M. L. H. Arnold Snow, M.D.
Relation of Mechanical Vibration to the Digestive System
The functions of digestion and assimilation are associated
with physical (mechanical) and chemical processes, which under atonic or otherwise
impaired conditions may be restored by the judicious employment of mechanical
vibration, alone or in combination with indicated auxiliary measures.
Mechanical vibration is therefore a valuable means
for inducing the functional activity and correcting other derangements
of digestion. The applications require skillful regulations as to
site and adaptations of speed, stroke, pressure, and time to the conditions
present and to the patient's natural resistance.
Constitutional vibratory treatment, i.e., the spinal
treatment, when not prolonged, will produce a general sedative effect associated
with a sense of buoyancy.
THE SALIVARY GLANDS get their nerve supply from the
sympathetic and from a cranial nerve.
"1. The sympathetic nerve [Landois and Stirling.
of Human Physiology, 4th edition, page 251] gives branches (a) to the
sub-maxillary and the sub-lingual glands derived from the plexus on the
external maxillary artery; (b) to the parotid gland from the carotid plexus.
These nerve fibres can be traced to the superior cervical ganglion and
from thence through the cervical sympathetic into the cord. "
"2. The facial nerve gives branches to the sub-maxillary
and sub-lingual glands from the chorda tympani which accompanies the lingual
branch of the fifth nerve." The branches of the parotid arise from
the tympanic branch of the glosso-pharyngeal nerve (dog). "The tympanic
plexus joins the otic ganglion, and this ganglion sends branches to the
auriculo-temporal nerve (itself derived from the third branch of the trigeminus),
which as it passes upwards to the temporal region under cover of the parotid,
gives branches to this gland."
"The sub-maxillary ganglion, which gives off branches
to the sub-maxillary and sub-lingual glands, receives fibres from the tympanico-lingual
nerve (chorda-tympani) as well as sympathetic fibres from the plexus on
the, external maxillary artery.
Sajous [The Internal Secretions and the Principles
of Medicine, pages 272 and 275] states that over the blood vessels
of the sub-maxillary gland (of a dog) are "entwined sympathetic fibres
from the superior cervical ganglion which fibres are enclosed in a common
sheath with the main sensory nerve present, the vagus," which strengthens
the belief that they must in a measure govern the quantity of blood distributed
to the organ." His deductions in regard to the functional mechanism of
the sub-maxillary are as follows:
"Some fibres of the chorda tympani are distributed
to the secreting elements to excite and govern their metabolism; the remaining
fibres of the same nerve are distributed to some of the glandular arterioles,
but not to those which supply capillaries to the secreting elements.
While the gland is in the passive state the blood flows equally through
"When the gland is active, the chorda tympani constricts
the arterioles to which it supplies fibres, and thus forces the bulk of
the blood through the, free arterioles and thence into the glandular capillaries.
"The rapidity of the blood-flow through the organ
is concurrently increased through sympathetic constriction of the extra-glandular
arterial branches functionally connected with the gland."
Arnold ["Effects of Vibration on the Back." Medical
News, March 18, 1905] believed that the vaso-constrictor neural cells
for the salivary glands are in the 2nd, 3rd and 4th dorsal segments and
the vaso-dilator neural cells of the sub-maxillary and sub-lingual glands
are in the nuclei of the 7th cranial and of the parotid glands in the nucleus
of the 9th cranial.
IF THE SYMPATHETIC NERVE which contains vaso-constrictor
as well as secretary fibres be stimulated it causes a thick secretion in
the sub-maxillary abounding in mucin, thereby increasing the normal specific
gravity of the secretion. Contraction of the blood vessels and lessening
of the rapidity of the venous circulation also result. It is probable
that "the nerves exercise a direct effect upon the secretory cells, apart
from their action on the blood vessels." Ludwig demonstrated that while
secretion is active the rise in the temperature of the glands is 1.50
C., and according to Landois and Stirling [Landois and Stirling. Text-Book
of Human Physiology, 4th edition, page 255], whether the stimulus be
electric or other stimulus "of the peripheral end of a glandular nerve
the following changes occur:
"(1) Vaso-motor changes, causing alterations in the
blood supply and blood-flow.
"(2) Chemical and histological changes in the gland-cells
connected with the elaboration of the organic and possibly of the inorganic
constituents of the saliva.
"(3) Changes by which water is secreted, i.e., passes
through the basement membrane and gland-cells and the consequent movement
of the fluid through the cells and ducts.
"(4) Electrical changes which do not seem to be associated
with the vaso-motor changes, for the electrical variations are readily
abolished by atropin which does not affect the vaso-motor changes."
Stimulation of remote sensory nerves, as the sciatic,
affects the parotid gland reflexly, causing secretion of the saliva (Owsjannikow
and Tschierjew). When considering the effect of vibratory stimulation
upon the glands it is well to mention the results of one of Colombo's experiments.
He found that "the parotid gland did not respond so quickly as the salivary.
Increased secretion occurred after 5 minutes' massage but 10 minutes were
required for the maximum secretion." Less time is required for the induction
of a corresponding effect with mechanical vibration.
Cyriax [Elements of Kellgren's Manual Treatment,
page 290] reports cure in a case of EPIDEMIC PAROTITIS, the treatment being
as follows: "Vibrations (manual) and shakings, followed by frictions on
the salivary glands and on the swollen lymphatic glands; running vibrations
from above downwards along the sterno-mastoids; frictions on the facial
nerves and on the nerves lying in the sub-maxillary region. General
treatment for fever."
Mechanical vibration applied to the glands should
be administered with the rubber-covered disc or cup-shaped vibratode and
may be applied by friction or interruptedly. Vibration of the PAROTID
GLAND, which "lies upon the side of the face immediately below and in front
of the external ear" should be begun behind the ascending ramus of the
jaw and continued downward. In front of the external ear vibrate
forward. Then follow the line of Steno's duct - "to a finger's breadth
below the zygoma from the lower part of the concha to midway between the
free margin of the upper lip and the ala of the nose." The vibration
should be applied lightly with a medium stroke.
Vibration of the SUB-MAXILLARY GLAND should begin
halfway between the angle of the jaw and the mentum as it is below and
to the inner side of the lower jaw. Vibrate up and forward in the
direction of Wharton's duct with interrupted vibratory applications.
The SUB-LINGUAL GLAND can be reached behind the chin.
Vibrate upward and forward.
THE PHARYNX, extending from the "under surface of
the skull to the cricoid cartilage in front and the intervertebral disc
between the 5th and 6th cervical vertebrae behind," receives its nerve
supply from the pharyngeal branch of the pneumogastric. This branch,
which is "the principal motor nerve of the pharynx, arises from the inferior
ganglion of the pneumogastric, receiving a filament from the accessory
portion of the spinal accessory, passes across the internal carotid artery
to the upper border of the middle constrictors Here it divides into filaments
communicating with those from the external branch of the superior laryngeal,
the glosso-pharyngeal and sympathetic to make the pharyngeal plexus which
supplies the pharyngeal muscles and mucous membrane.
The glosso-pharyngeal nerve supplies "fibres of ordinary
sensation to the pharynx and is the motor supply of the stylopharyngeus
and the superior and middle constrictor. It is found "below and internal
to the horizontal ramus of the jaw. "
When applying mechanical vibration to the pharynx
use the small cup-shaped vibratode, beginning posterior to the ascending
rami and administer vibratory interruption or friction from above downward.
IN CHRONIC FOLLICULAR PHARYNGITIS mechanical vibration
has already been demonstrated of value. Morse treated a case successfully
by vibrating "deeply over the cervical spinal nerves, and externally over
the glands of the neck," presumably to control the vaso-motor area of the
head to lessen congestion, and to unload the lymphatics, particularly the
cervical glands. To this treatment may be added vibratory friction
of the neck anteriorly and posteriorly.
MECHANICAL VIBRATION PROMOTES to a marked degree
the functional activity of the liver, stomach, and intestines - both promoting
absorption and increasing peristaltic activity.
HEPATIC ACTIVITY MAY BE INDUCED (1) directly by applying
over the liver interrupted vibration with moderate or deep pressure and
medium stroke followed by vibratory friction; (2) indirectly or reflexly
by the application of abdominal vibration or spinal stimulation.
Professor Colombo of Turin demonstrated in respect
to binary secretion that, "after ten minutes of trepidation (shaking or
vibration) and of tapotement or percussion the quantity of bile increased
considerably in the next four hours. The cholestrin and the binary
soda salts were most abundant. After twenty-five minutes of friction
and of petrissage the same results were obtained as after ten minutes of
trepidation and tapotement; the maximum result was obtained by combining
ten minutes of friction and petrissage." These observations are of
great interest and importance in vibration therapy; because they well illustrate
the relative effects of various modes of application in respect to time.
