Movements for Constipation.—Before the manipulations are commenced, the fingers should be passed gently over the abdomen, and any inequality of the surface, hardness or tenderness, noticed. Accumulation of faeces may be found at some point of the colon.

1. Standing so as to look across the patient, the muscles are kneaded with thumbs and fingers.

Fig. 84.—Kneading the Colon with the Fingers,

2.   Facing the patient, the palm of the hand is placed over the small intestines and vibrations given, also over the ascending, transverse, and descending colon. Vibrations are given in the same way over the stomach and liver.

3.   Kneading with the ball of the thumb round the umbilicus.

The Colon.—1. The same movement is done over the colon, beginning at the caecum, up the ascending colon, across the transverse, down the descending and to the middle line; pressure upwards on the ascending colon, outward on the transverse, downward on the descending to the sigmoid flexure, and inward and upwards to the middle line ; special attention is paid to the flexures.

2. Place the heel of the right hand at the beginning of the descending colon, the heel of the left hand at the beginning of the ascending colon ; the left hand is moved upwards to the ribs and then across the abdomen, while the right hand is moved downwards to the sigmoid flexure, and inwards to the middle line (Laisne's method).

Fig. 85.—Kneading the Colon with the Closed Hand.

3.   Kneading with fingers from caecum all round the colon, deeply, with a wave-like motion.

4.   The same, but with closed hand.

5.   Bearing over the colon.

6.   Kneading all the walls with fingers and thumbs, same as No. 1.

7.   Beating over sacrum.

If the colon is loaded, it is well to begin the manipulations at the left side over the sigmoid flexure, and to work backwards to the caecum, pressure being made in the right direction.

If a lump is found, gentle and careful manipulations are made on and about it. If it be faces, it will be broken up and moved onward. If it remain unchanged, it should be avoided till the doctor sees the patient.

If there are tender places in any part of the abdomen, they should be avoided at first, and afterwards gradually approached. They generally disappear, and the parts can be freely handled, but if the tenderness increases or vomiting sets in, massage must be stopped.

Great care must be used in abdominal massage when there is a movable kidney. The region of the kidney had better be avoided.

Exercises.—1. Flexion of thighs on abdomen.

2.  Circumduction of thighs.

3.  The body to be raised from the supine to a sitting position without aid of arms.

4.  Deep breathing.