used in the previous
methods), so that it may be in position under the chest when the patient
is turned over. The assistant at the head pays particular attention to
the patient's arms, that they may not be laid upon or twisted at the
wrists, elbows, hands or shoulders. The patient is then turned face
downwards, with the body reclining over the pillow, the operator makes a
firm pressure with the hand upon the back, between and on the shoulder
blades, he then pulls the patient slowly up on to the side towards
himself. Once in position, the operator pushes the patient back again
until the face is downward, when the pressure on the back is to be
repeated. These three movements must be continued at the rate of about
fifteen times a minute, until natural breathing has been restored.

Then came the methods of Dr H. R. Silvester and Dr Benjamin Howard, of
New York.

When using the Silvester method, or, for the matter of that, any other
method, the first thing to do is to send for medical assistance. Dr
Silvester recommended that the patient should not be carried face
downwards or held up by his feet. All rough usage should be avoided,
especially twisting or bending of limbs, and the patient must not be
allowed to remain on the back unless the tongue is pulled forward. In
the event of respiration not being entirely suspended when a person is
lifted out of the water, it may not be necessary to imitate breathing,
but natural respiration may be assisted by the application of an
irritant substance to the nostrils and tickling the nose.
Smelling-salts, pepper and snuff may be used, or hot and cold water
alternately dashed on the face or chest. Provided no sign of life can be
seen or felt or the heart's action heard, promotion of breathing, _not_
circulation must be the first aim and effort. Lay the patient flat on
his back, with the head at a slightly higher level than the feet. Remove
all tight clothing about the neck, chest and abdomen, and loosen the
braces, belts or corsets. The operator taking his place at the head,
with an assistant on one side, will turn the patient over until he is
lying face downwards, his head resting upon one arm. He should then,
after the assistant has given one or two sharp blows with the open hand
between the shoulder blades, wipe and clear the mouth, throat and
nostrils of all matter that may prevent the air from entering the lungs,
using a handkerchief for this purpose. This being done, the patient