MASSAGE. 7 27 



lateral aspects will come in for a secondary share. If the manipulator 

 be sufficiently expert he can work with both hands on this small sur- 

 face with the same rapidity as with one. Each finger and thumb will 

 be taken in turn, and the manipulations extended over the metacarpal 

 and carpal bones as far as the wrist-joint, and finally the palm of the 

 hand by stretching the tissues vigorously away from the median line. 

 Each part included in a single grasp may receive three or four manip- 

 ulations before proceeding onward to the adjacent region. The ad- 

 vance upon this should be such as to allow the finger and thumb to 

 overlap one half of what has just been worked upon. Advance and 

 review should thus be systematically carried on, and this is of general 

 application to all the other tissues that can be masseed. The force 

 used here and elsewhere must be carefully graduated so as to allow 

 the patient's tissues to glide freely upon each other ; for, if too great, 

 the movement will be frustrated by the compression and perhaps 

 bruising of the tissues ; if too light, the operators fingers will slip ; 

 and, if gliding with strong compression be used, the skin will be chafed. 

 To avoid this last objection various greasy substances have been em- 

 ployed, so that ignorant would-be masseurs may rub without injuring 

 the skin. When the skin is cold and dry, and the tissues in general 

 are insufficiently nourished, as well as in certain fevers and other mor- 

 bid conditions, there can be no doubt of the value of inunction ; but 

 no special skill is required in order to do this, and there is no need of 

 calling it massage unless it be to please the fancy of the patient. 



The feet maybe dealt with in the same manner as the hands, using 

 the ends of the fingers to work longitudinally between the metatarsal 

 as well as between the metacarpal bones. Upon the arms and legs, 

 and indeed upon all the rest of the body, both hands can be used to 

 better advantage than where the surfaces are small. Each group of 

 muscles should be systematically worked upon, and for this purpose 

 one hand can usually be placed opposite to the other and in advance of 

 it, so that two groups of muscles may be manipulated at the same 

 time. When the circumference of the limb is not great, the fingers 

 of one hand will partly reach on to the territory of the other, while 

 grasping, circulatory, spiral manipulations are made, one hand con- 

 tracting as the other relaxes, the greatest extension of the tissues being 

 upward and laterally, and on the fore-arms and legs away from the 

 median line. Subcutaneous bony surfaces, as those of the tibia and 

 ulna, incidentally get sufficient attention while manipulating their ad- 

 jacent muscles, for, if both be included in a vigorous grasp, unnecessary 

 discomfort results. Care should be taken not to place the fingers and 

 thumb of one hand too near those of the other, for by so doing their 

 movements would be cramped. The elasticity, or want of it, in the 

 patient's tissues, should be the guide, the object being to obtain their 

 normal stretch, ,nd in this every person is a law to himself, the 

 character of their tissues varying with the amount and quality of 



