Laryngitis.—1. The thumb is placed well up under the jaw at one side of the larynx, and the index-finger opposite to it

Fig. 96.—Kneading the Sterno-Mastoid.

on the other side ; a backward and forward movement is made in which the skin is moved with the fingers, the movement being made on the cartilages. This is continued down the trachea.

2.   Friction at each side of trachea.

3.   Work all muscles that can be got at in front of throat between thumb and finger.

4.  Effleurage; vibrations.

Active movements : The patient opens and closes the mouth several times. The lower jaw is carried out sideways many times.

Fig. 97.—Rotation of the Head.

Resistive movements: Flexion, extension, and rotation of head.

Above manipulations and exercises are useful also for tired or weak voice.

Congestion of the head, and catarrh of the nose, pharynx, and larynx, are relieved by throat effleurage. It is done in three ways.

Gerst's Method.—The patient sits or stands with her head tilted back ; the operator stands in front. The ulnar borders of the hands with palms upwards are placed well under the lower jaw, the little finger being in the groove under the ear, and the end of the third and second finger on the mastoid processes. The hands simply rotate on their own axis till the radial borders reach the clavicle, and the palms are turned downwards ; close contact and moderate pressure must be maintained all the time with the whole of the palms.

Fig. 98.—Throat Effleurage (Gerst's Method). Beginning of the Movement.

Pressure is made on the jugular and other veins, and on the. lymphatics of the neck. This movement requires much practice and flexible wrists.

Hoffinger's Method.—The patient is seated, and the operator stands behind. The thumbs are at the back ; the little fingers are close under the jaw ; the palms are kept in close contact with the neck as the hands come down with moderate pressure till the index-finger lies along the clavicle. In this movement the elbows are turned out as the hands rotate. In Geist's method the elbows are kept close to the sides.

Fig. 99.—Throat Effleurage (Hoffinger's Method). End of the Movement.

Weiss's Method.—The operator faces the patient, and places the hands round the neck, fingers at the back and thumbs in front. The stroking is done with the thumbs over the jugular veins.

Fig. 100 —Throat Effleurage (Weiss's Method).

In each method the patient should breathe deeply, to assist venous circulation.