Massage as a Mode of Treatment

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MASSAGE AS A MODE OF TREATMENT.

MASSAGE

AS A

^ MODE OF TREATMENT

BY

WILLIAM MURRELL, M.D., F.R.C.P.

LECTURER ON PHARMACOLOGY AND THERAPEUTICS AT THE WESTMINSTER

HOSPITAL ; EXAMINER IN MATERIA MBDICA IN THE UNIVERSITY OF

EDINBURGH, AND TO THE ROYAL COLLEGE OF PHYSICIANS

OP LONDON.

SECOND EDITION.

LONDON
H. K. LEWIS, 136 GOWER STREET, W.C.

1887

T

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i Ji>A-» 1^**^ '*^*.

PRINTED BY

H. K. LEWIS, 136 GOWER STREET

LONDON, W C.

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PREM

I AM afraid that a good deal of misconception exists
in this country on thf subject of Massage. Many
people think that it is only a Icind of " rubbing" or
"shampooing," whilst others associate it in their
minds with the idea of a Turliish bath. Patients often
suppose that if they are to undergo a course of treat-
ment they will have lo abandon their ordinary occu-
pations, cut themselves adrift from their friends and
submit to be isolated or live in seclusion. It is amus-
ing to watch their astonishment when they are
undeceived on these points. Another common mis-
take is to suppose that anyone can "do massage,"
and that the whole art can be acquired in one or two
easy lessons. Applicants are often anything but
pleased when they are told that it takes at least two
years to learn, and that many people from lack of
aptitude or defective general education never succeed
in acquiring it, I constantly see nurses and others
who think they are thoroughly competent to under-
take Massage, but who have not the dimest idea even
of the meaning of the word. Another very prevalent
mistake is to suppose that each seance should last an
hour. How this absurd idea originated it is difficult
to say. In the following pages I have endeavoured
Lto give a concise account of the Von Mosengeilian
Ltiystem as practised in Holland and Germany, to-

PREFACE.

gether with certain indications as to the class of
cases in which it is most likely to do good. The
ignorant rubber of course thinks that it will cure
everything, but as a matter of fact its sphere of action
is very limited. If carried out under the direction of
a scientific physician, who has had experience in this
mode of treatment, it yields excellent rusults, but if
allowed to drift into the hands of an ignorant empiric
it soon degenerates into the most arrant quackery.
There is one other point on which speaking from
personal experience I should like to say a word. I
do not think that a man-rubber should ever be em-
ployed for ladies or children. For them it is abso-
lutely necessary to obtain the services of an educated
and accomplished massiuie. It is a safe rule to have
nothing to do with the people who advertise. For the
Second Edition the work has been almost endrely
rewritten and numerous cases which have recently
been under observation have been added.

WILLIAM MURRELL.

Dtctmbcr i^th, iS36.

^

r

\

CONTENTS.

CHAPTER PAGE

I. Introduction I

^ 11. The History of Massage 3

III. The Method of Performing Massage . . 14

VI. The Masseur and the Masseuse .... 22

V. The Physiological Action of Massage . . 31

VI. Massage in Paralysis 41

/ VII. Massage for Constipation 53

I

VIII. Massage a Remedy for Rheumatism . .61

IX. Massage and Neurasthenia 71

X Spinal Irritation and Massage • • • • 75

^ XI. Massage in Organic Diseases 80

XII. Massage in Joint Affections 86

XIII. Massage in Poisoning 91

XIV. Massage in Uterine Complaints .... 93

MASSAGE AS A MODE OF TREATMENT.

CHAPTER I.

Introduction.

Some tnonths ago at the Westminster Hospital I
delivered a lecture, which was subsequently pub-
lished in the Lancet^ on the Treatment of Infantile
Paralysis, in the course of which I referred at some
length to the value of Massage as a therapeutic
agent. The subject attracted a good deal of atten-
tion, and I received a number of letters from medical
men in various parts of the country asking for further
information, many of my correspondents urging me
to publish full details of the methods employed. I
have much pleasure in acceding to their request, and
I do so the more willingly because I have recently
returned from Germany, where thanks to the kind-
ness and courtesy of my friend Professor Von
Mosengeil, I have had the opportunity of witnessing
the progress of a number of cases under his care.

B

MASSAGE.

The first question which naturally arises is ** What
is Massage? " It is always difficult to give a defini-
tion, but I should be inclined to say that by Massage
we mean a scientific mode of treating certain forms
of disease by systematic manipulation. The word is
derived according to some authorities from the Greek
jw^aa-o-gTy, to rub, whilst others refer it to the Arabic
word mass'h, to press softly. It is not by any means a
new mode of treatment, and it is probable as Billroth
says, that the art of performing the various manipu-
lations now embraced under this term is as old as
surgery itself.

1

i

CHAPTER II.
The History of Massage.

In a primitive form Massage was known both to the
Greeks and Romans, who resorted to it especially
after the bath, a custom which under the name of
" shampooing" " still prevails amongst Oriental
nations. After the struggles pf the circus it was
employed to dissipate the resulting contusions and
extravasations, and to restore pliability to the bruised
and stiffened joints. Homer tells us that beautiful
women rubbed and anointed war-worn heroes to
rest and refresh them after the toil and heat of the
battle. We all know the story of the Emperor
Hadrian who one day seeing an old soldier rubbing
himself against the marble at the public baths, stopped
him and enquired why he did so. The veteran an-
swered: — "Because I have no slave to rub me,"
whereupon, the Emperor pitying his condition gave
him two slaves and enough to keep them. On the
following day when the Emperor made his appear-
ance a number of old men commenced rubbing them-

B2

J

T

4 MASSAGE.

selves against the wall hoping to have similar g-ood,
fortune, but the Emperor divining their inti
directed them "to rub one another." Hippocrates
says: — "A physician muit be experienced in manjj
things, but assuredly also in rubbing, for things
that have the same name have not always tha
same effect. For rubbing can bind a joint that is to<J
loose, and loosen a joint which is too tight." Ar
he adds, "rubbing can bind and loosen, can mal
flesh, and cause parts to waste. Hard rubbing bin'
soft rubbing loosens, much rubbing causes pari
waste, moderate rubbing makes them grow." Cel
too, suggests the use of friction for the remova
deposits in the tissues, and especially for the relie
pain. Amongst the Chinese, written allusions w'
found dating back to a period three thousand
before the Christian era, and their oral tradition
of still greater antiquity. The Chinese manu;
Kong Fau, the date of which is yxio b.c, see
have contained detailed accounts of these oper
Closely allied in their nature and mode of act!
the sarchuna of the Persians, the 'caarpi^t? i
Greeks, and Khe/riclion of the Romans. Much

CRUDE FORMS.

information respecting Us early history will be found
in the works of Hippocrates, Celsus, Galen, Oribase,
C^elius Aurelianus, and other writers both ancient
and modern,

Baudin, in his Travels in Nrj) Holland, relates that
the individuals who have the greatest influence
amongst the savages are the mulgaradacks, or medical
charlatans. A mulgaradock is regarded as possess-
ing^ power over the elements either to avert wind and
rain, or to call down tempests on the heads of those
who come under their displeasure. In order to calm
a storm, he stands in the open air, spreads out his
arms, shakes his mantle, made of skms, and gesticu-
lates violently for a considerable time. In order to
effect a cure, he proceeds much in the same way, but
with rather less noise: he practises a mode of rub-
bing, and sometimes hits the patient with green rods
which have first been heated at a fire, stopping at
intervals to let the pain pass away. The Africans
follow the same fashion ; and with the Russians,
fiagellation and friction by means of a bundle of
birch twigs are resorted to. After the subject
has been well parboiled in a vapour bath, a pailful

MASSAGE.

of cold water is then dashed over him, the effect
which is described as electrifying-. After this,
plunges into the snow, and thus prepares himseli
endure the rigour of the climate with impunity. 1
Siberians and Laplanders also are said to indulge
these luxuries.

My attention has been called to a curious work e
titled "A Brief Account of Mr. Valentine Greatracl
{sic) and Divers of the Strange Cures by him late
performed as written by himself in a letter addresst
to the Honourable Robert Boyle. Esq.," and pul
lished at the Mitre in Fleet Street in the year i6
I have perused it with much care but cannot adi
as bas been suggested that it is an early work
Massage.

In the Gazette des Hopitaux for 1839, ** La La
cette Fran9ais" as it was called, I find a par
graph headed ** Massage employ^ dans Tile <
Tonga," in which it is stated that it is the custoi
when a traveller is fatigued from walking or othe
exercise, to make him lie down, and then to perforr
certain operations on him, known as toogi'toogt\ m
or /ota. The first of these consists of striking quid

" LOMI-LOMI."

and softly with the fist, the second is a process (^
rubbing with the palm of the hand, whilstyo/a meank
pressing and squeezing' the tissues between the fingers
I and thumb. These operations are usually performi
by females trained for the purpose, and they relievo
pain and fatigue, and in addition produce an agree-
able effect, which predisposes to sleep. When they
practice them with the view of relieving fatigue only,
the arms and legs are subjected to treatment, but
when the pain is localised it is to the part affected
or to the surrounding parts that the procedure \\
applied. For headache the skin over the frontal
^^1 region and the cranium generally is submitted to

^^H^ fotOy and often with speedy relief. Sometimes when

^^^^^^H the fatigue is very great, they employ young children
^^^^^^B to tread under their feet the whole body of the
H^^^^H^ patient. Dr. N. B, Emerson gives a similar account
of the lomi-lomi of the Sandwich Islanders, and de-
1 scribes it as a luxurious and healthful form of passive

H^^^^^L motion, bestowed by the Hawaiians as a crowning act
^^^^^^^ft Of gracious hospitality on the honoured guest or dis-
^^^^^^^Btinguished stranger. Nordhoif in his interesting
^^^^^^^nirork on "Northern California, Oregon, and the

\

Sandwich Islands,'" says that to be lomi-lomied you
must undress and lie down on a mat. The less
clothing you have on the more perfectly can the
operation be performed, "To you thereupon comes
a stout native with soft fleshy hands, but a strong
grip, and beginning with your head and working
down slowly over the whole body, seizes and squeezes
with a quite peculiar art every tired muscle, working
and kneading with indefatigable patience, until in
half an hour, whereas you were weary and worn out,
you find yourself fresh, all soreness and weariness
absolutely gone, and mind and body soothed to a
healthful and refreshing sleep." These are clearly
but primitive methods, and have little in common with
Massage as we now understand the term.

During the early part of this century there is reason
to believe that the true Massage was practised in
France, but it was carried on secretly, and the pro-
fessors of the art were but little inclined to impart
their knowledge to casual enquirers. It is to Dr.
Mezger of Amsterdam that we are indebted for much
of our knowledge of the modern phase of Massage.
His thesis was published in .i86S, and is entitled "De

I

I*

MEZGER AND VON MOSENGEIL. 9

Behandeling* van Distorsio pedis mit Fricties." In
the preface he states that he commenced studying the
subject in 1853, and that he has modified it and
practised it constantly since 1861. I may mention
incidentally that Mezger has published no large

Y work on the subject, and that his reputation rests

chiefly on the undoubted success which he has
attained in treating his private patients. He is not now
connected with any hospital, and some time ago de-
clined a Professorship in the University of Amsterdam.
It is, however, to the careful and painstaking obser-
vations of Prof. Von Mosengeil that we are indebted
for an accurate and scientific knowledge of the subject.
His experiments on rabbits have served to place the
whole question on a firm basis, which will not be
readily shaken. The literature of Massage is now

^ so extensive that it is not possible in the space at my

disposal to refer to even a tithe of the able works and
articles which have from time to time appeared on
various branches of the subject. I can only mention
in the most casual way even such well known authori-
ties as Mezger, Von Mosengeil, Reibmayr, Estradbre,
Norstrom, Iljha Gopadze, Zabludovski, Benjamin Lee,

and Douglas Graham. Of late the Russians hi

'7

thank Dr. Theodore Maxwell for calling my alti
lion to several valuable papers written
language.

In this country unforlunalely very little i:
about Massage, As an example of the ignorai
which prevails on the subject, it may be noted that
a well-known Dictionary of Medicine, it is stated
Massage, "shampooing," "kneading," and "mC'
rubbing," are synonyms, and it is defined as a "
cess of treatment by rubbing, which consists in do/
manipulations." The so-called Massage practij
by "medical rubbers " and nurses is not Massage '<
all, as the term is understood on the Continent, ai
has little or nothing in common with it. In tl
words of the Lancel r — " It is as absurd to suppose th;
'rubbing' and ' shampooing ' is Massage as it is t
say that a daub of paint is a work of art." Ther
seems to be a deep-rooled objection to the tru
Massage as a method of treatment, but this will i)
time disappear when the fact is generally recognis'
that il is really a useful and scientific moda.

OR THODOX REMEDIES. 1 1

cure, not unworthy of the notice of even the most
distinguished physician or surgeon. More than
ten years ago it received in Germany the adhe-
sion and support of such distinguished authorities as
Billroth, Esmarch and Langenbeck. It is not free
from the taint of quackery, but as Dr. Playfair says,
in speaking of his special method of treatment, " To
my mind quackery does not consist in the thing that
is done, so much as the spirit in which it is done.
The most time-honoured and orthodox remedies may
be employed in such a manner, and by men boasting
of the highest qualifications, as to be fairly charge-
able with this taint. That we should be debarred
from the use of such potent therapeutic agents as
Massage, or systematic muscular exercise, or elec-
tricity, or hydro-therapeutics and the like, because in
unworthy hands they have been abused, seems to me
almost worse than absurdity."

As much misconception still exists on the subject,
it may be as well to point out the differences between
Massage and the so-called medical rubbing. Mas-
sage, as already stated, is a scientific method of
treating disease by means of systematic manipulation.

MASSAGE.

