The Art of Massage J. H. Kellogg, M.D. 1895   RULES RELATING TO MASSAGE.  
 
    1. Correct Use of Terms. - In speaking of massage or its application, be careful to use correct terms (pp. 238, 239).
    2. Good Health Necessary. - Of all persons, one who administers massage should have perfect health. The so-called magnetism which renders some persons so much more successful than others in massage, as well as in other callings, is largely the outgrowth of the vivacity, freshness, good cheer and good nature which result from abounding health. A few things of special importance in this relation are proper diet; healthful, loose, and appropriate clothing; a daily cool morning sponge bath; and daily out-of-door exercise.
    3. Personal Cleanliness. - Massage is hard work, equal to almost any form of manual labor. A masseur who does his duty will perspire vigorously; hence the necessity of due attention to personal cleanliness. Cleansing of the skin may be promoted by the addition of a little carbonate of ammonia to the water used for the morning bath. When one perspired freely, stockings and underclothing should be changed daily. After airing for a day or two, the same garment may be worn again for a day. Special attention must also be given to the hands, teeth, and also the nasal cavity, if a catarrhal condition is present, and to the hair and scalp.
    4. The Hands. - Good hands are necessary for success in massage. The hands must be soft, warm, dry, strong, and elastic. A bony, sweaty, hard, or calloused hand is exceedingly objectionable. The hands should also be free from blemishes, such as warts, abrasions, chaps, etc. The nails should be trimmed close. Absolute cleanliness, is the best means of promoting a healthy state of the skin of the hands, as well as, other parts. A perfectly clean hand is not likely to chap. Always wash the hands just before giving massage; doing so, if convenient, in the presence of the patient, or at least with his knowledge. Always wash the hands a second time just before manipulating the head, face, or neck, if the hands have been used upon other parts since washing. The following lotions are valuable for keeping the hands in a healthy state:-
 
    (1) Comp. tri benzoin .............................. dr. 4.
        Alcohol ................................................oz. 1/2.
        Glycerine ............................................. oz. 1.
        Water ...................................................oz. 2.

    (2) Borax .................................................dr. 11/2.
        Carbonate of soda ...............................dr. 11/2.
        Carbonate of ammonia .........................dr. 2.
        Aquae ammonia, ..................................dr. 4.
        Glycerine .............................................oz. 1.
        Water to make .................................... oz. 6.
 
