Towards the end of pregnancy some patients suffer from a varying amount of discomfort, due to tension of the skin of the abdomen. Occasionally the irritation is intense. Complete relief can be afforded by massage, which should usually be performed with sweet oil. No pressure on the abdominal contents should be exerted. The movement must consist of light surface frictions and gentle picking up and rolling of the skin, and, possibly, even of gentle kneading.

More and more medical men are becoming convinced of the desirability of the mother nursing her baby. During the last two months of pregnancy, if it is apparent, or if we know from previous experience, that this is not likely to be accomplished, a great deal can be done before labour to counteract the tendency to failure of the milk supply. There is an old fable that the region of the breasts should be avoided when administering massage to a pregnant patient. Doubtless it arose in connection with the consideration that post-partem inertia can sometimes be relieved by putting the baby to the breast. Provided the treatment is skilful, this danger is purely theoretical. The technique should vary with the conditions found. If the breasts are atrophic, oil should be freely used. The palm of one hand supports the breast on one side while the other performs centripetal stroking. Slow, gentle squeezing between the two palms and frictions all round the periphery should end the seance. If the skin is not supple, cupping around the bases of the breasts may be employed.

During pregnancy some women suffer from constipation, and massage has been prescribed for its relief - as I am told, with great success. Personally, I should hesitate to prescribe this treatment under the circumstances; and, were I to do so, I should confine the massage solely to frictions over the iliac colon. To allow any other form of mechanical treatment for the relief of this condition during any period of pregnancy seems to me to court disaster of the most serious nature.

During labour, massage of the uterus is a well-recognised part of obstetrical treatment. It is only referred to here to emphasise the point already so frequently made, that un-striped muscle contracts by reflex in response to mechanical stimulation. Uterine muscle will take a lot of "punishment"; but, looking back through obstetrical experience, one cannot help wondering whether the treatment is not overdone, and whether the inertia, which is sometimes seen after delivery, is due in part to over-stimulation at an earlier stage.

During the puerperium and after, countless ills seem to be attributable amongst civilised races to the direct effects of childbirth. Amongst savage races, so far as one can gather from literature, this is not the case. A negro woman, for example, carries on her work in the fields or elsewhere up to the onset of labour, and resumes it again almost immediately after. The civilised woman remains in bed for ten to twenty days, and not infrequently suffers severely. Surely there must be something radically wrong. Attempts of all sorts have been made to secure prophylactic treatment for prolapse and enteroptosis. Two or three generations ago it was usual for patients to keep in bed for ten days after a confinement. As these troubles still arose, the length of time was gradually increased in the hope that prolonged rest might secure relief from these distressing sequels. But the remedy has not proved efficacious. American and German obstetricians, finding this, swung round to the other extreme, and began to get their patients up at the end of a week; but, however successful this may have proved as a physical remedy, as a method of psychical treatment it has proved a colossal failure. In civilised society it would appear that the ordeal of child-birth is one which the central nervous system does not stand particularly well unless a prophylactic dose of rest is administered. Just as there is all the difference in the world between prescribing movement and allowing function in the treatment of recent injuries, so, too, a vast difference exists between prescribing definite use of the muscles of the body once or twice a day while the patient is in bed, and allowing a full return to the ordinary activities of life. Neurasthenia and enteroptosis are both difficult to cure. Our object should be to devise some prophylactic treatment for both. Rest in bed is the prophylactic treatment for neurasthenia. It is unquestionably the cause of the other troubles. Exercise which shall prevent the onset of muscle weakness is the cure of prolapse and enteroptosis. Unless graduated with care, it is not the correct treatment, prophylactic or curative, for neurasthenia. We saw, when considering the treatment of fractures, that it was safe for a patient who was able to walk at the end of six weeks to perform active movement at an earlier date, and have passive movement performed for him earlier still, and that it was a mistake to leave the limb immobilised until function was permissible. So, too, it is a mistake to think that we gain any useful object by enforcing complete rest upon a patient for three weeks, and then suddenly allowing the full return to daily duty. Surely the more sensible line of treatment would be to allow complete rest immediately after confinement, and graduated exercises throughout the subsequent days. In this way, when the patient resumes her normal daily life, she will be able to do so without any undue or sudden increase of exertion.

It is desirable to this end that a definite therapy should be established, though, of course, actual detail must vary with each individual case. In devising a therapy the first question that arises is whether or no anything can be done to assist involution. At the Rotunda Hospital, in Dublin, an attempt is made to do this as a routine measure, relying on the reflex response to mechanical stimulation as a means to this end. The fundus of the uterus is gently kneaded with the palm of the hand. As we are relying on reflex response, the treatment should, of course, be very short; and it may be administered for the first time on the day after confinement. The muscles of the abdominal wall, however, will almost inevitably be sore and painful. A great deal can be done to relieve this condition by gentle stroking, followed by picking up movements. The stroking is best performed starting from above in the axillary line over the lower ribs, following the intercostal nerves to the middle line, the hands meeting somewhere in the region of the umbilicus. The level of the stroke is gradually lowered until the lower portion of the abdomen is encroached upon. After five minutes or so of this treatment considerable relief will be afforded, and then the treatment to the uterus can be administered with little or no discomfort. Incidentally, this treatment may materially assist any atony of the bladder which may be present. The seance may terminate with deep stroking over the colon, followed by frictions of the iliac colon, in order to try to overcome the tendency to constipation. Throughout the treatment, of course, the patient's knees should rest upon a pillow. The patient may be advised to draw a few deep breaths at frequent intervals throughout the day. Deep sighing is an art which might well be encouraged. A quarter of an hour's treatment will be ample during the first two days unless any special symptom, such as cramp in the legs, calls for attention.