The Art of Massage
J. H. Kellogg, M.D.
THE PHYSIOLOGICAL EFFECTS OF MASSAGE
The interest in the therapeutic applications of
massage which has increased so rapidly within the last twenty years has
led to numerous investigations by able physiologists for the purpose of
determining with exactness the physiological effects of the various procedures
included under the general term massage, and thus obtaining a correct
basis for their therapeutic use. Many of these experiments have been
repeated and verified by the writer in the physiological laboratory under
his charge in connection with the Battle Creek Sanitarium, and some of
the results will be recorded in an Appendix, in addition to this brief
summary of the conclusions which have thus far been obtained by those who
have most carefully studied the subject. These investigations have
established beyond all possibility of question, that massage affords one
of the most effective means of influencing the functions of the human body.
Experiments clearly show that every function of
both animal and organic life may be powerfully influenced by some or all
of the numerous procedures of massage. The various effects produced
may be included under the following heads: -
1. Mechanical, in which the tissues
are wholly passive, being simply acted upon in a mechanical way by the
hand of the manipulator, as in the movement of the blood and lymph in the
venous and lymph channels, or the restoration of a displaced viscera to
its normal position.
2. Reflex, in which the peripheral
and central portions of the nervous system, both cerebro-spinal and sympathetic
are chiefly active, an impression made upon the nerve ends of the sensory
or afferent fibers connected with the nerve centers of the cerebro-spinal
and sympathetic systems being transmitted to the related centers, where
new activities are set up, resulting in the sending out of nerve impulses
by which vital changes are effected, not only in the parts directly acted
upon, but in related parts.
3. Metabolic, in which important modifications
occur in the tissue activities both of the parts directly operated upon
and of the body as a whole, as the result in part of the direct mechanical
effects of massage upon the tissues, and in part of the reflex activities
set up by it.
In a brief manual like this there is not space to
consider in detail the modus operandi of all the different effects
of massage. We must be content with a simple enumeration of the specific
effects upon the principal systems and functions of the body.
Effects of Massage upon the Nervous System.
All the different procedures of massage produce
a decided effect upon the nervous system through the influence of the manipulations
upon the nerve endings of both the cerebro-spinal and the sympathetic -nerves,
which are found in so great abundance in the skin and muscles-the former
in connection with the special senses of locality, temperature, pressure,
weight; the latter more especially in connection with the glands, blood
vessels, and thermic mechanism located in the skin and muscles.
1. Direct Stimulating Effects. - Vibration
and nerve compression may be made to act directly upon nerve trunks, thereby
causing powerful stimulation not only of the peripheral nerves but of all
the nerve centers with which a nerve trunk is connected.
Friction is an effective means of exciting languid
Light percussion simply increases nervous irritability,
while strong percussion may cause so great a degree of nervous irritability
as to exhaust the nerves, and thus produce a benumbing effect.
Tapping, slapping, clapping, and hacking are the
most effective means of exciting nerve trunks.
Beating and vigorous hacking are especially useful
for exciting the nerve centers, and hence are especially applicable to
the spine. The nerve centers may also be directly excited by deep
vibration and by strong percussion.
2. Reflex Effects - The reflex effects of
massage are very remarkable and exceedingly interesting. All the procedures
of massage produce powerful reflex effects. Some of the most striking
effects are produced by very light stroking, especially when applied to
certain reflex areas. (See Reflex Stroking.)
Percussion and vibration are also powerful means
of producing reflex effects, which include not simply muscular action,
but increase or decrease of vascular and glandular activity, and general
3. Sedative Effects. - The sedative effects
of massage are equally as marked as the stimulating effects. Strong percussion
relieves pain in the same manner as does strong faradization, by tiring
out and thus obtunding nerve sensibility. Pinching produces an anaesthetic
effect in essentially the same way.The physician always pinches the skin
before introducing the
Sedative effects are also produced by gentle stroking
-the so-called hypnotic effect, doubtless, through reflex influence upon
the nerve centers.
