Definition

The term massage is probably derived from the Arab word mass, which signifies "to knead." The French word massage is equivalent to the term shampooing, and is applied to a process of rubbing, friction, and percussion of the body. Masseur is a male rubber, and masseuse a female rubber—that is, persons who make a business of massage.

Method

Massage by friction consists in rubbing, rolling under the fingers, and gently pinching the skin, and rubbing, tapping, kneading, and exercising the muscles and joints. Beginning at an extremity, the foot for example, the skin is taken up between the thumb and fingers and rolled and pressed; then the muscular masses are well grasped, rolled and pressed and kneaded, and rapidly tapped a quick succession of light blows; and then each articulation is in turn put through all of its motions. Even the muscles of the neck and the in-terossei may be subjected to the same treatment, with a little address and painstaking. In fact, no part of the body should be omitted except the face.

Massage by percussion alone consists in applying to various parts of the body a very rapid succession of short blows, not forcible enough to cause pain. The blows or taps may be made with a wooden spatula, with the fingers as arranged for percussion, or with the lateral margin of the hand fully extended.

Dr. Mortimer Granville has accomplished notable results in the treatment of neuralgia by rapid percussion over the trajectory of the nerves affected. He has devised a small instrument for this purpose, called percuteur. The curative results of this delicate percussion are attributed by Granville to a modification in the nerve-molecules.

Physiological Effects

The good effects of massage are popularly ascribed to electrical or supernatural agency. That electrical currents are induced by massage is true, but the curative effects are attributable to other agencies.

The effects of massage are: 1, local; 2, systemic.

1.  The masseur or rubber puts forth more or less muscular power, which at the points of contact or friction develops or is transformed into another mode of motion—heat. The action thus induced in the constituent tissues of the parts operated on, also serves to elevate the temperature. The vessels dilate and an increased quantity of blood enters them, and the motion of the blood-current is accelerated. The immediate effect of these changes is to promote the nutritive energy of the tissues subjected to friction. This result is seen in the improved color, warmth, and volume of the parts.

2.  A general rise of temperature, equal in most instances to one degree, has been observed to take place quite uniformly (Mitchell). The body increases in weight; all the organic functions are performed with more energy, and power is gained in every way. Massage in its several forms exercises peculiar effects on the nervous system, which should not be overlooked. When an inflamed part which can be manipulated, a joint for example, is rubbed with excessive gentleness, the sensibility, which was at first so acute that every touch gave pain, rapidly subsides, until, after an hour of friction, it may be handled with some roughness, without evoking painful sensations. When the local condition is that of pain merely, it is remarkable how the acutest suffering is alleviated by persistent friction of a gentle kind. Again, the state of spasm of a muscle is relieved and relaxation induced by persevering rubbing of the affected muscle. Results such as these are explicable only on the theory that the gentle titillation of the cutane-ous branches of the nerves (end-organs) has so far lowered their irritability that they cease to receive and transmit painful impressions. The rapid and long-continued transference to the centers of conscious impressions of the gentle titillation of the end-organs allays the irritability of the center, so that, if pain be transmitted, it excites no reaction, and therefore is not realized.

Therapy

Obstinate wakefulness and nocturnal restlessness may often be relieved by massage of pressure or percussion. Very gentle and long-continued friction of the extremities, especially of the lower extremities, is necessary, or corresponding tapping. Simple headache, even severe paroxysms of neuralgia, and the spasms of tic douloureux, are often most surprisingly relieved by, at first, exceedingly delicate frictions of the end-organs of the fifth—the skin of the face, forehead, neck, and the scalp—and subsequently stronger rubbing of the same parts. The same method has been effective in hemicrania, migraine, and spinal pain (Westerlund, Graham, Putnam, and others). Next to electricity, massage is the most useful remedy we possess in the treatment of infantile paralysis and other wasting palsies, after the acute symptoms have subsided. In hemiplegia and other forms of paralysis due to intra-cranial lesions, the indications for the treatment by massage are a lowered state of the nutrition of the paralyzed parts, cold- ness and blueness of the skin, wasting and contracted muscles, ulcerations, etc. In progressive muscular atrophy, much more may be accomplished by persistent frictions and kneadings of the wasting muscles. The treatment should be begun early, and the first indications—pain, fibrillary trembling, weakness, etc.—require the massage, without waiting for obvious wasting. Of course, any treatment is useless when the wasting has proceeded so far that no muscular elements remain.

Probably massage has accomplished more conspicuously good results in chronic joint affections, synovitis, contractions and deformities, and thickening from inflammatory deposits (Berghmann and Helle-day, Billroth, Mosengeil, and others). It is in this class of cases that healers, natural bone-setters, and other empirics sometimes achieve surprising success in the face of failures by regular surgeons. The author therefore especially urges on young surgeons and physicians the extraordinary utility of massage in this group of cases, and the great results which can be achieved by it, when sections of muscles, tendons, and cicatrices may appear to be imperatively demanded. In many cases patient and long-continued use of the method may be required.

In the hands of Weir Mitchell, massage has proved of surprising benefit in cases of the so-called spinal irritation, with its protean manifestations in the nervous, muscular, digestive, and sexual systems.

He uses it as a means of promoting the nutrition of the body generally, and of the muscular system particularly, while he maintains the body in a condition of nearly absolute rest.

As the results obtained have been surprisingly great, it were better to indicate with some particularity the kind of cases to which massage seems best adapted, and we can do no better than employ the graphic language of Mitchell: "It includes that large group of women, especially, said to have nervous exhaustion, or who are described as having spinal irritation, if that be the prominent symptom. To it I must add cases in which, besides wasting and anaemia, emotional manifestations predominate, and which are then called hysterical, whether or not they exhibit ovarian or uterine disorders. Nothing is more common in practice than to see a young woman who falls below the health-standard, loses color and plumpness, is tired all the time, by-and-by has a tender spine, and soon or late enacts the whole varied drama of hysteria. . . . But no matter how it comes about, the woman grows pale and thin, eats little, or, if she eats, does not profit by it. Everything wearies her—to sew, to write, to read, to walk—and by-and-by the sofa or the bed is her only comfort."

"In the treatment of these, massage plays an important part. Rest, electrical excitation and exercise of the muscular system, systematic feeding, are employed in conjunction with massage."

How far the results in the treatment by massage are affected by psychical impression has not been ascertained. The separation of these patients from home influences and associations, the confinement to bed, and the novel treatment, combine to affect the imagination profoundly, and to arouse hope and expectation to the highest point. In the class of cases described by Mitchell, these mental influences are powerful factors both in causing and curing morbid mental states. In illustration may be quoted Davy's celebrated case of paralysis cured by the mere application of the thermometer, and the remarkable recoveries which occurred under the religious ministrations and prayers of Prince Hohenlohe.

The extraordinary effects produced by the application of certain metals in hysterical subjects (Burq's Metallotherapy) may also be quoted in illustration. The results obtained by Charcot from metallotherapy have been even more remarkable than the cures effected by Mitchell with massage.

The Muscle-Beater

Massage has its ill effects, and is now, like the "rest-cure," much overdone. Besides the expense and inconveniences of the treatment, it is used injudiciously in cases of debility, and in convalescence, when the material produced is not in excess of the needs.

The muscle-beater may well be substituted for massage in many cases. It is composed of a wooden handle of size convenient to be grasped, sixteen to eighteen inches in length, and at the end are placed two elastic balls of vulcanized caoutchouc, having a diameter of two and a half to three inches. Each ball has a small hole in it to permit the entrance and exit of air. With this instrument blows of varying force and frequency can be made over the body as a whole, or to any part.