[Columbo, of Turin, through experiments upon animals and men, demonstrated that massage doubled the secretion of gastric juice, and increased the flow of bile, urine, saliva, tears, sperm and sweat.]

Undue nervous activity, as in chorea, hysteria, epilepsy, spasmodic affections, and in insomnia, are greatly benefited by massage. The muscular activity induced by massage suspends the nervous incitement by more blood being brought to the muscles and less to the nerves, the muscles being the counterpoise to the nerve centers.

The brain and spinal cord virtually have their peripheral ending in the skin. The smallest area measured by a pin point contains a matting of nerve plates and endings. These are connected through the nerves and nerve trunks with the nerve centers. The manipulation of the skin serves to originate impulses here which are transmitted inward to the centers. Hence, we have at hand a powerful means of toning up the nervous system through stimuli applied to these nerve endings. Sedative movements, as stroking, will induce repose and sweet sleep, while, on the other hand, percussion and vibratory movements serve to arouse and give tone.

In what manner does massage act, in a curative way, in diseased states? Take, for example, obesity, diabetes and rheumatism. There is a common etiological factor present in each of these states. All three have present imperfect or partial oxidation of food material. The muscles, liver and large glands of the body are furnaces. The oxygen, by way of the lungs, enters the blood stream, and with the food material is carried to the individual cell, where cell enzymes begin a series of oxidations by which the solid food elements are broken up into a liquid and a gas, carbonic acid gas, and water. The former is eliminated by the lungs, and the latter by the kidneys. In the above-mentioned diseases this cleavage of food is more or less imperfect. Carbohydrate food elements are imperfectly burned and deposited as adipose tissue or pass out as sugar in the urine. The proteid elements, particularly flesh foods, are imperfectly oxidized into. uric acid and other bodies, and circulate in a crystalline form in the blood stream, blocking the capillaries in the joints, in the sheaths of the muscles or in the nerve sheaths, causing joint rheumatism, lumbago or intercostal neuralgia. Massage by increasing oxidation greatly benefits. or cures these cases. After a treatment of this nature applied to the whole body, an analysis of urine will reveal greatly-increased solids, indicating more active metabolic changes and increased activity of the emunctories. A clear intellect, augmented powers of the entire body, a general feeling of well being, are among the symptoms noted by the recipient of a massage treatment.

It is a means par excellence of improving a feeble circulation, of stimulating the skin and of strengthening muscles. The blood of the anæmic becomes augmented by red-blood corpuscles, brought from the lurking places in the bone marrow, the spleen, and the liver, out into the circu

lation, where they increase the oxygen-carrying power of the blood, while leucocytes are proportionately increased, and so augment the phagocytic power of the blood, and also the power to regenerate torn tissue.

By the stimulation of the skin we supplement the work of the kidney and other organs of elimination; as the skin contains twenty-eight miles, or more, of sewer pipes, it is, therefore, capable of doing a vicarious work for the kidney, a great desideratum when the physician has to deal with an acute nephritis.

One important procedure of massage quite generally omitted or overlooked by the masseur, is that of nerve compression. Indeed, the extent of his knowledge is usually confined to compression of some of the branches of the facial nerve for the relief of toothache, or of migraine. He remains in ignorance of the vast field of usefulness open before him in a knowledge of pressure as applied to the posterior spinal nerve branches. Through these branches we reach the spinal nerve centers, and reflect an impulse along the anterior branches of these same centers which reach nearly all the viscera of the body. Indeed, all the organs of the trunk contained in the thorax, abdomen and pelvis can be reached through these centers. A brief pressure serves to stimulate, and a prolonged pressure inhibits these centers. We may relieve pain or hasten the flow of blood through an organ connected with these centers. A brief pressure, applied along about the second to fourth dorsal spine, will cause a quickened pulse-rate through direct stimulation of the heart, or the stomach. can be filled with water, and by a prolonged two-minute pressure along fourth dorsal spine the pyloric muscles will be caused to relax and allow this water to pass into the intestines. A sluggish-acting liver or bowel can be stimulated in this manner, or a pleuritic, gastric or appendiceal pain can find instant relief through this method.

