Friction over the surface of the body must be at once resorted to, using handkerchiefs, flannels, &c., so as to propel the blood along the veins towards the heart, while the operator attends to the mouth, nose and throat. The friction along the legs, arms and body should all be towards the heart and should be continued after the patient has been wrapped in blankets or some dry clothing. As soon as possible, the patient should be removed to the nearest house and further efforts made to promote warmth by the application of hot flannels to the pit of the stomach, and bottles or bladders of hot water, heated bricks, &c. to the armpits, between the thighs and to the soles of the feet. If there be pain or difficulty in breathing, apply a hot linseed meal poultice to the chest. On the restoration of life, a teaspoonful of warm water should be given; and then, if the power of swallowing has returned, very small quantities of wine, warm brandy and water, beef tea or coffee administered, the patient kept in bed, and a disposition to sleep encouraged. The patient should be carefully watched for some time to see that breathing does not fail, and, should any signs of failure appear, artificial respiration should at once be resumed. While the patient is in the house, care should be taken to let the air circulate freely about the room and all overcrowding should be prevented.

In the Howard method there are only two movements; its knowledge is said to be necessary in case the patient’s arm be in any way injured, or a more vigorous method than the “Silvester” deemed necessary, but care should be exercised not to injure the patient by too forcible pressure. The patient is laid on his back, the roll is larger than that used in the Silvester method, and is placed farther under the back in order that the lower part of the chest may be highest. After adjusting the roll, the operator kneels astride of the patient, while his assistant goes to the head, lifts the patient’s arms beyond the head, and holds them to the ground, cleans the mouth and nose, and attends to the tongue. The operator, with his fingers spread well apart, taking care that the thumbs do not press into the pit of the stomach, grasps the most compressible part of the lower ribs, and with both hands applies pressure firmly by leaning over the patient; then he springs back, lifting his hands off the patient. Artificial respiration is thus effected, and continued at the rate of about fifteen times a minute. When natural breathing has been restored, the treatment is the same as in the Silvester method.

These methods have now been superseded by the Schäfer method, which has been taken up by the Royal Life Saving Society, a body instituted in 1891 for the promotion of technical education in life saving and resuscitation of the apparently drowned. The Schäfer method has much to recommend it, owing to its extreme simplicity and the ease with which the physical operations necessary to carry on artificial respiration may be performed, hardly any muscular exertion being required. It involves no risk of injury to the congested liver or to any other organ, and as the patient is laid face downwards, there is no possibility of the air passages being blocked by the falling back of the tongue into the pharynx. The water and mucus can also be expelled much more readily from the air passages through the mouth and nostrils.

It was due to the happy selection of Professor E. A. Schäfer, as chairman of a committee appointed by the Royal Medical & Chirurgical Society for the investigation of the methods in use for resuscitation of the apparently drowned, that the new method was devised. This committee made many experiments upon the cadaver but failed to arrive at any definite conclusion by that means. The necessity then appeared of thorough investigation of the subject by experiments upon animals, so that the phenomena attendant upon drowning might be better known, and the various methods of resuscitation properly tried. These experiments were made in Edinburgh by Professor Schäfer, with the co-operation of Dr P. T. Herring, and the results obtained were embodied in the report of the committee, which was presented to the Royal Medical and Chirurgical Society in 1904, and published as a supplement to volume 86 of the Transactions of the society. As the direct outcome of these experiments, Professor Schäfer was led to believe that a pressure method of resuscitation was not only simpler to perform but also more efficacious than any other. This conclusion was put to the test by measurements of the results obtained upon the normal human subject by the various methods in vogue; from these measurements, which were published in the Proceedings of the Royal Society of Edinburgh in December 1903, it appeared that when such pressure is exerted in the prone position the highest degree of efficiency as well as simplicity is obtained. The description of this method was communicated to the Royal Medical and Chirurgical Society, and was published in the following year (1904) in volume 87 of the Transactions of the society.

Fig 8..—Schäfer method of treatment of the apparently drowned. Position A.

Thus it came about that by investigating the phenomena of drowning, and the means of resuscitation in dogs, and by applying the results obtained to man, the method which the society now advocates as the best was arrived at. In the experiments referred to, it was found necessary to drown 38 dogs, all but two of which were from first to last in a complete state of anaesthesia, the two exceptions having been simply drowned without anaesthesia. It is important that the public should understand that the evolution of a method which will probably be the means of saving thousands of lives has resulted from the painless sacrifice of less than 40 dogs, a number which would doubtless in any case have been destroyed by drowning or some other form of suffocation, but without the benefit of the anaesthetics which were employed in the experiments.

Fig. 9.—Schäfer method of treatment of the apparently drowned. Position B.

Professor Schäfer describes the method as follows:—Lay the subject face downwards on the ground, then without stopping to remove the clothing the operator should at once place himself in position astride or at one side of the subject, facing his head and kneeling upon one or both knees. He then places his hands flat over the lower part of the back (on the lowest ribs), one on each side (fig. 8), and then gradually throws the weight of his body forward on to them so as to produce firm pressure (fig. 9)—which must not be violent, or upon the patient’s chest. By this means the air, and water if any, are driven out of the patient’s lungs. Immediately thereafter the operator raises his body slowly so as to remove the pressure, but the hands are left in position. This forward and backward movement is repeated every four or five seconds; in other words, the body of the operator is swayed slowly forwards and backwards upon the arms from twelve to fifteen times a minute, and should be continued for at least half an hour, or until the natural respirations are resumed. Whilst one person is carrying out artificial respiration in this way, others may, if there be opportunity, busy themselves with applying hot flannels to the body and limbs, and hot bottles to the feet, but no attempt should be made to remove the wet clothing or to give any restoratives by the mouth until natural breathing has recommenced.

In his paper read before the Royal Society of Edinburgh in December 1903 Professor Schäfer gave the following table of the relative exchanges of air under different methods:—

Mode of Respiration.Number
per
minute.		Amount of air
exchanged per
respiration.		Amount of air
exchanged per
minute.
Natural respiration (supine)13489 c.c.6.460 c.c.
Natural  ”  (prone)12.5422 ”5.240 ”
Prone (pressure), “Schäfer”13520 ”6.760 ”
Supine (pressure), “Howard”13.6295 ”4.020 ”
Rolling (with pressure), “Marshall Hall”13254 ”3.300 ”
Rolling (without pressure), “Marshall Hall”12192 ”2.300 ”
Traction (with pressure), “Silvester”12.8178 ”2.280 ”