UC-NRLF IIHllll HI :i I. B 3 SMS TMD mmmmmiimmmmmmMmmmmm Pkactioal Massage AND COKREGTIVE EXERCISES BY HAETYIG NISSElsr Prrsidcnt of Posse Normal School of Gymnastics; Superintendent of llosijital Clinics in Massage and Medical Gymnastics; For Twenty- lour years Lecturer and Instructor of Massage and Swedish Gymnastics at Harvard University Summer School; Late Director of Physical Training at Boston and Brookliue Public Schools: Former Instructor of Physical Training at Johns Hopkins University and Wellesley College, Former Director of the Swedish Health Institute, Washington, D. C, etc.; author of "Swedish Movements and Massage Treatment," "Practical Massage in Twenty Les- sons," "A. B. C. of Swedish Edu- cational Gymnastics," "Rational Home Gymnastics," etc. REVISED AND ENLARGED EDITION OF THE AUTHOR'S "PRACTICAL MASSAGE IN TWENTY LESSONS," WITH MANY ADDITIONS. With 68 Original Illustrations, Including Several Full- page Half-tone Plates, PHILADELPHIA F. A. DAVIS COMPANY, Publishers English Depot Stanley Phillips, London 1916 COPYRIGHT, 1905 COPYRIGHT, 1916 F. A. DAVIS COMPANY Copyright, Great Britain. All Rights Reserved Philadelphia, Pa., U. S. A. Press of F. A. Davis Company 1914-16 Cherry Street PREFACE TO REVISED EDITION. As years roll by there are constantly new theories and methods coming up, and my own exjx^rience teaches me, more and more, one is never too old to learn ; so 1 have found it necessary to enlarge and im- prove on my former books, and also to add the im- portant "Corrective Exercises," with full description of their effect and muscles used in the different movements. This new book, then, is what forty years O'f study and experience, practice, and teaching have taught me ; and I earnestly hope it will be of value to those who wish to learn in a practical way to treat suffering hu- manity v.'ith Mechanotherapy. Hartvig Nissen. Boston, Mass. (iii) 357331 rf; PREFACE TO FIRST EDITION. Since my book, "Swedish Movement and Mas- sage Treatment," was piublished in May, 1889, I have had many hundreds oif pupils as well as patients; and during my thirty years of experience as a masseur and teacher, I have been constantly studying and practis- ing and broadening my views and ideas. My first book was written on the authority of others and the theory which they taught. This book, which I hope will be found worthy of its title, "Practical Massage," is the result of my life's work. It is written just as I have been teaching "mas- sage" for several years at Harvard University Summer School and to my private pupils. My method is a combination of what I have found to be the best and most useful "manipulations" and "movements" in other systems as well as original. I trust this little book will be accepted as a practical help in the treatment of the sick. Hartvig Nissen. Boston, Mass. (iv) CONTENTS. CHAPTER 1. PAGE The History — Swedish Movement Treatment — A Word to the Physician — Variety of Movements and Dura- tion — How Often the Treatment Should be Repeated — How to be Dressed — Physiological Effects of Move- ments — Passive Movements — Active and Resistive Movements 1-18 CHAPTER II. Active and Passive Movements — Resistive or Duplicate Movements — The Positions — Manipulations of Arms — Centripetal Stroking, Kneading and Circular Fric- tion — The Effects of These Manipulations 19-29 CHAPTER III. Manipulations of Arms— Nerve Compression — Muscle Rolling — Slapping — Friction— Combination Kneading — Percussion — Beating — \'ibration 30-36 CHAPTER IV. Passive Movements of Arms — Finger Rotation — Hand Rotation — Forearm Rotation — Arm Rotation (Smgle) — Flexion of Arm, Hand, and Finger — Vertical Arm Rotation — Forward Arm Rotation — Shoulder Rota- tion and Chest Lifting 37-43 CHAPTER V. Manipulations of Legs — Centripetal Stroking. Kneading, and Circular Friction — Xerve Compression, Muscle Rolling, Slapping, and Friction — Combination Knead- ing — Percussion — Beating — ^\'''ibration — Stretching the Sciatic Nerve — Passive Movements of Legs : Foot Rotation (Single and Double) — Foot Flexion and Extension — Thigh Rotation — Hip Rotation 44-48 (v) vi CONTENTS. CHAPTER VI. PAGE Passive Movements of the Trunk: Manipulations of the Chest- — Chest Friction and Kneading — Chest Vibra- tion — Chest Slapping — Chest Lifting and Vibration — Abdominal Massage : Stomach Friction — Muscle Kneading of the Abdomen — Knuckle Kneading of the Abdomen— Circular Kneading of the Abdomen — ■ Stomach Vibration — Bowel Vibration — Bowel Concus- sion — Loin Vibration — Loin Traction 49-57 CHAPTER VH. Massage of the Back : Back Friction — Back Muscle Kneading, Muscle Rolling — Back Circular Kneading — Back Vibration — Spinal Nerve Compression — Back Percussion — Long Friction Down the Back — Breech Beating 58-63 CHAPTER VHL Head, Face, and Throat Massage — Head Percussion — Vibration at the Base of the Skull — Kneading of the Head — Head Vibration — Friction of the Forehead and Temples — Facial Massage — Throat Massage — Head Rotation — Head Flexion (Passive) 64-71 CHAPTER IX. Resistive Movement of Arms : Finger Flexion and Ex- tension — Hand Flexion and Extension — Arm Flexion and Extension — Vertical Arm Flexion and Extension — Horizontal Arm Flexion and Extension — Horizontal Arm Separation and Closing — Lateral Arm Elevation and Depression — Forward Arm Traction — Arm Tor- sion CHAPTER X. Resistive Leg Movements : Foot Flexion and Extension — Leg Flexion and Extension — Upward Knee Traction — Knee Flexion and Extension — Leg Elevation and Depression — Backward Leg Traction — Leg Separation 72-79 CONTENTS. vii PAGE and Closing — Bent Knee Separation and Closing — Leg Torsion 80-87 CHAPTER XI. Passive and Resistive Movements of the Trunk : Trunk Rotation — Trunk Torsion (Sitting and Kneeling) — Forward Trunk Mcxion and Extension — Neck Flex- ion and Extension 88-91 CHAPTER Xn. Corrective Active Exercises of Arms: Standing Position — Shoulder Circling — Arm Circling — Arm Elevation — Arm Flinging — Arm Rotation — Arm Flexion and Extension 92-96 CHAPTER Xni. Corrective Active Exercises, of Legs: Leg Elevation, Sideways — Leg Elevation, Forward — Leg Elevation, Backward — Knees Bend — Heel Elevation — Charge, or Fall Out, Forward — Horizontal Balance, Standing — Back Curving — Leg Elevation, Lying 97-101 CHAPTER XIV. Corrective Active Exercises of Head and Trunk : Head Bending, Backward — Trunk Flexion, Backward and Forward — Chopping Movement — Harvesting Move- ment — Trunk Flexion. Sideways — Trunk Torsion — Trunk Circling — Trunk Elevation, Lying — Body Hori- zontal on Toes and Hands 102-108 CHAPTER XV. Stiffness of Joints and Tendons — The Modus Operandi — The Knee Joint — My Method — Mistake to Apply Mas- sage Too Long at a Time — Sprains, Synovitis — Hydrarthrus 109-1 18 CHAPTER XVI. Flat-foot: "Morbid Condition of Foot in Which the Arch is Destroved" 119-122 viii CONTENTS. CHAPTER XVII. PAGE General Massage — My Advice to Newcomers — Neuras- thenia — Prescription I — Prescription II — Prescription III — "High Blood-pressure" — "Arteriosclerosis" 123-132 CHAPTER XVIII. Hysteria and Hypochondria — Chlorosis and Anemia — In- somnia — Diabetes Mellitus 133-142 CHAPTER XIX. Local Diseases: Diseases of the Brain, Spinal Cord, and Nerve — Congestion of the Brain — Anemia of the Brain — Paralysis as a Result of Apoplexy 143-149 CHAPTER XX. Local Diseases : Congestion of the Spine — Locomotor Ataxia , 150-152 CHAPTER XXI. Infantile Paralysis, "Poliomyelitis Anterior" 153-158 CHAPTER XXII. Occupation Neuroses — Writers' Cramp — Cramp of the Legs — Chorea 159-162 CHAPTER XXIH. Sciatic Neuralgia 163-170 CHAPTER XXIV. Diseases of the Organs of the Circulation : Chronic Heart Disease — Diseases of the Respiratory Organs 171-178 CHAPTER XXV. Diseases of the Organs of Digestion : Dyspepsia — Con- stipation — Hyperemia of the Liver — Appendicitis — Indigestion and Biliousness — Obesity — Diseases of Urinary and Sexual Organs: Chronic Catarrh of the CONTENTS. i'x PAGE Bladder — Chronic Catarrh of the Womlj — Displace- ment of the Womb — Irrigularity and Painful Men- struation 179-186 CHAPTER XXVr. Diseases of the Organs of Movement: Scoliosis, "Lateral Curvature of the Spine" — "Lordosis" — "Kyphosis" — "Pigeon-breast" — "Round Shoulders" 187-196 CHAPTER XXVH. Rheumatism, "Myitis" — Muscular Rheumatism, of the Right Arm, of the Neck — Lumbago — Rheumatism of the Joints, "Arthritis" 197-205 LIST OF ILLUSTRATIONS. PAGE 1. Centripetal Stroking 22 2. Muscle Kneading of Fingers 23 3. Muscle Kneading of Ann 24 4. Circular Kneading 25 5. Circular Friction 26 6. Nerve Compression 30 7. Muscle Rolling 31 8. Percussion 33 9. Beating 34 10. Arm Vibration 35 11. Forearm Rotation 3fi 12. Vertical Arm Rotation 4U 13. Forward Arm Rotation 41 14. Shoulder Rotation and Chest Lifting 43 15. Foot Rotation ( Double ) 46 16. Thigh Rotation 47 17. Chest Lifting and Viliration 51 18. Muscle Kneading of the Abdomen 52 19. Knuckle Kneading of the Abdomen S3 20. Circular Kneading of the Abdomen 54 21. Loin Vibration 55 22. Back Muscle Kneading 59 23. Back Percussion 60 24. Breach Beating 62 25. Veins of Head and Neck 68 26. Vertical Arm Flexion and Extension 73 27. Horizontal Arm Flexion and Extension 75 28. Horizontal Arm Separation and Closing 76 29. Lateral Arm Elevation and Depression 77 30. Forward Arm Traction (Lying) 78 31. Leg Flexion and Extension 80 32. Upward Knee Traction 81 33. Knee Flexion and Extension 82 (xi) xii LIST OF ILLUSTRATIONS. PAGE 34. Leg Elevation and Depression 84 35. Backward Leg Traction 85 36. Bent Knee Separation and Closing 86 ZT. Trunk Torsion (Kneeling) 89 38. Forward Trunk Flexion and Extension 90 39. Standing Position 92 40. Arm Circling 92 41. Arm Elevation (Forward. Upward) 92 42. Arm Flinging (Sideways) 92 43. Arm Rotation 92 44. Arm Flexion (and Extension) 92 45. Arm (Flexion) and Extension, Upward 92 46. Leg Elevation, Sideways 100 47. Leg Elevation, Forward 100 48. Leg Elevation, Backward 100 49. Knees Bend (Deep) 100 50. Charge, or Fall Out, Forward 100 51. Charge, or Fall Out. Forward (Side View) 100 52. Horizontal Balance ( Standing) 100 53. Back Curving 100 54. Leg Elevation (Lying) 100 55. Trunk Flexion (Backward) 104 56. Trunk Flexion (Forward) 104 57. Trunk Flexion (Forward) 104 58. Harvesting Movement 104 59. Harvesting Movement 104 60. Trunk Flexion (Sideways) 104 61. Trunk Torsion 104 62. Trunk Elevation (Lying) 107 63. Body Horizontal' 104 64-69. Curvature of the Spine 191-195 PRACTICAL MASSAGI^: AND CORRECTIVE EXERCISES. CHAPTER I. Massage is a very much misinterpreted word and frequently erroneously used, sometimes intentionally, but often 1)y mistake. It means kneading, or a me- chanical action — a handling and manipulating — of the flesh, as in stroking, pressing, kneading, percussing, etc., for a therapeutical pui-pose. In certain cases massage proper is all which is needed, but very frequently it must be used together with passive and resistive exercises, and in such cases massage becomes a part of Medical Gymnastics, Mechanotherapy, Swedish IMovements, or whatever name one prefers to give; they all mean the same thing'. The attempts made by certain authors to separate massage from medical gymnastics, and espe- cially, while doing so, attacking ''messieurs the gymnasts" (Dr. Kleen) as overanxious to secure all possible recogiiition, are rather ill-chosen, and prove that those authors do not know gymnastics and only a part of massage, viz., that small part which can produce a cure without any exercises. (1) 2 ■ PRACTICAL MASSAGk. A first-class masseur noAvadays must necessarily know gymnastics, and a medical gymnast surely knows massage. ' In these lessons then we will consider massage together with such gymnastic exercises as are neces- sary in order to do the most good for the patient. Let us, however, be frank and come to a full understanding of what we are trying to do. It would be impossible for anyone to gain a thorough knowledge of this system, and how, under- standingly, to give a full treatment, from a few lessons or a brief manual. But there are hundreds of cases where massage, together with a few possiz'c and resistive movements, and also active corrective exercises, will not only give a great relief, but even effect a cure, wlien applied judiciously and according to physiological laws. The object of these lessons is to describe, for the use of the doctor himself, or for an operator under the doctor's direction, such "movements" as may be applied in the sick-room and without the use of apparatus, and also to outline some simple, active, corrective exercises which the patient may be taught to practise. First, let us look a little into THI". HISTORY. The History of this curative agent. It is as old as mankind. Nature early taught the man to knead his flesh, or bend his body, to relieve him of certain ills. And there are books as old as 3000 years B.C. written alx)ut g}annastics, among them the Kong-Fu in Chinese. We also know that the Persians, Phoeni- cians, and Egyptians knew alx)ut massage as well as gymnastics. The Greeks were the first to make a genuine progress, however, in this branch, as in so many others. yEsculapius, Apollo's descendant, is said to have l)een the inventor of the art of grymnastics. Medea l>rocured health and youth, by gymnastics. It was four hundred to five hundred years before Christ that Iccus, and, later, Herodicus, reduced bodily exercises to a system, and Herodicus made it a branch of medical science to preserve the health and cure diseases by use of gymnastics, and among his pupils was the famous Hippocrates. Diodes, Praxagoras, Herophilus, Asclepiades, Atheuceus, Celsus, and Galen recommended "move- ment treatment," and gave rules for it. Mercurialis in the sixteenth century wrote a book, "De Arte Gymnastica," or the science of bodily exercise, which he divided into "G\minastics for Athletes, for the IMilitary, and for the Cure of Dis- 4 PRACTICAL MASSAGE. eases," to which, as used by the Greeks and Romans, he gave especial attention, and pointed out the use of the different movements in different diseases, and also gave rules for their application in special cases. Many a poor woman v/as burned at the stake in northern Europe during the Middle Ages because she knew a little more than other persons and cured suffering men by massage, a magic which was looked upon as a power of Satan. It is interesting to read about Thomas Sydenham, 1624-1689, a noted English physician, called "the English Hippocrates," who left the routine practice and based his own upon the theory that there is in nature a recuperative power wdiich ought to be aided and not opposed ; also saying that, "if anyone knew of the virtues of friction and exercise, and could keep this knowledge secret, he might easily make a fortune." There are many of these persons at the present day in the United States claiming mysterious and magical powers of curing diseases, setting bones, etc., by the application of their hands. Thomas Fuller, another English physician, pub- lished in 1704 "Medicina Gymnastica," treating of the power of exercise in preserving health and cur- ing disease. F. Hoffman, who was physician to the King of Prussia in the first part of the eighteenth century, wrote that exercise is the best medicine for the body, and that we cannot imagine how salutary and favor- able to health it is. "for it excites the flow of the SWEDISH MOVEMENT TREATMENT. 5 spirits, and facilitates tlic excretions iruiu ftlie blood." Clement J. Tissot, a iMxnch physician, who several times gained the prize of the Academie Royale de Chiriirgie for his lectures, Dublished in Paris, 1781, "Gymnastic IMedecinale." Gutsmuth, Jahn, Clias, and Spiess worked with energy to spread the German gymnastics, but paid no attention to gymnastics as used for the treatment of diseases. As Herodicus observed the curative effects of gvmnastics on his own delicate health, and thereby was brought to use movements in therapy, so did the Swede, Pehr Henrik Ling, in the beginning of the nineteenth century, study the movement treatment, Ijccause he had cured himself of rheumatism in the arm by percussions. Ling formerly had been a) fencing-master and instructor of gymnastics; but afterward, studying anatomy and physiology, and the influence of the movement and manipulations in different chronic diseases, he founded a system of gymnastics cor- responding with the knowledge of physiology, which is universally known as "the Ling System," or the "Swedish ^Movement Treatment," By ardent study and labor. Ling succeeded at last in making his new ideas recognized, and in 18 13 the first college for pedagogical, military, and medi- 6 PRACTICAL MASSAGE. cal gymnastics, called the ''Royal Gymnastic Central Institute," was established in Stockholm at the ex- pense and under the supervision of the Swedish gov- ernment, and Ling was its first president. The principal studies for graduation are : Anat- omy, Physiology, Pathology, Chemistry, Hygiene, Diagnosis, Principles of the Movement Treatment, and the use of exercises for general and local de- velopment. In the rooms of this institute persons of every condition and age, the healthy as well as the sick, the wealthy as well as the poor, executed prescribed movements. The number of those who adopted the use of the therapeutic movements increased every year, and among them were even physicians who in the beginning had been the most opposed to Ling. Ling died in 1839. His pupils, Brandting, Geoi'gii, Liedback, and G. Indebeton, published Ling's theories, and by this means and through the many foreigners who studied at the Central Institute of Stockholm, Ling's system soon became known in a great part of the world. Dr. Joseph Schreiber, of Vienna (in his "Man- ual of Massage and Muscular Exercise"), says: ''The most powerful impetus, however, given to the revival of mechanotherapy originated with a Swede, the creator of the modern 'movement cure,' whose doctrines, spreading to England and Germany, have, after many decades, and in spite of l^eing marked by some extravagances, gained universal recognition." SWEDISH M()vi-:mi-:.\t tkkatmext. 7 De Ron, in St. Petersburg; Georgii, Indclxjton, Bishop, and Roth, in London; Rothstein and Neu- nian, in Berhn; Richter, in Dresden; Schreber, in Leipzig; Melicher, in Vienna; Eulenburg, in Baden; Laisne at the "Hopital dcs Enfants Malades," in Paris; Taylor, in New York, and many others, estabHshed special institutions for movement treat- ment and published their results, partly in medical papers, partly in books. Dr. Douglas Graham, of Boston, has written several articles, and also one "Practical Treatise on Massage," in which he says: "Li 1844 the Supreme Medical Board of Russia appointed twO' members of the Medical Council to inquire into the merits of the movement and manipulation treatment as prac- tised by M. de Ron, one of Ling's disciples at St. Petersburg, who had been using it then for a period of twelve years. From the highly commendatory report of the councillors we quote the following: *A11 passive movements, or those which are executed by an external agent upon the patient, as well as active ones produced by the effort of the voluntary muscles, and the different positions with the aid of the apparatus or without it, are practised according to a strictly defined method, and conducted ration- ally, since they are based upon mechanical as well as anatomical principles. Experience teaches us the usefulness of the institution, as many patients thus treated have recovered their health after having 8 PRACTICAL MASSAGE. suffered from diseases which could not be cured by other remedies.' " It was not, however, until after the middle of the nineteenth century that massage became really known and was considered by the medical profes- sion as a scientific and valuable remedy in the treatment of diseases. Dr. Mezger, of Amsterdam, who was a famous masseur in the early sixties, was the man who under- stood how to win the confidence of the public, and later, through his many pupils, exercised a powerful influence upon the standing of massage in the medi- cal world. The best known German and Austrian physicians, as Langenbeck, Billroth, Esmarch, von Mosengeil, GussinlMuer, and many others began to employ it and scientifically publish its effects. And soon the conviction gained gTound that massage was a powerful curative agent which had been neglected by the profession, and, therefore, had been abused and overestimated by ignorant people. All o\'er northern Europe massage was known and constantly used, and Prof. W. S. Playfair, of King's College, London, wrote, in 1883, "The Systematic Treatment O'f Nerve Prostration and Hysteria," which greatly encouraged the more general use of massage. In the United States massage was hardly known when I arrived here in the early eighties. The late Dr. Lewis A. Sayre, of New York, prescribed it frequently, and I had several cases from him during my short stay in that city. Dr. Weir Mitchell, in SWEDISH MUVhMK.XT AXU MASSAGK IX U. S. 9 Philadelphia, prescribed "g^eneral massai^e" to his jxitients, and he wrote, in id from the part ; in other cases, as anemia, it is necessary to increase the flow of blood to the parts. Now% for instance, there are two patients, a delicate, small woman and a strong, big man, Ixjth sufYering with the same kind of illness. It might be fair to treat the man for about an hour, but it would surely be too much to let the woman undergo the same treatment for the same length of time. Ahvays bear in mind that the old maxim, "If a little does good, more will do more good," is an exploded thec^ry. A good masseur can accomplish more in fifteen minutes than a poor one in an hour. "General" massage should nczrr hurt, and if black and blue spots appear after the treatment, it is a sure sign that the operator did not know his busi- ness, although we often hear people talk al)out the excellent and strong masseuse, who makes them "black and blue all over." "Local" massage, however, often has to hurt, and if the patient is strong and, can stand it, the cure 14 PRACTICAL MASSAGE. will many times be hastened considerably by a strong and vigorous treatment. But great care and tact must be used by the operator in cases of weak and delicate oatients. How Often the Treatment Should BE Repeated is next to be considered, as the mistake is frequently made by physicians to recomjinend their patients to try massage treatment only two or three times a week, "because they cannot stand it," or "they are too weak to try it oftener." The weaker a patient is the oftener he ought to have the treatment. It should be applied at least once a day, and sometimes twice, in order to derive the most l3€nefit from it. The effect which is derived from one treatment should not be lost before the next treatment is applied. It is the treatment which builds up the patient's strength, but if only tried once in a while he will feel tired and stiff a day or two afterward, and naturally conclude that the treatment does him harm — just as a man who takes a ten-mile horseback ride once a week feels sore and stiff each time, and never gets over it until he repeats the riding- several times weekly. To a weak patient the treatment has to be given very gently in the beginning, and, providing it is PHYSlOUXilCAL I'l'l'KCTS Ol- MOVEMENTS. 15 applied reg'ularly, may soon 1k> increased in force, and thus more vigor is given to the patient. IIow TO BE Dressed when under treatment is a frequent question. In all cases where the manipulations ^re to be directed ccntripctally, it is necessary to strip the body; but in other cases it is preferred that it should be clothed, as that will lessen the pain which sometimes is pro- duced by the manipulations, and the skin (not being the seat of the trouble) will te more protected. The dress should be as light as possible, and all tight clothing dispensed with. Physiological Effects of Movements. These may be divided into two groups : — First. — Purely mechanical effects to secure the removal of lymph, exudations, extravasations, etc., softening of exudations, and loosening of adhesions. Second. — Increased circulation by stimulating the muscular and nervous systems, causing molecular changes, changes in sensation, and changes in the nutritive functions. By Passive Movements the following results are obtained : — I. Extravasations occurring about dislocated joints are, by pressing and kneading the tendons and 16 PRACTICAL MASSAGE. ligaments in which they are imbedded, finally lique- fied, and thus more quickly absorbed. 2. In stiffness of joints the contracted muscles and tendons are forcibly but generally elongated, and any existing exudations or vegetations within the joints are disintegrated and absorbed. 3. By the forcible stretching of the muscles their nen^es are likewise stretched, molecular changes being thus set up in both. 4. Forced extension of the muscles causes pres- sure on their blood and lymphatic vessels, thus accelerating the circulation. 5. Finally, such muscles as have by rheumatic or neuralgic pains been kept in a state of inactivity have some of this much-needed exercise restored to them. Passive movements thus form in certain dis- eases, as in neuralgia and rheumatism, the introduc- tion, as it were, for the more painful active motions which have to follow. The Active and Resistive Movements cause an increased flow of blood to the muscles and soft parts, increasing thereby the circulation and re- moving accumulation of tissue waste. They cause resorption of exudations, transudations, and infiltra- tions, and a separation of adhesions in tendon- sheaths and in joints. They increase the oxidizing powers of the blood ; they relieve the congestion of PHYSIOLOGICAL EFFECTS OF MOVEMENTS. 