This may be performed with the ulnar border of the little finger, either alone or supplemented in turn by the other fingers - the result being a series of soft blows, the first from the little finger direct, the others from each successive finger in turn transmitted through the finger or fingers that have already delivered their tap (see Fig. 13). Sometimes the little finger is curled up in the palm of the hand, and only the middle fingers are used. If a more vigorous action is deemed necessary, the ulnar surface of the whole hand may be used with all the fingers kept close together and contracted but not rigid. The tips or palmar surfaces of the three middle fingers can be used; and a complicated movement called "tapote-ment a I'air comprime" has been devised in which the palm is kept concave with the phalanges fully extended until the moment the hand is about to come in contact with the body, when the whole surface of the palm of the hand and fingers is rendered suddenly convex, the fingers being opened and extended. The movement is performed from shoulder, elbow, and wrist combined. It is only used in heart treatment: its value is speculative, and presumably it can only act by reflex due to rhythmical skin stimulation. As a psychical method of treatment it may be of greater value (cf. p. II).

Fig. 13. - Hacking. Mildest form. Note wrist action and position of the fingers.