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Page 23
"It is evident that our present definitions of an�mia 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 hoarded and not made use of, and interference with commerce and
manufactures results.
"Neither an an�mic 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 an�mia. For
instance, many cases here recorded had full normal or even supra-normal
corpuscle-count, with a good percentage of h�moglobin. 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]
I have said above that the face was not touched in the course of the
rubbing. There are cases, however, in which massage of the head and face
may be usefully practised. Some obstinate neuralgias are helped by it
temporarily, and very often it is of use with other means to aid in a
permanent cure. Many headaches of a passing character may be dissipated
promptly by careful massage of the head or by downward stroking over the
jugular veins at the sides of the neck to lessen the flow of blood into
the cerebral vessels, where the pain is due to congestion or distention,
and careful manipulation of the facial muscles in paralysis is of
service in restoring loss of tone and improving their nutrition. It is
worth adding here, as women patients frequently say that during their
illness the hair has become thin or shown a great tendency to fall, that
daily firm finger-tip massage of the head for ten or twelve minutes,
followed by rubbing into the scalp of a small amount of a tonic, either
a bland oil or if need be of some more stimulating material, will in a
great majority of the instances where loss of hair is due to general
ill-health perfectly restore its vigor and even its color.
I am accustomed to pay a good deal of attention to the observations made
on these and other points by practised manipulators, and I find that
their daily familiarity with every detail of the color, warmth, and
firmness of the tissues is of great use to me.
A great deal of nonsense is talked and written as to the use and the
usefulness of massage. The "professional rubber" not unnaturally makes a
mystery of it, and patients talk foolishly about "magnetism" and
"electricity;" but what is needed is a strong, warm, soft hand, directed
by ordinary intelligence and instructed by practice; and this is the
whole of the matter, except in the massage of such obscure conditions
as need full knowledge of the anatomical relations and physiological
functions of the parts to be rubbed. It is a fact that I have known
country physicians who, desiring to use massage and not having a
practitioner of it within reach, have themselves trained persons to do
it, with considerable resultant success.
It is not, perhaps, putting it too strongly to say that bad massage is
better than none in those cases in which manipulation is needed. Very
little harm can result from its use even by unskilled hands, provided
that reasonable intelligence direct them.
CHAPTER VII.
ELECTRICITY.
Electricity is the second means which I have made use of for the purpose
of exercising muscles in persons at rest. It has also an additional
value, of which I shall presently speak.
In order to exercise the muscles best and with the least amount of pain
and annoyance, we make use of an induction current, with interruptions
as slow as one in every two to five seconds, a rate readily obtained in
properly-constructed batteries.[24] This plan is sure to give painless
exercise, but it is less rapid and less complete as to the quality of
the exercise caused than the movements evolved by very rapid
interruptions. These, in the hands of a clever operator who knows his
anatomy well, are therefore, on the whole, more satisfactory, but they
require some experience to manage them so as not to shock and disgust
the patient by inflicting needless pain. The poles, covered with
absorbent cotton well wetted with salt water, which may be readily
changed, so as not to use the same material more than once, are placed
on each muscle in turn, and kept about four inches apart. They are moved
fast enough to allow of the muscles being well contracted, which is
easily managed, and with sufficient speed, if the assistant be
thoroughly acquainted with the points of Ziemssen. The smaller electrode
should cover the motor-point and the larger be used upon an indifferent
area. After the legs are treated, the muscles of the belly and back and
loins are gone over systematically, and finally those of the chest and
arms. The face and neck are neglected. About forty minutes to an hour
are needed; but at first a less time is employed. The general result is
to exercise in turn all the external muscles.[25]
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