Extravasations in the true pelvis respond to massage in the same way as exudations, and massage is now constantly used for retrouterine haematocele, and in the treatment of extravasations the same rules apply on the whole as for exudations. It is important that the massage should not be begun too early. One should wait several weeks in order to avoid giving rise to fresh haemorrhage.

Chronic metritis, which is rare as a primary disease without complications, has been treated by many doctors by massage, and a considerable amount of information is contained in the literature of the subject (chiefly in the writings of Asp, Brandt, Reeves-Jackson, and Prochownik). If one examines their writings critically and at the same time listens to the Swedish gynaecologists who are specially experienced in such cases, one comes to the following conclusion : - massage for chronic metritis gives results which may be considered tolerably satisfactory compared with other treatment, especially with regard to the extreme obstinacy of the products of inflammation.

The very marked discomfort in the form of pains and dragging sensations of chronic metritis is speedily relieved; similarly, the dysmenorrhoea diminishes or ceases, as well as the symptoms from the bladder and rectum, and the haemorrhages. In quite a number of cases after treatment has continued some time it has been possible to feel both by palpation and with the sound a shrinking of the swollen uterus and a return to the normal volume and consistency. (Brandt himself stated, on the other hand, that he had scarcely ever been able to restore normal consistency to a hardened uterus.) The sterility which so often accompanies metritis is removed, and women who for many years of married life have not yet conceived, or who have had miscarriages, are after treatment often able to bear children quite normally. The displacements which often accompany chronic metritis have a very bad prognosis.

Chronic endometritis, which usually accompanies chronic metritis, also responds to massage (alone ?), and the mucous membrane returns to the normal even when "fungoid" changes are present. Profanter adds to his account of a ease of chronic metritis of Brandt's treated by Schultze, where retroflexion and prolapse as well as severe endometritis were present, the observation that before beginning to massage in chronic metritis, the accompanying chronic endometritis must first be removed by the usual treatment. There are, however, many statements, some certainly reliable, to the effect that massage has a healing effect on chronic endometritis, which is very probable, considering its effect upon chronic catarrhs of other mucous membrane. There is no objection to using various local (or general) means along with massage. Statistical information given by Prochownik shows that the simple forms of endometritis give also fairly good results with massage treatment.

Among cases of chronic metritis are included incomplete involution ("sub-involution") of the uterus after childbirth. Although I may say that even these have been treated advantageously with massage by many people, I must not omit to add at the same time an opinion of Prochownik which seems to me hard to confute.* He also acknowledges the good and fairly speedy results of massage in these diseases. But as he has obtained equally good results with other treatment (washing out of the vagina with gradually increasing pressure and warmth, hip baths, glycerine tampons, iron, quinine, hydrastis canadensis and subcutaneous injections of ergot) he considers that he has good reason for entirely giving up the treatment of sub-involution by massage, which is a troublesome and unpleasant treatment for every one, and which may have harmful effect on a nursing mother. It seems to me clear that in these cases massage should be avoided, unless other treatment proves unsatisfactory.

The technique of the treatment for chronic metritis is similar to that described above, viz., bimanual, with the index finger of the left hand in the vagina as support for the uterus and the fingers of the right hand used to massage through the abdominal wall. The length of treatment required is, on an average, two to three months.

It is, however, important, especially in chronic metritis, to remember to remove any possible cause, especially the not uncommon abnormal sexual irritation of various kinds.

Along with massage it is an excellent plan to use the various hydro-therapeutic means and those which regulate the action of the bowels, etc., common mineral waters, general hygiene, gymnastics, and other means.

* Norstrom also, whoso optimistic tendency is well known in Sweden, confesses that the position of the uterus as a rule after his massage treatment was, or soon became, the same as before, while the chronic metritis and its symptoms definitely disappeared, and he considers this fact a proof of the unimportance of deviations in the position of the uterus.