Massage with Hydrotherapy

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John Harvey Kellogg, M.D., LL.D., F.A.C.S.
Fellow of the Royal Society of Medicine; the Societe d'
Hygiene of France; the British and American Association
of the Advancement of Science; Medical Director of the
Battle Creek (Michigan) Sanitarium

In addition to the remarks made elsewhere, there remain to be discussed a few points in relation to the combined use of massage and hydriatic measures. The value of massage as a measure associated with hydriatic procedures depends chiefly upon the following characteristic physiological effects:
1. Increase of circulatory activity.
2. Stimulation of all the functions of the skin and promotion of reaction.
3. The promotion of nutritive changes in the muscles.

Massage may be advantageously associated with hydriatic procedures not only as an accompaniment of the hydriatic process entering into the technique of the application but it may be employed either as a preparatory or a supplementary measure.

All the procedures of massage may be associated with hydrotherapy. Friction, percussion, and deep massage are especially of service.

FRICTION: Friction as elsewhere explained, is almost universally employed as an essential means of promoting reaction after general cold baths. It has other uses of almost equal importance, of which the following may serve simply as illustrative examples:

1. Friction of the skin at intervals of 15 to 30 minutes in connection with the cold compress, to prevent benumbing of the skin and obliteration of the reflexes upon which the efficiency of the compress depends. This measure is especially of use in connection with the cold precordial compress, the cold chest compress in pneumonia, ice-bag to the back of the neck, the ice-cap, and the spinal ice-bag. Friction should be avoided when the purpose of the cold application is to allay superficial inflammation. The hot fomentation should be employed instead of friction in cases in which deep-seated pain exists, which is aggravated by the friction, and in cases in which the superficial parts are tender. The friction should be applied with sufficient vigor and duration to redden and warm the parts.

2. Friction may often be employed advantageously before an applicaton to accelerate the surface circulation, and prepare the parts to react quickly after a cold application is made. This method is of special value in connection with the wet girdle, the abdominal compress, and the chest pack. It may also be usefully employed as a general measure before cold applications when there is a tendency to gooseflesh or the patient complains of slight chilliness, or when reaction is difficult, especially when the application of heat as a preparation for the cold procedure cannot be conveniently utilized.

3. Vigorous friction may be advantageously used after either hot or cold localized applications which are employed for derivative effects, such as the cold running foot bath, the standing shallow, Scotch douche to the feet and legs, and the revulsive compress. It is only contraindicated in connection with these measures when pain or cutaneous hyperesthesias or eruptions are present.

PERCUSSION may be employed in the same manner as friction and for the same purposes, either by itself or in connection with friction, but is a less useful procedure, its specific effects being less frequently indicated.

1. Percussion is especially indicated in cases in which very powerful circulatory reaction is required, and in which pain is not a marked symptom and the superficial parts not at all sensitive. When percussion is employed, it should be continued until the surface is well reddened. The special purpose of percussion is to produce a very intense and prolonged circulatory reaction.

2. Percussion as well as friction may be employed after the Scotch douche to the legs for relief of asthma or cerebral, pulmonary, or spinal congestion. It may likewise follow the leg pack or the leg bath. 3. Percussion as well as vigorous friction must be avoided in cases in which inflammation is present, as in peritonitis and all acute inflammation of the pulmonary or abdominal cavities, in pelvic inflammations, and in most cutaneous eruptions and by hyperesthesias of the skin.

GENERAL MASSAGE: General massage, including massaging of the muscles, so-called petrissage, or deep massage, may be administered with special advantage after general cold applications for the reason that the application of cold to the skin produces a marked effect upon the muscles, rendering them susceptible to the circulatory and nervous impressions made by the manipulations of massage.

1. The application of massage after the cold bath is especially useful after prolonged cold procedures such as are appropriately employed in obesity and fat diabetics, as the plunge, the shallow, the prolonged cold douche, and the dripping sheet. Massage following the cold bath is indispensable in cases of obesity in which the patient is too weak to secure good reaction by vigorous exercise after the cold bath.

2. Very vigorous massage may be applied with advantage after the cold bath in cases of rheumatism, especially in cases in which the patient is so crippled that vigorous or prolonged exercise is impossible, either on account of general weakness or of a crippled condition of the limbs.

3. Gentle massage may be administered with very great advantage after moderate general cold applications in Bright's disease. These measures are not applicable to cases of advanced Bright's disease, but are especially useful in cases in which the patient has been gradually trained to the employment of cold water at a moderate temperature. Massge should not be employed in cases in which active inflammation is present as shown by elevation of temperature.

4. General and thorough massage may be advantageously employed to promote sweating in connection with the Turkish or the Russian bath, or the hot immersion bath. It is especially indicated in cases in which the skin is dry and inactive so that perspiration begins with great difficulty. It should be employed during the first fifteen minutes of the Turkish bath and the first two or three minutes of the Russian bath. It may be discontinued as soon as perspiration begins.

5. Massage may sometimes be administered with special advantage in connection with the hot immersion bath, the bath having the effect to relax the tissues and to lessen their sensibility. In this way, manipulation for the purpose of reducing joint dislocations may be made to succeed.

6. Massage may be employed with great advantage after various localized applications, as the cold abdominal douche, the cold plantar douche, cold muscle douche, in cases of degeneration of the muscles from neuritis, spinal cord disease, or other disorders of the central nervous system. These combined procedures are indicated in a general way in all cases of localized paralysis.

7. General massage may sometimes be employed after the general hot bath as a means of promoting vigorous perspiration, especially in cases of chronic rheumatism. This measure is also useful for the removal of exudates such as are found about joints after the subsidence of acute inflammatory processes; in the muscular shortening and rigidity which follow muscular rheumatism; in cases of sciatica after the employment of the Scotch douche, and in cases of old, badly united fractures in which pain is a prominent symptom.