Very marked sedative effects are produced by derivative
friction and kneading. Centrifugal friction (rubbing down) diminishes the
blood supply of the brain, and hence lessens cerebral activity.
Light friction over a deep-lying organ diminishes
its blood supply by increasing the activity of the overlying vessels, thus
causing the blood to go around instead of through it.
Massage of the soft parts above a joint, and movements
of the next joint above, relieve pain by emptying the lymph and blood vessels
of the part.
4. Restorative or Reconstructive Effects. -
Mental fatigue is relieved by massage, through its effect upon the circulation
and the eliminative organs. The toxic substances produced by mental activity,
are more rapidly oxidized and removed from the body, while the hastened
blood current more thoroughly repairs and cleanses the wearied nerve tissues.
General reconstructive effects are experienced by
the entire nervous s stem through the improved nutrition induced by massage.
Effects of Massage upon the Muscular System.
Massage, when skillfully administered, has to do
chiefly with the muscles. That form of manipulation which consists simply
of skin-pinching excites the nervous system and the surface circulation,
but has little influence upon the muscles. When we reflect that the
muscles constitute one half of the bulk of the body, and receive
one fourth of all the blood of the body, it is at once apparent that any
procedure which acts directly upon them must have a decided influence
upon the whole body.
Although the muscles constantly receive a certain
blood supply, this supply is comparatively small except during activity;
consequently, it may be said that “the muscles are well fed only when
exercising." When the muscle is inactive, the blood goes around it
rather than through it ; but the moment activity of the muscle begins,
there is a great increase in its blood
supply, even before any acceleration in heart activity has occurred.
Massage may serve to a considerable extent as a
substitute for exercise by increasing the blood supply of a muscle, just
as exercise may be considered a sort of massage, through the pressing and
rubbing of the muscles against each other. When properly administered,
the manipulations of massage act upon the muscles in such a way as to produce
a suction, or pumping effect, pressing onward the contents of the veins
and lymph channels, and thus creating a vacuum to be filled by a fresh
supply of fluid derived from the capillaries and the tissues.
Specific Effects of Massage upon the Muscles.
- Massage in its specific effects upon the muscles, may be said to accomplish
the following results : -
1. To Encourage Nutrition and Development
of the Muscles. The increased blood supply of the muscle induced by
massage naturally improves its nutrition. Experience shows that, when systematically
and regularly employed, massage produces an actual increase in the
size of the muscular structures. The muscle is also found to become firmer
and more elastic under its influence.
Massage feeds a muscle without exhausting it, in
which respect it differs from exercise ; nevertheless, it is not a complete
substitute for exercise, for the reason that exercise brings into active
play the whole motor mechanism - nerve center, nerve, and muscle - while
massage affects chiefly the muscle.
The improvement in the nutrition of the muscle,
as regards increase in size or firmness, is seldom noticeable for the first
three or four weeks, and the most marked effects should not be expected
until after two or three months.
2. To Excite Muscular Contraction. - A smart
blow upon a muscle is one of the ways by which contraction may be excited.
By a succession of blows, one following another with sufficient rapidity,
tetanic contraction of a muscle may be induced.
Strong vibration will also cause tetanic contraction
of a muscle; but very rapid and strong vibrations are required to produce
tetanus. In voluntary tetanus (ordinary muscular contraction) the number
of impulses received by the muscle per second is ten to twenty. It
is evident that the rate of vibration required for producing tetanus must
be as great or greater. and consequently mechanical means of some sort
must be applied, as the highest rate of movement which can be communicated
by the hand directly is ten to twelve double movements per second.
A vibratory apparatus which I have had in use for many years, and which
produces decided muscular contractions, has a movement of sixty per second.
In certain cases, muscular contraction may be induced
more readily by the application of percussion than by the faradic current.
3. To Increase Electro-excitability of the Muscle.
- Numerous experiments have shown that massage increases the electro-excitability
of a muscle, as indicated by the fact that a smaller number of milliamperes
of current is required to cause contraction of the muscle after massage
According to Kroneker, however, a muscle is less
easily 'tetanized after massage than before, but its power of action is
greatly increased. An abnormal degree of muscular irritability is certainly
relieved by massage.
