MASSAGE.
Von Gerard, Elle sume, Estradere, Berenger-Fhaud, N•aton, Demarquay, Stromeyer, Volkmann and others, recommended it in case of disease of the joints, and it became popularized through Metzger's efforts; but in the diseases of the female genital organs massage meets with difficulties and with ob jections, which is the reason why it has not been resorted to by many good observers, and why no exact indications have as yet been formulated. Brandt, Hartelius, 0. Nissen, and others, find indications from the side of the uterus, but they have not met with acceptance in Germany. The above authors massage in case of versions and flexions, of chronic inflam mations of the mucosa and the muscularis, of hypertrophy of the uterus, and, in particular, in case of descent of the uterus, of fibroids, metror rhagia, pare- and perimetritis, pelvic adhesions, oophoritis, etc.
Brandt's original method consisted in a number of procedures, " taps," " punctiform pressure," etc., which were often limited to the abdomen, but again resorted to through the vagina or the rectum on the uterus. In the discussion of Nissen's paper, in the very home of mas sage, the procedure found a number of opponents, like Malmsten, and they condemned it not only because it was likely to cause hemorrhage, cellulitis, etc., but also on moral grounds. The teachings of Brandt and his immediate pupils have latterly been considerably modified by Asp, although he clings to the essential procedure, massage of the uterus, which is resorted to by the operator seizing the organ between the fingers of both hands, even as during the bimannal palpation by vagino-abdomi nal or the recto-abdominal method, and then exerting a slight, lasting, pressure upon it. In addition, the lower portion of the abdomen is kneaded.
Up the Swedish gymnastic cure and massage have largely found their home in cold-water-cure institutions, although more than thirty years ago, possibly as the result of Priessnitz's teaching, some of the movements were resorted to in case of disease of the pelvic organs, the method, however, not being specially known or connected with the term " massage." My own recollection and recorded results testify, how
ever, to the fact that, while certain physicians, who kneaded without special selection of cases, obtained good results, others had bad results, such as abortion, rupture of tumors, etc.
To-day a number of authors have spoken in favor of massage: Asp, Hartelius, Reeves Jackson, Operum, Bandl, IIegar, Schroder, nik, Runge, Reibmeyer (who has given a good digest of the literature, as well as described the methods of performance); myself, and others, have frequently had the opportunity to note good results.
The unquestioned facts that massage influences greatly the motion of the blood and of the lymph, that it increases absorption where other means are not applicable or have been ineffectively tried,—such facts, which have been substantiated experimentally by Mosengeil, allow us to state with certainty that the treatment by massage is applicable to many cases, and that it is entitled to a prominent place in the therapeusis of the diseases of females.
As to whether by the gymnastic treatment of the pelvic organs the elasticity and contractility of the uterine ligaments may be increased, as is claimed by Brandt's pupils, must for the present remain in doubt; but it is to be noted that by means of the massage of cystic tumors very pro fuse diuresis may be produced, as Winiwarter's observation proves, and as I have often noted myself.
The difficulties in the way of the general acceptance of massage de pend particularly on the unpleasant results and the dangers which may follow on manipulation of and in the female genitals. Asp's suggestion that the massage movements should be performed by women only par tially does away with the obstacles, since these in great part depend on the physical sensibility of the patients, and besides, as Prochownik and Reibmayer have insisted, it is essential that the physician himself should conduct the treatment for a sufficient length of time to satisfy himself in regard to the exact indications and essential technique.