The aborigines of America are not entire strangers to massage. It is found among the Redskins of North America, although it seems to play no essential part in their therapy.* Further, one hears of it among South American Indians, with whom massage seems to be somewhat general judging by the repeated stories of it found in tales of travel.+

In Australia massage is found among the low aborigines ++ of New Holland as well as among the more advanced races of the island groups § of the Pacific. Among the last-named people it is used both as general (chiefly as a "restorative measure") and local massage, and seems to have reached a definite technical development. The different manipulations are classified by the natives of Tonga much as with us.

For the medical worker massage is often more important than gymnastics. The latter is certainly more important in diseases of the respiratory and circulatory organs, in dystrophic conditions and in certain nervous diseases, and in connection with orthopaedics plays a more vital part than massage in the treatment of deformities and anomalies of position. But gymnastic treatment, especially in respiratory and circulatory diseases and the commonest dystrophy, obesity, is carried out in its fundamental and most effective form, as " terrain-cure," which only differs in a slight degree from the everyday movements of the human body, and which the patient, after a few short descriptions, can perform on his own account. Even the essentials of Frenkel's gymnastics for ataxic patients can be arranged with quite simple means, and can be carried out with a little help from the doctor or trained gymnast. In resisted and other gymnastic movements, which require something besides the patient's own body, apparatus can more easily replace the work of the gymnast than that of the masseur on the soft tissues.

* I have received definite reports of this from American doctors, and especially of the existence of tapotement with a therapeutic aim. Reports of it are also found in some of the better known descriptions of North Indian life. On the other hand, in Schoolcraft's great work " Indian Tribes " (Philadelphia, 1853 - 1860), in a somewhat detailed account of Indian therapy, there are no references to anything which could be considered massage. While on a visit among Shoshon Indians in Utah I heard from one of them that they are in the habit of using kneadings to cure " aching in the body."

+ Franz Keller Lenziger speaks of a cure (" Von Amazonas und Madeira," Stuttgart, 1874) which a medicine man (paye) of the Cazowa Indians living near Madeira River undertook for " painful rheumatism " and which (except for some mystic decorations) consisted of his giving the patient very strong massage, and began " ihn alsdann von Scheitel bis zur Zehe und zwar mit solcher Heftigkeit zu streichen und zu kneten dass dem Beschworer sowohl wie dem Patienten der Schweiss in Stromen vom Korper rann." It is worth noting that the Indian paye asserted that he transferred the patient's illness to his own body, exactly as a renowned Swede with little less authority professes to treat the highly civilised inhabitants of London. Dr. K. von den Steinen (" Durch Central-Brasilien," Leipzig, 1886, p. 260) tells of a medicine man among the Yuruna Indians who gave what must be considered " general massage " to a sick woman.

+ Baudin : " Voyage dans La Nouvelle Hollande," Paris, 1800.

§ One comes across many reports of massage in the Islands of the Pacific. The first sailors who visited Tahiti made its acquaintance there. It is mentioned by Wallis, who visited the Islands in 1767, and by Forster (" Cook's Second Journey "). Dr. Emerson speaks of it (in Beard's " Neurasthenia ") in the Sandwich Islands, and lastly we find in the interesting article in the Gazette des Hopitaux (of 1839) that in the Tonga Islands manipulations are divided into " mili " (effleurage and friction), " fota " (petrissage) and " toogi-toogi " (tapotement). It is a pity that the French did not learn from the kindly inhabitants of Tonga their classification of manipulations; it is distinctly more rational than their own, at any rate as found in Estradere's book.

Massage, on the contrary, can only in exceptional cases be performed by the patient himself, and is infinitely more important than gymnastics in the commonest cases of illness. The different muscle infiltrations alone, rheumatic, traumatic and others, and chronic constipation form much the greatest number of all the cases suitable for treatment by manual or "medico-mechanical" gymnastics, and in these, in spite of the gymnast's misrepresentations and assertions, any other kind of gymnastics than ordinary everyday bodily movements is quite unnecessary. Even in the mechanical treatment of joint affections, in which certainly passive movements play a definite part, massage is much more important than gymnastics. It is no exaggeration to say that among those whose occupation is massage and gymnastics, gymnastics does not represent 5 per cent. of their work. It is also no exaggeration to say that every middle-aged or elderly person has at some time been in need of massage, and that a great many people need it for long periods of their lives.

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An enormous need for physical therapeutic work is thus making itself felt all over the world, and will be felt the more as more knowledge of the value of massage reaches the general public. At the same time in all civilised countries a numerous class of medically untrained workers has arisen who earn their living by massage and to a less extent by gymnastics. The existence of such a class of workers is an absolute necessity, since the general need for the treatment in question is much greater than could be fulfilled by doctors. The busy doctor often refrains from mechanical work, for which he not seldom lacks the necessary physical strength and inclination, and which seems to him monotonous and tiresome, accustomed as he is to more purely intellectual occupation. In almost every case it can without the slightest danger be carried out by workers whose training is less expensive, and whose services are therefore cheaper. Most doctors who employ massage and medical gymnastics in their practices know from experience that they can often hand over such treatment after a short period of supervision to some untrained but intelligent and handy attendant.