This effect of massage may be advantageously utilized
as a preparation for applications of electricity in cases in which the
electro-excitability of a muscle is diminished by trophic changes, as in
4. To Remove the Effects of Muscular Fatigue.
- Ranke, Helmholtz, Du Bois-Raymond, Mosso, and more recently, Abelous,
have conclusively shown that special toxic substances are produced as the
result of muscle work, and that the phenomena of fatigue are due to the
influence of these substances upon the nervous and muscular systems.
Abelous has shown that the first effect is a sort
of auto-curarization, or paralysis, of the terminal motor plates of the
nerves which actuate the muscles, while in advanced fatigue the muscle
itself is exhausted by the consumption of the material (glycogen) necessary
The fact that a fatigued muscle can be restored
to full vigor at once by simply rinsing its vessels with a normal saline
solution, as shown by Ranke, demonstrates the toxic character of the phenomena
of fatigue. Bowditch, Bernstein, and others have shown that the nerve itself
Zabloudowski has shown that frogs completely exhausted
by faradization of the muscles, although not restored by fifteen minutes'
rest, were revived at once by massage, and were even able to do twice as
much work as before.
In another experiment, a man lifted with his little
finger, one kilo (2 1-5 lbs.) 840 times, lifting the weight once a second.
The muscles of his finger were then completely exhausted. After five
minutes' massage he was able to lift the same weight 1100 times, and his
muscles were even then not greatly fatigued.
The Sandwich Islanders employ massage under the
name of lomi-lomi as a means of, resting fatigued persons, and sometimes
even apply it to restore an exhausted companion when swimming long distances
in company. An intelligent native Maori informed the writer that the same
method is used by the natives of New Zealand to relieve cramp resulting
from cold when swimming in the sea. The term used for massage among the
Maoris is romi-romi, the literal meaning of which is the same as petrissage
in the French.
The stiffness and soreness of muscles which occur
from so called consecutive or secondary fatigue resulting from over-exercise,
is also relieved by massage. It should be remembered, however, that secondary
fatigue may be produced by too vigorous an application of massage in a
person not accustomed to it, especially in those who are very fleshy.
Muscular Electricity. - Physiological experiments
have demonstrated that with each muscular contraction an electrical discharge
takes place, and Mervy has shown that a muscle is a sort of electrical
accumulator, electricity doubtless being generated by the muscular and
thermic activities which are constantly present in the muscle. As an accumulator
it is auto-excitant, and may also be excited by induction or by contact.
In this way the muscles of the person masséed may be favorably influenced
through induction from the more highly charged muscles of the masseur.
This influence, however, must be very slight, and its therapeutic value
can scarcely be said to be established.
Effects of Massage upon the Bones, Skeleton,
and Ligaments. - That massage is capable of influencing such hard structures
as the bones, ligaments, and cartilages, is clearly demonstrated
by numerous facts and observations. A bone has essentially the same blood
supply as its overlying muscles. It is for this reason that the same
exercise which causes increase in the size of a muscle, at the same time
induces growth in the bone to which the muscle is attached. The bones and
joints of persons who are much addicted to exercise are decidedly larger
than those of persons who have made little use of their muscles. This is
especially noticeable in comparing the large, strong hand and knotty knuckles
of the laboring man with the puny band and straight, slender fingers of
the man of sedentary pursuits.
The blood vessels and lymphatics are largest in
the vicinity of the joints, and the change of fluids effected by joint
movements, resulting from the action of the muscles upon the bones, necessarily
produces increase in the nutrition of the parts, and consequently an increased
growth in the cartilages, ligaments, and other structures of the joint.
It is now known that the red matter of the bones
is the blood forming tissue of the body. This fact gives a new importance
to massage, since the acceleration of the circulation of the blood through
the muscles must improve the nutrition of the bones as well as of the muscles,
thus favorably influencing the blood-making processes both as regards the
quantity of the blood produced and its quality.
Effects of Massage upon the Circulation.
