The Art of Massage
J. H. Kellogg, M.D.
Inventive genius has devised a considerable number
of appliances by means of which a more or less perfect imitation of the
action of the hands in the application of massage may be obtained.
Zander, of Stockholm, and Taylor, of New York, as well as the writer, have
invented machines for this purpose. For nearly thirty years the author
has made use of various forms of apparatus designed to administer mechanical
massage, or what is more commonly termed mechanical Swedish movements,
with most excellent results in appropriate cases.
Mechanical massage may be advantageously used as
a substitute for a number of the procedures of manual massage. I have,
however, found no device quite equal to the human hand, for the administration
of kneading movements. Shaking and vibratory movements, on the other hand,
may be applied more efficiently by apparatus than by hand in cases requiring
vigorous and prolonged application, for the reason that much more vigorous,
rapid, and uniform movements can be executed by machinery than by the hand,
and the movement may be continued as long as necessary; whereas these movements
are exceedingly trying to the masseur, and cannot be maintained, at best,
for more than a few minutes continuously.
Several other procedures may be given by mechanical
appliances quite as well as by the hand, and with even greater efficiency.
A brief description of some of the more important means and methods employed
in mechanical massage, or Swedish movements, will not be out of place in
a work which undertakes, as does this, to cover the whole ground of the
subject from a practical standpoint. This chapter gives a brief description
of the apparatus and modes of application which the author has had in use
in the Battle Creek Sanitarium during the last fifteen to twenty years,
and which have stood the test of practical use in some thousands of cases,
not as an exclusive mode of treatment, but as an auxiliary means employed
in connection with manual massage, exercise, hydrotherapy, electricity,
and other rational methods.
The meager knowledge which has heretofore existed
in regard to the functions of the sympathetic nerve and its relations to
the activities of the viscera, has rendered difficult an explanation of
the remarkable therapeutic results which have been constantly witnessed
from the employment of mechanical massage, especially in the treatment
of hepatic and digestive disorders. Now that the functions of the great
sympathetic nerve and of the abdominal ganglia and solar plexus are coining
to be better understood, it is very clear that the application of strong
vibratory or shaking movements to the abdomen may produce powerful physiological
and therapeutic effects through the stimulation of the sympathetic. When
it is recollected that the great abdominal brain controls the nutrition
of the entire body through its influence upon the circulation and its universal
control of glandular action, it must be clearly seen that therapeutic applications
capable of affecting this portion of the nervous system cannot be made
without marked results.
The observations of the late Professor Charcot,
of Paris, have called the attention of, the profession to the powerful
physiological and therapeutic effects of vibration in the treatment of
organic disease of the spine, one of the most intractable classes of maladies.
The confidence in mechanical massage as a therapeutic measure inspired
by the great prestige of this renowned Parisian physician, has encouraged
the writer to give publicity to some of the observations which he has made
upon this subject during the last thirty years, and to describe some
of the various means employed by him. Among the several devices made use
of are a number which were invented by Zander and Taylor, who have, also
been working in this line; but the majority of those which the author considers
the most effective are the outgrowth of his own personal experience, and
have been constructed after designs furnished by him. Several devices other
than those described have been made and utilized, and have been found not
without merit, but are not described here for lack of space.
Mechanical Vibration. - One of the most useful
of all the several forms of mechanical massage is mechanical vibration.
The highest rate of movement which can be attained by the hand is ten to
twelve to-and-fro movements per second , whereas, by the use of mechanical,
electrical, or acoustic devices, effective vibratory movements may be produced
at any rate desired between forty or fifty per second to ten times that
number. Vibratory movements forcibly communicated to the body at the rate
of sixty per second, have been shown to produce at first a distinct muscular
contraction with each oscillation ; but if the vibration is long continued,
the individual contractions become gradually less distinct, and after a
time merge one into another, so that the contractions become continuous,
or tetanic. From this fact it is apparent that mechanical vibration is
capable of producing very decided physiological results as a mode of exercise;
and that it exercises a powerful influence upon the circulation is a frequent
observation. My patients constantly report that vibratory movements make
them warm, and restore the balance of the circulation when disturbed by
morbid reflex action, so that, while the feet are warmed, the head is cooled.
