M. L. H. Arnold Snow, M.D.
The Relation of Mechanical Vibration to the
Heart, Blood-Vessels, and Ductless Glands
PERCUSSION OF THE HEART yields dulness of two type - superficial
and deep. (1) Superficial or absolute dulness is elicited by weak percussion
only, representing "that portion of the heart not covered by lung tissue."
A small part of the heart posterior to the sternum and uncovered by lung tissue
yields a resonance because "the percussion blow is conveyed by the sternum to
the adjacent lung structure." (2) Deep or relative dulness is elicited by strong
percussion. The deep cardiac dulness, which concerns us in the study of
the heart reflex of Abrams, "extends vertically from the 3rd rib and ends at
the 6th, but owing to the cardiac merging in the hepatic dulness, this lower
limit cannot be accurately ascertained, while transversely at the 4th rib it
extends from just within the nipple line to slightly beyond the right of the
THE AREA OF CARDIAC DULNESS varies in pathological conditions, and as
any change from the normal should be considered when studying the reflex
action of the heart, a brief summary of such changes is here noted.
In hypertrophy and dilatation it is increased from above to the left and
downward when the left ventricle alone is involved. The dulness is
"broader and increased toward the right side" when the right ventricle
is involved. When there is hypertrophy of both ventricles "the apex
beat is rounded and diffuse." In hydro-pericardium the outline of "precordial
flatness is a blunt cone" and different positions change the area.
The presence of tumors, pleuritic effusions on the left side, retraction
of the lung, or "infiltration of lung adjacent to the heart" may apparently
increase the cardiac dulness when the heart is normal. Diminished
area of dulness is found in atrophy of the heart, absorption of fat in
wasting disease, emphysema of the lung and mediastinum, and pneumo-pericardium.
For diagrammatic illustrations of heart dulness in disease the reader is
referred to Butler's "Diagnostics of Internal Medicine."
A BRIEF REVIEW OF THE NERVOUS MECHANISM OF THE HEART is of value in
the analysis of vibratory or concussional effects upon the heart.
The heart's action according to Howell [Text-Book of Physiology],
is under control of:
"1. Efferent nerve fibres from the central nervous system through the
vagus nerves (inhibitory nerve fibres). Their stimulation slows or
stops the heart beat.
"2. Efferent nerve fibres from the central nervous system through the
sympathetics (accelerator or augmentor fibres). Their stimulation
accelerates or increases the force of the heart beats.
"3. Afferent nerve fibres. Their stimulation pathologically may
cause sensations of pain."
The branches of the vagus [Cunningham's Manual of Practical Anatomy,
page 67] supplying the heart are:
"l. Cervical branches, except lowest on each side, as a rule join the
sympathetic cardiac branches and lose their identity. The lowest
cervical cardiac branch of left pneumogastric goes to the superior cardiac
plexus. The lowest cervical cardiac branch of right pneumogastric
goes to right portion of deep cardiac plexus.
"2. Thoracic cardiac branches are from trunk of right pneumogastric
and go to deep plexus.
"3. Recurrent laryngeal branches of pneumogastric go to deep plexus."
The cardiac branches of the sympathetic are:
1. Upper sympathetic cardiac from upper cervical ganglion.
2. Middle sympathetic cardiac from middle cervical ganglion.
3. Lower sympathetic cardiac from lower cervical ganglion.
The cardiac branches of the vagus and of the sympathetic
form the cardiac plexus which are tabulated by Cunningham as follows:
|a. "Superficial cardiac plexus"
||1. Superior cardiac branch of evmpathetic of left side.
2. Lowest cervical cardiac branch of left pneumogastric.
|b. "Left portion of deep cardiac plexus"
1. It gives off a branch to left auricle.
2. A branch to left anterior pulmonary plexus.
3. To form left coronary plexus.
|1. Middle and lower cardiac, branches of
sympathetic of left side.
2. Upper two cervical eardiae branches of pneumogastric.
3. Cardiac branches of the left recurrent laryngeal.
|c. "Right portion of deep cardiac plexus"
1. It gives off a branch with filaments for right auricle.
2. A branch to right anterior pulmonary plexus.
3. To join superficial cardiac plexus and form right coronary plexus.
|1. Three cardiac branches of sympathetic of right side.
2. Cervical cardiac branches of right pneumogastric.
3. Thoracic cardiac branches of the right pneumogastric.
4. Cardiac branches of the right recurrent laryngeal.
The influences of the cardiac nerves have been summarized
by Engelmann [Howell. Text-Book of Physiology, page 565] as
"l. The chronotropic influence, affecting the rate of contraction.
a. Positive chronotropic actions causing an acceleration
of the rate.
b. Negative chronotropic actions causing a slowing
of the rate.
"2. The bathmotropic influence, affecting the irritability of the muscular
"3. The dromotropic influence a:ffecting the conductivity of the tissue.
"4. The inotropic influence affecting the force or energy of the contractions.
THE IRRITABILITY OF THE HEART is of concern to the
student of vibration.
Landois [Text-Book of Human Physiology, page 115]
1. A weak stimulus alone not of sufficient strength to affect the heart
when repeated may affect the heart as "the heart is capable of summation
of individual stimuli.
2. A stimulus (even the feeblest) that will excite a contraction has
"a maximal effect." (Bowditch, Kroiaecker and Stirling).
THE MAGNITUDE of the heart's beat depends not on
the magnitude of the stimulus, but on the condition of the ventricle (or
the heart) [Foster. Text-Book of Physiology, page 303]. This
probably explains why one operator might obtain no result from vibration
and another operator would get results, the element of strength and the
number of stimuli being important.
THE CARDIO-INHIBITORY CENTER can be stimulated reflexly
[Landois and Stirling. Text-Book of Human Physiology, 4th
Edition, page 849] by stimulating sensory nerves; or the central end of
one vagus, if other intact, or by stimulating the sensory nerves of the
intestines, which "arrests the heart's action," as proved by the tapping
experiment of Goltz. Stimulation of the cervical sympathetic, the
abdominal sympathetic or the splanchnic nerve directly (Asp and Ludwig)
produces the same effect. "Very strong stimulation of the sensory
nerves, however, arrests the above named reflex effect upon the vagus.
The action of the heart may be arrested by stimulation of the vagus, not
only by means of electrical stimuli but also by chemical (common salt,
glycerine), or by mechanical stimuli. As a rule, the right vagus
is more powerful than the left." The vagus lies under the sterno-mastoid
between the internal jugular vein and the internal and common carotid arteries.
Cyriax [The Elements of Kellgren's Manual Treatment, page 159] has
the patient bend "the head forwards or sideways" and by passing the finger
"in front of the muscle or behind it" and giving friction "transversely
across the nerve, cardio-retardation or
eructations or even vomiting may result." If mechanical vibration
is used in the same manner the soft cup-shaped vibratode is to be preferred.
The automatic rhythm of the heart, the force of its contraction, and the
power of conduction ("the capacity for conducting muscular contractions")
are influenced by stimulation of the vagus. Abdominal vibration with
the disc vibratode and cap shield has been found by the author to lessen
the pulse rate. "The inhibitory neural cells for the heart are located
in the nuclei of the 10th and llth cranial nerves and their paths to the
heart are through the 10th nerve." (Arnold.)
A rhythmical interrupted stimulus of a frequency
of eighteen to thirty per second is necessary to produce cardiac inhibition.
Sajous' [The Internal Secretions and the Principles
of Medicine, page 452] recent conclusions relative to the heart, are
"Inhibition is a morbid process due to excessive
vasomotor contraction of the coronaries causing a reduction in the quantity
of blood supplied to the heart walls.
"1. No cardiac inhibitory apparatus exists as a physiological entity.
"2. Active inhibition of the heart may be caused by excessive stimulation
of the vagus. "Abrams considers that the best site for exciting the
vagus is "the region of the spine in juxtaposition to the vertebral exits
of the upper spinal nerves (at about the spinous process of the 4th dorsal
The writer has demonstrated that if the ball vibratode
be applied on each side of the spine alternately between the transverse
processes of the 7th cervical and lst dorsal or 2nd and 3rd or 3rd and
4th dorsal vertebrae for five minutes the pulse rate will often be lowered.
THE RELATION OF THE HEART BEAT TO THE PRESSURE is
thus stated by Foster [Text-Book of Physiology, page 323]
"'The rate of the beat is in inverse ratio to the arterial pressure,'
a rise of pressure being accompanied by a diminution, and a fall of pressure
by an increase of the rate of the rhythm. This, however, only holds
good if the vagus nerves be intact. This is opposite to what we would
naturally expect; for a high blood pressure means an increased resistance
to the ventricular systole and a larger quantity of blood flowing through
the coronary arteries, and naturally with a resulting increase in the heart's
action, we would expect an increase "in the rate of rhythm as well as in
the force of the individual beats." [Text-Book of Physiology, page
In one instance the pulse rate was lowered by the
writer from 87 to 69 with a five-minute vibratory treatment, and the pressure
was lowered at the same time 4 mm. which does not conform to Foster's law.
The writer has also noted a lowering of both pulse and arterial tension
from intervertebral vibration between the 2nd and 3rd dorsal vertebrae.
The following case is illustrative.
||tension 152 mm.
||tension 144 mm.
The arterial tension was reduced by the writer in
one case from 188 to 180 mm., and the pulse rate from 96 to 90 by intervertebral
vibration between the 7th cervical and the lst dorsal vertebrae.
Cyriax cites a case where accompanying other conditions
there was irregular heart action, the "whole body shook, and every third
or fourth beat was missed," with a systolic murmur in the mitral area.
Pulse was 130 per minute. "Heart vibration (manual) and shaking with
frictions on the left 4th and 5th dorsal nerves near the spine, together
with stomach exercise, caused the "intermittency and irregularity to almost
disappear" and the pulse fell to 108. Sleep followed. The symptoms
returned the next morning. The same treatment relieved the heart
condition and the pulse fell to 100. Sleep followed. On awakening
the heart was better - more regular, and the intermittencies and the murmur
had disappeared. The pulse was 112. Treatments were continued
twice daily for the next two days, when the "heart was quite normal beyond
slight acceleration of pulse."
Landois [Text-Book of Human Physiology, 4th
edition, page 759] states that the vagus can be stimulated mechanically
occasionally by digital "compression against the cervical portion of the
vertebral column, but alarming attacks of syncope have been observed to
follow this procedure." Arterial tension was also reduced in another case
by the author from 120 to 112 mm. and the pulse rate from 86 to 80.
Apparently the vagus was affected or "efferent nerve fibers from the cerebral
nervous system through the vagus" or the adrenals were affected. There
at least resulted a "reduction of the vagal vibratory rhythm" causing a
lower number of heart beats per minute. Butler believes that "a decreased
pulse rate may be due to pneumo-gastric irritation or paralysis of the
cardiac sympathetic nerves and ganglia."
"3. Passive inhibition of the heart is primarily due to
insufficiency of the adrenals."
The reasons for this are embodied in the following
general summary of the functional mechanism of the heart:
"1. The nervous supply of the heart is derived from the general motor
(sympathetic) and vagus systems.
"2. The general motor plexuses and nerves maintain the normal tonic
contraction of the coronaries and other cardiac vessels and insure distribution
of the blood among the muscular elements.
"3. The vagal plexuses and nerves incite and govern the rhythm of the
heart, reducing or increasing its beats.
"4. Increase of the vagal vibratory rhythm (impulses) causes quickening
of the heart-beats.
"5. Excessive vibratory rhythm of the vagus (or spinal accessory) causes
arrest of the heart-beats: i.e., inhibition.
