Definition of Massage.—Massage is a method of treating abnormal conditions by various manipulations of the more accessible structures of the body. Its object is to stimulate to greater activity the contents of the cells of such tissues as are susceptible to the effect of kneading, rubbing, rolling, pinching, slapping, stretching, etc.

Swedish Movements.—With massage it is quite usual to combine Swedish movements, a system in which motions of a rhythmical character, both active and passive, are employed. To facilitate the execution of the manoeuvres of both these methods of treatment mechanical contrivances are often used. While not strictly accurate it is customary to include all the manipulations of both these systems, under the general term "massage."

Effects of Massage.—The effect of these manipulations is to promote nutrition, either general or local, to relieve congestion, to aid in the removal of waste products and in the absorption of effusions and abnormal deposits. In the main their influence is felt in the lymphatic and circulatory systems, in the cutaneous, muscular and nervous structures, upon the digestive and nutritive functions, and upon certain of the internal organs.

By alternate contraction and relaxation of the muscles they are exercised as fully as possible without exhaustion, and the blood is propelled with greater activity, thus permitting its life-giving qualities to reanimate and restore the vitiated and worn-out tissues. Respiration and secretion are likewise increased, and the peristaltic movements of the intestines promoted. Probably from a reflex effect on the nerves of sensation it often gives relief from pain. A rise of temperature usually accompanies a treatment by general massage, and where the massage is confined to a limited area a local rise of a number of degrees may occur.


Any knowledge of the technical details of massage which can be gained from text-books or lectures must necessarily be superficial and theoretical, for the manual dexterity essential for its proper application require long and continued practice on the human body to acquire the art. For its intelligent execution a fair knowledge of anatomy and physiology should first be secured.

Forms and Movements.—When the hands of the operator only are employed for massage, the process is termed immediate; when mechanical appliances are used it is termed mediate. The main movements employed in either form are stroking, friction, kneading and percussion, with their modifications. In immediate massage the palms of the hands, the tips of the fingers and the balls of the thumbs are principally, though not exclusively, employed, and the action is a free one from the wrist.

The movements should be smooth and even, and, until the patient becomes accustomed to the treatment, gentle and not too rapid. The degree of firmness and rapidity is regulated by the rigidity of the muscles, the amount of adipose tissue, the part treated, the sensitiveness present and the general nervous irritability of the patient, and may be increased with the duration of the treatment.

In Cases of Obesity.—It may even be necessary in cases of obesity to supplement the action of one hand by pressure from the other. In general massage the extremities should be treated first, the motion being in the direction of the long axis of the bone and extending from the distal end toward the trunk. Each group of muscles is systematically treated, one area being treated before a new one is selected.

Stroking.—1st. In stroking, the palm of the hand or the radial border is used over large areas of surface, or the pulps of the fingers or sides of the knuckles over smaller surfaces.

Friction.—2d. In friction, the tips of the fingers or the full hand is employed over small areas by a circular rubbing.

Kneading.—3d. In kneading, a muscle or group of muscles is subjected to pressure by the hand or hands sufficient to cause the skin to move over the subjacent tissues, the thumb and fingers being well separated and a slightly rotary motion being used. In some portions of the body the tips of the fingers and the backs of the thumb tips are employed.

Fulling.—In which the muscles of the extremities are rolled rapidly back and forth, between the extended palms of the hands, transversely to the long axis of the bone; vibrations in which very rapid pressures and relaxations are employed, and pressure by the knuckles or tips of the fingers, are all modifications of kneading.

Percussion.—4th. This consists of successive blows of varying intensity and delivered by different portions of the hand, according to the part of the body treated.

Position and Rest.—In treating by general massage the patient should be recumbent, with the position relaxed, breathing quietly and regularly. After treatment a period of rest of at least half an hour should be observed. In abdominal and cervical massage the same relaxation should be regarded.

The duration of a single treatment should be from forty to sixty minutes for general massage, or a shorter time for local treatment. The rapidity of the manipulations varies from seventy to two hundred per minute, depending on the method employed and the effect desired.


Massage a Safe Resource.—"It may be said, in a general way, that whenever we desire to modify profoundly the processes of nutrition; to remove effete material from the system; to stimulate assimilation and invigorate digestion; to soothe nervous irritability and relieve nerve pain; to arouse dormant nerve force; to remove morbid deposits from, and from the neighborhood of, inflamed joints, and thus restore their normal mobility; to equalize the circulation, drawing blood from the hot head, congested abdominal viscera or laboring heart, and accelerating its passage through the cold extremities—we may find a safe resource in this system."—Dr. Benjamin Lee, "Hare's System of Practical Therapeutics." Vol. I, page 291.

The wide field of its applicability is thus suggested. Attention is now called to the individual diseases in which it may be usefully employed. Among these may be first mentioned those of the alimentary tract.

