SAGE AND THE SWEDISH MOVEMENTS OSTROJVl. H EDITION THE GIFT OF .-.v- -- 43{«.5lH-(p :: kk All books are subject to recall after two weeks Olin/Kroch Library DATE DUE [^ i^^pMH^ iHl^ "B'tHW' nmtmm ■wuiaofta OMX. hih '- W juj^titiA 39;} t_ M. GAYLORD PRINTED IN U.SJL ^j^ RM 721.08ri915'™""'' '■'''"''' " nfm.^Sl?.^"'' "'* original Swedish movemen 3 1924 012 177 402 The original of tliis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924012177402 MASSAGE AND THE ORIGINAL SWEDISH MOVEMENTS OSTROM MASSAGE AND THE Original Swedish Movements THEIR APPLICATION TO VARIOUS , DISEASES OF THE BODY Lectures before the Training Schools for Nurses Connected with THE Hospital of the University of Pennsylvania, German Hos- pital, Woman's Hospital, Philadelphia Lying-in Charity Hospital, the Philadelphia Polyclinic and College for Graduates in Medicine, and the Kensing- ton Hospital for Women, of Philadelphia BY KURRE W. OSTROM FROM THE ROYAL UNIVERSITY OF UPSALA, SWEDEN SEVENTH EDITION, REVISED AND ENLARGED WITH ONE HUNDRED AND FIFTEEN ILLUSTRATIONS PHILADELPHIA BLAKISTON'S SON & CO. 1012 Walnut Street 1915 Am(r" l\,5(e5lH-(? Copyright, 1912, by P. Blakiston's Son & Co. Press of 60WER8 PRINTING COMPANY LEBANON, PENNA, PREFACE TO THE SEVENTH EDITION. The continued demand for this manual has induced the publishers to issue another edi- tion, the seventh. The text in general has been gone over carefully and the following new subjects have been added: Neuritis, Splanchnic Neurasthenia, Infantile Paralysis and additions to Diseases of the Eye .and Ear. It is to be hoped that this edition, as it now is presented, will prove a useful aid to those who desire to carefully investigate the prac- tical side of mechano-therapeutics. KURRE W. OSTROM. 112 N;orth Sixteenth Street, Philadelphia. PREFACE TO THE SIXTH EDITION. In preparing this new edition the whole text has been carefully gone over and revised in the light of recent methods. Six new subjects " have been added, including sections on the Prostate Gland, Headache, Colds, Affections of the Bladder, Varicose Veins and Hernia. The practical instructions for giving massage have been revised and enlarged. The first edition of this little book was is- sued barely fifteen years ago. Since this was published the author has gained a better and wider knowledge of the value of massage as a remedial measure, and of the actual needs of nurses by his experience in private practice as well as by his experience as a teacher in the various hospitals of Philadelphia, and by in- structing many head nurses sent to him from different parts of the United States and Can- ada. When the second edition was issued it was deemed wise to incorporate a practical de- scription of the Swedish movements. This was done, entailing the insertion of upward of sixty vii Vlll PREFACE TO THE SIXTH EDITION. new illustrations copied from the authoritative text-book by Dr. Hartelius as used at the Royal Central Institute of Stockholm. Several new illustrations were added to the third edi- tion, and considerable new material, especially in the latter part of the book, dealing with the application of massage to the various diseases of the human body. Considerable new ma- terial and a number of illustrations were added to the fifth edition, special attention being- given to those sej:tions dealing with the treat- ment of Constipation and Lateral Curvature of the Spine. It has been the author's aim to strictly main- tain the practical character of the book, for which he has received so many encouraging letters, and in revising the sixth edition he has not deviated from this rule. Much new ma- terial has, however, been included, and many original practical points inserted throughout the text, while at the same time he has pre- served that conciseness and clearness so neces- sary in a text-book of this kind. It is the author's desire that this manual, as it is now published, will be of value to the physician who desires to study the principal points of mechanotherapeutics and the treat- ment indicated, while to the nurse who needs a text-book, and to the professional masseur who PREFACE TO THE SIXT,H EDITION. IX desires to keep abreast of the latest develop- ments of the subject, he trusts that the addi- tional suggestions will prove helpful. The Author. PREFACE TO THE FIRST EDITION. As the tendency of modern therapeutics is to cure disease by the application of the laws of hygiene, the author feels that in presenting this little work to the medical profession, and to those especially interested in the subject, he will be supplying in English a treatise that has long, been needed. It is true, several books have been written on this subject by physicians, but none of them has been sufficiently explicit in telling how to perform the various manipulations, or the cases which may be benefited by the move- ments. This work endeavors to explain how the movements are to be applied to all parts of the body, and also to show for what diseases such movements are indicated. I am very much indebted to Drs. Charles K. Mills and H. Augustus Wilson for their kind- ness in giving me ample opportunity to prac- tically demonstrate the Swedish methods of massage and movements at the Philadelphia xi xii PREFACE TO THE FIRST EDITION. Polyclinic and College for Graduates in Medi- cine. I am also under obligations to several other professors of the same institution for valuable information received. In describing the various movements and their influence upon the different parts of the body, I have consulted such well-known Swed- ish authors as Wretlind, Hartelius, Kleen, etc. It is hoped that this little text-book will be a practical and valuable addition to what has already been published on the subject of mech- anotherapy. The Author. CONTENTS. PAGE. Introduction i Exercise in TJierapeutios 5 Massage 9 Massage as a Therapeutic Agent 21 Pressing and Shaking (Vibrations) 55 Details of Treatment 63 Contraindications for Massage , 64 Swedish Movements 66 Positions • ■ . . 67 Divisions of Movements 79 The Various Movements 80 The Pliysiology of the Movement Treatment 112 Mechanical Action of Muscles 117 Application of Massage, etc., to Various Diseases of the Body 121 General Weakness 122 Anemia 122 Hysteria ■ 124 Chorea 124 Plethora 125 Insomnia 126 Headaches 127 Apoplexy 130 Infantile Paralysis 132 Tabes 136 Neuralgia 138 Neuritis I39 Progressive Muscular Atrophy 140 Writer's 'Cramp 141 Splanchnic Neurasthenia '. . • 141 xiii 2— .M XIV CONTENTS. PAGE Affections of the Respiratory Organs 143 Catarrh of the Lungs 144 Pharyngitis and Laryngitis I44 Consumption 14S Bronchitis, Nervous Asthma, etc 145 Colds 14s Diseases of the Heart I47 Diseases of the Digestive Organs 151 Dyspepsia ISI Habitual Constipation 1S2 Hemorrhoids ■» IS7 Obesity 158 Enlargement of the Liver IS9 Diabetes •. 159 Uterine Affections 160 Amenorrhea 161 Dysmenorrhea 161 Affections of the Bladder :...■... . . . . 162 . Rheumatism 163 Lumbago . . . . ; 164 Stiff Neck 165 Gout ; l6s Lateral Curvature of the Spine : 166 Sprains 177 Synovitis 178 Varicose Veins 180 Hernia ; : . 181 Fractures ■.■ . . . 182 Deformities of the Feet -. .• 184 Affections of the Eye 187 Affections of the Ear 188 General Remarks 189 The Massage Treatment in America 191 Bibliography 195 Index ...'..• 199 MASSAGE AND THE SWEDISH MOVEMENTS. INTRODUCTION Manual treatment for disease has to a certain extent existed since the creation. Man had, by instinct, acquired the art of manipulation long before nature yielded her secrets in medi- cine. This is still the practice among many nations. In Sweden, even at the present time, certain manipulations are used among the peasants for cramps, swellings, etc. The Swedes seem never to have lost the art — but recently revived in other countries. Amiot and Dally speak of a perfect system of gymnastics among the Chinese three thou- sand years before the Christian era. They maintained that gymnastics, by preventing 2 MASSAGE. stagnation, produced an even and harmonious movement of the fluids in the human body, which is necessary to health. Not only did they use gymnastics to preserve health, but they also had a thorough knowledge of their therapeutic efie-cts. From each of the natural positions they placed the body and limbs in certain derivative positions, which modified the movement of the fluids and were, of course, important in different diseases. The priests of Egypt used some manipula- tion in the form of kneading and friction for rheumatic pains, neuralgias, and swellings. The Hindoos, also, had some knowledge of their therapeutic importance; but the masses were soon mystified by the priests, who by in- cantations and magical words, led them to be- lieve they were invented by the gods. Even the Persians used a few movements for dififerent affections. The Greeks were the first to recognize gym- nastics as an institution — a fact of much im- portance to the free states. Here they were auxiliary to the. development of the people both socially and politically. The gymnasts were political, pedagogic, esthetic, and thera- peutic. The philosophers and the physicians recommended manual treatment. Plato even di- vided it into active and passive movements, MASSAGE. 3 and especially recommended the latter. Some physicians practised the movements them- selves ; but there arose a class of people, called Pddotribes, some of whom acquired great skill in the manipulation of the human body. Although the Romans imitated the Greeks to some extent, they rather preferred calis- thenics ; yet the manual method was more ex- tensively practised in Rome under the emper- ors than it had hitherto been by any other na- tion. Thus we see that among the ancients the most common movements were a few passive manipulations, while in the Middle Ages the gymnastics of an earlier period were more or less forgotten. In the fifteenth and sixteenth centuries well-known physicians recommended gymnas- tics. Fuller and Tissot wished to combine the movements with the study of medicine. In the early part of the last century a therapeu- tic system of gymnastics acquired a reputa- tion heretofore unknown, in movements based upon a certain action between operator and patient. The Swede, P. H. Ling (i 776-1 839), and his predecessors, erected the first scientific sys- tem, in which they adopted the new medical science, making the movement treatment a 4 MASSAGE. perfectly scientific remedy, worthy of the con- fidence of every educated man. In our own time. Dr. Mezger, of Wiesbaden, has demonstrated certain passive movements, and arranged them into a system that is now indorsed by every intelligent physician. EXERCISE IN THERAPEUTICS. In walking or riding, or even in some of the ordinary occupations of life, it is true that s ' person takes a certain amount of exercise, but there is no method in such movements. It is easy to determine how much is to be done and how long it may be continued, but it will be a very difficult matter to estimate the amount of vital force necessary to carry these exercises into execution. For instance, in walking, the strength of the motion depends not only upon the time and speed used, but also upon the weight of the body, supported by the lower extremities. In many cases the strength and tone of the mus- cles of the leg are not in proportion to the weight of the body. This condition is exemplified in most of the calisthenic exercises. When a person is practising calisthenics, the strength of the exercise depends upon the con- stitution and upon the weight and the natural 5 6 MASSAGE. activity of the body, which are not necessarily in proportion to the individual's strength. For instance in jumping; to a person v^^eigh- ing one hundred pounds the exercise may be only light and agreeable, whereas to another, weighing two hundred pounds, the weight of whose body is out of proportion to the muscu- lar strength, the same exercise might prove positively injurious. Not being able to estimate the vital force force used in the common exercises practised under the head of calisthenics, or in the differ- ent sports or games, they should not be classi- fied under the name of Medical or Remedial Gjminastics. In the latter case it is necessary to be able to estimate the amount of force re- quired in every movement, and apply it ac- cording to the strength of each individual. The diflference between the Movement Treatment and the common exercise does not consist only in the quantitative estimate of the movements. In the exhilarating exercise of riding the motion is general, acting upon the entire body, no part being excepted. On the other hand, in walking or dancing the muscles of the legs are used almost exclusively, those of the arms not being brought into action at all. The dancing-master has well-developed muscles in MASSAGE. 7 his legs, whereas, unless he resorts to some special exercise for his arms, their muscles will not be in proportion to those of the legs. Persons of sedentary habits, especially dress- makers and clerks, who have but little exer- cise of any kind, are sure to have an ill-devel- oped muscular system. Unless such persons take exercise systematically, they are liable to injure themselves severely. Persons who try to excel in any one kind of athletics run great risks of exceeding their strength. Thus we see it is impossible to estimate the benefit of calisthenics, which can easily be done with the Swedish movements. Finally, in the movement treatment, all movements are arranged in such a way and in such a form as to be comfortable and adapted to all parts of the body. Based upon a knowledge of the anatomy and physiology of the parts, and of their proper physiologic limits, this treatment is much su- perior to any other, as well as more agreeable. All joints have a natural motion within cer- tain fixed limits. When such joints are gently exercised, an agreeable sensation is produced; but if the exercise be too violent, — flexing, extending, or rotating to excess, — severe pains will probably result. The same may be said of the muscular system. Each muscle having a K MASSAGE. distinct and certain function to perform, pro- per exercise of these muscles, if confined to physiologic limits, will be invigorating and agreeable to the patient. In giving the Swedish movements special attention is directed to the natural functions of joints and muscles. This is not the case with any other kind" of exercise, consequently the sensation and value of promiscuous move- ments can never be the same. When movements are necessary over painful parts of the body, the patient must sometimes judge how much he can bear. An operator who is not able to explain the physiologic action of every manipulation or movement he uses is liable to do more harm than good to the patients. * The Swedish movement treatment can better adapt itself to all conditions than any other treat- ment. Finally, the aim of the Swedish treatment is, by a careful manipulation of muscles and joints, to re- store to good health such as are in any way dis- eased. The force of such manipulations can be esti- mated and the extent of their duration fixed. MASSAGE. The word Massage is a derivation from the Greek massein, or the French masser, which both mean : to knead. A male operator is called a masseur, a female operator, a masseuse. _ Massage is a scientific treatment, by certain pas- sive systematic manipulations, upon the nude skin of the human body. Dr. Mezger, of Amsterdam (now practising in Wiesbaden, Germany), and his two pupils, the Swedish physicians Berghman and Helle- day, were among the first to apply the massage treatment scientifically. Their method is now used throughout Europe. According to Mezger, massage is a scientific treatment — i. c., based upon the anatomy and the physiology of the human body; his manipulations are certain — that is, given or fixed, so that an uninstructed person can not pick up the treatment — it is an art that can not be self-acquired ; all manip- ulations are passive — i. e., applied to the pati- ent without his assistance or resistance; the manipulations are also systematic — i. e., they 9 lO MASSAGE. are arranged so as to act systematically upon the different tissues of the human body. Dr. Mezger divides the massage treatment into four principal manipulations : 1. Effleurage. 2. Frictions. 3. Petrissage. 4. Tapotement. Fig. I. — Stroking with One Hand. I. EFFLEURAGE (STROKING). This manipulation consists of centripetal {toward the body or heart) Strokings. It is performed in four different ways : (o) Stroking with the palm of one hand, (o) " " " palms of both hands, (c) " " " thumb. {d) " " " tips of the fingers. MASSAGE. 1 1 Stroking with the One Hand (see Fig. i) is used upon the extremities, the back of the head, and in single massage of the neck (Gerst's method). Fig. 2. — Stroking with Both Hands. Stroking with Both Hands is used upon the lower extremities of adults, upon the chest (see Fig. 2) and back, also in double massage of the neck. 12 MASSAGE. Stroking with the Thumb (see Fig 3) is used between two muscles, or between a mus- FiG. 3. — Stroking with the Thumb. cle and a tendon; also frequently to reach the interossei in the hands and the feet. Fig. 4. — Stroking with the Tips of the Fingers. Stroking with the Tips of the Fingers (see Fig. 4), or the last two phalanges, is prin- MASSAGE. 13 cipally used around the joints (in cases of sprains, etc.), the fingers conforming them- selves to the shape of the part to be worked upon. The strength of the manipulation, stroking, varies from the slightest touch to the strong- Fic. 5. — Friction with the Thumb. est pressure ;%ven with one hand on top of the other, if necessary. The aim of all Strokings is to increase the cir- culation in the venous blood-vessels and the lym- phatics, thereby causing absorption. 2. FRICTIONS (FRICTION) Are firm, circular manipulations, always followed by centripetal strokings. As a rule, they are per-- formed over one group of muscles at a time. 14 MASSAGE. Friction is given in three different ways : (a) Friction with the thumb. (b) " " " tips of the fingers. (c) " " " one hand. kH, Fiu. 6. — Friction with the Tips of the Fingers. Friction with the Thumb (see Fig. 5) is used upon the extremities, but also upon smaller surfaces ; as, for instance, around the knee-joints and upon the facial muscles. Friction with the Tips of the Fingers is used around the joints, the thumb often sup- porting the hand (see Fig. 6). The circles are MASSAGE. 15 sometimes made a great deal smaller than demonstrated in Fig. 6. Friction with the One Hand is used upon the larger surfaces and fleshier parts, like the thigh, arm proper, and lumbar region of back. Fig. 7. — Kneading with the Two Thumbs. All Frictions should be centripetal, , and should always be followed by centripetal strok- ings, as the aim of this manipulation is to trans- form pathologically changed parts into a condition that will permit them to be incorporated into the l6 MASSAGE. healthy tissues, and thence be absorbed by the veins and lymphatics. 3. PETRISSAGE (KNEADING). This manipulation is performed in such a manner as to cause a double centripetal pres- sure on a tissue (muscle or tendon), at the Fig. 8. — Kneading on the Hand, for Contracted Tendons and Muscles. same time raising it up from its normal point of attachment. We have three different kinds of Petrissage: (o) Kneading with the two thumbs. (b) Kneading with the thumb and fingers. (c) " " " two hands. Kneading with the Two Thumbs (see Figs. 7 and 8) is used to reach individual mus- cles. MASSAGE. 17 Kneading with the Thumb and Fingers, which manipulation is • called Pinching (see Fig. 9.— Kneading with the Thumb and Fingers, Called Pinching. Fig. 10.— Kneading with Both Hands, Called Squeezing. Fig. 9), is also used to reach individual mus- cles, but is preferred on a deep-seated tissue. i8 MASSAGE. Kneading with Both Hands, called Squeezing, is used upon the lower extremities, and upon the arm proper (see Fig. lo) of adults. The aim of the manipulation Kneading is to reach the separate muscles with a Urm double pres- sure and expose them to an action similar to that of Friction. Fig. II. — ^Clapping of the Leg. 4. TAPOTEMENT (PERCUSSION). This manipulation is always performed by the operator's wrist, the hands striking quickly. We have four different kinds of Percussion: (a) Clapping (see Fig. 11) is performed with the palms of the hands. It is used to act upon the skin and the superficial nerves and vessels. MASSAGE. 19 (b) Hacking (see Fig. 12) is performed with the ulnar border of the hand. It is used around nerve centers and upon the muscles. Fig. 12. — Position of Hands in Hacking. Fig. 13. — Position of Hands in Punctation of the Forehead, (c) Punctation (see Fig. 13) is perform- -ed with the tips of the fingei-s. It is used upon the head and in circles around the heart. 20 MASSAGE. (d) Beating (see Fig. 14) is performed by the clenched hand. It is used upon the glutei and upon the lower extremities over the sciatic nerve. Fig. 14. — Beating over the Sciatic Nerve. ^ MASSAGE AS A THERAPEUTIC AGENT. is divided into Introductory, General and Local. INTRODUCTORY MASSAGE. In many affections it is necessary to com- mence the operation of massage with what has been termed introductory treatment. In the majority of cases of both acute and chronic affections of the joints it is well to ap- ply the treatment to the' neighborhood of the part, and especially above it. This is essential if the skin is abraded or if a severe inflamma- tion of the part exists. The treatment consists of centripetal strok- ings (with one or both hands) in connection with a few kneadings. Special attention should be paid to the in- side parts of the extremities where the prin- cipal veins and lymphatics pass. If possible and convenient, always try to get the aid of gravity by elevation. By this treatment we prepare the venous and lymphatic systeins to absorb the diseased 21 22 MASSAGE. particles subsequently expelled from the af- fected part. If for instance we have a case of synovitis of the knee-joint we commence by stroking the inside part of the thigh, slightly elevating the lower part of the extremity so as to get the aid of gravity. The introductory massage in treating circulatory and nervous affections of the head consists of Hoeffinger's method of massage of the neck so as to procure a free outlet for the venous blood from the head. In the treatment of hemorrhoids by mas- sage we should always commence by treating the liver, thereby procuring an outlet for the congested blood of the abdomen. When taken in time massage is really a specific in the treat- ment of hemorrhoids. This is mentioned only to emphasize the im- portance of the introductory massage in all manual treatment. The success of massage used in joint afifections will often depend upon how well and how judiciously the introductory treatment is applied. GENERAL MASSAGE. By general massage we mean the treatment applied to the whole body, with the exception of the head. The operator begins with the foot, stroking MASSAGE. 