M. L. H. Arnold Snow, M.D.
The Relation of Mechanical Vibration to the
Heart, Blood-Vessels, and Ductless Glands
THE LYMPHATICS, which finally discharge their contents into
the blood stream at the junction of the subclavian and internal jugular veins
by means of the thoracic duct on the left, and the right lymphatic duct on the
right, are remarkably influenced by vibratory stimulation, particularly so in
respect to drainage and metabolism. The same is true of all lymphatic
glands - those of the neck, the mesenteric, mediastinal, axillary, inguinal,
popliteal, and the coeliac glands. For stimulation to greater activity
of the functions of the glands, the application of interrupted mechanical vibration
with moderate or deep pressure with the rubber-covered disc is very effective.
Cyriax [Vibrations and Their Effects] thinks
that "The anatomical arrangements of the lymphatics in all tendons, fasciae
and aponeuroses is such that the slightest pressure or stretching with
subsequent relaxation promotes the onward flow of the lymph (Ludwig and
Schweigger-Seidel). Centripetal vibrations must have the effect of
furthering the lymph flow in these parts; they no doubt act in the same
way on the lymphatics of other parts. Centrifugal running vibrations
have the opposite effect. Ledermann found that vibration materially
hastened the absorption through the skin."
The lymphatic vessels, most numerous in muscle fasciae,
between and around the muscle in subcutaneous tissue are readily acted
upon and the lymph stream directed to the outlet by vibratory friction.
When the stroke is percussive much of "the energy
conveyed by the process (percussion) is expended on the skin and its reflex
and sensory powers are highly stimulated by the application." The lacteals
are probably susceptible to vibration, and their metabolic processes are
possibly affected. Water, peptones, glucose and soluble salts pass
into the general circulation, being emptied from the hepatic vein into
the inferior vena cava. Their course is through the lymph-spaces
of the villi, passing by endosmosis through the walls of the capillaries
to the blood stream going through the portal vein and thence to the hepatic.
The emulsified fat is forced from the villus by the contraction of the
muscles around it on into the lacteal, and is thence carried into the general
circulation through the, thoracic duct. Through vibratory influences
affecting the circulatory system absorption is affected, as in absorption
is less rapid the fuller and more tense the blood vessels are" - and "is
the quicker the more rapid the circulation of the blood." The
lymphatic circulation can be increased by interrupted vibration or vibratory
friction according to the part treated for both produce tissue massage
and exercise. This is of importance in treating inflammatory conditions,
and enlarged glands, and in promoting absorption in cases of local oedema,
dropsy and similar conditions, and also in reopening obstructed lymph channels.
The main force promoting the chyle and lymph flow
depends (1) on difference in pressure in the thoracic duct and in the commencement
of the lymphatic vessels, which is due to muscular contractions of the
villi as before stated, aided by muscular contraction of the fibres of
the vessels and by intermittent pressure arising from muscular contractions
in different parts of the body. (2) Respiratory movements are important
factors-inspiration increasing the flow in the veins and expiration diminishing
it as well. (3) The nervous system as shown by Goltz and Hoffman
also influences the flow.
Vibratory action, therefore, either impulse or friction,
affecting contraction, accelerates the lymphatic circulation. While
the body is at rest Reibmayr observed that the flow of lymph nearly ceased.
These glands are safeguards in infectious processes and their activity
is necessary in order to effect, good drainage. The necessary activity
may be induced by interrupted vibration or vibratory friction, varying
with the part treated, each being especially applicable to different structures.
To stimulate the glands of the neck employ interrupted vibration with the
rubber-covered disc vibratode and over the vessels apply vibratory friction.
If the glands at the elbow are to be stimulated apply deep interrupted
vibration to the axillary glands and around the shoulder joint, then apply
vibratory friction centripetally to the arm. Follow this with deep
interrupted vibration with moderate or deep pressure around the elbow joint.
Then apply centripetal vibratory friction to the forearm, followed by deep
interrupted vibration with moderate or deep pressure with the disc vibratode
around the wrist joint, and employ vibratory friction from the tips of
the fingers, on the dorsal surface, to the wrist, and from the tips of
the fingers, on the palmar surface, to the wrist. Absorption is assisted
by stimulating the lymphatics communicating with the adjacent glands.
Horvath of Keiff has discovered that bacteria reside
mostly in the lymphatics; and Meltzer seems to have demonstrated that bacteria
cannot withstand continued vibrations, which suggests the importance of
vibration of the lymphatic glands except under some conditions when it
might scatter the infection.
Sajous [The Internal Secretions and the Principles
of Medicine, page 1795] observes, that the lymphatic system is poorly
self-protected by lack of red blood cells, and hence of adrenoxidase.
Bactericidal and antitoxic ,agents due to adrenal stimulants first appear
in the blood to combat toxaemias, so in disease we should endeavor "to
increase the proteolytic power and the aggressiveness of the phagocytes
by agents which cause their digestive vacuoles to be well supplied with
auto-antitoxin (their digestive triad) and to sensitize actively the bacteria."
