The operator may stand at either side, facing the patient.

1. The hands are placed on the chest, spread out over the pectoral muscles, the ends of the fingers on the top of the humerus. They should be drawn towards the middle line turning at the same time on their own axis, so that on the sternum the fingers point to the chin ; they are then drawn down, and once more turned, with fingers outward, under the breasts and over the ribs to the back. They are then brought back in exactly the same way till the finger tips are on the shoulder (five times).

2.  The thumbs are placed at each side of the top of the sternum between the first two ribs, and drawn outwards to the axilla with good pressure over the intercostal muscles. To be repeated between as many ribs as possible.

3.   Both hands are laid flat on the chest, thumbs parallel in the centre, fingers pointing to chin, friction with whole hands.

4.  With hands in same position, but stationary, the patient takes a deep breath, drawn in through the nose, raising the ribs against the pressure of the hands. Or the hands may be placed under the breasts, the fingers towards the back, and the thumbs end to end on the lower part of the sternum.

For children with narrow or depressed chests artificial respiration movements are useful. Standing at the head of the couch, the arms are grasped above the elbows, and drawn up at each side of the head to full length, then carried back to the body, folded and pressed against the sides and chest.

Outward circumduction of the arms is also good.

The Breasts.—Much relief is given to breasts over-burdened with milk by gentle manipulations.

1.   Gentle pressure with cushions of fingers from outer circumference to the nipple, going over all the breast.

2.   The same movement with palms of hands, working also in both cases in the armpit.

3.   Circular movements with one finger over hard or knotty spots to relieve the over-distended ducts.

4.  The breast is taken between the two hands, and encircled by them with gentle equal pressure.