The Art of Massage
J. H. Kellogg, M.D.
MASSAGE OF SPECIAL REGIONS.
In the foregoing pages has been given a careful
description of the various procedures employed in massage. I will now proceed
to give more specific directions for the general and local application
of. massage in which the various manipulations are combined.
General Massage. - The order of application
to different parts of the body in the administration of general massage
should be as follows:
(1) Arms ; (2) chest ; (3) Legs; (4) Abdomen ; (5)
Hips; (6) Back; (7) Head.
In the application of the different procedures named
below, it should be understood in general that the parts are to be gone
over with each manipulation from four to eight times. For specific directions
respecting the application of each of the various procedures, the reader
is referred to previous pages, except in the case of such movements as
are especially adapted to particular regions, directions for which will
be given as may be required to make their application plain.
Massage of the Arm. - The several procedures
are applied in the following order:
1. Friction - light centripetal (193, 199-201,
2. Fulling (244).
3. Friction - spiral and centripetal (196).
4. Petrissage, or muscle kneading (248-254).
5. Rolling (255-260).
6. Friction - centripetal.
7. Wringing (261-264).
8. Friction - centripetal
9. Percussion - hacking (316), spatting (314),
10. Joint movements (343-348) - flexion,
extension, rotation, stretching, etc. (355-365, 372-376).
11. Vibration - shaking (303).
12. Stroking (175, 169-172).
In masseing the arm, centripetal friction and fulling
are first applied to the whole arm, beginning with the hand, as preliminary
treatment. Friction and deep kneading are then alternately applied in sections,
first to the hand, then the forearm, then the upper arm. Procedures 5,
6, 7, 8, 9, 11, and 12 are applied to the entire arm; joint movements (10)
are applied in succession to the fingers, wrist, elbow, and shoulder; rolling,
wringing, and stroking, from above downward; friction, from below upward;
percussion, both from above downward and below upward. Shaking, or vibration,
may be applied simultaneously with stretching.
Massage of the Chest. - Order of movements:
1. Friction - centripetal (very light) (203,
2. Fulling (carefully) (244).
4. Palmar kneading (266).
5. Percussion - tapping (313), hacking (316),
spatting (314), beating (317), clapping (for very fleshy
6. Assistive and resistive respiratory movements
To assist expiration, compress the sides
of the chest during expiration, or raise the arms outward and upward with
To resist inspiration, place one hand upon
the abdomen, causing the patient to lift it upward by the inspiratory movement,
making at the same time a degree of pressure adapted to the patient's condition;
or a shot-bag may be used instead of the hand (Fig. 72).
To resist expiration, have the patient breathe
through a small tube (Fig. 72) or through a small opening in the lips.
In massage of the chest, great care should be observed
that the patient breathes properly. The patient should be taught the proper
mode of chest and waist expansion in breathing (Fig. 73). Few women know
how to expand the lower part of the chest. Patients should be made to inspire
through the nose, and to take deep and slow respirations.
Massage of the Leg. - The order of movements
is essentially the same as for the arm, as follows:
1. Friction - centripetal (193, 202).
2. Fulling (244).
3. Friction - spiral (196), circular (195),
4. Petrissage, or muscle kneading (248-254).
5. Rolling (255-260).
6. Friction - centripetal.
7. Wringing (261-264).
9. Percussion - backing (316), spatting (314),
beating (317), clapping (315).
10. Joint movements (343-348) - flexion,
extension, abduction, adduction, circumduction, stretching (366-372).
11. Shaking (303).
12. Stroking (175, 169-172).
Movements 1 and 2 are preparatory; 3 and 4 are applied
successively to the feet, lower leg, and thigh; 5, 6, 7, and 8 are applied
in succession to the leg and thigh in connection with 3 and 4 ; 10 is applied
successively to the toes, ankle, knee, and thigh; 9, 11, and 12 are applied
to the whole leg.
The principles laid down in relation to massage
of the arm apply equally to the leg.
The muscular structures of the thigh are so massive
in adults, and especially in very fleshy persons, that they cannot be so
conveniently grasped as in the arm and lower leg, hence it is impossible
to so perfectly individualize muscles and muscular groups in the manipulation.
Rolling movements must, to a considerable extent, be substituted for petrissage.
Special pains must be taken, however, to follow the general contour of
the bones, so as to lift and stretch every muscle, working especially over
the course of the great vessels which lie along the inner border of the
extensors, and taking care to pull and stretch the muscular masses away
from them on each side.
Massage of the Abdomen. - Order of movements:
1. Preliminary movements - deep breathing (441,461);
inspiratory lifting (444, 445); lifting the abdominal contents (442).
2. Reflex stroking (395).
3. Nerve compression (160, 396, 397).
4. Vibration - deep vibration, lateral shaking,
circular shaking (398-400).
5. Percussion - tapping (313), spatting (314),
hacking (316), beating (317), clapping (315).
6. Deep kneading - digital kneading of the colon
(404, 405); kneading of the colon with the fist (406-408);
kneading of the colon with the fingers and heel of the hand (412-414)
; kneading of the colon with the thumbs (409, 410).
7. Mass kneading of the abdominal contents (411).
8. Rolling (415).
9. Fulling (carefully) (420).
10. Petrissage, or muscle kneading (421, 422).
11. Stroking (175, 170).
12. Percussion of lumbar spine and sacrum (315-317).
13.. Hips-raising and knees-separating exercises
The twelfth step may be omitted when massage of
the abdomen is employed in connection with general massage, as it is included
in massage of the back (426), and also the knees-separating exercise
(13), which is included in joint movements of the legs (385 (10),
The following rules should be carefully observed
in abdominal massage:
1. General abdominal massage should not be administered
until two hours after eating.
2. The bladder, should always be emptied just before
3. In obstinate cases of faecal accumulation, a
coloclyster ( large enema taken in right Sims's, or knee-chest, position
) of warm water should be administered, the water being allowed to pass
off before treatment.
4. The patient should be taught to relax the abdominal
muscles, and to breathe deeply and regularly during treatment.
5. If the abdomen is very sensitive, apply a hot
fomentation before giving the massage.
6. If the skin perspires very freely, render it
firm and smooth by sponging with cold water.
7. Very "ticklish" patients require careful education
by avoidance at first of superficial movements.
8. Pain and coldness of the extremities, or depression,
after abdominal massage, is due either to bungling or violent treatment,
or to extreme hyperaesthesia of the abdominal sympathetic. In such cases,
employ fomentations and the moist abdominal bandage in connection with
9. It is important in all manipulations of the abdomen
to exercise great care not to excite pain. All movements should be executed
in such a manner as to avoid sudden thrusts, thereby causing the patient
pain or other disagreeable sensations, as such disturbances create rigidity
of the abdominal muscles, thus seriously interfering with the effects of
10. In applying massage to the abdomen, the operator
should stand over the patient, so as to aid his hands, as far as possible,
by the weight of his body, taking care, of course, to graduate the pressure
to the requirements of each individual case.
11. All deep-kneading movements in massage of the
abdomen should be slower than for other parts of the body, to allow time
for movement of the faecal mass.
Therapeutic Applications. - Abdominal massage
is so important a therapeutic procedure, and is so much employed as a special
measure of treatment, that the subject is worthy of further consideration
and, a more particular description of the several procedures enumerated,
and of the conditions in which each is useful. Abdominal massage
is useful for the following purposes:
1. To relieve chronic constipation.
2. To aid stomach, intestinal, and liver digestion.
3. To promote the absorption of fluids and elimination
by the kidneys in ascites and in cases of deficient renal action.
4. For the removal of abnormal deposits of fat.
5. To develop weak or relaxed muscles.
6. For the replacement of displaced viscera in enteroptosis.
The stomach, general intestinal mass, colon, one or both kidneys, spleen,
and liver when prolapsed may usually be replaced by proper manipulations.
7. Abdominal massage is a necessary accessory in
the treatment of many forms of pelvic disease. Indeed, in most of
these cases the primary seat of the disorder is the abdomen rather than
The most common and important use of abdominal massage
is as a means of relieving chronic intestinal inactivity. The general causes
of constipation, as regards conditions of the bowels which may be relieved
by massage, are the following:
1. Relaxed abdominal muscles, resulting in prolapse
of the bowels and other viscera, and consequent stasis of the intestinal
contents, with resulting dilatation of the colon. The dilatation may exist
either in the caecum or the sigmoid flexure, or the entire colon may be
affected. In consequence of delay to evacuate the bowels, the faecal contents
often form hard masses, as the result of the excessive absorption of fluid
due to their .prolonged sojourn in the colon.
2. Deficient production of bile, due to an inactive
state of the liver, either as a result of inactivity in the portal circulation,
or that, condition of the liver termed by the French "hepatism," in which
there is some local functional derangement. This condition, commonly spoken
of in this country as "torpidity" or "biliousness," is one in which the
liver fails to perform its work effectively in destroying ptomaines which
are received in the food or are formed in the alimentary canal, or to convert
into less toxic forms the leucomaines, or tissue poisons, normally developed
in the system and prepared by the liver for elimination by the kidneys.
This condition is commonly present in rheumatism, gout, and the various
conditions included under the term "uric acid diathesis".
3. Deficient activity in the nerve elements supplying
the intestines and controlling the reflexes by which peristalsis is maintained,
the contents of the bowels moved along the intestine, and the normal diurnal
rhythm maintained whereby the residuum reaching the lower part of the colon
is regularly discharged from the body.
The immediate indications in relation to the removal
of these causes, so far as massage is effective to accomplish it, may be
enumerated as follows :
1. Increase of glandular activity by an increase
of the activity of the blood current in the portal vein, and stimulation
of the abdominal sympathetic ganglia, the splanchnics, and Meissner's and
Auerbach's plexuses, the nerve mechanisms which control the motor, vascular,
and secretory functions of the intestines.
2. Increase of peristaltic activity through a stimulation
of the nervous reflexes by which this activity is maintained, and by an
increased outflow of bile from the liver, the natural laxative by which
rhythmical peristaltic activity is promoted.
3. Relief of passive congestion of the portal system
and of the viscera under the influence of this branch of the circulatory
system, especially the liver, spleen, stomach, and intestines, thus aiding
the return of these structures to a normal state and a consequent restoration
of their functions.
4. Mechanical dislodgment of the contents of the
5. Development of the abdominal muscles, thereby
increasing intra_abdominal tension, which favors expulsion of the intestinal
6. Replacement of displaced viscera.
Not infrequently - in the majority of cases, in
fact - all of, these indications are found coincidently present.
The procedures offered by massage by which these
indications are best met, are the following :
1. To stimulate the nervous reflexes, and hence
the peristaltic, glandular, and vascular activities, under control of the
This may be accomplished by employing the following
(1) Reflex Stroking. - With the ends of the
fingers, make very light strokes in a circular or semicircular direction
about the umbilicus. Begin very close to that point, gradually extending
outward, then return and repeat. Also make vertical strokes along the sides
in the mammary line, and parallel with the rectus muscle. Strokes may also
be made over the fourth, fifth, and sixth ribs at the sides of the chest.
In sensitive persons, one-sided contraction of the abdominal muscles or
a twitching at the epigastrium will be noticed as the result of the so-called
abdominal and epigastric reflexes. This procedure is strongly exciting
; some patients are not able to endure it. The profound reflex effect produced
in patients who are very sensitive, or "ticklish," is evidence of the strong
influence of this procedure upon reflex nervous activity.
(2) Nerve Compression (Figs. 35, 76). - The
stomach and the intestines are directly controlled by the solar plexus
and the lumbar ganglia of the sympathetic. The solar plexus is at
the epigastrium, just below the lower end of the sternum. The chief lumbar
ganglia are situated on each side of the umbilicus, about two inches from
it. Pressure upon these ganglia has a marked stimulating effect, because
they send out energetic nerve impulses into the parts which they supply,
which include not only the stomach and the intestines but all the abdominal
It should be remembered that these nerve masses
lie beneath the abdominal contents, resting upon the bodies of the vertebrae.
It is hence necessary to make a considerable degree of pressure in order
to reach them. The tips of the fingers, being placed upon the points indicated,
should be carried directly back toward the spinal column, the patient in
the meantime being directed to take first a full breath and then to exhale
as completely as possible. This diverts the mind of the patient from the
procedure which is being executed, and also diminishes the abdominal tension,
thus making it less difficult to bring pressure to bear upon the posterior
wall of the abdominal cavity.
With patients who are extremely fleshy, and in cases
in which the abdomen is greatly distended with gas, this procedure can
be executed only in a very imperfect manner.
The position of the patient is a matter of great
importance. The shoulders should be slightly raised and the knees well
drawn up, the legs being supported, so that the anterior abdominal wall
shall be relaxed as much as possible. The patient's hands should be by
his side, and all the muscles of the body in a state of rest. Only gentle
pressure should be employed, and the application should be continued only
two or three seconds at each point. In many cases it will be found that
extreme sensitiveness exists at the points indicated, which is evidence
of an excited or hyperaesthetic state of the abdominal sympathetic. Continuous
gentle pressure may be beneficial, even in these cases, however, acting
as in other cases of abnormal nerve sensibility, as chronic sciatica, by
setting up a series of vital activities which result in the restoration
of the nerve to its normal condition.
(3) Vibration. - (a) Strong vibration applied
to the abdominal contents has been shown to be one of the most powerful
means of stimulating the nervous reflexes, circulation, glandular activity,
and peristalsis, which can be employed for this part of the body. Either
one or both hands may be used. The flat palm of the hand is applied to
the surface, with the arm extended, and fine vibratory movements are executed
in such a manner as to throw the whole abdominal contents into vibration.
The same movement, which consists of a sort of trembling, as elsewhere
described, may be beneficially applied to the liver (Fig. 55).
