efforts have been made by physicians, who are thoroughly familiar with massage, to instruct intelligent nurses and others how to apply it, and at the training-schools for nurses the pupils receive some general instruction in the matter. In this way something has been accomplished to bring massage within the rules and regulations of common sense and rational therapeutics. But still there is great room for improvement even in this direction, for it is but too often the case that after one or two persons are specially trained to do massage they are requested to give instruction to some of the pupils at the schools for nurses, and to others, a few of whom, after having received some general desultory lessons, are in turn delegated or relegated to teach others. and so on, until, by the time massage reaches the needy patients, there is often little left of it but the name. Hence it is not to be wondered at that many a shrewd, superannuated auntie, and others who are out of a job, having learned the meaning of the word massage, immediately have it printed on their cards, and keep on with their "rubbin'" just as they always have done.
The vaguest generalities exist as to the manner of doing massage, even among the best authors on the subject, and, after having studied and tried the methods of all, the writer proposes to briefly formulate, as much as space will permit of, what he has found to be of value, without having adopted the methods of any in particular. By so doing it is hoped that some will be able to judge whether those employed to do massage know anything about it or not, or whether it would not be as well to employ one of their own domestics for ordinary rubbing, the advantages of which are not to be despised. At any rate, from the description which follows, I trust that not a few intelligent friends of chronic invalids, who are beyond the reach of the professional manipulator, will be enabled to apply massage so as to afford even greater relief and comfort than can be gained from many of those whom the ignorance of the community on this subject alone tolerates as experts.
The multiform subdivisions under which the various procedures of massage have been described can all be grouped under four different heads, viz., friction, percussion, pressure, and movement. Malaxation, manipulation, deep-rubbing, kneading, or massage, properly so called, is to be considered as a combination of the last two. Each and all of these may be gentle, moderate, or vigorous, according to the requirements of the case and the physical qualities of the operators. Some general remarks here will save repetition: 1. All of the single or combined procedures should be begun moderately, gradually increased in force and frequency to their fullest extent desirable, and should end gradually as begun. 2. The greatest extent of surface of the fingers and hands of the operator consistent with ease and efficacy of movement should be adapted to the surface worked upon, in order that no' time be lost by working with the ends of the fingers or one
