In describing the physiological and general therapeutic effects of massage it is convenient to consider each class of manipulation to some extent separately.

Effleurage accelerates the circulation in the blood vessels and lymphatics in the area acted upon and in its neighbourhood. Centripetal stroking as it goes over the skin must compress the underlying veins and empty their contents centrally (Mosengeil). The fact that this stroking is performed in the opposite direction to the blood flow in the arteries does not in a perceptible degree counteract this effect, owing to their more protected situation and more resistant walls. On the contrary, the arterial circulation is hastened by the quicker outflow from the veins and the diminished pressure within them. Immediately after the veins have been emptied this pressure becomes negative owing to the elasticity of their walls, blood is sucked in (certainly with no great force) from the adjoining tributary veins, and thus massage not only helps the circulation in the area worked upon, but also in its immediate periphery. In other words, effleurage acts, as Mosengeil aptly remarked, both as a pressure and as a suction pump.

So much for the important effect of effleurage on the circulation in and near its own area. I will return later in this chapter, in connection with the effects of general massage, to the subject of the influence of effleurage on blood formation, blood flow, distribution of blood in the body, blood pressure and pulse - an influence partly due to vaso-motor reflexes.

That the stream in the lymph vessels is also accelerated by stroking (and other manipulations) has been proved experimentally in Ludwig's laboratory, and especially demonstrated by Lassar (1877), and more recently by Buchheim in 1892. In this all manipulations which exert pressure on the tissues have an effect (although in a less degree than centripetal strokings), since the lymphatics as well as the veins are provided with valves which only open centripetally.

I have already indicated that there are different forms of effleurage, corresponding with its different aims. Sometimes, as in general massage and in some other cases, it aims at hastening the circulation in a whole extremity; the strokings are then given with very moderate strength over the superficial veins in their whole length. One often wants to help the circulation within a smaller area, e.g., over the ankle in a recent sprain, and then one gives light stroking only over the ankle and the parts immediately adjoining it peripherally and centrally. Again, in other cases effleurage aims at sending the blood and lymph on from the muscles, and is then given more strongly.

The power of effleurage to help the circulation locally is extremely important, and renders it of great service therapeutically. Amongst other things it counteracts inflammation in its earlier stages, and is thus in certain cases an excellent antiphlogistic.

Inflammation begins by a dilatation of the small blood vessels (affecting arteries, capillaries, and veins), a slowing of the blood stream, on which follows crowding of the white corpuscles against the vessel walls, diapedesis or the wandering out of these, and in more severe cases also of the red corpuscles, as well as of plasma from the vessels into the tissues and the consequent increase of cells (and plasma) in the latter. By accelerating the circulation as above described, effleurage prevents stasis and the accumulation of white cells against the walls of the vessels and their wandering out; and in the same way conduces to the carrying off, in the lymphatics, of the cells and lymph already in the tissues. The effect of effleurage in this respect is often palpable in the most literal sense. For instance, in a case of ordinary sprain of the ankle, one often sees a little effleurage produce a visible retrogression of the inflammatory symptoms, the redness, swelling, heat, and pain diminishing rapidly, and the power of movement returning. In this case, as always when one has an antiphlogistic aim, the strokings are performed quite gently, so that they produce as little mechanical irritation as possible.

The power of effleurage to promote the circulation and act as an antiphlogistic peripheally from the area over which it is used has led to its use as a preparatory form of massage. For instance, one often begins the massage seance, especially in acute cases, with effleurage centrally from the affected area, in order to diminish the inflammatory tension in it.

The secretory activity of the skin is increased by the more rapid circulation and by direct stimulation of the sweat and sebaceous glands, and the exchange of gases by the skin, which in man is trifling, is also somewhat increased (carbonic acid is given to the air and oxygen is taken from it). The temperature of the skin (which is normally about 32° C.) s raised most by strong effleurage and vibrations (see Mosengeil, Berne, Eccles, Rosenthal) on an average about 2° C. for ten minutes' eflleurage, while a rise of nearly 5° C. can be produced by five minutes' vibration. According to Rosenthal this is produced chiefly by friction, and only to a small extent by the more rapid circulation. During abdominal kneading the temperature falls oyer a large area, probably over the whole body, due to the congestion of the abdominal organs (Eccles, Rosenthal).