Abdominal massage, as technically described in the last chapter, is an extremely valuable form of massage. It is, however, much less valuable for its effect upon the glands of the digestive apparatus and on the circulation than for its powerful influence upon the musculature of the alimentary canal.

By this influence on musculature abdominal massage or abdominal kneading produces its well-known effect on dilatation of the stomach (due to atony) and on chronic constipation, far excelling all other means of treatment.

We work upon the alimentary canal, and especially its muscular coats, by kneading it between the anterior and posterior abdominal walls in the manner already described - the manipulation most nearly resembling petrissage.

The non-striated muscle fibres answer to mechanical manipulation almost like skeletal muscles. The former, however, are more elastic, contract more slowly and to a less extent, as well as less strongly, than the latter. N. Zuntz and Loewy in 1909 gave the shortening of striated muscle in tetanus as 60 to 80 per cent. of its resting length, that of non-striated muscle as 50 per cent. They gave the absolute force of striated muscle as 10 kgms., that of non-striated muscle as 1 to 1.4 kgms. per cubic cm. (in frogs).

In true dilatation of the stomach, as far as I have been able to see by careful examination, the treatment does not restore the organ to normal nor markedly diminish its size. But it increases its motor power and restores a certain degree of efficiency to the organ, which, at least while massage is continued, and by its direct help, empties its contents into the duodenum. Under treatment by massage vomiting ceases, the body weight increases, and general nutrition improves. As soon as the treatment by massage ceases, the symptoms generally return, and the treatment, in severe cases, would have to be continued throughout life.

In chronic constipation due to atony in different parts of the alimentary canal, in almost all cases abdominal massage, after being used for some months, preferably twice a day, can restore the bowel to normal function. This shows to my mind that it is the strengthening of the weakened muscles which brings about their restoration, and which should be the aim of treatment. Were it only a question of direct or reflex stimulation of nerves, or of pressing the contents of the intestine onwards by manipulation, the constipation would return as soon as massage ceased.

The influence of abdominal massage on the glands of the alimentary canal is not yet fully understood, and opinions are divided on the subject. Meanwhile what is known as to its influence may help the reader to form an opinion as to what one may expect from the stimulation of gland cells.

G. Berne (1880 - 1890) stated that abdominal massage increased all the digestive juices, especially bile.

It is well known that nerve stimulation has a strong effect upon glandular secretion, especially in the case of the glands of the digestive tract. Every one knows the effect on the salivary glands of thinking of certain spices and foods ("the mouth waters "). The mere sight of food produces an active secretion in the dog's stomach (Bidder and Schmidt, Richet, Pawlow).

Owing to the numerous nerve elements present in the alimentary canal, it is difficult to say which of the effects of massage can be ascribed to nerve stimulation and which are due to direct stimulation of the protoplasm of the gland cells.

It is further to be noted that an inhibiting as well as an accelerating influence upon secretion may be produced by nerve stimulation. For example, under certain circumstances, by stimulation of the vagus and sciatic nerves the secretion of the pancreas can be arrested (Bernstein, Afanasiew, Pawlow).

We are at present ignorant of the effect of the quality of the stimulus upon secretion - whether, for example, mechanical stimulation of the gastric mucosa produces a gastric juice of similar composition to that produced by the presence of pieces of meat in the stomach.

On the whole the most experienced experimenters have formed the opinion that mechanical stimulation does not produce, or at least is a long way behind chemical stimulation in producing, secretion of active digestive juices. All points to the fact that the food which is to be digested best calls forth that substance in the corresponding secretion which has the power of digesting it.

Beaumont observed the flow of gastric juice in the world-famed case of gastric fistula in his Canadian hunter when he stimulated the gastric mucosa with a feather. Thiry performed the same experiment on the intestinal mucosa in intestinal fistula. But we shall see from what follows that these experiments were useless.

Pawlow (1893) by oesophagotomy prevented the flow of saliva into the stomach of a dog, washed out the stomach through a gastric fistula, and then stimulated the mucous membrane for half an hour, first with a feather, then with a glass rod. Not a drop of gastric juice, not even a drop of water, was produced.

Pawlow showed also that lean meat and its extractives called forth a gastric juice larger in quantity but poorer in digestive power than that following on carbohydrate food, while fat delayed secretion.

The observations of Pawlow and his pupils and followers on the subject of pancreatic secretion show that it exhibits an adaptation to the nature of the food. When meat or other protein is present in the duodenum the pancreas produces a secretion containing more trypsinogen (the enzyme which digests protein); when fat is present a secretion containing more steapsin is produced (the enzyme which digests fat); when bread is present the secretion is richer in the active diastatic ferment.

As already said, it has been proved that the vagus contains fibres which inhibit secretion as well as fibres which promote secretion. The sympathetic vaso-constrictor and vaso-dilator nerves take part in this and co-operate with the secretory nerves, but the latter are of cerebral origin.

In spite of the above experiments, those who treat by physical methods are inclined to assert that mechanical stimulus, i.e., massage, has the power to produce active secretion.

Colombo (1895) found no noticeable effect upon secretion after five-minutes vibration of the stomach through a gastric fistula. But after fifteen minutes of such treatment he procured a gastric juice rich in pepsin and Hc1. Further vibration merely increased the watery content and thereby lowered the digestive power of the secretion.

By kneading the accessible parts of the liver Colombo produced very slight effect. But liver - shaking for the same time produced a marked increase of all the constituents of the bile.

(Colombo, however, found that vibration on the salivary, lachrymal, and sweat glands, as well as over the kidneys and testicles, increased their respective secretions, but chiefly; it is thought, their watery content. The secretion of the testicles was especially watery, although phosphates, salt, and spermatozoa were found in considerable quantity.)

Frumerie considers that he increased secretion of bile by massage over the liver.

Zabludowski thought that he produced an increase of gastric juice by massage over the stomach, and Gopadse thought that he had done the same. He also thought that the Hc1 was increased.

Gaglio, however, has shown that a string tied round the cardiac end of the oesophagus produces a more copious flow of a strongly-acid gastric juice. Mario Serena massaged a patient of fifty-five whose gastric secretion contained no Hci, although he was not suffering from pernicious anaemia or cancer, and for fifteen days he analysed the gastric secretion one and a half hours after an ordinary test meal (with meat). It remained free from Iic1, although the patient gained in weight and well-being, which Serena could not ascribe with certainty to massage, since the improvement had already begun before massage. Serena performed similar experiments on three children and on some dogs, and came to the conclusion, which, however, is only a surmise, that massage alone cannot produce an active gastric secretion containing Hc1 in those cases in which the acid is quite absent, but that it can increase the power of acid production in those cases where it is diminished. Like other observers, he found that even if massage does not alter the gastric juice it improves the patients well-being (probably by its influence on absorption, blood formation, etc.).

About 1880 I treated or observed under treatment by abdominal massage a number of non-cancerous patients whose gastric juice showed a diminution of Hc1. I found no definite effect on the Hc1 content as the result of this treatment, and have not used it since in similar uncomplicated cases.

By abdominal kneading the appetite is often noticeably increased, metabolism is increased (Gopadse, Kijanowski), and digestion takes place more quickly (Chopoliansky).

When the large bowel is kneaded through the abdominal wall one often sees, especially at the outset of treatment, large masses of mucus cast off in defaecation.

I will refer to the influence of abdominal massage on blood pressure and the pulse-rate in dealing with the effects of general massage and in the "special" portion of this work.