The Art of Massage
J. H. Kellogg, M.D.
Clinical Notes of Cases Treated by Massage.

    In the following cases treated by myself and my colleagues at the Sanitarium at Battle Creek, Michigan, massage, manual Swedish movements, and gymnastics have been employed as the principal therapeutic means. Baths, and usually some electrical applications, together with other appropriate measures, have also been made use of, as in most cases treated in the institution; but these particular cases have been selected to illustrate the effects of massage, for the reason that in them more benefit was clearly attributable to this agent, than to any other.

    Obesity. - Mrs. W., aged fifty-three, was received for treatment in February, 1893. She had always been inclined to obesity, but had recently found herself increasing in weight so rapidly that life had come to be almost a burden. This patient remained under treatment six weeks, during which time, under vigorous massage administered daily, she lost in weight at the rate of nearly one pound a day. Baths and a systematic dietary were also used.


    Mrs. A., aged twenty-five, was treated for obesity for two weeks. At the end of two weeks she weighed fourteen pounds less than at the beginning of treatment.


    Col. X., aged fifty-three, weighed at the beginning of treatment 334 pounds. He was naturally a very large man, but his weight had been gradually increasing for more than twenty years; and when received, he weighed fully one hundred pounds more than in health. As the result of treatment during eight weeks, the patient's weight was reduced seventy-five pounds. He was then obliged, by business engagements, to return home. He came back the following year, when he was found to have regained in part his former excess of weight; but a second course of treatment secured a still further reduction of the enormous accumulation of flesh about the trunk, which had given the patient's body most unwieldy proportions.


    Emaciation. - Miss B., aged thirty-two, had suffered from tuberculosis. A year in Colorado had effected a cure of the tuberculosis, but had left a large cavity in the upper lobe of the left lung. The patient had never recovered her normal weight or strength since this illness, and within two or three years had been still further reduced by uterine hemorrhages, until her condition had become very grave. Her physician sent her to the Sanitarium with the hope that the hemorrhages might be arrested and her general condition improved. She weighed less than one hundred pounds, was extremely anaemic, and was so weak that it was necessary to confine her strictly to bed for several weeks. At the end of six months this patient had improved to such a degree that she was enjoying better health than ever before in her life. Her weight had increased forty pounds, and her strength had improved proportionately. Digestion and all the other bodily functions were perfectly performed. The patient returned to her home enjoying excellent health, and has remained well to the present time, with the exception of an attack of la grippe.


    Prof. W., aged sixty years, had been a dyspeptic since he was twenty years of age, and had for many years been greatly emaciated. He declared that his stomach was a "swill-barrel." He had been confined to his bed for six months before coming to the Sanitarium for treatment; and was then barely able to stand upon his feet. He could take a few steps with assistance, but was obliged to use a wheelchair in going to meals. During the first four weeks of treatment, this patient gained on an average one pound each day, and at the end of six weeks was so greatly improved that he walked a mile to the depot to meet a brother whom he had not seen for several months, and who, as he afterward stated, had difficulty in recognizing him, so greatly was his appearance changed for the better. Many other similar cases might be cited. It is the author's custom to weigh each patient at the beginning of treatment, and regularly every week thereafter; and it is not an uncommon thing to find a patient who has gained three to five pounds in a single week. From twelve to twenty pounds is very frequently gained in the course of two or three weeks' treatment. Under the system advocated in this work, the patient gains not merely in flesh, but also in strength. A test of the strength is made at the beginning of treatment, and each month while the patient remains under observation. A gain of five hundred to six hundred pounds in strength capacity within four weeks is very common, and sometimes double this amount is gained within a month.


    Rheumatism. - Mrs. T., aged sixty, was received for treatment in September, 1893. In addition to general debility, anaemia, neurasthenia, dyspepsia, and disordered hepatic and renal functions, this patient was suffering from rheumatism and with much stiffness of the left shoulder. General tonic treatment, with general and local massage, especially directed to the shoulders, entirely relieved the rheumatic affection in six weeks.


    Mrs. C., aged seventy, was received for treatment in April, 1892. This patient had a fracture of the wrist which had been treated by means of a plaster bandage. The whole arm was useless; the fingers were extended and could not be flexed; the arm could not be raised as high as the shoulder; only a very slight movement of the elbow joint was possible; the entire arm was practically useless. The application of massage for two months entirely restored the arm, so that it was stronger than the other, as shown by the dynamometer. The patient, when she left, was able to use the arm and fingers freely in combing her hair and for any other purpose.


    Miss R., aged twenty-three, was received in March, 1891. She had suffered from lameness in the left arm for seven years, the elbow being stiff, and the muscles of the arm considerably wasted. For a year she had not been able to use her hand or arm at all, and all the joints were more or less stiffened. The patient was under treatment for five months, at the end of which time the restoration of the arm was nearly complete. The motion of some of the joints was still slightly limited, but she
had good use of the arm, and suffered no pain.


    Mrs. K., aged fifty-three, was received for treatment in August, 1894. She had for several years suffered from stiffness of the shoulder joints, the limitation of movement being accompanied by pain, which was doubtless due to rheumatism. The disability was so great that the patient had for several years been unable to dress herself without assistance. At the end of one month's treatment, she was able to use the affected arm nearly as well as the other; could move it freely in all directions, lifting it above the head and placing it behind her, - movements which had not been possible for more than ten years previous.


    Neuritis. - Mr. X., aged fifty years, a carpenter, had for several months suffered from severe pain in his left shoulder joint. The muscles of the arm had wasted considerably, and the arm was wholly useless; he could not even raise it from his side. He had evidently suffered from neuritis of the nerves of the shoulder joint, and from muscular atrophy, which usually accompanies this disease. Massage, with applications of fomentations and electricity, effected a complete cure in the course of a few months, and the patient has now for seven or eight years enjoyed the full use of the arm as before.


