eee ees i aed crt rath ar a tae antares QOOIN Ka} fat Ai 72 GRO CORNELL UNIVERSITY LIBRARY wi PRACTICAL MASSAGE AND ‘CORRECTIVE EXERCISES WITH APPLIED ANATOMY BY HARTVIG NISSEN President of Posse Normal School of Gymnastics; Superintendent of Hospital Clinics in Massage and Medical Gymnastics; For Twenty- four years Lecturer and Instructor of Massage and Swedish Gymnastics at Harvard University Summer School; Late Director of Physical Training at Boston and Brookline Public Schools; Former Instructor of Physical Training at Johns Hopkins University and Wellesley College, Former Director of the Swedish Health Institute, Washington, D. C., etc.; author of ‘A. B. C, of Swedish Educational Gymnastics,” “Rational Home Gymnastics,’ etc. FOURTH REVISED EDITION With 68 Original Illustrations, Including Several Full-page Half-tone Plates. PHILADELPHIA F. A. DAVIS COMPANY, PusLisHERS 1923 Na A suyayie F, A, DAVIS COMPANY Copyright, Great Britain. All Rights Reserved PRINTED IN U.S.A. PRESS OF F. A. DAVIS COMPANY PHILADELPHIA, PA, PREFACE TO REVISED EDITION. As years roll by there are constantly new theories and methods coming up, and my own experience teaches me, more and more, one is never too old to learn; so I have found it necessary to enlarge and im- prove on my former books, and also to add the im- portant “Corrective Exercises,” with full description of their effect and muscles used in the different movements. This new edition represents the results of what forty-five years of study and experience, practice, and teaching have taught me; and I earnestly hope it will be of value to those who wish to learn in a practical way to treat suffering humanity with Mechanotherapy. In this fourth edition I have thought it wise to add “The Most Essential Applied Anatomy,” together with some of my latest experiences. HartTvic NISSEN. Boston, Mass, (iii) PREFACE TO FIRST EDITION. Since my -book, “Swedish Movement and Mas- sage Treatment,” was published in May, 1889, I have had many hundreds of pupils as well as patients; and during my thirty years of experience as a masseur and teacher, I have been constantly studying and practis- ing and broadening my views and ideas, My first book was written on the authority of others and the theory which they taught. This book, which I hope will be found worthy of its title, “Practical Massage,” is the result of my life’s work. It is written just as I have been teaching “mas- .sage’’ for several years at Harvard University Summer School and to my private pupils. My method is a combination of what I have found to be the best and most useful “manipulations” and “movements” in other systems as well as original. 1 trust this little book will be accepted as a pee help in the treatment of the sick. Hartvic NISSEN. Boston, Mass, (iv) CONTENTS. CHAPTER I. The History—Swedish Movement Treatment—A Word to the Physician—Variety of Movements and Dura- tion—How Often the Treatment Should be Repeated —How to be Dressed—Physiological Effects of Move- ments—Passive Movements—Active and _ Resistive Movements Circling—Arm Circling—Arm Elevation—Arm Fling- ing—Arm Rotation—Arm Flexion and Extension ....103-109 CHAPTER XIII. Corrective Active Exercises of Legs: Leg Elevation, Sideways—Leg Elevation, Forward—Leg Elevation, Backward—Knees Bend—Heel Elevation—Charge, or Fall Out, Forward—Horizontal Balance, Standing— Back Curving—Leg Elevation, Lying ............... 110-114 CHAPTER XIV. Corrective Active Exercises of Head and Trunk: Head Bending, Backward—Trunk Flexion, Backward and Forward—Chopping Movement—Harvesting Move- ment—Trunk Flexion, Sideways—Trunk Torsion— Trunk Circling—Trunk Elevation, Lying—Body Hori- zontal on Toes and Hands ............-seeeeeeceees 115-121 viii CONTENTS. CHAPTER XV. PAGE Stiffness of Joints and Tendons—The Modus Operandi— The Knee Joint—My Method—Mistake to Apply Mas- sage Too Long at a Time—Sprains, Synovitis— Hydratthrus: scccncoosarvautiexasesee see's Seauciaaen 122-132 CHAPTER XVI. Flat-foot: “Morbid Condition of Foot in Which the Arch 18 Destroyed” jisccnsnrasdexcrascscnngiasesccawen 133-136 CHAPTER XVII General Massage—My Advice to Newcomers—Neuras- thenia—Prescription I—Prescription I]—Prescription TUT radeawk seinitactitene sess selena eevee Wie catulaye 137-144 CHAPTER XVIII. “High Blood-pressure’—‘“Arteriosclerosis” ............. 145, 146 CHAPTER XIX. Hysteria and Hypochondria—Chlorosis and Anemia—In- somnia—Diabetes Mellitus ..............0ceecee wees 147-156 CHAPTER XxX. Local Diseases: Diseases of the Brain, Spinal Cord, and Nerve—Congestion of the Brain—Anemia of the Brain —Paralysis as a Result of Apoplexy ............... 157-164 CHAPTER XXI. Local ‘Diseases: Congestion of the Spine—Locomotor Ataxia beosaghilactrykhosenes eiaatanmaneiin wien 165-167 CHAPTER XXII. “Poliomyelitis Anterior” ............ 168-173 Infantile Paralysis, CONTENTS. ix CHAPTER XXIII. PAGE Occupation Neuroses—Writers’ Cramp—Cramp of the Legs—Chorea ...,...cscseeeceeecenee canes GIN sere 174-177 CHAPTER XXIV. Sciatic Neuralgia .............ceceeeeeeeee iubeene Kenge 178-185 CHAPTER XXV. Diseases of the Organs of the Circulation: Chronic Heart Disease—Diseases of the Respiratory Organs ....... 186-193 CHAPTER XXVI. Diseases of the Organs of Digestion: Dyspepsia—Con- stipation—Hyperemia of the Liver—Appendicitis— Indigestion and Biliousness—Obesity—Diseases of Urinary and Sexual Organs: Chronic Catarrh of the Bladder—Chronic Catarrh of the Womb—Displace- ment of the Womb—Irregularity and Painful Men- Stration avecs so wadansieeaeesarenmneeead j dintataiaraiee 194-201 CHAPTER XXVII. Diseases of the Organs of Movement: Scoliosis, “Lateral Curvature of the Spine”’—“Lordosis”—“Kyphosis”— “Pigeon-breast”—“Round Shoulders” ............08. 202-211 CHAPTER XXVIII. Rheumatism, “Myitis’—Muscular Rheumatism, of the Right Arm, of the Neck—Lumbago—Rheumatism of the: Joints, “Arthritis” cacicoannuswensieas daweuandnes 212-220 Tin OX: cissde i os des bdieinswa ee eerais Sine a wee Weaenein we Pane We caus 221 . ILLUSTRATIONS. FIG, PAGB 1. Centripetal Stroking ............. sieenWieieveseesb eaten Ze 2. Muscle Kneading of Fingers ........... diapers ene lee 23 3. Muscle Kneading of Arm ...........ccecececeeeseeeees 24 4. Circular Kneading ...............005 stdaienieesuie ives oats . 25 5. Circular: Friction. saiiescvsinawscerssaxcemammeeans ees 26 6. Nerve Compression ..........ccceccevcceceeenceeeceeee 30 7.. Muscle: Rolling! sac veaswonedanse ei ee emeanniwnenee 31 8. Percussion ......... aGayameatens sr aouabeed pram 33 OD RAEN cde cts scaed aust ax Gtevshnigiiendoe des eas gnrgioy bud laat hija lSiaverusafatacah dee 34 10: -Atim; Vibfationi: soxcessocuvansawkaiatenvesiwaees eons 35 11. Forearm Circumduction .............cccceeecceeecceees 38 12. Vertical Arm Rotation .........cceece eee eer eeeeeene 40 13. Forward Arm Circumduction ............00eeeeeeeeeees 41 14. Shoulder Circling and Chest Lifting ................5- 43 15. Foot Circling (Double) ...........cceeeecce eee ee eens 46 16. Thigh Circumduction ............cceecseeeeees acevo 47 17. Chest Lifting and Vibration ............... sioner wmies SL 18. Muscle Kneading of the Abdomen .......... Savanas «a 52. 19. Knuckle Kneading of the Abdomen ..................005 53 20. Circular Kneading of the Abdomen ................... 54 2), Loin: Vibtiation) aaicscwuxcsnicia cena cei wean 55 22. Back Muscle Kneading .............cccceeccceecsceeees 59 23), Back: Percussion. casedondvietadiadioowaawteesans iar 60 24. Breach, Beating: .csscerssoesensmianrnsswvecweeeaweaewes 62 25. Veins of Head and Neck ...........cceeccceecccceeucce 68 26. Vertical Arm Flexion and Extension .................. 73 27. Horizontal Arm Flexion and Extension ............... 75 28. Horizontal Arm Separation and Closing ............... 76 29. Lateral Arm Elevation and Depression ............... 77 30. Forward Arm Traction (Lying) ............eeeeeeeeees 78 31. Leg Flexion and Extension ..........ccccceseesaeeeees 80 32. Upward Knee Traction ....... siebhewkiessetratvdeantat 81 xii ILLUSTRATIONS. FIG, PAGE 33. Knee Flexion and Extension ............ccecccceccsece 82 34, Leg Elevation and Depression ..............cceeeeeece &4 35. Backward Leg Traction ..........ccccececccececucucece 85 36. Bent Knee Separation and Closing ............ PPE Ad a sanat 86 37. Trunk Torsion (Kneeling) ...........0.ceccevecceceees 89 38. Forward Trunk Flexion and Extension ...............- 90 39; Stariding: Position s0s0i.cse0neapeeerieie oumnneeede tans 92 40. Arm Circling £0.00... cece cece cece cence eneeeeeneenes 92 41. Arm Elevation (Forward, Upward) ......... seapesienk wine, 92: 42. Arm Flinging (Sideways) ............eeeeceeeeeer ences 92 43. Arm: Rotation scsavdassceis sss wmenied bees ook EEA SSS 92 44. Arm Flexion (and Extension) ..........eeseeeceeecees 92 45. Arm (Flexion) and Extension, Upward .............4 92 46. Leg Elevation, Sideways .........cceeceee ec eeeceeneees 100 47, Leg Elevation, Forward ...........cccccceevecesccvece 100 ' 48, Leg Elevation, Backward ..........ccecceececeeveuceacs 100 49, Knees Bend (Deep) ........ccccccececcensececcecceces 100 50. Charge, or Fall Out, Forward ............cceececeees “.. 100 51. Charge,.or Fall Out, Forward (Side View) ........... 100 ° 52. Horizontal Balance (Standing) .............c.ceeceeees 100 53; Back (Curvinpy 2: petansoaricncd Sotnuseonw ane weawamaace 100 54. Leg Elevation (Lying) .............ccccececsesecevuces 100 55. Trunk Flexion (Backward) ..,.....ccsccceccecceccuces 104 56. Trunk Flexion (Forward) ..........c..000s eee 1044 57. Trunk Flexion (Forward) ..... ah ont aa neadesetts 104 58. Harvesting Movement ............cecceecees aia .. 104 59. Harvesting Movement ..............ccecccucsceeccceces 104 60. Trunk Flexion (Sideways) ..........ccceececcccveceees 104 Ob. Drunk Torsion) 5 conssasiaeciis so se-aaiecnvornccdiee amsrsausecd 104 62. Trunk Elevation (Lying) ..... Bhs tvgrcccestbane Geeee Guha. 107 63. Body Horizontal scscsowvievns a4 0 snawsiesedns «cuaewaced 104 64-69, Curvature of the Spine ...........cccseeceeeeees 206-21} PRACTICAL MASSAGE AND CORRECTIVE EXERCISES. CHAPTER I. MassacE is a very much misinterpreted word and frequently erroneously used, sometimes intentionally, . but often by mistake. It means kneading, or a me- chanical action—a handling and manipulating—of the flesh, as in stroking, pressing, kneading, percussing, etc., for a therapeutical purpose. In certain cases massage proper is all which is needed, but very frequently it must be used together with passive and resistive exercises, and in such cases massage becomes a part of Medical Gymnastics, Mechanotherapy, Swedish Movements, or whatever name one prefers to give; they all mean the same thing. The attempts made by certain authors to separate massage from medical gymnastics, and espe- cially, while doing so, attacking “messieurs the gymnasts” (Dr. Kleen) as overanxious to secure all possible recognition, are rather ill-chosen, and prove that those authors do not know gymnastics and only a part of massage, viz. that small part which can produce a cure without any exercises, (1) 2 PRACTICAL MASSAGE. A first-class masseur nowadays must necessarily know gymnastics, and a medical gymnast surely knows massage. : In these lessons then we will consider massage together with such gymnastic exercises as are neces- sary in order to do the most good for the patient. Let us, however, be frank and come to a full understanding of what we are trying to do. It would be impossible for anyone to gain a thorough knowledge of this system, and how, under- standingly, to give a full treatment, from a few lessons or a brief manual. But there are hundreds of cases where massage, together with a few passive and resistive movements, and also active corrective exercises, will not only give a great relief, but even effect a cure, when applied judiciously and according to physiological laws. SkThe object of these lessons is to describe, for the use of the doctor himself, or for an operator under the doctor’s direction, such “movements” as may be applied in the sick-room and without the use of apparatus, and also to outline some simple, active, corrective exercises which the patient may be taught to practise. First, let us look a little into Tue History of this curative agent. It isasold as mankind. Nature early taught the man to knead his flesh, or bend his THE HISTORY. 3 body, to relieve him of certain ills. And there are books as old as, 3000 years B.c. written about gymnas- tics, among them the Kong-Fu in Chinese. We also know that the Persians, Phcenicians, and Egyptians knew about massage as well as gymnastics. The Greeks were the first to make a genuine progress, however, in this branch, as in so many others. #Esculapius, Apollo’s descendant, is said to have been the inventor of the art of gymnastics. Medea procured health and youth by gymnastics. It was four hundred to five hundred years before Christ that Iccus, and, later, Herodicus, reduced bodily exercises to a system, and Herodicus made it a branch of medical science to preserve the health and cure dis- eases by use of gymnastics, and among his pupils was the famous Hippocrates. Diocles, Praxagoras, Herophilus, Asclepiades, Athenzeus, Celsus, and Galen recommended ‘“move- ment treatment,” and gave rules for it. Mercurialis in the sixteenth century wrote a book, _“De Arte Gymnastica,” or the science of bodily exer- cise, which he divided into “Gymnastics for Athletes, for the Military, and for the Cure of Diseases,” to which, as used by the Greeks and Romans, he gave especial attention, and pointed out the use of the differ- ent movements in different diseases, and also gave rules for their application in special cases. Many a poor woman was burned at the stake in northern Europe during the Middle Ages because she knew a little more than other persons and cured suffer- 4 PRACTICAL MASSAGE. ing men by massage, a magic which was looked upon as a power of Satan. It is interesting to read about Thomas Sydenham, 1624-1689, a noted English physician, called “the English Hippocrates,” who left the routine practice and based his own upon the theory that there is in nature a recuperative power which ought to be aided and not opposed; also saying that, “if anyone knew of the virtues of friction and exercise, and could keep this knowledge secret, he might easily make a fortune.”’ There are many of these persons at the present day in the United States claiming mysterious and magical powers of curing diseases, setting bones, etc., by the application of their hands. Thomas Fuller, another English physician, pub- lished in 1704 “Medicina Gymnastica,” treating of the power of exercise in preserving health and curing disease. F. Hoffman, who was physician to the King of Prussia in the first part of the eighteenth century, wrote that exercise is the best medicine for the body, and that we cannot imagine how salutary and favor- able to health it is, ‘for it excites the flow of the spirits, and facilitates the excretions from the blood.” Clement J. Tissot, a French physician, who several times gained the prize of the Academie Royale de Chirurgie for his lectures, published in Paris, 1781, “Gymnastic Médecinale.”” Gutsmuth, Jahn, Clias; and Spiess worked with energy to spread the German gymnastics, but paid no SWEDISH MOVEMENT TREATMENT. 5 attention to gymnastics as used for the treatment of diseases. As Herodicus observed the curative effects of gymnastics on his own delicate health, and thereby was brought to use movements in therapy, so did the Swede, Pehr Henrik Ling, in the beginning of the nineteenth century, study the movement treatment, because he had cured himself of rheumatism in the arm by percussions. Ling formerly had been a fencing-master and instructor of gymnastics; but afterward, studying anatomy and physiology, and the influence of the movement and manipulations in different chronic dis- eases, he founded a system of gymnastics correspond- ing with the knowledge of physiology, which is univer- sally known as “the Ling System,” or the “SwEDIsH MovEMENT TREATMENT.” By ardent study and labor, Ling succeeded at last in making his new ideas recognized, and in 1813 the first college for pedagogical, military, and medical gymnastics, called the “Royal Gymnastic Central Insti- tute,” was established in Stockholm at the expense and under the supervision of the Swedish government, and Ling was its first president. The principal studies for graduation are: Anat- omy, Physiology, Pathology, Chemistry, Hygiene, Diagnosis, Principles of the Movement Treatment, and the use of exercises for general and local development: 6 PRACTICAL MASSAGE. In the rooms of this institute persons of every condition and age, the healthy as well as the sick, the wealthy as well as the poor, executed prescribed move- ments. The number of those who adopted the use of the therapeutic movements increased’ every year, and among them were even physicians who in the beginning had been the most opposed to Ling. Ling died in 1839. His pupils, Brandting, Georgii, Liedback, and G. Indebeton, published Ling’s theories, and by this means and through the many foreigners who studied at the Central Institute of Stockholm, Ling’s systeny soon became known ina great part of the world. Dr. Joseph Schreiber, of Vienna (in his “Man- ual of Massage and Muscular Exercise’’), says: “The most powerful impetus, however, given to the revival of mechanotherapy originated with a Swede, the creator of the modern ‘movement cure,’ whose doc- trines, spreading to England and Germany, have, after many decades, and in spite of being marked by some extravagances, gained universal recognition.” De Ron, in St. Petersburg; Georgii, Indebeton, Bishop, and Roth, in London; Rothstein and Neu- man, in Berlin; Richter, in Dresden; Schreber, in Leipzig; Melicher, in Vienna; Eulenburg, in Baden; Laisné at the “Hopital des Enfants Malades,” in Paris; Taylor, in New York, and many others, estab- lished special institutions for movement treatment and published their results, partly in medical papers, partly in books, SWEDISH MOVEMENT TREATMENT. 7 Dr. Douglas Graham, of Boston, has written sev- eral articles, and also one “Practical Treatise on Massage,” in which he says: “In 1844 the Supreme Medical Board of Russia appointed two members of the Medical Council to inquire into the merits of the movement and manipulation treatment as practised by M. de Ron, one of Ling’s disciples at St. Petersburg, who had been using it then for a period of twelve years. From the highly commendatory report of the councillors we quote the following: ‘All passive move- ments, or those which are executed by an external agent upon the patient, as well as active ones produced by the effort of the voluntary muscles, and the differ- ent positions with the aid of the apparatus or without it, are practised according to a strictly defined method, and conducted rationally, since they are based upon mechanical as well as anatomical principles. Experi- ence teaches us the usefulness of the institution, as inany patients thus treated have recovered their health after having suffered from diseases which could not be cured by other remedies.’ ” It was not, however, until after the middle of the nineteenth century that massage became really known and was considered by the medical profession as a scientific and valuable remedy in the treatment of diseases. Dr. Mezger, of Amsterdam, who was a famous masseur in the early sixties, was the man who under- stood how to win the confidence of the public, and later, through his many pupils, exercised a powerful 8 PRACTICAL MASSAGE. influence upon the standing of massage in the medi- cal world. The best known German and Austrian physicians, as Langenbeck, Billroth, Esmarch, von Mosengeil, Gussinbauer, and many others began to employ it and scientifically publish its effects: And soon the conviction gained ground that massage was a powerful curative agent which had been neglected by the profession and, ‘therefore, had been abused and overestimated by ignorant people. All over northern Europe massage was known and constantly used, and Prof. W. S. Playfair, of King’s College, London, wrote, in 1883, “The Systematic Treatment of Nerve Prostration and Hysteria,” which greatly encouraged the more general use of massage. In the United States massage was hardly known when I arrived here in the early eighties. The late Dr. Lewis A. Sayre, of New York, prescribed it fre- quently, and I had several cases from him during my short stay in that city. Dr. Weir Mitchell, in Phila- delphia, prescribed “general massage” to his patients, and he wrote, in 1877, “Fat and Blood and How to Make Them,” in which he advocates massage. But as a general rule the medical profession here did not know massage and were not willing to try it. A good illustration of their feeling toward it is shown in the answer I received from one of the oldest and best known physicians in Washington, D. C., in March, 1883, ‘when asking for co-operation: “No, sir; it ‘would be the straight way to get the patients out of our hands.” SWEDISH MOVEMENT TREATMENT 9 Nevertheless, massage had come to stay. I opened an institute, “The Swedish Health Institute for the Treatment of Chronic Diseases by Swedish Move- ments and Massage,” in Washington, where the for- eign diplomats assembled for treatment well known to them, and they soon brought scores of the great men and women of the United States to the institute, and gradually the physicians of the city came to inquire into the mode of treatment and send their patients there. In March, 1888, I read a paper before the Clinical Society of Maryland, on “Swedish Movement and Massage Treatment,” which appeared in several medical journals, resulting in numerous letters from medical men who wanted to know more about it, and urging me to write a manual and also give instructions on the subject, and in 1889 my book, “Swedish Move- ment and Massage Treatment,” was published. In the mean time massage had been introduced by reliable men in many’ other cities, as, Dr. H. V. Barclay, in New York, in the autumn of 1884; Baron Nils Posse, in Boston, 1885, where, as before said, Dr. Douglas Graham already had published a treatise on massage, and the medical profession soon adopted this mode of treatment as an excellent curative agent. Still, it was rather amusing sometimes to notice the fumbling of otherwise highly recognized professional men. It has happened more than once to the author of this book that he has been called in by physicians to apply mas- sage to patients who were already suffering with a high fever, and he invariably declined to do so. In one of 10 PRACTICAL MASSAGE. these cases the patient died the following day. Had the physician’s request been acceded to, the massage treatment would, no doubt, have been accredited with hastening, or even causing, the sick man’s death. At other times the writer has asked the physician in charge what the illness was, and has been told that it was “none of his business.” A WorpD TO THE PHYSICIAN. Some physicians seem to have the idea that we specialists are their rivals and their opponents. Still we have frequently repeated that we do not practise medicine. We are specialists, and, as such, necessarily physiologists, and have the practical experience gained by the practice of many years in this one branch, But it is co-operation between the medical pro- fession and the massage specialists which is desirable and necessary in order to produce the best results. Therefore, it is the aim of this book to enlighten those who want to know, and to show how the treat- ment should be applied in different cases. Massage is based on plain physiological laws, and has nothing in common with “magnetism,” nor is it “regular gymnastics,” nor “rubbing.” When the physician desires to have this treatment applied to a patient, and does not want to execute it himself, he should always take care that the one em- ployed thoroughly understands his business. WORD TO THE PHYSICIAN. 11 Much harm has been done both to patients and to the reputation of “massage,” because physicians have been too quick to accept the card of a “mas- seuse” or “masseur” and send them cases .without looking up their records. I know of several in- stances where good-looking women and easy talkers have obtained work, although they did not know the first principles of massage, while others, who were first-class masseuses, but did not look so well and could not talk so well as their sisters, did not receive any patients. As a natural result of this, in many cases the treatment proved of no value whatever, and in some instances actual harm was done. As Dr. D. Graham says: “It is not to be wondered at that many a shrewd, superannuated auntie, and others who are out of a job, having learned the mean- ing of the word massage, immediately have it printed on their card and continue their ‘rubbin,’ just as they have always done.” Finally, it must be said that it is not our claim to cure all kinds of diseases by massage. Far from that. Some diseases, it is true, can be cured quicker by this method than by any other. In most cases, however, it has to be used together with medical treat- ment, for the same reason that electricity, baths, etc., are very often employed to bring about a cure. In other cases it should be resorted to only as an after- cure, or as a means of exercise. 12 PRACTICAL MASSAGE. Tue VARIETY OF MOVEMENTS AND DURATION of treatment is of great importance. It is an utterly false idea that “massage” is merely “rubbing,” and needs only to be applied by a strong hand and for an hour’s time. As Dr. Graham says: “The argument, too often used, that massage can do no harm, if it does no good, is.a dangerous one. When a man understands one branch of the medical profession well, one of the com- monest errors is to suppose that he understands all the rest equally well, as if our knowledge of massage, like everything else, did not come through experience.” For instance, in a case of synovitis or glandular enlargement or sprains, etc., the manipulations should always be directed centripetally—toward the heart; but in case of insomnia, or very painful neuralgia, the manipulation should be directed downward, from the shoulder toward the fingers, from the hips toward the toes, in order to ease and quiet the nerves. In cases of congestion, movements must be applied to drive the blood from the part; in other cases, as anemia, it is necessary to increase the flow of blood to the parts. Now, for instance, there are two patients, a delicate, small woman and a strong, big man, both suffering with the same kind of illness. It might be fair to treat the man for about an hour, but it would surely be too much to let the woman undergo the same treatment for the same length of time. Always bear in mind that HOW OFTEN REPEATED. 13 the old maxim, “If a little does good, more will do more good,” is an exploded theory. A good masseur can accomplish more in fifteen minutes than a poor one in an hour. “General” massage should never hurt, and if black and blue spots appear after the treatment, it is a sure sign that the operator did not know his business, although we often hear people talk about the excellent and strong masseuse, who makes them “black and blue all over.” “Local” massage, however, often has to hurt, and if the patient is strong and can stand it, the cure will many times be hastened considerably by a strong and vigorous treatment. But great care and tact must be used by the operator in cases of weak and delicate patients, How OFTEN THE TREATMENT SHOULD BE REPEATED is next to be considered, as the mistake is frequently made by physicians to recommend their patients to try massage treatment only two or three times a week, “because they cannot stand it,” or “they are too weak to try it oftener.” The weaker a patient is the oftener he ought to have the treatment. It should be applied at least once a day, and sometimes twice, in order to derive the most benefit from it. The effect which is derived from one treatment should not be lost before the next treatment is applied. 14 PRACTICAL MASSAGE. It is the treatment which builds up the patient’s strength, but if only tried once in a while he will feel tired and stiff a day or two afterward, and naturally conclude that the treatment does him harm—just as a man who takes’ a ten-mile horseback ride once a week feels sore and stiff each time, and never gets over it until he repeats the riding several times weekly. To a weak patient the treatment has to be given very gently in the beginning, and, providing it is applied regularly, may soon be increased in force, and thus more vigor is given to the patient. How To BE DRESSED when under treatment is a frequent question. In all cases where the manipulations are to be directed centripetally, it is necessary to strip the body; but in other cases it is preferred that it should be clothed, as that will lessen the pain which sometimes is pro- duced by the manipulations, and the skin (not being the seat of the trouble) will be more protected. The dress should be as light as possible, and all tight clothing dispensed with. PHYSIOLOGICAL EFFECTS OF MOVEMENTS, These may be divided into two groups :— First—Purely mechanical effects to secure the removal of lymph, exudations, extravasations, etc., softening of exudations, and loosening of adhesions. BY PASSIVE MOVEMENTS. 15 Second.—Increased circulation by stimulating the muscular and nervous systems, causing molecular changes, changes in sensation, and changes in the nutritive functions. By Passive MovEMENTS the following results are obtained :— 1, Extravasations occurring about dislocated joints are, by pressing and kneading the tendons and liga- ments in which they are imbedded, finally liquefied, and thus more quickly absorbed. 2. In stiffness of joints the contracted muscles and tendons are forcibly but generally elongated, and any existing exudations or vegetations within the joints are disintegrated and absorbed. 3. By the forcible stretching of the muscles their nerves are likewise stretched, molecular changes being thus set up in both. 4. Forced extension of the muscles causes pres- sure on their blood and lymphatic vessels, thus acceler- ating the circulation. 5. Finally, such muscles as have by rheumatic or neuralgic pains been kept in a state of inactivity have some of this much-needed exercise restored to them. Passive movements thus form in certain diseases, as in neuralgia and rheumatism, the introduction, as it were, for the more painful active motions which have to follow. x 16 PRACTICAL MASSAGE. Tue ACTIVE AND RESISTIVE MOVEMENTS cause an increased flow of blood to the’ muscles and soft parts, increasing thereby the circulation and re- moving accumulation of tissue waste. They cause re- sorption of exudations, transudations, and infiltrations, and a separation of adhesions in tendon-sheaths and in joints. They increase the oxidizing powers of the blood; they relieve the congestion of the brain, lungs, intestines, uterus, liver, and kidneys, by increasing the flow of blood to the muscles; they stimulate directly the sympathetic nervous system, thus increasing secre- tion, and reflexly the activity of unstriped muscle-fiber, and so relieve various functional derangements. And they educate morbidly affected muscles to convert abnormal into normal actions and to suppress useless movements, Thus movement, or massage treatment, influences the living organism :— oe First, by increasing the circulation, respiration, and . temperature, improving the digestion, absorption, and ' nutrition, and facilitating excretion, Second, the muscles become developed, the bones and the whole human frame better proportioned. Third, appetite is increased, and the food is taken with greater relish, Fourth, sleep is facilitated. Fifth, the brain acts more vigorously and is freed from psychical depression. Sixth, relieves pain and removes congestion. TERMS FOR MOVEMENTS. 17 Tue MovEMENtSs May BE SPOKEN OF AS “Strengthening” movements, such as flexion, ex- tension, torsion, etc. “Stimulating” movements, as percussion, vibra- tion, etc. “Quieting” movements, as circumductions, friction, etc. “Derivative” movements, with special movements of the extremities. “‘Purgative’ movements, as kneading, pressing, and active movements of the abdominal muscles. Some movements have a special effect on the “respiration,” others on the “circulation,” etc. CHAPTER II. THE next thing to be considered is the classifica- tion of movements and their execution and effects. First, let us distinguish between “ACTIVE” AND “PASSIVE” MOVEMENTS. Active movements, being such as the subject per- forms entirely by voluntary muscular contraction, without the aid of the masseur, belong to the regu- lar gymnastic exercises, although some of them, the “corrective” exercises, are used in medical gymnastics. Passive movements are such as the patient takes no part in beyond allowing the operator to move the whole or any portion of his body—as flexion, extension, and circumductions—and to manipulate it, as in stroking, kneading, percussing, etc. ; these latter are more strictly what is meant by “massage.” But what is mostly used in medical gymnastics are the RESISTIVE, OR DUPLICATE MOVEMENTS, ’ viz., “concentric duplex” movements, such as the pa- tient makes while the operator resists. The patient is contracting his muscles to the suitable resistance (18) THE POSITIONS. 19 of the operator, and consequently the muscles in activity are shortened. This is the more frequently used form of resist- ive movement, although the “excentric duplex” move- ments, such as the operator makes while the patient resists, are very useful in certain cases. The patient’s already contracted muscles are gradually extended by the operator and consequently elongated. This form of resistive movements should be used either in cases where the muscles are abnormally contracted or where they are too weak to contract against resistance, but still have strength enough to resist excentrically. An illustration of the last named is frequently seen in the gymnasium, when the child is unable to pull himself up with his arms and “chin the bar,’”? while he may jump up to it, hang in his bent arms and gradually ex- necessary to help the patient to do an exercise so as to the desired strength. Sometimes, as for instance in cases of paralysis or locomotor ataxia, it becomes necessary to help the patient to do an exercise so as to train the motor nerve to obey the patient’s will and thereby gradually gain strength and confidence to move the muscles. These are assistive movements. Tue PosITIONS in which the movements are taken are numerous and also of very great importance, as the same move- ment often may have an entirely different effect in one position from that in another. 20 PRACTICAL MASSAGE. There are six fundamental positions, viz. :— Standing. Kneeling. Sitting. Reclining. Lying. Hanging. These are subdivided into a number of starting posi- tions with the arms, legs, trunk, and head, as:— Standing—hands on hips, : arms horizontal, arms vertical, etc. Sitting——astride sitting, forward bent sitting, etc. Lying—reclining, knees bent, on back lying, on front lying, etc. Which, combined in various ways, make thousands of positions in which the different movements may be either taken or given. And so the number of move- ments may be said to be endless, to suit each par- ticular ailment. Whatever the position is, care should be taken that nothing interferes with the patient’s breathing, as he should never hold his breath, but always breathe easily and as quietly as possible; therefore, the head must not be allowed to “fall down on the chest,”’ but be kept well up. MANIPULATIONS OF THE ARMS. 21 PassiIvE MovEMENTS. Manipulations of the Arms, I, CENTRIPETAL STROKING, KNEADING, AND CIR- CULAR FRICTION are all to be given from the tips of the fingers toward the shoulder. In stroking, grasp the patient’s finger with your Tig. 1—Centripetal Stroking. thumb and two first fingers, and make a firm pressing and stroking movement upward toward the hand; at the same time let your fingers glide in a circular way round the patient's finger, describing the motions of a screw. Let your fingers glide easily back to the start- ing point (the tip of the patient’s finger), and repeat the motions fifteen to twenty times in about ten seconds on each finger. In treating the hand, use your fingers and the palm and stroke first with your right hand, then with your left on both the back and palm of the patient’s hand. 22 PRACTICAL MASSAGE. Grasp around the arm with your right hand and make a firm stroking in the screw motion from the wrist to the élbow, gliding easily down again and repeat about eight times in ten seconds, then use your left hand in the same manner. (Fig. 1.) ‘Kneadings are of two kinds, viz., muscular and circular, In muscle kneading of the fingers make an alternate pressure with the thumb and index finger of both Fig. 2—Muscle Kneading of Fingers. hands, beginning at the tip of the patient’s finger, about twenty pressures in ten seconds. (Fig. 2.) Then knead the muscles of the hands and fore- arm toward the elbow by picking up each group of muscles with the one hand (Fig. 3, 4), and when re- leasing the grasp make an upward pressure with the other hand (Fig. 3, B). About fifteen kneadings in ten seconds. In circular kneading grasp the patient’s finger with your thumb and. two first fingers and let each of your fingers make a circular, or rotary, motion while press- MANIPULATIONS OF THE ARMS. 23 ing so hard that the patient’s skin is moved and not your fingers rubbed over the skin; gradually push your fingers upward to the hand. Fig. 3—Muscle Kneading. Now put your three middle fingers on the back of the patient’s hand and let them together make a circular motion hard enough to move the underlying 24 PRACTICAL MASSAGE. tissues and gradually pushing upward (Fig. 4), about twenty-five circular motions in ten seconds. Then the same manipulation of the palm of the hand. Around the wrist use both your thumbs in the same motions and knead well around and in the joint: Again use Fig. 4—Circular Kneading. your three fingers or the whole hand in the circular motion up the forearm and the elbow. In circular friction grasp the hand with both of yours, and make upward pushing movements alter- nately with right and left, constantly moving the hands and fingers, and especially the thumbs, in a semicircular direction, letting the one hand push upward while the other glides easily down, thereby making a sideways friction together with the upward stroke (Fig. 5), twenty-five motions in ten seconds. EFFECTS OF MANIPULATIONS. 25 Now repeat the same manipulations from the elbow to the shoulders, and when the whole arm has been worked over in this manner make firm strokes from the fingers to the shoulders, clasping the limb around with both your hands, from five to ten times. rrr eeg eens . Pe, %e ee” MPteumecee” oon veses?” ° aooee® Fig. 5.—Circular Friction. The Effects of These Manipulations are as follows :— Any pressure on the muscles must necessarily exert pressure upon the underlying veins and drive their contents away, and on account of the valves which open toward the heart only, it is clear that the contents of these vessels must be driven toward the center, or the heart. Therefore, it would make no difference if a pressure was begun at the shoulder and gradually worked down the arm—the circulation of the blood 26 PRACTICAL MASSAGE. would be accelerated either way ; but a continual strok- ing against the veins would interfere very much with the venous circulation, and even produce ruptures of the vessels. Centripetal stroking quickens the circulation in the blood- and lymph- vessels and even sucks the blood from the vessels below, so that the arterial stream is quickened through the faster outflow from the veins and the diminution of the venous blood-pressure. The strokings going in opposite direction of the arteries do -not interfere with the arterial stream, because the posi- tion of the arteries is deeper and more protected, and their walls are much more resistant. Centripetal strok- ing brings about the resorption and disappearance of all sorts of effusions, prevents stasis as well as ad- hesions of the white corpuscles to the walls of the ves- sels, and their subsequent migration, and réduces in- flammatory tension and the pain due to pressure. Strokings also heighten the nutrition of the tissues, and are a valuable procedure in many cases of traumatic injury, as well as in some cases of delayed healing from other causes; they will also limit or prevent a threat- ened mortification or gangrene in certain cases. And, finally, it has the property of removing fatigue, acting as a restorative to groups of tired muscles. Fatigue results from the presence of carbonic acid, lactic acid, acid phosphates, etc., due to the consump- tion of oxygen and the lack of those substances that are oxidized during muscular contractions; and the re- moval of these products, and the access of fresh blood, EFFECTS OF MANIPULATIONS. 