In these cases massage not only aids the baths and inunctions in their general action, but directly and powerfully increases nutrition and muscle force, and materially hastens an otherwise slow process of recovery.

(b) Constipation. Manipulation is a very efficient remedy in habitual constipation, and there are many cases that can be cured by it, combined with a properly regulated diet, without the use of drugs. Petrissage of the large intestine is the best method, instructions being given to follow the natural course of the faeces through this portion of the gut; thus, beginning in the right groin to proceed upward to the lower border of the ribs on the right side, to cross over, horizontally, to the same region on the left side, and then downward to the left groin. In this way the ascending transverse and descending colon are manipulated in order.

Five or ten minutes every morning, or every morning and evening in obstinate cases, constitute the proper duration and frequency of the manifestations. The pressure must be gentle, as delicate underlying tissues are being dealt with.

In this condition I have not found the dry method so efficient as a combination of massage with the inunction of warm olive oil.

Sometimes tapotement with the flat hand, with the hand partly closed forming a cushion, or with the margin of the hand, is necessary, but the course of the colon must always be followed. The beneficial action of this mode of treatment is, undoubtedly, threefold; it increases the intestinal and other secretions; it increases the expulsive action of the intestinal muscular fibers, and it mechanically forces accumulated faecal matter toward the natural gate of exit.

(c) Colic. Every experienced mother knows how often "wind," the cause of colicky pain, is expelled from the stomach or intestines by gently rubbing the abdomen with the hand. Any approach to scientific manipulation is much more efficient, and two or three minutes' effieurage may be resorted to, as the urgency of the symptoms requires, with the 18 most satisfactory effect. In this connection it must be remembered, also, that rubbing of the feet to increase the circulation is an important aid in relieving colic.

(d) General debility and impoverished blood. These conditions are much benefited by short, frequently repeated courses of massage. In the convalescence from many diseases - both acute and chronic - the above conditions are present, and manipulation, by improving general nutrition, leads to a rapid restoration of strength.

(e) Infantile paralysis. Here massage of the paralyzed muscles brings more blood into them and maintains their nutrition until, in favorable cases, new nerve cells take on the function of those which have been destroyed.

In infantile paralysis the affected members are always cold, and the muscles contract feebly, if at all, under the influence of electricity. By systematic massage - petrissage combined with effleurage and both performed centripetally - an improvement takes place" with more or less rapidity. The first indication of this is an increase in the temperature of the parts, continuing for several hours after the rubbing. Then the electrical contractility of the muscles begins to return, and they respond to a battery-current that at the commencement is entirely inoperative.

In recent cases the sittings should be of short duration and frequently repeated, five to ten minutes, three or four times daily. As improvement advances, the frequency may be reduced, and in chronic cases twice a day will be sufficient at any time.

Electricity is of great aid in the treatment, but it does not take the place of massage, for while it causes contraction and congestion of the muscles and an accumulation of blood in the skin, it does not have the same power of arresting rapid wasting. This method of treatment should never be undertaken without the counsel of a physician.

(f) St. Vitus's dance (chorea). So far as this branch of the management of chorea is concerned it requires to be aided by proper diet and rest in bed. On the onset of an acute attack the patient is put to bed, given a full supply of good food, and allowed to rest for two days without massage. Should the jerking movements be very violent, the sides of the bed are padded to prevent the child bruising himself, or, if too violent for this, to give security, he is slung in a hammock. At the end of this time the regular treatment is initiated. (For diet and regimen in chorea see page 265.) After two or three weeks of full feeding and rest and massage the patient should be able to sit up in bed, well supported by pillows, and may have a few toys to play with. It is a golden rule, however, never to hurry a patient with chorea out of bed. The muscular strength is more quickly recovered while at perfect rest, and too early exertion often causes a relapse. While carrying out this plan appropriate medical treatment should be employed.

(g) Among other nervous diseases in which massage is practised with success are facial paralysis; neurasthenia and spinal irritability occurring in girls about the approach of puberty, and that painful condition of rheumatic origin so often encountered in young subjects and known as "growing pains."

(h) Accumulations of watery fluid between the lungs and the chest wall (pleuritic effusions), enlarged glands, and stiffened rheumatic joints are all benefited by rubbing. In these special instances the manipulations are generally combined with the use of ointments or lotions, though the curative effects cannot be attributed to the latter alone.

In concluding the subject of massage in childhood, it is a point of importance to mention that those cases in which the manipulation is immediately followed by a sensation of comfort or by refreshing sleep are most benefited by it. On the contrary, those cases that are stimulated, derive little benefit, and perhaps positive injury from rubbing. This I have especially noted in cases of general debility and impoverished blood, and my own experience has been confirmed by a number of practical observers in whose judgment I have the greatest confidence.