, a peculiar kind of animal soap. To this stage the 5th Devergie gives the name of saponification. The 6th stage is termed desiccation, or drying, from the con tinued removal of the fluids from the body, which, thus hardened, is liable, from the action of the elements, to undergo corrosion ; and at the same time long immersion leads to the formation of various incrustations. Devergie treats of these two conditions under the heads of corrosion and incrustation. In the 9th and last stage we have the destruction of the soft parts generally. In the liquid decomposition the part of the body first attacked was the face, and the same order is observed in the later stages the soft parts of the face, now hardened by their transfor mation into adipocire, fall off, and leave nothing but a grinning skeleton of a face behind, the rest of the body being comparatively perfect. This peculiar progress of the process of decomposition in the drowned explains the cases recorded of apparently decapitated heads, and of bodies consisting of headless trunks, having been found floating in the sea. These stages of the putrefactive process Devergie states do not follow any definite order or period of sequence, and each case demands careful investigation as to the con dition of the body and the time of the year when the drowning occurred, but as the result of his experience he finds that the respective seasons of summer and winter make at least a month s difference in the period at which the earlier changes occur. As to the treatment of the drowned, a complete revolu tion has in recent times taken place in its details. To induce a renewal of the respiration it was formerly recom mended that air should bo forcibly introduced into the lungs by means of a pair of bellows, and, according to the older directions of the Humane Society, the body was &quot; to be well shaken every ten minutes in order to render the process of animation more certain.&quot; These expedients proved singularly inefficacious except in cases where the other proposals of the society, such as rubbing and the appli cation of warmth, would of themselves have procured recovery. In 1856 Dr Marshall Hall devised his ready method or postural treatment of the asphyxiated, and by dissections, and by actual results in cases of still birth and of drowning, proved that respiration could be imitated by simply changing the position of the body. Since then Dr R. Silvester has suggested a still more simple plan of postural treatment which, along with that of Dr Marshall Hall, has been adopted by the Humane Society and also by the National Life Boat Institution, from whose published directions we give the modern treatment of the drowned by both methods, which is &quot; in use in Her Majesty s, Fleet, in the Coast-guard Service, and at all the stations of the British Army at home and abroad.&quot; DIRECTIONS FOR RESTORING THE APPARENTLY DROWNED. I. Send immediately for medical assistance, blankets, and dry clothing, but proceed to treat the patient instantly on the spot, in the open air, with the face downward, whether on shore or -afloat ; exposing the face, neck, and chest to the wind, except in severe weather, and removing all tight clothing from the neck and chest, especially the braces. The points to be aimed at are first and immediately, the restoration of breathing,; and secondly, after breathing is restored, 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 pro mote 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 pro mote 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, harts- Fid. 1. Inspiration (Dr Marshall Hall s method). FIG. 2. Expiration (Dr Marshall Hall s method). horn, 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, lose 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