    Writers' Cramp. - Mr. A., aged twenty-seven years, cashier in a bank, presented the most extreme and graphic picture of writers' cramp which the author has ever encountered. The disease affected not only the hand, but the entire arm and the muscles of the neck and face ; and spasms were excited, not only by writing, but by any movement of the body. If the patient attempted to rise from a chair, his head was immediately drawn to the right side, the right side of the face was contorted by muscular contraction, and the muscles of the hand and arm became rigid. The patient's gait seemed to be also slightly affected. He had submitted to several surgical operations, in which some of the nerves of the neck had been divided, and the sterno-cleido-mastoid and other muscles had also been twice divided. Slight temporary relief had followed the operations, but the disease, when the patient came under my care, was worse than it had ever been at any previous time. Upon examination, I found that the patient was suffering from all the different phases of writers' cramp. Whenever he undertook to write, the whole arm became rigid, and the head was drawn around toward the right side until the face looked nearly toward the shoulder. Strange grimaces played upon the countenance in consequence of the contraction of the facial muscles. Examination of the neck showed here and there points of induration. Massage and gymnastics applied to the arm, and thorough local massage of the muscles of the neck, together with revulsive applications of various sorts, including dry cupping, hot and cold applications, and mild counter-irritation, effected a complete cure; and the patient has remained well until the present time, it being now some five years since he was under Treatment. Apparently little or no benefit was derived from other measures of treatment, nor until special attention was given to massage of the affected parts and to the points of induration above 'referred to. Many other equally successful cases might be cited from my experience, in which not only local but general neuritis has yielded completely as the result of the persevering and skillful application of massage.


    Asthma. - Mrs. B., aged forty-one years, was received for treatment in July, 1890, having suffered from nervous exhaustion and asthma for many years. On examination, she was found to have prolapse of the stomach and bowels, and extreme hyperaesthesia of the lumbar ganglia of the sympathetic nerve. The patient was scarcely able to walk about, and could not sleep on account of continued asthmatic paroxysms. During the first two weeks after being received, she was confined in bed by asthmatic attacks, which were extremely aggravated by the slightest exercise. Within five weeks, however, the patient returned home wonderfully improved. The asthmatic Paroxysms were especially relieved by percussion of the chest. Spatting and hacking movements were found most effective.


    Sprain. - Mrs. B., aged forty-four, was received in August, 1893- for treatment for severe sprain of the ankle. Derivative massage was applied at first; later, massage of the joint, including gentle flexion and extension. At the end of ten days the patient was able to visit the World's Fair. She had the misfortune, however, to sprain the ankle again, and was obliged to return for treatment. At the end of two weeks the ankle showed no trace of injury.


    Miss M., aged twenty-nine years, was received for treatment in August, 1893, being unable to walk in consequence of lameness of the left ankle, the result of a sprain received some months before. Massage was applied for several weeks, at the end of which time she was able to walk with ease. Hot and cold applications, heating compresses, local applications of electricity, and other means were also employed, but the chief benefit was evidently derived from massage. A great number of similar cases might be, cited.


    The writer had a personal experience of the benefits to be derived from massage in cases of sprain, which affords very conclusive evidence of the value of this simple method of treatment when skillfully administered in traumatisms of this character. The sprain involved both the ankle and the metatarso-phalangeal joints, chiefly the latter. The pain was so severe that it was impossible to sustain the weight of the body upon the anterior portion of the foot. It was only possible to walk by stepping in such a way as to keep the weight of the body over the heel of the affected foot. Being much engaged, the sprain was neglected for a couple of days, it being possible to hobble about after applying a tight bandage about the foot, with the hope that nature would effect a cure; but on the morning of the second day, it was found that the pain had become so great that the whole foot was involved, and it was impossible to step at all without very great pain. A masseur was accordingly sent for, and derivative massage was applied with gentle friction of the foot and careful joint movements of the ankle.
    At the end of a couple of hours the pain had disappeared, and in going about his usual duties, which require much exercise upon the feet, the writer was greatly surprised to find that the sprain was practically cured. No pain whatever. was noticeable, and it was, indeed, impossible to place the foot in any position by which pain could be induced.
    By the next morning, the third day following the accident,. the foot seemed perfectly well. It was possible to run and jump, and to hop upon the affected foot without pain. Several mishaps to the foot caused a return of lameness before it was cured, but relief was invariably found in the application of local and derivative massage.
    If the ordinary method of absolute rest, without massage, had been adopted, the writer feels confident that he would have been a cripple for at least three or four weeks.


    Spinal Curvature. - Miss R., aged fourteen years, was suffering from double lateral curvature of the spine, with rotation. The curvature had first been noticed two years before. After eight months' treatment, the curvature had so nearly disappeared that the patient was allowed to return home. Electricity, baths, and Swedish gymnastics were employed in connection with massage.


    Miss N., aged thirty-three years, was received in February, 1891, for treatment of double lateral curvature of the spine, -the result of sitting in a bad position in a large easy chair, a habit which had been maintained for many years. The curvature was first noticed five years previous. After five months' treatment the patient returned home so greatly improved that the curvature was no longer a matter requiring consideration.


    Miss B., aged twenty years, was received for treatment in December, 1891, suffering from double curvature of the spine, with rotation, -the result of an injury nine months before. In jumping from a wagon, she had fallen upon frozen ground, dislocating one shoulder, and causing partial paralysis of the arm and side. She was treated for a year and a half, wearing a plaster jacket for six months; and, at the time she came under my care, had worn a steel apparatus for six months. She complained of constant pain in the side and shoulder. The patient's strength was so much improved as the result of a few months' treatment, and the muscles of the trunk were developed to such a degree, that she was finally able to dispense with mechanical support of any kind. The total strength capacity was increased more than one thousand pounds, as shown by the dynamometer.


    Mr. K., aged thirty-five years, was received for treatment in March, 1885. This patient had an extremely pronounced lateral curvature of the spine, involving both the dorsal and the lumbar region; rotation to the right also existed. The disease had begun about one year previous, the chief symptom being severe pain in the right side. The muscles were extremely contracted. By massage, exercise, suspension, local applications of electricity, fomentations, and other measures of treatment, the patient was, in the course of three months, entirely cured, so that he was able to return to his business. His height was found to have increased two inches, and no trace of the curvature remained. The most important measures of treatment employed were massage and gymnastics, although the baths and other means employed were doubtless to some extent beneficial.


