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Page 17
Massage in some form has long been in use in the East, and is well known
as the _lommi-lommi_ of the slothful inhabitants of the Sandwich
Islands. In Japan it is reserved as an occupation for the blind, whose
delicate sense of feeling might, I should think, very well fit them for
this task. It is, however, in these countries less used in disease than
as the luxury of the rich; nor can I find in the few books on the
subject that it has been resorted to habitually as a tonic in Europe, or
otherwise than as a means of treating local disorders.
It is many years since I first saw in this city general massage used by
a charlatan in a case of progressive paralysis. The temporary results he
obtained were so remarkable that I began soon after to employ it in
locomotor ataxia, in which it sometimes proved of signal value, and in
other forms of spinal and local disease. At first I had to train nurses
to use it, but I soon found that, although it was of some service to
their patients, no one could use massage well who was not continually
engaged in doing it. Some men do it better than any woman; but I prefer,
nevertheless, for obvious reasons, to reserve men for male patients,
except that in cases where _strength_ is of moment, as in the forced
movements and the very hard rubbing needed for old articular adhesions,
in which force must be exercised without violence, it is usually
impossible to secure the necessary power in a feminine manipulator.
A few years later I resorted to it in the first cases which I treated by
rest, and I very soon found that I had in it an agent little understood
and of singular utility.
It will be necessary, in pursuance of my plan, to describe as minutely
as the limits of a chapter will allow how and why this means is
employed. The process and order of what is known to the manipulator as
"general massage" follows.
After three or four days in bed have somewhat accustomed the patient to
the general routine of treatment, a masseur or masseuse is set to work.
If any special care is needed,--the avoidance of manipulating one part
or added attention to another, tender handling of a sensitive or timid
patient,--these matters have been ordered in advance by the physician.
An hour midway between meals is chosen, and, the patient lying in bed
between blankets, the manipulator begins, usually with the feet. A few
rapid rubs of the whole foot and leg are given to start with; then the
leg, except the foot and ankle, is covered up, and the operation
commences upon the foot, of which the skin is picked up and rolled
between the fingers, the whole foot receiving careful attention,--the
toes are pulled, bent, and moved in every direction, the inter-osseous
groups worked over with the thumbs and fingers or finger-tips, the
larger muscles and subcutaneous tissues squeezed and kneaded, and last
the whole mass of the foot rolled and pressed against the bones with
both hands. A few rapid upward strokings with some force complete the
treatment of the part, and the ankle is next dealt with. The joint is
moved in every possible direction, slowly but firmly, the crevices
between the articulating bones sought out and kneaded with the
finger-tips, and the foot and ankle are then carefully covered. After
the same rapid stroking upward of the leg with which it began has been
repeated for the sake of the slight stimulation of the skin-vessels and
nerves, the muscles of the leg are treated, first by friction of the
more superficially placed masses, then by careful deep kneading
(_p�trissage_) of the large muscles of the calf, twisting, pressing, and
rolling them about the bone with one hand while the other supports the
limb. In fat or heavily-muscled subjects it may be necessary to use both
hands to get sufficient grasp of the muscles. The tibialis anticus and
muscles of the outer side of the leg are operated upon by rolling them
under the finger-tips and by pressing with the thumb while firmly
pushing upward from the ankle to the knee. At brief intervals the
manipulator seizes the limb in both hands and lightly runs the grasp
upward, so as to favor the flow of the venous blood-currents, and then
returns to the kneading of the muscles,--and each part is finished by
light yet firm upward stroking, the hand returning downward more
lightly, yet without breaking its contact with the skin.
Care must be taken as the different groups of muscles are treated that
the leg is placed in the position which will most completely relax the
ones to be operated upon. Any tension of muscles wholly defeats the
effort of the masseur.
After completing the process upon both legs, the arm is next treated in
the same manner, the hand receiving somewhat more detailed attention
than the foot. Pains must be taken to reach the several groups of the
forearm by operating from both sides of the arm. The ordinary
manipulation of the shoulder can be accomplished with the patient lying
down; but if special conditions, such as articular stiffening, call for
unusual care or unusual force, it will be found best to treat the
shoulder with the patient seated. The treatment of the arms is concluded
with upward stroking (_effleurage_), as with the leg.
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