The Art of Massage
J. H. Kellogg, M.D.
THE THERAPEUTIC APPLICATIONS OF MASSAGE.
As it is not the purpose of, this work to enter into
an exhaustive consideration of all the different applications of massage.
we shall scarcely do more than mention briefly those maladies in which
this therapeutic measure has been found most conspicuously useful.
It is, in fact, hardly necessary to devote any very great amount of space
to the general considerations which alone may be appropriately treated
of under this head, since the concise résumé of the
physiological effects of massage which has already been presented, will,
for the intelligent practitioner, serve as the best possible index to its
therapeutic applications ; while for the masseur, the more specific directions
given in connection with the individual measures of massage will be of
greater practical use.
Disorders of Nutrition. - Ancient as well
as modern physicians have regarded massage as a measure by which the general
nutritive processes of the body may be influenced in a most powerful degree.
The value of massage as a therapeutic means arises from its remarkable
influence upon the circulation (42), the direct and indirect stimulation
of the nerves and nerve centers (6, 10), and its remarkable modifying influence
upon assimilation, disassimilation, and all the processes of secretion
Anaemia and chlorosis are more rapidly and permanently
cured by massage than by any form of medication which has been proposed.
In connection with a properly regulated dietary and suitable hydropathic
measures, massage must be considered as the treatment par excellence
for these maladies.
The writer has seen excellent results in a number
of cases of myxoedema in which massage was the leading therapeutic agent
employed. If not capable of effecting a radical cure in this
disease, it must at least be accredited with the power to prevent a further
advance of the malady, and as a means of securing a very decided symptomatic
In cases of exhaustion from excessive mental, nervous,
or muscular work, general massage secures the most marked and satisfactory
results, relieving the sense of fatigue in a most wonderful manner, and
in cases of muscular exhaustion, restoring muscular power in a remarkably
short space of time (31).
Massage also exerts a decidedly quieting influence
upon the nervous irritability and insomnia so commonly accompanying cerebral
and nervous exhaustion (12).
The restorative effects of general massage act with
much efficiency as a means of retarding the encroachments of old age, as
well as in relieving the infirmities incident to that period. It
may be justly considered as a very excellent means of. prevention against
arteriosclerosis, especially if employed in conjunction with suitable exercise.
Diathetic Disorders. - While not a substitute
for regimen in the treatment of those maladies having their foundation
in a morbid diathesis, of which obesity, chronic rheumatism, and diabetes
are the three leading types, massage is certainly a valuable adjunct in
the management of this important class of disorders. It is of special
value in the treatment of obesity, particularly at the beginning of a course,
when the patient is too feeble muscularly to undertake the active exercises
necessary to effect a change in his nutritive processes.
Massage is equally useful in cases of rheumatism
in which exercise is impossible in consequence of pain, stiffness, or deformity,
and also as a means of relieving pain occasioned by the first attempts
Of equal value is massage in the treatment of diabetes
accompanied by great weakness or exhaustion, rendering the amount of exercise
necessary for the burning up of the surplus sugar impossible to the
patient on account of the feeble condition of his nervo-muscular apparatus.
Finkler reports a large number of cases of diabetes mellitus in which great
improvement was secured by massage. Zimmer has shown that vigorous
muscles, even when at rest, destroy more sugar than do feeble ones, a fact
which is easily understood when we remember that the muscles are the furnace
of the body, and are the chief seat of the vital combustion by which glycogen,
or sugar, is consumed (65, 66). Large and vascular muscles will naturally
consume more sugar than feeble and anaemic muscles, just as a large furnace
with a good draft will consume more fuel than a small furnace with a poor
draft. Under the influence of either massage or exercise, the blood
is made to go through the muscles; while in a state of rest it goes round
rather than through them. Bouchard also has shown that exercise of the
muscles increases the consumption of sugar, and thus diminishes the amount
of sugar found in the urine in cases of diabetes. I have often
had opportunity to confirm this observation in my own experience in
the treatment of this disease.
In the treatment of muscular rheumatism, massage
not only relieves the pain accompanying the disease, but also antagonizes
the muscular atrophy which is one of its most constant results.
In the treatment of articular rheumatism, massage
relieves the pain through its derivative action, and also promotes the
absorption of effused inflammatory products, and restores lost mobility.
