Hydrotherapeutic Measures

In connection with the general hydrotherapeutic treatment the abdominal muscles as well as the digestive tract may be favorably influenced by direct applications of water. The use of the Schott douche, lasting from one to two minutes, over the abdomen, especially in the course of the colon, is at times accompanied by good results. Priessnitz compresses, applied during the night over the abdomen, are of value if enteroptosis is complicated with painful symptoms in the abdominal region. These compresses may be used for three to four weeks or longer. The drinking of large quantities of plain or mineral waters seems to be contraindicated in this affection. Sometimes, however, moderate amounts of water may be taken one hour before breakfast. This is of especial advantage in cases of enteroptosis, complicated with constipation. A glassful of cold water, or, in hyperchlothydria, of an alkaline water (Vichy), or Carlsbad water (warm) is frequently of benefit in obstinate constipation.

Massage

Besides general massage of the body, light kneading of the abdomen may be practised. In cases of constipation it is advisable to employ massage, especially over the colon. In such cases, provided the patients are not too much run down, auto-massage of the abdomen by means of a cannon-ball may be applied.

In all cases, however, massage of the abdomen must be carefully executed, since from a rough and injudicious application inflammatory conditions of the peritoneum may result. I distinctly remember two cases of this kind. Both were women in whom at their own request abdominal massage had been practised by experienced masseurs for the relief of constipation. In the one case, after the second seance, a severe pain developed in the right iliac region, with a rise of temperature to 103.4° F. The fever continued two days, to disappear only with the amelioration of the symptoms. In the other case, after several applications of massage, intense pains, both in the right and left iliac regions, developed, and persisted nearly a week, confining the patient to her bed. Fever was, however, not present. In greatly run-down individuals it is not generally advisable to use abdominal massage.

In cases of enteroptosis with movable kidney, accompanied by painful sensations, it is best to combine general abdominal massage with massage of the kidney. The latter procedure, according to Reibmayr,1 is executed as follows:

"The patient lies in the same position as in abdominal massage, the abdominal muscles being relaxed as far as possible. The operator sits at the side which is to be massaged and places his flattened left hand, if it is the right kidney (his right hand in case of the left kidney), on the lumbar region, so that the kidney rests upon his fingers. The thumb is supported in front by the lower costal margin. With the right hand he now attempts gradually to reach the kidney through the abdominal walls by means of the finger tips, and after having grasped the kidney between both hands to knead and stroke the organ gently".

1 A. Reibmayr: "Die Unterleibsmassage," Leipzig und Wien, 1889, 8. 30.

A peculiar form of massage is that employed by Brandt in cases of nephroptosis. The patient lies in the lithotomy position, the physician at his side, facing the patient. After having replaced the kidney, he places both his hands in front under the margin of the ribs and guides them with constant vibratory movements backward and upward, allowing his finger tips to slip around to the back of the trunk. The motion is facilitated by the patient lifting his buttocks somewhat.

In connection with massage, special gymnastics as well as a suitable position of the patient may be employed.