MASSAGE IN SPRAINS AND DISLOCATIONS. 389 



In human beings M. Castex found that when massage was 

 begun early or from the very first in contusions, sprains, and dis- 

 locations not only were the immediate symptoms soon relieved, 

 but also the subsequent serious consequences that are so apt to 

 follow these injuries wasting, weakness, contraction, and stiff- 

 ness were prevented. But when he tried massage in old cases 

 of muscular atrophy or wasting following injuries to joints he 

 got no increase of muscular tissue. The stiffness was got rid of ; 

 the muscles became suppler, but they still remained thin and 

 lacking in strength. If he had combined passive and active 

 movements with the massage he would probably have gained 

 growth of muscle. He found that the galvanic and faradic cur- 

 rents were of benefit in promoting increase of muscular tissue. 

 Muscular contraction produced by electricity is but another form 

 of motion. 



Numerous theories as to the cause of muscular atrophy from 

 injuries to joints have been considered and abandoned. The 

 most probable and most generally accepted is that of reflex ac- 

 tion. The injury to the joint starts up more or less inflammation 

 (arthritis); the articular nerves are irritated; this irritation is 

 transferred to the spinal cord ; the nerve centers affected act in 

 turn upon the centrifugal nerves going to the muscles, and these 

 determine at their peripheral ends the muscular atrophy. With 

 a view to the elucidation of this, M. Deroche has repeated seven 

 times, and always with the same results, experiments which were 

 done for the first time at the College of France by MM. Ray- 

 mond and Onanoff. He divided the posterior roots of the three 

 last lumbar nerves on the left side in dogs and rabbits. After 

 cicatrization had taken place he assured himself that numbness 

 was complete from the thigh to the knee of the left lower limb, 

 so that irritation of this region was not felt. The corresponding 

 limb was left intact. An arthritis was then excited in both knees 

 by introducing a thermo-cautery into them. No pain was felt in 

 the left knee, but much in the right. Three months afterward 

 the animals were killed, and in both knees the lesions of arthritis 

 were found ; but the muscles of the thigh of the left leg were of 

 natural size ; of the right, atrophied. 



Prof. Simon Duplay and M. Cazin have also made a careful 

 study of this subject in much the same way. Under the micro- 

 scope they found that the articular filaments always presented 

 signs of inflammation; but the large nerve trunks and spinal 

 cord showed no appreciable change, and the results of the exami- 

 nation of the muscles were negative except as to diminution in 

 size. They therefore concluded that muscular atrophies con- 

 secutive to joint injuries consist of simple atrophy, and that 

 this can only be explained by a dynamic action, a simple reflex 