Vibratory stimulation by increasing binary excretion assists in staying
putrefaction, aids in the emulsification of fats, increases intestinal
secretion and peristalsis, and supplies a natural purgative and intestinal
The nervous supply of the liver [Sajous. The
Internal Secretions and the Principles of Medicine, page 360] consists
"first, of terminal subdivisions of the general motor system (splanchnic-sympathetic),
which furnish nervous energy during the passive stage of functional activity
by insuring tonic contraction of all, vessels, and, second, of terminal
subdivisions of the vagus, which excite and govern the active stage of
functional activity by regulating the calibre of the hepatic arterioles
and by supplying nervous energy to the hepatic cells." Arnold ["Examination
of the Back," Medical World, March 18, 1895] stated that the vaso-constrictor
neural cells of the liver are "from the 6th dorsal to the 1st lumbar segment,
but chiefly in the 10th, llth and 12th dorsal segments and that the vaso-dilator
neural cells are in the nucleus of the 10th cranial nerve."
The effects [Landois and Stirling. Text-Book of
Human Physiology, 4th ed., page 338] of nerve stimulation on binary
secretion are as follows: "All conditions which cause contraction of
the abdominal blood vessels, e.g., stimulation of the ansa Vicussenii,
of the inferior cervical ganglion, of the hepatic nerves, of the splanchnics,
of the spinal cord (either directly by strychnia, or reflexly through stimulation
of sensory nerves), affect the secretion. Stimulation of the nerves
around the hepatic artery causes at first, an acceleration, and afterwards
the secretion." A rapid and copious blood supply favors secretion
the velocity influences it more than blood pressure. A more copious
supply of blood to other organs, e.g., to the muscles of the trunk - during
vigorous exercise, diminishes the secretion. "Stimulation of the
spinal cord, from which the motor nerves of the larger bile ducts and gall-bladder
pass, causes acceleration of the out-flow, which is afterwards followed
by a diminished out-flow. Direct stimulation of the liver,
and reflex stimulation of the spinal cord, diminishes the excretion.
By stimulation of the sympathetic at the lowest cervical and first thoracic
ganglion, the hepatic vessels at the periphery of the liver lobules become
contracted and pale. (Cyon.)" [Landois and Stirling.
Text-Book of Human
Physiology, 4th edition, pages 330 and 340]
"Francois-Franck and Hallion [Sajous. The
Internal Secretions and the Principles of Medicine, page 1012] have
shown that the vaso-motor nerves of the liver leave the spinal cord
by the rami below the fifth, i.e., the sixth (dorsal) down to the second
lumbar. These limits have been confirmed by Langley. The former
physiologists remark however that 'centrifugal excitation of the vertebral
nerve (composed of 4 or 5 of the lower cervical nerves) after section of
the upper rami communicantes (from the first to the fifth) no longer
produces hepatic vaso-constriction' - statement which implies that
stimulation of the vertebral nerve does produce hepatic vaso-constriction.
The manner in which this effect is brought about, Francois-Franck and Hallion
were unable to explain, however, they ascribed them, therefore, to 'reflex
action' or to some unexplained 'indirect influence.'" This influence
according to Sajous is due to overactivity of the adrenals.
Landois [Landois. Text-Book of Human Physiology,
page 321] states that "stimulation of its (the splanchnic nerve) central
extremity causes relaxation of ducts and bladder, while stimulation of
the central end of the pneumogastric causes their contraction, together
with relaxation of the sphincter of the duodenal orifice.
Mechanical vibratory treatment for relieving TORPIDITY
OF THE LIVER is applied as follows. With the patient lying in a prone
position, apply interrupted vibration with moderate pressure and medium
stroke with a ball vibratode to the dorsal region of the spine, and note
the points of tenderness. Then apply vibratory friction over the
liver posteriorly with the disc vibratode moving from the spine outwards
over the spaces between the ribs. After a rest of a few minutes,
with the patient in the first position, he should then lie upon his back
and interrupted vibration should then be applied with moderate pressure
and medium stroke over the liver anteriorly, employing medium speed and
a stroke suited to conditions of each case. "One of the causes of
the excretion of bile is the interrupted periodic compression of
the liver from above by the diaphragm at every inspiration."
The observation has been made by the writer that
in many cases of morbid states of the liver, tenderness is elicited by
interrupted vibration with the disc vibratode below and internal to the
inferior angle of the right scapula. These areas of tenderness correspond
to the 6th and 7th dorsal nerves which may be vibrated at their vertebral
exits between the 6th and 7th and 7th and 8th dorsal vertebrae with the
PERCUSSION OF THE LIVER elicits according to Butler
[Diagnostics of Internal Medicine, page 464]:
Limits of covered dulness:
Limits of exposed dulness:
4th space in mammillary line.
7th space in midaxillary line.
9th space in scapular line.
Limits of exposed dulness:
6th rib in mammillary line.
8th rib in midaxillary line,
10th rib in scapular line.
THE LIVER REFLEX OF CONTRACTION (Abrams) is obtained
by vibrating with the ball vibratode for five or ten minutes with short
rest intervals between the 1st and 2nd, and the 2nd and 3rd lumbar vertebrae.
This procedure is indicated in hepatic engorgement unless contraindicated
by the nature of the cause of such engorgement as in abscess or cancer
of the liver. In combination with high colonic flushings it relieves
the symptoms of such engorgement.
3 1/2 to 4 in. below ensiform appendix in anterior median line.
Costal margin in mammillary line.
10th space in midaxillary line. Fuses with dulness of right kidney
in scapular line.
THE LIVER REFLEX OF DILATATION (Abrams) is elicited
by prolonged spinal vibration with few interruptions for five or ten minutes
between the llth and 12th dorsal vertebrae. It must be remembered
that mild applications stimulate but strong or long continued exhaust or
inhibit an action; therefore in vibratory administrations proper discrimination
must be observed.
Vibratory treatment of the liver is contraindicated
in cancer of the liver, in acute attacks of hepatic colic, in cases of
acute gastro-duodenitis, and in hepatic abscess.
Mechanical vibratory treatment applied with upward
stroking to the extremities will temporarily relieve oedematous conditions
due to interference with circulation as in CIRRHOSIS OF THE LIVER and NEPHRITIS.
The writer employs for this purpose a rubber-covered disc vibratode with
interrupted vibration over the inguinal glands followed by vibratory friction
centripetally from the knee to the groin. Dusting the surface with
a dusting powder greatly facilitates the administration of the friction.
To the knee-joint apply deep interrupted vibration with deep pressure and
medium stroke, after which apply vibratory friction from the ankle to the
knee, followed by deep interrupted vibration to the foot and interrupted
vibration on the sole of the foot under the instep. When giving the
above treatment, the posterior as well as the anterior surface of the limb
is treated. Properly applied joint movements may be used with advantage
to assist the process.
FOR THE APPLICATION OF MECHANICAL VIBRATION TO THE
GALL-BLADDER employ deep interruptions at about the 9th costal cartilage
outside the edge of the right rectus muscle, downwards and inwards toward
the median line. Follow the line described four or five times across.
The vibratode best suited for the purpose is the flat disc, which should
be crowded up to where the lower edge of the liver can be located.
During the administration the abdominal muscles should be relaxed.
The gall-bladder and the ureters "are the parts least excited by stimuli."
If interrupted vibration is applied with pressure with a disc vibratode
relaxation is induced.
WHEN GALL STONES ARE PRESENT, however, vibration
is sometimes contraindicated and in any case if applied the greatest care
must be observed. In order to break up binary calculi which
have become impacted, Professor Bartholow recommended "that firm friction
be made with the fingers along the inferior margin of the ribs toward the
epigastrium and umbilicus while the opposite side posteriorly is supported
by the other hand spread out and firmly applied." Vibration may be so applied,
but the author favors the use of light, olive oil, and diet, succinate
of soda or surgical measures.
THE CARDIAC END OF THE STOMACH is situated "just
below the level of the junction of the 7th costal cartilage with the sternum,"
and the PYLORUS is "near the end of the cartilage of the 8th rib."
Any stimulation affecting stomach secretion affects proteid digestion.
The peristaltic action of the stomach is affected by direct stimulation
as massage or mechanical vibration.
When PERCUSSING THE STOMACH it should be remembered
that the thorax and liver overlap above, and the transverse colon is in
close proximity below. "The normal stomach tympany begins at the
site of the apex of the heart about at the 4th intercostal space in the
axillary region, extending below this into the abdomen so that its greater
curvature extends from about the 9th costal cartilage, across the abdomen
above the umbilicus to the right of the median line."
