By F.A. BURRALL, M.D., New York.

As is usual at this season, casualties from drowning are of frequent occurrence. No class of emergencies is of a more startling character, and I think that a history of the case which I now present offers some peculiar features, and will not be without interest to physicians.

The accident which forms the subject of this paper occurred August 29, 1890, at South Harpswell, Casco Bay, Me., where I was passing my vacation.

At about 9.30 A.M., M. B - - , an American, aged eighteen, the son of a fisherman, a young man of steady habits and a good constitution, with excellent muscular development, and who had never before required the aid of a physician, was seen by the residents of the village to fall forward from a skiff into the water and go down with uplifted hands. I could not learn that he rose at all after the first submersion. Two men were standing near a bluff which overlooked the bay, and after an instant's delay in deciding that an accident had occurred, they ran over an uneven and undulating pasture for a distance of two hundred and fifty paces to the shore. One of them, after a quick decision not to swim out to where the young man had fallen in and dive for him, removed trousers and boots and waded out five yards to a boat, which he drew into the shore and entered with his companion, taking him to a yacht which lay two hundred and forty yards from the shore, in the padlocked cabin of which was a boat hook. The padlock was unfastened, the boat hook taken, and they proceeded by the boat directly to where the young man lay. He was seen through the clear water, lying at a depth of nine feet at the bottom of the bay, on his back, with upturned face and arms extended from the sides of the body.

He was quickly seized by the boat hook, drawn head upward to the surface, and with the inferior portion of the body hanging over the stern of the boat, and the superior supported in the arms of his rescuer, was rowed rapidly to the shore, where he was rolled a few times, and then placed prone upon a tub for further rolling. I was told that much water came from his mouth. Meantime I had been sent for to where I was sitting, one hundred and fifty-one yards from the scene, and I arrived to find him apparently lifeless on the tub, and to be addressed with the remark, "Well, doctor, I suppose we are doing all that can be done."

I have given these details, as from a study of them I was aided in deciding the time of submersion, as well as the intervals which transpired before the intelligent use of remedies. It is also remarkable that, notwithstanding all which has been written about ready remedies for drowning, no one present knew anything about them, although living in a seafaring community.

I immediately directed that the patient should at once be placed upon the ground, which was sloping, and arranged his rubber boots under the back of the head and nape of the neck, so that the head should be slightly elevated and the neck extended, while the head was turned somewhat upon the side, that fluids might drain from the mouth. The day was clear and moderately warm. Respiration had ceased, but no time was lost in commencing artificial respiration. The patient had on a shirt and pantaloons, which were immediately unbuttoned and made loose, and placing myself at his head, I used the Silvester method, because I was more accustomed to it than any other. It seems to me more easy of application than any other, and I have often found it of service in the asphyxia of the newly born.

The patient's surface was cold, there was extensive cyanosis, and his expression was so changed that he was not recognized by his fellow townsmen, but supposed to be a stranger. The eyelids were closed, the pupils contracted, and the inferior maxilla firmly set against the superior. One of the men who had brought him ashore had endeavored to find the heart's impulse by placing his hand upon the chest, but was unable to detect any motion.

I continued the artificial respiration from 9.45 until 10, when I directed one of his rescuers to make pressure upon the ribs, as I brought the arms down upon the chest. This assistance made expiration more complete. When nature resumed the respiratory act I am unable to say, but the artificial breathing was continued in all its details for three-quarters of an hour, and then expiration was aided by pressure on the chest for half an hour longer. Friction upward was also applied to the lower extremities, and the surface became warm about half an hour after the beginning of treatment.

About twenty minutes after ten, two hypodermic syringefuls of brandy were administered, but I did not repeat this, since I think alcohol is likely to increase rather than diminish asphyxia, if given in any considerable quantity. A thermometer, with the mercury shaken down below the scale, at this time did not rise. At 11.8 the pulse was 82; respiration, 27; temperature, 97.

After a natural respiration had commenced, the wet clothing was removed, and the patient was placed in blankets. Ammonia was occasionally applied to the nostrils, since, although respiration had returned, there was no sign of consciousness; the natural respiration was at first attended by the expulsion of frothy fluid from the lips, which gradually diminished, and auscultation revealed the presence of a few pulmonary rales, which also passed away. There were efforts at vomiting, and pallor succeeded cyanosis; there were also clonic contractions of the flexors of the forearm. The pupils dilated slightly at about one hour after beginning treatment. Unconsciousness was still profound, and loud shouting into the ear elicited no response. Mustard sinapisms were applied to the praecordium, and the Faradic current to the spine.

Coffee was also administered by a ready method which, as a systematic procedure, was, I believe, novel when I introduced it to the profession in the Medical Record, in 1876. I take the liberty of referring to this, since I think it is now sometimes overlooked. It was described as follows: