n the tender regions, and will end by
kneading them with all desirable force. The same remarks apply to the
spine when it is hurt by a touch; and it is very rare indeed to find
persons whose irritable spots cannot at last be rubbed and kneaded to
their permanent profit.

Sometimes when the patient is found to be much exhausted by massage, it
is well to give some stimulating concentrated food afterwards;
occasionally it may be necessary both before and after. In this case it
would be well to see that the rubbing was not being made too severe.

Very rarely I find a patient to whom all massage is so disagreeable or
produces such annoying nervousness as to make manipulation impossible;
sometimes, though very rarely, massage, especially frictional movements,
causes sexual excitement when applied in the neighborhood of the genital
organs, or even on the buttocks and lower spine, and this may occur in
either sane or insane patients: if the rubber observe any signs of this,
it will of course be best to avoid handling the areas which are thus
sensitive.

Another complaint sometimes made is of chilliness after treatment, and
especially of cold feet. If this is not lessened after a few days, the
lower extremities may be rubbed last instead of first, or as is now and
then useful, the whole order of massage may be changed so as to begin
with the abdomen, chest, and upper extremities and conclude with the
back and legs.[17]

Beginning with half an hour and gradually increasing to about an hour (a
little more for very large or very fat people,--a little less for the
small or thin) the daily massage is kept up through at least six weeks,
and then if everything seems to be going along well, I direct the rubber
or nurse to spend half of the hour in exercising the limbs as a
preparation for walking. This is done after the Swedish plan, by making
very slowly passive and extreme extensions and flexions of the limbs for
a few days, then assisted movements, next active unassisted movements,
and last active movements gently resisted by nurse or masseuse. When the
patient is able to sit and stand, it is well to keep up and extend the
number of these gentle gymnastic acts and to encourage the patient to
make them habitual, or at least to keep them up for many months after
the conclusion of treatment.[18]

At the seventh week massage is used on alternate days, and is commonly
laid aside when the patient gets up and begins to move about.

I