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THE QUESTION OF PAIN IN DROWNING.

By ROGER S. TRACY, M. D.

EVERY one has tried the experiment of "holding the breath," and has found that after the lapse of a minute, or a minute and a half at the farthest, there supervenes a most peculiar and intolerable kind of anguish. Nature then takes the management of the lungs out of our hands into hers, and we breathe in spite of ourselves. The distress felt at such times we think of when we read of a death by drowning or hanging; and, although it has been asserted over and over again that such a death is painless, hardly any one really believes it. And yet I think it can be shown not only that drowning and hanging are painless modes of death, but why they are so.

When a person, who cannot swim, falls into deep water, he is seized with a sudden and tremendous fright. The exceptions to this rule are too few to be worth noticing. This fright, of itself, kills some persons, and they go to the bottom like a plummet. Women are very apt to faint, and, as they sink beneath the surface and respiration still goes on involuntarily, they probably drown before they regain consciousness. Plethoric persons, or those in whom the degenerative processes of old age have weakened the coats of the arteries, may have a stroke of apoplexy, partly from the sudden emotional shock, and partly from the chill of the water, which, by driving the blood from the surface, over-fills the vessels of the internal organs. In fact, it is estimated by Taylor, in his "Medical Jurisprudence," that of all drowned persons twenty-five per cent, die of pure asphyxia, and in the remainder the asphyxia is complicated by syncope and apoplexy. The chances are, then, three out of four, that a person who falls into the water and drowns will die a painless death, because he becomes insensible on the instant. But what about the remaining fourth?

In the first place, it is to be remarked that persons who have come so near drowning as to be unconscious when taken from the water, and so must have passed through all the suffering that attends death by drowning, say that they remember no feeling of pain whatever. This declaration must have great weight, for it is not to be supposed that they could forget such terrible distress as that which follows when the respiration is suspended voluntarily. They all describe their feeling much in the same way: "I remember falling into the water. It was dreadfully cold. I felt my clothes clinging about me and hampering my movements, and as I rose to the surface I gasped for breath. My mouth was filled with water, and I sank again. I was chilled through and through; then a sort of delirium came over me, and there was a ringing in my ears. I remember nothing more." The last symptom ​mentioned immediately precedes unconsciousness, as all who have taken anæsthetics know.

It is probable that the entrance of water into the lungs has a great deal to do with the painlessness of drowning. It is certain that unconsciousness comes on more quickly when the person is deprived of air because the lungs are filled with water, than when the air-passages are closed, while the lungs remain intact. Most persons can hold their breath for a minute, very many for a minute and a half, some for two minutes. In one of the variety theatres of New York appeared recently "The Brilliant Pearl of the Enchanted Grotto, christened Undine, who performs, while under water, incased in a mammoth crystal illuminated glass tank, feats of astonishing suppleness and almost unbelievable endurance." This performer can probably remain under water, holding her breath voluntarily, two minutes and perhaps more. I have myself, watch in hand, seen Johnson, the celebrated ocean-swimmer, remain under water, in a tank before an audience, for the astonishing space of three minutes and twenty seconds, and, before he rose, the involuntary contractions of his respiratory muscles were uncomfortable to witness. In such cases, although extreme distress may be felt, there is no approach to unconsciousness. But if a person's head is under water, and he does not hold his breath, unconsciousness will usually come on in one or two minutes at the farthest.

