to cover all the movements mentioned; but this is a verbal subtlety of no importance. It is evident that alike among the Greeks, the Orientals, and savage races, the two processes have always been applied as part of the same treatment, and the definition quoted above from Littré goes to show that the word “massage” is properly applied to both.
Rubbing has been subdivided into several processes, namely (1) stroking, (2) kneading, (3) rubbing, and (4) tapping, and some practitioners attach great importance to the application of a particular process in a particular way. As a rule, oils and other lubricants are not used. But, however it may be applied, the treatment acts essentially by increasing circulation and improving nutrition. It has been shown by Lauder Brunton that more blood actually flows through the tissues during and after rubbing. The number of red corpuscles, and, to some extent, their haemoglobin value, are also said to be increased (Mitchell). At the same time the movement of the lymph stream is accelerated. In order to assist the flow of blood and lymph, stroking is applied centripetally, that is to say, upwards along the limbs and the lower part of the body, downwards from the head. The effects of the increased physiological activity set up are numerous. Functional ability is restored to exhausted muscles by the removal of fatigue products and the induction of a fresh blood supply; congestion is relieved; collections of serous fluid are dispersed; secretion and excretion are stimulated; local and general nutrition are improved. These effects indicate the conditions in which massage may be usefully applied. Such are various forms of paralysis and muscular wasting, chronic and subacute affections of the joints, muscular rheumatism, sciatica and other neuralgias, local congestions, sprains, contractions, insomnia and some forms of headache, in which downward stroking from the head relieves cerebral congestion. It has also been used in anaemia, hysteria and “neurasthenia,” disorders of the female organs, melancholia and other forms of insanity, morphinism, obesity, constipation, inflammatory and other affections of the eye, including even cataract. General massage is sometimes applied, as a form of passive exercise, to indolent persons whose tissues are overloaded with the products of incomplete metabolism.
As with other methods of treatment, there has been a tendency on the part of some practitioners to exalt it into a cure-all, and of others to ignore it altogether. Of its therapeutic value, when judiciously used, there is no doubt, but it is for the physician or surgeon to say when and how it should be applied. Affections to which it is not applicable are fevers, pregnancy, collections of pus, acute inflammation of the joints, inflamed veins, fragile arteries, wounds of the skin and, generally speaking, those conditions in which it is not desirable to increase the circulation, or in which the patient cannot bear handling. In such conditions it may have a very injurious and even dangerous effect, and therefore should not be used in a haphazard manner without competent advice.
The revival of massage in Europe and America has called into existence a considerable number of professional operators, both male and female, who may be regarded as forming a branch of the nursing profession. Some of these are trained in hospitals or other institutions, some by private practitioners and some not at all. Similarly some are attached to organized societies or institutions while others pursue their calling independently. Several things are required for a good operator. One is physical strength. Deep massage is very laborious work, and cannot be carried on for an hour, or even half an hour, without unusual muscular power. Feeble persons cannot practise it effectively at all. The duration of a sitting may vary from five or ten minutes to an hour. For general massage at least half an hour is required. A masser should have strength enough to do the work without too obvious exhaustion, which gives the patient an unpleasant impression. A second requirement is tactile and muscular sensibility. A person not endowed with a fine sense of touch and resistance is liable to exert too great or too little pressure; the one hurts the patient, the other is ineffective. Then skill and knowledge, which can only be acquired by a course of instruction, are necessary. Finally, some guarantee of cleanliness and character is almost indispensable. Independent massers may possess all these qualifications in a higher degree than those connected with an institution, but they may also be totally devoid of them, whereas connexion with a recognized hospital or society is a guarantee for a certain standard of efficiency. In London there are several such institutions, which train and send out both male and female massers. The fee is 5s. an hour, or from two to four guineas a week. On the European continent, where trained massers are much employed by some practitioners, the fee is considerably lower; in the United States it is higher. For reasons mentioned above, it is most desirable that patients should be attended by operators of their own sex. If this is not insisted upon, a valuable therapeutic means will be in danger of falling into disrepute both with the medical profession and the general public. (A. Sl.)
