Some diseases of other parts of the uro-genital apparatus have been treated by massage. These are : -

Organic Stricture of the Urethra

Geyza Antal used massage through the perineum along with the other usual dilating treatment with bougies for these diseases, so common after persistent gonorrhoea. The object of this is to remove the peri-urethral submucous infiltrations which cause the stricture. In a few cases during the last few years I have used this treatment, in itself entirely rational. It is necessary first to locate the seat of the stricture, which is easily done by inserting a coarse bougie, which stops at the first part of the stricture, and the point of which, in most cases, can easily be felt through the perineum. After having removed the bougie, frictions are performed, not too gently, for several minutes on the area of the stricture.* The patient may easily be instructed to carry out this treatment himself morning and evening, which, in order to avoid too strong mechanical irritation, should be done at other times than the dilatation with bougies (gradually increasing in size). I consider that dilatation can be considerably facilitated by massage.

* Hunerfauth mentions in talking of massage for stricture that the prostatic and membranous portions of the urethra should be massaged per rectum. It is, however, well known that stricture may arise anywhere in the urethra except in the prostatic portion. It is usually found, as Sir Henry Thompson and many others tell us, at the front of the membranous portion just where it joins the bulbous portion. The front part and the whole of the length of the membranous portion can, however, be particularly well worked upon from the perineum. So that I cannot see that it is necessary to massage stricture per rectum, and since one has the choice the majority would prefer the perineal method.

Residua after gonorrhoeal epididymitis is massaged by Colombo, who begins this treatment six weeks after the inflammation is over, and considers that it can prevent sterility.

Brandt treated nervous cramp in the bladder, either in the detrusor muscles with spastic enuresis or in the sphincter muscles with spastic dysuria, by depleting exercises and massage of the arms and (especially) of the legs, as well as by frictions upon the organ from the vagina. Others also have used mechanical treatment to bear upon atonic conditions in the bladder, and this must be reckoned as massage, more particularly as tapotement. Zander used several of his machines for these, and gave hackings on the spine to act upon the corresponding nervous centres, and applied shakings more directly over the bladder by letting the patient sit astride an upholstered board, vibrating up and down (generally used for the legs and feet), or by letting the patient support himself with the abdomen against the terminal of a lever vibrating from side to side immediately above the symphysis pubis. Many perform bladder massage by pressing the three middle fingers against the patient's abdominal wall as he sits opposite the doctor, and applying vibrations downwards. Narich massages for incontinence of urine in women with the forefinger in the vagina, first in the region of the neck of the bladder by strokings and vibratory manipulations, and later over the urethra. Cillag and Rawikowitsch massage for nocturnal enuresis with the index finger of the left hand in the rectum in the case of men and girls, in the case of women in the vagina, and with the fingers of the right hand as a help on the skin just above the symphysis, applying vibrations to the neck of the bladder, and obtaining good results after one or two weeks' treatment. In all these cases I should prefer vibrations over the symphysis with Zander's or other apparatus. In cases occurring in childhood I consider it far better to await the onset of puberty, which pretty certainly will bring recovery, and I consider all massage in and around the sexual parts a misuse of this treatment.

Chronic Prostatitis and Hypertrophy of the Prostate

Estlander of Helsingfors first began to massage these diseases in 1877. Later Rutte obtained complete cure by means of massage in cases of retention of urine due to hypertrophy of the prostate. Estlander considers massage to be useful in cases of infarct as well as of induration. In two cases of senile hypertrophy of the prostate, however, Estlander obtained no distinct improvement, but the massage treatment was certainly of short duration. Massage must be applied by frictions on the prostate through the rectum.