ach and head to do so. This kind will
produce constipation or make it worse. In such cases it should be
stretched thoroughly but carefully so that the muscle will be able to
close the opening and the bowel contents will not pass at any time
unhindered. There are two methods of stretching the muscle--forcible or
gradual. The forcible method is generally done by inserting the two thumbs
into the anus and stretching the muscle thoroughly in every direction
until there is no resistance. (Dilators are made for this purpose, but
unless they are very carefully used they will tear the muscle). The
forcible method should be done under an anesthetic. Gradual stretching is
done when an anesthetic cannot be used. It is better to do too little than
to do too much at the first sitting. The muscle is very stubborn
sometimes, and it requires careful handling or the irritability will be
increased. An instrument in the hands of a careful man is all right. They
can be stretched by the fingers or the Wales' bougie, thus: Patients
should come to the office two or three times a week, the instrument
(bougies) are introduced and allowed to remain within the bowel until the
muscle resistance is overcome, and many times their withdrawal will soon
be followed by a copious stool. Forcible stretching is seldom required
more than once, if a large sized instrument is used from time to time
afterward, just as in gradual stretching; when thorough dilatation has
been accomplished, the muscle instead of acting as an impassable barrier
to the discharge of the feces, now offers only passive resistance, but
sufficiently strong, however, to prevent any unpleasant accidents, yet not
strong enough to resist the power of the expulsory muscles when the latter
are brought into full play during stool. Large quantities of feces do not
now accumulate; consequently the pressure upon the mucous membrane and
neighboring nerves is eliminated, and the bowel regains its normal
sensibility and strength. There are now sold dilators in sets for self use
in almost every drug store. These when used continuously do good and
successful work.

[DIGESTIVE ORGANS 141]

Abdominal Massage. (Kneading, Rubbing, etc.).--This is an essential
feature in the treatment. It was practiced by Hippocrates hundreds of
years ago. Place the patient in the recumbent position upon a table which
can be so manipulated that the head may be raised or lowered, the body
rolled from side to side. Gentle b