- Massage profoundly affects the circulation, both general, and local,
its effects differing, however, according to the mode of application and
the part acted upon. General massage increases the rate and the force of
the heart beat, as does exercise, with the difference that it does not
raise the arterial tension as does exercise, and does not accelerate the
heart to the same degree, though producing a full, strong pulse. This is
due to the fact that the. influence of massage is chiefly upon the peripheral
The vigor of the circulatory activity is increased
not only in, answer to the greater demand for the removal of the poisons
resulting from oxidation as in exercise, but through the mechanical assistance
afforded by massage, in moving the blood forward, in the venous and lymph
channels, and in setting up reflex activities whereby the small vessels
are dilated and their activities quickened. The reflex influence of massage
acts as a tonic for the heart, while the dilatation of the vessels decreases
the resistance so that the heart acts more freely and efficiently in performing
its functions. Recent experiments by Brunton, verified
by the author, show that general massage produces at first, but briefly,
a rise in arterial pressure.
Locally, the effect of massage is to produce an
active hyperaemia of the part. Under the influence of massage the blood
vessels become more active, pumping forward the blood into the veins, through
which its flow is assisted materially by the manipulations. The increase
of blood is usually accompanied by reddening of the surface and an increase
of warmth, sensibility, and general vital activity.
Light percussion of the surface causes contraction
of the blood vessels of that portion of the skin acted upon. Strong percussion
very quickly produces dilatation of the blood vessels which may even amount
to paralysis. Light percussion, if sufficiently prolonged, also produces
When applied to a reflex area, percussion doubtless
also excites the circulation in the vessels of the related nerve centers.
Massage, of the abdomen slows the pulse by raising
the general blood pressure. This is accomplished both by the stimulation
of the abdominal muscles, thus increasing the intra-abdominal pressure,
and also by the stimulation of the vaso-constrictors of the abdominal vessels.
At the same time, a collateral hyperaemia of the skin and the abdominal
muscles is produced. and thus visceral congestion is diminished.
Massage has chiefly to do with the circulation of
fluid in the veins and the lymph channels, since these are more readily
accessible from the surface than the arteries.
Friction acts chiefly upon the superficial veins,
while petrissage and other forms of deep kneading act upon the deeper vessels
Indirectly, the portal and pulmonary circulations
are also influenced by massage. Massage of the extremities, for example,
especially if concluded with centrifugal friction, may relieve congestion
of both the portal and the pulmonary systems.
Massage of the legs acts more directly upon the
portal system, while massage of both extremities favorably influences the
pulmonary circulation in case of congestion of the lungs. Massage
of the arms and legs also acts derivatively upon the brain and spine. For
derivative effects upon the brain, however, care should be taken to avoid
such exciting procedures as percussion and reflex stroking.
Massage also has a powerful effect upon the circulation
by promoting the action of the diaphragm, which serves efficiently as a
pump in assisting the circulation, as well as in carrying on the process
of respiration. M. Camus has shown by experiments upon dogs that the increase
either of the rate or the depth of respiratory movement increases the flow
of lymph in the thoracic duct. The same has been shown in regard to the
blood circulation by numerous investigators.
The influence of massage upon the lymph circulation
is especially worthy of attention. The lymph vessels drain the tissues
of waste and toxic substances, and prevent clogging from wandering cells.
Lymph channels are most abundant in the subcutaneous tissue and in the
fascia which cover and lie between the muscles, so that 'these vessels
are mechanically acted upon in massage, especially by friction and kneading
That massage and exercise of muscles greatly increase
the flow of lymph has been repeatedly demonstrated by experiments upon
animals, as, for example, it was found that the flow in the lymph vessels
of a dog's leg nearly ceased when the animal was quiet, but as soon as
the limb was exercised or massaged, the flow of lymph began again (Reibmayr).
It has also been shown that the flow of lymph from
a limb in a state of inflammation was very easily induced, and was seven
or eight times greater than from a sound limb. A swollen limb was found
to diminish during the flow of lymph (Lassar).
