Friction differs from pétrissage proper in that the muscles are not raised or drawn away from the bone. It is done with the cushion of the thumb, or of the fingers, or with the palm of the hand. It is always followed by effleurage. The two movements may be done at the same time—friction with one hand while effleurage is done with the other ; this is a much more difficult way. It is used chiefly on joints, but is also very useful where tissues are matted and thickened.

The cushion of the thumb is placed on the skin and kept on one spot ; by describing small circles with it, without moving it on the skin, the tissues underneath are worked on each other. When several circles (five to ten) have been

made, the thumb is moved on, and the action is repeated. Effleurage is immediately done over the same region, then friction again, followed by effleurage. The tips of the fingers and the palm of the hand are used when more appropriate.

Fig. 5.—Friction.

The effect of this movement is to squeeze out and move on the products of inflammation, to further absorption, and stimulate local circulation. TAPOTEMENT. In doing tapotement, the hands must not be raised more than an inch from the patient's body. The movements should be light, sharp, and springy, the hands swinging from the wrists. It is performed rapidly, and in various ways.

1.   Slapping.—The palmar surface of the fingers, held straight and close together, strike the muscles transversely, evenly, and rhythmically, moving backward and forward and in every direction, leaving no part untouched.

2.   The Flail.—The back of the semi-flexed fingers, held loose and open, to strike as in the previous movement. These two movements are suitable for the forearms, legs, and back.

Fig. 6.—The Flail.

Fig. 7.—Beating.

3.   Tapping is done with the tips of the open fingers, or with the tips brought together so as to form a cone. In the first form one or all of the finger-tips are used. It is suitable on the head and chest. In the second form it is used on the thighs, over masses of muscles.

4.   Beating is done with the ulnar border of the closed hand, or hands, working alternately, used on thighs and buttocks.

Fig. 8.—Hacking.

5.   Chopping or Hacking.—The ulnar borders of the open hands and fingers are used ; the hands are held a little apart, palm towards palm. The fingers, separated and held loosely, fall together at each blow ; the hands strike alternately. This is a deservedly favourite movement. It is used on the back and over nerve trunks. In striking, the little and third fingers come down.

6.   Clapping is done with the whole palmar surface of the hands striking alternately ; the palms are contracted so as to form a hollow or cup. It is used on the thighs and back.

Tapotement excites capillary circulation, stimulates nerves, and causes muscle contractions.