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DETAILS OF TREATMENT

The strength of the various manipulations is a principal point in the massage treatment, and the "self-made'' masseur will often unnecessarily bruise his patients. As a rule, begin with a moderate pressure, ascertaining from the patient his sensation. A new operator has often the fault of using too much pressure.

To avoid abrasions most all Scandinavian operators use some kind of oleaginous substance. Among preparations recommended we have used with advantage: White vaselin, glycerin, lanolin, lard, olive oil, arnica oil (in sprains or distortions), belladonna ointment (in neuritis),—the two latter only when recommended by physicians. See Neuritis, page 135, for additional medication. 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 cocoanut-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, but just enough to make the manipulations smoothly. On very hairy persons it is absolutely 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 masséeing 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 patient's skin; but could anything be more pleasant and agreeable than a soft hand?

CONTRAINDICATIONS FOR MASSAGE

In several affections massage is most certainly contraindicated; and in many the treatment must be performed very carefully.

The first important requisite is that the skin is not severely abraded. Consequently, massage is not to be used in—

• 1. Skin affections: Wounds, burns, erysipelas, eczema, acne, and specific eruptions.
• 2. Certain Affections in the Blood-vessels or Lymphatics.—This must be especially remembered in elderly persons, whose vessels are, as a rule, very sensitive to mechanical pressure.
• 3. In tumors and purulent inflammations, in which 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 convalescent, massage, is, on the contrary, in many cases, one of the best tonics.)
• 6. Pregnancy.—As a rule, avoid massage during pregnancy, and especially massage of the abdomen.
• 7. All affections in which the pressure is liable to cause a hemorrhage.

During menstruation it is best to discontinue general massage, and under no circumstances should the abdomen be treated unless so ordered by the attending physician. Such prescriptions will sometimes be issued in cases of a retarded or too scanty flow.