Almost every conceivable variety of treatment has been advocated for this condition. It is impossible to compare results, as, apparently, whatever the treatment adopted, in some cases it will succeed rapidly and in others fail. The success of the above scheme when other attempts have been made and failed justifies its patient trial, as, even when it has appeared to be the last resource of the destitute, it has ultimately succeeded. Sometimes it too fails; but any other scheme of treatment by massage is almost certain to fail, and failure is usually accompanied by an aggravation of the condition. Unquestionably the most important factors in treatment are, first, to exercise to the full every muscle in the limb over which the patient retains control; and, second, to avoid placing any weight on the foot whatsoever, until muscular strength in the leg and in the intrinsic muscles of the foot has been restored.

True angina pectoris is usually associated with arteriosclerosis. The patient is therefore unable to take sufficient exercise, and general massage for the circulation will be of great service in aiding the elimination of waste products. Any form of local heart treatment is contra-indicated, and every care should be taken to avoid causing the faintest trace of irritation.

In pseudo-angina the success of massage may be very great. The trouble is purely neurasthenic, though some hysterical cases may be found to present pseudo-angina as a symptom. The treatment is general, as for an acute neurasthenic attack. It should start with two or three minutes of surface stroking to each leg. Presently the arms receive a dose, later still the lumbar region of the back is treated. The dorsal region is slowly included in the stroke, and finally the head should receive attention. Any attempt at general treatment in the early stages is liable to precipitate an attack. Local heart treatment is absolutely contra-indicated. The patient is likely to be deprived of exercise for some time, and therefore, on resuming walking, is liable to an undue quickening of heartbeat. This in turn is liable to precipitate an attack. Bergonie treatment, by building up muscular strength without effort or exertion, is a valuable prophylactic against relapse.

Spasm of the intestines produces colic, and is considered later (see Chapter XXVII (Massage Treatment For Disorders Of The Digestive System).).

Asthma, another disease due to spasm of involuntary muscle, will also be dealt with later (see Chapter XXX (Massage Treatment For Disorders Of The Respiratory System).).

Cases of spasm of the voluntary muscles are seen frequently in any massage clinic. It is often difficult to deal with, and its manifestations are varied.

Roughly speaking, there are four main types - the hysterical, the "functional," the irritative, and the occupation types.

Treatment of hysterical spasm has already been considered in the previous chapter. It calls for psychical or coercive treatment.

"Functional spasm" I am going to consider as a separate entity, though doubtless from a pathological point of view this is incorrect. There are, however, various spasms that follow minor injuries and sprains, and partake more of the nature of a local neurasthenia than of actual hysteria. They are usually due to an unfounded belief that movement beyond a certain point will cause pain. The spasm, in fact, is protective. It is, as a rule, far more easy to cope with than the more definitely "hysterical" spasms. There is one great exception, namely, the spasm which many small children develop after injury and splintage. The most troublesome type of all is the small child of three or four, who has sustained injury near the elbow-joint, and who has been treated with the elbow fully flexed. It is no uncommon event for spasm of the brachialis anticus to limit extension to a right angle. Many recover spontaneously if allowed merely to play with the arm; a few who do not do so require great care and patience. Massage is of little avail, but skilful playing with the child will succeed It is a difficult art to learn, and the key to success is patience and constant encouragement of voluntary use of the triceps. Digging in sand is perhaps the best remedy. Force is fatal.

Slow, rhythmical stroking of the surface, passing by infinitesimal stages into firm, deep stroking, will almost invariably relieve spasm which is protective in nature, provided that the evil against which the protection is set up is chimeral. The moment it begins to subside constant pressure is exerted very gently, so as to maintain an even tension, and thus movement of the joint that was fixed by the spasm can be performed (cf. Figs. 32 and 33, p. 74). The performance of the movement convinces the patient of its possibility without pain, and, as soon as active exercises can be performed after the spasm has been overcome, the patient is on the high-road to recovery. Temporary relapse is common and of no importance, provided the patient is taught to expect it. As the spasm partakes of the nature of a protective habit, it will soon vanish under treatment.

A form of spasm, usually regarded as of rheumatic origin and possibly irritative in character, is one of the symptoms of chorea. It is still an open question whether the disease may not be solely a functional brain disorder. Whatever its origin, the psychical disturbance is always considerable and may be very grave. The treatment applicable, therefore, is similar to that advocated for the treatment of neurasthenia. The chief alteration that should be made is materially to reduce the duration of the seance, though it may well be repeated twice during the day. There are two reasons for this reduction - first, that the disease is most commonly met with in children, who are much more amenable to the effects of reflex stimulation than adults; and, second, that the instinctive effort to control the movements during the seance is exhausting. Massage, correctly administered, is perhaps the most effective weapon we possess in combating spasm in this disease; but, if it is inefficiently performed, the result can only be disastrous.