23 with one hand or kneading with the thumbs. Then he proceeds with the legs, the arms, the chest, the abdomen, and finally the back. All the manipulations may be used, and special at- tention should be given to the hacking. Some authors advise to first take the extremities, then the back, and finally the neck and abdo- men (Kleen and others). With this treatment we generally combine a few passive rotations or flexions, similar to those recommended for anemia. The patient must be lying in bed, well covered on those parts not operated upon. It is of advantage for the operator to begin with the left foot and leg, and then have the patient turn over to the other side of the bed, where the balance of the treatment may be conveniently performed. In regard to the time necessary to spend in giving general massage, I would advise the operator to begin with thirty minutes, and gradually increase the time so that one hour is consumed at the end of the first week. The length and the severity of the treatment should always be regulated by the patient's condition. General massage should not be employed until two hours have elapsed after meals. As scTon as a part is operated upon it should be covered up at once. 24 MASSAGE. LOCAL MASSAGE. By local massage we mean the treatment applied to the different parts of the body at one time; for instance, massage of the shoul- der. I. MASSAGE OF THE LEG. Position, — The patient is lying or haJf ly- ing on a bed or couch. The operator sitting at his side performs the following manipula- tions : 1. Stroking of the foot sole and dorsum; quick stroking with the palm of the hand to the sole of the foot finishing with firm and quick clappings with one hand, the other grasping the ankle underneath, so as to ele- vate the limb. 2. Stroking with both hands from the ankle to the hip, the hand on the outside reaching up to the crest of the ilium, the thumb of the hand on the inside, with mod- erate pressure, going down toward the groin. (Avoid pressure upon the tibia.) 3. Friction with the thumb upon the out- side of the leg from ankle to knee-joint, cov- ering principally the flexors of the foot. 4. Stroking with one hand of the same part. 5. Friction with the thumb upon the inside MASSAGE. 25 and posterior part of the leg, covering prin- cipally the gastrocnemius and the soleus. 6. Stroking with one hand of the same part. 7. Friction with the thumb or hand upon the outside, inside and the back part of the thigh, dividing it into four distinct parts so as to thoroughly work upon all the different muscles. 8. Repeated strokings over the whole ex- tremity, from ankle to hip. 9. Kneading with the two thumbs or both hands upon the different muscles of the whole extremity. 10. Hacking or clapping upon the whole ex- tremity, avoiding the bones. In certain cases (dropsy, rheumatism, etc.), it is well to have the limb elevated, thereby promoting the return of the venous blood. The limb should be frequently turned, so that the posterior part may receive proper attention. II. MASSAGE OF THE ARM. Position. — The patient is sitting or lying, with the semiflexed arm supported, if conve- nient. The operator sits at the side. I. Stroking with one hand on the outside of the arm, from the wrist to the trapezius. 26 MASSAGE. The other hand should support around the wrist, but care -should be taken that no pres- sure be used over the radial artery, as that checks circulation considerably. 2. Stroking with the other hand upon the inside of the arm, from wrist to shoulder-joint, the thumb going out toward the pectoral mus- cles. Support is given in a similar manner as described in i. 3. Friction with the thumb upon the exten- sors of the hand and fingers with repeated strokings of the same part. 4. Friction with the thumb of the other hand upon the flexors of the hand and fingers, with repeated strokings upon the same part. 5. Friction with the hand upon the arm proper. 6. Stroking of the whole arm, as described in I and 2. 7. Kneading with the two thumbs of both hands upon different muscles, special atten- tion being paid to reach the extensors and flexors in the forearm, the biceps, triceps, del- toid, supraspinatus and infraspinattis. 8. Hacking over the whole arm. The most common mistakes in treating the arm are : I. Too tight grasp around the wrist with the supporting hand. MASSAGE. 27 2. The arm is kept too rigid, preventing the proper and necessary relaxation of the mus- cles. 3. The muscles of the upper part of the arm and shoulder are too often neglected. 4. Inefficient kneading. III. MASSAGE OF THE CHEST. Position. — The patient is lying flat on the back, without head-rest, and the arms placed at the sides. 1. Stroking with both hands, one on each side of the sternurh. The manipulation should be performed upward and outward, making a somewhat circular motion (see Fig. 2). 2. Friction with thumb over pectorales major and minor, with repeated strokings. Al- ways from the origin (sternum) toward the insertion (the arm). 3. Kneading with the thumb and fingers (pinching) if the muscles of the one side be paralyzed. 4. Hacking or clapping over the chest may also be used, according to circumstances. Punctation in circles around the heart has also been recommended, but if used, great care should be taken. As a rule, all percussions applied to the tho- rax should be used with discretion. 28 MASSAGE. In massage of the breast place the hands at the outer circumference and by alternate frictions proceed upwards to the nipple. In cases of caked breasts it is often necessary to use frictions with the tips of the fingers over hard places to relieve distended ducts. Al- ways finish the treatment with the so-called "fulling" consisting of gentle pressure from the base of the breast upward with both hands alternately. Massage with camphorated oiji is a great relief in over-distended breasts. The operator should always be careful not to bruise the glands in any way, as tumors are liable to develop in after years and cause no end of trouble. Massage and exercise are the only means by which the bust can be properly developed. The patient should be taught how to breathe properly and for the quick de- velopment of the mammary glands use in the massage as above described the following pre- paration, recommended by Dr. W. J. Haynes: Lanoline, 2 ounces Cocoa Butter, 2 ounces Oil Cajeput, i ounce Oil Sassafras, J/$ ounce Extract Saw Palmetto, 2 ounces This preparation has not a fine odoi", but produces a pleasant sensation in the skin. It is a valuable compound wherever we wish to de- MASSAGE. 29 velop a part, but should not be used on the face. IV. MASSAGE OF THE BACK. Position. — The patient is lying on his face, without the head-rest; the arms should be kept at the sides. 1. Stroking with both hands, one on each side of the spinal column, from the base of the skull down to the sacrum. If on a large per- son, the operator had better divide the back into three parts, in such a manner as to first work next to the spinal column, then over the center of the back, and finally over the sides, remembering that by the last manipulation he may conveniently reach the liver or spleen, if desirable in certain cases. In the case of an infant, and especially in infantile paralysis, we often use in the stroking only the index and the middle fingers, one on each side of the spi- nal column. 2. Friction with the hand or with the, last two phalanges of the one hand, from the upper part of the trapezius down to the glutei, one side at a time. 3. Stroking as previously described. 4. Kneading with the two thumbs, one on each side of the spine, so as to act upon the spinal nerves. The hands should be spread 30 MASSAGE. over the back, supporting the sides if possible (see Fig. 15). 5. Pinching on the sides so as to act upon the sympathetic ganglia. Fig. 15, — Kneading of the Back. 6. Hacking with one hand on each side of the spine, up and down, from the sacrum to the neck. 7. Clapping on both sides, lengthwise, one at a time. 8. Stroking repeated; performed very quick- ly if we wish to stimulate; very slowly and firmly if we wish the manipulation to have a soothing effect. MASSAGE. 31 V. MASSAGE OF THE GLUTEI. Position. — The patient is standing with the body bent forward and supported on a lounge or bedstead. The operator stands behind and performs : Fig. 16. — Stroking of the Glutei. 1. Stroking with both hands from the spine outward, downward (see Fig. 16). 2. Friction with the hand; one side at a time. 3. Beating in circles, one side at a time. 32 MASSAGE. If the patient is suffering severe pain from standing the manipulation may be performed while he is in bed, with a couple of pillows plac- ed underneath his abdomen and thighs. VI. MASSAGE OF THE ABDOMEN. Position. — The patient is lying flat on his back, generally without head-rest, and with the knees drawn up, so as to^ relax the abdo- minal muscles (see Fig. 17). It is most con- FiG. 17. — Position in ]\Iassage of the Abdomen and the Ventricle. venient for the operator to sit at the patient's right side. 1. Friction with the tips of the fingers in circles from right to left over the umbilical re- gion of the abdomen, thereby scting upon the smaller intestine. Begin with a very gentle pres- sure, gradually increasing the strength of the manipulation (see Fig. 18). 2. Spread the right hand over the abdomen MASSAGE. 33 so that the ball of the hand covers part of the ascending colon; press over that part upward to Fig. i8. the transverse colon; then stroke with the radial border of the hand firmly over to the left side. Here the tips of the fingers should be used for the downward pressure over the descending 34 MASSAGE. colon. The manipulation is repeated in circles without interruption (see Fig. 19). Fig. 19. These two manipulations are schematically illustrated in Figs. 18 and 19, and the operator MASSAGE. 35 should teach the patient how to perform them on himself every morning, particularly in cases of constipation. A cannon ball covered with leather is also very useful in manipulation No. 2, when the patient for some reason is obliged to do it him- self. They can be procured from Charles Lentz and Sons, Philadelphia. 3. Kneading with the heel of the hand over the whole abdomen, going carefully at first and avoiding any sore places. Fecal lumps are often found and they should be gently and gradually broken up. Near the sigmoid flexure we can sometimes accomplish more by substituting this manipulation for that of the friction with the tips of the fingers. The reason for that is that we can reach in deeper and our efforts be- come more localized. The same refers to the breaking up of adhesions around the appendix and the ovaries. This manipulation will sometimes produce an unpleasant sensation at first, which is fre- quently caused by the patient not breathing properly. Talk to him so as to make him forget that he is being treated. Some oper- ators place one hand as a support under the patient's back, and it is a very good idea, as the manipulation feels more comfortable and 36 MASSAGE. we have a better and more fixed control over the abdominal viscera. 4. Vibrations over the descending colon. 5. Turn the patient on his face and perform firm beating of the sacrum in circles so as to act upon the rectum. Massage of the abdomen must never be ap- plied soon after a meal is partaken of. It is well to tell the patient to evacuate the blad- der before beginning the treatment. In chronic cases of constipation it is a good plan to have the patient take an enema, so as to clean out the sacculated colon before starting the first treatment. The indiscrimi- nate and continued use of injections will pro- duce a relaxed condition of the bowel, while on the contrary massage will strengthen and stimulate to normal activity its various mem- branes. VII. MASSAGE OF THE LIVER. Position. — The patient is lying half way turned over on his left side. The operator sits at his right side. 1. Friction with the palm of the hand in large circles covering gradually the entire or- gan. 2. Kneading with the heel of the hand. 3. Clapping over the entire organ, firmly MASSAGE. 2,7 over the right hypochondriac region, more gently over the epigastrium and left hypO- chondrium. 4. Palmar vibration over the different lobes. 5. Digital vibration, working the separated and bent fingers gradually under the curve of the ribs and costal cartilages. Deep respiratory exercises are very import- ant in connection with massage of the liver. VIII. MASSAGE OF THE SPLEEN. Position. — The patient should, of course, lie on his right side. This treatment is per- formed in a similar way as massage of the liver. IX.. MASSAGE OF THE STOMACH. Several methods have been proposed to reach the ventricle by massage. They are all more or less dangerous, and we mention one of them only, for the completeness of the sys- tem. Position. — The patient is lying flat on his back, as described on page t,^. Fig. 17. I. The operator sits at his side, and quiet- ly placing his right hand, with abducted thumb, about two inches below the ribs of the left side, he performs strokings and fric- 38 MASSAGE. tions of the organ, from left to right. Fric- tion with the tips of the fingers is the most convenient form to use. 2. Kneading with the two thumbs may also be used, but the operator should always re- member that he has to deal with very sensi- FiG. 20. — Stroking of the Forehead. tive parts, consequently his pressure should be moderate. 3. Vibration with the tips of the fingers. X. MASSAGE OF THE HEAD. Position. — ^The patient is sitting, comfort- ably supported. I. Stroking. — Beginning with the back of the head, keeping the left hand firmly on the MASSAGE. 39 forehead, and with the right in a V-shape, stroke downward. In stroking the forehead place the thumbs between the eyebrows and stroke firmly over the temples to the ears, both thumbs working together, so as to act upon the supraorbital nerve (see Fig. 20). 2. Friction with the one hand, the other supporting, on the diagonally opposite part of the head. I have always found it best and most ex- pedient to divide the head into four divisions for applying this manipulation, always begin- ning with the back part of the right side. 3. Friction with the tips of the fingers pressing firmly so as to move the scalp and to prevent breaking off the brittle or weakened hairs. This manipulation is particularly valu- able when we work in a hair tonic. By work- ing the scalp we draw the blood to the hair- roots. 4. Hacking is used with both hands strik- ing together, making circles over the head, beginning on the top and moving backward, ■downward, and forward to the starting point. For increasing the hair growth the author has never found anything to equal the follow- ing treatment. Shampoo the head freely with a good, pure tar soap and let the lather re- main for two hours, then wash it ofif with 40 MASSAGE. warm water, adding a little of some good tonic. Now massage the scalp thoroughly with crude petroleum and allow that to stay on over night. Of course the patient must wear a night-cap or in some other way pro- tect the pillowslip. The author has experimented lately with the new oxygenated petroleum product, "Pe- trogen" (Wyeth), as a base for a hair tonic and the results have been so exceptionally good that he begs to call the reader's special attention to it. XI. MASSAGE OF THE FACE. Position. — The patient is lying or sitting with the head comfortably supported. Tell him to relax the muscles of the head and neck. 1. Stroking with the two thumbs over the forehead, starting near by the eyebrows gradually in succession working up to the hair-roots as in Fig. 20. 2. Friction with the tips of the fingers in small circles, the other hand being used to stretch the part worked upon; for this manip- ulation divide the forehead in two sections vertically. This is principally applied with the object of overcoming wrinkles of the fore- head. 3. Repeated stroking as in No. i, the oper- MASSAGE. 41 ator being careful to tightly grasp the tem- ples, so as to make the patient feel that the head is properly supported. 4. Stroking with the tips of the fingers over and below the eyes from the nose out- ward to the temples, both sides at a time. 5. Friction with the tips of the fingers over the same part with special attention to the outer corner of the eye and below it, where we generally find the so-called "crow feet." Stretch the part with the thumb and fingers of one hand, and perform the friction with the tips of the fingers of the other hand. ■ 6. Repeated strokings as in No. 4. 7. Stroking with the two index fingers over the nose from the eyebrows downward and outward. Raise the hands up high and hold them so during the manipulation from start to finish. In other words, the heel of the hand should be on a level with the tip of the fin- ger. 8. Stroking with both hands one on each side of the face from the extreme lower part of the inferior maxillary region well up to the temple. We stroke upwards because the face frequently presents a drawn and pulled-down appearance; particularly so after a prolong- ed illness or a siege of nervous worry or ten- sion. 42 MASSAGE. 9. Friction and kneading of tlie cheeks, picking up the muscles as much as possible, always remembering that the orbicularis oris is the insertion of most all the principal facial muscles. 10. Repeated strokings as in No. 8, only the patient is told to inflate his cheeks and to retain the air, breathing freely through his nose. 11. Stroking with the fingers around the lips and chin. 12. Frictions with the tips of the fingers over the same part of kneading if our object is to remove superfluous fat. In the latter case never use any fatty ointment, but in- stead some benzoin preparation that will help to contract the tissues. 13. Strokings repeated, as described in No. II. In treating wrinkles the operator should re- member that they are not, as a rule, caused by some trouble in the skin itself, but mostly always by a relaxed or weakened condition of the underlying muscular tissues ; consequently our work must not be superficial but deep, care being taken, of course, not to bruise the patient. By stimulating the circulation to this particular part, we bring in increased nour- MASSAGE. 43 ishment to the relaxed and weakened tissues. It is really wonderful what can be done in the way of improving the facial expression by scientific massage, but like other parts of this valuable therapeutic, it has been horribly abused. Steaming the face is frequently prac- ticed but it is not to be recommended inas- much as it frequently causes the patient to contract a severe cold. Facial paralysis and "tic douloureux" have been traced to steam- ing of the face. A massage operator who cannot, by his manipulations, bring enough blood to the relaxed parts should not treat a face! Scars are treated by stretching the part and working with the tips of the fingers in circles across the scar-tissue, finishing with strokings. Never use an ointment for facial massage that contains vaselin or lanolin. They are both apt to produce hair growth, particu- larly the former. There are so many inferior preparations on the market that the author feels prompted to here give a recipe for the best facial skin food known, and in the many years he has recommended it, he has never heard anything but the very best results from it. Oil of Sweet Almonds 2 ounces Spermaceti J4 ounce White Wax 54 " Orange fl. water V^ 44 MASSAGE. It will be noticed that there are no mineral fats amongst the ingredients. Care should be taken to see that the genuine spermaceti and wax be used, as both these preparations are "made" from coal oil and we should not Fig. 21. — Massage of the Face. be willing to risk causing a hair growth on the face. If we wish to make the eyebrows thicker and wider we can do so with the aid of coal oil preparations, but it must be done by a trained person. Mr. C. Keeny, 1601 Arch street, Philadelphia, prepares the above- mentioned "Skin-Food" and it can be ob- tained from him at any time. MASSAGE. 45 In cases of facial paralysis it becomes ne- cessary to work somewhat dififerently than previously described. Cover the antiseptic- ally cleaned index finger with a rubber tip or a silk handkerchief, insert it in the mouth and with the thumb stroke the muscles in the su- perior and inferior maxillary regions (see Fig. 21 ). The index acts as a good and easily regulated support. Friction and kneading are given in a similar way. In applying vibra- tions to the facial nerves and muscles, the author has used with the greatest satisfaction the mechanical vibrator made by the Vibra- tile Company of New York City. There are now many different vibrators on the market and the masseur should have at least one of them. Most of them are run by power obtained from the electric street cur- rent. Unfortunately this form of massage has been taken up by the barbers, many of whom use it without thought and discretion. XII. MASSAGE OF THE EYE. Position. — The patient sits with the head leaning backward, the operator standing at his side. I. The index finger is placed on his eye- brow, the middle finger grasping the eyelid, which is pressed, with either a radial or cir- 46 MASSAGE. cular motion,. against the eye. Be very care- ful not to use too much strength, and perform the movement as quickly as possible (see Fig. 2.2). By placing the index on the eyebrow we take the weight of the heavy hand off the ten- FiG. 22. — Massage of the Eye. der organ. The lid really performs the mas- sage by pressure generated through the finger. 2. Vibrations with the fingers (see Fig. 32). While it is understood that the operator's hands should at all times be scrupulously clean, it becomes necessary to always use a mild anti5-eptic before treating the eyes. MASSAGE. 47 XIII. MASSAGE OF THE THROAT. Position. — ^The patient is sitting, in a some- what reclining position. Fig. 23. — ^Massage of the Neck, Ger&t's Method. Stroke with two fingers on one side and the thumb on the other side of th-e trachea. Fin- ish with similar stroking in connection with a slight shaking. B— (M 48 MASSAGE. For the position of the hands in the vibra- tion of the trachea and its surrounding tissues see Fig. 31, on page 60. Fig. 24. — Massage of the Neck, Hoeifinger's Method. XIV. MASSAGE OF THE NECK. Position. — The patient faces the masseur (see Fig. 23) with the head thrown back, so as to expose the neck. The operator places his hands at the lobes of the ears and per- MASSAGE. 