The same author has shown that massage of a lymph
gland increases the outflow of the fluid. Deep massage applied to a limb
diminishes its size. The central tendon of the diaphragm contains a large
number of lymph channels. The diaphragm may be regarded as a great lymph
pump, since by its rhythmical movement, the lymph channels are alternately
Hoffinger has shown that the absorptive power of
the peritoneum is greatly increased by massage. In experiments upon rabbits,
the peritoneum was found to absorb under the influence of massage twice
as much water in an hour as without massage.
An experiment made by Mosengeil, an eminent German
physiologist, graphically demonstrates the influence of massage in promoting
absorption. The joints, of rabbits were injected with ink. Massage
was applied to some of the rabbits and not to others. In the cases subjected
to massage, the swelling which was produced by the injection rapidly passed
away. When the rabbits were killed, some months afterward, it was found
that the ink had entirely disappeared from the joints which had been masseed,
and was found in streaks between the muscles, and accumulated in the lymphatic
glands, indicating the course of the lymphatic channels. In cases in which
the joints were not masseed, ink was found in the joints, but none in either
the muscles or lymphatic glands. This result affords a striking illustration
of the value of massage in affections of the joints accompanied by exudate.
It is through its power to promote absorption that massage is of great
value in the treatment of local oedemas, general dropsy, and ascites.
Effects of Massage upon Respiration. - These
effects may be thus enumerated: -
1. Increase of Respiratory Activity. - Massage,
as does exercise, increases the depth of the respiratory movements. This
is doubtless in some measure due to the reflex influence of massage, but
must also be attributed in part to its effect in bringing into the
circulation waste products requiring elimination through the lungs, and
in increasing oxidation, or CO2, production, which necessarily
accompanies the increased heat production resulting from the effect of
massage upon the muscles.
2. Increase of Tissue Respiration. - It should
be borne in mind that the function of respiration is not confined to the
lungs. Respiration begins and ends in the lungs, but the most important
part of the process is effected in the intimate recesses of the tissues
Massage is certainly a most efficient means. of
increasing tissue metabolism, by which oxygen is absorbed by the tissues
and CO, taken up by the blood. This process takes place chiefly in. the
muscles, through the oxidation of the glycogen, of which they contain one
half the total bodily store. Hence it is that massage, by acting
directly upon the muscles, increases the tissue respiration by promoting
circulation and general tissue activity.
In thus promoting the depth of respiratory movement
and the intensity of tissue respiration, massage profoundly affects all
the bodily functions. Through the increased lung activity there is
also increased circulation, as the lungs materially aid the heart
in the circulation of the blood. Increased activity of the diaphragm serves
to pump both blood and lymph toward the heart with greater vigor.
Digestion, liver action, and other of the vital functions come in for their
share of benefit in the increased vigor and efficiency of the respiratory
process. The functions of the brain are more easily performed on
account of the more perfect movement of venous blood and the
better supply of oxygen received.
Influence of Massage upon the Heat Functions
of the Body. - The heat functions of the body being so intimately connected
with the circulation and general tissue activity, it is clear that any
agent which profoundly affects the latter must also affect the former proportionately.
The heat functions consist of three distinct processes, - heat production,
heat elimination, or dissipation, and heat regulation. Massage materially
influences all three of these processes.
The muscles are the chief seat of heat production
in the body, containing a great store of glycogen and a special mechanism
which, under the influence of the nervous system, gives rise to increase
or decrease of oxidation, or combustion of the glycogen. The muscles may
be considered as the furnace of the body. During activity, heat production
is very active; while during rest, it is considerably diminished. In fever
there may be either a great increase of heat production or simply a loss
of heat regulation, or both conditions may exist. It is thus evident that
those procedures of massage which especially concern the muscles, such
as different forms of deep kneading and strong percussion, must exert a
powerful influence upon heat production.