Diseases of the Stomach.—In atonic dyspepsia, and in chronic gastric catarrh, accompanied by dilatation of the stomach, in both of which there is a relaxed condition of the muscular fibres, it is often of benefit. Contractions of the stomach are stimulated, the food is forced onward, the nutrition of the organ is improved, the flow of gastric juice is promoted, flatulence is relieved, and pain and distress, either from this cause or when of nervous origin, is alleviated. From two to five hours should elapse after a meal before the treatment is given, and this should last ten or fifteen minutes.

The Proper Movement.—Dr. D. D. Stewart, in "Hare's System of Practical Therapeutics," Vol. II, page 965, thus describes the technique of massage, in these cases: "The massage movements, both stroking and kneading, should be from the fundus and cardia toward the pylorus, gentle and superficial at first, and after a few minutes' manipulation more energetic. The patient should be supine, with abdomen relaxed. At the termination of each treatment the massage should be extended to massage of the abdominal muscles."

Massage in Nervous Dyspepsia.—Lauder Brunton, in the Lettsomian Lectures on "Disorders of Digestion," speaks in glowing terms of the usefulness of massage with forced feeding in nervous dyspepsia, citing the case of a man who from this cause became progressively emaciated during two years to the last degree, and in whom medicines employed by the most eminent physicians had failed to benefit, and who by the treatment referred to was restored to robust health in the course of eight weeks. Such a result is nothing less than marvelous, and while the case may be regarded as phenomenal, it serves to illustrate how marked may be the benefit following the treatment in this class of cases.

Diseases of the Intestine.—Constipation.—One of the most useful fields for the application of massage is in the treatment of chronic constipation, a condition as difficult to radically cure as it is common in occurrence, and which is attended by a train of evils formidable in their effects. It is frequent to see benefit follow simple rubbing of the abdominal walls of children by mothers for the relief of this condition, but the more scientific employment of massage is of still greater value. The course of the colon is generally followed, beginning low down on the right side, moving upward, across to the left side and downward, and repeating these movements in a sort of rotary fashion. Their effect is largely mechanical in aiding onward the contents of the intestinal canal, A cannon ball weighing from four to six pounds and rolled around the abdomen in this direction is a method of mediate massage which may be used as a substitute for the manual form.

Abdominal Uses.—Aside from the mechanical effects produced, however, there are others much more important which may be achieved by the intelligent use of massage. Relaxed conditions of the abdominal muscles and of the muscular layer of the bowel may be overcome, peristaltic movements stimulated, secretions increased and the nutrition and general nerve tone of the tract improved. Hans Leber, directing physician of the Hydriatic Institute of Homberg, Germany, in an article on the treatment of constipation in vogue at that place, which appeared in the "International Medical Magazine," of November, 1898, discountenances the employment of massage for its purely mechanical effects, and advocates strongly the adoption of only those manipulations which will result in "strengthening the intestinal muscles, stimulating peristalsis, reducing the chronic inflammatory condition of the intestinal mucous membrane and removing the adherent tough coating of mucus."

Kneading Process.—Bueler, quoted by Lee in "Hare's System of Practical Therapeutics," emphasizes the importance of discrimination in the selection of the form of massage best adapted to the case in hand, and shows that kneading breaks up fecal accumulations, stroking aids in the excretion of materials loosened by these manipulations, while percussion of the abdominal walls stimulates a reflex contraction of the involuntary muscular layer of the intestine.

Massage Advocated.—In the "Journal of the American Medical Association," May 26th, 1900, Dr. Charles E. Stewart, of Battle Creek, Michigan, writes on chronic constipation as a symptom resulting from a disordered condition of that portion of the nervous system which presides over the alimentary canal, and advocates massage as a valuable adjunct to other treatment, describing as useful the employment of a mechanical device for abdominal kneading, which consists of a table with a large aperture near the centre of the top. In this opening plays a series of six vertically-placed bars. Each bar is separately connected with an eccentric, to give it an independence of motion. When in motion these bars have an undulatory movement. The top of the table is so constructed that with each vertical movement of the bars it moves back and forth, thus bringing the entire abdomen in contact with the kneading bars.


Diarrhoea.—In those cases of acute diarrhoea, which are the result of an accumulation of masses of hardened material, which serves to irritate the intestinal canal, massage aids in disintegrating and dislodging them. In chronic diarrhoea, where there is relaxation of the tissues, properly regulated percussion and vibration will serve to stimulate the parts to a healthier condition.

Hernia or Rupture.—This is a suitable case for the exercise of careful massage, but it requires the most skillful and patient handling by trained operators to avoid damage and to procure good results.

Congestion of the Liver.—This, together with catarrh of the bile duct, is relieved by massage of the abdomen, and by direct massage of the liver, the circulation being thus stimulated. The flow of bile is increased both by the mechanical effect of pressure on the duct and by stimulating the secretory function.

Gall Stones.—Manipulation of the gall bladder and duct has proved peculiarly efficaceous in the treatment of gall stones, and where these are impacted in the gall duct properly conducted massage will often dislodge them, and give speedy and absolute relief.