(b) A more vigorous shaking movement is communicated
to the abdominal contents by making intermittent pressure either with one
hand, or with one hand reinforced by the other, or by both hands in alternation,
the movements being made with sufficient rapidity to produce a decided
motion of the abdominal contents. The effect of this procedure is very
marked in cases in which the abdominal walls are considerably relaxed.
(c) A third method of applying shaking is by placing
the palm of the hand upon the abdomen, the arm slightly flexed, then making
a rapid rotary movement without allowing the hands to slide upon the surface.
The direction of the movements is alternated, half a dozen in one direction
and then an equal number in the opposite direction.
(4) Percussion . - This is unquestionably
the most powerful of all the stimulating means which can be applied to
the viscera through the abdominal wall. All the different modes of percussion,
viz., tapping, spatting, clapping, hacking, and beating, may be usefully
employed. The mode of executing these movements has been elsewhere indicated.
2. To produce mechanical effects by means of
which stasis of the intestinal contents may be overcome and accumulated
faecal matter dislodged at the same time that the circulatory and g1andular
activities are stimulated.
For this purpose deep kneading is especially to
be, recommended. This may be accomplished by a number of different procedures
(1) Digital Kneading (Fig. 77). - Standing
face to the patient's feet, and with the fingers very slightly flexed,
place the finger tips, the hand being reinforced by the other hand placed
above it, upon the abdomen, low down upon the right side. Crowd the finger
ends backward, pressing with as much force as possible without giving the
patient much inconvenience, against the caecum. Carry the hand upward in
the direction of the ascending colon as far as permitted by the ribs. Repeat
the movement four or five times. Execute similar movements on the left
side, beginning above instead of below, pressing the fingers upon the abdominal
wall at a point close under the ribs on the left side. Carry the hand downward,
turning toward the median line at the conclusion of the movement, so as
to follow as closely as possible the course of the sigmoid flexure of the
In cases in which it is believed that a considerable
amount of faecal matter exists in the colon, the procedure should be somewhat
different. It should begin with the left instead of the right side, and
instead of placing the hand at the start close under the ribs, it should
be pressed down at a point two or three inches above the point at which
the movement terminates. After two or three movements starting at this
point, the hands should be carried a little farther upward, the strokes
repeated as before, and the hand carried at each stroke down to the lowermost
point which can be reached.
After doing the left side in this manner, execute
the same movements upon the right side, beginning at a point just below
the ribs instead of at the lower end of the caecum, and gradually increasing
the length of the stroke from below upward until the lower end of the caecum
is reached. The above movements may be advantageously repeated with the
patient lying in the right. or left Sims position, the left side for the
ascending colon, and the right side for the descending colon.
(2) Kneading with the Closed Fist (Fig. 78).
- With the closed fists used in alternation, work along the whole course
of the colon, beginning at the lower end of the caecum, directing the movements
upward to the lower border of the ribs on the right side, following the
oblique border of the ribs to a point midway between the umbilicus and
the sternum, at which the median line is crossed ; then down on the opposite
side, ending at a point close to the pubic bone, and just to the left of
the median line.
It should be remembered that the colon lies much
deeper at the sigmoid flexure than at any other portion of its course,
so that in order to reach the lower part of the colon it is necessary to
press the hand in as deep as possible without giving the patient too much
inconvenience. The movements must be directed with great care and deliberation.
The rate of movement should not be more than
thirty per minute, or two seconds for each hand. Care should be taken not
to release the pressure upon the bowels with one hand until the other hand
has been placed in position just in advance and close to it. Care must
also be taken to follow the curves of the colon.
In the directions given above, the colon is supposed
to be in normal position. This is by no means always the case, however.
In the majority of women who have worn the ordinary dress, and in nearly
all elderly women, the colon will be found more or less prolapsed. The
prolapse usually involves chiefly the central portion of the colon, as
this portion is more easily displaced than the points of junction of the
ascending and descending colon with the transverse portion. The case shown
in Fig. 95, a photograph of which was sent to the writer by Professor Meinert,
of Dresden, Germany, will give a good idea of the unnatural conditions
often found in these cases. Many cases equally bad have been encountered
by the writer. A fairly correct idea of the location of the colon may be
obtained by noticing the contour of the abdomen when the patient is placed
in a sitting or standing position. The colon may be considered as lying
along the line of greatest prominence. This may be observed with the patient
standing or sitting, and marked with a soft sketching pencil or a bit of
cotton moistened with tincture of iodine.
Kneading with the Thumbs (Fig. 79). - With
the fingers behind and the thumbs in front, grasp the loin on each side
between the thumb and the fingers. The right hand should thus grasp the
lower end of the caecum, while the left hand grasps the upper part of the
descending colon just beneath the ribs. Movements are then executed in
an upward direction with the right hand, and a downward direction with
the left hand, the operator facing the patient's feet.
In thin persons the ascending and the descending
colon can be more efficiently manipulated in this way than in almost any
other, as at least some portion of the intestine may by this procedure
be actually seized between the fingers and the thumb, and the contents
forced along. When the colon is loaded with faecal matter, thumb kneading,
as well as fist and palmar kneading, should begin near the ribs on the
right side, and as low down as possible on the left side, working gradually
downward and upward respectively, in such a manner as to clear the way.
(4) Mass Kneading (Fig. 80). - Still another
procedure which is of value in abdominal massage, is what may be termed
"mass kneading," in which the operator endeavors to seize the abdominal
contents with both hands, manipulating them precisely as a baker does a
mass of dough, the fingers of one hand being used in opposition to the
heel of the other hand, and the abdominal contents kneaded and manipulated
between the two hands. In this procedure the heel of one hand of the manipulator
operates upon the side of the patient near est him, while the fingers of
the other hand operate upon the tissues of the opposite side. Mass kneading
is only applicable to cases in which the abdominal walls are considerably
(5) Palmar Kneading. _ Two movements, both
of great value, may be executed with the heel of the hand, as follows:
(a) Describe a circle about the umbilicus, the hands
being used in alternation, the heel of one hand moving up on the right
side, and the other moving down on the left side, the stroke on the left
side being made to slightly overlap that of the right side. This acts especially
upon the small intestines.
(b) Starting at the lower end of the ascending colon,
work the whole colon with the heel of the hand, carefully following its
direction from the caecum to the sigmoid flexure, one hand assisting the
other by supporting the tissues to prevent overstretching the skin. Or,
knead the ascending colon with the heel of the hand, the transverse colon
with the ulnar side of the hand, and the descending colon with the tips
of the fingers. This method obviates the necessity of changing the position
of the body during manipulation.
(6) Rolling. - When the abdominal walls are
considerably relaxed, they may be gathered between the hands placed parallel
with the body, one on each side, and thus compressed, rolled, and shaken,
together with the intestinal contents. Care must be taken to include the
abdominal contents_ not simply the skin and subcutaneous tissue or a mass
of subcutaneous fat. The patient's position must be such as to secure very
thorough relaxation of the abdominal muscles in order to make this procedure
(7) Massage of the Gall Bladder. - The movement
of the bile from the liver toward the intestine may be assisted, and the
liver be gently manipulated, by applying pressure with the left hand as
follows: The operator, standing by the left side of the patient, places
the left hand at the lowermost border of the ribs of the right side; a
stroking movement is then executed along the lower border of the ribs of
the right side in the direction of the epigastrium, the fingers being crowded
up under the ribs as high as possible or until the lower border of the
liver is felt. In this way it is possible to reach the gall bladder, and
to facilitate the discharge of its contents into the intestine. The bile
being a natural laxative, this is one of the most effective means of stimulating
Care should be taken to place the patient in such
a position as to completely relax the abdominal muscles, and he must be
made to take long, deep inspirations during the procedure, so as to prevent,
so far as possible, spasm of the abdominal muscles.
3. To Strengthen the Abdominal Muscles
Massage alone is not sufficient as a means of developing
the abdominal muscles, as is the case with all muscular structures. They
must be brought into voluntary action by proper gymnastics, for which the
Swedish gymnastics and the manual Swedish movements, or medical gymnastics,
afford the most effective means. The application of electricity, particularly
of the sinusoidal current, is the most efficient of all modes of passive
exercise. This current, used with slow alternations, brings the muscles
of the abdomen into vigorous contraction without producing pain or other
sensation than that of motion. Much, however, can be accomplished by massage.
The following procedures are the most effective :
(1) Kneading. - As with other muscular structures,
kneading is the most effective of the procedures afforded by massage, for
stimulating development of the abdominal muscles. Both superficial kneading,
or fulling (244), and deep kneading, or petrissage (248-254),
may be employed.
(a) Apply fulling movements to the whole abdominal
surface, working up and down in the direction of the recti muscles, and
in circles about the umbilicus.
(b) In deep kneading, or petrissage, of the abdominal
muscles, care should be taken, as in other regions, to include the individual
muscles or groups of muscles in the grasp of the hand, as far as possible.
The recti and the external oblique are the only muscles readily accessible
to the hand. The outline of these muscles may be easily discerned by causing
the patient to raise the head by forcible effort, and without the assistance
of the arms. Forcible contraction of the recti muscles causes the external
oblique to bulge at the sides, showing the outline of both sets of muscles.
When the abdominal muscles are thoroughly relaxed by proper position, and
in cases in which they are especially in need of this form of treatment,
the recti muscles can be quite easily grasped and manipulated individually.
The external oblique is less easily managed, but by a painstaking effort
the whole muscle can be subjected to a thorough manipulation.
A very effective mode of masseing the recti muscles
is to cause the patient to raise the head (Fig. 81); then, with both hands
placed upon the abdomen in such a mariner that the thumbs rest upon the
recti, the operator facing the patient, the muscles are rapidly manipulated
by the thumbs, working from below upward.
In some patients these manipulations are apt to
produce excoriations of the skin in consequence of its thinness. This is
especially the case when the skin becomes moist by perspiration. To obviate
this difficulty, the surface should be well lubricated with cacao butter
or talcum powder.
Replacement of the Abdominal Viscera. - This
is necessary in many cases of abdominal massage, as a preliminary procedure.
It is especially required in women, since in the majority of invalid women
some of the viscera are almost certain to be found displaced. The stomach
is displaced from two to five inches below its normal position in nineteen
out of twenty of all adult civilized women who have worn the conventional
dress. A movable, or floating,.right kidney is to be found in at least
twenty-five per cent of women who are likely to require abdominal massage.
The liver is also not infrequently found displaced. The methods employed
in replacing the various viscera are given elsewhere (439-450).
Massage of the Hips. - With the patient lying
upon the back the manipulations are applied to the fleshy portions of the
hips, or the buttocks, the several procedures being administered in the
1. Light centripetal friction (193).
2. Fulling (244).
3. Circular friction (195, 203).
4. Petrissage (248).
5. Palmar kneading (266).
6. Centripetal friction.
7. Nerve compression along the sacroiliac synchondrosis
(junction of sacrum with iliac bones) and over the sciatic nerve (Fig.
8. Percussion-hacking (316), spatting (314),
beating (317), clapping (315).
9. Stroking (175).
Massage of the Back. - The patient lies upon
the face, the forehead resting upon the crossed hands, the elbows well
raised from the sides so as to spread the scapulae and uncover as much
of the back as possible:
1. Centripetal friction (193).
2. Fulling of the neck, shoulders, sides, and loins
3. Friction - circular (195), centripetal
4. Deep kneading - palmar kneading, or rolling,
above the scapulae (Fig. 53); digital kneading, following the ribs (292);
palm kneading up and down the spine (288, 291, 494); digital kneading
of the spine (Fig. 54) (287, 289, 290, 293).
5. Nerve compression (156); spine stretching
6. Percussion of spine and sacrum - tapping, hacking,
slapping, beating, clapping (313-317)
7. Friction (alternating with kneading, as above)
8. Stroking (175, 176).
Spine stretching may be applied in one of the following
1. Suspension by the head or the head and shoulders.
By means of an improved form of apparatus which the writer has had constructed,
and has used for several years, the tension upon the head and shoulders
may be separately determined and proportioned with accuracy.
2. The patient lying upon his face, hips and chest
supported by pillows, his head is strongly flexed by the masseur over the
end of the couch.
3. The patient sitting with legs extended horizontally,
leans forward while the attendant flexes his head strongly forward.
Massage of the back is a very agreeable procedure
for most patients. The skin of the back is but little sensitive, and will
bear the employment of considerable force. Percussion of the spine is one
of the most powerful means of affecting the deep_lying nerve centers, and
affects not only the spinal centers but, reflexly, the sympathetic centers
also, and through the splanchnics, influences the circulation in the stomach
and intestines. Pain in the spine is most often due to hyperaesthesia of
the abdominal sympathetic but is often due to anaemia which may be present,
or the result of spasm of the vasomotor centers, having its origin in sympathetic
irritation. The pain usually disappears under treatment when the force
employed is graduated with sufficient care. Fomentations applied daily
and the moist, or so-called heating, compress worn at night are necessary
adjuncts to massage in cases in which there is much tenderness of the sympathetic.
Pain in the sacral region may be due to rectal, ovarian, or bladder disease.
Pain in the lumbar region is usually due to hyperaesthesia of the abdominal
sympathetic. Pain in the dorsal region originates in irritation of the
Massage of the Head. - Massage of the head
and neck is not usually included in general massage, but may often be advantageously
added to the general manipulations as a means of quieting any slight excitement
which may have been produced, and leaving the patient in a restful state.
Head massage is especially valuable for the relief of headache, neurasthenic
pains, baldness, the dullness and other uncomfortable sensations resulting
from loss of sleep, cerebral anaemia, neuralgia, and migraine.
The procedures which I have found most useful are
the following, usually employed in the order given :
1. Digital kneading, from forehead to occiput (Fig.
2. Hacking (316), from before backward.
3. Chucking (Fig. 45), one hand placed upon the
forehead or the side of the head, the other opposite.
