Practical Massage: Introduction to the Private Instructions in the Art of Massage

Practical Massage:
Introduction to the Private Instructions
in the Art of Massage
By Dr. J.D. Balkam Page 1 2

Editor’s introduction: This article comprises one of the smallest books on the subject of massage, only twenty-one pages in length. It was written by the author in 1887 while he was a practicing physician and proponent of massage in Boston, Massachusetts. It is evident from the material that he was widely read on the subject because his material reflects the thinking of most other proponents of massage during his time. In the article he deplores rubbing, describing how it is not massage and distinguishes massage from “magnetic treatments.” Dr. Balkam describes various basic techniques and mentions cross-fiber strokes with some detail. He includes contraindications such as inflammations and tells his reader, the practitioner, to begin gentle and work toward stronger treatments. He consistently gives advice to the practitioner about demeanor, technique, lubricants and the requisites of a good manipulator. Advising that massage treatments be given at the home of the patient, he emphasizes the need for complete rest after the session. Dr. Balkam believes most ailments are due to poor blood circulation and so massage is an excellent form of therapy. The practitioner must, though, look to the root causes of the disease or disorder.

In commencing these lessons on massage, it is perhaps best at the beginning to inquire a little into the history of the massage mode of treating the sick and afflicted in times long gone by. The reader may possibly think that massage is something new or but recently put in practice by physicians and others; but such however, is not the case, massage or some of the procedure belonging to it have been in practice and used by both civilized and uncivilized nations far back in remote times, and no doubt before the history of any people or nation had been written, massage was practised to remove the effects of violent exercise, pain, effects of overwork, and the fatigue incident to travel and other causes. The history of massage, according to writers and authors on the subject is very ancient, written allusions to it reaching back among the Chinese to a period three thousand years before our era. Among the nations of old who utilized and understood the good effects of massage, I might mention the Greeks and Romans; as combats between gladiators; severe athletic sports and games were among the entertainments to please the public. The actors engaged in these severe sports were often bruised, crippled, and otherwise used up, and it is stated that they resorted to the use of massage to bring their bodies and limbs back to their normal condition.


The different processes of massage, of which I shall speak farther on, when used according as the case requires, can not fail to show its good effects from the first treatment; you have not to wait one month or three to find out if you are cases of extreme tenderness of the skin and muscles, an unguent of some kind is necessary; it may be oil, lard, or vaseline, cocoa butter, or if a soothing effect is desired, a little laudanum added to simple ointment. It may be said as a general rule that no skilful masseur or operator will use lubricants or unguents unless the patient orders their use, or the circumstances of the case require it; as for making use of lubricants in every case would be considered by experts in the art of massage as a sure index of ignorance, and lack of experience and tact on the part of the operator, as bunglers generally resort to lubricants in order that their rough and unskilful work will not cause abrasion, and we might add dislocations, for if the patient is well greased they would be in the condition of the greased pig at the fair, and could stand a great deal of pulling and pounding, grabbing and scratching without apparent injury. It is well at the end of a treatment as a wind-up, to give the patient a light rubbing down with some simple medicated bath or lotion, as it might seem to end a treatment in a more medical and professional manner. It is best in all cases to treat patients at their own homes if possible, because the effects of massage produces and inclination to sleep; a disposition to rest and remain quiet, both mental and physically should be encouraged, as it is best for the patient to remain in a passive and easy condition in order that nature, or the system of the patient, may carry on its changes while at rest. The good effects of massage is partly lost by active exercise or sudden change of temperature immediately after treatment; for certain physiological and pathological reasons it is better for the patient to indulge in rest for a time, after a treatment by massage.

In giving directions in regard to the length of time to be taken for a treatment, we might say one hour including rests between processes for a general treatment, and a half-hour for a local treatment; but the operator must be guided by the disposition and endurance of the patient as well as by the amount of surface operated upon. In drawing these lessons or instructions to a close, I shall mention the necessary qualifications for a successful masseur or manipulator by massage; it is requisite first, to possess good health and physical strength; second, a cheerful disposition; third, a soft hand at the same time not too soft, a certain firmness without being hard is good. A pleasant address and confiding manner is a help.

