Many patients are told to massage their gums; few are instructed how to do it. The suggestion is usually made when pyorrhoea alveolaris is either present or suspected. There is a dual objective, namely, to empty any pockets of pus that may be present, and so to assist the vascular supply of the gums that infection may be overcome or prevented.

To empty any pockets which may be present, kneading should be employed from the labial attachment towards the edge of the gum. The side of the finger is applied firmly and the pad is then rolled over the gum in the direction indicated. When pus is present the gum will bleed slightly, so we are justified in the assumption that our manipulation will cause a certain amount of absorption. Thus, no doubt, each pressure entails the administration of a mild dose of vaccine. The kneading (which practically amounts to squeezing) should not, therefore, be very vigorous, at least in the earlier stages. It is well to wrap the finger round in a piece of lint dipped in strong peroxide of hydrogen (20 vols. per cent.), which can subsequently be burnt. Care should be exercised in using the lotion, as it tends to destroy anything it touches, and bleaches moustache or beard. The gums should then receive treatment by firm stroking from the mid-line in front to the extreme end behind. Both inner and outer surfaces should be dealt with. The whole seance should last about ten minutes. Indiscriminate scrubbing is of comparatively little use.

Pharyngitis can frequently be relieved by massage. The relief which can be secured when suffering from a "sore-throat" is considerable. The difficulty in swallowing is diminished, the general feeling of fulness and dryness is improved, and the "heavy feeling" in the head is relieved. It is probable that the whole attack can be considerably shortened, while many chronic cases clear up quickly. Plain downward stroking is all that is required (see Figs. 131, 132, and 133, pp. 297, 298). It should begin on the surface only, the pressure gradually increasing as the seance proceeds. After some ten minutes the palm of the hand may be placed over the area where the lymphatic glands are involved, and circular kneading administered for two or three minutes. The stroking is then resumed and gradually fades away into the surface variety again. Swallowing can be rendered less painful by taking a mouthful of water, then pressing the antitragus firmly into the external auditory meatus, so that the latter is completely closed. The water is then swallowed in small quantities, when it will be found that, on relief of the pressure on the ears, swallowing will be a comparatively simple matter.

In the treatment of tonsilitis the same plan should be followed, but the local treatment over the glands should be omitted while they are swollen or tender. The relief afforded may be very great, and it is probable that the duration of the attack can be curtailed.

Spasm of the oesophagus is usually a functional ailment. It can be most distressing to the individual. It may be one symptom among many, or it may be the solitary manifestation of nerve irritability. In the former instance treatment should proceed on the general lines mapped out for the treatment of neurasthenia. When the symptom is an isolated manifestation, it is usually possible to connect the spasm directly with some simultaneous mental excitement. In other words, the cause is hysteria rather than neurasthenia. One patient for many years rarely ventured upon solid food unless some one "in the know" was at hand ready to administer a very violent form of percussion to the dorsal spine. This invariably gave relief and suggested the correct line of treatment for similar cases, viz., systematic percussion daily throughout the dorsal region. This remedy, however, is probably an example of the use of physical treatment as a means of conveying psychical suggestion, and pure psychical treatment would probably prove more reliable.

Certain diseases of the stomach are amenable to massage treatment, others are not. In the latter event it may even be dangerous to perform abdominal massage at all. Thus, ignoring for the moment the ethical side of the question, the masseur who undertakes abdominal treatment without the recommendation of a medical man is guilty of a foolhardy act, which, should evil follow, could only be held to be severely reprehensible. Nothing could militate more against the chances of the patient's recovery than massage treatment for dyspepsia where the cause is the onset of malignant disease. Again, when we study post mortem a circular gastric ulcer with its base resting on the peritoneum - which alone separates the stomach contents from the general peritoneal cavity - it is possible to realise how highly dangerous massage treatment might be.

Considering the ethical side of the question, no advice whatever should be given by the masseur as to food or drink without consulting the physician - even the most homely remedies must not be recommended; while to suggest the use of magnesia, soda, lemon, charcoal, or other remedies, should be possible only to those who care not whether they disgrace or honour their profession, and who are willing to drag their fellow-workers into the general condemnation which such breaches of etiquette deserve.1

Atonic dyspepsia is the form of gastric trouble for the relief of which the aid of massage is usually invoked. The causes of this complaint are numerous, and treatment must be modified to suit the requirements of each individual case. Thus it may be a symptom of neurasthenia, when local treatment is useless without due attention being paid to the general condition, as indicated in a previous chapter. It may be part of a general debility, as for instance after a severe attack of influenza or of typhoid fever. Here, too, general treatment is probably of greater value than local, as restoration from stomach trouble is dependent on that of the whole organism. In chlorosis the benefit of massage will probably be very partial until any toxaemia due to the chronic constipation has been overcome.