4. Tapping (313).
6. Head rolling, flexion, and twisting both active
and passive, repeated four to eight times.
7. Stroking from vertex to base of skull, down back
of neck, and along the submaxillary groove.
8. Vibration - shaking (303).
10. Hypnotic stroking (189).
In cases of great immobility of the scalp (a "hidebound"
condition), when necessary, a better hold of the scalp may be obtained
by grasping the hair between the fingers close to the roots. Care should
be taken, however, not to give so great latitude to the movements as to
produce unpleasant sensations from pulling the hair.
Neck Massage. - The purpose of neck massage
is to withdraw blood from the brain. The circulation in the brain is so
directly affected by the breathing movements that it is especially important
that respiration should receive attention. The patient should sit with
the head well raised, the arms extended downward as far as possible, so
as to expose the neck to the fullest extent, and should be made to execute
deep breathing movements for a few times before the manipulations are begun,
so as to insure full respiration, and to distract his attention from the
manipulations. The strokes should be made at the same time with inspiration,
and with both hands simultaneously, except in cases in which the throat
is so sensitive that irritation of the larynx and coughing result from
compression of the larynx between the fingers or thumbs of the two hands,
when the strokes should be made in alternation.
Höffinger's Method. - Massage of the neck may
be applied in several ways. The following is known as Höffinger's
Method (Fig. 84): The patient sits upon a high seat, the operator standing
behind. The hands are brought in contact with the neck in such a way that
the little fingers fall into the groove beneath the jaw. The hands are
then made to move downward, the arms rotating inward at the same time,
the ends of the fingers pressing upon the jugular veins. After a few strokes
over the anterior portion of the neck, similar strokes are made with the
thumbs over the back part of the neck. The deep breathing should be continued
during the manipulation.
Höffinger employs only manipulations of the
anterior portion and sides of the neck. Experience has led me to employ
also manipulation of the back part of the neck, extending from the occiput
down on either side of the ligamentum nuchae to the vertebra prominens.
This manipulation powerfully influences the cervical sympathetic, and is
of very great value in cases of occipital headache and the "neckache "
so common with neurasthenics.
Gerster's Method. - Massage of the neck may
also be applied from the front - Gerster's method (Fig. 85). With the fingers
extended and held close together, the palm upward, the little fingers are
applied to the neck just below the ears. The hands are then moved downward
and rotated inward, so that the tips of the thumbs fall on each side of
the larynx. Friction is thus applied in such a manner that the fingers
compress and empty the external veins, while the thumbs press upon the
internal jugular veins.
In the case of children or persons with very small
necks, the thumb may manipulate the front part of the neck while the fingers
are applied to the back of it (Fig. 86).
Author's Method. - I employ hacking and fulling,
as well as friction, and direct my manipulators to apply the following
procedures in the order given :
1. Gentle fulling of the skin of the neck (244).
2. Friction of the anterior portion of the neck
(433 or 435).
3. Friction of the back of the neck (434).
4. Percussion - gentle tapping (313) and
hacking (316) of the back of the neck from occiput to vertebra prominens.
5. Stroking from the forehead backward and down
the back of the neck, and from the vertex downward and over the anterior
portion of the neck
Neck massage is. an extremely useful procedure for
the relief of insomnia and cerebral congestion, and is often effective
in cases of migraine and other forms of headache. Some cases have been
reported in which non-cystic enlargement of the thyroid gland has been
improved by neck massage.
Replacement of the Abdominal Viscera. - Glenard
of France, first called attention to the great mischief arising from the
condition which he terms enteroptosis, or prolapse of the viscera of the
abdomen. A careful study of the subject for the last ten years has convinced
the writer that displacements of the stomach, colon, kidneys, spleen, and
liver are responsible for a much greater number of symptoms than. is generally
supposed, and is the real cause of suffering in a large proportion of cases,
especially in women, which have been treated with little or no benefit
for supposed disorders of the pelvis. The accompanying cuts (Figs. 
to ) illustrate a few of the many cases of visceral prolapse which
have come under the writer's observation within the last ten years. Fig.
 represents a case in which the right kidney had become so diseased
in consequence of its prolapsed condition that its removal by a surgical
operation was necessary. In operating, for its removal, it was found to
contain a calculus weighing more than four ounces. This was a case in which
massage would have been unavailing; but it would have been a measure of
great value, had it been employed a few years earlier.
Figs. 87 to 95 illustrate the causes of visceral
prolapse, and will suggest the means necessary to aid recovery in these
cases, and the advantages which may be derived from massage. Gastric neurasthenia
certainly owes many of its distressing symptoms to disturbance of the abdominal
sympathetic resulting from displacements of the sort referred to. I have
found,.the following the most effective means of replacing the abdominal
contents, as a whole, and restoring the viscera to their normal position:
The patient lies upon the couch with the head, not
the shoulders, elevated, and with the knees well drawn up so that the abdominal
wall shall be as thoroughly relaxed as possible.
First of all, the patient is made to take several
deep breaths, care being taken to see that the abdomen is expanded well
with each inspiration (Fig. 73). In women the reverse is likely to be the
The next proceeding is to lift the entire intestinal
mass as follows (Fig. 75): The masseur stands with his right side to the
patient, facing the patient's feet, and places his hands one in either
groin, the hands resting upon their ulnar borders (little fingers), and
having the direction of Poupart's ligament. The hands are made to move
slowly upward, the ulnar borders being at the same time crowded as deep
as may be into the pelvis so as to grasp as much as possible of the abdominal
contents, which are then drawn forcibly upward.
Shaking and rolling movements are valuable as a
preliminary measure, or used in alternation with the lifting movements,
as a means of loosening up, so to speak, the abdominal contents, to prepare
them for gliding easily into their normal positions. The lifting movements
should be executed in alternation with rolling or shaking movements, from
three to six times.
Inspiratory Lifting (Fig. 74). - I was led
to adopt this means of lifting the abdominal contents by a series of studies
for the purpose of noting the influence of respiration upon intra-pelvic
pressures. I observed that the ascent and descent of the uterus in respiration
may be greatly increased by modifying the inspiratory and expiratory movements.
For example by, directing the patient to take a deep breath and then asking
her to force the breath downward, it was noticed that the pelvic contents
were forced downward to a notable extent; while by causing the patient
to completely empty the lungs, and then, with the glottis closed, to make
a forcible inspiratory effort, the pelvic and abdominal contents were made
to ascend, in a very remarkable manner. In one instance it was noted that
the uterus, which lay quite low in the pelvis, was drawn up more than an
inch with each respiratory effort.
Inspiratory lifting is administered thus: The patient
lying upon the back, with the hands at the side, so as to relax the abdominal
muscles as much as possible, she is directed to take first a full breath,
breathing as deeply as possible, then to completely empty the lungs. Then,
instead of drawing in the breath as usual, the glottis is closed, and a
strong inspiratory effort is made without the admission of air. By this
method the whole inspiratory force is used in lifting the abdominal contents.
In this movement the patient should be made to expand the chest, both the
upper and the lower parts, as much as possible, as it is desired to suppress
the action of the diaphragm so far as can be done voluntarily, while bringing
into most active play those muscles of inspiration which act upon the ribs.
This not only produces a powerful upward draft upon the abdominal contents,
but at the same time enlarges the waist, and makes room for the viscera,
so that their ascent is facilitated.
At the same time that the patient executes inspiratory
lifting (444,445), the abdominal contents should be lifted from
below with the hands, as directed above. The patient should not be allowed
to refrain from breathing more than ten or fifteen seconds. During this
time, however, from three to five vigorous inspiratory liftings may be
made. Then the patient may be allowed to take a few ordinary respirations,
and finally a deep inspiration, followed by a complete expiration and a
renewal of the inspiratory lifting. Repeat with the patient in the knee-chest
position. This procedure is of special value in connection with pelvic
Replacement of the Stomach (Fig. 96). - To
accomplish this, lifting of the abdominal contents (442) is first
executed; then the operator, standing upon the right side of the patient
and facing the side, places his right hand upon the left side of the abdomen
in such a way that its ulnar border is in contact with the skin and lies
in a transverse direction. With the fingers slightly flexed, the hand is
first pressed backward, then carried upward and toward the median line
in such a way that the tips of the fingers will sweep along the inferior
borders of the false ribs, the movement ending at the epigastrium. The
hand should be held at this point while the patient is asked to execute
a deep breath; the procedure is then repeated.
Replacement of the Right Kidney (Fig. 97).
- Displacement of the kidney is always associated with displacement of
the stomach and bowels, hence lifting movements (442) and movements
for the replacement of the stomach (446) should be employed in connection
with those for the replacement of the kidneys.
To replace the kidney, after making movements to
replace the stomach and bowels, the operator proceeds as follows: Standing
upon the right side of the patient, the fingers of the left hand are placed
behind, while those of the right are placed upon the abdomen; and by movements
of the two hands the location of the kidneys is determined. While gently
pressing the kidney upward, the patient is asked to take repeated deep
breaths. With each exhalation, an effort is made to press the kidney up
under the ribs of the right side by gentle pressure. As it moves upward
and approaches its position, the right hand is shut, and the closed fist
is made to follow the kidney and hold it in position while the patient
makes a number of deep respirations.
Replacement of the Left Kidney and Spleen.
- The method employed is precisely the same as that for the replacement
of the right kidney, except that the operator stands upon the patient's
left side, and places the fingers of the right hand behind, manipulating
the displaced organs with the left hand.
In all cases of enteroptosis, a proper abdominal
bandage must be applied after replacement of the prolapsed viscera, and
means must be employed for strengthening the abdominal muscles, - gymnastics,
massage, and proper applications of electricity, especially the sinusoidal
Massage of the Stomach (Fig. 96). - This is one of the most
important applications of massage. Its objects are:
1. To aid digestion by stimulating motor activity.
2. To aid digestion by increasing glandular activity.
3. To empty the stomach mechanically.
4. To restore the prolapsed stomach to its normal
The most important procedures to be employed are:
1. Abdominal massage (389).
2. Standing upon the right side, and with the back
to the patient, place the right hand upon the left side of the abdomen
opposite the umbilicus; with the fingers extended and close together, press
the ulnar border of the hand backward, at the same time carrying it upward
with a vibratory movement. Following along under the ribs of the left side,
continue the movement upward to the epigastrium. At this point, before
releasing the tissues, place the tips of the fingers of the left hand so
as to support the tissues at the point to which they have been lifted by
the movement of the right hand, making firm pressure ; then withdraw the
right hand and repeat the movement. Continue for three or four minutes.
If it is desired to empty the stomach, carry the strokes across the epigastrium
and along under the lower border of the ribs of the right side.
3. When the object is to aid digestion, combine
with these movements deep breathing movements (441) and inspiratory
compression, obtained by having the patient take a deep breath and hold
it for a few seconds while strongly contracting the abdominal muscles.
4. In cases of extreme prolapse of the stomach,
in which patients suffer from flow of bile into the stomach, replace the
abdominal viscera with the patient in the knee-chest position, standing
with the back to the patient's head, grasping the abdomen near the pubic
bone, and lifting toward the chest.
Firm compression of the stomach is an efficient
means of suppressing vomiting and hiccough.
Massage of the Liver (Fig. 98). - This procedure
is of great value in chronic cases of catarrhal jaundice, gallstones, and
in numerous cases of so-called torpid liver, and is, in fact, valuable
in all cases in which massage is indicated as a means of securing general
improvement in nutrition, as in chlorosis, anaemia, emaciation, and impaired
digestion. Increased activity of the liver aids digestion, and promotes
especially the fat-making processes and blood formation. Massage of the
liver is contraindicated in cancer of the liver, in acute attacks of hepatic
colic, in cases of acute gastro-duodenitis, and in hepatic abscess.
The method of procedure is the following, the patient's
knees being well drawn up and the shoulders slightly raised, so as to completely
relax the abdominal muscles:
1. Deep breathing with arm raising, four to eight
2. Abdominal massage (389). Whatever aids
the portal circulation will assist the liver.
3. Tapping (313) over the entire region of
the liver (Fig. 31), best executed with the patient lying on the left side,
which renders it possible to reach the liver behind as well as in front.
4. Fulling (244).
5. Kneading. Standing at the left side of the patient,
place the left hand behind the liver, against the lowermost ribs of the
right side, and with the other hand stroke and knead the liver by pressing
up underneath the ribs on the right side. When in normal position, the
liver lies half an inch above the lower border of the ribs. The direction
of the strokes should be from the loin along and beneath the inferior border
of the ribs to the epigastrium, and across to the opposite side.
6. Hacking (316) over the liver.
7. Spatting (314).
8. Deep vibration (jarring) (302).
9. Inspiratory compression. Have the patient take
a deep breath, and then contract the abdominal muscles as firmly as possible
while holding the breath. Compression with the hands may be made over the
region of the liver. at the same time.
10. Laughing exercise, consisting of the syllable
"ha" uttered in an explosive way, and up and down the scale.
Massage in Diarrhoea. - Abdominal massage is of very great value in
certain cases of chronic diarrhoea. Of these, two very distinct classes
are benefitted by massage, each requiring, however, a different mode of
application. In cases in which undigested food substances are passed soon
after eating, indicating excessive peristalsis, with deficient activity
of the digestive fluids, abdominal massage should be applied for half an
hour a short time before each meal. In cases in which the diarrhoea is
due to intestinal catarrh, resulting from dilatation of the stomach, whereby
the food is retained in the stomach for so long a time that fermentation
takes place, causing irritation of the intestinal membrane when the fermenting
food substances at last find their way out of the stomach, massage of the
stomach (451) should be applied soon after eating, or within an
hour after each meal.
