Massage * means a manipulation or handling of the soft tissues by movable pressure in the form of stroking, rubbing, pinching, kneading or beating performed with a therapeutic aim. This is generally applied by hand, but can, of course, also be given by means of instruments and apparatus of different kinds.

To limit accurately the term "massage" it is necessary in the first place to distinguish it from medical gymnastics, which is treatment by means of exercise of the organs of the motor apparatus. At a first glance at these definitions confusion of ideas seems unlikely. They have for long been denoted by different terms, and their existence has been distinguished both by the general public and by doctors. But the two methods of treatment have several points in common; they must often be used together therapeutically and are often performed by the same craftsman. Strangely enough, the idea had never to my knowledge been definitely and clearly defined in literature before I formulated the two definitions, and pointed out the difference in my "Manual of Massage" in 1888. In a concrete case the differences stand out so sharply that one can scarcely understand that any. one, especially any one practising massage and gymnastics, should have been unable to grasp them. One can, for example, massage an infiltration or a haematoma, since they are in a sense soft tissues, but it is impossible to apply gymnastics to them, since they are not organs and certainly not organs of movement. A muscle, on the other hand, can be treated both by gymnastics and massage : in the latter case it is treated not as an organ, but simply as a tissue (e.g., in getting rid of an infiltration by friction); in the former case it is used as an organ, and as such must act by shortening and lengthening, or by performing static work to maintain a position. The fact that massage by getting rid of the infiltration raises the muscle's functional power, and in this has the same aim and to some extent the same effects as gymnastics, as well as the fact that gymnastics used along with massage helps to get rid of the infiltration, in no way contradicts the legitimate distinction between these two methods of treatment, which coincide neither in their character nor in their effects. In contrast to gymnastics, massage is not treatment by exercise. On the other hand, passive as well as active gymnastic movements constitute treatment by exercise. Opinions may differ as to considering passive movements exercise-treatment for parts of the motor apparatus other than the joints. Passive movements, however, are the part of gymnastics most closely allied to massage. Positions, too, are exercise of the motor apparatus, especially for muscles and nerves, and obviously belong to gymnastics and not to massage.

* The French word massage may be derived either from the Arabic mass (to press), or from the Greek (to rub).

We must also distinguish from massage some manipulations which even gymnasts cannot say belong to gymnastics, but which are sometimes assigned to massage. Static pressure, whether it can be reckoned in orthopaedics or not, can under no circumstances be included in that division of physical therapy which is called massage. Similarly one must exclude from massage those manipulations which are performed in order to replace an organ or part of an organ from an abnormal position, e.g., taxis in case of hernia, manipulations through the abdominal wall to release an invagination or volvulus, replacement of the uterus, etc. Some obstetric manipulations I also consider outside the province of massage, Kristell's method of expression of the foetus, Crede's method of detachment of the placenta. lor my own part neither do I regard as massage the strokings by which in a skin wound one can get rid of the air in traumatic emphysema. Lastly, I also exclude from massage the method (in more than one sense heroic) employed in England by Teale, Sir William Fergusson and others, of causing detachment of parts of the contents of an aneurysmal sac by kneading, with consequent embolism of the peripheral arteries, leading to complete consolidation of the aneurysm. Lastly, we cannot consider as massage manipulations for the introduction of medication, e.g., rubbing which is performed for the inunction of mercury.

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The technique of massage is peculiarly important, since its effect depends on the method in which it is performed. But massage as an art is easy, requiring less practice and skill than many other of the mechanical tasks in which every one of us must have a certain skill, e.g., the use of the laryngoscope or the catheter, the common typical operations, etc. For those who from the standpoint of anatomy, physiology, and pathology know what is present in individual cases, the different manipulations come as it were of themselves. In this there is the greatest difference between the scientifically trained and the uneducated masseur. The former has during his years of medical study travelled over most of the ground which leads to becoming a good masseur; for the rest he only requires comparatively short study, normal upper extremities of average strength, hands neither too thin nor too small, and some aptitude for mechanical work. Further, it is a great advantage to watch or help a skilled masseur for some time. One thus acquires the technique more easily and surely than in any other way, and, besides, gains more quickly knowledge which belongs especially to the masseur and can only be slowly obtained from one's own experience. I would emphasise, on the other hand, that it is never worth while to follow slavishly a definite example in technique, but every one must work out his own method, which soon becomes as individual as his handwriting. It is obvious that manipulations which have quite the same effect on the patient may be performed in many different ways by the masseur. A good masseur thinks less of the way in which he moves his hands at his work than of the tissues he is working upon, and the quality of his massage depends to a very great extent on his knowledge of their condition.