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cal work even more practical.

It is true that general massage is often used when
medical gymnastics with some local massage would do
more good. But when the customer (I can hardly call
her patient) prefers the "massage" as a mode of exer-
cise which she enjoys and therefore also finds it bene-
ficial, I think the masseuses ought to be thankful that
there are so many well-to-do' women who are willing
to employ them.

General massag'e is of great benefit in cases where
the patient is unable to sit up, either from sickness or
weakness, or overtired mentally and physicall)^; and it
certainly also is a great remedy to "toaie up" the sys-
tem and to help the society lady to keep up her social
duties.

Dr. J. Schreiber says : "In the treatment of neuras-
thenia and its allied affections, hysteria and hypochon-
dria, we seek to attain a threefold end. First, to re-
generate the mass of blood as a whole ; secondly, to
combat indi\idual symptoms; and, thirdly, to favor-
ably influence the mental state.

"Beard, who claims for neurasthenia that it is a new
and especially American disease, considers massage
treatment as not only essential, but absolutely indis-
pensable, for those casesi whicli it seems advisable to
confine to bed."

Dr. Vieh Mitchell says, in his "Fat and Blood,"
that he has applied massage to deprive rest of its evils.



GF.XKRAL MASSAGE. 125

Amid all the numerous mdrhid manifestations ac-
companying neurasthenia, hyperesthesia and muscular
weakness are probaly the most prominent, so that
Arndt has declared the nature of the disease to con-
sist in increased irritability, with rapid tendency to
fatigue, especinlly of the muscular system.

In neurasthenia, all the morbid processes occurring
in the muscles are more rapidly influenced by move-
ment treatment than by either hydro- or electro- ther-
apy. Of all symptoms, the various hyperesthesias
(excessive sensibility) most frequently engage the
physician's attention.

These are generally regarded by the friends as
founded either on exaggeration or upon affectation.
Patients complain of muscular pain, especially in the
extremities and back, and of pains along the spinal
column, the latter being, indeed, considered quite char-
acteristic of the disease ("spinal irritation").

Besides these, neurasthenics suft'er from the great-
est variety of symptoms referable to the brain, as head-
ache, and a feeling of weight or constriction in the
head, eye, and ear, photopsia (sensation of light),
scotoma (dark spots in the vision), roaring and ring-
ing in the ears, hypersensitiveness to odors, and other
similar idiosyncrasies. Or there may be liability to
sudden changes of temper, or to depression and sad-
ness, or dizziness or insomnia may exist. Indeed, the
large number of various feelings of apprehension ex-
perienced in neurasthenia has been the occasion for
the'manufacture, bv various authors, of anv number of



126 PRACTICAL MASSAGE.

"phobias.". The restlessness sO' often seen in these-
patients is caused by the pains occurring in various
muscle groups.

The "general massage" of the whole body will be
found the most effectual in banishing the various anes-
thesias and hyperesthesias, while passive rotation, flex-
ion, and extension cause a stretching of the nerves
contained within the muscles, which reacts most favor-
ably upon the mental state.

Prescription I.

1. Legs — centripetal stroking, kneading, and circu-
lar friction.

2. Arms — centripetal stroking, kneading, and cir-
cular friction,

3. Chest kneading and friction.

4. Stomach kneading and friction.

5. Back kneading and friction,

6. Head friction.

If the patient has high blood-pressure, begin with
chest and stomach ; then legs, arms, back, and head.

This treatment, should be applied daily, and even
twice a day, until the patient has gained some strength,
\\'hen it will be advisable to increase the treatment.

In order to give a good treatment the operator
should be of a good disposition and cheerful, neat, and
healthy; finger-nails fairly short and well taken care
of. First, see that the patient is in a coirrfortable bed,
preferably a single bed or a couch ; then gO' to the bath-



GENERAL MASSAGE. 127

room and wash the hands and bring a towel with you
to the patient's room, sit down l>esi(le the bed with the
towel in your lap, and let the patient's foot rest on it
while you api)ly the massage up to the knee. Now put
the foot back in bed and treat the rest of the limb —
from the knee to the hi^) — while it is lying in Ijed. A
good masseur can apply this treatment on the bare
skin without exposing the limb. Then move over to
the other side and massage that leg. Next take the
arm on the same side and rest the hand in your lap
while you work the whole aruT and shoulder. Again
move your chair to the first side and treat that ami.
Then the chest and abdomen, and help the patient to
turn over, face down, the chin resting on the hands,
Avhile you treat the back. Again go and wash your
hands l^efore you apply head friction and strokings
do'wn the throat.

