ing together. No two masseurs are alike by nature nor in skill, tact, and education, and the one who knows his anatomy and physiology well, when called to a recent acute sprain, will not begin at once to masser the injured joint, but at a distance above it on the healthy tissues by gentle stroking or effleurage toward the heart, gradually proceeding nearer and nearer to the painful place. This has a soothing effect and pushes the flow along in the veins and lymphatics, making more space in them for the returning currents coming from beyond and carrying away the fluids that have leaked out of the vessels. The same should be done on the part of the limb beyond the joint, for the circulation is hindered both in going out and coming in by reason of the swelling.
Next, the masseur who knows his business will begin again at a safe distance above the injured joint, and use deep rubbing, kneading, or massage properly so called, one hand contracting as the other relaxes, alternately making circular grasps, with the greatest pressure upward, and this should be done on the parts above and below the seat of sprain. By this procedure the effects of the previous stroking or effleurage are much enhanced an analgesic or agreeably benumbing effect is produced upon the nerves which extend to the painful place, and the retarded circulation is pushed along more vigorously, making room in the vessels for the swelling, the effusion, the dammed embargo caused by the landslide of blood and lymph that is inundating the surrounding territory with exudates farther up the stream to float off, and preparing the way for the next step in treatment. At the end of fifteen or twenty minutes of this manner of working, gentle, firm pressure can be made immediately over the swollen and but recently very tender parts, which in a few seconds can have circular motion, with the greatest push upward added to it; and this, if sufficient tact be.used, will in all probability not hurt but be positively agreeable. By this the swelling is spread over greater space, pressed out of the tissues as water is out of a sponge, and brought into more points of contact with the veins and lymphatics by which they are absorbed and carried off; the same pressure that causes the dislodgment of stagnating fluids also aiding absorption by pressing them into the small vessels. Then a snug, well-fitting bandage should be applied, which may exhibit the bungling of a tyro or the skill acquired by twenty years' practice. Under this plan of treatment, used twice a day, the comfort produced and the speed of recovery would scarcely be believed unless experienced by one who had had a similar injury treated in the regular orthodox way, with absolute rest and immobility, by means of fixed dressings.
Some years ago I published the results of massage in more than seven hundred cases of sprains, joint contusions, and distor-