17 the brain, lungs, intestine^s, uterus, liver, and kidneys, by increasing- the flow of blood to the muscles; they stimulate directly the sympathetic ner^-oiis system, thus increasing secretion, and reflexly the activity of unstriped muscle-fiber, and so relieve various func- tional derangements. And they educate morbidly affected muscles to convert abnormal into normal actions and to sup- press useless movements. Thus movement, or massage treatment, influences the living organism : — First, by increasing the circulation, respiration, and temperature, improving the digestion, absorp- tion, and nutrition, and facilitating excretion. Second, the muscles become developed, the bones and the whole human frame better proportioned. Third, appetite is increased, and the food is taken with greater relish. Fourth, sleep is facilitated. Fifth, the brain acts more vigorously and is freed from psychical depression. Sixth, relieves pain and removes congestion. The Movements May be Spoken of as "Strengthening" movements, such as flexion, ex- tension, torsion, etc. "Stimulating" movements, as percussion, vibra- tion, etc. 2 18 PRACTICAL MASSAGE. "Quieting" movements, as rotation, friction, etc. "Derivative" movements, with special move- ments of the extremities. "Purgative" movements, as kneading, pressing, ajid active movements of the abdominal muscles. Some movements have a special effect on the "respiration," others on the "circulation," etc. CHAPTER IT. The next thing to be considered is the classifica- tion of movements and their execution and effects. First, let ns distinguish between "Active" axd "Passive" Movemexts. Active movements, l^eing such as the subject per- forms entirely by voluntary muscular contraction, without the aid of the masseur, belong to the regu- lar g)nnnastic exercises, although some of them, the "corrective" exercises, are used in medical gymnastics. Passive movements are such as the patient takes no part in beyond allowing the operator to move the whole or any portion of his body — as Hexion, exten- sion, and rotation — and to manipulate it, as in strok- ing, k)ieadi)ig, percussing, etc. ; these latter are more strictly what is meant by "massage." But what is mostly used in medical gymnastics are the Resistive, or Duplicate ^Movements, viz., "concentric duplex" movements, such as the pa- tient makes while the operator resists. The patient is contracting his muscles to the suitable resistance (19) • 20 PRACTICAL MASSAGE. of the operator, and consequently the muscles in activity are shortened. This is the more frequently used form of resist- ive movement, although the "excentric duplex" movements, such as the operator makes while the patient resists, are very useful in certain cases. The patient's already contracted muscles are gradually extended by the operator and consequently elon- gated. This form' of resistive movements should be used either in cases where the muscles are abnor- mally contracted or where they are too weak to contract against resistance, but still have strength enough to resist excentrically. An illustration of the last named is frequently seen in the gymnasium, when the child is unable to pull himself up with his amis and "chin the bar," while he may jump up to it, hang in his bent arms and gradually extend them, and thereby slowly develop his muscles to the desired strength. Sometimes, as for instance in cases of paralysis or locomotor ataxia, it becomes , necessary to help the patient to do an exercise so as to train the motor nerve to obey the patient's will and thereby gradually gain strength and confidence to move the muscles. These are assistiz'c vwi'cments. The Positions in which the movements are taken are numerous and also of very great importance, as the same move- ment often may have an entirely different effect in one position' from that in another. THE POSITIONS. 21 There are six fuiulanienlal positions, viz. : — Standing. Kneeling. Sitting. Reclining. Lying. Hanging. These are subdivided into a number of starting positions with the arms, legs, trunk, and head, as: — Standing — hands on hips, arms horizontal, arms vertical, etc. Sitting — astride sitting, forward bent sitting, etc. Lying — reclining, knees bent, on back lying, on front lying, etc. Which, combined in various ways, make thousands of positions in which the different movements may be either taken or given. And so the number of move- ments may be said to be endless, to suit each par- ticular ailment. \\'hatever the position is, care should be taken that nothing interferes with the patient's breathing, as he should nez'cr hold his breath, but always breathe easily and as quietly as possible; therefore, the head must not be allow'ed to "fall down on the chest," but be kept well up. 22 PRACTICAL MASSAGE. Passive Movements. Manipulations of the Arms. I. Centripetal stroking, kneading, and cir- cular FRICTION are all to be given from the tips of the fing-ers toward the shoulder. In stroking, grasp the patient's finger with your thumb and two first fingers, and make a finn pressing Fig. 1. — Centripetal Stroking. and stroking movement upward toward the hand ; at the same time let your fingers glide in a circular way round the patient's finger, describing the motions of a screw. Let your fingers glide easily back to the starting point (the tip of the patient's finger), and repeat the motions fifteen to twenty times in about ten seconds on each finger. In treating the hand, use your fingers and the palm and stroke first with your right hand, then MANIPULATIONS Ol- TIIIC ARMS. 23 with your left on Ixjth the hack and pahn of the patient's hand. Grasp around the ami with your riglit hand and make a firm stroking- in the screw motion from the wrist to the ellxnv, ghding easily down again and rei^ieat about eight times in ten seconds, then use your left hand in the same manner. (Fig. i.) Kncadiugs are of two kinds, viz., muscular and circular. Fig. 2. — Muscle Kneading of Fingers. In muscle kneading of the fingers make an alternate pressure with the thumb and index finger of both hands, beginning at the tip of the pa- tient's finger, about twenty pressures in ten seconds. (Fig. 2.) Then knead the muscles of the hands and fore- arm toward the elbow by picking up each group of muscles with the one hand (Fig. 3, x4), and when releasing the grasp make an upward pressure with the other hand (Fig. 3, 5). About fifteen kneadings in ten seconds. 24 PRACTICAL MASSAGE. In circular kneading grasp the patient's finger with your thumb and two first fingers and let each of your fingers make a circular, or rotary, motion Fig. 3. — Muscle Kneading. while pressing so hard that the patient's skin is moved and not your fingers rubbed over the skin; gradually push your fingers upward to the hand. MANIPULATIONS OF THE ARMS. 25 Now put your tlirce middle fino^crs on the back of the patient's hand and let them tog^ether make a circular motion hard enough to move the underlying tissues and gradually pushing upward (Fig. 4), alx)ut twenty-five circular motions in ten seconds. Then the same manipulation of the palnii of the hand. Around the wrist use both your thumbs in the same motions and knead well around and in the Fig. 4. — Circular Kneading. joint. Again use your three fingers or the whole hand in the circular motion up the forearm and the elbow. In circular friction grasp the hand with both of yours, and make upward pushing movements alter- nately with right and left, constantly moving the hands and fingers, and especially the thumbs, in a semicircular direction, letting the one hand push 26 PRACTICAL MASSAGE. upward while the other ghdes easily down, thereby making a sideways friction together with the upward stroke (Fig. 5), twenty-five motions in ten seconds. Now repeat the same manipulations from the elbow to the shoulders, and when the whole arm has been worked OA'cr in this manner make firm strokes from the fingers to the shoulders, clasping •..,, • -^ Fig. 5. — Circular Friction. the limb around with both your hands, from five to ten times. The Effects of These Manipulations are as follows : — Any pressure on the muscles must necessarily exert pressure upon the underlying veins and drive their contents away, and on account of the valves which open toward the heart only, it is clear that the EFFECTS OF MANIPULATIONS. 27 contents of these vessels must be driven toward the center, or the heart. Therefore, it would make no difference if a pressure was begiin at the shoulder and gradually worked down the arm — the circula- tion of the blood would be accelerated either w'ay; but a continual stroking- against the veins would interfere very much with the venous circulation, and even produce ruptures of the vessels. Centripetal stroking quickens the circulation in the blood- and lymph- vessels and even sucks the blood from the vessels below, so that the arterial stream is quickened through the faster outflow from the veins and the diminution of the venous blood- pressure. The strokings going in opposite direction of the arteries do not interfere with the arterial stream, because the position of the arteries is deeper and more protected, and their walls are much more resistant. Centripetal stroking brings alx)ut the re- sorption and disappearance of all sorts of effusions, prevents stasis as well as adhesions of the white corpuscles to the walls of the vessels, and their sub- sequent migration, and reduces inflammatory ten- sion and the pain due to pressure. Strokings also heighten the nutrition of the tissues, and are a valuable procedure in many cases of traumatic injur}% as w'ell as in some cases of delayed healing from other causes; they \\\\\ also limit or prevent a threatened mortification or gangrene in certain cases. And, finally, it has the property of removing fatigue, acting as a restorative to groups of tired muscles. 28 PRACTICAL MASSAGE. Fatigue results from the presence of carbonic acid, lactic acid, acid phosphates, etc., due to the consumption of oxygen and the lack of those sub- stances that are oxidized during muscular contrac- tions ; and the removal of these products, and the access of fresh blood, rich in oxygen and oxidizable substances, act as a restorative on the working power of the muscles. Experiments have been made flexing the arm at the elbow-joint, while raising a weight, till exhausted ; then centripetal stroking has been made for five minutes, immediately after which the arm was able to perform even more labor than before. Muscle kjicadiug and circular kneading are both used to crush newly formed vessels and half-organ- ized products of inflammation ; to stimulate the cir- culation and further the resorption, and to separate the exudations and infiltrations and force them out in the lymph. The muscle kneading in lifting the muscles up and again pressing them against the bones acts mainly on the deeper tissues and also helps to bring about contractions of the muscles, and is therefore especially valuable in reducing fatty degenerations and. make stronger muscles; while the circular kneading is more useful to sepa- rate foreign bodies and tO' licjuefy extravasations and promote absorption. Circular friction has a similar effect as the strok- ing, but by moving the hands in a semicircular direction we can easier reach all the capillaries and small lymph-vessels. EFFECTS OF MANIPULATION'S. 29 Generally speaking: Centripetal stroking quick- ens circulation and reduces inilammations ; muscle kneading crushes settled and waste matters in the deei)er tissues, while circular kneading does the same to the tissues nearer the surface, thus separating foreign material into small atoms, which again are sent forth through the veins by the circular friction and the last strokings. Further, muscle kneading, rather quickly and moderately hard, should be used on weak and atrophied muscles to make them contract and grow stronger; while circular kneading will loosen up tense and hardened muscles. For instance, suppose the flexor muscles of the arm are contracted from some injury, circular knead- ing and centripetal stroking under full extension of the arm should be applied on the flexors, while muscle kneading and "percussion" should be used on the extensors, and also some resistive movements to strengthen the extensor muscles so as to make them able to overcome the contraction of the flexors. CHAPTER III. 2. Nerve Compression. — Grasping the limb with both hands, a firm pressure is made around and down the whole ami from, the shoulder to the fingers. Repeated three to five times. (Fig. 6.) Fig. 6. — Nerve Compression. Both hands grasp simultaneously near the shoulder, and the pressure should be evenly distributed by the palm of the hand and all the fingers without pinch- ing; when the grasp is released, the hands move a trifle lower and around the arm and make another pressure, and so' on tO' the fingers — five to six pres- sures in teit seconds. A slow and even pressure is most soothing to nervous patients. This increases the circulation of the blood and has a very quieting and soothing effect on the nerves. (30) MANIPULATIONS OF THE ARMS. 31 In extreme nervous cases it is therefore a most valuable manipulation. 3. Muscle Rolling. — Grasping the limb with the palms of both hands (Fig. 7), and making a (|uick, alternate pushing and pulling motion, and gradually gliding downward from the shoulder, the muscles of the arm will be rolled and squeezed asfainst each other, whereby the circulation of the Fig. 7. — Muscle Rolling. blood is very much increased. Repeated three to five times. There are hardly any manipulations which will warm the arm and hand as quickly as this. 4, Slapping. — This is performed with the palms of both hands, with a light motion of the wrist- joint, and the whole arm is slapped from the shoulder downward from three to five times. This stimulates the action of the nerves and the circulation. 5. Friction is performed with the fingers and 32 PFLA.CTIC/VL MASSAGE. palm of the hand from the shoulder and downward, grasping lightly around the limb with both hands — repeated ten to thirty times. This should be done in slow time and very lightly sO' as not to interfere with the venous circulation. Three to five frictions in ten seconds. This has a quieting effect on the nerves, and is often sufficient to produce sleep in nervous and sleepless patients. Nerve compression, muscle rolling, slapping, and friction are frequently used together as an excellent way to increase the circulation of the blood and quiet the nerv^es. As before said, any pressure of the muscles must necessarily send the venous blood in a quicker cur- rent toward the heart, and as soon as the pressure is relieved the underlying blood-vessels suck the blood from veins and capillaries below, which again, by the diminished blood-pressure, increases the flow of arterial blood toward the parts; and it is a fact that the manipulations working in a downward direction have a much more soothing and quieting effect on the nervous system. Therefore, in certain nervous affections this mode of applying massage should be preferred to the centripetal, and in other cases follow it. In extreme nervous cases "nen^e compression" and long, light "friction," downward are most beneficial. 6. Combination Kneading. — Grasping the ami near the shoulder with both hands and a firm pres- MAXirULATIOXS OF THE ARMS. 33 sure, move each hand outward and upward hkc a combined, imtscle-rolliiig, circular kneading, circular friction, and centripetal stroking, not very rapid, so as to stretch and knead the underhng muscles, and gently move the hands dowmvard toward the wrist ; all pressure, however, being in centripetal (upward) direction. This procedure is very valuable to begin the massage of an ami or leg before the other centripetal strokings and kncadings are applied. Fig. 8. — Percussion. 7. Percussion is performed with the edge of the extended fingers (Fig. 8), which are kept loose, and with a quick motion of the wrist-joint the fingers are flung alternately across the muscles. The quicker the better. 8. Beating is performed with the clenched fist (Fig. g, A) on and. around the fleshy part- of the limb with a loose and light movement of the wrist-joint. 3 34 PRACTICAL MASSAGE. (Fig. 9, B.) The blow must be firm and deep, and one a second. These two motions stand foremost among the manipulations which aim at mechanical excitation. Fig. 9. — Beating. A blow calls forth a local contraction which is inde- pendent of any nervous stim'ulus by reason of the independent irritability of the muscle itself. This is a particularly effective way of stimulating a muscle, MANIPULATIONS OF THE ARMS 35 and often so when other forms of stimuli have gi\cn out. The contraction itself furnishes the conditions for a quicker access of blood and interchanj^e of material, increase of temperature, and nutritional activity. Fig. 10. — Arm Vibration. Percussion and heating are very important parts of massage, and are extremely serviceable in counter- acting muscular atrophy and in restoring normal size and functional power to groups of thin and weak muscles. These manipulations applied gently across the muscles cause contraction of muscles and blood- 36 PRACTICAL MASSAGE. vessels; while applied forcibly, muscles and tendons will loosen and thereby overcome contractons, and cause dilatation of the blood-vessels. 9. Vibration. — The operator takes hold of the patient's hand and makes a slight pull and a very rapid vibration (shaking) of the whole arm. Re- peated five to ten times. In order to apply this effectually it is necessary for the operator to make himself as rigid and tense as possible. (Fig. 10.) This has a stimulating and strengthening effect on the nerves and also on the respiration ; and it can be given with excellent results in nervous affections and fatigue. CHAPTER IV. Rotations or Circumduction of Arm, Hand, and Fingers. 10. Finger Rotation. — The joint between the finger and hand, metacarpal joint, is fixed by the operator's one hand, and with the other the finger is rotated (or circumdncted) in its joint; at the same time a "piull" is appHed to the fingers; rotated ten to twenty times each way, and abotit twenty-five rota- tions in ten seconds, unless the finger-joint is very stiff. In such case the joint must first be flexed (bent) and extended, and then the rotation per- formed in as big a circle as the joint will allow. 11. Hand rotation is performed by taking hold of the wTist with one hand and of the fingers wdth the other hand, and describing a circle in the wrist- joint from ten to twenty times each way — alx)ut twelve rotations in ten seconds, with a piill of the hand. 12. Forearm Rotation. — The patient's elbow is fixed in the operator's one hand, who, with the other hand, takes hold of the patient's w^rist (Fig. it) and moves the foreami, which is kept on an angle, in a circle in the elbow-joint, from ten to twenty times each w^ay — about eight times in ten seconds. (37) 38 PRACTICAL MASSAGE. 13. Arm Rotation (Single). — The operator takes hold of the patient's shoulder with one hand and of his elbow with the other hand, moves the arm forward, upward, backward, and down so as to describe a circle of the shoulder-joint, from five to Fig. 11. — Forearm Rotation. ten times one way and reverse as many times — about five times in ten seconds, with a pull of the arm. The arm, forearm, hand, and finger rotations are very useful in stiffness of the joints. The contracted muscles and tendons are forcibly but gradually elongated, and any existing exudations within the joints are disintegrated and absorbed. But these PASSIVE MOVEMENTS OE THE ARMS. 39 movements are also of great value in general )iias- sagc and in all cases where it is desired to quicken circulation or to draw the blood away from the chest and head. On account of the bent position of the axillary artery, the raising of the arm in rotation stretching it out, the arterial l)l()od-currcnt is very much increased at the same time that the pressure of the muscles on the veins drives the venous blood to the heart, and a very rapid flow of blood to the arm and hand is the result. The movements should always begin with the arm and end with the fingers; and if done well, these few exercises will, as a rule, make the coldest hand warm. Arm rotation (single), is an Excellent movement in cases of congestion or too much blood in the head. 14. "Flexion" (passive) of onn, hand, and finger is also a ^•ery valuable and necessary move- ment to break up adhesions within the joints ; and sometimes great force must be applied when the shoulder- or elbow- joints are stiff from dislocations, fractures, etc. In raising the ami vertical the big chest and back muscles — the pectoralis and latissimus dorsi — are being stretched, which in many of these cases is highly necessary. If the forearm is bent the exten- sors of the arm — especially the triceps — are stretched ; and when the arnn is extended the flexors — the bi- ceps and brachialis — are stretched, and so on. These passive stretchings of antagonistic muscles are of 40 PR.\CTICAL MASSAGE. great importance in many cases : besides, they are also beneficial in stretching nerves and blood-vessels. 15. Vertical Arm Rotation (Sitting). — The patient sits with his arms extended over his head ; the operator standing behind, supporting the patient's Fig. 12. — Vertical Arm Rotation. back with his knee, takes hold of his hands (.Fig. 12), and while stretching the arms well, he moves them in a small but ^'ery rapid circle fonvard, out- ward, backward, inward, taking care not to strike the anns against the head. This is not reversed, but repeated three to six times, and between each PASSIVE MOVEMENTS OF THE ARMS. 41 quick rotation of twenty to thirty circlings the arms should be gently lowered a little in front and pulled backward while a pressure is made with the knee on the patient's back; then the arms are again raised and the quick rotation repeated. Forward Arm Rotation. This makes a great expansion of the chest and stretches out the pectoral muscles ; the blood is drawn out of the arms, and the apex of the lungs is brought into vibration ; an increase of pulmonary circulation and bronchial absorption follows; the flow of the blood to the chest causes a diminution of 42 PRACTICAL MASSAGE. blood-pressure, especially in abdominal and pelvic vessels. i6. Forward Arm Rotation (Sitting). — The operator, standing behind the patient, the latter rest- ing his back against the operator's chest, then takes hold of his amis just below the elbows and moves them in a circle forward, upward, sideways, and down, but not reverse, from ten to twenty times (Fig. 13) — about twelve to fourteen movements in a minute. This expands the chest and has a great effect on the respiration and the circulation. 17. Shoulder Rotation and Chest Lifting (Sitting). — The patient sits on a stool, and the operator, standing behind, takes hold under and in front of the patient's shoulders, moves them up- ward, backward, and down, at the same time press- ing his chest against the patient's back. Repeated ten to twenty times, but not reversed. (Fig. 14.) About twelve to fourteen times in a minute. This is a mild but effective movement in weak- ness of the lungs and heart, as it deepens the in- spiration followed by a stronger expiration, thereby stimulating the flow of venous blood to the heart. Forward arm rotation and shoulder rotation are most effective respiratory movements, and should be given frequently to patients who are able to sit up, so as to increase the quantity of oxygen and purify the blood, which, during the treatment, is forced to- flow rapidly. But, aside from this, the deep inspiration draws the venous blood to the PASSIVE MOVEMENTS OF THE ARMS. 43 heart, and is therefore of great vakie in diseases of the heart i\s well as in cases of congestion of the brain and in all nervous affections which produce flushHig of the head and face. In lung troul)les these breathing exercises are invaluable, and I have Fig. 14. — Shoulder Rotation and Chest Lifting. often with a single application brought a man's respiration from 34 in a minute down to 20. Persons who have been diving or swimming under water frequently compilain of headache and their eyes are bloodshot from congestion as a result of "holding the breath" ; six to tw^elve deep breath- ings will quickly give relief to those cases. CHAPTER V. Manipulations of the Legs. i8. Centripetal stroking, kneading, and CIRCULAR friction shoulcl all be applied in the same manner as to the arms, beginning with the toes and gradually proceeding toward the hip. (Figs, i, 2, 3, 4, and 5.) In stroking the foot use your right hand on the patient's right sole from the toes toward the heel a few times, and also up along the instep; use the left hand on the front and outside of the right foot, and both hands alternately from the ankle to the knee. The uiitsclc kneading of the foot is done by an alternate squeezing with both hands. The rest of the manipulations are the same as to the arnii, 19. Nerve compression, muscle rolling, slap- ping, and friction from the hip toward the foot are similar to those movements given the arms, as described in Chapter III. (Figs. 6 and 7.) 20. The combination kneading, as applied to the arms. 21. Percussion, as applied to the amis. (Fig. 8.) 22. Beating, as ai^plied to the arms. (Fig. 9.) (44) PASSIVE MOVEMENTS Ol- THE LEGS. 45 23. Vibration. — The operator, taking hold of the patient's heel and ankle, makes a slight pulling and very rapid shaking movement of the whole limb. This has a stimulating effect on the nen-es. 24. Stretching the Sciatic Nerve and the Hamstrings. — The patient reclines on a bed or chair, etc. ; the operator bends the patient's knee and raises the leg, resting the patient's heel on his (operator's) shoulder. Now he makes a strong pull upward on the toes (flexing the foot) and at the same time stretches the knee by pulling on the thigh, just above the knee, with the other hand. This is an excellent way to stretch the nerve and very valuable in sciatic neuralgia. The higher the patient sits up, the more forcible is the exercise. Rotations or Circumductions of Leg and Foot. 25. Foot Rotation (Single). — The operator fixes the patient's ankle with one hand, and, taking hold around the toes, without pinching, moves the foot around in a circle ten to twenty times one way, and reverses. About fifteen times in ten seconds. This is useful to break adhesions in stiff ankle- joints, to limber the joints, and to bring the blood into a better circulation. 26. Foot Rotation (Double). — The patient, in a lying or reclining position, rests the back of his heels against a cushion. The operator, sitting 46 ' PRACTICAL MASSAGE. in front of the patient, takes hold of his toes (Fig. 15) and moves both the feet in a quick circle — the quicker the better — twenty to thirty times one way, and reverses. The legs should be kept straight but passive during the motion, so as to allow a vigorous shaking of the whole limb. This has a very good effect on the circulation, and, by increasing the flow of blood to the feet, acts as a good derivative from other parts. Fig. 15. — Foot Rotation (Double). 27. Foot and toe flexion, passive, whereby the muscles and nerves are put on a full stretch, are very useful movements. Especially in paralysis or other cases when some set of muscles are contracted — these should be passively stretched. 28. Thigh Rotation (Receining). — The oper- ator takes hold of the patient's foot — right foot with right hand, so as the thumb comes on the instep — and of his bent knee with the other hand (Fig. 16) ; the knee is now pressed upward, then PASSIVE MOVEMRXTS OF THE T.EGS. 47 moved outward and downward (without Ix^ing straightened) so as to descril)C a circle in the hip- joint; the knee should not be moved to pass the middle line of the Ixuly, and the movement should be firm and e\en, with a good pressure of the knee upward. The pressure is done at the foot, while the hand at the knee simply steers the miotion. The Fig. 16. — Thigh Rotation. foot must be kept in line with the knee and not be twisted outward. The rotation is done from six to fourteen times in one direction, then as many times reversed. About three tO' five times in ten seconds. This is one of the best exercises for equalizing the circulation, and as a derivative from diseases in the pelvis and abdomen, as well as to limber the hip- joint. It is considered a delightful movement by 48 PRACTICAL MASSAGE. almost every patient, and may be used frequently in general massage, as well as in local troubles. 