General massage, especially massage of the shoulders
and back, should be combined with abdominal massage in these cases, and
massage should be employed at least once daily. Ordinarily, manipulation
of the abdomen for ten or fifteen minutes is sufficient when the application
is made after meals.
Pelvic Massage. - This form of massage, first
introduced by Major Thure Brandt, a Swedish gymnast, in 1874, has been
variously modified by different physicians who have taken up its employment
since the favorable reports of Brandt, especially Norström, of Stockholm,
Jackson, of Chicago, and Bunge, of Berlin. The method of Brandt and Norström
consisted chiefly in supporting the uterus with one finger placed in the
vagina and behind the cervix, then making intermittent pressure with the
other hand placed externally over the fundus, the uterus being compressed
between the two hands. Jackson added gentle manipulations of the abdominal
walls, and Bunge ex tended the manipulations to the abdomen.
Pelvic massage concerns the following organs:
1. The uterus.
2. The uterine appendages - ovaries, Fallopian tubes,
broad, round, and other ligaments.
3. The vagina, in cases of rectocele and cystocele.
4. The rectum, in cases of prolapsed and relaxed
5. The prostate in men; sometimes, also, the bladder,
in cases in which it is atonic.
6. The coccyx, in cases of coccygodynia, in both
Pelvic massage should never be undertaken by any
person who is not a qualified and experienced physician. The success of
this procedure depends, first, upon a correct diagnosis; and secondly,
upon special aptitude on the part of the masseur.
It is scarcely possible for a person to become proficient
in this special application of massage without personal instruction from
some one who has by long experience become skilled in its employment and
in the selection of cases to which it is adapted.
It is hoped, however, that the student may obtain
an intelligent idea of pelvic massage by the following description of the
method which some twelve years' experience has led the writer to adopt:
Position. - The patient lies upon the back,
with the heels well drawn up, the knees separated, the hips slightly elevated,
arms by the side, and the head (not the shoulders) supported by a thin
1. Preliminary movements (461-467).
2. Intermittent compression of the uterus (468-470).
3. Digital kneading of the uterus (471).
4. Lifting movements (472,473).
5. Vibration of the uterus (474).
6. Kneading of the appendages (475).
7. Digital kneading of the round ligaments (476).
S. Stretching of adhesions and kneading of exudates
9. Nerve compression (478).
10. Massage of the abdominal muscles (480).
11. Finishing movements (481-483).
1. Preliminary Procedures. - The manipulations
practiced in pelvic massage are rendered very much more efficient by the
application of a few preliminary movements for the purpose of placing the
abdominal and pelvic contents in the most favorable condition possible
in any given case. It should be remembered that in pelvic displacement
there will always be found, also, displacement of the abdominal contents.
When the uterus falls backward, the folds of intestines which have formerly
been behind it, aiding and supporting it in its position, change their
position, overlying it above and in front. Replacement of the uterus requires,
first of all, a replacement of the intestines; in other words, room must
be made for it in its old position before it can be restored to its normal
It should also be borne in mind that in most cases,
displacement of the pelvic viscera is accompanied by a serious disturbance
in the positions of the various abdominal organs. There will be found in
nearly every case of this sort, displacement of the colon and stomach,
and not infrequently displacement of one or both kidneys, and occasionally
downward displacement of the liver. It is consequently evident that pelvic
massage should always be preceded by such manipulations as will, so far
as possible, aid in the restoration of the abdominal viscera to a normal
position and condition.
The preliminary movements which I, have found most
effective, are : (1) Deep breathing; (2) Lifting abdominal contents ; (3)
(1) Breathing Movements. - The patient is made to
execute a few full breaths (Fig. 73), in which the lower part of the chest
and the abdomen are well expanded with inspiration, and drawn in as far
as possible with expiration.
(2) Lifting the Viscera. - After the patient has
taken three or four deep breaths, the physician stands at the patient's
left, and, with his back to the patient, places the ulnar edge of the two
hands, with the fingers extended, just over Poupart's ligament, and parallel
with the ligament, the fingers pointing toward the pubes. From this position
the hands are moved slightly upward, the edge of the hands being made to
sink as deep into the abdomen as possible without severe pain, the arms
being slightly rotated at the same time, and the hands drawn upward in
such a way as to grasp the contents of the abdomen and drag them upward.
This movement is repeatedly executed during the act of inspiration, the
patient continuing to take deep and full breaths, expanding the lower chest
and abdomen as previously described. See that all displaced viscera are
in perfect position.
Essentially the same movement may be executed with
the patient in the knee-chest position. The masseur stands with his back
to the patient's head, and reaching around the patient with one arm, drags
the bowels upward during inspiration.
(3) Inspiritory Lifting (Fig. 74). - A number
of years ago, when engaged in a series of experimental studies of intra_
abdominal pressure, and while one day administering pelvic massage to a
patient in whom the uterine supports were greatly relaxed, I observed that
with each forcible inhalation the uterus was lifted upward a distance of
half an inch or more. I noticed also that the patient was breathing almost
wholly with the upper chest. In order to intensify the effect of the inspiratory
lifting, I caused the patient to exhale completely, and then to make the
movement of inspiration by lifting the upper chest forcibly while keeping
the glottis closed, so that the air could not enter the lungs. The effect
of this procedure was very remarkable, the uterus being lifted in an upward
direction more than an inch.
2. Intermittent Compression of the Uterus
. - The preliminary movements being completed, one, or, when possible,
two, fingers (index and middle fingers) of the left hand are introduced
into the vagina and crowded upward behind the cervix, the uterus being
first placed in perfect position, then lifted upward and forward as far
as possible without giving too much pain. The extended fingers of the right
hand are at the same time pressed upon the abdominal wall just above the
pubes, so as to impinge upon the fundus, covering as large an area of the
uterus as possible. Firm, intermittent pressure is then made, continuing
for two or three seconds, with intervals of one or two seconds, this being
repeated six to twelve times. In this procedure the pressure of the external
hand will fall chiefly upon the top of the fundus.
In many cases it is difficult to tilt the uterus
forward, even after the previous lifting of the abdominal contents which
has been described. In the effort to restore the uterus to its normal place,
much assistance may be obtained from manipulations with the hand employed
externally. The extended palm may be used in lifting the abdominal contents,
working from the pubes upward ; or the closed fist may be pressed backward
just above Poupart's ligament and the pubes, and crowded upward while the
patient makes breathing movements. By this means the way may be cleared
so that the tips of the fingers can finally be gotten down behind the uterus,
even in cases of retroversion.
Sometimes the cervix must be grasped between the
two internal fingers and used as a lever to pry the fundus up, when the
organ, has sufficient firmness to admit of such a procedure. It is often
necessary to work the fingers of the external hand down upon one side at
the same time that the internal fingers are crowded up as high as possible.
In this way a fundus lying in the hollow of the sacrum may be slid up over
the promontory of the sacrum, when the fingers of the external hand,
working down beneath it, will quickly bring it into position.
When the vaginal orifice is too small to admit of
two fingers, a useful application of massage may be made by the aid of
one finger introduced into the vagina, or even a single finger operating
through the rectum. A single finger, however, has less perfect control
of the uterus, and in cases of extreme backward displacement it is often
impossible to completely replace the uterus by means of one finger only
working internally. A better method, in cases in which the vagina will
admit of but one finger, is to introduce the forefinger into the vagina
and the middle finger into the rectum. The remaining fingers of the hand
should not be flexed, but extended and separated from the middle finger,
and slid over the coccyx. A special advantage in the last_named method
is that it facilitates palpation of the ovaries and tubes, the movements
of the middle finger not being restricted by the vaginal walls.
Without allowing the uterus to drop down in the
pelvis, the two fingers of the left hand are now transferred to the front
of the cervix, the uterus being supported by the external hand, the fingers
of which are made to pass down deep behind the fundus. The intermittent
pressure previously described is now renewed, the uterus being pressed
from before backward. This procedure should be repeated six to twelve times.
These procedures, must be executed with the greatest
care to avoid giving the patient pain, thereby exciting contraction of
the abdominal muscles, which necessarily interferes with the manipulation.
3. Digital Kneading of the Uterus. - The
fingers of the left hand being returned to the first position behind the
cervix, thus supporting the organ, the fingers of the right hand execute
a circular digital kneading movement, beginning at the top of the fundus,
and enlarging the circle until the fingers are made to press down the sides
of the uterus and all about it. A slight change in the direction of the
pressure made by the fingers of the left hand enables them to antagonize
constantly the movements of the right hand, so that the uterus may be by
this means very thoroughly manipulated in nearly all cases, and except
in patients who are very fleshy. This procedure is continued from one to
4. Lifting Movements. - The preceding manipulations
will have completely freed the uterus from the overlying intestines, so
that the top of the fundus will be lying in immediate contact with the
peritoneal surface of the anterior wall of the abdomen. By the combined
action of the internal and external hands, the uterus can now be freely
lifted forward so that its form may be easily outlined by the fingers of
the right hand. The action should be intermittent.
After lifting it forward as far as possible without
inconveniencing the patient, the uterus is released, and allowed to drop
down, then again lifted, the action being repeated six to twelve times,
at intervals of two to three seconds, the uterus being held forward for
a like period. The purpose of the lifting is to bring the blood vessels
under tension, thus emptying the venous sinuses, which are filled with
fresh blood as the uterus returns to its former position.
5. Vibration of the Uterus. - While supporting
the organ with the fingers of the left hand behind the cervix, the thumb
or one or more fingers of the right hand, is applied to the top of the
uterus, and fine vibratory movements are communicated to it. This is a
powerful means of stimulating the uterine circulation.
6. Digital Kneading of the Appendages. -
In pelvic massage the manipulations should not be confined to the uterus
alone. The ovaries, tubes, and the broad and round ligaments may be masséed
thus: After lifting the uterus well forward, freeing it from the overlying
intestines, the fingers of the left hand are directed toward an ovary.
Starting as low down as possible, firm pressure is made in an upward direction,
while the fingers of the external hand are made to cooperate in an effort
to grasp beneath the ovary and tube and lift them forward. At the same
time, gentle digital kneading movements are executed, the pressure of the
external (right) hand being directed toward the fingers placed internally.
7. Digital Kneading of the Round Ligaments.
- The fingers in the vagina should be directed toward the inguinal canal
while digital massage is executed by the fingers of the right hand traveling
in a curved line from the external ring along the side of Poupart's ligament
and toward the fundus. The internal fingers will, to some extent, follow
the movements of the right hand, so as to compress the tissues between
the fingers of the two hands.
8. Stretching of Adhesions and Kneading of Exudates.
- When adhesions and exudates are present, firm pressure should be made
directly upon the bands of adhesion or the masses of exudate
with the tips of the fingers which operate internally, counter-pressure
being made externally; and, so far as possible, the morbid parts should
be grasped between the fingers of the two hands, and thus subjected to
digital massage. Adhesions are also stretched by the lifting movements
of the uterus previously described.
9. Nerve Compression. - The sacral plexus
of the spinal nerves and several of the lowermost pairs of' ganglia of
the sympathetic are accessible to digital pressure through the vagina;
and in appropriate cases these, as well as other nerve structures, may
be stimulated by gentle compression in connection with other procedures.
One of the largest nerve masses accessible to compression through the vagina
is the hypogastric plexus, which is located on the anterior surface of
just below the promontory. A row of four or five sympathetic ganglia
lies on either side of the median line just over the junction of the sacrurn
and the ilium, the anterior aspect of the sacroiliac synchondrosis. A single
ganglion (coccygeal ganglion, or ganglion impar) lies in
front of the coccyx. Pressure made upon these points stimulates the ganglia
and their branches, and by this means excites the circulation in the pelvic
Nerve compression in this region, as in other parts
of the body, must be applied with very great discretion. This procedure
should never be employed in cases in which inflammation, active congestion,
or excessive hyperaesthesia exists. It is only appropriate in cases of
passive congestion, atony, subinvolution, and general relaxation of the
It is generally well to alternate some of the above-described
procedures, especially the lifting and kneading movements, instead of adhering
closely to the order in which they have been given for the purpose of precise
Upward deep kneading movements executed with the
closed fist may be advantageously alternated with the other movements mentioned.
10. Massage of the Abdominal Muscles. - After the
internal manipulations, the muscles of the lower abdomen and inner thighs
should be gently masséed. The procedures most useful are the following,
employed in the order named : Tapping, hacking, spatting, centripetal friction,
and finally, stroking.
11. Finishing movements:
(1) Knees separating, breathing. The patient should
inspire while separating the knees, and expire while closing them. The
vigor of the exercise may be increased by making a slight resistance to
the movements of both adduction and abduction (Fig. 71). The movements
should be made at the rate of ten to twelve per minute.
(2) Hips raising (Fig. 82), breathing in as the
hips rise, and breathing out as they sink. This movement should be repeated
from four to eight times. The movements of knees separating, hips raising,
and breathing may be executed simultaneously.
(3) The treatment should be concluded by having
the patient turn upon the face, and administering percussion - tapping,
hacking, spatting, beating, and clapping over the sacrum and fleshy portions
of the hips.
The following, points should be carefully observed
in the administration of pelvic massage:
1. Never administer pelvic massage to erotic patients,
nor in cases of vaginismus, acute pyosalpinx, pelvic abscess, growing tumors
of the uterus or ovaries, rectal ulcer, acute vaginitis, irritable urethra,
or inflammation of Skene's glands, until after these conditions have been
removed. The best results are obtained in cases of subinvolution of the
uterus, relaxed ligaments, recent exudates, and passive congestions with
little sensitiveness. Kesch recommends that uterine massage should be applied
especially during menstruation, but does not give what seem to the writer
to be valid reasons for the recommendation. My opinion is very positive
that massage should be discontinued during this period.
