One sometimes hears doubts expressed whether a patient with a high-grade anæmia is not "too feeble for such strong treatment" as massage. This study of one of the ways in which massage affects such cases may fairly be taken as proof of the certainty and safety of its effect on them, provided always it be done properly and with intelligence. Some check upon this may be had, as is said elsewhere, by the general effect upon the patient. It may be repeated that the pulse should be slower and stronger after an hour of deep massage, and that this effect will not be produced by superficial rubbing (indeed, with light or too rapid manipulation the pulse may become both less strong and more rapid), and finally the flow of urine should be increased. With these easily observed facts to aid, it may readily be judged whether massage is being rightly applied or not without the need of a visit from the physician during the hour of treatment. A final test might readily be made by examination of the blood and counting the red corpuscles before and after treatment. No doubt in very bad cases a small increase or none would be found at first, but a week of daily manipulation should show a distinct addition to the blood count. A striking instance in which this examination was repeatedly made is related on p. 184.
"It is evident that our present definitions of anæmia are insufficient. An essential part of the description in all of them is that there are defects of number, of color, or of both in the blood. This is not necessarily or always true. The fault may lie in a lack of activity or of availability in the corpuscles. The state of things in the system may be like the want of circulating money during times of panic, when gold is hoarded and not made use of, and interference with commerce and manufactures results.
"Neither an anæmic appearance nor a blood-count is alone enough for a certain diagnosis. Other signs must be used as a check on the blood examination for the establishment of the existence of anæmia. For instance, many cases here recorded had full normal or even supra-normal corpuscle-count, with a good percentage of hæmoglobin. Yet they presented every external sign of poverty of blood: pallor of skin and, more important still, of mucous membranes, cold extremities, anorexia, indigestion, dyspnœa on trifling exertion. In such cases we must suppose either that the total volume of the blood is reduced, or that the usefulness of the corpuscles is in some way impaired, or that both these troubles exist together."[23]
I have said above that the face was not touched in the course of the rubbing. There are cases, however, in which massage of the head and face may be usefully practised. Some obstinate neuralgias are helped by it temporarily, and very often it is of use with other means to aid in a permanent cure. Many headaches of a passing character may be dissipated promptly by careful massage of the head or by downward stroking over the jugular veins at the sides of the neck to lessen the flow of blood into the cerebral vessels, where the pain is due to congestion or distention, and careful manipulation of the facial muscles in paralysis is of service in restoring loss of tone and improving their nutrition. It is worth adding here, as women patients frequently say that during their illness the hair has become thin or shown a great tendency to fall, that daily firm finger-tip massage of the head for ten or twelve minutes, followed by rubbing into the scalp of a small amount of a tonic, either a bland oil or if need be of some more stimulating material, will in a great majority of the instances where loss of hair is due to general ill-health perfectly restore its vigor and even its color.
I am accustomed to pay a good deal of attention to the observations made on these and other points by practised manipulators, and I find that their daily familiarity with every detail of the color, warmth, and firmness of the tissues is of great use to me.
A great deal of nonsense is talked and written as to the use and the usefulness of massage. The "professional rubber" not unnaturally makes a mystery of it, and patients talk foolishly about "magnetism" and "electricity;" but what is needed is a strong, warm, soft hand, directed by ordinary intelligence and instructed by practice; and this is the whole of the matter, except in the massage of such obscure conditions as need full knowledge of the anatomical relations and physiological functions of the parts to be rubbed. It is a fact that I have known country physicians who, desiring to use massage and not having a practitioner of it within reach, have themselves trained persons to do it, with considerable resultant success.
It is not, perhaps, putting it too strongly to say that bad massage is better than none in those cases in which manipulation is needed. Very little harm can result from its use even by unskilled hands, provided that reasonable intelligence direct them.