THE ART 
Oi 
MASSAGE. 
'.’PACTS ON MASSAGE, 
TRANSLATED FROM THE 
„ J'EilitlAN OF REIBMAYR, WITH NOTES, 
BY 
IJENJAMIN LEE, A.M., M.D., PhD. 
P HIL . D E L PIIIA : 
* S 8 5 . TRACTS ON MASSAGE. 
No. I. 
THE ART OF MASSAGE. 
TRANSLATED FROM THE 
GERMAN OF REIBMAYR, WITH NOTES, 
BY 
BENJAMIN LEE, A.M., M.D., Ph.D., 
LATE PRESIDENT OP THE AMERICAN ACADEMY OP MEDICINE, MEMBER OF THE 
AMERICAN ME )IC A L OF.TltE IEDICAL SOCIF 1Y OF 
THE STATE >iJYillJl*&ialyAwl AVBOKiIh fetTkirlARfY DF THE AMERI AN 
MEDICAL OCIETY IN PARIS. MEMBER OF THE PHILA Wj|j>>mi> flO¥|IQ Y 
medic a i. Pggtg E yy T f 0 '1885 IBKJTIOITC TO THE I 
PATH )LOGY, DIAGNOSIS, AND TREATMENT >F ANGULAR 
CURVATURE OF THE SPINE,” FORMER EDITOR OF THE 
“AMERICAN MEDICAL MONTHLY,” ETC. ETC. 
PHILADELPHIA: 
x885. The price of any Tract of the Series will be Twenty-Five Gents. 
Address all orders to 
BENJAMIN LEE, M.D., 
j/j South ipth St., Philadelphia. 
Entered according to the Act of Congress, in the year 1885, by 
BENJAMIN LEE, M.D., 
in the Office of the Librarian of Congress. All rights reserved. 
Collins Printing House, 
705 Jayne Street- TRANSLATOR’S PREFACE. 
I propose to issue, in the shape of short tracts, for 
the benefit of the busy practitioner, the substance of 
a useful little treatise by Dr. Albert Reibmayr, of 
Vienna, entitled “ Massage and its Utilization in the 
various Departments of Medical Practice.” An 
acquaintance of twenty-five years with this important 
therapeutic means, enables me to assert without hesi- 
tation its unquestionable and too little recognized 
value, while the communications which I am receiv- 
ing from physicians in different parts of the country, 
in regard to the paper upon this subject which I had 
the honor to read before the recent meeting of the 
Medical Society of the State of Pennsylvania, under 
the title, “Massage the latest Hand-maid of Medi- 
cine,” convince me that the time is ripe for an 
enunciation of its principles and a description of its 4 
TRANS LA TOR'S PREFACE. 
practice. The present tract will be shortly followed 
by others on “The Physiological Effects of Massage,” 
and on its “Employment in Medicine,” in “Surgery,” 
in “Midwifery,” in “Gynaecology,” and in “Ophthal- 
mology.” A bibliography will be appended to each 
tract for the accommodation of those who desire to 
procure their information at first hand. The few 
notes which I shall add will be placed in brackets. 
Since penning the above, I have received from the 
author a short treatise, liberally illustrated with wood- 
cuts, on the “Art of Massage,” portions of which I 
shall incorporate in the text without special reference. 
BENJAMIN LEE, 
313 South 15TH Street, Philadelphia. AUTHOR’S INTRODUCTION. 
During the last decade of the present century Mas- 
sage has been rapidly winning the recognition both of 
physicians and of the invalid public, until it to-day 
holds equal rank in general therapeutics with other 
physical methods of treating disease, such as Hydro- 
therapy, Remedial Gymnastics, and Electrotherapy. 
The relatively short time which has elapsed since it 
celebrated its renaissance, and the fact that its spread 
and development first took place in foreign countries, 
account for the scanty and incomplete character of its 
German literature. Not until the last ten years did Ger- 
man medical writers begin to notice this therapeutic 
means; and their contributions, contained principally in 
journals and periodicals, usually describe but a single one 
of its manifold applications. It is very difficult, there- 
fore, for the practising physician adequately to picture 
to himself the extended field of usefulness which it 
already occupies in all branches of medicine. If there 
is still much clinging to it which cannot stand the severe 
scientific criticism of modern medicine, we may excuse 
this on the ground that the method is still in its infancy, 
and—that other methods fare no better. 
It is the object of this work to collect the scattered 
testimony as to the efficacy of massage as a mode of 
treatment, and to furnish the practitioner with as com- 6 
AUTHOR'S INTRODUCTION. 
plete a representation as may be of its present capabili- 
ties. It is also hoped, by means of a precise descrip- 
tion of its various modes of application, to enable him 
to adopt and utilize it in his own practice. 
The history of Massage, as demonstrated by Weiss* 
and Ritterfeld,f is very ancient, written allusions 
to it reaching back among the Chinese to a period three 
thousand years before our era. Older still than their 
writings are their oral traditions with reference to the 
same subject. The civilized nations of antiquity em- 
ployed it, both as a therapeutic and as a hygienic means. 
Among the Greeks and Romans it was resorted to espe- 
cially after the bath, and this custom still prevails among 
the Orientals. After the struggles of the circus, it was 
the function of massage to dissipate the resulting con- 
tusions and extravasations, and restore pliability to the 
stiffened joints. 
During the Middle Ages, it vanished completely 
from the medical schools, receiving only an occasional 
recognition in connection with midwifery. It thus fell 
completely into the hands of the laity, and this unfor- 
tunately is sufficient ground, in the minds of many 
physicians, for glancing askance upon a remedial agent 
of great value. 
The first nation to re-discover this therapeutic trea- 
sure and rescue it from oblivion were the French. 
Tissot (1780), Meibom (1795), and Bonnet (1845), 
* Bela Weiss: Ueber Massage, etc. Wiener Klinik, 1879. 
Heft 11 and 12. 
t Ritterfeld-Confeld : Massage, Wiesbaden, 1881. AUTHOR'S INTRODUCTION. 
7 
have laid us under obligations in promoting its regene- 
ration. But the writings of these men scarcely at- 
tracted a passing notice, even in their own country, to 
say nothing of foreign lands. 
To Dr. Mezger, of Amsterdam, and his pupils, 
Berghman and Helleday, is due the credit of having 
reduced massage to a system founded upon the basis of 
numerous experiments, and of earning for it the repu- 
tation of being a truly reliable remedial agency. His 
system possesses the great advantage of being as simple 
as it is clear, and should, therefore, be accepted by all 
adherents of this method of practice. 
From the first, massage found speedy acceptance in 
the northern countries of Europe: England, Sweden, 
Norway, Denmark, and Holland; hence the literature 
of these nations on the subject is relatively rich. Ger- 
man surgeons began to occupy themselves with it, as 
already said, about ten years since, and the fact that it 
was warmly received by such men as Billroth, 
Esmarch, Gussenbauer, Mosengeil, Thiersch, and 
Schmidt, and found a permanent place in their clinics, 
must not be underestimated in accounting for its rapid 
spread in Germany and Austria. This is not sufficient, 
however, to entirely explain the popularity which it has 
attained in all quarters, in so short a period of time. 