    Paralysis. - Mrs. K., aged forty years, had been confined to her bed for many months as the result of paralysis of one lower half of the body, resulting from a fall in which the back was injured. After the daily application of massage for a few months the patient was able to walk, and at the end of ten months' treatment was able to ride a bicycle. Electricity, baths, and other measures were employed in connection with massage.
    Scores of similar cases might be cited as illustrations of the benefit to be derived from massage in cases of paralysis of different forms. It is certainly of value, although not radically curative, in most forms of paralysis. The writer has seen marked beneficial results from massage in numerous cases of locomotor ataxia, and in a still larger number of cases of spinal sclerosis, and other forms of paralysis arising from degenerative processes in the general nervous system.


    Infantile Paralysis. - Miss N., aged fourteen, had paralysis of one leg and arm, as the result of an attack of poliomyelitis when an infant. After several months' treatment by massage, with electricity and baths, the patient was able to dance, skate, and make good use of both arm and leg, although some evidences of the disease still remained.


    Miss D., aged twelve, had suffered since infancy from infantile paralysis affecting the left leg. When received for treatment, the muscles below the knee were atrophied almost to complete disappearance. No response could be obtained to the application of faradic electricity, and only a slight one to the application of the galvanic current. The patient had scarcely any use of the limb, and was able to make only very slight movements of the toes. Her limb was constantly cold and moist. After one year's treatment by massage, galvanism, and baths, the patient was able to run about freely and make good use of the limb, and a very considerable degree of muscular development had taken place.


    Sclerosis. - Miss Z., aged twenty-six, entered the Sanitarium as a patient in January, 1883. She complained of an inability to use the right leg, having been compelled to use crutches in walking for several years. On examination, the right leg was found to be in a remarkable condition. Almost the entire limb had undergone such structural changes that it had become as hard as wood. The tissues were considerably shrunken, the surface was smooth as polished marble, the temperature was below normal, so that the limb felt cold to the hand, and the ankle and all the joints of the foot were fixed so that movement was impossible, although some mobility still remained in the knee joint. Below the knee the limb could not have been more rigid, hard, and lifeless in appearance if it had actually been made of wood or celluloid. The case seemed an utterly hopeless one, but the patient was so importunate that something should be done for her that we received the case on trial for a few months.
    At the end of three months the changes which had occurred were truly remarkable. Above the knee the tissues had become quite soft and pliable; below the knee the hardness was disappearing somewhat; all the tissues of the foot were still hard, but the ankle and other joints had loosened somewhat, so that slight. movement was possible. Continuance of the treatment at intervals for two years restored the limb to such a degree that the patient was able to walk without crutches, and scarcely a trace of the former condition remained. The improvement continued for several years.  No relapse has occurred, and the patient at present is in the enjoyment of excellent health, and the disability of the right limb is comparatively slight. Electricity and hydrotherapeutic applications of various sorts were employed in connection with massage, but the paramount utility of massage in this case was unquestionable.


    Constipation. - Mrs. H., aged thirty, was admitted for treatment in April, 1887. She had been an invalid since confinement, five years before, suffering from an aggravated form of dyspepsia and migraine. No natural movement of the bowels had occurred for three years. The constipation was entirely relieved by the employment of abdominal massage, together with general tonic treatment and a correct regimen.


    Miss H., aged twenty-two, had suffered extremely for a number of years from constipation, a natural movement very rarely occurring. At the end of two months' treatment the action of the bowels had become normal and regular. The patient has been enjoying good health ever since.


    Mr. X., a man of sedentary habits, had suffered from constipation for many years. After two weeks' treatment a daily natural evacuation of the bowels was secured without artificial means of any kind other than massage, although a natural movement, had not occurred for more than three years previous.


    Mrs.. W., aged forty-four years, was received for treatment in April, 1877, having suffered from extreme constipation for more than twenty years. No movement of the bowels had occurred during this time without the use of medicines. The lady's husband was entirely faithless of any improvement under treatment, but at the end of three weeks the patient's bowels were moving regularly, without tonic medicine of any kind.


    Neurasthenia; General Debility. - Mrs. H., aged twenty-eight years, was received for treatment in June, 1893, having been. an invalid for eight years. The patient had suffered greatly from acid dyspepsia, flatulence, distention of the bowels, aortic palpitation, and extreme constipation, with great hyperaesthesia of the lumbar ganglia of the sympathetic. The lower border of the stomach was found three inches below the umbilicus, also a floating kidney on the right side, and both ovaries prolapsed. Indeed, the conditions were sufficiently grave to render a person thoroughly miserable. The patient remained under treatment five months, during which time she received daily applications of massage, especially to the bowels, and electricity. At the end of five months she left the Sanitarium enjoying very comfortable health.


    Haematuria and Anaemia. - Mrs. L., aged thirty-eight, was received for treatment in June, 1892. The patient was extremely anaemic, as the result of several months' suffering from a very aggravated form of haematuria. Her face was without color; she was emaciated, and so weak as to be confined to her bed. She could only be moved upon a stretcher or wheel-chair, from which it was necessary to lift her to the bed. She was able to walk at the end of three weeks, and left. at the end of two months, entirely cured. She had gained greatly in flesh, and the natural color had returned to her cheeks. The patient pronounced herself entirely well. The haematuria ceased within a week after the beginning of treatment.


    Anaemia. - Miss A., aged twenty, had suffered from a variety of troubles which had resulted in a very grave form of anaemia. The chief of her troubles were chronic inflammation and prolapse of the left ovary; movable right kidney; enteroptosis and gastroptosis, the lower border of the stomach falling one inch below the umbilicus; extreme hyperaesthesia of the lumbar ganglia of the sympathetic; menorrhagia; and frequent attacks of acute gastritis. Strong anaemic murmurs were found at the base of the heart.
    At the first examination the patient's nutrition was found to be reduced to such a low point that the hemoglobin present was only four per cent -less than one third of the normal amount. The number of blood corpuscles per cubic millimeter was 1, 51 0, 000, or one third of the normal. Poikilocytes and microcytes -were exceedingly abundant, and there were a few macrocytes. This case, if not one of pernicious anaemia, certainly bordered very closely on that class of anaemics. Under rational treatment, by which massage, both manual and mechanical, was a leading feature, the amount of haemoglobin increased in ten days to seven per cent, and the blood count to 2,340, 000 per cubic millimeter. A few macrocytes and poikilocytes still remained, showing that normal haematogenesis was not yet restored, but that the process was becoming normal.
    A marked feature in this case was the small number of leucocytes contained in the blood. At the first examination the proportion of leucocytes to normal was only eighteen one hundredths; at the end of ten days the proportion had increased to fifty-four one hundredths. At the end of a few weeks' treatment the blood count was 3,210,000 and the haemoglobin eight per cent, as measured by Henocque's haematoscope. The patient's improvement remained permanent, and at the present writing she is still improving.


