Shoulder.—1. Friction with three fingers round the top of the humerus, beginning well in the armpit in front and finishing well in the armpit at the back.

2.  The palm, cupped or hollowed, is placed on the ' point ' of the shoulder, and the tissues moved about.

3.   Effleurage over and round joint.

4.   The pectoral muscle is kneaded from the sternum to the humerus with the ends of the fingers, followed by effleurage.

5.   The muscles of the scapula are kneaded with the heel of the hand from the vertebral border to the point of the shoulder ; effleurage over the same region.

6. The scapula is outlined with the ulnar border of the hand with a sawing movement backward and forward.

Where there is wasting, attention must be given to the folds of the axilla ; the fingers, covered with lint or a towel, should be worked well into the armpit, and the folds worked between the thumb and fingers.

It is not necessary to use all the above manipulations to a limb at one séance ; those are chosen which are the most suitable to any given case.

Sufficient time must be given to each movement that is used to make it effective.

Extra kneading must be given to any wasted muscle or muscles.

Passive Movements.—1. Flexion : the arm is brought forward on the chest.

2.   Extension : it is carried backwards.

3.   Abduction : it is carried outward on a level with the shoulder.

4.   Adduction : it is brought close to the side.

5.   Circumduction : a revolution of the whole limb in which all these movements are performed.

6.   Rotation : the arm is grasped about the middle, the forearm above the wrist ; the hand on the arm makes a twisting movement, forwards and backwards, which turns the head of the humerus in the socket. Another way of doing this movement is to fix the scapula with one hand, and, grasping the forearm with the other hand, make the elbow describe a circle.

7.   Elevation : the arm is raised to the side of the head.

8.   Depression : it is brought down to the side of the body. Resistive Movements.—Resistance is made by the operator's hand on the radial side of the wrist in elevation, and on the ulnar side in depression.

In circumduction, resistance is made on the radial side in the forward and upward movement, and on the ulnar side in the backward and downward movement. In abduction, the hand is placed on the back of the wrist, in adduction on the front of the wrist.

It is of the greatest importance that these movements, both passive and resistive, should be well practised and carefully performed, and that the mechanism of each joint should be thoroughly understood.