If this be so, it is evident that a person will drown more quickly if he loses his presence of mind on falling into the water than if he retains it. In the former case he will swallow water with his first gasp after sinking, while in the latter case he will hold his breath as long as he can. The latter will suffer more than the former. There is also a difference in the amount of mental agony in the two cases. A person who cannot swim sinks at the first plunge, but, as soon as the impetus of his fall is destroyed, his frantic struggles or a kick against the bottom, if he happens to touch it, sends him up to the surface, for the specific gravity of the body is so nearly that of water that a very slight motion of the hands or feet is sufficient to keep one afloat. Arrived at the surface, he gasps for breath, swallows a quantity of water, sucks some of it into his lungs, catches hold of straw's or small floating objects in a wild, senseless way, and, every time he lifts his arm above the surface, produces the same effect as if a piece of lead had been tied to his feet. So down he goes again half strangled, and the same process is repeated. As soon as unconsciousness comes on, the struggles cease, and the body remains beneath the surface. During all this agony the suffering of the drowning man is undoubtedly chiefly mental. It comes from the instinctive dread of death which even the stoic cannot rid himself of, and is of the same nature as the mental agony of the condemned man before his execution, though less prolonged. And it is probable that even this mental suffering is so much affected by the convulsive and tremendous physical agitation that, in a measure, the ​two counteract each other, and the drowning person, from the moment he strikes the water, is hardly conscious of what is going on.

A swimmer, or a person whose presence of mind enables him to keep his head above water for some time before drowning, passes through a different experience. But, although data are wanting on this point, it is probable that his final agony is short and painless. His physical exertions, kept up for a long time in the hope of relief, together with his exposure to cold and wet, and the lack of nourishment, combine to reduce his strength very rapidly, and it is not altogether a conjecture to suppose that a single draught of water into the lungs, when he finally gives up, is enough to bring on unconsciousness. His suffering, too, is chiefly mental, but he experiences the additional discomforts of exhaustion, cold, and hunger, if his struggle for life is a prolonged one.

It is believed that the rapidity and painlessness of death by drowning are due chiefly to the speedy obstruction of the circulation of the blood through the lungs. In ordinary asphyxia, by the simple deprivation of air, the blood throughout the body becomes charged with carbonic acid, and the arteries as well as the veins become filled with venous blood. Now, venous blood does not pass readily through the capillary vessels, and, when the accumulation of impurities has become so great as to prevent its passing at all, the circulation comes to a standstill. But the dreadful distress of suffocation comes on long before this point is reached. Now, when cold water is sucked into the lungs and comes in contact with their delicate and sensitive mucous membrane, it must cause an instant and powerful contraction of the capillaries, and obstruct the current of blood from the right side of the heart, thus indirectly damming back the venous blood in the brain. This state of things brings on unconsciousness rapidly, preceded by the pleasurable tingling sensations, rapid succession of ideas, and flashes of light and color, so often described by persons who have been rescued from drowning.

Drowning persons, then, die in different ways:

1. By syncope, and asphyxia while unconscious. Some of these die instantly.

2. By apoplexy (usually congestive), common in plethoric and aged persons, followed by asphyxia while unconscious.

3. By asphyxia pure and simple.

Deaths which come under the first two heads are rapid and painless, constituting probably a half, and, according to Taylor, three-quarters of all deaths by drowning.

Deaths which come under the third heading we presume are not accompanied by physical suffering for these reasons:

1. Persons who have been resuscitated, after having become unconscious, declare that they have felt no pain whatever.

2. Death is speedy.

3. Persons who lose their presence of mind are so occupied with ​their struggles and mental agony that a slight degree of physical pain would be unnoticed.

4. Swimmers, and persons who do not lose their wits, become so exhausted and chilled that, when the final act comes, their powers make but a feeble resistance. And, in both cases, the passage of water into the lungs tends to bring on insensibility by obstructing the circulation, before it is time for the agony of asphyxia to be felt.

So that, in drowning, we have reason to believe, contrary to Taylor's opinion, that pure, uncomplicated asphyxia never occurs.

If death by drowning be inevitable, as in a shipwreck, the easiest way to die would be to suck water into the lungs by a powerful inspiration, as soon as one went beneath the surface. A person who had the courage to do this would probably become almost immediately unconscious, and never rise to the surface. As soon as the fluid filled his lungs, all feelings of chilliness and pain would cease, the indescribable semi-delirium that accompanies anæsthesia would come on, with ringing in the ears and delightful visions of color and light, while he would seem to himself to be gently sinking to rest on the softest of beds and with the most delightful of dreams.