49 Fiu. 25. — Kneadings of the Neck. so MASSAGE. forms a stroking downward to the shoulder. The patient should be told to breathe freely and easily. This method (originated by Dr. Gerst) is used principally to increase the circu- lation in the veins of the neck. Another method of massage of the neck has been recommended by HoeMnger. The patient is sitting with the head erect. The operator stands behind and places his hands under- neath the patient's ears. The stroking is per- formed downward toward the shoulder, the hand covering the principal part of the trape- zius (see Fig. 24). I have often found frictions and kneadings of the neck (see Fig. 25) of the greatest bene- fit, especially in cases of congestions and headaches, as recommended by Reibmayer. XV. MASSAGE OF THE NOSE. Position. — The patient reclining. The forefinger of each hand of the operator is applied, with mild pressure, to each side of the nose, of the patient. A stroking down- ward is slowly and carefully performed. In removing scars on or near the nose stretch the part and work crosswise, as de- scribed under massage of the face. MASSAGE. 51 XVI. MASSAGE OF THE OVARIES. Position. — The patient should be flat on her back without head-rest and the knees drawn up so as to completely relax the abdomen. 1. Stroking with both hands. The operator stands with her back to the patient placing her hands near the crests of the ilium, stroke simultaneously with both hands downward and inward to the center. 2. Friction with the tips of the fingers. This manipulation is used particularly when we wish to break down adhesions. The patient should be instructed to breathe deeply. Massage of the ovaries is freely rec- ommended by European gynecologists and we have many remarkable reports of complicated cases successfully treated. XVII. MASSAGE OF THE UTERUS. Position. — The same as for massage of the abdomen (see Fig. 17, page 32). The external method is merely a modification of the massage of the abdomen. The patient must be in a half lying position, with the knees flexed in order to relax the abdominal rhus- cles. Begin with the circular manipulations, from right to left, following with stroking and friction over the lower part of the abdomen. It is generally used for atony of the uterine 52 MASSAGE. organs, and must always be succeeded by perc'ussion or -beating of the lower part of the back. The Swedish movements are a valuable auxiliary, controlling as they do, the circula- tion in the abdomen and the lower extrem- ities. The massage increases the current in the blood-vessels and the lymphatics, the re- sorption is restored, and the muscular organs in the smaller pelvis are strengthened. Special manipulation of the intestines re- lieve the bowels, which in cases of uterine af- fections must be of great importance. 2. A second method is rather difficult to per- form, as one or two fingers must be inserted in the vagina or the rectum, against which we work from the outside. It should be perform- ed only by a person who has a thorough knowledge of the parts; in fact it belongs to the practice of the' gynecologist alone. Dr. Homer C. Bloom, of Philadelphia, has writ- ten a valuable little pamphlet on "Pelvic Mas- sage." He describes the treatment and fur- nishes reports of some few cases. There is one part which is particularly interesting to every scientific masseur. Dr. Bloom, after summarizing the results, says : "It has been noticed that, in a great number of these cases, there was a concomitant condition of hemor- rhoids, which were relieved in every instance." MASSAGE. 53 Dr. Norstrom, in Paris, recommends in massage of the uterus: 1. Graduate the pressure of the uterine body after you have seized it. 2. In order to get a good hold, push down during expiration; maintain the distance gained during inspiration and start again dur- ing the next expiration. 3. Be careful not to increase by any sudden movements, the painful impression experi- enced by the patient when the uterus is first taken hold of; wait a moment before begin- ning pressure. The pressure sometimes pro- duces reflex pains in various parts of the body. 4. Devote all your attention to supporting the uterus. This is easy when it is large and soft; very diflficult when it is small and hard; it is then that it moves with great facility to one side or the other. Any one specially interested in uterine mas- sage will find a great deal of valuable informa- tion in a book published by Dr. Rob. Ziegenspeck, of Miinich, and translated into English by Dr. F. H. Westerschulte, of Chi- cago. In this book Major. Thure Brandt's methods are carefully analyzed and illustrated. 54 MASSAGE. XVIII. MASSAGE OF THE PROSTATE GLAND. Two methods are used, one external and one internal. In the first the patient is placed flat on his back, holding himself, the repro- ductive organs stretched up on the abdomen. The perineum is massaged with strokings and frictions. In the other method the operator inserts his covered index or if necessary index and mid- dle-finger in the patient's rectum, and fixing the gland he supports it from the inside while the thumb and the fingers of the other hand perform the manipulations. The bladder should always be evacuated before beginning the treatment. Some forms of vibrations have proved very useful, particularly when applied through the rectum internally. PRESSING AND SHAKING ^^^ (VIBRATIONS). ^ Closely connected with the massage proper are the oscillatory movements, — which we call vibrations, — used principally upon the extremi- ties and over some of the internal organs. We have two principal forms of vibrations — viz., digital, with one or more fingers; pal- mar, with the palm of the hand. In digital vibration the operator uses his fingers in verti- cal motion over a nerve or separate organ, no flexion or extension of the hand being allowed, as too lieavy pressure will then be made. "The straining of the muscles in the operator's arm ought to be so slight as to be scarcely per- ceptible to any one who has his hand over them." In Fig. 26 we have represented a digital vi- bration of the forearm. Vibration of the whole arm is given in the following manner: The operator grasps the hand and shoulder, keep- ing the arm in an extended position, and shakes as quickly as possible. The movement 55 =;6 MASSAGE. Fig. 26. — Digital Vibration. Fig. 27. — Shaking the Arms. MASSAGE. 57 may also be performed by two operators, as shown in Fig. 27. In vibration of the leg the operator grasps the foot with one hand and the thigh, as high Fig. 28. — Vibration of the Liver. as possible, with the other, he raises the limb up and shakes it quickly. In Fig. 28 we have demonstrated the palmar vibration of the liver. Change the position of the hand several times, so as to act upon the 58 MASSAGE. different parts of the organ. In vibration of the spleen the hand is placed in a similar posi- tion. Fig. 29. — Vibration over the Solar Plexus. Vibration at the pit of the stomach is clearly demonstrated in Fig. 29. Place the finger-tips about two inches below the ensiform cartilage and perform the shaking backward and up- ward. The patient may also stand with his MASSAGE. 59 hands clasped at the back of his head. This form of vibration is exceedingly useful in cer- tain affections of the stomach. It also acts strongly upon the solar plexus. Fig. 30. — Vibration over the Bladder. Pressing and shaking of the bladder. The patient is lying flat on his back with knees drawn up so as to relax the abdominal mus- cles. The operator stands at his side, as in Fig. 30, and with his fingers he performs a 6o MASSAGE. gentle pressure and quick vibrations. Used in affections of the bladder and the prostate gland with modifications, also in uterine and rectal troubles. Vibration of the larynx is shown in Fig. 31. The thumb is placed on one side of the thyroid Fig. 31. — Vibration of the Larynx. cartilage and the fingers on the other. It should be performed gently at first until the patient becomes used to it. In Fig. 32 we show the vibration of the eyes. The patient is sitting with the back supported. The operator stands behind and places two fingers over each eye. The lids should not MASSAGE. 6 1 move up and down, but be kept steady, as the vibration is generated through them. Vibrations are also used over the pharynx, the thorax (one hand on each side generally) Fig. 32. — Vibration of the Eyes. the head, the heart and different parts of the abdomen. The author frequently uses the vi- bration of the descending colon and over the sigmoid flexure with the most excellent re- sults. 62 MASSAGE. Pressing and shaking have a stimulating and strengthening effect upon the nerves ; they also act strongly upon the circulation of the venous blood-vessels and the lymphatics. Kellgren's "Technic of Manual Treatment" is an interesting book on the subject of vibra- tions in general and their therapeutic indica- tions. DETAILS OF TREATMENT. The strength of the various manipulations is a principal point in the massage treatment, and the "self-made" masseur will often unneces- sarily bruise his patients. As a rule, begin with a moderate pressure, ascertaining from the pa- tient his sensation. A new operator has often the fault of using too much pressure. To avoid abrasions most all German and Scandinavian operators use some kind of olea- ginous substance. Among preparations recom- mended we have used with advantage : White vaselin, glycerin, lanolin, lard, olive oil, arnica oil (in sprains or distortions), belladonna oint- ment (in neuritis), — the two latter only when recommended by physicians. Any of these preparations may be used, but I would caution operators against using too much glycerin, as it tends to irritate the skin. In America cocoa- nut-oil or cocoa-butter has been freely used. Some physicians and patients object to using grease of any kind. It is not my intention to advise operators to use large quantities of fat, 63 6— iM 64 MASSAGE. but just enough to make the manipulatiohs smoothly. On very hairy persons it is abso- lutely necessary to use some kind of grease. All grease must be well rubbed off the skin before leaving the patient. The operator should wash his hands before and after, every treatment; if necessary, use some antiseptic. Every part should be well covered after masseeing it. MASSAGE MUST ALWAYS BE APPLIED ON THE NUDE SKIN. The masseur who works outside the clothes, when acting upon special parts of the body, "works in the dark," tires his fingers, and loses a principal feature in the application — the feeling, which is so extremely necessary in a careful masseur. Some authors claim that working outside the clothes will save the pa- tient's skin; but could anything be more pleas- ant and agreeable than a soft hand ? CONTRAINDICATIONS FOR MASSAGE. In several affections massage is most cer- tainly contraindicated ; and in many the treat- ment must be performed very carefully. The first important requisite is that the skin is not severely abraded. Consequently, mas- sage is not to be used in — MASSAGE. 65 1. Skin affections: Wounds, burns, erysip- elas, eczema, acne, and specific eruptions. 2. Certain Affections in the Blood-vessels or Lymphatics.— This must be especially remem- bered in elderly persons, whose vessels are, as a rule, very sensitive to mechanical pressure. 3. In tumors and purulent inflammations, in v^^hich we run the risk of transferring the virus to other healthy tissues. 4. In all acute affections of the bone-tissue. 5. In severe constitutional or local diseases, where complete rest is necessary. (When con- valescent, massage, is, on the contrary, in many cases, one of the best tonics.) 6. Pregnancy. — As a rule, avoid massage dur- ing pregnancy, and especially massage of the abdomen. 7. All affections in which the pressure is lia- ble to cause a hemorrha'ge. During menstruation it is best to discontinue general massage, and under no circumstances should the abdomen be treated unless so or- dered by the attending physician. Such pre- scriptions will sometimes be issued in cases of a retarded or too scanty flow. SWEDISH MOVEMENTS. The Swedish Movements are a series of system- atic exercises therapeutically applied to the human body. "Every exercise the direction and the duration of zvhich are iixed is a movement." That is the definition of a movement given to us by the Swede, P. H. Ling, who lived and worked in the early part of the last century. He erected the first system of scientific move- ments, as before his time no approach had been made to a method of designating and classi- fying the positions and various movements of the body for the purposes contemplated in the Movement Cure. In every science terminology is necessary; So even in this. Ling gave every movement a complicated or double name, the first part of which indicated the position which the pati- ent must assume, the second part telling the nature of the movement itself; for instance, sitting, rotation of the arms. Thus it is left to us to first analyze the posi- iions and afterward the movements. 66 SWEDISH MOVEMENTS. 67 POSITIONS. Movements may be given or performed in many different positions of the body. It is necessary to have a commencing, intermediate and terminating position. Ling said that to render any movement definite and exact, a point of departure, a point of termination, and the line through which the b,ody or any of its parts must pass, are to be clearly determined, as well as the rhythm of the action itself. There are in Ling's system five principal or fundamental positions — viz. : 1. STANDING, 2. SITTING, 3. LYING, 4. KNEELING, 5. SUSPENDING. Standing. — In this position, the legs, trunk, and head are erect. The heels should be to- gether and the feet should form right angles. The arms should be kept at sides (see Fig. 33). Sitting. — In this position the buttocks and the posterior part of the thigh rest against the chair or sofa. The legs, close together, form right angles with the thighs. The trunk and head should be erect (see Fig. 34). 68 SWEDISH MOVEMENTS. Kneeling. — The body rests upon the knees and the anterior part of the legs. The feet should be kept outside of the supporting part, as demonstrated in Fig. 35. Fig. 33. — Standing Fig. 34. — Sitting Position. Position. Fig. 35. — Kneeling Position, r t Fig. 36. — Lying Position. Lying. — In this position, the patient's body rests against the sofa or bed with the head, the back and the legs (see Fig. 36). SWEDISH MOVEMENTS. 69 Suspending. — In this position the patient is to grasp a horizontal bar that is elevated so that the feet do not touch the floor. There should be the same distance between the hands on the bar as between the shoulders (see Fig. Fig. 37. — Suspending Position. ;^y). The position is very tiresome, as it, to a certain extent prevents respiration and circu- lation, on account of the extension of the tho- rax. It should be used with great care; and if the patient is weak, support his sides until he becomes accustomed to it. ^o SWEDISH MOVEMENTS. From each one of these principal positions Ling formed many derivatives or subdivisions of positions. We only mention the most important, and the illustrations will enable the reader to fully understand them. DERIVATIVE POSITIONS FROM THE STANDING POSITION. I. With the Lower Extremities. Fig. 38.— Flex- Fig. 39.— Little Fig. 40.— Walk- Standing. Knee-bend. Standing. SWEDISH MOVEMENTS. 71 Fig. 41. — Side- Fic. 42. — Side- Standing. Flex- Standing. Fig. 43. — Balance- Standing. Fig. 44- 72 SWEDISH MOVEMENTS. 2. With the Upper Extremities. Fig. 45. — Bent- Fig. 46. — Before Bent- Standing. Standing. Fig. 47- Fig. 48.— Talk- Fig. 49.— Arm Stretchec Standing. Standing. SWEDISH MOVEMENTS. 73 Fig. SO- — Wing- Standing. Fig. Si.-^Think- . Standing. Fig. 52.— Resist-Standing. Fig. 53.— Rest-Standing. 74 SWEDISH MOVEMENTS. Fig. 54. 3. With the Trunk. Fig. SS-— Curve- Fig. 56.— Turn- Fig. 57.— Stoop-Curve- Standing. Standing, Standing. SWEDISH MOVEMENTS. 75 DERIVATIVE POSITIONS FROM THE SITTING POSITION. I. With the Lower Extremities. Fig. s8. — Long-Sitting. Fig. sg. — Half-Long-Sitting. Fig. 6o. — Straddle-Sitting, g SWEDISH MOVEMENTS. Fig. 6i.— Short- Sitting. 2. With the Trunk. Fig. 62.— Fall- Sitting. SWEDISH MOVKMENTS. V DERIVATIVE POSITION FROM THE KNEELING POSITION. Fig. 63. — Side-Kneeling. DERIVATIVE POSITIONS FROAF THE LYING POSITION. See Fig. 17. Page 29. (Crook-lying.) Fig. 64.— Sit-Iying. 78 SWEDISH MOVEMENTS. The subdivisions of positions here mention- ed have given rise to a difficult terminology, as in many of them no equivalent English word can be found. They are, however, of great importance to everybody who contem- plates practising Swedish movements, and as to their practical use we will refer to them in Fig. 65. — Crook-Half-Lying. connection with the movements. Only a few examples of their importance will be given here. In the derivative positions of standing, with the arms, we can act upon certain parts or temporarily prevent certain organs or tis- sues from performing their functions. In the positions demonstrated in Figs. 43, 47, 49, 51, the chest is considerably expanded, which causes deeper inspirations. In cases of "round shoulders," "narrow chest," etc., it is of great importance to select the proper one of these derivative positions for the movement that is to be used. DIVISION OF MOVEMENTS. ^^. Ling and his pupils divided the movements into : 1. Single. 2. Double. The single movements they again subdivid- ed into passive and active, and the double move- ments into concentric and excentric. Passive movements are such as are applied to the patient without his assistance. (They may be performed by an operator, by a machine, or through the power of gravity.) Active movements are performed by the pati- ent. Concentric {active-passive) movements are per- formed by the patient, zvhile the operator or some other power resists. Excentric (passive-active) movements are per- formed by some power outside of the patient, while he resists. The principal difference between the concen- tric and excentric inovements is that in the for- mer the muscle is shortened, in the latter it is 79 7— .M 80 SWEDISH MOVEMENTS. Stretched. As to their nature and physiologic action, it is easy to understand that they are but little different from the single active move- ments. Practically they are of great use, as by them we are able to exactly iix the amount of me- chanical work done by the patient in each movement. To make the terminology somewhat simpler for the reader, we have in the description of the movements used the expression duplicated active movements, by that covering both con- centric and excentric movements in the Ling system. THE VARIOUS MOVEMENTS. 1. Rotation. 2. Flexion and Extension. 3. Separating and Closing. 4. Bending. 5. Raising. 6. Pulling. 7. Turning. 8. Depression and Elevation. I. ROTATION. Rotation is a circular movement by zvhich the different joints are brought into motion within their natural limits. I. Rotation of the Feet may be performed with the patient in a sitting or half-lying posi- tion. SWEDISH MOVEMENTS. 8l In the first position, the operator sits in front of the patient and, taking the feet in his lap, grasps the toes and moves the feet outward, describing a circle. In the second position, the patient is half-lying, his feet resting on the couch or bed. The operator grasps the toes and proceeds with the same motion as above. Relax the muscles, if necessary, by shaking the toes. The rotation of the feet is intended to pro- mote circulation in the lower extremities and is often used for attracting the blood from other parts. The movement is performed fif- teen to thirty times. The strength of the mo- tion depends upon the size of the circle de- scribed. (Passive.) II. Rotation of the Foot. — The operator, sitting in front of the patient, takes the heel in his left hand and, grasping the toes with the right, performs a rotatory motion from the ankle, pressing the foot forward. Ten to fif- teen times in each series. It is used principally for deformities and afifections of the feet. (Passive.) III. Rotation of the Leg. — The patient is in a half-lying position. The operator, placing one hand on the sole of the foot and the other below the knee, with the thumbs inward, raises the leg and performs a circular motion by the 82 SWEDISH MOVEMENTS. hip-joint, pressing upward, inward and out- ward. Twelve to fifteen times on each limb. It is used to regulate the circulation of the abdominal organs and to prevent stiffness in the hip-joint. (Passive or Active.) IV. Rotation of the Arms. — The patient sitting. The operator, standing behind, grasps the extended arms below the elbows and rotates them upward and outward. The patient may also be in a standing position, in which case the operator must support him with his chest. It is used principally to assist respiration and circulation. (Passive or Active.) V. Rotation of the Shoulder. — ^The patient sitting or standing. The operator, putting one hand on the shoulder-joint and the other be- low the elbow, rotates upward and outward. Fifteen to twenty times. The movement is used for stiffness in the joint and for inflam- mation of certain muscles. (Passive.) VI. Rotation of the Hand. — The operator takes the patient's hand, and, grasping the wrist with his free hand, rotates from side to side. Ten to eighteen times. It is used for stiffness in the wrist after fractures of the arm; also to increase the circulation. (Pas- sive.) VII. Rotation of the Head. — The patient SWEDISH MOVEMENTS. 83 sitting with the back supported. The oper- ator, placing one hand on the forehead and the other on the neck, rotates slowly from side to side. Eight to ten times. It is used for anemia of the brain, stiflfness of the neck, etc. (Passive.) VIII. Rotation of the Body.— The patient in a sitting position, with hands on hips. The operator, standing behind, places his right hand on the right shoulder-blade, and his left in front, on the chest of the left side, and per- forms the motion in such a way as to press the patient forward with one hand and carry him backward with the other, always being careful to describe a circle. When the move- ment is performed to. one side ten to fifteen times, change the position of the hands and rotate toward the other side. It is used prin- cipally for affections of the abdomen. To se- cure a very strong action of the movement, the patient turns his body somewhat in the motion. (Passive.) IX. Rotation of the Pelvis. — The patient resting with body on a couch or bed, and grasping it to keep immovable, the lower ex- tremities extended. The operator grasps the feet and proceeds with the rotation of the legs, endeavoring to produce a circle large enough to bring the pelvis into action. 84 SWEDISH MOVEMENTS. Rotate ten times to each side, if the pati- ent's strength permits. (Passive.) This movement may also be active and is performed as in Fig. 66. The aim of the rotation is to lengthen and shorten the veins, so as to produce a sucking of their contents, thus stimulating the circulation and as- sisting the heart in its action. Fig. 66. 2. FLEXION AND EXTENSION. I. Foot. — The patient lying or sitting. The operator, grasping the ankle with one hand and the. toes with the other, moves the foot up and down as far- as the limits of the joint per- mit. Ten to eighteen times. It is used for deformities, and especially for stiffness of the Achilles tendon. (Passive and Duplicated Active.) SWEDISH MOVEMENTS. 