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10 PASSIVE MOVEMENTS:
In any case, both forms must, according to my opinion, be made
slowly. If the hand is passed quickly over the skin, heat and
redness of the surface are caused. The operator has thus
produced hypertemia of the skin, i.e. drawn the blood to the distal
side say of an effusion,—and that is certainly a very questionable
advantage. Besides, in the deep eflieurage it gives the patient
more pain.
If the ettieurage is only superficial, one ought to begin at the
extremity of the limb ; when it is deep, however, a commence-
ment should be made somewhat higher than the upper border
of the swelling.
Fig. 1.
Take, for instance, efHeurage of the right forearm when
effusions are present (fig. 1).
The patient rests his arm on a table, and the operator
steadies it still more by grasping the wrist with his left hand.
He then, with the radial border of his right hand forwards, makes
a stroking movement from below upwards, beginning at first
above the effusion and gradually coming down, allowing each
individual stroke to have its normal direction.
The efHeurage ought to begin higher up than the exudation
extends, in order to stimulate the tissues above to brisker activity,
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