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Reviewers
Carla M. Bashaw, BA, LMT Kevin Pierce, MBA, NCBTMB
Program Coordinator—Therapeutic Massage Academic Dean
Great Bay Community College East West College of Natural Medicine
Portsmouth, New Hampshire Sarasota, Florida

Robin Devine, RMT, CLT Rebecca Steele, RMT

Instructor Instructor
Massage Therapy Centre for Complementary Health Education
Mount Royal University Faculty of Continuing Education and Extension
Calgary, Alberta, Canada Mount Royal University
Calgary, Alberta, Canada
Luke Allen Fritz, LMT
Instructor
Health Enrichment Center
School of Therapeutic Massage and Bodywork
Lapeer, Michigan

Contributors and Reviewers to

Previous Editions
Wayne J. Albert, PhD, CK, FCSB
Sandra K. Anderson, BA, LMT, ABT, NCTMB
Patricia J. Benjamin, PhD
Paul V. Berry Jr., BSHA, LMT, NCTMB, PTA, NCMA
Leon K. Chaitow, ND, DO
Kelly Challis
Whitney Christiano, LMT, RYT, CPT, BA
Emily Edith Safrona Cowall, Reg, MT
Karen Craig, LMT, NCTMB
Neal Delaporta, LMT, NCTMB, CPT
Michael Garcia, RN, LMT
Peter A. Goldberg, DIPL AC (NCCA), LMT
MaryAnne Hochadel, PharmD, BCPS
Cher Hunter, MA, LMT, NCTMB
Christopher V. Jones, CMT, NCTMB
Don Kelley, LMT, NCBTMB
Kathy Lee, LMT, BS Business Administration
Lucy Liben, MS, LMT
Jean E. Loving, BA, LMT
Edward G. Mohr, MSIE, CPE, CSP, NCTM
Karen B. Napolitano, MS
Kathleen Maison Paholsky, MS, PhD
Kevin Pierce, LMT, MBA
Monica J. Reno, AAS, LMT
Richard Schekter, MS, LMT
Jeffrey A. Simancek, BS, CMT, NCBTMB
Cherie Marilyn Sohnen-Moe, BA
Diana L. Thompson, BA, LMP
Mary Margaret Tuchscherer, DC, PhD
Richard van Why
Sherri Williamson, LMT
Ed Wilson, PhD, LMT
Jeffrey B. Wood, LMT, COTA/L, BS

vi

Education, training, and skill standards define professions. If
massage professionals wish to be more widely recognized by
the general public and by other health care professionals, as
educated, professional, and well trained and with high stan-
dards, then they would do well to study and apply the knowl-
edge contained in this superb, newly revised, and expanded
book. Since the first edition in 1995, author Sandy Fritz has
emphasized critical thinking and clinical reasoning as the
foundation of the text. These skills are the cornerstone of
evidence-informed practice. The range of topics, and their
depth of exploration—combined with the unique, practical,
easy-to-follow delivery of information—makes it a universally
useful resource for anyone in the manual therapy professions
in general, and massage therapists in particular, and not just
in their early training stages. There is much to learn for expe-
rienced therapists since the author has focused on bringing
the very latest in clinical and practical research and under-
standing into the text.
The first four chapters build on each other, moving from
fascinating discussion of the multiple aspects of touch—the
fundamental element in massage—to chapters on profession-
alism, ethics, and standards, which go to the heart of what
is essential in defining any profession in the modern world.
This is followed by a description of protocols for the develop-
ment of a professional career. The evaluation of the multiple
steps and stages required to achieve the launch of a successful
career as a therapist is spelled out in excellent detail—with the
authority of someone who has done it all.
An essential part of professional practice is the ability to
accurately record what you have done and to be able to com-
municate your findings and treatment interventions to the
patient/client, to other health care professionals, or to those
responsible for reimbursement. Chapter 4 offers the founda-
tions for achieving this by focusing on terminology associated
with the systems of the body and therapeutic methods, as
well as record keeping, whether in simple SOAP notes or
electronically.
Chapter 5 is among the most important chapters in the
book as it eases the reader into the realm of research literacy.
Knowing what evidence there is for the use of particular thera-
peutic approaches, in specific settings, is a vital step on the
road to true professionalism—as is the need to know when
not to treat a person or a condition. A part of this demands
that you are able to read a research paper or an abstract, and
are able to see the key elements that might inform or modify
what you do, and how you do it in practice, as well as being
able to see when research evidence may be flawed. This is a
chapter to read and reread—and that advice applies to working
professionals as well as students, as we move toward evidence-
informed practice. Chapter 6 is a logical follow-up, since its
focus is on indications and contraindications to the use of
therapeutic massage—which quite naturally segues into clini-
cal reasoning—the very heart of the clinical decision-making
Foreword
process. What, how, and when to treat—or not—and when to
refer, and to whom!
Chapters 7 to 9 cover the detailed importance of hygiene,
sanitation, and safety, with that key word safety being the
main ingredient of Chapter 8. For if you wish to have a long
and successful career, it is vital that your own body is well
cared for, with attention to good body mechanics. There is no
finer teacher of this than Sandy Fritz. The number of thera-
pists who are obliged to abandon their careers due to overuse
and other results of poor use of their own bodies or hands is
a testament to the need for this subject to be taken very seri-
ously. Equally important are the topics regarding massage
equipment and supplies, as well as draping procedures, the
veritable nuts and bolts of a clinical practice, as covered in
Chapter 9.
Technical skills and protocols for delivery of professional
treatment—massage, manipulations, and techniques, includ-
ing seated and mat massage—are all fully illustrated in color
in Chapter 10, followed in Chapter 11 by a comprehensive
focus on assessments, tests, and analysis, which are all vital if
advanced approaches are to be developed. The sixth edition
provides a clear transition from foundational skills of mas-
sage therapy to a more client-centered professional practice.
Chapters 12 to 16 are organized into Unit IV, Beyond the
Basics. The complementary and adjunct methods associated
with massage are found in Chapter 12. Topics range from
hydrotherapy and myofascial approaches to an overview of
traditional Chinese medicine. These chapters also emphasize
adaptation of massage therapy to support an outcome-based
approach to professional practice. Chapters 13 and 14 focus
on special populations, exploring massage in a variety of set-
tings, such as spa and animal practices and adaptive massage.
Chapter 15 informs us how to pay personal attention to our
well-being as massage therapists—for it should be self-evident
that your professional life will be more successful and will last
longer if you remain fit! The wide range of case studies in
Chapter 16 allows you to tie together the mass of knowledge
covered so well in the rest of the book, woven into the context
of the most common problems encountered in a massage
practice.
This is a beautifully illustrated, well-thought-out, and struc-
tured expansion of the previous editions of this book, with a
host of new features, including Focus on Professionalism, Men-
toring Tips, and guidance for Learning More on the Web. For
more than 20 years, this textbook has evolved with and guided
the professional advancement of massage therapy. The author
and publishers are to be congratulated on producing it.
Leon Chaitow, ND, DO
Osteopath & Naturopath
Honorary Fellow
School of Life Sciences
University of Westminster
London
vii
Preface
Almost 40 years ago, when I was exploring a career in thera-
peutic massage, there were few schools. Because none of them
was readily accessible to me, I taught myself. I took a course
of less than 100 hours, which at least provided basic skills.
The rest of my massage therapy training has come from
reading a multitude of books, attending hundreds of hours of
workshops, undergoing apprenticeship training, taking college
courses in related subjects, teaching more than 5,000 begin-
ning students and approximately 1,000 advanced students at
my school, the Health Enrichment Center School of Thera-
peutic Massage and Bodywork, and providing more than
38,000 massage sessions. Since the publication of the first
edition, I completed my Bachelor’s degree at Central Michigan
University and Master’s degree at Thomas Edison State
College. Becoming a student again in the university environ-
ment had a great influence on my perspective about educa-
tion, as well as on my professional development.
I am still learning the importance of the fundamental con-
cepts upon which all bodywork methods are based. I learn
more about the elegant simplicity of massage each time I
teach or do massage, and I have learned a great deal through
researching and writing textbooks as well. More than ever, I
am convinced that a strong understanding of the fundamental
concepts of therapeutic massage and the ability to reason
effectively through a decision-making process are essential for
proficient professional practice. In the four decades of my
massage career, I have experienced an evolution of massage
therapy, from a fringe alternative method to the integration of
massage into the maturity of evidence-based and informed
practice. When I compare the first edition of this textbook to
this sixth edition, it is apparent that the knowledge necessary
to begin a massage therapy career has increased, yet the under-
lying fundamental principle remains—compassionate, benefi-
cial application of touch to help people feel better.
WHO WILL BENEFIT FROM THIS BOOK?
The sixth edition of Mosby’s Fundamentals of Therapeutic
Massage is intended to be used by skilled therapeutic massage
educators and beginning and advanced students in the class-
room setting. It will also be used as a continuing education
resource by practitioners and as a reference text for health
professionals and massage and bodywork practitioners.
WHY IS THIS BOOK IMPORTANT TO THE
PROFESSION OF MASSAGE THERAPY?
The changes and additions to the sixth edition reflect how
much therapeutic massage has evolved as a profession over the
past few years. Today, therapeutic massage is in the process of
standardizing and organizing. Projects such as the Entry Level
Analysis Program (elapmassage.org) and the Massage Therapy
viii
Body of Knowledge (MTBOK.org), an effort to unify the prac-
tice and terminology of massage and its various modalities,
attest to the growing awareness among massage professionals
that their success depends on clarity and an agreed-upon base
of knowledge, as in other skilled fields. It is an exciting time
in massage therapy, as we see more and more people turning
to massage as a reliable and practical form of self-care. A cur-
riculum that is mindful of all these points is a curriculum that
aims high.
A well-rounded education in massage therapy includes
learning all of the following: how to perform massage manip-
ulations and bodywork techniques; understanding the ana-
tomical and physiological underpinnings for why the methods
work in a biologically plausible and logical framework; and
the importance of structure, intent, and purpose of touch. It
is as important to touch the whole person as it is to skillfully
apply techniques. The massage professional must do both. In
addition, the learner needs to understand the importance of
sanitation, hygiene, body mechanics, research literacy, busi-
ness practices, and ethics, and then apply this knowledge
through effective decision making to build a well-balanced,
professional massage career. To justify the cost and time
spent, massage therapy needs to be beneficial and meet the
outcomes and results desired by the clients served. Massage
therapists need to be able to adapt to the individual client to
be successful.
The fundamentals of massage methods remain relatively
simple. Fundamentally, massage methods are mechanical
force push and pull applications. Certainly then there must
be more to massage therapy than just being able to give a
massage. A well-planned school curriculum, as developed in
this textbook and its instructor resources (TEACH Lesson
Plan Manual and instructor resources), combined with a
comprehensive science curriculum as presented in Mosby’s
Essential Sciences for Therapeutic Massage and its various
ancillaries, provides a foundation for massage educational
programs and presents information necessary for entry-level
licensing. With in-depth study, these textbooks also provide
the information and skill foundation for the advanced creden-
tial, the Board Certification Exam from the National Certifica-
tion Board for Therapeutic Massage and Bodywork.
Massage education should be competency based, meaning
all information in the educational setting is relevant to the
actual professional practice of therapeutic massage. The design
of this textbook, combined with the Evolve website, also sup-
ports various types of Web-enhanced education.
The level of knowledge in this sixth edition has been
increased to reflect the skills necessary to work effectively in
the health care world with supervision. Although my personal
love for this profession lies in humble service to the general
public in the support of their wellness, and compassion and
help for the daily aches and pains of life, I recognize the