"Foster believes [Text-Book of Physiology,
page 313] that spinal accessory nerve fibres pass from the bulb to become
a part" of the vagus trunk in the dog and that these spinal accessory fibres
supply the inhibitory fibres to the heart. The spinal accessory nerve
can be reached "at about the middle of the posterior border of the sterno-mastoid"
or "at a point in the trapezium in a line drawn directly backwards from
the middle of the clavicle." (Cyriax.)
" 6. Reduction of the vagal vibratory rhythm causes, when physiological,
slowing of the heartbeats.
" 7. Reduction of the vagal vibratory rhythm, when pathological, especially
when due to adrenal insufficiency, results in quickening and weakening
of the heart-beats, through loss of vagal control.
"8. Cessation of the vagal vibratory rhythm (as after division of the
vagus on both sides) is followed by marked quickening and weakening of
the heartbeats, through loss of vagal control.
The preceding summary gives a physiological working
basis for vibratory research work in connection with the treatment of certain
cardiovascular derangements both functional and organic.
Kirke states that in a frog the heart's condition,
site of stimulation and intensity of stimulus applied to the vagus determine
the resulting effects, inhibition or increased activity. Varying
results are obtained [Foster. Text-Book of Physiology, page 308]
depending upon whether "we stimulate (1) the vagus in the cranium before
it is joined by the sympathetic, (2) the sympathetic fibres before they
join the vagus, (3) the vagus trunk containing both the real vagus and
the sympathetic fibres. A very prolonged inhibition [Foster. Text-Book
of Physiology, page 309] may be produced by prolonged stimulation.
The total effect of stimulating the vagus fibres is not to exhaust the
heart, but rather to strengthen it; and by repeated inhibitions carefully
administered, a feebly beating heart may be nursed into vigorous activity."
It is under such conditions that a person who has fainted can be revived
by spinal concussion of the 7th cervical vertebra or by intervertebral
vibration between the 7th cervical and the lst dorsal vertebrae.
ACCELERATION OF THE HEART BEAT or strengthening of
the contraction of the heart (Heideinhain and Lowit) or the latter effect
only may be induced by stimulation of certain accelerating fibres in the
cervical sympathetic. (Pawlow.)
Foster [Text-Book of Physiology, page 317]
says that stimulation of the augmentor fibres sometimes "increases the
rapidity of the rhythm," which increase may be conspicuous or slight, and
yet "a more constant and striking effect is the increase in the force of
the beat. The output of the heart is increased, which may occur in
spite of a concomitant rise of arterial pressure so that the effect of
the action of the augmentor nerves is distinctly to increase the work of
the heart, and this may take place even though no marked acceleration occurs."
These facts should be considered when employing mechanical vibration.
THE ACCELERATOR CENTER is believed by Howell [Text-Book
of Physiology, page 575] to be in the brain. He says, that "since
stimulation of the upper cervical region of the cord causes acceleration
it seems evident that the paths must begin somewhere in the brain." The
accelerating [Arnold. "The Importance of the Physical Examination of the
Back in General Diagnosis." Medical News, March 18, 1905]
set of neurons for the heart come principally "from the sixth cervical
to the first or second dorsal segments.
Experimentally the accelerators are stimulated [Howell.
Text-Book of Physiology, page 573] in branches communicating with the
inferior cervical ganglion, or the stellate, the first thoracic ganglion,
The inferior cervical ganglion may be vibrated
by applying the vibratode on the head of the first rib, the head articulating
with the body of the 1st dorsal vertebra, on each side of the spine.
It communicates with the 7th and 8th cervical (Krause says 8th cervical
and lst dorsal) spinal nerves whose exits are reached between the transverse
processes of the 6th and 7th cervical, and the 7th cervical and lst dorsal
vertebrae. Anteriorly the inferior cervical ganglion is "behind the
clavicular insertion of the sternomastoid."
The sympathetic [Foster. Text-Book of Physiology,
page 309] was stimulated in the neck, at Sy. Fig. 40 the nerve being
cut below so impulses could only "pass up to the vagus and then
down the mixed vagus trunk to the heart. The beat of the heart was
augmented." The beats increased in frequency or force or most generally
in both. "A heart which has almost ceased to beat by proper
stimulation of the sympathetic may be called back into vigorous
activity." Sajous [The Internal Secretions and the Principles
of Medicine, page 446] says, "that we are here dealing with
stimulation of the adrenals, seems probable. The anterior
pituitary body becomes activated under these circumstances, through
the carotid plexus." Not only is the vagus stimulated, but
the suprarenal glands are stimulated, which Sajous says represents
"the most effective means to bring about the effects witnessed."
"This is affirmed by Foster who says that the augmentation resulting
from the stimulation of the sympathetic is followed by a period
of reaction in which the beats are feebler, in other words augmentation
is followed by exhaustion and indeed by repeated stimulation
of these sympathetic fibres, a fairly vigorous heart, especially
a bloodless one, may be reduced to a very feeble condition.'"
Sajous believes that the vagus incites and governs the active stage
of the functional processes, of the heart and other organs supplied
by it. He also believes that: stimulation of augmentor fibres
affects first the adrenals and secondly the vagus. Foster
[See Fig. 40] "traces augmentor
fibres in a frog from the spinal cord by the anterior root of the
third spinal nerve through the ramus communicans to the corresponding
sympathetic ganglion G" and thence by the second ganglion G", the
annulus of Vieussens, and the first ganglion G' to the cervical
sympathetic Sy and so by the vagus trunk to the superior vena cava."
The course of the augmentor and inhibitory fibres in a dog is represented
in Fig. 41.
The same authority [Foster. Text-Book of Physiology, page 316]
says that stimulation of these several cardiac nerves has shown the presence
of augmentor fibres "in some or other of the nerve, passing from the lower
cervical ganglion (middle cervical ganglion?) and the adjoining vagus trunk
from the annulus of Vieussens, especially the lower ventral limb, and sometimes
from the stellate ganglion itself (receiving branches from the lst, 2nd,
and 3rd thoracic spinal nerves and from the 7th and 8th cervical nerves).
The results differ a good deal in different individuals, and there are
reasons for thinking that the nerves in question may contain efferent fibres
other than augmentor fibres by reason of which stimulation of them may
give rise to
other than pure augmentor effects."
The application of mechanical vibration between the
transverse. processes of the 7th cervical and lst dorsal vertebrae, where
the 8th cervical nerve has its exit often results in a lowering of the
pulse rate as the following cases illustrate.
Miss N. Sitting, pulse 82; lying, pulse 76.
Mr. T. Sitting, pulse 84.
After five minutes' application of vibration between
the transverse processes of the 7th cervical and lst dorsal vertebrae on
each side alternately.
Miss N. Sitting, pulse 76; lying, pulse 72.
Mr. T. Sitting, pulse 80.
Sometimes but more rarely vibration applied over
the same site gives accelerating effects as:
Mr. -. Sitting, pulse, 74.
After five minutes' vibration.
Sitting, pulse 80.
V. Bezold and others have observed that some accelerating
fibres are found in the cervical sympathetic. A few accelerating
fibres reach the heart through the vagus and their stimulation may cause
an accelerated heart-beat or strengthen cardiac contractions. The
excitability of the inhibitory vagal fibres is exhausted more quickly than
that of the accelerating fibres, "but the vagus fibres are more excitable
than those of the accelerans." [Landois & Stirling. Text-Book
of Human Physiology. 4th ed., page 854]
The same authors state that if the nervus accelerans
is stimulated, a long latent period ensues before the frequency
of the heart-beat is affected. If the vagus and accelerans fibres
are stimulated at the same time, only the inhibitory action of the vagus
is induced. If during the stimulation of the accelerans the vagus
is suddenly stimulated a reduction occurs in the number of heart-beats;
but if vagal stimulation ceases an accelerating effect is again noted.
Adrenals tend to strengthen and reduce pulse-rate, but vagus
under excessive oxidation tends to quicken it.
The preceding offers an explanation of the varying
effects obtained from the application of mechanical vibration over the
same site, the element of time - duration of treatment - being important.
When vibration was given between the transverse processes of the 7th cervical
and the 1st dorsal vertebrae in all cases of cardiac insufficiency that
were associated with a high arterial tension, and in most other cases of
high tension where vibration has been applied between the transverse processes
of the second and third dorsal vertebrae the result has been a lowering
of the blood pressure usually accompanied by a lowering of the pulse rate.
An increased frequency in the pulse rate has been the exception, not the
rule. Occasionally only a strengthening of the pulse beat has occurred
with no variation in frequency.
Butler [Diagnostics of Internal Medicine,
page 370] believes that "increased frequency of pulse may be due to paralysis
of the pneumogastric or to irritation of the sympathetic nerves or the
It is "evident that stimulation of the 'augmentor'
fibres," says Sajous [The Internal Secretions and the Principles
of Medicine, page 449] "increases the rapidity and the force of the
heart-beat by increasing the functional activity of the adrenals and, as
a result of the increased oxidation processes thus obtained, that of the
vagal centers. The excess of adrenal secretion increases the force
of the heart-beats, while the overactivity of the vagal centers increases
their number." Foster [Text-Book of Physiology, page 317] says,
that when the augmentor fibres are stimulated "in the case both of the
auricles and ventricles the extent of the systole is increased. It
would seem also that both cavities undergo a larger expansion. They
are filled with a larger quantity of blood during the diastole." The heart's
work is increased.
Von Ziemssen found that when mechanical stimuli
were applied to the heart from without, "slight pressure on the auriculo-ventricular
groove caused a second short contraction of both ventricles after the heart-beat."
Strong Pressure causes the cardiac muscle to act very irregularly.
This fact should therefore be considered when exerting pressure with the
vibratode over the heart muscles.
Cyriax [Elements of Kellgren's Manual Treatment,
page 192] who has used manual vibrations over the heart believes "that
the vibrations act by tending to restore the normal equilibrium between
the two sets of fibres, augmentor and inhibitory, which has become disturbed
through increased or decreased excitability of either of them and refers
the reader to Levin's [Tidskrift. Gymnastik, 1892] statistical report
regarding the effect of heart vibration. He noted that in pathological
conditions of the heart, tenderness over the 4th and 5th dorsal nerves
of the left side was elicited by frictions over said nerves.
The nervous system as a medium for influencing the
heart's functions is a most important field for the application of vibratory
stimulation. Oertel and Graham have for years obtained good results
from local treatment so directed. Yet some who consider vibratory
stimulation of the nerves of prime importance, vibrate other parts as well.
The branches of the spinal nerves sometimes apparently govern more than
one function as in the vagus of the frog, the stimulation of which may
cause either inhibition or increased activity, "according to the position
where the stimulus is applied, the intensity of the stimulus aiad the condition
of the heart." [Baker and Harris. Kirke's Handbook of Physiology]
Since the limitations of spinal stimulation are not
as yet fully demonstrated it will take time and experience with the administration
of mechanical vibration and other physical measures to discover their relative
The nerves in their various relations will be more
fully considered in a following chapter. Local or central stimulation
requires selective study of the pathological conditions present to be corrected
employing the treatment indicated as based upon the findings and the demonstrated
physiological action of mechanical vibration.
VIBRATION OF THE HEART according to Oertel's or Kellogg's
method of manual massage may be accomplished with a nicety of precision
and control of force hardly possible to obtain with the hands. With
the patient standing, use vibratory friction over the chest walls downward
and inward from the axillary line. For this purpose a rubber-covered
disc vibratode is preferable. Applied in this manner it helps to
perfect expiration and favorably influences the heart's nutrition.
It is so used in the following conditions:
"l. When the heart muscle is weak from deficient nutrition, Anemia or
"2. When the arterial system is imperfectly filled and there is passive
congestion as a result of insufficiency of the myocardium.
"3. When there are valvular lesions or obstruction to the circulation,
the pressure of tumors, or contraction of the pulmonary orifice.
Emphysema and curvature of the spine increase the demands of the heart.