GASTRIC SECRETION may be induced by stimulation,
- mechanical, chemical, or thermal. Landois and Stirling consider
the function to be a reflex one, the special center for which is probably
located in Meissner's plexus. The same eminent authorities acknowledge
that there are indications also that a connection exists "perhaps indirect
between the central nervous system and the gastric glands." It was said
by Pilgrim that stimulation of the glands can be produced by stimulating
the vagi in the neck, but on this point authorities differ. Landois
and Stirling state that "there is no nerve passing to the stomach whose
stimulation causes a secretion of gastric juice as the chorda tympani does
in the sub-maxillary glands," but Pawlow "found that direct stimulation
of the vagus produced a flow of gastric juice."
Colombo demonstrated that after massage the quantity
of fluid exuded from a "gastric fistula for two hours was more than double
that which flowed through in the same time without massage. A massage
(manual) of fifteen minutes gave the maximum secretion. If massage
was applied for a longer time the mucus increased, the gastric juice was
more diluted. Hydrochloric acid and pepsin did not increase." The
author had skiagraphs taken before and after vibration following a bismuth
dose. Vibration was given between the lst and 2nd and 2nd and 3rd
lumbar vertebrae for 10 minutes. The skiagraph showed a 50 per cent
increase in motility.
Experiments have also been made demonstrating the
effects of manual massage upon the stomach with salol which is not soluble
in the stomach. Ewald and Eccles experimented and found, according
to Graham, that "in most cases under natural conditions without massage,
salol could be detected in the urine in forty-five minutes after its administration;
but after massage upon abdomen for fifteen minutes the reaction of salol
was obtained in thirty minutes," and according to the same authority, Hopadze
"showed that abdominal massage hastened the food from the stomach from
fifteen to seventy-five minutes."
The general motor (sympathetic) and the vagus systems
supply the stomach. Sajous believes [ Sajous. The Internal
Secretions and the Principles of Medicine, page 309]:
1. That the general motor system (sympathetic) and
supplies efferent nerves which maintain tonic arterial contraction and
control functional efficiency" during the passive state, while the
vagus system (supplying sensory and motor nerves) is superadded during
the active state and "assumes control of the digestive process."
"2. The extrinsic efferent nerves from both systems,
constitute its extrinsic vaso-constrictor system, by means of which the
flow of blood in the organ is increased."
3. The intrinsic efferent nerves are formed of (1)
the branches of the "general motor system" (sympathetic system) each of
which divides into two branches, one going to the arterioles, and the other
supplying the muscles and glands, and (2) of branches of the vagus "which
inosculate with the general motor filaments and plexuses, except with those
distributed to arterioles that supply capillaries to the glands and probably
end in the muscularis mucosae.
Arnold thought that the vaso-constrictor neural cells
of the stomach were in the 4th to the 9th dorsal segments and the vaso-dilator
neural cells of the stomach were in the nucleus of the 10th cranial nerve.
Landois and Stirling [Landois. and Stirling. Text-Book
of Human Physiology, 4th ed., page 281] regard Auerbach's plexus as
its motor center, the vagi conducting the impulses. "Stimulation of
the vagi in the neck causes contraction of the pylorus (and upward
from the pyloric end) when the latent period may be seven seconds. Stimulation
of the splanchnics in the thorax arrests the spontaneous pyloric
contractions, the left splanchnic being more active than the right (Oser)."
Other fibres "pass from the spinal cord in the anterior roots of the nerves
from the sixth to the twelfth dorsal, passing in the splanchnic nerves
to the solar plexus, and thence to the stomach." If the splanchnics
be stimulated, the muscular movements of the stomach cease, and
the sphincter of the pylorus relaxes (Kirke). Pilgrim claimed
that stimulation of the fourth dorsal would open the pylorus. The
may be opened reflexly by stimulation of the sensory abdominal nerves
(e.g., of the kidney, uterus, intestine), or irritation of the sciatic.
Landois and Stirling locate the center for the contraction of the body
of the stomach in the corpora quadrigemina.
"The efferent paths lie in the vagi, but chiefly
in the cord, and from the latter emerge to the ganglia of the sympathetic.
Inhibitory centers lie in the upper part of the cord, and the efferent
paths are in the sympathetics and splanchnics." "Mechanical stimulation
causes contraction of the muscular layers directly affected." [Landois.
Text-Book of Human Physiology, page 281] The visceromotor accelerating
cells for the stomach according to Arnold are principally in the tenth
cranial nerve, possibly also in the eleventh and the inhibitory visceromotor
cells are chiefly. in the fourth to the ninth dorsal segments.
MECHANICAL VIBRATION APPLIED TO THE STOMACH improves
the general tone, and increases motor and glandular activity, thereby aiding
MECHANICAL VIBRATORY TREATMENT OF THE STOMACH should
never be administered directly after eating, and the bowels should be as
nearly evacuated as possible, and the bladder emptied. Vibration
should not be applied over the abdomen with so much force as to cause pain.
If the patient be ticklish avoid too light vibration. If the abdomen
be sticky from perspiration dust it with talcum powder before vibrating.
Vibration may be followed by visceral lifting, if advisable, for the purpose
of restoring the viscera to their normal positions.
VISCERAL LIFTING, a plan followed by Kellogg, is
accomplished as follows: The operator, standing at the left side of the
patient, his back being toward the face of the patient, places "the ulnar
edge of the two hands, with the fingers extended, just above Poupart's
ligaments and parallel with the ligaments, the fingers pointing toward
the pubes. From this position the hands are moved slightly upward,
the edge of the hands being made to sink as deeply into the abdomen as
possible without severe pain. The arms being slightly rotated at
the same time, and the hands drawn upward in such a way as to grasp the
contents of the abdomen and drag them upward." This should be done during
inspiration. At the same time use inspiratory lifting, that is, the
patient having expired the air from the lungs should "make the movement
of inspiration by lifting the upper chest forcibly while keeping the glottis
With the flat rubber-covered disc vibratode vibrate
from the cardiac end of the stomach using interrupted vibration or vibratory
friction proceeding downward and slightly inward. Then vibrate over
the pyloric end of the stomach upwards and slightly outward. This
area should be gone over about three times, pressure being regulated according
to the patient's tolerance. In pathological conditions of the stomach,
vibration of the 6th, 7th and 8th dorsal nerves on the left side will usually
elicit tenderness, and eructations often occur. An application of
static sparks over these sites also causes eructations. When the
pylorus is affected, the same nerves on the right side are tender.
The 6th, 7th and 8th dorsal nerves should be vibrated at their origins
or exits employing the ball vibratode, and moderate speed in order to produce
these effects. The tenderness is treated by prolonged interrupted
REFLEX DILATATION OF THE STOMACH (Abrams) is effected
by concussion or vibration of the spinous process of the 1lth dorsal vertebra.
REFLEX CONTRACTION OF THE STOMACH (Abrams), is produced
by vibration by applying the ball vibratode between the transverse processes
of the lst and 2nd, and the 2nd and 3rd lumbar vertebrae for five or ten
minutes as effects may demand with a rest period of a few minutes after
the first five minutes' treatment. This can be used to empty the
VOMITING is a reflex act induced by afferent and
efferent stimuli "occurring in consequence of contraction of the walls
of the stomach, the pyloric sphincter being at the same time closed." The
center "is connected with the respiratory center [Landois. Text-Book
of Human PhysioIogy, 4th ed., page 282], hence any agent increasing
respiratory movements has a favorable effect upon vomiting." The
"afferent impulses may be discharged from (1) the mucous membrane of the
soft palate, pharynx, root of the tongue (glosso-pharyngeal nerve) as in
tickling the fauces with the finger, (2) the nerves of the stomach (vagus
and sympathetic), (3) stimulation of the uterine nerves (pregnancy), (4)
the mesenteric nerve (inflanmation of the abdomen and hernia), (5) nerves
of the urinary apparatus (passing a renal calculus), (6) nerves to the
liver and gall duct (vagus), (7) nerves to the lungs in phthisis (vagus)."
The efferent impulses are carried by the phrenics
(diaphragm), vagus (oesophagus and stomach), and intercostal nerves (abdominal
muscles)." [Landois and Stirling. Text-Book of Human Physiology,
4th ed., page 282] Dr. W. E. Green of Arkansas reports the cure of
a case of persistent vomiting following two operations for its cure.
The ball vibratode was used on alternate days for deep interrupted vibration
"in the interspaces over the transverse processes of the third and fourth
dorsal nerves, and throughout the splanchnic region." He probably induced
dilatation. There was present at first a pyloric stricture.
In spasmodic stricture of the pylorus, vibration of the fourth or fifth
dorsal is indicated.
THE PANCREAS is situated, behind "the linea alba,
about two or three inches above the umbilicus," half way between the ensiform
appendix and the navel and corresponds to the 2nd lumbar vertebra.
Its head is in the duodenal curve and its tail reaches the spleen.