27 rich in oxygen and oxidizable substances, act as a restorative on the working power of the muscles. Experiments have been made flexing the arm at the elbow-joint, while raising a weight, till exhausted; _then centripetal stroking has been made for five minutes, immediately after which the arm was able to perform even more labor than before. Muscle kneading and circular kneading are both used to crush newly formed. vessels and half-organ- ized products of inflammation; to stimulate the cir- culation and further the resorption, and to separate the exudations and infiltrations and force them out in the lymph. The muscle kneading in lifting the muscles up and again pressing them against the bones acts mainly on the deeper tissues and also helps to bring about contractions of the muscles, and is therefore especially valuable in reducing fatty degenerations and make stronger muscles; while the circular kneading is more useful to separate foreign bodies and to liquefy extravasations and promote absorption. Circular friction has a similar effect as the strok- ‘ing, but by moving the hands in a semicircular direc- tion we can easier reach all the capillaries and small lymph-vessels. Generally speaking: Centripetal stroking quickens circulation and reduces inflammations; muscle knead- ing crushes settled and waste matters in the deeper tissues, while circular kneading does the same to the tissues nearer the surface, thus separating foreign material into small atoms, which again are sent forth 28 PRACTICAL MASSAGE. through the veins by the circular friction and the last strokings. Further, muscle kneading, rather quickly and ‘moderately hard, should be used on weak and atrophied muscles to make them contract and grow stronger ; while circular kneading will loosen up tense and hardened. muscles. For instance, suppose the flexor muscles of the arm are contracted from some injury, circular kneading and centripetal stroking under full extension of the arm should be applied on the flexors, while muscle kneading and “percussion” should be used on the extensors, and also some resistive movements to strengthen the extensor muscles so as to make them © able to overcome the contraction of the flexors. CHAPTER IIL. 2. NERVE CoMprESSION.—Grasping the limb with both hands, a firm pressure is made around and down the whole arm from the shoulder to the fingers. Re- peated three to five times. (Fig. 6.) Both hands Fig. 6.—Nerve Compression. grasp simultaneously near the shoulder, and the pres- sure should be evenly distributed by the palm of the hand and all the fingers without pinching; when the grasp is released, the hands move a trifle lower and around the arm and make another pressure, and so on to the fingers—five to six pressures in ten seconds. A slow and even pressure is most soothing to nervous patients. This increases the circulation of the blood and has a very quieting and soothing effect on the nerves. In (29) 30 PRACTICAL MASSAGE. extreme nervous cases it is therefore a most valuable manipulation. 3. Muscte Roiiinc.—Grasping the limb with the palms of both hands (Fig. 7), and making a quick, alternate pushing and pulling motion, and gradually gliding downward from the shoulder, the muscles of the arm will be rolled and squeezed against each other, Fig. 7—Muscle Rolling. whereby the circulation of the blood is very much in-’ creased. Repeated three to five times. There are hardly any manipulations which will warm the arm and hand as quickly as this. 4. SLAPPING.—This is performed with the palms of both hands, with a light motion of the wrist-joint and the whole arm is slapped from the shoulder down- ward from three to five times. This stimulates the action of the nerves and the circulation. 5. Friction is performed with the fingers and palm of the hand from the shoulder and downward, grasp- MANIPULATIONS OF THE ARMS. 31 ing lightly around the limb with both hands—repeated ten to thirty times. This should be done in slow time and very lightly so as not to interfere with the venous circulation. Three to five frictions in ten seconds. This has a quieting effect on the nerves, and is often sufficient to produce sleep in nervous and sleep- less patients. Nerve compréssion, muscle rolling, slapping, and friction are frequently used together as an excellent way to increase the circulation, of the blood and quiet the nerves. As before said, any pressure of the muscles must necessarily send the venous blood in a quicker current toward the heart, and as soon as the pressure is re- lieved the underlying blood-vessels suck the blood from veins and capillaries below, which again, by the dimin- ished blood-pressure, increases the flow of arterial blood toward the parts; and it is a fact that the manip- ulations working in a downward direction have a much ‘more soothing and quieting effect on the nervous sys- tem. Therefore, in certain nervous affections this mode of applying massage should be preferred to the centripetal, and in other cases follow it. In extreme nervous cases “nerve compression” and long, light “friction,” downward are most beneficial. 6. ComMBINATION KNEADING.—Grasping the arm near the shoulder with both hands and a firm pressure, move each hand outward and upward like a combined, muscle-rolling, circular kneading, circular friction, and centripetal stroking, not very rapid, so as to stretch and 32 PRACTICAL MASSAGE. knead the underlying muscles, and geatly move the hands downward toward the wrist; all pressure, how- ever, being in centripetal (upward) direction. This procedure is very valuable to begin the massage of an arm or leg before the other centripetal strokings and kneadings are applied. 7. PERCUSSION is performed with the edge of the extended fingers (Fig. 8), which are kept loose, and Fig. 8.—Percussion. with a quick motion of the wrist-joint the fingers are flung alternately across the muscles. The quicker the better. 8. Bratine is performed with the clenched fist (Fig. 9, 4) on and around the fleshy part of the limb with a loose and light movement of the wrist-joint. (Fig. 9, B.) The blow must be firm and deep, and one a second. These two motions stand foremost among the manipulations which aim at mechanical excitation. A MANIPULATIONS OF THE ARMS. 33 blow calls forth a local contraction which is inde- pendent of any nervous stimulus by reason of the independent irritability of the muscle itself. This is a particularly effective way of stimulating a muscle, Fig. 9.—Beating. and often so when other forms of stimuli have given out. The contraction itself furnishes the conditions for a quicker access of blood and interchange of material, increase of temperature, and nutritional activity. 3 34 PRACTICAL MASSAGE. Percussion and beating are very important parts of massage, and are extremely serviceable in counter- acting muscular atrophy and in restoring normal size and functional power to groups of thin and weak muscles. Fig. 10—Arm Vibration. These manipulations applied gently across the muscles cause contraction of muscles and_blood- vessels; while applied forcibly, muscles and tendons will loosen and thereby overcome contractions, and cause dilatation of the blood-vessels. 9g. ViBrATION.—The operator takes hold of the patient’s hand and makes a slight pull and a very rapid vibration (shaking) of the whole arm. Repeated five MANIPULATIONS OF THE ARMS. 35 to ten times. In order to apply this effectually it is necessary for the operator to make himself as rigid and tense as possible. (Fig. 10.) This has a stimulating and strengthening effect on the nerves and also on the respiration; and it can be given with excellent results in nervous affections and fatigue. CHAPTER IV. * CIRCUMDUCTION OF ARM, HAND, AND FINGERS. 10. Fincer CircumpDucTION.—The joint, between the finger and hand, metacarpal joint, is fixed by the operator’s one hand, and with the other the finger is circumducted in its joint; at the same time a “‘pull’’ is applied to the fingers; moved ten to twenty times each way, and about twenty-five circumductions in ten seconds, unless the finger-joint is very stiff. In such case the joint must first be flexed (bent) and extended, and then the circumduction performed in as big a circle as the joint will allow. 11. HAND CIRCUMDUCTION is performed by taking hold of the wrist with one hand and of the fingers with the other hand, and describing a circle in the wrist- joint from ten to twenty times each way—about twelve circumductions in ten seconds, with a pull of the hand. 12. ForEaRM CircumMpucTION. — The patient’s elbow is fixed in the operator’s one hand, who, with the other hand, takes hold of the patient’s wrist (Fig. 11) and moves the forearm, which is kept on an angle, in a circle in the elbow-joint, from ten to twenty times each way—about eight times in ten seconds. 13. ARM CIRCUMDUCTION (SINGLE).—The oper- ator takes hold of the patient’s shoulder with one hand (36) PASSIVE MOVEMENTS OF THE ARMS. 37 and of his elbow with the other hand, moves the arm forward, upward, backward, and down so as to describe a circle of the shoulder-joint, from five to ten times one way and reverse as many times—about five times in ten seconds, with a pull of the arm. Fig. 11—Forearm Circumduction. The arm, forearm, hand, and finger circumductions are very useful in stiffness of the joints. The con- tracted muscles and tendons are forcibly but gradually elongated, and any existing exudations within ‘the joints are disintegrated and absorbed. But these movements are also of great value in general mas- 38 PRACTICAL MASSAGE. sage and in all cases where it is desired to quicken cir- culation or to draw the blood away from the chest and head. On account of the bent position of the axillary artery, the raising of the arm in circumduction stretch- ing it out, the arterial blood-current is very much in- creased at the same time that the pressure of the muscles on the veins drives the venous blood to the heart, and a very rapid flow of blood to the arm and hand is the result. The movements should always be- gin with the arm and end with the fingers; and if done well, these few exercises will, as a rule, make the coldest hand warm. Arm circumduction (single), is an excellent move- ment in cases of congestion or too much blood in the head. 14. “FLEXION” (passive) of arm, hand, and finger is also a very valuable and necessary movement to break up adhesions within the joints; and sometimes great force must be applied when the shoulder- or elbow- joints are stiff from dislocations, fractures, etc. In raising the-arm vertical the big chest and back muscles—the pectoralis and latissimus dorsi—are being stretched, which in many of these cases is highly necessary. If the forearm is bent the extensors of the arm—the triceps—are stretched ; and when the arm is extended the flexors—the biceps and brachialis—are stretched, and so on. These passive stretchings of antagonistic muscles are of great importance in many cases; besides, they are also beneficial in stretching nerves and blood-vessels. PASSIVE MOVEMENTS OF THE ARMS. 39 15. VERTICAL ARM CIRCUMDUCTION (SITTING) .— The patient sits with his arms extended over his head; the operator standing behind, supporting the: patient’s back with his knee, takes hold of his hands (Fig. 12), Fig. 12.—Vertical Arm Circumduction. x and while stretching the arms well, he moves them in) a small but very rapid circle forward, outward, back- ward, inward, taking care not to strike the arms against the head. This is noé reversed, but repeated three to six times, and between each quick rotation ot twenty to thirty circlings the arms should be gently lowered a little in front and pulled backward while a 40 PRACTICAL MASSAGE. pressure is made with the knee on the patient’s back; then the arms are again raised and the quick rotation repeated. This makes a great expansion of the chest and Fig. 13.—Forward Arm Circumduction. stretches out the pectoral muscles; the blood is drawn out of the arms, and. the apex of the lungs is brought into vibration; an increase of pulmonary circulation and bronchial absorption follows; the flow of the blood to the chest causes a diminution of blood-pres- sure, especially in abdominal and pelvic vessels. PASSIVE MOVEMENTS OF THE ARMS. 41 16. Forwarv ARM CIRCUMDUCTION (SITTING) .— The operator, standing behind the patient, the latter resting his back against the operator’s chest, then takes hold of his arms just below the elbows and moves them. in a circle forward, upward, sideways, and down, but not reverse, from six to ten times (Fig. 13)—about twelve to fourteen movements in a minute. This exparids the chest and has a great effect on the respiration and the circulation. 17. SHOULDER CIRCLING AND CHEST LIFTING (Sittinc).—The patient sits on a stool, and the oper- ator, standing behind, takes held under and in front of the patient’s shoulders, moves them upward, back- ward, and down, at the same time pressing his chest against the patient’s back. Repeated six to ten times, but not reversed. (Fig. 14.) About twelve to four- teen times in a minute. This is a mild but effective movement in weakness of the lungs and heart, as it deepens the inspiration followed by a stronger expiration, thereby stimulating the flow of venous blood to the heart. Forward arm circumduction and shoulder circum- duction are most effective respiratory movements, and should be given frequently to patients who are able to sit up, so as to increase the quantity of oxygen and purify the blood, which, during the treatment, is forced to flow rapidly. But, aside from this, the deep inspira- tion draws the venous blood to the heart, and is there- fore of great value in diseases of the heart as well as in cases of congestion of the brain and in all nervous 42 PRACTICAL MASSAGE. affections which produce flushing of the head and face. In lung troubles these breathing exercises are invalu- able, and I have often with a single application brought a man’s respiration from 34 in a minute down to 20. Fig. 14—Shoulder Circling and Chest Lifting. Persons who have been diving or swimming under water frequently complain of headache and their eyes are bloodshot from congestion as a result of “holding the breath” ; six to twelve deep breathings will quickly give relief to those cases. CHAPTER V. MANIPULATIONS OF THE LEGs. 18. CENTRIPETAL STROKING, KNEADING, and ciR- CULAR FRICTION should all be applied in the same man- ner as to the arms, beginning with the toes and. grad- ually proceeding toward the hip. (Figs. 1, 2, 3, 4, and 5.) In stroking the foot use your right hand on the patient’s right sole from the toes toward the heel a few times, and also up along the instep; use the left hand on the front and outside of the right foot, and both hands alternately from the ankle to the knee. The muscle kneading of the foot is done by an alternate squeezing with both hands. _ The rest of the manipulations are the same as to the arm. 19. NERVE COMPRESSION, MUSCLE ROLLING, SLAP- PING, and FRICTION from the hip toward the foot are similar to those movements given the arms, as described in Chapter III. (Figs. 6 and 7.) 20. THE COMBINATION KNEADING, as applied to the arms. 21. PERCUSSION, as applied to the arms. (Fig. 8.) 22. BEATING, as applied to the arms. (Fig. 9.) 23. VIBRATION.—The operator, taking hold of the patient’s heel and ankle, makes a slight pulling and very rapid shaking movement of the whole limb. (43) 44 PRACTICAL MASSAGE. This has a stimulating effect on the nerves. 24. STRETCHING THE ScIATIC NERVE AND THE Hamstrincs.—The patient reclines on a bed or chair, etc.; the operator bends the patient’s knee and raises the. leg, resting the patient’s heel on his (operator’s) shoulder. Now he makes a strong pull upward on the toes (flexing the foot) and, at the same time stretches the knee by pulling on the thigh, just above the knee, with the other hand. This is an excellent way to stretch the nerve and hamstrings and very valuable in sciatic neuralgia. The higher the patient sits up, the more forcible is the exercise. CIRCUMDUCTIONS OF LEG AND Foot. 25. Foot CircLinG (SINGLE).—The operator fixes the patient’s ankle with one hand, and, taking hold around the toes, without pinching, moves the foot around in a circle ten to twenty times one way, and reverses. About fifteen times in ten seconds. This’ is useful to break adhesions in stiff ankle- joints, to limber the joints, and to bring the blood into a better circulation, 26. Foot Circtine (DousLe).—The patient, in a lying or reclining position, rests the back of his heels against a cushion. The operator, sitting in front of the patient, takes hold of his toes (Fig. 15) and moves both the feet in a quick circle—the quicker the better— twenty to thirty times one way, and reverses. The PASSIVE MOVEMENTS OF THE LEGS. 45 legs should be kept straight but passive during the motion, so as to allow a vigorous shaking of the whole limb. This has a very good effect on the circulation, and, by increasing the flow of blood to the feet, acts as a good derivative from other parts. 27. Foot and TOE FLEXION, passive, whereby the muscles and nerves are put on a, full stretch, are very Fig. 15—Foot Circling (Double). useful movements. Especially in paralysis or other cases when some set of muscles are contracted—these should be passively stretched. 28. THicH CrircumpucTion (REcLINING).—The operator takes hold of the patient’s foot—right foot with right hand, so as the thumb comes on the instep— and of his bent knee with the other hand (Fig. 16) ; the knee is now pressed upward, then moved outward and downward (without being straightened) so as to describe a circle in the hip-joint; the knee should not 46 PRACTICAL MASSAGE, be moved to pass the middle line of the body, and the movement should be firm and even, with a good pres- sure of the knee upward. The pressure is done at the foot, while the hand at the knee simply steers the motion. The foot must be kept in line with the knee and not be twisted outward. The movement is done Fig. 16.—Thigh Circumduction. from six to fourteen times in one direction, then as many times reversed. About three to five times in ten seconds. This is one of the best exercises for equalizing the circulation, and as a derivative from diseases in the pelvis and abdomen, as well as to limber the hip-joint. It is considered a delightful movement by almost every patient, and may be used frequently in general massage, as well as in local troubles. PASSIVE MOVEMENTS OF THE LEGS. 47 .29. Hip Circumpuction (Lyrnc).—The patient lies flat on his back with the lower extremities outside the bench or couch. The operator, taking hold of the ankles, moves both legs around in a big circle eight to twelve times in one direction, then as many times in the other. This is very effective in affections of the abdomen and pelvis. Passive circumductions alternately shorten and lengthen the blood-vessels, and are more especially effective, with the bigger veins. When they are stretched they carry more blood than when they are shortened, and, therefore, movements which alternately shorten and lengthen these vessels act as a sucking power on the venous circulation toward the heart, as the blood cannot go backward on account of the valves. CHAPTER VI. PassivE MOVEMENTS OF THE TRUNK. (a) Manipulations of the Chest. 30. CHEST FRICTION AND CHEST KNEADING.— , The operator puts his hands on the patient’s chest with ” the finger-tips pointing at the throat and the thumbs meeting at the sternum, then makes rapid strokings with both hands—one to each side—and gradually moving his hands down, always beginning at the middle of the chest. After the whole chest has been treated this way a few times, the muscle kneading is applied by picking up the skin and muscles alternately with both hands, beginning at the sternum and follow- ing the pectoral muscles out to the side. First manip- ulate one side of the chest, then the other. The circular kneading is next applied with one hand on each side of the sternum, making the rotary motions toward the side of the trunk. 31. CHEST VIBRATION should follow the kneadings by putting the hands, one on each side of the chest, and pulling downward, making a rapid vibration, or shaking, with very tense hands and fingers. The friction—sideways stroking—should finish these manipulations. (48) MANIPULATIONS OF THE CHEST. 49 32. CuHest SLappinc (STANDING).—The oper- ator, standing in front of the patient, brings his hands on the back of the patient’s shoulders and slaps him over the region of the lungs, thus moving forward under the arms to the chest and all over the chest up to the shoulders in front. Repeated three to six times. If the patient is lying down the slapping is done by alternately using both hands rapidly all over chest from side to side and gradually moving the hands up- ward to the shoulders. The slapping should be done with the palm and fingers and a light movement of the wrist, without keeping the hands stiff. The friction, kneading, vibration, and slapping of the chest are frequently used in “general”? massage as a fine exercise for the chest muscles and to increase the circulation and tone up the nervous system of the whole chest, lungs, and heart. They are very useful in weakness and emphysema of the lungs, organic dis- eases of the heart, and in nervous palpitation. 33. CurstT LirriING AND VIBRATION (RECLIN- ING).—The operator, standing in front of the patient, puts his hands on each side and under the shoulders of the patient, then lifts him slightly (Fig. 17), and, by shaking his hands while he pulls them forward under the patient’s arms, effects a vibration of the whole trunk. Repeated four to eight times. This stimulates the lungs and heart and is a very good respiratory movement for a patient who cannot sit up. 4 50 PRACTICAL MASSAGE. I have often given great relief to asthmatic patients with a few applications of this movement. (b) Abdominal Massage. 