The different forms of sensibility in the skin are affected by all manipulations, but especially by effleurage. In this, as in all other directions, the Germans have been active, and their descriptions are often so minute that it seems advisable to refer to them more in detail, so long as the results are uncertain. I think it is not too much to say that in regard to sense of pain, pressure, tactile sense, sense of temperature, and sense of localisation, sensibility is increased by effleurage, if light and not too long continued, perhaps by gentle stimulation of the nerves, perhaps also by the increased circulation. Schmotin, of Berne, found that hyperemia increased sensibility, anaemia lowered it. Long and strong massage undoubtedly lowers sensibility. The fact that Rosenthal always found with the aesthesiometer that the sense of localisation was lowered might well be due to too strong stimulation. I would refer those who wish to investigate further this point, which is of little practical importance, to Rosenthal's work on massage in 1910.

Owing to its power of helping the circulation, effleurage raises the state of nutrition of the tissues in and near the area worked upon by the supply in the blood of plastic material as well as of material which can be burnt and of oxygen with which to burn it. Effleurage contributes, therefore, to counteract local atrophic influences; this, of course, only in a marked degree when it is used long and frequently. It has for the same reason a great power, when anatomical conditions are suitable, of influencing favourably the healing process, which takes place more quickly and firmly with its help. Effleurage is therefore of use in many cases of injury, as well as in some cases of defective healing power due to defective circulation or bad condition of nutrition from any cause (e.g., in ulcer of the leg and in pseudarthrosis after fracture). Lastly, effleurage for the same reason has the power in certain cases, e.g., in frostbite, of limiting or preventing a threatening mortification or gangrene.

Further, on the power of effleurage to aid the circulation depends yet another of its properties, which, though less important, has been known from time immemorial, and long before the explanation of it was guessed at, it removes the substances causing fatigue and has a restorative effect on the respective groups of muscles. To sum up what we know at present of fatigue, although we have still much to learn, it seems to arise in the muscles from two causes, partly from the fatigue products found as the result of metabolism arising during muscle work (of these products carbonic acid, lactic acid, and the acid phosphates have been specially mentioned), partly from the lack of oxidisable material and oxygen. Fatigue also affects the motor nerve cells, causing temporary retrogressive changes (see later on "Over-strain"). It has been shown beyond a doubt that effleurage by hastening the removal of fatigue products from the "exhausted" muscles, and by supplying other oxidisable material and oxygen to them, has a strongly restorative effect on the muscles' power of work.

The important results of Zabludowski's, Mosso's, Maggiora's, and Ruge's experiments in massage, especially on the restorative effects of effleurage, may be mentioned along with Ruge's conclusions.

Massage gives both to the rested and the fatigued muscle more strength and endurance and causes stronger reflexes. Three to five minutes' massage has often a greater effect on fatigued muscles than twenty minutes' rest, and produces three to seven times greater manifestation of strength. To produce tetanus in a massaged muscle requires more frequent stimuli than to produce this form of cramp in a muscle not subjected to massage. (This fact was observed long ago by Kronecker and Stirling, and is conclusively proved.)

The restorative effect of massage is undoubtedly chiefly due to effleurage, and this manipulation is also of great value in improving the condition of atrophied muscle. In this respect, however, petrissage and tapotement are also very effective. To this subject I will refer later.

Zabludowski, who made many but lamentably uncertain observations on the physiological effects of massage, states that it lowers the irritability of muscle to electricity. This would appear to agree with the fact that a stronger stimulus is needed to produce tetanus in a muscle which has been massaged than in one not so treated.

Rosenthal has performed more careful experiments on this point, which he himself says are difficult to interpret. In this I heartily agree with him. However, it appears from these that massage, and especially effleurage, increases irritability, i.e., that after effleurage it requires a weaker stimulus to produce contractions (not tetanus; see above).

Mosso's and Maggiora's experiments with Mosso's ponometer and ergograph show that the restorative effect of massage within certain limits is proportional to its duration. With continual muscle work massage loses much of its restorative power, and nothing but rest is able to restore the strength of the muscle.

Lastly, effleurage as well as friction has the power of promoting absorption. Especially is this so with the products of serous inflammations, with fluids and their dissolved salts. Centripetal strokings hasten their removal by the lymph channels, perhaps also to some extent by the blood vessels. This property of effleurage is best demonstrated in the case of temporary oedema, of which the cause is not permanent, as in a sprain.