Indeed, massage can help the patient, even though it cannot cure, or even check, the progress of the disease. The general vitality is low, digestion often impaired, the bowels often act with difficulty, exercise fatigues, and the patient tends to become generally "flabby," and often at the same time puts on fat. He therefore suffers the additional evils of atonic dyspepsia, constipation, enfeebled circulation, and adiposity. All these can be remedied by massage. There are sundry other minor complaints which can also be relieved entirely and amongst these are obscure aches and pains that arise from time to time.

In giving general massage for the circulation it should be remembered that the muscular tone is always increased, and that every care must be taken to avoid causing reflex excitability. Thus the limbs must be placed so that the muscles are completely relaxed, and only rhythmical movements are allowed. Percussion in any form is contra-indicated.

The intention tremor is often a great source of annoyance to the patient. Much can be done to alleviate it by re-education on lines similar to those advocated for the tabetic. The name of the disease (disseminated) implies that the sclerosis does not affect all the nerve elements. During the earlier stages of the disease those that escape can be educated to control, or even to do the work of, those that are damaged.

Tabes dorsalis or locomotor ataxia is a disease of the posterior roots and of the dorsal columns of the cord. In other words, the afferent (or sensory) system is at fault. Thus the patient loses sensation, and when this has departed from the feet he can only control their movements by the use of other senses. For instance, in walking the patient often learns to watch the action of his feet, as he is unable to detect, from the muscle and joint senses of foot and leg, what the limb is doing. But some of the patients develop optic atrophy and may go completely blind. Then the ataxic symptoms vary conversely with the severity of the visual defect. Thus a blind tabetic only becomes ataxic at a very late stage. He loses sensation in his legs as does the sighted patient; but, having lost the use of the eyes, all the other sensory tracts are so thoroughly developed that between them they can arrange an effective substitute for vision. Then, as the controlling arcs are still all within the body, the ataxia is less marked than if a portion of the arc (as represented for example by the space between eye and foot) is extra-corporeal.

If it is possible for a blind tabetic to master his ataxia by the instinctive training of other senses, it is equally possible to teach a sighted patient to do likewise. This is the axiom underlying Frankel's treatment of locomotor ataxia. Details of the technique cannot be given here, but one word of warning may find place. It is a mistake to try to "go too quick," and to begin re-education of the finer movements before the coarser are fully mastered. It is safe to add that massage and resistive movements, "spaced" into the performance of the exercises, provide an accessory of the utmost value to the patient.

But the ataxia is only one portion of the trouble, and often the least troublesome to the patient. Pain - usually referred to by the patient as "shooting" or "lightning" pain - may be very distressing. In the limbs great relief follows massage, and it may even act as a prophylactic. The same may be said of many of the various sensory disturbances of which the patient is liable to complain.

If the pain is acute, stroking massage should open the seance, first of the surface only, then with gradually increasing pressure. If only anaesthesia, or a sensation of discomfort, is present, the stroking may be omitted, and kneading be administered from the outset. Gentle percussion or vibration should follow, and stroking terminates the programme. The seance should be short, five to ten minutes being ample for the treatment of each limb.

There may be great weakness of the leg muscles, and especially of the anterior tibial group, though the wasting is rarely propor-tionate to the feebleness of contraction. The "paralysis," in other words, is dependent on disuse atrophy. This may advance till response to Faradism is very poor. Gentle percussion with the finger-tips may, even then, assist contraction very materially.

Treatment for the general condition is also called for, and great benefit can be conferred upon the patient. It may even be possible to restore la joie de vivre to one who seems to have lost it for ever. The agent to employ is general massage to the four limbs, and abdominal massage to assist the portal circulation and to stimulate peristalsis.

For the gastric crises percussion of the spine has been advocated, and it is well worthy of a trial.

Graham, in his text-book on Massage, gives an account of the experiments of Hegar to elucidate the stretching effect of trunk movements on the spinal cord. It appears that the stretching may be very material. It is an acknowledged fact that suspension by the neck has a very beneficial effect in tabes dorsalis, though the rationale of the treatment is not evident. We can only suppose that the contents of the vertebral canal are subjected to a stretching process. If this is the remedial agent, then full trunk movements should be prescribed for all tabetic patients.