MASSAGE IN SPRAINS AND DISLOCATIONS. 383 



ing together. No two masseurs are alike by nature nor in skill, 

 tact, and education, and the one who knows his anatomy and physi- 

 ology well, when called to a recent acute sprain, will not begin at 

 once to masser the injured joint, but at a distance above it on the 

 healthy tissues by gentle stroking or effleurage toward the heart, 

 gradually proceeding nearer and nearer to the painful place. 

 This has a soothing effect and pushes the flow along in the veins 

 and lymphatics, making more space in them for the returning 

 currents coming from beyond and carrying away the fluids that 

 have leaked out of the vessels. The same should be done on the 

 part of the limb beyond the joint, for the circulation is hindered 

 both in going out and coming in by reason of the swelling. 



ISText, the mg.sseur who knows his business will begin again at 

 a safe distance above the injured joint, and use deep rubbing, 

 kneading, or massage properly so called, one hand contracting 

 as the other relaxes, alternately making circular grasps, with the 

 greatest pressure upward, and this should be done on the parts 

 above and below the seat of sprain. By this procedure the effects 

 of the previous stroking or effleurage are much enhanced an anal- 

 gesic or agreeably benumbing effect is produced upon the nerves 

 which extend to the painful place, and the retarded circulation 

 is pushed along more vigorously, making room in the vessels for 

 the swelling, the effusion, the dammed embargo caused by the 

 landslide of blood and lymph that is inundating the surrounding 

 territory with exudates farther up the stream to float off, and pre- 

 paring the way for the next step in treatment. At the end of 

 fifteen or twenty minutes of this manner of working, gentle, firm 

 pressure can be made immediately over the swollen and but re- 

 cently very tender parts, which in a few seconds can have circu- 

 lar motion, with the greatest push upward added to it; and this, 

 if sufficient tact be .used, will in all probability not hurt but be 

 positively agreeable. By this the swelling is spread over greater 

 space, pressed out of the tissues as water is out of a sponge, and 

 brought into more points of contact with the veins and lymphat- 

 ics by which they are absorbed and carried off ; the same pres- 

 sure that causes the dislodgment of stagnating fluids also aiding 

 absorption by pressing them into the small vessels. Then a 

 snug, well-fitting bandage should be applied, which may exhibit 

 the bungling of a tyro or the skill acquired by twenty years' prac- 

 tice. Under this plan of treatment, used twice a day, the com- 

 fort produced and the speed of recovery would scarcely be be- 

 lieved unless experienced by one who had had a similar injury 

 treated in the regular orthodox way, with absolute rest and im- 

 mobility, by means of fixed dressings. 



Some years ago I published the results of massage in more 

 than seven hundred cases of sprains, joint contusions, and distor- 