2. Before treatment, have the patient thoroughly
empty the bladder and bowels, employing an enema, if necessary, or a coloclyster
(large enema in right Sims's or in knee-chest position). A hot vaginal
douche should also be administered.
3. No movements should be made with the hand used
internally except with the ends of the fingers.
4. The force employed should generally be sufficient
to produce slight pain.
5. In cases of flexion, the flexion should, if possible,
be straightened during the manipulation. In all cases of displacement,
the uterus must be restored to proper position.
6. Care must be taken to have the patient breathe
deeply and regularly during treatment.
Massage of the Prostate. - In cases of enlarged prostate due
to thickening from inflammation especially in recent cases, much can be
accomplished by massage properly administered. Massage of the prostate
should be preceded by abdominal massage, and, followed by inspiratory lifting,
deep breathing, and percussing the sacrum (313-317).
1. Introduce one, or better two, fingers, well oiled,
into the rectum, making firm pressure against the prostate, but taking
care not to press so hard as to bruise the membranous urethra. With the
right hand, make pressure just above the pubes. After pressing the parts
for two or three seconds, allow a rest for an equal period, repeating the
pressure from six to twelve times.
2. Make gentle friction over the prostate in a downward
direction for the purpose of pressing out of the ducts the stagnant secretions.
3. Make gentle friction over the prostate by pressure
of the fingers, moving from below upward, covering the posterior surface
of the organ, to empty the blood-vessels.
Care should be taken to have the patient empty the
bowels and bladder thoroughly before the treatment is applied. Sometimes
the patient is unable to completely empty the bladder; in such cases a
catheter should be passed.
Massage of the Coccyx. - This procedure is
useful in cases of coccygodynia accompanied by painful points adjacent
to the coccyx or its ligaments. The bowels and bladder should be first
emptied, as in all forms of pelvic massage. Proceed as follows
1. With the patient in the right Sims's Position,
pass one finger, or better two fingers, of the left hand into the rectum
applying them to the anterior surface of the coccyx. With the fingers of
the other hand applied externally, make a suitable degree of pressure,
and knead the affected parts between the fingers, giving special attention
to points of induration or pain. In cases in which the parts are extremely
tender, begin the movements at a little distance from the most painful
points, gradually encroaching upon the more sensitive tissues. The manipulation
may be continued for three to ten minutes.
2. Apply to the sacrum, tapping (313) and
hacking (316) movements; to the more fleshy parts, clapping (315),
spatting (314), and beating (317).
3. Employ deep vibration, placing the hand over
the lower end of the spine (302).
4. Apply stroking with the palm of the hand from
the coccyx upward, outward, and downward .along the inner surfaces of the
Massage of the Rectum. - This procedure is
useful in cases in which the sphincter muscle is relaxed, and applicable
to many cases in which the muscle has been over-stretched by officious
and unnecessary dilatations applied by so-called "orificial surgeons."
The most important movements are the following:
1. Percussion with the finger tips, tapping (313).
2. Fulling (244) about the verge of the anus,
care being taken to avoid bruising the parts, which should be well lubricated.
The manipulations should be very delicate, the tissues being carefully
picked up with the ends of the fingers and thumbs.
3. Thumb kneading of the anus and the tissues immediately
adjacent, care being taken to roll the parts in when they are everted.
4. Hacking (316).
5. Beating (317).
6. Pressure (154) and vibration (302).
Firm pressure with the palmar surface of the fingers or with the closed
fist in an upward direction, accompanied by a vibratory movement.
7. Percussion of the sacrum and hips, as in massage
of the prostate and coccyx (485, 486).
8. Inspiratory lifting (467).
Massage of the rectum should be preceded by abdominal
massage. This procedure, as well as the following, is seldom required.
Massage of the Vagina. - This procedure is useful
in cases of rectocele, cystocele, and relaxed vagina, and is applicable
to cases in which for any reason a suitable surgical operation cannot be
performed. It is also valuable in cases of rigidity of the perineum, as
a preparation for confinement, for which it may be employed daily during
the last six or eight weeks of pregnancy. It should be resorted to in all
cases of pregnancy in which there has previously been an operation for
repair of the perineum. Proceed as follows:
1. Lifting abdominal contents (465).
2. Lifting uterus and appendages (472), two
fingers of the left hand being placed internally, the other hand cooperating
externally, as in massage of the uterus.
3. With patient in knee-chest position, lift the
4. With knee-chest or Sims's position, fingers placed
upon thighs, tips of thumbs at the mouth of the vagina, roll the tissues
in as much as possible, lift upward, and manipulate the perineum with the
5. With the index finger of the left hand in the
rectum and the thumb in the vagina, compress and knead the posterior wall
of the vagina.
6. With the closed fist firmly placed upon the perineum,
make strong vibratory movements (302).
7. Apply percussion to the sacrum and the buttocks
8. With patient lying upon the back, the heels well
drawn up, raising of hips and full breathing (482).
9. Knees separating and breathing, with resistance
10. Inspiratory lifting (467).
Massage of the Face. - This procedure is useful
for developing the muscles of the fleshy portion of the face, improving
the circulation (hence the complexion), removing wrinkles, especially about
the eyes and the corners of the mouth, and also relieving facial neuralgia
and muscular twitching.
For persons with fleshy faces, about all that can
be done by general facial massage is to knead the tissues by compressing
them with the thumb and fingers against the underlying bony surfaces, working
outward from the mouth, the nasal openings and the eyes. Care should be
taken to work toward the points at which the blood vessels emerge.
In persons with thinner faces, the tissues of the
cheek may be grasped between the thumb and finger. When indurations are
present, the protected finger may be introduced into the mouth and placed
against the cheek, while massage is applied with the tip of the thumb or
with the fingers of the other hand. The little finger, covered with soft
cotton, may be introduced into the nose and ears, although this procedure
is very seldom required. Make use of the following manipulations:
1. Digital kneading, working outward from the eyes,
nose, and mouth, at which points many muscles find their insertion.
2. Petrissage, or grasping-kneading of the muscles
of the face.
3. Massage of the orbit (Fig. 101), care being taken
to avoid the eyeballs. Place one thumb upon the lower lid and the other
just beneath the eyebrow, within the margin of the orbit. Make traction
outward, drawing upon the inner corner of the eye ; then change the position
of the thumbs so as to massér all the muscles about the eye. Massage
about the eye improves both the nerve and the muscular tone of the eye,
and in this way often relieves muscular asthenopia, frequently due to general
weakening of the eye, which renders annoying or injurious slight muscular
inequalities which are not noticeable when the muscles are well developed.
The attention of those neurologists and oculists who think it necessary
to operate upon every case of muscular asthenopia is especially called
to this statement. The habit of rubbing the eye for relief, which prevails
almost universally among persons thus suffering, is a strong suggestion
of the utility of massage administered systematically and in a skillful
Special attention should be given to the nose, working
from the root of the nose downward and outward. Relief is often afforded
in cases of nasal obstruction from catarrh by facial massage, which is
due to the fact that the lymphatics of the face arise from the mucous membrane
of the nose.
Massage for Wrinkles. - Facial massage may
be made useful in removing wrinkles (Figs. 99 and 100), which as often
indicate unhealthy tissues as advancing age or a wearisome existence. Wrinkles
are best relieved by making traction upon the skin in a direction at right
angles with the wrinkles, the wrinkled part being thoroughly manipulated
to restore the natural flexibility of the skin, which has been lost. The
patient must also be taught how to smooth out the wrinkles by cultivating
a suitable facial expression. For example, the vertical wrinkles of discontent
or despondency may be made to disappear by smiling, which wrinkles the
face in an opposite way.
In friction of the face, special care should be
taken to avoid making so great pressure as to cause irritation of the skin.
Compression of the nerve trunks which supply the
face is a valuable procedure in many cases. The chief points to which pressure
should be applied are shown in Fig. 32.
The different useful procedures in general facial
massage may be applied in the following order :
1. Digital kneading of the cheeks, nose, and orbit.
3. Stroking, localized as may. be indicated when
wrinkles are present.
4. Ear rolling (503 ).
5. Stroking along the inferior border of the lower
6. Friction of the neck (433, 435),
Massage of the Eye (Fig. 102). - Massage
of the eye was first suggested by Donders. The writer first saw it applied
by Landolt, of Paris. It has been found to be useful in ulceration and
cloudiness of the cornea, hypopyon, and in the early stage of glaucoma.
Massage of the eye increases the vascularity of the eye, and encourages
Reibmayr noted that when masseing one eye, the other
eye became, during the first minute, dilated; second minute, contracted;
while in the third minute, the pupil of the eye masséed became smaller
than the other, showing that massage of the eye, through reflex action,
affects the controlling nerve.centers as well as the eye itself.
Massage of the eye must be applied with very great
delicacy of touch. Proceed as follows: Have the patient close his eye;
place the fingers of the hand upon the temple a short distance from the
orbit, and the tip of the thumb upon the upper lid of the closed eye. Make
gentle rotary movements, gradually increasing the pressure, but taking
care that it be not so great as to cause pain. Patients whose eyesight
is impaired often remark that they are able to see better after the application.
Massage of the Ear (Fig. 103). - This procedure
is of great value in middle-ear disease, catarrhal disease of the Eustachian
tubes, in chronic disease of the middle ear unaccompanied by suppuration,
and in cases of perforated membrana tympani. It may also prove useful in
cases of tinnitus aurium.
Politzer recommends derivative massage as a means
of relieving the pain of otitis media and of furuncles. In case of acute
inflammation, the manipulations should be confined to the tissues about
the ear, avoiding the ear itself.
The following procedures are the most effective:
1. Digital kneading, friction, and stroking about
the ear, - in front, behind, and beneath. This procedure is especially
useful as a derivative measure.
2. Intermittent pressure upon the tragus in such
a manner as to close the external meatus. The pressure should be both applied
and withdrawn suddenly, but without too great force. The rate should be
sixty to one hundred per minute. Its purpose is to exercise the structures
of the middle ear.
3. Ear rolling (Fig. 103), with the fleshy portion
of the thumb applied to the ear in such a manner as to cause it to fit
into the external ear, and close the orifice; the right hand to the left
ear of the patient, and the left hand to the right ear. By means of a rolling
movement, the ear will be stretched in different directions, and the meatus
may be opened and closed in such a manner as to secure alternate compression
and rare-faction of the air in the external auditory canal, thus imparting
movement to the membrana tympani and to the ossicles connected with it.
This measure may, often replace the mechanical means ordinarily used for
treating the middle ear.
4. Stroking of the Eustachian tube, by pressing
one or two fingers into the furrow behind the maxillary bone, starting
close to the ear, and following the groove down beneath the jaw. By pressure
thus applied to the Eustachian tube it may be emptied of obstructing mucus;
and when in a state of chronic inflammation, useful reparative processes
are set up. An itching in the throat from which many patients complain
is frequently due to an irritation at the orifices of the Eustachian tubes,
which may be readily relieved by this means.
Massage of the Larynx (Fig. 104). - This
measure is especially valuable in chronic disease of the larynx, particularly
in cases in which the vocal cords are relaxed, or in which there is weakness
of voice from insufficient development of the laryngeal muscles. The object
aimed at in massage of the larynx is to relieve congestion, if it exists
; to improve the blood and lymph circulations, stimulate nutrition, and
thus strengthen the muscles and the nerve supply of the part..
The following are the most useful procedures:
1. Derivative massage of the neck (433, 435).
2. Fulling (244) of the skin overlying the
3. Digital kneading (268), in which the fingers
are worked into all the irregularities of the larynx, and between it and
the surrounding tissues.
4. Lifting, in which the larynx is seized between
the thumb and finger just below the pomum Adami, and crowded
upward. The vigor of this procedure may be increased by holding the larynx
up while the patient swallows.
5. Tapping (313).
6. Deep vibration (seize larynx and vibrate) (302).
Friction strokes, are intermingled with the other
Massage of the Heart. - The position of the
heart would seem to render it inaccessible to the application of massage;
but Oertel, in 1889, contributed to the literature of massage, a paper
upon "Massage of the Heart, " in which he claims to have obtained great
advantage from the use of massage in such a manner as to influence the
heart directly. He employs massage of the heart especially in connection
with his system of treatment by mountain climbing, and considers it indicated
in the following conditions :
1. When the heart muscle is weak, either as the
result of anaemia, impaired nutrition, or obesity.
2. When the arteries are imperfectly filled, resulting
in passive or venous congestion.
3. In cases in which there is mechanical obstruction
in the circulation, resulting from valvular lesions, diminution of the
respiratory field, pressure of tumors, or anything which increases the
work of the heart.
4. In connection with gymnastics for strengthening
Massage of the heart is contra-indicated:
1. In acute or recurring endocarditis or pericarditis.
2. In myocarditis.
3. In sclerosis of the coronary arteries and in
Massage of the heart is applied during expiration
only, and in the following manner: With the patient reclining, the head
supported upon a pillow, the masseur stands at his head, and, bending over
the patient, applies his hands to the sides of the chest at its extreme
upper part, the fingers touching the chest at the axilla, while the thumbs
are directed toward the sternum (Fig. 105). The patient should be instructed
to breathe deeply, slowly, and regularly. At the end of inspiration,. and
just as the act of expiration begins, pressure should be made with the
hands, which at the same time should move gradually downward and forward
until the thumbs fall upon the xiphoid cartilage (Fig. 106). The effort
should be made to narrow the chest laterally, and at the same time to compress
it antero-posteriorly. It is especially important to prevent increase in
the antero-posterior diameter of the chest during expiration. The application
of pressure should be gradual, increasing as expiration proceeds and as
the hands glide downward. The greatest force should be applied between
the fifth and eighth ribs, the maximum of pressure falling over the latter.
