adipose, modes of life, exercise, etc. A frequent error on the part of manipulators is in attempting to stretch the tissues in opposite directions at the same time, especially at the flexures of the joints, where the skin is delicate and sensitive, and where the temptation to such procedures is greatest because easiest, the effect being a sensation of tearing of the skin. The rate of these manœuvres varies from seventy-five to one hundred and fifty with each hand per minute on the arms, from sixty to ninety on the legs, and from forty to eighty on the thighs, where more force is required on account of the larger size and density of the muscles, and the need of using sufficient force to extend beneath the strong, tense fascia lata.
On the back the direction of these efforts will be from the base of the skull downward, stretching the tissues away from the spinal column while manipulating in graceful curves at an average rate of sixty per minute with each hand. And here one hand can often be re-enforced by placing the other upon it, and thus massage may be done with all the strength the manipulator can put forth. With the ends of the fingers the muscles on each side of the spinal column can be rolled, and the supra-spinous ligament can be effectually massèed by transverse to-and-fro movements. The ends of the fingers and part of their palmar surface should also be placed on each side of the spinous processes, and the tissues situated between these and the transverse processes worked upon by up-and-down motions parallel to the spine, taking care to avoid the too frequent error of making pushing, jerky movements in place of smooth, uniform motions in each direction.
On the chest and abdomen the same general direction will be observed as in using friction, but the manipulation will be more gentle than on the back and limbs, for the tissues will not tolerate being so vigorously squeezed and pinched. Here the massage will consist of moderate pressure and movement with the palms of the hands, and rolling and grasping the skin and superficial fascia; and, after this, on the abdomen, steady, firm, deep kneading in the direction of the ascending, transverse, and descending colon, using for this purpose the greatest force with the heel of the hand on the side of the abdomen next the operator, and on the other side the strongest manipulations with the fingers, avoiding the frequent and disagreeable mistake of pressing at the same time on the anterior portions of the pelvis.
Before leaving this part of the subject, the writer begs leave to say something more about the common errors into which manipulators fall, even some of those who pass for being skillful. Many do not know how to do the kneading or malaxation with ease and comfort to themselves and to their patients, for, in place of working from their wrists and concentrating their energy in the muscles of their hands and fore-arms, they vigorously fix the muscles of their upper arms and shoulders, thus not only moving their own frame with every