The injividual muscles or groups of muscles are
picked out or isolated, and stimulated to contraction
mechanically. The movements must be made in the
direction of the muscle fibres, and the tips of the
fingers must be carried along in the interstitia, so as
to promote the flow of lymph and increase tissue
metamorphosis. In addition an attempt should be
made to stimulate mechanically the various motor
points, in order that the muscles may be made to
contract by a stimulus conveyed along their nerves.
The manipulations are carried out systematically in
definite order and with a definite object. In medical
rubbing these conditions which are essential to
Massage are considered to be of no importance, and
the operator simply rubs or pummels the patient,
without any regard to the anatomical arrangement
of the parts, and usually without any very delinite
object. To perform Massage a knowledge of
anatomy is essential, whilst for rubbing and sham-
pooing, physical strength and endurance with a
certain amount of knack are all that is necessary.
Shampooing is very useful in its way, but it is not
Massage, and can never take the place of Massage.

''MEDICAL rubbing:' 13

There is as much difference between Massage and
shampooing as there is between playing a difficult
piece of music and striking the keys of the pianoforte
at random. The Weir Mitchell treatment of neuras-
thenia and hysteria is a combination of isolation or
seclusion, rest, electricity, overfeeding, and "Mas-
sage," the term Massage being employed, not in its
original sense, but simply as a synonym for rubbing.
Dr. Playfair's system is I believe identical with Weir
Mitchell's, and is applicable to the same class of
cases. Dr. Playfair tells us that Massage in the
sense in which he uses the term is " nothing more
than a vicarious way of giving exercise to patients
who cannot take it themselves." The Zander system
has nothing to do with Massage, but aims at curing
various ailments by mechanical exercises, machines
more or less complex in structure being employed
for the purpose.

CHAPTER III.

The Method of Performing Massage.

Now as to the method of performing- massage,
the first place it must be understood that there <
several different kinds of massage, or perhaps
ought rather to say, that massage comprises sevei
distinct modes of procedure. As a well known writ
says 'Hous les massages sont des manipulations tand:
que toutes les manipulations ne sont pas des ma
sages." Massage is the generic term which 5
eludes the other specific forms. The terms used
the different varieties of massage are, it will be s<
of French origin. They are in common use both
that country and in Germany. They are v
old and were employed ages ago, when mass<
flourished in France.

We begin then with what is called effleurage. T
is a stroking movement made with the palm of t
hand passing with various degrees of force over t
surface centripetally. It is of little value in its'

EFFLEURAGE.

but produces good results when combined in variousj
ways with the other procedures to be presently de*4
scribed. It is essential that the movement should bm
K as much as possible in the direction of the muscle \
I iibres. It should never degenerate into mere rub-
f bing. Every "movement" begins and ends with |
I an efBeurage performed quickly and perhaps for-
L cibly. For deep seated tissues the knuckles may J
■ lie used instead of the palm of the hand, Beuster j
[ of Berlin, describes tffiturage as consisting of " slow
Lgfentle strokes in a centripetal direction along the
KiGOurse of the veins and lymphatics made with the ]
tpalm of the hand and with the pressure inter-
Kmitting so as to cause passive peristaltic action."
I Jacobi says " the volar surface of the ends of the
fingers or of the entire hand having been applied to
\ the part at a point situated more peripherally than
I the affected portion, is then pushed centripetally '
\ forward and a short distance beyond the part. When '
r this hand has reached its destination the other hand '
^ is placed at the starting point, and the same move-
ment executed. Meanwhile the first hand has bem^
brought back, so that by the time the second one \

i6

MASSAGE.

fulfilled its purpose it is ready to begin again. This
is then repeated with regularity. The time to be
devoted to each stroke will vary much, the strokes
also following with more or less rapidity."

Next comes pHrissage which is more important
and is by no means easy to acquire. It is this
procedure above all others, as Lee of Philadelphia
has pointed out, by which we act upon the cir-
culation of the deep-seated parts and modify the
processes of tissue metamorphosis, "It is a power-
ful excitant to the capillary circulation, and stim-
ulant to secretion, and an awakener of dormant
nervous energ-y." It consists essentially in picking
up a portion of muscle or other tissue with both
hands, or the fingers of one hand, and subjecting it
to firm pressure, rolling it at the same time between
the fingers and the subjacent tissues. The hands
must move simultaneously, and in opposite directions,
II will be observed that the thumb and fingers are
wide apart, and that the whole muscle is taken up
between the fingers and firmly pressed and rolled.
The movement is made from below upwards, and
the parts are squeezed in much the same way that

PETRISSAGE.

one would squeeze out the contents of a sausagi
Professor Von Mosengeil always impresses on hi
pupils the necessity for ** working upstairs/' that i
from the extremities towards the centre of the bod}
The skin must move with the hands or the operatio
is a painful one for the patient. What one han
misses the other takes up so that all the tissues ar
subjected to the influence. It is of importance to pre
ceed uniformly and not to jump from spot to spo
To do this well it is essential to remember the ai
rangement of the groups of surface muscles, and t
keep well in the interstitia. It is hardly necessary t
say that it would be useless to attempt petrissage (
the hard tissues such as the bones. You will ofte
see a nurse trying to squeeze up the ridge of thetibi
under the impression that the bone is a muscle.

The next process is friction or massage a /riciiof
which is performed with the tips of the fingers, and i
employed chiefly in the treatment of affections of th
joints. To quote Beuster again : — *' The finger-tip
of one hand held at right angles to the axis of th
limb rub across and across in narrow elipses while th
fingers of the other hand stroke parallel to the axis c

C

t

I

i8 JIIASSAGE.

the limb," The term is a bad one for it has nothing to
do with what we ordinarily understand by friction, it
is always associated with effleurage, and it must be
performed quickly and with considerable facility or it
is well niffh useless. It is useful not only for treatment
but for the purposes of diagnosis.

Tapotemeiit is a kind of percussion which may be
made with the tips o( the fingers, their paimaraspects
{Iti tapoiements de Laisni), the palms of the hand, the back f
of the half-closed hand, the ulnar or radial border of;
the hand (hachures, haikwigm of Neumann), or with thv
hand flexed so as to contain when brought In contac'
with the surface of the body a cushion of air. In ex
ceptional circumstances lapoUmtni may be indirect, -■
bundle of swan's feathers lightly tied together beir
employed for this purpose, but this is now rarely
sorted to by the best operators.

There are other varieties of massage such for ex

pie as different forms of vibration — very useful for

stipation— but these it is hardly necessary to de

in detail, in fact, it is almost impossible to teach

npf massage by written or verbal description. It

^■uch as if one were trying to make a p^

"DRV" MASSAGE.

19

player by describing how it is done without recourse
to the instrument. Massage is undoubtedly difficult to
learn but it can be acquired by dint of constant prac-
tice, and after a time becomes almost a second nature.
There are several little points of detail to which atten-
tion must be paid. The massage should be "dry"
that is without the use of oil, or liniments, or oint-
ments of any kind, This is contrary to the teaching
of Busch and other writers, but a little experience
soon serves to show which method yields the best re-
sults. The only exception, or almost the only excep-
tion, to this rule is when the patient suffers from some
form of specific disease, when the operator should
use an antiseptic preparation, carbolic acid or oil of
cloves and lard for example— for his own safety and
protection. The less ointment one uses the better,
and it must be remembered that vaseline is never ad-
missible. Scrupulous attention must be paid to the
condition of the hands and nails. The hands should
be soft, and the nails short. A few months ago Prof.
Liebreich of Berlin advised me to try Lanoline the
newly discovered wool oil and basis for ointments.
I have used it in several cases, and although it is un-
C2

20 JtfASSJG-E.

doubledly infinitely superior to vaseline and other
petroleum fats I prefer dry rubbing-, and am sure it is
a mistake to employ lubricants of any kind. Dry
rubbing is to be preferred for the following reasonSi'
(i) You get better contraction of the muscles and
consequently a greater flow of lymph, (2) electiical
currents are more readily developed in the tissues,
(3) there is a greater elevation of temperature in the
part, (4) you do not make your patient in a mess.
There is not the slightest fear of causing abrasion of,
the skin in dry rubbing if the operator knows his
work. The rubber who rubbed a hole in his patient
because there was no vaseline had mistaken his
vocation. I do not deny that inunctions are of value
in suitable cases, but that is entirely another matter
and has nothing to do with Massage,

Many special preparations are recommended foi
keeping the hands soft and white, but it is hardly
necessary to resort to them. A little ammonia o'
borax in the water in which the hands are wash'
may be useful. At night the best mixture for
hands is white of egg mixed with a grain or Iw
atum. The so-called Roman toilet paste is a mi

MASSAGE AND ELECTRICIIY. 21

of white of egg", barley flour, and honey. Simple
oatmeal would in all probability do just as well, but
the best way of keeping the hands smooth and white
and fit for massage is never to do anything which
would make them rough or dirty.
In some parts of the Continent massage is employed

• alone, whilst in others it is associated with electrical
treatment. Von Mosengeil, in addition to being an
authority on Massage, is a thoroughly practical
electro- therapeutist. In suitable cases he employs
both the constant and the interrupted current, placing
one electrode on some neutral spot, and the other on
the various motor points in succession. In some

. cases — headache . for example — static electricity is
employed, sparks being taken from the painful spot.
Static electricity, so long discarded as a therapeutic
agent, is now employed by many physicians in' the
treatment of hysteria, hypochondriasis, and allied
conditions.

The Masseur and the Masseuse.

The next point for consideration is, who should do
the Massage? It would be absurd to suppose for one
moment that so delicate a duty could be entrusted to
an untrained or uneducated person. Both MezgeC
and Von Mosengeil are their own operators. For
women and children it is essential to obtain ths
services of a thoroughly accomplished Masstuse,
She must be an educated lady— I use the word ad'
visedly — who has been thoroughly trained in the
different methods, a process which will occupy at
least two years. She must have such a knowledge
of surface and visceral anatomy and of physiology,
as will enable her to carry out the instructions of the
physician intelligently. It is not necessary that she
should be physically strong, aptitude and intelligenr
being of far greater importance. She must be
woman of refinement, and the possession of a cer
■sympathetic temperament will greatly enhance
Rvalue of her services. I quite agree with

THE MASSEUR. 23

, TT^- ■ M H II I I 11 I I ■ I II ■ ' - - - I - ~

Benjamin Lee, who, in speaking- of the choice of a
manipulator, says : " He or she, for both sexes may
succeed admirably as masseurs or masseuses, must
possess firstly, vigorous health ; secondly, muscular
strength ; thirdly, a cheerful temperament, a pleasant
face, and an acceptable manner; fourthly, a soft and
pliant but strong hand ; fifthly, a fair education and
a certain amount of refinement; sixthly, a knowledg-e
of the leading" facts of anatomy, such as the position
of the various organs, the position and course of the
larger arteries, veins, and nerves, and of such facts
in physiology as the functions of the various organs,
the course of the circulation, and the general pro-
cesses of nutrition; and, seventhly and lastly, an
acquaintance with the efTects produced by the differ-
ent forms of manipulation, the order in which the$e
different forms should be employed to produce
certain general effects, the injury which may be
inflicted by employing them improperly or out of
their proper order, and a practical dexterity in their
application, to be attained only by training under an
experienced instructor. Hence it will be understood
that we cannot take John from the stable, or Biddy

from the wash-tub, and in one easy lesson convi
either into a safe, reliable, or efficient manipulator.
Massage is an art, and, as such, must be acquired by
study and patient practice under competent guidance."
The necessity for obtaining educated people to per-
form massage is as yet hardly recognised in thii
country. A short time ago on asking a medical
friend if he used massage much in his practice he
replied: — "Oh yes, a great deal, my butler does it."
After that 1 should not have been at all surprised to'
hear the electrical treatment was conducted by his
footman, and that the kitchen maid undertook the
obstetric cases. The so-called massage practised in!
some of the hospitals, and under the auspices of'
some of the nursing institutions, is a painful exhibi-
tion of iirnorance and incompetence being simply a '
degenerate form of rubbing or shampooing. Both
are useful enough in their way, but they hardly ran'
as scientific therapeutic agents. The art of Massag
depending as it does on a knowledge of Anaion?
and Physiology, takes two years to acquire, and '
lOnly plan at all feasible is to train one's
lerators. A short time since a gentlemen .•

THE SEANCE.

2S

in one of the medical papers, that it might be learnt
in a few easy lessons, "like fly-fishing, tennis and
cricket," but as it appeared that he had no practical
knowledge of the subject and that his views, to say
the least, were somewhat hazy, the assertion may be
allowed to pass without further criticism. The state-
ment made by the Za«rt/, that "skill in the proper
performance of Massage takes at least two years to
acquire," is correct.

The duration of the stance is another point of
great importance. The whole operation should
not occupy more than from eight to ten minutes,
and many authorities think that four minutes is
quite enough. In recent cases these short sittings
should be frequently repeated, say three or four
times a day, but in chronic cases such frequent
meetings are not essential. There seems to be a
general impression that massage should be sus-
pended during the menstrual periods, but this I
think is hardly necessary. It is desirable that the
patient should, if possible, come to the operator, for it
is difficult to work effectually when tired with a long
journey. The morning is by far the best time for

26 MASSAGE.

massage. It is never a good plan to employ a per
son who is uncongenial to the patient or who haS
damp and clammy hands. The patient must have
confidence in the treatment and in the operator. It
is useless to attempt massage in the face of persis'
tent objection on the part of the patient, or the
patient's friends. It is sometimes stated that patients
should rest in bed for an hour after each siance, but
I never Iind this necessary, on the contrary, I think
the sooner they go about their business the better.
It is difficult at first to make people understand that
if ten minutes' massage will do them good, twen^f
minutes will not prove twice as efBcacious. Such
however is not the case. An observation
Reibmayr may serve to impress this on the I
memory. He subjected a dog to massage for i
few minutes and found that the pulse rose fron:
twenty-four to sixty-four. He then continued th
manipulations for some time longer and the pu
quickly fell to thirly-six, Norstrom says: — '
dur^e des stances sera de cinq minutes ou h, peu
dans les cas chroniques on en fera une ou moir,
dans les cas aigus il en faul deux d

luch
byf

ir a,^

SUNDAY REST.