Sajous [The Internal Secretions and the Principles
of Medicine, page 385] believes that:
"l. When the pancreas is in the resting state, the
general motor mechanism (sympathetic) maintains the tonic contraction of
the vascular supply and alone transmits impulses to all the structures
of the organ, including the glands which, during this period, elaborate
their secretary products.
"2. When as a result of physical (reflex) or psychical
stimuli the pancreas becomes functionally active, the vagus impulses impose
their rhythm upon the general motor nerves, and the vagus system assumes
control of the secretary process."
The nerves which supply it are from the "hepatic,
splenic and superior mesenteric plexuses to which the pneumogastric and
splanchnic nerves send branches." If the "central end of the vagus
or certain sensory nerves, as the crural or sciatic, be stimulated suppression
of the normal (pancreatic) secretion results." It has been claimed
that the vaso-constrictors of the pancreas are from the fifth dorsal to
the second lumbar. The vaso-dilators are said to be mostly in the
vagus. Arnold states that the vaso-constrictor neural cells are in
the 8th to 12th dorsal segments with some above the 8th, and the vaso-dilator
neural cells are in the nucleus of the 10th cranial nerve. The blood
vessels are dilated during the act of secretion [Landois. Text-Book
of Human Physiology, page 307]. Direct stimulation of the gland
itself by induction shocks stimulates or excites secretion. Mechanical
vibration applied directly over the gland should produce practically the
same result. A rubber-covered disc vibratode should be used to apply
interrupted vibration or vibratory friction when treating the gland itself.
In vibrating the gland, begin at the splenic end, and if vibratory frictions
are used, apply friction from the splenic end toward the patient's right
side when the direction should be to the right and slightly downward and
outward following the line of the pancreatic duct.
CONSTIPATION is characterized by "an abnormal sluggishness
and imperfect evacuation in the movement of the intestinal contents through
their canal," which may be due to (1) atonic conditions caused by insufficient
blood supply in debilitated states, as relaxed abdominal walls, atony of
the intestinal tract; (2) obstructive causes as an interference mechanically
with fecal expulsion as fibroid tumors, hypertrophy of Houston's valves,
of the sphincter, or of the levator ani muscles, accumulation of feces,
uterine and vaginal displacements; (3) habit; (4) various diseases of the
spinal cord as tabes, hemiplegia and transverse myelitis; (5) a pulling
down of the recto-vaginal septum; (6) anomalies, as congenital dilatation
of the colon, or congenital strictures; (7) lead poisoning; (8) hernia;
(9) peritonitis; (10) displacement of the right kidney, obstructing the
lumen of the duodenum; (11) spasm of the pylorus, or the muscles of the
intestine, as in hysteria and neurasthenia; (12) diseases of the secretive
and intestinal tract, including chronic affections of the liver, stomach,
intestines, enteritis, colitis, and fissure of the anus; and (13) venous
obstruction which causes hypertrophy of the mucous and sub-mucous coats
and impairs peristalsis. (14) A very important cause is the formation of
a "pouch, changing the direction of the inter-abdominal rectal pressure
to that of the vaginal, at right angles to it, and making it difficult
for the rectal sphincters to relax and void the contents of the bowels."
Another classification of causes includes dryness of the feces, and differences
in the functional activity of muscles and motor nerve apparatus in the
Regarding the causes of atonic and spastic constipation
Reed [Reed. Diseases of the Stomach and Intestines, page 767]
states that "Glenard considered displacements of the stomach and intestines
as chiefly responsible, while Emminghaus traces habitual constipation to
degenerative changes in the splanchnics, and Dunin thinks it attributable
mainly to central functional anomalies in the nervous system. Boas
finds it difficult either to deny or confirm these theories, but points
out that in any fully developed case of neurasthenia, with constipation,
there is likely to be found a vicious circle."
DEFECATION may be either voluntary or involuntary,
the beginning and end of the act being voluntary, while the remaining part
of the act is involuntary. An accumulation of feces and gases presses
or stretches the fibres and induces peristalsis. The sphincter is
contracted tonically during the intervals between defecation. The defecation
centers are thought by Schafer to be under the control of the sacral
nerves, but others think the lumbar nerves govern defecation. Reed
locates the center at the second segment of the lumbar part of the spinal
cord, at 9th, 10th or llth dorsal vertebra. The sphincter
is also influenced by a cerebral center located, it is supposed, in the
optic thalmus. When the feces and gases pass from the sigmoid, they
stimulate the rectal mechanism, and an impulse to evacuation is induced.
According to Kirke, "the stimulus, however produced, is transmitted to
the center in the cord through the hemorrhoidal and inferior mesenteric
plexus, and is then reflected to the muscles of the rectum through the
pudendal plexus, resulting in a relaxation of the sphincter, a contraction
of the muscular gut walls, and expulsion of the feces."
By compression of the abdominal viscera, the feces
are aided in their downward course, when they reach the uppermost Houston
valve on the left wall they may rest there, or be pressed onward to the
next lower valve on the right anterior wall. The feces thus gradually
approach the anus, during which time the levator ani muscles "draw the
canal upward and over them." The levator ani not only thus raise
a part of the pelvic floor but prevent distension of the pelvic fascia.
Hyrtl says that "the levatores ani are related to the anus like two cords
of a tobacco pouch." It is thought that an inhibitory seat in the brain
in the optic thalmi allows the fecal mass to pass through the anus without
causing it to close reflexly.
THE AMOUNT OF FECES normally passed in twenty-four
hours should be about five ounces and should consist of about seventy-five
per cent. water, which depends, according to Landois and Stirling, partly
upon the food and partly on the "energy of the peristalsis." When
the peristalsis is very energetic, the feces are more watery, because the
fluid from the food does not have time to be absorbed. They state
also that "the quantity of water taken has no effect upon the amount of
water in the feces." It is thought by O'Beirne that when the desire
to go to stool is unheeded that the feces go back to the sigmoid by means
of a "reverse peristalsis," but Gant states that his experience is that
it is only exceptionally that the feces are returned to the sigmoid.
"In most instances digital examination revealed an accumulation of feces
in the rectum. In a few the earlier examination revealed a like condition,
while those made later showed the rectum to be empty." "Again, the
lower rectum may be found empty, but procto-scopic examination will reveal
the feces above and unsupported by the valves, moreover, if the entire
fecal mass is not discharged at stool, the remaining portion may sometimes
be seen above the valves."
HABIT is a matter of great importance, either as
a prevention or cause of constipation - sedentary habits, improper diet,
too rapid eating, irregular time for eating and going to stool, the use
of cathartics, and failure to drink enough water are the most common to
be noted. Considered from a mechano-therapeutic view-point, Cyriax
[Cyriax. "Mechano-Therapeuties in the Treatment of Chronic Constipation."
Medical Journal, 0ct. 8, 1910], when considering chronic constipation,
claims that "three features are apparent:
"1. Diminution in the expulsive power of the intestine.
"2. Diminution in the function of abdominal sympathetic.
"3. Diminution in the power and tone of the muscles
of the abdominal wall."
THE INTESTINES RECEIVE THEIR NERVE SUPPLY as follows
[Byron Robinson. The Abdominal and Pelvic Brain, page 318]:
"1. The cranial nerve (the pneumogastric). (Sajous
believes that the 'vagal system probably alone excites and regulates intestinal
functions during digestion as well as during intervals).'
"2. The spinal nerves especially those entering at
the distal and proximal bowel segment.
"3. The sympathetic system."
The sympathetic nerve supply includes:
(a) Billroth Meissner plexus "supplying glandular
structure and has to do with secretion.
(b) Auerbach plexus supplying muscles.
(c) Solar plexus.
(d) Lateral chain of sympathetic ganglia on each
side of the vertebral column from which arise the great splanchnic nerves."
He stated that the sympathetic nerve causes the periodic
movement, rhythmic in character. Pfluger noted that if the splanchnics
were stimulated the movements of the bowels were prohibited, "the bowels
become pale and the blood vessels anemic." The splanchnic supplies motor
and vaso-motor nerves to the blood vessels of the intestine and also sensory
THE SMALL INTESTINE (Arnold ["Examination of the Back." Medical
News, March 18, 1905] and Reed [Diseases of the Stomach and Intestines,
page 52] receives its vaso-constrictor neural cells from the 6th dorsal
to the 2nd lumber segment, and its vaso-dilator neural cells in the nucleus
of the 10th cranial nerve.
Inhibition of the action of the small intestine is
stated by Arnold to be chiefly in the spinal cord segments corresponding
to the vaso-constrictor neural cells supplying the part. He states
that probably there are some inhibitory paths in the 10th cranial and some
accelerators in the cord. The same author believed that the accelerating
cells for the small intestine were "chiefly in the nucleus of the 10th
and possibly of the llth cranial nerve."