Remember that the more comfortable the operator
is the better treatment is he, or she, able tO' give. Do
not stand up more than absolutely necessary, or you
will soon feel that you have a back.

The idea that a masseur or masseuse must be big
and very strong is a mistake. If they only know Aotc
to do it and how not to exhaust themselves, but 1>e
calm and quiet, they will often do much better than
their big sister ; of course, some strength in arms and
hands is needed, but that will soon come with the
practice.

In massage treatment it is very essential that the
patient take "a liking" to the operator and her treat-



128 PRACTICAL MASSAGE.

nient, as that will further the impro'vement very much.
On the other hand, if the patient docs not like the
operator, her mind will work ag-ainst the treatment,
and often "the massage" has been said to be a failure,
^^'hile it really was the person giving it who was
unsuccessful.

Further, remember that there are many kinds of
manipulations and- different movements, and if any of
the kinds you are giving- seenrs to disagree with the
]>atient, or she dislikes it, change it with some other
which mav have about the same effect. In general
massage it is not advisable to force unpleasant move-
ments on the patient. Neither is it necessary to use
any kind oi ointment ; it is even better not to use it,
unless the physician in charge prescribes it for some
curative reasons. As a rule, ointment should only be
used in local massage where vigorous strokings are
necessary, so as not to take the skin off.

Prescription No. i is to be given to^ all new patients
and those who are weak and delicate, but the treatment
should be gradually increased in strength and in num-
ber of moA'ements. After a while — four to eight days
— add "thigh rotation" after the first manipulation; in
a few days more give "arm rotation" after No. 2 ;
then give "foot rotation" single, and "forearm rota-
tion," and "hand rotation."

When the patient has had about two or three
weeks' treatment, use: —



GENERAL MASSAGE. 129

Prescription II.

1. Leg's — centripetal massage.

2. Thigh rotation — passive.

3. Foot rotation — single — passive.

4. Legs — nerve compression, muscle rolling, slap-
ping, and friction.

5. Amis — centripetal massage.

6. Ann rotation — passive.

7. Forearm and hand rotation — passive.

8. Arms — nerve compression, muscle rolling, slap-
ping, aud friction.

9. Chest' — kneading, slapping, vibration, and
friction.

10. Stomach' — kneading and friction.

1 1 . Back — massage.

12. Head friction (or if needed — head n?assage).
Keep this up for some time, then add "leg flexioo

and extension," and "upward knee, traction" after No.
2: and later "ann flexion and extension" (resistive)
and forearm rotation ; and still later "chest lifting and
vibration" after No. 8.

\\'hile we add more and more movements we grad-
ually shorten the length of the centripetal massage, till
we finally have the patient up and out of b^d and stop
the centripetal massage entirely.

Tn the l>eginning centripetal massage is most effec-
tual, liecause there is alwavs a great deal of waste



1 Chest and stomach first in cases of high blood-pressure.

9



130 PRACTICAL MASSAGE.

matter which must be absorbed quickly ; but after some
time the other manipulations and movements are more
necessary and will dO' more good. And it is a great
mistake to keep a patient with neurasthenia or ner-
vous prostration on the same kind of massage for
weeks and months. Their treatment should be pro-
gressive from, week to week, and as soon as the patient
is able to be up and out of bed the exercises should
be changed to

Prescription III.

1. Forward arm rotation — sitting — passive.

2. Foot rotation — double — reclining — passive.

3. Trunk rotation — astride sitting — passive.

4. Vertical arm flexion and extension — sitting —
resistive.

5. Leg flexion and extension — reclining — resistive.

6. Chest slapping — standing — passive.

7. Arms^ — nerve compression, rolling, slapping, and
friction.

8. Legs — the same — reclining.

9. Stomach- kneading, vibration, and friction —
reclining.

10. Back percussion — standing.

11. Head massage^ — sitting.

"High Blood-pressurf/'' and "Arteriosclerosis."

In treating persons with either of these maladies
Dr. H. V. Barclay, of New York, has for some years



2 Stomach first in case of high blood-pressure.



HIGH BLOOD-PRESSURE. 131

applied a sort of circular kneading with the palm and
"heel" of the hand oil ivcll-strctchcd muscles; and he
has had great success.