By actual observation it has been shown that massage
of a muscle, as well as exercise, may cause a rise of temperature amounting
to several tenths of a degree Fahrenheit. The importance of this fact will
be recognized when it is recalled that four fifths of all the food eaten
goes to the production of heat, only one fifth of the force represented
in the food reappearing as work or energy. This explains the enormous increase
of CO2 in connection with muscular exercise. The quantity of CO2, eliminated
during vigorous muscular effort sometimes rises to nearly five times the
usual amount. Muscular waste and weakness in fever is chiefly due to the
consumption of the glycogen, which occurs under the influence of the toxic
substances present in the tissues during febrile states.
The continued activity of the muscles in heat production,
even when the body is. at rest, is doubtless due to the slight muscular
activity constantly present as so-called muscular tone.
Winternitz has shown that under some circumstances
heat elimination by the skin may be nearly doubled (increased ninety-five
per cent) by friction. He accordingly recommends friction, in connection
with the cold bath, for reducing temperature in fevers.
Celsus, the famous old Roman physician, recommended
rubbing in fevers when the surface was cold, although be carefully interdicted
rubbing in fevers at other times. The increased heat dissipation resulting
from massage is directly due to the increased circulation of blood in the
skin. The higher the temperature of the skin the more rapid will be the
dissipation of heat from the body. The skin is the principal means by which
the blood is cooled, the heat brought from the interior to the surface
being dissipated by radiation, conduction, and especially by the
evaporation of water poured out of the skin by the sweat glands.
Massage, by dilatation of the blood vessels and
acceleration of the peripheral circulation, brings an increased quantity
of heat to the surface, and at the same time, through increasing the blood
supply and by reflex influence upon the sympathetic nerves, it induces
increased activity of the sweat glands, which leads them to pour out an
increased amount of perspiration. Thus heat dissipation is increased both
by radiation and by evaporation as the result of the application of
It thus appears that bodily temperature may be either
increased or diminished by massage, since by kneading the muscles we may
increase heat production, while by friction we may increase heat
elimination. It is particularly important to remember that when massage
is applied for the purpose of increasing heat dissipation, only such procedures
should be adopted as will act upon the surface alone, since any manipulation
of the muscles will increase heat production.
A small amount of heat is communicated to the surface
by the hand of the manipulator, and a further small quantity is generated
by the friction of the hand upon the surface; but these sources of heat
are too small to deserve more than mere mention.
Another point worthy of notice is the fact that
while general massage increases heat production, it does not necessarily
increase the bodily temperature, for the reason that the increase in heat
production may be more than balanced by the increased dissipation of heat.
For example, in a case in which general massage increased the surface temperature
1.40 F., the rectal
temperature fell 0.80 F.
Abdominal massage, however, exercises an effect
the opposite of that of general massage. Massage of the abdomen may cause
a fall of surface temperature of 0.20 F., while the rectal temperature
rises 2.20 F.
Effect of Massage upon Digestion. - There
is no single function which may be more clearly demonstrated to be directly
encouraged by massage than digestion. By its judicious application,
the digestive process is promoted in several ways : -
1. By Improving the Appetite. - The general
improvement in nutrition occasioned by the removal of waste and the acceleration
of the blood and lymph circulations, creates a demand for an increased
supply of nutriment which nature manifests by an improvement in appetite.
2. By Promoting Secretion of the Digestive Fluids.
- Massage, especially abdominal massage, through its reflex influence upon
the glands and circulation of the stomach and intestines, promotes the
production of the digestive fluids in sufficient quantity and quality.
3. By Promoting Absorption of the Products
of Digestion. - Hopadze has shown that massage of the abdomen, for
even so short a time as ten minutes, applied at once after eating, diminishes
by fifteen to seventy-five minutes the length of time the food is retained
in the stomach.
Hirschberg declares that massage of the abdomen
hastens the passage of food from the stomach even more efficiently than
does either exercise or electricity. This fact the writer has frequently
4. By Aiding Peristalsis. - Massage not only
aids the absorption of food from the stomach, and its passage from the
stomach into the intestine, but also excites the reflexes by which, the
alimentary mass is moved along in the small intestine to the colon, and
finally discharged from the body. Indeed, massage has no rival in
its efficiency as a means of promoting intestinal activity.
