Gynaecological massage, so much used over the greater part of Europe, and partly even in North America, was originally introduced by the well-known Major Thure Brandt,+ who died in Stockholm towards the end of the nineteenth century. Between the years 1880 - 1890 it became so generally known and so well established that it cannot be ignored by any doctor.

In gynaecological massage, which forms only a part of the manual treatment of the diseases of the female genital organs, frictions are chiefly used, in the majority of cases to remove the remains of inflammatory processes, sometimes to work upon inflammation of a torpid nature or to remove extravasation of blood.

Since the treatment for these conditions is practically the same for all, one description will suffice, and any necessary remarks will be added later in connection with the disease treated. Brandt's treatment of prolapse of the uterus is described by itself.

During the treatment the patient lies with the head raised, and if possible also with the pelvis slightly raised, upon a plinth, with knees flexed and abducted and with the feet resting with the whole sole upon the plinth. This position (which resembles the lithotomy position) aims, among other things, at relaxing the abdominal wall. The masseuse sits on the patient's left side near the pelvis and slightly turned towards her, so that, passing the left hand under the thigh, she can insert the forefinger into the vagina right up to the posterior fornix, and thus raise and support the uterus and the adnexa, particularly those parts which are to be massaged,* pressing them towards the right hand, which is performing massage over the uterus through the abdominal wall. The left hand is kept open, the three middle fingers against the perineum, the thumb at a slight distance from the symphysis pubis, and the forefinger (apart from the slight movements necessary to raise one after another the various parts against the abdominal wall) immovable in the vagina against one of the side walls or the posterior wall, never against the front wall. With the three middle fingers of the right hand pressed close together she presses the relaxed abdominal wall over that part which is to be massaged and proceeds according to the usual rules, of which we shall only repeat here that small circular frictions must be begun nearest the centre (in regard to the circulation), always with moderate strength, similar to those described in abdominal kneading; for this the masseuse may support her left elbow against the plinth. The movement necessary for the manipulations performed by the right hand takes place chiefly in the shoulder joint. This is the only useful manipulation in those cases in which the object is exclusively to remove exudations or infiltrations.+

* This chapter, which is little different from what I wrote in my first book on Massage, has been inserted as a result of the limited experience I have gained by watching Brandt's massage and by treating several cases of exudation in the female pelvis which I have come across in my own practice.

+ Certain forms of gynaecological massage were used, particularly by French doctors, before Brandt; but the honour of being the first who, by his independent energetic work compelled medical men to adopt this treatment and to give it a place in therapeutics must be assigned to Brandt. His very reliable gynaecological work dates from 1861. His scanty theoretical training and his assured way of expressing his at times fanciful opinions, his writings, which are full of the faults common among gymnasts, as well as his piety, all combined to set the medical profession against him. Brandt, in his mechano-therapeutic turn of mind and his technical skill, had much talent; those who consider that genius consists in reaching a high pitch of excellence in one particular direction will attribute even genius to him. Early in the seventies Dr. Sven Skoldberg made a complete study of "Brandt's method." The treatment thus found its way to Scandinavian doctors and gynaecologists. Netzel and Sahlin in Stockholm, Asp in Helsingfors, Howitz and Orum in Copenhagen, all took up massage, also Nissen in Christiania. On the Continent Bunge was the first who wrote anything of value (1882). Gynaecologists of authority - Bandl, Hegar, Martin, Schroeder and others - recognised and introduced far and wide the use of gynaecological massage, while a considerable number of German doctors obtained from Brandt himself a knowledge of his method. In America Reeves Jackson did good work in the same subject. A definite step towards permanently fixing the position of this treatment was made in November, 1886, when Brandt, on the advice of Dr. Profanter, who had seen his work in Stockholm, went to Jena, and under the control of Professor Schultze himself treated many cases exclusively by his method, cases afterwards examined by Profanter. Just before 1890 Brandt's method was described by several doctors (Seyffart, van Braun-Fernwald, Kleen and others), and in a few years became generally known.

In the numerous cases in which, besides the products of inflammation, one has to deal with a displacement or limitation in the mobility of the uterus, massage ought always to be accompanied by other manipulations, which have for a long time been used in gynaecology to stretch contracted or shrunken parts, to which subject I shall return later.

* In this way gynaecological examination is very easily carried out, and those who are accustomed to this method often prefer it to the usual way. The masseuse's right hand (the one working) ought to be kept closely upon the skin under the chemise. But no part of the patient's body need be exposed, and Brandt's method is less disturbing to the patient than the usual bimanual examination. When there is a question of local applications, operative manipulation, etc., the usual position of the doctor sitting between the patient's legs is of course a necessity.

+ After inserting the left index finger into the vagina and placing the right hand as described above, Brandt begins the treatment by means of strokings performed over the lymphatic vessels of the part in order to quicken the circulation and empty the vessels. a difficult task in view of their unfavourable anatomical position.

Brandt makes a point of using only one finger, the index finger, in the vagina under all conditions. Many doctors who have interested themselves in this form of massage often insert both the index and middle fingers into the vagina. I myself found at the beginning that this was better and less of a strain, but accustomed myself later to the use of only one linger.

At the end of the treatment Brandt tells the patient to raise the lower part of the back and pelvis actively from the plinth, so that she rests only on the back of the neck, upper part of the back, and the feet, and then makes her perform in this position abduction and adduction of the thighs, with resistance at the knees, several times. The abduction is said to deplete the pelvis. (Resisted abduction he uses to strengthen the floor of the pelvis, so that this is specially suitable in prolapse, to which subject we shall return later.)

With younger persons and virgins the support is made by the index finger in the rectum instead of in the vagina.

The length of treatment in gynaecological cases varies very much according to the nature of the case; the average is fifteen minutes.

The patient must empty the bladder immediately before treatment; if the manipulations are to take place through the rectum, this also should be empty.

For contra-indications to massage of the uterus I refer the reader to pp. 65 - 68. 1 will only repeat here that pregnancy in every stage is to be considered a contra-indication, and similarly all acute, particularly all purulent inflammation (e.g., gonorrhoea). The effect of massage of the uterus upon the nervous system not infrequently prohibits its continued use. Further, of course it is obvious that massage should not be done during menstruation, though Brandt did so, partly on account of the discomfort to the patient and masseuse, partly because it certainly increases the haemorrhage. Finally, it may be necessary to remark that the uterus must only be massaged in cases where there are symptoms of pelvic trouble. The remains of inflammation, displacement, etc., which, as is often the case, do not produce special symptoms, should be left alone.

Gynaecological massage, with very few exceptions, is the work of the medical practitioner. It requires long experience and the highest proficiency in palpation and diagnosis, together with sufficient knowledge of the normal and pathological anatomy of the parts, and it requires to a greater extent than any other form of massage the recognition of all the possible dangers, which is only possible with wide medical experience.