"4. As an accompaniment of treatment of the heart by mountain climbing.
Kellogg advocates the period during expiration as
the time best adapted for massage of the heart. He wishes the patient
to recline, and then manual massage is directed from each axilla "toward
the sternum," at the same time applying the greatest force "between the
fifth and eighth ribs, the maximum of pressure falling over the latter."
THE PHYSICAL AND PHYSIOLOGICAL EFFECTS OF VIBRATORY
STIMULATION ON THE CIRCULATION will vary with the methods of administration
and other physical conditions. When the circulation is accelerated
by vibratory stimulation the increased heart's action usually indicates
a rise in the arterial tension. Lessened frequency is usually found
with lowered tension, dilatation of the blood vessels and increased production
of heat. Reflexly an alteration in the exchange of oxygen and CO2
in the lungs produced by the greater demands for tissue combustion affects
the respiration. Mechanical vibration can be so applied as to restore
the equilibrium of the blood stream and raise the temperature of the, body.
THE EFFECT OF VIBRATION ON THE HEART and blood vessels
is described by Cyriax ["Vibrations and Their Effects." Lecture given before
the Ling Association, London, on January 5, 1906] as follows:
"(a) On the heart. That vibration can
diminish an excited cardiac action has been shown by Winternitz, Levin,
Hasebroek, Nebel, Ziegelroth and Achert. Siegfried found very little
effect, Bechterew and Tschigawej, a varying one.
"In stoppage of the heart during chloroform administration
Strassmann, Korte, and Kumpf, found a strong manual vibration on the heart
one of the best methods of causing it to beat again." (Heart reflex of
"Heitler found that vibration of the heart set up
by the so-called hacking over it raised the tone of the cardiac muscle
and diminished the size of the organ. (Abrams' heart reflex. Snow.)
"The theory that heart vibration acts chiefly in
a reflex way through the sensory nerves and the vagus has been advocated
by Heiligenthal, Nebel, Murray and Lorand. Bjorksten and Ziegelroth
on the other hand, considered that it acted directly on the heart itself;
Heitler and Hasebroek incline to this view."
From recent investigations the author may add that
mechanical vibration may be applied to induce either an inhibitory action
through vagal stimulation, or the heart 's action may be accelerated.
The pulse rate may also be accelerated or diminished.
(b) On the blood vessels. Most authors, Bjorksten, Zander,
Bechterew, and Colombo, consider that the effect of vibration is to cause
the blood vessels to contract and the blood pressure to rise, though, according
to some of these mentioned, a subsequent dilatation with fall of blood
pressure may result. (The blood pressure may be made to fail or rise.
THE HEART REFLEX described by Abrams [Spondylotherapy.
The Heart Reflex of Contraction, page 201] is elicited by: "1. Irritation
of nasal mucosa. 2. Irritation of gastric mucous membrane. 3. Irritation
of rectal mucosa. 4. Irritation of oesophageal mucosa in act of swallowing.
5. Percussion of muscles. 6. By psychic influences." 7. By intervertebral
vibration, or vertebral concussion of the 7th cervical vertebra.
This reflex he describes as "a contraction of the myocardium of varying
duration." This may be due to an effect sometimes observed by stimulating
the accelerators, i.e., to "strengthen the contraction of the heart,"which
may establish an equilibrium, or accepting Sajous' views the action may
be due to a secondary effect on the vagus and indirectly on the adrenals.
This effect may be induced by an interrupted vibration or concussion applied
to the spine of the 7th cervical vertebra, or as demonstrated by the author
by interrupted vibration applied between the transverse processes of the
7th cervical and lst dorsal vertebrae. Abrams observed that although
the reflex is usually more noticeable in the left ventricle, in some cases
it is confined to the left ventricle; but, on the other hand, when muscle
percussion is used the right ventricle only contracts. Normally this
is of short duration.
It is of interest to note the effect of manual frictions
on "the lower cervical nerves of the sympathetic system as observed by
Cyfiax. [Elements of Kellgren's Manual Treatment, page 162]
"As a general rule there is temporary vaso-constriction
is followed by a certain amount of vaso-dilatation with improved and slowed
cardiac action." Fainting may often be relieved by this method.
To ELICIT THE HEART REFLEX OF CONTRACTION the writer
uses a ball vibratode with a vibrator regulated to give a percussion stroke
of rather low rate. If the vibrator is applied over the spine of
the 7th cervical vertebra, the part should be first powdered with a dusting
powder and the vibratode be applied over an intervening thickness of rubber
belting or leather for protection of the tissues from the friction.
The application should be usually for three minutes with a few interruptions.
After a rest of one minute, another seance of five minutes is given if
the response has been inadequate. Care must be taken not to use too
great pressure and no friction should under any condition be allowed, otherwise
it may chafe the skin. If intervertebral vibration is employed, the
ball should be applied directly upon the skin, alternately on each side
of the spine between the transverse processes of the 7th cervical and lst
dorsal vertebrae. A medium rate of speed and full stroke should be
used. The latter is the method preferred by the writer. The
patient may either sit erect, or lie upon an operating table face down,
during the administration.
If mechanical vibration is applied to the PRECORDIAL
REGION to induce the reflex, the rubber-covered disc vibratode is used.
The author reduced the blood pressure 10 mm. on two occasions with local
vibratory treatment over the heart in the case of a child. Dr. Peckham
has employed local heart vibration with spinal vibration and auto-condensation
and is convinced that the local heart vibration is a great tonic.
In determining the heart reflex of Abrams the deep
cardiac dulness only is to be considered for the area of superficial
dulness will vary with "the position of the overlapping lung-borders."
These are of course affected by stimulation of the lung reflex of dilatation
"which may diminish the area of superficial dulness even to obliteration."
[Abrams. Spondylotherapy, page 204]
IN RELATIVE VALVULAR INSUFFICIENCY, in cases in which
the valves are otherwise normal, but relaxed and not competent to close
the orifices completely, permitting regurgitation, the murmur as present
has been caused by Abrams to temporarily disappear by an induction of the
heart reflex. The effect is to overcome the dilatation of one of
the chambers of the heart, which in these cases is always distended with
blood and incompletely discharging its contents at systole. He used
the sinusoidal current or mechanical percussion over the precordial region
with a percussion hammer to induce the reflex.
CARDIAC INSUFFICIENCY due to myocardial changes or
valvular lesions occurs: 1. When hypertrophy does not follow. 2. When the
hypertrophied heart is overworked. 3. When degeneration takes away its
When due to myocardial disease it occurs as follows:
[Abrams. Spondylotherapy, page 213]
"1. Arrhythmic form: pulse is irregular, intermittent and lacks force
"2. Form with accelerated pulse (tachycardia) and paroxysms of palpitation.
"3. Form with attacks of pulmonary oedema and cardiac asthma, with dyspnoea
equally inspiratory and expiratory."
Abrams states that in these cases if "a good heart
reflex can be obtained the prognosis is as a rule favorable." He induces
the reflex by his method of vertebral concussion of the spine of the 7th
cervical vertebra. The author elicited the same reflex by prolonged
vibration between the transverse processes.
This is accomplished by interrupted vibration with
the ball vibratode applied alternately on each side of the spine, between
the transverse processes of the 7th cervical and 1st dorsal vertebrae,
employing moderate pressure and a fairly low rate of speed for three or
five minutes with one long and several short intervals of rest. The
author has employed this method with gratifying results in the treatment
of cardiac insufficiency characterized by arrhythmia.
TO TEST MYOCARDIAL INSUFFICIENCY Abrams compares
the blood pressure taken previously with the blood pressure taken after
the heart has been concussed with a pneumatic hammer. If the latter
mvfigure shows a marked increase, the myocardia is held to be very strong;
if there is a marked decrease, myocardial insufficiency is present; if
there is a difference of but a few millimeters, there is indication of
myocardial sufficiency. The author noted the following:
Mr. L.'s tension, 140mm.
After a few vigorous blows over the precordial region.
- Mr. L.'s tension, 155 mm.
This marked rise signified that the myocardium was
strong which interpreted according to Abrams, meant that this patient's
pressure would be lowered not by vibration over the 7th cervical which
tones up the heart muscle, but over the spines of the 2nd and 3rd dorsal
vertebrae or by the writer's method in the intervertebral spaces between
the transverse processes of the 2nd and 3rd dorsal vertebrae. A vibration
of five minutes' duration over the spinous processes of the 2nd and 3rd
dorsal vertebrae in one case caused the tension to drop from 160 to 140
nun. Further vibration between the transverse processes of the 2nd
and 3rd dorsal vertebrae gave a further fall to 130 mm.
MYOCARDITIS is amenable to treatment by the induction
of the heart reflex if the myocardium responds. Symptomatic treatment
by diet, elimination and for the improvement of nutrition are indicated.
The duration of treatment by the induction of the heart reflex may be five
minutes or less or more according to results obtained. In some cases
the author has obtained good results in five minutes; in others better
results were obtained in ten minutes. Ten minutes is commonly the
OVER-STRAINED HEART characterized by the presence
of ventricular dilatation with feeble heart tones, and an irregular or
intermittent, feeble, rapid pulse, has been successfully treated by the
induction of the heart reflex.
The author has found the employment of vibration
in the same manner very effectual in the treatment of high blood pressure
associated with goitre. The application for five minutes of interrupted
vibration over the spine of the 7th cervical vertebra caused in one case
a fall from 125 mm. to 112 nun. Dr. A. B. Hirsh of Philadelphia,
to whom the author is indebted for his assistance in making investigations
and demonstrations, noted also a relative softening of the pulse.
Theoretically this method should be applicable to
the treatment of mitral incompetency particularly when complicated by hypertension,
also in mitral stenosis, in which the heart may be slightly enlarged, in
tricuspid regurgitation, which is a state of relative insufficiency, showing
usually an increase in the area of dulness to the right of the sternum
and in tricuspid stenosis with which dulness is increased especially to
the right of the sternum.
Failure of general nutrition, disturbance of the
local nutrition of the heart, very severe muscular exertion, and mental
emotions also cause an interruption of cardiac compensation.
The induction of the heart reflex may be employed
in all conditions of cardiac insufficiency occurring in the following conditions
if degenerative changes render it incompetent as in hypertrophy, or if
the hypertrophied heart becomes overburdened.
Hypertrophy of the left ventricle alone [Osler. Practice
of Medicine], or with general enlargement of the heart caused by:
"(a) Conditions affecting the heart itself:
"1. Disease of the aortic valve.
"2. Mitral insufficiency.
"3. Disturbed innervation with overaction, as in exopthalmic goitre,
in long continued nervous palpitation, and as a result of the action of
certain articles such as tea, alcohol, and tobacco."
"In all of these conditions the work of the heart
is increased. In the case of the valve lesions the increase is due
to the increased intraventricular pressure."
"(b) Conditions acting on the blood vessels:
"1. General arteriosclerosis with or without renal disease.
"2. All states of increased arterial tension induced by the contraction
of - the smaller arteries under the influence of certain toxic substances,
which affect the minute capillary circulation, render greater action necessary
to send the blood through the distant subdivisions of the vascular system.
"3. Prolonged muscular exertion."
Hypertrophy of the right ventricle is caused by:
"1. Lesions of the mitral valve, either incompetence or stenosis causing
increased resistance in the pulmonary vessels.
"2. Pulmonary lesions, obliteration of any number of blood vessels within
the lungs as in emphysema or cirrhosis.
"3. Valvular lesions on the right side occasionally cause hypertrophy
in the adult.
"4. Chronic valvular disease of the left heart and pericardial adhesions.
"Dilatation with hypertrophy:
Of the left auricle.
1. In lesions at the mitral orifice such as mitral stenosis.
Of the right auricle.