    Mrs. Z., aged twenty-five, was received at the Sanitarium for treatment in October, 1894. She had suffered for two years from marked anaemia, as the result of an attack of intermittent fever. On arrival, the examination of the blood gave the following results: Blood count, 3,760, 000; haemoglobin, 10. 5 per cent.
    Four weeks later a second examination showed an increase of the blood count to 3,930, 000. The percentage of haemoglobin was the same as at the first examination.
    At the end-of two weeks' further treatment, during which the patient made rapid gain, the blood count was found to be 4,370, 000, and the haemoglobin twelve per cent. The patient went home much benefitted, and with a prospect of continued improvement.


    Melancholia. - Mrs. B., aged thirty-one, was received for treatment in July, 1893. The patient was in an extremely weak and emaciated condition, and had been insane for three and a half years, as the result of a fright caused by the explosion of a lamp in a sleeping-car. For six months, marked suicidal tendencies had existed. After six months' treatment the patient returned to her home perfectly sound in health, mentally and physically. She has remained well up to the present time.


    Prolapsed Liver. - Mrs. N., aged fifty, was received for treatment in July, 1891. The abdominal muscles were found greatly contracted; but after the administration of massage for two weeks, the muscles became relaxed sufficiently to allow a minute exploration of the condition of the viscera, when a mass was found in the right side which, on further investigation, proved to be a prolapsed liver. This organ was daily replaced, in connection with abdominal massage, At the end of three months the patient returned to her home enjoying good health, the abdominal muscles well developed, and the liver in its normal position.
    Such encouraging results as these cannot be obtained in every case, although almost equally good success has been reached in a number of others which have come under the writer's care. In a recent case the abdominal muscles had been so overstretched by repeated pregnancy, and had become so relaxed and wasted by disuse, that little could be accomplished by means of massage.
    The pyloric end of the stomach was in this case found three inches below the umbilicus, the lower border of the liver falling an inch below the umbilicus. Finding it impossible to support the organs in position by abdominal bandages or supports of any kind, and despairing of relieving the patient in any other way, the following surgical procedure was adopted: It being necessary to perform an operation upon this patient for the relief of an irreducible direct inguinal hernia, in which a mass of omentum had become incarcerated, I determined to make an attempt at the same time to restore the prolapsed stomach and liver to position by surgical means. An incision was accordingly made from a point one inch below the ensiform cartilage of the sternum nearly to the umbilicus. Passing two fingers downward through this incision, it was, just possible to reach the lower border of the liver, which was forced up into its position under the ribs. The pyloric end of the stomach was drawn up to nearly its normal position, and by means of four silkwormgut sutures inserted along the line of the lesser curvature of the stomach (including, of course, only the perineal coat) near its pyloric end, the organ was attached to the abdominal wall. The sutures were passed through the inner margins of the wound at its upper part, so that when tied they not only attached the stomach to the abdominal wall, but also brought together the edges of the peritoneum and the divided fascia. The sutures were buried in the wound by the closing sutures, being cut off short to remain permanently. The position of the sutures was made such as to cause them to fall at the notch between the right and left lobes of the liver, and thus serve as a means of supporting it in its normal position. The patient had no febrile reaction whatever following the operation, and was greatly improved by it, the stomach and liver being held in nearly normal position. Three weeks after the operation she was able to eat heartily, and the lower border of the stomach was found an inch above the umbilicus, instead of three inches below it.


    Prolapsed Stomach and Bowels. - Mrs. A., aged twenty-seven, was received for treatment in July, 1891, The patient was very weak, anaemic, and nervously exhausted. Digestion was almost totally suspended. Upon examination, the lower border of the stomach was found two inches below the umbilicus. Special applications of massage to the abdomen; replacement of the stomach; and the employment of general massage, electricity, and baths restored the patient to complete health. At the end of six months the abdominal muscles were found to be vigorous and well developed. The stomach was held in normal position. The patient has since remained in good health.,
    After a thorough application of the procedures described elsewhere in this work for replacement of the stomach and lifting of the abdominal contents, the writer has frequently been able to demonstrate the lower border of the stomach at a point from two to four inches above the point at which it was found at the beginning of the treatment.


    Pelvic Disease and Constipation. - Mrs. T., aged thirty-two, had suffered for a number of years from severe constipation, extreme tenderness of the ovaries, uterine prolapse, and a variety of nervous symptoms arising from these conditions.- At the end of four months' treatment, the patient returned home cured of the constipation and of her pelvic disorders, and has remained in good health ever since.
    A large number of cases similar to the above might be cited, illustrating the beneficial results following the use of massage, both general and local, in cases of chronic constipation in its different forms. It is needless to remark that in the treatment of this class of cases, manual Swedish movements, gymnastics, and a proper regulation of the dietary are always combined with massage. In some instances, also, the sinusoidal electric current is employed, the chief value of this agent in these cases being the rhythmical exercise secured by it for the abdominal and other voluntary muscles which come within the influence of the application.


    Mrs C., aged thirty-four, was received in February, 1890. The patient had been an invalid for ten years, her ailments dating from the birth of her first child. She was nearly bedridden, emaciated, sallow, depressed, extremely nervous, and a constant sufferer from severe pain in the abdomen and pelvis, the result of chronic peritonitis. The abdomen was so tender that at first scarcely the weight of the hand could be tolerated. After a few weeks the patient was able to endure vigorous manipulation of the abdomen, also pelvic massage. She remained under treatment eleven months, at the end of which time she returned to her home restored to good health. Vaginal douches, fomentations to the abdomen, and applications of electricity were also used in connection with the massage.


