Abdominal Massage

Before beginning the treatment of any case of constipation by massage, a careful study of the case should be made, so that the causes of the condition present may be well understood. Such an examination requires, in serious cases, at least an X-ray examination with a bismuth meal. The bismuth enema must also be administered to show the condition of the colon and of the ileocecal valve. A radiogram of the colon or at least a tracing made by the aid of the X-ray, showing the position, size and form of the different portions of the colon is of greatest service. With the radiogram and such a sketch of the colon at hand, the masseur can make his applications with such a degree of accuracy as to effect a maximum amount of good with a minimum degree of effort, and without wearying his patient needlessly. The following methods of colon massage are described at greater length in the author's work on massage.*

Kneading the Colon.

Kneading the Colon.

Massage Of The Cecum

In cases in which there is stagnation of the fecal matters in the cecum and ascending colon, massage should be applied, with the patient's hips elevated to an angle of about 45°. Deep kneading movements should be made from below upwards, working along the colon in the direction of the lower ribs of the right side. When the liver is reached, the kneading movements should be carried across the body in the direction of the transverse colon. The hips of the patient should then be lowered, and the kneading movement should be directed downward along the descending colon, starting from high up on the ribs of the left side. When the upper border of the hip bone is reached, the movement should follow the inner surface of the bone to the pelvis. Not infrequently the colon is found in a contracted or spastic state when it feels like a rub-ber tube and may be rolled under the fingers. It is usually sensitive to pressure. When the pelvic colon is enlarged, it may also sometimes be felt, though not infrequently when it is distended with feces it lies so low in the pelvis that it cannot be reached. By putting the patient in a knee-chest position, and executing deep-breathing movements while making deep pressure with one hand on each side just above the groins, the pelvic colon can sometimes be lifted out of the pelvis, so that it can be brought within reach, and the hard masses with which it is filled may be broken up. In this region the colon will often be found filled with masses of hardened feces.

*"The Art of Massage." Published by Good Health Pub. Co Battle Creek, Michigan.

After careful manipulation of the contracted colon for a few minutes it will dilate, the spastic condition disappearing for the time being. The writer has often noticed this in making examinations of the colon. Harsh manipulations are likely to produce the opposite effect increasing the spasm This fact has led some authors to forbid massage altogether in cases of colitis, but this is quite wrong. Massage is highly beneficial in these cases but the manipulations must not be too severe.

Bowel Kneading Apparatus.

Bowel Kneading Apparatus.

Vibrating Chair.

Vibrating Chair.

Mechanical Kneading And Vibration

Mechanotherapy is capable of rendering more service in constipation than in any other single condition.

The mechanical applications which are of greatest service are kneading and vibration. Several mechanical kneaders have been devised. The one shown in the accompanying cut the writer has had in use for more than twenty years, and with satisfactory results. Patients generally realize immediate benefit from the use of the kneader, which may be employed for fifteen or twenty minutes twice a day, an hour after breakfast, and an hour or two after dinner.

The apparatus consists of six kneading arms attached to eccentrics, arranged in such a way as to be brought to bear upon the abdomen in consecutive order. The surface upon which the patient rests is at the same time moved to and fro in such a way that the kneading movement travels in a series of circles round the abdomen. The vigor of the application can be regulated at will.

There are vibrators of various kinds in use. The majority, however, are possessed of too little power to be of service in the treatment of the abdomen, The best for this purpose are the dumb-bell vibrator and the vibrating chair. Hill's dumb-bell vibrator has the advantage that it is heavy enough to compress the abdomen to a sufficient degree; and the power of the apparatus is sufficient to give the whole abdomen an active vibratory movement. It has been proved that these vibratory movements induce peristaltic action, while at the same time the weight of the instrument increases the abdominal pressure, and tends to fix the parts to which the application is made, so as to secure a maximum degree of effect.

The vibrating chair aids bowel action both by directly exciting the centers of the spinal cord and by stimulating the lower bowel. The use of the chair for ten or fifteen minutes will in many persons develop a lively "call" for bowel movement.