1. When there is greatly increased blood pressure in the lesser circulation
as in mitral stenosis or pulmonary lesions.
2. Narrowing of tricuspid orifice.
The heart reflex of contraction is also of use theoretically
in the treatment of dilatation of the heart when due to [Osler. Practice
of Medicine, page 635] "a weakened wall yielding to a normal distending
force." When the dilatation is due to "a normal wall yielding under a heightened
blood pressure," vibration applied in the intervertebral spaces between
the 2nd and 3rd dorsal vertebrae or to their spines should be indicated.
"A weakened wall [Osler. Practice of Medicine,
pages 625, 636] occurs in:
1. Myocarditis in fevers and infections.
2. Acute endocarditis or pericarditis.
3. Anemia, leukemia, and chlorosis.
A normal wall yields to heightened blood pressure
when an increased quantity of blood is to be moved or an obstacle is to
be overcome. The pressure may bring only hypertrophy.
1. Severe muscular effort.
2. All forms of valve lesion.
3. All conditions increasing the tension of the blood in the pulmonary
vessels as emphysema."
Dr. Victor G. Vecki [Physiologic Therapeutics,
September, 1910] reports a case of heart failure treated by spinal concussion
"A moribund patient had an apex pneumonia and during
the course of her disease the conventional cardiac stimulants were employed.
Suddenly during the night, however, she became extremely cyanotic and pulseless
and it was determined to concuss the seventh cervical spine to awaken,
as it were, the enervated heart. No percussion apparatus was at command
and, in lieu of the latter, the palmar surfaces of the fingers were applied
to the seventh cervical spine, and, with the clenched fist, the dorsal
surfaces of the fingers were struck a series of short and vigorous blows.
(Whether the sympathetics were acted upon or the vagus wisely and repeatedly
affected producing activity is not yet determined. The writer has
raised the arterial tension from 140 to 160 mm. with a two-minute vibratory
treatment between the 7th cervical and lst dorsal vertebrae. The
pulse was at the same time increased from 64 to 70 beats per minute).
"The latter method of concussion was continued for
about ten minutes with intervals of rest. Soon after concussion was
commenced the cyanosis became less evident and the pulse was again perceptible.
Every two hours during the night this method was continued and thereafter
at less frequent intervals until convalescence was established. It
was evident to the nurses and others that after each seance of the concussion
treatment there was an immediate evanescence of the cyanosis and the pulse
always became stronger and less frequent." Dr. Vecki also considers
it of value in pneumonia.
THE HEART REFLEX OF DILATATION [Abrams. Spondylotherapy,
page 221] is elicited by spinal concussion of the 9th, 10th, llth and 12th
dorsal vertebrae. He notes that here is an increase in the area of
dulness but no increase in the diameters of the heart as shown by the X-ray.
The heart can increase the size of its chambers without increasing "the
tension of its walls."
ANGINA PECTORIS is due to an organic lesion - sclerosis
of the coronary arteries - with consequent inability to respond to the
normal impulses of their vaso-motor nerves which otherwise regulate the
volume of blood supplied to the heart muscle, and the increased resistance
of a general circulation under these conditions constitutes a grave complication
- "increased demand for work to be done by the poorly nourished heart."
Toxaemia, directly or indirectly is the underlying cause, and its removal
is indicated. A restricted diet devoid of meat and limited in quantity
For relief of the condition Abrams recommends a trial
of "concussion of the lower dorsal vertebrae" to induce a heart reflex
of dilatation. The writer believes, as a preventive measure, however,
that as angina pectoris is accompanied by increased arterial tension, the
lowering of the blood pressure is naturally indicated to lessen the labor
of the heart. This may be accomplished by mechanical vibration or
high frequency auto-condensation.
PSEUDO-ANGINA of which there are three forms, neurotic,
vaso-motor and toxic, should be treated as indicated by their causes.
CARDIAC ASTHMA is sometimes relieved by vibrating
between the transverse processes of the 7th cervical and 1st dorsal vertebrae.
ANEURYSMS OF THE THORACIC AORTA [Osler. Practice
of Medicine] may be according to Bramwell:
1. Latent with no physical signs.
2. Those which cause intrathoracic pressure.
3. Those which appear as tumors and that cause pressure and other symptoms.
An aneurysm may cause an abdominal pulsation on either
side of the sternum "usually above the level of the third rib and most
commonly to the right of the sternum, either in the first or second interspace."
If the innominate is affected the pulsation may be at the sternal notch
or in the neck. Posteriorly the left scapulae region is the usual
site for pulsation when present. Aortic aneurysm in chronic aortitis
may cause interscapular pain "especially on the left side."
To diagnose the presence of aneurysm other
than by the use of the X-ray, vertebral or intervertebral vibration or
concussion is used. Abrams found that the aortic reflex of contraction
lessens the symptoms and the reflex of dilatation accentuates their presence.
Normally the transverse dulness [Abrams. Spondylotherapy,
page 258] of the aorta at the level of the manubrium is 2 or 3 cm. to the
right of the sternum and 1.5 to 2.5 cm. to the left of the medial line.
If the transverse dulness at this point exceeds 5 cm., it indicates a dilated
aorta or an aneurysm.
THE AORTIC REFLEX OF CONTRACTION produces a diminished,
area of dulness corresponding to the position of the aorta. It is
induced by vibrating between the 7th cervical and 1st dorsal vertebrae
and is used in diagnosing thoracic aneurism as cited in Chapter VI as well
as in its treatment, - according to Abrams [Spondylotherapy, page
261] ten minutes' concussion of the spine of the 7th cervical vertebra.
It contracts the aneurysm and favorably affects the symptoms present.
The author would suggest the application of intervertebral vibration between
the transverse processes of the 7th cervical and lst dorsal vertebrae.
ANEURYSM OF THE ABDOMINAL AORTA connected with the
front of the aorta near the coeliac axis, forms "a pulsating tumor [Keen.
Anatomy] in the left hypochondriac or epigastric regions usually attended
with symptoms of disturbance of the alimentary canal as sickness, dyspepsia,
or constipation and accompanied by pain which is constant, but nearly always
fixed in the loins, epigastrium, or some part of the abdomen, radiating
pain being rare."
When an aneurysm of the abdominal aorta communicates
with the back part of the abdominal aorta the pulsating tumor "presents
itself in the left hypochondriac or epigastric regions" with alimentary
canal disturbances. Pain usually occurs as fixed in the back caused
by pressure or displacement "of branches of the solar plexus and splanchnic
nerves and as lancinating pain along those branches of the lumbar nerves
Normally over the 12th dorsal vertebra resonance
is obtained; but, if the 9th, 10th, llth and 12th dorsal vertebrae be concussed
(Abrams) or in the author's opinion, their intervertebral spaces vibrated,
the resonance gives way to a dulness on percussion which dulness measures
about 5 cm. (Abrams). If this dulness at the 12th dorsal vertebra
is greater than 6 cm. he interprets it to mean "a dilated aorta and if
the dulness is irregular," an aneurysm. [Abrams. Spondylotherapy]
He induces a reflex contraction of the abdominal aorta by concussion of
the spine of the 7th cervical vertebra. The author has demonstrated
that for this other effects vibration of the intervertebral spaces produces
the same results as concussion of the spine and in this instance advises
vibration between the transverse processes of the 7th cervical and lst
THE AORTIC RELEX OF DILATATION [Abrams. Spondylotherapy,
page 22] causes an increase in the dulness normally present and an increase
in the symptoms if an aneurysm be present. It is elicited by vertebral
concussion of the last four dorsal vertebrae and is induced by affecting
the vasodilators. (Abrams.) Intervertebral vibration as in other
cases will produce the same effect.
PALPITATION OF THE HEART may be present in "an organic
[Landois and Stirling. Text-Book of Human Physiology, 4th ed., page
70] condition of the heart itself, especially where the cardiac muscles
are weak, in cases of dilatation and hypertrophy of the left ventricle,
where the heart is gradually becoming unable to overcome the resistances
offered to its work, and especially during exertion when the heart is taxed
above its strength." Spinal vibration with the ball vibratode between
the transverse processes of the 7th cervical and lst dorsal vertebrae is
indicated. Palpitation also occurs when there is low blood pressure
as in anemia and in fatty heart where there is increased muscle excitability.
Direct or reflex nervous conditions may cause it as stomach or bowel derangements.
If dilatation of the stomach be present, vibration
or lavage of that organ should be employed before treating the functional
condition directly. If a uterine fibroid is the cause, the X-ray
should be systematically employed to reduce it, unless surgical intervention
is found to be absolutely necessary. Palpitation should be treated
as a symptom, and the cause discovered and remedied when possible.
Mechanical vibratory treatment should be employed as indicated
IF THERE BE HEAT FLUSHES, TACHYCARDIA, OR IRREGULAR
HEART ACTION, mechanical vibration is indicated alone, or as conditions
demand, combined with other appropriate physical measures, as light, static
electricity, or hydrotherapy. Heat flushes associated with a high
blood pressure can be benefited by interscapular vibration between the
2nd and 3rd dorsal vertebrae, if there is no cardiac insufficiency, associated
with dietetic and hygienic measures, daily baths and outdoor exercise.
The frequency of tachycardia may be lessened by spinal vibration with the
ball vibratode applied in the interscapular region or abdominal vibration
with the disc vibratode, or if due to cardiac insufficiency vibration between
the transverse processes of the 7th cervical and 1st dorsal vertebrae is
indicated. Interrupted vibration with the rubber covered disc vibratode
employing moderate pressure, applied to the solar plexus and the lumbar
ganglia (two inches on each side of the umbilicus) in succession, making
the application three, four or five times at a sitting, has a marked effect
on the sensations of internal heat, the effect depending on the strength
of the stimulus. If the stimulus be too strong or too prolonged,
it will not control the condition. External parts are warmed by lowering
the blood pressure.
IN THE STUDY OF BLOOD PRESSURE four factors are to
be considered. [Howell. Text-Book of Physiology, page 499]
"1. Rate or force of heart-beat. If increased the pressure rises,
and vice versa.
"2. Resistance of blood flow especially peripheral. (a) Decrease
or increase in width of vessels results normally in a vaso-constriction
of the small arteries with increased arterial and diminished venous pressure
or vaso-dilation with diminished arterial and increased venous pressure.
"3. Elasticity of the arteries.
"4. Quantity of blood in the system. Great loss would cause
a fall of blood pressure."
In general the first three factors concern us the
most and of the three the first two are of prime importance. As blood
pressure is being more closely studied, high pressure is found not to be
so frequently due to arteriosclerosis as formerly thought; but to be the
ultimate cause. Auto-intoxication is the most common cause of hypertension,
and the ultimate cause of arteriosclerosis.
The first two factors depend on (a) the demands for
work to be done either from the demands of exercise or hypertension, causing
variations in the ventricular force which varies the demands on the heart
muscle, and (b) vaso-constrictor effects.
Two states are recognized in cardiac weakness: [Abrams.
pages 248 and 253]
"1. If the cardiac ventricular force is weak and vaso-constrictors
compensate the blood pressure may be high.
"2. If the cardiac ventricular force is weak and vaso-constrictors
do not compensate, the blood pressure is low."
MYOCARDIAL INSUFFICIENCY has already been considered
but another easy method of testing it as noted by Abrams is to compare
the pulse taken with the patient lying and sitting. When he is sitting
the pulse should show an increase of four to six beats per minute.
If instead it is lessened, the pulse rate being higher when lying than
when sitting, it indicates cardiac insufficiency. An illustrative
case that came to my notice was as follows:
Dr. P. Lying
Sitting 140 mm.
After interrupted vibration was applied between the
transverse processes of the 7th cervical and, lst dorsal vertebrae, the
conditions reversed as follows:
mm. immediately after.
