Mezger describes four principal manipulations: _First_, _stroking_ or _effleurage_, in which the hand is passed lightly over the skin, with the pressure from the periphery to the center, following the course of the venous circulation, and the long direction of the muscles from their insertion to their origin. It may be performed by stroking with the palm of one or both hands, with the thumb or tips of the fingers. The two hands are used upon the large fleshy parts of the thighs and buttocks, the back, chest, and neck. _Second, Friction._—This is a deep circular movement, performed with the thumbs and tips of the fingers, or by one hand open or clenched. The products of fatigue collecting in deep muscular tissues are thus thrown into the circulation, the gentle manipulations of stroking carrying them into the superficial veins. The friction should proceed in the same direction as the stroking movements. _Third_, _petrissage_, also described as _pinching_ and _grasping_, is performed by picking up the skin and subcutaneous tissues between the thumb and fingers, and manipulating it with an amount of force not sufficient to cause pain. In this procedure the skin moves with the hand of the operator, and the underlying structures are thus massaged by it under the pressure of the fingers. The thumb and fingers are used to reach the individual muscles and small groups. The movements should proceed from the periphery toward the center. It is used to improve muscular nutrition in case of fatigue, in atrophy, in obesity, and other forms of muscular degeneration. _Fourth, Striking, Tapôtement, or Percussion._—Other names are clapping, beating, knocking, or hacking. It has a stimulating action on the skin, superficial nerves, and vessels. Hacking is performed by the ulnar border of the hand, and is used along the nerve-trunks. _Fifth, Shaking or Vibration._—Shaking involves movements of the whole body or region to be treated, while vibration is a lesser motion in which the body or region remains at rest, while the surface and the structures immediately beneath it are affected. General massage is best given at an hour midway between meals, and never immediately after eating. The parts are at first lubricated with cocoa-butter or vaselin, to avoid the irritation which may follow the friction of the surface. The first process of massage is the simple stroking to empty out the lymph-channels; the next process is directed to the deeper tissues. This is deep kneading, and skill is particularly required here. As the result of this, the muscles are toned up and the nerves are soothed, so that the total effect is that of sedation, and is followed by the removal of the fatigue toxins, so that if necessary it will be possible to undertake work after the massage that would have been impossible before.