Carefully conducted experiments which I have made,
show that the temperature of a part subjected to mechanical vibration is
actually increased, the amount of the increase depending upon the length
of the application, and the degree of depression below the normal temperature
at the start. Vibration is also one of the most efficient means with which
the writer is acquainted for relieving the great variety of paraesthesias
from which neurasthenic patients suffer, such as numbness, formication,
The Vibrating Chair. - Figs. 115 and 116 represent
a vibrating chair which I devised in 1883, and have since had in constant
use at the Battle Creek Sanitarium. The usual rate of vibration which I
employ is sixty per second. A person needs to experience but a single application
to become convinced of the powerful physiological effects which may be
produced by mechanical vibration. When seated in the chair, strong vibratory
movements are experienced, in which the whole body takes part. The greatest
amount of force is applied to the lower portion of the trunk. The vibratory
impulses communicated are felt powerfully in the lower bowel, and have
a decided stimulating effect upon the rectum.
By placing the hands upon the arms of the chair,
and inclining the. trunk either forward or backward, the impulses may be
transmitted more or less forcibly, as desired, from the lower to the upper
portions of the spinal column. The application should continue from three
to ten minutes, to secure decided physiological effects.
Vibrating Platform. - In standing erect upon
the moving platform on which the chair rests, the muscles of the legs are
brought into powerful action. Not only the muscles of the lower leg, but
the muscles of the thigh, are thrown into tetanic contraction by the strong
vibratory movements transmitted through the legs (Fig. 116). The application
usually lasts about five minutes. A separate platform may also be used.
The Vibrating Bar. - Fig. 117 is a very imperfect
representation of an apparatus I had constructed several years ago, in
which a suitable mechanism drives a pair of horizontal bars at a high rate
of speed. In using the vibrating bar, the hands are first placed upon it
with the fingers spread and held rigid, but with the wrists flexible. This
throws the hands into violent vibration without communicating the vibratory
impulses to any other portion of the body. The bar is then seized by the
hands, which grasp it tightly while the arm is partly flexed at the elbow,
the shoulder joint being relaxed. Then, straightening the arms and holding
them rigid, the muscles of the shoulders being fixed and the bar held firmly,
the vibratory movements may be communicated to the upper spine and head
with very great vigor, producing a powerfully stimulating effect upon the
The vibratory impulses may also be communicated
to the stomach, liver, loins, sacrum, rectum, and other parts by bringing
these portions of the body into direct contact with the bar.
Powerful endwise vibratory movements are given to
the legs by placing the patient in a chair facing the apparatus, with the
feet against the uprights which support the end of the bar opposite the
driving mechanism. The vibratory movements obtained from this apparatus
are applied to each part from half a minute to one minute.
Vibration of the Arms and Legs. - The legs
are vibrated in three ways: (1) By means of an endwise movement; (2) by
means of a lateral movement; (3) by means of a rotary movement. The effects
of these three modes of vibration are similar, yet in some respects different.
The time of application is usually from three to five minutes.
Endwise vibration is by far the most vigorous
of the three modes. It is administered by means of a horizontal vibrating
bar against the end of which the feet are placed, supported in suitable
rests (Fig. 118).
Lateral vibration is administered by means
of the same apparatus, the feet being placed against the side of. the bar
instead of the end (Fig. 118).
Rotary vibration is produced by means of
a rotating bar, against the end of which the feet are supported (Fig. 119).
The leg is held straight, not flexed as in the cut.
The same apparatus is used for the arms.
Nerve-percuter, or Vibrator. - This instrument,
which I have recently had constructed and to which reference has previously
been made, consists of a metallic chamber in which a mass of soft iron
is made to play to and fro with considerable force by means of an alternating
electrical current passing through a coil of wire which constitutes a part
of the chamber. The blows struck by the oscillating mass of iron are communicated
to the portion of the body under treatment by a brass rod terminating in
a knob. By means of this simple device, very vigorous vibratory movements
may be applied to the head, to a nerve trunk, or to any part of the body
to which it is desirable to make vibratory applications, (Fig. 121).