Other observers as well as the author have found massage useful in arthritis
deformans, and it has given excellent results in the arthritic neuroses,
which are so often the result of
acute or chronic inflammation, and injuries to the joints.
The consecutive or secondary fatigue which is so
apt to occur in the employment of exercise in these maladies is more readily
relieved by massage than by any other means (31-37).
Disorders of the Circulatory System. - Oertel
has employed massage of the heart in cases of cardiac weakness with great
Massage and joint movements are of special advantage
in cases of chronic diseases of the heart, by aiding the circulation and
thus relieving the heart of a portion of its work, whereby it is afforded
an opportunity to rally and its nutrition is improved (42,43).
Centripetal friction of the extremities is the most
powerful of all means of aiding the venous and lymphatic circulations in
oedema and allied conditions (54-58).
When the heart and blood vessels are excessively
active, as after violent exercise, the circulation may be quieted by centrifugal
friction. This measure is useful in cases of insomnia from cerebral congestion,
over-compensation through excessive development of the heart
muscle as the result of valvular disease, or obstruction to the pulmonary
from disease of the lungs (50, 51).
In Raynaud's disease, or local asphyxia, massage
affords a measure of treatment of great importance (44). There is, in fact,
no single means which can be relied upon as of greater value than local
massage systematically employed in the management of this very remarkable
Diseases of the Muscular System. - Although
disease of the muscles is usually accompanied by disorder of the controlling
nerves, the application of massage directly to the muscles is of the highest
value in the treatment of most cases of muscular paralysis and paresis.
In spasmodic diseases, such as chorea, most excellent
results have been obtained through the improvement of the muscular tone
resulting from suitable applications of massage (29), especially when combined
In muscular atrophy, whether resulting from neuritis
or from disease of the cord, massage of the muscles, especially friction
and petrissage, is a measure of the highest value (22-24), affording, in
fact, the best of all known means by which the nutrition of a muscle
may be maintained while regeneration of the connecting nerve structures
is taking place.
Even in fatty degeneration of the muscles, massage
may still prove of value. It is not to be expected, of course, that muscles
which have undergone complete fatty change will be regenerated; but through
the increased nutritive activity set up by judiciously administered massage,
those muscular fibers remaining intact may be developed to such an unusual
that they are able to perform in a very satisfactory manner the functions
of the entire muscle or muscular group.
In pseudo-hypertrophy of the muscles, massage furnishes
the most satisfactory of all means of combating the morbid process which,
left to itself, ultimately results in tissue degeneration and corresponding
loss of function.
Diseases of the Nervous System. - There is
certainly no class of disorders in which massage has won greater triumphs
than in diseases of the nervous system, especially those which are purely
functional in character. In the various forms of neurasthenia, massage
has, in connection with a suitable regimen, often accomplished results
little less than marvelous, as is
illustrated not only by the cases published by S. Weir Mitchell, who
first systematized the use of massage in this class of nervous disorders,
but also by the experience of hundreds of other physicians who have witnessed
the effects of massage upon an emaciated, neurotic invalid, when applied
by a person thoroughly skilled in its employment.
Chorea, writer's cramp (550-555), blepharospasm,
wry-neck, and other maladies in which irregular muscular action, or spasm,
is a leading symptom, are more amenable to this measure of treatment than
to any other therapeutic means (12-14). Such other painful disorders as
facial neuralgia, lumbago, sciatica, crural neuralgia (339, 547-549), and
even migraine, also yield to general and local applications, and often
in a most surprising manner (12-16).
The curative effect of massage in migraine is due
to the fact that it may be employed in such a way as to influence the sympathetic
(160) as well as the central nervous system, since this disease has been
clearly shown to be dependent upon a disordered state of the sympathetic,
and probably in most cases to a disturbance of the abdominal sympathetic.
In rare cases there are found in connection with the disease, and apparently
sustaining a causative relation to it, points of induration or thickening
in the trapezius and scaleni muscles. Massage locally applied is of special
benefit in cases of this kind.
The various forms of headache are in a high degree
amenable to treatment by general and local applications of massage, especially
the different forms of headache from which neurasthenic and anaemic individuals
so commonly suffer (429-431, 155).
Even in the treatment of neuritis, massage proves
a serviceable measure, provided it is properly employed. It must, of course,
be used derivatively in the first stage, and be wholly suspended in the
second stage of the disease, while in the third stage, direct and vigorous
applications are most effective.