If the vagus is stimulated "the movements of the
small intestines are increased" (Braam Houckgeest). Landois and Stirling
[Landois and Stirling. Text-Book of Human Physiology, 4th
ed., page 289] state, however, that the inhibitory nerve of the small intestine
is the splanchnic while the capillaries contain arterial blood. When
this changes the splanchnics are stimulated and peristalsis is increased.
THE LARGE INTESTINE receives its vaso-constrictor
neural cells from the llth dorsal to the 2nd lumbar segments, probably
the vaso-dilator [Arnold. "Examination of the Back." Medical
News, March 18, 1905] neural cells for the first half of the large
intestine are in the nucleus of the 10th cranial nerve. The accelerating
cells for the ascending part of the large intestine are probably found
in the nucleus of the tenth and possibly in the eleventh cranial nerves.
Arnold believed that the inhibitory neural cells of same correspond to
its vaso-constrictor neural supply, and that probably the tenth may contain
inhibition paths and that some accelerators may be found in the cord.
Reed [Reed. Diseases of the Stomach and
Intestines, page 61] says that the colon is innervated partly by the
sympathetic and partly from the lower spinal nerves. He says that
the vaso-constrictors are from between the 6th dorsal and 2nd lumbar segments,
and that the vaso-dilators are from the same part and from the pneumogastrics.
Landois [Text-Book of Human Physiology, page 720] states that the lumar
branches of the sympathetic "contain inhibitory fibres for the descending
colon and rectum."
Reed states, that the vaso-constrictors of the sigmoid
flexure and rectum are from the 10th dorsal to the 4th lumbar segments
and that, the vaso-dilators are from between the lst and 4th sacral segments.
It should be noted that the vaso-constrictors of the genital organs come
from the lumbar nerve roots and their vaso-dilators from the sacral nerve
The neural cells (Arnold) for the external sphincter
are "probably in the last sacral and to some extent in the coecygeal segments."
If the nervi-erigentes, partly formed by fibres that
leave the cord in the sacral nerves (2nd to 4th) [Howell. Text-Book
of Physiology, page 706] be stimulated, contraction of the longitudinal
rectal fibres occurs, and the action of the circular fibres is inhibited,
even when the hypo-gastric nerves are stimulated by which they are supplied
and whose stimulation has "an inhibitory effect on the longitudinal muscles"
Malay measures and methods have been employed in
the treatment of constipation, among the most satisfactory have been dietary,
exercise, electrical, and mechanical means. Each has its particular
IN THE TREATMENT OF CONSTIPATION due regard should
be paid to causes, as they determine the initial step in the treatment.
Atonic conditions with relaxed abdominal walls may require systematic adapted
exercises, and in cases of the aged or weak, or those who cannot or will
not exercise a proper abdominal support is necessary. Irregular habits
of going to stool demand regularity. As habit has a marked influence
over constipation it is essential that the patient be trained to elect
a particular time for going to stool, and sit for twenty minutes if necessary
always abstaining from exertion or straining. If the desire comes
on during the day ignore it if possible until the next day at the stated
period and thus begin to establish a regularity. Fibroid tumors require
the use of the X-ray every other day for ten minutes until a dermatitis
occurs. A rest should ensue until the disappearance of the dermatitis
when a second series of rayings should follow. A hot douche within
and a cold cloth over the surface when raying may prevent dermatitis (Nagelschmidt).
Spasms of the pylorus require a restricted diet and treatment from the
50 candle power incandescent lamp. Diseases of the secretive organs
and intestinal tract demand special treatment suited to the case in question.
Dryness of the feces calls for the use of agar-agar and the copious drinking
The diet should in all cases be strictly regulated
and restricted to foods calculated to assist peristalsis and of a character
that the residue will be sufficient in quantity, and of a non-intoxicating
nature not disposed to ferment. Zoolak, milk, koumiss, toasted bread,
unsweetened zwiebach and cooked fruits are an effective and acceptable
diet. A more liberal diet includes in many cases a diet of triscuit,
shredded wheat biscuit, cracked wheat, oatmeal, farina, unsweetened zwiebach,
home made graham bread (a day old), carrots, white turnips, spinach, lettuce,
string beans, celery, stewed fruits, plums, peaches, or pears with thin
syrup, fresh apples, or grape fruit, nuts except almonds (unless blanched)
and soups not made from meat stock. Agar-agar owing to its affinity
for water makes the stools softer. It may be soaked in milk and eaten,
or boiled like oatmeal with a few mvfigs or other fruit to flavor it.
The equivalent of a few teaspoonfuls of the dried agar-agar is sufficient
daily for a child. An adult dose may even be half a cupful, measured
dry. A small baked sweet or white potato with the jacket on, to be
thoroughly masticated, is allowed occasionally. Hot water at meals
and a copious drinking of water daily, is employed on general principles.
Flesh, fish, fowl, oysters, shell fish and eggs are usually prohibited.
Food should in all cases be thoroughly masticated. Exercises
advocated by Dr. Watson L. Savage and others are the liver squeeze; flexion
of the knees on the chest; describing a circle with the feet, legs in apposition,
and knees not flexed; and other movements executed with the patient lying
upon a hard surface or table, and untrammeled by corsets, skirts or other
clothing. They are useful adjuncts in some obstinate cases.
These exercises should be done before breakfast, after drinking freely
Among mechanical means, the Taylor and Zander machines
were the forerunners of the mechanical method of today. They were
followed by the use of the oscillator which gives a general vibratory treatments
passive exercise of the body and the abdomen in particular. Such
treatment has proved very efficacious in the hands of some operators by
applying the belt to lumbar spine, to the side, over the liver, and to
the abdomen. The first treatment being from three to five and seven
minutes, the stroke being at first six millimeters, and later increased
to ten; with the motor speed adjusted to the patient's sense of greatest
efficiency which is usually at the highest rate. This treatment is
continued as a rule for about twenty-six days. Selective, harmonic
electric vibration is also a favored measure used by Dr. Morris W. Brinkmann.
THE TREATMENT OF CONSTIPATION BY MECHANICAL VIBRATION
calls for attention to a few details. (1) It is essential that the bladder
be emptied before the treatment is begun. (2) If the skin is sticky, owing
to excessive perspiration, dust the surface over the abdomen with talcum
powder. (3) The application of heat, dry or moist, to a hypersensitive
abdomen, before vibratory treatment will make the surface less sensitive.
(4) A high enema of warm water and soap-suds or a saline enema preceding
the local vibratory treatment is essential as a routine in obstinate cases
of constipation. (5) Relaxed abdominal muscles necessitating particular
attention to position, are a requisite.
The patient should be properly prepared. The
administrations can be made directly to the skin or over the undervest.
It is a waste of time and the unnecessary expenditure of much energy on
the part of the physician to attempt in any case to vibrate over other
clothing than an under garment.
The general vibratory treatment which should be instituted
on the first day of treatment consists of spinal stimulation followed by
an abdominal massage, and in most cases an internal rectal vibratory treatment.
Vibratory treatment of the liver and spleen is usually indicated.
The treatment should be thorough and given systematically with regard to
technique. The vibrations should be mild at first, then gradually
increased in pressure depending on the density of the part and the conditions
present. The system of bridging the condition of relief from treatment
to treatment, lessening the frequency as the requirements permit, is to
Moderate pressure is recommended to be applied between
the transverse processes on each side of the spine. Tolerance to
pressure increases during an administration and during the course of the
treatment. Pressure should be light at first, being gradually increased.
Too heavy pressure, especially when prolonged, inhibits, and may cause
nausea and weariness. Sensitiveness to impression is only an approximate
measure of irritability, for, as Luderitz found, the motor nerve fibres
are paralyzed sooner than the sensory by continuous pressure, which should
be taken into consideration.
The treatment should be administered with care to
avoid the production of contractions or pain. During the external
treatment pressure should be graduated in order to avoid the induction
of unpleasant effects. It is advisable always to begin the treatment
by vibrating the spinal nerves, using a small ball vibratode, employing
a medium stroke, and moderate pressure on each side of the spine, alternately
from above downward, to elicit points of tenderness. The sensitive
sites should be given slightly prolonged interrupted vibration. Otherwise
the spinal vibration should be limited to the nerves whose centers are
involved in the case under treatment. It is thought that the treatment
of opposite sides alternately intensifies the effect on nerve centers.
DIVULSION OF THE SPHINCTER is necessary in some cases.
This may be accomplished by mechanical vibration. A pyramidal vibratode
is employed, with fairly rapid speed, and full stroke, for five minutes
daily. The vibratode should be gradually introduced. As the
tissues relax it can be gradually worked inward.