importance of being able to also work within the health care
and sport and fitness systems. My work over the past several
years with a clinical physiologist, numerous physicians, ath-
letic trainers, and physical therapists supports this observa-
tion. Because of the development of comprehensive textbooks,
more schools will be better able to expand their curricula for
those who wish to pursue therapeutic massage applications in
health care.
The foundation for therapeutic massage was laid centuries
ago and will not change, provided human physiology remains
constant. It is virtually impossible to acknowledge all those
who have contributed to the knowledge base of this field. Our
observations of the natural world are a good starting point for
this basic knowledge. For example, animals know the value of
rhythmic touch. Just watch a litter of puppies or kittens and
observe the structured application of touch. The base of infor-
mation goes beyond us to an innate need to rub an area that
is hurting and to touch others to provide comfort, pleasure,
and bonding.
TEXTBOOK THEMES
These major themes guide the structure of this textbook.
• Massage therapy is an outcome-based approach targeting
the four main outcomes of relaxation and pleasure, stress
management, pain management, and functional mobility.
• Massage is based on three main approaches to care: pallia-
tive, condition management, and therapeutic change.
• Massage is uniquely adapted to every client based on goals,
assessment, special circumstances, client-centered inten-
tion, and compassion and nurturance.
• Massage is uniquely designed for each client based on
critical thinking, clinical reasoning, and evidence-informed
practice.
• Massage is a biologically plausible system based on applied
mechanical forces modified in multiple ways to both assess
the client and provide appropriate intervention to achieve
client goals.
• Massage is a professional health service provided in mul-
tiple environments and is dependent on the therapeutic
relationship between the massage therapist and the client.
TEXTBOOK ORGANIZATION
The textbook is divided into four units based on related
content.
Unit I: Professional Practice
1 Therapeutic Massage as a Profession
2 Ethics, Professionalism, and Legal Issues
3 Business Considerations for a Career in Therapeutic
Massage
4 Professional and Medical Terminology for Communica-
tion and Documentation
The chapters focus on building a solid basis for professional-
ism and decision-making skills before moving into the actual
physical and mental work of practicing massage. Chapter 1
Preface ix
begins with an exploration of touch and reveals its historical
foundations. Chapter 2 introduces the clinical reasoning,
problem-solving model for ethical decision making and also
explains what it means to be a professional, including aware-
ness of laws and regulations. Chapter 3 provides a newly
expanded look at the business of massage, job-seeking skills,
and the options of creating a career as a business owner or
as an employee. Chapter 4 presents appropriate medical and
massage therapy terminology to support professional record
keeping and documentation. Students are exposed to a lan-
guage that is understood across many disciplines and that
allows professionals to communicate accurately.
Unit II: Foundations for Massage Benefit
5 Research Literacy and Evidence-Informed Practice
6 Indications and Contraindications for Therapeutic Massage
7 Hygiene, Sanitation, and Safety
Massage therapy has become an evidence-informed practice.
Chapter 5 further explores what this means and explains the
scientific basis for evidence that supports the benefits of thera-
peutic massage. This chapter also focuses on research literacy,
empowering students to look deeper into their practice and
its value. Chapter 6 begins the process of decision making in
terms of indications and contraindications to massage.
Chapter 7 presents information on sanitation, hygiene, and
safety, ensuring the reader understands the importance of pro-
tecting the client from harm.
Unit III: The Massage Process
8 Body Mechanics
9 Preparation for Massage: Equipment, Professional Envi-
ronment, Positioning, and Draping
10 Massage Manipulations and Techniques
11 Assessment Procedures for Developing a Care/Treatment
Plan
Chapter 8 covers the very important content of body mechan-
ics and ergonomics. It is necessary for massage therapists to
be able to use their bodies effectively, efficiently, and wisely to
have a successful massage career. Chapter 9 describes massage
equipment and supplies, positioning and draping procedures,
various massage environments, and other information ancil-
lary to a successful massage practice. Chapters 10 and 11 focus
on technical skills. Each section builds on the previous one,
beginning with the basics and expanding assessment methods
to support therapeutic applications. As the methods and tech-
niques of therapeutic massage are presented, the reader learns
how and why they work and when to use them to obtain a
particular physiologic response. Upon completion of this unit,
the learner should be able to provide an outcome-based
massage.
Unit IV: Beyond the Basics
12 Complementary Bodywork Systems
13 Massage Career Tracks and Practice Settings
14 Adaptive Massage
x Preface
15 Wellness Education
16 Case Studies
Chapter 12 introduces the concept of adjunct methods, such
as hydrotherapy and essential oils. Massage application sys-
tems that have become specialized, such as lymphatic drain-
age, connective tissue, and myofascial release, and approaches
to treating trigger points are presented in the next section of
the chapter. An overview of Eastern and cultural approaches
based on traditional Chinese medicine, Ayurveda, and others
is covered in the next section. Reflexology is also included in
this content. Finally, a discussion on the adjunct methods
based on biofields (often called energy work) is provided, as
well as technical skill from the polarity system, which provides
a model for this type of bodywork.
Chapter 13 is a new chapter that focuses on three main
career tracks—wellness/spa, health care, and athletics. Chapter
14 describes how to adapt massage to address the needs rele-
vant to particular populations, from pregnant mothers and
infants to hospice patients and people with physical impair-
ments. Chapter 15 explores the issues of wellness and nutri-
tion. Massage therapy is a physically taxing field of work. An
MT must stay strong and healthy to do a good job and to
continue feeling rewarded by the work.
Finally, Chapter 16 sets the stage for putting the material
and your study to work through the use of comprehensive case
studies based on the clinical reasoning model, outcome-based
massage, and treatment plan development. This chapter pre­
sents 20 case studies that integrate the information from both
this textbook and the student’s science studies, such as those
covered in Mosby’s Essential Sciences for Therapeutic Massage.
The case studies cover the majority of common conditions
seen by massage professionals in day and destination spas, as
well as in wellness, health, fitness, sport, and medical settings.
If students study the process of clinical reasoning carefully,
these case examples will enable them to address almost all
other conditions encountered in professional practice. The
entire book focuses on developing clinical reasoning skills for
this profession.
Appendices
Helpful appendices are located at the end of the book.
These include an updated appendix on indications and
contraindications, a pictorial skin pathology appendix, as well
as a basic pharmacology for massage reference written espe-
cially for this textbook by a clinical pharmacist. All three
provide at-a-glance information that is supplemental to the
content within the chapters of the textbook.
AN ADAPTABLE DESIGN
It is not necessary to have multiple textbooks for each course.
Chapters in Mosby’s Fundamentals of Therapeutic Massage
can be used in multiple ways to provide content for courses
within the curriculum. The textbook can be taught in a
sequential manner from Chapter 1 to Chapter 16, or it can be
adapted to fit the order of topics within the chosen curricu-
lum. Another approach is to cluster the chapters into units as
previously described or modules such as the following:
• Chapters 1-4 as the professionalism and ethics unit
• Chapters 5-6 as the research literacy unit
• Chapters 7-12 as the guide on how to build massage appli-
cation skills
• Chapters 13-16 can then act as an integration unit.
Another organizational approach is as follows:
• Chapters 1-6 cover the practical and critical thinking skills,
which can simultaneously be taught with
• Chapters 7-12, so that the student learns hands-on skills
with thinking skills, all in a coordinated manner.
• Chapters 13-14 can be presented as practice specialization
content.
• Chapters 15-16 focus on integration of skills, such as clini-
cal experience. Chapter 15 (as well as many of the exercises
provided throughout the text) promotes introspection,
understanding, and topics that are supportive to the general
well-being of the therapist, and Chapter 16 offers a wide
variety of case studies.
When combined with Mosby’s Essential Sciences for Therapeu-
tic Massage, Mosby’s Fundamentals of Therapeutic Massage
provides a complete textbook resource for a relevant, accurate,
and outstanding massage therapy curriculum. Designed for
teachers and students by someone who is a teacher and
massage therapist, it is my hope that the textbook, all the ancil-
laries, and instructor support materials serve both teachers
and students in the journey of becoming extraordinary
massage therapy professionals.
Fritz Gives You the Fundamentals and More!
Welcome to the Sixth Edition
For content you can trust,
this text delivers:
CHAPTER OBJECTIVES
After completing this chapter, the learner will be able to
perform the following:
1. Identify personal interpretations of touch and their influence
on professional interactions
2. Describe professional touch
3. Explain the rich heritage and history of therapeutic
massage
4. Explain the influence of historical events and global culture
on the current development of therapeutic massage 1. The learner will be able to identify personal interpretations of touch
5. Self-assess for leadership qualities
Professional and Medical Terminology for Communication and Documentation
disabilities. Although the term intellectual disability is often
used in conjunction with developmental disability, many
people with a developmental disability do not have an
intellectual disability. Say she has cerebral palsy, he has
autism, or he has a developmental disability. Do not say she
is mentally retarded.
• Disfigurement refers to physical changes caused by burns,
trauma, disease, or congenital conditions. Do not say burn
victim. Say burn survivor or child who has burns.
• Down syndrome describes a chromosomal disorder that
causes a delay in physical, intellectual, and language devel-
opment. Say person with Down syndrome. Do not use
Mongol, mongoloid, or Down person.
• HIV/AIDS is a disease of the immune system. Over time,
HIV (human immunodeficiency virus) can weaken the
immune system to a point where the body becomes sus-
ceptible to certain illnesses that healthy immune systems
resist. People with HIV are diagnosed with AIDS (acquired
immunodeficiency syndrome) when one or more specific
conditions are met. Use person living with HIV or people
who have AIDS. Do not use AIDS victim.
• Intellectual disability refers to limitations in intellectual
functioning and adaptive behaviors that require environ-
mental or personal supports for the individual to live inde-
pendently. Although mental retardation was previously an
accepted clinical term, many consider it an insult, so people
who have this condition, their families, and related organi-
zations have campaigned to end its use. Say people with
intellectual disabilities. Do not use retarded, mentally
retarded, or subnormal.
• Learning disability describes a neurologically based condi-
tion that may manifest itself as difficulty learning and using
skills in reading (called dyslexia), writing (dysgraphia),
mathematics (dyscalculia), and other cognitive processes
due to differences in how the brain processes information.
Individuals with learning disabilities have average or above
average intelligence, and the term does not include a learn-
ing problem that is primarily the result of another cause,
such as intellectual disabilities or lack of educational
opportunity. Say person with a learning disability. Do not
use slow learner or retarded.
• Postpolio syndrome is a condition that affects some people
who have had poliomyelitis (polio) long after recovery
from the disease. It is characterized by new muscle weak-
ness, joint and muscle pain, and fatigue. Say person with
postpolio syndrome. Do not use polio victim.
• Psychiatric disability refers to a variety of psychological
conditions. Say person with a psychiatric disability or mental
illness. In a clinical context or for medical or legal accuracy,
use schizophrenic, psychotic, and other diagnostic terms.
Note, too, that bipolar disorder has replaced manic depres-
sion. Words such as crazy, maniac, lunatic, schizo, and psycho
are offensive and should never be applied to people with
mental health conditions.
• Seizure describes an involuntary muscle contraction, a brief
impairment, or loss of consciousness resulting from a neu-
rologic condition such as epilepsy or from an acquired
brain injury. Say girl with epilepsy or teen with a seizure
• Detailed and
competency-based
chapter and section
objectives.
PROFESSIONAL TOUCH
SECTION OBJECTIVES
Chapter objective covered in this section:
and their influence on professional interactions.
Using the information presented in this section, the learner will be able
to perform the following:
CHAPTER 4 151 • Distinguish between professional and nonprofessional forms of touch
disorder. The word convulsion should be used only for sei-
zures involving contraction of the entire body. Do not use
• List factors that influence the communication of touch
epileptic, fit, spastic, or attacks.
• Service animal or service dog describes a dog that has been
individually trained to do work or perform tasks for people
with disabilities. In addition to guiding people who are
blind, they may alert people who are deaf, pull wheelchairs,
alert and protect a person who is having a seizure, remind
a person with mental illness to take prescribed medica-
tions, or calm a person with posttraumatic stress disorder
during an anxiety attack. Miniature horses are also consid-
ered service animals under the Americans with Disabilities
Act (ADA), although monkeys no longer are. Do not use
seeing eye dog.
• Short stature describes a variety of genetic conditions
causing people to grow to less than 4′10′′ tall. Say person of
short stature, although some prefer little people. Dwarfism
is an accepted medical term but should not be used as
general terminology. Do not refer to these individuals as
midgets because of its circus sideshow connotations.
• Speech disability is a condition in which a person has
limited or impaired speech patterns. Use child who has
a speech disability. For a person without verbal speech
capability, say person without speech. Do not use mute or
dumb.
• Spinal cord injury describes a condition in which there has
been permanent damage to the spinal cord, resulting in
some degree of paralysis. Quadriplegia denotes loss of
function in all four extremities, whereas paraplegia refers
to loss of function in the lower part of the body only; in
both cases the individual might have some function in the
affected limbs. Although people with spinal cord injuries
often refer to themselves as a para or a quad, communica-
tors should use man with paraplegia, woman who is para-
lyzed, or person with a spinal cord injury. Don’t say cripple
or handicapped.
• Substance dependence refers to patterns of substance use
that result in significant impairment in at least three life
areas (family, employment, health, etc.) over any 12-month
period. Although such terms as alcoholic and addict are
medically acceptable, they may be derogatory to some indi-
viduals. Acceptable terms are people who are substance
dependent or person who is alcohol dependent. Individuals
who have a history of dependence on alcohol and/or drugs
and are no longer using a substance may identify them-
selves as recovering or as a person in recovery.
• Survivor is used by people to affirm their recovery from or
conquest of an adverse health condition such as cancer
survivor, burn survivor, brain injury survivor, or stroke sur-
• ELAP and MTBOK knowledge, skills, attitudes,
vivor. Don’t call them victims.
Additional terms related to the Americans with Disabilities
Act (ADA):
• Accessibility: describes the degree to which an environ-
ment, service, or product allows access by as many people
and terminology content.
as possible, in particular, people with disabilities.
• Accessibility standards: a standard is a level of quality
accepted as the norm. The principle of accessibility may be
mandated in law or treaty and then specified in detail
xi
 Therapeutic Massage as a Profession CHAPTER 1 3

