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12 PASSIVE MOVEMENTS.
I have seen diagrams showing effleurage of the throat. There
has been, according to niy judgment, one common mistake in
them, viz. the leaning back of the head. The movement, I
suppose, is to have its effect by the centripetal pressure produced
on the vena jugularis interna. But if we look at the anatomical
arrangement of the parts, we shall find that the sterno-cleido
mastoid and omohyoid muscles cross the vein, and must also
produ.ce their pressure when the head is thrown back. If any-
thing is to be avoided it is decidedly positions which in them-
selves hinder the venous circulation,—much more so then, when,
as in the present case, they are entirely unnecessary, since the
completely erect position is the correct one.
As regards the duration of effleurage, this depends on the
cause of treatment. I am quite unable to offer an opinion as
to how long effleurage should be given in order to lull pain
alone, because I always use nerve vibrations. Under other
circumstances, I prefer a few slow, strong, and deep strokes to
any number of light and quick ones.
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