29. Hip Rotation (Lying). — The patient lies flat on his back with the lower extremities outside the bench or couch. The operator, taking hold of the ankles, moves both legs around in a big circle eight to twelve times in one direction, then as many times in the other. This is very effective in affections of the abdo- men and pelvis. Passive rotations alternately shorten and lengthen the blood-vessels, and are more especially effective with the bigger veins. When they are stretched they carry more blood than when they are shortened, and, therefore, movements which alternately shorten and lengthen these vessels act as a sucking power on the venous circulation toward the heart, as the blood cannot go backward on account of the valves. CHAPTER VI. Passive ^Movements of the Trunk. (a) Mcniipitlafions of tJic Chest. 30. Chest Friction and Chest Kneading. — The operator puts his hands on the patient's chest with the finger-tips pointing at the throat and the thumbs meeting at the sternum, then makes rapid strokings with l3oth hands — one to each side — and gradually moving his hands down, always begin* ning at the middle of the chest. After the whole chest has been treated this way a few times, the iintsclc kneading is applied by picking up the skin and muscles alternately with both hands, beginning at the sternum and following the pectoral muscles out to the side. First manipulate one side of the chest, then the other. The circular kiicadi>ig is next applied with one hand on each side of the sternum, making the rotary motions toward the side of the trunk. 31. Chest vibration should follow the knead- ings by putting the hands, one on each side of the chest, and pulling downward, making a rapid vibra- tion, or shaking, with very tense hands and fingers. The friction — sidew^ays stroking — should finish these manipulations. ^ (49) 50 PRACTICAL MASSAGE. 32. Chest Slapping (Standing). — The oper- ator, standing" in front of the patient, brings his hands on the back of the patient's shoulders and slaps him over the region of the lungs, thus mov- ing' forward under the amis tO' the chest and all over the chest up to the shoulders in front. Re- peated three to six times. If the patient is lying down the slapping is done by alternately using both hands rapidly all over chest from side to side and gradually moving the handsi upward to the shoulders. The slapping should be done with the palm and fing-ers and a lig'ht movement of the wrist, without keeping the hands stiff. The friction, kneading, vihrati -., and slapping of the chest are frecpiently used in "general" mas- sage as a fine exercise for the chest muscles and to increase the circulation and tone up the nervous system of the whole chest, lungs, and heart. They are very useful in weakness and emphysema of the lung's, organic diseases of the heart, and in nervous palpitation. 33. Chest Lifting and Vibration (Reclin- ing). — The operator, standing in front of the pa- tient, puts his hands on each side and under the shoulders of the patient, then lifts him slightly (Fig. 17), and, by shaking his hands while he pulls them forward under the patient's arms, eft'ects a vibration of the whole trunk. Repeated four to eight times. This stimulates the lungs and heart MASSAGE OF THE ABDOMEN. 51 and is a very good rcspiratoiy movement for a patient who cannot sit up. 1 liax'e often gi\-en great relief to asthmaiic patients with a few apphcations of this movement. (b) Abdoiiiiual Massage. 34. Stomach friction is made with both hands all over the abdomen from the middle and out to Fig. 17. — Chest Li f tins: and Vibration the sides, beginning under the ribs and gradually moving downward ; this is followed with an upward stroke with the one hand on the right side, beginning at the cecum and over to the left in the direction of the ascending and transverse colon, and then a down- ward stroke with the other hand on the left side in the direction of the descending colon to the sigmoid flexure. Repeated four to eight times. This influences the activity of the intestines. 52 PR.A.CTICAL MASSAGE. 35. Muscle Kneading of the Abdomen. — \\'ith both hands the operator ahernately kneads and rolls the flesh and muscles of the abdomen in a circle from the right upward, oxer to the left and down- ward, in the direction of the ascending, transverse, and descending colon. After a few treatments the operator should be able to make very finn and deep kneadings without any disagreeable feeling to the patient ; the intestines will be forced to greater con- Fig. 18. — Muscle Kneading of the Abdomen. traction and activity, and fat and flabby abdominal muscels will be reduced and made firmer. (Fig. 18.) The muscle kneading of the abdomen is espe- cially useful in constipation and obesity. 36. Knuckle Kneading of the Abdomen. — With the slightly bent knuckles of th© fingers an alternate pressure is made with both hands, begin- ning at the middle line under the ribs, and grad- ually and evenly moving the hands out to the sides, taking care not to press on the hip-bones ; then the MASSAGE OF THE ABDOMEN. 53 knuckles are again placed at the middle line a little lower than fn'st time, and so on till the whole ahdo- men has been kneaded in this manner. ( h ig. 19.) This is very useful in constipation and to make the intestines more active. T^y. Circular Kneading of the Abdomen. — The operator places his three middle fingers, which are held close together, upon the spot which is to be Fig. 19. — Knuckle Kneading of the Abdomen. manipulated — either in the gastric region or on the stomach, or beginning at the cecum and following the colon — and pressing lightly (Fig. 20) executes circular kneading. After a thorough kneading on one spot the fingers are lifted and placed on another spot nearby and so on. In case of constipation begin at the sigmoid flexure, kneading thoroughly, then lift the fingers and move a little higher up the descending colon, again kneading well, and move higher up, then 54 PRACTICAL MASSAGE. across the transverse colon to the right and down the ascending colon to the cecum, always making" the pressure of the kneading in line of the normal passage. This will help to loosen up hardened matters. Then knead the colon from cecum to sigmoid flexure. Fig. 20. — Circular Kneading of the Abdomen. This kind of kneading is probably the mO'St effectual of them all and acts very powerfully on the glands and epithelium of the alimentary canal ; it has a very stimulating effect on the abdominal organs and their nerves. It increases the activity of MASSAGE OF THE ABDOMEN. 55 the stomach and the secretion of the juices, and effects a l)etter mixture of the secreted juices and the food substances. It is therefore of great vahie in cases of inchgcstion, dysj^psia, constipation, etc. 38. Stomach Vibration. — The operator presses his shghtly l>ent fingers under the patient's ribs on the left side and apphcs a rapid vibration on the Loin Vibration. ventricle; the hands should be mo\ed so as to apply the vibration all over the left hypochondriac. Re- ]:)eated three to six times, and followed by stomach friction. Useful in dyspepsia and chronic catarrh of the stomach and to increase the appetite. 39. Bowel Vibration (Standing). — The oper- ator, standing behind the patient, puts both hands on 56 ■ PRACTICAL MASSAGE. the patient's abdomen, and by a rapid pushing and pulhng motion of his hands an effective vibration is applied tO' the whole bowel. Repeated three to six times ; very useful in constipation. 40. Bowel Concussion (Lying). — The oper- ator's hands are placed on the patient's abdomen, and a pressure is made — deep- but evenly ; then the hands are cjuickly taken off, allowing the abdomen to spring back like a rubber ball. Repeated three to five times. This strengthens the abdominal muscles and the digestive powers. 41. Loin Vibration (Sitting). — The operator, standing behind the patient, who sits on a stool slightly stooping forward, presses his hand with the ulnar edge on each side of the patient just above his hips (Fig. 21), and applies a very rapid alternate pushing and pulling movement with his hands. The hands must be firm and not glide on the flesh. Re- peated three to six times at short intervals. This has a very stimulating effect on the liver and stomach and on the lungs and the diaphragm. 42. Loin Traction (Lying). — The operator puts his hands on each side and under the small of the back of the patient, and pulls his hands forcibly forward, just above the hips. Repeated four to ten times. This has a very soothing effect and is useful as a finish to abdominal massaee. MASSAGE OF THE ABDOMEN. 57 Of all the different kinds of massage, the "ab- dominal" has more special intluencc on blood-pres- stn'e, which is increased considerably durino^, and for a while after, these manipulations. Abdominal mas- sag-e, therefore, should not be used in cases of recent bleeding within the brain, in the lungs, or stomach. CHAPTER VII. Massage of the Back. 43. Back Friction. — The operator puts his hands on the patient's neck with the finger-tips point- ing upward and the thumbs meeting at the spine, then makes rapid strokings simultaneously with both hands, one to each side, gradually moving down- ward to the buttocks, but always applying the strokes from the spinal column outward and never toward the spine, neither up the back. Repeated four to ten times. Has a soothing and quieting effect. 44. Back Muscle Kneading.— The operator first manipulates the muscles of the neck and shoul- ders and gradually proceeds downward to the but- tocks, picking up the muscles with one hand and squeezing with the other, from the spinal column outward, following the course of the trapezius and latissimus muscles, first on one side of the back, then on the other. Repeated three to six times. (Fig. 22.) Increases circulation and the action of the nerA'^esi and has a good effect on tired muscles. 45. Back Muscle Rolling. — The operator, put- ting both his hands side by side on one of the pa- tient's shoulders, makes an alternate, very rapid pushing and pulling motion with hisj hands, gradually (58) MASSAGE OF THE BACK. 59 moving' downward to the buttocks; the hands must be so firmly on the patient as to move his muscles from side to side, thereby causing- a quick stretching and a vibration of them. First roll the muscles of one side of tb.e back three to five times, then the other side. Increases circulation. 46. Back Circular Kneading. — The oper- ator's middle three fing-ers of each hand begin at the Fig. 22. — Back Muscle Kneading. neck on each side of the spine and apply the circular kneading outward, then begin a little lower and work outw^ard, one hand on each side, and so on to the end of the spine, thus kneading the buttocks and hips thoroughly. Repeated three to six times. Increases resorption and has a very soothing effect. 47. Back ^^IBRATION. — The operator puts both hands, with the fingers spread out, one on each side of the patient's back up at the shoulders, then pulls downward ■with a firm pressure and a rapid vibra- 60 PRACTICAL MASSAGE. tion of hands and fingers. Repeated three to five times. Stimulates the nerves. 48. Spinal Nerve Compression. — The operator presses with his middle and index fingers on each Fig. 23. — Back Percussion. side of the spinal column from the neck to the end of the spine ; the pressure should be made a little inward and upward, fimily, without jerking, in a slow and quiet way. Repeated two to four times. Relieves backache and is very soothing and restful; if done with vibration of the fingers it is stimulating- to nerve-centers. MASSAGE OF THE BACK. 61 49. Back percussion is applied with the edge of both hands and fmg'ers aUcrnatcly and very (juickdy from the neck downward on brt, and with the ulnar edge of the other hand or little finger, pressed on the neck just l^elow the base of the skull, make a very rapid vibration — three or four times at short in- tervals. 66 PRACTICAL MASSAGE. 53. Kneading of the Head (Sitting). — The patient's head rests against the operator's chest, he standing behind. Begin at the comer of the nose and make cirailar kneading with the index and middle fingers of 'one hand, followed with stroking of the other hand, working from the nose around the eye- brows and to the temple; then begin a little higher over the nose and work outward, next still higher, till the line of the hair is reached. Now work the other side of the forehead in the same manner. Then give circular kneading with both hands, one on each side of the nose, working outward to each temple. After the whole of the forehead has been well kneaded, spread all the fingers on the scalp and let each finger make a small circular kneading, taking care not to glide on the skin or pull the hair; raise the hands and remove the fingers to other spots, and so on until all of the scalp has been well treated. In kneading the neck support the head with one hand and knead — both muscle kneading and circular kneading — with the other hand from the skull down the neck 011 each side and over 011 the shoulders, fol- lowed with a few strokings in the same direction. 54. Head Vibration. — After the kneading place both hands around the patient's head and make a firm, even pressure and rapid vibration, or trembling, of the hands. 55. Friction of the forehead and temples and back over the neck with both hands should finish the head massage. FACIAL MASSAGE. 67 These manipulations of the licad are exceedingly beneficial in cases of headache, weariness, insomnia, etc., and always have a soothing- and (juieting effect on nervous patients. But aside from these general effects there is no doubt, to my mind, that the circular kneading of the scalp will produce new growth of hair. In fact, I have seen several excellent proofs thereof. One, a lady of 65 years, who had worn a wig for more than twenty years; she began after my advice to give herself scalp massage twice every day for about ten or fifteen min- utes each time, and when I saw the lady again, after a couple of years, she had a good crop of hair all over her head. The simple reason is that the massage will bring nourishment to the roots of the hair and thereby awaken Nature to new life. 56. Facial Massage. — Soon after I had opened my Institute in Washington, in 1883, two ladies, who had seen their best days of life, called and asked if massage would take away wrinkles from the face. At that time I had not thought of this and had never seen any account of such treatment from other masseurs, so I did not encourage the ladies and I never saw them again. But the incident set me to thinking, and I do not now hesitate to say that massage will prove itself to 1>e the best agent in removing wrinkles and in mak- ing a face younger and more beautiful if kept up regularly for weeks and months at a time. This cer- tainly is reason enough for the many offices and "par- lors" for facial and scalp massage, or, as it is often 68 PRACTICAL MASSAGE. called, the "scientific" manipulation, which signs we now see everywhere in the cities. However, this kind of massage is often errone- ously explained by certain waiters of "beauty and health" in magazines and newspapers. Fig. 25. — Veins of Head and Neck. Let us take a look at Fig. 25, which shows the veins leading from the head and face. The facial vein (i) coming from the corner of the eye and nose, crosses obliquely down the cheek, taking up the venous blood from other parts of the face and finally emptying FACIAL MASSAGE. 69 its contents into the inlcnia! jii'^uhir I'cin (2) farther down the neck. The external jiii^iilar z'ciii (3) re- ceives the venous blood from the head, neck, and ears, and carries it in an ahirost straight Hne to the superior vena cava. Now v^^ith this fact in view it is hard to understand how persons who claim to know can advise making strokings upward the cheek from the neck and chin. This is in strict opposition to all laws for massage and cannot produce any good effect. The strokings and also circular kneading with the tips of one or more fingers should follow the direction of the veins in order to accelerate the circulation of the blood and to produce quick absorption of waste material. If strokings are directed from below and upward, congestion may set in and impure matters may be more firmly imbedded in* the walls of the blood-vessels and even rupture of small vessels may occur. In case of wrinkles put the index and middle finger of one hand on each side of the groove and stretch it out, while circular kneading is applied with one finger of the other hand right on the groove ; this process to follow the course of the wrinkle in the same direction as the veins. If the face is discolored, or there are pimples, the circular kneading followed with strokings on the big facial and jugular veins should l^e applied. If the face is too fat or flabby, muscle kneading, or, rather, a pinching, picking up the flesh with the thumb and index and middle fingers, and letting each 70 PRACTICAL MASSAGE. finger squeeze and knead thq part before releasing" the hold and removing to another spot near by. This process may as well be given from the chin and up if that seems desirable, as there is no stroking to be done. If the face is poorly nourished apply circular knead- ing and also pressure and light vibration on the twigs of the fifth cranial nerv^es, where the stars are shown on Fig. 25. Always keep in nnnd that the circular kneadi)ig, not too hard, brings nourishment and produces health and growth, while muscle kneading reduces fatty sul> stances. 57. Throat massage has proved itself of such ^'alue in cases of sore throat, tonsillitis, and catarrh of the throat and nose, and against rushing of blood to the head, that it ought to be a common remedy in every family. If mothers would apply this method as soon as the children complain of any soreness or pain in the throat and ears, or they are troubled with catarrh, much suffering would be spared the little ones and many a wakeful night and big doctor and drug- gist bills l^e spared the parents. In applying throat massage, stand in front of the patient, who sits or reclines, with his head well back ; put your hands with the palms upon the side of the patient's neck so as to let the edge of your right little finger comei just under the left ear, and the edge of your left little finger under the right ear of the patient; now make a stroke down toward the chest and shoulder over the course of the jugular vein, at the same time THROAT MASSAGE 71 turning your hands with the pahn full a,iL;ainst the throat and neck, and continue the stroke down to the chest. Keep this up for five to ten minutes. In connection with the stroking- of the throat it is often valuable to give circular kticadiii'^ in the same direction and vibration of flic larynx by applying the hand on the patient's larynx, the thumb on one side and the fingers on the other, and, without squeezing, give a rapid vibration, trembling, gradually sliding the fingers forward. Stimulation of the nerves. 58. Head Rotation (Sitting). — The operator places his one hand on the back of the patient's head, and the other hand on his forehead, and slowly moves the head in a circle, five to ten tinres one way, then as many times the other way. Four to five times in ten seconds. This acts on the blood-vessels and nerves ol the neck and throat ; it is a derivative movement from the brain, and has a quieting effect. 59. Head Flexion, Passive (Sitting). — In cases of stiff neck it often becomes necessary to bend the head in the opposite direction, so as to stretch out the contracted muscles, and while they are under stretch centripetal stroking (from head down) and also cir- cular kneading should be applied. CHAPTER IX. Resistive Movements of the Arms. 60. Finger Flexion and Extension. — The pa- tient's -hand rests either on the operator's knee or on the edge of a table, while he bends and stretches all the fingers, and the operator makes resistance. 61. Hand flexion and extension is done by tak- ing hold of the patient's wrist with one hand, and with the other hand resist, while the patient is bending and stretching the wrist-joint. These twO' exercises develop and strengthen the muscles of the forearm, hand, and fingers, and increase the flow of blood to them. 62. Arm Flexion and Extension. — Position as in "forearm" rotation. (Fig. 11.) The patient bends his arm in the elbow-joint as far up as possible, while the operator resists, and gradually gives way, so as to make the flexor muscles, the biceps, contract and shorten to their utmost, whereby the extensor muscles, with their nerves and blood-vessels, are passively extended. Then the patient gradually stretches out the arm, under resistance, so as to make the extensor muscles, the triceps, contract and shorten, and thereby pas- sively extend the flexor muscles, nerves, and vessels. These exercises are "concentric-duplex" and de- velop and strengthen the muscles and also act as an excellent l>lood-propeller to and from' the heart. (72) RESISTIVE MOVEMENTS OF THE ARMS. 73 If the muscles are rather contracted and stiff, the "excentric-duplex" movements should be given in the following way: Position as before, beginning with the ami bent well up; the operator gradually stretches out the armi, while the jxitient makes resistance; the con- tracted flexor muscles are slowly elongated and ex- Fig. 26. — Vertical Arm Flexion and Extension. tended. Then the operator l>ends the arm, while the patient resists, and the contracted extensor muscles are slowly stretched out. The first kind — "concentric" movements — are used alternately, bending and stretching for general exer- cise: while the second — "excentric" movements — should be used either for the elongating of the flexor 74 PRACTICAL MASSAGE. muscles or for the extensor muscles, whichever of them are in need of such exercise. 63. Vertical Arm Flexion and Extension (Sitting). — The operator stands behind the patient and takes hold of both his hands, resisting the patient when he bends the arms close down to the side and stretches his arms to vertical position, "concentric- duplex," in a slow movement alongside of his ears, the elbows being- kept well out to the side. The operator's knee should be pressed against the patient's back with a small pillow between. Repeated from> five to four- teen times. (Fig. 26.) In the extension of the arms, the triceps, deltoid, supraspinatus, trapezius, and serratus magnus are principally at work, and a full passive extension of the pectorals is effected. In flexion of the arms, by hold- Hig the arms well to the side and not allowing them to be pulled forward, the latissimus dorsi and teres major are the chief workers, and the pectorals are kept in a semi-neutral condition sO' as not to contract and de- press the chest. The rhomboids and levator anguli scapuLne draw the shoulders backward ; and the biceps and brachialis anticus bend the forearm. These exercises then are very valuable to strengthen the miuscles, straighten the back, and to expand and deepen the chest. 64. Horizontal Arm Flexion and Extension (Sitting). — The patient's arms are raised horizon- tally and kept well back, with the forearms sharply l>ent upon them ; the operator, standing behind, press- RESISTIVE MOVEMENTS OF THE ARMS. 75 \ug liis chest against the ])riticnt's hack, takes hold of both his wrists (Fig. 27) and resists, wlicn the patient stretches and bends his arms at the ellxjw-joints, "con- centric-duplex." Repeated from five to fourteen times. By keeping the upper amis well back and not allow- ing them to be moved forward, this exercise exerts a Fig. 27. — Horizontal Arm Flexion and Extension. powerful tension on the chest and contraction of the muscles of the shoulder-blades, and neck (the trape- zius, rhomboids, and levator anguli scapukne), and the arms. It is therefore an excellent exercise to flatten round shoulders and round out flat chests, and it is a good respiratory and derivative movement. 76 PRACTICAL MASSAGE. 65. Horizontal Arm Separation and Closing (Sitting). — The operator, standing in front of the patient, who holds his arms straight out tO' the sides, takes hold of his wrists and pulls the arms forward under resistance by the patient, "excentric-duplex." Fig. 28. — Horizontal Arm Separation and Closing. Then the patient brings his arms back to the former position, resisted by the operator, "concentric-duplex." Repeated from five to fourteen times. (Fig. 28.) This is another form of strong contractive exercise for the muscles of the back and shoulders, while it is absolutely passive for the chest muscles, and is very RESISTIVE MOVEMENTS OF THE ARMS. 77 useful in stooping shoulders and many cases of lung troubles, as it has a gooerator stands in front of the :^ Fig. 35. — Backward Leg Traction (Standing). patient and takes hold of both his ankles, resisting, while the patient separates his legs, and ag^ain pulls them together under resistance of the patient. The abductors of the legs, viz., the glutei muscles, tensor .vagin?e femoris, pyrifonnis, gemelli, sartorius, obturator internus, are hereby strongly contracted. 86 PR.\CTICAL MASSAGE. while the adductors are kept passive ; and the exercise becomes a strong one for the hips and thighs and tends to reduce big hips as weh as to draw the blood from the pelvic organs to the surface muscles. 76. Bent Knee Separation and Closing (Re- clining). — The patient, reclining, bends his knees to a right angle, the. feet resting on the bed or chair ; the operator puts his hands on the outside of each knee Fig. 36. — Bent Knee Separation and Closing. (Fig. 36) and resists when the patient separates the knees ; then the operator changes his hands to the in- side of the knees and resists while the patient closes them, "concentric." Repeated four to ten times. Often the movement is reversed, so that the oper- ator separates and closes the knees when the patient resists, "excentric." The feet should be kept firm in their place during the mo^ ing of the knees. RESISTIVE MO\EMEi\TS OE THE LEGS. 87 This brinc^s into play both the aiKhiclors aiul the abihictors and strengthens the liips and thighs, and the iloor of the i>elvis, and by its derivative effect from the pelvic organs is an excellent exercise in diseases of" these organs. jj. Lkg Torsion (Lying). — The i)atient keeps his legs straight and the operator takes iK^ld of the feet and resists while the patient twists his legs out and inward by opening and closing the feet, the heels being kept together. Repeated five to ten times. This is useful in stiffness and weakness of the hip- joint and as a derivative from the organs of the jielvis. CHAPTER XI. Passive and Resistive Movements of the Trunk. 78. Trunk Rotation (Astride Sitting — Pas- sive). — The patient sits astride over a box or stool, while the operator, standing behind, takes hold of the patient's shoulders and moves his trunk from the waist, describing as large a circle as possible, first six to four- teen times in one direction, then as many times; in the other. The patient should be perfectly passive and al- low the operator to move him without resistance, and therefore it would be well to have some person to sup- port the patient's knees. This acts strongly on the portal system of the cir- culation, strengthens the muscles of the waist, and has a cjuieting effect. 