of nervous disorders it is often combined with rest, rigid dietetics, and electrical excitation. Perhaps the most conspicuously good results are in cases of chronic joint affections and thickening from inflammatory deposits.

Massage consists of a peculiar kneading of the underlying muscles, and is quite distinct from friction and percussion, which touch only the external tissues, but it is often combined with them, and with the "Swedish movements," active, passive, resistive, or assistive. The word, as commonly used, may be understood to embrace all forms of manipulation.

A few desultory lessons will not qualify you to give or teach massage. It takes time, patience, and a great deal of strength to acquire the art, and constant practice to retain any facility in it; for, even when once gained, it is soon lost by disuse. Mere rubbing is often agreeable and useful, but it is not massage.

Theoretic instruction does not amount to much on such a subject, and there are many variations in vogue even among good masseurs, so that the most that can be attempted here is to give a few of the points in which the most rational operators agree, and which experience has shown to be valuable. It is very hard work always-too hard to combine with nursing-but a skilled manipulator will accomplish more in less time, and with less effort, than an inexperienced one. The whole body can be gone over pretty thoroughly in an hour, after which a general rise of temperature of about one degree may be looked for.

The hands need to be at once strong and soft, the motions smooth and even, never jerky. The work should be done from the wrists, not from the shoulders, and you want equal flexibility and freedom of action in

both hands. All movements should be begun slowly and gently, and their force and frequency gradually increased. A very tender spot can be barely touched at first, but, after a little skillful handling, an amount of force can be employed which would have seemed incredible. The whole hand, not merely the ends of the fingers, should be used. In malaxation, or massage proper-manipulation of the deeper tissues-the work is chiefly performed by the ball of the thumb and the palm of the hand. Each muscle is kneaded and rolled with carefully graded force. Begin at the extremities and work toward the trunk. If the feet are cold, keep at them until they are quite warm before going on. Take up each group of muscles systematically, compress, rotate, and relax, advancing by degrees, that each handful may include part of what has been previously treated. Never stretch the tissues in opposite directions at the same time. Muscles should be stretched in the direction from their insertion to their origin, from extremities toward the trunk, on the back from the base of the skull downward, and away from the spinal column. On the chest follow the pectoral muscles in the same way, and on the abdomen knead steadiily and firmly the ascending, transverse, and descending colon. Massage of the abdomen often relieves dyspepsia and constipation.

Friction should act only upon the skin. If counterirritation is desired, a coarse towel, or a brush, is better than the hand. Friction may be vertical, transverse, or spiral. Rectilinear friction should be toward the center of circulation, to assist the venous currents. Thus, on a limb, the heaviest strokes should be upward, the returning ones much lighter. Friction circularly, or at right angles to the long axis, though some

times practiced, is awkward and of little use. What may be done by such motions can be accomplished more effectively by vertical and spiral movements. In the latter, both hands are used at once-one ascending as the other descends. On the limbs, friction may be applied at the rate of one to five hundred strokes per minute; on the body and thighs, the pressure must be greater, and the strokes longer, so that they can not be as rapid. Malaxation and friction may be used in alternation. Take a small portion of the body at a time, as the space between one joint and another, and manipulate it thoroughly before passing to the next. With them may be combined also percussion over masses of muscle, and the various passive, assistive, and resistive motions.

Passive motions are conducted without any effort on the part of the patient. When there is partial control of the muscular action, the operator either helps or tries to hinder the efforts of the patient, being careful not to overtax his little strength, and the exercises are then known as assistive or resistive. Such movements are applied, together with massage, to strengthen weakened muscles and break up adhesions in diseased or ankylosed joints. It is of importance to know something of their anatomical structure and the limits of natural motion.

What is known as the Roman bath is massage with inunction. When there is a dry and insufficiently nourished skin, inunction may be useful; but it is not an essential part of treatment by massage, though unskilled manipulators often use oil of some kind on their hands to avoid chafing the skin.

The "lomi-lomi" of the Sandwich Islanders is a crude kind of massage.

CHAPTER XIII.

The excretory organs-Normal urine-Variations from the normal, in health and disease-The examination of urine-Tests for albumen-Tests for sugar-Retention and suppression-The use of the catheter-Washing the bladder.

THE principal elimination of waste matter from the body is through the kidneys. These are two beanshaped bodies, each about four inches long, lying in the lumbar region, one on either side of the spine. The urine, as it is excreted by the kidneys, passes through two connecting tubes-the ureters-into the bladder, whence it is periodically discharged through another tube-the urethra. The capacity of the bladder, fully distended, is about three pints. The urethra in the adult female is an inch and a half or two inches in length.

Urine, in a healthy condition, consists of some 960 parts water to 40 of solid matter, principally urea-the chief waste product of animal life. The average quantity of urine passed in the twenty-four hours is two and a half pints, or forty fluid ounces. This will contain from 450 to 600 grains of urea, besides a small proportion of uric acid, and various phosphates, urates, and chlorides. It is transparent, of pale amber color, having a characteristic aroma, an acid reaction, and a specific gravity of 1020.

There may

be considerable deviations from the above

standard, even strictly within the limits of health. The quantity will vary in proportion to the amount of fluid taken into the system, and to the activity of the skin. When there is free perspiration, less water is left to be carried off by the kidneys, and, consequently, the urine is less abundant, darker in color, and of greater specific gravity, owing to the increased proportion of solid matter. The specific gravity may vary from 1010 to 1025 without indicating any departure from health. The reaction may for a time become neutral or even alkaline after a meal, owing to the character of the food taken. Diminished transparency may be due to the presence of the earthy phosphates, or the mixed urates of sodium, potassium, calcium, and magnesium, or to mucus from the genito-urinary tract.

The same causes of variation may exist to an extreme degree in sickness. The quantity may be diminished to two or increased to two hundred ounces. The color may be affected either by diminution of the normal coloring matters or by the addition of abnormal ones. Opacity may be occasioned by the presence of pus. Blood gives a characteristic smoke hue to acid urine; with an alkaline reaction, it is more nearly red. Urine containing blood enough to be readily recognizable as such is probably albuminous. Bile imparts a

greenish tinge, often seen with jaundice. In some cases the urine becomes viscid or glutinous; in a variety known as chylous urine, there is an increased consistency, owing to an addition of molecular fat. In hysteria, alcoholism, anæmia, and convalescence from acute diseases, the urine may be expected to be pale and abundant. In the early stage of acute fever the specific gravity is likely to be high, as a large amount of solid matter is excreted. Lowered specific gravity is