    Ovarian Disease. - There is no class of functional disorders more amenable to the intelligent application of massage than disease of the ovaries. A great number of cases-.some scores - might be quoted in demonstration of the truth of this statement. A few typical ones only will be cited.
    Miss W., aged twenty-four, was admitted as a patient in September, 1892. She had spent the greater part of her life in boarding school, where she had been subjected to the usual deteriorating influences of boarding-school life. Examination showed that, in addition to a very marked anaemia and a great variety of neurasthenic symptoms, there was also a posterior curvature of the spine at the middle dorsal region, resulting in extreme flatness of the chest and abnormal prominence of the abdomen, marked hyperaesthesia of the abdominal sympathetic and pneumogastric; stomach and bowels sunken; left ovary prolapsed, enlarged, and extremely tender; severe dysmenorrhoea and menorrhagia, menstrual flow lasting a full week; and constant backache. She had had two attacks of pelvic inflammation; could take no exercise at all without inducing severe pelvic pain; for the last year and a half had been receiving treatment of the eyes from, an eye specialist, who labored under the belief that muscular asthenopia, or eyestrain, was the cause of all the symptoms. She grew steadily worse, however, instead of better, although several operations were performed upon the, muscles of the eye. At the end of three months the patient declared she felt stronger and better than ever before in her life. The pelvic inflammation, ovarian congestion, and other local disorders have entirely disappeared. The curvatures of the spine, which were wholly due to unbalanced muscular action, were cured. The total gain in strength was 1029 pounds, the increase being from 1582 to 2611. The patient returned to her home with rosy cheeks and ruddy lips, giving no evidence, either objective or subjective, that she was enjoying other than perfect health.


    Miss H., aged twenty, entered the Sanitarium Hospital as a Patient with the expectation that the ovaries would have to be removed, as they had been a source of great pain and suffering. She had been bedridden most of the time for three years. There was extreme pain in the left leg, which seemed to proceed from the left ovary; also in the left ovarian region; the uterus was anti-flexed and retroverted ; the patient generally feeble and anaemic. A sear in the median line below the umbilicus was evidence of the fact that she had had, some months previous, an abdominal section performed, the purpose of the operator having been to remove what he supposed to be a diseased left ovary. A disagreement between the two physicians who were in charge of the case at the time of the operation, as to whether or not the ovary was sufficiently diseased to require removal, led to a conclusion of the operation as an exploratory incision. I took care to restore the prolapsed ovary to position, and replaced the uterus, supporting it by means of a suitably adjusted pessary, and rendered the replacement permanent by shortening the round ligaments. Under the influence of massage and proper exercise, coupled with local applications of electricity, vaginal douches, etc., the patient made an excellent recovery, and escaped mutilation by the removal of the ovaries.


    Miss. S., aged twenty-five, arrived at the Sanitarium in a wheel chair, pale, weak, thoroughly discouraged - an invalid, - having been in bed for nearly three years and for two years unable to sit up long enough to take a single meal. The patient was extremely neurasthenic, anaemic to a marked degree, emotional, hysterical, and had constant ovarian pain, which was very greatly increased at the menstrual periods; bowels were constipated; gastric and intestinal catarrh were present. The patient was so susceptible to cold air that she was constantly muffled up in warm blankets, and the slightest draught gave rise to extreme neuralgic pains in various parts of the body.
    An examination of the stomach fluid showed hyperpepsia, Physical examination discovered no disorder of the heart or lungs, but extreme hyperaesthesia of the abdominal sympathetic; great pelvic congestion, which was indicated by the almost universal throbbing of the pelvic vessels, the uterus being enlarged to more than twice its normal size, and in a state of extreme retroversion; prolapsus and tenderness of the ovaries, each being twice the normal size; extreme tenderness and irritability of all the pelvic viscera, with general prolapse of the abdominal organs.
    This patient had been under the care of physicians for many years. For the last two years she had been under the care of eminent metropolitan physicians, who had employed "rest-cure, " and the various methods of treatment commonly adopted in such cases, but without benefit; in fact, the patient had steadily grown worse. She was brought to the Sanitarium from a hospital in Chicago, where she had spent some time, but without receiving help. Massage, manual Swedish movements, and exercise with a wheel-crutch were employed, together with replacement of the uterus and ovaries, and pelvic massage twice a week.
    As the patient gained strength, she was required to take more vigorous exercises from day to day; and at the end of six weeks her wheel-chair was taken from her, and regular walking exercises, with the aid of the wheel-crutch, were instituted. At the end of two months the blood had become normal, the amount of haemoglobin being fourteen per cent, as shown by Henocque's haematoscope. The right ovary was still enlarged and somewhat tender, and had a disposition to prolapse; the left ovary was not at all tender, and remained in place. Less than four months after the patient's arrival, the uterus was normal in size and position. Neither ovary could be felt. The patient still complained occasionally of pain in the right ovarian region, but had so far recovered that she was able to begin to ride the bicycle; and since that time has made steady improvement. Her total strength was 2558 pounds, a gain of more than one thousand pounds. The patient was able to exercise freely, and to go about on her feet all day like a well person, and could ride seven or eight miles on a bicycle without the slightest inconvenience. The general sagging of the viscera, although a very noticeable feature at the beginning of the treatment, had entirely disappeared. The bowels were well held up; the lower border of the stomach had risen two inches; and the patient was discharged as cured. She has remained well.


    Miss D., aged twenty-two, came to the Sanitarium a very frail, undeveloped woman, a victim of nervousness, spinal irritation, and a multitude of symptoms, one of the worst of which was so-called muscular rheumatism. She had never in her life enjoyed good health. Menstruation was irregular, accompanied by extreme pain; uterus anteflexed, in a state of retrocession; left ovary prolapsed and tender; profuse leucorrhoeal discharge. At the end of six weeks the patient had increased in weight from eighty-six to ninety-six pounds, and had gained 500 pounds in strength. Her waist measure had increased one inch. Her countenance, formerly sallow, was now fresh and full of color; cheeks plump; and her appetite, which had been almost wholly absent, was now so excellent as to oblige her to leave the table hungry, to avoid overeating. The patient was no longer depressed, but wore a happy, cheerful face, being as "busy as a bee" all day long, working for the health and vigor which she already enjoyed in greater measure than ever before in her life. Pelvic massage was administered twice a week. The result was complete relief from ovarian tenderness and pain.