Anaesthesias, hyperaesthesias (153), and the
various forms of paraesthesia-numbness, tingling, crawling, burning, prickling,
and other morbid sensations -when of functional origin, quickly yield to
suitable applications of massage.
Even such structural maladies as locomotor ataxia,
spinal sclerosis (309, 341), infantile paralysis, and progressive muscular
atrophy, not infrequently make more improvement under massage than can
be secured by any other means. The writer has seen, in cases of this sort,
results which were truly surprising, and far beyond the most sanguine expectations.
Disorders of the Digestive Organs. -
In the treatment of the various forms of indigestion, massage, general
and local, is second in value only to diet and hydrotherapy. In certain
classes of cases, indeed, massage can hardly be said to be second to the
important therapeutic agents mentioned, especially in cases in which dilatation
of the stomach, prolapse of the stomach or bowels, or other mechanical
or static derangements of the viscera are chiefly responsible for the symptoms
present (439-450). We need not dwell further upon this point, however,
as the application of massage in this class of disorders is considered
at length elsewhere in this work (389-424).
Diseases of the Liver. - Although the liver
is one of the most important organs concerned in the digestive function,
it performs so many and such varied functions that it is proper to consider
it by itself. While organic diseases of the liver are only to a very
slight degree benefitted by massage, nearly all its functional disorders
are capable of being very directly and beneficially influenced by appropriate
applications of massage and joint movements. In acute inflammatory
affections of the liver, massage and joint movements of the legs, carefully
administered, are of great value as a means of relieving the general visceral
congestion which results from hepatic inflammation, as well as the congestion
of the liver itself.
In those conditions of the liver commonly termed
torpidity, or sluggishness, massage of the liver itself is a measure of
the greatest value. Vigorous percussion over the region of the liver,
and kneading of those portions of the organ which are accessible to the
hand of the masseur, are of very great value; but even greater value must
be .attached to general abdominal massage and chest massage combined with
breathing movements, by which the stagnating circulation of the liver may
In cases of gallstones, massage has often proved
a valuable measure, furnishing a means whereby the gall bladder may be
made to discharge its contents into the intestinal canal. Manipulations
of this sort must be employed with the greatest discretion, however, and
should be trusted only to the hands of a trained masseur acting under intelligent
Renal Disease. - Massage is undoubtedly of
value in the treatment of certain forms of renal disease, although in this
class of cases it is necessary that it should be used with great care and
discretion. This is especially true as regards acute inflammatory
conditions of the kidneys, in which the throwing into the circulation of
a great quantity of waste matters-leucomaines -by means of massage, might
overtax the disabled kidneys.
Massage affords an excellent means of relieving the
oedema sometimes present in renal disease, although, of course, it is
not to be expected that a radical cure will be effected in all cases of
In displacement of the kidney (447,448), massage
locally and skillfully applied is of paramount importance, and in cases
of renal insufficiency, massage may often be used with excellent results.
Disorders of the Pelvic Organs. - In diseases
of the uterus and ovaries, massage often affords relief which cannot be
obtained by any other means (457- 488). While cures can seldom be expected
in cases of chronic retro-displacement, displaced ovaries may often be
restored to position by skillful manipulation; and even in cases in which
the uterus and ovaries cannot be permanently replaced, so great improvement
in the nutrition of the parts may be effected by massage as to relieve
the patient from the distressing symptoms which had previously made life
Employed in connection with hydrotherapy, especially
the sitz bath, the vaginal douche, and the moist abdominal girdle, with
judicious applications of electricity and carefully graduated exercise,
general and local massage may often be made to secure the most wonderful
results. It is almost always necessary as a supplementary mode of
treatment in cases in which an operation has been performed for shortening
the round ligaments as a means of correcting retro-displacement. The neglect
to employ massage and other curative means in these cases often results
in failure to accomplish what might, otherwise be effected in a most satisfactory
manner, in the relief of this most obstinate, and with ordinary means incurable,
class of maladies.
Amenorrhoea .and dysmenorrhoea are often more effectively treated by
massage than by any other therapeutic means. Massage is useful not only
in cases in which the menstrual pain is due to a morbid condition of the
uterus, but also in ovarian dysmenorrhoea. In the latter- class of cases,
indeed the writer has witnessed the most satisfactory and even remarkable
Subinvolution, and many other morbid conditions
following childbirth, are most efficiently treated by pelvic massage (457-484).
