98-1/4 99

98-1/4 98-1/4

99 99-3/4

100-1/5 100-2/5

100-2/5 101-2/5

100-2/5 100-3/5

100-3/5 100

Mrs. L., a very thin, feeble, and bloodless woman, aet. 29 years:

Before Ma.s.sage. After Ma.s.sage.

99 100

98-1/2 99-1/5

98 98-2/5

99 100

98-2/5 98-4/5

99 99-4/5

100 100-1/5

99 99-4/5

Mrs. P., aet. 31, feeble and anaemic, nervous, slight alb.u.minuria and chronic bronchitis. Liable to fever. 3 P.M.:

Before Ma.s.sage. After Ma.s.sage.

101-3/5 102

100 100-4/5

99 99-4/5

100 101

99-2/5 100-1/5

99-4/5 100-3/5

100-3/5 101-3/5

100-2/5 99-4/5

100-3/5 100-2/5

100-3/10 100-9/10

99-1/5 99-4/5

These temperatures were taken always before 4 P.M., and at intervals of three days. Her morning temperature was usually 99 to 99-4/5, and in the evening, 9 to 10 o'clock, it always rose to 100, 101, and at times to 102.

As I have said already, there are persons who, under circ.u.mstances seemingly alike, have from ma.s.sage a large rise of temperature, and others who experience none. I give a single case of what is rare but not exceptional,--an almost constant fall of temperature.

Miss N., aet. 21, hysteria, good condition:

Before Ma.s.sage. After Ma.s.sage.

98 97-3/5

98-1/2 98-1/2

98 98

98-2/5 98

98-4/5 98

These facts are, of course, extremely interesting; but it is well to add that the success of the treatment is not indicated in any constant way by the thermal changes, which are neither so steady nor so remarkable as those caused by electricity.

If now we ask ourselves why ma.s.sage does good in cases of absolute rest, the answer--at least a partial answer--is not difficult. The secretions of the skin are stimulated by the treatment of that tissue, and it is visibly flushed, as it ought to be, from time to time, by ordinary active exercise. Under ma.s.sage the flabby muscles acquire a certain firmness, which at first lasts only for a few minutes, but which after a time is more enduring and ends by becoming permanent. The firm grasp of the manipulator's hand stimulates the muscle, and, if sudden, may cause it to contract sensibly, which, however, is not usually desirable or agreeable. The muscles are by these means exercised without the use of volitional exertion or the aid of the nervous centres, and at the same time the alternate grasp and relaxation of the manipulator's hands squeezes out the blood and allows it to flow back anew, thus healthfully exciting the vessels and increasing mechanically the flow of blood to the tissues which they feed. It is possible also that a real increase in the production of red corpuscles is brought about by repeated applications of ma.s.sage, as will be seen later on.

The visible results as regards the surface-circulation are sufficiently obvious, and most remarkably so in persons who, besides being anaemic and thin, have been long unused to exercise. After a few treatments the nails become pink, the veins show where before none were to be seen, the larger vessels grow fuller, and the whole tint of the body changes for the better.

In like manner the sore places which previously existed, or which were brought into sensitive prominence by the manipulation, by degrees cease to be felt, and a general sensation of comfort and ease follows the later treatments.

Although this plan of acting on the muscles seems to dispense with any demands upon the centres, it is not to be supposed that it is altogether without influence on these parts. In fact, extreme use of ma.s.sage occasionally flushes the face and causes sense of fulness in the head or ache in the back. The actual large increase in the number of corpuscles in the circulation brought about by ma.s.sage may be one of the reasons for this. We have added, perhaps, millions of cells to the number in the vessels in a very short time, and need not be astonished if some signs of plethora follow. Moreover, in some spinal maladies it has effects not to be altogether explained by its mechanical stimulation of the muscles, nerves, and skin.