    Miss K., aged twenty-one, had suffered from constant backache, and was very nervous; had been for some time a student, but had become so ill that her studies were seriously interfered with, and she was unable to endure any physical exertion. Examination showed extreme tenderness of the spine, retroversion of the uterus, prolapse and tenderness of the ovaries, and, as usual in such cases, prolapse of stomach and bowels. The patient was under treatment for several months, during which time she continued her studies, when her health became so greatly improved that she entered the employ of the Sanitarium as a nurse. She now enjoys better health than ever before in her life. Her waist, which had been compressed by tight bands and corsets, expanded several inches as the result of physical exercise, and the vigor of respiration increased to such an extent that the waist enlarged fully six inches in taking a deep breath. Her waist measurement has increased four inches. The ovarian tenderness has disappeared, and not the slightest uterine displacement remains. There is no longer any complaint of backache, and the patient enjoys almost perfect health.


    Miss T., aged twenty-two, had suffered constantly from great distress in the head, mental confusion, extreme nervousness and lassitude, backache, and severe dysmenorrhoea. The patient had been so long a sufferer that she had lost all interest in life, - a fact which was clearly indicated by her dejected and hopeless countenance. On examination, I found the uterus and ovaries pro-. lapsed, and the ovaries tender. The patient had worn a corset since fifteen years of age. The waist measure was 23.5 inches; waist expansion, with clothing entirely loose, 1. 3 inches. The abdomen was sagging, and general visceral prolapse existed. The patient was so feeble that her aggregate strength was but 832 pounds. At the end of two months' treatment, by the methods previously outlined, this patient's total strength was increased to 1600 pounds, or nearly doubled. There was an increase of one and one half inches in waist measurement, and general improvement in every particular. Ovarian irritation, which was very marked at the beginning of treatment, had entirely disappeared. The patient soon entered the Sanitarium Training School for Nurses, and has since done very efficient work as a nurse. She has now (1894) fol lowed her profession for five years, and is enjoying excellent health. At the end of one year from the beginning of treatment, and several months after the treatment and training had been discontinued, her aggregated strength was found to be 3031 pounds. Her waist measure had increased to thirty inches. There was a marked gain in the lung capacity, and the patient's entire appearance had undergone so decided a change that she could scarcely be recognized as the same person. The sallow complexion had disappeared, and a fresh, ruddy countenance had taken its place. The air of lassitude and dejection previously worn was wholly gone, and an expression of energy, vigor, and cheerful content had taken its place. The increase of strength in the several regions of the body, in this case, was so interesting as to be worth noting. The total increase in strength of arms was from 257 to 855 pounds; in the legs, from 251 to 1058 pounds; in the trunk, from 161 to 712 pounds ; in the chest, from 164 to 406 pounds: by which it appears that the arms had increased in strength seventy per cent; the legs, seventy-six per cent ; the trunk, seventy-seven per cent; and the chest, or respiratory muscles, sixty per cent. The greatest gain was in the trunk muscles, which I have almost uniformly found to be the case, as this is the weakest point with women suffering from displacement of the abdominal and pelvic viscera. Figures 93 and 94, Plate XXXIV, show the change which took place in this young woman's figure as the result of her treatment.


    Miss T., aged twenty-one years, had been a miserable invalid for a number of years, having suffered extreme pain at the menstrual period, and being subject to constant headache, a great number of neurasthenic symptoms, and extreme nervousness. Examination showed the following conditions: Prolapse of stomach and bowels; movable right kidney; great tenderness of the abdominal sympathetic, and especially of the renal plexus and lumbar ganglia; the uterus in an abnormal position, and the left ovary prolapsed and exceedingly sensitive; congestion of all the pelvic viscera. After a few months' treatment, in which massage and exercise were the most prominent agents, although electricity and other means were employed, the patient returned home enjoying perfect health. The ovaries were in position and not sensitive. The stomach and bowels were elevated to nearly their normal position. The right kidney remained in place so long as the patient maintained a correct posture. Her stomach, which had been exceedingly foul, was clean, and the patient was relieved of all her previous symptoms of ill health. Since that time, now some three years she has been constantly engaged in ordinary household employments without injury. In this patient the total strength increased in three months from 1004 pounds to 2647 pounds. The waist measure increased two and one half inches.


    Miss L., . aged twenty-two years, had for a number of years been a student at a boarding school. At the time I first saw her, she had been for several years a confirmed invalid, had suffered extremely, and was very nervous. I think I have never met a patient who suffered more severely from menstrual pains and dysmenorrhoea. She was so reduced in flesh as to be scarcely able to walk; had been under the care of leading New York gynecologists, but without benefit. At the end of twelve months, by the careful employment of massage and other measures, with physical training she returned home the picture of health, free from pain, without ovarian tenderness, which had been extreme, and able to walk several miles without injury or discomfort. Two months later she resumed her studies in the advanced classical course of a well-known college.


    Miss A., aged twenty-six, had been a confirmed invalid for a number of years; had suffered from severe dysmenorrhoea, and the menstrual pain was increasing from month to month. She had become extremely nervous, hysterical, and generally hyperaesthetic. Examination showed tenderness of the spine the whole length, the slightest touch being extremely painful; and the same was practically true of all portions of the body. The uterus and both ovaries were prolapsed, and the latter were extremely sensitive. There was also prolapse of the stomach and bowels. In addition to the symptoms mentioned, the patient was subject to very severe headaches, a symptom which I have found very common in these cases. I believe these headaches to be due, however, not to the ovarian disease, but to the accompanying stomach disorder, for the relief of which massage and careful regulation of the dietary are among the most efficient means of treatment. This patient was under treatment for four months, during which time physical culture, massage, Swedish movements, hydrotherapy, and electricity were employed, either in conjunction or consecutively, and with the result that at the end of the period named, I was able to send the patient home to her friends in excellent health. The menstrual suffering had entirely ceased. The patient's flesh and blood had increased so that she had become the picture of health. There was still slight ovarian tenderness, but it was disappearing so rapidly that there was every reason to believe it would be entirely gone in a very short time. Unfavorable conditions caused a partial relapse after the patient reached home, but a return to the same methods of treatment resulted ultimately in complete and permanent recovery.