85 The movement may also be performed on both feet at the same time, as demonsti-ated in Fig. 67. II. Leg. — The patient is in a half-lyiiig (see Figs. 70 and 71) or standing (see Fig. 69) posi- tion. The operator places one hand at the Fig. 67. — Flexion and Extension of the Feet. knee, the other either on top of the instep or underneath the sole of the foot. The patient generally moves the limb up and down while the operator resists. (Duplicated Active.) It may also be a passive movement, and is used for stiffness in the knee and hip-joint, and for contraction of certain muscles. In Fig. 68 we have demonstrated the single active, standing flexion and extension of the 86 SWEDISH MOVEMENTS. leg. Until the patient gets used to the exer- cise, it is safest to have him grasp something to support himself and prevent him from fall- ing. The effect of this movement is not con- fined to the extremity only, but the abdominal muscles are strongly and effectively acted Fig. 68. — Standing Flexion and Extension of the Leg. upon. It is therefore very valuable in the treatment of constipation and hemorrhoids. III. Arms. — The patient sitting. The oper- ator, standing behind, grasps the patient's wrists, telling him to keep his elbows close to the body and to move the arms up and down, the operator making suitable resistance. Ten SWEDISH MOVEMENTS. 87 times. It is a circulatory movement. (Dupli- cated Active.) IV. Arm. — The patient sitting. The oper- ator, standing in front, grasping the wrist with one hand and around the triceps muscle with the other, the patient moves the ai-m up and down, the operator making suitable resistance. Fig. 69: — Flexion and Extension of the Leg. Ten to fifteen times. The motion may also be passive, and is used for acting upon the joints and for certain local afifections. (Passive or Duplicated Active.) V. Hand. — ^The patient sitting. The oper- ator, in front, takes the fingers firmly in one hand, the other grasping the wrist, and works 88 SWEDISH MOVEMENTS. Fig. 70. Fig. 71. SWEDISH MOVEMENTS. 89 up and down, about ten times. It is used for stiffness of the wrist and for writers' cramp. (Passive or Duplicated Active.) Flexion and extension are used principally for regulating the circulation in certain parts and for relieving local congestion. Fig. 72. 3. SEPARATING AND CLOSING. I. Arms. — The patient sitting with arms ex- tended. The operator, standing in front, grasps his wrists ; the patient moves his arms out and in, the operator resisting. It is used for ex- panding the chest. (Duplicated Active.) (See Fig. 72.) II. Legs. — The patient sitting, or half-lying. The operator grasps the ankles underneath, 90 SWEDISH MOVEMENTS. the patient separates and closes his legs, with the resistance of the operator, who may need an assistant. (Duplicated Active.) This movement acts upon different abdomi- nal organs. III. Knees. — The patient in a half-lying position, with the knees flexed. The operator, standing at his side, places one hand on each knee and resists the patient, who separates and closes his legs. Eight to sixteen times. (Du- plicated Active.) 4. BENDING. I. Head. — The patient, sitting or suspended, bends the head backward and forward eight to ten times. It is used to force the blood to the. head in anemia of the brain, and to act upon the muscles of the back in lateral curvature of the spine. (Active or Duplicated Active.) In Figs. 73 and 74, we have demonstrated the active bending of the head forward and backward, and to the sides respectively. These are used when we wish to draw the blood from the head in plethoric individuals or when we wish to develop the neck. The patient resists himself while performing the movement. II. Body (sideways). — Suppose a case of lateral curvature of the spine. If the right SWEDISH MOVEMENTS. 91 Fig. yz. Fig. 74- Fig. 75- Fig. ^6. 92 SWEDISH MOVEMENTS. Fig. 77. Fig. 78. ^"N W^V-.^-^ Fig. 79. SWEDISH MOVEMENTS. 93 side is the originally afifected one, the patient Stands with his left arm straight up, close to the head. The operator, standing behind, Fig. 8o. places one hand on the right side, at the high- est point of curvature, the other on the oppo- FiG. 8i. site hip; the patient bends slowly toward the side, thus acting upon the afifected muscles. The movement may also be single active, as shown in Fig. 74. 94 SWEDISH MOVEMENTS. Bending of the body sideways may also be performed in a sitting position (see Fig. 75), or as a single active movement from side to side as shown in Fig. 79. This is particularly recommended when we wish to act upon the liver or spleen. It should be performed slow- ly, otherwise the patient is apt to become dizzy. Fig. 82-. III. Body (forward and backward). — The patient is standing with the hands on hips (see Fig. yy') or with the arms stretched (see Fig. 78). He bends slowly forward and back- ward, being careful to keep the heels to- gether. (Active.) IV. Trunk (up and down). — See Figs. 80 and 81. This movement should only be used on SWEDISH MOVEMENTS, 95 strong individuals, it being very efcctive. (Duplicated Active.) V. Trunk (backw^ard). — The patient is sit- ting at the edge of a sofa or lounge. The operators stand behind and support as shown in Fig. 82. The patient bends his trunk back- FiG. 83. ward while the operators resist, and the pati- ent resists while the operators raise him up. The support should be made firm, so that the patient feels confident in performing the movement. It is an excellent exercise to act upon the muscles of the back. (Duplicated Active.) VI. Knee. — The operator stands behind the patient, as demonstrated in Fig. 83, and 96 SWEDISH MOVEMENTS. Fig. 84. Fig. 85. SWEDISH MOVEMENTS. 97 resists the patient rising. (Duplicated Ac- tive.) VII. Knees. — The patient stands with the hands'on the back of his head or supported as in Fig. 84. The patient is told to rise on his tip-toes, flex his knees as much as possible, rise up on the tip-toes and to regain standing position. The operator supports either as shown in Fig. 84 or with one hand on the chest and the other on the back. It may also be single active as shown in Fig. 85. This movement is called "Deep Knee-Bend." 5. RAISING. I. Leg. — ^The patient lying on his back. The operator grasps the heel underneath, one hand supporting the knee on top and xaises the extended leg upward. Ten times. This movement may also be active and is used principally for sciatica and slight rup- ture. 98 SWEDISH MOVEMENTS. II. Legs. — The patient is lying flat on his back with the limbs' extended as shown in Fig. 86. The operator grasps over the shoulders and presses the trunk down, while the patient raises the limbs upward far enough to have them form a right angle with the trunk at the hip. The movement acts firmly upon the abdomen. (Duplicated Active.) Fig. 87. III. Body. — The patient sitting on a stool or a turned chair. The operator places his hands flat on the shoulder-blade. The pati- ent, if strong enough, clasps his hands on the back of his head and bends forward, keeping the head up. He then raises his body up, with a strong resistance of the operator. It is used for deformities of the back. (Dupli- cated Active.) IV. Body. — The patient lying with hands clasped on the back of his head. The oper- ator places his hands around the ankles, with SWEDISH MOVEMENTS. 99 thumbs inverted, and holds them firmly. The patient then rises slowly to a sitting position. There is no better movement for compressing the contents of the bowels. The movement may also be general active, and is used prin- cipally for constipation. (DupHcated Active or Active.) V. Body. — The movement may also be per- formed with the trunk extended from the lounge, as shown in Fig. 87. It is then very lOO SWEDISH MOVEMENTS. effective, and should be used with great con- sideration. VI. Body. — Another form of raising the body in standing position is demonstrated in Fig. 89. The operator is sitting in front of the patient and resists him firmly in his rising. (Duplicated Active.) Fig. 89. Body. — The movement may also be per- formed as shown in Fig. 88. The patient is lying on a bed or couch the lower extremities out, feet on the floor and arms stretched. He is told to slowly rise to a sitting position. This exercise acts strongly upon the muscles of the back and upon the abdomen. VII. Chest. — The patient sitting. The oper- ator standing behind and placing his hands around the patient's armpits in front, raises the body slowly forward, upward and back- SWEDISH MOVEMENTS. lOI ward, describing a circle. This mqvement is always passive, and is used to assist respiration (see Fig. 90). When performing this movement the oper- ator should be careful not to press the patient too much forward in the beginning. Fig. 90. OSTROM'S COMBINED RESPIRATORY MOVEMENT. The patient stands erect with head thrown back and arms extended on a level with his .shoulders. 1. Flex the arms slowly under slight resist- ance (single active), gentle inspiration. 2. Expiration. 102 SWEDISH MOVEMENTS. 3. Raise the flexed arms up so that the points of the elbows reach above the head, with deep inspiration. 4. Expiration while in this position. 5. Bring the still flexed arms downward and backward as far as possible with a deep Fig. 91. inspiration. The head should be as far back as possible so as to help expand the chest to its fullest capacity. 6. Expiration. 7. The arms are raised up on a level with the shoulders with deep inspiration. 8. The arms are extended back to their fundamental position slowly, while the pati- ent exhales. SWEDISH MOVEMENTS. 103 This movement is very strong and conse- quently rather tiresome to the patient. It should therefore be given carefully in the be- ginning. 6. PULLING. I. Leg. — The patient standing on a chair, vi^ith hands against the wall for support (see Fig. 91). Fig. 92. The operator, grasping the foot around the instep, carries- the leg backward. Eight to fif- teen times. The movement is abducent, as it causes a great tension in the front part of the abdo- men. (Passive.) II. Leg. — Another form of pulling of the leg in sitting position is demonstrated in Fig. 92. The patient draws the limb upward with 104 SWEDISH MOVEMENTS. the operator's resistance; the operator pulls the limb down to the original position. III. Body (backward). — The patient kneel- ing on the sofa, with knees separated; hands on hips. The operator stands behind, with one knee supporting the lumbar region, his Fig. 93. hands grasping the armpits from behind, and carries the patient slowly backward (see Fig. 93) ; the latter making slight resistance. Six to twelve times, according to strength. (Du- pHcated Active.) The movement has a strong effect upon the abdomen, and is used principally for case of dysmenorrhea. IV. Body. — The position of operator and SWEDISH MOVEMENTS. I05 patient is shown in Fig. 94. The operator pulls the body backward, being careful to see that the bent position of the body is kept all through the movement. 7. TURNING. I. Foot. — The patient sitting or lying. The operator puts one hand back of the ankle, the Fig. 94. other grasping the toes and the front of the foot, and turns the foot from side to side. The movement is always passive, and is used chief- ly for sprains and deformities. II. Leg. — The patient lying. The operator places one hand at the sole of the foot, the io6 SWEDISH MOVEMENTS. other pressing on the knee to keep the leg ex- tended, thumbs inward, and moves the limb slowly inward and- outward. The motion is used for stiffness in the hip joint and for con- traction of certain muscles. (Passive.) Fig. 95. Fig. 96. III. Body. — The patient standing (see Fig. 95) or sitting (see Fig. 96), with hands on the hips or clasped on the back of the head. The operator, standing behind, places his right hand on one shoulder and his left in front of the other, and moves the patient to one side and back again, changing the position of the hands before turning to the other side. The movement is also duplicated active, and is SWEDISH MOVEMENTS. 107 used for congestion of the abdominal organs and for acting upon the great venous system. In Figs. 97, 98, 100 and loi we have de- picted certain modifications of turning of the body. The one show^n in Fig. loi should be used with great care, it being very effective, especially in the case of a woman. Fig. 97. Fig. 98. Fig. 99 shows how the turning of the body is performed as a single active movement. It acts . strongly upon the abdominal viscera, especially upon the liver. The patient should be told to take deep breaths while performing the exercise. IV. Arm. — The patient sitting or standing. The operator, supporting the elbow with one hand and grasping the hand with the other. I08 SWEDISH MOVEMENTS. moves the forearm from side to side (prona- tion and supination). If the whole arm is to be turned, the operator must grasp the elbow to keep it extended. The movement is pas- sive, and is used principally for stiffness in the , ^ Fig. 99. joints and for relaxing the tendons and mus- cles in cases of after-operation. V. Head. — ^The patient sitting. The oper- ator, placing one hand on the forehead, the other on the neck, moves the head slowly from side to side. Ten times. (Duplicated Active, Passive.) VI. Pelvis. — The patient is in a position as show -in Fig. 102. The operator stands be- SWEDISH MOVEMENTS. 109 Fig. 102. no SWEDISH MOVEMENTS. hind and resists the patient in his turning for- ward and backward. 8. DEPRESSION AND ELEYATION. I. Arms. — The patient sitting or lying. The patient raises his arms, the operator grasping the hands from behind. The operator presses Fig. 103. the arms down, the patient resisting. The pati- ent raises the arms while the operator resists. Ten to twelve times. (Duplicated Active.) In Fig. 103 is shown a form of depression and elevation of the arms in which the oper- ator stands elevated in front of the patient. II. Legs. — The patient lying flat on the back, grasping the bed or couch to keep him- SWEDISH MOVEMENTS. Ill self immovable. The operator grasps the soles of the feet, thumbs mward. The movement is performed down and up with the knees turned out, the patient resisting in the eleva- tion and the operator in the depression. The movement is very effective and must be performed with great care. Six to ten times. (Duplicated Active.) Fig. 104. III. Leg. — In Fig. 104 we have demon- strated depression of the one leg, used for cer- tain muscular affections in the thigh and around the pelvis. Several movements belonging to the Swedish sys- tem have been omdtted as not being of much practical use. THE PHYSIOLOGY OF THE MOVE- MENT TREATMENT. The movement treatment is not shrouded in mystery, nor is a minute knowledge of anat- omy or physiology necessary to understand its nature and comprehend its workings. Its physiology is very simple and easily under- stood, because it always endeavors to follow the laws of nature. Motion and activity are the principal char- acteristics of man ; and all parts of the body are so formed as to fulfil their proper func- tions. By the law of metamorphosis, every particle, after remaining a certain time in the body, is cast ofif, to be replaced by a new one. This alteration is carried on very slowly and almost imperceptibly, but without interruption. Every one knows that it is impossible to ab- stain from food and not lose in weight and flesh. This loss indicates that the body is con- suming itself, under a chemic process called combustion, by which heat is produced, and car- 112 SWEDISH MOVEMENTS. II3 bonic acid, water, etc., excreted by the lungs, the skin, the kidneys, and the intestines. The process may be too rapid or too slow. The first takes place in fevers, with their high temperature and great emaciation ; the second, in many chronic disorders, with lowered tem- perature and lowered vitality. Those organs which are in a state of per- manent activity are most likely to suffer from overwork; but there is danger of the opposite extreme in the muscular system, so much of which is dependent for action entirely upon the exercise of the will. This great muscular system, with the nerves and vessels by which it is supplied, and the joints which it controls, comprises about nine- tenths of the whole organism. Generally speaking, the action of the volun- tary muscles is reduced to a minimum. How much of the great muscular system has the clerk brought into use? Only the muscles of the arm, the rest remaining inactive ; and these muscles are so overtaxed as to cause an irrita- tion of the nerves communicating with them, and the result is nervous disorders, such as writers' cramp. Aside from what their occupation affords them (and that is more or less defective), most persons have no other exercise than the daily 114 SWEDISH MOVEMENTS. walk to and from their business, which rarely exceeds an hour a day. While this exercise is better than none, its benefits are often over- estimated. In walking, only certain muscles are actively engaged, and even those very im- perfectly. The muscles of the leg are used in taking the step and the muscles of the back in keeping the body upright, but this exercise, with its uniform nature, is of less value than any other. It is necessary to give the muscles alternate work and rest. In walking, the muscles of the back are kept in a permanent state of tension, so that they have not the time perfectly to con- tract and relax, which is essential to beneficial exercise. Although, from a purely hygienic standpoint walking in the pure air is of great benefit, aid- ing respiration, yet the daily walk to a given place becomes mechanical and automatic, no attention being paid to the movements by the will power. It is evident to all that in the various mo- tions of the body or the limbs a change is tak- ing place in some of its tissues by means of combustion. First, this activity creates heat, the intensity of which can be estimated, but not the amount. Second, a certain amount of waste material is SWEDISH MOVEMENTS. I [5 thrown off and absorbed by the, veins and the lymphatics, to be eventually excreted from the body. The creation of heat, which in a few minutes reaches several degrees, is soon made evident by copious perspiration. The chemic change produces carbonic acid and other substances, which cause the feeling of languor. The sense of fatigue remains un- til the products of the change are carried away by the blood-vessels and the lymphatics. By this process, which is constantly going on in the working muscles, some part of the tissue is consumed but the loss is compensated by the nourishment which it receives from the blood. This exercise demands a greater supply of blood and neither its quantity nor its quality can be diminished without seriously endangering health. To replenish the blood, the lymphatics carry the digested food from the stomach and intes- tines into the blood-circulation. But before it is in a condition to nourish the body it must be carried to the great vessels of the lungs, where it is brought in contact with oxygen. By proper exercise the respiratory move- ments become longer and deeper and the ca- pacity of the lungs is very much increased. The same stimulating effect is produced Il6 SWEDISH MOVEMENTS. upon the circulatory system. An increased amount of blood is sent to the different parts, necessitating a freer circulation. Thus we find that exercise systematically applied produces direct and positive action upon the circulatory, digestive and respiratory systems. Since carbonic acid gas is carried off through the lungs and water through the kid- neys and skin, we can easily comprehend that exercise will aid materially in hastening the elimination of such waste. Of course in the process of combustion heat is necessarily produced, and if the excess is not carried off, serious results may ensue. In health, nature has provided proper facil- ities for carrying off all heat above the normal amount by exhaustion from the skin and lungs. MECHANICAL ACTION OF MUSCLES. There is also a mechanical process that takes place in every kind of muscular work, for when the muscle contracts, its mass is con- densed, and the soft parts near the muscle are exposed to a very strong- pressure. This fact has a very important bearing upon the veins and the lymphatics, and upon the fluids which these vessels carry to the heart. While the heart controls the action of these vessels, much aid is afforded them by the tem- porary pressure of the contracted muscles, and thus we see that exercise stimulates and in- creases the circulation in the veins and lym- phatic vessels. But these are not all the results that are produced by proper exercise. In voluntary muscular action, as a rule, one or two joints are set in motion. These joints are protected, to prevent their bony surfaces from coming in contact with each other. While the motion is a rubbing or friction movement, exercise properly taken is 117 Il8 SWEDISH MOVEMENTS. free from all danger; moreover, the joint is de- cidedly benefited by such action, nutrition to the part being increased. Generally, where the muscles are attached to the bones large processes or elevations are found; and the greater the muscles the larger the processes. This must indicate an increased nutrition to the bone, as well as increased strength to the osseous system. The effect of exercise is not only chemic and mechanical, but also physiologic. The voluntary movements are what distin- guish animals from plants. The higher we go in the scale of animal life, the more perfect is the mechanism for execut- ing the various movements necessary to its ex- istence. We find a liner muscular develop- ment in connection with a more highly devel- oped nervous system. Involuntary motions are adjusted by the sympathetic nervous system, while the voluntary movements are controlled and regulated by the cerebrospinal nervous system. That mysterious power which we call will imparts, at times, an impulse to muscular ac- tivity, and at others it restrains and impedes it. Whatever the nature of the will, we know that when an impulse is generated in the brain it is carried to the nerves of the spinal cord. SWEDISH MOVEMENTS. 