ABDOMINAL VIBRATION has a curative effect on constipation,
assists digestion by increasing the functional activity of the pancreas,
liver and stomach, promotes muscular nutrition, increases absorption, and
renal elimination, strengthens the muscles of the abdomen, and increases
nervous and circulatory activity, and slows the pulse rate.
In treating the abdomen, apply compressing or deep
vibratory friction, employing a flat disc vibratode, using a medium stroke
for the purpose of relieving intestinal stasis and to assist in dislodging
feces, as well as to stimulate the vascular system.
It is always preferable, as there is apt to be a
quantity of feces present, to treat the lower part of the bowel as the
first step in the treatment. In that event, commence on the left
side a short distance from the sigmoid. Use vibratory friction downward
and inward six or seven times, gradually beginning higher up, finally proceeding
from beneath the ribs downward and inward to the point of termination.
Then vibrate the transverse colon, working from left to right, gradually
lengthening the line of advance as you approach and pass the median line.
Then begin a little below the hepatic flexure and apply vibratory friction
in the same manner as in the preceding description, using deep pressure
and moving upward six or seven times, gradually lengthening the line of
advance. Extend the vibration lower and lower until the caecum has
been thoroughly vibrated. Finish by a deep circular friction from
right to left, moving over the surface ten or twelve times, repeating the
operation if deemed necessary like cannon ball massage, using a ball vibratode
or the cap shield of some vibrators. The speed should be slow, because
parts containing unstriped fibres after being stimulated react "for a long
time after the stimulus is withdrawn."
In a Thirty-Velly fistula, Fubini estimated the rate
of motion of a smooth sphere of sealing-wax along the intestine.
It took 55 seconds to travel 1 cm. (2-5 of an inch). An induction
current greatly increased the motion, to 1 cm. in 10 seconds.
Landois and Stirling state that "the strong peristalsis
which precedes defecation, can be aided, and to a certain degree excited,
by rapid voluntary movements of the external sphincter and levator ani,
whereby the plexus myentericus of the large intestine is stimulated
mechanically, thus causing lively peristaltic movements in the large intestine."
These movements may also be excited by the action of mechanical vibration
by the employment of an internal rectal vibratode which procedure should
follow the abdominal vibration.
When administering an INTERNAL RECTAL VIBRATORY TREATMENT
the rectal vibratode should be well lubricated and introduced while in
motion to avoid shock. Great care must be taken, however, not to
overstimulate the intestine; lest dysperistalsis be induced. For
"all stimuli applied to the plexus myentericus increase the peristalsis
which may become so very violent as to cause evacuation of the contents
of the large intestine, and may even produce spasmodic contractions of
the musculature of the intestines." The administration should be
from three to five minutes, using a short stroke, and a rate of speed which
will give the maximum width to the loops that are formed by the vibration
of the vibratode. In some cases, the first treatment is made slightly
shorter. In using the short rectal vibratode have the patient lie
with his back toward the machine, and knees flexed. In many cases,
the treatment is more easily given when the patient is in the knee-chest
position. In very obstinate cases a flexible rubber vibratode, twelve
to fifteen inches long is of service, it being introduced while the patient
is in the knee-chest position. Duration of this treatment should
be about three minutes, a moderate rate of speed and full stroke being
employed. If the stimulus be strong and long continued, overstimulation
and exhaustion, otherwise termed "intestinal paresis," takes place, that
is, "continued congestion of the intestinal blood vessels ultimately causes
In chronic cases, and when impaction is present,
copious high injections of warm water are advisable, at first daily.
Care should be taken that these injections be properly administered ' which
under no conditions should be left to the patient, as in most cases it
will be improperly done. A special vibrating colon tube from eighteen
to twenty-four inches in length should be employed. Not more than
one, or one and one half quarts of quite warm water are generally necessary,
and it should be retained as long as conveniently possible, a saline solution
of one quart 1100 F, twice a week being advisable in some cases.
Such enemas increase the fluidity of the blood and assist the elimination
of "pathogenic toxic" wastes. With the patient in the knee-chest
position, and the rectal vibratode, well vaselined, inserted in the cap
shield and connected to the douche tank, start the vibrations and allow
some of the water to flow, to carry the air out of the tube. Then
slowly insert the tube while it is vibrating. Allow the vibrations
to continue while the first quart or half quart flows, then stop the vibrations
while part of the remainder flows. While the last part flows, continue
the vibrations. The following day an oil enema, 20 tablespoonfuls
or a cupful if sufficient, of warm olive oil are given in the same manner
to soften adherent masses. This enema is usually retained for twelve
hours, when but a cupful is used. Water and oil enemas are given
alternately until no hard scyballa appear in the movements. Rectal
vibratory treatment may be indicated in connection with the external treatment
for the purpose of toning up the bowels or to overcome spasmodic strictures.
When soap is mixed with the water-enema, green soap or soft soap is to
be preferred, as, according to Bolton, irritating rashes may appear "on
the day following the injection" when, hard soap is used. He makes
this statement from results from observation of 903 enemata.
Vibratory treatment of constipation should be administered
daily until the bowels move regularly, after which, for a time on alternate
days, gradually lessening the frequency as the bowels become normal.
The majority of these cases are practically cured in a few weeks' time.
A retroverted uterus which complicates the condition will require treatment.
The static wave current per rectum for twenty minutes every day for a month
during an intra-menstrual period and every other day the following month,
will in most cases remove this obstacle unless adhesions are present.
Mechanical vibration in conjunction with a regulated
diet together with systematic exercise, when indicated, is the treatment
excellence for constipation. When carefully administered, mechanical
vibration is absolutely painless, harmless, and productive of the most
CONTRA INDICATIONS FOR VIBRATORY TREATMENT are the
presence of ulcer, cancer, hemorrhage, acute inflammations or febrile states.
IN THE TREATMENT OF MUCOUS COLITIS as Koehler [Geo.
P. Koehler, M. D. Some Remarks on the Signa, Symptoms and Treatment of
Mucous Colitis. Medical Sentinel] has so well said it is best:
"1st. To eliminate as far as possible any known
"2nd. To use the best possible means of overcoming
stasis of the bowel, and procure, if possible, normal evacuations of the
"3rd. To use necessary means to restore and
improve the natural tone of the mucous membrane and muscular coats of the
Mucous colitis responds favorably to a daily
vibratory treatment of the abdomen when employed in conjunction with a
modified Van Noorden's diet [Van Noorden. Mucous Colitis],
which follows, together with exposure to the X-ray over the abdomen for
ten minutes every other day (one milliampere at 14 inches or an equivalent),
until a reaction occurs, and the wearing of a proper abdominal support
either a corset or abdominal supporter. Mechanical vibration to the
spine, liver, stomach and spleen are indicated if there is constipation.
Oil enemas, 20 tablespoonfuls of warm oil (pure olive oil, owing to deleterious
effects of an acid in cotton seed oil) may be injected through the rectal
vibratode (see Fig. 58). These are of the utmost importance.
Daily hot baths of very short duration or a cold sponge, when followed
by prompt reaction, and outdoor life are essentials.
Modified Van Noorden Diet
In the morning in bed at seven o'clock. -
Three-tenths of a quart of milk and cream (two parts of milk and one part
of thick sweet cream); then, usually, a rub with moderately cold water.
At eight o'clock. - One-half pint of Kissengen
water. It can be made from Kissengen tablets.
At nine o'clock. - Three-tenths of a quart
of the above milk-cream mixture or of thin tea or coffee with much cream;
sometimes, also cocoa prepared with cream. In addition one slice
of coarse bread, with butter.
At eleven o'clock. - Soup made from leguminous
plants; in addition whole -wheat bread with plenty of butter. Also
a glass of Kissengen water.
At one o'clock. - Some meat dish (the author
prefers none if indican present in urine). In addition vegetables
of different kinds (except onions, cabbage, or turnips), boiled or baked
potato with butter. Fruit with coarse skins and large seeds, as currants,
gooseberries, cranberries, boiled, or a pound of grapes. One glass
of Kissengen water. After eating rest in bed for an hour and a half
with hot applications to the abdomen.
At four o'clock. - A light lunch similar to
the breakfast, at nine o'clock. Then a walk of one and one-half to
At seven o'clock. - Supper like the dinner;
sometimes, also junket or fruit-soup. In addition a slice of graham
bread or zwiebaeli, unsweetened, with plenty of butter.
At nine o'clock. - Three-tenths of a quart
of the milk-cream mixture as in the morning.
This diet must be continued for some time, 6 months
or a year in some cases.
FLAT'ULENCE ["Aerophagia & Flatulenee."
C. 0. Spivak, M. D., Medical Record, April 29, 1905] may arise from:
"1. Fermentatioin. Food may undergo acid fermentation
(lactic, butyric) or alcoholic fermentation.