The principal reason is, that, in consequence of the 
progress of the modern natural sciences, especially 
their medical departments, physiology, pathological 
anatomy, and so on, the old routine-fettered modes of 
practice had fallen into complete discredit with think- 8 
AUTHOR'S INTRODUCTION. 
ing physicians. The aspiration after more rational reme- 
dial measures, which could to a certain extent maintain 
themselves beforfe this scientific tribunal, was thus stimu- 
lated. In addition to this, the nihilism of Skoda on 
the one hand, and Homoeopathy on the other, com- 
bined to seriously weaken the supremacy of routine 
medication, and thus the way was prepared for the phy- 
sical methods of treatment, Hydrotherapy, the Swedish 
Remedial Gymnastics, Electrotherapy and Massage. 
The successful results obtained by Priessnitz, Schrott, 
and others who had not enjoyed the advantages of a 
medical education, accomplished the rest; so that all 
these simple modes of treating disease speedily found 
numerous enthusiastic, and not seldom, we must allow, 
fanatical advocates among physicians as well as among 
the public. 
Besides all this, Massage possesses the great advantage 
of being a method of practice which suits our skeptical 
age. Its results follow its employment so immediately 
—being often not simply visible to the eye, but recog- 
nizable by the touch, and even susceptible of measure- 
ment—that it must disarm the most complete skeptic, no 
doubt being possible as to the “post hoc propter hoc." 
Farther, this therapeutical system answers better than 
any other to the more purely mechanical theory of the 
physiological processes of the human organism which 
are to-day in vogue. 'All these influences conspired to 
aid the rapid spread of massage, and its recognition by 
the medical world finally assured its success. THE ART OF MASSAGE. 
[By Massage I understand the communication of 
motion to the tissues of the living human body from 
an external source for therapeutic purposes. It is thus 
distinguished from Movements, variously designated as 
Swedish Movements, Localized Movements, Remedial 
Gymnastics, and so on, which imply motion of entire 
limbs or of the trunk, through the medium of the 
joints, and from Exercise, which presupposes the exer- 
tion of the will, and therefore the communication of 
motion from an internal source. It may be Immediate, 
communicated directly to the tissues by the hand of 
the operator, or Mediate, communicated through the 
agency of mechanical contrivances or machines. In 
the latter case it matters not whether the motor power 
be the muscle of an operator or steam or electricity. 
But the latter sources of motion must of course be 
under intelligent and watchful supervision. The word 
massage comes to us from the Greek through the 
French, and means simply Kneading, the idea to be 
conveyed being that the operator works the flesh as the THE ART OF MASSAGE. 
baker works his dough. It is better to use the French 
word than to translate it into English, because the Eng- 
lish equivalent is used-to describe one of the particular 
modes of massage, and also because the former has now 
a well established position and definite signification in 
scientific medical literature all over the world. The 
attempt to belittle the system by calling it 11 rubbing,'" 
an entirely inadequate designation, can only react on 
those who employ it, by indicating their partial educa- 
tion and their lack of familiarity with the recent medi- 
cal literature of other countries.] 
French writers upon this subject, among them Estra- 
dere(i) in particular, have burdened the art with a large 
variety of procedures, having in point of fact quite im- 
material differences: such as stroking, friction, kneading, 
sawing, fulling, pinching, ?nalaxation, percussion, chop- 
ping, clapping, pointed vibrations, and deep vibrations. 
At the present day we find that we can accomplish 
our results with the employment of much fewer modes 
of application, but on this very account we lay great 
stress upon the manipulations which should precede and 
follow massage proper. In the following chapters we 
shall see how important it is in many cases not to begin 
at once with massage of the affected part, but, com- 
mencing our operations upon the cardiac side, to 
manipulate first the contiguous healthy tissues. This 
Introductory Massage, should, wherever it is practicable, 
especially in the case of affections of the extremities, 
precede massage proper of the affected region. THE ART OF MASSAGE. 
11 
It consists, essentially, in tolerably firm centripetal 
stroking of the surface, first with the palm of one hand— 
afterwards with those of both hands—the entire limb 
being in the second instance grasped immediately above 
the seat of disease and the pressure made principally 
with the radial borders of the hands. These manipu- 
lations are continued for two or three minutes, and 
usually extend as far as the next joint above. The 
flexure of that joint should receive especial attention 
and be subjected to very firm pressure, inasmuch as it 
is there that the larger venous and lymphatic trunks are 
found. This modification has also an important appli- 
cation when for any reason, such, for example, as 
excoriation of the surface or extreme sensitiveness of 
the inflamed parts, massage directly upon the injured 
or otherwise morbidly affected region is impossible. 
The importance of this preparatory procedure has 
been recognized by all authors. I have already else- 
where referred to its usefulness in chronic inflammations 
of the joints.* In these cases, the deposits which form 
around the inflamed joints invariably extend upward 
along the lymphatics and bloodvessels between the 
sheaths of the muscles, the tendons, and the fasciae. 
They are easily recognized as little rounded nodules, of 
varying consistence, usually very painful under firm 
pressure. As invariably, as the result of such inflamma- 
tions, do we observe that certain contiguous groups of 
* Reibmayr ; The Treatment of Chronic Synovitis by Massage. 
Pester Med. Chirurg. Presse, 1883. 12 
THE ART OF MASSAGE. 
muscles begin to atrophy. From the investigations of 
Le Fort and Valtat, it appears that this condition be- 
gins to develop very early. The groups which this 
atrophy attacks by preference, and to the greatest ex- 
tent, are : at the knee, the quadriceps; at the shoulder, 
the deltoid first, subsequently the supra-spinatus, infra- 
spinatus and pectoralis major; at the hips, the glutei; 
at the elbow, the biceps and brachialis internus; at the 
ankle, the extensors of the foot. The articular inflam- 
mation insidiously and almost unnoticed propagates 
itself to these particular muscular groups, and in the 
iorm either of induration or of fatty degeneration ex- 
erts a prejudicial influence upon their nutritive pro- 
cesses, thus bringing about wasting of the individual 
muscular fibres. It must, therefore, be our especial 
aim in the treatment of these cases, to protect the con- 
tiguous muscles and prevent these deposits of exu- 
dation and the resultant atrophy. We must invari- 
ably plant the lever of our massage here first, and so 
doing we shall afterwards find no difficulty in restoring 
the joint itself to its normal condition. The permea- 
bility of the numerous lymphatics which have been 
plugged up by inflammatory detritus will thus be in- 
sured, and the process of absorption greatly facilitated. 
