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Page 18
In the order usually pursued, the back is the next region treated. The
patient lies prone, folding the arms under the head; a firm pillow is
put under the epigastric region, so as to the better relax the back
muscles, which are too tense when a person lies flat. Beginning from the
occiput, both hands stroke firmly and rapidly downward and outward to
the spines of the scapul�, at first lightly, then with increasing force.
Then the whole back is vigorously rubbed--scrubbed one might call
it--with up-and-down strokes, as a preliminary application. The erector
spin� masses are treated by careful finger-tip kneading. Working from
the spine outward to the axillary line, the muscles of the ribs are
acted upon with flat-hand rubbing. The groups of the upper back and
shoulder-blades are kneaded and squeezed, the arms being partly
abducted so as to separate the shoulder-blades and allow the operator to
reach the muscles underlying them. The lumbar regions receive their
manipulation last. If it is desirable to give special attention or an
extra share of manipulation to any part of the spinal region, this is
done as the physician may have ordered, and the whole process is
completed by downward friction over the spine, given vigorously and as
rapidly as possible.
The chest is the next region to be handled, the patient turning from the
prone to the supine position. In women the breasts are usually best left
untouched unless special conditions demand their treatment.
The last and perhaps most important part of the process of general
massage is the rubbing of the abdomen. Particular care is needed to
secure complete relaxation, as nervous patients and, still more,
hysterical patients are apt to present extreme rigidity of the abdominal
muscles. The head is raised by pillows, the knees are slightly flexed
and sometimes supported by a folded pillow also. With this position the
rigidity generally yields to gentle persistence, at any rate after a
few treatments. If it does not do so, a lateral decubitus may be tried,
a position in which the intestinal regions may be very thoroughly
treated, and in which, if there be gastric dilatation, the stomach-walls
can be best reached. Sweeping circular frictions about the navel as a
centre begin the process; the abdominal walls are then kneaded and
pinched[16] with one or both hands; deep, firm kneading of the whole
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.
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