It is possible that we may be able to influence the liver, in some way unknown, by reflex as a result of surface stimulation, just as we can excite the stomach to activity. But, putting this possibility aside, the direct effect of massage on the liver must remain non-proven. To influence the liver and its functions by massage we can aid the circulation through it, and we can also doubtless imitate nature's own treatment of indirect massage via the abdominal wall by general abdominal massage. We can go further still and give indirect massage to the organ from above by prescribing breathing exercises.

Anyone who has been called upon to attend any considerable number of cases of jaundice must have been struck by the comparative frequency with which the symptoms begin to subside from the moment examination is made. This is usually attributed to skilful prescribing. Yet the careful physician never fails in any suspicious case to palpate the gall-bladder, and it is always possible that the "cure" originates in this simple act. The examining hand is pressed firmly down below the costal margin and the patient is told to draw a deep breath. Considerable pressure must be exerted on the contents of the bladder, and the unstriped muscle in its wall - little though there may be - is stimulated to contract. This must assuredly raise the pressure of the bile and tend to drive onwards any impeding plug of mucus.

At least it may be said that nothing but good can come if, as part of the routine treatment in general abdominal massage, we give a few gentle kneading movements over the gall-bladder during inspiration. Local treatment over the ribs which cover the liver may be added in the hope of securing reflex effect.

Massage of the kidneys can produce a flow of urine and may be used for the purpose of aiding diagnosis during a cystoscopy. The kidney is "milked" between the two hands, or between the fingers and thumb of one hand, during inspiration. In no other circumstances should this treatment be administered. The organ is far too delicate for mechanical treatment to be free from danger. In fact, palpation of the kidney leads instantly to a transient albuminuria. Countless experiments have shown, however, that the output of urine is increased by massage and that the percentage of solids excreted is also increased. The total output of solids is therefore very considerable. Massage of the limbs alone can attain this end, but abdominal massage has a far greater effect, particularly if applied with the object of assisting the portal circulation.

Massage is sometimes invoked as part of the treatment of patients suffering from movable kidney. So many people - particularly women - have movable kidneys, and remain for ever in blissful ignorance of the fact, that it is impossible not to wonder whether those who are conscious of it, when the mobility is only slight, are not really suffering from some general hypersensitiveness of the central nervous system. This is tantamount to saying that most of those who recognise symptoms caused by the mobility of the organ are in reality suffering from neurasthenia. Much benefit can be derived from rest and massage treatment; but the latter must be general, and in the earlier stages, at any rate in part, should be of the type mapped out for neurasthenia. If the neurasthenic symptoms are not a prominent feature in other directions, then general abdominal massage should be administered. Every endeavour should be made to get the patient to put on weight, so that fat may be deposited in the kidney-bed. As the usual primary cause of the trouble is laxity of the abdominal wall, every means should be employed to build up its muscles. The chief of these means is the prescription of a course of exercises, very mild at the outset and increasing in severity very gradually day by day. Breathing exercises should be a prominent feature of all such tables.

Atony of the bladder may be remedied to some slight extent by massage in two ways: first, by reflex as the result of sacral beating; and, second, by kneading just over the pubes. Massage of the prostate is best left in the hands of the surgeon. There is always risk of spreading infection locally; and, if this must happen, it is better that he alone should take the responsibility.

On the Continent with some frequency, and occasionally in America, advocates of massage for the female pelvic organs are to be found. In this country the treatment has rarely, if ever, been extolled; it can only be regarded with mistrust, and had better be left alone. Much benefit can be secured, however, by the treatment of many female patients with exercises as indicated in the following chapter. The treatment is both palliative and curative. The only form of internal massage that might possibly be given a trial is that devised by Professor Turck. In cases of haemorrhoids, when operation is refused, he inserts a rubber bag into the rectum and attaches this to a Politzerising bulb. The pressure of the air in the bag is alternately increased and diminished, with, so he claims, considerable benefit to the patient.1

1 See Graham's "Massage," p. 243.