The Art of Massage
J. H. Kellogg, M.D.
    The names of Metzger and Zabludowski stand prominent above all other living authorities in all that pertains to scientific massage. Though first in the field as a remarkably successful practitioner of massage, Metzger has done little or nothing for the advancement of our knowledge of the physiologic effects of manual manipulations of the body; but Zabludowski, the professor of massotherapy in the medical department of the University of Berlin, has contributed largely to the establishment of massotherapy upon a sound scientific basis.
    The writer having been afforded an opportunity to study and observe the methods of applying and teaching massage in the clinic devoted to this special department, which is presided over by the amiable Professor Zabludowski, he is able to speak from personal knowledge of the great efficiency of the methods employed, and it is the purpose of this chapter to add a brief description of some of the special features which have been found useful in connection with the methods which have been
elsewhere described in this work.
    The special characteristics of Zabludowski's work are great thoroughness and the speedy accomplishment of results. Zabludowski, although a most enthusiastic specialist, nevertheless does not claim massage to be a panacea. While he makes use of no other measures whatever in the treatment of his patients, he does not undertake to cure every malady by this means alone, but occasionally refuses to take patients whom he deems unsuited to manual treatment. The special methods which the writer considers of greatest value, and which are employed by both Zabludowski and Metzger, are the following: --
    Grasping Kneading. - A method of deep kneading, designated as wringing, is elsewhere described in this work. An excellent modification of this method employed kv Zabludowski is administered as follows to the leg: The manipulator stands facing the patient. (Plate L.) Both hands grasp the limb close to the foot. The hand nearest the foot is carried over as far as possible. Then, firmly grasping the limb, the soft tissues are moved on the bones as the hand is drawn over toward the manipulator. While this movement is being executed by one hand, the other hand moves in the opposite direction, so that when the hand first set to work relaxes its grasp, the other hand is just grasping the limb. With this grasping and twisting movement, the hands, working in alternation, move up the limb from the ankle to the upper parts of the thighs. While the masseur stands on one side, he manipulates the inside of the leg nearest to him, and the outside of the other leg; then stepping to the other side of the couch, or after the patient turns over, he executes the same movements, thus completing the work on the lower extremities. The arms are treated in a similar manner.
    Abdominal Kneading. - Zabludowski's method (Plate M.) of abdominal kneading is simple and effective. The movements consist almost exclusively of alternate movements of the two hands, pressure being made first with the heel of the hand, then with the fingers. In beginning, the two hands are placed upon the abdomen, one above the umbilicus, the other below this point. The right hand is first put in action, firm pressure being made with the ball of the thumb and the heel of the hand until the median line is reached. Then the pressure is transferred to the palmar surface of the fingers, upon which firm pressure is made, care being taken to avoid pressure with the finger tips, which is painful. This movement is executed four to eight times; then the same movements are made with the other hand. Next the two hands are made to work in alternation. Then both hands work together in the same direction. Next the same movements are executed in a semicircular way, each hand describing about a third of a circle, one below the umbilicus, the other above the umbilicus.  Pressure is then made the whole length of the colon, beginning at the lower end of the cecum, and following the colon around from right to left with the left hand, while re-enforcing pressure is made with the right hand placed upon it.
    The manipulator now changes his position, and with his right side turned toward the patient's right, and facing the head of the patient, he places his hands upon the abdomen, parallel with the axis of the patient's body, the right hand to the left of the umbilicus, the left hand to the right, the palms of the hands resting upon the lower abdomen just above the pubes. The same movements are now executed as before.
    The patient is now made to turn upon the left side, and while he lies in this position, the transverse movements first described are executed. He then turns upon the right side, and, the manipulator kneels upon a low stool beside him, and repeats the same transverse movements.
    There are several reasons for the application, of these movements in these several positions. A change of position is agreeable to the patient. Second, the manipulations reach in a more thorough-going manner all parts of the abdominal contents. Third, the work is less wearisome to the manipulator.
    If accumulations of fecal matter are found in any portion of the colon, special kneading movements are applied for the purpose of breaking them up. Zabludowski does not believe that abdominal massage to any considerable extent mechanically removes the intestinal contents. The chief effects produced are the breaking up of impactions and stimulation of peristalsis by means of which the stagnating contents may be moved downward and discharged.
    Abdominal massage is always terminated by making the patient breathe very deeply while the attendant makes firm pressure on the abdomen with both hands. The effect of this is to drive the blood out of the abdomen into the, general circulation, thus raising general blood-pressure while relieving visceral congestion.
    Rhythmical Manipulations. - Zabludowski lays special stress upon executing movements in a rhythmical way. Prolonged manipulations of parts for the purpose of removing exudations are chiefly executed with the ball of the thumb, the hand being placed upon the part in the manner indicated in the accompanying cut. (Plate M) Pressure is made in one direction only, the hand being drawn back with a double patting movement. The rate is about two to the second, the count being, one, two and,- one, two and,- in two-four time. The effect of this mode of manipulation is very pleasant, indeed. It is commonly continued from three to ten minutes, or until decided effects have been produced. In applications made to the wrist, the hand of the patient rests upon a stand of convenient height, so that firm pressure may be made. The same manipulations may be applied to the ankle, the hand, the groin in chronic appendicitis, to the hypogastrium in cases of chronic passive congestion of the pelvic viscera, to the elbow, knee, shoulder, and parts in which fractures or dislocations have occurred, leaving behind stiffness, soreness, or exudates.
    Friction. - Much attention is given by Zabludowski to friction movements to the back. The movement is made in one direction only, usually from below upward. Both hands are employed, and as they are pushed, from below upward, an alternate lateral movement is executed, thus diminishing the traction upon the skin, and facilitating the upward movement with the hand. This is especially important in the case of patients in whom there is an unusually luxuriant growth of hair.