Massage of the heart is beneficial:
1. In completing the act of expiration.
2. Through direct pressure made upon the heart,
whereby its nutrition is favorably influenced, as in massage of other muscles.
Massage in Scoliosis. - Apply massage (426)
only after first putting the patient into a correct position. The following
procedures are helpful in accomplishing this: In mild cases, patient lying
on face, arms stretched upward; in cases in which the patient has lost
the power to correct the deformity by voluntary effort, side lying on quarter
circle, concave side uppermost. Massage may also be applied with the patient
suspended by head and shoulders, or hanging by the arms.
Untwisting the Patient. - The patient, sitting,
passes the arm of the high side in front, with the hand on the opposite
shoulder; while the hand of the low side is passed behind, and rests upon
the back. Useful in cases of rotation.
Three degrees of deformity may be described:
1. Deformity reducible by the patient's unaided,
2. Deformity readily reducible by manual assistance
or such mechanical assistance as the patient can apply.
3. Deformity irreducible by manual assistance, and
not easily reducible by mechanical aid.
The first class is curable; the second class may
be curable, and can certainly be benefited; the third class is incurable,
but may possibly be somewhat improved, and will require the permanent use
of mechanical support.
Method of Testing the Patient's Ability to Correct
Deformity without Assistance.
1. Give usual directions for correct standing (575)
(Figs. 108,109, and 110).
2. Rest-standing position (hands at back of neck,
arms in line ).
3. Standing, arms stretched upward.
4. Rest-close-standing ( heels and toes together).
Exercises . - The following exercises are
valuable for patients of this class, to be used in connection with massage:
1. The patient sitting untwisted (511), leans
forward, then raises the body backward against resistance applied to the
2. The patient sitting untwisted, operates a pulley
weight with each hand.
3. Rowing, sitting on an inclined plane, high side
of body on high side of seat.
4. Sitting on an inclined seat, untwisted, use pulley
weights in opposite directions, high side pulling down, low side pulling
up; high side pulling from behind, low side from in front; both sides simultaneously
pulling from opposite sides toward the body.
5. Hanging from swinging rings or "ladder-wall,
" the low side grasping higher than the high side.
Method of Correcting Curvature by Manual Assistance.
1. For posterior curvature, patient should bend
forward at hips, holding hips back. As the patient rises, press upon the
convexity of the curve; and tell him to raise the chest, and draw the head
back and the chin in.
2. Patient should take downward-bend position; one
side of back higher than the other indicates rotation (see accompanying
cut). Masseur, placing one hand upon highest part, and having the patient
rise, should at the same time make gentle resistance.
3. Patient should stand facing the table, thighs
touching the table, and bend forward at the hips; head erect, chin well
drawn in. Masseur should place his hands upon the convexity of the curve,
and have the patient raise the trunk backward.
4. Patient standing, the masseur should place one
hand on the convexity in front, the other on the convexity behind, and
stroke with firm pressure from before backward. If necessary, repeat with
the patient in rest-standing position, or rest-forward-bend standing. (**These
and other gymnastic positions are fully explained in another work by the
nearly ready for publication.)
In applying massage to the back in scoliosis, particular
attention should be given to percussion, especially of the concave side.
Use all the different kinds of percussion movements. Make pressure upon
the prominent surfaces. Endeavor to work the spines into position by pressure
and manipulation with the thumbs. A daily hot and cold douche or sponging
of the back is of great importance in these cases, as a means of stimulating
the nutrition of the tissues.
Massage of the Joints. -There is no single class of cases in
which the benefits derived from massage are more evident than in those
of chronic joint disease or of recent injury to the joint; at the same
time there is no one class of cases in which large discretion and experience
are of greater importance. Excessive manipulation of an irritable joint
or of a joint the ligaments of which have recently been injured, as in
case of a bad sprain, may do almost irreparable injury, and will certainly
subject the patient to a great degree of unnecessary suffering, and may
discourage him altogether, thus depriving him of the great benefits to
be derived from massage skillfully administered. It may be laid down as
a principle, that massage of the joints should never be applied in such
a manner as to produce any considerable degree of pain. Slight pain is
often produced by the first manipulations, especially in cases in which
there has been much loss of motion, but the pain thus induced should be
of a transient character, subsiding within a short time after the manipulation.
When the pain increases for some days afterward, the manipulation has been
applied in a violent or bungling manner, or the application should have
been derivative rather than made directly to the joint.
A matter which requires the most careful discrimination
is that of determining when manipulations should be applied directly to
the joint, and when above or below it. Briefly, the best advice upon this
point is this: When a joint is very sensitive, derivative massage only
should be employed for a week or ten days at the beginning, the manipulations
being gradually brought nearer the joint from day to day.
A careful examination of the tissues in a case of
chronic rheumatism of a joint will show rheumatic nodules lying along the
course of the lymphatics above the joint. In a fleshy person it is not
always easy to find these, but a delicate touch will generally discover
them. The work should begin upon the tissues above the joint for the purpose
of opening up these obstructed channels, and thus acting indirectly upon
the lymphatics and blood vessels of the joint.
The derivative effects may be greatly increased
by giving special attention to the healthy joint next above the affected
joint, in the employment of strong traction, pressure, and other joint
movements. The lymph and blood channels are largest in the vicinity of
the joints, and by acting upon these by means of joint movements, pressure,
and manipulations, the vessels of the joint below may be drained, especially
after the lymph channels connecting the two have been opened up.
It must not be forgotten that in cases of chronic
joint disease the muscles and other tissues about the joint are affected,
as well as the joint itself. This is especially true of chronic rheumatism,
and is evidenced by muscular atrophy, induration, or fatty degeneration,
one or the other of which conditions is nearly always present in chronic
It is useful to know that certain muscles or muscular
groups suffer more than others in connection with joint disease. For example,
when the knee is involved, the quadriceps atrophies; in hip joint
cases, the glutei muscles are chiefly affected; in cases of the
elbow, the biceps and the brachialis anticus; in cases of
the shoulder, the deltoid and supra- and infra-spinatus.
In derivative massage (238), fulling
friction, and deep kneading are most effective. In the manipulation of
a joint, begin with light friction and pressure. If these applications
are tolerated, add digital massage, working between the ligaments, and
following all the irregularities of the ends of the bones and the articulating
surfaces so far as accessible. Later, add percussion, first tapping, afterward
Joint movements should be employed from as early
a period as possible in cases of joint disease, so as to prevent the limitation
of movement, or to restore motion which has been lost. The application
must at first be very gentle indeed, and should not be carried to such
an extent as to produce continued pain. The derivative manipulations which
are first employed should be continued in connection with applications
to the joint, since the effect of kneading a joint is to increase the circulation
through it; while the effect of derivative massage is not to carry the
blood through the joint, but rather around it, thus relieving excessive
local congestion, or hyperaemia, by diverting the blood into other channels.
By the combination of local and derivative massage
applied in connection with compression of the joints and gentle joint movements
(342), the vital activity of the part may be greatly increased.
In cases of extremely painful joints in which beat and congestion are marked
symptoms, derivative massage may be employed upon the soft parts both above
and below, and joint movements should be applied to the joint above, care
being taken to avoid motion of the affected joints.
Centripetal friction applied to the tissues and
next joint above, relieves painful joints by increasing the surface circulation,
and so diverting the blood from the joint itself. Downward stroking below
the joint also affords relief by lessening the supply of blood to the joint.
The cautions which have been given respecting the
manipulation of affected joints, apply, of course, only to those in which
the disease is active, or to painful or congested joints. In many old cases
of joint disease there is; a decreased vascularity and also a morbid and
decreased secretion, as is evidenced by a grating, snapping noise, and
other sounds induced by motion of the joint. When this condition exists,
the massage should be applied directly to the joint itself. Even though
it should have the effect to slightly increase the pain at first, the ultimate
result will be improved nutrition of the joint, and the restoration of
the normal secretion. I have seen some most remarkable results in cases
in which improvement would certainly, have been regarded as most improbable.
In rheumatic gout and in old cases of rheumatism,
very persevering efforts are required. The maximum amount of benefit to
be derived from massage is not always obtainable except by its continuous
employment for several months, and sometimes even two or three years. In
one case under the writer's care, a lady who had suffered from rheumatic
gout for many years, the limbs were flexed to nearly a right angle, and
the patient had despaired of again standing up_right ; but at the end of
two years she was able to walk erect without the aid of a cane.
In cases of chronic rheumatism and rheumatic gout,
it must be remembered that the patient is suffering from a diathesis, and
that the disease is not a purely local malady; consequently, general massage,
hydrotherapy, proper regimen, and other measures must be combined with
the local treatment.
It is of great advantage also, to employ local applications
of electricity as well as hydrotherapeutic measures, in these cases. The
irritation occasioned by manipulations is usually promptly relieved by
a hot fomentation, followed by a heating compress, which should be applied
thus: Wring a linen towel out of water as cold as can be obtained. If the
patient is feeble, it should be wrung dry ; in a more vigorous person,
a larger amount of water may be retained. The towel is wrapped tightly
about the joint, and is then covered with oiled muslin, and closely wrapped
with several folds of flannel, which should be applied in such a manner
as to prevent any air from reaching the moist surface. It is generally
well to change these compresses three or four times a day. When there is
considerable heat, in the joint, they may be changed more frequently with
In old cases in which the tissues are much relaxed,
or in which secretion is deficient, the hot and cold douche is the most
effective means of stimulating the vital activities of the joint. Massage
and hydrotherapy combined are twice as beneficial in the treatment of chronic
joint, troubles as either used alone. Together they are capable of effecting
a cure in every case in which a cure is possible.
Massage for Sprains. - The treatment of sprained
joints by massage is by no means a recent idea. Massage has been thus employed
in Germany for more than thirty years, and was used in England half a century
ago; but the method is so diametrically opposed to that in common use by
the profession, that it has been but slowly adopted. It also requires special
skill, while the employment of, the old method of immobilization is compatible
with any degree of ignorance and stupidity.
The value of this method is now so well established
that it is not necessary to offer statistics in support of it. Any physician
who has once had the satisfaction of seeing the victim of a severe sprain
walking about without inconvenience at the end of a week or ten days, who
under the old regime would have been crippled for months, and possibly
have suffered the loss of a limb, will require no further argument to convince
him of the efficacy of this mode of treatment. Much skill and experience
are needed, however, to enable a masseur to accomplish a rapid cure.
The following is the method:
Apply massage as soon after the injury as possible,
beginning with derivative manipulations of the soft parts above the affected
joint and of the joint next above it. Centripetal friction, with quite
firm pressure, applied very carefully, may be advantageously employed upon
the joint itself from the very first, but other manipulations of the joint
itself should be deferred for a day or two. The derivative manipulations
should gradually approach the joint from above, until by the second or
third day the joint itself is reached.
Careful joint movements should be executed after
the second day, pains being taken not to carry flexion or extension so
far as to produce the feeling of resistance, as this will bring a strain
upon the bruised or lacerated ligaments or pressure upon the injured articulating
surface. If there is much swelling, the external tissues are probably the
chief seat of injury. Both external and internal parts may be injured.
At first, when the manipulations are very light
in character, the massage should be applied twice daily; later, when more
vigorous measures of treatment are employed, once a day is sufficient.
After each manipulation apply a tight bandage, taking care to begin the
bandage at the toes. If there is much pain, apply a hot pack, followed
by a cool compress, for an hour; or place the feet in hot water, and gradually
increase the temperature until it is as hot as can be borne. Continue bath
for fifteen minutes. This is an excellent means for relieving local congestion.
It may be used once or twice a day, the bandage being applied immediately
after the bath.
I think it very advantageous to employ these hydrotherapeutic
measures in connection with massage. Cold water has been much recommended
in the treatment of sprains, and has certainly been highly successful,
although less rapidly curative than massage. By the combination suggested,
most rapid results may be obtained, and the, patient may be saved from
great and prolonged suffering.
Muscular Rheumatism. - In muscular rheumatism,
pain is occasioned by use of the affected muscles. There is often also
considerable loss of both motion and elasticity in the muscle. Frequently,
rheumatic nodules will be found along the course of the lymphatics. Muscular
rheumatism may exist alone or in connection with a like affection of the
joints, as in the last_named disease the rheumatic process not infrequently
extends from the joint to adjacent muscles.
Daily manipulation is essential in the treatment
of muscular rheumatism. The most important procedures are friction, deep
kneading, hacking, rolling, wringing, chucking, stretching, and such resistive
movements as will act upon the affected muscles, together with movements
of the joint acted upon by them.
Fomentations and heating compresses are of special
value in these cases. Rheumatism of the muscles, as well as of the joints,
is connected with a systemic condition, or diathesis, which must also receive
attention. Not infrequently in the majority of cases, in fact there is
to be found dilatation of the stomach; and complete relief will only be
obtained by a combination of local
measures with such general treatment as will correct the constitutional
condition, which includes careful adaptation of the diet to the state of
the digestive organs, and an antiseptic regimen. Local treatment of the
stomach is essential in many cases, also general tonic and eliminative
Massage of the Breast (Figs. 111 and 112).
- The procedures in massage of the breast consist of gentle grasping, compressing,
rubbing, and fulling movements, beginning at the periphery of the breast
and working toward the nipple. The manipulation is very similar to that
usually employed in milking. The parts should be thoroughly lubricated,
and care taken to avoid so great pressure as to bruise the tissues. The
manipulations should not be employed when the breast does not contain milk,
as harm will thus be done rather than good. The purpose is to remove the
milk from the obstructed channels in the gentlest manner possible, and
thereby relieve the over-distended ducts. When hardness of the breast exists
in the puerperal or nursing woman, milk is almost always, present, although
the patient may feel very certain to the contrary. .
