Page:Popular Science Monthly Volume 21.djvu/743

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portion of the hands when all the rest might be occupied. 3. The patient should be placed in as easy and comfortable a position as possible, in a well-ventilated room at a temperature of about 70° Fahr. 4. What constitutes the dose of massage is to be determined by the force and frequency of the manipulations and the length of time during which they are employed. A good manipulator will do more in fifteen minutes than a poor one will in an hour, just as an old machanic working deliberately will accomplish more than an inexperienced one working furiously. Friction has been described as rectilinear, vertical, transverse or horizontal, and circular. It has been stated, and very properly, that rectilinear friction should always be used in an upward direction, from the extremities to the trunk, so to favor and not retard the venous and lymphatic currents. But a slight deviation from this method I have found to be more advantageous, for though in almost every case the upward strokes of the friction should be the stronger, yet the returning or downward movement may with benefit lightly graze the surface, imparting a soothing influence, without being so vigorous as to retard the circulation, and thus a saving of time and effort will be gained. The manner in which a carpenter uses his plane represents this forward-and-return movement very well. Transverse friction, or friction at right angles to the long axis of a limb, is a very ungraceful and awkward procedure. It has been introduced on theoretical considerations alone, and may with safety be laid aside, for the method already spoken of, together with circular friction, will do all and a great deal more than rubbing crosswise on a limb can do. A convenient extent of territory, to begin with, is from the ends of the fingers to the wrist, each stroke being of this length, the returning stroke being light, without raising the hand. The rapidity of these double strokes may be from one hundred to one hundred and fifty a minute. The whole palmar surface of the fingers should be employed, and in such a manner that they will fit into the depressions formed by the approximation of the phalang and metacarpal bones. The heel of the hand should be used for especially vigorous friction of the palm, as well as for the sole of the foot. From the wrist to the elbow, and from the elbow to the shoulder, are separately convenient extents of surface, and here not only straight-line friction, extending from one joint to the other, may be used, but also circular friction. The form of the latter which I have found most serviceable is in that of an oval, both hands moving at the same time, the one ascending as the other descends, at the rate of one hundred and twenty-five to two hundred and fifty each a minute, or two hundred and fifty to five hundred with both hands, each stroke reaching from joint to joint, the upward stroke being carefully kept within the limits of chafing the skin. These observations apply to the lower limbs also, but, as they are larger than the arms, the posterior and lateral aspects, from ankle to knee, will be a convenient