27

minutes ou davantage;" but an expert masseuse from
whom I have derived many practical hints, assures
me that half an hour is not too much for a case of
infantile paralysis, I always tell my patients that
they must have one day's rest during; the week, pre-
ferably on the Sunday. It must be remembered,
however, that the same method of treatment with
respect to details is not applicable to all cases. Each
case must be taken on its own merits, and it is here
that the special skill and knowledge of the physician
come into play. Massage is a powerful therapeutic
ag^ent, but if improperly employed, or if used in
unsuitable cases, may do a great deal of harm.

The terms used to designate those who practice
massage and the words employed in describing the
different methods and processes, are as Dr. Charles
K. Mills of Philadelphia points out, somewhat awk-
ward for English speaking people. "The proper
term for a male operator is masstur, for a female
masseuse, the plurals being Tnasseurs and masseuses.
The verb which expresses the performance of the
procedure is masser. It is therefore proper to speak
of a patient as being mass^ed or of mass^eing a

28 MASSAGE.

patient. 1 certainly would not advise you t
either of massageing or massacreing: a patient. The i
latter is certainly expressive in describing the violent |
performances of some of the untrained exponents of .1
the art."

Some months ago my attention was called to an I
article on " Massage and Morals " in a weU-known^I
Society Journal. The author writes forcib'y and ism
evidently well acquainted with the subject. He says;
" I have heard more than one complaint of the con- i
duct of their manipulators from ladies who have beeal
advised by their doctors to try the massage cure, and„l
knowing something about the matter from statements J
which have been volunteered to me by men of practical 1
experience, I have since made certain inquiries, the
results of which demonstrate that about one half o'
the so-called surgical massage that goes on is,
reality, nothing of the kind, ll is simply and entir
a misleading system, which ought to be well inv
^ated by the husbands, wives, and friends of
who by order of the doctor or from their own
place themselves for treatment in the hant'
professional advertising masseurs. It is i

MASSAGE AND MORALS. 29

people who may be recommended by their medical
attendants to resort to massage, should know the in-
dividuals into whose hands they are liable to fall ;
and although I cannot here print all that has come to
my knowledge with respect to the practices of the
objectionable section of the fraternity, I intend to give
some account of what I have learnt."

A description then follows of the practices pursued
in the establishment of a certain professor, and the
article concludes with the following words : —

"At some of these establishments the so-called
cure is carried on in large rooms, where the female
patients congregate together and perform rather
after the manner of athletes at a gymnasium than
sufferers in a doctor's reception-room. Not unlike
the outer chamber of a Turkish bath, the women
lie about on couches, or straddle wooden horses,
meanwhile discussing at their leisure with the German
male attendants the possible efficacy of the professor's
cure."

I was inclined at first to think that the account was
somewhat exaggerated, but from what I have heard
since, from various sources, I am satisfied that it is

3b MASSAGE.

correct and if anything* understated. The practical
conclusions to be deduced from a perusal of the
article are : —

(i) That massag-e should never be resorted to un-
less under medical advice and superintendence.

(2) That no medical man should permit his patients
to remain under the care of any advertising rubber
or " professor.'*

(3) That under no circumstances should a lady or
child be treated by anyone but a well-trained and
reliable masseuse who should act under the direction
of the medical adviser.

CHAPTER V.

The Physiological Action of Massage.

Respecting the physiological action of Massagfe, it is
necessary to speak with caution. Here, as is so
often the case, practice has preceded theory. The
art of massage has been acquired, but we know
little of its mode of action. We find that we cure
our patients, but hardly know exactly how these
results are obtained. It is easy to theorise, but we
want carefully observed facts and accurately recorded
experiments^ Fortunately we have something to
guide us, and we turn with pleasure to the pains-
taking observations of Gopadze, Zabludovski, and
Von Mosengeil. Dr. Gopadze's experiments were
made on four medical students who were kept in the
hospital, and subjected to systematic massage for
twenty minutes or more daily. The operation com-
menced with efileurage beginning at the extremities
and working upwards. This was followed by petris-
sage, friction and tapotement, ending up with a second

34 MASSAGE.

were so marked as to be visible to the naked eye
The conclusion arrived at as the result of these, ai
a number of similar observations, was that massaj
promoted absorption by the lymphatics. It is pro
bably in this way that effusions and other morbi(
products are removed. Another fact observed bj
Von Mosengeil was that massage raised the tern
perature of the limb or part operated on, a fac
susceptible of easy demonstration. This was i
first thought to be purely mechanical, the result o
the friction with the hand. It was noticed, however,
that it was quite as marked after petrissage as afte'
effleurage, and it was found too that this elevation of
temperature was not merely temporary, but lasted
for some hours. It was so marked as to be appre-
ciable, not only to the thermometer but to the touch.
It is obvious that massage increases the circulatioi
through the part, and this probably explains
efficacy in hastening the union of fractured bones, i
fact now well established. The elevation of temj
perature in some recent experiments was found to fc
from three to four degrees, and in infantile paralysi
Lccording to Professor Weir Mitchell, it is often froi

RESTORATIVE EFFECT.

3S

six to ten degrees. It is probable that effleurage of
the surface lightly performed, contracts the super-
ficial blood vessels locally, whilst deep and persistent
eSleurage combined with petrissage dilates them.
The redness of the surface observed after a few
minutes petrissage has long been recognised, and
this may to some extent explain the beneficial effects
of massage in infantile paralysis. As already shown,
the nutrition of the parts is maintained until new
cells in the cord take on the function of those which
have been destroyed.

It is well known that massage increases the elec-
trical contractility of muscular tissue. Zabludovski
has shown that kneading restores the contractile
power of muscles exhausted by the rhythmical ap-
plication of maximal induction currents, whilst simple
rest without massage has very little restorative effect.
This point can easily be demonstrated on the human
subject. Professor Von Mosengeil applied an elec-
trode to one of my motor points— it was the external
popliteal nerve if I remember rightly — and then
gradually reduced the strength of the current, until it
I failed to produce any contraction in the muscles; he

MASSAGE.

then massed the limb for two or three minutes, after
which the current whicii had previously failed to
elicit a response, produced vigorous contraction.
Douglas Graham, of Boston, states as the result of his
observations, that muscles respond more readily,
more vigorously, and more agreeably to the Faradic
current after massage, than they do before, especi-
ally if they are somewhat deficient in contractility.
It would seem that massage exerts an action similar
to very complete and perfect circulation through the
part, in removing waste products, and restoring
muscular power. It is probable that it is by stimu-
lating the circulation, and increasing the supply of
blood to the part, that it promotes the union of bone
after fracture. Reibmayr has shown that as the
result partly of the development of surface heat and
partly of the friction, delicate electrical currents are
developed in the tissues themselves, Zabludovski
demonstrated this experimentally ; he found too that
a man who could lift a weight of one kilo at intervals
of one second, by flexion of the elbow joint, from a
table on which the fore-arm rested horizontally, was
enabled after the arm had been massed for five

minutes, to lift it In the same way over eleven hundred
times. The work was performed with less difficulty,
and gave rise to very little pain or sense of fatigue.

There can be but little doubt that massage exerts
much of its beneficial effect by stimulating the flow of
lymph in the lymphatics. This explains its use in
hasmorrhagic effusions, and throws light on its mode
of action in promoting absorption of tissue round
chronic ulcers. The manipulations exert some in-
fluence mechanically, which is facilitated by the
arrangement of the valves permitting the passage of
lymph in one direction only, and in addition the con-
traction of the muscular fibres has much to do with
the production of the effect. When the muscle fibre
is stimulated mechanically to contract it shortens and
thickens, and the lymph in the spaces immediately
surrounding it is driven onwards. There seems to
be a general consensus of opinion in Germany, that
this is by far the most important factor in the pro-
duction of the good effects, witnessed in many cases
of disease treated by massage.

It has been suggested that possibly Massage may
in some cases exert a beneficial effect by getting rid

38

MASSAGE,

of or dispersing— to use a. popular expression —
certain deposits or lliickenings in the muscular and
otlier tissues. Dr. Walter Johnson says: — " If any
surgeon or physician who has not hitherto had his
attention directed to this point, will manipulate the
flesh of his patients, he will be surprised to find in
how many cases he will detect thickenings, harden-
ings, and swellings in various parts. He will find
the necks of nearly all his patients who have suffered
for any length of time from head affections swollen
and indurated, with most probably enlarged ab-
sorbent glands in the neighbourhood. The neck and
shoulders will frequently be tender to the touch, and
the muscular and other fibres will be dry and will
crackle perhaps on pressure. He will notice a
similar condition of the shoulders and upper part of
the back in asthmatic patients particularly, and he
will find the long muscles of the back very much
disordered in many chronic diseases affecting the
stomach, liver, kidneys, etc. The arms and legs
will on examination present swellings and harden-
ings and thickenings, accompanied by swollen
glands in a multitude of patients." The credit of

-S WELLINGS AND THICKENINGS. 39

this observation is assigned to a certain Mr.
Beveridge, who many years ago practised as a
rubber in Edinburgh. He found we are told such
swellings could be dispersed by friction, and that
coincidentally with the removal of these deposits as
they were called, the patient's health materially
improved, and sometimes chronic diseases of long
standing were cured. A young gentleman, the son
of a wealthy merchant, was for many years subject
to epileptic fits, and was treated in vain by the most
eminent physicians, both in Edinburgh and London.
At last he was cured by Mr. Beveridge. Beveridge
discovered a crop of deposits, rubbed them away,
and the lad got well. Dr. Johnson says : — *' I knew
the young gentleman, and I knew his parents, and
there is no doubt of the truth of this statement."
The theory about the deposits may not be worth
much, but still empirical observations such as these
deserve consideration.

The value of friction in maintaining the health, is
referred to by many writers of repute. Lord Bacon
for example points out that *' frictions make the parts
more fleshy and full as we see, both in men and in

40 MASSAGE.

the currying of horses. The cause is for that they
draw greater quantity of spirits and blood to the
parts, and again because they draw the ailment
more forcibly from within ; and again because they
relax the pores and so make better passages for the
spirits, blood, and ailment ; lastly because they dissi-
pate and digest any inutile or excrementitious mois-
ture which lieth in the flesh ; all which help assimila-
tion/' This may not be quite in accordance with our
modern views of pathology, but still it is extremely
interesting. Sir William Temple writing on '• Health
and Long Life," says ** Friction is of great and
excellent use and of very general practice in the
Eastern countries, especially after their frequent
bathings ; it opens the pores, and is the best way of
all forced perspiration ; is very proper and effectual
in all swellings and pains of the joints, or others in
the flesh which are not to be drawn to a head and
break."

CHAPTER VI.
Massage in Paralysis.

We have now to consider the class of cases in which
massage is most likely to prove beneficial. It is by
no means easy to say in what diseases it is most
useful. Unfortunately its employment has been
advocated in the treatment of many complaints for
which it is essentially unsuited. Accurate diagnosis
is of the utmost importance, so that the sphere of use-
fulness of this remedy may with increased experience
become more accurately defined.

I will begin with infantile paralysis because it
was in the treatment of this sad affection that my
experience of this method of treatment was first
obtained. The history of these cases is only too
familiar to most of us.

A child — a bright, happy, intelligent child — is put
to bed one night with little or no indication of illness,
or at the most suffering from some slight ailment,
and in the morning wakes up paralysed and a cripple.
The little girl who only yesterday could run and

42 MASSAG£.

jump and dance with the best of them is now a help-
less invalid, tied to her couch and incapable of the
slightest movement. If you examine the leg's — for
they are the limbs most frequently affected — what do
you find? They are deadly cold, there seems to fae
but very little life or circulation in them, reflex action
is abolished, and not unfrequently iheyareexqulsitely
tender to the touch. The child tries to move, but
her best efforts are in vain; she has no more control
over those palsied limbs than if they belonged to an
inanimate object. The physician after a few days
applies his electrical tests, and points out that both
nerves and muscles refuse to act. In poliomyelitis
anterior acuta, as we technically call the disease, the
excitability of the nerves to the faradaic current
begins to diminish about the tliird day from the
commencement of the illness, and by the end of the
week is gone, perhaps never to return. On the ap-
plication of galvanism to these nerves there is no
response, but placed directly over the muscles them-
selves it is found that there is increased excitability,
a feebler current than in health sufficing to cause
contraction. After a time this excessive irritability

SPINAL CURVATURE. 43

passes away, and it is impossible to obtain any
response with either form of electricity. The outlook
is indeed bad, and the ultimate chances of recovery
are small, unless recourse be had to some special
mode of treatment. It must be remembered that all
this has come on suddenly, possibly without any
warning" or antecedent illness of any kind ; or it may
follow in the wake of measles, scarlet fever, whooping-
cough, or one of those apparently trivial febrile dis-
turbances which are so common in children, and for
which we ordinarily do so little. Sometimes there
may be a fit or an attack of convulsions, but this is
not usually the case. Even when the paralysis to
some extent passes away, one or two muscles or
groups of muscles fail to perform their accustomed
functions ; and the child, even if able to get about,
walks with a limp and is a cripple for life. As
Professor Erb points out, club-foot, loose joints with
dangling limbs, and extreme degrees of spinal curva-
ture nearly always owe their origin to infantile
paralysis. "The shrunken, paralysed, crippled
members, hideously distorted, incapable of use, con-
stitute a burdensome appendage to the body rather

than an integral part, and present a striking contrast
to the healthy, well -developed, and well -nourished
limbs,"

The general mode of treatment to be adopted has
already been sufficiently indicated in the lecture to
which I have already referred (Laneii, Dec. 26, 1881).
In essential paralysis, as we have already seen, the
legs or at all events the affected members are always
cold, and the muscles react but feebly to the electrical
current. By systematic massage an improvement
is speedily effected. We resort chiefly to petrissage
associating It of course wiih efHeurage, Both pro-
cesses must be centripetal, working upwards from the
extremities. The sittings should be at first of short
duration and frequently repeated, say three or four
times a day, but in chronic cases twice a day will
suffice. The first effect noticed is that the limbs be-
come much warmer, and this is not temporary, but
lasts for some hours. Then it is seen that the suscep-
tibility of the muscles to the electrical current is
greatly increased, so that they contract at once after
a few minutes massage to a stimulus which would
otherwise exert not the slightest effect. During the

INFANTILE PARALYSIS.