79. Tritnk Torsion (Sitting — Resistive). — The patient sits on a stool or lounge, with hands on hips ; the operator, standing behind, puts his right hand on the front of the patient's right shoulder and his left hand on the back of his left shoulder, and resists tlie patient when he twists his trunk to the left (Fig. 37). Then the operator changes his grip, reverses his hands, and resists when the patient turns to the right. Re- peated four to eight times on each side. 80. Trunk Torsion (Kneeling — Resistive). — The patient kneels on a lounge with hands on hips. (88) MOVEMENTS OF THE TRUNK. 89 The operator, staiulini;" behind and lixing the patient's I)ack with one knee, takes hold and resists, as in the former movement (Fig. 2)7) • P)Oth of these movements have a good effect on the spine, the nerves, and circulation; the former has a Fig. 37. — Trunk Torsion (Kneeling). Special effect on the respiration, and the latter on the digestion, by strengthening and elevating the muscles of the abdomen. 8i. Forward Trunk Flexion and Extension (Sitting — Resistive). — The patient, sitting on a lounge or stool, with hands on hips, bends forward, and, Avhile rising up to the former position, the oper- 90 PR.\CTiCAL MASSAGE. ator puts his hand on the patient's back and resists him (Fig. 38). Repeated four to ten times. In this exercise all the muscles of the back are brought into play, and the chest is kept well expanded ; which makes it a good respiratory movement as well Fig. 38. — Forward Trunk Flexion and Extension. as a strengthening to the muscles of the back and a straightening of the spine. 82. Neck Flexion and Extension (Standing OR Sitting). — The operator places his one hand on the back of the patient's skull and resists him when he MUX liMliXTS Ui'" THE TKL XK. 91 l)cn(ls his licad l)ack\varil as far as possible. ReiKatcd five to ten times. This acts on the muscles of the neck and the upper part of the back, and on the* blood-vessels and nerves of the neck and throat. It is a derivative from the brain, and it tends to straighten the upper part of the spine. \\'hen this is given to a patient in hanging position it is very effective in straightening the spine, and therefore exceedingly useful in the treatment of cur\atures of the spine and round-shouldered persons. CHAPTER XII. Corrective Active Exercises of Arms. The correct standing position is most essential and a good method to obtain it is to stand with the back agamst the wall; heels, buttocks, shoulders, and head touchnig; then try hard to make the small of the back also touch the wall,— this will hardly be possible, but the effort is a very gooc^ one to, create a correct position. 83. Stand firmly on both feet, knees straight, without strain.' Hips e^•en in the same plane and drawn well back, so as to keep the abdomen in. The chest raised well forward and expanded. ^ The shoulders even in the same plane, drawn back without being pushed up, and without stiffness. The arms hanging down by the sides in straight • line from the shoulders to tip of fingers, palms^'in toward the thigh. The head raised even on the shoulders, and chin drawn well in. The weight of the body inclined a little forward so as to rest on the balls of the feet, and not on the heels. A line from the crown of the head should fall just in front of the ear, armpit, hip, and knee-cap to the instep. (Fig. 39.) (92) Fig. 39.— Standing Position. Fiff. 42. — Arm Flins:in£? (Sideways). Fig. 44.— Arm Flexion and Extension. Fig. 45. — Arm Flexion and Extension (Upward). ACTIVE EXERCISES OF ARMS. 93 84. Shoulder Circling (three to ten times). — The shoulders are slowly moved upward, l)ackward. dowmvard, and forward, so as to describe a circle, the arms hanging down. Inhale when shoulders go up and backward, and exhale when they go down and forward. I'his strengthens the chest and shoulder muscles, expands the lungs, and' relieves the work of the heart. It increases the flow of blood toward the heart, espe- cially from the brain. Useful in chronic catarrh of the air-passag^e, in wenk heart-action, and in congestion of the brain. 85. Arm Circling (five to twelve times. Fig. 40). — The fully extended arms are slowly moved up- ward, backward, downward, and forward, so as to describe a conical figure in the air, with the apex in the shoulder-joint. Inhale and exhale as in the former exercise. Keep the head erect and motionless, and the chest well expanded. Effects) as the former, but stronger. 86. Arm Elevation — Forward, Upward (se\'en to sixteen times. Fig. 41). — The fully extended amis are quickly raised forward and upward over the head, whereby the fo-llowing muscles are brought into action : The anterior portion of the deltoid, the upper pecto- ralis major, the short head of the biceps and the coraco- brachialis bring the arms to horizontal position; from this the posterior deltoid, the infraspinatus and teres miinor, the trapezius, and also the rhomboids and leva- tor anguli scapula? raise the arms to thes vertical posi- tion. Concentric action. 94 PRACTICAL MASSAGE. NoAV the arms are lowered sloAvly sideways to their original position. Excentric action. Keep the chest well forward, head and trunk mo- tionless. Inhale when arms are raised ; exhale when they are lowered. It expands and elevates the chest and lung's, strengthens the nerves and muscles of the shoulders, limbers the shoulder- joints, and straightens the back. Useful in narrow and weak chest, in weakness of the respiratory organs and the heart, and corrects stooping shoulders. 87. Arm Flinging — Sideways (ten to sixteen times). — The upper arms are raised horizontally, side- ways, and kept well back with the forearms shaq>ly bent upon them in front (Fig. 42). From this posi- tion the forearms are smartly and energetically thrust outward without moving the upper arms ; during this movement inhale, the forearms being again bent for- ward to their former position under exhalation. The muscles used are: the deltoid, supraspinatus, trapezius, levator anguli scapul?e, rhomboids, biceps and triceps, and to some extent the latissimus dorsi. Strengthens the nerves and muscles of the arms aud back, expands and widens the chest, straightens the back and increases the flow of blood to the arms. If this exercise is taken with the trunk bent for- ward (head up) it becomes a very powerful mo^•e- ment for the back. ACTIVE EXERCISES OF ARMS. 95 88. Arm Rotation (ten to twenty times). — Take position as in Fig. 43 ; now rotate, or twist, lx)tli arms in the shoulder-joints so as to bring- the forearms hori- zontally forward, parallel with the lloor and with each other; the right angle in the elbows is maintained, and the upper arms kept in the same height as the shoul- ders, with the chest well expanded. Rotate back to the first position. This is an excellent exercise to straighten round shoulders, as it brings the following muscles into strong action : Infraspinatus, teres minor, posterior deltoid, trapezius, rhomlxDids, levator ang'uli scapulae, and latis- simus dorsi. In fonvard bent position it is very effective. 89. Arm Flexion and Extension (Upw^\rd, Sideways, and Downward). — The foreanns are slowly bent up against the upper arms, the elbows kept close to the sides, the fingers slightly bent and pointed toward the shoulders (Fig. 44). From this position the arms are energetically stretched upward to a verti- cal position a1x)ve the head, the palms facing each other (Fig. 45). The arms are again slowly bent to their fonner position and then quickly stretched hori- zontally sideways, the palms turned downward and arms kept well back. Now bend the arms and stretch them sharply downward. This alternate l)cnding' and stretching to be repeated as' above from eight to six- teen times ; the head and back to be kept upright during the movement, and shoulders well back. Strengiihens the muscles and nen-es of the arms 96 PRACTICAL MASSAGE. and shoulders, widens the chest, limbers the joints, in- creases the circulation of the blood, and strengthens the energy of the heart and lungs. Useful in rheumatism and stiffness of the anns; in weakness of nerves and muscles ; to draw the blood away from the chest and head ; as a means of warming, to prevent taking colds, and to energize the action of the heart. In case of one shoulder lower than the other, stretch the corresponding arm upward and the other arm downward. CHAPTER XTTT. Corrective Active Exercises of Legs. (JO. Leg Elevation — Sideways (five to ten times). — \\ ith the hands placed on the hips, or hohhng on to a chair or a table, raise one leg slowly up sideways; repeat five to ten times with each leg. After some practice the amis may be raised sideways (Fig. 46). Brings into strong action : the glutei muscles, ten- soT \-agin3e femoris, pyriformis, gemelli, sartorius, ob- turator internus, and, as all balancing exercises, has a strengthening effect on the nervous system. It is also useful in weakness of the organs of the pelvis, and to reduce large hips. 91. Leg Elevation (Eorward). — Raise the leg slowly forward as high as possible without bending the body, then lower it slowly, and repeat five to ten times with each leg; stretch the foot well (Fig. 47). Here the abdominal muscles and flexors of the thigh and extensors of the leg are strongly contracted, viz., psoas magnus, iliacus, sartorius, pectineus, graci- lis, gluteus minimus, obturator externus, tensor vaginae femoris and rectus femoris. At the same time the hamstrings and sciatic nerve are passively stretched. Useful in sciatic neuralgia, in stiffness of the joints, in constipation, in weakness of the pelvis, and in obesity. ■^ (97) 98 . PRACTICAL MASSAGE. 92. Leg Elevation (Backward). — With hands on hips, raise one leg backward, without bending the tniiik or knees ; point the toes well back and down ; keep the chest well forward; repeat five to ten times. Later with hands on neck '(Fig. 48.) Contraction of : gluteus maximus, gluteus medius, pyriformis, obturator internus, gemellus, cjuadratus femoris, long head of biceps femoris, posterior part adductor magnus. Also passive stretching of the abdominal and flexor muscles of the thigh. Fine balancing exercise and. to straighten the back and produce an easy and graceful carriage of the body. 93. Knees Bend (Deep). — Raise the heels, then bend the knees slowly way down ; keep the knees well out o\'er the toes ; then straighten knees slowly ; repeat three to ten times; keep chest out and back erect (Fig, 49)- Very strong exercise for the hip-joint extensors and abductors, viz., the hamstring muscles, glutei and tensor fasciae latre ; the quadriceps extensors of the knee; the gastrocnemius, soleus, plantaris and other extensors of the foot. First "excentric," then "concentric." The erector spina: is strongly contracted all through the movement to keep the trunk erect. This exercise therefore is very valuable for the in- crease in size and strength of all these large muscles of the lower trunk and the legs ; to limber the knees and ankle-joints ; strengthen the nerves and muscles ACTIVE EXERCISES OF LEGS. 99 of the loins and alxlomcn ; quicken the circulation of hloocl toward the* leg's, and streng-thcn the organs of the pelvis and the action of the intestines. Useful in weakness of the nerves and muscles of the lower limbs, in sciatica, ix)or digestion, hemor- rhoids, weakness of the pel\-is, curvature of the spine, and! to counteract too strong flow of l)lood to internal organs. 94. Heel Elevation (ten to thirty times). — Keep heels together and raise them, quickly as high as possible without beuding the knees or trtmk, then sink heels slow'ly and raise again ten to thirty times. Strengthens the nerves and muscles of the legs and feet (enlarges the calves), and straightens the back. In case of "flat-foot," raise the heels and turn toes in and heels outward. 95. Charge — or Fall out — Forward. — Right foot is placed forward, leaving a distance of three times the length of the foot between the heels. The forw^ard knee is bent to a right angle and over the foot (Fig. 50). The body is at once advanced so that the back and rear leg, which is kept sraight, are in the same plane (Fig. 51). Head up and both feet firmly on the floor. This movement consists of: flexion and some ab- duction in the right hip-joint ; flexion in the right knee- and ankle- joints ; rotation outward in the left hip-joint ; some rotation to the left of the pelvis ; some twist oi the spine to the right, with a slight bend to the} same side and convexity to the left. 100 PRACTICAL MASSAGE. The psoas, iliacus and rectus femoris muscles of the right thigh raise it ; when the foot strikes the floor the right hip-, knee-, and ankle- joint extensors con- tract to check the flexion in these joints. There is alsb a strong' contraction oi the left glutei, hamstring, and quadriceps muscles, as well as the inward rotators — tensor fascise latse, anterior part of gluteus medius and minimus. The left foot is kept fimily on the floor by the left hip-joint adductors and by the tibialis anti- cus and posticus. The whole erector spinas group on each side is strongly contracted ; the left) external and right internali oblique abdominal muscles, the left ser- ratus posticus superior and right serratus posticus in- ferior, etc., are also brought into strong action ; and z'icc versa when the feet are changed. . The mo'vement is very efl^ective as a general exer- cise as well as in cases of curvature of the spine, using one or the other side according to the case. By stretching one or bothi arms over the head and also bending the trunk forward this movement becomes an exceedingly strong exercise for the back. 96. Horizontal balance — standing (Fig. 52) is another very powerful movement for the straighten- ing and strengthening of the spine and back muscles. 97. "Back-curving/' or prone lying, trunk RAISED BACKWARD (Fig. 53) is probably the best and strongest movement to* counteract double curvature oi the spine, as all the muscles of the back, hip-joint ex- tensors and adductors O'f the scapukne are vigorously contracting. It is also very effective for round shoulders and narrow chest. Fig. 47. — Leg Elevaiiun (^Forward). Fig. 49. — Knees Bend (Deep). Fig. SO.-rharge-or Fall out Fig. 52.-Horizontai MalancV (Standin-) — Forward. '^ Fig. 53. — Back Curving. Fie. 54. — Lefj Elevation CLving-). ACTIVE EXERCISES OF LEGS. 101 But it produces a considerable liiin1)ar hyi^erex- tension, and should therefore always l>e followed by 98. Leg Elevation — Lying (three to eii^ht times). — Lying on the back, first pull Ixjth knees u\) toward the chest (as high as possible) ; then straighten the legs up (h'ig. 54), and lower them slowly to 45 degrees, when they should be bent with the feet rest- ing on the couch. This will prevent the excessive lumbar anterior curve, and should be given frequently in cases of "lordosis." It also strengthens the abdominal muscles and the action of the Ijowels, stretches the sciatic nen-e, and reduces obesity. CHAPTER XIV. Corrective Active Exercises of Head and Trunk. 99. Head Bending — Backward (five to ten times). — The head is bent slowly backward with a strong pull of the back and posterior neck muscles, re- sisted gently by the flexors of the head and neck — rec- tus capitis, anticus major and minor, longus co'lli, sca- leni, and the small muscles numing between the stern- urni, hyoid bone, and lower jaw — or, as we say, "draw in the chin." The two sets of muscles thus working against each other, the posterior in excess ol the an- terior, keeiif the head steady on the top of the cervical spine, produce a straightening of the latter, bind, the two togetlier and make them move backward as one piece. It is valuable for the cultivation of good posture of the head, for impro'ving the muscles o£ the neck, straightening^ the upper spine, and to produce a mod- erate expansion of the upper chest. 100. Trunk Flexion — Backward (Fig. 55). — With the hands on hips the trunk is slowly bent back- ward at the dorsal region, raising and arching the chest and holding the abdomiinal muscles in so as not to bend at the lumbar region, and keeping the legs firm and straight. If done well, this exercise produces a powerful (102) ACTIVE EXERCISES OE THE TRUNK. 103 contraction of all the Ixick nniscles of tiic thoracic spine, viz., trapezius, rhonilxnds, latissinnis dorsi, serratus posticus su])erior and inferior, erector spin;e, sacrolunibahs, spinalis dorsi, semispinalis dorsi, and also by the depressors of the scapula : lower serratus magnus and pcctoralis minor. This again will elevate the ribs. A complete straightening of the| dorsal spine and a considerable expansion of the chest through the stretching of costovertebral, ligaments will ensue. If this exercise is taken with inhalation, which is a good way to teach l>eginners to do the exercise cor- rectly, the following muscles will also be active, viz., external intercostals, anterior i>ortion of "internal inter- costals, levatores costarum, scaleni, sternomastoid, and suljclavius. In such case the l)ackward flexion should immedi- ately l3e followed by the raising of the trunk, wath exhalation. Later on this exercise should l^e practised with hands on neck. Very useful in narrow and contracted chest and round shoulders ; in weakness of the lungs, curvature of the spine, and to produce a correct and upright posture. loi. Trunk Flexion (Forward). — Hands on hips, later on neck, and stretched over head (Figs. 56 and 57), the trunk is l)ent forward from the hips and kept in this position for awhile, w'ith the shoulders and head well back and chin in, the chest well forward and the knees straig-ht. 104 PRACTICAL MASSAGE. This exercise begins with a contraction of the ab- dominal muscles and continues by gravity. Now all the back muscles and posterior hip muscles are con- tracting vigorously to keep the spine straight — the more so, the longer the position is held ; and the same muscles will again raise the trunk tO' the erect position. Very valuable to strengthen the back and straighten the spine. 102. Chopping Movement. — ^Standing with feet apart and arms over head, bend the iDody quickly for- ward and downward, and fling the arms to the floor; then raise the body and bend a little backward with arms and head well back; repeat six to twenty times. This strengthens the nerves and muscles of the back, arms, and abdomen, and increases the action of the organs of the pelvis, as well as the stomach, liver, and intestines. It should be followed by 103. Harvesting Movement (Figs. 58 and 59). — The patient bends the trunk forward. Now fling the arms forcibly from one side to the other and twist the trunk with them ; repeat ten to thirty times. This com]Diletes the effect of the former exercise, increases the circulation of the blood, strengthens the nerves and miuscles; of the chest and back, shonlders, and loins, and is of great value in li^'er and stomach troubles and obesity. 104. Trunk Flexion (Sideways). — The trunk is bent alternately to the left and right, as far as pos- sible without twisting (Fig. 60), first with hands on hips, later on neck or sideways, etc. l"iy". 5o.— Trunk i'lexion (Forward). Fig, 57. — Trunk I'lcxion (Forward). Fig. 60. — Trunk Flexion (Sideways"). Fig. 61. — Trunk Torsion. Fig. 63. — Body Horizontal. ACTIVE EXERCISES OF THE TRUNK. 105 The alxlominal muscles, lower erector spiiKV and olnteiis luaxinnis, giuteus niedius, gluteus niiniiuus, and tensor fjusciic latjc contract to Ix'gin the movement on the left side; then gravity becomes the motor force, while the same muscles on the right side contract "ex- centrically" to hokl the bcxly, until, by shortening, they raise the trunk to the original position and start the movement to the right, when the muscles' on the left beg"in to \vork. Besides being a jxjwerful exercise for these mus- cles, it also acts strongly on the floAv of blood through llie inferior vena cava and the portal system, and therefore is an excellent exercise for constipation and Ii\'er troubles. 105. Trunk Torsion (Fig. 61). — The trunk is turned (rotated) round its long axis alternately to the left and right, without moving the hips, so as to make the whole movement alx)ve the hips with the head immovable with the shoulders. This employs the whole range of rotation in the thoracic spine, and a small amount in the lumbar region, while the cerx^ical spine, the pelvis, the hii>-, knee-, and ankle- joints reniain fixed in the funda- mental position, by a strong muscular effort. The oblique alxlominal and back muscles are di- rectly concerned in this movement: and practically all the muscles of the hips and lower extremities, includ- ing the inverters of the feet, contract in the effort to fix the pelvis and legs. It is a strong abdominal exercise, and probably a 106 PRACTICAL MASSAGE. better "reducer" of obesity than any of the former; and owing to the strong contraction of the tibiahs anticus and posticus and plantar muscles, it is also strengthening- to^ the arches O'f the feet. io6. Trunk Circling (three to eight times).— With the hands on hips and feet apart, bend the trunk forward, then to) the left side, then backward, then to the right and forward, describing as large a circle as possible from the waist. The trunk should not be twisted, but kept square to the front throughout the whole movement, the chest well expanded,, the hips, shoulders, and head steady, and the legs straight. When the circling has been done from three to eight times in one direction, it should be repeated as many times in the other. The effects of this movement are to strengthen the muscles of the abdomen, the sides, and back ; limber the back and loins, stimulate the spine and its nerves; assist the action of the liver, stomach, kidneys, and intestines, and to increase the oortal system of the circulation. 107. Trunk Elevation (Lying) (Fig. 62). — The patient, lying on a lounge or bed, with his legs hanging down, raise his body to a sitting position, while somebody holds down his knees ; or it may be practised sitting on the floor or a stool, Mnth the feet held under a bureau, etc., and the body raised and lowered according to the strength of the patient. The movement should be done only at the hips, without any lumbar hyperextension ; the back straight, the head well back, and) the chest expanded. ACTIVE EXERCISES OF THE TRLXK. 107 The flexors of the hip-joint, viz., the ps^>as, ihacus, sartorius, and pcctineus, are here stroni^ly contracted, which again demand a vigorous contraction of the abdominal muscles. The upper back muscles nmst also be well con- tracted in order to hold tlie 1)ack straight and chest expanded; otherwise the upper part of the body will Fig. 62. — Trunk Elevation (Lying). be "curled," the shoulders and head drawn forward, and the chest depressed, which would result in a very faulty position. When properly executed, this movement is one of the most powerful abdominal exercises, and gives ex- cellent training in the kind of muscular control required for a good carriage of both the upper and lower parts of the body. 108 PRACTICAL MASSAGE. Care should be taken to begin gently, and never to allow "tremors" to appear. io8. Body Horizontal on Toes and Hands (Fig-. 63) or on the Bent Elbows and Toes. — • Keep the whole body in one horizontal line for a few seconds ; then rest by lowering the trunk to the floor, and again raise up to the first position. Repeat two to six times. Elffects a muscular contraction of the front part of the abdomen and pehis ; ^■iscera gravitate forward ; the chest is expanded, and elevation of internal organs results. The blood is drawn into the anterior portion of the bo'dy, away from the spine. Useful in prolapsus of the uterus, vagina, or rec- tum, and in obesity. CHAPTER XV. Stiffness of Joints and Tendons. From Dr. Schreiber the following is quoted: — "It not infrequently happens that, after arthritis, thickening of the periarthritic structures or even adhe- sion of the articular surfaces themselves may occur, leading to very considerable disability of motions. Only by mechanical means can we then hope toi break up the existing adhesions, to smooth the roughened articular cartilages, and to restore tO' the ligaments their fonner suppleness and elasticity. "All the mechanical interferences used — pressing, stroking, kneading — as well as the passive exercises — must be performed with the greatest care, since it is quite pe (109) 110 PRACTICAL MASSAGE. gently rubbed, using' in the beginning the finger-tips only; later, the force may be increased. "As soon as the part has, in a measure, become accustomed to the pain, the passive motions suitable to the joint may be begun. "The adhesions existing within and around the joint may be of so firm and resistant a nature as to readily lead to the belief in the existence of lx)ny ankylosis. At first the amount of motion obtained in the joint will be exceedingly small, but even with this we will be bound to rest satisfied, for an increase of mobility often does not begin for months ; in the mean- while the patience of both physician and patient will necessarily be put to a severe test. Nevertheless, keep- ing in mind the old saying, .that 'constant dropping wears away the rock,' troatment must be continued steadily and systematically. "The astonishing results which experienced me- chano-therapists often obtain in cases declared incur- able by others can often be explained by the consistent and methodical treatment which they pursue. "The knee-joint is very often the seat of extensive synovial exudation in consequence of chronic' rheuma- tism. Resorption is to be effected as in synovitis in general, namely, by centripetal stroking, pressing, and kneading." The following is an interesting case of stiffness, of the right shoulder which I treated a few years ago^: — A rather feeble lady, about 45 years of age, was struck on her right forearm. There was no fracture STIFFNESS OF JOINTS AND TENDONS. m nor sprain, but the arm was kept in a sling for two months. Then the lady found that she could hardly move her arm at the shoulder-joint. The adliesions were broken up. During the oi>eration the slioulder was mechanically dislocated and reset. InHammatory adhesions followed, and the operation was rei>eated with no better result. The joint was stiff, with great inflammation of the deltoid and the adjacent nerves and tendons, and so tender and sore that it could not be touched when the ph^-sician prescribed massage. The patient being under the influence of an injec- tion of morphine administered by the physician, the writer was enabled to apply treatment consisting of centripetal kneading and stroking. After a few days the injection was discontinued and passive motions were applied, in addition to the manipulations. Two weeks later active and resistive movements were used. After two months' treatment the patient was well. My method now in treating- stiff joints is to put the contracted nmscles on a passive, but strong ex- tension and, while holding them in this position, apply centripetal stroking, quite hard circular kneading, and vigorous vibration on the extended contracted parts ; also muscle kneading and percussion on the antagonists so as to make them stronger. I have found that in most of these cases — after the inflammation had left — the more strength the operator can use in bending and stretching the