119 and from them to the peripheral nerves, and thence to the muscles, which causes what we call contraction. Thus we see that exercise is not so simple a thing as is commonly supposed, but, on the contrary, it is a complex process involving the brain, the spine, the nerves, and the muscles. As the activity of a muscle produces a con- stant change in the circulation, so this same action will greatly influence the substance of the nerves themselves. This applies only to motor nerves, although some authors claim that exercise has an in- direct effect upon the central nervous system. At times physicians employ certain reme- dies called derivatives, the object of which is to relieve certain parts and certain conditions by acting upon other parts of the body. For instance, by the use of purgatives, to relieve portal congestion or to remove a sluggish circulation in the brain. In some mental dis- orders, as in melancholy or hysteria, the same theory directs that the mind should be con- stantly employed, so that the patient may have no time to think of himself. Again, when there is a disturbance in the normal condition of the motor nerves, as in spasms, it may be removed by a strong and decided impression upon the central nervous 120 SWEDISH MOVEMENTS. system through sorrow, sudden terror, etc., or by an impression upon the nerves, by burn- ing. When there is any disturbance in the cen- tral nervous system, we can often, by employ- ing agents to act upon the motor nerves, re- move its cause. We reach this conclusion because persons suffering from irritation of the central nervous system are generally those who use their mo- tor nerves but little. Again, it is a common experience for the well-trained masseur to see these patients improve very rapidly, and be finally cured by fixed duplicated active move- ments. Thus we conclude that active movements have a beneficial effect upon the nervous system, direct upon the motor nerves, and indirect, upon the cen- tral and sensory nerves. What we have said about the effects of the movements has been of a general character, but it is necessary to understand the local ef- fects upon the different organs of the body. When treating a local affection, the move- ments or manipulations are to be applied in such a way that the aft'ected part will derive the benefit. When the circulation is feeble in certain parts, the muscles in the neighbor- hood must be made to act, so that the blood will circulate more freely in the part diseased. APPLICATION OF MASSAGE AND THE SWE- DISH MOVEMENTS TO VARIOUS DIS- EASES OF THE BODY The movement treatment, being an invigorating remedy, is recommended principally for chronic diseases, where either the ivhole organism or only a part is weakened. The prescriptions of massage and move- ments given here are only mentioned in a gen- eral way; the operator must use them only after a careful consideration. What may be beneficial to one individual may injure an- other. The operator should consequently use such movements and manipulations as he finds suitable to the individual case, in the mean- time being guided by the prescriptions here mentioned. It is necessary in all cases to note how^ the patient bears each movement. If any are too strong, they must be omitted, only to be re- sumed as the patient's strength increases. 121 122 MASSAGE AND MOVEMENTS IN TREATMENT. During the first tr.eatments great care should be taken not to overtax the patient's Strength ; it is always better to do too little than too much — the one is much easier remedied than the other. GENERAL WEAKNESS. Apply general massage. Follow with pas- sive flexions and extensions, rotations and pressings. Finally give percussion of the back, if the patient's strength permits. The first treatments should last from twenty to thirty-five minutes, gradually increasing to an hour at the end of the first week. Daily treatments are necessary. Under this heading come most of the affec- tions or rather conditions treated by general massage; for instance, when a patient is con- valescent after fevers (typhoid, scarlatina), after operations, when the body is emaciated, in many conditions of nervous disorders, and in general when we propose the treatment as a tonic instead of outdoor exercise. ANEMIA. For this disease some authors recommend general massage of the whole body, others recommend a complete series of movements. A series of well selected movements in connection MASSAGE AND MOVEMENTS IN TREATMENT. 1 23 with the general massage will perhaps be the most effective agent in renewing the blood. The treatment must be only by passive .move- ments, and such as will aid the digestion, the circulation and the respiration. When the patient is very feeble, use only the general massage, gradually commencing with the movements as the strength increases. AH exercises should be passive, so as not to over- tax the patient. The following series, recommended by Pro- fessor Hartelius, of Stockholm, Sweden, has frequently been used with success: 1. S. rotation of the arms.' 2. Half L. rotation of feet. 3. Massage of abdomen. 4. S. rotation of arms. 5. S. rotation of body. 6. Half L. flexion and extension of legs. 7. St. percussion" of back. The first movement is for respiration, ex- tending the chest. The air is inspired more freely and a greater quantity of oxygen brought in contact with the blood. Eight to twelve times. The second carries the blood to is. means sitting; St., standing; L., lying; Kn., kneeling; Sp., suspending. ^Whenever the expression "percussion" is used, the author means hacking. 124 MASSAGE AND MOVEMENTS IN TREATMENT. the feet, which are generally cold; the third aids digestion and increases the appetite; the fourth, see i ; the fifth afifects the great venous system ; the sixth increases circulation in the lower extremities; the seventh has a refreshing action on the whole system. The movements are scientifically arranged to remove the tired feeling, the loss of appetite, the cold hands and feet, the backache, and all symptoms we find in an anemic patient. If there be any abdominal affections, special attention must be paid to them in the selection - of the movements. HYSTERIA. For hysteria we use such manipulations as will act directly upon the peripheric nervous system. The general massage, followed by a few rotary movements of the extremities, is to be recommended. CHOREA. If the disease has advanced so far that the child has no control whatever over the limbs, place him on a couch or bed, one operator standing at the head^ holding the arms, another standing at the feet, grasping the lower ex- tremities. Begin with gentle stroking with the palm of the hand over the extremities and the chest, gradually increasing the strength; then MASSAGE AND MOVEMENTS IN TREATMENT. 121, turn the patient over on his face, and continue the firm stroking over the back and neck. The full treatment should last an hour, and be re- peated daily four or five times. (Blache.) As soon as improvement is visible, begin with cer- tain passive movements, such as flexion and extension of the extremities, separating and closing of the knees, bending of the head, de- pression and elevation of the arms. The patient is soon able to take dupHcated active movements, and is finally instructed in general active movements or calisthenics, the operator keeping exact time. Strong, persistent treatment every day, with special attention to the duplicated active move- ments, will yield good results. PLETHORA. In this affection we use movements such as will attract the blood from the head and pro- duce muscular activity. The most important part of our treatment is the massage of the neck and head. By the for- mer we can relieve the blood-pressure on the brain to a remarkable extent, the patient often after the treatment telling us: "How much lighter my head feels." Both methods of mas- sage of the neck may be used, but that of Hoeffinger should be selected as the introduc- 126 MASSAGE AND MOVEMENTS IN TREATMENT. tory massage, to reach the deeper veins and give an outlet for the congested circulation. 1. Massage of neck and head. 2. Half L. rotation of leg. 3. S. rotation of body. 4. Half L. rotation of feet. 5. S. rotation of head. 6. Kn. turning of body. 7. Beating of sacrum. 8. S. rotation of arms. 9. S. percussion of head, with shaking and stroking. INSOMNIA. There are certain movements which so af- fect the central or the sympathetic nerve-sys- tem that they are called by some authors "sleeping-movements." As a rule, the general active movements are sufficient. The treatment should always be applied at bedtime. "I"he following manipula- tions and treatments will prove beneficial : 1. Firm general massage. 2. S. Depression and elevation of arms. 3. Half L. flexion and extension of legs. 4. S. turning of body. 5. Separating and closing of arms. 6. L. raising of body. 7. St. bending of knees. 8. Massage of neck and head. MASSAGE AND MOVEMENTS IN TREATMENT. I27 HEADACHES. During the past few years the author has had such exceptional results in the treatment of peripheral headaches that he wishes to pay some special attention to their treatment by massage. It has been clearly established that many cases of headaches with negative eye- conditions have been cured by thorough mas- sage of the neck and head. Dr. Gustaf Nor- strom has shown us in his excelient little book on headaches, that many of these cases are caused by myositic deposits in the neck, gen- erally in the nape, but frequently also in the respective anatomical extremes of the rieck. This may seem rather strange to many, but the trained masseur knows and almost daily experiences the fact that the "spontane- ous pain has not always the same seat as the lesion." The cases are readily defined; the oculist reports that there is no condition of the eyes that could possibly cause the suffering. Then let us carefully examine the neck and head. The first thing to look for is this: is there a cerebral congestion of some standing? Hoef- finger's method of massage of the neck will tell us that. We as a rule find this congestion, particularly in the plethorics who have ob- structions to the circulation in the upper part 10— -M 128 MASSAGE AND MOVEMENTS IN TREATMENT. of the trunk. In the nape of the neck we find many lumps or myositic deposits, which in contradistinction to the ganglia and lymphatic glands are movable only with the particular muscle of which they form a part. Pressing of a myositic deposit will cause acute paiti, often extending to the supraorbital nerve and eyelid of the corresponding side. These deposits may be recognized in three stages or degrees (Norstrom) : we may have a swelling only, or a resistive touch, or an actual induration where the consistency is very hard and the de- posit consequently well defined. Now to the practical application of massage for headaches. First of all we must give strong, thorough strokings with both hands from the base of the skull to the acromion pro- cesses. This is our introductory massage to relieve not only the cerebral congestion, but also the pronounced congestion of the nape of the neck. The first few treatments should consist of these manipulations only, with a few strokings of the head added, but as soon as we can clearly define the deposits we commence with our strong frictions and kneadings, pick- ing up the lump separately and squeezing it between the thumb and fingers. This causes pain often to such a degree that it becomes necessary to allow the patient some rest occa- MASSAGE AND MOVEMENTS IN TREATMENT. I29 sionally; the whole treatment should never exceed twenty minutes, and by that time not only the. patient but also the operator has had enough! The patient should be compelled to take a rest in a recumbent position for fifteen minutes after ihe treatment. It is not sufficient to massage the muscles and their deposits only but the nerves of the scalp and of the forehead should receive atten- tion, particularly in those cases where we are able to find local structural changes. In regard to the Swedish movements we have principally the following as the most use- ful: 1. Susp. bending of head (concentric). 2. Sitting bending of head. 3. St. bending of turned body sideways. 4. Sitting turning of the head. 5. Ostrom's combined resp. movement (see page loi). In the movements marked 3 and 5 the reader will notice that the author wishes to act upon the organs of the trunk which are apt to be- come congested, especially the liver. I have had several cases of headaches in plethorics which did not yield at all until I carefully treated the liver. It is well to mention that in all the cases the author has watched and treated, there was in- 130 MASSAGE AND MOVEMENTS IN TREATMENT. variably a history of gout or rheumatism, con- sequently we must not lose sight of the neces- sity of proper diet and medication to prevent the further formation of deposits — massage is effective only for what has been formed by im- paired digestion and stored up in the muscles by locally impaired circulation. APOPLEXY. Experience shows that even old cases of paralysis are very often improved, and some- times completely cured, by mechanotherapy. Its advantages consist in being able to work upon the entire nerve-system as soon as the least activity is apparent in the aflfected side. The massage is used at first to irritate the nerves and to increase nutrition. It will always be of some benefit, provided the system has power to react. In treating a case of paralysis the operator should remember two special points : 1. Find out which muscles are affected and treat them and their nerve-supplies with mas- sage. 2. Overcome the contraction of the antagon- ists by movements, or if necessary by braces. Where, there is active power in the affected side, use, in connection with the massage, the MASSAGE AND MOVEMENTS IN TREATMENT. I3I following movements (for instance, for the right side) : 1. S. rotation of arms. 2. Half L. rotation of legs. 3. S. rotation of right shoulder. 4. Flexion and extension of right leg. 5. Depression and elevation of right arm. 6. Pressing and shaking of right leg. 7. Pressing and shaking of right arm. 8. Percussion of back. It is generally the best plan not to start the massage until three weeks after the stroke. The operator should remember to always se- lect such manipulations and movements as will prevent a rush of blood to the cerebrum. Paralysis from accident, gout or rheuma- tism, is very often treated by massage, the re- sult depending upon the condition of the af- fected nerves. When caused by poison, mechanotherapy is recommended principally as a stimulating reinedy, when the patient is convalescent. In paralysis from lead-poison- ing massage is an excellent remedy. The necessity of a knowledge of anatomy on the part of the operator is more apparent in treating cases of paralysis than any others. Careful attention should be paid to the facial muscles if required. In a Swedish journal is recorded a case of 132 MASSAGE AND MOVEMENTS IN TREATMENT. an eighteen-year-old patient paralyzed in one leg from childhood. He was treated twice daily for three consecutive years by thorough massage and movements, and at the age of twenty-one his leg was restored to its natural size and strength. It is astonishing what the inunction of cod- liver oil in connection with the massage will do in some cases of paralysis. INFANTILE PARALYSIS. In this obscure and troublesome affection scientific massage has won some of its great- est victories. With the aid of the electric cur- rent we first find out which muscles or which groups of muscles are afifected. This should not be done however until one full month from the day of the first attack. It is a well ack- nowledged fact that the amount of damage done to the tissues will all depend upon how soon the disease is properly recognized, so as to promptly apply the counter irritation to the whole spinal column. When we begin the massage we should give strokings only over the whole afifected limb to increase nutrition and tone up the different parts, but the deep massage should at first be given only to the most affected muscles and their nerve supply, the other or stronger MASSAGE AND MOVEMENTS IN TREATMENT. I33 groups being severely let alone. In my own practice I have often taken cases of this trou- ble and in a short time gotten the most marked improvement simply by adhering to the above rule, when before the ordinary "rubbing-mas- sage" had been tried for a year or more and failed to give any result. It seems to me that the attending physiciap should plainly write out his prescription for the massage to be faithfully filled by a competent operator. We stretch the spinal column by movements or better still by suspension as we gain stijength and I always arrange the bar with cleats in a doorway so that I have two heights, one for the child sitting and one for the stand- ing position. When the braces are first put on I use a double bar fitting the height of the child like a crutch ; there is also another cross- bar below to put the hands on; the uprights are slanting inward and only room enough is given for the child to get through. This is an excellent arrangement in the early starting of teaching coordination. My next move is generally to let the child push the rolling chair, if old enough ; by this time there is more co- ordination, he will begin to balance at first for a minute, then more and more every day; now we maj begin with crutches cut rather short so as to get a slight forward bend which helps 134 MASSAGE AND MOVEMENTS IN TREATMENT. to steady the patient; then only one crutch and a cane and finally the one cane. Of course it will be understood that in the meantime the child has medical tonic treatment also elec- tricity and hydrotherapy in connection with the massage. The treatment must be given every day if there is to be any result expected. A careful record should be kept and the most accurate measurements taken at fixed intervals. The salt air at the seashore for a short interval seems to have a wonderfully beneficial effect upon these cases and it is well to stop the mas- sage occasionally for a week or so for a trip to the shore. The improvement will afterward be so much more rapid. The movements which I use are principally for the spine as Lying raising of the body. At first it is often necessary to tie a sheet around the foot-board of the bed and have the patient try to pull himself up or it may be necessary for the operator or the mother who should be taught how to give these movements, to assist the child by placing the hand between the shoulder blades. Suspension, passive and ac- tive we have already discussed. Now in re- gard to the movements for the extremities used in connection with our massage we will take a fairly typical leg for demonstration: the foot is constantly extended, hence we flex the MASSAGE AND MOVEMENTS IN TREATMENT. I35 foot (much easier done if the leg is flexed at the same time) to overcome the contraction of the extensors. The foot is not only extended but also everted; consequently w^e invert it with our flexion. The same child can draw her leg up but can not possibly push it down or in any way extend it, hence we practise extension of the leg; the right leg she can bring in to the median line hence her adductors of the right side are saved, but she lacks power of rotation outward so we give that movement to act upon the biceps femoris and the gluteus maximus. In her left leg this condition is reversed and of course the treatment also reversed. The intel- ligent operator must of necessity study out each individual case to obtain good result, as there are never two cases of poliomyelitis ex- actly alike. On account of the excellent results that the author has had in treating this affection, it has frequently been suggested that he had some new, secret methods of treatment, but such is not the case and any intelligent and' qualified operator will by following the above instruc- tions have the same good results, of course within the limit of natural possibilities. It should also be mentioned that I frequently make use of exercises similar to those de- scribed by Fraenkel to help along coordina- 136 MASSAGE AND MOVEMENTS IN TREATMENT. tion. On a board I draw two large, round points connected with a line and make the child learn to follow this; afterwards I make a tri- angle in the same way later a semi-circle or an ellipse. I have found these simple exercises of great practical value. TABES. Apply massage of the back in connection with pressing. Massage of the abdomen, with pressing above the bladder and pressing and shaking of the extremities, are frequently used. Some authors recommend extension of the legs, pulling of the legs and beating of the sacrum. The movements should be refreshing and invigorating and great care should be taken not to overexert the patient. A rest in bed for six weeks with intelligently applied massage and inunctions, if indicated, have given the most satisfactory results in the author's experience, including some sixty cases. Of all movements recommended by the au- thors on mechanotherapeutics in the treatment of locomotor ataxia none equals the pulling of the legs. Place the patient perfectly flat on his back without head-rest; grasp with one hand around the ankle, with the other firmly above the knee — pulling downward slowly without MASSAGE AND MOVEMENTS IN TREATMENT. I37 jerking. Carefully and properly applied, this simple movement will often relieve the most agonizing ataxic pains. As trained nurses are often requested by the attending physician to inunct a patient with blue ointment in this affection, and as the au- thor has seen several cases in which the "in- unction" consisted of merely placing the pre- scribed quantity in the groin or axilla, he con- siders it proper to here give the correct method of inunction as recommended by Dr. Sigmund. The patient should, if possible, take a hot bath as a preparation. If that, for some reason, be impossible, it becomes the opera- tor's duty to wash the part to be inuncted, either with soap and warm water or with alco- hol and water, to dissolve the fat in the pores. The ointment should be worked in with mod- erate friction by the palm of the hand : on the first day on the inside of the legs ; on the sec- ond day on the inside of the thighs; on the third day on the sides of the trunk; on the fourth day on the back; on the fifth day on the inside of the arms ; on the sixth day commence a new series. In twenty to thirty minutes the seance is completed.. The operator should wear a glove to protect himself from absorbing the drug. In the friction it is best to try to de- scribe a figure eight, unless the parts are heav- 138 MASSAGE AND MOVEMENTS IN TREATMENT. ily covered with hair — then work in a circle. If the p'atient desires to conceal the fact that he is taking the inunction, wash the parts worked upon and remove every trace of the proceeding. The best result will be accom- plished if the drug is allowed to remain on the skin to be gradually rubbed in by the clothing. Three hot baths a week are generally recom- mended. The new preparation " Mercury- Vasogen" is now generally used for inunction and it is far superior to the blue ointment as it works in so much quicker and does not leave a disagree- able odor. Besides it has been the author's experience that it does not produce any skin- afifections, while the blue ointment is very apt to cause not only local irritations of the parts inuncted, but also eczema and erythema. NEURALGIA. Diseases of the peripheric nerves are more successfully treated by mechanotherapy than are aflfections of the central nerve-system. Most neuralgias yield readily to massage, and in cases of sciatica it has been used with most excellent results. For the latter disease, if the right leg is af- fected, use: I. Stroking of right leg (from behind). MASSAGE AND MOVEMENTS IN TREATMENT. 