Personally I have practised this method more or
less the last few years with satisfaction; and I have
also had an exi>ert physician to take the "blood-pres-
sure" of some of my patients before and after treat-
ment, with the average result of a decrease of 9 mm.

The modus operandi is as follows: The patient
lying straight on his back, with a small pillow under
the shoulder-blades, head and shoulders well back on
the bed, so as to keep the anterior muscles of the body
on a good passive "stretch."

Now give a few centripetal strokings of the throat
and light circular kneading with the whole hand on
the pectoral muscles, and some strokings from, the
middle line of abdomen outward. Next, have the pa-
tient lying on his side (say left side), pull right arm
backward and perfectly straight at the elbow, bend
hand backward ; in this position knead front of
shoulder and all the flexor muscles of the arm with
the palm, or "heel," of your hand, beginning at the
shoulder and gradually work downward, taking care
not to "stroke" against the venous current.

Now bend the ann over and in front of the pa-
tient's head to put all the extensor muscles on the
stretch and knead, beginning at the cendcal and dorsal
spine and work toward the hand ; finally raise the arm
well over the head and work down the latissimus dorsi.

Bend the right knee well up against the patient's



132 PR.\CTICAL MASSAGE.

body and knead the buttocks and back of the thigh;
then pull the leg backward and knead front of the
thigh ; bend the knee and knead front of the leg ;
straighten the leg and bend the foot and knead the
calf.

When both sides have been manipulated, have the
patient on his stomach and give a few frictions down
the back.

The whole procedure should not occupy more than
fifteen to twenty minutes.



CHAPTER XVIII.
Hysteria and Hypochondria.

These affections are, according to Arndt, quite
impossible to separate from neurasthenia. He con-
sidered the numerous temis of different authors — such
as spinal neurosis, spasnTophilia, spinal weakness or
irritability, neurosism,, erethism, and others — to be but
different names for one and the same condition. The
different writers seem, however, tO' be of the opinion
that it is impossible to permanently cure this condi-
tion, and that no medicaments exist capable of per-
manently allaying the irritability of the hyperesthetic
nerves.

Nevertheless, a daily course of carefullly system-
atized exercises will always be of great value to these
patients. Several of the active exercises- will be good.
When the masseur can get the hysteric woman to
work hard and to enjoy the exercises, he will be able
by moral strength of character tO' effect a great change
in her mind, and a steady iuTprovement, although slow,
may be looked for.

It is the same with the hypochondriac man. Give
him some hard work and try to gain his confidence and
also tO' get his mind away from himself, and the mas-
seur will accomr)li=:h wonders. But, of course, these
are tryins- cases which require a good deal of patience
and tact to be able tO' do' anjrthing with them.

C133)



134 ' PRACTICAL MASSAGE.

The prescription of exercises should be made with
special attention to the ills complained of and a gen-
eral exercise for muscles and nerves.

Chlorosis and Anemia.

The character of these diseases is weakness, there-
fore it may seem strange tOi treat them with exercises.
To apply fatiguing movements would also be as absurd
as to prescribe weakening medicines, but by stimu-
lating and strengthening movements re-establishment
may be accomplished.

The muscles being the chief site of chemical change
occurring in the body, stimulating and increasing their
action leads to increased oxygenation of the blood ; to
greater combustion oi oxygen and elimination of car-
bonic acid : to increased metabolism and consequently
tO' greater desire for food and tO' better digestion ; to
production of more and better blood; to improved
nourishment of the nervous system: ; tO' an increase, both
in number and strength, of the mnscle-fibers ; to the
endowment of the whole body with vigor and elasticity,
and to a consequent revival of all the mental faculties.

In dilorosis and anemia the blood-vessels are both
thin-walled and of narrow caliber; therefore, active and
resistive movements should be used which stimulate
cardiac activity and increase the blood-pressure. The
augmented hemic oxygenation thus brought about
leads both to an increase in the number of red corpus-
cles as well as of the amount of hemo'srlobin contained



CHLOROSIS AND ANEMIA. 135

in each. At first, owing to the general lassitude from
which chlorotics suffer, the movements will have to l>e
of a very gentle nature.

Although there may be a little difference in the
treatment of two different persons, it should always be
directed so as to restore the digestion, circulation and
respiration.

In the first two or three weeks the following pre-
scription would be most acceptable : —

Prescription I.