4S

last six years I have had a large number of cases of
this description under observation, and in every
instance in which the treatment was carried out
actively and systematically the best possible results
were obtained. Many of them were of many years
standing, and some remained under treatment for
many months. Two patients have been under obser-
vation for over four years, and from being helpless
invalids have grown into bright, active, happy chil-
dren. Electricity is most useful as an adjunct. One
electrode — the cathode — is applied to the spine about
the tenth dorsal vertebra, whilst the other is placed
over the various motor points. The weakest currents
are employed, and contraction may be obtained by
opening and closing the current from time to time.
Shocks of any kind are quite inadmissible, and the
application should never be permitted to cause the
child pain. It is a good plan to search for tender
spinal processes, and this applies equally to many
other forms of paralysis. A big sponge to the head
and the passage of a weak constant current is useful,
especially if there be much contraction of the limbs,
I see no objection to the employment of such accessory

46

MASSAGE.

treatmeni as pine-extract baths, salt water baths,
rabbit-wool stockings, and the administration of cod-
liver oil, extract of malt, and the beef and iron wine.
In comparatively recent cases the pro^osis Is essen-
tially good, but in old standing cases one has to be
cautious in expressing an opinion.

In other forms of paralysis massage is equally
efGcacious, and benefit will be experienced from its
employment in pseudo- hypertrophic paralysis, facial
paralysis, wasting palsy, and allied conditions. In
writers' cramp and especially dancers' cramp it is an
excellent mode of treatment. The spasm of the
muscles of the legs from which diaieuut so frequently
suffer is often cured by a single application. Zabin-
dovski has recently published in the i'mci a number
of cases of violinists" cramp treated by this method.
The success obtained in some forms of writers" cramp
by a modified process of massage is well known.
Douglas Graham thinks that in many cases it is
capable of " fulfilling therapeutical indications of the
utmost importance, such as the removal of increase
and decrease of resistance in the paths of conduction,
excitation, and motion; restoration of harmonioos

HYSTERICAL PARALYSIS. 47

co-operation of iodivkSua] movements of natsral con-
ductivity and excitability, as well as of muscular
sense and muscular effort, in a urord correction of
under-action and over- action of muscles, nerves and
their central reflex apparatus/' All writers are
agreed as to the enormous benefit which may be
effected by massage in hysterical paralysis. In cases
of hemiplegia due to cerebral haemorrhage, massage
may be useful in maintaining the condition of the
musdeSy and arresting those unpleasant starlings to
which many paralysed or partially paralysed persons
are liable, but it can hardly be expected to effect a
cure. In all cases of chronic paralysis progress must
of necessity be very slow, and Schreiber verv
properly lays much stress on the necessity for
patience and preseverance. It is perhaps hardly
necessary to say that by massage I mean real
massage, or to point out that these good results are
not likely to follov,- what is commonly called •• medical
rubbing." The late Mr. Maclean in a short commu-
nication to the Z^wwi?/, 1S77, vol. i., p. 311, says: —
" Friction is the only form of manipulation ordinarilv
made use of by the profession in the treatment ct

48 MASSAGE.

paralysis, and when the medical attendant orders
friction, the "medical rubber" is usually called i
and without any instructions from the medical atten
darit is left to his own devices, which in most c
consists in rubbing the skin with various degrees oP
force, using" as a lubricating' agent some oil to which,
some virtue is ascribed. If attention is directed to it,
one immediately recognises the Fact that such manipu-
lation as this can have little effect on anything but
the skin itself."

A case of chronic myelitis which was under my
care serves, however, to illustrate the benefit which
may sometimes be derived from a course of Massage'
even if very imperfectly carried out. I may say at
once that 1 saw the patient, usually in consultation,
only at long intervals, so that I am unable to trac^
his progress towards recovery very accurately. He
'was a young clergyman, a curate in the country, antt
it was supposed that his illness originated from
getting wet through whilst riding across country one/
bitteriy cold winter's night to see a poor woman who
was at death's door and longed for the consolation a
the Church. When first I saw him he was lying or

CHRONIC CASES.

49

his back in bed, and was completely paralysed from
ills waste downwards. He had no control over his
leg's which were drawn up towards the abdomen in a
most painful position. He was racked with pain
which was controlled only by targe and frequent
injections of morphine. The urine had to be drawn
off by the catheter and was strongly ammoniacal,
Constipation was a prominent symptom, enemata
having' to be used every time an action of the bowels
was desired. There was impairment of sensation in
both hands, and the breathing was irregular and
spasmodic. He had been carefully examined a few
days previously by a distinguished authority on
nervous diseases, who is reported to have said that
no treatment would be of the slightest avail, and that
in ail probability the patient would not live ten days.
I took a more hopeful view of the case, and after
reducing the morphine, prescribed pills of physostig-
mine and phosphorus every three hours, with the
constant current to the spine twice a day, and
Massage to the legs. Considerable difKcully was
experienced in finding anyone to carry out the
necessary manipulations, but at last a man was sent

down, who, if not a Masseur, was at all events a verj
good rubber. In a few weeks difficulties arose chiefly
in consequence of tfie expense attending the rubbing,
and the treatment was partly suspended or at all
events very imperfectly carried out. Some sis
months later I again saw the patient who was still
confined to his couch, and at my earnest solicitatioi
Massage was resorted to for six weeks, A hitch/
however, occurred once more and I saw nothing of
my patient for over a year when one morninf
walked into my room the picture of health and
having almost perfect control over his legs. He told
me that he had carried out my treatment during the*
whole time to the best of his ability, and that 1
attributed his recovery to the various remedial agents
which had been suggested. He stili walks with a
stick and it will probably be many months before he.
can resume his duties, but no doubt is entertained of
his ultimate recovery. He has white atrophy of ona
optic nerve, and the other shows signs of degenera-
tion, but the mischief is not progressing, and there.
has even been some slight improvement in his sight
of late. This I admit is a very incompl

omplete account oil

LOCOMOTOR ATAXY, 51

an interesting case, but the main features are unmis-
takable. Had he been placed from the first under
the care of an accomplished Masseur^ I cannot help
thinking that the result would have been even more
striking and satisfactory.

There is reason to think that massage is of much
value in the treatment of locomotor ataxy. In
Germany, however, ihey rarely rely on it alone for
effecting a cure, but resort to active medicinal treat-
ment as well. They are great believers in the efficacy
of the green iodide of mercury, which unfortunately
has been struck out of the British Pharmacopoeia^ find-
ing that it exerts a beneficial effect in arresting the
progress of the disease. They give it even when
there is no history of syphilis. Their "Resolvent
Pills'* are made by mixing one gramme of the green
iodide with some inorganic substance as an excipient,
and dividing into 120 pills, two of which should be
taken three times a day, the patient meanwhile ab-
staining from the use of red wine. The massage is
most useful in allaying the acute pains which are so
commonly an accompaniment of this complaint. Dr.
Weir Mitchell of Philadelphia says, "it is many years

52

MASSAGE.

since I first saw in this city general massage used by
a charlatan in a case of progressive paralysis. The
temporary results he obtained were so remarlcable
that I began soon after to employ it in locomotor
ataxy, in which it sometimes proved of signal value,
as in other forms of spinal and local disease."

Massage is useful in Landy's paralysis — paralysis
ascendens acuta. In these cases there is usually at
first slight fever, pain in the back and limbs and
general weakness lasting one or two days or it may
be three or four weeks. This is followed by paraly-
sis of the lower limbs, then of the body, and finally
of the upper extremities with perhaps some distur-
bance of respiration. The electric excitability of the
paralysed nerves and muscles remains perfectly nor-
mal — an important point in distinguishing it from
central myelitis and poliomyelitis anterior acuta. In
most cases the tendon reflex is present at the begin-
ning of the disease but is abolished later on. The
paralysis in untreated cases usually progresses up-
wards until it involves the medulla oblongata and
death ensues.

CHAPTER VII.
Massage for Constipation.

For constipation it is certainly one of the most
powerful therapeutic agents at our command. Petris-
sage of the abdomen is the best method, care being
taken to make the requisite manipulations in the
direction of the ascending, transverse and descending
colon. It should be associated with different varie-
ties of tapotement, the flat open hand, the hand
partially closed so as to form an air cushion, and the
margins of the hands being employed according to
circumstances. Vibratory movements are in addition
resorted to in obstinate cases. Years ago Piorry
advocated a mode of treatment for constipation,
which is not essentially different from that now des-
cribed. Averbech says " disorders of the digestive
apparatus and especially constipation constitute one
of the most marked indications for the employment
of massage. When there are no complications
but the symptoms are due to disordered secretion,
one can always effect a cure in one or two months, or

S4

MASSAGE.

at the outside three or four." Speaking from my
own experience I should say that the effects were
remarkably prompt. Massage answers admirably for
women who sufFerfrom this condition, especially when
there is a lax condition of the walls of the abdomen
resulting from frequent preg;nancies. It is cf the
greatest service too in constipation associated with
obesity, and in that form of conMipatiun which fre-
quently results from taking too litlle exercise. It
probably acts in three ways (i) by increasing the
intestina] and other secretions, (2) by stimulating the
peristaltic action of the intestines, and (3) mechanically
by pressing the accumulated feeees towards the rectum, j

Cases of chronic constipation are common enough
and I have recently met with several instances in
which treatment by massage has dono much good.
Most of these depended in all pr&babilily on chronic
catarrh of the intestine, but one or two were
complicated by the presence of fjecal tumours which
could be detected with more or less distinctness
through the walls of the abdomen. In one case, the
patient, a lady, had been a constant sufferer for eight
years. She also complained of "uterine disorder"

HARDENED F^CES. 55

' _ ' -

and "spinal irritation/' The faeces were passed at
irregular intervals in the form of little hard dry
pellets or lumps varying in size from a bullet to a
hen's egg, their passage being attended with great
pain. It would seem that certain articles of food
were delayed in the intestine for some considerable
time. Thus the remains of French beans and especi-
ally of brown bread were noticed by the patient in
the motions six weeks after these articles had been
discontinued, and the same occurred with strawberry
pips and other things which could be readily recog-
nised. In this case the services of an excellent
Masseuse were obtained, and petrissage and effleurage
of the abdomen were practised in the direction of the
colon for twenty minutes twice a day. At the
expiration of a week the lumps were passed with
much less difficulty and the patient was able to dis-
pense with the morning enema to which she had been
long accustomed. The treatment was continued for
twenty-one days, and after the interval of a month
was resumed at the patient's desire for four weeks
longer. She had medicinal treatment during a por-
tion of the time, but most of the benefit derived was

i

56 JifASSAGB.

I think attributable to the massage, A medical man
suffering from persistent constipation associated with
a movable kidney for whom 1 recommended massage
and who wisely placed himself in competent hands,
writes at the expiration of a fortnight:' — "For ten
consecutive days my bowels acted promptly just after
breakfast, a feat which they had not previously ac-
complished for five years! " In some of these cases
a relapse is not uncommon necessitating a second
course of treatment.

Mr. Treves, speaking of Massage, says; — "With
regard to its effect in cases of fsecal accumulation it
must act largely as a mechanical agent, influencing
the conformation of the stercoral mass and modifying
its position. It would appear also to act as a direct
stimulant to the intestine, for within a few minutes of
the commencement of the manipulation peristaltic
movements are excited which may in time reach such
a grade as to cause much colicky pain. It is possible
that such effect may be brought about by the imme-
diate stimulation of Auerbach's plexus, under the
control of which the peristaltic rhythm is supposed lo
lie. The stimulation also of the skin of the abdominal

DYSPEPSTA.

S7

parietes may not be without influence. It is supplied
by branches from the last seven of the dorsal nerves,
and it is significant that it is from these very nerves
that the splanchnics are in great part derived. The
part played by the splanchnics in the abdominal
nervous system need not be commented upon. Their
precise influence upon the bowel has yet to be estab-
lished, but so far as movement is concerned they
appear to contain both excitor and inhibitory fibres.
These explanations of the efiects of massage are not
entirely satisfactory, nor are they such as would
satisfy the captious doubter. The doubter, however,
can wait, and in the meantime the practical man may
be satisfied that he has in massage a therapeutic
measure of considerable value." Dr. Cheadle has
recently recorded three cases of intussusception
treated by inflation and massage.

In DYSPEPSIA and other functional disorders of the
digestive apparatus, massage is most useful. Applied
to the abdomen it is a powerful stimulant to both the
gastric and biliary secretions. Gopadzeand Shpolian-
sky have shown that under the influence of Massage
food is retained in the stomach a much shorter time

58

JUASSAGE.

than usual, and in cases of slow and difficult diges-
tion, petrissage alternating' witli intermittent pressure
with the warm hands has been found by M. Dally to
be most valuable. The case was recorded not Ions'
ago in one of the daily papers of a retired Colonial
Judge " a man of intelligence and experience, accus-
tomed all his life to carefully discern between truth
and falsehood" who was cured of dyspepsia of many
years' standing by a short course of massage. The
recovery was complete and he soon found himself
able to eat and drink everything that came along
without suffering or discomfort.