34. STOMACH FRICTION is made with both hands all over the abdomen from the middle and out to the Fig. 17—Chest Lifting and Vibration. sides, beginning under the ribs and gradually moving downward; this is followed with an upward stroke with the one hand on the right side, beginning at the cecum and over to the left in the direction of the ascending and transverse colon, and then a downward stroke with the other hand on the left side in the direction of the descending colon to the sigmoid flex- ure. Repeated four to eight times. This influences the activity of the intestines. MASSAGE OF THE ABDOMEN. 51 35. MuscLe KNEADING OF THE ABDOMEN.—With both hands the operator alternately kneads and rolls the flesh and muscles of the abdomen in a circle from the right upward, over to the left and downward, in the direction of the ascending, transverse, and des- cending colon. After a few treatments the operator should be able to make very firm and deep kneadings without any disagreeable feeling to the patient; the Fig. 18.—Muscle Kneading of the Abdomen. intestines will be forced to greater contraction and activity, and fat and flabby abdominal muscles will be reduced and made firmer. (Fig. 18.) The muscle kneading of the abdomen is especially useful in constipation and obesity. 36. KNUCKLE KNEADING OF THE ABDOMEN.— With the slightly bent knuckles of the fingers an alternate pressure is made with both hands, beginning at the middle line under the ribs, and gradually and evenly moving the hands out to the sides, taking care 52 PRACTICAL MASSAGE, not to press on the hip-bones; then the knuckles are again placed at the middle line a little lower than first time, and.so on till the whole abdomen has been kneaded in this manner. (Fig. 19.) This is very useful in constipation and to make the intestines more active. SS SN = TES — _— So TH Fig. 19—Knuckle Kneading of the Abdomen. 37. CIRCULAR KNEADING OF THE ABDOMEN.—The operator places his three middle fingers, which are held close together, upon the spot which is to be manipulated—either in the gastric region or on the stomach, or beginning at the cecum and following the colon—and pressing lightly (Fig. 20) executes circular kneading. After a thorough kneading on one spot the fingers are lifted and placed on another spot nearby and so on. In case of constipation begin at the sigmoid flex- ure, kneading thoroughly, then lift the fingers and MASSAGE OF THE ABDOMEN. 53 move a little higher up the descending colon, again kneading well, and move higher up, then across the transverse colon to the right and down the ascending colon to the cecum, always making the pressure of the Fig. 20.—Circular, Kneading of the Abdomen. kneading in line of the normal passage. This will help to loosen up hardened matters. Then knead the colon from cecum to sigmoid flexure. This kind of kneading is probably the most effectual of them all and acts very powerfully on the glands and epithelium of the alimentary canal; it has 54 PRACTICAL MASSAGE. a very stimulating effect on the abdominal organs and their nerves. It increases the activity of the stomach and the secretion of the juices, and effects a better mixture of the secreted juices and the food substances. It is therefore of great value in cases of indigestion, dyspepsia, constipation, etc. 38. StomacH VisraTion.—The operator presses his slightly bent fingers under the patient’s ribs on the left side and applies a rapid vibration on the ventricle; the hands should be moved so as to apply the vibration all over the left hypochondriac. Re- peated three to six times, and followed by stomach friction. Useful in dyspepsia and chronic catarrh of the stomach and to increase the appetite. 39. BOWEL VIBRATION (STANDING).—The oper- ator, standing behind the patient, puts both hands on the patient’s abdomen, and by a rapid pushing and pulling motion of his hands an effective vibration is applied to the whole bowel. Repeated three to six times; very useful in constipation. 40. BowEL Concussion (Ly1nc).—The oper- ator’s hands are placed on the patient’s abdomen, and a pressure is made—deep but evenly; then the hands are quickly taken off, allowing the abdomen to spring back like a rubber ball. Repeated three to five times. This ‘strengthens the abdominal muscles and the digestive powers. . MASSAGE OF THE ABDOMEN. 55 41. Lorn VisraTION (Sittinc).—The operator, standing behind the patient, who sits on a stool slightly stooping forward, presses his hands with the ulnar edge on each side of the patient just above his hips (Fig. 21), and applies a very rapid alternate pushing Fig. 21—Loin Vibration. and pulling movement with his hands. The hands must be firm and not glide on the flesh. Repeated three to six times at short intervals. This has a very stimulating effect on the liver and stomach and on the lungs and the diaphragm. 42. Lorin Traction (Lyinc).—The operator puts his hands on each side and under the small of the back of the patient, and pulls his hands forcibly forward, just above the hips. Repeated four to ten times. 56 PRACTICAL MASSAGE. This has a very soothing effect and is useful as a finish to abdominal massage. Of all the different kinds of massage, the ‘“ab- dominal” has more special influence on blood-pres- sure, which is increased considerably during, and for a while after, these manipulations. Abdominal mas- sage, therefore, should not be used in cases of recent bleeding within the brain, in the lungs, or stomach. CHAPTER VII. MASSAGE OF THE BACK. 43. Back Friction.—The operator puts his hands on the patient’s neck with the finger-tips pointing up- ward and the thumbs meeting at the spine, then makes rapid strokings simultaneously with both hands, one to each side, gradually moving downward to the but- tocks, but always applying the strokes from the spinal column outward and never toward the spine, neither up the back. Repeated four to ten times. Has a soothing and quieting effect. 44. Back MuscLe Kneapinc.—The operator first manipulates the muscles of the neck and shoulders and gradually proceeds downward to the buttocks, picking up the muscles with one hand and squeezing with the other, from the spinal column outward, following the course of the trapezius and latissimus muscles, first on one side of the back, then on the other. Repeated three to six times. (Fig. 22.) Increases circulation and the action of the nerves and has a good effect on tired muscles. 45. Back MuscLe Roitiinc.—The operator, put- ting both his hands side by side on one of the pa- tient’s shoulders, makes an alternate, very rapid push- ing and pulling motion with his hands, gradually mov- ing downward to the buttocks; the hands must be so (57) 58 PRACTICAL MASSAGE. firmly on the patient as to move his muscles from side to side, thereby causing a quick stretching and a vibra- - tion of them. First roll the muscles of one side of the back three to five times, then the other side. /Increases circulation. 46. Back CiRcULAR KNEADING.—The operator’s middle three fingers of each hand begin at the neck Fig. 22.—Back Muscle Kneading. on each side of the spine and apply the circular knead- ing outward, then begin a little lower and work out- ward, one hand on each side, and so on to the end of the spine, thus kneading the buttocks and hips thor- oughly. Repeated three to six times. Increases resorption and has a very soothing effect. 47. Back VisratTion.—The operator puts both hands, with the fingers spread out, one on each side of the patient’s back up at the shoulders, then pulls downward with a firm pressure and a rapid vibra- MASSAGE OF THE BACK. 59 tion of hands and fingers. Repeated three to five times. Stimulates the nerves. Fig. 23.—Back Percussion. 48. SPINAL NERVE Compression.—The operator presses with his middle and index fingers on each side of the spinal column from the neck to the end of the spine; the pressure should be made a little inward and upward, firmly, without jerking, in a slow and quiet way. Repeated two to four times. Relieves backache and is very soothing and rest- 60 PRACTICAL MASSAGE, ful; if done with vibration of the fingers it is stimulat- ing to nerve-centers. 49. Back PERCusSION is applied with the edge of both hands and fingers alternately and very quickly frorn the neck downward on both sides of the spinal column. On the upper part of the back, from the shoulders to the lower end of the lungs, the percus- sion may also be applied outward to the sides. Re- peated six to ten times. (Fig. 23.) This has a very stimulating and strengthening effect on the nerve-centers. 50. Lone Friction Down THE Bacx.—Place both hands, one on each shoulder, and make long, slow, and light strokings down the whole back. Re- peated ten to twenty times. This should always follow.and finish the other manipulations of the back, as it has an exceedingly soothing and quieting effect. In extreme nervous cases this friction downward is often enough to put the patient to sleep. The whole process of back massage—back fric- tion, muscle kneading, muscle rolling, circular knead- ing, vibration, spinal nerve compression, percussion, and long friction downward—is considered the most delightful and soothing of all manipulations. And it is well worth while for a masseur or masseuse, to practise this to perfection. - Affections of the heart, lungs, and stomach are also reached and relieved through back massage. MASSAGE OF THE BACK. 61 Many a mother has been able to quiet and put to sleep her crying baby simply by patting and stroking its back, whereby stomach-aches have been relieved. 51. Breech BrEatTinc (STANDING).—The oper- ator puts his left hand on the patient’s abdomen for Fig. 24.—Breech Beating. support, the patient standing with his hands on a table or bed, and with his right, moderately clenched fist he applies the beating over the sacral bone from hip to hip and down, all over the buttocks to the thighs. The beating should be done with a light wrist- movement, but firm, deep, and slowly. (Fig. 24.) 62 PRACTICAL MASSAGE. Then put the right hand on the small of the back and apply a quick vibration by making your arm very tense. If the patient is in bed a pillow should be put under the abdomen, and sPINAL VIBRATION, with the right hand placed against the end of the spine may be ap- plied by shaking the hand very rapidly. This acts on the sacral nerves and on the pelvic organs, and draws the blood to the surface muscles; it is useful in weakness and congestions of the bladder and sexual organs, and also in constipation and hemorrhoids, etc. CHAPTER VIII. . Heap, Face, AND THROAT MASSAGE. WHEN a boy of about 14 years I suffered a great deal from headache over the forehead and temples, and as Dr. Winge, of Christiania, Norway, had just returned from his study with Dr. Mezger, I went to him for massage, and after one month’s daily treat- ment I was completely cured. This treatment lasted only five minutes each day and consisted of hard per- cussion all over the forehead with a small hammer on the end of which there was a layer of rubber; after a couple of minutes of this pounding my head was rested against the doctor's chest while he rubbed my forehead with all his might with his right hand, using some lard in order not to take the skin off together with the headache. It was a heroic treatment and did not “feel good,” especially when I would sit down in the chair with a bursting headache before the doc- tor began. But a few minutes after the treatment I would walk away “light-hearted” and “clear-headed.” And I am still in debt to this doctor for many reasons —he chased away my headache, and gave me the first ideas about Mezger massage, of which I later made a deeper study. The Mezger method is pretty rough, and at times it is necessarily so, but in most cases it is not, and the (63) 64 PRACTICAL MASSAGE. masseur will, as a rule, find it much more beneficial, both to himself and to his patients, to use a little longer time and a little less roughness. Especially in head, face, and throat massage it will be found of great value; so that the patient says; “Ah! that is good—it feels so nice! It rests me so!” 2 52. Heap Percussion (SITTING).—The operator, standing in front of the patient, first makes some fric- tion with both his thumbs from the middle of the forehead and over the temples, several times. Then percussion is applied with the edges and tips of the fingers of both hands simultaneously, beginning at the middle of the forehead and going straight backward to the base of the skull; now begin again at the fore- head, but each hand a little farther out to the temples, next still nearer, and at last over the temples and back- ward down the neck—about thirty percussions in ten seconds. Then a rapid percussion is given alternately with both hands, all over the forehead and temples, the crown of the head and the neck—four to eight times. A vibration at the base of the skull is often applied after the percussion, by placing one hand on the patient’s forehead for support, and with the ulnar edge of the other hand or little finger, pressed on the neck just below the base of the skull, make a very rapid vibration—three or four times at short intervals. 53. KneapING oF THE Heap (SittTinc).—The ‘patient's head rests against the operator’s chest, he standing behind. Begin at the corner of the nose and HEAD MASSAGE. 65 make circular kneading with the index and middle fingers of one hand, following with stroking of the other hand, working from the nose around the eye- brows and to the temple; then begin a little higher over the nose and work outward, next still higher, till the line of the hair is reached. Now work the other side of the forehead in the same manner. Then give circular kneading with both hands, one | on each side of the nose, working outward to each temple. After the whole of the forehead has been well kneaded, spread all the fingers on the scalp and let each finger make a small circular kneading, taking care not to glide on the skin or pull the hair; raise the hands and remove the fingers to other spots, and so on until all of the scalp has been well treated. ‘ In kneading the neck support the head with one hand and knead—both muscle kneading and circular kneading—with the other hand from the skull down the neck on each side and over the shoulders, fol- lowed with a few strokings in the same direction. The kneading and stroking up the neck and head frequently used by hair dressers, is contrary to all physiological rules. 54. Heap VisraTion.—After the kneading place both hands around the patient’s head and make a firm, even pressure and rapid vibration, or trembling, of the hands. 55. FRICTION OF THE FOREHEAD AND TEMPLES and back over the neck with both hands should finish the head massage. 5 66 PRACTICAL MASSAGE. These manipulations of the head are exceedingly beneficial in cases of headache, weariness, insomnia, etc., and always have a soothing and quieting effect on nervous patients. -But aside from these general effects there is no doubt, to my mind, that the circular kneading of the scalp will produce new growth of hair. In fact, I have seen several excellent proofs thereof. One, a lady of 65 years, who had worn a wig for more than twenty years; she began after my advice to give herself scalp massage twice every day for.about ten or fifteen min- utes each time, and when I saw the lady again, after a couple of years, she had a good crop of hair all over her head. The simple reason is that the massage will bring nourishment to the roots of the hair and thereby awaken Nature to new life. 56. FactaL MassaGe.—Soon after I had opened my Institute in Washington, in 1883, two ladies, who had seen their best days of life, called and asked if massage would take away wrinkles from the face. At that time I had not thought of this and had never seen any account of such treatment from other mas- seurs, so I did not encourage the ladies and I never saw them again. But the incident set me thinking, and I do not now hesitate to say that massage will prove itself to be the best agent in removing wrinkles and in making a face younger and more beautiful if kept up regularly for weeks and months at a time. This certainly is reason enough for the many offices and “‘parlors” for facial and scalp massage, or, as it is FACIAL MASSAGE. 67 often called the “scientific” manipulation, which signs we now see everywhere in the cities. However, this kind of massage is often errone- Fig. 25.—Veins of Head and Neck. ously explained by certain writers of “beauty and health” in magazines atid newspapers. Let us take a look at Fig. 25, which shows the veins leading from the head and face. The facial vein (1) coming from the corner of the eye and nose, crosses obliquely down the cheek, taking up the venous 68 PRACTICAL MASSAGE. blood from other parts of the face and finally emptying its contents into the internal jugular vein (2) farther down the neck. The external jugular vein (3) re- ceives the venous blood from the head, neck, and ears, and carries it in an almost straight line to the superior vena cava. Now with this fact in view it is hard to understand how persons who claim to know can advise making strokings upward the cheek from the neck and chin. This is in.strict opposition to all laws for massage and cannot produce any good effect. The strokings and also circular kneading with the tips of one or more fingers should follow the direction of the veins in order to accelerate the circulation of the blood and to produce quick absorption of waste material. If strokings are directed from below and upward, congestion may set in and impure matters may be more firmly imbedded in the walls of the blood-vessels and even rupture of small vessels may occur. In case of wrinkles put the index and middle finger of one hand on each side of the groove and stretch it out, while circular kneading is applied with one finger of the other hand right on the groove; this process to follow the course of the wrinkle in the same direction as the veins, If the face is discolored, or there are pimples, the circular kneading followed with strokings on the big facial and jugular veins should be applied. If the face is too fat or flabby, muscle kneading, or, rather, a pinching, picking up the flesh with the THROAT MASSAGE. 69 thumb and index -and middle fingers, and letting each finger squeeze and knead the part before releasing the hold and removing to another spot near by. This process may as well be given from the chin and up if that seems desirable, as there is no stroking to be done. If the face is poorly nourished apply circular knead- ing and also pressure and light vibration on the twigs of the fifth cranial nerves, where the stars are shown on Fig. 25. Always keep in mind that the circular kneading, not too hard, brings nourishment and produces. health and growth, while muscle kneading reduces fatty sub- stances. 57. THROAT MASSAGE has proved itself of such value in cases of sore throat, tonsillitis, and catarrh of the throat and nose, and against rushing of blood to the head, that it ought to be a common remedy in every family. If mothers would apply this method as soon as the children complain of any soreness or pain in the throat and ears, or they are troubled with catarrh, much suffering would be spared the little ones and many a wakeful night and big doctor and drug- gist bills be spared the parents. In applying throat massage, stand in front of the patient, who sits or reclines, with his head well back; put your hands with the palms upon the side of the patient’s neck so as to let the edge of your right little finger come just under the left ear, and the edge of your left little finger under the right ear of the patient ; now make a stroke down toward the chest and 70 PRACTICAL MASSAGE. shoulder over the course of the jugular vein, at the same time turning your hands with the palm - full against the throat and neck, and continue the stroke down to the chest. Keep this up for five to ten minutes. In connection with the stroking of the throat it is often valuable to give circular kneading in the same direction and vibration of the larynx by applying the hand on the patient’s larynx, the thumb on one side and the fingers on the other, and, without squeezing, give a rapid vibration, trembling, gradually sliding the fingers forward. Stimulation of the nerves. 58. Heap Circumpuction (SittTinc).—The oper- ator places his one hand on the back of the patient’s head, and the other hand on his forehead, and slowly moves the head in a circle, five to ten times one way, then as many times the other way. Four to five times in ten seconds. This acts on the blood-vessels and nerves of the neck and throat; it is a derivative movement from the brain, and has a quieting effect. 59. Heap FLExion, Passive (SitTinc).