nipulator.]

The same operation may be applied also to the legs while the patient is
standing.

In Fig. 7, the back is presented to the action of the rubbing-pad. The
action will, if desired, be made to reach from the neck to the hips, and
even to the thighs. All sensitive portions of the back should at first
be omitted, in order that they may be benefited by the
counter-irritation or drawing away of the blood. This is easily produced
by those familiar with the use of the machine. The rubbing of the back
should be deferred till the close of each application, in order that the
spinal centers may be relieved of hyperaemia, or excess of blood.

The machine, as represented by Fig. 8, is brought to the desired
elevation, about as high as the shoulders, and the hand-holder is
attached. One arm is extended horizontally, and the hand grasps the
hand-holder, while rapid motion is given by turning the wheel. An
alternate twisting motion is communicated to the arm, which causes
corresponding pressure and relaxation of all the soft tissues of the
limb, combined with slight rubbing or attrition. The action is increased
by contracting the muscles, and also by grasping at greater distance
from the center. Both hands may grasp at the same time, or the two sides
may receive the motion in turn. The effect is similar to that of the
rubbing before described, but it is less limited; by grasping firmly, it
may extend to the whole chest.

[Illustration: Fig. 11.
Vibrating Kneader.]

The foot-holder is attached, as shown in Fig. 9, and brought by the
means before described to a position to receive one foot at a
comfortable elevation, the leg being extended, while the patient is
seated in an ordinary chair in an easy position. The action is precisely
like that above described as applied to the arm, and extends to the
thigh and pelvis. If the knee is slightly flexed, the action is almost
entirely confined to the lower leg. Each leg may be operated on in turn.

_Mode of Applying Mechanical Movements to Very Feeble
Invalids_.--Experience demonstrates that no degree of feebleness
excludes the beneficial use of these operations. Invalids too weak to
stand, or able to help themselves in the least degree are often treated
with perfect success. A judicious use of the Manipulator _always_
increases nutrition and strength without any fatigue or exhaustion,
however feeble the patient may be. It is only necessary to provide for
these cases addition