    The writer's method of applying friction to the extremities is, the following: The manipulator stands with the right side to the patient's right, and near the patient's feet. The left foot is placed a little in advance of the right. The right hand is placed upon the inner surface of the limb, close to the ankle, and in such a way as to grasp it as completely as possible. The hand is then carried with a firm movement as high as the knee. It is then slipped around under the knee so as to make pressure upon the large blood-vessels underneath the knee, and to avoid unpleasant pressure of the thumb upon the knee-cap. As soon as the knee is passed, the thumb is allowed to glide back to the front of the leg, and the hand is carried upward along the inside of the thigh to within three or four inches of the perineum. By a movement at the wrist the hand is then swept around until it lies parallel with the limb, the fingers upward. Then the hand is pushed on up to a point just above Poupart's ligament, firm pressure being made with the heel of the hand over the femoral vein. By this means the large veins which lie just beneath the skin are emptied in the most thorough manner possible. After three or four movements made with the right hand upon the inner surface of the limb, the left hand executes similar movements upon the outer surface.
    The arms are treated in a similar manner. The patient is then made to turn over, and in a similar way the back of the legs, the back, and the buttocks are treated.
    It is important for the manipulator to give attention to the position of his body. The arms are held straight and rigid during the movements. The back is not bent as the arm is carried upward, but the body is carried forward by bending at the hips and by slightly bending the knee of the advanced limb. By a little practise this method is easily acquired, and it is found to be very effective. The work is chiefly done by the weight of the body. There is thus an enormous saving of muscular effort both for the arms and the back, while much stronger pressure is brought to bear upon the patient than would be possible by any other means. (Plate L.)
    Musical Percussion. - All movements, whether kneading, friction, or percussion, should be applied in perfect time and tune. No false moves should be made; no discordant notes should spoil the harmony. Percussion movements should be made with an even, regular rhythm. The movement and rhythm may be varied in various ways, especially by change of time and accent. A very effective variation is to make two movements of the right hand to one with the left hand. This gives the effect of exceedingly rapid movements. Slow, heavy movements may be made with one hand, preferably the left, for example, and lighter movements at twice the rate with the other. This variation. is easily executed by raising the left hand two or three times as high as the other. This movement should always be executed with a flexible wrist so that the tissues will not be bruised, and to avoid an unpleasant jarring effect.
    The above suggestions will, I feel sure, be found helpful by those who will take pains to perfect themselves in the measures which have been briefly described.
    Order of Movements in General Massage. - The following order is followed at the Battle Creek Sanitarium, in what is commonly known as " Battle Creek Massage," and may be found useful by those who have not had the advantage of instruction by a skilled manipulator trained at Battle Creek, and who desire to use in a systematic way the methods described in this volume:
1. Lubricate from hand to shoulder twice, coming down with four rotary sweeps.
2. Deep kneading to hand and fingers.
3. Friction from hand to shoulder four times.
4. Deep kneading from wrist to shoulder four times.
5. Friction from hand to shoulder four times.
6. Grasping kneading from foot to body four times.
7. Percussion, hacking, spatting, and beating.
8. Friction from hand to shoulder four times.
9. Joint movements, flexion and extension, circumduction.
10. Vibration.
1. Lubricate from foot to body twice, coming down with four rotary sweeps.
2. Foot. Friction to bottom of foot four times. Friction to top four times. Knead foot well. Rotate ankle joint.
3. Friction from foot to body with both hands four times.
4. Deep kneading from foot to body four times.
6. Grasping kneading from foot to body four times.
7. Percussion to feet, and hacking, spatting, beating, and clapping to thighs.
8. Friction from foot to body four times.
9. Joint movements, flexion and extension, Circumduciion.
10. Vibration.
1. Preliminary deep breathing.
2. Friction back of ears and to sides of neck, four passes.
3. Friction from lower end of sternum upward over shoulder to elbow, and from elbow along inner surface of arm across axilla and sides to sternum. The patient lies with hand under head.
4. Circular friction and palm kneading over pectorals.
5. Friction same as 3.
6. Friction and compression over lower chest, with breathing.
7. Percussion, tapping, hacking, and spatting.
8. Stroking.
1. Preliminary deep breathing, chest lifting.
2. Abdominal lifting four times with both hands.
3. Reflex stroking to abdomen.
4.    a. Palm kneading with right hand four times.
       b. Palm kneading with left hand four times.
       c. Alternate four times.
5. Palm kneading of colon, two to six times.
6. Repeat with patient lying on right side.
7. Repeat with patient lying on left side.
8. Deep kneading down and up each side twice.
9. Shaking and vibration.
10. Nerve compression.
11. Percussion, hacking, spatting, beating, and clapping. (Give special attention to the liver and spleen.)
12. Stroking.
1. Friction from foot to body four times, both bands.
2. Deep grasping kneading four times. 
3. Friction from foot to body four times.
4. Percussion to feet, hacking, spatting, beating, and clapping to thighs.
5. Friction.
1. Friction with both hands four times, alternate and circular.
2. Petrissage twice.
3. Friction with both hands four times.
4. Palm kneading twice.
5. Friction with both hands four times.
6. Vibration and shaking.
7. Percussion, hacking, spatting, beating, and clapping.
8. Stroking.
1. Friction, from below up.
2. Petrissage down each side twice.
3. Friction.
4. Muscle-grasping up and down back.
5. Palm kneading down spine twice.
6. Digital friction down spine twice (reinforced).
7. Transverse palm kneading up and down spine.
8. Vibration down spine.
9. Percussion, hacking, spatting, beating, and slapping.
10. Stroking.

    The time required for the above is thirty to forty minutes.