—In cases of stiff. neck it often becomes necessary to bend the head in the opposite direction, so as to stretch out the contracted muscles, and while they are under stretch centripetal stroking (from head down) and also cir- cular kneading should be applied, CHAPTER IX. Tue Most Ess—enTIAL APPLIED ANATOMY, The Shoulder-joint Muscles. Flexors (raising the arm forward) : Pectoralis major; anterior deltoid; short head of biceps; coraco- brachialis. Extensors (raising the arm batkward): Latissi- mus dorsi; teres major; long head of triceps. Abductors (raising the arm sideward): Deltoid; supraspinatus; long head of biceps. Adductors (lowering the arm to the body): Latis- simus dorsi; teres major; pectoralis major. Rotation inward: Subscapularis; pectoralis major ; latissimus dorsi; teres major; anterior deltoid. Rotation outward: Infraspinatus; teres minor; posterior deltoid. From.arm raised horizontally forward and moved to horizontally sideward. Posterior deltoid; trapezius; infraspinatus and teres minor; levator angula scapula; rhomboids. From arm raised horizontally sideward to vertical position. Deltoid ; supraspinatus ; trapezius; serratus magnus. DELTOID. Origin: Outer third of the anterior border of the clavicle, top of the acromion, posterior border of the spine of scapula. (71) 72 PRACTICAL MASSAGE. Insertion: Outer surface of the humerus near its middle. SUPRASPINATUS. Origin: Supraspinous fossa. Insertion: Great tuberosity of the humerus. PECTORALIS MAJOR. Origin: Inner two-thirds of the anterior border of the clavicle, the sternum and the cartilage of the first six ribs. Insertion: Outer border of the bicipital groove of the humerus. CORACO-BRACHIALIS. Origin: The coracoid process, Insertion: Inner surface of the humerus, opposite the deltoid. ? LATISSIMUS DORSI. Origin: The spinous process of six last dorsal, all the lumbar vertebrz, the sacrum, the crest of the ilium, and lower three ribs. Insertion: The bicipital groove of the humerus. TERES MAJOR. Origin: The lower end of the scapula. Insertion: The bicipital groove of the humerus. SUBSCAPULARIS. Origin: Inner surface of the scapula. Insertion: ‘The lesser tuberosity of the humerus. THE SHOULDER-JOINT MUSCLES. 73 INFRASPINATUS AND TERES MINOR. Origin: Outer surface of the scapula below the spine. Insertion: Posterior part of the great tuberosity. BICEPS. Origin: 1. The short head from the coracoid proc- ess. 2. The long head from the scapula at the top of the glenoid fossa. Insertion: Bicipital tuberosity of the radius, TRICEPS. Origin: 1. The middle or long head from the scapula just below the shoulder joint. 2. External head, back of the humerus from the great tuberosity to the middle; the internal head from the lower part back of humerus. Insertion: The olecranon. Muscles of the Shoulder Girdle. TRAPEZIUS. Origin: , Base of the skull, ligament of the neck, and the spinous processes of the vertebrae from 7th cervical to 12th dorsal. Insertion: Outer third of posterior border of the clavicle, the top of acromion, and upper border of the spine of the scapula. 74 PRACTICAL MASSAGE. LEVATOR ANGULI SCAPULZ. Origin: Transverse processes of the first five cervical vertebrze. Insertion: Superior angle of the scapula. RHOMBOIDS, Origin: Spinous processes of the vertebrae from 7th cervical to 5th dorsal. Insertion: Veretebral border of the scapula. “SERRATUS MAGNUS. Origin: Outer border of upper nine ribs. Insertion: Vertebral border of the scapula. PECTORALIS MINOR. Origin: Outer border of 3d, 4th, and 5th ribs, Insertion: The end of coracoid process. Flexors of the Elbow: Biceps, Brachialis Anti- cus; Brachio-radialis (Supinator longus). Extensors of the Elbow: Triceps. BRACHIALIS ANTICUS. Origin: Anterior surface of the humerus. Insertion: Anterior surface of ulna near the elbow. BRACHIO-RADIALIS (Supinator longus). Origin: Upper two-thirds of the external condy- loid ridge of humerus. EXTENSORS AND FLEXORS. 75 Insertion: External surface of the radius lower end. SUPINATOR BREVIS. Origin: External condyle of humerus. Insertion: Outer surface of upper third of radius. PRONATOR TERES. Origin: Front side of internal condyle of humerus. Insertion: Outer surface of radius near its middle. PRONATOR QUADRATUS. Origin: Lower fourth of front side of ulna. Insertion: Lower fourth of front side of radius. Flexors of Hand, Wrist, and Fingers. Origin: Inner condyle of humerus and front side of radius and ulna. Insertion: Front side of the carpal, metacarpal, and phalangés. Extensors of Hand, Wrist, and Fingers. Origin: Outer condyle of humerus and back of radius and ulna. Insertion: Back side of the carpal, metacarpal, and phalanges. RESISTIVE MOVEMENTS OF THE ARMS. 60. FINGER FLEXION AND EXTENsION.—The pa- tient’s hand rests either on the operator’s knee or on 76 PRACTICAL MASSAGE. the edge of a table, while he bends and stretches all the fingers, and the operator makes resistance. 61. HAND FLEXION AND EXTENSION is done by tak- ing hold of the patient’s wrist with one hand, and with the other hand resist, while the patient is bending and stretching the wrist-joint. These two exercises develop and strengthen the muscles of the forearm, hand, and fingers, and increase the flow of blood to them. 62. ArM FLEXION AND ExTENSION.—Position as in “forearm” circumduction. (Fig. 11.) The patient bends his arm in the elbow-joint as far up as possible, while the operator resists and gradually gives way, so as to make the flexor muscles, the biceps, contract and shorten to their utmost, whereby the extensor muscles, with their nerves and blood-vessels, are passively ex- tended. Then the patient gradually stretches out the arm, under resistance, so as to make the extensor muscles, the triceps, contract and shorten, and thereby passively extend the flexor muscles, nerves? and vessels. These exercises are ‘“‘concentric-duplex” and de- velop and strengthen the muscles and also act as an excellent blood-propeller to and from the heart. If the muscles are rather contracted and stiff, the “excentric-duplex” movements should be given in the following way; Position as before, beginning with the arm bent well up; the operator gradually stretches out the arm, while the patient makes resistance; the con- tracted flexor muscles are slowly elongated and ex- tended. Then the operator bends the arm, while the RESISTIVE MOVEMENTS OF THE ARMS. 77 patient resists, and the contracted extensor muscles are slowly stretched out. The first kind—‘“concentric’” movements—are used alternately, bending and stretching for general exer- cise; while the second—‘excentric’” movements— Fig. 26:—Vertical Arm Flexion and Extension. should be used either for the elongating of the flexor muscles or for the extensor muscles, whichever of them are in need of such exercise. 63. VERTICAL ARM FLEXION AND EXTENSION (Sirrinc).—The operator stands behind the patient and takes hold of both his hands, resisting the patient when he bends the arms close down to the side and 78 PRACTICAL MASSAGE. stretches his arms to vertical position, “concentric- duplex,” in a slow movement alongside of his ears, the elbows being kept well out to the side. The operator's knee should be pressed against the patient’s back with a small pillow between. Repeated from five to four- teen times. (Fig. 26.) In the extension of the arms, the triceps, deltoid, supraspinatus, trapezius, and serratus magnus are principally at work, and a full passive extension of the pectorals is effected. In flexion of the arms, by hold- ing the arms well to the side and not allowing them to be pulled forward, the latissimus dorsi and teres major are the chief workers, and the pectorals are kept in a semi-neutral condition, so as not to contract and de- press the chest. The rhomboids and levator anguli scapule draw the shoulders backward; and the biceps and brachialis anticus bend the forearm. ‘ These exercises then are very valuable to strengthen the muscles, straighten the back, and to expand and deepen the chest. 64. HorizontaL ARM FLEXION AND EXTENSION (Sittinc).—The patient’s arms are raised horizon- tally and kept well back, with the forearms sharply bent upon them; the operator, standing behind, press- ing his chest against the patient’s back, takes hold of both his wrists (Fig. 27) and resists, when the patient stretches and bends his arms at the elbow-joints, “con- centric-duplex.” Repeated from five to fourteen times. By keeping the upper arms well back and not allow- ing them to be moved forward, this exercise exerts a RESISTIVE MOVEMENTS OF THE ARMS. 79 powerful tension on the chest and contraction of the muscles of the shoulder-blades, and neck (the trape- zius, rhomboids, and levator anguli scapula), and the arms. It is therefore an excellent exercise to flatten Fig. 27.—Horizontal Arm Flexion and Extension. round shoulders and round out flat chests, and it is a good respiratory and derivative movement. 65. HorizontaL ARM SEPARATION AND CLOSING (Sirtine).—The operator, standing in front of the patient, who holds his arms straight out to the sides, takes hold of his wrists and pulls the arms forward under resistance by the patient, “excentric-duplex.” Then the patient brings his arms back to the former 80 PRACTICAL MASSAGE, position, resisted by the operator, “concentric-duplex.”’ Repeated from five to fourteen times. (Fig. 28.) This is another form of strong contractive exercise for the muscles of the back and shoulders (deltoid, infraspinatus and teres minor, trapezius, rhomboids, Fig. 28.—Horizontal Arm Separation and Closing. and levator) while it is absolutely passive for the chest muscles, and is very useful in stooping shoulders and many cases of lung troubles, as it has a good effect on the respiration and the circulation. As a rule the pec- toral muscles of patients do not need encouragement for contraction, but once in a while it may be neces- RESISTIVE MOVEMENTS OF THE ARMS. 81 sary, and in such a case the above movement, while the operator resists both forward and backward, making each move a “concentric” exercise, will be very valuable. Fig. 29.—Lateral Arm Elevation and Depression. 66. LATERAL ARM ELEVATION AND DEPRESSION.— The operator, standing behind the patient, takes hold of his forearms, which are hanging down, and resists when the patient raises his arms sideways, upward, and when he brings them down again, “concentric.” The elbows should be kept straight. Repeated five to ten times. (Fig. 29.) 32 PRACTICAL MASSAGE. This is a very effective movement to widen the chest and to strengthen the muscles of the shoulders, back, and upper arms, viz., the deltoid, supraspinatus, rhom- boids, levator anguli scapulz, trapezius, and triceps in upward motion; and latissimus dorsi, pectorals, and Fig. 30.—Forward Arm Traction (Lying). teres major going downward. It is also effective on the respiration and circulation. 67. Forward Arm Traction (Ly1nG).—The pa- tient lying on a table or a couch with his arms ex- tended alongside the ears, gradually pulls his arms upward, forward and downward, while the operator makes resistance, “concentric.” (Fig. 30.) Now the patient resists while the operator pulls the arms back- ward again, “exceutric.” Repeated four to ten times. RESISTIVE MOVEMENTS OF THE ARMS. 83 This is a very powerful movement on the anterior . muscles of the trunk; it raises the chest and pulls all upward. It produces a suction of the blood from the abdomen and pelvic vessels to the chest, and is there- fore of great value in reducing congestions in those organs, as well as to reduce obesity. 68. Arm Torsion (rotation).—The patient takes hold of the middle of a stick with one hand and keeps his arm straight out from the shoulder. The operator takes hold of each end of the stick and resists the pa- tient when he fwists his arm outward and inward, “concentric.” This movement may be changed by let- ting the patient resist when the operator twists the arm, “excentric.” Repeated from six to ten times. This brings into play the rotators of the arm, viz., inward rotaton: subscapularis, pectoralis major, latis- simus, teres major, and anterior deltoid ; outward rota- tion: infraspinatus, teres minor, and posterior deltoid, and is used in stiffness of the shoulder-joint and in abnormal enervations of the muscles of the arm, and as a derivative from the chest and head. CHAPTER X. Tue Most EssentTIAL APPLIED ANATOMY or Hip anpD LEc. The Hip-joint Muscles. Flexors (raising thigh forward): Psoas; iliacus; sartorius; rectus femoris; pectineus. Extensors (raising thigh backward): Gluteus maximus and medius; upper hamstrings. Abductors: Glutei muscles; tensor vagina femoris. Adductors: Adductor magnus, longus, and brevis; pectineus; gracilis. Rotators inward: Tensor vaginze femoris; glutei. Rotators outward: Psoas; iliacus; sartorius; pec- tineus; all adductors. PSOAS., Origin: The bodies of last dorsal and all lumbar vertebrae back of the intestines. Insertion: The small trochanter of the femur. ILIACUS. Origin: The inner surface of the ilium and part of the sacrum. Insertion: Same as the psoas. SARTORIUS. Origin: The notch between the two anterior spines of the ilium. Insertion: Inner tuberosity of the tibia. (84) THE HIP-JOINT MUSCLES. 85 RECTUS FEMORIS. Origin: Anterior inferior spine of the ilium. Insertion: Patella. PECTINEUS. Origin: Front of the pubes, Insertion: Back of the femur just below the small trochanter. TENSOR VAGIN/E FEMORIS. Origin: Just below the anterior extremity of the crest of the ilium. Insertion: Outside of the femur. GLUTEUS MAXIMUS. Origin: Outer surface of the ilium, the posterior surface of the sacrum and lumbar region. Insertion: On the back of femur between the great trochanter and linea aspera. GLUTEUS MEDIUS. Origin: Outer surface of the ilium near its crest. Insertion: Back part of the top of the great tro- chanter. GLUTEUS MINIMUS. Origin: Lower part of outer surface of ilium. Insertion: Front part of the top of the great tro- chanter. HAMSTRINGS. Biceps; Semitendinosus; Semimembranosus. 86 PRACTICAL MASSAGE, BICEPS. Origin: The long head from the tuberosity of the ischium; the short head from the lower half of the back side of the shaft of the femur. ‘Insertion: Outer tuberosity of the tibia and the head of the fibula. SEMITENDINOSUS. Origin: The tuberosity of the ischium. Insertion: Front side of the internal tuberosity of the tibia along with sartorius. * SEMIMEMBRANOSUS. Origin: The tuberosity of the ischium. Insertion: Posterior surface of the internal tuber- osity of the tibia. GRACILIS. Origin: Inner edge of the ramus of pubes. and ischium, Insertion: Internal tuberosity of the tibia. ADDUCTOR LONGUS. Origin: Front of the pubes. Insertion: The linea aspera, middle third of thigh. ADDUCTOR BREVIS, Origin: Front of the pubes. Insertion: Upper half of linea aspera. 1 MOVEMENTS OF THE KNEE-JOINT. 87 ADDUCTOR MAGNUS. Origin: Front of the pubes, the tuberosity of ischium, and the ramus connecting them. Insertion: Whole length of linea aspera and the inner condyloid line. Movements of the Knee-joint. Flexors: Biceps; semitendinosus; semimembran- osus; sartorius’ gracilis; gastrocnemius, Extensors: Quadriceps (rectus femoris; vastus externus, internus, and intermedius). GASTROCNEMIUS. Origin: By two tendons from the back side of the condyles of the femur. Insertion: The back of oscalsis (calcaneum). VASTUS EXTERNUS. Origin: Outer surface of the femur just below the great trochanter and upper half of linea aspera. Insertion: Patellar ligament on the tubercle of the tibia. VASTUS INTERNUS. Origin: Whole length of linea aspera and the inner condyloid line. Insertion: Patellar ligament. VASTUS INTERMEDIUS. Origin: Surface of the upper two-thirds of the shaft of the femur. Insertion: Patellar ligament. 88 PRACTICAL MASSAGE. Movements of the Foot. Three muscles flex the foot: Tibialis anterior; ex- tensor longus digitorum ; extensor hallucis. _ Three extensors: Gastrocnemius ; soleus ; peroneus longus. ; Three adductors: ‘Tibialis anterior; soleus; gas- trocnemius, Two abductors: Peroneus longus ; peroneus brevis. Two flex foot laterally: Tibialis posterior; pero- neus brevis. TIBIALIS ANTERIOR. Origin: Upper two-thirds of outer surface of the tibia, Insertion: Inner margin of the first cuneiform bone and the first metatarsal. EXTENSOR LONGUS DIGITORUM. Origin: Outer tuberosity of the tibia and the front of the fibula. Insertion: Top of the bones of the four outer toes. EXTENSOR HALLUCIS, Origin: Front side of the fibula. Insertion: Top of the great toe. SOLEUS. Origin: Upper part of posterior surface of the tibia and fibula. Insertion: By the tendon of Achilles into oscalsis: RESISTIVE MOVEMENTS OF THE LEGS. 89 PERONEUS LONGUs (Plantar). Origin: Outer tuberosity of the tibia and the upper two-thirds of the outer surface of fibula. Insertion: Outer margins and lower surface of the first cuneiform bone and first metatarsal. PERONEUS BREVIS, Origin: Lower two-thirds of outer surface of fibula. Insertion: Lower side of the base of the fifth metatarsal. TIBIALIS POSTERIOR. Origin: Upper half of the posterior surface of the tibia and fibula. Insertion: Lower and inner surface of the scaphoid and first cuneiform bone. RESISTIVE LEG MOVEMENTS. 69. Foot FLEXION AND ExTENSION: (A) SINGLE AND (B) DovuBLe (Fig. 15).—Positions as in foot rotations. The patient bends and stretches his feet during resistance by the operator, “concentric.” These strengthen the anterior and posterior mus- cles of the leg and foot, and strengthen and limber the ankle-joint. It is a good derivative movement, and is especially beneficial in cases of cold feet. 70. LEG FLEXION AND EXTENSION (RECLINING). —The operator, standing by the side of the patient, takes hold of his heel with one hand and of the ball of 90 PRACTICAL MASSAGE. the foot with the other hand. (Fig. 31.) The leg is bent way up without resistance, and then the patient stretches it out, while the operator resists by pressing the leg upward and slightly giving way till it is per- fectly straight, ‘‘concentric.” Repeated five to four- teen times. The first part of this movement puts the extensor muscles of the thigh, viz., gluteus maximus, gluteus Fig. 31—Leg Flexion and Extension. medius, upper hamstrings, etc., and also the quadriceps muscles of the leg, with their nerves and blood-vessels, on a perfect stretch, while the second part makes them contract vigorously, and thereby serves as an excellent movement to strengthen the extensor muscles of the whole limb and also as a derivative from diseases of the pelvis and abdomen. 71. Upwarp KNEE TRACTION ( RECLINING).— The operator takes hold of the back of the patient’s RESISTIVE MOVEMENTS OF THE LEGS. 9] heel with one hand and on the front of his foot with the other hand and resists, when the patient bends his leg—pulling his knee upward—by holding it straight, and slightly giving way till it is doubled up, “concen- tric;” now the patient resists while the operator pulls the leg straight again, “excentric.” Repeated four to ten times. (Fig. 32.) Fig. 32—Upward Knee Traction. This movement strengthens the flexor muscles of the hip, the knee and the muscles of the abdomen, viz., psoas iliacus, sartorius, rectus femoris, pectineus, and hamstrings, and thus has a purgative effect. Leg flexion and extension and upward knee traction are often used alternately as a good “general” exercise. 72. KNEE FLEXION AND EXTENSION (SITTING) .— The operator, sitting by the side of the patient, whose thigh is resting on the operator’s knee (Fig. 33), fixes the patient’s knee with one hand and takes hold with 92 PRACTICAL MASSAGE. the other' hand around his ankle, resisting, when the patient bends and stretches his knee, ‘‘concentric.” Re- peated five to ten times. In this movement all the flexor and extensor mus- cles of the leg are in vigorous action, whereby the thigh Fig. 33.—Knee Flexion and Extension. and the knee are developed and strengthened; it is also a valuable exercise to break adhesions and overcome stiffness of the knee-joint, The exercise is still better when the patient is stand- ing and'rests his thigh—in a right angle with the body —on a bar. Fig. 40.—Arm Circling. Fig. 39.—Standing Position. Fig. 41—Arm Elevation (Vorward, Upward), Tig. 42.—Arm Flinging (Sideways), Fig. 43—Arm Rotation, Fig. 44—Arm Flexion and Extension. Fig. 45—Arm Flexion and Extension (Upward). RESISTIVE MOVEMENTS OF THE LEGS. 93 73. LEG ELEVATION AND DEPRESSION (LyING).— The patient, keeping his knee straight, raises his leg upward by bending the hip-joint, the operator making slight resistance with his hand on the patient’s knee, “concentric.” Then the patient resists, while the op- erator presses the limb down again, “excentric.” Re- peated two to ten times. (Fig. 34.) Fig. 34.—-Leg Elevation and Depression. This may also be performed with both legs at the same time when the patient is young and strong; but often in the beginning, it is all the patient can do to raise the leg ‘“‘actively”—without resistance—and let it slowly down; and sometimes it will be found enough to simply raise the bent knees. The muscles of the abdomen, the flexor muscles of the thigh, and the extensor muscles of the leg are here- . by brought into play. It is a fine exercise in cases of 94 PRACTICAL MASSAGE. constipation and obesity, and other cases where the abdominal muscles need to be strengthened. 74. Backwarp Lec Traction (STanpiNG).—The patient, standing on a stool and holding on to a bar or Fig. 35.