"2. Putrefactioin. Albuminous substances may
"3. Alimentary. Certain articles of food and
drink produce flatulency as cabbage, beans, peas, carbonated waters, etc.
"4. Intestinal respiration. Flatulence due
to exchange of gas (CO2 & N) between the blood and the contents of
the stomach and intestines.
"5. Aerophagia, or swallowing of air may cause flatulence.
Flatulence may cause palpitation, distress, shortness
of breath, irregular movements and pain, often supposed to be heart disease."
Abdominal vibration in connection with the
regulation of general hygiene, diet, and in some cases the use of a proper
abdominal support, are indicated. Spinal vibration applied at the
exit of the 6th, 7th and 8th dorsal nerves on the left side of the spine
sometimes causes eructation of gases. The ball vibratode is used here as
always for applying spinal vibration. Aerophagia calls for special
treatment ["Aerophagia & Flatulenee." C. 0. Spivak, M. D., Medical
Record, April 29, 1905] as an abdominal support and correction of habit.
REFLEXLY THE INTESTINES MAY BE CONTRACTED (Abrams)
by vibrating between the lst and 2nd and 2nd and 3rd lumbar vertebrae.
It is indicated in the treatment of atonic constipation. Abrams
believes that the circular fibres may thus be made tonic.
THE INTESTINAL RFFLEX OF DILATATION (Abrams) can
be elicited by concussion or vibration of the spine of the llth dorsal
vertebra. He recommends its induction in the treatment of spastic
constipation. He believes that it tones up the longitudinal fibres.
VIBRATORY TREATMENT OF THE RECTUM with the rectal
vibratode for five minutes, will tone up the parts and relax spasm of the
sphincters. Spinal vibration may or may not be necessary. Apply
prolonged rectal vibration for inhibition. Tenderness of the 4th
sacral nerve Cyriax [The Elements of Kellgren's Manual Treatment,
page 165] noted as often present in rectal affections.
IN THE TREATMENT OF DIARRHOEA colonic flushings -
vibratory or otherwise - are indicated followed by a leucodescent light
treatment for sedation. If dilatation of the stomach be present,
causing retention of food, then the stomach reflex of contraction should
be induced. The author has employed mechanical vibration between
the 10th and llth dorsal alternately with that between the lst and 2nd
and 2nd and 3rd lumbar vertebrae successfully.
Chronic diarrhea is sometimes due to irritation
caused by the presence of retained feces. In these cases a high enema
should be employed and may be followed with rectal vibratory treatment
or static electricity in the form of the rectal administration of the wave
current to tone up the parts. Abrams employs concussion alternately
on the spines of the first three lumbar and the 11th dorsal vertebrae.
THE KIDNEY "lies on the quadratus lumborum and psoas
muscles opposite the two lower dorsal and two upper lumbar spines; the
right about 3/4 of an inch lower than the left. The upper border
is on about a level with the space between the llth and 12th dorsal spines,
the lower border being as low as the third lumbar spine. "It is accessible
to pressure just below the last rib, on the outer edge of the erector spinae."
The nerve supply of the kidney is from the
"renal plexus, which is formed by branches from the solar plexus, the lower
and outer part of the semilunar ganglion, and from the lesser and smallest
splanchnic nerves." The vaso-motor fibres come from the spinal cord
mostly in the 10th to 13th thoracic spinal nerves (dog), and are likely
affected by reflex stimulation. "The vagus [Landois. Text-Book
of Human Physiology, page 516] innervates the intrinsic unstriated
musculature of the kidney."
Cl. Bernard and Eckhard [Landois and Stirling.
Text-Book of Human Physiology, 4th ed., page 545] claim that stimulation
of the splanchnic, whose "renal vaso-motor fibres, which, in part at
least, leave the spinal cord at the first dorsal nerve and pass into the
sympathetic nerve," causes less urine. Section of the renal nerves
causes polyuria "increased by stimulation of the spinal cord below the
medulla oblongata as the contraction of the blood vessels throughout the
body, still further raises the blood pressure within the glomeruli."
Irritation of the cervical sympathetic lessens the secretion [Landois.
of Human Physiology, page 516]. The vaso-constrictor nerves respond
to electrical stimulation when rapid and of short duration. Stimulation
of these causes a "shrinkage in volume of the whole organ [Howell.
of Physiology, page 811]. "Stimulation [Howell. Text-Book
of Physiology, page 811] of the peripheral end of the renal nerves
also causes a diminution in the volume of the kidney." "Vaso-dilator
fibres are best excited by slow rhythmical stimulation (2-5 shocks per
second)." According to Bradford [Howell. Text-Book of Physiology,
page 811] the vaso-dilators of the kidney come from the llth, 12th and
13th dorsal (dog) which when stimulated increase the functional activity
of the organ.
If the KIDNEY IS DISPLACED Kellogg's method of replacement
is as follows: After making movements to replace the stomach and bowels,
the operator proceeds as follows for the right kidney. (The same is true
for the left kidney and spleen, only "the fingers of the right hand" are
placed behind). "Standing upon the right side of the patient the
fingers of the left hand are placed behind, while those of the right hand
are placed upon the abdomen; and by movements of the two hands the location
of the kidneys is determined. While gently pressing the kidneys upward,
the patient is asked to take repeated deep breaths. With each exhalation
an effort is made to press the kidney up under the ribs of the right side
by gentle pressure. As it moves upward and approaches its position,
the right hand is shut and the closed fist is made to follow the kidney
and hold it in position while the patient takes a number of deep respirations."
This should be followed by abdominal vibratory friction for toning the
relaxed abdominal muscles and also to increase the elimination of urine
by accelerating the function of the kidneys and thereby increase the excretion
of "waste products, chiefly nitrogenous bodies and salts," the excretion
of water and perhaps even the reabsorption of "water from the uriniferous
The amount of urine secreted depends upon
the differences of pressure between the blood in the glomeruli and the
pressure within the renal tubules. "The secretion depends partly
on the blood pressure as in (1) Increase [Landois and Stirling. Text-Book
of Human Physiology, 4th ed., page 536] of the total contents of the
vascular system so as to increase the blood pressure (2) Diminution of
the capacity of the vascular system, provided the pressure within the renal
area be thereby increased, "which latter may be caused by stimulation of
the vaso-motor center," (3) Increased action of the heart." (4) The fullness
of the renal artery governs the rise or fall of urinary secretion.
The blood's composition also affects it slightly.
MECHANICAL VIBRATION MAY BE APPLIED TO THE KIDNEYS
as follows: With the disc vibratode apply interrupted vibration or frictions
over the kidneys. The 10th, llth and 12th dorsal nerves may be vibrated
at their exits with the ball vibratode to stimulate the renal plexus.
If vibrated anteriorly, frictions are given, from without inwards beginning
three inches above and three inches external to the navel after Cyriax's
THE KIDNEY REFLEX OF CONTRACTION [Abrams. Spondylotherapy,
page 360] is induced according to Abrams by concussion of the spine of
the 12th dorsal or 7th cervical vertebra. Vibration may be likewise
THE KIDNEY REFLEX OF DILATATION (Abrams) is elicited
by vibrating with the ball vibratode between the 6th and 7th and 7th and
8th dorsal vertebrae, or the 10th dorsal spine. In diseases of the
kidneys the 10th, llth and 12th dorsal nerves are tender [Cyriax.
The Elements of Kellgren's ManuaI Treatment, page 165].
Mechanical vibration may also be employed to relieve
when present in cases of renal trouble; the effect, however, is only palliative.
In certain conditions, especially inflammation of the kidneys, it must
be applied with the utmost caution.
THE BLADDER receives its vaso-constrictor neural
cells chiefly from the llth dorsal to the 2nd lumbar segments probably
occasionally from the 3rd and 4th lumbar segments, and its vaso-dilator
cells from the 3rd and 4th sacral segments (Arnold). Inhibition of
its muscular coat with contraction of the sphincter of the bladder can
be aroused in the 2nd, 3rd and 4th lumbar segments and the opposite effects
in the 2nd, 3rd and 4th sacral segments (Arnold).
INCONTINENCE is sometimes cured by applications of
supra-pubic mechanical vibration with the disc vibratode which may be applied
either by the interrupted or frictional method. Spinal vibration
may also be applied with the ball vibratode as indicated. "Kellgren
[Cyriax. The Elements of Kellgren's ManuaI Treatment, page 168]
found that vibrating or shaking over the bladder has the extraordinary
effect of relieving cough and rendering respiration freer. Sympathetic
nerves over the bladder [Cyriax. The Elements of Kellgren's ManuaI
Treatment, page 168] are affected by vibrations or shakings in an upward
direction just over the symphysis pubis about an inch from the middle line.
This often leads to an immediate desire on the part of the patient for
micturition; in some cases a rush, of blood to the head also ensues."