It is my habit in treating either acute or chronic inflam- 
mations of the joints to knead only the regions lying 
above the affected parts, as for example in the case of 
the knee, the muscles of the thigh, for the first week or 
ten days, and I thus save the patient much unnecessary 
suffering. By observing this precaution, serious irrita- THE ART OF MASSAGE. 
13 
tion of the inflamed joint is never produced, even 
Jhough very forcible manipulations are employed. 
When the venous and lymphatic systems have, in this 
way, been prepared for the absorption of pathological 
products, we are ready to proceed to massage proper of 
the diseased tissues. 
In my division of the subject I follow Mezger and 
his pupils Berghman and Helleday,(2) who describe 
only four methods of procedure ; Stroking, Friction, 
Kneading, and Percussion. 
This practical subdivision has been adopted by most 
of the more recent Masseurs, as for example, von 
Haufe,(3) Gautier,(4) and Little and Fletcher.(5) 
1. Stroking is done with the palm of the hand or 
its radial border, the thumb being abducted, and the 
force employed varying with the indications from the 
gentlest caress to the heavy pressure made by reinforc- 
ing the operating hand by the other laid on top of it. 
When old exudations are strung along between tendons 
and muscles, it is necessary to penetrate more deeply 
into the tissues with the fingers. This may be accom- 
plished with the thumb alone or with several fingers, 
the tips being held nearly perpendicular to the surface, 
and pushed slowly forward, while the depth to which 
they penetrate is regulated by the degree of prominence 
of the indurations. In working over limited areas, and 
where the bone lies immediately below the surface, very 
moderate pressure must be made, the palms of one or 
both thumbs being brought into requisition. On the 
other hand, in situations where large muscular masses are 14 
THE ART OF MASSAGE. 
found, the hands must be so held that the fleshy cushions 
of the palm, corresponding to the thumb and the little 
finger, may be chiefly used, the relative positions of the 
operator and the patient being such that the former can 
utilize the weight of the upper part of his body in im- 
parting emphasis to the stroke. The direction of the 
strokes is nearly always centripetal (toward the body 
or heart), but in rare cases, to be especially noted, it 
may be centrifugal (away from the body or heart.) 
2. Friction consists in forcible, circular rubbing 
with the hand, especially with the tips of the fingers, 
alternated with firm centripetal stroking either with the 
same hand or the other hand. Over very small surfaces, 
the last phalanx of the thumb is used to perform this 
manipulation. The remaining fingers of the hand, or 
if need be of both hands, clasp the limb which is under 
treatment, and thus make use of it as a point of support. 
Inasmuch as it is the object of this mode of manipu- 
lation, as we shall see subsequently, to force out pa- 
thological deposits from diseased parts and distribute 
them through the surrounding healthy tissues, we should 
always begin just at the border of the pathologically 
altered tissue ; and for the same reason there is little 
to choose as regards the direction in which the pressure 
shall be made, so long as it is towards sound tissue. 
It may even be centrifugal if healthy parts can thus be 
more readily reached. Only let it be borne in mind 
that friction must invariably conclude with centripetal 
stroking. 
3. Kneading : By this term we understand picking THE ART OF MASSAGE. 
up a muscle or other portion of tissue, with both haqds 
or with the fingers of one hand, and subjecting it to 
firm pressure, or fulling and squeezing it between the 
fingers on one side, and a dense underlying tissue, 
as for instance, bone, on the other. If we have to 
deal with a very small object, as, for example, a 
thickened tendon on the back of the hand (ganglion), 
we seize the tendon between the tips of both thumbs, 
taking care that the nails are cut short, and are thus 
able to subject it to firm pressure. 
[Dr. Douglas Graham, of Boston, who unites in a 
greater degree than any one in this country the practical 
skill of an accomplished masseur, with the theoretical 
knowledge of an intelligent and educated physician, in 
his recent work, “A Practical Treatise on Massage,”(17) 
gives some very useful general instructions as to the 
mode of procedure in friction and kneading, from 
which I quote : “1. All of the single or combined pro- 
cedures should be begun moderately, gradually in- 
creased in force and frequency to their fullest extent 
desirable, and should end as gradually as begun. 2. 
The greatest extent of surface of the fingers and hands 
of the operator consistent with ease and efficacy of 
movement should be adapted to the surface worked 
upon, in order that no time be lost by working with 
the ends of the fingers, or one portion of the hands 
when all the rest might be occupied. 3. If too near 
the patient, the manipulator will be cramped in his 
movements; if too far away, they will be indefinite, 
superficial, and lacking in energy. . 4. The patient 16 
THE ART OF MASSAGE. 
should be placed in an easy and .comfortable position, 
with joints midway between flexion and extension . . 
6. The direction of the procedures should be almost 
invariably from the extremities to the trunk, from the 
insertion to the origin of the muscles, and in the direc- 
tion of the returning currents of the circulation.” 
This author is the only one with whose writings I am 
acquainted, who attempts to define the rapidity with 
which the individual strokes should be given in stroking 
and friction. In stroking the hands from the finger 
tips to the wrist, he advises that from ninety to one hun- 
dred and eighty strokes, each including a light return 
stroke, be made per minute. The oval strokes with 
both hands, upon the arm or forearm, one hand de- 
scending as the other ascends, may be delivered at the 
rate of from seventy-five to one hundred and eighty, 
for each hand, which in point of fact constitutes from 
one hundred and fifty to three hundred and sixty 
strokes in the minute. 
Below the knees, from the ankles up, they may num- 
ber from one hundred to one hundred and sixty with 
each hand; above the knee from sixty to one hundred. 
Upon the back they will not reach more than from sixty 
to seventy-five. Kneading cannot be executed with as 
much rapidity as stroking and friction, owing to its 
more complex character. That of the separate fingers 
may be accomplished at the rate of from seventy-five 
to one hundred and fifty movements per minute, of the 
arms at very nearly the same rate; of the legs from 
sixty to ninety, and of the thighs from forty to eighty. THE ART OF MASSAGE. 
17 
On the back these manipulations will average about one 
a second for each hand. A valuable feature of Dr. 
’Douglas’s work is his careful delineation of the various 
regions which may be advantageously included in a 
single application or procedure. He says : “From the 
wrist to the elbow, and from the elbow to the shoulder- 
joint are suitable extents of surface to be worked upon. 
As the lower limbs are larger than the upper, the late- 
ral and posterior aspects from ankle to knee will form 
a convenient territory, while the lateral and anterior 
aspects will make another. He directs that the operator 
should stand facing the patient in treating the lateral and 
posterior aspects, and after having completed the fric- 
tion here, without stopping the strokes, turn his back to 
the patient, and continue the operation on the anterior 
and lateral aspects, each thumb following the other, 
with tolerably firm pressure on the anterior tibial group 
of muscles. The same systematic division of surface 
may be made above the knees as below; but the ope- 
rator’s back to the patient will, on the whole, be the 
easiest and most efficacious way of applying friction to 
the thighs. . . . From the base of the skull to the spine 
of the scapula forms another region well bounded for 
downward and outward semicircular friction, and from 
the spine of the scapula to the base of the sacrum forms 
another surface, over which one hand can sweep, while 
the other works towards it, from the insertion to the 
origin of the glutei. . . . The chest should be done 
from the insertion to the origin of the pectoral mus- 
cles.” 18 
THE ART OF MASSAGE. 
