MASSAGE. 733 



qualifications of the i:>erson who does it as in any other occupation. 

 It would be wrong to leave the impression that massage is always 

 agreeable from the first. In proportion as the muscles, superficial 

 fascia, and skin are unnaturally tough, tense, matted and hide-bound, 

 will the massage be disagreeable until they become soft, supple, and 

 elastic. An appreciation of the proper consistence of the tissues and 

 their anatomical structure is of the utmost importance for the success 

 of this treatment. 



But we must hasten to consider how massage acts locally. By up- 

 ward and oval friction, with deep manipulation, the vein's and lym- 

 phatics are mechanically emptied the blood and lymph are pushed 

 along more quickly by the additional vis a tergo of the massage, and 

 these fluids can not return by reason of the valvular folds on the inter- 

 nal coats of their vessels. Thus, not only is more space created for 

 the returning currents arising from beyond the region masseed, but, at 

 the same time, a vacuum is formed, which is visible in the superficial 

 veins of persons who are not too fat ; and this is thought by some to 

 add a new force to the more distal circulation. In this way the col- 

 lateral circulation in the deeper vessels is aided and relieved, as well 

 as the more distal stream in the capillaries and arterioles. One would 

 naturally suppose that the circulation in the larger arteries would, in 

 this manner, be interrupted, and such is the case. But, herein comes 

 an additional advantage to aid the circulation, for the temporary and 

 momentary intermittent compression causes a dilatation of the artery 

 from an increased volume of blood above the part pressed upon, and 

 this accumulation rushes onward with greater rapidity as soon as the 

 pressure is removed, in consequence of the force of the heart's action 

 and the resiliency of the arteries acting upon the accumulated volume 

 of blood. 



But the same pressure also acts upon the tissues external to the 

 vessels, causing a more rapid resorption of natural or pathological 

 products through the walls of the venous capillaries and lymphatics. 

 When muscular nerves are stimulated, the vaso-dilators are influenced, 

 and this takes place by massage, whence follows enlargement of the 

 lumen of the vessels, so that an increased flow passes through them 

 with greater ease and diminished pressure. When stimuli are applied 

 to the skin, reflex vaso-motor action shows that the vaso-dilators are 

 acted upon, hence the redness and congestion of the skin when mas- 

 sage is specially directed to it. It can be readily seen now that mas- 

 sage rouses dormant capillaries, increases the area and speed of the 

 circulation, furthers absorption and stimulates the vaso-motor nerves, 

 all of which are aids and not hindrances to the heart's action, as well 

 as to nutrition in general. Seeing that more blood passes in a given 

 time, there will be an increase in the total interchange between the 

 blood and the tissues, and thus the total amount of work done by the 

 circulation will be greater and the share borne by each quantity of 



