It is not necessary, in giving general massage, to use all the movements that have been learned. In manipulating, say, a paralyzed limb more movements are given to it than would be given to any limb in the course of general massage. No special movements, such as are used in sprains, synovitis, etc., are called for. There is no fixed rule, but it is usual to begin with the lower limbs ; it is unimportant, except where there is congestion of abdominal organs, when massage of the lower limbs follows that of the abdomen. In some instances the medical man may wish the abdomen ,to be the part to commence with, which would, of course, decide the matter.

The patient is prepared as in Chapter II.

The Foot.—Each toe is rubbed lengthwise between the thumb and finger and crosswise with the palm of the hand, as on p. 125 ; the sole is kneaded with the palm ; then the foot is taken between the hands and effleurage given on dorsum, sole, and sides ; lastly, the foot is compressed with the hands.

The ankle is kneaded with the heel of the hand on every aspect.

The Leg.—Effleurage on sides and back, carefully avoiding the tibia ; all the muscles are then taken in the hands and deeply kneaded with palms. Fulling and squeezing from ankle to knee ; slapping ; rolling effleurage. The leg is covered.

The knee is kneaded as the ankle in every aspect ; effleurage in semicircular fashion.

The Thigh.—Effleurage on sides, back, and front ; deep kneading of muscles with palms, as on the leg. Fulling and squeezing ; tapping ; beating ; rolling effleurage.

The Hip-joint.—Kneading, as for the other joints. It is difficult to get at this joint, as it is deeply seated and covered by such strong muscles.

Exercises.—The limb is covered. The toes are taken in one hand and flexed, extended, and circumducted en masse, while the other hand steadies the foot. The knee is flexed and extended ; the thigh is flexed, extended, and circumducted. The exercise of these and all other joints should be carefully and thoroughly performed, whether passive or resistive ; for, though there will probably be nothing the matter with the joints in these cases, it must not be forgotten that the results of joint movements are far-reaching. They act on the muscles, strengthening them ; they stretch and compress bloodvessels, thereby increasing circulation ; tendons, ligaments, fascia are stretched. Many veins are attached to fascia: when it is stretched the walls of the vessels are drawn apart and suction is set up.

Stretching of tendons causes an increased flow of lymph ; nerves are stimulated. This is dwelt on here because beginners, who may be careful and painstaking in moving a painful or stiff joint, are sometimes careless in giving movements to an uninjured limb, not doing the movements thoroughly, and giving no support to the limb while moving it, simply half bending and straightening, and, for circumduction, which is a very important movement, giving a little twist.

The upper limb is treated in the same way as the lower.

Should the muscles of the limbs or of one of the limbs be wasted, it is better to isolate the various groups and knead them separately with thumbs and fingers, and to omit fulling and squeezing. There is not time in the hour allowed for general massage to do all the movements if each has due care and time : hurried work is not good work. Such movements as are the most suitable are chosen, but deep kneading with palms is never omitted.

The Neck.—Effleurage downwards ; kneading with fingers.

The Chest.—The hands are placed on the points of the shoulders, drawn forward to middle line, down on sternum, turned under the breasts, then returned to shoulders the same way. To be repeated five times. Friction with both hands laid flat on the chest, fingers pointing upwards. All muscles well moved.

The breasts do not require to be manipulated in general massage, and should be avoided in working on chest and abdomen.

The Abdomen.—Liver and stomach as in Chapter IX. Any or all of the movements for constipation, according to circumstances. Vibrations with the palm of the hand over liver, stomach, and intestines. Vibrations may also be given to each limb as it is finished.

The hand or foot is taken between the hands of the masseuse, thumbs on the back, fingers underneath. By gently shaking her own arms a vibration is produced in the limb of the patient ; this is kept up for half a minute, traction being made at the same time.

The Back.—The patient is turned and the back massed as in. Chapter IX. In a séance of one hour the time may be divided as follows : Lower limbs, twenty-five minutes ; upper limbs, ten minutes ; front of trunk, fifteen minutes ; back, ten minutes. There is no hard-and-fast rule; some part might require more work, when less would be given to the rest of the body.

Before leaving, the masseuse should assure herself that someone is within call, or a bell within reach of the patient.

A weak or nervous patient may require a drink of milk or beef-tea.

If the patient is not confined to bed she should remain there for an hour after general massage.

General massage, or massage of the lower limbs only, is now frequently prescribed for pregnant women, who are unable or unwilling to take sufficient exercise. It in no way differs from that just described, except that massage of the abdomen, tapotement of the sacrum, and circumduction of thighs and arms are omitted.

It is not always necessary that the séance should last for an hour ; in the majority of cases forty or forty-five minutes are ample, and in some cases half an hour is sufficient. A small and thin patient could not stand an hour's work without fatigue, while in the case of a large and stout patient an hour is scarcely enough. Judgment must be used ; in any case, it is well to begin with half the time that is intended to be the maximum.

Although massage is used to relieve the sense of fatigue, and is most successful in doing so, the masseuse must remember it is quite possible for her to fatigue her patient by her work, and thus do her harm ; therefore if a patient complains of fatigue after massage it behoves the masseuse to examine herself as to the character of her work. Again, massage soothes irritable nerves, but may, if improperly done, irritate them to an unbearable degree. As has been said before, the operator must set out with a fixed idea of what she wants to do and the results she wishes to produce. The only way to attain good work is by the study of the theory of massage and by constant intelligent practice, thinking out the effect of every movement. It must not be supposed that when the student has gone through a course of instruction, or even has passed a proper examination, that she is a finished masseuse : she has only been prepared to begin her own training, and thereafter it must be practice, practice, practice—study, study, study.