He very judiciously observes that in kneading, “each 
group of muscles should be systematically worked upon, 
and for this purpose one hand should be placed oppo- 
site the other, or, when the circumference of the limb 
is not great, one hand may be placed in advance of the 
other, the fingers of one hand partly reaching on to the 
territory of the other, so that two groups of muscles 
may be manipulated at the same time, with grasping, 
circulatory, spiral manipulations, one hand contracting 
as the other relaxes, the greatest extension of the tissues 
being upwards and laterally, and on the trunk, forearms, 
and legs away from the median line. . . It is well first to 
go over a surface gently and superficially before doing 
the manipulation more thoroughly and in detail.” In 
kneading a leg of considerable size, he finds “three 
divisions of surface necessary; the posterior and lateral 
aspects will form one; the stretching of the peroneal 
muscles from those of the anterior tibial region . . . 
will make another, and for the third, a rolling of the 
tissues will be made away from the crest of the tibia. . . 
Above the knee one hand will grasp the adductors, 
while the other embraces the quadriceps extensor, and 
the alternate contraction and relaxation of the hands 
will be made in such a way as to stretch these two 
groups of muscles away from the line of the femoral 
artery. The posterior femoral region may next be gone 
over, which will principally engage the fingers, while 
the upper parts of the hands work upon the sides of the 
limb. The external aspect of the thigh may receive as 
vigorous kneading as it is possible to give with evenly THE ART OF MASSAGE. 
19 
distributed force ; and with the thumbs in advance of 
each other on the rectus femoris more special and effec- 
tual manipulation can be given to the extensors, while 
the remaining surfaces of the hands make a review of the 
lateral aspects of the thigh.” In manipulating the back, 
“ the muscles on each side of the spinal column can be 
rolled outwards with the ends of the fingers, and the 
supra-spinous ligament can be effectually treated by 
transverse to-and-fro movements. The ends of the fin- 
gers and part of their palmar surfaces should also be 
placed on each side of the spinous processes, and the 
tissues situated between these and the transverse (pro- 
cesses) worked by up-and-down motions parallel to the 
spine, taking care to avoid the too frequent error of 
making pushing, jerking moverpents, in place of smooth 
uniform motions in each direction.”] 
Large masses of muscle may be seized with both 
hands and kneaded and squeezed in all directions much 
as one would squeeze water out of a full sponge. At 
the moment of making pressure, a certain amount of 
longitudinal traction may be superadded, which adds to 
the value of the manipulation. Another, but much less 
effective form of kneading, consists in rolling the limb 
between the palms of both hands. This movement 
should be made with great rapidity ; pressure is here a 
secondary consideration ; the principal effect is pro- 
duced by the frequently-recurring stretching and forci- 
ble separation of the individual muscles, fasciae, and 
nerves. 
[Kneading is the procedure by means of which above 20 
THE ART OF MASSAGE. 
all the others we act upon the circulation of the deeper- 
seated tissues, and profoundly modify the processes of 
absorption, assimilation, and destruction, in short of 
tissue metamorphosis, in other words, of life. Hence 
our aim should be, to as great an extent as possible, to 
avoid allowing any motion between the hand and the 
surface of the skin, that is to say, friction or stroking, 
and to compel the integuments following the motion of 
the hands or fingers to describe the desired movements 
over the underlying tissues. We thus not only act 
upon the circulation of the blood in the muscular and 
visceral capillaries, but accomplish the very desirable 
objects of increasing the elasticity of the skin, opening 
the areolar lymph spaces, sundering pathological adhe- 
sions between the inferior layer of the skin and the tis- 
sues beneath, and stimulating the flow of the areolar 
fluid. Just to the extent that we allow rubbing do we 
lose the essential virtues of kneading. 
Vibrations constitute one modification of kneading. 
The alternate pressure and relaxation which are the 
essential feature of that form of massage are here made 
with great rapidity. While the hand may be made the 
medium of communication, few manipulators have at 
once the skill and the endurance to make the move- 
ments with the necessary rapidity and continue them 
for a sufficient length of time. Machinery is usually 
brought into requisition for this purpose, and by its aid, 
any portion of the body or extremities can be thrown 
into vibration at the rate of many hundred times a 
minute. The reflex, thermal and electrical effects of 
such a rapid agitation of the tissues are remarkable. THE ART OF MASSAGE. 
21 
The sensation produced is very similar to that caused 
by a mild current of electricity. It is a powerful ex- 
citant to the capillary circulation, a stimulant to se- 
cretory action, and an awakener of dormant nervous 
energy. The same mechanical contrivance which de- 
liver the vibrations may by a simple change of connec- 
tion and of terminal appliances, be made to perform 
with considerable effectiveness the operations of friction 
and of ordinary kneading, but can never quite supply 
the place of the sentient and intelligent human hand in 
these procedures.] 
4. Percussion (sometimes more appropriately de- 
scribed as clapping) : Signifies striking and beating the 
part to be treated. This may be done either with the 
hand or with an instrument constructed for the purpose. 
Percussion with the hand is performed either with the 
palms of the hands, with their ulnar borders (the chop- 
ping of the French), with the tips of the fingers held 
closely together, with the closed fist, or with the dorsal 
surfaces of the first two joints of the fingers. No great 
amount of force need be used. On the contrary, the 
movements should be rather light, delivered from the 
wrist, and with considerable elasticity and rapidity. 
In percussing with an instrument we usually avail 
ourselves of a Bennett’s percussion hammer, either 
striking the surface directly with it, or making use of a 
thin plate of ivory as a shield. 
Granville(6) has devised a percussor* for this pur- 
* This instrument is manufactured by the English firm of Weiss 
& Son. THE ART OF MASSAGE. 
22 
pose, driven by electricity, which within a given time 
delivers a given number of blows, with a degree of 
force which can be exactly regulated. 
In muscle-clapping, we may avail ourselves of 
Weil’s(8) refreshers, or Klemm’s(7) muscle-beaters. 
The human hand, however, still remains the best instru- 
ment. In no other way can the degree of force em- 
ployed be so surely measured and controlled. 
On the conclusion of massage active and passive 
movements of the parts which have been manipulated 
may, when possible, be performed. Great importance 
has been recently attached to this after-treatment, many 
masseurs considering the active and passive exercises 
almost as valuable as massage itself. Mezger early 
recognized the importance of this auxiliary manipula- 
tion, and declared it to be indispensable in the manage- 
ment of diseased joints. In the north, in Sweden and 
Norway, massage has been very generally combined 
with the Swedish Remedial Gymnastics, to the great 
advantage of both methods of treatment. According 
to the unanimous reports of the northern masseurs truly 
wonderful results have thus been attained in many 
chronic diseases. 