That the deep circulation shares in the changes which are so obvious in the superficial vessels has been shown by various observers of experimental and clinical facts. Firm deep muscle-kneading of the general surface will almost always slow and strengthen the pulse. If the abdomen alone is thoroughly rubbed the same effect appears in the pulse, but less in degree, and ma.s.sage of the abdomen has also a distinct effect in increasing the flow of urine, a fact worth remembering in cases of heart-disease. In a case of alb.u.minuria from exercise, W.W.

Keen has shown that ma.s.sage did not cause the return of the alb.u.min after rest, though exercise did, a difference due to the opposite effects upon blood-pressure of the two forms of activity. Lauder-Brunton has shown that more blood pa.s.ses through a ma.s.seed part after treatment.

Dr. Eccles and Dr. Douglas Graham both found a decided decrease in the circ.u.mference of a limb after ma.s.sage, showing how completely the veins must have been emptied, for the time at least,--an emptying which would surely be followed by an increased flow of arterial blood into the treated region. Dr. J.K. Mitch.e.l.l, in 1894,[21] made a large number of examinations of the blood before and after ma.s.sage, some in patients under treatment for a variety of disorders affecting the integrity of the blood, and a few in perfectly healthy men. With scarcely an exception there was a large increase in the number of corpuscles in a cubic millimetre, and an increase, though of less extent, in the haemoglobin-content. Studies made at various intervals after treatment showed that the increase was greatest at the end of about an hour, after which it slowly decreased again; but this decrease was postponed longer and longer when the manipulation was continued regularly as a daily measure.[22] The author's conclusions from these examinations were interesting, and I quote them somewhat fully. The fact that the haemoglobin is less decidedly increased than the corpuscular elements makes it seem at least probable that what happens is, that in all the conditions in which anaemia is a feature there are globules which are not doing their duty, but which are called out by the necessities of increased circulatory activity brought about by ma.s.sage. If this is the first effect, yet as it is observed that the increase of corpuscles, at first pa.s.sing, soon becomes permanent, we must conclude that ma.s.sage has the ultimate effect of stimulating the production of red corpuscles.

One sometimes hears doubts expressed whether a patient with a high-grade anaemia is not "too feeble for such strong treatment" as ma.s.sage. This study of one of the ways in which ma.s.sage affects such cases may fairly be taken as proof of the certainty and safety of its effect on them, provided always it be done properly and with intelligence. Some check upon this may be had, as is said elsewhere, by the general effect upon the patient. It may be repeated that the pulse should be slower and stronger after an hour of deep ma.s.sage, and that this effect will not be produced by superficial rubbing (indeed, with light or too rapid manipulation the pulse may become both less strong and more rapid), and finally the flow of urine should be increased. With these easily observed facts to aid, it may readily be judged whether ma.s.sage is being rightly applied or not without the need of a visit from the physician during the hour of treatment. A final test might readily be made by examination of the blood and counting the red corpuscles before and after treatment. No doubt in very bad cases a small increase or none would be found at first, but a week of daily manipulation should show a distinct addition to the blood count. A striking instance in which this examination was repeatedly made is related on p. 184.

"It is evident that our present definitions of anaemia are insufficient.

An essential part of the description in all of them is that there are defects of number, of color, or of both in the blood. This is not necessarily or always true. The fault may lie in a lack of activity or of availability in the corpuscles. The state of things in the system may be like the want of circulating money during times of panic, when gold is h.o.a.rded and not made use of, and interference with commerce and manufactures results.

"Neither an anaemic appearance nor a blood-count is alone enough for a certain diagnosis. Other signs must be used as a check on the blood examination for the establishment of the existence of anaemia. For instance, many cases here recorded had full normal or even supra-normal corpuscle-count, with a good percentage of haemoglobin. Yet they presented every external sign of poverty of blood: pallor of skin and, more important still, of mucous membranes, cold extremities, anorexia, indigestion, dyspnoea on trifling exertion. In such cases we must suppose either that the total volume of the blood is reduced, or that the usefulness of the corpuscles is in some way impaired, or that both these troubles exist together."[23]