It will be necessary, in pursuance of my plan, to describe as minutely as the limits of a chapter will allow how and why this means is employed.  The process and order of what is known to the manipulator as “general massage” follows.

After three or four days in bed have somewhat accustomed the patient to the general routine of treatment, a masseur or masseuse is set to work.  If any special care is needed,—­the avoidance of manipulating one part or added attention to another, tender handling of a sensitive or timid patient,—­these matters have been ordered in advance by the physician.  An hour midway between meals is chosen, and, the patient lying in bed between blankets, the manipulator begins, usually with the feet.  A few rapid rubs of the whole foot and leg are given to start with; then the leg, except the foot and ankle, is covered up, and the operation commences upon the foot, of which the skin is picked up and rolled between the fingers, the whole foot receiving careful attention,—­the toes are pulled, bent, and moved in every direction, the inter-osseous groups worked over with the thumbs and fingers or finger-tips, the larger muscles and subcutaneous tissues squeezed and kneaded, and last the whole mass of the foot rolled and pressed against the bones with both hands.  A few rapid upward strokings with some force complete the treatment of the part, and the ankle is next dealt with.  The joint is moved in every possible direction, slowly but firmly, the crevices between the articulating bones sought out and kneaded with the finger-tips, and the foot and ankle are then carefully covered.  After the same rapid stroking upward of the leg with which it began has been repeated for the sake of the slight stimulation of the skin-vessels and nerves, the muscles of the leg are treated, first by friction of the more superficially placed masses, then by careful deep kneading (petrissage) of the large muscles of the calf, twisting, pressing, and rolling them about the bone with one hand while the other supports the limb.  In fat or heavily-muscled subjects it may be necessary to use both hands to get sufficient grasp of the muscles.  The tibialis anticus and muscles of the outer side of the leg are operated upon by rolling them under the finger-tips and by pressing with the thumb while firmly pushing upward from the ankle to the knee.  At brief intervals the manipulator seizes the limb in both hands and lightly runs the grasp upward, so as to favor the flow of the venous blood-currents, and then returns to the kneading of the muscles,—­and each part is finished by light yet firm upward stroking, the hand returning downward more lightly, yet without breaking its contact with the skin.

Care must be taken as the different groups of muscles are treated that the leg is placed in the position which will most completely relax the ones to be operated upon.  Any tension of muscles wholly defeats the effort of the masseur.