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In the internal-external method, one or two fingers are inserted into the rectum or the vagina to support the uterus while manipulation is done with the fingers of the other hand upon the abdomen. The manipulations must be gentle, yet with gradually increasing force and the uterus should be firmly supported. This is not a treatment to be given without a thorough knowledge of the technic and of the internal parts and their relations; but when properly done it is beneficial in some abnormal conditions, among the most important of which are adhesions and displacements.
Vibration may be given to the uterus or the prostate, espe¬cially the latter, by manual means, though it is difficult. A special applicator may be attached to the portable vibrator for direct vibration through the rectum. Such treatment properly administered is often a considerable benefit.
The application of massage need not be discussed here. In a great number of abnormal conditions massage, either gen¬eral or local, is of benefit, sometimes of great benefit—as, for instance, in infantile paralysis, insomnia, neurasthenia, writer’s cramp and similar affections, chorea, neuralgia and chronic neuritis, dyspepsia, constipation, lumbago, locomotor ataxia and sprains. In this and the following volume the various diseases are discussed and suitable treatment for them sug¬gested, massage being mentioned when it is known to be of benefit, and special instructions given when considered neces¬sary in connection with its administration.
Uterus. Massage of the uterus is often given for its tonic effects. It may be done externally, entirely or partly intery nally and partly externally. In external massage the patient lies on the back, as for abdominal massage.
The first move-ments in this massage are manipulations of a circular nature, clockwise, to the center of the lower abdomen. Stroking and friction terminate the massage, these movements to be in the same direction but covering a somewhat larger area of the lower abdomen. The bladder should be emptied before the massage. The final procedure of this treatment consists in beating the lower part of the back alternately with the two hands. If this treatment (massage and percussion) follows massage of the entire abdomen for relieving the bowels, better results upon the uterus will be secured.
Ovaries. Massage of the ovaries is sometimes advocated by gynecologists for the relief of congestion, neuralgia, adhe¬sions and other conditions. The patient lies on her back, as for abdominal massage. The operator stands facing the pa¬tient’s face, her hands on the sides of the patient’s lower abdo¬men, near the prominent anterior bony projections of the iliac bones (the iliac crests). Stroking is done with both hands at the same time (in opposite directions) from center to sides of the lower abdomen. Friction is done with the finger-tips in the same direction. Moderate manipulation may also be done with the finger-tips about the ovarian region. During the massage the patient should breathe deeply and regularly.
Prostate. Massage of the prostate is given much more frequently than that of the uterus. There is an internal and an external method, but the external method is rarely used. It is much less direct than the internal method. For the internal method the patient may either stand at the end of a table and lean forward until the elbows rest on the table, or lie on the right side (for a right-handed operator), with the knees somewhat bent, the upper knee more than the lower. The operator inserts the index finger (sometimes the long finger or both fingers) into the patient’s rectum and gives downward stroking and circular massage movements.
Another method, a combination of internal and external, is similar to the above, except that the finger or fingers in the rectum serve only to secure the prostate, which then is manipu¬lated through the abdomen with the thumb and fingers of the other hand. The inserted finger should be covered with a rubber finger-cot, or a rubber glove should be worn, the in¬serted finger being well lubricated. In the external method the patient lies on the back with the knees drawn up (as for abdominal massage), holding the sexual organs up on the abdomen. The operator strokes and frictions the perineum. This has only a slight and indirect effect upon the prostate. In every case the bladder should be emptied before the treat¬ment begins.
Nose. In massage of the nose the operator stands at the side of the reclining patient and gives slow, moderately firm pressure in downward strokes with an index finger on each side of the nose, turning out slightly at the nasal wings to the cheeks. The skin is stretched and the massage movements given crosswise when scars are to be treated on or near the nose. Small circular movements may be given at the junction of nostrils and cheeks.
Eye massage is given with the patient sitting and the head bent backward, the operator standing at the side. Placing the index finger of the right hand (for the right eye) on the eyebrow to support the hand, place the second finger on the eyelid and give quick rotary motions with moderate pressure. The finger may change positions so as to reach all parts of the eyelid, but it is chiefly the eyeball that it is desired to massage.
This can be reached with the finger near the edge of the lid. In this operation great care must be taken to avoid un¬due pressure on the eyeball. For vibration to the eyeballs the operator stands behind the patient and places one or two fin¬gers on each closed eye, tenses his arm muscles and gives rapid vibratory movements. The distance covered by the fingers necessarily is slight in this movement. A good eye vibration is also secured by striking the finger on the closed eyelid with the ends of the first and second fingers, having these flexed and rapidly tapping with and lifting them alternately.
In facial paralysis the above procedures are not used, ex¬cept those about the forehead and the eyes. Somewhat more effective massage is given with the thumb over as much of
the cheek region as can be reached, working opposite the in-dex finger which is placed in the patient’s mouth. The finger, of course, should be thoroughly cleansed. It may be pro¬tected by a rubber cot or a bit of silk or linen. Stroking, friction and kneading are given with the thumb in this position.
With a hand on each side of the face, stroking is done from restore it to a normal condition, in which case friction may be repeated, followed by upward stroking and stroking around the lips and the chin. If vibration is to be used (and when property used it is excellent), a mechanical hand or a portable vibrator should be employed, the soft-rubber applicators and especially the rubber brush being selected for use. This part of the treatment, however, must be of short duration.
Face. In facial massage the patient may be sitting or reclining, and should be as much relaxed as possible. The ■ treatment begins with the strokes to the forehead as mentioned above. Then with one hand stretching the part worked upon, the other hand frictions one half of the forehead at a time, in small circles. The strokings are repeated, firm pressure being made at the temples, moderately stretching the skin across the forehead. Then, with the finger-tips, outward strokes are made from the nose to the temples immediately above and below the eyes, followed by friction to the same parts and in the same directions.
The fingers and thumb of one hand stretch the skin at the outer corner of the eye while the fingers of the other hand friction this region. This is excellent for the wrinkles commonly called “crow’s feet.” Then light stroking above and below the eyes is repeated. The sides of the nose are then stroked with the forefingers, from the eyebrows to the wings of the nose and then outward to the cheeks.
Head. Mas¬sage of the head and face is some¬times given dur¬ing a general massage, but not as a rule. In head massage the patient is usually leaning against a chair-back so as to be comfortable and relaxed. Supporting the patient’s forehead with the left hand (if right-handed), the operator places the thumb of the right hand on one side of the patient’s head at the top, the fingers on the other side, and strokes downward to the neck, over the hair. The fingers are then slightly separated and passed through the hair so as to be in as close contact with the scalp as possible. Then they are moved to and fro over the skull, drawing together and toward the thumb so as to roll the scalp between them. The fingers maintain a firm pressure but do not move over the scalp during the movement. This avoids breaking brittle hairs. To move the fingers to another region the pressure is relaxed though the contact is maintained.
After the entire head is stroked and kneaded (one hand doing the work at all times while the other is opposite, serving as a support), hacking (punctation) is done with the finger tips, or lightly with the ulnar surface of the hands. For this movement both hands work at the same time, in rapid alter¬nation. Scalp massage is soothing and many bedfast patients are benefited by it. A considerable portion of the head may be massaged with the patient reclining. In most cases, how¬ever, hacking should be avoided.
Forehead. In massage of the forehead the thumbs are placed together between the eyebrows, and firm stroking move¬ments are made in a curve upward and outward over the tem¬ples to the ears, the two thumbs working in opposite directions at the same time. The successive strokes gradually ascend on the forehead to the roots of the hair.
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