Among intelligent medical practitioners, massage
of the breast (541-543) has almost wholly replaced the old fashioned breast
pump, which has been responsible for so much mischief in cases requiring
artificial emptying of the breast in nursing women.
Massage of the prostate (485) has afforded valuable
results in certain cases of recent enlargement of this organ as the effect
of inflammatory action. In chronic enlargement from hypertrophy, however,
very little result can be expected.
Spinal Curvatures. - In the treatment of
spinal curvatures (510-517), massage is an extremely important adjunct
to exercise and electrical applications, although it can hardly be said
to be a substitute for either of these. By the combination of these
three remedies, however, results which seem little less than marvelous
may be obtained in suitable cases, but little can be
expected when fatty degeneration of the muscles and structural changes
of the vertebrae have taken place. In the last-named cases, mechanical
support of some kind must be employed.
Pulmonary Disorders. - Massage is of value
in various forms of pulmonary disease, especially in chronic pleurisy
accompanied by serous exudate. Poliakow reports most excellent results
in the treatment of cases of pleurisy with exudation, absorption having
taken place in eight to twenty days in each of the ten cases treated by
In the application of massage to the thorax to promote
absorption, the manipulations should be in the direction of the lymphatics,
which run toward the axilla (380-384).
All of the different procedures of massage of the
chest should be employed, but special attention should be given to friction
and hacking movements.
Massage, in cases of this sort, is much to be preferred
to blisters and other forms of counter-irritation, for the reason that
the mild effects which it produces may be daily repeated, and it is accompanied
by other results of even greater importance.
In emphysema, massage may be so employed as to relieve
pulmonary congestion and aid expiration (381).
In phthisis the writer has seen excellent results
from the use of massage, but it should be remembered that massage, as well
as exercise, must be suspended during febrile conditions, as the
heat-regulating functions of the body are seriously interfered with in
phthisis as well as in acute febrile states. Massage, administered in such
conditions, will increase the production of heat, and out of all proportion
to the vigor of the treatment, just as so slight an amount of exercise
as sitting up in bed will sometimes produce a relapse in cases of typhoid
fever after convalescence is well established. The only form in which massage
can be employed with advantage, or without risk of injury, is that
of light friction. Both centripetal and centrifugal friction (193, 194)
may be employed. As a rule, centrifugal friction should conclude the seance
in all cases in which there is so slight an amount of temperature rise
as one or two degrees Fahrenheit, and the patient should rest for at least
two hours after the treatment. The best time of day for applying
massage in cases of pulmonary disease, is soon after breakfast, or before
the daily temperature rise begins. Massage of the chest is especially useful.
Sprains and Fractures (533-537). - The general
plan to be pursued in the employment of massage in the treatment of fractures
is the following: When the fracture is reduced, place in an immobilizing
apparatus. After three or four days, remove each day and apply massage
to the whole limb, taking care to avoid displacement of the fragments.
After the massage the splints or other immobilizing apparatus must be carefully
The massage of the portion of the limb adjacent
to the fracture should at first be very gentle, consisting of centripetal
friction and fulling movements, the pressure being gradually increased
from day to day, deep massage being introduced not later than eight or
ten days from the, date of the fracture. Light percussion of various sorts
may be applied to the whole limb. Deep massage may be applied to the uninjured
portions of the limb from the start. The author has found it advantageous
to use hot fomentations and alternate hot and cold compresses in connection
with massage. At each treatment, the joints which are confined by the splints
should be carefully flexed, so as to maintain perfect mobility.
The attention of the profession has been especially
called to the value of massage in fractures by Schode, Mezger, Lucas-Championnière,
Diseases of the Eye and Ear. - Muscular asthenopia,
glaucoma, corneal ulcer, corneal opacity, and various other, affections
of the eye, have been successfully treated by massage (498-500).
Certain forms of deafness, particularly deafness
due to catarrhal disease of the Eustachian tubes, may be not only temporarily
relieved but permanently benefitted by massage of the ear, neck, and throat
Even acute and chronic nasal catarrh is improved under careful
applications of massage to the face (489-497) and neck.