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JAMA 100 Years Ago Section Editor: Jennifer
Reiling, Editorial Assistant.
BY DOUGLAS GRAHAM, M.D.BOSTON.
When we come across good things in medical literature it should be our
duty and pleasure to pass them along to those who have not easy access to
the same. Hence the need of occasional reports. . . .
In 1884 your reporter wrote that no more fertile field awaits the investigations
of physiologists than that of ascertaining the similarities and differences
existing between exercise and massage.1 Partly in fulfillment
of this prophecy we present the following:
The effects of baths, massage and exercise on the blood-pressure.
In The Lancet for June 10, 1899, Drs. Edgecombe
and Bain have given a detailed account of their experiments to determine the
effects of baths, massage and exercise on the blood-pressure. For arterial
pressure the radial artery was taken, the subjects being in the recumbent
posture, with the arms extended in a line with the heart. For venous pressure
the veins in the back of the hand were taken in some, in others those of the
forearm. Ten subjects were experimented on, and the results were confirmed
by repeated observation.
Cold.—The effect of the cold bath was
to raise the arterial and to lower the venous pressure. When to cold, percussion
was added in the form of a strong needle douche applied simultaneously to
the surface of the whole body, the arterial pressure became raised to a greater
extent than with cold alone.
Heat.—The effect of warm baths of plain
water, on the other hand, was to reduce the arterial pressure to an extent
roughly proportionate to the increase of temperature.
The fall in venous pressure was in greater proportion than the fall in arterial.
Heat and cold alternately.—In the alternating
needle-bath or Scotch-douche, where the temperature is made to rapidly oscillate
between warm and cold, the net result was a rise in arterial with a slight
fall in venous pressure.
Massage.—Observations led Drs. Edgecombe
and Bain to the conclusion that general dry massage, in the form of pétrissage, while it may cause an initial rise of
blood-pressure of brief duration, produced as the net result a fall in arterial
pressure both mean and maximum, provided the abdomen was not masséed too vigorously. Deep massage and compression of the
abdomen caused an immediate rise in blood-pressure by dispersion of blood
accumulated in the splanchnic veins into the systemic circulation. The venous
pressure was observed to be always relatively, and in some cases actually,
raised; the amount of rise appearing to depend to some extent on the temperature
of the room, being greater in a warm atmosphere. . . .
Wet massage in the form of the Aix douche,
in which massage is administered under a warm douche conveyed by a flexible
pipe playing between the hands of the masseur, causes an increased effect—temperature
added to massage. Here was observed a greater fall in arterial pressure than
was obtained with dry massage, and coincidently an actual rise of venous pressure.
On the other hand, wet massage in the form of the Vichy douche, in which
massage is administered under a warm needle spray, the patient being in the
recumbent posture, causes a rise in all pressures, maximum, mean, arterial
and venous. The difference between this bath and the preceding is due: 1,
to the percussion of the needle-spray tending to raise the pressure, and 2,
to the fact that the patient being in the recumbent posture abdominal massage
is more efficiently performed and hence a rise in pressure results. Vigorous
abdominal massage would seem to abolish the fall produced by massage of the
limbs and the rest of the body, and when this was but slightly performed,
the net result was a fall. The influence of warm temperature plus massage
was to considerably augment this fall. In all probability the factor primarily
and chiefly disturbed by massage is the peripheral resistance rather than
the output of the heart, and the result is to be attributed mainly to diminished
resistance from arteriolar dilatation.
Exercise.—The effect of exercise on the
blood-pressure depends on the severity of the exercise. In all forms an initial
rise in arterial pressure occurs; if the exercise be mild there is a fall
during its continuance; if severe, the rise is maintained; after exercise,
moderate or severe, a fall takes place. The venous pressure is raised during
all forms of exercise and remains raised during the subsequent arterial fall.
The return to normal after exercise takes place more or less rapidly according
to the gentleness or severity of the exercise and the temperature of the atmosphere.
. . .
1. A Practical Treatise on Massage, 1884.
REPORT ON MASSAGE. JAMA. 2000;283(23):3046. doi:10.1001/jama.283.23.3046
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