FIGURE 1-3 Novel repetition can be seen and heard in music, for
example.

eventually teaching you to become your own teacher to

FIGURE 1-1 Spiral learning.
2 massage therapy?
3
4 tions mentioned previously are explored in this text, especially
FIGURE 1-2 Straight-line learning.
begins to ignore the information because it is too familiar
(Figure 1-2).
Repetition is absolutely necessary to learn anything.
However, to keep the brain interested, the repetition somehow
must be different each time. Think of a piece of music. You
can hear the repetition of a melody in a few lines of music,
but you can also hear where the composer has changed a note
or two. You enjoy hearing the repetition of a good melody, but
you also enjoy when it is changed slightly, because this pre-
vents you from becoming bored with it. This is called novel
repetition (Figure 1-3); that is, the same information is given
over and over, but always a little differently and in a circular
format. As you learn the profession of massage, this type of
repetition eventually spirals into the ability to become a cre-
ative and skilled massage therapist. As you read and study this
textbook, notice how learning spirals, novel repetition, and
asking questions are teaching you to use critical thinking and
support lifelong learning.
In massage, which is professional, structured, therapeutic
touch, education begins with questions.
• What is the significance of touch?
• What is professional touch?
• What motivates me to study therapeutic massage?
• What is therapeutic?
• How am I served by touching others?
• When did touch become professional?
• Why did touch become professional?
• Do therapeutic forms of touch have to be provided by a
professional?
• In what way is professional therapeutic touch different
from casual touch, friendship touch, family touch, intimate
touch, or erotic (sexual) touch?
• How do different individuals, social groups, or cultures
view touch?
• In what way does the past affect the present and provide
guidance for the future development of the profession of
Questions continue to arise, and the answers are not neces-
sarily simple. As we seek to serve our clients, eventually we are
faced with these questions and many others. Some of the ques-
as they relate to the professional practice of therapeutic • ONGOING AND EXPANDED emphasis on
critical thinking and clinical reasoning
massage. Some are not explored directly; rather, both the
questions and the answers evolve for each learner as the indi-
vidual’s information base and experience increase and the
journey through education continues. This text does not
provide definitive answers to any of these questions; however,
skills development.
it does provide information to help you find your own answers
to questions you may face.
• UPDATED Chapter 5: Research Literacy
What will your questions be? How will your answers influ-
ence those you touch? How will your answers touch you? and Evidence-Informed Practice, which
These are huge issues to consider at the beginning of any
course of study. As you begin to think about them, you might focuses on the expanding role students
can play in learning more about the
feel interested, excited, overwhelmed, or maybe even fright-
ened as you come to realize how necessary, beneficial, complex,
and powerful touch can be. Remember that understanding
evolves. These important questions are posed at the beginning
of this study and possibly before you have sufficient informa-
growing body of science within the
tion to develop effective answers. Your awareness of these
questions will help you make decisions and find answers as
massage field.
you progress in your study of therapeutic massage.
You will come to understand the process of developing
your answers to the previously mentioned questions and
many others that will arise by embracing the importance of
respect—not only for yourself but also for all those with 210 MOSBY’S FUNDAMENTALS OF THERAPEUTIC MASSAGE

• Direction involuntary response to a stimulus, and massage can be the

• Drag source of the stimulus.
• Speed The problem with this simple categorization is that the
• Pacing mechanism by which massage produces an effect cannot
• Rhythm always be clearly identified. According to Dr. Philip E. Green-
• Sequencing and transitioning man, the effects of massage occur through the interrelation-
• Spiral approach to learning is • Frequency
• Duration
ships of the peripheral nervous and central nervous systems
(and their reflex patterns and multiple pathways), the auto-
embedded where first the basic • Intention for outcome
Adapted methods generate appropriate force to load the
nomic nervous system, and neuroendocrine control (Green-
man, 2003). Dr. John Yates (1990) has said, “It appears far
facts of a subject are presented. As body tissue in order to create 5 stresses to which the physiol-
ogy must adapt:
more reasonable just to recognize that massage produces
effects that are due to a combination of mechanical, neural,

the learner progresses through the • Compression stress

• Tension stress
chemical, and psychological factors and to identify these
wherever possible rather than to attempt to use them as a basis

textbook, the basic content is

• Shear stress
• Torsion stress
• Bending stress
reinforced, expanded, and framed The techniques of therapeutic massage and other types and
styles of bodywork are merely variations of the fundamental
in increasingly more complex ways, application of manual manipulations. The benefits of the
techniques are simply the result of basic physiologic effects. It
which supports critical thinking and is helpful to have a method for categorizing information into
similar bundles. By doing this, we can take many large pieces
for classifying those effects.”
To understand the basis of research findings, we must
understand the biologically plausible mechanisms by which
massage applications achieve benefits. This understanding is
grounded in the study of functional anatomy and physiology
as they relate to therapeutic massage. The recommended text
for this purpose is Mosby’s Essential Sciences for Therapeutic
Massage: Anatomy, Physiology, Biomechanics, and Pathology, by
Sandy Fritz.

content retention. of information and sort them into manageable sizes. This
process helps with the clinical reasoning process used to make
sense of information and to make decisions about what to do
with the data. The problem with this method is that most
things do not clearly fit into one category or another, and often
the result is not entirely accurate. However, as long as we
understand this, we can make use of the process.
A premise of massage application is to mimic and support
normal function. The anatomic and physiologic areas most
targeted by massage are:
• Nervous/neuroendocrine system (the central, auto-
nomic, and somatic nervous systems, in addition to
neurochemicals and hormones)
• Circulation
• Connective tissue

Physiologic Effects
As stated previously, conclusive research on the physiologic
effects of massage is lacking. The following sections present
theories—not facts—about how massage works. A theory
presents a concept or idea that is testable. In science, a theory
is not merely a guess. A theory is a fact-based framework
for describing a phenomenon. The problem in massage
therapy is that not enough research has been done on the
theories, and because research is very expensive and time-
consuming, it may be quite a while before this situation
changes.
The fundamental concepts that explain the effects of thera-
peutic massage can be divided into two general categories,
mechanical effects and reflexive effects.
• Mechanical effects occur when a mechanical force (push
or pull), which creates mechanical stress (tension, bending,
shear, torsion, and compression), is applied directly to the
body and directly affects the soft tissue through techniques
that normalize the connective tissue or move body fluids
and intestinal contents. Myofascial tissue (muscle and its
associated connective tissues) and fluid content determine
the density and pliability of a muscle structure.
• Reflexive effects occur when various mechanical forces are
introduced into body tissues during massage with the
intent to stimulate the nervous system, the endocrine
system, and the chemicals of the body. A reflex is an
TRANSLATING EVIDENCE INTO
PRACTICAL APPLICATION: NERVOUS/
NEUROENDOCRINE SYSTEM
SECTION OBJECTIVES
Chapter objective covered in this section:
7. Explain the effects of therapeutic massage in physiologic terms.
Using the information presented in this section, the learner will be able
to perform the following:
• Explain the possible anatomic and physiologic influences of massage
on the neuroendocrine system
Effects of Massage on the Nervous System
The body’s responses to massage and its effects on the nervous
system are primarily reflexive.
Briefly, the nervous system is divided into the central
nervous system (CNS), which consists of the brain and the
spinal cord and its coverings, and the peripheral nervous
system (PNS), which consists of nerves and ganglions (Figure
5-5). The PNS is further divided into the autonomic and
somatic divisions. The autonomic nervous system (ANS)
division is subdivided into the sympathetic and parasympa-
thetic systems. The sympathetic system is responsible for
functions that expend energy in response to emergency or

