But usually in a few days a change takes place, and the limbs all grow warm when kneaded, as happens in most people from the beginning of the treatment.[19] The extremely low temperature of the limbs of children suffering with so-called essential paralysis is well known.

I have frequently seen these strangely cold parts rise, under an hour's massage, six to ten degrees F.In such small limbs, the long contact of a warm hand may account for at least a part of this notable rise in temperature.

In adults this can hardly be looked upon as a cause of the rise of temperature produced by massage, first, because the long exposure of large surfaces incident to the process is calculated to lessen whatever increase of heat the contact of the hand may cause, and secondly, because this rise is a very variable quantity, and because occasionally some other and less comprehensible factors actually induce a fall rather than a rise in the thermometer as a result of massage.
In very nervous or hysterical women, ignorant of what the act of kneading may be expected to bring about, and especially in such as are thin and anaemic and have either a somewhat high or an unusually low normal temperature, we may find at first a slight fall of the thermometer, then a fairly constant rise, with some irregularities, and at last, as the health improves, a lessening effect or none at all.
The most notable rise is to be found in persons who, owing to some organic disease, have acquired liability to great changes of temperature.
It is impossible to observe the increase of heat which follows both massage and electricity without inferring that these agents must for a time, like exercise and other tonics, increase the tissue-waste by the stimulus they cause of the general and interstitial circulations, and by the direct influence they seem to have on the tissues themselves.

I have sought to study this matter carefully by placing patients on a fixed and competent diet of milk alone, and by estimating the waste of tissues as shown in the secretions before and after the use of massage.

This study, although it was never completed in a satisfactory manner, would seem to show that massage does not much alter the total elimination of the entire day, but causes a large and abrupt increase within three hours, followed by a compensatory decline.[20] I add a number of tables, which very well illustrate the facts above stated as to rise of temperature.
Mrs.J., at rest, on the usual diet.