LANDRY'S PARALYSIS.

III

progressive paralysis. The temporary results he obtained were so remarkable, that I began soon after to employ it in locomotor ataxy, in which it sometimes proved of signal value, as in other forms of spinal and local disease."

Massage is useful in Landry's paralysis—paralysis ascendens acuta. In these cases there is usually at first slight fever, pain in the back and limbs, and general weakness lasting one or two days, or it may be three or four weeks. This is followed by paralysis of the lower limbs, then of the body, and finally of the upper extremities, with perhaps some disturbance of respiration. The electric excitability of the paralyzed nerves and muscles remains perfectly normal-an important point in distinguishing it from central myelitis and poliomyelitis anterior acuta. In most cases the tendon reflex is present at the beginning of the disease, but is abolished later on. The paralysis in untreated cases usually progresses upwards until it involves the medulla oblongata and death ensues.

In many forms of paralysis Massage must be employed with the greatest caution. When prescribed

in unsuitable cases, it may lead to degeneration of the muscular tissue, wasting being rapid, and the muscles presenting irregular vibratile oscillations due to contraction of individual fibres.

In connection with this subject it should be mentioned that Blache has shown (Bull. de l'Acad. de Méd., t. xix., p. 919) that Massage employed for ten minutes or a quarter of an hour three or four times a day is useful in the treatment of chorea, especially in the acute stage. The circulation is improved, the pulse falls and becomes more regular, the surface temperature increases, the patient sleeps better, and in a few days the movements are less violent or perhaps have entirely ceased. I have seen some four or five cases treated by this method in hospital practice, and although there has been some improvement, the results have not been very striking. I did not see the Massage performed and cannot answer for its quality.

CHAPTER VII.

MASSAGE FOR CONSTIPATION.

FOR constipation it is certainly one of the most powerful therapeutic agents at our command. Pétrissage of the abdomen is the best method, care being taken to make the requisite manipulations in the direction of the ascending, transverse, and descending colons. It should be associated with different varieties of tapotement, the flat open hand, the hand partially closed so as to form an air cushion, and the margins of the hands being employed according to circumstances. Vibratory movements are in addition resorted to in obstinate cases. Years ago, Piorry advocated a mode of treatment for constipation, which is not essentially different from that now described. Averbech says: "Disorders of the digestive apparatus, and especially constipation, constitute one of the most marked indications for the employment of Massage. When there are no complications, but the symptoms are

I

due to disordered secretion, one can always effect a cure in one or two months, or at the outside, three or four." Speaking from my own experience, I should say that the effects were remarkably prompt. Massage answers admirably for women who suffer from this condition, especially when there is a lax condition of the walls of the abdomen resulting from frequent pregnancies. It is of the greatest service, too, in constipation associated with obesity, and in that form of constipation which frequently results from taking too little exercise. It probably acts in three ways: (1) by increasing the intestinal and other secretions; (2) by stimulating the peristaltic action of the intestines; and (3) mechanically by pressing the accumulating fæces towards the rectum.

Dr. Georg Hünerfauth, of Bad Homburg, has published a capital little book on Habitual Constipation and its Treatment with Electricity, Massage, and Water, in which he says:-" The usefulness of abdomen Massage is especially manifest in cases of atony of the muscular coats of the bowels which is the primary and original cause of

CHRONIC CONSTIPATION.

chronic constipation.

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This must be the more

insisted on, as the much more frequent application of Massage of the joints causes many physicians to overlook the advantages of abdomen Massage ; there are even a good many physicians wholly unacquainted with it.”

Cases of chronic constipation are common enough, and I have recently met with several instances in which treatment by Massage has done much good. Most of these depended in all probability on chronic catarrh of the intestine, but one or two were complicated by the presence of fæcal tumours which could be detected with more or less distinctness through the walls of the abdomen. In one case, the patient, a lady, had been a constant sufferer for eight years. She also complained of "uterine disorder" and "spinal irritation." The fæces were passed at irregular intervals in the form of little hard dry pellets or lumps, varying in size from a bullet to a hen's egg, their passage being attended with great pain. It would seem that certain articles of food were delayed in the intestine for some considerable time. Thus the remains of