139 2. Percussion and beating over the nerve. 3. Flexion and extension of right leg. 4. Raising of leg. 5. Beating of sacrum and right leg. Some of the manipulations must be repeated in the series five or six times. In raising the leg, place it, if necessary, on the shoulder, and, bending up and down, extend the sciatic nerve as much as possible. Rheumatic neuralgia in other nerves, as in the trigeminus, so often found in anemic wo- men, is often relieved by massage in a few treatments. Use freely punctation over superficial nerves, and firm kneading and stroking with the thumbs. If the nerve is very tender, begin with a slight introductory stroking with the thumb. In some cases it may be advisable to use massage of the head, as described in Local Massage. Massage of the neck (Hoefifinger's method) is an excellent remedy for many forms of neu- ralgia of the head and face. NEURITIS. Neuritis is an inflammation of the nerve- trunks with pain, specially intensified by pres- sure. Gentle massage in the form of strokings 140 MASSAGE AND MOVEMENTS IN TREATMENT. is indicated from the beginning. In a case of neuritis of the arm we treat the brachial plexus carefully and stroke upward from the finger- tips to the spinal column. It is best to have the arm well supported in a sling broad enough to fully support the whole length of the fore- arm. In multiple neuritis we have had most excel- lent results from massage gently applied. It will not do to treat a neuritis — no matter of what cause — with deep pressure as the nerves are extremely tender and the inflammation will be increased. The strokings help because they relieve the blood tension along the nerve-tract. If the operator only remembers this rule of care, we shall not hear any more complaints that massage is not indicated in the treatment of neuritis. PROGRESSIVE MUSCULAR ATROPHY. Use massage in the neighborhood of the af- fected muscles and upon them, and such move- ments as are calculated to increase circulation through the diseased parts. Suppose a case of atrophy in the deltoid and supraspinatus ; the following treatment should be used: I. Massage of the arm from the fingers up to the trapezius. MASSAGE AND MOVEMENTS IN TREATMENT. I4I 2. Rotation of the hand. 3. Flexion, and extension of the arm. 4. Rotation of the shoulder. 5. Firm hacking or clapping upon the whole arm, and especially around the shoulder. 6. Vibrations over brachial plexus. WRITERS' CRAMP. Use massage from the tips of the fingers to the shoulder. Rotation, turning, flexion, and extension of the hand and arm may be used as the patient grows stronger, but massage is the principal part of the treatment. ** The operator must be careful not to overtax his patient's strength. In beginning only treat the hand and foreartn from ten to fifteen min- utes. SPLANCHNIC NEURASTHENIA. So important has this functional disturbance lately become in this country that it is high time that its proper mechanical treatment be analyzed. As Dr. Abrams so clearly puts it, the principal symptoms are: "Abdominal sen- sitiveness, tenderness of the liver and enlarge- ment of that organ and gaseous accumulation in the bowels.^' In regard to the treatment we have to re- member that physiologists have proven to us 14.2 MASSAGE AND MOVEMENTS IN TREATMENT. the fact that the abdominal veins are very elas- tic and that they are really capable of holding at one time the total blood volume of the whole body. In splanchnic neurasthenia we have first of all to overcome the intense congestion of blood in the splanchnic and ab- dominal veins in general. We begin with massage of the liver, so as to give the venous circulation a free outlet. The patient is lying on his left side with the right arm over his head and the operator carefully works over the whole hepatic region not for- getting the three splanchnic nerves. Many "paths and — practics" would have you believe that they are the only ones who pay proper at- tention to organic nerve-supply, but it is not true. Fortunately we possess the plain writ- ings of P. H. Ling and his true pupils published almost one hundred years ago to conclusively prove that the Swedish mechanical operator, or medical gymnast who is properly trained al- ways is taught to attend to the nerve supply of the individual organ or muscle that he may be treating. The massage of the abdomen in gen- eral is now given so as to improve the muscu- lar-tone and overcome the local congestion. Massage of the neck is also given. As we gain ground we instruct the patient in some of those Swedish movements which com- MASSAGE AND MOVEMENTS IN TREATMENT. I43 press the viscera an^ tone up the whole abdo- men. Other therapeutics in the shape of elec- tricity and hot-cold sponge baths are most ef- fective, and the reader who is specially inter- ested in the rational treatment of this affection, should procure that excellent work: "The Blues" by Dr. Albert Abrams. AFFECTIONS OF. THE RESPIRATORY ORGANS. Respiration is altogether mechanical, de- pending upon the constitution of the muscles of the chest, the extension of the latter, and the quantity of air-inspired. If the capacity of the lung& be increased, all difficulty of breathing, coughs, etc., caused by an imperfect respira- tion, will soon disappear. In cases where defective respiration is the result of weakness of the respiratory muscles or of deformities of the chest, the movements have proved the best means for increasing the capacity of the respiratory organs (see page lOl). The effect of the medical gymnastics is to necessitate frequent and deep inspirations, and thus increase the capacity of the lungs, pro- moting pulmonary circulation and causing a more complete oxygenation -of the venous blood. 11— M 144 MASSAGE AND MOVEMENTS IN TREATMENT. CATARRH OF THE LUNGS. Certain manipulations (hacking, clapping and shaking) on the chest have been used to induce expectoration. The movements must be such as to cause muscular activity and in- crease the secretion from the skin. Action upon the digestive organs will produce a deri- vative effect upon the lungs. PHARYNGITIS AND LARYNGITIS. Because massage of the neck and throat in- duces such an evacuation of the blood-vessels, it has been freely used for acute catarrh of the pharynx, trachea and nose. We are able by careful examination of the inflamed mucous membranes, before and after the application of massage, to notice directly the result. Not the local symptoms only, but the headache, the pain in the forehead, the dizziness, etc., result- ing from the stagnation of blood, -disappear af- ter a few treatments. By massage we also act upon the tonsils and other glands, thus assist- ing expectoration. Croup may sometimes be speedily relieved. Weiss has noted a case of croup in which a sin- gle application removed the most imminent peril. The massage of the neck and throat ought to be more freely used for these affections. MASSAGE AND MOVEMENTS IN TREATMENT. I45 CONSUMPTION. Some respiratory movements are used to make the patient more comfortable, increasing tiie inspiration and assisting the heart in its action. Massage of the lower extremities is some- times applied to relieve the swelling and to in- crease the circulation. General massage is often recommended as a tonic, but should always be given in the fore- noon, and never at night, as it has then a de- cided tendency to increase the night sweats. BRONCHITIS, NERVOUS ASTHMA, ETC., are frequently treated by massage, generally in the form of strokings of the entire chest, the patient inspiring deeply at the same time. The seance must not exceed twenty minutes. COLDS. So many persons sufifer with recurrent colds in our changeable climate that we deem it well to pay some attention to the matter, A cold is an inflammation of the mucous membrane lin- ing the upper respiratory passages. One re- gion is generally more affected than the others. A cold begins with a congestion and its prin- cipal causes are: (i) "chilling the skin in a per- son whose skin is sensitive and tender to the 146 MASSAGE AND MOVEMENTS IN TREATMENT. changes of temperature, causing a contraction of the superficial blood-vessels, and driving an excess of blood to the deeper structures of the body; (2) local irritation to an already con- gested respiratory tract, by the inhalation of polluted air, and air containing irritating sub- stances such as dust, smoke, gases, etc." Colds are most common in v\^inter time, not on account of the cold v\^eather but because at that time we bi-eathe the most impure air, everything often being shut up in order to save fuel. To prevent colds we must consequently breathe pure air and keep the function of the skin normal. This latter is best accomplished by proper daily bathing, massage and exercise. For the younger person we think nothing bet- ter than a cool sponge off with brisk friction every morning in a room of a temperature never less than 70° F. For older persons and for those not so very robust we recommend the hot-cold spray bath. The person sits in a tub with warm water up to the hips; now spray the spine, neck and chest with cool water, starting with a temperature of 85° F., and gradually in the course of a week or two, lowering it down to 50° F. Half a minute is enough at first. A strong self-massage with a rough rubber sponge or wash cloth is advis- MASSAGE AND MOVEMENTS IN TREATMENT. I47 able, but the patient should always rub him- self perfectly dry with a rough towel. If weak this must of course be done by an attendant. If the patient has the opportunity of scien- tific massage for half an hour each morning so much the better; if not we must teach him some few effective movements to be practiced every morning after his bath. The following are good : 1. Standing rotation of arms. 2. Ostrom's combined resp. movement. 3. St. bending of the body forward and back- ward. 4. Deep knee bend. 5. St. bending of the body sideways. We do not wish the reader to lose sight of the fact that there are certain remedies which, if taken in the very incipiency of a cold, are really specific in their efifect. DISEASES OF THE HEART. Massage and movements are indicated in af- fections of the heart caused by nervous debil- ity, anemia, diseases of the stomach, etc. The movements mostly used are : Sitting, raising of the chest, with shaking, to produce strong respiration ; Rotation of the extremities, to assist the heart in its action; 148 MASSAGE AND MOVEMENTS IN TREATMENT. Rotation and turning of the body, to give ef- fect upon the great venous system; Centripetal stroking, to remove the subcuta- neous efifusions. In organic diseases of the heart, movements are recommended by some of the most emi- nent physicians. They apply movements to support the heart in its action, generally using such as will increase the circulation in the dis- tant parts of the body. Within the last few years a new system of exercise for heart-afifections has been develop- ed by Dr. August Schott, of Bad Nauheim, Germany. The results have at times been re- markable. He employs the effervescent Nau- heim water, as a rule, daily, and directs a series of resistive exercises (original Swedish move- ments) to be given daily, or every other day if the patient is quite weak. The general mas- sage — gently applied — is too often lost sight of as a most excellent preparation for this par- ticular movement cure. All the movements are duplicated-active, and the resistance should be so applied as not to interfere with the circulation — preferably, when possible, with the palmar surface of the hand. Every movement should be performed slowly, and the operator should watch his patient most carefully. At first the seance should last but MASSAGE AND MOVEMENTS IN TREA,TMENT. I49 ten minutes, to be gradually and carefully in- creased to thirty minutes. A rest should be allowed after each movement, and, contrary to the Swedish methods of treatment, no ex- ercise is to be applied more than once in each series. The operator should carefully guard against the following symptoms : 1. Intermission of the pulse. 2. Weakness of the pulse. 3. Increased respiration. 4. Palpitation of the heart. 5. Dilatation of the nostrils. 6. General feeling of discomfort. When any of the above-mentioned symp- toms appear allow a few minutes' rest; or, if necessary, stop the treatment for the day. It is customary to take the pulse and respiration before starting, during the middle of the seance, and at its close. A careful record should be kept for the reference of the attend- ing physician. The principal Schott exercises are : 1. Separating and closing of arms. 2. Flexion and extension of each arm. 3. Raising of the arms upward. 4. Rotation of the arms. 5. Pronation and supination of the forearm. 6. Flexion and extension of the hand. 150 MASSAGE AND MOVEMENTS IN TREATMENT. 7. Flexion and extension of the fingers. 8. Abduction and adduction of the fingers. 9. St. bending of the body forward and backward. 10. S. bending of the body sideways. 11. S. rotation of the body. 12. Same as i, with clenched fist. 13. Same as 2, with clenched fist. 14. St. arms extended forward and back- ward. 15. L. flexion and extension of the leg. 16. L. flexion and extension of the foot. 17. L. separation and closing of the thighs or legs. 18. St. leg extended forward and backward. Careful operators are sometimes requested to apply treatment locally; then use massage of the chest, as previously described, with hacking in small circles over the cardiac re- gion. Palmar vibrations are also used. In the European institutes of medical gymnastics it is quite common to see the vibrations applied over the heart. The operator then places his arm upon the artificial vibrator and the wave- like movements are transferred to the cardiac region through the semi-flexed and abducted fingers. Except when especially requested by a physician, however, this local application is seldom used. Gentle respiratory movements MASSAGE AND MOVEMENTS IN TREATMENT. 151 should always form the conclusion of the treat- ment, and an hour's rest should be rigidly in- sisted upon. DISEASES OF THE DIGESTIVE ORGANS. In applying mechanotherapy for these affec- tions, we must call attention to the fact that most of them develop from circulatory disturb- ances, the vessels being relaxed. There are different ways to apply massage of the stomach; one has already been describ- ed. Another way is to place the fingers about two inches below the ribs and, with pressing, move the hand upward in connection with shaking. In a .'special position (half lying, with the knees flexed, so as to relax the abdominal muscles, crook-half-lying) it is quite easy to reach the stomach by pressing, shaking and kneading. Massage of the stomach is indicated in all affections caused by circulatory disturbances or general weakness (atony) of the parts. DYSPEPSIA. 1. Massage of the stomach and the abdo- men (fifteen minutes). 2. Percussion of the back. 3. High St. pulling of legs. 4. S. turning of body. 152 MASSAGE AND MOVEMENTS IN TREATMENT. 5. Flexion and extension of legs. 6. S. rotation of arms. The movements are repeated. HABITUAL CONSTIPATION. Massage and movements are now fi'eely used for constipation. The treatment must al- • Fig. 105. v^^ays be local in the beginning, and afterward constitutional. 1. Local massage (ten to twenty minutes). 2. St. bending of knees (hands on hips). 3. L. raising body. 4. S. turning of body. 5. St. beating of sacrum. 6. See 3. 7. See 4. MASSAGE AND MOVEMENTS IN TREATMENT. 1 53 8. Flexion and extension of legs. 9. St. percussion of back. Schreiber says : "Chronic constipation ofifers the most signal success to mechanotherapy, for it is possible to make direct mechanical pressure upon the celiac and hypogastric plex- FiG. 106, uses, and through these to reflexly excite per- istalsis ; furthermore, the vasomotor nerves and the intestinal muscular ribcr= are directly stimulated by the squeezing to which they can be subjected." The treatment is indeed very effective, and it is not rare to obtain an evacu- ation of the bowels immediately after the manipulations. After the patient has taken a course of treat- ment he should be instructed to take every 154 MASSAGE AND MOVEMENTS IN TREATMENT. morning a few exercises to keep the bowels working properly. The patient will, as a rule, offer the common excuse that he has no time for such a procedure, but the operator should rigidly insist upon it, telling him that he, by neglecting to take the exercises, may gradu- ally lose the benefit of the course of treatment Fig. 107. he has undergone, and incidentally, he may suggest to his patient simply to rise ten min- utes earlier and he will have ample time to per- form the movements. We have selected five of the most effective exercises easily perform- ed in the bedroom. As in Fig. 105, the patient should lie fiat on his back, without head-rest, with hands clasp- ed back of the head ; he should slowly rise to MASSAGE AND MOVEMENTS IN TREATMENT. 1 55 a sitting position, and, if able, even bend for- ward as much as possible. When first taking the movement he will have some difificulty in keeping his feet down ; tell him to put a pillow or quilt on top of his feet. By this exercise Fig. 108. Fig. 109. we strongly compress the abdomen, aiding in fecal movement mechanically, increasing the general peristaltic action, and accelerating the secretions from the various glands. The fol- lowing four exercises (see Figs. 106-109) are very similar in their effect, and they are so clearly illustrated that we do not deem it nec- essary to separately describe them. (The 156 MASSAGE AND MOVEMENTS IN TREATMENT. standing bending of the body should be care- fully done by patients suffering from hemor- rhoids.) Constipation is of most frequent occurrence in infancy. Less than three evacuations a day indicate a constipated condition. Place the child flat on its back in the bed, or, if conveni- ent, on the mother's lap ; inunct the abdominal wall virith pure olive oil, and proceed with "the massage of the abdomen as previously de- scribed, paying special attention to the vari- ous parts of the colon. Colic, so frequently caused by improper action of the bowels, is often quickly relieved by massage. If the abdo- men is much distended, care and judgment must be used so that too much pressure is not applied. Pass lightly over the region of the transverse colon, and never use so much pres- sure on any part as to cause pain. Any intelli- gent mother can be properly instructed to treat her child for constipation, and such knowledge will often be very useful not only directly at the time, but also indirectly after- ward, as it will often save the child from irri- tating and weakening laxatives carelessly ad- ministered without the physician's orders. Even in cases of infants, we must not lose sight of the wonderfully strong tonic effect of the massage. MASSAGE AND MOVEMENTS IN TREATMENT. 1 57 HEMORRHOIDS. Closely connected with the former disease is the accumulation of blood in the abdominal parts, called hemorrhoids. By the manipulations on the abdomen we assist the intestines in their action; by rota- tion and turning of the body we control the great venous system, and by beating over the sacral region we increase the circulation through the rectum. The following movements have been used with success: 1. Massage of the liver and the abdomen (ten to fifteen minutes). See page 21. 2. St. bending of knees. 3. Separating and closing of knees. 4. L. raising of body. 5. Rotation of legs. 6. Beating of sacrum. 7. Rotation and turning of body. Although we highly recommend the move- ments for this affection, we must acknowledge that one treatment a day is not enough. The patient must be instructed in certain calis- thenics which give a direct effect upon the great venous system. 158 MASSAGE AND MOVEMENTS IN TREATMENT. OBESITY. Massage and Swedish movements have been used with great success in cases of obesity. Muscular exercise decreases the fat by pro- moting a more perfect oxygenation through the whole organism. In connection with firm massage use the fol- lowing movemeiits : 1. Separating and closing of arms. 2. Separating and closing of legs. 3. L. raising of body. 4. St. bending of knees. 5. St. rotation of arms (active). 6. St. turning of body. During the first treatments use only a few movements, gradually getting the patient used to them. As pathologic changes in the tex- ture of the blood-vessels are rather common in cases of obesity the operator should use care- ful judgment ip regard to the strength of the manipulations. Without proper diet massage will accom- plish but very little. Frequently the masseur will be asked by the patient how he can consistently claim that mas- sage will reduce fat, and also in a thin person produce fat. When we desire to reduce fat we give firm massage, especially kneading, which produces heat; this causes combustion MASSAGE AND MOVEMENTS IN TREATMENT. 1 59 of fat. When we apply the treatment with the object of increasing weight we do so by build- ing up the whole system and particularly the digestive organs. Whatever our aim may be, one of the most important parts of the treat- ment consists in teaching the patient how to breathe properly. ENLARGEMENT OF THE LIVER. We use such movements as are calculated to increase the circulation through the great ven- ous system. 1. S. rotation of arms. 2. L, rotation of feet. 3. S. raising of body. 4. L, rotation of legs. 5. S. rotation of body. 6. St. flexion and extension of feet. 7. Massage of the liver with clapping. 8. Separating and closing of knees. 9. Vibration over the liver. 10. St. percussion of back. The movements must be performed twice a day, and the patient instructed in certain calis- thenics. DIABETES. Some authors report cases of diabetes suc- cessfully treated by mechanotherapy. Schrei- ber says : "The best effects will ensue when 12— M l6o MASSAGE AND MOVEMENTS IN TREATMENT. the greatest number of muscles are brought into play. It is necessary to select such move- ments as will call into action equally all the great muscle-groups." In Paris, where diabetes is common, the pa- tients are advised to take very strong bodily exercise. The quantity of sugar secreted must indicate a deficient oxygenation of the ma- terials produced by the liver. Strong bodily exercise, which increases oxygenation in all the membranes of the body, ought to elimi- nate the abnormal deposit of sugar. The proper exercise for this afifection is not yet well determined. When the patient has a constitution strong enough to bear the treat- ment, use the following movements : 1. St. percussion of back. 2. L. rotation of feet. 3. Separating and closing of arms. 4. S. bending of body backward. 