In the treatment of corpulence massage is of very
great value. It answers admirably for ladies, who
about thirty-five, as the result of a sedentary life and
other complications into which it is unnecessary to
enter, find that they are beginning to get stout and
lose their figures. This is a condition not uncom-
monly met with, and I do not know that it is ame-
liorated in any way by purely medical treatment.
Petrissage and effleurage of the limbs, with petrissage
and tapotement of the abdomen following the course
of the colon, are the best forms. Massage in a

A STIMULATOR OF ENERGY. 59

modified form is often resorted to by ladies engaged
professionally, who find they are getting too stout. It
is especially useful for women who have passed much
of their lives in hot climates, and have been precluded
from taking much exercise. Dr. Lauder Brunton
says : — ** We all know how active exercise increases
the appetite. Tissue-change goes on more rapidly
in the organs, waste is more abundantly excreted,
and more food is eagerly sought for. But there
are many feeble flabby persons who can not
take exercise, or if they can, will not. Moreover,
there are others who are quite willing to exercise the
voluntary muscles of the limbs, but cannot exercise the
involuntary muscles of their internal organs. Now
treatment by massage helps both of these. It
increases the nutrition, both of the voluntary muscles
and of the internal organs, and under its use patients
apparently hopelessly incurable completely recover,"
It is a great stimulator of energy, and will ''brace
up" people as nothing else will. A physician who
recently called on me from Sydney, told me that it
was of great service for women who had been long
in Australia, and who were getting stout, and I have
heard similar accounts from American physicla.Kv^*

6o MASSAGE.

Some months ago I saw a lady, aged 38, who as
the result of much good living and little exercise, had
become inordinately stout. She was very short of
breath, and was disinclined for exertion of any kind.
She had been fond of literary pursuits, but even
those had lost their charm and were irksome to her.
She was extremely irritable, and a source of trouble
and anxiety to her friends and relatives. Massage
was prescribed, and in two months she lost a stone
and a half in weight, and improved notably in other
respects.

CHAPTER VIII.

Massage a Remedy for Rheumatism.

In rheumatism and rheumatic affections, massage
has long" enjoyed a high reputation. It is efficacious
in both the articular and muscular forms. In a
curious work by William Balfour, M.D., published in
Edinburgh in i8ib, and entitled ** Observations, with
cases illustrative of a new and simple and expeditious
mode of curing Rheumatism and Sprains without in
the least debilitating the System," an account is
given of the treatment of rheumatism by percussion,
friction, and compression. His attention was called
to the subject by a little personal experience. "Hav-
ing been seized with a rheumatic affection of the left
shoulder, chiefly in the course of the deltoid muscle,
the pain at times, but especially towards morning
when warm in bed, was so severe as to make me cry
out. Desirous on one of these occasions of moving
my arm, a task to which its own powers were un-
equal, I grasped it firmly with my right hand about
the middle of the pained muscle, to my surprise and

MASSAGE.

">?rh gratification I was instantly relieved from pain,
and while I thus held my arm I could do anything-
with it I pleased without further aid from my right
hand, than mere compression." This led to an
investigation of the subject, and the systematic em-
ployment in a number of cases of rheumatism, of
compression, percussion, and friction; a rude and
primitive form of massage in fact. By far the most
startling case in Dr. Balfour's book is that of Madam
Rey De La Ruaz, a French lady, long resident and
well known in Edinburgh. She is said to have in-
herited gout, and to have suffered from it Irom the
age of six. Dr. Balfour tells us that when first he
saw her "all her fingers were extremely weak, some
of them swelled, others so exquisitely painful that she
could not suffer them to be touched, she could not lift
a wine-glass with one hand, but she contrived to do
it with both by turning" their backs to each other.
Both wrist-joints were stiff and painful, but the left
could not be moved without the greatest suffering.
Both elbow-joints were greatly affected, the left did
not possess half the natural range of flexion and ex-
tcnvon. On each humerus immediately above the

DR. BALFOUR. 63

inner condyle a large tumour was situated, so painful
that it could not be touched without making" the
patient cry out. All the muscles covering the humeri
were from origin to insertion rigid, knotted, thick-
ened. The deltoid muscle felt like two boards ; the
connections of the clavicles with the shoulders and
the joints at their flexures, the patient could not suffer
to be touched. She could not lift a hand to her
head .... Her head and a small part of the anterior
portion of the trunk of her body were indeed the only
parts free from disease, and she had not walked a
step for eight years." The account of her case
extends over nearly twenty pages, and is too long to
reproduce here. It may not be very clear what was
the matter with this lady, but it is interesting to note
that she was completely restored to health in five
months by friction, percussion, and compression,
without taking any medicine, '* with the exception of
a few laxative pills and a saline julep when she was
feverish." The author seems to have been rather
proud of his success, for he says: — "I congratulate
this excellent meritorious woman upon her restora-
tion to independence ; I congratulate those who are

66

MASSAGE.

pure it is almost colourless. Il is the Oleum Succini J
of the United States Pharmacopceia, and the ffta'I^
Volaitle de Succin of French writers. I think it is use- \
ful for slight cases and when massage caDnot be oknl
tained I often prescribe it. It is said to be the active!
ingredient in Roche's Embrocation, and rubbed intol
the spine night and morning it is an excellent remedy I
for whooping-cough.

These of course are not quoted as cases of rheu- I
matism treated by massage. I often find massage of '1
the greatest value in this condition after the complete J
failure of ordinary rubbing. A lady who has for many \
years suffered from chronic articular rheumatism re-
cently told me that she derived more benefit from
three weeks' massage which was carried out under
my direction than from all the drugs she had ever
taken, and this is not an exceptional experience,

M. Martin of Lyons has recorded a number of
cases of lumbago treated by massage, and Laisn^ has
published other cases treated by what he calls
sage par endulalions. The last named procedure is J
carried out somewhat in this way ; the patient is 1
made to lie on his face, a pillow being placed under J

LUMBAGO. 67

the abdomen so that the muscles of the back are
relaxed. The operator then places the tips of the
fingers, slightly separated, a little below the seat of
pain, and to the right of the spine ; the fingers are
then moved slowly upwards, pressing gently, and at
the same time describing a series of small circles.
When the seat of pain is passed, this is repeated in
a similar way on the other side of the spinous pro-
cesses. Should the pain be limited to one side, or be
more severe on one side than on the other, that
should have the preference, but in most cases it will
be found better to make the movements first on one
side and then on the other. The pressure should be
gradually increased as the pain decreases. After
from twenty to twenty-five minutes working in this
way, similar movements should be made with the
ball of the thumb and little finger, the whole ending
up with the application of a moderately tight band-
age. In lumbago tender spots may often be detected
on careful examination, due in all probability to some
morbid condition of the ligaments. Massage and
friction over the seat of pain will usually effect a cure
in these cases.

FZ

MASSAGE.

There are few conditions more amenable to treat- i
ment by massage than what is commonly called j
backache. This is a composite condition and may be I
due to a variety of causes. The patients are usually 1
women and the suffering is undoubtedly often very j
acute. In the majority of cases it has its seat in the 1
muscles, and is the result of strain or over-fatigue.
The strain may be equally severe on both sides, but 1
in patients who are in the habit of throwing the .
weight of the body on one leg when standing, it may j
be confined to one side, I have met with many ex-
amples of this in young women who have to stand for I
many hours a day behind the counter. Sometimes |
the pain is the result of pregnancy, the accumulation
of dropsical fluid in the abdomen or even the
velopment of fat. A still more common cause is
uterine disturbance, this being simply one of a group
of symptoms indicative of the existence of some dis- i
placement. More rarely it arises from a defect in
the process of digestion and assimilation, the muscles,
as Dr. George Johnson has pointed out, being irritated
rather than nourished by the imperfectly digested
food. In many instances I have known massage i
give prompt if not immediate relief.

OBSCURE PAINS. 69

Many people suffer from vague uneasy pains in
the legs, usually said to be rheumatic or neuralgic
pains. In young people they are sometimes called
"growing pains/' they are intensely painful, and the
patient not uncommonly suffers at the same time from
a feeling of depression and wretchedness. They may
be associated with disordered digestion and constipa-
tion, but this is not always the case. Very little is
known about these pains, but it is found practically
that they are relieved by massage. Some time ago
I saw a gentleman who suffered from periodical
attacks of pain in the legs; he was unable to describe
the pain beyond saying that it was not an acute pain,
and curiously enough he was unable to localir>e it; he
did not think it was in the joints and yet he could not
say where it was. There was no tenderness, but
the legs seemed to him to be heavy, and to be
perpetually aching ; sometimes it would attack the
arms, and was then most marked in the shoulders
and wrists: it rarely troubled him at night, and
never incapacitated him in any way ; he had never
had rheumatic fever or any acute illness, and lived a
fairly regular life, eating well, working hard, and

70 MASSAGE.

taking" a fair amount of exercise; there was no
hereditary tendency to gout as far as he knew, and
he usually drank hock or claret, and took but little
beer ; he was in fairly comfortable circumstances ;
but had had a hard struggle to get on in the world;
the attacks of pain usually lasted some three or four
hours, sometimes all day, and were accompanied
by a good deal of mental depression ; they were in-
tensified and commonly excited by worry or anxiety
of any kind. I was unable to g^ive any definite
opinion as to their origin and nature, but suggested
massage as a mode of treatment, and this afforded
prompt relief.

CHAPTER IX.

Massage and Neurasthenia.

Dr. Douglas Graham, of Boston, speaks highly of
massage in the treatment of neurasthenia. He uses
it for those "who, in spite of rest, change and medi-
cation, have become chronic neurasthenics, the result
of business reverses, overwork, worry, loss of rela-
tives, disappointed hopes, or as a sequel of some
affection that has existed in some part of the system,
but which has recovered or has become of secondary
importance." These symptoms may be somewhat
ill-defined ; but I have certainly found massage of
the greatest use in what, for want of a better name,
has been called " spinal nervous weakness," or
** neurasthenia spinalis." Erb speaking of this con-
dition says: — "Abundant experience has shown me
that these cases are not rare, ^nd that they are of
great practical importance ; they give rise to much
anxiety, not only to the patient but to the physician,
owing to the striking resemblance they often exhibit
to severe disease of the cord.'* These cases of spinal

MASSAGE.

weakness are usually met with amongst the rich and
educated. Some months ago I saw a young man
who had had a distinguished college career and was
working hard for a profession. He was a great big
strong fellow capable of any amount of physical
exertion, but instead of devoting himself to athletics,
he preferred reading medical works and analysing
his feelings and sensations. He complained of
"restlessness at night," of "inability to apply his
mind," of "coldness in the hands and feet," of
" burning pain in the spine and across the back," of
"dimness of sight," of " numbness of the hands and
fingers," and " disturbed dreams." His appetite was
good, he was well nourished, and I failed to detect
any organic disease. He had taken a good deal of
medicine, and had tried rest and change of air with-
out much benefit. I recommended efHeurage and
petrissage of the back and iegs, with the application
of a constant current ta the lower dorsal vertebrfe by
means of a large sponge electrode, and in six weeks
almost all the symptoms had disappeared. Neuras-
thenia or at all events a closely allied condition is
common amongst Americans who have been engaged

^'PLAYED OUT."

73

in large business transactions, I recently had under
my care a gentleman who offered ati excellent exam-
ple of this condition. He was certainly one of the
"brightest" and most original thinkers it has ever
been my pleasure to meet, a brilliant conversation-
alist, a genial companion and a smart writer. He
had built up a gigantic enterprise and his operations
were conducted on an enormous scale. He told me
that he wrote or dictated as many as 90,CCX) letters
a year. He had travelled all over the world and had
made an enormous success. But everything had been
on his shoulders and after twelve years of hard work,
both night and day, he felt that he could do no more
and that he was temporarily " played out." He tried
rest but to a man of his temperament rest was an
impossibility and he had little or no faith in medi-
cines. He had been through all kinds of "cures" but
without much benefit. He had such a superabun-
dance of energy that he always got through a three
weeks' course in about two days and a half. I tried
electricity at his own request, sometimes the constant
and sometimes the interrupted current, and it certainly
did him more good than anything. I cannot say that

74 MASSAGE.

I treated him, but I carried out certain treatment at
his suggestion and I was glad to be of use to him. I
never had a pleasanter patient, or one I liked better.
His sufferings were very real and I heartily sym-
pathised with him and was delighted when he got
better.

The Weir Mitchell system is now largely used in
the treatment of many of these cases. It is not
Massage in the sense in which we employ the term
but a combination of isolation, rest, over-feeding,
electricity and rubbing. It does good in a great
many cases and sometimes harm. Seclusion is a
serious matter and the expense has also to be taken
into consideration.

Weir MitchelFs " Fat and Blood," an Essay on the
Treatment of certain forms of Neurasthenia and
Hysteria, may be regarded as the classical work on
the subject, and is so familiar to readers on both
sides of the Atlantic that it is hardly necessary to do
more than mention it. The fourth edition should be
in the hands of every one interested in the treatment
of these marvellous, interesting cases.

CHAPTER X.
Spinal Irritation and Massage.

Massage is of the greatest use in the various forms of
that peculiar and interesting condition described many
years ago by the late Mr. Thomas Pridgin Teale of
Leeds, and the brothers Dr. and Mr. Griffin of
Limerick, and now commonly known as spinal irri-
tation. Mr. Pridgin Teale in his classical work
says: — "The symptoms of this affection consist in an
infinite variety of morbid functions of the nerves of
sensation and volition, which have their origin in the
spinal marrow, and the parts in which these morbid
functions are exhibited of course bear reference to
the distribution of the spinal nerves. The morbid
states of sensation include every variety, from the
slightest deviation from healthy sensibility of any
part, to the most painful neuralgic affections on the
one hand, and to complete numbness or loss of feel-
ing on the other, including pains which may be fixed
or fugitive, or darting in the direction of the nerves,
pricking and tingling sensations, a sense of creeping

MASSAGE.

in the skin, of cold water trickling over it, and
numerous otiier states of perverted sensation, of which
words are inadequate to convey a description. In
the muscular system we find weakness or loss of
power, and sometimes a tendency to rigidity. These
symptoms sometimes estst in so light a degree that
the patient considers them unworthy of notice, and
only admits their existence when particular inquiry is
made respecting them ; the only complaint which he
makes being an unaccountable sense of weakness
and inability of exertion. In other cases the tremors
have excited alarm ; sometimes the neuralgic pain in
the scalp, or the fixed pain in the muscles, particu-
larly when it occurs in the intercostal muscles, have
suggested the idea of serious disease in the brain or
in the lungs, and when the pain is seated in the mus-
cles of the abdomen, a fear that some organic disease
of the abdominal organ has taken place harasses the
mind of the patient."

