Abdominal massage is very much used, not only in treatment of diseases of the digestive organs, but also in many forms of general weakness and disturbances of nutrition or circulation, especially of the portal circulation.

Contra-indications (see Stomach-pit-shaking, or preferably Dr. Kleen's account of it).

In connection with Abdominal massage may be described here : (1) A manipulation introduced by Major Brandt and called by him "S-romanum-lifting" (Sigmoid-flexure-lifting), and (2) Anal massage, given on the sphincter ani and its surroundings.

Sigmoid-Flexure-Lifting

This is performed by the patient taking Crook-half-lying position with knees drawn well up, in order as much as possible to relax the abdominal wall. The gymnast stands on the right side of the patient and places the hands in the left iliac fossa, and by degrees goes in deeply under the sigmoid flexure till he can press the rectum against the posterior abdominal wall. While continually pressing backwards he makes a drawing upwards with gentle shaking, causing the patient to feel a slight indrawing of the anus, if the manipulation has the desired effect.

Used in treatment of prolapsus ani, and attempts to replace the part completely and to stimulate the intestinal wall and its surroundings. The prolapsed intestine is pushed back into the sphincter before the manipulation is begun.

Anal Massage

For this the patient takes a suitable Arm-lean-stoop-stride-standing position against the end of a high plinth or other suitable apparatus. Massage is given round the anus, and consists of small circular kneadings and strokings, alternating with shakings. Also internal vibration done with a vibrator may be used. It is usually not given on the bare skin, but over some covering (underlinen or towel). May be done with the finger-tips or with a short rod. In mild cases the patient can himself do the massage.

Effects And Uses

(a) Products of inflammation, both in the walls of the rectum and its surroundings and in the sphincter and other perineal muscles, are broken up.

(b) The shaking causes a mechanical stimulation of the cells of the tissues, so that their activity and tone is increased, which effect may also extend to the other organs in the true pelvis.

Used with advantage in treating haemorrhoids and prolapsus ani and in coccydynia.

Nerve Pressures, Nerve Frictions, and Nerve Vibrations.

Nerve Pressures may be given as "General" and as "Special" or "Local"

General Nerve-pressures are given on the arms, legs, and back, and down the back of the legs in sequence (in Forward-lying position). They are done by the gymnast grasping the part to be treated with both hands, the crooked fingers like a claw being pressed into the skin with a gentle shaking. In this way the arm and leg or back is treated from above downward two or three times with quickly-repeated pressures. In this one does not aim at treating the special nerve trunks, but only their peripheral branches.

Special or Local Nerve-pressures are given over the large nerve trunks, which are looked for and pressed against the underlying bone. The pressure may either be static (for a few minutes or more), or may be done by the finger gliding quickly forward and backward transversely across the trunk of the nerve with slight pressure, and in this way producing stimulation of the nerve.

Nerve-frictions are given along the nerve trunks, and are usually performed by the tips of the first finger and thumb being placed against each other and applied over the nerve so that it lies in a groove between the tips of the fingers, while small frictions are made at right angles to the direction of the nerve trunk as they glide along its course.

Nerve-vibrations are performed by placing one or more fingers over a nerve and vibrating strongly or finely by small muscular contractions, while the fingers exercise firmer or weaker pressure on the nerve or glide along it. Both frictions and vibrations can with advantage be given by means of a vibrator.

The value of the various manipulations on the nerves is chiefly similar to the effects of hacking on nerves spoken of above (see General Effects of Hacking), that is : -

(a) The nerve path to the corresponding cells in the spinal cord and brain are brought into action and receive increased nutrition.

(b) Various reflexes arise, which possibly stimulate different parts of the body, among others the heart.

(c) In local stimulation of motor nerve trunks the corresponding muscles may be made to contract, and their nutrition and functional power are thus increased. This is effected chiefly by special nerve pressures.

(d) Products of inflammation in nerves and their surroundings are broken up and absorbed. This is chiefly brought about by nerve frictions.

(e) Finally, continuous pressure on a nerve trunk, if given strongly, can break its power of carrying impulses (probably through pressure on the axis cylinder), and in this way stop or diminish cramp and pain.

For these reasons nerve-pressures, etc., are used in treatment of various diseases both of the brain and spinal cord and of the peripheral nerves; in paralyses of all kinds, to try to maintain functional power in the muscles and nerves until the brain can take up its power again over them; in tabes and other diseases of the spinal cord, to improve the nutrition of the nerve paths and to maintain their functional power as long as possible; in neuritis, neuralgia, cramp, etc., to break up the products of inflammation in and around the nerves, or to diminish their irritability. Finally, they have also been used in treating heart diseases, in order by reflex action to stimulate the heart.