It is, as a rule, improper to manipulate a breast
when suppuration exists. It should not betaken for granted, however, that
suppuration is present because the patient has had a chill, and shows a
rise of temperature, as the application of massage, even under such circumstances,
will often result in resolution. But the greatest utility of massage of
the breast is as a means of preventing an over_accumulation of milk, with
resulting chill, fever, and suppuration. Violent or bruising manipulations,
however, may result in great damage, encouraging suppuration rather than
Manipulation of the breast is sometimes employed
as a means of encouraging development of the organ, especially in cases
in which the nipple is unusually small or retracted. In applying massage
for this purpose, the areola should be drawn back by pressure with the
thumb and forefinger until the nipple becomes prominent.. It should then
be seized and drawn forward, as by the action of the child's lips when
nursing (Fig. 112), a pinching and rolling movement being at the same time
applied. The proper time for such applications is during the later months
of pregnancy. It should be remembered, however, that manipulation of the
breast sometimes, has an exciting effect upon the pelvic organs, and any
marked indication of such a result should be considered sufficient reason
for discontinuing the applications. This treatment is also an excellent
means of hardening the skin of the breast and the nipple, and hence is
a useful precaution against soreness of the nipples from nursing.
Massage in Pregnancy. - Massage is a most
valuable means of preventing a variety of the most serious complications
of pregnancy and parturition. A woman who is accustomed to active muscular
employment during the period of gestation will not require the assistance
of massage; but for those women who lead sedentary lives or who are lacking
in physical development, massage affords a most excellent measure of preparation
for the parturient process. Both general and local massage are of value
in these cases. General massage should consist of the ordinary procedures,
with this exception Special care must be taken to avoid violent manipulations
of the abdomen and too vigorous percussion of the lower portion of the
back, especially at the beginning of the treatment. The "deep " procedures
in massage should not be undertaken unless the masseuse has had special
experience in these cases, and knows how to reach the colon without disturbing
the gravid uterus. The chief aim of the manipulations should be to develop
the muscles, and hence they will principally consist of fulling movements
and petrissage of all the muscular structures of the abdominal wall. Lifting
of the abdominal contents will also be found extremely useful in many cases,
relieving the strain upon the back, and aiding in the "rising" of the uterus,
which is likely to be delayed in women of feeble muscular development,
resulting in many distressing pelvic symptoms.
Massage of the Perineum. - This procedure
is especially valuable in cases of rigid perineum, and cases in which a
laceration has previously occurred and has been repaired by an operation.
By suitable manipulations, the parts being thoroughly lubricated, the structures
of the perineum may be rendered stronger and more elastic, so as to be
able to bear a larger amount of stretching. The applications should be
as follows: With the patient lying upon her side, in the left Sims's position,
the operator stands facing the back, with the fingers resting upon the
buttocks, and manipulates the perineum, using the thumbs in alternation,
stretching the tissues away from the median line. Only one thumb should
be used at once, stretching in opposite directions, as by the use of both,
the stretching might be overdone and the skin irritated.
The patient should also be made to execute breathing
movements in which both the abdominal and the perineal muscles are vigorously
contracted during the act of expiration. Under the instructions of a physician,
the manipulations may be somewhat extended and varied by introducing the
forefinger into the vagina or the rectum, the muscle being grasped between
the forefinger and the thumb, and thoroughly pressed and stretched.
Neuralgic Pain. - Massage is one of the most effective means
of relieving neuralgic pain. General massage acts by improving the blood
and the general nutrition. Dr. Chapman has very well said that "pain is
the cry of a hungry nerve for better blood." With better blood and better
nutrition, the cause of neuralgic pain is usually removed. Local massage
may act both as a derivative measure and as a means of directly stimulating
the nutrition of the nerve itself, according as the applications are made
in a derivative manner or applied directly to the nerve.
All the various procedures of massage may be used
in the treatment of neuralgia. The most effective measures for direct application
are nerve compression and vibration. Vibration may be employed either by
manual or mechanical means. Mechanical vibration may be simply ordinary
shaking, or what may be termed musical vibration. Musical vibrations were
first employed and brought to the attention of .the profession by Mortimer
Granville, of London, whose "nerve percuter" the writer has had in use
for some twelve years. Dr. Granville believes that pain is due to disharmony,
or morbid vibration, in a nerve, and has found in his experience that acute,
sharp pain is best relieved by musical vibration of a low tone, while dull,
heavy pain is best relieved by high-keyed vibrations. He thinks that relief
is obtained by interruption of the discordant nerve vibrations, which he
considers the cause of the pain.
Charcot claims to have obtained good results with
the vibrating helmet for relief of painful head symptoms. I have not found
Mortimer Granville's nerve percuter entirely satisfactory, as it is very
prone to get out of order, but have obtained good results from the use
of a percuter constructed by modifying Bonwell's dental engine. The writer
has recently had constructed an electrical device by which vibrations may
be applied directly to a nerve trunk, or to any desired point accessible
from the surface of the body. (See Fig. 121.)
Writer's Cramp. - This disease, which appears
under various forms, and to which different terms are applied as it occurs
in writers, telegraph operators, piano players, or persons engaged in other
occupations which chiefly employ the muscles of the forearm, is more amenable
to massage than to any other mode of treatment. Three distinct phases are
described, characterized respectively by trembling, spastic contraction
of the muscles, and paralysis. All three phases of the disease are sometimes
found present in a single case. This condition is largely the result of
unbalanced muscular and nerve action.
The following procedures are the most effective
in relieving it:
1. Thorough kneading of the fingers and dorsal interossei
2. Kneading of the palm (275), especial attention
being given to the fleshy masses of the palm of the hand ; and rolling
of the hand (Fig. 47).
3. Kneading of the forearm with very firm pressure
4. Hacking (316) of forearm and arm.
5. Stretching of the finger, wrist, elbow, and shoulder
joints (342, 372_376).
6. Vibration-shaking (303).
Centripetal friction, with firm pressure, should
be used in alternation with the various procedures named.
In addition to the passive movements of massage,
the patient should be directed to take special exercises. These. exercises
should be so directed as to bring into action the muscles which antagonize
the affected muscles or those which are most employed in the exercise which
has given rise to the disease. In writing, the interossei are used such
a way as to fix and steady the fingers, holding the metacarpal bones tightly
together; hence these muscles should be exercised in the opposite direction,
which will be accomplished by causing the patient to separate the fingers,
at the same time making resistance, which may be offered by grasping the
extended fingers between the thumb and forefinger, then directing the patient
to spread his fingers, the pressure being carefully graduated to the condition
of the muscles, and increased from time to time.
The patient may take the exercise by himself, making
resistance with the opposite band, or applying it by means of a rubber
band slipped over the fingers. As the muscles gain in strength, a stronger
band may be used, or another may be added, the number of bands being increased
as the muscles gain in strength. These exercises should be taken four to
eight times daily.
Writing exercises are also useful. These exercises
should be at first chiefly confined to such letters as give the patient
the greatest amount of trouble. They, should begin with black board work,
or writing with a pencil in a very large hand. The purpose of this exercise
is a double one ; first, to gradually train the muscles to execute proper
movements ; and, second, to train the motor centers in the brain, which
acquire a perverted habit through the long-continued morbid action of the
muscles. As the muscular balance is improved, the letters are gradually
decreased in size. Such letters as l and n are good ones
for practice. To these, other letters may be added later, such as f,
t g, and combinations of letters, as, li, lim, lo, log, fog,
The writer has succeeded in curing some extraordinarily
bad cases of this kind which had previously resisted all measures of treatment,
including operative .procedures.
Massage in Heart Disease. - There is no condition
in which massage is of greater value than in the treatment of disorders
of the heart. Space is lacking for a consideration here of the pathology
of cardiac disease, nor is it necessary that the masseur should possess
this knowledge. It is important , however, that the trained masseur should
know that different forms of cardiac disease require very different, indeed
actually opposite, applications of massage, so that it is quite possible
to do much harm by inappropriate measures, as well as incalculable good
by the skillful employment of judicious procedures. For practical purposes,
the various forms of cardiac disease may be classified in relation to the
indications for the application of massage, as follows:
1. Overaction of the heart, due to overcompensation
from valvular disease, to disease of the lungs in which the respiratory
field is lessened, or to hypertrophy, the result of overtraining. Excessive
action of the heart is indicated by its heavy beating (not palpitation,
but excessive force of beat), strong, full, and sustained pulse, and congestion
of the head, often accompanied by insomnia.
2. Weakness of the heart, a condition resulting
from dilatation from advanced valvular disease, from fatty degeneration,
or from hemorrhage or long existing and exhausting disease, as a prolonged
attack. of fever accompanied by high temperature. Heart weakness may be
recognized by the feeble, frequent pulse, easily extinguished by pressure
with the finger; by the bluish, or cyanotic, appearance of the face or
lips; and by the inability of the patient to exercise. to any extent without
quickly getting out of breath.
3. Functional disorders of the heart, such
as palpitation and intermittent or irregular beating. These troubles are,
In the great majority of cases, connected with disturbances of digestion.
The treatment indicated for there conditions is
Massage for Overactive Heart. - This condition
requires, first of all, rest in bed. Massage is essential in these cases:
(1) To obviate the evils which arise from long-continued rest in bed; (2)
to aid in quieting the overactive heart. For the accomplishment of the
first purpose, abdominal massage should be administered daily. Moderate
breathing exercises should be employed for five minutes before and after
each meal, and on first awaking in the morning. The only general procedures
which should be employed are stroking (169, 175) and centrifugal
friction (194), the purpose being not to accelerate the circulation
of the blood in the vessels, but rather to retard it. Care should be taken,
even in the application of the measures named, to avoid the employment
of too great a degree of force in the friction movements, as the reflex
action occasioned thereby may result in giving the treatment an exciting,
rather than a sedative, effect.
Massage for Weak Heart. - In cases of extreme.
weakness of the heart; that is, cases in which even so small an amount
of' exercise as that involved in walking slowly for a short distance, cannot
be taken without producing shortness of breath, the patient must first
of all be put to bed. He must not be allowed to stand upon his feet at
all, nor even to sit up, but must be kept in a horizontal position either
in bed or on a cot, or in a reclining chair. In a case of this kind, nearly
all the procedures of massage are beneficial, with the exception of centrifugal
friction, which should be avoided. The measures of greatest value are centripetal
friction (193), respiratory exercises (381-384), joint movements
(342-376), and massage of the heart (506-509), all of which
should be employed from two to four times daily. Abdominal massage (389-424)
should also be applied, care being taken, however, to avoid the use of
too much force, as it is not desirable to draw too large a quantity of
blood to the abdomen. In joint movements. great care must be taken not
to overdo in exercising. The force employed should not be so great as to
cause the patient to breathe rapidly. The slightest evidence of breathlessness
or quickened respiration on the part of the patient, as shown ,by increased
movements of the anterior nares, is an indication that the treatment has
been too severe.
In order to avoid the possibility of injury from
joint movements, care should be taken not to apply a movement to the same
joint twice in immediate succession. Beginning with one arm, apply gentle
flexion and extension, first to the wrist, then to the elbow, then rotate
the shoulder joint, describing the circle but once; next proceed to the
other arm, then take the opposite leg, then the other leg. Now return to
the arm first treated, and so continue until each of the extremities has
been gone over from two to six times. Centripetal friction should be applied
to each limb immediately after the application of the movements, and before
proceeding to the exercise of another part.
In employing the flexion and extension, care should
be taken that the movement is carried to the extent of quite decided resistance,
otherwise the circulation will not be excited. Flexion and extension thus
applied to a joint constitute an invaluable pumping process, in which the
lyrnphatics and vessels of first one side and then the other are alternately
stretched or compressed and emptied, then relaxed and filled.
When the patient becomes able to bear a considerable
amount of purely passive flexion and extension without excitement of the
heart, the movements should be made at first slightly, and later more strongly,
resistive. Resistive movements are most safely and effectively executed
in these cases by having the patient first flex the joint to be operated
upon, and then attempt to hold it in a flexed position while the masseur
extends it ; the, movement is then reversed; that is, the patient extends
the limb and holds it rigid while the masseur over-comes the rigidity in
flexing it. Very little force should be used at first.
When sufficiently recovered to allow some exercise
upon the feet, the patient may be taught to operate upon his own joints
by executing flexion and extension movements without the aid of the masseur.
This may be accomplished thus: Extending the limb (an arm, for example),
the patient renders it rigid by contracting both the flexor and extensor
muscles as forcibly as possible. Flexing the joint to the fullest extent,
the flexor and extensor muscles are again brought into a state of firm
rigidity by voluntary contraction. The movements should be applied in a
rotating series, passing rapidly from one joint to another until all the
joints of both the upper and the lower extremities have been exercised,
and then repeated as directed for passive movements administered by the
A patient suffering from cardiac insufficiency,
as is the case with other patients for whom the "rest_cure " is employed,
cannot be cured in bed. The purpose of rest in bed is to restore the balance
of the circulation. When this has been accomplished, as indicated by improved
aeration of the blood, outwardly manifested by the disappearance of the
blue color of the lips or skin, and of oedema of the face or extremities,
or of dropsical accumulations in the abdomen and chest or the pericardial
sac, the patient may begin to take exercise upon the feet.
The exercise must not be carried so far, however,
as to cause an increase of the dropsical accumulation in the feet or the
abdomen. Great care must be taken that the patient does not take such violent
or long-continued exercise as to cause breathlessness, or even a decided
increase in the rate of breathing. When this precaution is disregarded,
the breathlessness will increase from day to day, even though the exercise
be not increased, and the patient's former condition will gradually return,
necessitating his again being put to bed, and the employment of the same
measures as before.
Walking and other voluntary exercises should stop
just short of a decided increase of respiratory activity, so that the heart
shall not be to any degree excited. The greatest care will be required
at the beginning of exercise to avoid going beyond the safe limit.