Vibration of the Trunk. - In Fig. 120 is shown
a method of applying vigorous vibratory movements to the trunk. The apparatus
consists of a mechanism by means of which a strong horizontal bar is made
to oscillate at the rate of 1200 to 1500 per minute. By means of suitable
padded rests placed upon the bar, vibratory movements may be communicated
to the back, the abdomen, or to either side, as may be desired. The special
purpose of this apparatus is to communicate mechanical motion to the liver,
stomach, bowels, and other abdominal viscera. It is a vigorous means of
stimulating peristaltic activity, and of quickening the circulation in
the large viscera of the abdomen. This apparatus the writer has had in
use at the Battle Creek Sanitarium for twenty years, and has found it an
exceedingly effective device. It is not simply a means of amusing the patient,
but is capable of producing powerful physiological and therapeutic effects.
The time of application to each part is usually from three to five minutes.
Mechanical Kneading. - By means of suitable
apparatus, mechanical kneading may be applied in a very efficient manner
to the bowels, the arms, the legs, and even to the whole trunk.
Mechanical kneading of the abdomen is one,
of the most useful of the several forms of kneading; it may perhaps with
justice be said to be the most useful of all. It is best administered by
means of the apparatus shown in the cut (Fig. 122). The writer had this
apparatus specially constructed for the purpose some twelve years ago,
and has had it in constant use since. The, apparatus consists of a table
with a large aperture near the center of its top. In this opening plays
a series of six vertically-placed bars, each surmounted by a suitable pad.
Each bar is separately actuated by a cam, or eccentric, so that it has
its own independent motion. These six eccentrics are so arranged as to
give a wave-like form to the combined movement of the six kneading pads.
Simultaneously with the vertical movement of this kneading device, the
table top, with the patient which it bears, is made to move back and forth,
thus changing the relation of the pads to the abdominal surface, and causing
them to knead the entire abdomen. The two sets of movements are so timed
that the wave-like kneading movement is made to follow very closely the
course of the colon, thus bringing this part of the intestine especially
under control. Zander has a similar machine.
I have found this apparatus of very great service
in the treatment of constipation. It is not, of course, a panacea for this
disease, which arises from many different causes; but it is a most efficient
auxiliary to other measures, and riot a few cases have been observed in
which the patient traced the greater part, of the, benefit received from
a systematic course of treatment to this apparatus alone.
Mechanical kneading of the abdomen is useful not
only in constipation, but also in cases of dilatation of the stomach in
which there is, as a result of the dilatation, a considerable degree of
motor insufficiency, in consequence of which the stomach does not empty
itself with normal promptness. This treatment is of value in all cases
of slow digestion so-called, and should be used within an hour or two after
each meal. The kneading is usually continued from five to fifteen minutes.
Mechanical kneading of the arms is executed by means
of the apparatus shown in Fig. 123. When the pressure is made sufficient
to prevent the rubbers from slipping over the surface, the movement is
that of rolling, a form of deep kneading; with lighter pressure, it is
that of friction. This is a valuable mode of utilizing mechanical massage.
The time of application is from three to five minutes.
The legs may receive mechanical massage by means
of a similar apparatus, shown in Fig. 124. This is an excellent means of
aiding the circulation in cases in which the legs and feet are habitually
cold. The application should be continued from five to eight minutes, or
until the extremities are thoroughly warmed.
Mechanical kneading of various parts may
also be employed, as shown in Fig. 123. The apparatus utilized is similar
to that used for rotary vibration of the feet. A suitable pad is secured
at the end of a bar, which is made to rotate while it rests against any
portion of the trunk to which it can be conveniently applied. It is especially
useful in making applications to the back, stomach, bowels, shoulders,
and the region of the liver. In cases of gall-stones, it is a most excellent
means of jostling imbedded calculi down into the bile duct, thereby hastening
the emptying of the gall-bladder. It also facilitates the discharge of
the fluid contents of the gall-bladder, and is thus a valuable aid to digestion.
It will be apparent from these observations that this particular form of
apparatus is a very efficient form of vibration, as well as a thorough
kneading procedure. The time of application should be from one to three
minutes to each part.
Trunk Rolling. - The apparatus represented
in use in Fig. 125 consists of a pair of pulleys moving in alternation
and in opposite directions, a fraction of a revolution in each direction.
To each pulley is attached one end of a broad strap, which is passed around
the trunk in such a manner that, as the strap is pulled first in one direction
and then in the opposite, the tissues are acted upon very much as in certain
forms of palm. kneading. When applied about the waist, it is a very excellent
means of administering a rolling movement to the muscles of the trunk,
and a shaking movement to the viscera; when applied across the shoulders,
the effect is that of deep kneading. This is a favorite apparatus with
patients who are under treatment by mechanical massage. It was devised
by the author about ten years ago. This application is so vigorous that
it is not usually continued longer than from two to four minutes.