Adrenoxidase is an auto-antitoxin. Therefore we should increase the
functional activity of the adrenals which should be accomplished by stimulating
the upper three thoracic nerves.
The same author notes that "the functional activity
of the adrenals is increased proportionally with that of the anterior pituitary
body where the latter's activity is increased from any cause. The
anterior pituitary body is directly connected with the adrenals through
the cervico-thoracic ganglia, the splanchnic nerves, and the semi-lunar
ganglia of the sympathetic nervous system."
IN METASTATIC PROCESSES, mechanical vibration may
be of value alone or in connection with other methods of treatment to relieve
accompanying oedema. The surface to be vibrated should first be dusted
with talcum powder. The disc vibratode should be employed, the treatment
being the same as that given for oedema. The results of such treatment
will be permanent or temporary, usually temporary, according to the pathologic
process causing it.
IN CASES OF ABSCESS, open and use the vacuum apparatus
of the vibrator giving a vibratory suction to empty the abscess and follow
with a prolonged treatment with radiant light and heat. The condition
of the patient should also be improved by regulation of hygiene, diet and
LYMPHANGITIS has been treated successfully by Cyriax
[The Elements of Kellgren's Manual Treatment, page 381] by "running
vibrations (manual) to keep the process from extending toward the body,
and frictions, ete., centrifugally down to the infected focus,"
in connection with exercises to promote metabolism and nutrition, and to
further the elimination of the toxins that have been absorbed. In
the treatment of abscess of the foot with reddened areas up the leg and
enlarged inguinal glands he used "suction vibrations around the abscess,
and centrifugal running vibrations along the inflamed area down
to the abscess. Vibrations over the inguinal glands and a stomach
exercise were also given." The author prefers opening of the focus
if pus is present and the use of hot air baths in the treatment of this
ADENITIS OF A NON-INFECTIVE CHARACTER, may be treated
by interrupted vibration over the nearest lymphatic glands, employing the
rubber-covered disc vibratode with a stroke suited to the part and using
a fairly rapid rate of speed. Prolonged interrupted vibration over
the affected glands and vibratory friction of the lymphatics should follow.
Treatment should be given daily at first.
In the treatment of NASAL AFFECTIONS the nervous
supply of the nose must be considered. Arnold states that the vaso-constrictor
neural cells of the mucous membrane of the nose are from the 2nd, 3rd,
and 4th dorsal segments and that the vaso-dilator neural cells are in the
nucleus of the 7th cranial. The nasal mucous membrane -may be directly
affected by interrupted vibration with the small cup-shaped soft rubber
vibratode, shortest stroke and very light pressure, on each side of the
nose on the motor points beginning near the inner angle of the eye near
the root of the nose. This area should be treated about three times.
Vibratory friction from the bridge of the nose downward and at the same
time outward, employing the shortest stroke and fairly rapid speed with
the same soft rubber vibratode to stimulate the activity of the lymphatics
follows. The hyperaemia of acute or chronic nasal catarrh is relieved
by vibratory treatment as indicated above.
Attacks of HAY FEVER are sometimes relieved by mechanical
vibration given as above outlined. Sajous believes that hay fever
is due to "hypersensitiveness of the trigeminal center in the pituitary
body - and that stricto-dilatation (the mode of action of all motor nerves)
provokes muscular contraction, - the stricto-dilators regulate the flow
of blood into sinuses, which thus become engorged with blood, causing the
copious secretion, marked obstruction, etc., seen in hay fever."
For NASAL VIBRATION Witthauer [The Journal of
Physical Therapy, page 105. Text-Book on Vibration Massage with
Special Reference to Gynecology. Dr. Kurt Witthauer] disinfects a
vibration sound and introduces it. "Braun makes use of 2-8 per cent
menthol vaseline; others wrap cotton around the sound and dip it in a solution
of cocain, potassium of iodide-glycerin (1 per cent iodin) for the atrophic,
and 2 per cent solution of protargol for hypertrophic conditions." In atrophic
conditions the diseased parts should first be cleansed. The vibrations
must be given cautiously and evenly... The time of treatment was short
at first but was gradually lengthened. Witthauer treated vasomotoric
hypertrophy of the turbinates with a vibration-sound avoiding the alae
nasi. He vibrated each side for two minutes when he began treatment.
A pocket vibrator operated by a small pocket battery, a special vibratode
being used, is to be preferred to the sound.
NASAL CATARRH may be favorably affected by employing
vibration in the nasal cavity or interrupted vibration over the motor points
on each side of the nose with the cup-shaped vibratode, followed by stroking
downward and outward from the bridge of the nose across the cheek.
A vibratory treatment of the neck will also assist in relieving the process.
