Aulus Cornelius Celsus (25 B.C.E.–57 C.E.) is credited with scribing the first organized medical history, tracing the development of healing practices from the simple remedies of “barbarous” nations to Hippocrates and Alexandrian medicine. He was a faithful follower of Hippocrates, and was known less for his medical practice than for the advice he recorded as a medical encyclopedist. He wrote about many subjects, especially agriculture and medicine, but only his De medicina, libri octo (”book about medicine”) has survived. He “divided therapy into three forms: dietetic, pharmaceutics and surgical, wrote Douglas Guthrie, M.D., in A History of Medicine (J.B. Lippincott Co., 1946). Massage was considered a part of the last form. Surgery composes quite a bit of the text, osteology is covered, and detailed descriptions of amputation are given. Celsus also wrote about therapeutics; his advice in cases of phthisis (pulmonary tuberculosis or atropic diseases) includes “light massage, and warm baths.” He also recommended a long trip to Egypt, which would have been by sea, advice often given well into the 19th century and called “climatotherapy.” His therapeutic remedy for headaches, to which he devoted quite a bit of attention, includes massage in addition to an exacting diet, bleeding and mustard plasters. His other recommendations incorporating massage included remedies for weight and stomach problems. Celsus provides the following remark, quoted by Herman L. Kamenetz in Manipulation, Traction and mustard plasters, which expresses the thoughts of Hippocrates regarding massage: “Vigorous friction’s [sic] harden the fiber, light friction’s loosen it. When pursued a long time, weight is lost; applied with moderation they increase weight.” Then Celsus adds the following thoughts of his own, clearly based on Hippocratic anatripsis, and provides many of the details not found in the general aphorisms of Hippocrates:
“Consequently, friction’s are indicated to strengthen relaxed organs, to relax those which are too tense, to dissipate detrimental plethora or to add weight to lean subjects without strength. If we try to determine how these different results are produced (which is beyond the physician’s realm) we see that they all consist in the removal of the noxious principle. Indeed, tightening occurs with elimination of the cause of relaxation. Relaxation of the parts results after what made them hard is removed. Gain of weight does not result directly from friction’s but with the help of friction of the skin, which becomes more supple, becomes more permeable to nutritious substances. The difference among these results depends upon the procedure used. Both inunction [rubbing in of ointment] and light friction may be used in acute disease of recent onset provided they be applied during the remission and with an empty stomach. However, prolonged friction’s are contraindicated in acute diseases, particularly during their anabasis [advance], except as a soporific for a madman. By contrast they are useful in chronic diseases during remission … Friction’s are as favorable when the disease is beginning to decline as they are detrimental when fever is increasing. Thus, as far as is possible we should, before using them, wait for the fever to subside or at least for a moment of remission. Friction’s are applied either to the whole body, as when we wish to invigorate a debilitated person, or only to a part, in order to remedy the weakness of a limb or some other local condition. Friction’s may alleviate inveterate headaches, provided that the treatment is not applied at the acme [height of development]. Friction’s also give strength to the palsied limb. Most often, however, we should apply friction’s at a distance from the painful regions; thus, when we wish to draw matter from the upper or middle parts of the body we rub the lower limbs.”

“It is difficult to determine the exact number of friction’s to apply to a person since this will depend upon the strength of the individual. A weakened subject might not stand more than fifty, while a more vigorous one might take two hundred … Thus, we must be more careful in applying them to women than to men and to children and older people more than to young adults.”

“Finally, if we rub certain limbs, we proceed vigorously for a long time, for, acting on one of its parts, we do not fear to weaken the body soon, and the noxious matter should be resolved as much as possible, be it to remove it from the limb we treat or to divert if from another area. However, if a weak constitution necessitates friction’s of the entire body, we rub for a shorter time and less vigorously with the thought of softening the skin so that it can draw new material from the nutrients taken more easily. I have already noted as untoward signs the chilling of the surface while heat and thirst are experienced internally. The only thing to do in such a case is to rub the patient, and after having succeeded in producing warmth exteriorly, we can then apply other therapeutic agents.”

Galen
According to medical historians, the greatest physician of antiquity, second only to Hippocrates, was Galen (130–201 C.E.), a Roman. He wrote many volumes of medical and philosophical texts and was an ardent disciple of Hippocrates. He had extensive experience dissecting animals, even the Barbary ape, and was one of the first to correlate anatomy and physiology, which is an ongoing theme in his writings. At age 28 he was physician to the gladiators of Rome, and gained a considerable reputation for his treatment of open wounds and tendon injuries. Later he was physician to a number of Roman emperors. His work on anatomy is his greatest contribution, especially his descriptions of bones and muscles and their attendant tissues, such as ligaments and tendons. One medical historian tells that Galen had the rare opportunity during his career to observe the beating heart in two live patients.

A brief remark in Galen’s book Hygiene reveals his deep feelings toward massage and his disdain for those who would attribute a less-than-professional - in this case, sexual - meaning to its use. This quote is taken from the opening paragraph of the chapter titled “Morning and Evening Massage”: “It still remains, therefore, to discuss morning and evening massage, but not, verily, in the manner in which they say Quintus replied to a gymnast who enquired what was the value of anointment, ‘It makes you take off your tunic.’” Galen responds by writing, “These are all wanton witticisms, not at all befitting a man learned in so august an art.”

Galen elaborated upon Hippocrates’ simple description of anatripsis, including the variety of possible hand directions: “And the rubbings should be of many sorts, with strokes and circuits of the hands, carrying them not only from above down and from below up, but also subvertically, obliquely, transversely and subtransversely … But I direct that the strokes and circuits of the hands should be made of many sorts, in order that so far as possible all the muscle fibers should be rubbed in every direction.” Many other references to massage can be found in R.M. Green’s 1951 publication, A Translation of Galen’s Hygiene, such as the following:

“If, therefore, he is completely rested, it is superfluous to massage or anoint him, unless it were necessary to overcome extreme cold; for then we shall prepare him with massage, just like those who are going to employ cold bathing … But if there should be any sense of fatigue, it has been said before that then it is necessary to anoint and to massage gently. And so also if he were drier than desirable, he should be anointed with sweet oil; for this moistens the dry skin. And he should be massaged little, but with neither firm nor gentle massage. For we want the administration only to favor digestion, not to change the condition of the skin or of the flesh [muscle], nor to eliminate any of the excrements in them. But gentle massage does both, and firm massage the former, for it thickens and toughens the skin, whereas gentle massage purges and makes the body relaxed and soft.”

Galen wrote much more on this subject, describing the details of preparatory massage, the duration of massage at each stage of exercise, and finally “the rubbing of the body - which ought always to follow the exercises.” He concludes with an application of massage techniques and their staged applications to the health and well-being of non-athletes, or those exercises not for competition but for health.

Galen was a student of Hippocratic medicine, and his writings, as they relate to massage, can be considered as representing five centuries of Greco-Roman anatripsis theory and practice.
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Robert Noah Calvert is the founder and CEO of Massage Magazine. The material for this column comes from the World of Massage Museum’s collection and Calvert’s book, The History of Massage, published in February 2002 by Healing Arts Press.

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