In children massage removes the cause which is the most frequent: i.e., atony of the muscular coat. It failed in no case in which it was thoroughly tried. It was done usually about 2 P.M., and a stool followed frequently within fifteen or twenty minutes after the manipula tion, usually before evening of the same day. Karnitzky (Archiv f. Kinderh., p. 66, '90).
Method of treating constipation fol lowed by good results: The patient is made to lie upon a. bench about thirty two inches wide covered with a hair mat tress, and clad in light-flannel under wear, the head supported by means of a pillow, and the knees bent up. The large intestines only, from the mem» to the rectum, are massaged, as it is usually in that portion of the intestinal canal that fwcal masses are formed and re tained. Considerable force is employed, the large intestines being pressed against the iliuna by means of the fingers held stiff. J. Schreiber (Wiener med. Presse, B. 36, p. 808, '95).
The following process of massage for constipation is far more efficient than the usual process. The patient is placed on his right side and the operator picks up with his thumb and index of each hand the skin and the subcutaneous tissue at the level of the iliac spine. This makes the intestine directly accessible to the other fingers, and he manipulates it with them, always pressing from above down ward, and with the ends of his fingers, for five minutes. Then the patient is turned on the left side and the process is repeated on the cmeum, and the ascend ing colon, only in the opposite direction, from below upward. This leaves only the small intestine and the transverse colon to be massaged, for which the pa tient is placed in the decubitns genu pectoral position, as this relaxes the ab dominal walls and brings the intestines closer into the hand of the operator. Kfimmerling (Sem. M6d., Dec. 5, '95).
For constipation in infants under 12 months old that cannot be relieved by regulation of diet, massage is recom mended. It should be given only in the morning, for not more than ten minutes, and the movements made in a circle about the umbilicus; pressure should be light and exerted especially in the right iliac region. For babies more than a year old the finger-tips are exclusively employed and the movements are con fined to the course of the large intestine, from right to left. Carriere (The Prac titioner; N. C. Med. Jour., Dec. 5, '97).
To perform abdominal massage the mother anoints her hand with sweet oil or vaselin and slowly and carefully kneads the abdominal walls, grasping the superficial structures and rubbing them upon the underlying ones, follow ing, respectively, the course of the ascend ing, transverse, and descending colons, and ending with a circular movement of the hand around the umbilicus. J
Madison Taylor (Phila. Polyclinic, May 2S, '93).
Electricity and hypnotic suggestion have also been recommended. The first may be classed as an adjuvant to mass age of no mean value in cases of intes tinal atony, while the third may be considered as meriting as yet but little confidence.
The theory that constipation depends upon an hypertrophy of the rectal valves is a distinct advance and emi nently practical. The rectal valves are always present, they are definite ana tomical structures, and they may be come pathological and obstructive. In observing the cavity of a rectum with thickened valves, one cannot fail to note the rigidity and elasticity of these bands, which jump across the view and span two-thirds of the calibre of the canal when relieved by the withdrawal of the proctoscope. The lower, or first, valve is at right angles with the gilt axis, while thc second aud third are obliquely- placed; so that it is evident that the first may be more obstructive. It requires the rarest judgment to de termine when the valve should be cut or when massage will overcome the ob struction. The instruments required for valvotomy are proctoscopes of graded lengths for each valve to be treated, a test-hook to determine the depth of the valves, two tenacula to secure position of the valve, a valvotome, a, curved needle and shot compressor, and an electric headlight. The patient is placed in the genti-pectoral position and the proper proetoscope introduced. The se lected valve is sprayed with a 1-per-cent. solution of cocaine and the surface is mopped with a. concentrated solution of suprarenal extract. The test-hook de termines the point of safety and depth at which the structure may be divided. The tenacula are put, in place and the division effected with the valvotome. Two incisions are made on each valve by transfixing and cutting out through the tendinous margin. A suture is placed in the angle of the gaping wounds to lessen the area which must granu late and to prevent a possible perito nitis. The dangers are hmmorrhage and peritonitis. The patient is given a daily saline and a hot enema for two weeks. Beach (Penna. Med. Jour., July, 1902).