xii

Massage Equipment
Massage Table
Massage therapists typically work in the standing position.
Therefore the width and height of the massage table deter-
mine the postures the therapist uses. Massage therapists are at
higher risk of cumulative episodes of pain in the low back and
upper extremities if they are required to maintain awkward,
static postures for the duration of a massage treatment.
The massage table can cause these awkward postures in three
main ways:
• If the table is too low, the therapist may be required to
slouch and bend over. In this case the table should be
raised.
• If the table is too high, the therapist may have to elevate
the shoulders, use lateral flexion and twisting of the torso,
and stand on the toes. The solution is to lower the table.
• If the table is too wide (or the massage stroke is too long),
the therapist must reach. The solution is to use a narrower
table, shorten the strokes, and step forward and perpen-
dicular to the massage table.
Ideally the table height could be varied according to the
technique used and the client’s size. However, this is seldom
actually possible. Although electric-lift adjustable massage
tables are becoming more common, they are not portable.
Many textbooks state that the proper working height of a table
is equal to the distance from the floor to a point between the
therapist’s wrist and the tips of the extended fingers (or about
the middle of the hand) when the arm is hanging at the side
of the body. However, some suggest that occasionally the
optimal height may be as low as the therapist’s knees or as
high as the waist (Figure 8-2).
According to the Canadian study by Albert et al. (2006)
mentioned earlier, the average fingertip height is 38% of a
person’s stature. Interestingly, the massage therapists in this
study all chose table heights that were 40% to 43% of their
standing height, which would be between the fingertips and
wrist, as suggested in their training manuals. The study found
that on average, trunk postures were divided 50-50 between
the neutral position category and the mild posture distortion
category; the shoulder and neck were in neutral postures for
30% and 40% of the time, respectively. Obviously, these table
heights resulted in an inappropriate workstation.
Punnett et al. (1991) found that the risk of back disorders
increased significantly with time worked in nonneutral pos-
tures and that the risk increased further when a nonneutral
posture (meaning some sort of twisting) was used in more
than one of the principal axes at a time.
The posture categories reported in the study by Albert et al.
(2006) mirrored those of Punnett, and the significant working
time in a mild trunk flexion reported for the massage thera-
pists is reason for concern. The trunk postures required of the
massage therapists in this study would result in significant
cumulative loads for a 45- to 60-minute massage. These find-
ings indicate that the massage therapists were flexing forward
to do massage; therefore, the massage table was too low, and
raising the height of the table would be logical. The massage
table must be kept at a comfortable height, which depends on
• Comprehensive content revision
based on new developments in
the massage therapy field.
Body Mechanics CHAPTER 8
Box 8-2 Massage Equipment Ergonomics
Working with a Massage Table
• As a general rule, the table height should be one half the
practitioner’s height. Therefore, if the practitioner is 5
feet, 6 inches tall (66 inches), the table should be
approximately 33 inches high.
• Depending on the therapist’s torso, arm, and leg length
ratios, the correct height for the table will be 2 to 3
inches higher or lower. An individual with long arms may
need a shorter table than a person with short arms. A
person with a short torso, short arms, and long legs
often needs a taller table.
• Typically a woman needs a taller table than a man of the
same height.
• A table 24 to 28 inches wide provides adequate space
for the client to lie down comfortably, but it is not so
wide that the therapist must reach for the client in the
middle of the table.
• The knees and hips are used to lift portable tables. The
therapist should not bend forward at the waist when
lifting the massage table. Some tables have shoulder
straps, wheel bases, and other devices to aid in
transport by redistributing the weight load.
• Consistently carrying the table on only one side of the
body may be harmful. Alternate carrying arms; for
example, carry in with the left arm, carry out with the
right.
Working on a Floor Mat
• Body mechanics similar to those used for working with a
table apply for working on a mat on the floor. The
notable difference is that the center of gravity is lower,
necessitating greater core strength.
• Movement around the client is different when the person
is on a floor mat rather than a massage table. The
weight-bearing balance points on the floor are from the
knees instead of the feet.
• Padding on the knees may be required. Kneepads are
available.
• The mat must be large enough so that the massage
therapist can keep his or her knees on the mat while
doing the massage.
Working with a Massage Chair
• Specially designed massage chairs help with positioning
the client so that compression can be applied correctly.
Regardless, prolonged use of a massage chair to deliver
massage strains the massage therapist’s body.
the practitioner’s height, the client’s size (thick or thin), and
the style of massage used (Box 8-2).
Awkward posture is associated with an increased risk for
injury, and the more a joint deviates from the neutral position,
the greater the risk of injury (Box 8-3). Every joint in the body
has a neutral position, in which joint spaces are even and sym-
metric (Box 8-4). The muscles around a joint in neutral posi-
tion are neither short nor long, but rather at their neutral
physiologic resting lengths. Joint stability is provided with the
least amount of muscle activity and maximizing stability
• Chapter 8: Body Mechanics, which takes
301
a closer look at adapting massage
application based on body shape and
gender. Therapeutic massage is a
physically labor-intensive therapy that
requires time to perform, with an
emphasis on ergonomics and correct
body mechanics. The sixth edition has
expanded coverage of this information,
and new content has been evaluated by
ergonomics experts.
654 MOSBY’S FUNDAMENTALS OF THERAPEUTIC MASSAGE
for cancer. Palliative care is aimed at relieving suffering and
improving quality of life in patients undergoing treatment
for the primary condition. Such care addresses physical symp-
toms, such as pain, shortness of breath, and nausea, but
also nonphysical causes of pain, such as sadness, depression,
and anxiety. Palliative care is not the same as hospice, which
provides end of life care for patients who no longer want
to pursue more aggressive therapy. A major priority of pallia-
tive care is to incorporate the principles of palliative care
into the care of all patients with cancer from the time of
diagnosis, not only in the setting of advanced or terminal
disease. Palliative care focuses on the whole person, encom-
passing body and mind to enhance comfort and preserve
dignity.
Therapeutic Massage Strategies During
Cancer Treatment
Massage is accepted as part of a multidisciplinary approach to
cancer treatment. The benefits of massage are obvious: stress
management, preoperative and postoperative pain manage-
ment, management of treatment side effects, and more. There
are no specific protocols for massage and cancer care. The
person undergoing cancer treatment must be evaluated each
session, and the massage treatment must be based on the
individual’s status at that time.
The concern that massage increases metastasis is unfounded.
However, it is prudent not to massage over any type of tissue
masses. Specific, extensive, full-body lymphatic drainage may
task already compromised immune function and should not
be used. The areas of radiation treatment need to be avoided,
because the skin is damaged by the treatment.
Caution:
• Avoid all sources of heat (hot water bottles, heating
pads, and sun lamps) on the treatment field.
• Avoid exposing the treatment area to cold temperatures
(ice bags or cold water treatment).
• Avoid any form of saltwater treatment.
• Avoid the use of all lotions or oils on the skin in the
treatment field and use only approved lotion during
massage.
• Avoid direct massage of the treatment area, other than
light application of approved lotion (Lewis et al., 2006).
Bones under areas of radiation treatment can be brittle;
therefore, massage pressure levels need to be monitored care-
fully. Do not use any massage methods that may cause tissue
damage because chemotherapy reduces the body’s ability to
repair tissues. The general protocol may be too intense during
cancer treatment, but the modified, palliative protocol (dis-
cussed later in the chapter on page 655) can be used as an
appropriate starting point for massage and then adapted spe-
cifically for each client.
Key Points
• Cancer treatment can be curative or palliative.
• Massage as part of an oncology treatment plan targets pal-
liative care as part of symptom management, especially the
side effects of treatment.
• Survival rates for cancer patients are steadily increasing as
a result of early detection and advances in treatment.
• Cautions for massage typically arise from changes in the
client’s skin as a side effect of treatment.
• Caution is necessary for fatigue and limits in adaptive
capacity.
HOSPITAL, LONG-TERM CARE,
AND HOSPICE PATIENTS
SECTION OBJECTIVES
Chapter objective covered in this section:
10. Adapt massage for integration into the various medical settings.
Using the information presented in this section, the learner will be able
to perform the following:
• Explain the importance of comfort measures
• Adapt massage application based on the circumstances of
hospital care
• Adapt massage application for individuals in long-term
medical care
• Define hospice care
• Adapt massage for end of life care
Use of massage therapy in hospitals is becoming more common. Some
of the reasons it is used include:
• Pain management
• Relief for cancer patients
• Pregnancy massage
• Adjunct to physical therapy
• Mobility/movement training
• Palliative care
A common theme in hospital-based massage is pain man-
agement. Massage is effective at managing acute and chronic
pain and supports other pain treatments, such as medica-
tion, ultrasound, and hydrotherapy. As mentioned, although
massage targeting pain reduction commonly is thought of as
therapeutic change, in reality it is palliative (see Chapter 6).
Massage for the hospital patient is not targeted specifically to
the pathologic condition or injury; rather, it is intended to
provide comfort care and symptom management (Box 14-8;
also see Box 14-7).
Benefits of Massage for
Box 14-8
Hospital Patients
1. Pain: Through the use of massage, the subjective
experience of pain is diminished, even when the use of
analgesics is reduced.
2. Anxiety: Anxiousness caused by the hospital stay and
fear of procedures is reduced.
3. Nausea: The subjective experience of nausea and the
use of antiemetics are reduced.
4. Stress: Physiologic indicators of stress (e.g., raised
cortisol level) are diminished, and indicators of reduced
stress (e.g., improved serotonin level) are increased.
5. Sleep: The ability to sleep more easily and for longer
periods increases with massage.
xiii
 Features and activities that
motivate and make you think
PROFICIENCY EXERCISE 10-2
1. Inflate a series of balloons with different internal
pressures. Fill some with water and others with gelatin
and use these to represent the density and pliability of
different tissue types. Balloons are great for practicing
the angle and pressure of the manipulation. The best
angle allows good, firm compression into the balloon
without it slipping out from under you.
2. Use pieces of foam of various densities and place them
over objects of different sizes and shapes. Determine
how much pressure it takes to feel each object. Pay
attention to the difference between the low-density foam
and the high-density foam.
3. Design a complete massage using only compression.
Pay very close attention to ways in which you can use
compression techniques to access the client’s body
successfully. Adjust depth of pressure, speed, rhythm,
frequency, and duration and observe the different
physiologic effects. Have a client lie on a mat and
experiment with using your leg and foot to apply
compression.
Visuals that guide
A B
D E
FIGURE 10-28 Examples of percussion. A, Hacking. B, Cupping. C, Fist beating. D, Beating over the palm. E, Slapping.
tapping.
xiv
• Reality-based examples embedded
throughout the textbook, helping readers
understand content.
effect on the nervous system, it initiates or enhances
sympathetic activity of the autonomic nervous system. The
effects of the manipulations are reflexive. However, percussion
also can have mechanical results, which involve loosening
and moving mucus in the chest. People with cystic fibrosis
are treated with percussion, but massage therapy of this
type is beyond the beginning skill levels of the massage
therapist.
The most noticeable effect of percussion results from the
response of the tendon reflexes. A quick blow to the tendon
stretches it. In response, protective muscle contraction occurs.
To obtain the best result, stretch the tendon first. The most
common example of this reflexive mechanism is the knee-jerk
(or patellar) reflex, but this response happens in all tendons to
some degree. This is very helpful when the massage therapist
is preparing the muscles for elongation applications, such as
when a client indicates that the hamstrings are tight and need
to be lengthened. With the client supine, the hip flexed to 90
degrees, and the knee flexed to 90 degrees, percussion on the
stretched quadriceps tendon causes the quadriceps to contract.
As a result, the hamstrings are inhibited, which makes them
easier to lengthen to a more normal resting length.
When applied to the joints, percussion affects the joint
kinesthetic receptors responsible for determining the position
and movement of the body. The quick blows confuse the
system, similar to the effect of joint-focused rocking and
shaking, but the body muscles are stimulated rather than
inhibited. This method is useful for stimulating weak muscles.
The force used must move the joint but should not be strong
enough to damage it. For example, a single finger may be used
to administer percussion over the carpal joints, whereas the
fist may be used over the sacroiliac joint.
Percussion is very effective when used at motor points that
usually are located in the same area as the traditional acupunc-
ture points which in turn are located at neurovascular bundles.
C The repetitive stimulation causes the nerve to fire repeatedly,
stimulating the nerve.
Percussion focused primarily on the skin affects the
superficial blood vessels of the skin, initially causing them to
contract. Heavy percussion or prolonged lighter application
dilates the vessels by causing the release of histamine, a
vasodilator.
Applying Percussion
Two hands usually are used alternately to do percussion. One
or two fingers can be used to tap a motor point located at the
center of the muscle mass where the motor nerve enters the
muscle (this sometimes is called neurotapping). The forearm
muscles contract and relax in rapid succession to move the
elbow joint into flexion and then allow it to release quickly.
This action travels down to the relaxed wrist, extending it; the
wrist then moves back and forth to provide the action of the
percussion. Percussion is a controlled flailing of the arms as
F the wrists snap back and forth. Remember that the wrist must
always stay relaxed. Beginning students usually want to use the
wrists to F, Finger
provide the snap action. This is especially tempting
when using small movements of the fingers; however, it will
damage the wrist.
Massage Manipulations and Techniques CHAPTER 10 381
Heavy percussion should not be done in the kidney area or
anywhere pain or discomfort is present. The following are
methods of percussion (Figure 10-28).
• Hacking. Hacking is applied with both wrists relaxed and
the fingers spread, with only the little finger or the ulnar
side of the hand striking the skin surface. The other fingers
hit each other with a springy touch. Point hacking can be
done by using the fingertips in the same way. Hacking is
done with the whole hand on the larger soft tissue areas,
such as the upper back and shoulders. Point hacking is used
on smaller areas, such as the individual tendons of the toes,
or over motor points.
• Cupping. To perform cupping, the fingers and thumbs
are positioned as if making a cup. The hands are turned
over, and the same action used in hacking is performed.
When done on the anterior and posterior thorax, cupping
is good for stimulating the respiratory system and for
loosening mucus. If the client exhales and makes a mono-
tone noise during cupping, enough pressure is used
so that the tone begins to break up, changing from
“AAAAAAAAAAAAHHHHHH” to “AH AH AH AH AH
AH”.
• Beating and pounding. These moves can be performed
with a soft fist with the knuckles down or with the fist held
vertically and the action performed with the ulnar side of
the palm. This technique is used over large muscles, such
as the buttocks and heavy leg muscles.
• Slapping (splatting). For this technique, the whole palm of
a flattened hand makes contact with the body. This is a
good method for causing the release of histamine, thereby
increasing vasodilation and its effects on the skin. It also is
a good method to use on the bottoms of the feet. The broad
contact of the whole hand disperses the force laterally
instead of downward, and the effects remain in the
superficial tissue. Kellogg (2010) called this movement
splatting.
• Tapping. For this technique, the palmar surface of the
fingers alternately taps the body area with light to medium
pressure. This is a good method to use around the joints,
on the tendons, on the face and head, and along the spine
(Proficiency Exercise 10-8).
PROFICIENCY EXERCISE 10-8
1. Play a drum or watch a drummer. Pay attention to the
action of the arms and wrists and the grasp of the
drumsticks. Notice that the drummer holds the
drumsticks loosely.
2. Get a paddleball or yo-yo and see what actions it takes
to make these toys work. Play with a rattle or tambourine.
3. Use the foam from the compression exercises and
practice the different methods and intensity of percussion
(light to deep, slow to fast).
4. While shaking your hands very quickly, use hacking to
strike the foam or a practice client. Without stopping,
change hand positions so that all the methods are used.
5. Design a stimulating massage with various applications
of percussion. Notice which qualities of touch are most
reflected with these methods.
• UNIQUE TO THIS TEXT: The final chapter
in this book contains 20 case studies
that help the student to appreciate the
complexities of a therapeutic relationship,
all in a competency-based format.
FOCUS ON PROFESSIONALISM 1-1
The actions of every massage therapist affect the massage
profession as a whole. There is an expectation of behavior
when one claims to be a massage therapist. Behaviors include
appearance, speech, actions, and advancement of knowl-
edge and skills through lifelong learning. As professionals we
need to walk the talk. Each of us has a responsibility to the
entire massage community. When a professional, we have to
always act as a professional even during personal time if in
public view. Social media is an example of when the profes-
sional commitment can be confused. If a posting to social
media does not comply with accepted and expected profes-
sional behavior, especially when directly related to massage
therapy, the conduct could be considered unethical. For
example, it is very unprofessional when a picture of a massage
therapist in revealing clothing or discussing involvement in
questionable behavior such as driving under the influence of
alcohol is included with posts about massage appointment
availability. Think about it.
696
MOSBY’S FUNDAMENTALS OF THERAPEUTIC MASSAGE
CASE 2. MUSCLE TENSION HEADACHE
A 26-year-old woman is in good health except for frequent
headaches that radiate pain from the back of her skull around
her ears and over her eyes. Migraine and cluster headaches
have been ruled out. The diagnosis is muscle tension head-
aches. Because no medical reason has been found for the
headaches, they are assumed to be related to stress. They do
not follow any cyclic pattern. A relationship to the menstrual
cycle has not been indicated.
The client has a temporary job as a waitress while she fin-
ishes college. She spends a lot of time sitting, reading, and
working at the computer. She notices increased tension in her
neck, shoulders, and lower back when she has to spend a lot
of time with her studies. She swims three times a week for
exercise and is careful with her diet. She has a moderate intake
of caffeine and alcohol, and she smokes. She is not under any
medical care.
Because common over-the-counter analgesics such as
aspirin and acetaminophen bother her stomach, she is seek-
ing an alternative to manage the pain. She has tried chiro-
practic care, with limited success, and often experiences a
headache right after an adjustment. She has heard that mas-
sage can help these types of headaches. A friend referred her,
indicating that she would be comfortable with a middle-aged
female therapist with a home-based practice. The client has
completed an informed consent process and has agreed to
treatment.
Assessment
Observation
The client is nearsighted and wears glasses. She repositions her
glasses often, and she squints in the bright light. She is polite
and soft-spoken. She appears frustrated and tired of the
inconvenience of the headaches. She is neatly groomed and
very organized; she provides a list of all the treatments that
have been tried for the headaches, including a food diary and
schedules attempting to identify the cause of the headaches.
Her weight is normal for her height. She has long, thick hair
that she wears in a ponytail.
Interview and Goals
The client’s history reveals that she has had headaches for as
long as she can remember. She has a headache severe enough
to interfere with daily activities about 10 days out of a month.
The headaches last about 12 hours, and the pain is a 7 on a
scale of 1 to 10 (1 being slight, 10 being extreme). She does
not remember any injury or surgery or any childhood diseases
other than the normal ones. She had the headaches during
adolescence. She generally ignores the headaches, but they are
becoming draining. The family history provides no insight.
There is a family history of cancer. She wore braces for 3 years
and recently had them removed. She has worn glasses and has
had long hair since her early teens. She admits to being a
perfectionist.
Her goals for the massage are to reduce the frequency and
intensity of the headaches.
• NEW FOCUS ON PROFESSIONALISM feature
throughout the text that reinforces the importance
of professional and ethical behavior.
Physical Assessment
Posture
No obvious postural asymmetry.
Gait
No obvious gait distortions.
Range of Motion
Slightly limited in all directions in the neck with moderate
reduction of capital flexion. Temporomandibular joint (TMJ)
opens only to two fingers’ width (three is normal).
Palpation
Near Touch. Neck near the occipital base and the lower
back are warm.
Skin. All areas are normal except for goose bumps and
dampness at the occipital base and lower back. Tissue texture
is symmetric and normal. Unable to lift a skinfold over the
entire length of the spinal column.
Superficial Connective Tissue. Superior and inferior binding
of connective tissue is present at the occipital base, sacrum,
forehead, and calves.
Vessels and Lymph Nodes. Normal
Muscles. Tender points are noted in the masseter, frontalis,
temporalis, and occipital base muscles. Moderate pressure on
these points results in pain that mimics the headaches. Neck
extensors are short and tight. Surface muscle tone seems gen-
erally high. Calf muscles are tight and short bilaterally.
Tendons. Normal
Deep Fascia. Fascia from the skull to the sacrum binds.
Scalp is tightly bound to the skull.
Ligaments. Normal
Joints. TMJ palpates tender to mild pressure and has
reduced range of motion.
Bones. Normal
Abdominal Viscera. Normal
Body Rhythms. Rhythmic but fast
Muscle Testing
Strength
Normal except that head and neck extensors are overly strong.
Head and neck flexors are inhibited.
Neurologic Balance
Tonic neck reflexes and eye-righting reflexes are overactive;
consequently, limb and back extensors do not inhibit when
client looks down toward navel.
Gait
Normal except that head seems to be held stiffly when client
walks.
Interpretation and Treatment Plan Development
Clinical Reasoning
What Are the Facts?
Muscle tension headaches are a common and recurring
problem for many people. They are benign, although all other
xv