It is an invaluable aid in the treatment of colics and diarrheas of children, of giving relief in swollen glands of the neck, and of tonsillar swellings. It is a field that, through neglect by the medical profession and which rightfully belongs to the physician, has been usurped and preoccupied by the Osteopath.

Five minutes of massage will allow a fatigued muscle to recuperate better than twenty minutes' rest, and the power of the muscle can be increased three to seven fold over its last effort, by this length of treatment. Dr. Graham says: "It is to be regretted that physicians do not oftener try their hands at massage themselves. They would be fully indemnified for their time and trouble. Furthermore, the benefit of their visit would be immediate, in place of mediate, as when it is the medicine prescribed and not the physician that does the work. French, German and Scandinavian physicians often apply massage themselves, without any thought of compromising their dignity. Non-medical people may become expert

and skillful in the individual maneuvers embraced under massage, but they ought to have their efforts directed by a physician."

An ancient writer, describing massage, waxes "past-eloquent" in these words: "Perfectly massé, one feels completely regenerated, a feeling of extreme comfort pervades the whole system, the chest expands and we breathe with pleasure; the blood circulates with ease, and we have a sensation as if freed from an enormous load; we experience a suppleness and lightness till then unknown. t seems as if we truly live for the first time. There is a lively feeling of existence, which radiates to the extremities of the body, whilst the whole is given over to the most delightful sensations, the mind takes cognizance of these and enjoys the most agreeable thoughts; the imagination wanders over the universe, which it admires, sees everywhere smiling pictures, everywhere the image of happiness. All is followed by a delicious calm."-Graham.

Massage should be measured as our medicines are dosed, according to age, capacity and ability of patient to react to the same. One can easily overtreat, and cause fatigue, or treat unsuitable cases and do much damage, as has frequently been done, thus causing this most valuable therapeutic agency to be discredited and brought into disrepute.

The gynecologist finds a place for local massage as a valuable adjunct to usual methods in the management of subinvolution, chronic metritis, retroflection and other displacements due to adhesions, the sequelæ of previous inflammations of the uterus, its adenexa and surrounding tissue, gluing the organs together, retarding their mobility, and thus misplacing them; also in ovarian enlargement, when not of a cystic nature or not associated with tubal suppuration.

Let the physician and the surgeon familiarize themselves with the technic and effects of pelvic massage in such cases, and the result will be the performance of fewer ovariotomies, and a lessening of the number of desexualized women. While the general treatment may be left to the nurse, manual treatment, as applied to special organs, should be applied only by the physician.

Massage is a general tonic and reconstructive, it increases metabolism in all the tissues, toxic substances are set free for elimination. There is noted increased frequency of respiration, of body weight, of red-blood corpuscles. It relieves insomnia, prevents atrophy of muscles in paralysis, of benefit in tabes, augments the secretion of the kidneys through the increase of albuminoid poisons thrown off by the tissues. It acts by deterging parts of their morbid matter which traumatism has caused in fractures and dislocations and sprains, bringing the affected parts back to their normal state. In chronic diseases demanding stimulation, percussion causes an efflux of nervous energy and sanguineous fluid to the part. Vessels in a state of atony are aroused and become turgescent with blood. Massage is one of the most efficient means of increasing the activity of

the skin. Metabolism is dependent upon circulation, and it is reasonable to suppose that the improved nutrition of the skin resulting from this treatment may induce so great a degree of vital energy as to enable the affected structure to successfully combat the morbid condition found in such chronic skin affections as ulcer, eczema, and psoriasis.

Recent cases of sciatica and muscular rheumatism are almost invariably cured by massage, while it is about the only effectual treatment in gout. It has its uses in hypertrophied tonsil, in headache and neuralgia, and, let the hay-fever sufferer take note that in the initial stage of coryza, manipulation of the bridge and base of the nose, and along the lower cervical and upper dorsal vertebræ (that area of the spine from which the nose is enervated) will dissipate this symptom with surprising rapidity.

