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170                                               MEDICAL JURISPRUDENCE

j Occasionally, death may occur from asphyxia caused by laryngeal spasm
/ set up by a small amount of water entering the larynx. In such a case
f water does not enter the lungs and the signs of drowning will be absent.

H Shock.—This is brought about by fright or terror, or^it may be caused
during a falt,""tte water striking against the chest and pit of the stomach.
Again, if water is very cold, it may induce shock through the recurrent
laryngeal or trigeminal nerves, which reflexly inhibit the action of the heart
and lungs. Shock may also be induced through the cutaneous nerves.

* Concussion,—This may occur by falling into water on the head or
buttocks from a height and striking against some hard solid substance or
even against the water itself.

> Syncope.—-This may occur in persons suffering from epilepsy by falling
suddenly into cold water.

Apoplexy.—Cerebral vessels, especially if they happen to be diseased,
* may be ruptured by a sudden rush of blood to the brain from cold, excite-
ment, or the first violent struggles to keep above the surface of the water.

£ Exhaustion.—This results from continued efforts to keep above the
surface of the water.

*' Injuries.—Fracture of the skull bones and fracture-dislocation of the
cervical vertebrae may result, if a man falling from a height into shallow
water or into a narrow deep pucca well strikes his head forcibly against
some hard solid object.

In August 1918, a Mahomedan girl, 2| years old, fractured her right parietal and
temporal bones by falling accidentally into a well.

On January 10, 1923, a Hindu male, while jumping into a well with a view to
committing suicide, struck his head against a wooden board fixed in the well above
the surface of water. Autopsy revealed three contused wounds on the head and rupture
of the left middle meningeal artery.

Fatal Period.—Asphyxia supervenes within two minutes after complete
submersion, and tKFneart stops in two to five minutes afterwards. It has
been found from observations that even expert divers cannot hold their
breath under water for two minutes continuously. It is, however, recorded
that Miss E. Wallenda remained submerged in a tank at the Alhambra Music
Hall for four minutes, forty-five seconds and a half. Death is almost sure
after complete submersion for five minutes, unless water was prevented
from entering the lungs on account of shock or syncope caused at the time
of the fall. Such cases are possible of resuscitation even after an immersion
of ten to twenty minutes.

Treatment—In the case of persons rescued from drowning, an attempt
at resuscitation should be made without delaying for a moment, and should
be continued for at least an hour, unless it is certain that death has occurred

object in the treatment of an apparently drowned person
removal of water from the lungs and the introduction of air
instead. lHjlgll?can be best accomplished by stripping the person naked to
the waist, Seeing the mouth and nostrils from mud or sand and froth, turn-
ing the body with the head lowered downwards so as to allow the water
to drain from the upper respiratory passages and then starting artificial
respiration. This should be supplemented by the administration of oxygen
at high tensioHy-try friction to promote heat of the body, by alternate splashes
of hot and cold water to the face and chest, and by hypodermic injections
of strychnine, atropine sulphate, adrenaline hydrochloride or coramine,

Tbge are five methods of artificial respiration, viz. (1) Schafer's
method (prone posture), (2) Sylvester's method, (3) Howard's method,
(4) Marshall Hall's method, and (5) Laborde's method. But Schafer's