• NEW LEARN MORE feature that provides
information in the text and links on the website to
expand on selected content. The information and
links guide the reader in exploration of the many
helpful resources from a variety of U.S. government
and affiliated agencies, nonprofit organizations, and
sources for valid research.
LEARN MORE ON THE WEB
MEDLINEPLUS is one of the most useful websites for
massage therapists and massage therapy students
interested in learning more about the techniques described
in this chapter. Visit the site and use the search term burns,
hydrotherapy, and hot stone massage, for example. The U.S.
Food & Drug Administration has some content on essential
oils, and the EVOLVE site provides links to articles related to
connective tissue and aromatherapy.
• UPDATED workbook sections that are
also available in an e-format on Evolve.
xvi
• NEW MENTORING TIP feature from the experiences
of the author to promote introspection and
classroom discussion.
MENTORING TIP 10-1
It is unclear how various massage manipulations and tech-
niques specifically affect the physiology to provide massage
benefits. Research has provided clues, and we can make
educated guesses, but we do not know the exact mecha-
nisms of how massage helps us feel and do better. For each
massage method in this chapter, there is a description, theo-
ries of effect, and instruction in how to apply the methods.
The description reflects the Entry Level Analysis Project and
Massage Therapy Body of Knowledge content. The theories
of effect are biologically plausible and justifiable based on
what we do know about massage. The instructions about
application are consistent with historical data and reflect
current recommendations by experts. It is difficult to reach a
consensus because there are so many different opinions and
ideas about massage. Learn from this textbook, your instruc-
tors, your classmates, and yourself. There is no absolute right
or wrong way to give a massage, as long as no harm is done
and safety is a priority for both you and the client.
28
Workbook Section All Workbook activities can be done electronically online
as well as here in the book. Answers are located on Evolve.
Review Questions _____ 19. Margaret Knott and Dorothy Voss
_____ 20. Esalen and Gestalt
Write your personal definition for each of the following words.
_____ 21. Autonomic approach
1. Professional
_____ 22. Mechanical approach
_____ 23. Dr. Boris Chaitow and Dr. Stanley Lief
_____ 24. Dr. Milton Trager
_____ 25. Ronald Melzack
2. Structured
_____ 26. ELAP
a. Proposed an integrated program of active and passive
movements based on Swedish gymnastics
b. Systems based on lines and points
3. Therapeutic
c. Developed Rolfing
d. Divided the effects of massage into two categories:
mechanical actions and reflex actions
e. Founded bioenergetics
4. Touch
f. Inspired psychotherapists to explore massage and
movement therapies
g. Changes abnormal movement patterns into optimal
ones
Essay Questions h. Used French terms such as effleurage and pétrissage
i. An English physician who studied directly with Ling
1. What does “touch intention” mean to you? and was also a leader in the homeopathic movement
j. Commonly called resistive exercises
k. Cofounders of the neuromuscular technique
l. Developed the therapeutic touch–energetic approach
2. How would you describe your professional touch m. Range of motion and stretching performed by a
intention? therapist
n. A physician from Battle Creek, Michigan, who used
massage and hydrotherapy
o. Attempts mechanical changes in soft tissue
p. Introduced Swedish movements in the United States
Matching
 Ancillaries that are
more than just extra
• EXPANDED Web-based content on
the EVOLVE site, including 3 hours of
NOTE TO STUDENTS
case studies, demonstrations, As the author, my intent is to make reading this textbook an enjoyable
animated footage, and more! learning experience; I hope my purpose is reflected in the conversa­
• Licensing review questions. tional tone in which I have written the text. My personal conviction
• NEW QUICK CONTENT REVIEW IN is that Mosby’s Fundamentals of Therapeutic Massage effectively pre­
QUESTION FORM, which is a student sents the information and reflects both the heart and the art of thera­
Evolve resource that reinforces key peutic massage. After all, no one cares how much you know until they
concepts in the chapter and allows know how much you care.
learners to quiz themselves as a Sandy Fritz
review and for learning strategies.
• TEACH lesson plan manual for
instructors, which is available on
Evolve at http://evolve.elsevier.com/
fritz/fundamentals/.

xvii
Acknowledgments
My thanks to the all of the professionals who have influenced the content and clarity over mul-
tiple editions of this text to ensure accurate presentation of information.
There are several people who deserve special recognition for their efforts in the publication
of this edition:
Shelley Bertrand, for the incredible photos and for her energy and enthusiasm during the
photo shoot.
Luke Fritz, BS, Board Certified NCBTMB reviewer
My daughter, Laura, and son, Luke, as reviewers, models, and proofreaders, who understand
the commitment necessary to write high-quality textbooks.
And a special thank you to:
All of the individuals on my support team at Elsevier—especially Shelly Stringer, Brandi
Graham, Rich Barber, Maggie Reid, Jeff Ryals, Maria Broeker, and Kate Odem.
The clients I have had for more than three decades, the athletes I work with for a day or
throughout their careers—for constantly challenging me to figure out what to do with all their
assorted bumps, bruises, sprains, strains, breaks, performance stresses, and personalities. And to
all the students I have worked with, for keeping me honest and humble.
It truly has been a team effort.

xviii
 Contents

People-First Terminology, 149

UNIT I Medical Terminology, 153
PROFESSIONAL PRACTICE Body Structure and Bones, Joints, and Muscles, 157
Body Systems: Nervous, Cardiovascular, Lymphatic, and
Immune Systems, 164
1 Therapeutic Massage as a Profession, 2 Body Systems: Respiratory, Digestive, Endocrine, and
Professional Touch, 4 Integumentary Systems, 169
Professional Classifications of Touch, 8 Documentation, 172
Historical Perspectives, 13
Recent Events and Current Professional Trends, 22
Leadership, 25 U N IT I I
FOUNDATIONS FOR MASSAGE BENEFIT
2 Ethics, Professionalism, and Legal Issues, 30
Professionalism and Therapeutic Massage, 32
The Definition of Therapeutic Massage, 39 5 Research Literacy and Evidence-Informed
Scope of Practice, 43 Practice, 188
Evidence-Based/Evidence-Informed Practice, 51 Massage as Art and Science, 189
Ethics and Standards of Practice, 52 Research Literacy, 192
Informed Consent, 54 Current Research Overview, 194
Confidentiality, 58 The Research Process, 202
Health Insurance Portability and Accountability Act of Why Massage Is Effective: Translating Evidence into
1996 (HIPAA), 59 Practical Application, 209
Professional Boundaries, 60 Translating Evidence into Practical Application:
The Therapeutic Relationship, 62 Nervous/Neuroendocrine System, 210
Ethical Decision Making, 71 Translating Evidence into Practical Application:
Communication Skills, 73 Autonomic Nervous System, 213
Credentials and Licensing, 81 Translating Evidence into Practical Application: Somatic
Dealing with Suspected Unethical or Illegal Behavior, 84 Nervous System, 216
Translating Evidence into Practical Application:
3 Business Considerations for a Career in Circulation, 221
Therapeutic Massage, 91 Translating Evidence into Practical Application:
Inspiration, Intention, Intuition, 92 Connective Tissue, 225
Motivation, 93
The Résumé and Cover Letter, 97 6 Indications and Contraindications for Therapeutic
The Interview, 98 Massage, 237
Self-Employment or Employment by Others, 100 Indications for Massage, 237
Client Retention, 104 Approaches to Care, 238
Generating Income, 108 Pathology, 243
The Business/Career Plan, 113 Common Pathologic Conditions and Indications for
The Business Structure, 117 Massage, 247
The Target Market, 120 Contraindications to Massage Therapy, 258
Management, 122
Hallmarks of a Successful Employee, 128 7 Hygiene, Sanitation, and Safety, 270
Personal Health, Hygiene, and Appearance, 271
4 Professional and Medical Terminology for Sanitation, 273
Communication and Documentation, 135 Preventing the Transmission of HIV Infection,
Massage Therapy Terminology, 136 Hepatitis, Tuberculosis, and Other Contagious
Quality of Life Terminology, 144 Conditions, 284
Cultural Competency and Humility, 149 Premise and Fire Safety, 286
xix
xx Contents
UNIT III
THE MASSAGE PROCESS
8 Body Mechanics, 296
Research: Efficacy of Body Mechanics in Massage
Therapists, 297
Ergonomics and Biomechanics, 300
Gender Differences, 318
Self-Care and the Effects of Improper Body
Mechanics, 321
9 Preparation for Massage: Equipment, Professional
Environment, Positioning, and Draping, 332
Equipment, 332
Massage Environment, 338
Determining a New Client’s Expectations, 342
Feedback, 344
Premassage and Postmassage Procedures, 346
Positioning and Draping the Client, 348
10 Massage Manipulations and Techniques, 356
Quality of Touch, 357
Types of Mechanical Force and Massage
Manipulations, 360
Massage Techniques Using Joint Movement, 382
Muscle Energy Techniques, 392
Sequence and Transitioning: the Basic Full-Body
Massage, 402
11 Assessment Procedures for Developing a
Care/Treatment Plan, 435
Assessment, 437
Physical Assessment: Objective Aspect of
Assessment, 442
Posture Assessment: Standing Position, 447
Gait Assessment, 454
Assessment of Joint Range of Motion, 457
Basic Orthopedic Tests, 459
Assessment by Palpation, 462
Assessment Procedures for Muscle Testing, 474
Putting It All Together: Functional Biomechanical
Assessment, 496
Clinical Reasoning and Problem Solving, 500
UNIT IV
BEYOND THE BASICS
12 Complementary Bodywork Systems, 510
Complementary Bodywork Systems, 512
Hydrotherapy, 514
Hot and Cold Stones, 526
Aromatherapy, 529
Implement-Assisted Massage—Safety First, 534
Lymph, Blood, and Circulation Enhancement, 536
Connective Tissue Approaches, 547
Trigger Point Treatment Approaches, 556
Asian Bodywork Methods, 561
Ayurveda, 570
Biofields and Polarity Therapy, 572
Reflexology, 579
13 Massage Career Tracks and Practice Settings, 588
Therapeutic Massage in the Wellness/Spa/Franchise
Environment, 589
Therapeutic Massage in the Health Care
Environment, 601
Therapeutic Massage in the Sports and Fitness
Environment, 614
14 Adaptive Massage, 620
Animal Massage, 621
Athletes, 628
Breast Massage, 636
Pregnancy, 637
Pediatrics, 641
Geriatrics, 645
Acute Care, 648
Chronic Illness, 649
Oncology Care, 651
Hospital, Long-Term Care, and Hospice Patients, 654
Individuals with a Physical Impairment, 658
Individuals with a Psychological Diagnosis, 661
15 Wellness Education, 669
Challenges to Wellness, 670
The Body: Nutrition, 672
The Body: Physical Fitness, 675
The Body: Relaxation, 679
The Mind, 684
The Spirit, 687
16 Case Studies, 690
Case 1. Generalized Stress and Anxiety with Breathing
Pattern Disorder Symptoms, 692
Case 2. Muscle Tension Headache, 696
Case 3. Generalized Pain Syndrome: Subclinical
Fibromyalgia, 698
Case 4. Neck and Shoulder Pain with Limited Range of
Motion, 701
Case 5. Generalized Low Back Pain with Limited Range
of Motion, 704
Case 6. Athletic Delayed-Onset Muscle Soreness, 707
Case 7. Third Trimester Pregnancy, 709
Case 8. Premenstrual Syndrome, 711
Case 9. Repetitive Strain/Overuse Injury: Bursitis, 712
 Contents xxi

