ocess 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 excit