lateral aspects will come in for a secondary share. If the manipulator be sufficiently expert he can work with both hands on this small surface 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 manipulations before proceeding onward to the adjacent region. The advance 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 masséed. 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 employed, 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 morbid 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 contracting 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 adjacent 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, and in this every person is a law to himself, the character of their tissues varying with the amount and quality of
