The Liver.—1. Firm friction all over the region of the liver with whole palmar surface of hand, first placed over the epigastrium and encroaching on left hypochondrium, then moved over right hypochondrium.

2.   Kneading with heel of hand over same region.

3.  Thumbs placed end to end below and somewhat under tenth rib, a to and fro sawing movement is made from right to left and left to right, following the curve of the ribs and costal cartilages, carrying the flesh with the thumbs, the better to make pressure directly on the liver and gall-bladder. This movement may be done with the ulnar border of the hand, or with the base of the hand.

4.   Deep stroking many times with both hands.

5.  The patient is turned on the left side, that the liver may be reached from behind, where friction and kneading are repeated.

6.  Tapotement with ulnar border of closed hand over the whole region of the liver. Hacking may be added.

It is permissible to work in a jerky manner over the liver. Vibrations with palm of hand may be used when suitable.

Fig. 81.—Kneading the Liver with the Ulnar Border of the Hand.

Fig. 82.—Kneading the Liver with the Base of the Hand