    5. The Personal Appearance. -Simplicity, neatness, and tidiness in dress are in the highest degree commendable. The personal appearance should be made attractive by extreme care and appropriateness in dress, without showiness, which always indicates vulgarity or ignorance. Nurses connected with a hospital in which a uniform is used should always wear it when on professional duty.
    6. No person should undertake to practice massage who has not received a thorough practical training. Massage is both an art and a science, and only those who have had long practice can be thoroughly efficient.
    7. Never countenance the belief that vitality, magnetism or any other occult force is imparted by manipulation. Avoid flourishes.
    8. Do not be hurried, flurried, nor out of breath from fast walking, in approaching a patient to administer massage.
    9. Avoid a bustling, nervous manner.
    10. Only in most extraordinary cases and under exceptionally justifying circumstances, and, then only in the presence of other persons, should a masseur or a masseuse administer massage to an adult person of the opposite sex.
    11. The room in which massage is given should be well ventilated, temperature about 75^o to 80^o F.
    12. As a rule, the patient should be undressed, or clad in .a single loose gown. Care should be taken to keep the body well covered, with the exception of the part undergoing manipulation.
    13. The patient should be placed in an easy, comfortable position.
    14. The position of the operator varies with the part operated upon, but should always be such as is best suited for the part undergoing manipulation.
    15. In bending over the patient, the body should be flexed at the hips, not at the waist or shoulders. By this precaution the masseur may avoid becoming round-shouldered. The height of the bed or couch should be such that the masseur will not need to bend to any great extent.
    16. Movements of the hands should always be executed from the wrist.
    17. Apply as much of the surface of the hands and fingers as possible to the part operated upon, thus distributing the pressure and saving time.
    18. The body should be gone over systematically, for which purpose it should be divided into separate territories. Each part should be finished before going to another part.
    19. Opposite sides of the body should be manipulated in succession, so as to intensify the effect upon the nerve centers.
    20. The masseur should always keep in mind the anatomy of the body, -- the outline of the bones, the location of the large nerves, arteries, and veins, and of the principal muscular groups, -- and should take care to follow the bones, thinking of the bony framework as well as its covering of soft parts. Work down between the muscles and tendons, around the head of the bones, taking special care to work into all the irregularities of the joints, where the blood vessels and lymph channels are the largest.
    21. At the beginning, movements should be slow and gentle, being gradually increased in rapidity and force to the maximum, then gradually diminished to the termination.
    22. As a rule, always employ the same rate of motion for the same movement. This indicates skill and good training.
    23. It is well to run rapidly and lightly over a part before giving the more vigorous movements.
    24. In the first application of massage to a patient not accustomed to treatment, great care should be taken not to produce soreness and black-and-blue spots. These unpleasant effects are especially likely to occur in fleshy and aged persons, owing to the feeble circulation in the adipose tissues of the first class, and the brittleness of the blood vessels of the second class. Fever convalescents and persons who have been long in bed are also liable to these effects, for similar reasons.
    25. For relief of sensitive parts, employ Only gentle stroking over the affected areas, and administer derivative massage to the muscles and other tissues of the vicinity, especially between the affected part and the heart. The painful part may be approached by degrees until applications can be made directly to it.
    26. In many cases it is well to lubricate the hand with some unctuous substance, such as olive oil, fine vaseline, cocoanut oil, or cacao butter. The last-named substance is, perhaps, the best of all. It is solid at ordinary temperatures, melting, however, at the temperature of the body. A cake of cacao butter rubbed upon the hands occasionally during the administration of massage, keeps the hands well lubricated without smearing the body of the patient with a surplus of oil. In case oil is objectionable, talcum powder may be used.
    27. Lubricants should always be used when much pressure is required, and where prolonged manipulation is necessary, also in the treatment of parts where the skin is extremely sensitive.
    28. When it is desired to stimulate the skin to a high degree by friction, lubricants should be avoided. A part may be rubbed six to ten minutes when oil is employed; but the same surface should not be operated upon more than from two to five minutes when a lubricant is not used.
    29. Some authorities recommend that the parts should be shaved before the application of massage, but this is rarely necessary; and when the treatment must be employed a long time, may become a source of serious inconvenience.
    30. The amount of massage administered must be suited to each case and to the mode of application.
    31. Do not recommend massage for everything.
    32. General massage should never be given in cases of fever. .Local applications should not be made to parts which are the seat of acute inflammation.
    33. Fleshy persons do not bear massage well, for the reason that the manipulations set free a large amount of waste matter and imperfectly oxidized products which, absorbed into the system, produce the same effect as excessive exercise,-effects resembling those of consecutive or secondary fatigue, to which fleshy persons are very liable. Fleshy persons often complain of languor, lassitude, and lameness after massage, and the tissues are very easily bruised because of the weak circulation and on account of the excessive amount of adipose tissue. Another cause of this condition is probably the disproportion existing between the lymph spaces and the amount of waste matter set free, because so much space is occupied by fat and subcutaneous tissue.
    34. Massage is contra-indicated in nearly all forms of skin disease, except in the thickened condition of the skin left behind by chronic eczema. It is also contra-indicated in cases of apoplexy and in the early stages of neuritis, when excessive irritability still exists, and should never be administered to abscesses, tumors, or tubercular joints.
    35. Order in General Massage . - (1) Arms; (2) Chest; (3) Legs; (4) Abdomen; (6) Hips; (6) Back; (7) Head ; (8) Neck.
    36. General Observations. - Percussion is sometimes more effective in strengthening a weak muscle than either kneading or faradization.
    37. Percussion and vibration should be avoided in hyperaesthesia. In such cases, deep kneading, stroking, and joint movements may be employed.
    38. Deep kneading is especially suitable for excitable neurasthenics and patients suffering from chorea.
    39. In infantile paralysis and other diseases accompanied by lowered vitality and diminished activity without increased sensibility, percussion is indicated.
    40. In chorea and locomotor ataxia, - in fact, in most cases in which massage is valuable, - gymnastics should, be added. In locomotor ataxia the patient should exercise by walking and standing with the eyes closed, to develop the coordinating centers.
    41.In convalescence from fevers, massage must be applied with care, because of the disturbance of the heat-regulating function on the part of the body. The same is true in tuberculosis. Use chiefly friction in such cases
    42. Patients in whom the skin is rigid and inelastic, or in a "hidebound" condition, may be prepared for general massage by the administration of a warm bath.
    43. In some patients the application of oil to the surface is objectionable through the irritating effect of oleaginous matters upon the susceptible skin, especially in persons subject to certain forms of skin disease. In such cases we have found a glycerine ointment compounded after the following formula, an excellent substitute: Glycerine, 15 oz. ; boracic acid, 1 1-2 oz. ; starch, 1 1-2 oz.; gum tragacanth, 1 1-2 oz. oil of wintergreen, 1 dr.
    After lubricating the surface with the ointment, a little moisture should be added by dipping the tips of the fingers in water. By means of a moist towel this lubricant can be completely removed after the treatment, leaving the skin delightfully smooth. Talcum powder is preferable in warm weather.