In these cases tenderness over the spine corres-
ponding to the origin of the affected nerves is always
a prominent symptom. Sometimes, however, it is
not complained of until specially inquired for, and

SPINAL TENDERNESS. 77

now and then its existence is not even suspected by
the patient, until she is made to wince when pressure
is exerted by the hand of the physician. Nervous
pains and neuralgias of different kinds shifting sud-
denly from place to place, are amongst the common
symptoms of this peculiar affection. They are brought
on by the slightest exertion, by lifting a weight, by
twisting or straining the back, or by any effort mental
or physical, and usually they are relieved to some
extent at all events by lying down. Teale says : —
** Irritation of the lower cervical portions of the spinal
marrow gives rise to a morbid state of the nerves of
the upper extremities, shoulders, and integuments at
the upper part of the thorax. Pains are felt in
various parts of the arm, shoulder, and breast, some-
times the pain takes the course of the anterior thoracic
branches of the brachial plexus, occasionally the pain
is fixed at some point near the clavicle, scapula or
shoulder joint, at the insertion of the deltoid or near
the elbow, or shoots along the course of some of the
cutaneous nerves. Frequently one or both of the
mammaR become exquisitely sensitive and painful on
pressure, and some degree of swelling occasionally

78

MASSAGE.

takes place in the breast, attended with a knotty and
irregular feel when the neuralgic pains have existed
a considerable time in the part." Nausea, retching",
and vomiting, are not unusual concomitants, and the
same may be said of spasmodic cough and difficulty
of breathing-. Palpitation is often met with, fre-
quently associated with a feeling- of pulsation at the
pit of the stomach, throbbings in the temples, heats
and flushes, and a tendency to faint. Prolonged and
spasmodic muscular contraction, as in the case
described by Dr. Radcliffe in Reynolds' "System of
Medicine," is sometiraesthe most prominent symptom.
In a case described by Dr. and Mr. Griffin, sudden
insensibility was always induced by even slight
pressure on the seventh or eighth dorsal vertebra. In
another case a sense of faintness was engendered in
the same way: — "On examining the spinal cord,
although there did not appear to be any tenderness,
the sensation of pain was excessively disagreeable to i
him through its whole course. When the finger
rested on one of the dorsal vertebra he grew pale
and terrified, and would have fainted had the pressure
been continued. He felt no pain, but a sudden indes.

SPINAL IRRITATION. 79

cribable sensation or thrill through every nerve in his
frame, which was inconceivably horrid, he shuddered
at the idea of permitting* a repetition of the pressure,
and had an unpleasant feeling about the part for the
remainder of the day. When a few weeks had
elapsed, however, he allowed another examination
with precisely the same results." I know of no
class of cases in which general massage does so much
good as in spinal irritation. Very often the patients
have long been in the habit of taking morphia, but this
mode of treatment will enable the physician to discon-
tinue its use, or at all events materially diminish the
dose. The brothers Griffin although in all probability
they knew nothing of massage, as we understand the
term, clearly recognised the value of friction to the
spine; they say: — "Friction of the spine along its
whole length for a considerable time daily, has been
employed by most practitioners who have directed
their attention to the complaint. It will sometimes be
found a good substitute where blistering disagrees,
and occasionally gives more relief than any other
remedy. It seems particularly useful in abating the
morbid sensibility of the vertebral column, which is
so striking on pressing certain portions of it."

CHAPTER XI.

Massac

IN Organic Diseases.

There are undoubtedly many cases of organic dis-
ease in which massage proves directly useful. A
short time ago I mentioned in the Stilish Medical Jour-
nal that I had treated with success a gentleman, aged
68, who came to me complaining of shortness of
breath, and increasing disinclination to take exercise.
He had been in business, and had led a most active
and energetic life. Three or four years ago he re-
tired, and from that time experienced a gradual
falling off in health. His appetite was poor, his
bowels were obstinately confined, and he was ner-
vous and anxious about himself. He was found to
have a loud apex systolic murmur, and the heart's
action was weak and irregular. I suggested mas-
sage, which was carried out systematically four days
a week, for a period of six weeks. He improved from
the very first, and before (he conclusion of the course,
was better than he had been for many months. His

HEART DISEASE.

appeiite returned ; his hands and feet were warmer;
the bowels became regular; he slept well at night;
and his spirits improved in a most satisfactory man*
ner. A still more striking case has recently been
under my care, A young: lady, aged 22, was brought
to me suifering from palpitation, shortness of breath
on the slightest exertion, and extreme cedema of the
legs. She was unable to take exercise, and the legs
were so swollen that they pitted deeply on pressure.
On examination of the chest, she was found to have
a loud apex systolic murmur. She had never suffered
from rheumatic fever, and her parents had not the
slightest idea that her heart was affected. I gave
her first digitalis and then strophanthus but without
much benefit. Systematic massage was then resorted
to and almost immediately a diuretic action was in-
duced, and the patient was relieved of her most
urgent symptoms. In three weeks her legs had re-
turned to their normal condition, and she was able
to walk farther and better than she had done for two
years previously. In all cases of cedema of the legs
where the tissues are so puffed up that they pit or*
pressure, either as the result of cardiac disease or

S2

MASSAGE.

chronic kidney affection, massage is of great value in
promoting' absorption and improving" tlie circulation.

Massage is most useful as a nervous sedative,
Graham says, " upon the nervous system as a whole,
massage most generally exerts a peculiarly delightful
and at the same time profoundly sedative and tonic
effect. While it is being done, and often for hours
afterwards, the subjects are in a blissful state of
repose, they feel as if they were enjoying a long
rest, or as if they had just returned from a refreshing
vacation ; quite frequently it makes optimists of them
for the time being. An aptitude for work usually
follows, though generally those who submit to this
treatment feel gloriously indifferent, and needless
apprehensions are dispelled." In insomnia general
■massage at bed time undoubtedly promotes sleep.
Several cases have come under my observation in
which it has been resorted to with marked success.
The result is not only certain but prompt, the
patient usually enjoying a good night's rest after the
first stance. It has the great advantage over all
narcotics that there are no disagreeable after effects.

Ordinary medical rubbing often does a great deal

A NERVOUS SEDATIVE. 83

of harm in these cases. Dr. Walter Johnson of
Great Malvern in his work on the " Anatriptic Art,"
says, " rubbing has a very peculiar effect upon the
nervous system. I have produced sleep by delicate
soothing strokings of the upper part of the back in a
sleepless patient, and everyone who is rubbed ap-
propriately has a tendency to sleep. But there is a
way of rubbing which irritates and excites the nerves,
and an unskilled rubber, rubbing in this manner will
do frightful mischief. A lady suffering from spinal
weakness came to Malvern for change of air. Here
she was introduced to a female rubber who professed
to be able to do great things for her spine. The lady
wrote to her medical attendant who resided in a dis-
tant town and received his permission to be rubbed.
So the rubbing took place and was persevered in, in
spite of a continued increase of unfavourable symp-
toms, until at last the lady grew so ill that I was sent
for. I found her suffering from acute congestion
of the brain, produced entirely by the injudicious
rubbing."

There are many general or constitutional diseases
in which massage is useful. It would at first sight

G2

84

MASSAG£.

perhaps hardly be supposed that massage would do
much good in anemia, and yet in obstinate cases it is
a most valuable accessory. Persistent ansmia is
often met with in women who take little exercise and
remain indoors the greater part of the winter. Iron
up to a certain point does g'ood, but after a time it is
rot assimilated, and fails to do any good, and the
patient no longer improves, A short course of mas-
sage thus proves most useful, and on resuming the
iron there is immediate improvement.

I have found massage of much value in certain
stages of SYPHILIS, especially in women. The patient
has perhaps been well treated, and has taken mercury
in small doses at intervals for a year or more, and
all the active symptoms have subsided. A general
condition of debility, however, still persists, which is
intensified rather than relieved by medicinal treat-
ment. Massage may then be resorted to with great
benefit, and the patient rapidly improves in general
health. In the cohvalescgnce from many diseases
acute and chronic, massage is most useful. It im-
proves the general nutrition, and the patient often
gains strength very rapidly Indeed.

NEURALGIA.

8S

I am told that massage is often used with success
in the treatment of neuralgia, but my experience has
as yet been limited so that I cannot speak with cer-
tainty on this point, I know, however, that it is useful
in many kinds of headache and in megrim. In conges-
tive headache effleurage should be performed gently
over both the external and internal jugular veins, so
as to facilitate the passage of venous blood. The
effect is almost immediate, relief being obtained in a
few minutes. My friend Dr. Dujardin-Beaumetz of
Paris speaks well of massage in neuralgia. Professor
Max Schiiller of Berlin has recorded fifteen cases of
sciatica successfully treated by massage, and is con-
vinced of its superiority over all remedial agents
commonly employed. The pain quickly abates, and
the power of walking improves daily. The duration
of treatment is, on an average, two weeks and a half,
but in one case a cure was affected in nine days,
and several others in from ten to fourteen days. One
patient abandoned the treatment after five days in
favour of electricity and vapour baths, but deriving
no benefit, returned to the massage and was cured in
nineteen days.

CHAPTER XII.

Massage in Joist Affections.

There seems to be a general consensus of opinion
that massage is wel! adapted for the treatment of
certain chronic joint affections, and most of those I
saw treated by Von Moscngeil were such as would
in this country be considered incurable, or would drift
into the hands of "bone-setters," Reibmayr has
demonstrated its value in chronic synovitis, whilst
Norstrom's article on " Massages dans les Maladies da
Articulations el leur annexes" is well known. Friction
with effleurage is the method employed. Massage
is of the greatest possible value in the treatment of
sprains, both acute and chronic. The old fashioned
plan was rest in bed and evaporating lotions, the
modern treatment is massage and nothing else. As a
rule massage is not well adapted for cases in which
there is acute inflammation, but an exception has to be
made for sprains, a host of observers having recorded
their opinion in favour of the innovation. The pain,
the discolouration and the swelling disappear as if by
magic. It is important to begin the treatment at

SPRAINS AND CONTUSIONS. 87

once, there being nothing to be gained by delay.
Norstrom records the case of a lady aged 46 who
slipped and sprained her ankle. The pain was very
acute and she was unable to walk. She was nervous
and excited and cried out when the part was touched*
There was some swelling in front of the malleoli but
fortunately no bones were broken. Very gentle
effleurage was resorted to for a quarter of an hour,,
and it was then found that the joint was much less
painful, and could be moved more readily. The treat-
ment was repeated, and the same evening she was
able to proceed to Saint Germain where she lived.
On a previous occasion she met with a similar acci-
dent and was confined to her bed for six weeks.

Dr. Douglas Graham records the results of the
massage treatment in 308 cases of sprains, contusions
of joints and distortions, the average time needed for
recovery being nine days. The average of 55 cases
treated by rest and compresses was 26 days. The
Massage average would have been better had it not
been for 39 cases which were not seen until from tei>
days to three weeks after the accident. These cases
took on an average 2 1 days to get well. Dr. Grahan^

MASSAGE.

points out that the sooner the treatment is com-
menced the shorter is its duration. The advantages
resulting from Massage are speedy relief of the pain
and swelling, and earlier and more perfect use of the
joint and limb. Bergham has treated successfully by
Massage no less than 145 cases of recent traumatic
Joint affections, including contusions, distortions and
synovitis with effusion. Seventy cases affecting the
ankle joint recovered on an average in six days,
whilst 38 cases of old sprains required 22 days each.
It was found that after a plaster of Paris dressing had
been applied even for a very short time, the duration
of ihe treatment was much prolonged. N^iaton, S^e,
Demarquay, Labbe, Duplay, and others, speak highly
of the value of Massage in affections of the ankle
joint. Dr. Roux of Lausanne, says that it acts almost
like magic in cases of synovitis, whether of rheumatic
origin or resulting from an injury. For stiff joints
of various kinds nothing could be better. Many
surgeons are now employing this mode of treatment
in this country, and will presumably in due course
publish their experiences.

There is a curious work which gives some very

interesting information on the use of various forms
of friction in the treatment of sprains and joint af-
fections generally. It is entitled "A Full Account of
the System of Friction as adopted and pursued with
the greatest success in cases of Contracted Joints and
Lameness from various causes, by the late eminent
surgeon John Grosvenor Esq., of Oxford, with obser-
vations on those cases to which it is most applicable,
by William Cleobury, Member of the Royal College
of Surgeons of London, and one of the surgeons to
the Radcliffe Infirmary, Oxford," Although published
as recently as 1825, it is a comparatively rare work,
there not being a copy in any of the medical libraries
in London. The third edition contains a reprint of
the life of Mr. Grosvenor, and is illustrated with his
portrait. His method of manipul.ition is described
at considerable length, but is hardly worth repro-
ducing, as it is simply an imperfect form of Massage.
His results, however, appear to have been wonder-
fully good, and people came from all parts of the
world to be under his treatment. He selected his
cases carefully, and declined to undertake those
which in his opinion would not yield speedily to

90 MASSAGE.

treatment. He recommended friction for " contrac-
tions of the joints, unattended with inflammatory
symptoms proceeding from colds, damp beds, or
rheumatism." He thinks too that it is useful "where
there is too great a secretion of the synovial fluid of
the joints, particularly in the knee-joints." Good
results have in his hands followed this treatment
"in incipient cases of white swelling." He by
no means confines himself to surgical cases, but
devotes much attention to children " who are weakly
or rickety, or in whom the circulation is languid."
It is recorded of Mr. Grosvenor that he always in-
sisted that his patients should "work with him.*'
"Your own constant exertions are necessary as well
as mine " he would say. He occupied a good deal
of his leisure time in walking with his lame patients,
in order that he might judge for himself what pro-
gress they were making. The book is interesting
and well worth reading.

CHAPTER XIII.

Massage in Poisoning.

