b 



MASSAGE. 191 



it. In the intervals the patient himself has to earn- out certain 

 movements with care. At tirst massage generally causes pain, which, 

 however, disappears on each occasion during the process, and is 

 replaced by a pleasant feeling of warmth, flexibilit}', and increased 

 power in the parts. 



From the above it will be seen that massage favours increase of 

 bodil}' strength and endurance, but its best effects can only be 

 obtained by practice and by a thorough knowledge of the pathological 

 processes to be combated, the exact anatomy of the diseased parts, 

 and the physiological effects of the different massage manipulations. 

 Experiment shows that the effects vary, similar manipulation being 

 irritant or soothing, inclined to produce or to dissipate inflammation, 

 and to alleviate or arouse pain, according to the personal idiosyncrasy 

 of the patient. The operator must first clearl}' conceive the changes 

 he desires to effect in the diseased parts, as only then can he reason- 

 ably expect to effect improvement^ or even to know whether massage 

 is likely to be of benefit apart from choosing the exact system to be 

 followed in the case in question. V'- 



The action of massage depeij,i(,ls on its favouring and increasing 

 absorption, accelerating circulation, apd relieving pam. By stroking 

 centripetall}', not only is circulatfe4\ in the collecting vessels locally 

 stimulated and tension relieved, put ^l^echanical congestion in parts 

 removed from the centre is lessi^ried, and exuded l3miph absorbed, 

 while accumulated exudates and ^Extravasations in the tissues them- 

 seh'es are distributed over a larder a'^a, are brought in contact with 

 numerous absorbents, and are mechSiniCally assisted in entering them. 

 For these reasons it is best to coBiimerice not at the diseased spot 

 itself but on the central side of it, and graduall}' to approach the 

 diseased spot in order to first cleai":^ space, into which the exudate or 

 extravasation may more readih- flow. 



Alosengeil's experiments prove it possible to remove fluid even from 

 joints by pressure and stroking. He injected Indian ink into the 

 s}'no\ial cavities of rabbits, and in twc or three minutes reduced the 

 joints to their normal form by massage. On j!)os/-;»or^^;;? examination 

 the Indian ink was found in the nearest lymphatic channels, vessels, 

 and glands. 



Massage promotes active resorption, diminishes swelling of tissues, 

 and therefore pressure on the sensor}- nerves they contain, a fact 

 parti}- explaining the decrease of pain. Massage also directly 

 stimulates nerves, at first increasing, but afterwards diminishing 

 their irritability. Newly formed adventitious tissue and vessels 

 may be broken down by powerful pressure and rubbing. The 