Mechanical Percussion. - There are two forms
of percussion which may be administered mechanically, viz.: (1) Slapping;
Slapping is administered mechanically by
means of a vertical revolving bar, to which is attached a broad strap about
sixteen inches in length (Fig. 126). The strap is fastened to the bar at
its middle, the two ends being free; and thus two blows are struck at each
revolution. Different degrees of force are secured by modifications of
the speed with which the bar is made to revolve, the thickness of the strap,
and the position of the patient in relation to the bar and the strap. The
time of application, is from one to three minutes.
Mechanical slapping is a most effective measure
for stimulating the surface circulation. In this respect it is not excelled
by any procedure which can be administered by the hand. It is most usefully
applied to the shoulders and back, the legs and thighs, and the soles of
Mechanical beating (Fig. 127) is an efficient
mode of percussion, though less valuable in comparison with beating administered
by the hand than is mechanical percussion in comparison with manual percussion.
It is most effectively applied to the spine and chest, and over the abdomen.
The apparatus shown was devised simultaneously by the writer and by Zander,
of Stockholm. The usual time of application is from two to four minutes.
Mechanical Friction. - Friction may be applied
to the soles of the feet by a revolving ribbed cylinder (Fig. 128), which
was first used by Zander. The writer has added a number of features which
have proved serviceable. One of these is the employment of an apron to
cover the ribs of the revolving cylinder, thus preventing the wearing upon
the patient's stockings or slippers ; another improvement is the insulation
of the chair in which the patient sits, which I was led to make by noticing
that sparks could often be drawn from different parts of the patient's
body while receiving treatment from the apparatus. It is not an uncommon
thing to see the hair of a patient sitting in the insulated seat, erected
by the electric charge generated by the friction of the machine. It is
possible that a certain portion of the static electricity may be generated
by the driving belt. This phenomenon is of course chiefly confined to the
colder months, when the atmosphere is dry.
The apparatus is a very valuable one, as it performs
its work efficiently, and does something which cannot be so well accomplished
in any other way. It is a favorite machine with our patients. The application
is a very agreeable one, and may be continued almost ad libitum
without injury. The usual time is from five to ten minutes.
Tilting-table. - In Fig. 129 is represented
a tilting-table, which the writer devised nearly twelve years ago, and
has had in use since. The patient lies upon his back while one end of the
table top is lifted by means of a large cam operating beneath it The patient
lies with his head at the stationary, end of the table.
The purpose of this apparatus is to secure what
I have termed "vasomotor gymnastics." When the hand is raised above the
head, a strong contraction of its blood vessels occurs, the effect being
rendered visible to the eye by blanching of the skin. At the same time
that the blood vessels of the arm are thus made to contract by a vasomotor
reflex, the vessels of the corresponding portion of the brain also contract.
By a repetition of the movement, real gymnastics of the muscular walls
vessels may be executed, and thus relaxed vessels be contracted and
strengthened, and local congestion relieved, if so situated as to come
within the sphere of the reflex action set up by the change in the position
of the arm.
This same principle applies with equal force to
the lower extremities, which have a relation to the organs of the pelvis
similar to that which the arms sustain to the brain. Leg raising, with
the patient lying in a horizontal position, is one of the recognized and
most valuable movements in the medical gymnastics of the Swedes. There
is, however, a certain disadvantage in this mode of exciting vascular contraction.
It is impossible to raise a limb by voluntary effort without a certain
degree of strain, which involves holding the breath, and producing, as
a result, an increase of pelvic and portal congestion, so that the exercise
must to some degree defeat its own purpose. In this exercise, also, but
one leg is raised at once. When the lower part of the body is elevated
mechanically, there is no exertion on the part of the patient, consequently
no strain, and both limbs are elevated at the same time; thus the maximum
effect is obtained.
