and skillful in the individual maneuvers embraced under massage, but they ought to have their efforts directed by a physician."

An ancient writer, describing massage, waxes "past-eloquent" in these words: "Perfectly massé, one feels completely regenerated, a feeling of extreme comfort pervades the whole system, the chest expands and we breathe. with pleasure; the blood circulates with ease, and we have a sensation as if freed from an enormous load; we experience a suppleness and lightness till then unknown. t seems as if we truly live for the first time. There is a lively feeling of existence, which radiates to the extremities of the body, whilst the whole is given over to the most delightful sensations, the mind. takes cognizance of these and enjoys the most agreeable thoughts; the imagination wanders over the universe, which it admires, sees everywhere smiling pictures, everywhere the image of happiness. All is followed by a delicious calm."-Graham.

Massage should be measured as our medicines are dosed, according to age, capacity and ability of patient to react to the same. One can easily overtreat, and cause fatigue, or treat unsuitable cases and do much damage, as has frequently been done, thus causing this most valuable therapeutic agency to be discredited and brought into disrepute.

The gynecologist finds a place for local massage as a valuable adjunct to usual methods in the management of subinvolution, chronic metritis, retroflection and other displacements due to adhesions, the sequelæ of previous inflammations of the uterus, its adenexa and surrounding tissue, gluing the organs together, retarding their mobility, and thus misplacing them; also in ovarian enlargement, when not of a cystic nature or not associated with tubal suppuration.

Let the physician and the surgeon familiarize themselves with the technic and effects of pelvic massage in such cases, and the result will be the performance of fewer ovariotomies, and a lessening of the number of desexualized women. While the general treatment may be left to the nurse, manual treatment, as applied to special organs, should be applied only by the physician.

Massage is a general tonic and reconstructive, it increases metabolism in all the tissues, toxic substances are set free for elimination. There is noted increased frequency of respiration, of body weight, of red-blood corpuscles. It relieves insomnia, prevents atrophy of muscles in paralysis, of benefit in tabes, augments the secretion of the kidneys through the increase of albuminoid poisons thrown off by the tissues. It acts by deterging parts of their morbid matter which traumatism has caused in fractures and dislocations and sprains, bringing the affected parts back to their normal state. In chronic diseases demanding stimulation, percussion causes an efflux of nervous energy and sanguineous fluid to the part. Vessels in a state of atony are aroused and become turgescent with blood. Massage is one of the most efficient means of increasing the activity of

the skin. Metabolism is dependent upon circulation, and it is reasonable to suppose that the improved nutrition of the skin resulting from this treatment may induce so great a degree of vital energy as to enable the affected structure to successfully combat the morbid condition found in such chronic skin affections as ulcer, eczema, and psoriasis.

Recent cases of sciatica and muscular rheumatism are almost invariably cured by massage, while it is about the only effectual treatment in gout. It has its uses in hypertrophied tonsil, in headache and neuralgia, and, let the hay-fever sufferer take note that in the initial stage of coryza, manipulation of the bridge and base of the nose, and along the lower cervical and upper dorsal vertebræ (that area of the spine from which the nose is enervated) will dissipate this symptom with surprising rapidity.

By use of abdominal massage, we have a means of relieving congestion of the solar plexus, and in stimulating these great nerve centers of the abdominal sympathetic we accelerate the vital activity of all the abdominal viscera and benefit hepatic congestion, constipation and gastric atony. "We hasten portal circulation and circulation of lymph in lymph channels, absorption is stimulated, producing of gas diminished, and its expulsion encouraged." (This is of much value in dangerous distention of the bowels in surgical cases.)

Massage strengthens the abdominal muscles, increases intra-abdomina! pressure, and thus aids in overcoming gastro-ptosis, enteroptosis and movable kidneys, and other prolapses, included under the general term of viscero-ptosis.

We but mention cosmetic massage for wrinkles, pimples, facial blemishes, cicatrices and baldness. From the foregoing are we prepared to answer the question of the place massage should occupy in modern therapy. The average practitioner of medicine, making reply to this question, is willing to assent that massage serves as a valuable adjunct to medicine. But, through a failure to acquaint himself with its physiological workings and effects, and to familiarize himself with the location and connection of the various reflex arcs of the body, he loses the opportunity of observing its powerful curative actions in disease. Armed with but materia medica the student of medicine, confident that he has in this a cure-all, separates himself from his alma mater, but soon learns that drugs have their limitations, that they are not sure antidotes to the ills of the flesh brought on by wrong habits, and without further temporizing adds to his armament electrotherapy and, perhaps, phototherapy; but as he becomes cognizant of the limitations of his field of usefulness, he gladly seeks for added forces wherewith to combat disease. His investigations, if sincere, will doubtless lead him also to a free application of the methods of hydrotherapy, and use of massotherapy and materiæ-alimentariæ, and soon learns that in these, supposed to be but mere adjuncts, he has found the very pillars of medical science.

715 Schofield Bldg.

DEFECTIVE CIRCULATION, ITS SYMPTOMS AND CURE.

BY LOUIS FAUGERES BISHOP, A. M., M. D., New York City. Clinical Professor of Heart and Circulatory Diseases, Physician to Lincoln Hospital, Etc., Etc.

[Written for the MEDICAL BRIEF.]

Defective circulation shows itself by local or general signs, according to the type of the organs involved. These signs are most striking when the supply of pure arterial blood is temporarily cut off from the brain. Loss of consciousness when a person faints means that for the time being the brain is not supplied with fresh blood, which fact is well proven by the restoration which ensues when the head is placed low, and the blood returns to the brain.

More serious is the case when there is a breaking-down of the circulation, as when a blood-vessel becomes ruptured or stopped by a clot in some particular part of the brain. This causes a loss of power to move those parts of the body controlled by that area of the brain in which the circulation has failed.