—Backward Leg Traction (Standing). between the door, pulls one leg forward as far as pos- sible, while the operator resists, “concentric” ; then the patient resists while the operator pulls the leg back- ward, “concentric.” The operator resists with one hand on the front of the ankle, and gives support on the patient’s hip with the other hand. (Fig. 35.) RESISTIVE MOVEMENTS OF THE LEGS. 95 This is another and very useful form of abdominal exercise and very useful in constipation and obesity, and to draw the blood from the pelvic organs, 75. Lec SEPARATION AND CLosine (Ly1IncG).— The operator takes hold of the patient’s ankle and re- sists him when he brings his leg out to the side, “con- centric.” Then the patient resists while the operator Fig. 36.—Bent Knee Separation and Closing. presses the leg into its former position, ‘“excentric.” Repeated four to ten times. This may also be performed with both legs at the same time, when the operator stands in front of the patient and takes hold of both his ankles, resisting, while the patient separates his legs, and again pulls them together under resistance of the patient. The abductors of the legs, viz., the glutei muscles, tensor vaginz femoris, sartorius, are hereby strongly contracted, while the adductors are kept passive; and 96 PRACTICAL MASSAGE. the exercise becomes a strong one for the hips and thighs and tends to reduce big hips as well as to draw the blood from the pelvic organs to the surface muscles. 76. BENT KNEE SEPARATION AND CLOSING (RE- CLINING).—The patient, reclining, bends his knees to a right angle, the feet resting on the bed or chair; the operator puts his hands on the outside of each knee (Fig. 36) and resists when the patient separates the knees; then the operator changes his hands to the in- side of the knees and resists while the patient closes them, “concentric.” Repeated four to ten times. The feet should be kept firm in their place during the moving of the knees. This brings into play both the adductors and the abductors and strengthens the hips and thighs, and the floor of the pelvis, and by its derivative effect from the pelvic organs is an excellent exercise in diseases of these organs. 77. LEG Torsion (Ly1nc).—The patient keeps his legs straight and the operator takes hold of the feet and resists while the patient twists his legs out and inward by opening and closing the feet, the heels being kept together. Repeated five to ten tims. This is useful in stiffness and weakness of the hip- joint and as a derivative from the organs of the pelvis. CHAPTER XI. THE Most EssentTiaL APPLIED ANATOMY. Abdominal Muscles. RECTUS ABDOMINIS. Origin: Crest of the pubes. Insertion: Cartilage of 5th, 6th, and 7th rib. The right and left rectus are separated by a tendinous strip, the linea alba. EXTERNAL OBLIQUE, Origin: Front half of the crest of the ilium, the upper edge of the femur and the linea alba. Insertion: The lower eight ribs. INTERNAL OBLIQUE. Origin: Anterior two-thirds of the crest of the ilium, the lumbar fascia, upper edge of the femur. Insertion: The cartilage of 8th, gth, and roth ribs and linea alba. Back Muscles. EXTENSORS OF THE SPINAL COLUMN. Splenius; Erector Spinze; Oblique Extensors.. There are five layers of muscles on the back: First layer: Trapezius and latissimus dorsi. Second layer: Rhomboids and levator anguli scapule. ' (97) 98 PRACTICAL MASSAGE. Third layer: Serratus posticus superior and in- ferior, and splenius. Fourth layer: Erector spine. Fifth layer: Oblique extensors. SPLENIUS (Extensor of head). Origin: Lower two-thirds of ligament nuche and the spinous processes of the seventh cervical and first five dorsal vertebre. Insertion: Base of the skull and the transverse processes of the upper ceryical vertebree. ERECTOR SPINA. Origin: The posterior one-fifth of the crest of the ilium, back of sacrum, the spinous processes of the lumbar and toth, rith, and 12th dorsal vertebrae and the transverse processes of all dorsal vertebrz. Insertion: The processes of the vertebrx, the angles of the ribs, and the base of the skull. OBLIQUE EXTENSORS, Origin: The transverse processes of the vertebrze. Insertion: The spinous process of the vertebrze above the origin. QUADRATUS LUMBORUM. Origin: Crest of the ilium, the ilio-sacral ligament and transverse processes of 2d, 3d, 4th, and sth lumbar vertebra, MOVEMENTS OF THE TRUNK. 99 Insertion: Transverse processes of 1st and 2d lum- bar vertebrze and 12th rib. PASSIVE AND RESISTIVE MOVEMENTS OF THE TRUNK. 78. TRUNK CiRcUMDUCTION (ASTRIDE SITTING— PAssIVE).—The patient sits astride over a box or stool, while the operator, standing behind, takes hold of the patient’s shoulders and moves his trunk from the waist, describing as large a circle as possible, first six to fourteen times in one direction, then as many times in the other. The patient should be perfectly passive and allow the operator to move him without resist- ance, and therefore it would be well to have some per- son to support the patient’s knees. This acts strongly on the portal system of the cir- culation, strengthens the muscles of the waist, and has a quieting effect. 79. TRUNK TorsION (S1TTING—RESISTIVE).— The patient sits on a stool or lounge, with hands on hips; the operator, standing behind, puts his right hand on the front of the patient’s right shoulder and his left hand on the back of his left shoulder, and resists the patient when he twists his trunk to the left (Fig. 37). Then the operator changes his grip, reverses his hands, and resists when the patient turns to the right. Re- peated four to eight times on each side. 80. TRUNK Torsion (KNEELING—RESISTIVE) .— The patient kneels on a lounge with hands on hips. 100 “PRACTICAL MASSAGE. -The operator, standing behind and fixing the patient’s back with one knee, takes hold and resists, as in the former movement (Fig. 37). Both of these movements have a good effect on the spine, the nerves, and circulation; the former has a Fig. 37.—Trunk Torsion (Kneeling). special effect on the respiration, and the latter on the digestion, by strengthening and elevating the muscles of the abdomen. 81. Forwarp TRUNK FLEXION AND EXTENSION (Sirtinc—REsisTIVE).—The patient, sitting on a lounge or stool, with hands on hips, bends forward, and, while rising up to the former position, the oper- Vig. 40.—Leg Elevation (Sideways). Fig. 47—Leg Elevation (forward). Tig. 48.—Leg [Elevation (Backward), Fig. 49—Knees Bend (Deep). Fig. 54—Leg Elevation (Lying). MOVEMENTS OF /THE TRUNK. 101 J ator puts his hand on the patient’s back and resists him (Fig. 38). Repeated four to ten times, In this exercise all the muscles of the back are brought into play, and the chest is kept well expanded ; Fig. 38.—Forward Trunk Flexion and Extension. which makes it a good respiratory movement as well as a strengthening to the muscles of the back and a straightening of the spine. 82. NEcK FLEXION AND EXTENSION (STANDING or SITTING).—The operator places his one hand on the back of the patient’s skull and resists him when he 102 PRACTICAL MASSAGE. bends his head backward as far as possible. Repeated five to ten times. This acts on the muscles of the neck and the upper part of the back, and on the blood-vessels and nerves of the neck and throat. It is a derivative from the brain, and it tends to straighten the upper part of the spine. When this is given to a patient in hanging position it is very effective in straightening the spine, and therefore exceedingly useful in the treatment of curvatures Of the spine and round-shouidered persons. CHAPTER XII. THE Most EssEnTIAL APPLIED ANATOMY— PosTuRE EXERCISES, Breathing Muscles, Inhalation: External intercostals Diaphragm \ Normal Sternocleidomastoid Forced Scaleni Serratus posticus superior Serratus magnus. Exhalation: Internal intercostals, the abdominal muscles, transversalis, serratus posticus inferior. EXTERNAL INTERCOSTALS. Origin: The lower border of each rib (1st to 11th). Insertion: Upper border of rib below (2d to 12th). DIAPHRAGM. Origin: Around the inner surface of the body, the Ist and 2d lumbar vertebra, 11th and 12th ribs, six lower costal cartilages and sternum. Insertion: The central tendon forming the sum- mit of the dome. (103) 104 PRACTICAL MASSAGE. STERNOCLEIDOMASTOID. Origin: The mastoid process. Insertion: Front of the sternum, the inner third of the posterior border of the clavicle. SCALENI (three parts). Origin: Transverse processes of the cervical vertebra. Insertion: The anterior and middle scaleni on the first rib; the posterior on the second rib. SERRATUS POSTICUS SUPERIOR (under the scapula), Origin: The ligament of the neck and the spinous processes of 7th cervical and Ist, 2d, and 3d dorsal. vertebre. ' Insertion: Second to fifth ribs, SERRATUS POSTICUS INFERIOR. Origin: Eleventh and twelfth dorsal and first and second lumbar vertebre. Insertion: The last five ribs. TRANSVERSALIS, (Third layer of the abdominal wall). Origin: Lower, six ribs, lumbar fascia, anterior two-thirds of crest of ilium and upper edge of the thigh. Insertion: Linea alba. Fig. 55.—Trunk Flexion (Backward). Fig. 56—Trunk Flexion (Forward). tb rf Fig. 58.—Harvesting Movement. Fig. 57.—Trunk Flexion (Forward), Fig. 59.—Harvesting Movement, Fig. 60—Trunk Flexion (Sideways). ia Fig. 63—Body Horizontal. ACTIVE EXERCISES OF ARMS. 105 CoRRECTIVE ACTIVE EXERCISES OF ARMS. The correct standing position is most essential, and a good method to obtain it is to stand with the back against the wall; heels, buttocks, shoulders, and head touching ; then try hard to make the small of the back also touch the wall,—this will hardly be possible, but the effort is a very good one to create a correct position. 83. STAND FIRMLY on both feet, knees straight, without strain. Hips even in the same plane and drawn well back, so as to keep the abdomen in. The chest raised well forward and expanded. The shoulders even in the same plane, drawn back without being pushed up, and without stiffness. The arms hanging down by the sides in straight line from the shoulders to tip of fingers, palms in toward the thigh. The head raised even on the shoulders, and chin drawn well in. The weight of the body inclined a little forward so as to rest on the balls of the feet, and not on the heels. A line from the crown of the head should fall just in front of the ear, armpit, hip, and knee-cap to the instep. (Fig. 39.) 84. SHOULDER CIRCLING (three to ten times).— The shoulders are slowly moved upward, backward, downward, and forward, so as to describe a circle, the arms hanging down. 106 PRACTICAL MASSAGE, Inhale when shoulders go up and backward, and exhale when they go down and forward. This strengthens the chest and shoulder muscles, expands the lungs, and relieves the work of the heart. It increases the flow of blood toward the heart, espe- cially from the brain. Useful in chronic catarrh of the air-passage, in weak heart-action, and in congestion of the brain. 85. ArM CIRCLING (five to twelve times. Fig. 40).—The fully extended arms are slowly moved up- ward, backward, downward, and forward, so as to describe a conical figure in the air, with the apex in the shoulder-joint. Inhale and exhale as in the former exercise. Keep the head erect and motionless, and the chest well expanded. Effects as the former, but stronger. 86. Arm ELEVATION—ForwarbD, Upwarp (seven to sixteen times, Fig, 41).—The fully extended arms are raised forward and upward over the head, whereby the following muscles are brought into action: The anterior portion of the deltoid, the upper pectoralis major, the short head of the biceps and the coraco- brachialis bring the arms to horizontal position; from this the posterior deltoid, and the trapezius, steadied by the rhomboids and levator anguli scapule raise the arms to the vertical position. Concentric action. Now the arms are lowered slowly sideways to their original position, Excentric action of deltoid, supra- spinatus and trapezius. ACTIVE EXERCISES OF ARMS. 107 Keep the chest well forward, head and trunk mo- tionless. Inhale when arms are raised; exhale when they are lowered. It expands and elevates the chest and lungs, strengthens the nerves and muscles of the shoulders, limbers the shoulder-joints, and straightens the back. Useful in narrow and weak chest, in weakness of the respiratory organs and the heart, and corrects stooping shoulders. 87. Arm FLincinc—SipEways (ten to sixteen times).—The upper arms are raised_horizontally, side- ways, and kept well back with the forearms sharply bent upon them in front (Fig. 42). From this posi- tion the forearms are smartly and energetically thrust outward without moving the upper arms; during this movement inhale, the forearms being again bent for- ward to their former position under exhalation. The muscles used are: the deltoid, supraspinatus, trapezius, infraspinatus, teres minor, levator anguli scapulz, rhomboids, biceps and triceps, and to some extent the latissimus dorsi. Strengthens the nerves and muscles of the arms and back, expands and widens the chest, straightens the back and increases the flow of blood to the arms. If this exercise is taken with the trunk bent for- ward (head up) it becomes a very powerful move- ment for the back. 88. Arm RotTATIon (ten to twenty times).—Take position as in Fig. 43; now rotate, or twist, both arms 108 "PRACTICAL MASSAGE. in the shoulder-joints so as to bring the forearms hori- zontally forward, parallel with the floor and with each other; the right angle in the elbows is maintained, and the upper arms kept in the same height as the shoul- ders, with the chest well expanded. Rotate back to the first position. This is an excellent exercise to straighten round shoulders, as it brings the following muscles into strong action: Infraspinatus, teres minor, posterior deltoid, trapezius, rhomboids, levator anguli scapulz. In forward bent position it is very effective. 89. ArM FLEXION AND EXTENSION (UPWARD, SIDEWAYS, AND DowNnwarpb).—The forearms are slowly bent up against the upper arms, the elbows kept close to the sides, the fingers slightly bent and pointed toward the shoulders (Fig. 44). From this position the arms are energetically stretched upward to a verti- cal position above the head, the palms facing each other (Fig. 45). The arms are again slowly bent to their former position and then quickly stretched hori- zontally sideways, the palms turned downward and arms kept well back. Now bend the arms and stretch them sharply downward. This alternate bending and stretching to be repeated as above from eight to six- teen times ; the head and back to be kept upright during the movement, and shoulders well back. Strengthens the muscles and nerves of the arms and shoulders, widens the chest, limbers the joints, in- creases the circulation of the blood, and strengthens the energy of the heart and lungs. ACTIVE EXERCISES OF ARMS. 109 Useful in rheumatism and stiffness of the arms; in weakness of nerves and muscles; to draw the blood away from the chest and head; as a means of warming, to prevent taking colds, and to energize the action of the heart. In case of one shoulder lower than the other, stretch the corresponding arm upward and the other arm downward. CHAPTER XIII. CorRECTIVE ACTIVE EXERcISES OF LEGS. go. Lec ELEVATION—SIDEwaYys (five to ten times). —With the hands placed on the hips, or holding on to a chair or a table, raise one leg slowly up sideways; repeat five to ten times with each leg. After some practice the arms may be raised sideways (Fig. 46). Brings into strong action: the glutei muscles, ten- sor vaginze femoris, sartorius, and, as all balancing exercises, has a strengthening effect on the nervous system. It is also useful in weakness of the organs of the pelvis, and to reduce large hips. gt. Lec ELEvaTION (Forwarp).—Raise the leg slowly forward as high as possible without bending the body, then lower it slowly, and repeat five to ten times with each leg; stretch the foot well (Fig. 47). Here the abdominal muscles and flexors of the thigh and extensors of the leg are strongly contracted, viz., psoas magnus, iliacus, sartorius, pectineus, tensor vaging femoris and rectus femoris. At the same time the hamstrings and sciatic nerve are passively stretched. Useful in sciatic neuralgia, in stiffness of the joints, in constipation, in weakness of the pelvis, and in obesity. (110) ACTIVE EXERCISES OF LEGS. 111 92. Lec ELEvaTion (BACKWarD).—With hands on hips, raise one leg backward, without bending the trunk or kriees; point the toes well back and down; keep the chest well forward; repeat five to ten times. Later with hands on neck (Trig. 48). Contraction of: gluteus maximus, gluteus medius, quadratus femoris, and upper hamstrings. Also passive stretching of the abdominal and flexor muscles of the thigh. Fine balancing exercise and to straighten the back and produce an easy and graceful carriage of the body. 93. Knees Benn (DerEp).—Raise the heels, then bend the knees slowly way down; keep the knees well out over the toes; then straighten knees slowly ; repeat three to ten times; keep chest out and back erect (Fig. 49). Very strong exercise for the hip-joint and knee extensors and adductors, viz., the hamstring muscles, glutei and tensor fasciz latz; the quadriceps extensors of the knee; the gastrocnemius, soleus, plantaris and other extensors of the foot. First “excentric,”’ then “concentric.” The erector spine is strongly contracted all through the movement to keep the trunk erect. This exercise therefore is very valuable for the in- crease in size and strength of all these large muscles of the lower trunk and the legs; to limber the knees and ankle-joints; strengthen the nerves and muscles of the loins and abdomen; quicken the circulation of 112 PRACTICAL MASSAGE, blood toward the legs, and strengthen the organs of the pelvis and the action of the intestines, Useful in weakness of the nerves and muscles of the lower limbs, in sciatica, poor digestion, hemor- thoids, weakness of the pelvis, curvature of the spine, and to counteract too strong flow of blood to internal organs. 94. HEEL ELevaTion (ten to thirty times).— Keep heels together and raise them quickly as high as possible without bending the knees or trunk, then sink heels slowly and raise again ten to thirty times. Strengthens the nerves and muscles of the legs and feet (enlarges the calves), and straightens the back. In case of ‘‘flat-foot,”’ raise the heels and turn toes in and heels outward. 95. CHarGE—or FALL out—Forwarp.—Right foot is placed forward, leaving a distance of three times the length of the foot between the heels. The forward knee is bent to a right angle and over the foot (Fig. 50). The body is at once advanced so that the back and rear leg, which is kept straight, are in the same plane (Fig. 51). Head up and both feet firmly on the floor. This movement consists of: flexion and some ab- duction in the right hip-joint; flexion in the right knee- and ankle- joints; rotation outward in the left hip-joint ; some rotation to the left of the pelvis; some twist of the spine to the right, with a slight bend to the same side and convexity to the left. ACTIVE EXERCISES OF LEGS. 113 The psoas, iliacus, and rectus femoris muscles of the right thigh raise it; when the foot strikes the floor the right hip-, knee-, and ankle- joint extensors con- tract to check the flexion in these joints. There is also a strong contraction of the left glutei, hamstring, and quadriceps muscles, as well as the inward rotators —tensor fasciz late, anterior part of gluteus medius and minimus. (The left foot is kept firmly on the floor by the left hip-joint adductors and by the tibialis anti- cus and posticus. The whole erector spine group on each side is strongly contracted; the left external and right internal oblique abdominal muscles, the left ser- ratus posticus superior and right serratus posticus in- ferior, etc., are also brought into strong action; and vice versa when the feet are changed. The movement is very effective as a general exer- cise as well as in cases of curvature of the spine, using one or the other side according to the case. By stretching one or both arms over the head and also bending the trunk forward this movement becomes an exceedingly strong exercise for the back. 96. HorizoNTAL BALANCE—STANDING (Fig. 52) is another very powerful movement for the straighten- ing and strengthening of the spine and back muscles. 97. “BACK-CURVING,” Of PRONE LYING, TRUNK RAISED BACKWARD (Fig. 53) is probably the best and strongest movement to counteract double curvature of the spine, as all the muscles of the back, hip-joint ex- tensors and adductors of the scapule are vigorously 8 114 PRACTICAL MASSAGE. contracting. It is also very effective for round shoul- ders and narrow chest. But it produces a considerable lumbar hyperex- tension, and should therefore always be followed by 98. Lec ELevation—Lyinc (three to eight times).—Lying on the back, first pull both knees up toward the chest (as high as possible) ; then straighten the legs up (Fig. 54), and lower them slowly to 45 degrees, when they should be bent with the feet rest- ing on the couch. This will prevent the excessive lumbar anterior curve, and should be given frequently in cases of “lordosis.” It also strengthens the abdominal muscles and the action of the bowels, stretches the sciatic nerve, and reduces obesity, CHAPTER XIV. CorRECTIVE ACTIVE EXERCISES OF HEAD AND TRUNK. 