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Massage Today
December, 2011, Vol. 11, Issue 12

Nursing and Massage from Our Past

By Judi Calvert, LMP

I believe that nurses are angels sent down from God's hospital. They do so much for humanity. I wanted to go back in time to find out some history of nursing, especially nurses trained to perform massage i sanitariums and hospitals.

What was it like for them in the late 1880s?

Sanitariums

Sanitariums, such as the Lindlahr Sanitarium in Chicago, wanted nurses for training in "natural therapeutic methods." This included training in massage, Swedish gymnastics, hydrotherapy, electrotherapy and nutrition. The sanitarium placed many nursing ads in major magazines in the early 1900s. The applicants had to be 19-years-old and have one year of high school. They would make $7 per day.

In 1887, Dr. John Harvey Kellogg of the Battle Creek Sanitarium trained hundreds of men and women to become nurses. He trained them to perform massage, hydrotherapy, Swedish movements and calisthenics. Kellogg had courses of instruction in general nursing, surgical nursing and monthly nursing in a two-year program. He had 1,000 patients and the equipment from hospital wards and treatment rooms. Kellogg "assured constant, congenial employment at good salaries, with many personal expenses saved."

Nursing Schools

Many schools in the U.S. had home study courses to become a nurse. The Chicago School Of Nursing was organized in 1899. I have their 1948 nursing course book. Lesson 35 is a chapter on massage and shows pictures of the movements of effleurage, petrissage, friction and tapotement employed in massage. The first page says, "massage can be of great value to you throughout your career as a practical nurse and you will use it in all its many forms, from the simple daily body rubs to the complete general massage described in this lesson."

I found a very small booklet dated 1924, from the Mercy Hospital Training School for Nurses from Johnstown, Penn., describing the program for nurses. During the months of probation, the students were "boarded and lodged at the expense of the school, but received no compensation." If they proved themselves, then they would be accepted as student nurses and would remain at the school for three years. The students would rise at 6 a.m. and return to their rooms at 10 p.m. and they weren't allowed to use the telephone while on duty. They couldn't wear jewelry when in uniform and couldn't wear shoes without rubber heels. Hot water bottles could never be left in the patient's bed or the student nurses might face dismissal.

We can find some history about how hospitals began to adopt classes in massage from the book, Massage for Nurses and Beginners by Maude Rawlins. She tells us that around 1895, "hospitals here and there in the United States conceived the idea that a few lessons in massage might be of value to nurses; so massage was adopted and six hours were devoted to the subject." More hospitals added the course to their curriculum and over time, the hours increased until the end of the war. The New York State Nursing Department then made it "a compulsory, instead of a selective, course and demanded sixteen hours of elemental training in practical massage."

There have been many books written about the history of nursing and massage. Let us pay tribute to one of the pioneers: Nellie Elizabeth Macafee, R.N. She wrote a book in 1920 called Massage: An Elementary Text-Book for Nurses. This book contained only 42 pages, but gave us a peek into the past of massage history. She did not intend this book as "a textbook for anyone expecting to make massage a profession." It was the result of years of experience, teaching, lectures and practical work with nurses in Pennsylvania. The Pittsburgh League of Nursing Education had a curriculum of "sufficient knowledge of massage to meet the requirements of the Pennsylvania State Board of Registration for Nurses."

Of course, Macafee mentions Peter Henry Ling and "The Ling System." She then pays tribute to mechano-therapy as taught in America and adopted by Dr. Weir Mitchell to be used in the treatment of "nervous diseases by the rest cure." In fact, there were many different methods of mechano-therapy taught by the 1920's and she recommended that her readers learn many of them so the operator can judge which one of the movements could be used for each particular treatment. The few lessons that she wrote in her book were mainly to help nurses "treat nervous diseases" that required nurses to give "either a local or light general massage." Macafee felt that nurses could not give a heavy treatment every day to their patient in addition to all of their other duties. She writes that would be "beyond the strength of most nurses." From this, we learn that nurses gave both massage and used Swedish movements in their treatment plans. Macafee taught that "massage is a systematic manipulation of the human body according to diagnosis." Today, many states have laws forbidding massage therapists from diagnosing clients. But we can assume that back in her day the doctors did.

If a person wanted to give a successful massage, Macafee believed that they "must have a thorough knowledge of anatomy, of the effect of disease on the different parts of the body, the technique of massage and such knowledge of the physiological effect of the different movements of massage that she will know which to use to restore the parts of the health most quickly." The idea was to give the patient "a feeling of tiredness without fatigue or exhaustion, a sense of comfort and desire for rest and sleep." Therapists reading this article today could learn from Macafee's many years of experience. She believed and taught that "massage is not a cure for all diseases." But it was used as "one of the remedial agents with other treatments for nervous or chronic diseases, in orthopedic work and to take the place of exercise."

Even though nurses used mechanical appliances on the bodies of patients, Macafee wrote that nurses who used their hands instead could give a "sympathetic touch" and gain better results. She definitely was a very smart nurse, and knew the need and value of touch. Through her years of experience, she taught that massage was divided into seven general movements, two were light and five were heavy and deep, and she also sub divided them. If you gave a firm, deep pressure over a motor point, then it would have a stimulating effect. If you gave a continued pressure, it would "paralyze a nerve trunk as to have a sedative effect." Macafee taught that if the nurse used "heavy effleurage" with her palms, she should go in a centripetal direction. When working with sprains, one should "always use both hands as it gives a greater action upon the circulation and economizes the work."

The massage strokes that therapists use today were the same ones that Macafee taught: effleurage, friction, kneading or petrissage, percussion and vibration. She did have a subdivision of kneading called fulling. It was given with the thumbs and the ends of the fingers of both hands used alternately. Nurses could never give a general treatment of massage to a patient without the order from the physician in charge of the patient's case. She could perform the massage movements when giving an alcohol rub. Nurses would give a forty-five minute treatment while their patient was in bed. Treatments could be shorter depending on the disease, the size and the condition of the patient. Bending over a bed to give a massage treatment must have been hard on the nurse's bodies over time. Did I mention that nurses are angels?

The massage lubricants that the nurses used on the patient were "solidified albolene, coconut oil or a rather thin cold cream." The nurses were taught about contra-indications for massage. One of those was that massage was contra-indicated in pregnancy. They did do massage sometimes in mild cases of insanity and extreme nervous conditions. One of the most useful massage treatments that they gave was a head treatment in order to sedate the patient at night. Now wouldn't that be great today for patients, instead of drugs that the doctor orders. Drug companies would not want to hear that now, would they?

The final great massage treatment that the nurse would give: a hot iron. They would use a hot iron, cover the back with an old blanket and iron the entire back. They had to be careful and not scorch the flannel. The trick was to keep the iron moving constantly without any pressure and stop when the skin became red. All in a day's work for a nurse back in the 1920's. So, I hope you have enjoyed stepping back in time in our massage history for nurses.

References:

  1. Massage: An Elementary Text-Book for Nurses by Nellie Elizabeth Macafee, R.N. (1920).
  2. Massage for Nurses and Beginners by Maude Rawlins (1930).
  3. Chicago School Of Nursing (1948).

Click here for more information about Judi Calvert, LMP.

 

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