192 OPERATIVE TECHNIQUE. 



extravasate thus produced, together with the cells of the broken down 

 tissue, may be rapidly absorbed. 



Infiltrations, even of cartilaginous hardness, may be dispersed by 

 repeated and long continued massage, and callus formations, so long as 

 they are not of bony hardness, may be markedly diminished. 



Muscles are stimulated to contraction, which, as is well recognised, 

 constitutes an important factor in favouring absorption. Not only 

 healthy but relaxed and semi-paralysed muscles again respond to 

 stimulation, as shown by the electric current, a fact explained by the 

 increase in supply of nourishment to the part. Muscular exhaustion 

 following exertion is soon removed by kneading, both because meta- 

 bolic products which accumulate in muscles during work are more 

 rapidly absorbed, and because at the same time nutritive material is 

 brought to the parts. The capacity of the muscle for exertion may 

 even become greater than it was before the period of exhaustion set in. 



Massage is of special service in diseased conditions dependent on 

 hypersemia, extravasations, exudations, thickening of tissue, adhesions, 

 in short, on the results of non-specific inflammation, the products of 

 which therefore not being of bacterial origin ma}' be absorbed into the 

 blood without producing bad results. 



Considering now for a moment the relation between the individual 

 manipulations in massage and the varying diseased conditions to which 

 they may be applied, we find that stroking is specially indicated for the 

 removal of extravasations and inflammatory products, and usualh' forms 

 the best conclusion to more vigorous manipulations. Rubbing benefits 

 cases of partially organised inflammatory products, infiltration of 

 muscles, distension of tendon sheaths, commencing new bony 

 growths, etc. Kneading is recommended for inflammatory swelling of 

 muscles in muscular rheumatism, and in inflammation and thickening of 

 tendons. The parts are percussed or gently struck in order to arouse 

 or depress nervous sensibility. The most remarkable effects have been 

 claimed for an electric "vibrator" which inflicts several hundred 

 slight blows per second on any given part. The number and strength 

 of these blows can be regulated within very wide limits. 



Massage is largely applicable to animals as well as to man. We 

 have to deal with many forms of inflammatory swelling resulting from 

 pressure, thickening of the skin and subcutaneous tissue of the ex- 

 tremities, bruising of the margins of joints, the early stages of exostbses, 

 periostitis, inflammation of tendons and tendon sheaths, adhesions of 

 tendons, etc., to one another or to neighbouring tissues, distension of 

 synovial and mucous bursae, induration of the udder, impaction of 

 the bowels, tympanites, etc. In the treatment of most of these 