THE BLADDER REFLEX OF CONTRACTION can be elicited,
states Abrams [Spondylotherapy, page 359] "with one electrode over
the sacrum and the interrupting electrode at the spine of the 5th lumbar
vertebra." In disease of the bladder the sacral nerves particularly
the lst and 3rd are found [Cyriax. The Elements of Kellgren's ManuaI
Treatment, page 165] sensitive when the vibratode is applied to the nerve
MORPHINE HABIT AND ALCOHOLISM and other drug habits
in connection with moral restraints may be benefited by mechanical vibration,
either by employing Dr. Pilgrim's method of "mesenteric flushing" as described
in Chapter III, or by administering the abdominal and intestinal treatment
described in the preceding pages. For the insomnia and restlessness,
give a vibratory treatment to relieve the causes.
IN THE COCAIN HABIT peripheral circulation must be
strengthened and in alcoholism the vibration must be directed to
the strengthening of the feeble heart as well. (See chapter on Circulation.)
THE APPLICATION OF MECHANICAL VIBRATION TO THE TREATMENT
OF THE PELVIC ORGANS is indicated for the relaxation of contracted muscles
which should be treated as muscular contractions elsewhere. Applications
may also be made to the other organs and structures including the rectum,
the vagina, uterus, ovaries of the female, and male genital organs as indicated
for purpose of sedation or stimulation.
THE PELVIC PLEXUS SUPPLYING the rectum, bladder,
prostate, vagina and uterus, according to Gray, is formed "by branches
from the 2nd, 3rd, and 4th sacral nerves and by a few filaments from the
first two sacral ganglia."
The vaso-dilator neural cells for the uterus and
ovaries are chiefly in the 3rd, 4th and 5th sacral segments [Arnold. "Examination
of the Back." Medical News, March 18, 1905] and the vaso-constrictor
cells for the same organs are chiefly from the llth dorsal to the 2nd lumbar
segment, probably occasionally from the 3rd and 4th lumbar segments. Arnold
stated that inhibitory cells of the muscular coat of the Fallopian tubes
and uterus with those which contract the cervix, vagina and perineum are
chiefly in the 2nd, 3rd and 4th lumbar segments, and that the neural cells
for contraction of the Fallopian tubes and the muscular coat of uterus
with dilatation of cervix, vagina and perineum are in the 2nd, 3rd and
4th sacral segments.
THE MOTOR FIBRES OF THE UTERUS are supplied "from
the sympathetic chain, chiefly from the fourth to the sixth lumbar ganglia."
(Landois and Stirling.) If the hypo-gastric plexus, whose fibres come from
the "last dorsal and upper 3 or 4 lumbar serves, run into the sympathetic
and then reach the hypogastric plexus" (Frankenhauser), be stimulated,
uterine contraction is induced. If the nervi erigentes be stimulated,
movement results (v. Basch and Hofman). The uterus may be made
to contract reflexly by stimulating the central end of the sciatic.
Abrams states that REFLEX UTERINE CONTRACTION may
be induced by stimulation over the spines of the first three lumbar vertebrae.
Probably deep interrupted mechanical vibration between the 12th dorsal
and lst lumbar also between the lst and 2nd lumbar, and between the 2nd
and 3rd lumbar and between the 3rd and 4th lumbar vertebrae, the exits
of the last dorsal and first three lumbar nerves, will produce the same
Cyriax [Cyriax. The Elements of Kellgren's
ManuaI Treatment, page 235] observes that sometimes "supra-pubic uterine
frictions, at the side of the symphysis pubis about two inches from the
middle line will induce contraction of the uterus.
"Kumpf [Cyriax. Vibrations and Their Effects]
found very strong uterine contractions to arise from a vibrator, and a
less marked contraction from the use of manual vibrations. Lange
also obtained a stimulating effect with his vibrator."
PROLAPSE OF THE UTERUS may be treated by "lifting
up the protruding parts with simultaneous vibration" and interrupted vibration
over the posterior sacral nerves and the subtrapezial plexus (found in
the trapezium at a point in a line drawn from the middle of the clavicle
backwards) as suggested by Cyriax [Cyriax. The Elements of Kellgren's
ManuaI Treatment, page 160]. He states that pelvic disease is sometimes
associated with "chronic shoulder ache."
DISEASE OF THE GENITAL ORGANS is sometimes the cause
of tenderness of the 12th dorsal, 5th lumbar, and 2nd to 4th sacral nerves.
The 3rd sacral nerve is particularly sensitive in uterine inflammations
or displacements [Cyriax. The Elements of Kellgren's ManuaI Treatment,
page 165]. Interrupted vibrations are indicated over the site of tenderness.
MECHANICAL VIBRATORY TREATMENT of the pelvic organs
is valuable in AMENORRHEA, DYSMENORRHEA, VAGANISMUS, NON-INFECTIOUS ENDOMETRITIS,
METRITIS AND OOPHORITIS, RECTAL ATONY, SOME PROSTATIC CONDITIONS AND COCCYGODINIA.
IN AMENORRHEA treatment is directed to increasing
the metabolism due attention being given to diet, baths, outdoor life and
hygiene in genera. Locally a tonic spinal application is made externally
with the ball vibratode and a vibratory treatment of the liver, spleen,
stomach and abdomen with additional rectal supra-pubic and ovarian vibration
MECHANICAL VIBRATION IS CONTRA-INDICATED in pyosalpinx,
tumors, and pelvic abscess.
OVER THE OVARIES frictional or interrupted mechanical
vibration may be applied with the disc vibratode two inches internal to
and two inches below the anterior superior spine of the ilium downwards
MECHANICAL VIBRATORY TREATMENT OF THE VAGINA may
be employed in VAGINISMUS, vibrating either per vagina or from the rectal
site, using a vaginal or rectal vibratode. The vibratory treatment
should be continued for five minutes or more. A very efficient method
is the employment of a static current with the vaginal vacuum electrode
for fifteen minutes daily.
THE PROSTATE AND TESTICLES have their vaso-constrictor
supply from the llth dorsal to the 2nd lumbar segment, probably occasionally
in the 3rd and 4th lumbar segments. (Arnold.) The nerves of the prostate
gland are from the hypo-gastric plexus. The testicles have vaso-dilator
cells chiefly in the 3rd, 4th and 5th sacral segments. (Arnold.)
The visceral afferent nerve fibres which supply the prostate are governed
by the 10tb, 11th, 12th thoracic and the 1st, 2nd, and 3rd sacral.
The "motor nerves of the ischio-cavernosus and deep periueal muscles arise
from the 3rd to the 4th sacral nerves."
ENLARGED PROSTATE AND NON-INFECTIOUS PROSTATITIS
may be treated by the static current or mechanical vibration. When
employing mechanical vibration introduce a rectal or other specially constructed
soft rubber vibratode which has been previously well lubricated.
Insert the vibratode into the rectum while in motion.
The application should be continued for from three to five minutes or longer,
if so indicated. As with all intra-pelvic administrations the bladder
and bowels should be evacuated before treatment. This method is of
no avail in the treatment of chronic enlargement with hyperplasia.
It "accelerates the function of the glandular epithelium," and causes a
"more abundant afflux of blood, which favors filtration."
Schmidt believes that the cases of chronic prostatitis
that are most benefited are "(1) where mental condition is influenced by
prostatic results; (2) where there are small inflammatory foci; (3) isthmical
inflammations combined with old infiltrations in the prostatic urethra;
(4) simple sexual exhaustion." The treatment par excellence for this
condition is the static wave current per rectum with a metal electrode
for twenty minutes (Snow). X-ray is sometimes indicated.
BUBO following specific urethritis, has been reported
as successfully treated by Dr. Fechner of New York, in which cases "application
by deep pressure was made over the 8th and 12th dorsal and 5th lumbar spinal
nerves, and to the inguinal glands."
IN COCCYGEAL ANTERIOR OR LATERAL, DISPLACEMENTS,
the contracted muscles about the part should be treated with local interrupted
vibration with the disc vibratode. After which introduce the rectal
vibratode into the rectum, the left hand being placed over the coccyx,
the patient lying on her right side with the knees drawn up. Apply
prolonged vibration with suited pressure to relax the contracted parts
in order that the coccyx may resume its normal position. Posterior
displacement will require prolonged heavy vibration with the disc vibratode
over the posterior surface of the coccyx. Care must be exercised
not to apply too much force. If the parts are sensitive very light
pressure should be used at first and the pressure should be gradually increased.
The static wave current applied by means of a metal electrode fitted over
the coccyx relieves tension and soreness. The brush discharge as
well as vibration is excellent for removing the bruises as well as lessening
In the treatment of pelvic conditions mechanical vibration
can often be employed to advantage in connection with light, electricity, hydrotherapy,
or exercise according to indications.