Case 10. Joint Sprain with Underlying Hypermobility AP P EN DIX A

and Lax Ligament Syndrome, 715 Indications and Contraindications to Massage, 742
Case 11. Osteoarthritis and Arthrosis, 717
Case 12. Nerve Impingement Syndrome, 720 AP P EN DIX B
Case 13. General Relaxation, 722 Skin Pathology: Common Skin Disorders, 756
Case 14. Sleep Disturbance, 723
Case 15. Circulation Impairment, 726 AP P EN DIX C
Case 16. Fatigue Caused by Cancer Treatment, 728 Basic Pharmacology for the Massage Therapist, 758
Case 17. Breathing Disorder: Asthma, 730
Case 18. Seasonal Affective Disorder, 733 GLOSSARY, 765
Case 19. Sports Performance Enhancement, 736
Case 20. Scar Tissue Management, 738 I N DEX, 776
This page intentionally left blank
 UNIT I
Professional Practice
1 Therapeutic Massage as a Profession, 2
2 Ethics, Professionalism, and Legal Issues, 30
3 Business Considerations for a Career in Therapeutic Massage, 91
4 Professional and Medical Terminology for Communication and
Documentation, 135

To be a successful massage therapist, you will need two classifications of skills: soft skills and hard
skills. Soft skills, such as communication, etiquette, friendliness, teamwork, problem solving,
interpersonal skills, and leadership, are essential to success. Hard skills are specific teachable
abilities that can be measured. The massage skills, as well as some business and documentation
skills, are considered hard skills. Soft skills are related to social and emotional intelligence. Daniel
Goleman, a psychologist, wrote a book in 1995 titled Emotional Intelligence, and he and others
have continued to investigate and describe the importance of human interaction. Soft skills relate
to social neuroscience—the study of what happens while people interact. We now know that
intelligence is multifaceted, and the soft skills in this unit are just as important for career success
as the massage (hard) skills you will learn in Units 3 and 4. The information in the first four
chapters of this textbook combine to address the spectrum of soft skills including the mindset,
behavior, and interpersonal skills needed to function as a massage therapist in a professional
setting. In addition hard skills needed for business and documentation skills are presented. Unit
2: Foundations for Massage Benefit will support Unit 1 and bridge to Unit 3: The Massage Process
and Unit 4: Beyond the Basics. So let’s begin Unit 1, Professional Practice, starting with Chapter
1: Therapeutic Massage as a Profession.

LEARN MORE ON THE WEB

This feature will appear at the end of each chapter and leads you to valuable information
provided by the various departments of the U.S. government (and sometimes those of other
countries). Unless specifically noted, the content in the LEARN MORE features is in the public
domain and free for you to use. The links and additional information are found on the Evolve
website. For example, soft skills such as communication, attitude and teamwork are extremely
important in a service profession such as massage. The U.S. Department of Labor has many
resources to expand your knowledge on these topics. Use search term soft skills.
On the Evolve site, you will find the links and topics. For example: Soft Skills: U.S.
Department of Labor (http://www.dol.gov/odep/topics/youth/softskills/)
Soft Skills to Pay the Bills—Mastering Soft Skills for Workplace Success
Soft Skill #1: Communication
Soft Skill #2: Enthusiasm and Attitude
Soft Skill #3: Teamwork
Soft Skill #4: Networking
Soft Skill #5: Problem Solving and Critical Thinking
Soft Skill #6: Professionalism

1
Another random document with
no related content on Scribd:
 Then Dode, his mother and sister began most unconcernedly to
speculate as to what if anything was next to be done with the old
farmer, the while the latter rolled a vacant eye over a scene he was
no longer able to interpret.
 X
MARRIAGE—FOR ONE