Still it will not do to become routinists in this 
any more than in other forms of practice. In each 
individual case all the conditions must be taken into 
account, and the appropriate time for the commence- 
ment of these active and passive movements, as well as 
their duration and severity, must be carefully deter- 
mined. In convalescence from acute inflammatory TIIE ART OF MASSAGE. 
23 
affections much good may be done by allowing the 
patient to begin active movements before he leaves his 
He should be instructed to make systematic 
movements of flexion and extension after the method 
laid down by Schreiber.* When he begins to find 
these bed gymnastics tedious, he may be allowed to get 
up and go about his room, taking the precaution to 
protect the affected region with a flannel bandage as 
long as any fear exists of a return of inflammatory exu- 
dations. 
It will not be out of place to advert just here to a cir- 
cumstance which has occasionally proved an obstacle 
in the minds of physicians to the acceptance of massage, 
and has given rise to a false impression as to this mode 
of treatment. The objection has been made that it 
would overthrow a principle in the management of 
certain inflammatory diseases, which has been conse- 
crated by the experience of centuries. Such a revolu- 
tion must necessarily be looked upon with considerable 
suspicion. This principle is: Rest to inflamed parts. 
Now massage does not in the least affect this principle 
in general, or with regard to any diseases which are 
not appropriately treated by it. But, exactly as expe- 
rience has taught that motion is injurious in the 
majority of inflammatory affections treated antiphlogis- 
tically, in like manner has experience taught that when 
massage is used, active or passive exercise judiciously 
* Schreiber : Aertzliche Zimmergymnastik. Leipzig, 1872, 17 
Aufiage. 24 
THE ART OF MASSAGE. 
administered is not only not injurious, but decidedly 
hastens the reparatory processes, and is, further, a pre- 
ventive of many of the unfortunate sequelae of such 
i?iflanvnations. It may not be easy to offer a scientific 
explanation of the above assertion, but the fact cannot 
be denied for, as has been said, experience has abun- 
dantly established it. We have then in the active and 
passive movements an important auxiliary to the remedial 
action of massage, and their employment will never 
prove harmful if they are prudently administered. 
A method of application, in my opinion of great 
value, and not yet fully appreciated by physicians, 
is Massage of the Neck, as first suggested by Von 
Gerst.(io) 
The mode of procedure is as follows: “The patient 
stripped to the middle of the chest, is instructed to stand 
with the head tilted a little back and the shoulders re- 
laxed ; the former because the operator does not become 
fatigued so quickly as when the patient is sitting, and 
the latter, because a broader surface of the neck is thus 
presented for manipulation. The patient must be 
enjoined to breathe quietly, regularly, and deeply dur- 
ing the operation ; otherwise his entire attention will be 
engaged with the procedure, and he will breathe super- 
ficially and slowly, and occasionally even hold his 
breath altogether, thus impeding the return of the 
venous blood from the head and antagonizing the antici- 
pated effect of the treatment. 
The strokings are now begun. Each motion may be 
divided into three acts: First, the open hands with THE ART OF MASSAGE. 
25 
the palms upwards are placed with their ulnar borders 
in the right and left cervical fossae between the head 
and the neck, so that the tip of the little finger and the 
last joint of the ring finger shall rest upon the mastoid 
process behind the ear, and the ball of the little finger 
under the horizontal branch of the lower jaw. A cen- 
tripetal movement is now begun with the ulnar borders 
of the palms thus placed in the superior cervical region, 
and is performed as follows: While the ulnar border 
is moving toward the middle of the neck, both hands 
perform a rotation on their long axes, so that the radial 
border turns upwards and inwards towards the head, 
and finally reaches the position at first occupied by the 
ulnar border. By means of this rotation, the entire 
palm has come into contact with the neck and is now 
employed in giving the stroking. Meanwhile the ope- 
rator must be careful to exert a moderate degree of 
pressure with the balls of the outstretched thumbs upon 
the right and left common jugular veins, and with the 
palmar surfaces of the fingers upon the venous and 
lymphatic vessels which course along the lateral cervical 
regions. Arrived at the supra-clavicular fossa, the hand 
again turns upon its long axis, and the radial border of 
the palm once more comes into play. 
During the movement in the superior cervical region 
all pressure upon the lateral cornua of the hyoid bone 
must be avoided, as this would cause pain and inclination 
to cough ; and for the same reason, in stroking in the 
middle of the neck, the balls of the thumbs must not be 
allowed to press upon the larynx, but leaving it free 26 
THE ART OF MASSAGE. 
between them, should simply move backwards along its 
sides.” 
Gerst sometimes permits the patient to perform neck- 
massage upon himself. The procedure consists in this: 
The patient holding his head slightly tipped backwards, 
uses but one hand at a time, alternating them at each 
stroking. For this purpose, the neck having been well 
anointed, he places the outstretched palm with the 
thumb partially abducted beneath the lower jaw, so 
that the thumb lies upon one side of the neck and the 
four fingers upon the other. While now the hand exe- 
cutes a tolerably rapid movement downwards, the thumb 
is making firm pressure upon the corresponding com- 
mon jugular vein, and the fingers are emptying the 
superficial veins of the opposite side of the neck. As 
soon as the right hand has in this way completed the 
act, it is at once followed by the left, and so on. The 
strokings should follow one another in rapid succession, 
and the same precaution should be suggested as to 
pressure upon the hyoid bone and larynx as before. 
Weiss(ii) has suggested another mode of cervical 
massage, especially adapted to children and persons 
having thin and slender necks. In the case of a child 
it is placed in the nurse’s lap, and the head held some- 
what tilted backward. The physician sits in front of 
the child, and having previously oiled his thumbs, joins 
the fingers of both hands over the cervical vertebrae. 
The thumbs thus reach forward to the larynx and the 
neck is completely embraced. Downward strokings 
are now made with the thumbs, at first slow and gentle, THE ART OF MASSAGE. 
27 
and gradually increasing in rapidity and severity. The 
thumbs pass from the border of the lower jaw down- 
wards as far as the clavicles, now stroking the region of 
the common jugular vein, and now the lateral regions 
of the larynx. When the clavicles have been reached, 
the thumbs are again transferred to the lower border of 
the jaw without touching the neck. 
Hoffinger performs cervical massage as follows: 
The patient sits on a chair with a high seat, the head 
bent somewhat backwards, and the neck, throat, and 
upper part of the chest uncovered. The masseur 
stands behind the patient, places the fingers of both 
hands in the groove beneath the lower jaw, and strokes 
rapidly downwards and outwards with moderate and 
equable pressure, the thumbs being directed posteriorly 
and not touching the surface, and the arms moving 
easily and lightly from the shoulders and elbows. The 
method has these advantages, that it reduces the pressure 
upon the larynx to a minimum, and that the sitting can 
be concluded without fatigue to either party. The pa- 
tient breathes more quietly and regularly, too, than 
when the masseur is sitting in front of him. 
