The Art of Massage
J. H. Kellogg, M.D.



    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 and excretion.

    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 improvement.

    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 at exercise.

    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 success.

    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 circulation arising
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 malady.

    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 with gymnastics.

    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 degree
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 be accelerated.

    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 medical direction.

    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 this sort.

    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 miserable.

    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 results.

    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 this method.

    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 replaced.
    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, and Berne.

    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 (501-503, 432-438).

    Even acute and chronic nasal catarrh is improved under careful applications of massage to the face (489-497) and neck.