joint passively, thei quicker it wdll be well ; but, of course, care must be taken not to over- do it or to fracture some bone, ^^'e must find out 112 PRACTICAL MASSAGE. exactly which muscle or muscles are the contracted ones and which are the weak ones, and treat themi ac- cordingly. Sometimes we find, after we have been treating- a joint-affection qnite roughly for weeks and months, that neuritis has set in, and then the treat- ment must be altered altogether, otherwise we shall gO' from bad to worse. Neuritis, as will be seen later, is to be treated very gently and not with centripetal strokings and kneading^s. As soon as the patient is able, he should be encour- aged to move the jonit, and be given resistive exercises for the weak muscles ; thereby he, himself, passively stretches the contracted muscles. One great mistake is often made by masseurs, viz., to apply massag-e too long- at a time. IMuch harm may te and has been done by long treatment, while no hann will ever occur by too short a treatment. It is safer to make it tooi short than too long, especially if the treatment is strong and vigorous. Ten to^ fifteen min- utes suffice; sometimes even less will be better. Remember that moderate muscle kneading and percus- sion make muscles contract and become stronger, while circular kneading — especially strong — and vigorous vibration loosen the muscles, and still more so' when the muscles are kept on the "stretch." At times it is necessary to lift some muscles either by one hand or by certain positions on the part of the patient, and with the other hand, or fingers, knead under and aronnd them to break up adhesions ; but all these different manipulations must be seen or learned by long experience. SPRAIXS. SYNOVITIS, ETC. 113 I could give hundreds of cases which I have treated with good success by thi's method ; but my success at the chnic in Boston City Hospital, which has gained the appnnal and praise of the head surgeons there, must be enough to prove the merits of my methoe touched ; all the massage is to be above and below. Of course, there are cases when massage had better not be used. For instance, if a muscle is ruptured throug'h over- work, it should be "plastered" up till it is healed; then gentle kneading may be good. The most cases of sprains which are treated with massage stop too' soon. Especially is this the case where the sprain is an old one. Here the muscles have become very weak through the long inactivity. There- fore, whenever a sprain is seemiingly well — that is, pain is gone — passive rotations, flexions, and exten- sions should be applied; and also' resistive movements to make the muscles strong again, and even stronger than before, so they will not allow of any more sprains to that joint. Persons who' frequently "turn" the foot do this SPRAIN'S, SYNOVITIS, ETC. 115 because the ligaments arc "slack," and as we cannot niake tliein shorten, we must make the muscles strong enough, to act for the ligaments as well. Old sprains, when the inflammation has disap- peared, are treated like stiff joints, often with great force. Syjioz'itis is best treated with centripetal stnjking above the diseased part and, better, ten minutes twice a day; then not so frequently. These different traumatic cases, when; no fractures occur, if treated early and by an expert, will most frequently be cured in quite a short time, while if they have been allowed to go on for months and even years, this treatment will still prove to be most effective, and on the average in these old cases a cure may be ef- fected in from one to three months. Other joints are treated on the same plan. The hip- and shoulder- joints are more difficult to treat and require a much longer time in order to pro- duce a cure. The following-cited cases are especially note- worthy : — Ca.se I. — A gentleman, 36 years old, sprained his right ankle by a fall, and had been on crutches for eight months, when he came for treatment. There was no flexibility of the ankle, which was very tender and swollen. After six weeks' treatment once a day the patient was cured. Case IT. — A young lady had come to Washington to attend the inauguration of one of the Presidents. 116 PRACTICAL MASSAGE. Three weeks before, she shpped on the icy pavement and sprained her right ankle. She was laid up, and all sorts of liniments, etc., were prescribed by her physi- cian. After ten days he told her that there was noth- ing more to do but to keep quiet for two or three months, when she probably would be well. At this point I was called in, and the young lady told m:e, with tears in her eyes, why slie had come to the city, and that now she was told that she would have to be cjuiet in her room for months, and she implored me to do my best. The ankle was still black and blue and very m;uch swollen, and the pain did not allow of touching the parts. After the examination she was informed that she would pro1>ably be well in ten days if treat- ment was applied twice a day. To this she was only too glad to consent. The treatment was given twice that day. The next day the most of the discoloration had disappeared, and now she was told to walk a little at a time in her room. The improvement was remarkable from day to day. The ninth day after, the seventeenth sitting, she was cured, and went to the inauguration ball on the tenth day. She had no relapse. Case III. — About two years ago one of my assist- ants sprained his left ankle in a gymnasium. He was brought home by his friends and told to be quiet in bed. He kept on all night bathing the leg with hot and cold water, and came next mo'ming to> the Insti- tute. The joint was slightly dislocated, the foot was SPR.\IXS, HYDRARTHRUS, ETC. 117 turned upward and inward, and twice as large as usual. The patient was a strong young man, so that I at once went to work and succeeded in getting the joint straight, after which a full treatment was applied. .Vfter four days' treatment, twice a day, the young man was well. Prof. Dr. J, Nicolaysen, of Christiania (in Norsk Mag. for La-gczndenskab, 1874), communicates the following case of hydrartJints ( water on the knee) : — "A man, 32 years old, had suffered from hydrar- tlirus for six and one-half years. Repeated punctures and evacuation had ahvays been follow^ed by a re- accumulation of the fluid. "Massage was used for several months, and the patient returned to his work. There was no relapse." Another gentleman, 26 years old, had suffered from hydrarthrus for two months, when he came to the same professor, who sent him toi me, at that time in Norway. After two w'eeks' treatment the collection of fluid in the knee-joint disappeared, but the swelling of the capsule continued. After five weeks' treatment the patient was well. AMienever massage is applied to a leg after an acci- dent, it is best to begin with vigorous centripetal strok- iugs at the inside of the thigh; or if it) be the arm. make the same kind of strokings on the inside of the upper arm, as this will, quicker than any other manipu- lation, produce absorption through the big veins from the diseased part. 118 PRACTICAL MASSAGE. I have always found that the quickest way to cure sprains or bruises is to bathe with hot water immedi- ately after the accident for half an hour or more, and then apply the massage oboz'e the sprain, until it will allow of being touched with gentle strokings, which gradually should be increased in force ; then a circular kneading on and around the sick parts with the fingers of one hand, while the other hand is continuosly strok- ing upward. Even in fractures it will be of great value to use the hot water, and centripetal strokings above the frac- tured parts, which will reduce the swellings and enable the surgeon to set the bones with more accuracy. CHAPTER XVI. Flat-foot. ("Morbid condition of foot in ivhich the arch is destroyed." ) This troii])le has grown very marked the last twenty-odd years, iuid many theories are advanced, and espe,cially have the orthopedic surgeons insisted that the habit of standing and walking with the toes turned out is the chief cause of this malady. In this I cannot agree; and although I am not a surgeon, I still believe I have some right to my opin- ion — having taught gymnastics to hundreds of thou- sands, boys, girls, and adults, and treated many hun- dreds in the last forty years. The surgeon says : "These patients come to me invariably with the feet turned abnormally out; they are fiat-footed, and I tell them to practice standing and walking with their feet parallel — even turned inward — which relieves them and helps to cure them." Very well ; but supposing a physician orders a pa- tient to take stiychnine, are we tO' understand that he is tO' do so all his life, or even that other persons must take it because it cures in some cases? My theory is, that it was the broken-down arch which made the foot turn abnormally outwird, not the reverse. (119) 120 PIL\CTICAL MASSAGE. Who are those who mostly suffer from fiat-foot? They are saleswomen and nurses; and wdiy? Because they have tO' be on their feet all day (most frequently in poorly fitting- shoes) ; their feet tire, and they begin to walk with stiff ankles^ — no- foot action ; consequently all the muscles are weakened and cannot do their work; they "give," and the pressure on the arch of the foot being nO'W unbearable, the foot gradually turns O'Utward. And this is what the surgeon sees; but he did not see this patient before she was taken ilk when her foot in ninety-nine out of a hundred cases was normally turned. Of course, if it was an abduction of the foot in the ankle, which made us turn our feet outward in stand- ing, I would- say "the surgeon is right;" but the gym- nastic standing position with the toes turned out is done by a rotation of the thigh at the hip^joint, and we insist that the toes shall always be in line with the patella, and there is no^ danger for the arch of the foot as long as the muscles are kept strong and active. There is another cause why women suffer so- much more with the malady than men, namely, because they are naturally "knock-kneed," this puts a heavier bur- den on the arch of the foot. If people would be careful about always keeping the toes in line with the knee in walking and standing, in g\Tnnastics and dancing, and exercise their ankles, as well as having shoes comfortable and well-fitting, we should see much less of these troubles. The crusade which has been going on for several FLAT-FOOT. 121 years and whicli has resulted in nnsi^^litly. awkward p()siti(Mis of the feet in many sehouls, in this eountry will ultimately lead to a nation of l)ow-lei;"j:;"e(l men and wonren. ( )ne argiiment nften used is, that the Indians st.and a.nd walk with toes strait;ht ahead — iJicrcfovc it is natural! A\'ell, the mountaineers of Norway walk with their feet abnormally out to Ijetter climl> the mountains. In either case it is the condition which has made them as they are. We have alsoi been told that our "forefather." the "monkey," keeps his feet (rather hands, th.ough ) turned inward — that it is natural and we must do the same. There are very few people nowadays who care to "ape" the monkey; we will rather keep a big distance. Sometimes we find some girls in the gymnasiums suffering with "flat-foot," and it is rather strange that there are not many more of them. These voung ladies ha^•e for many years been wearing hig'h shoes with high heels, and now^ they are suddenlv forced to wear gym. shoes without any heels for three to five hours a day. No wonder that they suft'er. These people shonld be given small heels inside their shoes. I have had great success in treating /7o/-/oo/ with massage and a few simple exercises, as follows : — 1. Centripetal stroking of foot and leg to knee. 2. IMuscle kneading of foot and up the inside of the leg ; also percussion. 122 PRACTICAL MASSAGE. 3. Foot rotation. 4. Foot flexion inward and upward, with resist- ance. 5. Foot extension wnth resistance. 6. Again muscle kneading, percussion, and stroking. This ought to be given every day, or at least every other day ; and the patient should take some exercises at home morning and night : — 1. Sit and rotate her foot actively. 2. Turn the foot inward and upward and resist with her hand. 3. Stand and raise on tip-toes and at the same time turn toes in and heels out. 4. Deep knee bending. 5. Sit or stand and try to pick up a marble with the toes. 6. Centripetal stroking of foot and leg. CHAPTr:R XVII. General ]\Iassage has within the last thirty years become of such great importance in the treatment of many kinds of ills that I ^\•ish to take it up as a special branch of massage. Thirty years ago it was hardly known in Europe, and even to-day we hear the young masseuses, who have recently come over from Sweden, saying that they don't like to give "general" massage and don't care for such cases. The real reason is that; they have not learned that kind of massage in Sweden. They have had a thor- ough course in medical gymnastics and local massage, but not in general massage, and because the American people have come to look to every Swede as a natural masseuse, \\hich, however, is a great mistake, these inexperienced young ladies put on the air of authority and knowledge and scorn the idea of giving general massage. My advice to all newcomers is to learn general massage as quickly as possible, and also to learn how American patients are treated, and even to take a sh(^rt course of study here before they visit the physicians with their cards. There was a time when "graduated from Sweden" was the best possible recommendation on a card, but (123) 124 PRACTICAL MASSAGE. that time has passed, since we have just as good schools right here, where the theory is broader and the practi- cal work even more practical. It is true that general massage is often used when medical gymnastics with some local massage would do more good. But when the customer (I can hardly call her patient) prefers the "massage" as a mode of exer- cise which she enjoys and therefore also finds it bene- ficial, I think the masseuses ought to be thankful that there are so many well-to-do' women who are willing to employ them. General massag'e is of great benefit in cases where the patient is unable to sit up, either from sickness or weakness, or overtired mentally and physicall)^; and it certainly also is a great remedy to "toaie up" the sys- tem and to help the society lady to keep up her social duties. Dr. J. Schreiber says : "In the treatment of neuras- thenia and its allied affections, hysteria and hypochon- dria, we seek to attain a threefold end. First, to re- generate the mass of blood as a whole ; secondly, to combat indi\idual symptoms; and, thirdly, to favor- ably influence the mental state. "Beard, who claims for neurasthenia that it is a new and especially American disease, considers massage treatment as not only essential, but absolutely indis- pensable, for those casesi whicli it seems advisable to confine to bed." Dr. Vieh Mitchell says, in his "Fat and Blood," that he has applied massage to deprive rest of its evils. GF.XKRAL MASSAGE. 125 Amid all the numerous mdrhid manifestations ac- companying neurasthenia, hyperesthesia and muscular weakness are probaly the most prominent, so that Arndt has declared the nature of the disease to con- sist in increased irritability, with rapid tendency to fatigue, especinlly of the muscular system. In neurasthenia, all the morbid processes occurring in the muscles are more rapidly influenced by move- ment treatment than by either hydro- or electro- ther- apy. Of all symptoms, the various hyperesthesias (excessive sensibility) most frequently engage the physician's attention. These are generally regarded by the friends as founded either on exaggeration or upon affectation. Patients complain of muscular pain, especially in the extremities and back, and of pains along the spinal column, the latter being, indeed, considered quite char- acteristic of the disease ("spinal irritation"). Besides these, neurasthenics suft'er from the great- est variety of symptoms referable to the brain, as head- ache, and a feeling of weight or constriction in the head, eye, and ear, photopsia (sensation of light), scotoma (dark spots in the vision), roaring and ring- ing in the ears, hypersensitiveness to odors, and other similar idiosyncrasies. Or there may be liability to sudden changes of temper, or to depression and sad- ness, or dizziness or insomnia may exist. Indeed, the large number of various feelings of apprehension ex- perienced in neurasthenia has been the occasion for the'manufacture, bv various authors, of anv number of 126 PRACTICAL MASSAGE. "phobias.". The restlessness sO' often seen in these- patients is caused by the pains occurring in various muscle groups. The "general massage" of the whole body will be found the most effectual in banishing the various anes- thesias and hyperesthesias, while passive rotation, flex- ion, and extension cause a stretching of the nerves contained within the muscles, which reacts most favor- ably upon the mental state. Prescription I. 1. Legs — centripetal stroking, kneading, and circu- lar friction. 2. Arms — centripetal stroking, kneading, and cir- cular friction, 3. Chest kneading and friction. 4. Stomach kneading and friction. 5. Back kneading and friction, 6. Head friction. If the patient has high blood-pressure, begin with chest and stomach ; then legs, arms, back, and head. This treatment, should be applied daily, and even twice a day, until the patient has gained some strength, \\'hen it will be advisable to increase the treatment. In order to give a good treatment the operator should be of a good disposition and cheerful, neat, and healthy; finger-nails fairly short and well taken care of. First, see that the patient is in a coirrfortable bed, preferably a single bed or a couch ; then gO' to the bath- GENERAL MASSAGE. 127 room and wash the hands and bring a towel with you to the patient's room, sit down l>esi(le the bed with the towel in your lap, and let the patient's foot rest on it while you api)ly the massage up to the knee. Now put the foot back in bed and treat the rest of the limb — from the knee to the hi^) — while it is lying in Ijed. A good masseur can apply this treatment on the bare skin without exposing the limb. Then move over to the other side and massage that leg. Next take the arm on the same side and rest the hand in your lap while you work the whole aruT and shoulder. Again move your chair to the first side and treat that ami. Then the chest and abdomen, and help the patient to turn over, face down, the chin resting on the hands, Avhile you treat the back. Again go and wash your hands l^efore you apply head friction and strokings do'wn the throat. Remember that the more comfortable the operator is the better treatment is he, or she, able tO' give. Do not stand up more than absolutely necessary, or you will soon feel that you have a back. The idea that a masseur or masseuse must be big and very strong is a mistake. If they only know Aotc to do it and how not to exhaust themselves, but 1>e calm and quiet, they will often do much better than their big sister ; of course, some strength in arms and hands is needed, but that will soon come with the practice. In massage treatment it is very essential that the patient take "a liking" to the operator and her treat- 128 PRACTICAL MASSAGE. nient, as that will further the impro'vement very much. On the other hand, if the patient docs not like the operator, her mind will work ag-ainst the treatment, and often "the massage" has been said to be a failure, ^^'hile it really was the person giving it who was unsuccessful. Further, remember that there are many kinds of manipulations and- different movements, and if any of the kinds you are giving- seenrs to disagree with the ]>atient, or she dislikes it, change it with some other which mav have about the same effect. In general massage it is not advisable to force unpleasant move- ments on the patient. Neither is it necessary to use any kind oi ointment ; it is even better not to use it, unless the physician in charge prescribes it for some curative reasons. As a rule, ointment should only be used in local massage where vigorous strokings are necessary, so as not to take the skin off. Prescription No. i is to be given to^ all new patients and those who are weak and delicate, but the treatment should be gradually increased in strength and in num- ber of moA'ements. After a while — four to eight days — add "thigh rotation" after the first manipulation; in a few days more give "arm rotation" after No. 2 ; then give "foot rotation" single, and "forearm rota- tion," and "hand rotation." When the patient has had about two or three weeks' treatment, use: — GENERAL MASSAGE. 129 Prescription II. 1. Leg's — centripetal massage. 2. Thigh rotation — passive. 3. Foot rotation — single — passive. 4. Legs — nerve compression, muscle rolling, slap- ping, and friction. 5. Amis — centripetal massage. 6. Ann rotation — passive. 7. Forearm and hand rotation — passive. 8. Arms — nerve compression, muscle rolling, slap- ping, aud friction. 9. Chest' — kneading, slapping, vibration, and friction. 10. Stomach' — kneading and friction. 1 1 . Back — massage. 12. Head friction (or if needed — head n?assage). Keep this up for some time, then add "leg flexioo and extension," and "upward knee, traction" after No. 2: and later "ann flexion and extension" (resistive) and forearm rotation ; and still later "chest lifting and vibration" after No. 8. \\'hile we add more and more movements we grad- ually shorten the length of the centripetal massage, till we finally have the patient up and out of b^d and stop the centripetal massage entirely. Tn the l>eginning centripetal massage is most effec- tual, liecause there is alwavs a great deal of waste 1 Chest and stomach first in cases of high blood-pressure. 9 130 PRACTICAL MASSAGE. matter which must be absorbed quickly ; but after some time the other manipulations and movements are more necessary and will dO' more good. And it is a great mistake to keep a patient with neurasthenia or ner- vous prostration on the same kind of massage for weeks and months. Their treatment should be pro- gressive from, week to week, and as soon as the patient is able to be up and out of bed the exercises should be changed to Prescription III. 1. Forward arm rotation — sitting — passive. 2. Foot rotation — double — reclining — passive. 3. Trunk rotation — astride sitting — passive. 4. Vertical arm flexion and extension — sitting — resistive. 5. Leg flexion and extension — reclining — resistive. 6. Chest slapping — standing — passive. 7. Arms^ — nerve compression, rolling, slapping, and friction. 8. Legs — the same — reclining. 9. Stomach- kneading, vibration, and friction — reclining. 10. Back percussion — standing. 11. Head massage^ — sitting. "High Blood-pressurf/'' and "Arteriosclerosis." In treating persons with either of these maladies Dr. H. V. Barclay, of New York, has for some years 2 Stomach first in case of high blood-pressure. HIGH BLOOD-PRESSURE. 131 applied a sort of circular kneading with the palm and "heel" of the hand oil ivcll-strctchcd muscles; and he has had great success. Personally I have practised this method more or less the last few years with satisfaction; and I have also had an exi>ert physician to take the "blood-pres- sure" of some of my patients before and after treat- ment, with the average result of a decrease of 9 mm. The modus operandi is as follows: The patient lying straight on his back, with a small pillow under the shoulder-blades, head and shoulders well back on the bed, so as to keep the anterior muscles of the body on a good passive "stretch." Now give a few centripetal strokings of the throat and light circular kneading with the whole hand on the pectoral muscles, and some strokings from, the middle line of abdomen outward. Next, have the pa- tient lying on his side (say left side), pull right arm backward and perfectly straight at the elbow, bend hand backward ; in this position knead front of shoulder and all the flexor muscles of the arm with the palm, or "heel," of your hand, beginning at the shoulder and gradually work downward, taking care not to "stroke" against the venous current. Now bend the ann over and in front of the pa- tient's head to put all the extensor muscles on the stretch and knead, beginning at the cendcal and dorsal spine and work toward the hand ; finally raise the arm well over the head and work down the latissimus dorsi. Bend the right knee well up against the patient's 132 PR.\CTICAL MASSAGE. body and knead the buttocks and back of the thigh; then pull the leg backward and knead front of the thigh ; bend the knee and knead front of the leg ; straighten the leg and bend the foot and knead the calf. When both sides have been manipulated, have the patient on his stomach and give a few frictions down the back. The whole procedure should not occupy more than fifteen to twenty minutes. CHAPTER XVIII. Hysteria and Hypochondria. These affections are, according to Arndt, quite impossible to separate from neurasthenia. He con- sidered the numerous temis of different authors — such as spinal neurosis, spasnTophilia, spinal weakness or irritability, neurosism,, erethism, and others — to be but different names for one and the same condition. The different writers seem, however, tO' be of the opinion that it is impossible to permanently cure this condi- tion, and that no medicaments exist capable of per- manently allaying the irritability of the hyperesthetic nerves. Nevertheless, a daily course of carefullly system- atized exercises will always be of great value to these patients. Several of the active exercises- will be good. When the masseur can get the hysteric woman to work hard and to enjoy the exercises, he will be able by moral strength of character tO' effect a great change in her mind, and a steady iuTprovement, although slow, may be looked for. It is the same with the hypochondriac man. Give him some hard work and try to gain his confidence and also tO' get his mind away from himself, and the mas- seur will accomr)li=:h wonders. But, of course, these are tryins- cases which require a good deal of patience and tact to be able tO' do' anjrthing with them. C133) 134 ' PRACTICAL MASSAGE. The prescription of exercises should be made with special attention to the ills complained of and a gen- eral exercise for muscles and nerves. Chlorosis and Anemia. The character of these diseases is weakness, there- fore it may seem strange tOi treat them with exercises. To apply fatiguing movements would also be as absurd as to prescribe weakening medicines, but by stimu- lating and strengthening movements re-establishment may be accomplished. The muscles being the chief site of chemical change occurring in the body, stimulating and increasing their action leads to increased oxygenation of the blood ; to greater combustion oi oxygen and elimination of car- bonic acid : to increased metabolism and consequently tO' greater desire for food and tO' better digestion ; to production of more and better blood; to improved nourishment of the nervous system: ; tO' an increase, both in number and strength, of the mnscle-fibers ; to the endowment of the whole body with vigor and elasticity, and to a consequent revival of all the mental faculties. In dilorosis and anemia the blood-vessels are both thin-walled and of narrow caliber; therefore, active and resistive movements should be used which stimulate cardiac activity and increase the blood-pressure. The augmented hemic oxygenation thus brought about leads both to an increase in the number of red corpus- cles as well as of the amount of hemo'srlobin contained CHLOROSIS AND ANEMIA. 