In children colon stroking is usually all-sufficient if the dietary is correct. Sacral beating and gluteal hacking should be absolutely prohibited, especially in boys.

When poisoning is the cause of the trouble, it is very important to assist the portal circulation to the limit of our power, so that the poison may be eliminated with all possible speed.

In all cases of visceroptosis or kinking it is well to raise the foot of the bed on two chairs before beginning treatment, and gentle alternate pressure and relaxation may be applied to the whole of the abdomen in the hope that the general movement within the abdomen may help to "straighten things out." The pressure should be applied during expiration, and relaxation should coincide with inspiration. The muscles of the abdominal wall are almost sure to be poor in quality and quantity, and exercises should be given "spaced" with massage, chiefly of the picking-up variety. (See also the subsequent chapter.) Faradism, particularly with the Bergonie chair, may prove invaluable.

Care must be taken to give treatment applicable to any stomach disorder that may be present. The treatment of colitis has already been considered.

If, as is sometimes the case, the caecum has become a huge dilated reservoir, the patient should be treated as for viscero-ptosis. All attempts to empty it should be governed by laws similar to those laid down for the treatment of oedema, of which it has been said that it is useless to try to empty the bottle with the stopper still in place. Indeed, in all massage of the colon it is necessary to apply our treatment to the distal portion before attacking the proximal. When treating this type of case it is sometimes of service to elevate the foot of the bed.

Post-operative cases are not suitable for general abdominal massage owing to the presence of the wound. But there are few cases in which it is impossible to apply vibration to the iliac colon, and this simple remedy will often suffice to relieve.

Speaking of massage as a cure for constipation, Kleen says 1: "H. Sahli, of Berne, recommended letting the patient, in lying position, himself roll a cannon-ball of 3 to 5 lb. weight over his colon. In spite of the indignation such a course would awaken among those who attempt to surround the technique of massage with a nimbus of purely mystic difficulty, .I agree with Dr. Sahli's statement that the effect of this process in many cases is excellent." The italics are mine. There is no need to veil the massage treatment for constipation in a cloud of mysticism: the simpler the treatment the more efficacious it is likely to be. In support of this we can again refer to Kleen, who writes2: "Many classes of manipulations, so warmly recommended in some quarters, with circular strokings round the umbilicus, with pressures over the coeliac plexus (half-way between the ensiform process and the umbilicus), and over the splanchnic plexus (half-way between the umbilicus and the symphysis pubis), with sacral beating, etc., are empty 'ornaments,' or at least of very doubtful and certainly subordinate value, and one only wastes time over them." The only criticism I have of Kleen's technique is that he seems to lay equal stress on the value of treating the transverse colon and the other two portions. This seems to me an error, as it is impossible to administer the same treatment to a part of the bowel which is free to move under the anterior abdominal wall, as to other parts which are fixed to the posterior wall. Moreover, we know where these are to be found: we rarely know the exact position of the transverse colon.

The most famous spot for the treatment of "liver complaints" is, without doubt, Vichy. The treatment consists in the main of a fine spray douche over the hepatic region, followed by general kneading. The skin area over the liver is then treated by squeezing, gentle tappings with the palmar surfaces of the fingers follow, and finally the lower liver edge is subjected to very gentle kneading. The result is a feeling of general buoyancy and relief. It is stated that the liver is emptied of its fluids, the circulation through it is benefited, absorption is hastened, and the flow of bile increased. This stimulates the flow of pancreatic juice, and hence aids the absorption of fats. It also aids peristalsis and helps to relieve constipation. No account is taken of the regular hours, the enforced exercise, the administration of fluid internally, and the more or less strict dietary.

The improvement of patients at Vichy is of course beyond question. Where so many agencies are at work it is difficult to be certain to which of them should be ascribed the glory of success. For instance, it is probable that the increased fluid intake dilutes the bile, while the massage for aiding the portal circulation would assist the circulation through the liver and thereby stimulate all its functions. This seems a far more reasonable supposition than that the end is secured by kneading the lower edge of the organ - a very small portion of it can be reached directly - or by comparatively gentle taps on the surface which have to be submitted through the chest wall. In life the liver is little more than a semi-solid organ, contained within a firm fibrous capsule, as anyone who has watched the process of sewing up a rent in it can testify. This being so, the contents of the liver capsule must be subject to the universal laws of hydrostatics. Also we have seen that the other abdominal contents as a whole may be considered en masse as being semi-solid, so that any pressure exerted at any point must be transmitted equally in all directions. Hence during any form of abdominal massage, when any noticeable degree of pressure is exerted over an appreciable area, this pressure must in turn be submitted to the liver substance. It is thus in everyday life that the liver receives its daily dose of massage with every movement of diaphragm and abdominal wall. Doubtless this is the physiological origin of the adage "Laugh and grow fat," and the explanation of the great value of a ride on horseback when "a little bilious."