CHAPTER X.

MASSAGE.

Systematic manipulation is of great value both as a means of preserving health and as a scientific method of treating certain diseases in children.

Mere rubbing or friction of the surface cannot be included under massage in its literal sense, still, it is a useful form of manipulation, and needs no special instruction, being possible to any intelligent, soft-handed mother or nurse.

Massage, on the contrary, is an art, and, like every other art, requires study and patient preparation for its successful practice. It is a powerful remedy, too, and, like other agents of its class, as potent for evil as for good in unskilled hands. Therefore, to insure good results, a trained masseuse is necessary-and she must act under the direction of the physician.

Massage includes several processes of manipulation. Those given by Murrell, from whose excellent little work* I have taken much of the description of the different "movements," are effleurage, pétrissage, friction and tapotement.

* 66 Massage as a Mode of Treatment." W. Murrell.

Effleurage is a stroking movement made with the palm of the hand passing with more or less force over the surface of the body centripetally. The movements are made to follow as nearly as possible the direction of the muscle fibres, and for deepseated tissues the knuckles can be used instead of the palm. This method is of minor value in itself, but of great use when combined, as is the rule, with the procedures to be described.

Pétrissage consists essentially in picking up a portion of muscle or other tissue with both hands, or the fingers of one hand, and subjecting it to firm pressure, at the same time rolling it between the fingers and the subjacent tissues. The hands must move simultaneously and in opposite directions, the skin must move with the hands to avoid giving pain, and the thumb and fingers must be kept wide apart in order to grasp a bulk of tissue, a whole muscle belly, for instance. The manipulation must be uniform, in a direction from the extremities toward the centre of the body, bearing in mind the arrangement of groups of superficial muscles and keeping well in the spaces between them.

Friction, or massage à frictions, is performed with the tips of the fingers. It is a pressure movement rather than a rubbing. It is always associated with effleurage, and, to be of any use, must be performed quickly and readily.

Tapotement is a percussion which may be made with the tips of the fingers, their palmar surfaces, the palm of the hand, the back of the half-closed hand, one or other border of the hand, or with the hand partly closed, so as to contain, when brought in contact with the surface of the body, a cushion of air.

The hand of the masseuse must be perfectly clean and soft, and the finger-nails short and smooth. The length and frequency of the sittings must vary with the individual case. Murrell is in favor of short and frequent séances, and also recommends dry massage, that is, without the use of oil, liniments or ointments; vaseline especially is to be avoided.

Our knowledge of the physiological action of massage is based upon experimental research and clinical experience. Experiments were made by Dr. Gopadze (quoted by Murrell) upon four medical students, who were kept in hospital and subjected to systematic manipulations for twenty minutes or more daily. The séance began with effleurage, followed by pétrissage, friction and tapotement, and ending with a second effleurage. The results were increased appetite and a notable gain in body weight. The body temperature fell, never more than .5°, for about thirty minutes after each massage; then it rose steadily, and an hour

later was generally a degree higher than at the commencement of the operation. The movements of breathing were uniformly increased in frequency, depth and fulness. The pulse varied with the kind of “movement" used-light surface effleurage increased its frequency, while pétrissage made it slower.

Zabludowski, experimenting on himself and two servants for eighteen days, noted increased bodily and mental vigor and improved appetite and sleep.

Clinical experience shows that massage increases the activity of the circulation, reddens the skin and elevates the temperature in the part manipulated. It also increases the electrical contractility of muscular tissue, and stimulates the flow of lymph in the lymphatic vessels. Muscular stiffness and fatigue are relieved, nervous irritability is calmed, and restless and wakeful patients are soothed by it into refreshing sleep.

With these facts at hand, it is not difficult to see what a useful agency we possess in skillfully employed massage. By its application we have the power to prevent the wasting of muscles and to augment muscle strength, to build up such tissues as fat and blood, to improve nerve force, both directly by producing a better blood supply and indirectly by relieving irritability and giving rest and sleep, and, finally, to hasten the absorption of

waste tissue and of morbid effusions. At the same time it must always be remembered that massage is a powerful remedy. A short séance with gentle movements may do good in infantile palsy, for example, but it does not follow that by doubling the time or force, twice as much benefit will be derived. In fact, the reverse of the proposition is true; short, gentle massage maintains the size and strength of the muscles, while long, forcible manipulation causes them to waste quickly. The same truth runs through the whole question and must be observed.

sure.

Before entering upon the therapeutic application of massage proper, it will be well to revert to the process of simple rubbing, already mentioned. This is of much value as a general hygienic meaEach day, after the bath, the skin having been thoroughly dried by a soft, warm towel, the whole surface should be gently rubbed with the palm of the hand, the process occupying about five minutes. This increases the circulation in the minute blood-vessels, encourages thorough reaction, aids nutrition and adds vigor to the frame. Weakly children especially thrive under it. In older children, friction with a soft towel may be substituted for hand-rubbing, but this change should not be made before the fifth or sixth year.

Sometimes it is well to rub certain portions of