    Miss B., aged thirty-six years, entered the Sanitarium in February, 1893. She had never been well, and was so weak, anaemic, and emaciated that she was supposed to be suffering from serious lung trouble, for which she had been under treatment for some time. Diagnosis of some pulmonary disease was favored by a night cough. Examination showed the following conditions: Prolapse of the stomach; hyperaesthesia of the left lumbar ganglion and solar plexus; right kidney floating; both ovaries extremely sensitive. Examination of the stomach fluid showed hyperpepsia, with fermentation. After less than two months' application of massage and other treatment appropriate to the case, the patient went home improved in every particular; in fact, was so greatly changed for the better that she considered herself in excellent health.


    Miss E,, aged twenty-four, entered the Sanitarium in August, 1892. She had been a chronic invalid for many years, and had despaired of recovery. Her principal symptoms were general nervousness, exhaustion, and severe pelvic pains. Local examination showed left ovary to be extremely sensitive and prolapsed. The patient remained under treatment a little less than three months, at the end of which time she returned home with no trace of pelvic disease, and enjoying excellent health. This patient nearly doubled her muscular strength while under treatment, the aggregate lifting capacity of the muscles being increased from 1365 to 2350 pounds. In this case, as in a great majority of those of this kind, the greatest proportion of gain was in the muscles of the trunk, The gain in strength for the several parts of the body was as follows: Arms, from 414 to 571 pounds; legs, from 674 to 1168 pounds; trunk, from 197 to 451 pounds; chest, from 80 to 160 pounds. Massage of the muscles of the trunk and abdomen plays a very important part in a systematic course of treatment for the development of this part of the body, the weakness of which is one of the principal causes of disease in women.


    Miss B., aged twenty-five, entered the Sanitarium as a patient in July, 1891. She had been more or less an invalid ever since her twelfth year, having suffered from pelvic inflammation at various times, and from the beginning of menstruation at the age of twelve, from severe menstrual pain. Examination showed retrocession of the uterus; ovarian sensitiveness and congestion; prolapsed stomach and bowels; and floating right kidney. By the employment of abdominal massage, manual and mechanical Swedish movements, and a carefully conducted course of physical training, together with other appropriate treatment, the patient was, at the end of four and a half months, able to leave the Sanitarium in the enjoyment of very good health. The menstrual pain had ceased; ovarian irritation had disappeared; the stomach and bowels were well held in position, and there had been a gain in strength of from 1600 pounds to 3000 pounds. The gain in symmetry was even more remarkable than the gain in physical strength, as is well shown by the physical chart obtained in this case (Chart I). The radical improvement made in this patient's health has been permanent.


    Miss. T., aged thirty-three entered the Sanitarium as a patient in September, 1892. She had been an invalid for a long time; had suffered greatly,from ovarian pain and the usual accompanying symptoms,-general neurasthenia, hyperaesthesia of the spine, and hysteria. The patient was in an extremely wretched and helpless condition. In two months she returned to her home, having been absolutely free from pain for several weeks and with entire relief from pelvic symptoms.


    Miss X., aged forty-three, was received at the Sanitarium as a patient in July, 1893. She had been an invalid since her sixteenth year; had suffered from menstrual pain and leucorrhoeal discharge; right kidney palpable and sensitive; stomach prolapsed; uterus in retrocession; right ovary prolapsed and tender; left ovary prolapsed and very sensitive, and more than double the normal size. The slightest attempt to replace the uterus and ovaries gave extreme pain. At the end of six weeks, the patient had gained several hundred pounds in strength. The pelvic pains had disappeared. . The digestion, which had formerly been very much disturbed, was greatly improved, and the patient had begun to enjoy good health. Pelvic and abdominal massage played the most important part in the cure of this case.


    Miss M., thirty-two years of age, became a patient in the institution in July, 1893. She had suffered for years from a great variety of nervous disturbances, which were mostly neurasthenic in character. Some of the most troublesome symptoms were a severe burning sensation of the spine, a constant ringing sound in the head, and great distress at the base of the brain. She had suffered also from severe dysmenorrhoea. On examination, I found the stomach prolapsed; extreme sensitiveness of the left lumbar ganglion of the sympathetic; right kidney movable; left ovary large, prolapsed, and tender. Examination of the stomach fluid showed that the patient was suffering from hyperpepsia, with fermentation. General and local massage, abdominal massage, Swedish gymnastics, apparatus work in the gymnasium, also general and local baths, applications of galvanic, faradic, and the sinusoidal electrical currents., together with the establishment of a suitable dietary, resulted in the restoration of this patient to good health in the course of a few months.


    Miss H., aged seventeen, came to the Sanitarium in December, 1893. This patient was sent from a distant State by her physician, for the removal of the ovaries, as she had suffered from severe dysmenorrhoea from the very beginning of menstruation, which first appeared two years previous, at the age of fifteen. The periods were irregular, the flow profuse; and pain, which was excruciating during the menstrual period, was constantly present between the periods to such an extent that the patient was practically disabled. The patient complained of a dragging sensation in the pelvis, and what her family physician believed to be an abscess of the left ovary. Examination showed anteflexion of the uterus, with extreme sensitiveness of both ovaries. The patient also suffered from indigestion, was extremely anaemic, and weak; and she, as well as her parents, was very desirous that the operation of ovariotomy should be performed without delay. Indeed, the patient seemed very much disappointed when I informed her that I thought ovariotomy not necessary in her case, but that she could probably be cured without the adoption of any such radical measures. Curettement relieved the profuse flow. The patient was gradually gotten upon her feet, and trained to active exercise in the gymnasium, taking daily breathing exercises, Swedish gymnastics, apparatus work, and mechanical Swedish movements, in addition to massage, baths, and electrical applications. Especial attention was given to pelvic massage, which was certainly a very important agent in securing a rapid disappearance of painful symptoms. In fact, the patient improved so rapidly that. within a month all thought of a serious surgical operation was abandoned.
    A little more than five months after her arrival, the patient was dismissed. She no longer suffered from pain at her menstrual periods, or at any time; had gained twenty pounds in flesh; and gave every indication of the enjoyment of absolutely perfect health, which condition continues to the present time.