By use of abdominal massage, we have a means of relieving congestion of the solar plexus, and in stimulating these great nerve centers of the abdominal sympathetic we accelerate the vital activity of all the abdominal viscera and benefit hepatic congestion, constipation and gastric atony. "We hasten portal circulation and circulation of lymph in lymph channels, absorption is stimulated, producing of gas diminished, and its expulsion encouraged." (This is of much value in dangerous distention of the bowels in surgical cases.)

Massage strengthens the abdominal muscles, increases intra-abdomina! pressure, and thus aids in overcoming gastro-ptosis, enteroptosis and movable kidneys, and other prolapses, included under the general term of viscero-ptosis.

We but mention cosmetic massage for wrinkles, pimples, facial blemishes, cicatrices and baldness. From the foregoing are we prepared to answer the question of the place massage should occupy in modern therapy. The average practitioner of medicine, making reply to this question, is willing to assent that massage serves as a valuable adjunct to medicine. But, through a failure to acquaint himself with its physiological workings and effects, and to familiarize himself with the location and connection of the various reflex arcs of the body, he loses the opportunity of observing its powerful curative actions in disease. Armed with but materia medica the student of medicine, confident that he has in this a cure-all, separates himself from his alma mater, but soon learns that drugs have their limitations, that they are not sure antidotes to the ills of the flesh brought on by wrong habits, and without further temporizing adds to his armament electrotherapy and, perhaps, phototherapy; but as he becomes cognizant of the limitations of his field of usefulness, he gladly seeks for added forces wherewith to combat disease. His investigations, if sincere, will doubtless lead him also to a free application of the methods of hydrotherapy, and use of massotherapy and materiæ-alimentariæ, and soon learns that in these, supposed to be but mere adjuncts, he has found the very pillars of medical science.

715 Schofield Bldg.

DEFECTIVE CIRCULATION, ITS SYMPTOMS AND CURE.

BY LOUIS FAUGERES BISHOP, A. M., M. D., New York City. Clinical Professor of Heart and Circulatory Diseases, Physician to Lincoln Hospital, Etc., Etc.

[Written for the MEDICAL BRIEF.]

Defective circulation shows itself by local or general signs, according to the type of the organs involved. These signs are most striking when the supply of pure arterial blood is temporarily cut off from the brain. Loss of consciousness when a person faints means that for the time being the brain is not supplied with fresh blood, which fact is well proven by the restoration which ensues when the head is placed low, and the blood returns to the brain.

More serious is the case when there is a breaking-down of the circulation, as when a blood-vessel becomes ruptured or stopped by a clot in some particular part of the brain. This causes a loss of power to move those parts of the body controlled by that area of the brain in which the circulation has failed.

A like process may go on in any part of the body, but the effects are not so striking, because the organs, unless the lesion be in the heart, are not so important. A failure of circulation in the lungs leads to shortness of breath, because, without regenerated blood, we can not breathe. A failure of circulation in the stomach leads to indigestion, as is strikingly shown by the arrest of digestion when the surface of the body is chilled after a meal, and the blood is drawn to the skin in an attempt to keep the body warmed. If the circulation in the heart muscle is stopped there results instant death from an arrest of the heart.

In the same way every organ of the body is dependent upon a competent circulation for its proper functioning. When the circulation in the hands or feet is impeded; a person suffers from the sensations of cold and numbness and tingling.

The efficiency of circulation in a given individual is in a great measure an index of the age of that individual. We grow old in two ways: according to the indications of the calendar, and according to the indications. of our circulation. No truer statement was ever made than that of the brilliant George Cheyne who postulated that: "A man is as old as his arteries." This is recognized by all those who give thought to the maintenance of health, and, in fact, every effort that is made with a view to promote health and regain the strength and vigor of youth has something to do with the circulation.

When middle life is reached, those who would live out the traditional three score and ten, and still be healthy, must give much care to those organs which, at this period, are perhaps the most vital, namely: the heart and blood-vessels.

While we are spared many of the things that formerly shortened our existence, such as epidemics, impure food, badly-heated houses, and the