135 in each. At first, owing to the general lassitude from which chlorotics suffer, the movements will have to l>e of a very gentle nature. Although there may be a little difference in the treatment of two different persons, it should always be directed so as to restore the digestion, circulation and respiration. In the first two or three weeks the following pre- scription would be most acceptable : — Prescription I. 1. Shoulder rotation and chest lifting — sitting. 2. Foot rotation — double — reclining. 3. Stomach vibration — reclining — knees bent. 4. Forward arm rotation — sitting. 5. Trunk rotation — astride — sitting. 6. Knee flexion and extension — sitting — resistive. 7. Stomach friction — lying. 8. Back percussion and friction. The first movement is a respiratory one; the chest is expanded, the inspiration becomes deeper and is fol- lowed by a stronger expiration. Thus a greater amount of o^xygen is taken and waste matter given off. This must stimulate the functions of the organs and thus accelerate the process of renewal and an exchange of material in all parts of the body. The second movement equalizes the circulation by increasing the flow of blood tO' the feet. The third movement has a direct effect on the stom- ach, and will improve the appetite and the digestion. 136 PRACTICAL MASSAGE. The fourth movement is a respiratory one and has a similar effect as the first one. The fifth movement brings the muscles of the waist and bowels into play, and acts on the circulation, espe- cially in the portal system. The sixth movement has a strengthening effect on the flexors and extensors of the legs and promotes the circulation. The seventh movement promotes operations of the bowels. l"he eighth movement has a stimulating effect on the nerve-centers. When the prescription has been applied for a while, and the patient has improved in strength, the treat- ment may be changed in force, but according tO' the same principle. Prescription II. 1. Forward trunk flexion and extension — sitting — resistive. 2. Foot flexion and extension — double^ — reclining — resistive. 3. Trunk torsion — sitting — resistive. 4. Vertical arm flexion and extension — sitting — resistive. 5. Forward trunk elevation — lying — active. 6. Leg flexion and extension — reclining — resistive. 7. Stomach friction — lying. 8. Breech beating — standing. 9. Back percussion and friction downward — stand- ing.. INSOMNIA. 137 If the patient is very weak and hardly able to walk about, she should lie down on a lounge and have the foiiowmg manipulations applied to her: — 1. Back percussion and friction downward. 2. Foot rotation — double. 3. Arm vibration. 4. Leg nerve compression. 5. Stomach vibration. 6. Breech beating and vibration at the end of the spine. 7. Leg vibration. 8. Spinal nerve compression. g. Head percussion and friction. Insomnia. Of the numerous cases of insomnia which have couTe under my observation, the following-described one was considered by the attending physicians to be exceedingly dangerous, and one in which the patient was so weak and irritable that the greatest care and gentleness were imperative. On one occasion I was called to see a gentleman, 40 years old, who had been without sleep for three weeks. He was very weak and' complained of great pain in the back, legs, and wrists. He was. very ner- vous and irritable, and had no appetite. The first two days only the following movements were applied : — I. Arms — friction — downward. 138 PRACTICAL MASSAGE. 2. Legs — friction — downward. 3. Back friction — downward. 4. Head friction. The patient had some sleep the first night, which was increased a httle every following night. The third day the treatment was increased as fol- lows : — 1. Stomach friction. 2. Arms — nerve compression, rolling, and friction. 3. Legs — nerve compression, rolling, and friction. 4. Chest friction. 5. Back kneading and friction. 6. Head kneading and friction. The force of the manipulation was increased a little every day. The seventh day the following treatment was ap- plied : — 1. Stomach kneading and friction. 2. Legs — thigh rotation. 3. Arms — arm rotation and hand rotation, 4. Chest lifting and vibration. 5. Chest slapping, kneading, and friction. 6. Arms — nerve compression, rolling, and friction. 7. Legs — nerve compression, rolling, and friction. 8. Back kneading, vibration, percussion, and fric- tion. 9. Head percussion, kneading, and friction. After two weeks' treatment the patient slept the whole night, and he did not complain of any pains, and INSOMNIA. 139 accordingly resistive movements were added to the former ones in tlie following manner: — 1. Stomach kneading and friction, 2. Legs — fcxot rotation — doiiI>le — passive. 3. Arms — rotation and hand rotation — passive. 4. Chest lifting and vibration. 5. Chest slapping, kneading, and friction. 6. Arms — flexion and extension — resistive. 7. Arms — nerve compression, rolling, slapping, and friction. 8. Legs — flexion and extension — resistive. 9. Legs — nen-e compression, rolling, slapping, and friction. 10. Back kneading, vibration, percussion, and fric- tion. 11. Head rotation — sitting. 12. Head percussion, kneading, and friction. One month after the treatment began the patient was well. It is astonishing how quickly relief and sleep can be effected to seemingly sleepless patients by light fric- tions d ozi'uzcard , and also by long and deep inhalations. Time and time again I have been called in the middle of the night to apply such treatment to men of high standing and great mind. Indeed, during my practice in Washington I frequently had to shut off the light in the W'hite House, telling the officers at the door, as I left, that the President was asleep. 140 PRACTICAL MASSAGE. Diabetes Mellitus has often been treated with massage and exercise. It has been shown that a large percentage of these cases occur in corpulent individuals belonging tO' the richer classes of society, and that an inactive mode of life, affording but little bodily exercise, combined with ex- cesses in diet, are favorable predisposing causes. Among the commonest sympoms are muscular weakness and its accompanying fatigue, due to the insufficient nourishment which the saccharine blood affords the muscles. Cantani holds diabetes to be due to a metabolic anomaly, in which both the sugar ingested and that formed in the body from albumins, is not destroyed as is normally the case, and hence reappears in the urine. All physiologists agree on the muscles being the prin- cipal seat of metabolism, and Zimmer reasons as fol- lows : "Liver and muscle both contain glycogen, a fer- ment, and water — the three elements necessary for the formation of sugar. The proportion of glycogen and ferment are relatively constant, while that of water is variable. If the amount of water be permanently in- creased, a continuous fonnation of sugar in these organs occurs, and diabetes results. "Where the diabetes is of hepatic origin the liver will be in a state of constant hyperemia." Active exercise, however, causes a diminution of the amount of blood in all internal organs through de- termination to the muscles, and the oxidative processes DIABETES MELLITUS. 141 taking place in the latter result in the combustion of niiicli of the suiiar contained in the blood. Thus in. diabetics who indulge in little or no exercise accumu- lation of sugar necessarily occurs. ZimnTer is convinced that persistent exercise, in- \olving all the large muscle groups, is capal)le of en- tirely curing hepatogenous diabetes in many cases, and much improving the condition in others. Prescription I. 1. Back percussion — standing. 2. Foot rotation — double^ — reclining. 3. Horizontal arm t^exion and extension — sitting — resistive. 4. Forward trtmk flexion and extensioin — sitting — • resistive. 5. Leg nerve compression — reclining. 6. Arm nerve compression — sitting. 7. Leg flexion and extension — reclining — resistive. 8. Vertical arm flexion and extension — sitting — resistive. 9. Stomach vibration — reclining. 10. Leg vibration — reclining. 11. Arm vibration — sitting. When the patient has gained some strength change to Prescription II. I. Horizontal arm separation and closing — sitting -resistive. 142 PRACTICAL MASSAGE. 2. Foot flexion and extension — reclining — resis- tive. 3. Trunk torsion — kneeling — resistive. 4. Backward leg traction — standing — resistive. 5. Chopping movement — standing — active. 6. Harvesting movement — standing — active. 7. Neck flexion and extension — standing — resis- tive. 8. Bent-knee separation and closing — reclining — resistive. 9. Lateral arm elevation and depression — standing — resistive. 10. Back percussion — standing. CHAPTER XIX. Local Djskasi;s. — Diskasks oi- the ]*>raix, Spinal Cord, and Xi:r\e. congestion of the i'.kain (congestio cerebralis). Severe acute congestion of the brain will hardly be favorable to movement treatment, but milder cases have often been treated with success. The movements should be directed so as to drive the blooent. This is the "excentric" exercise, which will gradu- ally make the muscles stronger and able to bend and stretch "concentrically." This mode of treatment should be given to any part where it seems necessary — ann, hand, leg, foot, etc. Besides this, be cheerful and agreeable to the* pa- tient; take him under the arm and walk with him, tiying to make him lift both his legs and put the feet squarely down on the floor without hesitating. Let him try to hit you with his lame fist and, grab your arm, and also tell him to spread out his fingers a cer- tain number of times, several times daily, etc. The most cases of paralysis are slow to recover, and especially is the hand, as a rule, far l>ehind the rest of the body in becoming well. The treatment is agreeable to this kind of patients and it has a soothing and cheerful influence on them. Here it may be well to say that all persons w4io have been troubled once with apoplexy ought never to stop taking movement treatment, or at least only at short intervals, unless they have plenty of other healthful exercise, as it is the best means to prevent another stroke. CHAPTER XX. Local Diseases (Continued). CONGESTION OF THE SPINE. This disease has often been quickly inTproved by a proper treatment of derivative movements, which are herein set forth :— 1. Forward arm rotation — sitting — passive. 2. Foot rotation, double — reclining" — passive. 3. Vertical arm flexion and extension — sitting — resistive. 4. Leg flexion and extension — reclining — resistive. 5. Trunk torsion — astride sitting — resistive. 6. Bent knee separation and closing — reclining — • resistive. 7. Breech beating — standing — passive. 8. Knee flexion and extension — sitting — resistive. 9. Stomach friction— lying — passive. 10. Shoulder rotation and chest lifting— sitting. LOCOMOTOR ATAXIA ( TABES DORSALIS). Dr. Anders Wide, of Stockholm, says in his book on "Medical and Orthopedic Gymnastics" : — "A few cases of tabes dorsalis are treated with gymnastics every year, and I dare assert that the treat- ment has, in no case, been without result, as improve- (150) LOCOMOTOR ATAXIA. 151 nient in certain symptoms has always been gained. It is specially worthy of notice, that the unsteadiness in Avalking and the inner paresis of the intestine and bladder can be diminished or even, for a time, totally disappear. I consider it, however, to be my duty to point out here that, as far as I know, no return to health has occurred in any case treated." Patients with this disease are generally more hope- ful of beneficial results than physicians, and the knowledge that this affection frequently comes to a standstill and improves, and that in some few instances recovery has taken place, ought to inspire us with more hope and zeal to co-operate with the sufferers. This disease is characterized clinically by want of power to co-ordinate voluntary movements, by violent shooting pains, especially in the legs ; absence of knee- jerk, atrophy of the optic nerve, paresthesia and anes- thesia in certain parts, dysuria, and functional sexual disorders; anatomically, by a sclerosis (hardening) of the posterior columns of the spinal cord. The treatment prescribed by Dr. ^^^ide and other Swedish as well as German authorities consists merely of passive movements and massage, and, of course, they are useful and even necessary. But I firmly be- lieve, with Dr. H. V, Barclay, of New York, that a thorough course of educational gymnastics is what is mostly needed in order to train the nerves and again awaken the activity of the nerve-centers and make the muscles obey the will. Aly mode of treating these cases is as follows : — 152 PRACTICAL MASSAGE. 1. Back percussion — standing. 2. Thigh rotation — recHning. 3. Arm rotation and forearm rotation — sitting. 4. Trunk rotation — astride sitting. 5. Abdominal massage — ^recHning. 6. Arms nerve compression, muscle rolling, slap- ping and friction — sitting. 7. Legs — the same. While the patient is lying down, he is told to move his legs in certain directions. — pull one knee up and slowly lower it ; bring- the leg outward and back again; cross one leg over the other; bring one foot toi touch the other leg, or knee, etc. At first these are done assisfk'cly till the patient gradually is able to do it alone. Later, tlie patient stands up and practises dif- ferent exercises at my comniand, both with the lower and upper extremities. These have been of very great value. This is what has been called the "Frankel" sys- tem, but has been practised by myself and otliersi long before we heard of Frankel. 9. Full massage of the back and buttocks. After this kind O'f treatment has been used for some time — two to three months — rcsistwe exercises may be used, always taking care not tO' overtax the patients' strength, as they are generally very eager toi get well and apt to do more than the}^ oug'ht to do. Cures are rare, although there are some on record, but great improvement is a frequent occurrence. CHAPTER XXI. Infantile Paralysis, roliomyelitis anterior. This dreaded disease is nowadays treated almost entirely with massage. At least our greatest medical experts have frequently advised patients to try mas- sage as the^ only remedy which probably will restore the functions of the paralyzed parts, saying, at the same time, that electricity will not do- it and m;ay even do harm. My experience with these cases fully agrees with the physicians — but even massage may do harm, if not applied carefully, and the patient constantly warned not to overdo. ^^"e must by careful examination find the para- lyzed muscles and their nerves, and apply mild muscle kneading and percussion to them. Give' passive exer- cises — flexion, extension, abduction, adduction, and ro- tations: stretch contracted muscles and ti*y our best to make the weak, paralyzed muscles contract and gradu- ally begin to work. Here again it is of value to apply assisfk'e exer- cises and make the patient concentrate his will on the nmscles to be used — always taking care not to do too much. Of course, with a small child this is rather (153) 154 PRACTICAL MASSAGE. out of the question ; but then we must nivent some exercise which the child wih be interested in doing, and which will have the same effect. When we know the exact muscles involved we can also find the ner\Ts and apply some vibratory pressure on them at their outlet from the spinal cord, which will have a stimulating effect. Two interesting cases of mine may give an idea of my method of treatment : — I. Some years ago I was called to attend to a girl Off 6 years of age; she had never been able to stand on her feet ; and the parents asked me what I could do. They had "been going to a doctor for electricity one year, to an osteopath one year, and a lady had applied massage every day for one year." I told them that, although I might give some massage, it would probably be different from what the girl had been given, and that I would rely mostly on what I called educational gymnastic training. This child was in a rather feeble and nervous con- dition ; so I did give her some massage — nerve com- pression and frictions of amis and legs, stomach fric- tion and circular kneading and full massage of the back. Besides this, muscle kneading and percussion to the weak muscles of the legs and passive exercises, soon followed by assistive, and before one month (treatment three times a week) the child began tO' re- spond and "jerkingly" do several exercises. Now it was to make the exercise even, and not toi allow any movement without first being told, as, for instance: INFANTILE PARALYSIS. 155 "Give me that foot in my hand," which I held out- side. She would do so, l)ut inimcdiatcly tiy to pull it back again, which I checked by saying "Hold it"; and after a short rest, "Now pull it back," and so' on in different directions. After three months' treatment the child could stand and, holding on to somebody, take a few steps. Then they went away for the summer, which was good for her general health. In> September I began again, but only twice a week. In the following spring one of our first neurologists saw the child and told them to continue my treatment, but every day and not twice a week. Another summer vacation and, we continued treatment three times a week. Now the child stood up and I taught her tcy place the feet in different di- rections and before the next summer she and I danced a waltz together. Next year, treatment twice a week and she walked back and forth tO' school, morn- ing and afternoon; the abdominal muscles still w^eak, so her gait w^as rather swaying, bending the body backward wdth each step. But even that could have been remedied if the parents had been willing to con- tinue ; they think she will outgrow it by honre practis- ing and, of course, much can be done if they stick to it. II. In November, 19 14, I was called to a yoitng married gentleman, 24 years of age. Two months be- fore he had been stricken wdth infantile paralysis, very high fever, and for a while given up by the physicians. Now he w^as flat on his back, without being able to mo've a single muscle in either leg or lower part of 156 PRACTICAL MASSAGE. the back. He had been constipated all his life and had taken some physic every day to move his bowels. The expert physician, who had been called in con- sultation, said : "Massag-e, and nothing else, will do yoii any good." I began with massage of the stomach, then gentle "combination" kneading, nerve compression and fric- tion of both legs, and back massage. Next day the same and passive movements. In giving massage of the stomach I noticed some- thing loosen in the ascending colon, and when I re- turned I was told that without taking any medicine the bowels had acted and he had passed a black, hard lump, which probably had been lodged in his co'lon. a long time and caused autotoxin. He has ne\'er taken any physic since. Gradually I led this patient to concentrate his will on certain muscles, and already, at the end of the first week, he could move the quadriceps and patella of his right leg. I found the nerves at the lumbar spine and applied vibratory pressure, gave muscle kneading and percus- sion to his weak muscles, and as I found that the gastrocnemius was inclined to contract, I applied stretching by bending the foot upward. The adductors were next to begin to show life; then we worked on the flexors of the thigh and the abductors. Dr. Brown, orthopedic surg-eon of Boston, came once a month, and he ordered hot tul>bath and, while in the tub, trying tO' draw the knees up, which iNl^ANilLh. i'AKALYblb. 157 worked very well. The patient was also lying- down with a pillow under his lumbar and lower dorsal back, and in this jx>sition made to draw in his abdominal muscles. This also worked well, until I noticed that he beg^an to have "backache" from the pressure of the lumbar vertebrae, and the pillow was discontinued. Treatments were given every day fo^r one month, then six times a week, four times a week during the third month, aud finally three times till the middle of June. Already in March the patient had rig^ged up a bar between two doors and, by taking hold of this, would raise himself up and stand upright, gradually beginning to move his body in different directions. He would sit on a table and move his legs forward and backward, and also sideways, etc. All morning he was in a chair on. his piazza, in sunshine and fresh air. His little wife was a wonder of a helper to him ; they were all alone and I felt as if they were my own children. By the end of April we rigged up two long, parallel bars (ten feet) in the parlor, and here he stood up and walked forward and backward between the bars. In J\Iay he was given braces and crutches, and he soon learned to walk pretty well. Then the two went in their own automobile to Canada, where the im- provement steadily continued. He still uses the crutches, but there is no doubt now that he will ulti- mately recover, by rest and judicious exercises, tO' the great astonishment of his physicians, who never ex- pected to see him ou his feet again. 158 PRACTICAL MASSAGE. Of course, this young man was an intelligent fel- low aiid eager to do his best, which* helped my treat- ment greatly, but I had to caution him frequently and even scold him for doing too much. I had to put the check-rein on him as on a wild colt. These two cases ought to give some idea of how to treat patients with this malady. CHAPTRR XXIT. Occupation Neuroses. These generally occur during the best working period of a man's life. The illness creeps upon one, and its course is slow. Nctu'itis in any of the nerve- roots of the arms or even in plexus brachialis is some- times the cause of the illness. Often there is great tenderness over the nerves of the arm; but more fre- quently OA'er the muscles. Excess of work is the cause oi the trouble, and therefore the first thing to do' is to quit the particular work which has produced the neurosis. Then passive movements oi the arm and centripetal massage should be applied. But where the nerve is sensitive and tender light circular kneading should be gi\-en, and often the sore spot entirely avoided while the centripetal massage is applied a,bo>ve. This is especially the case with masseur neurosis and other neuroses occurring after very hard work. The prognosis is not always good in occupation neurosis. The illness may follow the patient all through life; although I believe that many failures to cure it have come from too hard treatment. My per- sonal experience is that moderate and even very light massage will produce a cure. Some tinie ago a gentleman, druggist, who used his left hand frequently in the ice-basket while making ice- (159) 160 PRACTICAL MASSAGE. cream was taken ill with neuritis of the median nerve oi the left ami aiid. hand. P'oir seven) weeks lie was treated by his physician with all sorts of rem^edies, among them electricity and vibrator machine, but he grew steadily worse and finally was unable to sleep, and confined to his room. His friends had told him to send for me, but his doctor said "No, — what could massage do when electricity and) vibration made him worse?" Nov/ he changed his doctor and he at once sent for me. The patient told me about his experience and that his first doctor had said massage would ag- gravate the trouble, to which I said that probably the iBost masseurs vrould do so, but I would undertake to give him five treatments, and) if he by that time felt no relief we would stop, and I should not charge him, but if he was better he should continue the treatment. The first treatment consisted of light friction from the spine, over the shoulder and down the ami, and slight pulling of the anm — six nuinutes in all. The next day the same and nerve compression; third day the same; fourth and fifth the same and some com- bination kneading and singie anrr rotation. After the fifth treatment the patient was entirely well, and has not had any attack later. writers' cramp. These movements are useful : — 1. Back percussion. 2. Right arm centripetal stroking, kneading, circu- latory friction. CHOREA. 161 3. Right arm rotcation. 4. Forward trmilv llexion and extension — sitting- resistive. 5. Right arm torsion — resistive. 6. Right hand and finger flexion and extension — resistive. 7. Right arm viljration. 8. Trunk rotation — astride sitting — passive. 9. Vertical ami flexion and extension — resistive. 10. Right arm nerve compression, rolHng, slapping, and friction. Cramp of the Legs. 1. Thigh rotation. 2. Leg vibration. 3. Foot flexion and! extension — resistive. 4. Trunk torsion — sitting — resistive. 5. Leg nerv^e compression, rolling, and friction. 6. Leg flexion and extension — resistive. 7. Trimk ele\'ation — lying — active. 8. Upward knee traction — resistive. 9. Breech beating. 10. Leg torsion — resistive. TT. Leg nerve compression, slapping, and friction. 12. Back percussion and friction. Chorea. This disease has been treated with great success by the Swedish movement. M. Napoleon Laisne has applied this treatment to 11 152 PRACTICAL MASSAGE. hundreds of children at the "Hopital des Enfants Malades," in Paris, with the greatest success. Dr. Blache, the president of this hospital, addressed in 1851 an assembly of directors, and prominent physicians upon the results of this treatment. He closed his re- port by saying that in four yea,rs not one of the choi-eic children thus treated had suffered a relapse. Resistive mo\'ements followed with light friction downward of the parts just treated, and also some active exercises according to command, are the most beneficial. 1. Horizontal arm separation and closing — sitting — resistive. 2. Bent-knee separation and closing — reclining — resistive. 3. Trunk torsion^ — sitting — resistive. 4. Foot flexion and extension — double — reclining — resistive. 5. Neck flexion and extension — standing — resistive. 6. Vertical arm flexion and extension — lying — re- sistive. 7. Leg flexion and extension — reclining — resistive. 8. Arm torsion — sitting — resistive. 