Influence of Massage upon Nutrition, Haematogenesis,
and Phagocytosis. - That massage encourages the blood-making
process is demonstrated by the rapidity with, which the number of red blood
corpuscles and the amount of haemoglobin increase in the blood under the
influence of this therapeutic means in cases of anaemia. The value
of this fact can scarcely be over-estimated. The blood is one of
the most important of all the tissues of the body. The total amount
of blood contained in the body is about ten pounds, each cubic millimeter
of which contains from four and a half to five million corpuscles, making
in all 32,500,000,000,000 - more than twenty thousand times the entire
population of the globe. These little bodies have a combined area
of nearly 2900 square meters, or more than 3100 square yards - equal to
a square nearly 175 yards on each side. When we consider that this
enormous area of blood must pass through the lungs every twenty-two seconds
in order to secure the proper amount of oxygen for the tissues, it is readily
apparent how great a loss must be suffered when the quantity of blood is
diminished ten to twenty or even seventy-five per cent, as in cases of
anaemia, and also the great gain effected by a like increase in the number
of corpuscles, or oxygen carriers.
Another important influence of massage upon the
blood which has recently been noted is the immediate increase in the number
of corpuscles produced by a general application of massage. Winternitz
pointed out, several years ago, the interesting fact that by the application
of cold water to the surface in such a way as to secure vigorous reaction,
the number of corpuscles could be immediately increased from twenty-five
to fifty per cent. In one case an increase of more than 1,800,000 corpuscles
was noted within half an hour after the administration of the cold bath.
Winternitz also showed that exercise has a like effect, and Mitchell,
of Philadelphia, has proven the same for massage, and the author has confirmed
It is not to be supposed, as is remarked by Winternitz,
that this sudden increase of blood corpuscles is due to a new production
of blood cells ; the apparent increase in numbers is due to the sudden
bringing into the circulation of a great number of corpuscles which had
previously been retained in the large vascular viscera of the interior
of the body, especially
the spleen and liver.
Quincke has noticed that the corpuscles accumulate
in the capillaries of the liver and spleen in great numbers just before
they are disintegrated, which naturally leads to the suggestion that the
corpuscles set free by massage, and restored to usefulness by being brought
into circulation, are at the same time rescued from destruction by
the organs devoted to this work in the body.
Some experiments conducted under the author's direction
for the purpose of determining the influence of massage upon the
blood, show an increase of from three to seven per cent in the red
cells, and from forty to eighty per cent in the white cells. The
increase in the blood-count usually became apparent within thirty
minutes, and lasted from an hour and a half to two hours. When massage
is applied to persons in health , the effect upon the blood-count
is, of course, temporary, but when the application is made to persons
whose blood-count is deficient, the increase continues for several hours;
and if the application is repeated daily, there will be noted a permanent
increase in the blood-count from day to day. In this regard the effect
of massage is precisely the same as that of cold applications. By
the combination of these two potent measures,- short cold applications
followed by massage,- the composition of the blood may be more rapidly
and favorably influenced than in any other known way.
Phagocytosis.-This interesting phenomenon,
the complete demonstration of which was worked out by Metchnikoff in Pasteur's
laboratory, is influenced by massage to a remarkable degree. In the
case of exudates in parts which have suffered from inflammatory processes,
the removal of the exudate depends first upon its solution. This
is effected by the white blood-corpuscles, which actually digest the inflammatory
products, thus setting them free so they can be carried off by the venous
and lymph currents.
Phagocytosis is also the principal means by which
the body antagonizes an invasion of foreign microbes which always takes
place in connection with infectious disease. Microbes of various
sorts, and even animal parasites such as the plasmodia of malaria,
are captured and destroyed by the white blood corpuscles. It is,
indeed, through the action of these blood cells that the vital current
is kept free from foreign matters of various kinds. They seem to
be, in fact, a sort of vital patrol which march up and down the highways
of the body, resisting and destroying intruders of various sorts.
It is evident that massage, as already pointed out
(81-83), by bringing into circulation an increased number of blood cells,
must greatly increase the resisting powers of the body. It is especially
worthy of notice that while both the red and the white corpuscles are greatly
increased by massage, the white corpuscles are increased in much greater
proportion than the red ones.