135 mm. a few minutes later. 84
It may be here noted that a temporary rise in arterial
tension may be noticed to be followed later by a fall.
VASO-MOTOR INSUFFICIENCY is determined as follows
by Abrams' method used by the writer.
Blood pressure taken in recumbent position 180 mm.
Blood pressure taken in sitting position 168 mm.
A fall of 12 mm.
The fall shows an abnormal relation indicative of
vaso-motor or vaso-constrictor insufficiency.
Blood pressure taken in recumbent position 90 mm..
Blood pressure taken in sitting position 102
An increase of 12 mm.
The rise shows the normal relation in which the vaso-constrictors
acted. They increased the resistance by the normal constrictor effect,
which caused a rise of arterial tension with its accompanying fall of venous
SPLANCHNIC NEURASTHENIA (so-called by Abrams: Spondylotherapy,
page 345) - is characterized by abdominal sensitiveness, tenderness and
enlargement of the liver, gaseous accumulations and an exaggeration of
the "cardio-splanchnic phenomenon" so-called by Abrams. If the lower
part of the sternum "contiguous to the heart" is percussed it is resonant
or hyperresonant. If the patient then lies down and the same area
is percussed, after compressing vibration has been applied to the stomach,
it will be dull or flat in the normal person - the cardio-splanchnic phenomenon.
In splanchnic neurasthenia this phenomenon is exaggerated, there is an
increased area of dulness.
Splanchnic neurasthenia is treated by spinal vibration.
There is under these conditions an accumulation of blood in the splanchnic
area owing to a lack of tone in the, vaso-motor nerves. This condition
may cause syncope. If the ball vibratode be employed to give intervertebral
vibration between the 2nd and 8th dorsal vertebrae for five minutes or
so, the cardio splanchnic phenomenon is shown. It tones up the vaso
motors of the splanchnic vessels and thereby lessens intra-abdominal congestion.
Conditions associated with relaxed abdominal parts and intra-abdominal
stasis are benefited by the same treatment. In studying these cases
the author has noted as Abrams previously noted, that in those so affected,
there is lower blood pressure when sitting or standing than when lying,
as the following cases will illustrate.
Mr. H. Lying 148 mm.
Sitting 135 mm.
Mr. W. Lying 135 mm.
Sitting 126 mm.
The author vibrated these patients between the 2nd
and 3rd dorsal vertebrae with the ball vibratode and lowered the tension
with a reversal of conditions - the tension being higher when sitting than
when lying. In cases characterized by a cardiac insufficiency, vibration
between the 7th cervical and lst dorsal vertebrae has reversed conditions.
Abrams speaks of five methods among which is abdominal massage which has
the same effect on the pulse rate as interscapular vibration or vibration
between the .transverse processes of the 2nd and 3rd dorsal vertebrae.
In some cases the author's experience agrees with that of Abrams in that
concussion of the 2nd to 3rd dorsal spines relieves "intraabdominal congestion.
"The patients immediately feel relief.
A case presenting the symptoms of a splanchnic neurasthenic
had the following record.
Lying 110 mm.
Sitting 108 mm.
In this case there was a cardiac and a vaso-motor
insufficiency. The cardiac insufficiency was treated by vibrating
between the transverse processes of the 7th cervical and lst dorsal vertebrae
with the ball vibratode, with the following result.
Lying 108 mm.
Sitting 110 mm. 66
The sphygmomanometer according to Abrams [Spondylotherapy,
page 244] measures only the force of the left ventricle; for the determination
of the sufficiency of the right ventricle he uses auscultation.
The following is Howell's view of vaso-motor reflex
of control of the rise and fall of arterial pressure.
"Afferent fibres giving vaso-motor reflexes.
I. Pressor fibres. Cause vascular constriction and rise of arterial
pressure from reflex stimulation of the vaso-constrictor center - e.g.,
sensory nerves of the skin.
II. Depressor fibres. Cause vascular dilatation and fall of arterial
pressure from reflex inhibition of the tonic, activity of the vasoconstrictor
center - e.g., depressor nerve of heart.
III. Depressor (or reflex vaso-dilator) fibres. Cause vascular
dilatation and fall of arterial pressure from stimulation of the vaso-dilator
center - e.g., erectile tissue, congestion of g lands in functional activity.
HIGH BLOOD PRESSURE is caused by pain, chronic inflammation
of the kidneys which leads to cardiac hypertrophy, and an increase in peripheral
resistance due to the vaso-motor disturbances. Cardiac hypertrophy
with dilatation, Graves' disease, goitre, and some neuroses increase the
tone of the vasomotors.
LOW BLOOD PRESSURE is present with exhausting diseases,
infections, the insomnia of low resistance, cardiac failure, hemorrhages,
chlorosis and in advanced tuberculosis.
Foster observes that the "general arterial tone of
the body is maintained and that an increase or decrease of vaso-constrictor
action, in particular arteries or in arteries generally is brought about
by means of the bulbar vaso-motor center."
BLOOD PRESSURE WHEN LOWERED BY STIMULATION OF THE
DEPRESSOR falls gradually. If the heart-beat [Foster. Text-Book
of Physiology, page 343] is not markedly changed with a lowered blood
pressure, the fall of pressure must be due "to the diminution of peripheral
resistance occasioned by the dilation of some arteries." He believes that
possibly "those dilated are chiefly those of the abdominal viscera, governed
by the splanchnic nerves."
In man a nerve homologous to the depressor in a rabbit
is found arising "from the vagus from the junction of the vagus and superior
laryngeal nerves, but quickly joins again the main trunk of the vagus.
[Sajous. The Internal Secretions and the Principles of Medicine,
page 1125] Almost all parts of the vascular system can be thrown
into dilatation by the depressor nerve" and therefore a fall of blood pressure
ensues, which Sajous attributes to "the depressor nerve inhibiting the
functions of the thyroid gland and pituitary body, and through the latter
that of the adrenals. [Sajous. The Internal Secretions and the Principles
of Medicine, page 1126]
"When the central end of the depressor nerve in a
,rabbit was stimulated "a surprising fall of arterial pressure accompanied
by a slight decrease in cardiac frequency" ensued (Ludwig and Cyon). [Sajous.
Internal Secretions and the Principles of Medicine, page 1125]
THE "DEPRESSOR NERVES are those through which the
adreno-thyroid center regulates the circulation of the anterior pituitary
body and of the thyroid apparatus. [Sajous. The Internal Secretions
and the Principles of Medicine, 1133] the depressor nerve can "inhibit
the functions of the thyroid grand and anterior pituitary body by constricting
their arteries." (This "reduces general oxygenation and metabolism
throughout the entire body, including the muscularis of all vessels, thus
causing them to relax, i.e., to dilate.) It also influences the abdominal
and peripheral vessels." [Sajous. The Internal Secretions and
the Principles of Medicine, page 1128]
BLOOD PRESSURE WHEN LOWERED BY CARDIAC INHIBITION
[Foster. Text-Book of Physiology, page 344] (vagal stimulation)
Blood pressure may be affected "by stimulating or
depressing one or more centers in the spinal system, and particularly and
in many instances solely, those located in its chief center - the posterior
BLOOD PRESSURE MAY BE LOWERED by depressing the
sympathetic center which causes a general dilation of the arterioles
which "allows an excess of arterial blood to enter the capillaries in general.
This passive hyperemia of the capillaries may when excessive "excite the
peripheral end-organs of sensibility," and tingling, flushing and headache
BLOOD PRESSURE MAY BE LOWERED by inhibiting the functional
activity of the vaso-motor center. The depression of the vaso-motor
center permits the blood vessels to dilate. The blood retreats as
it were from "all peripheral structures, the skin, cerebral spinal system,
etc., including the pituitary body, to collect in the great central channels,
" in consequence of which "the functions of all centers including the adrenal
center are likewise depressed, and the production of adrenoxidase being
correspondingly reduced, general nutrition is impaired. Depression
of the vaso-motor center causes "ischaemia of the peripheral organs and
therefore the hypothermia and cyanosis sometimes witnessed." [Sajous. The
Internal Secretions and the Principles of Medicine, page 1310]
These observations are of importance to the practitioner
who uses the vibrator scientifically whether in research work or therapeutically.
BLOOD PRESSURE MAY BE MADE TO RISE OR FALL "BY AFFERENT
[Foster. Text-book of Physiology, page 344] IMPULSES passing along
other nerves than the depressor." When afferent nerve stimulation
induces a rise in arterial tension and there is no "increase in the heart-beat,
such at least as could give rise to it, the rise must be due to the constriction
of certain arteries." Foster believes that the arteries affected
are "those of the splanchnic area certainly, and possibly, those of other
vascular areas as well." When afferent nerve stimulation shows a
fall, the result is "very similar to that caused by stimulating the depressor.
" He [Foster. Text-Book of Physiology, page 345] observes, furthermore,
that "the condition of the central nervous system seems to determine whether
the effect of afferent impulses on the central nervous system is one leading
to augmentation of vaso-constrictor impulses and so to a rise, or one leading
to a diminution of vaso-constirictor impulses and so to a fall of blood
In connection with the lowering of blood pressure
it is of interest to note (Fig. 41), the arrangement of the augmentor (sympathetic)
fibres in a dog. The rami communicantes connect the sympathetic with
the 2nd and 3rd dorsal nerves whose exits in man are between the 2nd and
3rd and 3rd and 4th dorsal vertebrae which are reached by intervertebral
vibration between the 2nd and 3rd, and the 3rd and 4th dorsal vertebrae.
Mechanical vibration in man in these sites for five minutes, followed by
a brief interval of rest, and then another five minutes of vibration, will
often reduce blood pressure. Whether we affect the pneumogastric
(see page 184) or filaments noted by Bradford and Dean [Sajous. The
Internal Secretions and the Principles of Medicine, page 474] that
emerge from the cord located from the 2nd to 6th dorsal, "and in respect
to maximum effects on a level with the 3rd, 4th and 5th nerves, which cause
pulmonary vaso-constriction and a fall of aortic pressure," is to be determined.
The pulmonary vaso-constrictors ascend the chain up to the lst thoracic
ganglion. The 2nd to the 6th dorsal nerves may be related through
their origin to the 6th and 7th cervical, and 1st, 2nd, 3rd, 4th and 5th
dorsal vertebrae. (See Table Chapter VI.)
In the TREATMENT OF HIGH BLOOD PRESSURE the cause
must be removed if possible, and measures, hygienic, preventive, or therapeutic,
be taken to abate or diminish it. If due to arteriosclerosis, two
stages should be noted. [Sajous. The Internal Secretions and the Principles
of Medicine, page 1560] The first stage includes (1) "general adynamia,
which entails (2) hypocatabolism and therefore, an accumulation of toxic
wastes in the blood, the cause in turn of (3) the vascular lesions."
The second stage is marked by functional derangements of organs due to
noticeable organic lesions. Two indications are to be met: - (l)
to reduce the waste products, and (2) to counteract the morbid process
by drugs or physical measures [The author] which affect the depressor [Sajous.
The Internal Secretions and the Principles of Medicine, page 1562] nerve,
causing "constriction of the arterioles through which the anterior pituitary
and the thyroid apparatus are supplied with blood. The supply of
adrenoxidase (besides thyroidase) being diminished, the metabolic activity
in the vascular walls is reduced, and the chief pathogenic process is thus
In the second stage, if the tension is high, vibrate
to support the hypertrophied heart.
As before stated high blood pressure can be lowered
by vibrating in the intervertebral space between the 2nd and 3rd or 3rd
and 4th dorsal vertebrae, unless there is a weakened heart muscle with
compensatory vaso-constriction (Abrams) when it can be lowered by vibrating
in the intervertebral space between the transverse processes of the 7th
cervical and 1st dorsal vertebrae.
