belly with the heel of the hand follows, the movements following the course of the colon.  Next, the fingers of one hand are all held together in a pyramidal fashion and thrust firmly and slowly into the abdomen, in ordinary cases both hands being used thus alternately, in fat or resisting abdomens one hand pressing upon and aiding the other, and travelling thus over the ascending, transverse, and descending colon.  To conclude, the whole belly is shaken by a rapid vibratory motion of the hands (to which is sometimes added succussion by slapping with the flat or cupped hand), and the whole process ends with quick, circular rubbing of the surface.

In cases of troublesome constipation or where other special indications exist, treatment of the abdomen may be much extended beyond the limits here suggested, and indeed it must be remembered that the process of “general massage” as described is capable of a great variety of useful modification to meet individual needs, and is so modified daily by the careful physician and the watchful masseur.  It would not be possible or desirable here to describe all the movements which a skilful rubber makes in his treatment, and I have only attempted a skeleton-statement.  It will perhaps be noticed by those familiar with the technique of massage that nothing is here said about the use of the movements classed under the general head of “tapotement,” the tapping and slapping motions.  They have no proper place in the treatment of cases of nervousness, and usually will serve only to irritate and annoy the patient, and often greatly to increase the nervous excitement.  Their routine use or over-use constitutes one of the defects of the system of massage as usually practised by the Swedish operators; and when patients tell me, as many do, that “they cannot stand massage,” it is often found that the performance of a great deal of this useless and fretting manipulation has constituted a great part of the treatment, and that deep, thorough, quiet kneading can be perfectly borne.

A few precautions are necessary to observe.  The grasping hand should carry the skin with it, not slip over the skin, as the drag thus put upon the hairs will, if daily repeated, cause troublesome boils.  The use of a lubricant avoids this, and is a favorite device of unskilful manipulators.  It also does away with much of the good effected by skin-friction, is uncleanly, very annoying to many patients, promotes an unsightly growth of hair, and should be avoided except where it is desired to rub into the system some oleaginous material.  There are exceptional cases where a very dry, harsh skin or a tendency to excessive sweating during massage makes the use of some unguent desirable.  Cocoa-oil may be used, or what is perhaps more agreeable, lanolin softened to the consistency of very thick cream by the addition of oil of sweet almonds.  As little as possible should be made to serve.