This apparatus is of great service in all forms
of pelvic congestion, in ovarian disease, uterine catarrh, displacements
of the pelvic viscera, and in rectal disease of various forms. After spending
a few minutes upon the tilting-table, rising and falling with its oscillations
at the rate of about eight times a minute, patients suffering from the
maladies named and others similar, almost invariably express themselves
as experiencing a marked sense of relief. The effects of this mode of passive
exercise of the blood vessels are so agreeable that patients are inclined
to continue the application as long as they are allowed to do so. As a
rule, ten to fifteen minutes is sufficient to secure decided physiological
Pelvis Tilting. - Nearly all forms of pelvic
disease give indications for the use of the tilting-table above described.
In displacement of the womb or ovaries, however, as well as of the stomach,
liver, kidneys, bowels, and other abdominal organs, it is important to
combine with the vasomotor gymnastics described, the employment of position
as an aid to restoration of the displaced viscera. This is accomplished
by adding to the tilting-table above described a device by means of which
the pelvis is lifted free from the table while the patient lies upon the
face, thus causing the abdominal wall to sag downward (Fig. 130). As the
table is tilted, the patient is lifted into such a position as to cause
gravity to make an upward (in relation to the normal position) pull upon
the viscera of the trunk. The device consists simply of an attachment placed
in the center of the table, which is made to rise more rapidly than the
table itself, thus lifting the pelvis before the rest of the body, and
holding it in this relation until the table returns to a state of rest.
The effect of this apparatus is increased, if, while the patient is elevated,
the attendant applies percussion or beating to the sacral region.
The use of this apparatus alone is not sufficient
to restore displaced organs to position, but it aids greatly in relieving
congestion, and is certainly a help toward a cure of visceral prolapse.
The application should be made daily, or twice daily, and continued from
eight to ten minutes each time.
Trunk-exercising Apparatus. - Figs. 131 and
132, represent forms of apparatus which are of substantial service in exercising
the muscles of the trunk. Although the results obtained are different,
the principle of both machines is the same, and is based upon the fact
that the body involuntarily seeks to maintain its equilibrium.
Active-passive Rotation of the Hips. -
Fig. 131 is an apparatus so constructed as to cause a seat to revolve in
such a manner that its plane shall continually change, thus inducing the
patient, when seated upon the apparatus, to contract the muscles of the
trunk in maintaining his equilibrium, the body being steadied by the hands.
There is thus secured a complete and perfect rotation of the hips. This
is a most excellent form of, exercise for persons with weak trunk muscles,
which is the condition of most women who come under the care of the gynecologist,
as well as of a large share of the cases of nervous dyspepsia in both men
and women. This apparatus has the advantage over other forms of gymnastic
apparatus in that it brings the muscles. into action automatically, as
in walking, and thus secures a more complete and natural movement of the
muscles of the trunk. The first applications with this apparatus should
be brief, - not more than one or two minutes, - as the muscles of the trunk
are brought into such vigorous action that they are likely to be overtaxed,
especially in feeble persons. The apparatus may be used either with or
without power attachment, but is usually employed without.
Trunk Flexion. - In the apparatus shown in
Fig. 132 the movement is a tilting of the seat from side to side. It is
used in two positions: (1) With the patient sitting parallel with the line
of movement; (2) with the patient sitting at right angles to the line of
movement. In the first position, the patient is induced to make alternate
flexion of the trunk forward and backward; in the second position, the
patient flexes the trunk from side to side.
The use of this apparatus is indicated in the same
class of cases as the preceding. Its action is less powerful, and consequently
it is especially adapted to feeble patients at the beginning of a course
of treatment, and as an introduction to the more vigorous movements. The
action of this apparatus being less energetic than the preceding, the applications
may be somewhat longer - two or three minutes at first, and longer after
the patient becomes accustomed to them.
Mechanical Respiration. - In Fig. 133 is shown an
apparatus by means of which artificial respiration may be mechanically administered.
In its use the patient is seated upon a stool, the arms being placed over movable
rests, which fall in the axillae. The back is supported by a padded rest placed
between the shoulders. When the machine is set in motion, the shoulders are
lifted upward and backward in such a way as to expand the chest in an efficient
manner, producing a strong inspiratory movement quite independent of any effort
on the part of the patient. The effect is to correct the condition known as
flat, or hollow, chest, and to give flexibility to the chest walls when they
have become rigid in consequence of insufficient use. This apparatus is in part
modeled after a similar arrangement by Zander, but several improvements have
been added; among others, is a device by means of which the arms, as well as
the shoulders, are raised, thus increasing the vigor of the inspiratory movement.