It is necessary or a great aid to a masseur or manipulator to understand something about anatomy and physiology, so that they may know the location of the arteries, veins, and nerves, and the positions of the principal vital organs belonging to the body and their functions; the course of the circulation of the blood and nerve fluids, and the processes of digestion, so as to have a clear knowledge of the effects produced by the different forms of massage, and how to apply, and where to apply the different processes.

Like every other physical science or art, massage must be practised in order to perfect the operator; the theory may be taught, but the best teacher cannot impart tact, talent, or genius to any one; so the reader will understand that however well stored his mind may be with knowledge on the subject, or how well posted he may be on the theory and art of massage, he must have practice, and gradually acquire the art.

I think in the future, the massage mode of treating the sick, and those afflicted with chronic ailments will be more resorted to both by physicians and the people, and I consider its use a happy medium between the extremes of mental or mind cure on the one hand, and dosing and drugging the system with patent medicines and minerals through the stomach, on the other. While acknowledging that massage belongs to the people, and has been practiced in all ages by cultivated and uncultivated people and nations, I do not think it can be scientifically applied by every man or woman who may fancy themselves cut-out by nature for healers of the people. Still, I would throw no obstacle in the way of any, who with right motives are trying to benefit their fellow men by massage, or any other mode of healing the sick and allaying pain. In my judgment the worst cases to handle, and the cases that will bring all the powers, tact and skill of the masseur in play, are those met with occasionally, and are classified under the heading of nervous mental ailments. In examining these cases, sometime we fail to locate any serious functional, to say nothing of organic disease of any of the vital organs of the body or system; but we find sluggish action and slow circulation of the blood, especially to the feet.

As every effect must have a cause, we seek to find out if possible the causes that have led to the state we find these patients in. And right here it is pertinent to remark that no one can regain lost vitality and permanent health, if they continue to practice habits and vices that cater to causes that produce disease and disorder in their physical bodies. And what I wish to impress on the reader’s mind is, that as long as the cause of disease remains undisturbed, you may dose, drug, and employ massage or any other mode of treatment without any permanent good results. We should direct if possible, our investigations to discover and remove the cause of disease on the start, and then the conditions will be favorable to employ treatment. It sometimes happens, that the cause of the trouble in nervous patients are family or social inharmonies, uncongenial companionship or something approximating to it. In such cases it would be best on the start to have such patients removed entirely away from their place of residence, for change of scene and environment is one of the first proceedings towards a cure. After getting the patient removed to other and more harmonious quarters you may then proceed to employ massage as your best judgment would dictate. In treating such patients try and inspire them with hope and confidence in their ultimate recovery, and as soon as their strength will permit, urge them to take a drive in the open air, and when still stronger, to use their limbs in walking, and other exercise that will not be too tiresome.

It would fill a large volume to give directions suitable for every case, that might present itself to a practical masseur, so I shall not attempt it. I would advise the students in the art of massage however, to procure a work on anatomy and physiology, to assist them in mastering the art. It also being a very interesting study, would help to while away an hour at times, that might be otherwise spent in doing something that would neither improve the mind or body.

To go a little more into detail in regard to practical massage of the hands and feet, I would say in giving treatment to those parts, the same processes are applied in giving either a general or local treatment, unless there is local inflammation or soreness from some cause. In that case notice, and go by the advice laid down in the preceding instructions, where it treats of inflamed parts. If there is no inflammation or soreness, commence the manipulations if treating the hands, with rotary movements of the fingers, grasping the patient’s wrist with one hand, and working with the other. After rotary movements of all the fingers and thumbs, gently pinch, pull, squeeze and press them, then treat the body of the hand from fingers to wrist, using one or both hands so as to be thorough and expediate your treatment. After concluding massage of the hand, take the patient’s wrist in one hand, and with the other give the hand a rotary movement have the wrist as a centre, also press and give the hand a bending movement, forward and backward, taking care not to hurt the patient, working gently and with sufficient force to accomplish the desired results. In massage of the feet, proceed the same as with the hands, using one or both hands as seems best, or when they can be both utilized together, manipulate the toes in the same manner as fingers. Rotary movement of the foot with the ankle as a centre, forward and backward, stretching and bending, percussion or slapping, when the patient can stand it are in order, and excellent to promote the free circulation of the blood to these parts.

