348 MANUAL FOE NONCOMMISSIONED OFFICERS. 



The operator kneels, straddles one or both of the patient's 

 thighs, and faces his head. Locating the lowest rib, the oper- 

 ator, with his thumbs nearly parallel to his fingers, places 

 his hands so that the little finger curls over the twelfth rib. 

 If the hands are on the pelvic bones, the object of the work is 

 defeated; hence the bones of the pelvis are first located in 

 order to avoid them. The hands must be free from the pelvis 

 and resting on the lowest rib. By operating on the bare back 

 it is easier to locate the lower ribs and avoid the pelvis. The 

 nearer the ends of the ribs the hands are placed without slid- 

 ing off the better. The hands are thus removed from the 

 spine, the fingers being nearly out of sight. 



The fingers help some, but the chief pressure is exerted by 

 the heels (thenar and hypothenar eminences) of the hands, 

 with the weight coming straight from the shoulders. It is a 

 waste of energy to bend the arms at the elbows and shove in 

 from the sides, because the muscles of the back are stronger 

 than the muscles of the arms. 



The operator's arms are held straight, and his weight is 

 brought from his shoulders by bringing his body and shoul- 

 ders forward. This weight is gradually increased until at the 

 end of the three seconds of vertical pressure upon the lower 

 ribs of the patient the force is felt to be heavy enough to com- 

 press the parts; then the weight is suddenly removed. If 

 there is danger of not returning the hands to the right posi- 

 tion again, they can remain lightly in place ; but it is usually 

 better to remove the hands entirely. If the operator is light 

 and the patient an overweight adult, he can utilize over 80 per 

 cent of his weight by raising his knees from the ground and 

 supporting himself entirely on his toes and the heels of his 

 hrinds, the latter properly placed on the ends of the floating 

 ribs of the patient. In this manner he can work as effectively 

 as a heavy man. 



A light feather or a piece of absorbent cotton drawn out 

 thin and held near the nose by some one will indicate by its 

 movements whether or not there is a current of air going and 

 coming with each forced expiration and spontaneous inspira- 

 tion. 



The natural rate of breathing is 12 to 15 times per minute. 

 The rate of operation should not exceed this. The lungs must 

 be thoroughly emptied by three seconds of pressure, then re- 