Cervical massage is simple, easily acquired, and very 
efficacious. The objection to self-massage is that a 
smaller surface is acted upon, and therefore the super- 
ficial veins are not so generally depleted. It is also 
fatiguing to the patient, and on the whole is only to be 
recommended to a very limited extent, and as a supple- 
ment to the operations of the physician. Hoffinger’s 
method must be designated as the best, and the most con- 28 
THE ART OF MASSAGE. 
venient for both patient and operator. Whatever be the 
method employed, the aim must be kept constantly in 
view of inducing the patient to inspire deeply and forci- 
bly during the operation, since the diminished pressure 
thus produced in the thorax powerfully invites the 
returning venous current already quickened by the 
and so far heightens the desired result. 
[The author here devotes considerable space to a de- 
tailed description of a procedure introduced by a Swede 
named Kellgrenn, for the treatment of acute congestions 
and inflammations of the lungs. Notwithstanding that 
its originator claims to have used it with great success, 
and that it has met with considerable favor in England, 
it appears to me so chimerical—not to say dangerous— 
that I do not care to undertake the responsibility of in- 
troducing it into American medical literature. Indeed, 
Reibmayr himself confesses that he has “ given the 
description of this method a place simply for the sake 
of completeness,” and points out the danger of its use 
in the presence of organic disease of the heart.] 
I proceed at once, therefore, to the consideration of 
Abdominal Massage. In employing this manipulation, 
it is of especial importance to warn the patient against 
antagonizing the treatment by voluntarily or involunta- 
rily stiffening the abdominal muscles, and thus dimin- 
ishing, or it may be, even entirely preventing its phy- 
siological action. It will aid him in this effort if he be 
placed with the trunk elevated, and the feet drawn up, 
and directed to breathe quietly and regularly. 
Laisne(i3) describes the method as follows: The THE ART OF MASSAGE. 
29 
masseur lays his hands on either side of the abdomen, 
and executes a firm but not violent double rubbing 
movement, one hand ascending as the other descends, 
the principal pressure being made by the thenar and 
hypo-thenar eminences, and not going higher up than 
the transverse colon, or lower down than the ileum. On 
reaching the ccecum) the colon is to be followed along 
its ascending, transverse, and descending portions suc- 
cessively. This manipulation is to be repeated two or 
three times. 
After a long trial of Laisne’s method, I have concluded 
that it is not thoroughly practical, and have substituted 
the following of my own devising. It is composed of 
four distinct manipulations which I employ according 
to the indications, either singly or combined. If I have 
principally in view stimulation of the peristaltic move- 
ment of the intestines by reflex action, I make use of 
the first and second, but if I wish to act mechanically 
upon the intestinal contents, I superadd to the second 
the third or the fourth, or employ all three at once. 
First Manipulation.—This consists in tracing circles 
around the umbilicus with the tips of the three long 
fingers of the right hand, the end of the thumb lying 
sideways upon the surfac. of the abdomen, and serv- 
ing as a hypomochlion, for the motion which is taking 
place through the joints of the finger and hand. To 
make the application more powerful, the circles are 
enlarged, and the pressure is made alternately heavier 
and lighter. The thumb meanwhile remains inactive. 
This manipulation is extremely irritating, nervous per- 30 
THE ART OF MASSAGE. 
sons, women especially, often being unable to endure 
it. In that case, the following manoeuvre must be re- 
sorted to. 
Second Manipulation.—The finger tips now remain 
inactive, and the circles around the navel are described 
with the palm of the hand. To accomplish this, the 
hand is extended as strongly as possible, so that it 
stands nearly at a right angle with the long axis of 
the forearm. The force is exerted principally by the 
heels of the thumb, and of the little finger. The 
fingers, slightly flexed, follow the movements of the 
hand without exercising the least pressure. This ma- 
noeuvre is always well borne, and combines a certain 
amount of mechanical action with the reflex stimulation. 
However forcibly it is employed, it very rarely causes 
pain. 
The two following manipulations aim especially at 
producing a mechanical effect upon the intestinal con- 
tents. They are therefore to be applied over those 
regions in which the feces are known to remain longest, 
and where the intestinal walls are therefore most likely 
to become distended and their muscles be weakened, 
namely, the catcum and the sigmoid flexure. 
Third Manipulation.—In this the right hand is to 
be laid flat upon the right inguinal region, the tips of 
the fingers pointing downwards. The left hand must 
then make pressure upon the first phalanges of the right, 
and stroking be performed with both hands in this posi- 
tion, from below and within, upwards and outwards, 
following the course of the ccecum. In returning to THE ART OF MASSAGE. 
31 
the point of departure the hands pass down over the 
navel, making scarcely any pressure. The use of the 
left hand is not simply to reinforce the right, but to pre- 
vent flexion of the fingers, and thus keep the entire 
hand closely applied to the surface throughout the 
entire stroke. 
Fourth Manipulation.—This is similar to the pre- 
ceding, except that it is applied upon the opposite side 
of the abdomen, and the tips of the fingers are directed 
upwards towards the spleen. The movement is, corre- 
spondingly, from above and without, downwards and 
inwards, and the nearer we approach the lesser pelvis, 
the more deeply do we endeavor to bury the pha- 
langes in it. The patient in receiving this manipula- 
tion should be reclining with the body at an angle of 450, 
and the knees semiflexed, while the operator kneels or 
sits close to the right side, reaching across the abdo- 
men. If the patient is in bed, the manipulator usually 
stands, being able thus to exert the greatest amount of 
force and at the same time to call to his aid the weight 
of the upper part of the body. 
When we have to deal with a case of excessive torpor 
of the bowels, or when a large accumulation of fat is as- 
sociated with great muscular relaxation, it is advisable to 
make use of an assistant in administering the second 
manipulation. This is thus accomplished. The pa- 
tient sits erect on a high-backed chair. The manipu- 
lators stand one on either side with a hand resting on 
the patient’s shoulder. Their other hands are then 
joined in front of the patient’s abdomen, and strong 32 
THE ART OF MASSAGE. 
circular strokings made about the umbilicus with their 
combined strength. This form of massage, much in 
vogue with the practitioners of the Swedish movement 
cure, is very efficient, stimulating the functions of the 
abdominal organs in the highest degree. It is employed 
principally in the case of men. 
In these cases of torpidity, I also add to the above 
described manipulations, percussion of the abdomen. 
This, however, must be of very brief duration, since, as 
the experiments of Goltz have taught us, long-continued 
clapping of the abdominal walls, results in relaxation of 
the muscular and vascular systems of the coats of the 
intestines. 
General Massage of the Body so called must not 
be omitted. This consists in quite firm centripetal 
stroking of the entire surface, especially of that of the 
limbs and back. *As it is principally made use of in 
the case of patients who suffer from sluggish digestion, 
it almost invariably terminates with kneading of the 
abdomen. 