1. Shoulder rotation and chest lifting — sitting.

2. Foot rotation — double — reclining.

3. Stomach vibration — reclining — knees bent.

4. Forward arm rotation — sitting.

5. Trunk rotation — astride — sitting.

6. Knee flexion and extension — sitting — resistive.

7. Stomach friction — lying.

8. Back percussion and friction.

The first movement is a respiratory one; the chest
is expanded, the inspiration becomes deeper and is fol-
lowed by a stronger expiration. Thus a greater
amount of o^xygen is taken and waste matter given off.
This must stimulate the functions of the organs and
thus accelerate the process of renewal and an exchange
of material in all parts of the body.

The second movement equalizes the circulation by
increasing the flow of blood tO' the feet.

The third movement has a direct effect on the stom-
ach, and will improve the appetite and the digestion.



136 PRACTICAL MASSAGE.

The fourth movement is a respiratory one and has
a similar effect as the first one.

The fifth movement brings the muscles of the waist
and bowels into play, and acts on the circulation, espe-
cially in the portal system.

The sixth movement has a strengthening effect on
the flexors and extensors of the legs and promotes the
circulation.

The seventh movement promotes operations of the
bowels.

l"he eighth movement has a stimulating effect on
the nerve-centers.

When the prescription has been applied for a while,
and the patient has improved in strength, the treat-
ment may be changed in force, but according tO' the
same principle.

Prescription II.

1. Forward trunk flexion and extension — sitting —
resistive.

2. Foot flexion and extension — double^ — reclining
— resistive.

3. Trunk torsion — sitting — resistive.

4. Vertical arm flexion and extension — sitting —
resistive.

5. Forward trunk elevation — lying — active.

6. Leg flexion and extension — reclining — resistive.

7. Stomach friction — lying.

8. Breech beating — standing.

9. Back percussion and friction downward — stand-
ing..



INSOMNIA. 137

If the patient is very weak and hardly able to walk
about, she should lie down on a lounge and have the
foiiowmg manipulations applied to her: —

1. Back percussion and friction downward.

2. Foot rotation — double.

3. Arm vibration.

4. Leg nerve compression.

5. Stomach vibration.

6. Breech beating and vibration at the end of the
spine.

7. Leg vibration.

8. Spinal nerve compression.

g. Head percussion and friction.

Insomnia.

Of the numerous cases of insomnia which have
couTe under my observation, the following-described
one was considered by the attending physicians to be
exceedingly dangerous, and one in which the patient
was so weak and irritable that the greatest care and
gentleness were imperative.

On one occasion I was called to see a gentleman,
40 years old, who had been without sleep for three
weeks. He was very weak and' complained of great
pain in the back, legs, and wrists. He was. very ner-
vous and irritable, and had no appetite.

The first two days only the following movements
were applied : —

I. Arms — friction — downward.



138 PRACTICAL MASSAGE.

2. Legs — friction — downward.

3. Back friction — downward.

4. Head friction.

The patient had some sleep the first night, which
was increased a httle every following night.

The third day the treatment was increased as fol-
lows : —

1. Stomach friction.

2. Arms — nerve compression, rolling, and friction.

3. Legs — nerve compression, rolling, and friction.

4. Chest friction.

5. Back kneading and friction.

6. Head kneading and friction.

The force of the manipulation was increased a little
every day.

The seventh day the following treatment was ap-
plied : —

1. Stomach kneading and friction.

2. Legs — thigh rotation.

3. Arms — arm rotation and hand rotation,

4. Chest lifting and vibration.

5. Chest slapping, kneading, and friction.

6. Arms — nerve compression, rolling, and friction.

7. Legs — nerve compression, rolling, and friction.

8. Back kneading, vibration, percussion, and fric-
tion.

9. Head percussion, kneading, and friction.

After two weeks' treatment the patient slept the
whole night, and he did not complain of any pains, and



INSOMNIA. 139

accordingly resistive movements were added to the
former ones in tlie following manner: —

1. Stomach kneading and friction,

2. Legs — fcxot rotation — doiiI>le — passive.

3. Arms — rotation and hand rotation — passive.

4. Chest lifting and vibration.

5. Chest slapping, kneading, and friction.

6. Arms — flexion and extension — resistive.

7. Arms — nerve compression, rolling, slapping, and
friction.

8. Legs — flexion and extension — resistive.

9. Legs — nen-e compression, rolling, slapping, and
friction.

10. Back kneading, vibration, percussion, and fric-
tion.

11. Head rotation — sitting.

12. Head percussion, kneading, and friction.

One month after the treatment began the patient
was well.

