( Originally Published 1921 )
The question of massage will come up some time or other in the care of all invalids, but it is of particular importance that it be correctly applied in connection with heart disease. In general some form of manipulation, such as rubbing in connection with the daily bath, will naturally form part of the care of an invalid. The nurse must be guided in great measure by the actual effect upon the patient. If the patient feels better after massage, it is ordinarily beneficial; but it should never be forgotten that massage exhausts some people, and in certain instances of high blood pressure a patient is made distinctly worse by too strong massage.
As the literature of massage is not available to the average nurse, I have quoted part of an article on this subject from a standard reference book, and I commend its careful study; tho it is better, if possible, to obtain instruction from some one who has been specially trained, preferably in the Swedish school.
"Manipulation, malaxation, deep rubbing, or kneading is a combination of pressure and movement without allowing the hand to slip on the skin. It is of more value than all other procedures, and constitutes the massage, properly so-called, of the older writers and also of the later ones who know anything about it. Each and all of these may be gentle, moderate, or vigorous. Some general remarks will save repetition. 1. All of the single or combined procedures should at first be begun moderately, then gradually increased in force and frequency to the fullest extent desirable, and should end gradually as begun. 2. The greatest extent of the hand and fingers of the manipulator, consistent with ease and efficacy of movement, should be adapted to the surface worked upon, in order that no time shall be lost by working with the ends of the fin ers or with one portion of the hands, when all the rest might be occupied. 3. The manipulator, if too near the patient, will be cramped in his movements; if he s too far away, they will be lacking in energy, indefinite, and superficial. 4. The patient should be in an easy and comfortable position, with joints midway between flexion and extension, in a well ventilated room, at temperature of 70° to 750 F. Any sensations of tickling will soon disappear when firm, steady, deep kneading is employed. 5. The direction of these procedures usually should be from the insertion to the origin of the muscles, from the extremities to the trunk, in the direction of the returning currents of blood and lymph, unless there be a plug in a vein. 6. What constitutes the dose of massage is to be determined by the force and frequency of the manipulations, and by the length of time during which they are employed, conside ed with regard to their effect upon the patient; in other words, the reaction must be studied. A good manipulator will do more in fifteen minutes than a poor one in an hour, just as an old mechanic working deliberately will accomplish more than an inexperienced one working furiously.
"I using friction upon the limbs, after the strong upward stroke, the hand should return gently grazing the surface, so as to impart a soothing sensation; it should , not press upon the parts so vigorously as to retard the currents pushed along by the upward stroke; and thus a saving of time and effort will be gained. The manner in which a carpenter uses his plane represents this to-and-fro movement very well. Six to a dozen or more of these up-strokes and as many returning may be used at a time, according to the effect desired. On the hands and feet the friction may be done in a rectilinear manner, parallel to the long axis of the limb, and on the arms and legs it can be used not only in straight lines, but also by long oval strokes extending from joint to joint, the strong stroke up, the light one returning. It is well to begin these strokes on the inner sides of both arms and legs, so that the larger superficial and deep vessels may be first emptied, as this makes room for their tributaries to pour their contents into them. From the base of the skull to the spine of the scapula forms a well bounded region for downward and semicircular friction; and from the spine of the scapula to the base of the sacrum forms another surface over which one hand can sweep in downward and outward strokes, alternating with those of the hand at work upon the shoulder, the patient for this purpose lying on the opposite side. The application of friction to the hip should be done in an upward direction with alternate strokes from the insertion to the origin of the glutei; to the chest from the insertion to the origin of the pectoral muscles; and to the abdomen, from the right iliac fossa in the direction of the ascending transverse and descending colon. Friction over the stomach should be upward and inward from the left side; and over the liver, up and in from the right side.