qualifications of the person who does it as in any other occupation. It would be wrong to leave the impression that massage is always agreeable from the first. In proportion as the muscles, superficial fascia, and skin are unnaturally tough, tense, matted and hide-bound, will the massage be disagreeable until they become soft, supple, and elastic. An appreciation of the proper consistence of the tissues and their anatomical structure is of the utmost importance for the success of this treatment.
But we must hasten to consider how massage acts locally. By upward and oval friction, with deep manipulation, the vein's and lymphatics are mechanically emptied—the blood and lymph are pushed along more quickly by the additional vis a tergo of the massage, and these fluids can not return by reason of the valvular folds on the internal coats of their vessels. Thus, not only is more space created for the returning currents arising from beyond the region masséed, but, at the same time, a vacuum is formed, which is visible in the superficial veins of persons who are not too fat; and this is thought by some to add a new force to the more distal circulation. In this way the collateral circulation in the deeper vessels is aided and relieved, as well as the more distal stream in the capillaries and arterioles. One would naturally suppose that the circulation in the larger arteries would, in this manner, be interrupted, and such is the case. But, herein comes an additional advantage to aid the circulation, for the temporary and momentary intermittent compression causes a dilatation of the artery from an increased volume of blood above the part pressed upon, and this accumulation rushes onward with greater rapidity as soon as the pressure is removed, in consequence of the force of the heart's action and the resiliency of the arteries acting upon the accumulated volume of blood.
But the same pressure also acts upon the tissues external to the vessels, causing a more rapid resorption of natural or pathological products through the walls of the venous capillaries and lymphatics. When muscular nerves are stimulated, the vaso-dilators are influenced, and this takes place by massage, whence follows enlargement of the lumen of the vessels, so that an increased flow passes through them with greater ease and diminished pressure. When stimuli are applied to the skin, reflex vaso-motor action shows that the vaso-dilators are acted upon, hence the redness and congestion of the skin when massage is specially directed to it. It can be readily seen now that massage rouses dormant capillaries, increases the area and speed of the circulation, furthers absorption and stimulates the vaso-motor nerves, all of which are aids and not hindrances to the heart's action, as well as to nutrition in general. Seeing that more blood passes in a given time, there will be an increase in the total interchange between the blood and the tissues, and thus the total amount of work done by the circulation will be greater and the share borne by each quantity of