It is astonishing how quickly relief and sleep can be
effected to seemingly sleepless patients by light fric-
tions d ozi'uzcard , and also by long and deep inhalations.
Time and time again I have been called in the middle
of the night to apply such treatment to men of high
standing and great mind. Indeed, during my practice
in Washington I frequently had to shut off the light
in the W'hite House, telling the officers at the door, as
I left, that the President was asleep.



140 PRACTICAL MASSAGE.

Diabetes Mellitus

has often been treated with massage and exercise. It
has been shown that a large percentage of these cases
occur in corpulent individuals belonging tO' the richer
classes of society, and that an inactive mode of life,
affording but little bodily exercise, combined with ex-
cesses in diet, are favorable predisposing causes.

Among the commonest sympoms are muscular
weakness and its accompanying fatigue, due to the
insufficient nourishment which the saccharine blood
affords the muscles.

Cantani holds diabetes to be due to a metabolic
anomaly, in which both the sugar ingested and that
formed in the body from albumins, is not destroyed as
is normally the case, and hence reappears in the urine.
All physiologists agree on the muscles being the prin-
cipal seat of metabolism, and Zimmer reasons as fol-
lows : "Liver and muscle both contain glycogen, a fer-
ment, and water — the three elements necessary for the
formation of sugar. The proportion of glycogen and
ferment are relatively constant, while that of water is
variable. If the amount of water be permanently in-
creased, a continuous fonnation of sugar in these
organs occurs, and diabetes results.

"Where the diabetes is of hepatic origin the liver
will be in a state of constant hyperemia."

Active exercise, however, causes a diminution of
the amount of blood in all internal organs through de-
termination to the muscles, and the oxidative processes



DIABETES MELLITUS. 141

taking place in the latter result in the combustion of
niiicli of the suiiar contained in the blood. Thus in.
diabetics who indulge in little or no exercise accumu-
lation of sugar necessarily occurs.

ZimnTer is convinced that persistent exercise, in-
\olving all the large muscle groups, is capal)le of en-
tirely curing hepatogenous diabetes in many cases, and
much improving the condition in others.

Prescription I.

1. Back percussion — standing.

2. Foot rotation — double^ — reclining.

3. Horizontal arm t^exion and extension — sitting
— resistive.

4. Forward trtmk flexion and extensioin — sitting — •
resistive.

5. Leg nerve compression — reclining.

6. Arm nerve compression — sitting.

7. Leg flexion and extension — reclining — resistive.

8. Vertical arm flexion and extension — sitting —
resistive.

9. Stomach vibration — reclining.

10. Leg vibration — reclining.

11. Arm vibration — sitting.

When the patient has gained some strength change



to



Prescription II.

I. Horizontal arm separation and closing — sitting
-resistive.



142 PRACTICAL MASSAGE.

2. Foot flexion and extension — reclining — resis-
tive.

3. Trunk torsion — kneeling — resistive.

4. Backward leg traction — standing — resistive.

5. Chopping movement — standing — active.

6. Harvesting movement — standing — active.

7. Neck flexion and extension — standing — resis-
tive.

8. Bent-knee separation and closing — reclining —
resistive.

9. Lateral arm elevation and depression — standing
— resistive.

10. Back percussion — standing.



CHAPTER XIX.

Local Djskasi;s. — Diskasks oi- the ]*>raix, Spinal
Cord, and Xi:r\e.

congestion of the i'.kain (congestio cerebralis).

Severe acute congestion of the brain will hardly
be favorable to movement treatment, but milder cases
have often been treated with success. The movements
should be directed so as to drive the bloo<l from the
brain, therefore movements of the extremities should
be applied. If the patient is not confined to bed the
following prescriptioii would be useful : —

1. Shoulder rotation and chest lifting — sitting.

2. Thigh rotation — reclining.

3. Trunk rotation — astride* — sitting.

4. Leg flexion and extension — reclining — -resistive.

5. Neck flexion and extension — standing — resis-
tive.

6. Foot rotation and flexion and extensioii — double
— reclining.

7. Arm rotation — single — sitting.

8. Breech beating — standing.

9. Knee flexion and extension — sitting — resistive.

10. Head percussion, vibration, and friction.

11. Forward ami rotation — sitting.

(143)



144 PRACTICAL MASSAGE.


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