In the fourth edition of " What to do in Cases of
Poisoning," I pointed out that Massage is of un-
doubted value in the treatment of many cases of
acute and chronic poisoning. In acute chloral poi-
soning it serves to maintain the temperature, whilst
in chronic lead poisoning it does as much as any-
thing to restore the condition of the affected muscles.
To be of the slightest value it must be performed by
a properly trained and qualified person. Amateur
" mashing " is worse than useless.

In a review of the first edition of this book which
appeared in the Praciilwner, exception was taken to
the foregoing paragraph. The reviewer says : —

"Dr. Murrell's recommendation of Massage in
poisoning involves we fear a practical paradox.
After stating that ' Massage is of undoubted value in
the treatment of many cases of acute and chronic
poisoning,' including 'acute chloral poisoning,'
where it seems to maintain the temperature, he

92

MASSAGE.

gravely adds, 'To be of the slightest value it must
be performed by a properly trained and qualified
person ' ! "

What parodox, practical or otherwise, is involved
in this simple statement, I confess I do not see. The
writer was probably not aware that we technically
recognise two forms of chloral poisonings, the chronic
and the acute. When chloral is taken habitually as
a sedative or to induce sleep, as many young ladies
take it night after night during the season, and it
produces injurious effects, we speak of it as chronic
chloral poisoning or "chloral tippling," When,
however, a man takes a large dose, either by acci-
dent or with suicidal intent, and is in danger of losing
his life, we call it an acute case. These acute cases
do not of necessity terminate rapidly, and the patient
may remain in a critical condition for twelve or
fifteen hours or even for two or three days. These
accidents occur as a rule in large towns like London,
and not in remote country districts, so that there is
no difficulty* in obtaining skilled assistance. Of
course one does not wait to train one's operator until
someone is poisoned. You make the baby linen be-
fore the woman is in labour.

CHAPTER XIV.
Massage in Uterine Complaints.

For many forms of menstrual disturbance massage
may be safely prescribed. I recently saw a young-
lady, aged 19, who suffered intensely at each monthly
period, the pain being so severe, that hypodermic
injections of morphine had to be resorted to. Mas-
sage of the abdomen and pelvis was prescribed, and
from that time there was no return of the trouble,
Cazeaux has reported several similar cases in detail.
Dr. Beresford Ryley advocates the employment of
massage in fibroid degeneration of the uterus with
long standing monorrhagia.

In a well-known group of symptoms from which
women frequently suffer, massage is essentially use-
ful. I recently saw a lady, aged 45, or thereabouts^
a professional singer, who was labouring under the
impression that she was going mad. *She was so
nervous that she was quite unable to accept an en-
gagement, although she had been constantly before

94

MASSAGE.

the public, and had hardly missed a nighl for twenty
years. She told me that she felt she was not to be
trusted, and that, if left alone, she would do herself
or her children an injury. She was afraid to go near
an open window, so great was the temptation to
throw herself out; and she even begged that the
knives might be removed from the table at dinner.
These symptoms were greatly intensified after each
monthly period, and she insisted that she was suffer-
ing from cancer, or some organic disease of the
stomach or womb. She was restless at night, and
would often get up in the early morning and walk for
hours, until thoroughly exhausted. She was given
full doses of the bromides — a drachm, or more, four
times a day — but with only temporary benefit. Mas-
sage was then tried ; and it seemed, to use her own
expression, to soothe her, and calm her, and make
her forget her troubles. The case was a prolonged
one, but now, at the expiration of three months, she
is much better, and will soon be able to resume her
professional duties.

In another common and well marked group of
symptoms, massagels of essential benefit. I recently

FIDGETS. 9S

r

saw a lady, aged 38, who had been reduced in cir-
cumstances, in consequence of the death of her hus-
band, who after a long and painful illness, had died
of diabetes. She complained of restlessness and
pain at night, the pain affecting chiefly the legs and
back. She said it was almost indescribable, but was
like electric shocks. She described it as "nervous
restlessness," and found it was always intensified by
worry and anxiety, and was usually worse after a
hard day's work. It was worse than pain, and was
often so severe that she had to get out of bed and
walk about the room the greater part of the night.
Three weeks general massage cured her entirely. I
have met with several similar cases, and the condition
seems to be allied to what is often called "fidgets.**
I have seen it in quite young women, chiefly in those
who are nervous and excitable, and suffer from neu-
ralgia. I do not know of any drug that takes in this
group of symptoms, and have no doubt that massage
is the best remedy, A lady who suffered from it told
me that she was often impelled to get up in the
middle of the night and walk round the square in
scanty attire.

96 MASSAGE".

Massage is a most valuable therapeutic agent, and
will yield good results in many complaints, other
than those I have roughly indicated.

ERRATUM.

There is a misprint on page 15, "Jacobi" should be " Jacoby,"
the quotation being from an admirable paper by Dr. George W.
Jacoby of New York which recently appeared in the journal of
Nervous and Mental Diseases. The article is of interest from the
account which it gives of massage of the neck. The method ad-
vocated was originally introduced by Gerst of Wurzburg, who
found that by practising effleurage over the jugular veins he could
abstract blood from the brain and meninges. He noticed that
patients, who before the seance complained of a feeling of pressure
and congestion in the head with flushed face and dilated pupils,,
were at once relieved by this simple procedure.

^^H ^^H

■ abdomen, Maaaageof the, 54

Cheadle, Dr., on Massage, 57

■ Advertisers, 30

Children, Massage for, 22,30

■ Amber oil, 65

Children, paralysis of, 41, 42.

43.44

^ tial, 12

Chinese manuscript. 4

Anatriptic art, 83

Coloral tippling, 92

Anemia, 84

Circulation, improved by MaE-

Appetite improved hy Massage,

aage. 16. 34, 36

32

Cleobury. William, 89

Aptitude for work, 81

Club-foot, 43

Ascending paralysis. 52

Contractility of muacle im-

Attributes of a good Maneust,

proved by Massage, 35

22,23

Conatipation and obesity. 54

Averbcch on constipation, 53

Convalescence. 84

BACKACHE, 68

Bacon, Lord, on friction, 39

Balfour, Dr. William, 61

Constipation, Massage for, 33

Bandin, travels in New Holland, 5

Contracted joints, Sg

Beefand iron wine, 46

Corpulence, 58, 6o

Bei^ham on apraina, 88

Beuster of Berlin, 13, 17

Beveridge, Mr., 39

DALLY on difficult digestion.

Billroth, Prof., on Massage, j, 11

58

Bodily vigour improved, 33

Dancer's cramp, 46

Bone-setters, 86

Daiueuses, cramp of, 46

Borax for the hands, 20

DeRnition of Massage, 2

Boyle, the Hon. Robert, 6

Demarquay on Massage, 88

Brewts, irritable, 77

British Medical journal, caae

Derivation of Massage. 2

Details not same in all cases, 27

in, 80

Diagnosis, Massage an aid to.

Brunton, Lauder, on nutrition.

IS

59

Digestion, M. Dally on, 58

Burning pam in spme, 72

Diuretic action, 81

Busch on oinlmenta, 19

Duration of jsaiwe, as

Dujardin-Beaumetz, Prof., of

C^LIUS Aurelianus, 5

Paria, 85

California, Nordhoff on, 7

Dutch, thesis in, on Massage, 8

Cazeaux on uterine diseases, 93

Dry rubbing preferred, 19, ao

CeUua 00 friction, 4, 5,

Duplay on Massage, 88

Cerebral hieraorrhage, 47

„„ ^

I

1

EDUCATION neceaaary for a

Elusions removed by Massage,

37
Electrical currents developed by

MsBGage, 36
Elcclricat treatment, 31
Electricity and Massage, zi
Emerson, Dr., on lomi-lomi, 7
Erb, Professor, 43, 71
Esmarch on Massage, 11
Essential paralysis, 44
Eatradere on Massage, g
Exercise, want of, 54
Extract of malt, 46

FACIAL paralysis, 46

Fatigue relieved by Massage, 3

Fidgets, 95

Fola. 6

Fractitrea, union of, 34

France, Maasage in, 8

Friction, 4, tj

GALEN, 5

Gazelle des Hopilaux, 6

Gopadze .lljba, on Massage, g,

30.37
Gout, 6a
Graham, Douglas, an Massage,

10,36,46, 87
Great racks, Mr. Valentine, 6
Greeks, use of Massage by, 3
GrifGn, Dr. and Mr., of Limerick,

•/5. 78, 79
Grosvenor, John, the late, 89
" .ving pains, 69

HACHURES. 18

HactungcH of Neumann, 18
the Emperor. 3

Hiemorrhages removed by Mas-
sage, 37
ds, (he care of the, ig, 20

Hands, preparations for the, 20

Head, electricity to the, 45

Health and long life, 40

Hemiplegia. 47

Henry, Admiral, o! Rolvendon,
64

Hippocrates, on rubbing, 4, 5

History of Masaage, 1

Homer on Massage, 3

HuiU Volalili dt Saccin, 65

Hypochondriasis, static electri-
city ir -

INDIAN INK, injection of, into

joints, 33
Infantile paralysis, 34, 35, 41
Injury produced by bad Ma«-
,83

Intelligen

1, 82

Ltlal for a

JOHNSON, Dr. George, on

backache, 68
Johnaon, Dr. Walter, 38, 39, 83
Joint affections treated by Mas-

KNEADING, 10

Kong fau, 4

LABBE on Massage, 88
Ladies trained as Masieuies, 22
Laisn^, tapotements de, 18
Lameness, 89
Lanccl on Massage, lo, 25

Landy's disease, 52
Langenbeck, adhesion of, 11

Lead poisoning, 91

Lecture in LuKCtl, 44

Lee Benjamin on Massage, 1

16, 23
Legs, pains in the, 69

Liebreich, Prof., on lanoline, ig
Limbs, shrunken, 43
LinamenCs, use of, 19
Literature of Massage, 3, 4, 5, 6
Locomotor ataxy, 51
Lomi-lomi, 7, 8

Loose JQIDtE, 43

Lumbago, 66, 67

Lymph, circulation of, 33, 37

MACLEAN, Mr., the late, 47
Martin, M., on lumbago, 66
Masaage not medical rubbing, 11
Massage i frictions, 17
" Massage and Morals," 23
Massage par ondtilations, 66
Massevr, the, 22
Masseuse, the, 2t, 23, 30
Masseuse, the characteristics of

a good, 23
Max Schuller, Prof., 85
Maxwell, Dr. Theodore, 10
Medical rubbers, 48
Medical rubbing, 10
Medical rubbing not Massage,

Medical rubbing, the dangers of,

S3
Medical students, experiments

on, 31
Menstrual periods, 25
Menstrual troubles, 93
Mental activity improved, 33
Mercury, green iodide of, 51
Methods of performing Massage,

14
Mezger, Dr., 8, 9
Mili, 6

Mitchell, Dr. Weir, 51, 74
Mills, Dr. Charles K., 37
Morning best time for Massage,

Motor points. 35
Movable kidney, 56
Malgaradocks or medical char-

Myelitis, 48
NAILS cut short, 19

a. 93

Neumann, the hachures of, 18
Neumann, hackungen of, 18
Neuralgia. 85
Neurasthenia, 71, 72
Neurasthenia spinalis, 71
Nitrogenous transformation in-

NumbnesB of the hands, 72

OBSCURE pains, 69
Oil of amber, 65
Oils, use of, ig, 65
Ointments, use of, 19
Oleum succini, 6;
Operator, the training of the, 3
Oregon, Nordhoff on, 7
Organic diseases. Massage ii

PARALYSIS, Infantile, lecture '

on treatment of, 44
Paralysis, Massage in, 4r, 4G

Physical strength not requisite

for a MasseusCt 23
Fhysiabgical action of Massage,

Poisoning, Massage in, gr
Progressive paralysis, 5a
Pulse, influence on, 3a

I

RABBITS, experiments on, 33
Raddiffe, Dr., 78
Refinement essential in a Mas-
seuse, aa, 43
Reibmayr on Massage, g, z6,

36,86
'' Resolvent pilla,'' 51
Reepirations, influence on, 32
Rest after Massage not esaen-

Rheumatism, Maaaage for, 61
Rickets, go

Roche's embrocation, 65
Roman toilet paste, 20
Romans, use of Massage by, 3
Roux, Dr., of Lausanne, 38
Ruaz, Madame Rey De La, 62

SANDWICH islands, Massiige

in the, 7
Sarchuna of the Persians, 4
Schreiber on chronic paralysis,

Schiiller, Prof. Max, of Berlin, 85

Sciatica, 85

Seance, duration of. 35, 26, 27

S£e on Massage, SS

Shampooing, 3, 10, 12

Short sittings. 26

Sbpolian sky's experiments. 57

Shrunken limbs, 43

Sinclair, Sir John, 64

Sleeplessness, S2

Sleep, Massage predisposing to

S2

Spinal curvature, 43
Spinal irritation, 75,79
Spinal nervous weakness, 71
Spinal tenderness, 72, 76
Spine, tenderness and irritability

of, 76
Spinal weakness, 71. 72
Sponge electrode, 45
Sprains, Massage for, BG, 87, 8S
Starlings of muscles, 47

Static electricity, 21
Stimulator of energy, 59
Sunday rest, 27

Swan 's feat hers for fn^ of fintHf, 18
Sympathetic temperament, ad-
vantage of, 23
Synovitis with effusion, 88
Syphilis, 84

TAPOTEMENT, 18

Teale, Thomas Pridgin, 75, 77

Temperature, influence on, 33,

34
Temple, Sir William, 40
Tender spots in lumbago, 67
Terms employed, 27
Terms, origin of, 14
Time required to learn Massage,

Toop-toogi, 6.
Training of the Masseuse, 24
Treatment in different cases, 2
Treves, Mr. on Massage, 56

Von Moaengeil, Prof., i, 9, 17,

2I1 30.33.34.35. 86
Vraeh, the, 46

WASTING Palsy. 46

Weights lifted after Massage, 36'

Weir Mitchell, Dr., 34

Weir Mitchell treatment, 13, 74

White swelling, go

Writer's cramp, 46

ZANDER system, 13
Zabludovshi on Massage, 9, 30,
33.35.36,46

, October, 1386.

