That the deep circulation shares in the changes which are so obvious in the superficial vessels has been shown by various observers of experimental and clinical facts.  Firm deep muscle-kneading of the general surface will almost always slow and strengthen the pulse.  If the abdomen alone is thoroughly rubbed the same effect appears in the pulse, but less in degree, and massage of the abdomen has also a distinct effect in increasing the flow of urine, a fact worth remembering in cases of heart-disease.  In a case of albuminuria from exercise, W.W.  Keen has shown that massage did not cause the return of the albumin after rest, though exercise did, a difference due to the opposite effects upon blood-pressure of the two forms of activity.  Lauder-Brunton has shown that more blood passes through a masseed part after treatment.  Dr. Eccles and Dr. Douglas Graham both found a decided decrease in the circumference of a limb after massage, showing how completely the veins must have been emptied, for the time at least,—­an emptying which would surely be followed by an increased flow of arterial blood into the treated region.  Dr. J.K.  Mitchell, in 1894,[21] made a large number of examinations of the blood before and after massage, some in patients under treatment for a variety of disorders affecting the integrity of the blood, and a few in perfectly healthy men.  With scarcely an exception there was a large increase in the number of corpuscles in a cubic millimetre, and an increase, though of less extent, in the haemoglobin-content.  Studies made at various intervals after treatment showed that the increase was greatest at the end of about an hour, after which it slowly decreased again; but this decrease was postponed longer and longer when the manipulation was continued regularly as a daily measure.[22] The author’s conclusions from these examinations were interesting, and I quote them somewhat fully.  The fact that the haemoglobin is less decidedly increased than the corpuscular elements makes it seem at least probable that what happens is, that in all the conditions in which anaemia is a feature there are globules which are not doing their duty, but which are called out by the necessities of increased circulatory activity brought about by massage.  If this is the first effect, yet as it is observed that the increase of corpuscles, at first passing, soon becomes permanent, we must conclude that massage has the ultimate effect of stimulating the production of red corpuscles.

One sometimes hears doubts expressed whether a patient with a high-grade anaemia is not “too feeble for such strong treatment” as massage.  This study of one of the ways in which massage affects such cases may fairly be taken as proof of the certainty and safety of its effect on them, provided always it be done properly and with intelligence.  Some check upon this may be had, as is said elsewhere, by the general effect upon the patient.  It may be repeated that the pulse should be slower and stronger