A like process may go on in any part of the body, but the effects are not so striking, because the organs, unless the lesion be in the heart, are not so important. A failure of circulation in the lungs leads to shortness of breath, because, without regenerated blood, we can not breathe. A failure of circulation in the stomach leads to indigestion, as is strikingly shown by the arrest of digestion when the surface of the body is chilled after a meal, and the blood is drawn to the skin in an attempt to keep the body warmed. If the circulation in the heart muscle is stopped there results instant death from an arrest of the heart.

In the same way every organ of the body is dependent upon a competent circulation for its proper functioning. When the circulation in the hands or feet is impeded, a person suffers from the sensations of cold and numbness and tingling.

The efficiency of circulation in a given individual is in a great measure an index of the age of that individual. We grow old in two ways: according to the indications of the calendar, and according to the indications of our circulation. No truer statement was ever made than that of the brilliant George Cheyne who postulated that: "A man is as old as his arteries." This is recognized by all those who give thought to the maintenance of health, and, in fact, every effort that is made with a view to promote health and regain the strength and vigor of youth has something to do with the circulation.

When middle life is reached, those who would live out the traditional three score and ten, and still be healthy, must give much care to those organs which, at this period, are perhaps the most vital, namely: the heart and blood-vessels.

While we are spared many of the things that formerly shortened our existence, such as epidemics, impure food, badly-heated houses, and the

hardships of travel, modern life has brought us a certain intensity of mental activity that in a very insidious way undermines the health through the circulation. This can be charged to those nerves which cause the blood-vessels to be so unduly contracted that there is great obstruction. to the flow of blood everywhere in the body. This obstruction is often spoken of by physicians as "high blood pressure," and leads to damage of the arteries so that almost any part of the body may become defective in circulation. The amount of excessive work thus enforced upon the heart is so great that strain and hypertrophy result.

At first, attention was drawn to this subject only when there was some circulatory disturbance in the brain, and the person affected was spoken of as having paralysis, but now we know that the same thing may happen in other organs, such as the liver, the kidneys, and the spleen, consequently, when we find people with defective circulation due to hardening of the arteries, suffering from indigestion, etc., the relation of cause to effect is apparent. These persons often suppose that they are suffering from some simple disorder, but their condition never improves until the circulation is restored.

The cure of defective circulation depends upon a proper regulation of the work of the heart and blood-vessels. This can be done only when we recognize that the heart and circulation are very much influenced by the nervous condition and by the diet.

When a machine fails to do efficient work, the first thing that the machinist thinks of is to get at the part that is not working well, and give it a good oiling, and consequently he has a right to expect of the machine greater working power as a result of his management. In the management of the circulation, the first thing we think of is to dilate the bloodvessels, and this can often be accomplished temporarily by certain drugs which enlarge the arteries by relaxing their walls. Then we secure more power by improving the condition of the heart, or, if we think that the heart has latent power enough that is not in use, we give it a stimulant.

There are certain methods of management that have a marked effect in improving the circulation, even when the organs are defective. These at first include the proper use of drugs as the tools with which we set the mechanism right; then the removal of nervous influences, such as may be acting to the detriment of the patient, and lastly, the institution of suitable exercises and restricted diet, such as experiments have shown to be beneficial.

There has been too much prejudice of late years against drugs, but there are cases in which you might as well tell an engineer not to use oil on his engine as to tell a physician not to use drugs. When the adjustment has once been accomplished, and the patient has learned how to take care of himself, these particular tools may not be necessary.

Nearly every individual under modern conditions of life reaches a period when the circulation must become a subject of careful attention: and, if one is on the lookout to apply the proper measures early instead of late, it is possible to escape much of that invalidism in older people that is so distressing to their friends as well as to themselves.

To illustrate: let us recite the story of a typical case of grave disorder of the circulation leading to breakdown. The subject is a man of mental strength, who is devoted to some absorbing occupation which places him under responsibility and offers him many causes for worry. Such a man, unmindful of the fact that he is over fifty years of age, and that the machinery of the body no longer has the recuperative power of youth, continues his work unceasingly. Under these circumstances he develops an over-activity of that nervous mechanism which should be just active. enough to maintain the circulation in an even balance. The mind-strain overflows, as it were, and, involving the whole body, manifests itself in increased tension of the circulation. There is a contraction of the bloodvessels, causing a resistance in them which makes it very hard for the heart to keep the blood in proper circulation. The heart becomes enlarged in nature's effort to meet the demand upon it. Thus there is established in the arteries a constant degree of blood pressure that damages the kidneys and vessels.

As the brain in such a man's body is an organ of great activity there is apt to develop some slight tendency to inflammation in the already damaged blood-vessels, and a thrombus is formed, which stops the circulation in that particular area.

The man has probably been going on all this time unconscious of the storm that is gathering within himself and threatening his destruction; and his first warning is a sudden helplessness of an arm or leg, or the loss of his power of speech.

We are too apt to look upon a stroke of paralysis as an act of Providence, and to overlook the disorder of the circulation that preceded it. But even when there has been so severe an accident, a great deal can be done that should have been done before. Means must be taken to counteract the vicious nervous force that caused the irregular circulation in the first place. This is accomplished, after the patient has recovered from the first shock of the accident, by physical exercise which diverts the nervous energy from the blood-vessels to the muscles, and by the administration of remedies that dilate the blood-vessels or calm the action of the heart. Then means must be applied to restore the integrity of the heart and blood-vessels. Iodide of soda has this property. Even after the damaged circulation is repaired and is functioning properly, the whole nervous system of such a patient needs to be restored by weeks of careful effort on his own part as well as on the part of his medical attendants.