EXTERNAL RESPIRATION AND RESPIRATORY MOVEMENTS. 649 



must be employed to expand and contract the chest alternately, and 

 several different ways have been devised. The Marshall Hall 

 method consists in placing the subject face down and rolling the 

 body from this to a lateral position, making some pressure upon the 

 back while in the prone position. The Sylvester method, which is 

 frequently used, consists in raising the arms above the head and 

 then bringing them down against the sides of the chest so as to 

 compress the latter. The Howard method consists in simply com- 

 pressing the lower part of the chest while the subject is in a supine 

 position. Schaefer, who has recently compared these different 

 methods, suggests one of his own, which seems to be effective, saves 

 labor, and is less injurious to the subject.* He describes it as fol- 

 lows: "It consists in laying the subject in the prone posture, 

 preferably on the ground, with a thick folded garment underneath 

 the chest and epigastrium. The operator puts himself athwart or 

 at the side of the subject, facing his head (see Fig. 269) and places 

 his hands on each side over the lower part of the back (lowest ribs). 

 He then slowly throws the weight of his body forward to bear upon 



Fig. 269. — Shows the position to be adopted for effecting artificial respiration in cases 

 of drowning. — (Schaefer.) 



his own arms, and thus presses upon the thorax of the subject and 

 forces air out of the lungs. This being effected, he gradually re- 

 laxes the pressure by bringing his own body up again to a more 

 erect position, but without moving the hands." These movements 

 are repeated quite regularly at a rate of twelve to fifteen times a 

 minute until normal respiration begins or the possibility of its 

 restoration is abandoned. A half-hour or more may be required 

 before normal breathing movements start. 



These several so-called manual methods of artificial respira- 

 tion have been investigated in this country by commissions ap- 



* Schafer, "Medico-chirurgical Transactions," London, vol. Ixxxvii, 1904; 

 also "Journal of the American Medical Association," 51, 801, 1908. 