99. Heap Benpinc—Backwarp (five to ten times).—The head is bent slowly backward with a strong pull of the back and posterior neck muscles, resisted gently by the flexors of the head and neck— rectus capitis, anticus major and minor, longus colli, scaleni, and the small muscles running between ‘the sternum, hyoid bone, and lower jaw—or, as we say, “draw in the chin.” The two sets of muscles thus working against each other, the posterior in excess of the anterior, keep the head steady on the top of the cervical spine, produce a straightening of the latter, bind the two together and make them move backward as one piece. It is valuable for the cultivation of good posture of the head, for improving the muscles of the neck, straightening the upper spine, and to produce a mod- erate expansion of the upper chest. 100. TRUNK FLExION—Backwarp (Fig. 55).— With the hands on hips the trunk is slowly bent back- ward at the dorsal region, raising and arching the chest and i 1 muscles i as not to bend at the jimmie region, and keeping the legs firm and straight (115) 116 PRACTICAL MASSAGE. If done well, this exercise produces a powerful contraction of all the back muscles of the thoracic spine, viz., trapezius, rhomboids, latissimus dorsi, serratus posticus superior and inferior, erector spine, sacrolumbalis, spinalis dorsi, semispinalis dorsi, and also by the depressors of the scapula: lower serratus magnus and pectoralis minor. This again will elevate the ribs. A complete straightening of the dorsal spine and a considerable expansion of the chest through the stretching of costovertebral ligaments will ensue. If this exercise is taken with inhalation, which is a goc i way to teach beginners to do the exercise cor- tectly, the following muscles will also be active, viz., external intercostals, levatores costarum, scaleni, ster- nomastcid, and subclavius. . In such case the backward flexion should immedi- ately be followed by the raising of the trunk, with exhalation. Later on this exercise should be practised with hands on neck. Very useful in narrow and contracted chest and round shoulders; in weakness of the lungs, curvature of the spine, and to produce a correct and upright posture. 101. TRUNK FLExion (Forwarpd),—Hands on hips, later on neck, and stretched over head (Figs. 56 and 57), the trunk is bent forward from the hips and kept in this position for awhile, with the shoulders ACTIVE EXERCISES OF TRUNK. 117 and head well back and chin in, the chest well forward and the knees straight. This exercise begins with a contraction of the ab- dominal muscles and continues by gravity. Now all the back muscles and posterior hip muscles are con- tracting vigorously to keep the spine straight—the more so, the longer the position is held; and the same muscles will again raise the trunk to the erect position. Very valuable to strengthen the back and straighten the spine. 102. CHOPPING MovEMENT.—Standing with feet apart and arms over head, bend the body quickly for- ward and downward, and fling the arms to the Moor; then raise the body and bend a little backward with arms and head well back; repeat six to twenty times. This strengthens the nerves and muscles of the back, arms, and abdomen, and increases the action of the organs of the pelvis, as well as the stomach, liver, and intestines. It should be followed by 103. HarvEsTING MovEMENT (Figs. 58 and 59). —The patient bends the trunk forward. Now fling the arms forcibly from one side to the other and twist ‘the trunk with them; repeat ten to thirty times. This completes the effect of the former exercise, increases the circulation of the blood, strengthens the nerves and muscles of the chest and back, shoulders, and loins, and is of great value in liver and stomach troubles and obesity. 104. TRUNK FLEXION (SmwEways).—The trunk is bent alternately to the left and right, as far as pos- 118 PRACTICAL MASSAGE. sible without twisting (Fig. 60), first with hands on hips, later on neck or sideways, etc. The abdominal muscles, lower erector spin, the oblique extensors and gluteus maximus, gluteus medius, gluteus minimus, and tensor fasciz late contract to begin the movement on the left side; then gravity be- comes the motor force, while the same muscles on the right side contract “excentrically” to hold the body, until, by shortening, they raise the trunk to the original position and start the movement to the right, when the muscles on the left begin to work. Besides being a powerful exercise for these mus- cles, it also acts’ strongly on the flow of blood through the inferior vena cava and the portal system, and therefore is an excellent exercise for constipation and liver troubles. 105. TRUNK Torsion (Fig. 61).—The trunk is turned (rotated) round its long axis alternately to the left and right, without moving the hips, so as to make the whole movement above the hips with the head immovable with the shoulders. This employs the whole range of rotation in the thoracic spine, and a small amount in the lumbar region, while the cervical spine, the pelvis, the hip-, knee-, and ankle- joints remain fixed in the funda- menial position by a strong muscular effort. The oblique abdominal and back muscles are di- rectly concerned in this movement; and practically all the muscles of the hips and lower extremities, includ- ACTIVE EXERCISES OF TRUNK. 119 ing the inverters of the feet, contract in the effort to fix the pelvis and legs, It is a strong abdominal exercise, and probably a better “reducer” of obesity than any. of the former; and owing to the strong contraction of the tibialis anticus and posticus and plantar muscles, it is also strengthening to the arches of the feet. 106. TrRuNK CircLine (three to eight times).— With the hands on hips and feet apart, bend the trunk forward, then to the left side, then backward, then to the right and forward, describing as large a circle as possible from the waist. The trunk should not be twisted, but kept square to the front throughout the whole movement, the chest well expanded, the hips, shoulders, and head steady, and the legs straight. When the circling has been done from three to eight times in one direction, it should be repeated as many times in the other. The effects of this movement are to strengthen the muscles of the abdomen, the sides, and back; limber the back and loins, stimulate the spine and its nerves; assist the action of the liver, sto. ach, kidneys, and intestines, and to increase the portal system of the circulation. 107. TRUNK ELEvaTIOon (Lyinc) (Fig. 62).— The patient, lying on a lounge or bed, with his legs hanging down, raises his body to a sitting position, while somebody holds down his knees; or it may be practised sitting on the floor or a stool, with the feet 120 PRACTICAL MASSAGE, held under a bureau, etc., and the body raised and lowered according to the strength of the patient. The movement should be done only at the hips, without any lumbar hyperextension ; the back straight, the head well back, and the chest expanded. The flexors of the hip-joint, viz., the psoas, iliacus, Fig. 62.—Trunk Elevation (Lying). sartorius, rectus femoris, and pectineus, are here strongly contracted, which again demand a vigorous contraction of the abdominal muscles, The upper back muscles must also be well con- tracted in order to hold the back straight and chest expanded; otherwise the upper part of the body will be “curled,” the shoulders and head drawn forward, and the chest depressed, which would result in a very faulty position. ACTIVE EXERCISES OF TRUNK. 121 When properly executed, this movement is one of the most powerful abdominal exercises, and gives ex- cellent training in the kind of muscular control required for a good carriage of both the upper and lower parts of the body. Care should be taken to begin gently, and never to allow “tremors” to appear. 108. Bopy HorizontaL on Tors AND HAaNnps (Fig. 63) oR ON THE BENT ELBows AND Tors.— Keep the whole body in one horizontal line for a few seconds; then rest by lowering the trunk to the floor, and again raise up to the first position. Repeat two to six times. Effects a muscular contraction of the front part of the abdomen and pelvis; viscera gravitate forward; the chest is expanded, and elevation of internal organs results. The blood is drawn into the anterior portion of the body, away from, the spine. Useful in prolapsus of the uterus, vagina, or rec- tum, and in obesity. CHAPTER XV. STIFFNESS OF JOINTS AND TENDONS. From Dr. Schreiber the following is quoted :— “It not infrequently happens that, after arthritis, thickening of the periarthritic structures or even adhe- sion of the articular surfaces themselves may occur, ‘leading to very considerable disability of motions. Only by mechanical means can we then hope to break up the existing adhesions, to smooth the roughened . articular cartilages, and to restore to the ligaments their former suppleness and elasticity. “All the mechanical interferences used—pressing, stroking, kneading—as well as the passive exercises— must be performed with the greatest care, since it is quite possible to initiate fresh inflammatory action by injudicious treatment. “The successful treatment of these cases affords one of the most difficult problems of the mechano-therapist, for it requires untiring perseverance and patience, as well as nice judgment and all the fruits gained by ex- perience, to tide the patient over the necessary pain which for months he may be called upon to bear. “The modus operandi in each case will be indicated by the mechanism of the particular joint to be treated, which sometimes will be found to be immovably fixed. At first the tissues surrounding the joint are to be (122) STIFFNESS OF JOINTS AND TENDONS. 123 gently rubbed, using in the beginning the finger-tips only; later, the force may be increased. “As soon as the part has, in a measure, become accustomed to the pain, the passive motions suitable to the joint may be begun. “The adhesions existing within and around the joint may be of so firm and resistant a nature as to readily lead to the belief in the existence of bony ankylosis. At first the amount of motion obtained in the joint will be exceedingly small, but even with this we will be bound to rest satisfied, for an increase of mobility often does not begin for months; in the mean- while the patience of both physician and patient will necessarily be put to a severe test. Nevertheless, keep- ing in mind the old saying, that ‘constant dropping wears away the rock,’ treatment must be continued steadily and systematically. “The astonishing results which experienced me- chano-therapists often obtain in cases declared incur- able by others can often be explained by the consistent and methodical treatment which they pursue. “The knee-joint is very often the seat of extensive synovial exudation in consequence of chronic rheuma- tism. Resorption is to be effected as in synovitis in general, namely, by centripetal stroking, pressing, and kneading.” The following is an interesting case of stiffness of the right shoulder which I treated a few years ago:— A rather feeble lady, about 45 years. of age, was struck on her right forearm. There was no fracture 124 PRACTICAL MASSAGE. nor sprain, but the arm was kept in a sling for two months. Then the lady found that she could hardly move her arm at the shoulder-joint. The adhesions were broken up. During the operation the shoulder was mechanically dislocated and reset. Inflammatory adhesions followed, and the operation was repeated with no better result. The joint was stiff, with great inflammation of the deltoid and the adjacent nerves and tendons, and so tender and sore that it could not be touched when the physician prescribed massage. The patient being under the influence of an injec- tion of morphine administered by the physician, the writer was enabled to apply treatment consisting of centripetal kneading and stroking. After a few days the injection was discontinued and passive motions were applied, in addition to the manipulations. Two weeks later active and resistive movements were used. After two months’ treatment the patient was well. My method now in treating stiff joints is to put the contracted muscles on a passive, but strong ex- tension and, while holding them in this position, apply centripetal stroking, quite hard circular kneading, and vigorous vibration on the extended contracted parts; also muscle kneading and percussion on the antagonists so as to make them stronger. I have found that in most of these cases—after the inflammation had left —the more strength the operator can use in bending and stretching the joint passively, the quicker it will be well; but, of course, care must be taken not to over- do it or to fracture some bone. We must find out STIFFNESS OF JOINTS AND TENDONS. 125 exactly which muscle or muscles are the contracted ones and which are the weak ones, and treat them ac- cordingly. Sometimes we find, after we have been treating a joint-affection quite roughly for weeks and months, that neuritis has set in, and then the treat- ment must be altered altogether, otherwise we shall go from bad to worse. Neuritis, as will be seen later, is to be treated very gently and not with centripetal strokings and kneadings. As soon as the patient is able, he should be encour- aged to move the joint, and be given resistive exercises for the weak muscles; thereby he, himself, passively stretches the contracted muscles. One great mistake is often made by masseurs, viz., to apply massage too long at a time. Much harm may be and has been done by long treatment, while no harm will ever occur by too short a treatment. It is safer to make it too short than too long, especially if the treatment is strong and vigorous. Ten to fifteen min- utes suffice; sometimes even less will be better. Re- member that moderate muscle kneading and percussion make muscles contract and become stronger, while circular kneading—especially strong—and vigorous vibration loosen the muscles, and still more so when the muscles are kept on the “stretch.” * At times it is necessary to lift some muscles either by one hand or by certain positions on the part of the patient, and with the other hand, or fingers, knead under and around them to break up adhesions; but all 126 PRACTICAL MASSAGE, these different manipulations must be seen or learned by long experience. I could give hundreds of cases which I have treated with good success by this method; but my success at the clinic in Boston City Hospital, which has gained the approval and praise of the head surgeons there, must be enough to prove the merits of my method. SPRAINS, SYNOVITIS, HyDRARTHRUS (WATER ON THE KNEE), “CHARLEY-HORSE,” ETC.—In my opinion such afflictions should be given massage as soon as possible. This I am also able to back up with many successful cases. One of my sons, as captain of M. A. H. football team, one Saturday was badly injured, and the coach looking at him said: “You have water on that knee; it will be the last of your playing this season,” at which the boy answered that he was not so sure about that, as he was going to see “Dad.” Well, “Dad” just applied hot water on the knee for about fifteen minutes; then gave light “combination” kneading of the thigh, beginning at the hip all around toward the knee, but not touching it, followed by cen- tripetal stroking from the knee and up the whole thigh, especially the inside, where the big veins are; also some stroking from the foot and up, avoiding the knee. This was done for ten minutes, three times a day the first few days and then twice a day; and the fol- lowing Saturday the boy played a winning game as half-back. Some time later he was struck, and a “Charley-horse” appeared. I gave the same treatment STIFFNESS OF JOINTS AND TENDONS. § 127 and also circular kneading right on the spot for three days, and all was well. In sprains I have had hundreds of similar cases. Bathe the parts in hot water immediately after the accident, then apply “combination’”’ kneading from above and gradually move down toward the sprain, stopping before it is reached; then centripetal stroking. When the sorene$s has disappeared give gentle circu- lar kneading all around the joint, followed by strok- ing; also apply circular kneading with one hand while centripetal stroking is applied with the other hand. Provided no ligament is torn, a sprained ankle, if treated at once, should be well in from two to six days. If a ligament is torn the massage is still of great help, but the sore spots must not be touched ; all the massage is to be above and below. Of course, there are cases when massage had better not be used. For instance, if a muscle is ruptured through over- work, it should be “plastered” up till it is healed; then gentle kneading may be good. ‘The most cases of sprains which are treated with massage stop too soon. Especially is this the case where the sprain is an old one. Here the muscles have become very weak through the long inactivity. There- fore, whenever a sprain is seemingly well—that is, pain is gone—passive circumduction, flexions, and ex- tensions should be applied, and also resistive move- ments to make the muscles strong again, and even 128 PRACTICAL MASSAGE. stronger than before, so they will not allow of any more sprains to that joint. Fersons who frequently “turn” the foot do this because the ligaments are ‘“‘slack,’’ and as we cannot take them shorten, we must make the muscles strong enough to act for the ligaments as well. Old sprains, when the inflammation has disap- peared, are treated like stiff joints, often with great force. Synovitis is best treated with centripetal stroking above the diseased part and, better, ten minutes twice a day; then not so frequently. These different traumatic cases, when no fractures occur, if treated early and by an expert, will most frequently be cured in quite a short time, while if they have been allowed to go on for months and even years, this treatment will still prove to be most effective, and on the average in these old cases a cure may be ef- fected in from one to three months. Other joints are treated on the same plan. The hip- and shoulder- joints are more difficult to treat and require a much longer time in order to pro- duce a cure. The following-cited cases are especially note- worthy :— Case I.—A gentleman, 36 years old, sprained his right ankle by a fall, and had been on crutches for eight months, when he came for treatment. There was no flexibility of the ankle, which was very tender STIFFNESS OF JOINTS AND TENDONS. 129 and swollen. After six weeks’ treatment once a day the patient was cured. ; Case II.—A young lady had come to Washington to attend the inauguration of one of the Presidents. Three weeks before, she slipped on the icy pavement and sprained her right ankle. She was laid up, and all sorts of liniment, etc., were prescribed by her physi- cian. After ten days he told her that there was noth- ing more to do but to keep quiet for two or three months, when she probably would be well. At this point I was called in, and the young lady told me, with tears in her eyes, why she had come to the city, and that now she was told that she would have to be quiet in her room for months, and she implored me to do my best. The ankle was still black and blue and very much swollen, and the pain did not allow of touching the parts. After the examination she was informed that she would probably be well in ten days if treat- ment was applied twice a day. To this she was only too glad to consent. The treatment was given twice that day. The next day the most of the discoloration had disappeared, and now she was told to walk a little at a time in her room. The improvement was remarkable from day to day. The ninth day after, the seventeenth sitting, she was cured, and went to the inauguration ball on the tenth day. She had no relapse. Case III.—About two years ago one of my assist- ants sprained his left ankle in a gymnasium. He was 9 130 PRACTICAL MASSAGE. brought home by his friends and told to be quiet in bed. He kept on all night bathing the leg with hot and cold water, and came next morning to the Insti- tute. The joint was slightly dislocated, the foot was turned upward and inward, and twice as large as usual. The patient was a strong young man, so that I at once went to work and succeeded in getting the joint straight, after which a full treatment was applied. After four days’ treatment, twice a day, the young man was well. Prof. Dr. J. Nicolaysen, of Christiania (in Norsk Mag. for Legevidenskab, 1874), communicates the following case of hydrarthrus (water on the knee) :— “A man, 32 years old, had suffered from hydrar- thrus for six and one-half years. Repeated punctures and evacuation had always been followed by a re- accumulation of the fluid. “Massage was used for several months, and the patient returned to his work. There was no relapse.” Another gentleman, 26 years old, had suffered from hydrarthrus for two months, when he came to the same professor, who sent him to me, at that time in Norway. After two weeks’ treatment the collection of fluid in the knee-joint disappeared, but the swelling of the capsule continued. After five weeks’ treatment the patient was well. Whenever massage is applied to a leg after an acci- dent, it is best to begin with centripetal strokings at the inside of the thigh; or if it be the arm, make the STIFFNESS OF JOINTS AND TENDONS. 