5. Flexion and extension of legs. 6. Raising of body. 7. Flexion and extension of arms. 8. Separating and closing of knees. 9. Percussion of back. UTERINE AFFECTIONS. Massage is applied directly to force the or- gans to contract, and the movements to regu- MASSAGE AND MOVEMENTS IN TREATMENT. l6l late the circulation through the abdomen. Atony and dislocations of the organ are gen- erally treated by massage; distuirbances in re- gard to menstruation, only by movements. AMENORRHEA. 1. S. rotation of arms. 2. Rotation of feet. 3. S. turning of body (inspiration). 4. S. rotation of body. 5. Beating of sacrum. 6. Vibrations. 7. Rotation of arms. 8. St. percussion of back. Some of the movements must be repeated several times in the series, but when treating extremely anemic women great care should be taken not to give too many. DYSMENORRHEA. A great number of women suffer severe pain before and during the periods. In many of these cases we can by overcoming the local congestion give the greatest relief. We rec- ommend : 1. Massage of the liver. 2. Massage of the whole abdomen. 3. St. rotation of arms 4. L. rotation of feet. l62 MASSAGE AND MOVEMENTS IN TREATMENT. 5. St. rotation of body. 6. L. rotation of leg. 7. St. bending of turned body. 8. L. rotation of pelvis. This treatment should be given to the pati- ent at least tvi^o weeks before the period is ex- pected, and she should be properly instructed how to take a few good movements to pre- vent the congestion of blood in the abdomen. I have made the observation that women who lace tightly are always the greatest suf- ferers from dysmenorrhea. AFFECTIONS OF THE BLADDER. We have here to deal with two common con- ditions : the retention of the urine and the in- continence of the urine. Both have been suc- cessfully treated by massage. Before starting the treatment the bladder should be emptied naturally, or artificially, if necessary. Massage the whole abdomen first and then use strokings, frictions and vibrations (see page 59) locally. In many nervous women especially at the climacteric period we find the symptom of fre- quent desire to urinate. In such cases massage is an excellent rem- edy, vibrations being especially effective. The bladder should never be treated me- MASSAGE AND MOVEMENTS IN TREATMENT. 163 chanically except on the order of a physician, as there are many conditions in which massage may do a great deal of harm instead of good. RHEUMATISM. The active movements, as well as hacking and beating of the affected parts, are of great benefit in cases of rheumatism. In severe at- tacks the treatment should be applied twice daily. The patient must move his limbs freely instead of keeping them inactive. Begin with general massage around and over the afifected part; continue with local massage on the diseased muscle or joint and finish the treatment with a few movements that give effect upon the circulation and re- spiration. The operator should study his case carefully and by passive and active movements of the afifected part try to localize the rheumatic de- posits. How important this is will be clearly illustrated to the reader in the following case : A gentleman was sent to me for massage for a "rheumatic shoulder"; he had been treated for some time with massage applied locally, i. e., right over and close to the joint. The re- sult had been unsatisfactory and he had no faith in the treatment. The joint was carefully examined and was found all right. He could 164 MASSAGE AND MOVEMENTS IN TREATMENT. raise the arm and he could rotate it without pain or difficulty, but when I told him to throw the arm downward and backward, I then saw that his trouble was located in the latissimus dorsi. This muscle was then carefully treated and with very satisfactory result. He at first ridiculed the idea of curing an affected shoul- der by treating the lower part of the back, but is today a very enthusiastic believer in scientific massage. LUMBAGO. The patient should lie on his face with the abdomen supported by pillows. The operator should perform firm strokings with both hands over the lumbar region, from the spinal col- umn toward the sides. In many cases it is well to give massage to the whole back and the glutei, as previously described. The treatment must be given twice or three times daily. It generally takes from two to five days to conquer the trouble. To prevent lumbago the following move- ments may be used: 1. St. bending of body. 2. L. raising of body. 3. S. bending of trunk. 4. S. raising of body. MASSAGE AND MOVEMENTS IN TREATMENT. 165 STIFF NECK. This affection is somewhat similar to lum- bago and has been treated with like success. Begin with massage over the sterno-cleido- mastoid and continue with pressing and shak- ing. A few (in the beginning passive) move- ments will finish the treatment. Though at first painful, the patient will in a few days be relieved by the treatment: The following movements may be used: 1. S. or susp. bending of head. 2. S. turning of head. 3. S. rotation of head. GOUT. Between the attacks massage is often pre- scribed, especially for podagra. The treatment must be given for general activity of the mus- cles. 1. St. bending of knees. 2. St. bending backward (back supported). 3. L. flexion and extension of legs. 4. S. turning of body. 5. S. rotation of arms. 6. Flexion and extension of feet. 7. S. raising of body. 8. Beating of sacrum. 9. Massage of stomach. 10. St. percussion of back. l66 MASSAGE AND MOVEMENTS IN TREATMENT. The general massage is always of benefit and firm friction on the sole of the foot is very efifective in cases of podagra. LATERAL CURVATURE OF THE SPINE. There are few affections in which the move- ment treatment has met with more signal suc- cess than in this. The aim should be to invig- orate and develop the weakened and patho- logically changed muscles of the convex side so as to restore the natural equilibrium of the two sides. There are but four known and acknowledged methods of developing muscles locally — viz., massage, movements, electricity and hydropathy. As the two latter do not come within the province of this manual we shall only describe the two first mentioned. The main things to remember in treating lateral curvature of the spine are : • 1. To elongate the spine by suspension. 2. To raise the lower shoulder. 3. To counteract rotation of the vertebrae. 4. Massage to stimulate the muscles. 5. Selected movements in carefully selected positions. Massage of the back is very useful in most all cases of scoliosis, and the operator should pay special attention to the convex side, par- ticularly in the early stages of the affection. MASSAGE AND MOVEMENTS IN TREATMENT. 167 The treatment should be applied also to the glutei — the gluteus maximus in particular. Pinching is a very valuable manipulation, and when the patient becomes used to the massage apply it firmly, so as to reach the deeper lay- ers of muscles. In older cases, it sometimes becomes necessary to treat also the muscles of the concave side, which from disuse have become atrophied. When the primary curve is high up, the cervical region should be faith- fully attended to. Patients will often com- plain if too much pressure is used over the extreme convexity of the compensation curve . — "the abrupt lower bend," as some patients style it. We give here a list of the various Swedish movements used in the treatment of lateral curvature, and the intelligent operator who has been properly trained will experience no difficulty in selecting those which will prove the most beneficial to the individual case in question. I. St. Bending to the (Convex) Side. — The patient stands with hands clasped on the back of the head. The operator places one hand on the highest point of the curvature and the other on the opposite hip, the patient bending slowly about ten times. It may also be used as a single active movement. l68 MASSAGE AND MOVEMENTS IN TREATMENT. 2. St. Bending to the (Convex) Side. — Same mavement as i, only the patient places the arm corresponding to the lower shoulder- FiG. no. blade over his head as demonstrated in Fig. no, the other hand on hip. Single active or duplicated active, in the latter case the oper- ator placing his hands as in i. MASSAGE AND MOVEMENTS IN TREATMENT. l6g 3. St. Rotation of the Arms. — The patient should stand as erect as possible with arms at sides; he should carry his arms slowly for- ward and upward, then backward and down- ward. A very useful respiratory exercise, be- sides acting strongly upon the muscles of the shoulders. 4. S. Separating and Closing of the Arms. — Described on page 89. It acts strongly upon the muscles of the chest, but also upon those of the upper part of the back. . Kellgren says that if this exercise is performed with one arm at a time, correction of the rotation in lateral curvatures of the spine is produced. 5. St. Flexion and Extension of the Arms. — This movement is described on page 86. 6. St. Raising of the Arms. — The patient is standing with thighs supported; the arms are extended outward and raised upward by the patient, while the operator resists, grasp- ing the wrists. If one shoulder-blade is much lower than the other, work only with the cor- responding arm. 7. St. Raising^ of the Arms. — This move- ment is the same as No. 6, only it is single active ; that is, the patient performs it himself. He should raise his arms from the sides to above his head with a deep inhalation, after- 170 MASSAGE AND MOVEMENTS IN TREATMENT. ward lower them slowly to original position, and exhale while doing so. 8. St. Bending of the Body Forward and Backward. — (See Fig. ']'j.) The patient should place his hands on his hips or clasp them on the back of his head. Another form of this exercise is performed in the following way : The patient stands .with his limbs separ- ated and his arms stretched straight up; he should bend slowly forward until the tips of the fingers touch the floor (see Fig. 78). 9. L. Extension of the Back. — The patient is lying with legs on couch, the trunk extend- ing; the operator supports the feet; the pati- ent bends his body upward as far as possible. This is a very effective movement and must be given with care. At first it is safest to have some one to aid in holding the patient. He may place his hands on his hips, or clasp them on the back of the head; after he grows stronger he may keep them extended straight forward parallel with the ears. 10. L. on the Side, Bending the Trunk. — The patient is lying with legs on couch and trunk extended in side position, the convex side up and the feet supported. The bending should be performed slowly. 11. S. Raising of the Body. — The patient sitting on a stool or a turned chair with hands MASSAGE AND MOVEMENTS IN TREATMENT. 171 on back of head, bends forward, the operator resisting him when he resumes the original position. The lower shoulder may be raised up, as the operator has perfect control of the trunk by his firm grasp of the back. Fig. III. 12. St. Raising of the Body.— The patient, standing with thighs supported against a couch or table and hands clasped on the back of the head, bends forward as far as possible. The operator, standing behind and supporting the feet with his turned foot, places one hand 172 MASSAGE AND MOVEMENTS IN TREATMENT. on each side of the spine. The patient raises his body while the operator resists. 13. L. Raising of the Body. — See page 152. 14. St. Turning of the Body. — The patient stands with feet closed and hands back of Fig. 112. head. He turns from side to side with or without the operator's resistance. 15. Raising of the Arm of the Convex Side. — The patient is standing with the arm of the concave side flexed over the head as in Fig. III. The arm of the convex side is raised MASSAGE AND MOVEMENTS IN TREATMENT. 1 73 from the side to the head. A weight is gen- erally used. Careful instructions in regard to respiration should be given. 16. St. Bending of the Knees; Book on Head ("Deep Knee-Bend"). The hands are placed on the hips with fingers in front; the patient bends slowly downward, counting: (i) raising on the tiptoes; (2) bending down as far as possible; (3) resuming tiptoe posi- tion; (4) back to original standing position (see Fig. 112). The efifort of keeping the body erect in balancing makes this a very useful exercise in the earlier stages of curva- tures. The operator should watch the pati- ent carefully to see that the proper position is maintained from start to finish. 17. Stretch-standing Bending of the Knees. — Similar to 16, only the patient stands with his arms stretched upward close to his ears, as shown in Fig. 49. 18. St. Bending of the Body.— The right (if the convexity is on the right side) foot forward; right hand on hip; left arm raised up and left hand down the back, between the ' shoulder-blades; the patient should bend slowly forward. Generally single active, but may also be duplicated active. 19. Kneeling Bending of the Body. — Same exercise as 18, only the patient rests on the 174 MASSAGE AND MOVEMENTS IN TREATMENT. knee of the concave side and places the foot of the convex side forward. Single active. 20. Bending Backward; Free-standing. — "The patient stands at a distance somewhat less than the length of his own foot from the wall. He places his hands on his hips with his elbows well thrown back. Then he stretches himself and bends backward. When the movement can not be continued any farther, the patient falls back until the back of his head touches the wall by which he stands. Then he slowly rises up on his toes, and while doing so draws a deep inspiration and goes slowly down again" (Kellgren). 21. St. Bending of the Head Forward and Backward. — The patient stands with his hands against the wall and with his feet about twenty inches from the wall ; the operator places his hand on the back of the patient's head and resists in the movement. This movement is very effective, and the author begs to suggest to his reader to have it ap- plied to himself so as to personally feel its re- markable effect upon the different muscles of the back. 22. St. Stretching of the Vertebral Column. — This is a new movement, recommended by the well-known Mr. H. Kellgren, of London. The patient stands as straight as possible; MASSAGE AND MOVEMENTS IN TREATMENT. 175 the operator stands in front of him and places one hand on the patient's head, and with the other he steadies him by placing it over the sternum or abdomen; he presses firmly down with the hand on the head, while the patient is told to stretch upward as far as possible. Be careful to see that it does not become only a simple raising of the shoulders. We want a stretching of the whole spinal column. 23. Susp. Bending of the Head. — The pati- ent is suspended a few inches from the floor. The operator, standing at his side, places one hand on the forehead, the other on the back of his head. The patient moves the head for- ward and backward, the operator resisting, according to the strength. 24. Susp. Separating and Closing of Legs. — If the patient is weak, make the movement active at first, while the operator supports the sides. Afterward make it concentric, the operator grasping around the ankles. 25. Susp. Flexion of Legs upon the Abdo- men. — The patient is suspended and flexes his extended limbs upon the abdomen. This is a very strong movement and should be used only when the patient's strength allows. It is very important to watch the patient in regard to his position for each movement. A rest should be given after every exercise, and 1/6 MASSAGE AND MOVEMENTS IN TREATMENT. it may be well to mention that the most com- plete rest is obtained when the patient lies flat on his abdomen with pillows under chest and stomach. Measure the patient's height; also curvature itself. This is best done by put- ting the end of the tape-measure on the ver- tebra corresponding to the extreme point of the convexity; carry it forward over the high- est point of the convexity to the sternum or a fixed point on the sternum; then measure the concave side in the same manner and you will know from time to time how your patient improves. Always ha,ve a set rule to measure either before or after taking the movements. It becomes the operator's absolute duty to explain to the patient the tedious process of the treatment and the patient's own responsi- bility in regard to the final result. Exercise should be taken every morning and evening in the patient's own home. The results are remarkably good if proper judgment is used in the selection of movements. This treat- ment for curvature of the spine is very little known in America, but if given a fair trial, and the movements properly performed, many un- fortunates might be saved from being crip- pled for life. A few cases of Pott's disease have been treated by the author. Massage of back and MASSAGE AND MOVEMENTS IN TREATMENT. 177 chest with respiratory movements were given with good results. Of course it will be under- stood that there was no inflammatory process going on in the spinal column at the time of treatment. By the use of the pneumauxetor the author fully convinced himself of the in- creased respiratory capacity. The patients would invariably express themselves as feel- ing more able to hold the head and thorax erect and the increased respiratory power was always a great relief in this very trying de- formity. SPRAINS. A sprain is a sudden dislocation with a quick replacement of a joint. By the bursting of some smaller veins and lymphatics there is quite an effusion in and around the joint; the sooner that fluid is worked away mechanically the better for the patient. It seems impos- sible to comprehend that many surgeons still use plaster of Paris casts in the treatment of ordinary sprains, when massage properly ap- plied will effect a cure in a few days. In sprains it is necessary to begin with slight, careful introductory massage, in the form of centripetal stroking, the pain being very severe. The strength of the manipulation must not be increased until most of the swell- ing is gone, and the operator must be very 178 MASSAGE AND MOVEMENTS IN TREATMENT. careful to work upon every part in the neigh- borhood of the joint, applying, as a rule, stroking only. Then begin kneading the mus- cles and tendons, always ending with strok- ing. The treatment is greatly assisted by water applications at night. A flannel or rub- ber bandage must be used to keep the swell- ing down. Some authors recommend move- ments from the beginning, but I have found the best results from the massage alone. In contraction of the tendo Achillis, turning and rotation of the foot, also flexion aiid ex- tension, ought to be used after the fifth treat- ment. The weakness of the joint after a sprain is frequently relieved by massage, the operator being careful to apply properly the bandage after each seance. SYNOVITIS. Massage is always indicated in cases of syn- ovitis, so long as there is no purulent inflam- mation. The introductory massage, in the form of centripetal stroking, is to be used with great care. When the pain is diminished some passive movements may be applied, as flexion and extension. If the joint be very sore, as is usually the case, work in its neigh- borhood with kneading and stroking. MASSAGE AND MOVEMENTS IN TREATMENT. I79 In chronic inflammation of the joints it is always necessary to pay special attention to atrophied muscles above and below the joint. Friction (with strokings followed) is the most effective manipulation around joints (see Fig. 113)- Fig. 113. — Friction with the Thumb in Cases of Synovitis of the Knee-joint. In ankylosis always apply very hot water before every seance. Evald Johnsen, a Scandinavian masseur, out of 137 cases of synovitis, cured 94 per- fectly, improved 39 and treated only 4 with- out any result. The patient must not be kept in bed, but must use his limbs as much as possible. l80 MASSAGE AND MOVEMENTS IN TREATMENT. Massage not only relieves stiffness of the joint, but also prevents total ankylosis. The treatment must continue not for weeks, but for months. VARICOSE VEINS. It is best to slightly elevate the affected limb. Start the treatment with massage of the thigh and if the saphenous vein is not seri- ously inflamed, work with centripetal strok- ings gently up to the groin. In regard to the local treatment, the operator should avoid too strong pressure directly over the veins af- fected, but should try to improve the circula- tion in the collateral veins, thereby relieving the tension in the varicose veins. Stroking is the only safe manipulation directly over the vein, and I always use an oil made of oil of sweet almonds three (3) parts and oil of eucalyptus one (i) part. This oil prevents too strong friction and, besides being antiseptic, seems to have a soothing effect on many pati- ents. We must remember to use the various cir- culatory movements of the foot and leg. We are used to hear persons suffering with this trouble complain during the warmer sea- son of the year about their elastic stockings as being so hot and uncomfortable. I have MASSAGE AND MOVEMENTS IN TREATMENT. l8l used lately with great satisfaction the "Ben- der Elastic Bandage" instead of elastic stock- ings. In cases of phlebitis we use similar treat- ment as here described for varicose veins, ex- cept that we are safer in using more direct pressure over the veins. HERNIA. Many cases of recent hernia have been suc- cessfully treated by massage. The patient is placed flat on his back without l^eadrest, so as to relax the muscles of the abdomen. We massage the muscles in a general way at first and afterwards locally, the object being to so strengthen the muscular parts around the ring that the normal retentive power is establish- ed. I have used with great satisfaction the Iodine Vasogen 7 per cent, with this treat- ment. There is no use of trying manual treatment for this trouble unless the patient can be made to fully understand that he is not to stand up without his truss on. In a severe case a surgical operation is of course necessary for a complete cure. The patient should be instructed in the useful her- nia-movements recommended by Dr. George H. Taylor, of New York. l82 MASSAGE AND MOVEMENTS IN TREATMENT. FRACTURES. Since the ambulatory treatment of fractures has been described by Krause in Germany and by Hood and Sir William Bennett, of Eng- land, the American surgeons seem to begin to take to it more in a few selected cases. Every simple fracture of the extremities should be treated by massage before being re- duced; we can, by gentle manipulations above and around the fracture, draw^ the effusions away. The nearer a joint the fracture, the more important the massage becomes. The operator should of course be very careful in handling the injured member and it is neces- sary to have someone to assist in support- ing it. In fracture of the patella we must take spe- cial care of the quadriceps extensor fempris and we must prevent adhesions of the frag- ments above and below. In giving the mas- sage around the knee we hold the fragments together with the thumb and index finger of one hand and work with the other hand. In severe fractures with complications treated by the old method the masseur is often called upon to deal with some difficult conditions. Where there is impaired motion from faulty nerve or inuscle action the opera- tor should carefully find out which muscles MASSAGE AND MOVEMENTS IN TREATMENT. 