Before I quit the subject of manipulations, I wish to state for the benefit of the reader who may practice massage, that kneading and gentle pinching where they can be employed or applied to the patient, are considered the most effective by physicians and practical operators by massage, for either chronic ailments or hygienic effects.

In writing these instructions on massage, I have endeavored to avoid being prolix, and also to refrain from repeating as much as possible. It has been my desire to place at the student’s command, a short practical treatise on the art of massage, stripped as far as the circumstances would permit of the usual medical verbiage and technicalities that generally accompany a work of this kind, and which to my mind only serve to mystify and confuse the reader, and are really not necessary, or of paramount importance in acquiring the practical art of massage. And unless the student had previously obtained a medical education, the medical terms, technicalities, and phrases would be annoying, if not repulsive. I have been assisted in these instructions, or lessons on the art of massage by the experience of others, and have quoted and used some of the phraseology employed by such eminent doctors and physicians as Drs. Douglas, Graham, Taylor and Lee, well-known practitioners and others; also with the results of my own personal experience and practice, which has enabled me to put this practical work into the readers’ hands containing the necessary information (coupled with the reader’s desire to learn) suitable instructions to qualify any one of ordinary intelligence for immediate practice in the art of massage.

Practical Massage:
Introduction to the Private Instructions in the Art of Massage
By Dr. J.D. Balkam

Page 1 2

Continued from Page One –As I have not mentioned or described the mode or method of treating the back by massage in the preceding instructions, I will now attempt to do so, and as a supplement to these lessons in practical massage, I shall give some advice in regard to the care of the sick, and shall mention something about nursing, exercise, bathing, diet, and the importance of pure air for invalids. In treating or manipulating the back it is well to keep in mind the course of the nerves, where they pair off from the spinal cord, especially the large ones that course and ramify down the arms, and also the large nerves called the sciatic, passing down to the lower limbs. Brisk rubbing can be employed up and down the spine, with both hands if possible, the down strokes to be more forcible than the return. Transverse or crosswise rubbing from the spine on each side will be next in order, with sufficient force, rapidity and pressure alternating from one side to the other, using one or both hands, with pointed, vibratory action and motion, burying the first phalanx of the fingers as deeply as possible into the muscles, tissues, and fibres beneath, working and manipulating all the surface, from the neck to the termination of spinal cord. Percussion or slapping must not be employed on the back, but any other procedure used in massage, can be made use of that will not irritate or harm the patient. Percussion can be used when not in the vicinity of any of the vital organs of the body, or where the bone does not approach or come near the surface of the skin or the body. I have not mentioned the attitude or position to place a patient in when treating, or manipulating by massage, as I consider that matter should be left entirely to the judgment, tact and ability of the masseur or operator, practice will soon tell the best positions, and the most practical and easy way to manipulate, having always the comfort and feeling of the patient in mind. A bed is better than a low lounge to treat a patient on, and a hard mattress better than material that is too soft and yielding. But the best apparatus would be a lounge constructed expressly for the purpose, standing high enough to admit of operating on a patient without the operator having to stoop, or bend his body too much or cramp and hinder the free use of his limbs while treating. In treating patients at their homes, however, the masseur will have to make use of whatever facilities are at hand, let it be a bed, cot or lounge, and do the best he can under whatever disadvantage he may be placed.

It is to be understood that massage is not to be employed in all forms of disease, but its use is especially adapted to chronic disease, nervous trouble, and slow or weak circulation of the blood and nerve fluids of the body, cramps, and in certain cases of acute forms of disease, and in all functional derangement of the vital or other organs of the body, the object being to restore the circulatory fluids of the body to a healthy and normal condition, and to equalize the heat of the body, drawing from congested parts or organs, causing the blood to circulate to parts hitherto scantily supplied with the vital element. For wherever the blood circulates freely, the nerve fluids will also penetrate, thereby promoting healthy action of the secretory glands, lymphatics and cellular tissues of the body, and assisting the electrical and magnetic changes that are constantly taking place in all healthy bodies. Disease of every description or character is originally caused by a disturbed condition of the mind, or as the metaphysicians would say, disease is the result of a wrong way of thinking, and excepting such accidents as may happen to our body or limbs, we must acknowledge the truth of the assertion. The passions have a greater influence on health then most people are aware of. All violent and sudden passions disposes to, or actually throw people into acute diseases; slow and lasting passions such as grief, melancholy and hopeless love, bring on chronic diseases and low fevers. So, in the treatment of the body, we must not ignore the mind, and in all morbid conditions of the mind, we must endeavor to bring about a change to a normal and healthy way of thinking, and remember that the passion that causes disease must be removed or calmed before permanent health can be enjoyed.