9. Back percussion — standing. A regular course of Educational Gymnastics should be given for several years. CHAPTER XXIII. Sciatic Neuralgia. Of all writers on the treatment of this malady Dr. J. Schreiber seems to have had the most cxi>erieiice and to have been the most successful in his cures. Upon this subject he says: — "As the greater number of sciaticas which have come under my notice have been combined with crural neuralg'ia as well, I think it best to consitler these two conditions together. It seems advisable, also, to dis- cuss the treatment according to a plan which may, with suitable modifications, be applied tO' each special case, and yet one which will embrace the details gleaned from numerous observations. Let us take a case: — "A patient suffering from well-UTarked sciatica and crural neuralgia of the right side applies for relief, after having been under treatment by others for many years in vain. He has used veratria, aconite, and belladonna ointnients, moq^hine injections, electricity, sinapisms, and vesicants. We may assume, also, that for a con- siderable period he took arsenic, quinine, and potas- sium iodide and bromide, that he has l>een to a number of springs, like Gastein, Wiesbaden, Teplitz. and Ragaz, and also that neither sea-bathing nor hydro- therapy has had any effect upon his obstinate malady. He is only able to drag himself painfully along by the (163) 164 PRACTICAL MASSAGE. use of a cane, and every step causes acute suffering. Rising and sitting down can only be accomplished by aid of the anns, while for g'oing upstairs or getting out of bed the assistance of an attendant is necessary. He is never entirely free from pain, and there is gen- erally a daily exacerbation lasting often several hours, and preventing much-needed rest. "Examination shows no other functional disturb- ances. There is great sensitiveness in the buttock, at the point of exit of the sciatic nerve, and many painful points exist along the outer and inner aspects of the thigh. The limb, furthermiore, will be seen to be held in a characteristically pathognomonic position, namely, the thigh rotated inward and adducted, the knee slightly bent, and the foot not resting on the groiuid with the sole, but touching it with the toe only. *'0n sitting down, the patient supports himself by his left arm, and lets himself fall, as it were, upon his left buttock, instead of perfonning the usual move- ments of flexion with knees and hips. The involve- ment of the semitendinosus and semimembranosus muscles causes great sensitiveness to pressure over their tendons. Voluntary abduction of the affected thigh is impossible, and abduction of even the well extremity cannot be performed on standing erect, on account of inability of the patient to support himself upon the affected limb. External rotation is also im- possible. Hence it appears that the glutei, the pyri- formis, the internal obturator, and the gemelli (ex- ternal rotators) are all affected. Nor can the patient SCIATICA. 165 flex the thigh (involvement of the ihac and psoas major), nor can he addiict it after it has once been passively abducted (involvement o-f the sartorius, in- ternal rectus, adductors longus, brevis and mag-nus, and pectineus). But the greatest pain of all is caused by rotating the thigh outward, as the sciatic is thus made to glide upon and rub against the quadratus femoris. "I have purposely selected a case in which all the muscles of the buttock, alxDUt the hip-joint, and of the thigh have become involved, and hence almost entirely deprived of function. Many years of experience and many trials have convinced me that the cure of these forms of sciatica will be most rapidly effected when, in addition to the mechanical interferences, passive and active motions of all the affected muscles are employed. It has also seemed to me best to begin the daily treat- ment with the passive and active movements, leaving the mechanical manipidations, which are very painful, till the last. They cause so much exhaustion, as a rule, that the patient is anxious only for rest, and will hardly have the energy necessary for performing acts which he kno'ws must only increase his suffering." If the cause of the neuralgia is a pressure, as froin a tumor, etc., it is of no use to try this treatment, but otherwise it will generally effect a cure. At the end of each day's trea.tment the patient will generally complain of much pain and fatigue, which usually diminishes considerably in about half an hour, although it some- times lasts for hours after^^^rd. In the beginning, too, the night's rest may be more broken than before. 166 PRACTICAL MASSAGE. In six to twelve days usually a changfe for the better occurs, the night's rest becomdng more tranquil, the pain less, and the first signs of approaching conva- lescence begin to appear. Dr. Schreiber says : "It is almost a matter of course that the physician will be confronted with every kind of doubt on the part of the patient regarding the ulti- mate results of treatment, but, as failures are rare where sufficient perseverance and the requisite skill have been employed,- he may confidently combat these miisappirehensions. The duration of the treatment will depend on the following various factors : — "i. On the previous length of the illness. "The longer the disease has existed the more pro- tracted will have to be the treatment. Eight weeks will, as a rule, be the limit ; at least, that was the limit needed to cure one of my cases of a previous four years' duration. Cases of only a few months' standing often need but ten or twelve days for a cure. "2. On the extent of the disease. "The greater the number of muscles involved the more numerous must the number of corresponding ex- ercises be, and hence the longer the time required. "3. On idioisyncrasy. Individual peculiarity. *Tn sensitive individuals it is often necessary to pro- ceed very cautiously and gently at first. More time is, therefore, required in these cases than where the pa- tient is not of a timorous or complaining dispo'sition. "4. On the skill, the experience, and the persever- ance of the physician. SCIATICA. 157 "Familiarity with the methods frequently enables a practised hand to employ many devices which an in- experien.ccd i)erson veiy pnii)erly avoids. "5. On the age and general nutrition of the patient." Two very interesting cases are illustrated by Dr. Schreiber, and he claims to have cured numerous per- sons of very bad sciatica. His mode of treatment is in its character the same as I have been; using, but as Dr. Schreiber already, the first day of treatment, uses some kind of apparatus, the dcscrii).tion l>elow given shows the method found by me to be the best where the patient is confined to his room, as in a case of sciatica of the rig"ht leg. The first day the treatment must be very gentle and of short duration, the patient lying down. 1. Right leg flexion and extension — passive — four to teil times, according to his strength. 2. Right leg nerve compression and rolling. 3. Breech beating. 4. Right leg (back of the thigh) percussion and friction. The second day the same treatment with more force. The third day the following is applied: — ■ 1. Right leg flexion and extension — passive. 2. Right leg nerve compression and rolling. 3. Right thigh rotation. 4. Right leg vibration. 5. Breech beating. 6. Right leg nerve compression, percussion, and friction. 168 PRACTICAL MASSAGE. The fourth day give: — 1. Right thigh rotation. 2. Right leg flexion and extension — resistive. 3. Right leg nerve compression and rolling. 4. Right leg sq>aration and closing — passive. 5. Right foot flexion and extensioii — resistive. 6. Right leg vibration. 7. Breech beating. 8. Right leg nerve compression, percussion, and friction. The fifth, sixth, and src'cnth days we may apply deep kneading of all the muscles of the buttock and thigh, just before "breech beating" and "sciatic nerve stretching," in connection with the former prescription. The next four or five days the following move- ments should be used : — ' 1. Thigh rotation' — both legs — passive. 2. Right leg flexion and extension — resistive. 3. Right leg nerve compression and rolling. 4. Right leg torsion — passive. 5. Right leg separation and closing — resistive. 6. Kneading and beating of right leg andj buttock. 7. Right knee upward traction — resistive. 8. Right foot flexion and extension — resistive. 9. Right leg vibration. 10. "Sciatic nen^e stretching." 11. Right leg nerve compression, rolling, and fric- tion. The last prescription, which ma}^ be continued till the patient is well, has a more all-sided effect. SCIATICA. 169 1. Thigh rotation — Ijoth legs — passive, 2. Right leg iicrve C()ini)ressi(jn, rolling, and fric- tion. 3. Trnnk rotaticni — astride sitting — passive. 4. Right leg llexiun and extension — resistive. 5. Kneading- and beating- of right leg- and buttock. 6. Forward trunk flexion and extension — sitting — resistive. 7. Bent-knee separation and closing- — resistive, 8. Right leg- percussion. 9. Right leg torsion — resistive. 10. Breech beating. 11. "Sciatic nen-e stretching." 12. Right leg nerve compression, rolling, and fric- tion. In connection with this it will be of great advantage to let the patient walk and run on tiptoe, and to go up and down a few steps, or stairs. There should also be taken good care that the patient always sits straight and rests e\'enly on both buttocks. Of the many cases of sciatica which the writer has treated, the following one was cured in the shortest time, considering the previous duration of the dis- ease : — A lady, 29 years old, suffered from sciatica for ten months. She had been in bed most of the time, and all kinds of treatment had been tried without any re- lief. One, day she felt well enough to be taken in a carriage and carried into the writer's Institute, where the movement treatment was applied. It pained her 170 PRACTICAL MASSAGE. a great deal, but after awhile it gavel her relief, and she returned the next day. The fifth day she walked alone to the Institute, and after three weeks' treatment was cured. She has not had any return of the dis- ease since. CILVrTER XXIV. Diseases of the Organs of the Circulation', chronic heart disease. Dr. Gu.staf Zander, of the ]\Icchanico-Therapeu- tic Institute in Stockholm, says: "In heart diseases, movement treatment is an uninterrupted necessity, at least during the winter. It is a pity when in such cases the patients have no opportunity to use this treat- ment. It is astonishing what excellent effects regular, gentle, but many-sided muscular exercises have on dis- eases of the heart. Some of these, when not too far gone, can be entirely cured ; others can be stopped from further development, and all can be relieved." From Dr. Hartelius, the Principal of the Royal Central G^nnnastic Institute, in Stockholm., we quo'te the following : — "A lady, 30 years old, with a dangerous organic heart disease — stenosis of left osfiuiii afriozrnfricular, zcith insufficiency of mitralis. The action of the heart was very weak. The patient suffered with great short- ness of breath and painful palpitations; a great deal of subcutaneous effusion in the lower extremities and also considerable effusion in the peritoneum. Her aspect was cyanotical. "Mild chest liftings and vibrations were given to produce strong inspirations, also rotation of the arms (171) 172 PRACTICAL MASSAGE. and legs to increase the circulation, gentle rotation and torsio'n of the trunk to act on the portal system, and centripetal stroking on the lower extremities tO' pro- mote resorption of the suljcutaneous effusion. In the beginning the movements were very mild, but gave relief for a few hours at a time. Later the movements were applied several times daily, and then more lasting effects were produced. Patient received great relief, more strength, and the effusion was lessened, but her organic trouble could not be cured. "Experience tells us that each difficult heart disease must nearly always be under the influence of move- ment treatment in order to secure permanently good results. A weakened circulation is the necessary consequence oif every heart disease, and the object of the nuassage treatment is therefore to facilitate the work of the heart by improving the circulation. Movements must be given which shall diminish the pressure of the blood and decrease the activity of the heart. Centripetal massage and rotations further the cir- culation, especially in the more peripheral parts of the body; and respiratory movements do' the same in the chest. Inspiration acts as a pump on the circulation toward the heart. Muscle-contractions produce aj pressure on the walls of the blood-vessels, whereby the blood is forced toward the heart ; hence, respiratory and circu- latory movements are here of great value. As before said, every pressure of a muscle causes HEART DISEASE. 173 the blood to be squeezed out of the veins of the mus- cles in the direction toward the heart. It should be remembered that kneadings and strokings are suffi- ciently strong- to press together the veins, and thus further the flow of blood to the heart; but, on the contrary, they do not offer any hindrance toi the free course of the arterial blood. It is known that the veins hold more when they are lengthened. In rotations of a joint a frequently re- peated elongation and shortening of tlie numerous veins take place; each time a vein is elongated the blood is sucked up from the peripherally situated tribu- taries, which, in their turn, react in a circvilato^ry furthering manner on the capillaries. On the shorten- ing of the veins, which immediately follows, they empty their contents in a centripetal direction. Of special importance are the thigh rotations and arm ro- tations, because a strong suction arises in the great veins lying near these joints. Trunk rotations have especial influence on the in- ferior vena cava, but to a slight extent also^ the suj^erior vena cava. Respiration is to oxidize the blood, and in heart disease the oxidization of the blood is incomplete. Therefore, it is of the greatest importance to give fre- quent respirator}'- movements to these patients. But the chest also ser\'es as a blood-pump, because deep respirations further the circulation. Inspiration increases the negative pressure in the chest, by which a strong attraction of blood to the heart arises in both 174 PRACTICAL MASSAGE. of the venae cavse. Further, the diaphragm., in con- tracting during respiration, expands the inferior vena cava and, by simultaneously exercising pressure on the abdominal organs, presses the blood from these into the veins. Dr. Anders Wide says: "Since the action oif the heart is facilitated through medical gymnastics, a dis- eased heart should, to a certain extent, be improved by the treatment. This ought especially to be the case in diseases of the muscles of the heart, which latter are strengthened by the treatment. But even in, valvular lesions symptoms of failing compensation can be dimin- ished by the gradually increased work given the heart. Heart dilatation should also be diminished by facilitat- ing the work of the heart-muscle. But even if a medi- cal gymnastic treatment cannot free the patient from heart disease itself, and only in few cases improve it, still I dare assert that every patient with heart disease will obtain relief from the troublesome symptoms of palpitation, shortness of breath, pain and oppression over the heart, with other symptoms that always ac- company heart disease; and even this is much to be thankful for. It is true that the improvement will not be lasting in every case, l>ut that it must be often re- peated and for long periods ; but it should also be rememibered that the disease is chronic and that no other treatment gives better results." It is clear that the same kind of treatment may be used for nearly all kinds of heart disease, because the object in every case is to facilitate the work oi the HEART DISEASE. I75 heart. Passive moA^ements are of the greatest impor- tance in this treatment, but some resistive movements are also of great value. In arranging a treatment for heart disease, passive movements only should be used to begin with, and gradually, as the patient Ijecomes stronger, some few resistive exercises may be added. Prescription I. 1. Chest lifting and vibration. 2. Foot rotation, double. 3. Arms — centripetal stroking, kneading, and fric- tion. 4. Legs — centripetal stroking, kneading and fric- tion. 5. Hand and finger rotation, flexion, and extension — passive. 6. Thigh rotation. 7. Chest percussion. 8. Loin traction. 9. Leg vibration. 10. Back percussion and friction. This should be gradually increased to the follow- ing:— Prescription 11. T. Shoulder rotation and chest lifting — sitting — passive. 2. Thigh rotation — reclining — passive. 3. Leg flexion and extension — reclining — resistive. 176 PRACTICAL MASSAGE. 4. Arm nerve compression, muscle rolling, slap- ping, and friction — sitting. 5. Forearm flexion and extension — sitting — resis- tive. 6. Trunk torsion — sitting — resistive. 7. Chest lifting and vibration — reclining — passive. 8. Foot rotation — double — reclining — passive. 9. Leg nerv'e compression, muscle rolling, slapping, and friction — reclining. 10. Arm rotation — single — sitting — passive. 11. Hand and finger flexion and extension — resis- tive. 12. Trunk rotation — astride sitting — passive. 13. Chest slapping — standing. 14. Shoulder rotation and cliest lifting — sitting — passive. A short rest should be taken between every exercise. The so-called "Schott" treatment by exercise is a century old and has been used by Ling and all his fol- lowers ever since. I myself have been using the same method for over forty years. But the medical profes- sion in the L'nited States did not wake up to the fact before ''Schott" was thrown at them in medical jour- nals. Up to twenty 3^ears ago the advice to people with heart troubles in this counry was always "rest," "don't move." and so on. Now it is "exercise," "play gO'lf" ; but that should l>e done with great care. A course of medical gymnastics by an expert would be better and safer. DISEASES OF THE RESPIRATORY ORGANS. 177 FOR COLD HANDS AND FEET the following moveni/ents are very useful: — 1. Forward arm rotation — sitting — passive. 2. Foot rotation, (loul)le — reclining — passive. 3. Vertical arm flexion and extension — sitting — ■ resistive. 4. Leg flexion and extension — reclining — resistive. 5. Trunk rotation — astride — passive. 6. Hand and finger flexioii and extension — resis- tive. 7. Foot flexion and extension — resistive. 8. Arm nerve compression, rolling, slapping, and friction. 9. Leg nerve compression, rolling, slapping, and friction. 10. Arm vibration. 11. Foot-sole slapping and friction. 12. Back percussion and friction. Diseases of the Respiratory Organs. Catorrli of the larynx, caforrh of the. lungs, conges- tion of the lungs, 'emphysenia of the lungs, spasmus hronchialis, and e\'en tuberculosis have all been treated with success at different establishments by movements, but each of them requires quite a special treatment by a skillful and experienced gymnast, and therefore, only a prescription for rrrovements to be used where there is a disposition to a lung trouble, showing a narrow chest, 178 PRACTICAL MASSAGE. round and stooping shoulders, and lack of muscular power, is here given : — 1. Shoulder rotation and chest lifting — sitting. 2. Foot flexion and extension — resistive. 3. Trunk torsion — sitting — resistive. 4. Forward ami rotation — sitting. 5. Leg: flexion and extension — reclining — resistive. 6. Horizontal ami separation and clo'sing — resis- tive. 7. Neck flexion and extension — standing — resis- tive. 8. Forward trunk flexion and extension — sitting — resistive. 9. Lateral arm elevation and depression — sitting — resistive. 10. Chest slapping. In connection with these exercises, or as a single treatment, should be used Throat massage, and Chest and back massage, and also freciuent breathing exercises in open air. There is probably nothing better for lung troubles than the methods now in use: Cleanliness, good and wholesome food, sleep with open windows, and be out of doors and take deep breathing exercises. CHAPTER XXV. Diseases of the Organs of Digestion. The following prescriptions are given only iur the most frequent cases, as dyspepsia, constipatioii, and hyperemia of the liver. The treatment in these cases should be directed to strengthen the whole system, as well as to act locally on the diseased organ. DYSPEPSIA. If the patient is very weak it will be necessary to give him a light treatment for the first two or three weeks, viz. : — 1. Arm nerve compression, rolling, slapping, and friction. 2. Legs the same. 3. Stomach vibration and friction. 4. Thigh rotation. 5. Armi vibration. 6. Chest lifting and vibration. 7. Stomach kneading (circular) and frictio'n. 8. Leg vibration. 9. Back percussion and friction. When the patient is improved and has gained some strength, not confined' to bed, the following should be applied : — I. Forward arm rotation — sitting — passive. (179) 180 PRACTICAL MASSAGE. 2. Stomach kneading, vibration, and friction. 3. Upward knee traction-^ — reclining — resistive. 4. Trunk rotation — astride sitting — passive. 5. Stomach concussion and friction — lying. 6. Leg elevation — lying — resistive. 7. Vertical arm rotation — sitting — passive. 8. Loin traction — lying. 9. Leg flexion and extension — reclining — resistive. 10. Back percussion and friction. CONSTIPATION. If the patient is in bed a local manipulation for about five to ten minutes twice a dav will be most effective, viz. : — 1. Stomach kneading, vibration, concussion, and friction — five to ten minutes. 2. Breech beating. 3. Loin traction. If the disease is of long standing it is necessary to apply strong muscular nrovements, as: — 1. Forward trunk flexion and extension — sitting — resistive, 2. L^pward knee traction — reclining — resistive. 3. Bowel vibration — standing — passive. 4. Trunk elevation — lying — active. 5. Trunk rotation — astride sitting — passive. 6. Stomach kneading and friction — reclining. 7. Trunk torsion — kneeling — resistive. 8. Forward arm traction — lying — resistive. 9. Loin vibration — sitting — passive. DISEASES OF THE ORGANS OF DIGESTION. 181 10. Breech beating-^-standing — passive. 11. Stomach kneading, concussion, and friction. 12. Shoulder rotation and chest lifting — sitting — passive. In connection with this treatment, the patient should l)e taught to take some active exercise by himself every day, separate from the time of the massage treatment. 1. A breathing exercise. 2. Chopping movement. 3. Harvesting movement. 4. Lie on the back and raise both legs. 5. Breathing. I ha^■e had some of my greatest success in treating these diseases. Some years ago the German ambas- sador at A\'ashington came to me for treatment directly from Dr. IMezger, and he wasi so greatly pleased with the success of my treatment that he soon brought me a number of foreign ministers and the United States high officials. But of all cases one was especially remarkable. A gentleman, abo-ut 40 years of age, came to me in Bos- ton some years ago. He told me a pitiful story. He had been in a good business, but commenced to drink, as he said hiuTself, one bottle French Cognac during the day and half a bottle at night. After a couple of years his business was gone and he himself a wreck. W^hen he came to me he had not been drinking for three years, but he had stuffed his stomach with every kind of pills and medicine to get relief for his consti- pation. Nothing would help him any more ; he would 182 PRACTICAL MASSAGE. go two and three weeks without an operation, and he looked worse than any man I had ever seen. After five days' massage he had his first natural operation for many years, and he gradually gained in health. Four months later he was entirely changed, had gained flesh and strength, had good appetite and daily movements of the bowels, and he is today a prosperous and healthy business man. HYPEREMIA OF THE LIVER. The following-cited case of this disease will be especially interesting : — A gentleman of middle age had been ailing two years. He had grown very lean, the skin was yellow, and his feet and ankles were swollen. The liver was considerably enlarged, especially the left lobe. There was no organic heart disease, but there was a mild ca- tarrh of the lungs. Operations of the bowel w^re slow and difficult. He was treated twice every day by means of movements, and no other remedies were used. After one month' the patient was considerably better, the liver was smaller, swelling had disappeared, and his appetite and flesh had increased. After the second month, having been treated once a day, the patient was cured. The following prescription was used : — 1. Shoulder rotation and chest lifting — sitting. 2. Foot rotation, double — reclining. 3. Trunk rotation — astride sitting. DISEASES OF THE ORGANS OF DIGESTWN. 183 4. Vertical ami flexion aiul extension — resistive and vertical arm rotation — passive. 5. T.diii vibration — sitting. 6. Thigh rotation — reclining, 7. Chest lifting and vibration — reclining. 8. Leg flexion and extension — reclining — resistive. 9. Stomach kneading and friction — reclining. 10. Back percussion and friction — standing. APPENDICITIS should not be treated by massage. But I have good reasons to believe that persons who take judicious ex- ercise will not be attacked by this malady; and, further, I earnestly advise that circular kiicadiiig and friction of the abdomen should be used at the first "threaten- ing" of appendicitis. Often we hear of persons who have been ''threatened" one or more timies, and even been told that it was nothing more than indigestion, and some time later they have suddenly been taken violently ill, and a surgical operation had to be resorted to. If these cases had been treated by massage from the first day of the symptoms, I do not hesitate to say that the appendicitis would have been avoided. INDIGESTION" AND BILIOUSNESS can often be quickly cured by 1. Breathing exercises. 2. Standing and bend the trunk forward and back- ward, and from side to side. 184 • PRACTICAL MASSAGE. 3. Vertical arm rotation — sitting'— passive. 4. Loin vibration — sitting. 5. Trunk rotation — astride sitting — passive. 6. Circular kneading of the abdomen — reclining. 7. Back percussion — standing. OBESITY is frequently treated with success by massage, but it must be pretty hard treatment and kept up regularly for some time, and some strong active movements should i:!e used also, all according to the patient's srength. 1. Forward trunk flexion and extension — sitting — resisti^-e. 2. Backward leg traction — standing — -resistive. 3. Vertical arm flexion and extension — sitting — resistive. 4. Trunk torsion — kneeling — resistive. 5. Upward knee traction — reclining — resistive. 6. Chopping nTovement — standing — active. 7. Harvesting movement — standing — active. 8. Forward ami traction — lying — resistive. 9. Leg elevation — lying — resistive. 10. ]\'Iuscle and knuckle kneading of the abdomen. 11. Forward arm rotation — sitting — passive. 12. Back percussion — standing. URINARY AND SEXUAL ORGANS. 185 Diseases of Urinary and Sexual Organs. CHRONIC catarrh OF TIIE' BLADDER. Tlic movements slmuld ])e (len'\ati\e f n >m the pel- \is and ntlierwise l)e directed according to the [jatient's condition — for instance : — 1. Thigh rotation — reclining. 2. Breech beating — standing. 3. Bent-knee separation and closing — resistive. 4. Forward trnnk flexion and extension — sitting — resistive. 5. Leg torsion, doul)]e — reclining — resistive. 6. Breech beating — standing. 7. Lateral arm elevation and depression — standing — resistive. 8. Foot rotation, double — reclining. CHRONIC CATARRH OF THE WOMB. 1. Back percussion and friction — standing. 2. Breech beating- — standing. 3. Leg separation and closing — reclining — resistive. 4. Forward arm rotation — sitting. 