131 same kind of strokings on the inside of the upper arm, as this will, quicker than any other manipulation, pro- duce absorption through the big veins from the dis- eased part. I have always found that the quickest way to cure Sprains or bruises is to bathe with hot water immedi- ately after the accident for half an hour or more, and then apply the massage above the sprain, until it will allow of being touched with gentle strokings, which gradually should be increased in force; then a circular kneading on and around the sick parts with the fingers of one hand, while the other hand is continuously strok- ing upward. Even in fractures it will be of great value to use the hot water, and centripetal strokings above the frac- tured parts, which will reduce the swellings and enable the surgeon to set the bones with more accuracy. I have frequently advocated the use of massage a day or two after a fracture has been set by the sur- geon. But we had to go through the great war before the surgeons of the United States would listen to stich a treatment. Now, however, many of them have be- gun, and it is a fact, that patients treated in this way will be well in about half the time it otherwise would take. The splint is to be removed and the limb rest on a pillow while gentle stroking above and below the fracture is applied for six to ten minutes, then the splint is to be replaced. In case of a fractured joint, slight movements of the same while it is held firmly by the doctor’s hand 132 PRACTICAL MASSAGE. should also be practised to avoid stiffness and ad- hesions taking place. Splints and tight bandages are generally worn too long. If taken away sooner, the patients in many cases would be much better off, CHAPTER XVI. FLAT-FOOT. (“Morbid condition of foot in which the arch is destroyed.” ) Tus trouble has grown very marked the last twenty-odd years, and many theories are advanced, and especially have the orthopedic surgeons insisted that the habit of standing and walking with the toes turned out is the chief cause of this malady. In this I cannot agree; and although I am not a surgeon, I still believe I have some right to my opin- ion—having taught gymnastics to hundreds of thou- sands, boys, girls, and adults, and treated many hun- dreds in the last forty-five years. The surgeon says: “These patients come to me invariably with the feet turned abnormally out; they are flat-footed, and I tell them to practice standing and walking with their feet parallel—even turned inward—which relieves them and helps to cure them.” Very well, but supposing a physician orders a pa- tient to take strychnine, are we to understand that he is to do so all his life, or even that other persons must take it because it cures in some cases? My theory is, that it was the broken-down arch which made the foot turn abnormally outward, not the reverse. (133) 134 PRACTICAL MASSAGE. Who are those who mostly suffer from flat-foot? They are saleswomen and nurses; and why? Because they have to be on their feet all day (most frequently in poorly fitting shoes) ; their feet tire, and they begin to walk with stiff ankles—no foot action ; consequently all the muscles are weakened and cannot do their work; they “give,” and the pressure on the arch of the foot being now unbearable, the foot gradually turns outward. And this is what the surgeon sees; but he did not see this patient before she was taken ill, when her foot in ninety-nine out of a hundred cases was normally turned. Of course, if it was an abduction of the foot in the ankle, which made us turn our feet outward in stand- ing, I would say “the surgeon is right;” but the gym- nastic standing position with the toes turned out is done by a rotation of the thigh at the hip-joint, and we insist that the toes shall always be in line with the patella, and there is no danger for the arch of the foot as long as the muscles are kept strong and active. There is another cause why women suffer so much more with the malady than men, namely, because they are naturally “knock-kneed,” this puts a heavier bur- den on the arch of the foot. If people would be careful about always keeping the toes in line with the knee in walking and standing, in gymnastics and dancing, and exercise their ankles, as well as having shoes comfortable and well-fitting, we should see much less of these troubles. FLAT-FOOT. ' 135 The crusade which has been going on for several years and which has resulted in unsightly, awkward positions of the feet in many schools in this country will ultimately lead to a nation of bow-legged men and women. One argument often used is, that the Indians stand and walk with toes straight ahead—therefore it 1s natural! Well, the mountaineers of Norway walk with their feet abnormally out to better climb the mountains. In either case it is the condition which has made them as they are. We have also been told that our “forefather,” the “monkey,” keeps his feet (rather hands, though) turned inward—that it is natural and we must do the same. There are very few people nowadays who care to “ape” the monkey ; we will rather keep a big distance. Sometimes we find some girls in the gymnasiums suffering with “flat-foot,” and it is rather strange that there are not many more of them. These young ladies have for many years been wearing high shoes with high heels, and now they are suddenly forced to wear ‘gym. shoes without any heels for three to five hours a day. No wonder that they suffer. These- people should be given small heels inside their shoes. I have had great success in treating flat-foot with massage and a few simple exercises, as follows :— 1. Centripetal stroking of foot and leg to knee. 136 . PRACTICAL MASSAGE. 2. Muscle kneading of foot and up the inside of the leg ; also percussion. 3. Foot circumduction. 4. Foot flexion inward and upward, with resist- ance. 5. Foot extension with resistance. 6. Again muscle kneading, percussion, and stroking. This ought to be given every day, or at least every other day; and the patient should take some exercises at home morning and night :— 1. Sit and circle her foot actively. 2. Turn the foot inward and upward and resist with her hand. 3. Stand and raise on tip-toes and at the same time turn toes in and.heels out. 4. Deep knee bending. 5. Sit or stand and try to pick up a marble with the toes. 6. Centripetal stroking of foot and leg. CHAPTER XVII. GENERAL MASSAGE has within the last thirty years become of such great importance in the treatment of many kinds of ills that I wish to take it up as a special branch of massage. Forty years ago it was hardly known in Europe, and even to-day we hear.the young masseuses, who have recently come over from Sweden, saying that they don’t like to give “general” massage and don’t care for such cases. The real reason is that they have not learned that kind of massage in Sweden. They have had a thor- ough course in medical gymnastics and local massage, but not in general massage, and because the American people have come to look to every Swede as a natural masseuse, which, however, is a great mistake, these inexperienced young ladies put on the air of authority and knowledge and scorn the idea of giving general massage. My advice to all newcomers is to learn general massage as quickly as possible, and also to learn how American patients are treated, and even to take a short course of study here before they visit the physicians with their cards. There was a time when “graduated from Sweden” was the best possible recommendation on a card, but (137) 138 PRACTICAL MASSAGE. that time has passed, since we have just as good schools right here, where the theory is broader and the practical work even more practical. It is true that general massage is often used when medical gymnastics with some local massage would do more good. But whén the customer (I can hardly call her patient) prefers the “massage” as a mode of exer- cise which she enjoys and therefore also finds it bene- ficial, I think the masseuses ought to be thankful that there are so many well-to-do women who are willing to employ them. General massage is of great benefit in cases where the patient is unable to sit up, either from sickness or weakness, or overtired mentally and physically; and it certainly also is a great remedy to “tone up’ the sys- tem and to help the society lady to keep up her social duties. Dr. J. Schreiber says: “In the treatment of neuras- thenia and its allied affections, hysteria and hypochon- dria, we seek to attain a threefold end. First, to re- generate the mass of blood as a whole; secondly, to combat individual symptoms; and, thirdly, to favor- ably influence the mental state. “Beard, who claims for neurasthenia that it is a new and especially American disease, considers mas- sage treatment as not only essential, but absolutely indispensable, for those cases which it seems advisable to confine to bed.” Dr. Weir Mitchell says, in his “Fat and Blood,” that he has applied massage to deprive rest of its evils. GENERAL MASSAGE. 139 Amid all the numerous morbid manifestations ac- companying neurasthenia, hyperesthesia and muscular weakness are probably the most prominent, so that Arndt has declared the nature of the disease to con- sist in increased irritability, with rapid tendency to fatigue, especially of the muscular system. In neurasthenia, all the morbid processes occurring in the muscles are more rapidly influenced by move- ment treatment than by either hydro- or electro- ther- apy. Of all symptoms, the various hyperesthesias (excessive sensibility) most frequently engage the physician’s attention. These are generally regarded by the friends as founded either on exaggeration or upon affectation. Patients complain of muscular pain, especially in the extremities and back, and of pains along the spinal column, the latter being, indeed, considered quite char- acteristic of the disease (“spinal irritation’). Besides these, neurasthenics suffer from the great- est variety of symptoms referable to the brain, as headache, and a feeling of weight or constriction in the head, eye, and ear, photopsia (sensation of light), scotoma (dark spots in the vision), roaring and ring- ing in the ears, hypersensitiveness to odors, and other similar idiosyncrasies. Or there may be liability to sudden changes of temper, or to depression and sad- ness, or dizziness or insomnia may exist. Indeed, the large number of various feelings of apprehension ex- perienced in neurasthenia has been the occasion for the manufacture, by various authors, of any number of 140 PRACTICAL MASSAGE. “phobias.” The restlessness so often seen in these patients is caused by the pains occurring in various muscle groups. The “general massage” of the whole body will be found the most effectual in banishing the various anes- thesias and hyperesthesias, while passive rotation, flex- ion, and extension cause a stretching of the nerves contained within the muscles, which reacts most favor- ably upon the mental state. Prescription I, 1. Legs—centripetal stroking, kneading, and circu- lar friction. 2. Arms—centripetal stroking, kneading, and cir- cular friction. 3. Chest kneading and friction. 4. Stomach kneading and friction. 5. Back kneading and friction. 6. Head friction. If the patient has high blood-pressure, begin with chest and stomach; then legs, arms, back, and head. This treatment should be applied daily, and even twice a day, until the patient has gained some strength, when it will be advisable to increase the treatment. In order to give a good treatment the operator should be of a good disposition and cheerful, neat, and healthy; finger-nails fairly short and well taken care of. First, see that the patient is in a comfortable bed, preferably a single bed or a couch; then go to the bath- room and wash the hands and bring a towel with you GENERAL MASSAGE. 141 to the patient’s room, sit down beside the bed with the towel in your lap, and let the patient’s foot rest on it while you apply the massage up to the knee.’ Now put the foot back in bed and treat the rest of the limb— from the knee to the hip—while it is lying in bed. A good masseur can apply this treatment on the bare skin without exposing the limb. Then move over to the other side and massage that leg. Next take the arm on the same side and rest the hand in your lap while you work the whole arm and shoulder. Again move your chair to the first side and treat that arm. Then the chest and abdomen, and help the patient to turn over, face down, the chin resting on the hands, while you treat the back. Again go and wash your hands before you apply head friction and strokings down the throat. Remember that the more comfortable the operator is the better treatment is he, or she, able to give. Do not stand up more than absolutely necessary, or you will soon feel that you have a back. The idea that a masseur or masseuse must be big and very strong is a mistake. If they only know how to do it and how not to exhaust themselves, but be calm and quiet, they will often do much better than their big sister; of course, some strength in arms and hands is needed, but that will soon come with the practice. In massage treatment it is very essential that the patient take “a liking’ to the operator and her treat- ment, as that will further the improvement very much. , 142 PRACTICAL MASSAGE. On the other hand, if the patient does not like the operator, her mind will work against the treatment, and often “the massage” has been said to be a failure, while it really was the person giving’ it who was unsuccessful. Further, remember that there are many kinds of manipulations and different movements, and if any of the kinds you are giving seems to disagree with the patient, or she dislikes it; change it with some other which may have about the same effect. In general massage it is not advisable to force unpleasant move- ments on the patient. Neither is it necessary to use any kind of ointment; it is even better not to use it, unless the physician: in charge prescribes it for some curative reasons. As a rule, ointment should only be used in local massage where vigorous strokings are necessary, so as not to take the skin off. Prescription No, 1 is to be given to all new patients and those who are weak and delicate, but the treat- ment should be gradually increased in strength and in number of movements. After a while—four to eight days—add “thigh circumduction” after the first manipulation; in a few days more give “arm circum- duction” after No. 2; then give “foot circling” single, and “forearm rotation,” and “hand circling.” When the patient has had about two or three weeks’ treatment, use :— GENERAL MASSAGE. 143 Prescription II, 1, Legs—centripetal massage. 2. Thigh circumduction—passive. 3. Foot circling—single—passive. 4. Legs—nerve compression, muscle rolling, slap- ping, and friction. 5. Arms—centripetal massage. 6. Arm circumduction—passive. 7. Forearm and hand circling—passive. 8. Arms—nerve compression, muscle rolling, slap- ping, and friction. g. Chest!—kneading, slapping, vibration, and friction. 10. Stomach!—kneading and friction. 11. Back—massage. 12. Head friction (or if needed—head massage). Keep this up for some time, then add “leg flexion and extension,” and “upward knee traction” after No. 2; and later “arm flexion and extension” (resistive) and forearm circling; and still later “chest lifting and vibration” after No. 8. While we add more and more movements we grad- ually shorten the length of the centripetal massage, till we finally have the patient up and out of bed and stop the centripetal massage entirely. In the beginning’ centripetal massage is most effec- tual, because there is always a great deal of waste matter which must be absorbed quickly ; but after some 1 Chest and stomach first in cases of high blood-pressure. 144 PRACTICAL MASSAGE. time the other manipulations and movements are more necessary and will do more good. And it is a great mistake to keep a patient with neurasthenia or ner- vous prostration on the same kind of massage for weeks and months. Their treatment should be pro- gressive from week to week, and as soon as the patient is able to be up and out of bed the exercises should be changed to Prescription III. 1. Forward arm circumduction—sitting—passive. 2. Foot circling—double—reclining—passive. 3. Trunk circumduction—astride sitting—passive. 4. Vertical arm flexion and extension—sitting— resistive. 5. Leg flexion and extension—reclining—resistive. 6. Chest slapping—standing—passive. 7. Arms—nerve compression, rolling, slapping, and friction. 8. Legs—the same—reclining. g. Stomach? kneading, vibration, and friction— reclining. 10. Back percussion—standing. 11. Head massage—sitting. 2 Stomach first in case of high blood-pressure. CHAPTER XVIIL “HicH BLoop-PRESSURE” AND “ARTERIOSCLEROSIS.” In treating persons with either of these maladies Dr. H. V. Barclay, of New York, has for some years applied a sort of circular kneading with the palm and “heel” of the hand on well-stretched muscles; and he has had great success. Personally I have practised this feta more or less the last few years with satisfaction; and I have also had an expert physician to take the “blood-pres- sure’ of some of my patients before and after treat- ment, with the average result of a decrease of g mm. The modus operandi is as follows: The patient lying straight on his back, with a small pillow under the shoulder-blades, head and shoulders well back on the bed, so as to keep the anterior muscles of the body on a good passive “stretch.” Now give a few centripetal strokings of the throat and light circular kneading with the whole hand on the pectoral muscles, and some strokings from the middle line of abdomen outward. Next, have the pa- tient lying on his side (say left side), pull right arm backward and perfectly straight at the elbow, bend hand backward; in this position knead front of shoulder and all the flexor muscles of the arm with the palm, or “heel,” of your hand, beginning at the 10 (145) 146 PRACTICAL MASSAGE. shoulder and gradually work downward, taking care not to “stroke” against the venous current. Now bend the arm over and in front of the pa- tient’s head to put all.the extensor muscles on the stretch and knead, beginning at the cervical and dorsal spine and work toward the hand; finally raise the arm well over the head and work down the latissimus dorsi. Bend the right knee well up against the patient's body and knead the buttocks and back of the thigh; then pull the leg backward and knead front of the thigh; bend the knee and knead front of the leg; straighten the leg and bend the foot and knead the calf. When both sides have been manipulated, have the patient on his stomach and give a few frictions down the back. The whole procedure should not occupy more than fifteen to twenty minutes. CHAPTER XIX. HystErRIA AND HyPOCHONDRIA, THESE affections are, according to Arndt, quite impossible to separate from neurasthenia. He c¢on- sidered the numerous terms of different authors—such as spinal neurosis, spasmophilia, spinal: weakness or irritability, neurosism, erethism, and others—to be but different names for one and the same condition.: The different writers seem, however, to be of the opinion that it is impossible to permanently cure this condi- tion, and that no medicaments exist capable of per- manently allaying the irritability of the hyperesthetic nerves. Nevertheless, a daily course of carefully system- atized exercises will always be of great value to these patients. Several of the active exercises will be good. When the masseur can get the hysteric woman to work hard and to enjoy the exercises, he will be able by moral strength of character to effect a great change in her mind, and a steady improvement, although slow, may be looked for. It is the same with the hypochondriac man. Give him some hard work and try to gain his confidence and also to get his mind away from himself, and the mas- seur will accomplish wonders. But, of course, these are trying cases which require a good deal of patience and tact to be able to do anything with them. (147) 148 PRACTICAL MASSAGE. The prescription of exercises should be made with special attention to the ills complained of and a gen- eral exercise for muscles and nerves. CHLOROSIS AND ANEMIA. The character of these diseases is weakness, there- fore it may seem strange to treat them with exercises. To apply fatiguing movements would also be as absurd as to prescribe weakening medicines, but by stimu- lating and strengthening movements re-establishment may. be accomplished. The muscles being the chief site of chemical change occurring in the body, stimulating and increasing their action leads