Abrams noted that concussion on the 7th cervical
caused rise of temperature. Sajous notes that the path to increase
heat is down the cord to the 1st, 2nd and 3rd dorsal nerve. The first
dorsal nerve has its origin at the level of the 6th and 7th cervical vertebrae
(Krause). Consequently we must reach the governing center of the
adrenals. [Sajous. The Internal Secretions and the Principles of Medicine,
pages 1023 and 1024]
HIGH PRESSURE FOLLOWING IN SPASMODIC DISCHARGE STIMULATION
OF THE VASO-MOTOR CENTER ALONE, is noted in an experiment by Hill cited
by Sajous. "The vaso-motor center can be stimulated independently
of the sympathetic center and vice versa. Excitation of the vaso-motor
center [Sajous. The Internal Secretions and the Principles of Medicine,
page 1206] causes "constriction of the larger and deeper vessels in consequence
of which an increased volume of blood is forced towards the periphery.
The arterioles may not only remain passive under these conditions, but
they may be forcibly dilated by the centrifugal streams, and the blood
invade the tissues" causing "excessive hypereamia."
Masay [Sajous. The Internal Secretions and the
Principles of Medicine, page 985] demonstrated that STIMULATION
OF THE PITUITARY BODY (which is a vaso-motor center) or of the medulla
oblongata including the BULBAR VASOMOTOR CENTER caused a sudden rise of
blood pressure followed by a fall when excitation ceased. depressor [Sajous.
Internal Secretions and the Principles of Medicine, page 988]
Stimulation of the pituitary constricted all the arterioles through sympathetic
fibres controlled by the sympathetic center. The high blood pressure
was caused by arteriole constriction and "resulting accumulation and pressure
behind the vascular obstruction." [Sajous. The Internal Secretions and
the Principles of Medicine, page 992]
When the SYMPATHETIC CENTER [Sajous. The Internal
Secretions and the Principles of Medicine, page 1206] IS STIMULATED
the sympathetic terminals whose function is to regulate the "media calibre
of the arterioles during their dilation and contraction at each pulsation
exaggerate this function: they reduce this mean calibre. Some drugs
as digitalis at first or
when small therapeutic doses are given increase the propulsive activity
of the arterioles for the abnormal narrowing of these vessels is followed
by their reflex dilation (strictodilation - Sajous) the increase of the
propulsive power being due to the fact that both dilation and contraction
of, the vessels are exaggerated. Gradually as the dose is increased,
the sympathetic stimuli become so energetic that the arterioles are kept
constricted, the vaso-dilator reflex action being increasingly overpowered."
When constriction causes obliteration of their lumen, "circulation in the
heart muscle" is arrested and death follows.
Reichert, [Sajous. The Internal Secretions and
the Principles of Medicine, page 1226] Vulpian, Mayer and Klapp found
"that after division of the upper portion of the spinal cord (the path
also of the adrenal secretary nerves) strychnine could no longer raise
the arterial pressure."
When the ADRENO-THYROID CENTER IS STIMULATED there
results an increase in oxidase and thyroidase (thyroid and parathyroid
secretion). Sajous says "This means that the protective properties
of the blood are enhanced by augmenting its proportion of auto-antitoxin.
" As the adrenal center is the heat or thermogenic center "there is a rise
The effects of digitalis illustrates the STIMULATION
OF THE "TEST ORGAN AND THROUGH IT THE ADRENAL CENTERS, AND ALSO, but with
less violence, THE SYMPATHETIC CENTERS (only when the average therapeutic
dose is given), which enhances the propulsive action of the arterioles.
The drug increases the arterial pressure largely by increasing the peripheral
resistance without centric vaso-motor stimulation" which Sajous believes
indicates that the adrenals are "the source of the vaso-constricting influence,
for Langley found, in a series of experiments with adrenal extract, that
its action 'runs parallel with the action of the sympathetic nerves on
the blood vessels' and that 'in many cases the effects produced by the
extract and by electrical stimulation of the sympathetic nerve correspond
exactly.' As the peripheral arterioles are governed by the sympathetic,
the adrenal secretion corresponds in its action with that of this nerve,
because its action (as adrenoxidase) on the arterioles is the first to
manifest itself, owing to their diminutive size. Digitalis acting
mainly through the adrenal secretion also increases the peripheral resistance."
Von Broeck noted in regard to the effect of digitalis on metabolism; that
the elimination of urea and carbon dioxide was increased while the blood
pressure was high and was diminished with its fall.
BLOOD PRESSURE MAY BE RAISED [Sajous. The Internal
Secretions and the Principles of Medicine, page 1222] by stimulation
of the TEST ORGAN AND IN CONSEQUENCE THE ADRENAL CENTER. An increased
production of adrenal secretion increases the contractility of the right
ventricle, and also increases the quantity of adrenoxidase in the blood,
and thus increases the organic metabolic activity. The heart muscle
and the arteries receive more nutrition and become more active, and thus
raise blood pressure.
From experiments [Sajous. The Internal Secretions
and the Principles of Medicine, pages 1012, 1013] STIMULATION OF THE
VERTEBRAL NERVE, made up of four or five of the lower cervical nerves,
through the rami communicantes, causes an increased vascular tension in
the liver due to the general rise of blood pressure probably due to the
production of an excess of adrenoxidase, caused by the excessive adrenal
secretion. "Hardly any other agent will produce such an enormous
increase of pressure" writes Schafer referring to injections of adrenal
extract after division of the vagi, as direct stimulation of the vaso-motor
center. The writer has observed the following in respect to vibration
with the ball vibratode between the transverse processes of the 2nd and
3rd cervical vertebrae.
Mr. S. Tension 110 mm. Pulse 74.
After two minutes' vibration, tension 116 mm. Pulse 72.
Mrs. S. Tension 106 mm. After two minutes'
vibration, tension 112 mm.
Adrenoxidase, according to Sajous, is the " activating
agent in all metabolic processes. An excess in the blood enhances
its oxygenizing power in proportion. "This blood in the vasa vasorum
of the arteries and veins, he states abnormally stimulates and contracts
the muscular portion of the vessels, reducing their calibre.
THE BLOOD TENSION CAN BE RAISED empirically (Abrams)
when low by applying vibration in the intervertebral spaces between the
transverse processes of the 6th and 7th dorsal vertebrae. If due
to a weakened heart muscle, associated with no compensatory action on the
part of the vaso-motors, by vibrating in the intervertebral space between
the 7th cervical and 1st dorsal, the pressure may be raised in some cases.
During experimental work with the vibrator the author
has caused the blood tension to rise from 140 mm. to 160 nun., the vibration
being applied for two minutes between the transverse processes of the 7th
cervical and lst dorsal vertebrae.
Mr. L .
||tension 130 mm.
|After 1/2minute treatment,
||tension 140 mm.
|After 1/2 minute more treatment,
||tension 140 mm.
|After 1 minute more treatment,
||tension 160 mm.
The influence of the stimulation may last for some
time after treatment. Possibly the accelerating fibres of the vagus
were stimulated. Blood pressure is sometimes lowered and the pulse
beat strengthened by vibrating at the same site, noted especially when
there is a weak heart muscle with compensatory vasomotor action (Abrams).
In which event the inhibitory fibres of the vagus respond to stimulation
and its accelerating fibres respond "by strengthening the contraction of
the heart" as Heidenhain, Lowit and Pawlow have noted as possible, or the
governing path [Sajous. The Internal Secretions and the Principles of
Medicine, page 1024] to the adrenals may be reached and inhibition
of adrenal activity result. A re-establishment of equilibrium follows
with consequent fall of pressure. Possibly this is due to the action
of the vagus noted by Landois when the accelerators and the vagus are both
irritated. If the vagus and accelerator are irritated "simultaneously [Landois.
of Human Physiology, page 761] only the inhibitory action of the vagus
makes its appearance."
When we vibrate in the intervertebral space between
the 7th cervical and lst dorsal vertebrae, the sympathetics (inf. cervical
ganglion) may sometimes respond and induce results as heretofore noted
experimentally by other methods in the hands of other observers; because
the inferior cervical ganglion is situated "between the base of the transverse
process of the last cervical vertebra and the neck of the first rib.
The head of the first rib articulates with the body of the first dorsal
"THE EFFECT OF MECHANICAL VIBRATION ON THE LUMEN
of the arteries is influenced by their elasticity and tonus which normally
controls the blood pressure, thereby equalizing the blood current and determining
the amount sent to each part, their lumen being under the control of the
vaso-constrictors and vaso-dilators or rather stricto-dilators. Their
elasticity and the responsive action of the vaso-motor nerves regulate
the blood supply to the organs and tissues of the body. It must be
remembered that when the arteries contract, the capillaries which have
no muscular walls dilate, owing to the pressure exerted; and when the arteries
dilate, the capillaries contract owing to the resiliency of the latter.
THE EFFECTS OF MECHANICAL STIMULI "ON BLOOD VESSELS
may be due to their action on the peripheral nervous mechanism (supposed
ganglia along the course of the vessels). The arteries may contract
so much as to almost disappear, but sometimes," observes Landois and Stirling,
"dilatation follows the primary stimulus." It has been found that in order
to obtain the maximum vaso-constrictor effect (by stimulating the center)
as indicated by the maximum blood pressure from 10 to 12 strong or 20 to
25 moderately strong shocks in one second are necessary. Waves of
vaso-constriction and vaso-dilatation may occur in succession from frictions
(manual) is the belief of Cyriax [Elements of Kellgren's Manual Treatment,
Consideration of the vaso-constrictors and vaso-dilators
belongs properly in the chapter devoted to the relation of mechanical vibration
to the nervous system. Their relation, however, to the study of the
blood vessels and the manner of influencing pathological states depending
on the constriction and dilatation of said blood vessels renders it necessary
to refer to them here. The author wishes to call attention to Sajous' [The
Internal Secretions and the Principles of Medicine, page XII. Volume
II] conclusions on the subject which are as follows:
"1. That it is the function of the sympathetic center (in the
posterior pituitary body) and of the sympathetic system to governthe
calibre of all arterioles, and to regulate, through the spiral muscular
coat of these vessels, the volume of blood admitted into the capillaries
of any organ, including those of the brain and nervous system.
"2. That the vaso-motor center governs the calibre of the larger
vessels only, i.e., of all vessels that are larger than the arterioles:-veins
and larger arteries.
"3. That active vaso-dilation exercised through vaso-dilator
nerves is limited to the arterioles.
"4. That dilation of an arteriole is due to constriction by
the terminal fibres of a cranial nerve (the vagus, for example) of
the vasa vasorum which supply its walls with adrenoxidase-laden
plasma, thus causing ischaemia and relaxation of its muscular coat.
"5. That while this process, "stricto-dilation," serves to admit
an excess of blood into an organ when the functional activity of the latter
is to be increased, the sympathetic fibres, when the organ's functions
are to cease, restore the arterioles to their normal calibre.
"6. The cranial and sympathetic filaments distributed to the arterioles
carry on an additional and more important function than that of maintaining
"7. These nerves, owing to the presence in the walls of the arterioles
of spirally disposed muscles, endow these vessels with a special property;
that of increasing the vis a tergo motion of the blood in order
to overcome the resistance of the capillaries."
"8. The sympathetic center (in the posterior pituitary body)
sleep by constricting arterioles of the anterior pituitary (including
its test organ which governs the adrenals) and arterioles of the thyroid
thereby lowering the functional activity of the anterior pituitary body
and of the adrenal system. Lowered metabolic activity follows, which
in cardiac and vascular muscular fibres, causes a general vasodilation,
resulting in an accumulation of blood in the splanchnic area, and ischaemia
of the cerebrospinal system."
Sleep follows when "the intrinsic metabolism
of all nerve elements, including those of the cortex is itself reducied."
