Chronic Gastric Catarrh is treated by some doctors with massage, which has its enthusiastic advocates in this as in all other departments of medicine. But it is not going too far to say that, in the absence of reliable examination, we do not understand the effect massage by itself has on gastric catarrh. At the same time we may safely say that massage has never been the chief method of treatment, but so far has generally been replaced by dietetic means, mineral waters, washing out, etc., and only "specialists" ever think of treating simple gastritis by massage. On account of the constantly good results obtained from abdominal massage by a great number of patients with constipation, among whom a not inconsiderable number have also chronic gastric catarrh, and also on account of the undeniably good effects of massage upon sluggish chronic intestinal catarrh (so often underlying constipation) and other chronic catarrhs, we have reason to consider that massage may also be of great use in treating chronic gastric catarrh. As we can only reach a small part of the stomach of normal size its use must always be limited.

The same uncertainty applies to True Dyspepsia.*

We do not yet possess (see p. 52) a satisfactory knowledge of the effect of mechanical stimulation upon the composition of gastric juice. It is reasonable to suppose that as the amount of gastric juice as a whole is certainly increased by mechanical stimulation, pepsin and hydrochloric acid, the constituents necessary for digestion, are also increased and their percentage possibly affected, and that this improvement, brought about by the active influence of mechanical stimulation on the cells of the glands, may perhaps be permanent; but at present Colombo's, Maria Serena's, and Romano's investigations into this cannot be definitely relied on.+

* By a true dyspepsia I mean a condition of disturbed digestion depending on anomalies in the composition of gastric juice.

+ Investigations into this are more difficult to make on account of the numerous influences (bodily or mental) which may affect the composition of gastric juice, even under which by many doctors is summed up as cramp of the stomach (spasmus ventriculi, spastic cardialgia), often in my own experience quickly yields to frictions over the stomach. The same occurs with similar trouble in the intestine. Cases of flatulence especially are benefited, and the discomfort due to gases is diminished. The habitual vomiting of hysterical or otherwise nervous anaemic patients seems likewise to be benefited by abdominal massage.

On the other hand, there can be no doubt that the symptoms which arise in dyspepsia are lessened or disappear after abdominal massage; this surely everyone has experienced who has treated chronic constipation by this means, in which dyspeptic symptoms are also very common. Patients often confess that the feelings of pressure and weight, fulness or pain, which they experienced in the pit of the stomach after or apart from meals, are relieved, that flatulence ceases, the appetite is increased, etc., etc. One may state that there can be no question of massage when dyspepsia is combined with cancer or an unhealed gastric ulcer, but that it should be used when dyspepsia is combined with dilatation of the stomach. Apart from these diseases it may be tried, if desired, provided that there are no contra-indications, and it is not improbable that it may be of use in the former cases where there is diminished secretion of hydrochloric acid.