Valvular Diseases of the Heart.—In valvular diseases of the heart massage may be advantageously employed to decrease the vascular pressure, and thus to relieve the laboring organ.

Dropsy.—Effusions of serum, whether abdominal or in the extremities, is a condition amenable to treatment by massage. Its reabsorption is effected by manipulation of the abdomen and liver, and its excretion by percussion and strong stroking over the kidneys. Moreover, by increasing the tone of the capillaries, a diminution in the amount of watery secretion occurs. Dropsy, the result of pressure from abdominal tumors, may often be relieved by massage.

Varicose Veins.—As an adjunct to other agencies in the treatment of this disorder massage by upward strokings and carefully applied kneadings is useful.

Neuralgia.—From its effect in improving nutrition and the general tone of the system, many cases of nerve pain are relieved by massage. Aside from this, however, treatment of neuralgias by local massage, especially when the superficial nerves are involved, is often of marked benefit. Sciatica is one form in which it has been particularly efficacious.

Headache.—Headaches, whether of a neuralgic character, or dependent on a determination of blood to the brain, are suitable cases for this treatment. In the former the forehead is gently stroked or the scalp rubbed more briskly; in the latter the congested condition is relieved by massage of the neck, downward stroking, using the ulnar border and palmar surface of the hands, the movements extending from the angle of the jaw to the collar bone.

Nervous Prostration.—In this condition, to an extent seen in few, if any others, is the marked benefit of massage shown. The improved digestion, the bettered condition of circulation and general nutrition, the heightened nerve and vascular tone are results which go far toward restoring to a normal state the patient who is suffering from this complex trouble. In the large majority of cases this can be effected by the use of massage, especially when used in conjunction with enforced rest, systematic feeding, and the other agencies employed in what has been brought more particularly to the notice of the profession by Dr. S. Weir Mitchell, under the name of the "Rest Cure."

Paralytic Affections.—In infantile paralysis improvement and often cure will be the result of the systematic use of massage, persisted in for weeks or months, even though a considerable time may have elapsed during which nothing apparently has been achieved. In pseudo-hypertrophic muscular paralysis, in acute muscular atrophy, in posterior spinal sclerosis (locomotor ataxia), and in the paralysis following diphtheria and other infectious diseases it is also often curative. In locomotor ataxia deep massage of the muscles of the back aids in relieving the paroxysms of pain which are so frequently an accompaniment of this disease in its earlier stages, and helps to establish a better circulation. Later on, after muscular movements are wholly or in large measure suspended, the use of general massage to promote nutrition is of service.

St. Vitus' Dance.—Truly remarkable results are sometimes accomplished in this disease by massage. At first light strokings and friction are used over limited areas, these are gradually increased in extent, in frequency and in degree of pressure, and subsequently are followed by systematic movements of the extremities and by light gymnastic exercises.

Writer's Cramp.—This and the allied affections occurring in overused muscles among piano players, violin players, telegraphers, knitters, blacksmiths and others whose occupation requires the constant employment of certain groups of muscles are all improved by massage treatment.

Mental Affections.—In mental depression, melancholia and in those forms of insanity which are not characterized by active delirium and excitement, massage and passive exercise are useful.

Muscular Rheumatism, in such form as occurs in lumbago, wry neck, and so forth, is curable by circular kneading and stroking.

Stiff Joints, following rheumatism and gouty affections, and effusions in and around the joints, are often remarkably benefited by massage.

In these cases the treatment should be begun above the joint and gradually extended to it, and should consist of friction and upward stroking and of the kneading of the tissues.

Sprains.—Gentle massage, even in the acute stage of sprains, is followed by the most gratifying results. Pain is relieved, swelling is reduced and the duration of the trouble is much less than by the ordinary methods of treatment by rest and fixation. If masseed by a skilled operator from the beginning of the injury, two or three times daily, only about one-fourth of the usual time is occupied in effecting a cure.

Curvature of the Spine.—Certain cases of spinal curvature not dependent on mechanical causes are amenable to treatment by exercise and massage of special muscles.

Congestion of the lungs.—In this trouble, especially when chronic in character, benefit may be expected by massage.

Consumption.—It is more especially, however, in consumption, where it is applied vigorously and persistently, and is to be judged from its effect in toning and invigorating the system and in improving nutrition that its gain is most apparent.

Croup.—The spasmodic condition present in ordinary or false croup is relieved by massage, and the membrane dislodged and congestion relieved in true croup by its use.

Pleurisy with Effusion.—In this affection the intercostal muscles on the side of the lung involved are firmly masseed several times a day, absorption of the fluid being thereby stimulated.

Diseases of Women.—This form of treatment is applicable to the relief of some of the diseases peculiar to women, among them ovarian and uterine congestion and ovarian dropsy. In the latter condition greater benefit sometimes results than from tapping, though of course a radical cure cannot be effected.

Miscellaneous Diseases.—Obesity which is probably due to faulty nutrition, stone in the kidney, congestion of the brain and certain diseases of the eye and of the skin are also among the complaints in which massage is sometimes usefully employed.

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