183 are the weaker and massage them; he should also overcome contractions of the antagonists by movements or splints even, if necessary. Strokings of the inside of the whole extrem- ity affected are necessary to restore the circu- lation. Anyone interested in the treatment Fig. 114. — Forcing a Stiff Elbow-joint. of fractures should read the two following books: "Massage in Recent Fractures," by Sir William Bennett, and "The Treatment of Injuries," by Dr. Wharton P. Hood. The active movements are sometimes indi- cated. In Figs. 114 and 115 we have represented two different ways of forcing contracted 184 MASSAGE AND MOVEMENTS IN TREATMENT. limbs and stiff joints. The practical -operator will see at a glance the great benefit obtained from the positions given. DEFORMITIES OF THE FEET. In cases of club-foot use iTiassage on the foot and on the leg up to the knee. A few turnings and flexions are very beneficial. In cases of "pigeon-toes" use similar treat- ment as for club-foot, but with the massage extended up to the hip. Also the following inovements : 1. St. turning of the leg outward. 2. St. rotation of ext. leg (semicircle). 3. L. separating and closing of knees. 4. Feet at inore than right angle, deep knee-bend, operator supporting chest and back. 5. Depression and elevation of legs, the operator turning the feet out as much as pos- sible. 6. L. separating and closing of legs, feet turned out as much as possible. In cases of flat foot we can, by the Gefvert splint and our massage and movements, cure the deformity in a comparatively short time, if the patient will only persevere and. be wil- ling to stand a little pain. Apply careful mas- MASSAGE AND MOVEMENTS IN TREATMENT. 185 sage to the whole foot and leg up to the knee. The following movements are very effective: 1. Turning of the foot inward. 2. Rotation of the foot. 3. Flexion and extension of the foot. 4. Walking on tiptoe. 5. Walking on the outside border of the foot. 6. Feet closed ; deep knee-bend. Fig. 115. — Forcing a Knee-joint. Try to teach the patient to practice walking on his tiptoes five or six times dail}^ Massage is a valuable remedy in the complicated local nerve-troubles, so frequently caused by a con- dition of talipes valgus. In other deformities of the feet the aim of the treatment must be to work the affected part back to its proper position by turning, ro- tation, flexion and extension, etc. Local mas- ]86 MASSAGE AND MOVEMENTS IN TREATMENT. sage is used to invigorate the muscles and to relax contracted tendons. All the deformities arising from infantile paralysis have been successfully treated by massage. In talipes calcaneus, where the heel only touches the floor, w^e massage the posterior part of the leg to strengthen the soleus and gastrocnemius. We extend the foot by move- ments so as to overcome the contraction of the stronger flexor muscles. (See rules for treating paralysis on page 130). In talipes equino-varus where the toes come to the floor and the heel is drawn up and the foot inverted we massage the tibialis anticus, peroneus tertius and peroneus longus princi- pally. We flex, evert and abduct the foot. In talipes equino-valgus where the toes touch the floor and the heel is drawn up and the foot is everted, we treat the tibialis anticus and the peroneus tertius principally. Our movements should be selected so as to adduct and invert the foot. When you have reached the safe limit of a movement hold the foot in that ex- treme position for some time to overcome ten- dinous contraction. With a good brace and intelligent massage there is rarely any real need for operating on the tendo-Achillis. MASSAGE AND MOVEMENTS IN TREATMENT. 187 AFFECTIONS OF THE EYE. Ocular massage is being used more every day; we use the second finger mostly but also instruments like corneal spoon, glass rod, etc. We press either on the lid to act upon the lid itself or to act upon the ball by firmer pres- sure. See Fig. 22. Massage of the lid is used mostly to absorb extravasations in black-eye. The Scandinavian oculists employ ocular mas- sage freely to hasten the complete maturation of an unripe cataract. The Russian Maklakow has invented an electric vibrator in which per- cussion is given by a small hammer striking the ball regularly several thousand times a minute. Massage is used for several chronic inflam- mations of the eye. By local massage we in- crease the circulation around the eye, and act directly upon- the cornea. When we desire to see more clearly we rub the eyes, instinct tell- ing us to remove from the cornea such parti- cles as are stagnated. Certain swellings of the eyelids have been treated with great success by massage in the clinics of Schmidt, Rimpler, Rossander and Pagenstecher. Cases of maculae corneae (granules on the cornea) have been very successfully treated. In some cases it is wise to apply massage on the whole front part of the afifected side, and also on the same side of the neck. 1 88 MASSAGE AND MOVEMENTS IN TREATMENT. General massage is frequently used to strengthen the nervous system, thus giving ef- fect upon the optic nerve. Manual treatment must never be applied to the eye without an order from a physician. AFFECTIONS OF THE EAR.. Some authors (Politzer, Eitelberg) recom- mend massage for certain affections of the ear, and in my practice I have often been able to relieve severe pain, in cases of otitis, by massage only, in the form of centripetal strok- ings over the mastoid process and the corre- sponding side of the neck, as recommended by Gerst. In a few cases local massage has been ap- plied to the ear with good results (Meyer and Lautenbach). As in chronic congestive head- aches, see page 127, massage of the liver and the cervical and dorsal nerves is of greatest benefit in many ear-conditions. In a case of catarrhal deafness of long standing the author has clearly demonstrated that perfect hearing was restored for several hours after each treatment. Suspending bending of the head, concentric is also of great help, relieving as it does the congestion of the many vessels of the neck. Bending rotation and turning of the head are also useful movements. GENERAL REMARKS. I. It is rather difficult to fix the time for a massage treatment. Dr. Mezger works only a few minutes (five to twelve minutes), but I am satisfied that he accomplishes more in that time than many do in half an hour. As a rule, use shorter time for a local than for a consti- tutional affection. In the rest-cure some eminent physicians begin with fifteen to twenty minutes, gradu- ally increasing the time to an hour or even longer. II. The weakest person may be treated by massage, since it is a remedy so easily adapted to circumstances and so perfectly controlled. III. The patient must not feel any severe pain or disagreeable fatigue after the treat- ment. Should such be the effect, stop the treatment for a few days, and on resuming it regulate the pressure carefully. IV. After each treatment the patient should rest for at least an hour in a comfort- able position. V. The patient should be urged to refrain 189 igO GENERAL REMARKS. from excessive eating and drinking, and the treatment should not be applied within two hours after meals. VI. The operator must breathe freely while giving the treatment, and must be in a proper position, neither too close to the pa- tient nor too far off; VII. The temperature of the room should be 7o°-7S° F. ; the operator should always be careful to cover up the part masseed and avoid having any draft from windows or doors. VIII. The operator should possess vigor- ous health and muscular strength. He should be cheerful and of refined habits, and should have a fair educatioui with a perfect knowl- edge of the principal facts in anatomy and physiology. IX. Massage treatment is an art which can not be self-acquired; but must be taught by an experienced instructor. X. The manual treatment of disease ought to be regulated by the medical profession; hence the physician's order should be properly carried out, even though the operator be of a different opinion. XI. A student of massage should have the treatment applied to his own body, by that ascertaining the proper pressure to be used upon the various tissues. THE MASSAGE TREATMENT IN AMERICA. There is no medical agency that has been so much abused as massage. When I came to America I was anxious to find out how the manual treatment of. disease was carried on here. I soon learned that there were no laws requiring registration, but that I could find the masseurs through the physicians and the daily papers. I visited several of these, and submitted myself to treatment by some. I discovered there was no science whatever in their treatment; some seemed to entirely ig- nore the fact that nature had provided me with sensitive nerves. Most of these opera- tors used no oil, and consequently the hair bulbs of the limbs operated on by them be- came inflamed. I do not know where they had acquired their knowledge of massage, or, as they termed it, "the rubbing." One of them was sure that he had an inherited power of magnetism, etc., because his father had been "a prominent rubber" in Germany. An- 191 14— M 192 THE MASSAGE TREATMENT IN AMERICA. Other, I understood, had been working in a hospital, and while the buildings were under- going repair he was offered a position in the basement, — whether to wash dishes or not, I could not find out, — but he declined, and left the place to become "a rubber," and is rub- bing still. Not only is the massage treatment practised by such persons whose muscular power should be exerted on something less sensitive than the diseased and weakened human body, but it has also been used as a cloak for vicious purposes. It is reported that the police in Chicago have raided a number of "massage shops," and one of the leading daily papers of Philadelphia asserted that a raid had been made upon simi- lar houses in this city, where the massage treatment was used as a cloak for vice. So long as there is an abundant supply of both masseurs and masseuses, there is no ne- cessity that a woman should be treated by a man, or a man by a woman. There are, of course, exceptions, as, for instance, that of a trained scientific masseur or of a trained female nurse who is attending a patient in his family. I see no reason why such a powerful, reme- dial agency as massage should not be fully THE MASSAGE TREATMENT IN AMERICA. I93 controlled by the medical profession, as it is in Europe. It seems to me that the physician who recommends an incompetent person to attend his patients does wrong, and we have fre- quently heard sad experiences from patients whose social standing ought to have protected them from being imposed upon by incompe- tent, uneducated persons. Some time ago there was a masseur in this city who was given a case of sprain at the an- kle-joint. The surgeon performed a very slight flexion of the foot, so as to ascertain the amount of contraction in the tissues around the joint. At one of the first seances this mas- seur thought he would repeat the flexion and a fracture was the result. Such things are unpleasant to bring before the public, but it is quite proper, they should be noticed in a text-book on massage, when there is danger that one of the most natural and powerful medical agencies will be neglect- ed because it has not been duly protected, but practised by persons who would be more ap- propriately employed at the wash-tub or in the Idtchen. Let me now say a few words about edu- cated practitioners of the manual treatment. Some of them, and especially females, have T94 THE MASSAGE TREATMENT IN AMERICA. been accused of thinking too much of them- selves, of being too independent. Masseurs and masseuses should remember that they are only using one special remedy that nature has taught man to employ to arrest disease. Per- sons who are properly trained will not at- tempt to enter into competition with medical doctors, but confine themselves to the scien- tific treatment that we have endeavored to analyze in this little text-book. Were it not for abuses that have prevailed, the manual treatment of disease would no doubt be more universally adopted and recom- mended by the medical profession and the general public. From this short sketch we conclude: 1. That the massage and movement treat- ments should be applied only by educated and properly trained persons, with due regard to the physician's directions. 2. That the operator (if not a medical docr tor) should be of the same sex as the patient, with only the two exceptions before men- tioned. 3. That there should be a place where skil- ful and trained operators could have an oppor- tunity for passing an examination and for registering, thus protecting not only them- selves and the profession, but the general public as well. BIBLIOGRAPHY. For the convenience of those who desire to study especially certain branches of mechano- therapeutics I herewith give a list of some of the English literatui-e on the subject. Abrams, Albert.— "The Blues." "Spondylo-Thera.py." Altbaus, J. — "The Eisks of Massage," "British Medical Jour- nal," London, 1883. I. 1223. Bacot, J. — "Observations on the Use and Abuse of Fric- tion," etc. London, 1888. Baynes, Donald. — "Auxiliary Methods of Cure: Massage," etc. London, 1888. Bennett, Sir William. — "Massage in Recent Fractures." Lon- don, 1903. Black, S.— "Massage." New York, 1885. Bloom, Homer C. — "A Clinical Study in Pelvic Massage." "Journal Am. Med. Asso.," April 30, 1898. Blundell, J. W. F. — ^"Cases of Neuralgia, Rheumatism, etc.. Successfully Treated by Swedish Movements." Lon- don, 1856. Bullock. — ^"Massage in the Treatment of Disease." "Louis- ville Medical News," 1885. XX, 401-403. Butler, J. — "Electro-Massage." Philadelphia, 1881. Comstock, A. — "Massage Therapy." "Therapeutic Gaz- ette," Detroit, 1888. IV, 602-605. Dowse, Thomas Stretch. — ^"The Modern Treatment of Dis- ease by Massage." (Lectures.) London, 1887. "The Treatment of Disease by Physical Methods." New York, 1890. 195 196 BIBLIOGRAPHY. Eccles, A. S.— "The Practice of Massage." New York, 1898. "Massage in Dyspepsia and in Sleeplessness." "British Medical Journal," London, 1887. II, 502-504. Ellison, M. A. — "A Manual for Students of Massage." Lon- don, 1898. Franks, K. — "Reports on Massage." "Dublin Journal of Medical Science," 1889. LXXXVIII, 241-250. Garry, T. G. — "Massage as a Curative Agent." "Lancet," London, 1888. I, 921. Grafstrom, Axel. — "A Text-book of Mechano-Therapy." Philadelphia, 1899. Graham, Douglass. — "Massage." "Medical and Surgical Reporter," Philadelphia, 1874. XXXI, 181-188. "Massage in Amenorrhea and Dysmenorrhea," "Boston Medical and Surgical Journal," 1876. XCIV, 146-150. "The History of Massage." "Medical Record," New York, 1879. XVI, 147-171. "A Practical Treatise on Massage." New York, 1884. Grant, D. — "On Massage." "Edinburgh Medical Journal," 1887-'88. XXXIII, 35-39, 119-124. Granville, I. M. — "Nerve Vibration as a Therapeutic Agent." "Lancet," London, 1882. I, 949-951. Hood, Wharton P. — "Treatment of Injuries." London, 1903. Jackson, A. Reeves. — "Uterine Massage as a Means of Treating Certain Forms of the Enlargement of the Womb." "Boston Medical and Surgical Journarl," 1880. cm, 388-391. Jones, H. M. — ^"The Use and Abuse of Massage in Gyneco- logical Practice." "British Gynecological Journal," London, 1889-'90. V, 89-105. Keen, W. W. — "Passive Exercise on the- Production of Albuminuria." "Medical and Surgical Reporter," Philadelphia, 1885. LIII, 333. Kellgren, Arvld.^"Technic of Manual Treatment." Edin-. burgh, 1890. Kellogg, J. H. — "The Art of Massage." Battle Creek, Michigan, 1895. Kleen, Emil.— "Handbook of Massage." Philadelphia, 1892. Little, J. F.— "Medical Rubbing." "British Medical Jour- nal," London, 1882. II, 351. BIBLIOGRAPHY. I97 Martin, F. H. — "Massage: its Application." "Chicago Medi- cal Journal and Examiner," 1883. XLVII, 26-34. Mills, Charles K. — "Proper and Improper Methods of Per- forming Massage." "Polyclinic," Philadelphia, 1886- '87. IX, 111-116. Murrell, W. — "Massage as a Mode of Treatment." Phila- delphia, 1890. MuUer, George. — ^"Spinal Curvature/' etc. London, 1904. Nissan, H. — "Manual for Instruction in Giving Massage and Swedish Movements." Philadelphia, 1889. Ostrom, Kurre W. — "Massage in the Treatment of Sprains." "Medical and Surgical Reporter," Philadelphia, Janu- ary 4, 1890. Palmer, Marg. D. — "Lessons on Massage," London, 1901. Posse, Baron NUs. — "The Therapeutic Applications of Medi- cal Gymnastics." "Boston Medical and Surgical Jour- nal," 1889. CXX, 459-462. "School-Gymnastics," Boston, 1891. Post, Sarah E.— "Massage Primer." New York, 1891. Reibmayer, Albert. — (Translated by Dr. B. Lee.) — "Tracts on Massage." I, II, III. Philadelphia, 1885. Ryley, I. B. — "Remarkable Effects of Massage on Gastric Assimilation and Nervous Debility." "Lancet," Lon- don, 1883. 1, 946. Smith, A. J. — ^"On the Treatment of Prolapse of the Uterus by Massage and Pelvic Gymnastics." "Medical Press and Circular," London, 1888. N. S., XLVII, 560-562. Smith, A. J. — "A Brief Outline of Dr. Zander's Institution in Stockholm." "Lancet," London, 1881. I, 860-862. Snell, S. — "On Massage in Certain Eye Affections." "Oph- thalmological Review," London, 1888. VII, 134-139. Soderberg, John. — "Swedish Manual Treatment." London, 1898. Sturge, W. K. — ^"Klemm on Muscle Beating." "London Medical Recorder," 1878. VI, 290. Taylor, C. F. — "The Movement Cure, with Cases." New York, 1888. Tibbits, Herbert. — "Massage and its Application." London, 1887. 198 BIBLIOGRAPHY. White, W. A. "On Massage and the Weir Mitchell Treat- ment." "Guy's Hospital Report," London, 1888. 3d S., XXX, 267-286. Wide, Anders. — "Handbook of Medical Gymnastics." New York, 1899. Williams, Edward. — "The Bevived Ancient Art of Mas- sage," etc. London, 1888. Von Noorden, Carl.— "Obesity." New York, 1903. "The Technique of Reduction Cures," New York, 1904. Zeigenspeck, Rob. — "Massage Treatment in Diseases of Wo- men." Translated by Westerschulte. Chicago, 1898. INDEX. Active movements, 79. Aim of manual treatment, 8. Amenorrhea, 161. Anemia, 122. Ankylosis, 180. Apoplexy, 130. Application of treatment to diseases, 121. Asthma, 145. Ataxic pains, 136. Atony of Muscles, 121. of intestines, 156. Beating, 20. Bending, 90. Bibliography, 195. Blachg, 124. Bladder, vibrations of, 59. diseases of, 162. Bronchitis, 145. Calisthenics, 5. Catarrh of lungs, 144. Chorea, 124. Clapping, 18. Colds, 145. Colic in infants, 156. Combustion, 158. Concentric movements, 79. Constipation, 152. home exercises for, 153. in infancy, 156. Consumption, 145. Contraindications for mas- ' sage, 64. Croup, 144. Curvature of the spine, 106. Deformities of the feet, 184. Depression and elevation, 110. Derivative positions, 70. Derivatives, 119. Details of treatment. 63. Diabetes, 159. Division of movements, 79. Duplicated active move- ments, 80. Dysmenorrhea, 161. Dyspepsia, 151. Ear, affections of, 188. Effleurage, 10. Eitelberg, 188. Estimation of exercise, 7. Excentric movements, 79. Exercise in therapeutics, 5. effect upon the nerves, 121. 199 200 INDEX. Eye, affections of, 187. Fat, the use of, in massage, 63. Flat-foot, 184. Flexion and Extension, 84. the aim of, 89. Fractures, 182. of the patella, 182. Frictions, 13. the aim of, 15. Friction with the hand, 15. the thumb, 14. the tips of the fingers, 14. Gefvert's flat-foot splint, 185. General massage, 22. remarks, 18.9. weakness, 122. Gerst's massage of the neck, 50. Hacking, 19. Hartelius, 123. Heart, diseases of the, 147. exercises for, 148. local treatment of, 150. Headaches, 127. Hemorrhages, 65. Hemorrhoids, 157. Hernia, 181. History of treatment, 1. HoeflGlnger, 49. Hysteria, 124. Infantile paralysis, 132. Insomnia, 126. Introduction, 1. Introductory massage, 21. Inunction of mercury, 137. "Johnsen, Eyald, 178. Kellgren, 174. Kneading, 16. the aim of, 18. with both hands, 17. with the thumb and fin- gers, 17. with the thumbs, 16. Kneeling, 68. Laryngitis, 144. Lautenbaeh, 188. Lead-poisoning, 131. Ling, P. H., 3. Liver, enlargement of, 159. vibration of, 58. Local massage, 24. Locomotor ataxia, 136. Lumbago, 164. Lying position, 08. Maculse, cornse, "187. Massage, 9. after operations, 65. as a tonic, 145. definition of, 9. details of, 63. in America, 191. in therapeutics, 21. of abdomen, 32. of arm, 25. of back, 29. of chest, 27. of eye, 45. of face, 40. of glutei, 31. of head, 38. of leg, 24. of liver, 36. INDEX. 20 1 of neck, 48. of nose, 50. of ovaries, 51. of prostate, 54. of spleen, 37. of throat, 47. of uterus, 51. of ventricle, 37. rest after, 189. salve, 63. Mechanical actions of mus- cles, 117. Menstruation, 05. Meyer, 188. Mezger, 9. Nauheim, 148. Neuralgia, 138. rheumatic, 139. Neuritis, 139. Norstrom, 127. Obesity, 158. Oil in massage, 63. Otitis, 188. Ovaries, massage of, 51. Padotribes, 3. Paralysis, 130. Passive movements. 79. Patella, fracture of, 182. Percussion, 18. Petrissage, 16. Pharyngitis, 144. Physiology of movement treatment, 112. Pinching, 17. Plethora, 125. Podagra, 165. Politser, 188. Positions, 67. Potts' diseascj 176. Pregnancy, 65. Prescriptions of movements, 121. Pressing, 55. Pressure in massage. 63. Pulling, 103. Punctation, 19. • Raising, 97. Respiratory movements, 101. Rheumatism, 163, Rossander, 187. Rotation, 80. the aim of, 84. Round shoulders, 78. Scarlatina, 65. Schmidt. 187. Shott, August, Dr., 148. Schreiber, 153. Sciatica, 138. Separating and closing, 89. Shaking, 55. the aim of, 62. Sigmund, 137. Sitting position, 67. Skin-food, 43. Sleeping movements, 126. Splanchnic neurasthenia, 141. Sprains, 177. Squeezing, 17. Standing positions, 68. Stiff neck, 165. Stroking, 10. the aim of, 13. with both hands, 11. with one hand, 11. 202 INDEX. Stroking, with the fingers, 12. with the thumb, 12. Suspended position, 69. Swedish moTements, 66. definition of, 66. Synovitis, 178. Tabes, 136. Tapotement, 18. Temperature of operating room, 190. Time for massage, 189. Torticollis, 165. Tumors, massage in, 65. Turning, 105. Typhoid fever, massage in, 65. Uterine affections, 160. Varicose veins, 180. Vibrations, 55. digital, 55. of abdomen, 58, 61. of arm, 56. of arms, 56. of bladder, 59. of eyes, 60. of head, 61. of heart, 150. of larynx, 60. of leg, 57. of liver, 58. of pharynx, 61. of pit of stomach, 58. of throat, 61. palmar, 55. Vibrators, 45. Weiss, 144. Writer's cramp, 141. Ziegenspeck, 53. >•'/ •^^ 'X, gc/ ^ -- ''/ "W «^ X/- irf <- ■> .