Position

The same as for massage of the abdomen. (See Fig. 17, page 37.)

The external method is merely a modification of the massage of the abdomen. The patient must be in a half lying position, with the knees flexed in order to relax the abdominal muscles. Begin with the circular manipulations, from right to left, following with stroking and friction over the lower part of the abdomen.

It is generally used for atony of the uterine organs, and must always be succeeded by percussion or beating of the lower part of the back. The Swedish movements are a valuable auxiliary, controlling as they do, the circulation in the abdomen and the lower extremities. The massage increases the current in the blood-vessels and the lymphatics, the resorption is restored, and the muscular organs in the smaller pelvis are strengthened.

Special manipulations of the intestines relieve the bowels, which in cases of uterine affections must be of great importance.

2. A second method is rather difficult to perform, as one or two fingers must be inserted in the vagina or the rectum, against which we work from the outside. It should be performed only by a person who has a thorough knowledge of the parts; in fact it belongs to the practice of the gynecologist alone. Dr. Homer C. Bloom, of Philadelphia, has written a valuable little pamphlet on "Pelvic Massage." He describes the treatment and furnishes reports of some few cases. There is one part which is particularly interesting to every scientific masseur. Dr. Bloom, after summarizing the results, says: "It has been noticed that, in a great number of these cases, there was a concomitant condition of hemorrhoids, which were relieved in every instance." Dr. Norstrom, in Paris, recommends in massage of the uterus:

1. Graduate the pressure of the uterine body after you have seized it.

2. In order to get a good hold, push down during expiration; maintain the distance gained during inspiration and start again during the next expiration.

3. Be careful not to increase, by any sudden movements, the painful impression experienced by the patient when the uterus is first taken hold of; wait a moment before beginning pressure. The pressure sometimes produces reflex pains in various parts of the body.

4. Devote all your attention to supporting the uterus. This is easy when it; is large and soft; very difficult when it is small and hard; it is then that it moves with great facility to one side or the other.

Any one specially interested in uterine massage will find a great deal of valuable information in a book recently published by Dr. Rob. Ziegenspeck, of Munich, and translated into English by Dr. F. H. Westerschulte, of Chicago. In this book Major Thure Brandt's methods are carefully analyzed and illustrated.