Massage is also valuable as a regulator of the nutritive
processes. Hopadze has proven that massage increases the assimilation
of nitrogenous food substances, while Zabludowski has shown that massage
both diminishes the weight of very fleshy persons and increases the weight
of badly nourished persons, giving increased appetite and sleep.
He showed that these effects continue not only during the treatment but
for some time afterward.
Influence of Massage upon Elimination. -
The chief effects of massage upon elimination are: -
1. To Improve Elimination. - In general it
sets waste matters free, by encouraging oxidation, by encouraging cell
exchanges by which the waste matters are poured into the blood and the
lymph currents from the tissues, and by stimulating the flow of the venous
blood and the lymph, as well as by promoting general activity of the circulation,
thus bringing the waste matters in contact with the organs devoted to their
2. To Encourage Activity of the Liver. -
The liver requiring oxygen in the various branches of its work as an eliminative
organ, its action is greatly encouraged by the increased amount of oxygen
brought into the blood by massage. The .increased activity of the
portal circulation produced by abdominal massage especially aids the liver.
Hepatic activity may also be directly stimulated
by the application of massage to the liver-especially by vibratory .movements
and percussion applied over the organ. The fact is .worthy of notice
that not only hepatic activity but renal efficiency depend upon the integrity
and activity of the hepatic cell, which, when stored with glycogen, is
capable of transforming leucomaines and various other toxic substances
normally produced in the body, into less toxic forms, preparing them for
elimination by the kidneys, and also actually destroying ptomaines and
other alkaloids which may be taken in with the food or generated in the
alimentary canal. Massage, by promoting these important activities
in the liver, not only aids elimination through both liver and kidneys,
but contributes to purity of blood by the destruction of poisons.
3. To Encourage Renal Activity. - That massage
aids renal, activity has been actually demonstrated by experiments upon
both dogs and human beings. Abdominal massage frequently gives,.rise to,
a copious discharge of newly formed urine, although massage of the back
or loins does not produce the same effect. Abdominal massage doubtless
promotes kidney activity through its influence upon the lumbar ganglia
of the abdominal sympathetic and the solar plexus.
In experiments made upon a dog, it was observed
that massage of the legs also promoted renal activity. The increased
secretion of urine was, however, observed to be but temporary, probably
because the quantity of fatigue-poisons in the body, the removal of which
was especially aided by massage, was soon exhausted. It was found
that the same effect was again noticeable after tetanizing the leg, whereby
a new quantity of fatigue-poisons was produced.
4. To Promote Activity of the Skin. - The
activity of the skin is promoted by massage, both in the direct stimulus
of the sweat and sebaceous glands and the hair follicles, and also in the
reflex influence upon the vasomotor nerves whereby an increased supply
of blood is brought to the skin, thus promoting and continuing the glandular
activity directly excited. An evidence of this stimulation of the
skin as the result of massage is to be seen in the reddening of the surface;
the increased perspiration, which may be so great as to interfere with
the manipulations; the increased production of oil, which is particularly
noticeable in cases in which the skin is abnormally dry at the beginning
of a course of treatment; and the increased growth of hair, especially
upon the legs and arms. Winternitz has shown that friction of the
skin increases the elimination of water sixty per cent.
When it is remembered that the skin is an organ
of respiration as well as perspiration, its increased activity must be
regarded as one of the most valuable effects of massage.
It is also noticeable that massage of the skin increases
its reactive power and so gives it increased ability to defend itself against
changes in temperature, weather changes, etc.
Local Effects of Massage. - The local effects
of massage may be briefly stated to be:
1. Increase of blood and lymph circulation.
2. Increase in both constructive and destructive tissue change.
3. Absorption of waste or effused products.
4. Development of the muscles, ligaments, and other structures
5. Increased heat production and tissue respiration.
6. Reflex or sympathetic effects upon the vasomotor centers,
and through them upon the large internal organs,-the liver, spleen, stomach,
intestines, kidneys, and the general glandular system of the whole body.