Position

The patient is lying flat on his back, generally without head-rest, and with the knees drawn up, so as to relax the abdominal muscles.

Fig. 16. - Stroking of the Glutei.

(See Fig. 17.) It is most convenient for the operator to sit at the patient's right side.

Fig. 17. - Position in Massage of the Abdomen and the Ventricle.

I. Friction with the tips of the fingers in circles from right to left over the umbilical region of the abdomen, thereby acting upon the smaller intestine.

Fig. 18.

Begin with a very gentle pressure, gradually increasing the strength of the manipulation. (See Fig. 18.) 2. Spread the right hand over the abdomen so that the ball of the hand covers part of the ascending colon; press over that part upward to the transverse colon; then stroke with the radial border of the hand firmly over to the left side. Here the tips of the fingers should be used for the downward pressure over the descending colon. The manipulation is repeated in circles without interruption. (See Fig. 19.)

Fig. 19.

These two manipulations are schematically illustrated in Figs. 18 and 19, and the operator should teach the patient how to perform them on himself every morning, particularly in cases of constipation. A cannon ball, covered with leather, is also very useful in manipulation No. 2 when the patient for some reason is obliged to do it himself. They can be procured from Charles Lentz and Sons, Philadelphia.

3. Kneading with the heel of the hand over the whole abdomen, going carefully at first and avoiding any sore places. Fecal lumps are often found and they should be gently and gradually broken up. Near the sigmoid flexure we can sometimes accomplish more by substituting this manipulation for that of the friction with the tips of the fingers. The reason for that is, that we can reach in deeper and our efforts become more localized. The same refers to the breaking up of adhesions of the appendix and the ovaries.

This manipulation will sometimes produce an unpleasant sensation at first, which is frequently caused by the patient not breathing properly. Talk to him so as to make him forget that he is being treated. Some operators place one hand as a support under the patient's back, and it is a very good idea, as the manipulation feels more comfortable and we have a better and more fixed control over the abdominal viscera.

4. Vibrations over the descending colon.

5. Tell the patient to turn on his face and perform firm beating of the sacrum in circles so as to act upon the rectum.

Massage of the abdomen must never be applied soon after a meal is partaken of. It is well to tell the patient to evacuate the bladder before beginning the treatment.

In chronic cases of constipation it is a good plan to have the patient take an enema, so as to clean out the sacculated colon before starting the first treatment. The indiscriminate and continued use of injections will produce a relaxed condition of the bowel, while on the contrary massage will strengthen and stimulate to normal activity its various membranes.