after an hour of deep massage, and that this effect will not be produced by superficial rubbing (indeed, with light or too rapid manipulation the pulse may become both less strong and more rapid), and finally the flow of urine should be increased.  With these easily observed facts to aid, it may readily be judged whether massage is being rightly applied or not without the need of a visit from the physician during the hour of treatment.  A final test might readily be made by examination of the blood and counting the red corpuscles before and after treatment.  No doubt in very bad cases a small increase or none would be found at first, but a week of daily manipulation should show a distinct addition to the blood count.  A striking instance in which this examination was repeatedly made is related on p. 184.

“It is evident that our present definitions of anaemia are insufficient.  An essential part of the description in all of them is that there are defects of number, of color, or of both in the blood.  This is not necessarily or always true.  The fault may lie in a lack of activity or of availability in the corpuscles.  The state of things in the system may be like the want of circulating money during times of panic, when gold is hoarded and not made use of, and interference with commerce and manufactures results.

“Neither an anaemic appearance nor a blood-count is alone enough for a certain diagnosis.  Other signs must be used as a check on the blood examination for the establishment of the existence of anaemia.  For instance, many cases here recorded had full normal or even supra-normal corpuscle-count, with a good percentage of haemoglobin.  Yet they presented every external sign of poverty of blood:  pallor of skin and, more important still, of mucous membranes, cold extremities, anorexia, indigestion, dyspnoea on trifling exertion.  In such cases we must suppose either that the total volume of the blood is reduced, or that the usefulness of the corpuscles is in some way impaired, or that both these troubles exist together."[23]

I have said above that the face was not touched in the course of the rubbing.  There are cases, however, in which massage of the head and face may be usefully practised.  Some obstinate neuralgias are helped by it temporarily, and very often it is of use with other means to aid in a permanent cure.  Many headaches of a passing character may be dissipated promptly by careful massage of the head or by downward stroking over the jugular veins at the sides of the neck to lessen the flow of blood into the cerebral vessels, where the pain is due to congestion or distention, and careful manipulation of the facial muscles in paralysis is of service in restoring loss of tone and improving their nutrition.  It is worth adding here, as women patients frequently say that during their illness the hair has become thin or shown a great tendency to fall, that daily firm finger-tip massage of the head for ten or twelve minutes, followed by rubbing into the scalp of a small amount of a tonic, either a bland oil or if need be of some more stimulating material, will in a great majority of the instances where loss of hair is due to general ill-health perfectly restore its vigor and even its color.