MASSAGETAE, an ancient warlike people described by Herodotus (i. 203–216; iv. 22, 172) as dwelling beyond the Araxes (i.e. the Oxus) in what is now Balkh and Bokhara. It was against their queen Tomyris that Cyrus undertook the expedition in which according to one story he met his end. In their usages some tribes were nomads like the people of Scythia (q.v.), others with their community of wives and habit of killing and eating their parents recalled the Issedones (q.v.); while the dwellers in the islands of the river were fish-eating savages. Probably the name denoted no ethnic unity, but included all the barbarous north-eastern neighbours of the Persians. Herodotus says they only used gold and copper (or bronze), not silver or iron. Their lavish use of gold has caused certain massive ornaments from southern Siberia, now in the Hermitage at St Petersburg, to be referred to the Massagetae. (E. H. M.)
MASSA MARITTIMA, a town and episcopal see of the province of Grosseto, Tuscany, Italy, 24 m. N.N.W. of Grosseto direct and 16 m. by rail N.E. of Follonica (which is 28 m. N.W. of Grosseto on the main coast railway), 1444 ft. above sea-level. Pop. (1901), (town) 9219; (commune) 17,519. It has a cathedral of the 13th century containing a Romanesque font (1267 with a cover of 1447) and a Gothic reliquary (1324) of the saint Cerbone, to whom the cathedral is dedicated. The battlemented municipal palace of the 13th century is picturesque. There are mineral springs, mines of iron, mercury, lignite and copper, with foundries, ironworks and olive-oil mills. At Follonica on the coast, but in this commune, are the furnaces in which are smelted the iron ore of Elba.
MASSAWA, or Massowah, a fortified town on the African coast of the Red Sea, chief port of the Italian colony of Eritrea, in 15° 36′ N. and 39° 28′ E. Pop. about 10,000. The town stands at the north end of the bay of Massawa and is built partly on a coral island of the same name—where was the original settlement—and partly on the islets of Tautlub and Sheik Said, and the neighbouring mainland. Massawa Island is from 20 to 25 ft. above the sea, its length does not exceed 12 m. and its breadth is about 14 m. The harbour is formed by the channel between the island and the mainland. It affords good anchorage in from 5 to 9 fathoms. The town possesses several good public buildings, chiefly built of coral, as are the houses of the principal European and Arab merchants. Landward the town is guarded by forts erected by the Italians since 1885. Water was formerly scarce; but in 1872 an ancient aqueduct from Mokullu (5 m. distant westward) was restored and continued by an embankment to the town. A railway connects Massawa with Asmara, the capital of the colony. Besides the Abyssinians, who speak a Tigré dialect corrupted with Arabic, the inhabitants comprise Italian officials and traders, Greeks, Indians, Arabs from Yemen and Hadramut, Gallas and Somalis. Massawa is the natural port for northern Abyssinia but commerce is undeveloped owing to the lack of rapid means of communication. The trade done consists mainly in exporting hides, butter, Abyssinian coffee and civet, and importing European and Indian cotton goods and silks. It increased in value from about £65,000 per annum in 1865 (the last year of Turkish control) to from £240,000 to £280,000 between 1879 and 1881, when under the administration of Egypt. Under the Italians trade greatly developed. The returns for the five years 1901–1905 showed an average annual value of £1,800,000, about two-thirds being imports.
The island of Massawa has probably been inhabited from a very early date. It appears to have formed part of the Abyssinian dominions for many centuries. It was at Massawa (Matzua, as it is called by the Portuguese chroniclers) that Christopher da Gama and his comrades landed in July 1541 on their way to aid the Abyssinians against the Moslem invaders. Captured by the Turks in 1557, the island remained a Turkish possession over two hundred years. A military colony of Bosnians settled at Arkiko (a port on the bay 4 m. south of Massawa Island) was appointed not only to defend it in case of attack from the mainland, but to keep it supplied with water in return for $1400 per month from the town’s customs. For some time at the close of the 18th century Massawa was held by the sherif of Mecca, and it afterwards passed to Mehemet Ali