Passive, active-passive, and voluntary exercise
of the joints, with the patient in a horizontal position, should be employed
for half an hour after each effort of the patient to become accustomed
to exercise in a vertical position, and will be found a very excellent
means of quieting the heart. Among the most useful exercises in which the
patient may at first engage, is the use of the treadle, which has the motion
of the velocipede without the incitement to overexercise which accompanies
the use of this admirable means of exercise.
By degrees the patient may be accustomed to more
and more severe effort, until such exercises as slowly climbing a hill
of moderate grade, or a flight of stairs not too steep nor too long, may
be attempted. It is only by voluntary exercise, gradually and systematically
increased, that a patient suffering from cardiac insufficiency can be brought
to a state in which he may be said to enjoy health, and in which he is
comparatively safe from the extension of the pathological condition under
which he is laboring.
That exercise is the only means by which a muscle
can be strengthened is a principle which 'applies to the heart as well
as to every other muscle of the body.
Massage for Palpitation of the Heart. - As
palpitation and other forms of functional disease of the heart are, in
the majority of cases, due to a disturbance of the sympathetic nerve arising
from some disorder of the abdominal viscera, special attention should be
given to abdominal massage in this class of cases. Palpitation may arise
from dilatation of the stomach and resulting indigestion, or from the dragging
upon the abdominal sympathetic, due to prolapse of the stomach and bowels,
a floating kidney, a prolapsed liver, or a dislocated spleen. Care should
be taken to see that each viscus is in its proper position, replacement
being performed by the methods previously described, when necessary. Lifting
the abdominal contents is especially important, and in cases of dilatation
of the stomach massage of the stomach must be applied in such a manner;
as to empty the organ of its fermenting and decomposing contents. In some
instances, lavage of the stomach is essential as a preliminary measure
whereby the disturbing poisonous substances may be removed. Massage of
the heart (506-509) is also useful as a means of assisting the heart
to acquire its normal rhythm. Massage of the stomach (451, 452)
and replacement of the viscera (439-450) should be employed at least
twice a day. In case the viscera are prolapsed, an abdominal bandage must
be worn, being carefully applied after the viscera have been replaced.
General massage is required daily.
Special Exercises to be Employed with Massage.
- Every masseur or masseuse ought to be skilled in gymnastics, as some
of the morbid conditions which most urgently require the employment of
massage are the result of deficient exercise and incorrect positions in
standing and sitting. Weakness of the muscles of the trunk is the
principal cause of prolapse of the abdominal and pelvic organs and of deformities
of the spine, and is either directly or indirectly the cause of a great
variety of functional disorders of the abdominal and pelvic organs, as
well as local and general nervous maladies for which massage is frequently
Massage alone is not sufficient to effect a permanent
cure in these cases, for the reason that it does not remove the original
cause. It is only capable of palliating or temporarily removing the consequences,
and not the cause. It is necessarily of great importance that gymnastics
should be combined with massage. I constantly employ manual Swedish movements,
gymnastics with apparatus, Swedish educational gymnastics, and various
outdoor exercises, such as bicycle riding, horseback riding, rowing, etc.,
as necessary complements of massage.
BODILY SYMMETRY AND CORRECT POISE.
The trained manipulator should understand the importance
of symmetrical development and the maintenance of correct poise when the
body is in the erect position. Not a few of the maladies for which massage
is frequently administered are quite as much the result of a wrong attitude
assumed in sitting as of deficient muscular development. The sedentary
life to which the majority of civilized men and women are subjected, and
especially the sitting posture, which, as employed by civilized man is
quite unnatural, are the immediate cause of various bodily deformities,
especially contracted and rigid chest and prolapsed viscera, with wide_reaching
mischiefs involving nearly every organ and structure of the body resulting,
from these conditions. In enteroptosis, massage of the chest and abdomen,
breathing exercises and daily replacement of' the stomach, bowels, liver,
kidneys, or other displaced parts, will never effect a cure unless the
patient is trained to sit correctly, carrying the chest high, so that the
lungs may have an opportunity for full and free movement in inspiration.
When the chest is lifted high, and maintained in this position, the effect
is to draw the stomach, bowels, and other viscera up into position. With
each inspiratory movement, the viscera are lifted up, and_the blood which
is stagnating in their dilated vessels is sucked out by the diminished
pressure within the chest, combined with compression of the viscera between
the diaphragm and the abdominal walls.
In plates XXXIII and XXXIV are shown some asymmetrical
forms often encountered, together with natural and well-developed forms,
which may serve as models. These are presented for the purpose of calling
the attention of the reader to the importance of making a careful study
of the conformation of the body in each patient, carefully seeking out
deviations from the normal, and calling the patient's attention to, these
defects, and assisting him to correct them by massage, manual Swedish movements,
and such other measures as may be required.
Every patient should be trained in correct sitting.
It is especially important that the patient should be made to appreciate
what is a correct sitting attitude. This may be accomplished by the following
Figures 1 to 5 (Plate A) illustrate a very simple
method of acquiring a healthful poise. Figure 1 shows a lady sitting in
the position commonly assumed in the ordinary chair. The proper sitting
poise is shown in Figure 2. By a careful study of these two figures, the
difference in position maintained will be readily apparent. In Figure 1
the center of the back rests against the back of the chair, the chin drops
forward,.the chest is flattened, the stomach and bowels depressed, and
all the muscles of the trunk relaxed. In Figure 2 the hips and shoulders
touch the back of the chair, while the center portion of the back is not
in contact with the chair back. The chest is held well up, the chin drawn
in, the abdominal muscles and all the muscles of the trunk are contracted,
and the stomach, bowels, and other organs are thus held in proper place.
The position shown in Figure 1 is transformed into the correct position
of Figure 2. First, the hands are placed upon the hips, as shown in Figure
3. The head is thrown backward, so that the eyes look up toward the ceiling
a little more than is shown in Figure 3. The body is then bent forward,
as shown in Figure 4, the head being carried well backward, while vigorous
pressure is made on the back with the thumbs. The purpose of the pressure
with the thumbs is to cause firm contraction of the muscles of the back.
This brings the chest forward, and corrects the posterior curve of the
back, which is acquired by the habit of sitting in a relaxed position,
as shown in Figure 1. While making firm pressure with the thumbs, the body
is raised to the correct position shown in Figure 5. The pressure with
the thumbs prevents relaxation of the muscles of the trunk while the body
is being raised to position. While holding the body in correct position,
the hands are removed from the hips, the shoulders allowed to rest against
the back of the chair, the muscles of the trunk still remaining in forcible
action, and thus the position shown in Figure 2 is acquired.
The ordinary rocking chair is a recruiting agent
for the undertaker. It is rare indeed to find a chair of any sort which
is constructed in such a manner as to encourage a correct sitting poise.
After studying this question for more than twenty_five years, the writer
has had constructed a chair which he believes to embody the necessary principles
for securing a correct sitting poise. The special features of this chair
are a seat somewhat strongly inclined backward, a back curved slightly
for ward at the bottom and inclining backward considerably more than that
of the ordinary chair. The effect of this construction is to encourage
the occupant to sit well back in the chair, while the head is, by the inclination
of the back, carried backward to a point which necessitates the action
of the anterior muscles of the neck in supporting it. This has the effect
to make an upward pull upon the upper anterior part of the chest, thus
encouraging chest expansion and deep respiration. This will be readily
seen in the accompanying cuts (Plates A and B), which show the effect of
the ordinary chair and that of the author's physiological chair. Rocking
chairs constructed upon this plan are not only, comfortable, but wholly
The ordinary chair can be greatly improved by cutting
off the back legs half an inch or an inch and fastening a properly shaped
cushion to the back of the chair, two or three inches above the seat.
When the internal organs are crowded out of place,
various evils result. They become abnormally filled with blood, and their
functions are variously disturbed. The stomach, for ex ample, can not properly
discharge its contents into the intestines; the food is too long retained
in the stomach, fermentation takes place, indigestion results. The fermenting
and decomposing food passed into the intestines, produces disease there,
and the abnormal liberation of gas distends the intestines, and constipation,
hemorrhoids, intestinal catarrh, and other disorders are the consequence.
The poisons generated by the long delay of the decomposed foods in the
stomach and colon are carried to the liver and kidneys, and these organs
likewise become disturbed. Other parts besides the liver and kidneys suffer.
The brain becomes irritated. Neuralgia, confusion of thought, mental depression,
nervous headache, backache, and general vital depression, are common consequences.
The backache from which a large proportion of women, and many men, suffer,
may be attributed, in many cases, to prolapse of the internal organs, due
to a wrong position in sitting. Constipation and the numerous evil consequences
which result from this condition, including anemia, neurasthenia, or nervous
prostration, autointoxication, rectal ulcers displacement of the pelvic
organs, ovarian and uterine congestion, and other pelvic disorders, are
only a few of the morbid conditions which are a result of a relaxed sitting
The action of the lungs is also interfered with. Full and free respiration
is impossible so long as the chest is depressed. The forward droop of the
shoulders interferes with the raising of the ribs and proper expansion
of the chest cavity. The constant relaxation of the abdominal muscles weakens
that important muscle, the diaphragm, by removing the normal resistance
against which it operates. The weakness of the abdominal muscles results
in a corresponding weakness of the muscles of the back, so that the individual
loses the ability to hold the trunk erect, even for a short time, without
great weariness and inconvenience.
Nearly all persons whose occupations require them
to retain for considerable periods the sitting posture, suffer from these
evil consequences; hence most women are found to be suffering from prolapse
of the internal organs. The stomach and bowels are nearly always found
depressed in women of twenty years and upward, the downward displacement
varying from two to si x inches, or more. It is rare indeed to find a woman
twenty-five years of age or over who has not serious displacement of important
organs. Movable or floating kidneys and prolapsed stomach are exceedingly
common, as well as displacement of the uterus and ovaries, from which so
many civilized women suffer. Both men and women suffer from hernia, backache,
neurasthenia, nervous dyspepsia, and bladder troubles, as the result of
an unnatural sitting position.
A correct poise in standing and walking is almost
as important as in sitting. Drooping shoulders and forward carriage of
the hips, are perhaps the worse faults. A correct standing poise may be
easily acquired by the help of a very simple exercise when once the correct
position is understood.
Figures 6 and 7 show incorrect and correct standing
positions. The correct standing position may be readily found by a simple
exercise, taken by aid of the edge of a door, or a perpendicular wall.
In Figure, 6 the person is shown standing with the usual incorrect poise
against the edge of a door. Figures 8, 9 and 10 show how the correct standing
position is obtained. Standing with the heels, hips, head, and shoulders
against the edge of the door, the head is thrown backward until the chest
is lifted forward, as shown in Figure 9, the heels and hips being held
against the edge of the door. The hands are now put upon the hips, as shown
in Figure 3. With the thumbs backward, a firm pressure is made with the
ends of the thumbs. This contracts the muscles of the back so that when
,the head is thrown forward, the position shown in Figure 10 is found.
Holding the muscles of the trunk forcibly contracted, the arms are allowed
to drop by the side, and stepping free from the door, the excellent standing
position shown in Figure 7 is acquired.
Exercises Correcting Poise, to be Taken in Connection
with Massage. - The author has found the following series of exercises
of special value:
Series A. - With the patient lying upon the face,
the fore head resting upon the hands, placed one above the other, take
the following exercises:
1. Head raising backward four times.
2. Leg raising, leg and foot extended , each four
3. Leg raising, both together four times.
4. Head and leg raising (Fig. 113), each leg two
to four times.
5. Head and legs raising, both legs together, two
to four times.
Series B. - Repeat the above exercises while lying
upon back (Fig. 114).
Series C. - Patient lying upon back, with the heels
drawn up to the body.
1. Hips raising (Fig. 82), two to eight times. The
hips should be raised until the trunk and thighs are in line from shoulders
2. Knees separating (Fig. 71). The knees should
be separated as widely as possible. Repeat four to eight times.
3. Hips-raising and knees-separating movements,
thus: Separate the knees well, raise the hips, hold a few seconds, then
bring the knees together while lowering the hips.
The exercises of this series are especially designed
to develop those muscles which tilt the pelvis backward, thus increasing
the obliquity of the pelvis, a matter of much consequence in relation to
correct standing, and also with reference to uterine displacements.
Series D. - 1. Fill the lungs, raising the chest as high
as possible. Hold chest high, while breathing out, expelling the air by strong
contraction of the abdominal muscles. This raises the viscera and empties them
of blood. Alternate with full breathing. The effect of this exercise is increased
by placing the hands upon the hips with the thumbs and the elbows carried back
as far as possible. Firm pressure should be made with the thumbs while breathing
out. This prevents lowering of the chest.
2. Empty lungs. Close glottis, and raise chest, without admitting
air. Repeat, alternating with full breathing
3. Sitting on the edge of an ordinary chair, place the hands
upon the hips, as directed above, raise the chest high, and execute a swinging
movement of the body, lifting the feet from the floor each time the trunk moves
backward. The breath should be drawn in while the trunk moves forward. Sway
the trunk backward and raise the knees while holding the breath. Let the breath
escape just at the end of' the backward movement, and fill the lungs while bending
forward. This rocking exercise should betaken several times daily, from twenty-five
to fifty movements being executed each time. It is an excellent means of strengthening
the abdominal muscles and training them to hold the viscera in position.
4. Walking on tiptoe with the chest carried high, breathing
wholly by use of the diaphragm and the abdominal muscles, is a capital exercise
for strengthening the muscles of the trunk, especially those of the abdominal
5. Breathing while standing against the wall with the heels,
hips, shoulders, and head touching the wall, the chest being held as high as
possible, is a very excellent means indeed of developing the diaphragm and the