[Sajous. The Internal Secretions and the Principles of Medicine,
page 1260] Promotion of elimination, removal of exciting agents with reduction
of blood pressure by spinal vibration with the ball vibratode, d'Arsonvalization,
or prolonged body vibration (Bechterew and Tschigajew) [Cyriax. Vibrations
and Their Effects] are indicated.
VASO-CONSTRICTION AND VASO-DILATION [Sajous. The
Internal Secretions and the Principles of Medicine, page 1124] are
"1. Vaso-dilation is due, in the case of arteries and veins, to the
diminution of blood-plasma, and, therefore, of adrenoxidase, in the muscular
layers of these vessels.
"2. The blood-plasma being supplied to the vascular walls by the vasa
vasorum, it is through contraction of these nutrient vessels that dilation
of the vessels is caused.
"3. The vasa vasorum receiving their blood-plasma from larger arterial
vessels supplied with vaso-constrictor nerves it is through vaso-consiriction
of these vessels that the volume of blood circulating through the vasa
vasorum is diminished.
"4. It is therefore by vaso-constrictor action that vaso-dilation is
produced, 'vaso-dilator nerves' having no existence in fact.
"5. Vaso-dilation being caused by constriction of the nutrient arteries
of a vessel, the vaso-motor nerves supplied to these nutrient vessels should
not be termed 'vaso-dilators' but 'stricto-dilators.'
"6. The mechanism of vaso-dilation is that through which all exacerbations
of activity in any organ, whether belonging to the alimentary, circulatory,
locomotor, visual, auditory or any other system, is incited and sustained."
Impulses from the pituitary reach the peripheral
vessels by way of the bulb and its vaso-motor pathways. "General
contraction of all arteries result from exciting the bulbar vaso-motor
center, the sympathetic vaso-motor action being limited to the arterioles."
The sympathetic center and the bulbar vasomotor center may be independently
stimulated. [Sajous. The Internal Secretions and the Principles of Medicine,
page 1203] They are related through fibres of special sympathetic
type. [Sajous. The Internal Secretions and the Principles of Medicine,
The cerebral vessels, are thought by Spina
to have a spinal vaso-motor center "susceptible of reflex irritation extending
to the third cervical vertebra."
WHEN CONSTRICTION OF AN ARTERY IS PRODUCED, the following
effect results according to Foster in: (1) diminished flow through the
artery itself; and (2) increased general arterial pressure leading to increased
flow through the veins. It should be remembered that the contraction
of an artery is slow and of long duration. There is also a latent
period. Mechanical stimuli must not, therefore, be too continuous
or too heavy unless dilatation is sought, because strong percussion induces
dilatation of the blood vessel and light percussion if too prolonged has
the same effect.
THE EFFECT OF DILATATION is (1) to increase the blood
flow through the artery, (2) to lessen general pressure, and (3) to lessen
the flow through the other arteries. Dilatation then is especially
indicated in the treatment of diseased conditions associated with impaired
VASO-MOTOR DISTURBANCES AS ANGIO-SPASM OR PARALYSES
are treated by mechanical vibration or by spinal concussion (Abrams).
For angio-paralyses Abrams applies concussion over the spinous process
of the 7th cervical vertebra, and for angio-spasm he concusses over the
spinous processes of the 9th, l0th, 11th and 12th dorsal vertebrae.
The application of mechanical vibration to the intervertebral spaces between
the 7th cervical and lst dorsal and between the 9th and 10th, 10th and
llth, and llth and 12th dorsal vertebrae with medium pressure will obtain
the same result.
IN THE TREATMENT OF A CASE OF ERYTHROMELALGIA, the
following may be of interest. The patient suffered in addition to
other symptoms from most violent attacks of paroxysmal pain in the head,
- so violent that light could not be tolerated. The eye would have
to be closed to avoid a paroxysm. Noise could not then be tolerated.
There was intense pain across the head and internal pain as the patient
expressed it with a tendency to dyspnoea and palpitation. Intervertebral
vibration between the transverse processes of the second and third dorsal
vertebrae lowered the blood pressure and relieved the internal pain.
It also had some effect on the surface pain but not to such a marked degree
as on the internal pain. The adrenals were treated by applying the
static wave current over the kidneys and light to the lower part of the
abdomen and back to increase the general metabolism. The following
shows the effect of a few days treatment. A rise in blood pressure
(induced by auto-intoxication probably) seemed to invariably increase the
severity of the paroxysms.
||Tension 170 mm.
||After 5 min. vibration
||Tension 154 mm.
||Tension 170 mm.
||After 5 min. vibration
||Tension 160 mm.
||After 4 min. additional vibration
||Tension 160 mm.
||Tension 168 mm.
||After 10 min. vibration
||Tension 150 mm.
||After 7 min. vibration
||After 5 min. additional vibration
THE FUNCTIONAL ACTIVITY OF ORGANS is regulated by
the "joint action of the terminals of a cranial and sympathetic nerve"
[Sajous. The Internal Secretions and the Principles of Medicine,
page 1198] and as this activity involves the blood vessels the following
is of interest.
"(1) That the sympathetic system does not, as now believed, carry on
motor, dilator, secretary, or inhibitory functions.
"(2) That its function is purely vaso-constrictor, its field being limited
to the small arteries or arterioles.
"(3) That it is entirely independent of the vasomotor system (whose
action is general), being capable, unlike the latter, of influencing each
"(4) That its terminals form part of the mechanism of all organs.
"(5) That the specific role of its terminal fibres is to oppose the
stricto-dilators and restore the arterioles of an organ to their normal
calibre when the functional activity of that organ is to cease.
"(6) That the volume of blood which circulates through any organ, whether
the latter be in the passive state or functionally active, is regulated
by the joint action of the motor and sympathetic centers in the posterior
"(7) When the organ is to become functionally active, the stricto-dilators
(fibres of a cranial motor or secretary nerve) cause its vessels
to relax and to augment the volume of blood coursing through it; when its
activity is to cease, the sympathetic constrictors cause the vessels to
contract sufficiently to reduce the blood in transit to the volume required
for adequate local nutrition.
Methods for controlling the vaso-constrictors and
vaso-dilators of the organs by vibration will be considered in a following
chapter. The knowledge of the action of mechanical vibration, a recognition
of pathological conditions present, and an analysis of effects produced
will determine how and when vibration should be applied.
The writer has observed that when A COLD is treated
early by auto-condensation (d'Arsonvalization) it may be aborted.
This treatment lowers blood pressure. Abrams [Spondylotherapy,
page 284] noted that a cold, which he considered as presenting the symptoms
of an angio-paralysis, could be aborted by concussion of the spine of the
7th cervical which in many cases lowers blood pressure. For this
effect the author applies mechanical vibration with the ball vibratode
between the transverse, processes of the 7th cervical and lst dorsal vertebrae.
Dryness of the air passages or a temporary cough may ensue. Whether
a vibratory treatment between the transverse processes of the 2nd and 3rd
dorsal vertebrae which often lowers blood pressure will abort a cold, is
yet to be determined.
VIBRATORY FRICTION APPLIED CENTRIPETALLY to the extremities
assists lymphatic and venous circulation in joint affections, oedema, dropsy,
and similar conditions. For this administration the rubber-covered
disc vibratode is to be preferred and the surface to be vibrated should
be first dusted with talcum powder. In cases of oedema begin the
frictional treatment near the trunk and gradually approach the extremities,
and apply interrupted. vibra.tion about the joints. (See Chapter IV.)
VIBRATORY FRICTION APPLIED CENTRIFUGALLY to the extremities
is indicated in deficiency of compensatory hypertrophy of the heart,
associated with valvular lesions or pulmonary circulatory obstructions.
It is also valuable in the treatment of INSOMNIA due to congestion of the
blood vessels of the head, and all other conditions where acceleration
of the arterial flow is sought. If mechanical vibration be applied
to the bowels, it induces a slowing of the pulse. In an experimental
case the pulse was 84 before abdominal vibration and was reduced to 74
following the treatment. Mechanical vibration also affects the circulation
by increasing or diminishing the blood flow.
From the effects of mechanical vibration applied
as a tissue exerciser, it may be inferred that it increases the
number of red blood corpuscles and haemoglobin. Winternitz has demonstrated
that exercise increases the number of red blood corpuscles. It undoubtedly
also influences phagocytosis as does manual massage by causing more leucocytes
to become phagocytes and by breaking up minute adhesions coincidently increasing
IN THE TREATMENT OF CHLOROSIS the activity of the
digestive, circulatory, and respiratory systems together with that of the
nervous system should be promoted. Daily warm baths of five minutes'
duration, an easily digested diet, open bowels, and regulated daily walks
are insisted upon. Abdominal vibration with the disc vibratode and
the ball or cap shield as directed for constipation will stimulate the
abdominal sympathetics and promote circulatory activity. It will
induce a local vaso-constrictor effect and thus cause vaso-dilatation in
other parts - Cyriax notes the head. Appropriate exercises, as directed
by Cyriax [The Elements of Kellgren's Manual Treatment, page 381]
may be advantageously used.
SECONDARY ANAEMIA due to auto-intoxication may be
successfully treated by high colonic flushings, daily baths, outdoor walking,
light, the static wave current and spinal vibration of short duration for
stimulation and a vibratory treatment of the abdomen, liver and spleen.
Eliminate the poison and increase the metabolism.
IN PHLEBITIS mechanical vibration is sometimes of
benefit. Morris reports the cure of a case, "complicated with lymphangitis
and adenitis. " He sought to accomplish two objects, viz., " (1)
improvement of the systemic condition with a possible reduction of obesity;
and (2) the abatement, if not the actual cure, of the local inflammatory
trouble. For the accomplishment of the first indication, deep vibration
was applied to the spinal nerve centers of the liver and spleen (Vide Pilgrim's
'Vibration Stimulation,' 4, 5, 6, 7, 8 dorsal), and also to the organs
direct, as well as over the abdominal muscles. It was hoped that
this might favorably affect the local conditions."
He "sought to accomplish the second indication through
stimulation with the brush (multiple point vibratode) of the lymphatics
in the inguinal region and mild brush applications directly to the affected
area, following the venous current throughout, supplemented by the application
of the ball with medium stroke, to the lumbar-and dorsal spine."
Heavy pressure must be avoided and the greatest care
exercised in the employment of vibration in the treatment of phlebitis.
The author prefers the use of the high candle power incandescent light
and the static brush discharge which is the treatment par excellence in
The following, RELATIVE TO PAIN as it concerns
the arterioles, is important in a work on mechanical vibration.
Pain is commonly due to pressure (Wm. Benham Snow)
associated with stasis or tissue infiltration and exerted upon the sensory
nerve terminals or nerve trunks of the nervi nervorum; and any agent which
indirectly or directly causes diminution of such stasis or infiltration
or removes other objects which exert pressure, counteracts pain.
To reduce the stasis causing pain, four measures
may be adopted based on Sajous' findings. [Sajous. The Internal Secretions
and the Principles of Medicine, pages 1541-1543]
1. "Secure general vaso-dilation by depressing the vaso-motor center."
Vaso-dilation is accomplished by spinal vibration between the transverse
processes of the 2nd and 3rd dorsal vertebrae usually. When there
is myocardial insufficiency, vibrate with the ball vibratode between the
7th cervical and 1st dorsal vertebrae.
2. Secure general constriction of the arterioles by stimulating the
general sympathetic center.
3. Produce reflex constriction of peripheral arterioles including those
of the painful nerves, by irritating directly the cutaneous sensory terminals.
This can be accomplished by local vibration with the disc vibratode.
4. "Secure depletion of perineural arterioles, and therefore of the
endoneural capillaries. "This probably follows local vibration, interrupted
Spinal vibration with the ball vibratode over the
spinal segment corresponding to the skin area involved is indicated in
the treatment of painful areas.