    Miss S., aged twenty-nine., was received in June, 1894. For the last eight months she had suffered extremely from constant pelvic pain. The spine was extremely sensitive; all the pelvic viscera were congested; the patient complained of a bearing-down pain, constant and severe headache, neuralgia and a great variety of nervous symptoms. She was extremely anaemic and very weak, having been confined to the bed for nearly six months; had also severe dysmenorrhoea and menorrhagia. She had suffered several attacks of severe pelvic inflammation, and had steadily grown worse for months, until recovery was almost despaired of. Examination of the urine showed renal insufficiency, the amount of urea eliminated being but 5.86 grams, while the total solids were 18.63, indicating tissue waste and deficient elimination. Digestion was very greatly disturbed; there was no appetite. The patient was much emaciated. The same measures employed in the preceding case were adopted in this case also, and with equal success, although the progress was not quite so rapid.. Especial attention was given to abdominal and pelvic massage. The stomach symptoms were relieved by a diet of kumyss (New Era Kumyss). The following notes were made of the case two months after the patient was received for treatment: -
    "Her appetite is good; she is able to take ordinary food, has gained in flesh; the menorrhagia has disappeared, also the neuralgia and general neurasthenic symptoms; the patient is well established on her feet, and no longer suffers from ovarian pain either at the menstrual period or at other times, and expects to return in a short time to her field of labor as a foreign missionary. " The patient has since remained well.


    Miss C., aged thirty, was first examined in June, 1892. The patient's general health was fair, but she had suffered for many years from severe dysmenorrhoea and constant ovarian pain, which had in part disabled her, so that she was not able to do ordinary housework, which had been her occupation. The patient, did not at that time come under the writer's care for treatment, but fell into the hands of other physicians. In June, 1894, she was sent to me by her physician for the performance of the operation of ovariotomy, constant treatment having failed to cure her, or to prevent a steady decline. On examination, I found she was in every respect worse, having been for a year completely disabled. The ovaries were much enlarged, prolapsed, and sensitive. All the tissues about the uterus were in a hypersensitive condition, and the pelvic vessels throbbing. The patient was placed under treatment similar to that employed in other like cases, special prominence being given, however, to pelvic massage, which was employed every other day. After the third treatment the patient was relieved to a very marked degree, and after three weeks' treatment she was able to engage in vigorous work in a laundry, doing both washing and ironing, which she had not been able to do for more than two years. The menorrhagia and dysmenorrhoea, which had been very severe, had entirely disappeared. She was not obliged to stop work even during the menstrual period, although previously for several years she had been obliged to call a physician, and had habitually taken morphia at that time to relieve the severe menstrual pain. The patient's improved health has continued to the present time (April, 1895), and she pronounces herself in perfect health.
    When medical men come to appreciate the fact that patients, not simply maladies, are to be treated; that the woman suffering from functional ovarian disease needs, not simply the treatment of her diseased ovaries, but to be made a better "animal, "-a more vigorous, less sensitive, and more highly vitalized woman, -a vast number of women who now languish on beds of suffering, or drag out lives made miserable by chronic invalidism and perpetual local treatment, will be restored to health and usefulness; and a very large number of young. women who are now subjected to the operation of ovariotomy, will escape the surgeon's knife, and become. happy wives and mothers. Massage, manual Swedish movements, and gymnastics will be found to contribute more to the care of these cases than any other one class of therapeutic means.


    Fractures. - Mrs. P -, a lady about forty years of age, in attempting to enter a street-car, slipped and fell upon the ice, breaking the tibia and fibula just above the right ankle joint. The displacement was very great, and the ligaments were torn to such an extent that it was impossible to restore and maintain, perfect symmetry of the limb, although. this was accomplished as perfectly as possible by means of a properly adjusted splint. Fomentations were applied for an hour or two before the application of the splint. A snug bandage was then applied to the limb, and the splint adjusted. After the fourth day the splint was removed daily, fomentations or hot and cold applications were made, and massage was carefully administered (for method see page 51 and paragraph 385). The case looked to be a very unpromising one, but an excellent recovery occurred. In a few weeks the patient was on her feet, and after a few months, during which time massage was quite persistently employed, the function of the joint was perfectly restored. The ankle joint was not at any time allowed to become stiffened by disuse.


    Ununited Fractures. - Mr. A -, a young man aged thirty years, from Idaho, presented an ununited fracture of the humerus, the result of a gunshot wound. About two inches of bone had been lost shortening the humerus to that extent. Three operations had been performed, two of them by distinguished surgeons, but the fracture was still ununited. The muscles had wasted away, and the arm was practically useless. The elbow joint was completely stiffened as the result of long immobilization, to which the arm had been subjected. The patient was apparently in fair general health, but he was nevertheless subjected to a course of vigorous tonic baths, special attention being given to the improvement of the nutrition of the arm by means of fomentations, the hot and cold douche, and especially by the application of massage. After a few weeks an incision was made, and it was found that there had been no attempt whatever at union, though the ends of the bone had apparently been nicely adjusted and secured together. The ends of the bone were irritated by erosion, and another wire was introduced at right angles to the first. The wound was closed, and motion was restored to the stiffened elbow by forcible flexion and extension. The wound healed by immediate union, and at the end of a week the baths and massage were resumed with the result that solid union was obtained, and the patient sent home with a useful arm.


    Mr. H aged twenty-six years, sustained a severe compound fracture of the left humerus as a result of a railroad accident. He was received into a hospital in the Eastern city where the accident occurred. After a few weeks he was discharged, but upon subsequent examination it was found that no union had taken place. The patient urged an operation, but instead was encouraged to believe that union might be secured by means of massage, which was applied daily, and with the result that at the end of three months solid union had been obtained, and a few months later the patient pronounced his arm as good as ever. The arm was not immobilized, but care was taken to give it some support by means of a sling, so that an excessive amount of motion might not occur at the point of fracture.
    The philosophy of this method of treating fractures is that it improves the nutrition, encourages the circulation, and stimulates all the vital activities of the affected parts, and thus promotes a healthy and efficient reparative action.