e tender
places at first. These are usually in fixed positions, and can be
avoided or only lightly touched. The shooting pains may be lessened by
deep, slow massage in the tracks of the nerves affected. If, as
generally happens, there are also regions of defective sensation, these
should receive after the general manipulation active, rapid circular
friction, and, perhaps, experimentally, open-hand slapping. As
constipation is one of the troublesome features, the abdomen should have
particular attention, and an unusual amount of time be given to
manipulations of the colon, as described in the chapter on massage. A
full hour's rest in bed, preferably in a darkened room, must follow the
rubbing.

A schedule for the day on about the lines of the "partial rest"
schedule, as described on a previous page, should be followed. A
prolonged warm bath, with cool sponging after, if the latter be well
borne, is useful in lessening pains and nervous irritability,--and this
may begin the day or be used at any convenient hour.

At an hour as far from the massage as possible lessons in co-ordinate
movements are given, after a week or ten days of massage has prepared
the muscles, and baths and a quiet life have steadied the nerves. For
many years past, certainly fifteen or sixteen, the students and
physicians who have followed my service at the Infirmary for Nervous
Diseases have seen this systematic training given, and no doubt they
received with some amusement the excitement about it as a new method of
treatment when it was proclaimed in Europe two or three years ago.

The indication for this teaching appeared too obvious to publish or talk
much about. The patient has incooerdination; one, therefore, does one's
best to teach him to co-ordinate his movements by small beginnings and
by small increases.

The lessons may be given by the physician at first and be executed
under his eye. After a few days any tolerably intelligent patient should
be able to carry them out alone, but still each new movement should be
personally inspected to make sure that it is done correctly.

In patients in the first stage of ataxia the most striking result of
incooerdination is the impairment of station. We therefore begin with
balancing lessons. The patient is directed to stand at "Attention," head
up and chest out, not looking at his feet, as the ataxic always wishes
to do. At first this is enough to require; it will not do to be too
particular about