Painful or tender spinal areas when not due to organic
affections may be relieved by interrupted vibration with the ball vibratode
applied four or five times in succession, beginning with moderate pressure
gradually increasing it, in accordance with the patient's tolerance, a
moderate rate of speed and full stroke being employed. For the treatment
of sensitive areas other than spinal, the same method is employed, the
disc vibratode being substituted for the ball. Pain due to a diseased
viscus or tissue of course will not be relieved by such measures, on the
contrary it is apt to be increased.
"THE THYROID AND PARATHYROID GLANDS" Sajous [Sajous.
Internal Secretions and the Principles of Medicine, page 1072] holds
"are not true glandular organs" but that they consist of a capsule, enclosing
"a connective tissue reticulum forming tubular cavities lined with a basement
membrane, the follicles, whose secreting cells are leucocytes (from the
alimentary canal or circulation) whose granules represent the active constituents
of the colloidal secretion. He believes their secretion is carried
by the lymphatics and finally reaches the superior vena eava, the heart,
and the pulmonary alveoli."
The nerves [Sajous. The Internal Secretions and
the Principles of Medicine, page 1128] to the arteries (vaso-constrictor
and vaso-dilator) pass "either by way of the superior laryngeals or through
the plexus often formed by the depressor with the sympathetic and vagal
nerves." The "vaso-constrictors are sympathetic fibres." Constriction
of the arteries lessens the blood supply and consequently the gland's functional
activity is lowered. Landois thinks that THE THYROID GLAND RECEIVES
ITS VASO-MOTOR nerve supply from the superior cervical ganglion of the
sympathetics. [Landois. Text-Book of Human Physiology, page 763]
"By increasing" Sajous believes, "the functional
activity [Sajous. The Internal Secretions and the Principles of Medicine,
page XII, Vol. II] of the thyroid and parathyroids it (the test organ which
is the sensory organ in the partition between the two lobes of the pituitary
body) increases, through their secretions, the sensitiveness of all cells,
including bacteria, and their vulnerability to phagocytes, inasmuch as:
"The secretions of the thyroid and parathyroids jointly
form the opsonin and agglutinin of the blood:
"And consequently it follows from certain assertions:
"That the adrenal system, composed of the pituitary
body, the adrenals and the thyroid apparatus, constitutes the immunizing
mechanism of the body.
The vaso-dilator fibres of the thyroid are from the
depressor. [Sajous. The Internal Secretions and the Principles of Medicine,
page 1129] The adreno-thyroid center regulates the circulation of the anterior
pituitary body and of the thyroid apparatus, by means of the "depressor
nerves." [Sajous. The Internal Secretions and the Principles of Medicine,
page 1133] The thyroid's depressor vaso-dilator fibres - (some of which
go to the parathyroids) "jointly constitute the thyro-parathyroid secretary
nerve." Their stimulation increases its activity [Sajous. The
Internal Secretions and the Principles of Medicine, page 1130] because
the vaso-dilation brings more leucocytes, and this is shown by an increased
amount, an excess, of colloid, its secretion.
GOITRE, an enlargement of the thyroid gland, may
be "vascular, cystic, or parenchymatous with colloid degeneration."
EXOPHTHALMIC GOITRE or Graves' Disease pathologically
considered [Wm. Benham Snow. Treatment of Exophthalmic Goitre and Myxoedema]
"comprises a progressive hypertrophy with hyperplasia and varying degrees
of infiltration of the gland, which in undisturbed cases, progress ultimately
to a degree of extreme hypertrophy. The accompanying tachycardia
associated with great dyspnoea is undoubtedly due to the excess of thyroid
secretion thrown into the circulation, the same condition being produced
by the excessive administration of thyroid extract."
The indications are, according to the same authority,
"(1) to induce cessation of the process associated with increased enlargement
of the grand, be it inflammatory, or due to some metabolic disturbance;
(2) the coincident diminution of hypersecretion, and (3) the removal of
Our results in the treatment of goitre, simple and
exophthalmic, make another link in Sajous' chain of evidence. He
believes that exophthalmic goitre is due to suprarenal overactivity," though
initiated through thyroid overactivity." [Sajous. The Internal Secretions
and the Principles of Medicine, page 186] The X-ray treatment
of the gland in conjunction with the static wave current and mechanical
vibration, is a successful method. All of the writer's cases have
had a coincidental menstrual disturbance which has also received local
treatment. Radiant light and heat are sometimes used as an eliminant.
The X-ray [Wm. Benham Snow. Treatment of Exophthalmic Goitre and Myxoedema]
"in repeated regular doses is to inhibit the tissue activity; probably
by inducing contraction of the tissues with the induction of inertia in
all living cells." The application of the static wave current by "inducing
energetically successive contraction and relaxation, as when administered
with a discharge not too rapid at the spark gap, initiates an active tissue
gymnastics throughout the substance of the gland thereby forcing out all
infiltration and removing as elsewhere all inflammatory action and restoring
its normal metabolism" (Wm. Benham Snow). Mechanical vibration
applied over the gland and the lymphatics of the axilla and neck with the
disc vibratode promotes elimination and induces the removal of the glandular
infiltration. With the disc vibratode, and a half stroke, apply prolonged
interrupted vibration to the goitre, making the left hand a resisting surface
on the other side of the gland. Vibrate first one side, and then
the other, four or five times. Then use vibratory friction of the
neck anteriorly and at the side, for circulatory stimulation. As
a supplementary treatment to promote elimination, vibrate the axillary
glands, and the liver, and spleen. Interrupted vibration with the
ball vibratode in the interscapular region will lessen the pulse rate.
In some cases prolonged
interrupted vibration, full stroke, with the ball between the transverse
processes of the 7th cervical and lst dorsal vertebrae will reduce the
arterial tension and indirectly affect the gland. For this purpose
it should be continued for five minutes with a few periods of rest.
MYXOEDEMA is characterized by "hyperplasia of the
connective tissue and mucoid infiltration of the cutis and surrounding
organs. The thyroid gland also becomes atrophied, and it is probably
upon the absence of the thyroid secretion that the condition depends."
The lessening of the thyroid would mean according to Sajous' views on the
thyroid that the vaso-constrictor fibres of the thyroid were stimulated,
with consequent lowering of the metabolism; because the thyroid secretion
keeps the test organ functionally efficient and "through it the adrenals,"
which keeps up the supply of adrenoxidase supplying oxygen to the tissues.
In myxoedema the secretion being lessened there is less adrenoxidase hence
less oxygen for the tissues and consequently a deficient metabolism results.
The treatment calls [Wm. Benham Snow. Treatment
of Exophthalmic Goitre and Myxoedema] for (1) to supply the deficiency
from some external source (2) to induce, if possible, the functional activity
of the gland and (3) to restore so far as can be, the normal metabolism
and remove in adults the pronounced characteristic oedema or hardening
and thickening of the skin and subcutaneous tissues found in advanced and
The static wave current applied with a metal electrode
over the gland for twenty minutes, the sparkgap being from one to three
inches, promotes metabolism and increases the activity of the gland.
"The effect of the current is to remove infiltration, abate inflammation,
by removing stasis and re-establishing circulation, at the same time inducing
tissue activity. "The static wave current is also given over the
abdomen, a flat metal electrode six by eight inches, being used.
Slow speed and the length of the sparkgap regulated so as not to cause
tonic contraction is necessary. More recently thyroid extract has
been used in connection with the treatment with marked success.
Administer general spinal vibratory treatment with
the ball vibratode for its tonic effect. Do not use heavy pressure.
With the patient lying in the prone position apply deep vibratory friction
to the soles of the feet from the heels to the toes six or seven times,
interrupted vibration about the ankle, and vibratory friction particularly
to the posterior surface of the legs. Follow this with interrupted
vibration to the knees and vibratory friction to the thighs. After
a short rest, With the patient lying on his back, apply vibratory friction
anteriorly on the legs and thighs, particularly the thighs, and interrupted
vibration to the ankles, knees and inguinal glands. A vibratory treatment
of the abdomen, liver, and spleen, and a stimulating vibratory treatment
of short duration with half stroke and moderate speed, should follow, on
each side and over the thyroid gland. The face, tongue, hands, and
arms should also be vibrated as conditions indicate.
Exercises adapted to the use of the particular group
of muscles involved should be given daily. A daily cold sponge is
advisable each morning if the patient reacts well. Dry hot air or
radiant light and heat baths twice a week are indicated. Do not allow
these patients to lead a sedentary life, activity is necessary. Thyroid
extract may be used in conjunction with vibratory treatment.
THE SPLEEN is situated "beneath the 9th, 10th, and
11th ribs, between the axillary lines - lines drawn vertically downward
from the anterior and posterior margins of the axilla. Its upper
edge is on a level with the spine of the 9th dorsal vertebra and its lower
with the spine of the llth." Vaso-motor fibres of the spleen come from
the medulla and Landois [Text-Book of Human Physiology, page 195] states
pass through the spinal cord "which is said to contain between the 1st
and 4th cervical vertebrae ganglionic cells that likewise influence the
contraction of the spleen."
"THE NERVE [Sajous. The Internal Secretions and
the Principles of Medicine, page 390] SUPPLY OF THE SPLEEN is the general
motor system (sympathetic) which supplies efferent nerves, which serve
only to maintain toxic contraction of the arteries and of the trabecular
muscles thus sufficiently activating the flow of blood to the lobular compartments
and to the Malpighian corpuscles to maintain their functional efficiency
during the passive period, and the vagus system.
"The vagus system supplies both the sensory and motor
nerves that excite and govern the functions of the organ during its active
period, which begins about the fourth hour of digestion.
"When, as a result of reflex stimuli through the
efferent gastroduodenal branches of the vagus, the spleen becomes functionally
active, the vagus impulses impose their rhythm upon the extrinsic motor
plexuses (Extensions of the splenic plexus), and the vagus system assumes
control of splenic functions. As a result,
"(a) The extrinsic arteries are constricted beyond
their normal tonic calibre; the speed of the blood flow into the organ
is increased and the blood allowed to slowly accumulate therein (probably
owing to restricted calibre of the venous exit), thus causing its dilation.
"(b) About the fourth hour of the digestive process
the arterial and venous calibres are equalized and the splenic products
(secretion, leucocytes, broken-down corpuscles, and pigments) are voided
into the splenic vein and increased rapidly. This continues for two
to four hours, when the calibres are readjusted by the vagus and the organ
resumes the passive state."
Stimulation of (1) the central end of the sensory
nerve; (2) of the peripheral ends of both splanchnics; (3 ) of the peripheral
ends of both vagi, causes contraction of the spleen, as does also stimulation
of the spleen itself by cold, electricity, or vibration, directly or reflexly
by spinal stimulation.
FOR THE TREATMENT OF SPLENIC CONGESTION deep vibratory
friction or interrupted vibration with the disc vibratode should be administered
over the side of the gland from the 9th to, and including the llth rib
between the axillary lines. Reflex contraction of the spleen can
be induced by vibrating with the ball between the lst and 2nd and 2nd and
3rd lumbar vertebrae following Abrams' method of vertebral concussion.
The treatment should be prolonged for five, ten, or even fifteen minutes
as the response warrants. The same result is obtained by the static
wave current. This is of value in malaria and pathological states
characterized by an enlarged spleen.
DILATATION OF THE SPLEEN is obtained by Abrams [Spondylotherapy,
page 352] by concussion of the llth dorsal spinous process.
Tenderness has been noted of the 9th and 10th dorsal nerves
on the left side when the spleen was pathologically affected. The nerves
have their exit between the 9th and 10th, and between the 10th and 11th dorsal
vertebrae. These nerves if conditions warrant should be vibrated locally
with the disc vibratode or at their sites of exit with the ball vibratode.