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A-

New and Recent Works publlBhed by

EDGAR M. CROOKSHANK, M.B. LOND., F.R.M.8.

Ddnanslrator d[ PhyEiology, King's CallESC Londan.

N INTRODUCTION TO PRACTICAL BACTERIO-

LOGY, based upon the methods of Koch. With thirty
"■'" ' -■■. - g coloured and

General Ci

Pakt I. Apparatus, Material, and Reagents employed in a Bac-
teriological Laboratory — MicroBCopical Examination of Bacteria,
in Liquids, Cultivationson Solid Media, and Tissues— Preparation
and Staining otTissue Sections— Preparation of Nutrient Media
and Methods of Cultivation— Experiments upon the Living Ani-
mal — Examination of Animals Experimented upon, and Methods
of Isolating Micro- Organisms.

Part II. Hietory of our knowledge of BacteriiL. Classification
and Description of Bacteria.

Appendix. — Yeast and Moulds. Examination of Air, Soil,
Water. Literature.

Bv the Same Author.
PHOTOGRAPHS OF BACTERIA: An Investigation into
■'■ the value of Photography for delineating preparations of

Bacteria. Illustrated with 50 Permanent Autotypes and numer-
ous Wood Engravings, royal 8vo. [/« Preparation.

. and to the Lock Hoe;

ARTHUR COOPER, LR.C.P., M.R.C.S.

and of their Treatment. Fourth Edition, poet SvD, as. 6d.

H. £. Lewis, 136 Gower Street, London.
CHARLES CREIGHTON, M.D.

TIC GLANDS. Sec

DOVINE TUBERCULOSIS IN MAN: An Account of
'■' the Pathology of Suspected Cases. With Chromn-litho-
graphs and other Illustrations, Svo, Ss. 6d.

W, H. 0. 8ANKEY, M.D. LOND., F.R.C.P.

Lale Lecturer on Mental Diseases, University College, and Schooi o
HanwellAEyl'i^"^resrdenlof[S^;^o°Ps"holD^c"sgci'etyr&
I ECTURES ON MENTAL DISEASE. Second Edi-

tion, with coloured plates, Svo, i

lior Surgeon Ig Ihe Hospital far Diseases of Ihe Thtoal.

GIDDINESS, AND NOISES IN
THE HEAD.

Part 1— POST-NASAL CATARRH, AND DISEASES
OF THE NOSE CAUSING DEAFNESS. With Illus-
trations, crown Svo, 6s. 6d.
Part II.— ON DEAFNESS, GIDDINESS, AND NOISES
IN THE HEAD. Third Edition, with Illustrations, crown
Svo. [_In preparation.

E. CRESSWELL BABER, M.B. LOND.

to the Brighton and Sussex Throat and Ear Disj

New and Becent Works published b7

FANCOURT BARNES, H.D., M.R.C.P.

COGNATE SCIENCES. Square i2mo, Roxburgh binding, gs

ROBERTS BARTHOLOW, M,A., M.D., LLD,

A TREATISE ON THE PRACTICE OF MEDICINE
FOR THE USE OF STUDENTS AND PRACTI-
TIONERS. With IlluBtrations, jth Edition, large 8vo, 218.

[yiist published.

K PRACTICAL TREATISE ON MATERIA MEDICA
" AND THERAPEUTICS. Fifth Edition, ReviKcd and
Enlarged, 8vo, iSs. [Now ready.

GEO. M. BEARD, A.M., M.D.

A PRACTICAL TREATISE ON THE MEDICAL
■"■ AND SURGICAL USES OF ELECTRICITY; includ-
ing Localized and General Faradiialion ; Localized and Central
Galvanization ; Electrolysis and Galvano -Cautery. Fourth Edit.
Wilh nearly 200 Illustrations, roy. Svo, 185.

TEM. With Illuatrationa, 8vo, 8s. 6d.

and DLoeaaes of Women and Children in Ihe Faci
ol Medicine pf Paris.

QBSTETRICS: THE THEORY AND PRACTICE;
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stetrical Operations, &c. Seventh Edition, edited and revised by
RonEHT j. Hess, M.D., with twelve full-page plates, five being
coloured, and 163 wood-engravings, 1081 pages, royal 8vo, 35a.

W. H. CORFIELD, M.A., M.D. OXON.

ir ol Hreiene and Public Health in University College, London

. S.. Lewis, 136 Gower Street, London.

HENEAQE BIBBE8, M.D.

er on Physiolngy and on Normal and Morbid Hislology in the Medic!

J. B. GRESSWELL, M.R.C.V.S.

Provincial Veterinary Surfieon to Ihc Rdynl Agricullura] Society.
VETERINARY PHARMACOLOGY AND THERA-

^ PEUTICS. Fcap. 8vo, 5s.

WILLIAM A. HAMMOND, M.D.

al and Nervous Diseiaes In the Medical Departr
University of the City of New Vorli.

large Svo, 13s.
A TREATISE ON INSANITY. Large 8vo, 255.

J, WICKHAM LEGG, F.R.C.P.

AN THE BILE, JAUNDICE, AND BILIOUS DIS-

^ EASES. With Illustrations in chromo-lithography, 719
pages, roy. 8vo, 258.

A GUIDE TO THE EXAMINATION OF THE

" URINE; intended chiefly for Clinical Clerka and Slu-
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tnitioDB, reap. Svo, as Gd,

10 Hew and fteoeut Works published by

LEWIS'S PRACTICAL SERIES.
Under this title Mr. Lewis is publishing a cnmplele s
of Monographs embracing the various branches of Medicine
Surgery.

paralion. The works are inlendea to be gf a thoroughly Practical nalaro,
calculaled tD meet the Teqturemenis of the geneiol Pncliti oner, and to presmt

THE FOLLOWING ARE NOW READY.
HANDBOOK OF DISEASES OF THE EAR FOR THE

use OF STUDENTS AND PKACTlTtONERS. By URBAN
PKITCHARD, M.D. (Edin.), F.KC.S, (Eng.l, Professor of Aural
Surgery at King's College, Lonrlon ; Aural Satgeon to King's College
Hospital; Eeaior Surgeon 10 the Royal Ear Hospiul. With llluBtn-

A PRACTICAL TREATISE OH DISEASES OF THE KID-

NEYS AND URINARY DERANGEMENTS, By C. H. RALFE, M.A.,
M.D. Cantab., F.R.C.P. Lond., Assialaul Physician to the London Hoa-
pilal, late Senior Phytician to ilie Seamen's liospilal, Greenwich. With
flloslrations, crowo Bvo, .os. M,

DENTAL SURGERY FOR GENERAL PRACTITIONERS

AND STUDENTS OF MEDICINE. By ASHLEY W. BARRETT.
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Hoapital. Wilt Illustrationa, crown Bvo, 3B.

the RothI Orlhopied

FEVERS:

By ALEXANDER COLLIE, M.D. (AherdeccI, Member of the Royal
College of Physicians of London ; Medical Superi:ntendent of the Eaalero
Hospitals : Secretary of the Epidemiolugical Society fui Germany and
Russia. [In Ihi prai.

*,* PcDspeclua of the Serio, with Specimen pages, etc., post free on
application.

I EWIE

B. E, IiewiB, 136 Gower Street, London.
WILLIAM THOMPSON LUSK, A.M., M.D.

A. COWLEY MALLEY, B.A., M.B., B.CH. T.O.D.

pHOTO-MICROGRAPHY; mcludmg a deEcription of the
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with the best methods of mounting and preparing MiuToscopic
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PATRICK MAN80N, M.D., CM.

THE FILARIA SANGUINIS HOMINIS AND CER-
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INDIA. CHINA, AND WARM COUNTRIES. Illustrated
with Plates, Woodcuts, and Charts. Den.y 8vo, los. 6d.

WILLIAM MARTINDALE, F.C.8,

and DGmonitrstor of Maledi MeScl'lt University College.

W. WVNN WESTOOTT, M.B. LOND.

"THE EXTRA PHARMACOPCEIA with the additions
■^ introduced into the British Pharmacopceia 1885 ; and
Medical References, and a Therapeutic Index of Diseases and
Symptoms. Fourth Edition, revised, limp roan, med. 24mo, 7s.

WILLIAM MARTINDALE, F.C.S.
rOCA, COCAINE, AND ITS SALTS : their History,
^ Medical aod Economic Uses, and Medicinal Preparations.
Just puhlished, fcap. Svo, zs.

12 New and fi^cent Works published b;

OF THE EYE. With Map, post 3vo, 38.

A. STANFORD MORTON, M.B., F.R.C.S. ED.

Senior Aasistanl Surgean, Rcysl South LondoTi Ophthalmic HoEpLlal,
pEFRACTION OP THE EYE; Its DLagnoais, and

Correction of its Errors, with Chapter on Keratostapy.
Third Edition. Small 8vo, 2s. 6d.

WILLIAM MURRELL, H.D., F.R.C.P.

iBterli Mcdica nnd Therapeutics al Westminster Hoepi
■.T in Materia Medics and Therapeutics in the University

DR. FELIX VON NIEMEVER.

Lale Professor of Palhology and Tlrerapeutics ; Director of the Medical C

ATEXT-BOOK OF PRACTICAL MEDICINE, WITH
PARTICULAR REFERENCE TO PHYSIOLOGY AND
PATHOLOGICAL ANATOMY. Translated from the Eighth
Gennan Edition, by special permission of the Author, by G&ohug

Q. OLIVER, M.D., M.R.C.P.

a Clinical Guide to
le of Work. Third
Edition, considerably enlarged, fcap. 8vo, 39. 6i.

THE HARROGATE WATERS: Data Chemical and
*■ Therapeutical, with notes on the Climate of Harrogate.
Addressed to the Medical Profession. Crown Svo, with Map of
the Wells, 3s. 6d.

H. K. Lewis, 136 Qower Street, London.

SurGgoD lo Itii Eail

Q. V. POORE, M.D., F.R.C.P,

Professor of Medical JuriBptiidence, UnivErsity Coliege; Asslalanl Physidm
end Physician in cliarge of Iha Tliroat fiepartmcnt gf University
College HoBpilsl.
T ECTURES ON THE PHYSICAL EXAMINATION
■'-' OF THE MOUTH AND THROAT. Wilh an appendix
of Cases. 8vo, 3s. 6d.

CHARLES W. PURDY, M.D. (QUEEN'S UNIV.)

D. B. ST. JOHN ROOSA, M.A., M.D.

Frofeaaor of Diseases of the Eye and Ear in the University of the City at New

Yoik ; SuiKcon 10 Ihe Manhattan Eye and Ear Hospilal ; ConBulting

Surgeon to the Brooklyn Eye and Ear Kotpitsl. &c.. Sec.

A PRACTICAL TREATISE ON THE DISEASES OF
THE EAR, including the Anatomy of the Organ. Sixth
Edition, Illustrated by wood engravings and cbrorao-liihographs,
large 8vo, 25s.

ROBSOH ROOSE, M.D., F.R.C.P. EDIN.

GOUT, AND ITS RELATIONS TO DISEASES OP
THE LIVER AND KIDNEYS. Second Edition, crown
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14 STew and Recent WorkB published by

ALD^R SMITH, H.B. LOND,, F.R.C.8.

DINGWoRM : ITS DIAGNOSIS AND TREATMENT.

•^•^ Third Edition, rewritten and enlarged, with IlluslralionB,
fcap. 8vo, 5S. 6d.

FRANCIS W. SMITH, M.B., B.S.
'THK SALINE WATERS OF LEAMINGTON: Chemi-

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FREDERICK TREVES, F.R.C.S.

D. HACK TUKE, M.D., LLD., F.R.C.P.

A. DUNBAR WALKER, M.D., CM.

H. E. Lewis, 136 Gower StraGt, London,

PNTERIC FEVER: its Prevalence and Modifications;
'-' Etiology ; Pathology and Treatment ; as Jlliistrated by

Army Data at Home and Abroad. Demy Svo, 5s. 6d.

E. T. WILSON, B.M. OXON., F.R.C.P. LONO,

DAVID YOUNG, M.O., M.B., M.D.

Licentiate of Che Royal Collegeaf Plwaicians, Edioburgb; Licentiate □( the

ROME IN WINTER AND THE TUSCAN HILLS
IN SUMMER. A Conlribution to the Climate of Italy.
Small avo, 6b,

16 Periodical Works,

;PERIODIOAL WORKS PUBLISHED BY H. K. LEWIS.

TUB NEW SYDENHAU SOCIETY'S PUBLICATIONS.

scriplinn, One Guinen.
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THE NEW YORK MEDICAL JOURNAL. A Weekly Review of Medi-
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THE THERAPEUTIC GAZETTE. A Monthly Jo urnBl. devoled to the

Agents. Edited by Drs. H. C. WoMl'and R. M? Smith* Annuafsnb-

ISPOOL MEDICO-CHI SURGICAL JOURNAL, ineludine Iho Pro-
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Monthly' J ournBl, devoted lo tbe Di

Ihly Journal of Medicine sod Si:

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TRANSACTIONS OF THE COLLEGE OF PHYSICIANS OF PHILA.
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THE INDIAN MEDICAL JOURNAL. AJouroolof Medical and

%• Mk. Lewis is in constant comniiinicalion with (he leading
pabliehing firms in America and has transactions with them for
the sale of his publications in that country. Advantaged
arrangements are made in the tnlerests of Authors for the
publishing of their works in the United States.

Mr. Lewis's publications can be procured of any Bookseller ir
any part of the world.

CojnpMc CalahgMi of PuMicafiaia poit fra on applicalioB.

Printtd iy H. K. Liviii, Qo-aer Strul, London^ W.C.

■ > . - -1

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LANE MEDICAL LIBRARY

It MAR 6 2101

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M98 Massage as a mode of
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