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Page 19
Too much care cannot be used to cover with stockings and warm wraps the
parts after in turn they have been subjected to massage. As to time, at
first the massage should last half an hour, but should be increased in a
week to a full hour. I observe that Dr. Playfair has it used twice a day
or more, and I have since had it so employed in some cases, letting the
masseuse come before noon, and allowing the nurse to use it at night if
it does not interfere with sleep, which is a matter to be tested solely
by experiment. Commonly, one hour once daily suffices. I was at one time
in the habit of suspending the use of both massage and electricity
during menstruation, because I found occasionally that these agents
disturbed or checked the normal flow. Of late, however, I continue to
employ both agents, but confine them to the limbs. I have met with rare
cases in which almost any massage gave rise to a uterine hemorrhage, and
in which the utmost caution became necessary.
Women who have a sensitive abdominal surface or ovarian tenderness have
of course to be handled with care, but in a few days a practised rubber
will by degrees intrude upon the tender regions, and will end by
kneading them with all desirable force. The same remarks apply to the
spine when it is hurt by a touch; and it is very rare indeed to find
persons whose irritable spots cannot at last be rubbed and kneaded to
their permanent profit.
Sometimes when the patient is found to be much exhausted by massage, it
is well to give some stimulating concentrated food afterwards;
occasionally it may be necessary both before and after. In this case it
would be well to see that the rubbing was not being made too severe.
Very rarely I find a patient to whom all massage is so disagreeable or
produces such annoying nervousness as to make manipulation impossible;
sometimes, though very rarely, massage, especially frictional movements,
causes sexual excitement when applied in the neighborhood of the genital
organs, or even on the buttocks and lower spine, and this may occur in
either sane or insane patients: if the rubber observe any signs of this,
it will of course be best to avoid handling the areas which are thus
sensitive.
Another complaint sometimes made is of chilliness after treatment, and
especially of cold feet. If this is not lessened after a few days, the
lower extremities may be rubbed last instead of first, or as is now and
then useful, the whole order of massage may be changed so as to begin
with the abdomen, chest, and upper extremities and conclude with the
back and legs.[17]
Beginning with half an hour and gradually increasing to about an hour (a
little more for very large or very fat people,--a little less for the
small or thin) the daily massage is kept up through at least six weeks,
and then if everything seems to be going along well, I direct the rubber
or nurse to spend half of the hour in exercising the limbs as a
preparation for walking. This is done after the Swedish plan, by making
very slowly passive and extreme extensions and flexions of the limbs for
a few days, then assisted movements, next active unassisted movements,
and last active movements gently resisted by nurse or masseuse. When the
patient is able to sit and stand, it is well to keep up and extend the
number of these gentle gymnastic acts and to encourage the patient to
make them habitual, or at least to keep them up for many months after
the conclusion of treatment.[18]
At the seventh week massage is used on alternate days, and is commonly
laid aside when the patient gets up and begins to move about.
In 1877, several of the members of the staff of the Infirmary for
Nervous Disease, and especially my colleague, Dr. Wharton Sinkler,
obliged me by studying with care the influence of massage on
temperature, and some very interesting results were obtained. In
general, when a highly hysterical person is rubbed, the legs are apt to
grow cold under the stimulation, and if this continues to be complained
of it is no very good omen of the ultimate success of the treatment. But
usually in a few days a change takes place, and the limbs all grow warm
when kneaded, as happens in most people from the beginning of the
treatment.[19] The extremely low temperature of the limbs of children
suffering with so-called essential paralysis is well known. I have
frequently seen these strangely cold parts rise, under an hour's
massage, six to ten degrees F. In such small limbs, the long contact of
a warm hand may account for at least a part of this notable rise in
temperature. In adults this can hardly be looked upon as a cause of the
rise of temperature produced by massage, first, because the long
exposure of large surfaces incident to the process is calculated to
lessen whatever increase of heat the contact of the hand may cause, and
secondly, because this rise is a very variable quantity, and because
occasionally some other and less comprehensible factors actually induce
a fall rather than a rise in the thermometer as a result of massage.
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