Dilatation (and Atony) of the Stomach in those cases where it is not connected with malignant growths and when no other contra-indications are found, should decidedly, in my opinion, be treated by massage, which at least frequently proves a valuable addition to other treatment. Whether the gastric dilatation is due to non-malignant stricture of the pylorus or duodenum, to slackness during or after severe general disease, to disturbed nervous influences, or to habitual overloading of the organ, massage assists the development and maintenance of the compensating muscular hypertrophy, which arises to a certain extent even in these cases; also we must assume an effect on the altered secretion of gastric juice and the associated chronic catarrh.

There is no doubt that massage, in the earlier stages of the disease, is able to check its further development. It is also probable that in such cases, combined with other means, it is able to bring about a return of the organ to its normal size. I will not, however, put forward with certainty this claim for the effect of massage, as I am obliged to confess that, though I treated my first severe case of dilatation in 1878 with excellent symptomatic progress, and later have treated many such cases, I have never been certain on this point.* In all cases when dilatation was established, minute examination with a sound at the close of the treatment, even when the conditions throughout were satisfactory, has shown that the volume of the stomach has remained unchanged. On the other hand, I have often seen massage at once cause a retrogression of the symptoms and a decided improvement in cases which before have remained practically unaltered, in spite of all other available means, although there was no appreciable alteration in the volume of the stomach.

* When we have an authority such as Kussmauls in favour of the possibility of a return to the normal limits without massage, even in marked cases, there is no reason to doubt that when this powerful means is introduced into the treatment a similar result can be attained.

The technique is as simple as possible, and consists of the small frictions mentioned above, which form part of abdominal kneading. These, in order strongly to stimulate the musculature, may be performed somewhat jerkily, so that the manipulation resembles tapotement, though the masseur's fingers throughout remain continually in contact with the patient's skin. The treatment, which may be given by someone without medical or technical education, instructed in the manner of performing it, should be given at least once, preferably twice, daily. In more marked cases the massage must with short intervals be continued throughout the whole of the patient's life.

In treating dilatation one ought to include all really good methods. These are small, frequent meals consisting of the menu drawn up by Leube, containing the foodstuffs most easily digested (see below, in Weir-Mitchell's treatment), if necessary some aid to digestion such as hydrochloric acid and pepsin, faradisation of the stomach, stomach lavage (in Carlsbad by means of the mineral water) either (best) in the morning on getting up, or in the evening on going to bed, and finally an abdominal belt specially manufactured for the purpose; these, together with massage, produce practically all that can be accomplished. But in advanced cases the patient can only be kept in a tolerably healthy condition by constant treatment by massage.