To the masseur or operator who may be treating patients without the advice or presence of a regular physician, I would say that a great deal depends on the care and nursing the patients receive during this absence between treatments, in respect to their convalescence and ultimate recovery of health. The attendant nurse or companion of a sick patient, should be neat and clean in person, and of an amiable and cheerful disposition, and if the nurse can say or do something occasionally, to cause the patient to enjoy a hearty laugh it will do a great amount of good, and keep them both in good humor; it is an old an true saying, that a “hearty laugh will bring more than a dozen groans, in any market.” Avoid streams of cold air and sudden changes of temperature upon the patient, but air the apartment and let in the sunlight if possible, and anything that may taint the air or be offensive should be removed; in dusting the furniture use a damp cloth and take all dirt or dust out of the room, keep everything about the patient’s room or apartments clean and neat, let the patient, if confined to the bed, be placed so as to have a view from the window, on the street, garden or landscape without having to be bolstered up in bed. Pure air is one of the most important remedial agents to effect a cure, but the diet should be attended to, and the patient kept warm. The sick that have the best medical advice often suffer on account of not having proper food, care and nursing, when the patient is able to get up and be dressed the room should be warmer than when in bed as the patient would be more liable to contract a cold just after arising from bed, as the system would then be in a weak and negative condition; as soon as the patient has gained sufficient strength to allow or permit of taking exercise, endeavor in that direction should be encouraged, but the exercise should be light and not in the least fatiguing.

I shall not mention the different kinds of food or the method of preparing it for invalids, as every good nurse or sensible person understands, or should, how to prepare food for sick persons under their care. The great rule for sick persons (and I might add those that are well) is to suit the quality and quantity of the food to the strength of the patient’s stomach and digestion; to take always such a kind and amount as will sit light and easy on the stomach. The great trouble, especially with persons that have poor digestion and weak stomachs, is over eating and drinking. In the case of dispeptics who have had their weak and enfeebled, digestive organs strengthened, and toned up to a healthy condition by proper massage, they soon forget the suffering of the past and what caused it, and often bring back the distressing stomach trouble by over eating and drinking.

A few words in regard to bathing, and I will close. So far as my experience in relation to bathing is concerned, I should say bathing is indulged in too much by a great many, and not enough by others who perhaps need it most. It is very desirable to keep the person clean and sweet, and it can be done with a quart of water, soap, towel and sponge. I do not believe in water-soaking, as it robs the person of a great amount of vitality. Weak and delicate persons are often made more so by bathing too often in large quantities of water. Mothers should keep their children clean; but if they have a weak or fragile child to keep it out of the bath-tub, would be my advice; but let it have plenty of exercise, and romp, run and play in the sunshine and open air. For the robust cold bathing is a great advantage to health, it prevents abundance of disease, promotes perspiration, helps the circulation of the blood, and prevents the danger of catching cold; but if a person has become accustomed to cold water bathing, it has to be continued; and if perchance a person should miss their accustomed bath it would cause disagreeable feelings, with a tendency to contract a severe cold. I should not advise a person, however, to become accustomed, or get into a habit of taking cold baths too frequently, unless so situated that the conditions of life are favorable to regularity in the habit, as well as plenty of time at the person’s disposal to indulge in the luxury. Bathing is good and desirable for those who enjoy good general health, but for the delicate thin-blooded invalids, I should not recommend it; but keeping the person clean in case of invalids or healthy persons is absolutely necessary. Water is a great absorbent, and not only removes effete and waste matter from the body, but also a large amount of vitality and heat. For promoting the general health in conjunction with bathing, and in order that all the functions of the body be brought to a proper degree of activity, I should highly recommend the judicious use of massage in its various forms, either local or general treatments, for Hygienic effects.

From Volume 1, Issues 1 and 2 of Massage Heritage Times. Compiled and Edited by Robert Calvert.