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PETRISSAGE. 19
linen. It is also clear that if the hand moves over the surface
of the abdomen, the intestines are not acted npon, or only very
slightly. It is of the utmost importance that the hand works
firmly and yet softly, that there is no stiffness in any joint, and
that the fore-arm is kept as nearly as possible parallel to the
patient’s body.
The movement itself has a circular character, and is gene-
rally started from below with the base of the hand. This,
with slight extension (dorsal flexion) at the wrist, passes
under soft, gradually - increasing pressure to the right into
Fig. 7.
the iliac fossa, and then upwards in the line of the ascend-
ing colon. It is natural that the thumb is brought higher
up and comes to lie close under the ribs over the hepatic
flexure. The hand now moves, always in contact with the
abdominal wall, and continuing its slightly circular way to the
left, the thumb and the thenar part of the hand having over-
taken the work. It is not enough to move the hand over ; it
is also pronated a little at the same time, and the thumb is
adducted towards the fingers. These again, as the hand passes to
the left, come over the splenic flexure, and in their turn become
the principal agents. They move downwards, bending more and
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