Massage. The word massage has of late years come into general use to signify the method of treating disease or other physical conditions by manipulating the muscles and joints. According to Littre the word is derived from the Arabic mass, and has the specific meaning of "pressing the muscular parts of the body with the hands, and exercising traction on the joints in order to give suppleness and stimulate vitality." It was probably adopted from the Arabian physicians by the French, who have played a leading part in reviving this method of treatment, which has been practised from time immemorial, and by the most primitive people, but has from time to time fallen into disuse among Western nations. In the Odyssey the women are described as rubbing and kneading the heroes on their return from battle. In India, under the name "shampoo" (tshampua), the same process has formed part of the native system of medicine from the most remote times; professional massers were employed there by Alexander the Great in 327 B.C. In China the method is also of great antiquity, and practised by a professional class; the Swedish gymnastic system instituted by Pehr Henrik Ling is derived from the book of Cong-Fou, the bonze of Tao-Sse. Hippocrates describes and enjoins the use of manipulation, especially in cases of stiff joints, and he was followed by other Greek physicians. Oribasius gives an account of the application of friction with the bare hands, which exactly corresponds with the modern practice of massage. It is worthy of note that the treatment, after being held in high esteem by the leading Greek physicians, fell into disrepute with the profession, apparently on account of its association with vicious abuses. The same drawback has made itself felt in the present day, and can only be met by the most scrupulous care in the choice of agents and the manner of their employment. Among the Greeks, Romans, Egyptians, and later the Turks, massage came to be part of the ordinary procedure of the bath without any special therapeutic intention, and the usage has survived until to-day; but that mode of application was no doubt a refinement of civilized life. Medical rubbing is older and more elementary than bathing, as we see from its employment by savages. Probably it was evolved independently among different races from the natural instinct - shared by the lower animals - which teaches to rub, press or lick any part of the body in which uneasiness is felt, and is therefore the oldest of all therapeutic means.
According to Weiss, the therapeutic use of massage was revived in Europe by Hieronymus Fabricius ab Aquapendente (1537-1619), who applied it to stiff joints and similar conditions. Paracelsus in his De medicina Aegyptiorum (1591), gives a description of methodical massage as practised by the Egyptians quite on modern lines. Thereafter it appears to have been adopted here and there by individual practitioners, and various references are made to it, especially by French writers. The word "massage" occurs in an essay written by Pierre Adolphe Piorry (1794-1879) for a large encyclopaedia which appeared in 1818, but it was probably used before. The practice was gradually advocated by an increasing number of medical men. In Great Britain it was called "medical rubbing," and at Edinburgh Beveridge had a staff of eight trained male rubbers. A book published by Estradere in 1863 attracted much attention, but the man who contributed most to the modern popularity of massage was Metzger of Amsterdam, who began to use it tentatively in 1853, and then proceeded to study and apply it methodically. He published an essay on the subject in 1868. The modern refinements of the treatment are chiefly due to him. At the same time, its application by Dr Silas Weir Mitchell to hysterical and other nervous conditions, in conjunction with the "rest cure," has done much to make it known.
Massage, as now practised, includes several processes, some of which are passive and others active. The former ire carried out by an operator, and consist of rubbing and kneading the skin and deeper tissues with the hands, and exercising the joints by bending the patient's limbs. The active movements consist of a special form of gymnastics, designed to exercise particular muscles or groups of muscles. In what is called "Swedish massage" the operator moves the limbs while the patient resists, thus bringing the opposing muscles into play. Some writers insist on confining the word "massage" to the rubbing processes, and use the general term "manipulation" to cover all the movements mentioned; but this is a verbal subtlety of no importance. It is evident that alike among the Greeks, the Orientals, and savage races, the two processes have always been applied as part of the same treatment, and the definition quoted above from Littre goes to show that the word "massage" is properly applied to both.
Rubbing has been subdivided into several processes, namely' (r) stroking, (2) kneading, (3) rubbing, and (4) tapping, and some practitioners attach great importance ' to the application of a particular process in a particular way. As a rule, oils and other lubricants are not used. But, however it may be applied, the treatment acts essentially by increasing circulation and improving nutrition. It has been shown by Lauder Brunton that more blood actually flows through the tissues during and after rubbing. The number of red corpuscles, and, to some extent, their haemoglobin value, are also said to be increased (Mitchell). At the same time the movement of the lymph stream is accelerated. In order to assist the flow of blood and lymph, stroking is applied centripetally, that is to say, upwards along the limbs and the lower part of the body, downwards from the head. The effects of the increased physiological activity set up are numerous. Functional ability is restored to exhausted muscles by the removal of fatigue products and the induction of a fresh blood supply; congestion is relieved; collections of serous fluid are dispersed; secretion and excretion are stimulated; local and general nutrition are improved. These effects indicate the conditions in which massage may be usefully applied. Such are various forms of paralysis and muscular wasting, chronic and subacute affections of the joints, muscular rheumatism, sciatica and other neuralgias, local congestions, sprains, contractions, insomnia and some forms of headache, in which downward stroking from the head relieves cerebral congestion. It has also been used in anaemia, hysteria and "neurasthenia," disorders of the female organs, melancholia and other forms of insanity, morphinism, obesity, constipation, inflammatory and other affections of the eye, including even cataract. General massage is sometimes applied, as a form of passive exercise, to indolent persons whose tissues are overloaded with the products of incomplete metabolism.
As with other methods of treatment, there has been a tendency on the part of some practitioners to exalt it into a cure-all, and of others to ignore it altogether. Of its therapeutic value, when judiciously used, there is no doubt, but it is for the physician or surgeon to say when and how it should be applied. Affections to which it is not applicable are fevers, pregnancy, collections of pus, acute inflammation of the joints, inflamed veins, fragile arteries, wounds of the skin and, generally speaking, those conditions in which it is not desirable to increase the circulation, or in which the patient cannot bear handling. In such conditions it may have a very injurious and even dangerous effect, and therefore should not be used in a haphazard manner without competent advice.
The revival of massage in Europe and America has called into existence a considerable number of professional operators, both male and female, who may be regarded as forming a branch of the nursing profession. Some of these are trained in hospitals or other institutions, some by private practitioners and some not at all. Similarly some are attached to organized societies or institutions while others pursue their calling independently. Several things are required for a good operator. One is physical strength. Deep massage is very laborious work, and cannot be carried on for an hour, or even half an hour, without unusual muscular power. Feeble persons cannot practise it effectively at all. The duration of a sitting may vary from five or ten minutes to an hour. For general massage at least half an hour is required. A masser should have strength enough to do the work without too obvious exhaustion, which gives the patient an unpleasant impression. A second requirement is tactile and muscular sensibility. A person not endowed with a fine sense of touch and resistance is liable to exert too great or too little pressure; the one hurts the patient, the other is ineffective. Then skill and knowledge, which can only be acquired by a course of instruction, are necessary. Finally, some guarantee of cleanliness and character is almost indispensable. Independent massers may possess all these qualifications in a higher degree than those connected with an institution, but they may also be totally devoid of them, whereas connexion with a recognized hospital or society is a guarantee for a certain standard of efficiency. In London there are several such institutions, which train and send out both male and female massers. The fee is 5s. an hour, or from two to four guineas a week. On the European continent, where trained massers are much employed by some practitioners, the fee is considerably lower; in the United States it is higher. For reasons mentioned above, it is most desirable that patients should be attended by operators of their own sex. If this is not insisted upon, a valuable therapeutic means will be in danger of falling into disrepute both with the medical profession and the general public. (A. SL.)