Massage of individual organs, as for instance the 
uterus and the eye, will be more appropriately described 
in the tracts especially devoted to those subjects. 
In conclusion, I beg to offer a few general hints upon 
the art of massage. 
The position of the portion of the body which is to 
be treated, must be such as to cause the least possible 
discomfort and fatigue to both physician and patient. 
The diseased surfaces should be divested of all cover- 
ing, and especial care should be taken that all impedi- THE ART OF MASSAGE. 
33 
ments to the free return of the blood and lymph toward 
the centre, such as ligatures and close-fitting garments 
should be removed. In this respect I am unable to 
agree with Schreiber,(9) who counsels that especially 
in the case of women, the surface should be covered with 
flannel. This plan possesses no advantage, and the 
blunting of the sensation in the fingers of the operator 
is a positive disadvantage. In a prolonged seance, too, 
the skin is much more irritated by the roughness of the 
flannel than by the anointed hand. 
The object of sparing the woman’s modesty, which 
must be the only reason, as Schreiber mentions no 
other, can be attained in other ways without sacrificing 
the efficiency of the treatment. 
[In deciding this important question we must be 
governed to a great degree by the region on which we 
are operating, and the object of the treatment. But 
little can be accomplished in the relief of inflamed 
joints or the cure of sprains by working outside the 
clothing. On the other hand, in general medical treat- 
ment, in the majority of cases little or nothing is to be 
gained by having the surface actually nude. Fortu- 
nately this distinction, as a rule, enables the operator so 
to shape his requirements in this respect as to do the 
least possible violence to the modesty of his female 
patients.] 
If the surface to be treated has a heavy growth of 
hair upon it, this should be shaved off. Otherwise, 
inflammation of the hair-bulbs may be produced by pull- 
ing the hairs, and the recovery thus be delayed. 34 
THE ART OF MASSAGE. 
Massage may be performed dry or with the aid of 
oil, lard, or vaseline. If we desire to produce a powerful 
derivative action towards the surface, and have in view 
the reflex, thermal, and electrical influences of massage, 
we employ it dry. If, on the other hand, the opera- 
tion is to be prolonged, and if the more mechanical 
effects are sought, both the hands of the operator and the 
surface to be treated should be oiled or anointed. 
Vaseline and ordinary lard are the best materials.* 
When the patient is extremely sensitive, a little lauda- 
num added to simple ointment will prove soothing. 
In the case of narrow-minded people who find the sim- 
plicity of the treatment an obstacle to placing confi- 
dence in it, it may be well also to make some innocent 
addition to the lubricating material, as a placebo. 
[When we are obliged to use long-continued firm 
stroking or friction over a somewhat limited area, as 
in the treatment of sprains or of articular inflammations, 
it will undoubtedly be advisable to employ a lubricant. 
Especially is this the case when it is desired to promote 
the absorption of extravasations, the removal of old 
deposits, and of effusions into the cavities of joints. But 
in general massage where large regions of the body are 
rapidly gone over, this can never be necessary. Of 
course, I do not undervalue the beneficial effects of 
inunction in wasting diseases, especially in conjunction 
with massage following the Turkish bath, but they are 
* 111 this country cocoa-butter is a favorite substance for this pur- 
pose, as its odor is more agreeable to most patients than that of any 
oil or fat. THE ART OF MASSAGE. 
35 
quite distinct from those we are considering. It may- 
be said in a general way that when we are employing 
massage for surgical affections, the use of an unguent is 
appropriate ; but that when we are treating general or 
medical disorders, it is not called for. Of course, the 
intervention of such an agent would be a direct obstacle 
to stimulation, of the surface circulation, and inviting 
the blood into the capillaries of the integument, and 
must be avoided when our object is primarily deriva- 
tive. Dr. Graham is of the opinion that a truly skil- 
ful masseur will never need to resort to this expedient 
for protecting the skin of his patient, and also denies 
that it is ever necessary to shave the surface, instancing 
the fact that massage of the scalp can be performed 
without painful traction on the hairs. The cases, 
however, are scarcely parallel, since the hair of the 
head forms a thick layer, which moves in unison 
with the scalp itself, and may be looked upon as a part 
of the integument which is not at all the case with the 
isolated and straggling hairs of other surfaces.] 
The answer to the question : “ How often should 
massage be administered?” naturally depends to a 
great extent upon the nature of the disease, and cannot, 
therefore, be formulated in a general way. As far as 
possible, the question should be decided with reference 
to the individual case. 
The duration of the seance, too, must be governed 
by the disposition and endurance of the patient, as well 
as by the amount of surface to be operated upon. As 
an average, ten minutes suffices for each particular 36 
THE ART OF MASSAGE. 
region when oil is used, and from to two five when it is 
dispensed with. 
Much force should never be employed in dry massage. 
If this rule is neglected, a denudation of the corion 
from the epidermis—an excoriation—will quickly be 
produced, and continuance of the treatment will thus 
be rendered impossible. 
Every masseur is compelled at the outset of his career 
to observe a large number of black and blue spots, the 
result of his excessive zeal. This is not, as many sup- 
pose, essentially necessary, nor is it calculated to 
shorten the duration of the treatment, or to aid in 
any way in the cure of the case. These little extra- 
vasations are usually the result of too severe, and 
particularly, of too rigid massage. The more expert 
the manipulator becomes, the rarer will be their 
appearance. In cases, however, where we have to 
make pressure upon fungous or spongy tissues, or 
masses of organized exudation, the rupture of minute 
vessels cannot, of course, be avoided. In all other 
cases, and especially where our object is simply to dis- 
gorge the blood and lymph channels, in order to 
remove recent inflammatory products, it is entirely 
unnecessary to use sufficient force to produce these 
appearances. On the other hand, moderately firm, 
gentle, and well-distributed massage is in most cases 
both more acceptable to the patient, and easier for the 
manipulator. The former is thus spared severe and 
unnecessary pain, and becomes more readily reconciled THE ART OF MASSAGE.* 
37 
to the treatment, and the latter is able to conclude the 
seance without excessive fatigue. 
Very recently a new modification of massage has 
been recommended to us from America, the so-called 
“ Electro-massageIn this method massage and elec- 
tricity are administered in combination by means of very 
broad, sponge-covered electrodes. Appropriate instru- 
ments have been devised for the purpose by Posx(i5) 
and Stein(i6). For the greater convenience of the 
physician, the latter inventor places the battery inside 
of one of the electrodes. The idea of supplementing 
massage by the use of the electrical current in certain 
cases had already been suggested, particularly by Mez- 
ger. In electro-massage, this combined administra- 
tion may be more convenient for the physician, but can 
scarcely be more advantageous to the patient. On the 
contrary, in so far as the hand is substituted by an 
instrument, massage loses its efficacy. Nor would any 
electro-therapeutist be satisfied with this mode of apply- 
ing the current. 
