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EFFLEUBAGE. 11
and it must be carried step by step downwards, because the
amount of exudation which is driven forwards is of course far
less than it would be if one started at the extremity of the limb.
The consequence of this, again, is, that more force can be used,
less pain is caused to the patient, and the resorption is quicker.
The operator should be careful to hold his own arm as nearly
as possible parallel to that of the patient. The manipulation is
thus easier to give, and is less hard, as every bending in the
wrist joint causes more stiffness in it, greater pressure on the
part worked on, and also changes the direction of the force.
The part of the hand with which to work depends on the
portion of the body to be acted on, and the cause. For instance,
round the ankle, or for thickening of a tendon, the first phalanx
of the thumb or the fingers is used, but not in such a pointed
manner as is generally shown in diagrams.
For my own part, I never give effieurage first, but invariably
precede it with some other movement, such, for example, as
petrissage. Most operators, on the contrary, usually begin with
it. There are, I understand, even those who, as a preparation,
for several days limit their treatment to this movement alone,
and that only round the affected part, if it be painful, as in a
distortion. That is to say, the exudation is allowed to settle,
and the pain caused by it at the beginning is not relieved. Such
a procedure is simply a waste of time. I have given petrissage
and effleurage at once in fresh distortions, dislocations, fractures
of the fibula, radius, and round the elbow, and I have never had
the slightest reason to regret this method.
To give effleurage for neuralgic pains is a still greater error,
because there are other easier and more effective manipulations
suited to their cure,—I mean nerve vibrations.
Whenever effleurage is given in any affection where the
sbghtest movement produces pain, one hand must be used to
steady the part. In fact, I invariably make it a rule to do this
even when there is no pain. It gives me greater command over
the hmb, and the manipulation i.s more accurate.
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