W HENEVER I think of love and marriage I think of Wray. That

clerkly figure. That clerkly mind. He was among the first people
I met when I came to New York and, like so many of the millions
seeking to make their way, he was busy about his affairs.
Fortunately, as I saw it, with the limitations of the average man he
had the ambitions of the average man. At that time he was
connected with one of those large commercial agencies which
inquire into the standing of business men, small and large, and
report their findings, for a price, to other business men. He was very
much interested in his work and seemed satisfied that should he
persist in it he was certain to achieve what was perhaps a fair
enough ambition: a managership in some branch of this great
concern, which same would pay him so much as five or six thousand
a year. The thing about him that interested me, apart from a genial
and pleasing disposition, was the fact that with all his wealth of
opportunity before him for studying the human mind, its resources
and resourcefulness, its inhibitions and liberations, its humor,
tragedy, and general shiftiness and changefulness, still he was
largely concerned with the bare facts of the differing enterprises
whose character he was supposed to investigate. Were they
solvent? Could and did they pay their bills? What was their capital
stock? How much cash did they have on hand?... Such was the
nature of the data he needed, and to this he largely confined himself.
Nevertheless, by turns he was amused or astonished or made
angry or self-righteous by the tricks, the secretiveness, the errors
and the downright meanness of spirit of so many he had to deal with.
As for himself, he had the feeling that he was honest,
straightforward, not as limited or worthless as some of these others,
and it was on this score that he was convinced he would succeed, as
he did eventually, within his limitations, of course. What interested
me and now makes me look upon him always as an excellent
illustration of the futility of the dream of exact or even suitable
rewards was his clerkly and highly respectable faith in the same. If a
man did as he should do, if he were industrious and honest and
saving and courteous and a few more of those many things we all
know we ought to be, then in that orderly nature of things which he
assumed to hold one must get along better than some others. What
—an honest, industrious, careful man not do better than one who
was none of these things—a person who flagrantly disregarded
them, say? What nonsense. It must be so. Of course there were
accidents and sickness, and men stole from one another, as he saw
illustrated in his daily round. And banks failed, and there were trusts
and combinations being formed that did not seem to be entirely in
tune with the interests of the average man. But even so, all things
considered, the average man, if he did as above, was likely to fare
much better than the one who did not. In short, there was such a
thing as approximate justice. Good did prevail, in the main, and the
wicked were punished, as they should be.
And in the matter of love and marriage he held definite views also.
Not that he was unduly narrow or was inclined to censure those
whose lives had not worked out as well as he hoped his own would,
but he thought there was a fine line of tact somewhere in this matter
of marriage which led to success there quite as the qualities outlined
above led, or should lead, to success in matters more material or
practical. One had to understand something about women. One had
to be sure that when one went a-courting one selected a woman of
sense as well as of charm, one who came of good stock and hence
would be possessed of good taste and good principles. She need
not be rich; she might even be poor. And one had to be reasonably
sure that one loved her. So many that went a-courting imagined they
loved and were loved when it was nothing more than a silly passing
passion. Wray knew. And so many women were designing, or at
least light and flighty; they could not help a serious man to succeed if
they would. However, in many out-of-the-way corners of the world
were the really sensible and worthy girls, whom it was an honor to
marry, and it was one of these that he was going to choose. Yet even
there it was necessary to exercise care: one might marry a girl who
was too narrow and conventional, one who would not understand the
world and hence be full of prejudices. He was for the intelligent and
practical and liberal girl, if he could find her, one who was his mental
equal.
It was when he had become secretary to a certain somebody that
he encountered in his office a girl who seemed to him to embody
nearly all of the virtues or qualities which he thought necessary. She
was the daughter of very modestly circumstanced parents who dwelt
in the nearby suburb of O——, and a very capable and faithful
stenographer, of course. If you had seen the small and respectable
suburb from which she emanated you would understand. She was
really pretty and appeared to be practical and sensible in many
ways, but still very much in leash to the instructions and orders and
tenets of her home and her church and her family circle, three worlds
as fixed and definite and worthy and respectable in her thought as
even the most enthusiastic of those who seek to maintain the order
and virtue of the world would have wished. According to him, as he
soon informed me—since we exchanged nearly all our affairs
whenever we met, she was opposed to the theatre, dancing, any
form of night dining or visiting in the city on weekdays, as well as
anything that in her religious and home world might be construed as
desecration of the Sabbath. I recall him describing her as narrow “as
yet,” but he hoped to make her more liberal in the course of time. He
also told me with some amusement and the air of a man of the world
that it was impossible for him to win her to so simple an outing as
rowing on the Sabbath on the little river near her home because it
was wrong; on the contrary, he had to go to church with her and her
parents. Although he belonged to no church and was mildly
interested in socialism, he kept these facts from her knowledge. The
theatre could not even be mentioned as a form of amusement and
she could not and would not dance; she looked upon his inclination
for the same as not only worldly but loose and sinful. However, as he
told me, he was very fond of her and was doing his best to influence
and enlighten her. She was too fine and intelligent a girl to stick to
such notions. She would come out of them.
 By very slow degrees (he was about his business of courting her
all of two or three years) he succeeded in bringing her to the place
where she did not object to staying downtown to dinner with him on a
weekday, even went with him to a sacred or musical concert of a
Sunday night, but all unbeknown to her parents or neighbors, of
course. But what he considered his greatest triumph was when he
succeeded in interesting her in books, especially bits of history and
philosophy that he thought very liberal and which no doubt
generated some thin wisps of doubt in her own mind. Also, because
he was intensely fond of the theatre and had always looked upon it
as the chiefest of the sources of his harmless entertainment, he
eventually induced her to attend one performance, and then another
and another. In short, he emancipated her in so far as he could, and
seemed to be delighted with the result.
With their marriage came a new form of life for both of them, but
more especially for her. They took a small apartment in New York, a
city upon which originally she had looked with no little suspicion, and
they began to pick up various friends. It was not long before she had
joined a literary club which was being formed in their vicinity, and
here she met a certain type of restless, pushing, seeking woman for
whom Wray did not care—a Mrs. Drake and a Mrs. Munshaw,
among others, who, from the first, as he afterward told me, he knew
could be of no possible value to any one. But Bessie liked them and
was about with them here, there, and everywhere.
It was about this time that I had my first suspicion of anything
untoward in their hitherto happy relations. I did not see him often
now, but when I did visit them at their small apartment, could not
help seeing that Mrs. Wray was proving almost too apt a pupil in the
realm in which he had interested her. It was plain that she had been
emancipated from quite all of her old notions as to the sinfulness of
the stage, and in regard to reading and living in general. Plainly,
Wray had proved the Prince Charming, who had entered the secret
garden and waked the sleeping princess to a world of things she had
never dreamed of. She had reached the place where she was
criticizing certain popular authors, spoke of a curiously enlightened
history of France she was reading, of certain bits of philosophy and
poetry which her new club were discussing. From the nature of the
conversation being carried on by the three of us I could see that
Wray was beginning to feel that the unsophisticated young girl he
had married a little while before might yet outstrip him in the very
realm in which he had hoped to be her permanent guide. More than
once, as I noticed, she chose to question or contradict him as to a
matter of fact, and I think he was astonished if not irritated by the fact
that she knew more than he about the import of a certain plot or the
relativity of certain dates in history. And with the force and
determination that had caused her to stand by her former
convictions, she now aired and defended her new knowledge. Not
that her manner was superior or irritating exactly; she had a friendly
way of including and consulting him in regard to many things which
indicated that as yet she had no thought of manifesting a superiority
which she did not feel. “That’s not right, dearest. His name is
Bentley. He is the author of a play that was here last year—The
Seven Rings of Manfred—don’t you remember?” And Wray, much
against his will, was compelled to confess that she was right.
Whenever he met me alone after this, however, he would confide
the growing nature of his doubts and perplexities. Bessie was no
more the girl she had been when he first met her than he was like
the boy he had been at ten years of age. A great, a very great
change was coming over her. She was becoming more aggressive
and argumentative and self-centred all the time, more this, more
that. She was reading a great deal, much too much for the kind of life
she was called upon to lead. Of late they had been having long and
unnecessary arguments that were of no consequence however they
were settled, and yet if they were not settled to suite her she was
angry or irritable. She was neglecting her home and running about
all the time with her new-found friends. She did not like the same
plays he did. He wanted a play that was light and amusing, whereas
she wanted one with some serious moral or intellectual twist to it.
She read only serious books now and was attending a course of
lectures, whereas he, as he now confessed, was more or less bored
by serious books. What was the good of them? They only stirred up
thoughts and emotions which were better left unstirred. And she liked
music, or was pretending she did, grand opera, recitals and that sort
of thing, whereas he was not much interested in music. Grand opera
bored him, and he was free to admit it, but if he would not
accompany her she would go with one or both of those two wretched
women he was beginning to detest. Their husbands had a little
money and gave them a free rein in the matter of their social and
artistic aspirations. They had no household duties to speak of and
could come and go as they chose, and Wray now insisted that it was
they who were aiding and abetting Bessie in these various interests
and enthusiasms and stirring her up to go and do and be. What was
he to do? No good could come if things went on as they were going.
They were having frequent quarrels, and more than once lately she
had threatened to leave him and do for herself here in New York, as
he well knew she could. He was doing very well now and they could
be happy together if only these others could be done away with.
It was only a month or two after this that Wray came to see me, in
a very distrait state of mind. After attempting to discuss several other
things quite casually he confessed that his young wife had left him.
She had taken a room somewhere and had resumed work as a
stenographer, and although he met her occasionally in the subway
she would have nothing to do with him. She wanted to end it all. And
would I believe it? She was accusing him of being narrow and
ignorant and stubborn and a number of other things! Only think of it!
And three or four years ago she had thought he was all wrong when
he wanted to go rowing on Sunday or stay downtown to dinner of an
evening. Could such things be possible? And yet he loved her, in
spite of all the things that had come up between them. He couldn’t
help it. He couldn’t help thinking how sweet and innocent and
strange she was when he first met her, how she loved her parents
and respected their wishes. And now see. “I wish to God,” he
suddenly exclaimed in the midst of the “oldtime” picture he was
painting of her, “that I hadn’t been so anxious to change her. She
was all right as she was, if I had only known it. She didn’t know
anything about these new-fangled things then, and I wasn’t satisfied
till I got her interested in them. And now see. She leaves me and
says I’m narrow and stubborn, that I’m trying to hold her back
intellectually. And all because I don’t want to do all the things she
wants to do and am not interested in the things that interest her,
now.”
I shook my head. Of what value was advice in such a situation as
this, especially from one who was satisfied that the mysteries of
temperament of either were not to be unraveled or adjusted save by
nature—the accidents of chance and affinity, or the deadly
opposition which keep apart those unsuited to each other?
Nevertheless, being appealed to for advice, I ventured a silly
suggestion, borrowed from another. He had said that if he could but
win her back he would be willing to modify the pointless opposition
and contention that had driven her away. She might go her
intellectual way as she chose if she would only come back. Seeing
him so tractable and so very wishful, I now suggested a thing that
had been done by another in a somewhat related situation. He was
to win her back by offering her such terms as she would accept, and
then, in order to bind her to him, he was to induce her to have a
child. That would capture her sympathy, very likely, as well as
insinuate an image of himself into her affectionate consideration.
Those who had children rarely separated—or so I said.
The thought appealed to him intensely. It satisfied his practical and
clerkly nature. He left me hopefully and I saw nothing of him for
several months, at the end of which time he came to report that all
was once more well with him. She had come back, and in order to
seal the new pact he had taken a larger apartment in a more
engaging part of the city. Bessie was going on with her club work,
and he was not opposing her in anything. And then within the year
came a child and there followed all those simple, homey, and
seemingly binding and restraining things which go with the rearing
and protection of a young life.
But even during that period, as I was now to learn, all was not as
smooth as I had hoped. Talking to me in Wray’s absence once
Bessie remarked that, delightful as it was to have a child of her own,
she could see herself as little other than a milch cow with an
attendant calf, bound to its service until it should be able to look after
itself. Another time she remarked that mothers were bond-servants,
that even though she adored her little girl she could not help seeing
what a chain and a weight a child was to one who had ambitions
beyond those of motherhood. But Wray, clerkly soul that he was, was
all but lost in rapture. There was a small park nearby, and here he
could be found trundling his infant in a handsome baby-carriage
whenever his duties would permit. He would sit or walk where were
others who had children of about the age of his own so that he might
compare them. He liked to speculate on the charm and innocence of
babyhood and was amused by a hundred things which he had never
noticed in the children of others. Already he was beginning to
formulate plans for little Janet’s future. It was hard for children to be
cooped up in an apartment house in the city. In a year or two, if he
could win Bessie to the idea, they would move to some suburban
town where Janet could have the country air.
They were prospering now and could engage a nursemaid, so
Mrs. Wray resumed her intellectual pursuits and her freedom.
Throughout it all one could see that, respect Wray as she might as a
dutiful and affectionate and methodical man, she could not love or
admire him, and that mainly because of the gap that lay between
them intellectually. Dissemble as he might, there was always the
hiatus that lies between those who think or dream a little and those
who aspire and dream much. Superiority of intellect was not
altogether the point; she was not so much superior as different, as I
saw it. Rather, they were two differing rates of motion, flowing side
by side for the time being only, his the slower, hers the quicker. And
it mattered not that his conformed more to the conventional thought
and emotions of the majority. Hers was the more satisfactory to
herself and constituted an urge which he feared rather than
despised; and his was more satisfactory to himself, compromise as
he would. Observing them together one could see how proud he was
of her and of his relationship to her, how he felt that he had captured
a prize, regardless of the conditions by which it was retained; and on
the other hand one could easily see how little she held him in her
thought and mood. She was forever talking to others about those
things which she knew did not interest him or to which he was
opposed.
 For surcease she plunged into those old activities that had so
troubled him at first, and now he complained that little Janet was
being neglected. She did not love her as she should or she could not
do as she was doing. And what was more and worse, she had now
taken to reading Freud and Kraft-Ebbing and allied thinkers and
authorities, men and works that he considered dreadful and
shameful, even though he scarcely grasped their true significance.
One day he came to me and said: “Do you know of a writer by the
name of Pierre Loti?”
“Yes,” I replied, “I know his works. What about him?”
“What do you think of him?”
“As a writer? Why, I respect him very much. Why?”
“Oh, I know, from an intellectual point of view, as a fine writer,
maybe. But what do you think of his views of life—of his books as
books to be read by the mother of a little girl?”
“Wray,” I replied, “I can’t enter upon a discussion of any man’s
works upon purely moral grounds. He might be good for some
mothers and evil for others. Those who are to be injured by a picture
of life must be injured, or kept from its contaminating influence, and
those who are to be benefited will be benefited. I can’t discuss either
books or life in any other way. I see worthwhile books as truthful
representations of life in some form, nothing more. And it would be
unfair to any one who stood in intellectual need to be restrained from
that which might prove of advantage to him. I speak only for myself,
however.”
It was not long after that I learned there had been a new quarrel
and that Bessie had left him once more, this time, as it proved, for
good. And with her, which was perhaps illegal or unfair, she had
taken the child. I did not know what had brought about this latest
rupture but assumed that it was due to steadily diverging views.
They could not agree on that better understanding of life which at
one time he was so anxious for her to have—his understanding. Now
that she had gone beyond that, and her method of going was
unsatisfactory to him, they could not agree, of course.
 Not hearing from him for a time I called and found him living in the
same large apartment they had taken. Its equipment was better
suited to four than to one, yet after seven or eight months of absence
on her part here he was, living alone, where every single thing must
remind him of her and Janet. As for himself, apart from a solemnity
and reserve which sprang from a wounded and disgruntled spirit, he
pretended an indifference and a satisfaction with his present state
which did not square with his past love for her. She had gone, yes;
but she had made a mistake and would find it out. Life wasn’t as she
thought it was. She had gone with another man—he was sure of
that, although he did not know who the man was. It was all due to
one of those two women she had taken up with, that Mrs. Drake.
They were always interested in things which did not and could not
interest him. After a time he added that he had been to see her
parents. I could not guess why, unless it was because he was lonely
and still very much in love and thought they might help him to
understand the very troublesome problem that was before him.
It was a year and a half before I saw him again, during which time,
as I knew, he continued to live in the apartment they had occupied
together. He had become manager of a department of the agency by
this time and was going methodically to and fro between his home
and office. After living alone and brooding for more than a year, he
came to see me one rainy November night. He looked well enough
materially, quite the careful person who takes care of his clothes, but
thinner, more tense and restless. He seated himself before my fire
and declared that he was doing very well and was thinking of taking
a long vacation to visit some friends in the West. (He had once told
me that he had heard that Bessie had gone to California.) Yes, he
was still living in the old place. I might think it strange, but he had not
thought it worth while to move. He would only have to find another
place to live in; the furniture was hard to pack; he didn’t like hotels.
Then of a sudden, noting that I studied him and wondered, he
grew restless and finally stood up, then walked about looking at
some paintings and examining a shelf of books. His manner was that
of one who is perplexed and undetermined, of one who has stood
out against a silence and loneliness of which he was intensely
weary. Then of a sudden he wheeled and faced me: “I can’t stand it.
That’s what’s the matter. I just can’t stand it any longer. I’ve tried and
tried. I thought the child would make things work out all right, but she
didn’t. She didn’t want a child and never forgave me for persuading
her to have Janet. And then that literary craze—that was really my
own fault, though. I was the one that encouraged her to read and go
to theatres. I used to tell her she wasn’t up-to-date, that she ought to
wake up and find out what was going on in the world, that she ought
to get in with intelligent people. But it wasn’t that either. If she had
been the right sort of woman she couldn’t have done as she did.” He
paused and clenched his hands nervously and dramatically. It was
as though he were denouncing her to her face instead of to me.
“Now, Wray,” I interposed, “how useless to say that. Which of us is
as he should be? Why will you talk so?”
“But let me tell you what she did,” he went on fiercely. “You haven’t
an idea of what I’ve been through, not an idea. She tried to poison
me once so as to get rid of me.” And here followed a brief and sad
recital of the twists and turns and desperation of one who was
intensely desirous of being free of one who was as desirous of
holding her. And then he added: “And she was in love with another
man, only I could never find out who he was.” And his voice fell to a
low, soft level, as though he was even then trying to solve the
mystery of who it was. “And I know she had an operation performed,
though I could never prove it.” And he gave me details of certain
mysterious goings to and fro, of secret pursuits on his part, actions
and evidences and moods and quarrels that pointed all too plainly to
a breach that could never be healed. “And what’s more,” he
exclaimed at last, “she tortured me. You’ll never know. You couldn’t.
But I loved her.... And I love her now.” Once more the tensely
gripped fingers, the white face, the flash of haunted eyes.
“One afternoon I stood outside of a window of an apartment house
when I knew she was inside, and I knew the name of the man who
was supposed to occupy it, only he had re-sublet it, as I found out
afterwards. And she had Janet with her—think of that!—our own little
girl! I saw her come to the window once to look out—I actually saw
her in another man’s rooms. I ran up and hammered at the door—I
tried to break it open. I called to her to come out but she wouldn’t,
and I went to get a policeman to make him open the door. But when I
got back a servant was coming up as though she had been out, and
she unlocked the door and went in. It was all a ruse, and I know it.
They weren’t inside. She had slipped out with Janet. And she had
told me they were going to Westchester for the day.
“And another time I followed her to a restaurant when she said she
was going to visit a friend. I suspected there was a man—the man I
thought she was going with, but it was some one I had never seen
before. When they came out and were getting into a cab I came up
and told them both what I thought of them. I threatened to kill them
both. And she told him to go and then came home with me, but I
couldn’t do anything with her. She wouldn’t talk to me. All she would
say was that if I didn’t like the way she was doing I could let her go.
She wanted me to give her a divorce. And I couldn’t let her go, even
if I had wanted to. I loved her too much. And I love her too much
now. I do. I can’t help it.” He paused. The pain and regret were
moving.
“Another time,” he went on, “I followed her to a hotel—yes, to a
hotel. But when I got inside she was waiting for me; she had seen
me. I even saw a man coming toward her—but not the one I believed
was the one—only when he saw me he turned away and I couldn’t
be sure that he was there to meet her. And when I tried to talk to her
about him she turned away from me and we went back home in
silence. I couldn’t do anything with her. She would sit and read and
ignore me for days—days, I tell you—without ever a word.”
“Yes,” I said, “but the folly of all that. The uselessness, the
hopelessness. How could you?”
“I know, I know,” he exclaimed, “but I couldn’t help it. I can’t now. I
love her. I can’t help that, can I? I’m miserable without her. I see the
folly of it all, but I’m crazy about her. The more she disliked me the
more I loved her. And I love her now, this minute. I can’t help it.
There were days when she tortured me so that I vomited, from sheer
nervousness. I was sick and run down. I have been cold with sweat
in her presence and when she was away and I didn’t know where
she was. I have walked the streets for hours, for whole days at a
time, because I couldn’t eat or sleep and didn’t know what to do. By
God!” Once more the pause and a clenching of the hands. “And all I
could do was think and think and think. And that is all I do now really
—think and think and think. I’ve never been myself since she went
away. I can’t shake it off. I live up there, yes. But why? Because I
think she might come back some day, and because we lived there
together. I wait and wait. I know it’s foolish, but still I wait. Why? God
only knows. And yet I wait. Oh,” he sighed, “and it’s three years now.
Three years!”
He paused and gazed at me and I at him, shaken by a fact that
was without solution by any one. Here he was—the one who had
understood so much about women. But where was she, the one he
had sought to enlighten, to make more up-to-date and liberal? I
wondered where she was, whether she ever thought of him even,
whether she was happy in her new freedom. And then, without more
ado, he slipped on his raincoat, took up his umbrella, and stalked out
into the rain, to walk and think, I presume. And I, closing the door on
him, studied the walls, wondering. The despair, the passion, the
rage, the hopelessness, the love. “Truly,” I thought, “this is love, for
one at least. And this is marriage, for one at least. He is spiritually
wedded to that woman, who despises him, and she may be
spiritually wedded to another man who may despise her. But love
and marriage, for one, at least, I have seen here in this room to-
night, and with mine own eyes.”
 XI
FULFILMENT

