[Reprinted from The Medical News, December 23, 1893.] 
PRELIMINARY NOTE ON THE EFFECT OF 
MASSAGE ON THE BLOOD-COUNT} 
JOHN K. MITCHELL, M.D., 
OF PHILADELPHIA. 
While the manipulations of massage have always 
been said to increase the circulation and promote 
the movement of blood, it has never, I think, 
been definitely ascertained what the exact effect 
upon the blood itself is. In the examination of 
some recent cases I have had results so startling 
and so new that I thought them of sufficient interest 
to justify brief mention to the College to-night, and 
in advance of the fuller study on which I have 
already entered. 
In the first case, a patient the subject of a very 
chronic lead-poisoning from drinking-water, with 
marked anemia, the blood was examined three times 
before any massage was practised, and the counts 
were, respectively, 3,725,000 ied corpuscles to 
the c.mm., 4,000,000, and 4,100,000. The per- 
centage of hemoglobin was always the same—a little 
over 30. On the fourth day careful massage of the 
abdomen alone was applied, lasting twenty-five 
minutes. Ten minutes after the ending of the 
1 From notes read before the College of Physicians of Phila- 
delphia, December 7, 1893. manipulation I examined the blood, and found the 
red corpuscles 4,500,000, and the white corpuscles, 
which had previously not been in excess, as 1 to 85 
red. The percentage of hemoglobin was not 
measurably increased. On the fifth day, after 
general massage lasting one hour, the count showed 
6,500,000 red corpuscles, and the same percentage 
of hemoglobin. 
In the second case, a woman from Mississippi, 
aged forty-two, with a very pallid appearance, 
decided malarial cachexia, and slight enlargement 
of the spleen, the first count, made before massage, 
was 4,700,000, and the hemoglobin 70 per cent. 
The white corpuscles on this occasion, two hours 
and a half after the meal, were in the ratio of 1 to 120 
red. After one hour’s general massage the number 
of red corpuscles had increased to almost exactly 
7,000,000, and the number of white had a ratio of 
Ito 38. No further examinations of this case were 
made on account of the supervention of the patient’s 
menstrual flow. 
The third patient, a healthy adult, had a count 
before massage of 5,675,000, and Ixo per cent, 
of hemoglobin, with no excess of white corpuscles. 
After massage the red corpuscles were 7,900,000, 
and the hemoglobin fully 120 per cent. I could 
not find in this case that there was any excess of 
white corpuscles, but I had the opportunity of making 
but one examination, and did not use the only satis- 
factory method of counting these corpuscles, i. e. by 
a separate examination with a 5 per cent, solution of 
acetic acid. 
The fourth case was one of suspected early loco- motor ataxia in an adult male, who, for some weeks 
had been in hospital under daily massage treat- 
ment and quiet, with good food. He had not 
been rubbed for three days previous to the examin- 
ation. His count before massage was 6,575,000 red 
corpuscles, and hemoglobin no per cent. At a 
second examination, on another day, the count 
was 7,325,000 red corpuscles. On the same day, 
after massage, he had 7,340,000, a very small 
increase, and no increase in the amount of hemo- 
globin. 
The fifth case was in a boy of fourteen, who had 
transverse myelitis, in course of recovery, and had 
been daily rubbed for some weeks. His count before 
massage was 6,900,000, with 90 per cent, of hemo- 
globin, and after massage 8,100,000, with 100 per 
cent, full of hemoglobin. 
I should add that for several of these examina- 
tions I am indebted to the kind assistance of Dr. 
Charles W. Burr, who used a different instrument 
than mine. They were all made at about the same 
hour of the day, and, so far as possible, with similar 
conditions surrounding the patients—a matter of 
some importance when we recall the great changes 
that take place in the number of red and white cor- 
puscles in the veins at different hours of the day 
and in different relations to meal-times. Bernard, 
indeed, showed that the total amount of blood was 
so much increased during digestion that an animal 
could be bled to a greater extent without injury 
after feeding than before. 
This effect of massage does not seem impossible 
when one recalls how the bloodvessels look when seen in a frog’s foot under the microscope. In the lesser 
capillaries there appears, every now and then, to be 
a clogging, and, for a time, the corpuscles scarcely 
move. When this state is overcome, a like condi- 
tion is evident in another little vessel. Even in 
larger vessels, many corpuscles seem not to share in 
the general movement, and to be temporarily out 
of the current; the white ones especially cling along 
the walls, and some of the red ones progress less 
rapidly than others, or linger for an instant as if 
they were in an eddy or a side-current; it is prob- 
ably literally true that there is a “ side-current,” the 
serum nearest the walls moving more slowly than that 
in the central stream. A portion of the blood, 
therefore—and when the whole capillary system is 
taken into account, it must be a large portion—is 
not at all times in active circulation. 
It is easy to imagine that the alternate compres- 
sion and expansion of the veins and arteries during 
deep massage, and the consequent pumping of 
blood through them, must push many of the corpus- 
cles that are lingering in the by-ways of the circula- 
tion into the full stream of the blood-current, and 
make a demand upon the various reservoirs and 
factories of red and white corpuscles for further 
supplies to take their places. 
While, as I said at first, the number of cases is 
too small to make certain the constancy of this very 
remarkable change after massage, it seems to me of 
sufficient importance to justify this imperfect pre- 
liminary statement. Even so far as it has gone, it 
suggests matters of novelty both in physiology and 
in clinical medicine.