5. Tnmk rotation — astride sitting. 6. Knee flexion and extension — reclining — resis- tive. 7. Forward trunk flexion and extension — sitting — resistive. 8. Breech beating — standing. 9. Trunk torsion — kneeling — resistive. 10. Back percussion and friction — standing. 186 PRACTICAL MASSAGE. Displacement of the ivouih and irregular and painful menstruation are often not only relieved but even cured by movement treatment, but these cases require a special study and experience, and ought to be treated by a physician. Still, in connection with his treatment, it would be of great value toi the patient to have Thigh rotations — reclining — passive. Trunk torsion — kneeling — resistive. Bent-knee separation and cloising — resistive. Hand and toe lying — active. Breech beating — standing. Vibration at the small of the back. CTT APTKR XXVI. Diseases of the Organs of Movement, scoliosis. Ix "lateral ciiri'aliirc of (he spi)ic." where the mus- cles on the convex side are weakened and pathologi- callv changed, and the muscles on the concave side normal, it is clear that the weakened muscles on the convex side must be strengthened and developed. Ac- cording to Dr. T. J. Hartelius, "The restoration of a pathologically changed muscle canno't l>e produced by mechanical extensions, but only by muscular exercise and electricity. "But," he says, "for the restoration of a curved spine, extension is necessary. The question is, there- fore, whether this can be effected by the organism's own remedies. This is easy enough to prove. In mild cases of lateral curvature, where there is not yet any deformitv in the vertebra?, the spine is straightened at each extension of the back. By flexion to the convex side the spine is not only straightened, but it can be bent so far as to display a curve toi the other side. In cases where the deformity of the vertebrae makes a full extension of the spine impossible, it is still possible by its own strength to produce an extension in its highest degree. "For instance, in a 'forward trunk fllexion and ex- (187) 188 PRACTICAL MASSAGE. tension' the patient stands supported on the thighs and bends forward ; when he raises himself up, the operator resists him on the neck. Or, in 'backward trunk fletxion' the patient is lying* on the front of his legs and i^aises the back up backward. "These and a few other active and resistive move- ments can, better than any other mechanical remedy, straighten out the curved parts." In a one-sided scoliosis, for instance, witli the con- vexity to the left, "lateral trunk flexion tO' the left" may be given. The operator puts his hands on the highest point of the curve and resists the patient when he bends do^Mi. This can be performed either with the patient sitting, standing, or lying on his right side, the last one being the most powerful and effective. Several other movements are alsO' given with the view and intention of strengthening the muscles on the con- vex side and straightening out the spine, and should be used according to the strength of the patient and the particular shape of the defonnity. Dr. Schreiber says : "The treatment of scoliosis by the Ling system, which has scored some of its greatest successes in this very department, requires, however, quite a special study, and can hardly be carried out without both apparatus and trained assistants." Dr. M. Eulenberg, in "Die Schwedische Heilgyrrr- nastick," Berlin, 1853, says: — "Ling's method is the only truly rational therapeu- tic means for the cure of chronic disturbances of rno- tivity, such as result from spinal cun'ature, and from LATERAL CURVATURES OF THE SPINE. 189 pseudooiieliylosis, the phthisical tendency, pigeon- breast, peripheral paralysis, etc. **Even in cases of paralysis from lesions of the cord, it may still effect a cure where all other measures, undertaken after the original diseases have nm their course, will be found useless. Ling's gymnastics have an even greater and more certain effect upon enerva- tion and nutrition than the common fonn. of gymnastic exercises. Spinal (lateral) curvatures, resulting from faulty carriage (in consequence of a preponderance of muscular force on one side oi the body) , are nowadays never treated liy any good orthopedist by any other means than the Swedish system." Any one who will undertake the treatment of scolicv- sis should make it a special study, as it requires great experience, skill, and knowledge to lead it on success- fully. However, we can do so much good to the growing child with a few corrective exercises, that it seems a pity not to try it. And my experience has told me that a person with good common sense, and carefully watch- ing the effect of every exercise on the bare back of the child, is able to correct and cure most cases of lateral curvatures when taken in time. In Brookline (Mass.) public schools I organized a clinic, where the children suffering with scoliosis, lor- dosis, kyphosis, pigeon-breast, roimd-shoulders, etc., are examined and given a: prescription of exercises to practise at home, every day, and once a week they are treated at the clinic. Among the scores of children 190 PRACTICAL MASSAGE. who have been successfully treated this way, I believe the following six illustrations will be sufficient to sho'W how to apply the movements in the different cases. But every exercise should be watched with great care, as it often happens that the same exercise may be bene- ficial to one and harmful to another case cxi seemingly the same kind of a curve. In all cases of "double-curvature" a firm pressure should be made on the highest convexity at either side during Jiauguig and trunk raising. Of course, it will be understood that the heavy line on the illustrations represents the lateral curve of the spine when first examined, and the dotted line the spine at the last examination ; the short lines at the sides are the lower ends of the scapulse. For lordosis I use especially three exercises, viz : — ■ 1. Standing with arms over head and bending the trunk forward and downw^ard, touching the floor with- out bending the knees. 2. Hanging and raising the legs forward. 3. Lying and pulling both knees way up to the chest. For "pigeon-breast" : — 1. L}nng on hands and toes and bend and stretch the arms. 2. Hanging with arms well apart and pull up. 3. Florizontal arm flexion and extension — resistive. 4. Horizontal arm separation and closing — resis- tive. LATERAL CURVATURES OF THE SPLNE. I9I i ^M«*^ ■>oi\ Fig. 64.— Girl, 12 Years Old. First examined October, 1902; last examined March, 1903. Five home exercises and at the clinic. 1. Hanging — neck flexion and extension — resistive. 2. Lying on right side — bend trunk to the left — active. 3. Hanging — leg separation and closing — resistive. 4. Hanging— raise both legs forward— active. 192 PRACTICAL MASSAGE. %ll mi j9Cl3\\/90^ Fig. 65.^ — Girl, 13 Years Old. First examined October, 1902; last examined February, 1903. Five home exercises and at the clinic. 1. Hanging — neck flexion and extension — resistive. 2. Lying — leg elevation— active. 3. Right arm upward stretch — sitting — resistive. 4. Hanging — raise both legs to the left— active. LATERAL CURVATURES OF THE SPINE. 193 Fig. 66. — Girl, 14 Years Old. First examined October, 1902; last examined February, 1903. Four home exercises and at the clinic. 1. Hanging — neck flexion and extension — resistive. 2. Lying on right side — raise left leg— active. 3. Standing — stretch right arm upward — active. 4. Hanging— raise both legs to the left— active. 13 194 PRACTICAL MASSAGE. heVv ■ JUNC I J Fig. 67. — Girl, 15 Years Old. First examined February, 1901 ; last examined June, 1901. Prominent lordosis and severe back- ache. Home exercises onlj^ 1. Arm elevation forward and upward — standing. 2. Leg elevation — lying. 3. Right arm — upward stretch. 4. Standing with right hand on neck — raise right leg sideways. 5. Standing with trunk bent forward — horizontal arm flexion and extension. 6. Lie on stomach — raise right leg backward. 7. The same as No. 2. LATERAL CURVATL'RES 01' THE SPIXE. 195 / .]^, {$0i\\l99l Fig. 68.— Boy, 12^' Years Old. First examined October, 1902; last examined March, 1903. Five home exercises and at the clinic. 1. Forward trunk flexion and extension — sitting with left hand on neclv and right hand on hip — resistive. 2. Hanging — neck flexion and extension. 3. Lying— back curving — active. 4. Lying — leg elevation — active. 5. Hanging— raise legs backward and forward— active. 196 PRACTICAL MASSAGE. / \ Fig. 69.— Girl, 13 Years Old. First examined October, 1903; last examined March, 1904. Five home exercises and at the clinic. 1. Hanging— neck flexion and extension — resistive. 2. Back curving — lying— active. 3. Log elevation — lying — active. 4. Forward trunk flexion and extension — standing with thighs sup- ported at a bar — resistive. 5. Legs separated and closing — hanging — resistive. at a bar — resistive. For more information about "Scolio'sis" see Robt. W. Lovelt's "Curvatures of the Spine." CHAPTER XXVII. Rheumatism. "]\Iyitis" — in/lamiiiafioii of a iiiusclc, is one of the niO'St frequent ailments treated by massiige. It occurs oftenest in the muscles of the neck and in the glutei — the buttocks — the back and thorax, and in the muscles of the arms and legs. But no muscle can be considered immune from these insidious inflamimations of un- known origin, as they are found in the most protected places. "The pains, whether localized within a muscle or in an extensive nerve area, are of an extremely change- ful character, being now very sharp, as in lumbago ('back-shot'), which usually is due to myitis in the Iuml>ar muscles, oftenest of all in the sacrolumbalis ; or dull and diffused, so that they rather resemble the sensation of fatigue and correspond usually with the pains of anemia and chlorosis." (Dr. Kleen.) It can arise f rim different causes ; generally the rheumatism occurs in weakened muscles, from being exposed to draughts or dampness, but even external injuries and too much work with one set of muscles are often the cause of these ills. But the S}nnptoms are the same — pain and ache, when using the diseased mus- cles; diminution or cessation of function; tenderness on pressure, and often swelling of the muscle. (197) 198 PRACTICAL MASSAGE. Dr. J. Schreiber says : "We find that mechano'- therapy nowhere meets with more success than in the treatment of muscular rheumatism. "Any physician who has busied himself at all with mechanical therapeutics must have seen dozens of cases, abundantly proving- the assertion made by Matin in the Socicte de Mcdccine of Lyons as far back as 1837 (and since confirmed by Bonnet), that recent myalgias, no matter how severe or extensive, whether called lum- bago, 'stiff-neck,' or what not, are capable of being cured by a single application of massage. "A case of Stromeyer's is worth repeating here. A country doctor, who was accustomed to- visit his pa- tients on horseback, was attacked, after having been for some time in a draughty bam, with the most in- tense muscular pain in all parts of his body. An old peasant advised him to mount his horse again, as move- ment and exercise often dispelled these pains. He did so, though it required the help of several men to lift him into the saddle. The first paces of the horse caused most intense suffering, but gradually the pain diminished. A thunderstormi now coming up, the doc- tor put his horse to the top of his speed, which caused him to arrive home in a great perspiration, but en- tirely free from pain. "The words, 'arise and walk!' may be confidently said to any one suffering from a recent neuralgia who will but submit to treatment ; the power of motion re- turning almost invariably after the first application.'' My experience, however, has told me that whenever MUSCULAR RHEUMATISM. I99 myitis is caused l)y (ner\v(M-k, tlie muscles should be stretched out passi\ely and gentle centripetal massage applied, but no muscular exercise. This I have had aDundant occasion to experiment with in my own case, as my work has fre(iuently prixluced the most excru- ciating;- pain in my arms, sometimes in my leg's, which always was agg-ravated by movements or hard mas- sage, but immediately relieved and cured by stretching and gentle massage. In all O'ther cases I agree that good hard kneadings, percussion, and Ijeating, together with passive and re- sisti\e exercise, should be used; and the following prescriptions will probably be sufficient tO' show how the treatment ought to be : — MUSCULAR RHEUMATISM. A. Of the Right Arm. 1. Centripetal stroking, kneadings, and circulatoi'y friction of right arm. 2. Thigh rotation — reclining. 3. Right arm muscle beating. 4. Trunk rotation — astride sitting. 5. Right arm flexion and extension — resistive. 6. Leg flexion and extension — resistive. 7. Right arm torsion — resistive. * 8. Tlie same as No'. i. 9. Back percussion. 200 PRACTICAL MASSAGE. B. Of the Neck. 1. Forward arm rotation — sitting. 2. Head rotation — sitting, 3. Foot rotation — reclining. 4. Neck percussion — sitting. 5. Horizontal arm separation and closing — resis- tive. 6. Trunk torsion — kneeling — resistive. 7. Neck flexion and extension — resistive. 8. Knee flexion and extension — sitting — resistive. 9. Centripetal stroking, kneadings, and circulatory friction of the neck. 10. Back percussion and friction. C. Liimhago. 1. Forward trunk flexion and extension — sitting — resistive. 2. Thigh rotation — reclining — passive. 3. Stomach massage. 4. Trunk rotation — astride sitting — passive. 5. Breech beating — standing — passive. 6. Vertical arm flexion and extension — sitting — ■ resistive. 7. Bent-knee separation and closing — reclining — ■ resistive. 8. Muscle kneading, percussion, vibration, and friction all over the small of the back and the buttocks. These three examples show how to^ arrange the MUSCULAR RHEUMATISM. 201 treatmeiiL in the different cases of muscular rheuma- tism. Of course, if the patient is tooi sick to take tlie full prescription, we only a|>]ily the local treatment until he is able to take the whole, which has in \iew the increasing' of the circulation antl i;M\ing" nutrition to the \\hole system, as well as to relieve the local disease. ^\ few interesting cases it may be \vell to give here : — One September a lady, 55 years old, came to me. She was 5 feet 6 inches tall, and weig-hed 230 pounds. She complained of rheumatism in her legs and anns, and, could only walk up one flight of stairs, and that with the greatest difficulty. On her arrival she was gasping for breath and sat down tO' rest for nearh- an hour. Eight weeks later, having taken treatment every day, the lady asked if she might walk up tO' the top of the Washington ]\Ionument (about nine hundred steps). Although knowing that she had improved marvelously and had lost nearly thirty pounds, I told her that it would be better not to try it then, because there was no one to carry her down again if she be- came too tired. She laughed and said that she had walked up the monument the pervious day, looked aroimd for half an hour, and walked down and to her home, about a quarter of a mile distant. She felt veiy well after it, and had no lameness or pain. After ten weeks' treatment the lady was entirely 202 PRACTICAL MASSAGE. well, having had no rheumatism foir the last five weeks, and her weight was then 196 pounds. The next sum- mer she called to say that she still felt like a young girl, and was going West to live for the rest of her life. Other cases are as follow : — A gentleman, 31 years old, had suffered with mus- cular rheumatism in his right shoulder and arm for two weeks. He had not had any relief or sleep for several days when he came to me. Fi^'e days later he was cured. Dr. N. N., 46 years old, had been in bed about three weeks ^^•itll a very painful lumbago, and was unable to mo've himself when he sent for the author. Massage treatments were applied six times, after which he was out attending to his own business. A gentleman, 42 years old, had suffered from lum- bago and indigestion for nearly eight months, and had given up all kinds of treatment. On the advice of one O'f his friends I was called in. The patient, who' had once been a very strong and healthy laborer, was run down to a thin, very feeble-looking man. He did not believe in the treatment, but he submitted tO' a trial of it. The first treatment being satisfactory, it was con- tinued every day. The impro'vement was remarkable. The pain became less and less, and the appetite and strength were increased every day. After three weeks' treatment the patient had gained twelve pounds, and he was well enough to attend to his business. The treatment was then discontinued. Half a year later, when he felt some symptoms of ARTIIKITIS. 203 tlie lunil>ag-(:), he came to the Institute and took one month's treatment. He has been well ever since, A gentleman, 33 years old, big" and strong, had re- turned from a hunting trip and was attacked with a severe "lumbago." When I arrixed he had Ik'cu in bed four hours and groaned with pain. I first applied "thigh rotation" and "abdominal" massage ; then he was gently turned over and a vigorous massage of the back and buttocks was contiiuied for nearly an hour, when he got out of bed, dressed, and with a light step walked downstairs to enjoy his dinner. In the winter of 19 13 I v/as in Portland, Oregon, and while giving a lecture to the medical profession there, I claimed that I would cure any "lumbago" sent me, iu from two to six treatments. One of the well- known physicians immediately stood up and said that he would vouch for me, as he himself had come to me one morning in a verv bad condition and had one treat- ment at my office ; later in the afternoon I had come to him and given him another, after which he dressed and went to a banquet and had been well since. In less than a week after this I had six lumbago cases sent to me, each of which were cured in two treatments. Rheumatism of the Joints, arthritis. This disease is a very difficult problem tO' handle with massage, and must be done with great care and 204 PRACTICAL MASSAGE. gently, otherwise the inflammation wih be increased. Often it happens, if massage is applied tO' one joint and it seems to improve, that the inflammation will settle in some other joint. Still, even that may be better than to allow the inflammation tO' stay in one place. At least, I have seen a few cases where the elbow was first attacked, then the shoulder, and after the third treatment the hip; again the shoulder, but Anally disappeared, and were ciu'ed in six to eight treatments. But I do not care for these cases, and would rather not treat them, as they arei very unsatis- factory. Whenever I do give treatment for arthritis I al- ways begin with a good thorough massage of the stomach, and prefer to give massage tO' the whole body — always centripetal stroking and circular kneading of both arms and legs — and when soreness has disap- peared passive) flexion and extension, and rotation of every joint. If the joints are stiff and cannot be moved, local manipulation, as follows, are useful : — Centripetal stroking, pressing, kneading, heating, and friction of the diseased part and surrounding mus- cles, from ten to twenty minutes, will include the full treatment for some time, and even for months ; but when the joint finally responds tO' the treatment and allows of some motion, it will be most effecti\-e to treat it after the following method, given for rheumatism of the right knee: — ARTHRITIS. 205 1. Centripetal stroking, kneading-, beating, and friction — live minutes. 2. Right leg flexion and extension — resistive. 3. Trunk rotation — astride sitting. 4. Right knee muscle rolling — reclining. 5. Forward arm rotation — sitting. 6. Thigh rotation — both legs—reclining. 7. Trunk elevation — lying — active. 8. Right knee flexion and extension — sitting — re- sistive. 9. The same as No. i. In the first instance the treatment is given to in- crease the circulation in and around the joint, to pro- mote absorption, and to squeeze exudations out of the joints. In the second instance the treatment tends to tone up the whole system by strengthening the circulaion and digestive organs. Massage should not he used in any cases of high fever, cancer, ulcers, hemorrhages, infectious diseases, or diseases where the inflammatory products have as- sumed a quality injurious to the system, nor in most skin diseases. INDEX. Abdomen, massage of, 51, 52, 53, 54. 55, 56. effects of massage of, 51- 57. Adhesions, solution and re- moval of, 15, 16, 11, 28, 45, 110. Ankle-joint, to limber and strengthen, 45, 4<^), 80, 113. Arms, corrective active exer- cises of, 92. circling, 93. elevation, 93, 94. flexion and extension, 95, 96. flinging, 94. passive movements of the, 11. A. Manipulations of the, 11. beating, Z2i. friction, 31. circular, 25. kneading, 22. circular, 24. combination, 32. muscular, 23. muscle rolling, 31. nerve compression, 30. percussion, ZZ. slapping, 31. stroking, centripetal, 22. vibration, 35. Arms, passive movements of : B. Rotations, or circum- duction, of the, Zl . arm, 38. finger, Zl. forearm, Z7 . forward arm, 41. hand, Zl . shoulder, 43. vertical arm, 40. resistive movements of the, n. flexion and extension of arm, linger, hand, 11, IZ, 74, 75. lateral arm elevation, 11. separation and closing, 76. traction, 1%. Back, massage of, 58-62. Backache, relieves, 60. Bladder, weakness of, 63. Blood, circulation, good effect on, 26-108. high pressure, 130-132. I'rain, derivative from the, 36, 39, 42, 91. quieting eft'ect on, 71. "Charley-horse," treatment of, 113. Chest, derivative effect on, 36, 40, 42. (207) 208 INDEX. Chest, expansion of, 40, 41, 42, 43, 74-77. manipulations of the, 49, 50. Cold hands, treatment of, 32, 38. feet, treatment of, 177. Constipation, good effect in, 47, 48, 51-57, 81, 83, 84. useful in, 88, 89, 98, 102-107. Diseases and their treatment, 109. arteriosclerosis, 130, 131, 132. constitutional diseases chlorosis and anemia, 134, 135, 136. diabetis mellitus, 140, 141. hysteria and hypochondria, 133. insomnia, 137, 138, 139. neurasthenia, 125, 126, 127. diseases of the organs of circulation, 171. chronic heart diseases, 171, 172, 173, 174, 175. cold hands and feet, 177. high blood-pressure, 130, 131, 132. the "Schott" treatment, 176. of the organs of digestion, 179. appendicitis, 183. constipation, 180, 181. dyspepsia, 179, 180. indigestion and bilious- ness, 183, 184. liver, hyperemia of, 182. obesity, 184. Diseases of the organs of movement, 109-205. joints, stiffness of, 109, 110, 111, 112. rheumatism, muscular, 197, 198. joints, ''arthritis," 203, 204, 205. lumbago, 200, 201, 203. of arm, 199. of neck, 200. scoliosis, 187, 188, 189, 190, 191, 192, 193, 194, 195. sprains, 113, 114, 115, 116. synovitis, 113, 114, 115, 116. water on knee, 113. "Charley-horse," 113. of the respiratory organs, 177. bronchialis, spasmus, 177. larynx, catarrh of, 177. lungs, catarrh of, 177. congestion of, 177. emphysema of, 177. tuberculosis, 177, 178. of the urinary and sexual organs, 185. bladder, chronic catarrh of, 185. menstruation, irregular and painful, 186. womb, chronic catarrh of, 185. displacement of, 186. local diseases, 143. IXDEX. 209 Diseases, local, brain, conges- tion of the, 143. anemia of the, 144. chorea, 161, 162. legs, cramp of, 161. neuralgia, sciatic, 163, 170. paralysis, result of apo- plexy, 144-149. infantile, 153-158. spine, congestion of, 150. , tabes dorsalis (locomotor ataxia), 150-152. writers' cramp, 160, 161. Effects, physiological, of move- ments, 15. of active and resistive, 16, 17. of centripetal stroking, 27. of kneadings, 28, 29, 52, 53, 54. of manipulations, 26, 27. of nerve compression, 32, 33. of passive movements, 15, 16. of percussion, 34, 35. of respiratory movements, 42, 43. Face, massage of the, 67, 68, 69. Flat-foot, 119, 120, 121, 122. General massage, 123, 124, 125. prescription I, 126, 127, 128. prescription IT, 129. prescription III, 130, 131. Head, bending of the, 102. flexion of the, 71. massage of the, 64, 65, 66, 67. rotation of the, 71. Heart, organic diseases of, 171-175. Hip-joint, stiffness and weak- ness, 47, 81, 87. to limber, 47. Hydrarthrus, treatment of, 113. Indigestion, good effect in, 47, 51. 53, 55, 89, 99, 101- 107. Insomnia, good effect in, 30, 31, 58, 60, 61, 66. Joints, stiffness of, 109, 110, 111, 112. Kneading, circular, of abdo- men, 53, 54. circular, of ann, 24, 25, 28. of leg. 44. combination, of arm, 32. of leg, 44. knuckle, 52. muscle, 52, 53. muscular, of arm, 23, 24, 28. of leg, 44. Lameness, stimulating effect in, 31, 32. treatment of, 33. Legs, manipulation of the, 44. beating, 44. friction, 44. kneading, muscle, circular, combination, 44. 210 INDEX. Legs, muscle rolling, 44. nerve compression, 44. percussion, 44. slapping, 44. stretching the sciatic nerve, 45. stroking, centripetal, 44. vibration, 45. corrective, active exercises of, 97. balance standing, 100. bending, knees, 98. charge, 99. elevation of the, 97, 98, 99, 101. resistive movements of the, 80. elevation of the, 83. flexion and extension, foot and leg, 80, 81. knee, 83. separation of the, 84, 85, 86. torsion of the leg, 87. traction of the knee, 81. of the leg, 84. rotations, or circumductions, of the, 45. foot rotation, 45. flexion, 46. hip rotation, 48. thigh rotation, 46, Liver, stimulating effect on, 56. LungE, stimulating effect on, 36, 40, 41, 42, 43. 49, SO, 56. diseases of the, 177, 178. Lymph, removal of, 26, 27, 28. Massage, not to be used, 205. Muscles, abdominal, 82, 83, 97. to strengthen, 78, 82, 83, 84, 89, 104, 105, 107. abductor, of thigh, 85, 97,98. adductor, of thigh, 87. arm, 74, 79. to strengthen, 12,, 75, 79. back, 74, 75, 93, 95, 103. to strengthen, 74, 78, 89, 90, 95, 100, 104. calf and foot, 98. to strengthen, 80, 99, 121. extensors, of leg, 81, 83, 97, 98. of thigh, 81, 98. flexor, of leg, 82. of thigh, 82, 97. neck, 102. Nerve centers, stimulation of, 2,2,, 59. strengthening of, 50, 60. Nerves, good effect on, 31, 32, 60. stimulating effect on, 36, 61. to quiet, 31, 58, 60, 61. to sooth, 31, 58, 60, 61. to stimulate action of, 31, ZZ, 59, 61. Nervous palpitation, 50. Pelvis, derivative, from organs of, 47, 63, 81, 84, 86. diseases of, 185. Purgative effect, 47, 48, 51, 52, 54, 55, 63, 89. INDEX. 211 Respiration, good effect on, 36, 42, 50, 89, 93. good iiiovenient for, 41, 43, 50, 75, 78, 90. stimulating effect on, 36, 49, 50, 94. Rheumatism, 197. treatment of muscular, 199, 200. 201, 202. of joint, 203, 204, 205. Sexual organs, weakness of, 185. Shoulder-joint, muscles of, 79. stifYness of, 79, 109. to limber, 38. 93, 96, 104. to strengthen, 79, 93, 96, 104. Shoulders, to straighten, 40, 41, 42, 74, 75, 76, 11, 93, 94, 100. Spine, good effect on, 58, 59, 60, 61. Spine, to straighten, 74, 11 , 89, 94, 99, 100, 187-195. Stomach, friction of, 51. good eflfect on, 51-56. kneading of, 52, 53. vibration of, 55. Trunk, corrective active exer- cises of, 102. chopping movement, 104. circling of, 106. elevation of, 106, 107. flexion and extension, 102, 103, 104. harvesting, 104. horizontal, 108. torsion of, 105. movements of, 88. flexion and extension, 89, 90. rotation, 88. torsion, 88, 89. Throat, massage of the, 64, 70, 71. 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