H EARING the maid tap lightly on her door for the third or fourth
time, Ulrica uttered a semiconscious “Come.” It was her usual
rising hour but to-day she was more depressed than usual, although
the condition was common enough at all times. The heavy drag of a
troubled mental state was upon her. Was it never to end? Was she
never to be happy again? After several weeks of a decidedly
acceptable loneliness, during which Harry had been in the west
looking after his interminable interests, he was about to return. The
weariness of that, to begin with! And while she could not say that she
really hated or even disliked him deeply (he was too kind and
considerate for that), still his existence, his able and different
personality, constantly forced or persuaded upon her, had come to
be a bore. The trouble was that she did not truly love him and never
could. He might be, as he was, rich, resourceful and generous to a
fault in her case, a man whom the world of commerce respected, but
how did that avail her? He was not her kind of man. Vivian before
him had proved that. And other men had been and would be as glad
to do as much if not more.
Vivian had given all of himself in a different way. Only Harry’s
seeking, begging eyes pleading with her (after Vivian’s death and
when she was so depressed) had preyed upon and finally moved her
to sympathy. Life had not mattered then, (only her mother and
sister), and she had become too weary to pursue any career, even
for them. So Harry with his wealth and anxiety to do for her—
(The maid entered softly, drew back the curtains and
raised the blinds, letting in a flood of sunshine, then
proceeded to arrange the bath.)
It had been, of course, because of the magic of her beauty—how
well she knew the magic of that!—plus an understanding and
sympathy she had for the miseries Harry had endured in his youth,
that had caused him to pursue her with all the pathetic vehemence of
a man of fifty. He was not at all like Vivian, who had been shy and
retiring. Life had seemed to frighten poor Vivian and drive him in
upon himself in an uncomplaining and dignified way. In Harry’s case
it had acted contrariwise. Some men were so, especially the old and
rich, those from whom life was slipping away and for whom youth,
their lost youth, seemed to remain a colored and enthralling
spectacle however wholly gone. The gifts he had lavished upon her,
the cars, the jewels, this apartment, stocks and bonds, even that
house in Seadale for her sister and mother! And all because of a
beauty that meant so little to her now that Vivian was gone, and in
the face of an indifference so marked that it might well have wearied
any man.
How could she go on? (She paused in her thoughts to survey and
follow her maid, who was calling for the second time.) Though he
hung upon her least word or wish and was content to see her at her
pleasure, to run her errands and be ever deferential and worshipful,
still she could not like him, could barely tolerate him. Before her
always now was Vivian with his brooding eyes and elusive, sensitive
smile; Vivian, who had never a penny to bless himself with. She
could see him now striding to and fro in his bare studio, a brush in
one hand, or sitting in his crippled chair meditating before a picture
or talking to her of ways and means which might be employed to
better their state. The pathos!
“I cannot endure that perfume, Olga!”
In part she could understand her acceptance of Harry after Vivian
(only it did not seem understandable always, even to her), for in her
extreme youth her parents had been so very poor. Perhaps because
of her longings and childish fears in those days she had been
marked in some strange way that had eventually led her to the
conviction that wealth was so essential. For her parents were
certainly harassed from her sixth to her thirteenth years, when they
recovered themselves in part. Some bank or concern had failed and
they had been thrown on inadequate resources and made to shift
along in strange ways. She could remember an old brick house with
a funereal air and a weedy garden into which they had moved and
where for a long time they were almost without food. Her mother had
cried more than once as she sat by the open window looking
desolately out, while Ulrica, not quite comprehending what it was all
about, had stared at her from an adjacent corner.
“Will madame have the iris or the Japanese lilac in the
water?”
She recalled going downtown once on an errand and slipping
along shyly because her clothes were not good. And when she saw
some schoolgirls approaching, hid behind a tree so they should not
see her. Another time, passing the Pilkington at dinner-time, the
windows being open and the diners visible, she had wondered what
great persons they must be to be able to bask in so great a world. It
was then perhaps that she had developed the obsession for wealth
which had led to this. If only she could have seen herself as she now
was she would not have longed so. (She paused, looking gloomily
back into the past.) And then had come the recovery of her father in
some way or other. He had managed to get an interest in a small
stove factory and they were no longer so poor—but that was after
her youth had been spoiled, her mind marked in this way.
And to crown it all, at seventeen had come Byram the inefficient.
And because he was “cute” and had a suggestion of a lisp; was of
good family and really insane over her, as nearly every youth was
once she had turned fourteen, she had married him, against her
parents’ wishes, running away with him and lying about her age, as
did he about his. And then had come trying times. Byram was no
money-maker, as she might have known. He was inexperienced, and
being in disfavor with his parents for ignoring them in his hasty
choice of a wife, he was left to his own devices. For two whole years
what had she not endured—petty wants which she had concealed
from her mother, furniture bought on time and dunned for, collectors
with whom she had to plead not to take the stove or the lamp or the
parlor table, and grocery stores and laundries and meat-markets
which had to be avoided because of unpaid bills. There had even
been an ejectment for non-payment of rent, and job after job lost for
one reason and another, until the whole experiment had been
discolored and made impossible even after comfort had been
restored.
“I cannot endure the cries of the children, Olga. You will
have to close that window.”
No; Byram was no money-maker, not even after his parents in far-
distant St. Paul had begun to help him to do better. And anyhow by
then, because she had had time to sense how weak he was, what a
child, she was weary of him, although he was not entirely to blame. It
was life. And besides, during all that time there had been the most
urgent pursuit of her by other men, men of the world and of means,
who had tried to influence her with the thought of how easily her life
could be made more agreeable. Why remain faithful to so young and
poor a man when so much could be done for her. But she had
refused. Despite Byram’s lacks she had small interest in them,
although their money and skill had succeeded in debasing Byram in
her young and untrained imagination, making him seem even
weaker and more ridiculous than he was. But that was all so long
ago now and Vivian had proved so much more important in her life.
While even now she was sorry for Harry and for Byram she could
only think of Vivian, who was irretrievably gone. Byram was
successful now and out of her life, but maybe if life had not been so
unkind and they so foolish——
“You may have Henry serve breakfast and call the car!”
And then after Byram had come Newton, big, successful,
important, a quondam employer of Byram, who had met her on the
street one day when she was looking for work, just when she had
begun to sense how inefficient Byram really was, and he had proved
kind without becoming obnoxious or demanding. While declaring,
and actually proving, that he wished nothing more of her than her
good-will, he had aided her with work, an opportunity to make her
own way. All men were not selfish. He had been the vice-president of
the Dickerson Company and had made a place for her in his office,
saying that what she did not know he would teach her since he
needed a little sunshine there. And all the while her interest in Byram
was waning, so much so that she had persuaded him to seek work
elsewhere so that she might be rid of him, and then she had gone
home to live with her mother. And Newton would have married her if
she had cared, but so grieved was she by the outcome of her first
love and marriage that she would not.
“The sedan, yes. And I will take my furs.”
And then, living with her mother and making her own way, she had
been sought by others. But there had been taking root and growing
in her an ideal which somehow in the course of time had completely
mastered her and would not even let her think of anything else, save
in moments of loneliness and the natural human yearning for life.
This somehow concerned some one man, not any one she knew, not
any one she was sure she would ever meet, but one so wonderful
and ideal that for her there could be no other like him. He was not to
be as young or unsophisticated as Byram, nor as old and practical
as Newton, though possibly as able (though somehow this did not
matter), but wise and delicate, a spirit-mate, some such wondrous
thing as a great musician or artist might be, yet to whom in spite of
his greatness she was to be all in all. She could not have told herself
then how she was to have appealed to him, unless somehow surely,
because of her great desire for him, her beauty and his
understanding of her need. He was to have a fineness of mind and
body, a breadth, a grasp, a tenderness of soul such as she had not
seen except in pictures and dreams. And such as would need her.
“To Thorne and Company’s first, Fred.”
Somewhere she had seen pictures of Lord Byron, of Shelley, Liszt
and Keats, and her soul had yearned over each, the beauty of their
faces, the record of their dreams and seekings, their something
above the common seeking and clayiness (she understood that
now). They were of a world so far above hers. But before Vivian
appeared, how long a journey! Life had never been in any hurry for
her. She had gone on working and seeking and dreaming, the while
other men had come and gone. There had been, for instance, Joyce
with whom, had she been able to tolerate him, she might have found
a life of comfort in so far as material things went. He was, however,
too thin or limited spiritually to interest a stirring mind such as hers, a
material man, and yet he had along with his financial capacity more
humanity than most, a kind of spiritual tenderness and generosity at
times towards some temperaments. But no art, no true romance. He
was a plunger in real estate, a developer of tracts. And he lacked
that stability and worth of temperament which even then she was
beginning to sense as needful to her, whether art was present or not.
He was handsomer than Byram, a gallant of sorts, active and
ebullient, and always he seemed to sense, as might a homing
pigeon, the direction in which lay his own best financial opportunities
and to be able to wing in that direction. But beyond that, what? He
was not brilliant mentally, merely a clever “mixer” and maker of
money, and she was a little weary of men who could think only in
terms of money. How thin some clever men really were!
“I rather like that. I’ll try it on.”
And so it had been with him as it had been with Byram and
Newton, although he sought her eagerly enough! and so it was
afterward with Edward and Young. They were all worthy men in their
way. No doubt some women would be or already had been drawn to
them and now thought them wonderful. Even if she could have
married any one of them it would only have been to have endured a
variation of what she had endured with Byram; with them it would
have been of the mind instead of the purse, which would have been
worse. For poor Byram, inefficient and inexperienced as he was, had
had some little imagination and longings above the commonplace.
But these, as contrasted with her new ideal——
“Yes, the lines of this side are not bad.”
Yes, in those days there had come to her this nameless unrest,
this seeking for something better than anything she had yet known
and which later, without rhyme or reason, had caused her to be so
violently drawn to Vivian. Why had Vivian always grieved so over her
earlier affairs? They were nothing, and she regretted them once she
knew him.
“Yes, you may send me this one, and the little one with
the jade pins.”