Massage, it must be insisted on finally, is no exclusive 
method of treatment, as, for instance, hydropathy long 
continued to be made, greatly to its own detriment. 
It desires to be regarded as constituting only a modest 
department of our therapeutic treasury. Other methods 
of treatment may, therefore, be judiciously employed 
in connection with it. Of electricity we have just 
spoken. It is also often advantageously used in con- 
junction with cold water applications. The combina- 
tion of massage with baths, whether ordinary, thermal, 38 
THE ART OF MASSAGE. 
mud, sulphur, or salt baths, is in direct correspondence 
with its physiological effects and therefore very impor- 
tant. In warm baths the skin becomes vascular, soft 
and supple, and the dilated vessels and lymph-ducts 
offer the physician a favorable opportunity for its em- 
ployment. The conditions of life at a bathing resort 
are also highly favorable toward carrying out such 
plans of treatment, so that the results of this combina- 
tion will in the majority of cases be far more favorable 
than those of the present routine of baths alone. 
Like every other medical accomplishment, massage 
must be acquired. Although it is not strictly true as 
Podratzky(i4) thinks, that it can only be learned by 
dissection, still, in the course of my travels through 
Germany, Holland, and Belgium, undertaken with this 
very object, I became convinced that there are certain 
advantages of method which a self-educated manipula- 
tor will arrive at only with difficulty and perchance 
after years of practice, but which one may acquire in a 
comparatively brief time under the guidance of an ex- 
perienced and trained masseur. It is therefore highly 
advantageous to learn the art either at a clinic, or from 
a masseur of good repute. Every young practitioner 
will to day bring with him from his practical studies a 
knowledge of this art, since a surgical or obstetrical 
clinic can scarcely exist in which it is not both taught 
and practised as an important branch of treatment. 
Lastly, a still more important point, the neglect of 
which has already done the system great injury, must 
be insisted on : Every Physician should himself be a THE ART OF MASSAGE. 
39 
Masseur, and should never confide this important man- 
ipulation to the unpractised hands of an ignorant servant 
or attendant. The skilful performance of massage de- 
mands at least as much ability, anatomical and medical 
knowledge, and above all correct comprehension of the 
process itself, as the application of an antiseptic dressing. 
And what intelligent surgeon would entrust the appli- 
cation of such a dressing to an unprofessional hand? 
Only in rare individual cases, when one is well satisfied 
of the dexterity of the person, should any exception to 
this rule be allowed. [If then the physician knows 
how, and can spare the time, he will do it himself. If, 
as is more probable, he does not know how or has not 
the time to devote to it, he will employ an experienced 
masseur or manipulator to do it in his stead, but simply 
for the reasons stated, and not because it is in any way 
beneath his dignity to do it himself. 
What then shall guide him in his choice of a manipu- 
lator? He or she, for both sexes may succeed admira- 
bly as masseurs or masseuses, must possess, first, vigorous 
health; secondly, muscular strength; thirdly, a cheerful 
temperament, a pleasant face, and an acceptable man- 
ner; fourthly, a soft and pliant but strong hand; fifthly, 
a fair education, and a certain amount of refinement; 
sixthly, a knowledge of the leading facts in anatomy, 
such as the position pf the various organs, the posi- 
tion and course of the larger arteries, veins, and nerves, 
and of such facts in physiology as the functions of the 
various organs, the course of the circulation, and the 
general processes of nutrition; and, seventhly, and THE ART OF MASSAGE. 
40 
lastly, an acquaintance with the effects produced by the 
different forms of manipulation, the order in which 
these different forms should be employed in order to 
produce certain general effects, the injury which may 
be inflicted by employing them improperly or out of 
their proper order, and a practical dexterity in their 
application, to be attained only by training under an 
experienced instructor. Hence, it will be understood 
that we cannot take John from the stable or Biddy from 
the washtub, and, in one easy lesson, convert either into 
a safe, reliable, and efficient manipulator. Massage is 
an art, and as such must be acquired by study and pa- 
tient practice, under competent guidance. It cannot 
be picked up at an hour’s notice by any broken-down 
nurse or disappointed cobbler. As certainly as a 
trained nurse is superior to an untrained, so certainly, 
even more certainly, is a trained and well-instructed 
manipulator better than a self-taught “rubber.” In 
this as in every art, in the words of the great Roman 
lawyer, quam quisque nor it artem in hac se exerceat. ] THE ART OF MASSAGE. 
41 
BIBLIOGRAPHY. 
(1) EsTRADERE, J: Du Massage, son histoire, ses manipulations, 
ses effets physiologiques et therapeutiques. Paris, 1863. 
(2) Berghman und Helleday : Antekninger im Massage. Nord. 
med. Arch. v. I., Nr. 7, 1873. 
(3) Haufe : • Ueber Massage, ihr Wesen und ihre therapeutishe 
Bedeutung. Frankfurt, 1881. II. Auflage. 
(4) Gautier : Du Massage, son manipulation applique it la th6rapie 
et a, l’hygiene, 1881. 
(5) Little and Fletcher: On Massage. Brit. Med. Journal, 
1882. 
(6) Granville, Mortimer : Nerve-vibration as a therapeutic agent. 
Lancet, 1882, I. No. 23. 
(7) Klem: Die Muskelklopflung, eine active und passive Zimmer- 
gymnastik fur Kranke und Gesunde. Riga, 1877. 
(8) Weil, R : Der Restaurateur, ein elasticher Kraft- und Muskel- 
starker fur Zimmergymnastiker. Berlin, 1881. 
(9) Schreiber : Die Behandlung schwerer Formen von Neuralgien 
und Muskelrheumatismus mittelst Massage und Methodischen 
Muskel iibungen. Wiener med. Presse, 1881, Nr. 48, 49, 50, 
51- 
(10) Gerst: Ueber den therapeutischen Werth der Massage. Wurz- 
burg, 18^9. 
(11) Weiss, Bela : Casuistische Mittheilung iiber die Anwendung 
der Massage bei Laryngitis catarrhalis und crouposa. Archiv 
flir Kinderheilkunde, I. B. 5 und 6 H., 1880. 
(12) Glatter: Allgemeine Betrachtungen fiber den Werth der 
Heilgymnastik. Wiener med. Presse, 1875. Nr. 8, 9, und 11. 
(13) Laisne : Du Massage, des frictions et manipulations ap- 
pliques a la gudrison de quelques maladies. Paris, 1868. 
(14) Podratzky : Ueber Massage. Wiener med. Presse. Nr. 10 
und 11. 
(15) Post, S. Electro-massage. New York Medical Record, xix. 
26 June, 1881. 
(16) Stein, PIofrath : Ueber elektrische Massage und elektrische 
Gymnastik. Wiener med. Presse, 1883. Nr. 2, p. 10. 
(17) Graham, Douglas: A Practical Treatise on Massage; Its 
History, Modes of Application and Effects, Indications and 
Contra-Indications. New York, William Wood & Co., 1884.