The following in respect to the NERVE SUPPLY OF THE
LARYNX is of interest. The superior laryngeal nerve divides behind
the hyoid bone into its two terminal branches. The external branch
supplies the crico-thyroid and ramifies in the mucous membrane of the vocal
cord. The internal branch supplies all of the laryngeal mucous membrane.
The inferior recurrent laryngeal nerves, "the chief motor nerves of the
larynx, supplying all its muscles, except the crico-thyroid, pass backwards
into the furrow between the oesophagus and trachea. They ascend in
this furrow and divide at the level of the crico-thyroid articulation into
IN MECHANICAL VIBRATORY TREATMENT OF CERTAIN CHRONIC
AFFECTIONS OF THE LARYNX use the shortest stroke of the vibrator and the
rubber-covered disc or cup-shaped vibratode. Give light interrupted
vibration alternately on both sides of the thyroid cartilage.
Slow and gentle vibratory stroking or light vibratory
friction centripetally when applied td the neck anteriorly and posteriorly
is serviceable in catarrhal inflammations of the nose, pharynx and
larynx as well as in oedema of the neck affecting respiration.
Curtis reports success in the treatment of three
,cases of TONSILLITIS. Application was made to the spinal nerves
throughout the cervical region, using a ball vibratode and medium stroke.
The patient was then placed on his back and treatment applied to the cervical
sympathetics, using a throat vibratode with firm pressure to thoroughly
relax the muscles and allow the venous blood to more rapidly escape.
In addition the lymphatics in the axilla were stimulated with the multiple
point vibratode. Treatment was then applied to both the liver and
spleen to increase the elimination of waste products.
It is well to recall that many intermittent chronic
sore throats" have their source from auto-intoxication due usually to a
disordered stomach, or bowels which call for constitutional treatment and
regulation of diet, the local throat treatment being of minor importance,
for without the cause removed the after effects will resist unaided local
MECHANICAL VIBRATION AFFECTS RESPIRATION (1) by increasing
tissue combustion, and metabolism; and (2) by promoting the absorption
of 0 [oxygen] and the removal of CO2, which is induced principally
by stimulation of the muscles affecting the oxidation of muscle glycogen.
This also causes increased activity of the lungs, diaphragm, and all parts
affected by respiratory changes, the depth of respiratory movement being
Cyriax [Vibrations and Their Effects] notes
that "Hasebroek and many others found that vibration improved respiration.
The effect of every mechanical stimulus to ciliated epithelium is to stimulate
the cilia to increased waves of movement (Kraft, Verworn, Roth).
The vibrations in the lungs set up by "hackings" stimulate the lung and
facilitate expectoration (Thieme, Freidlander, Erni, Cybulsky)." The same
author states that Fleisch v. Marxow thought that the heart-beat imparted
shocks or vibrations that "were necessary for the gaseous interchange."
PERCUSSION of the lungs should yield a clear, pulmonary
resonance, but if the patient is stout the resonance may Joe less clear.
The supraclavicular, infraclavicular, mammary, axillary, suprascapular
and interscapular, scapular and infrascapular spaces should be percussed.
The lower border of the lung is lower than normal
in emphysema and bronchial asthma, and is higher than normal in "phthisical
shrinking, collapse, a distended abdomen or paralysis of the diaphragm."
Nerve stimulation is effected relatively, as the
muscles are under the control of nerves or nerve centers. If a particular
intercostal nerve be cut the action of the muscle which it supplies stops
absolutely, and if the spinal cord is divided below the level of the fifth
cervical nerve, that is, below the origin of the roots of the phrenic nerves,
costal respiration will cease but the diaphragm will still move.
Gowers [Diseases of the Nervous System, page 231] states that the
diaphragm is probably represented in the gray matter at the level of the
phrenic nerve, the 4th cervical nerve which has its exit between the 4th
and 5th cervical vertebrae. When the cord is divided below the medulla
all thoracic movements cease, but the respiratory action of the nostrils
and glottis does not cease." The degree of excitability and the stimulation
of the center depend upon the state of the blood, and chiefly upon the
amount of blood gases, the 0 and CO2 (J. Rosenthalt)."
The respiratory center may be stimulated by (1) the
will, (2) directly or (3) reflexly when afferent nerves are stimulated.
Stimulation of the pulmonary branches of the vagus, the auditory, the optic
and cutaneous nerves affects the center reflexly resulting in increased
activity, whereas stimulation of the superior laryngeal and the inferior
laryngeal nerves lessens respiratory activity or causes its arrest in expiration.
Both inspiratory and expiratory fibres are found in the vagus in the neck.
Stimulation of the expiratory fibres reflexly arrests respiration during
expiration. "Stimulation of the central end of the sciatic nerve
usually accelerates the respiration, more rarely reflex expiratory arrest."
"According to Langendorff, direct electrical, mechanical, or chemical stimulation
of the center may arrest respiration, perhaps in consequence of the stimulus
affecting the central ends of these inhibitory nerves where they enter
the ganglia of the respiratory center. During the reflex inhibition
of the respiration in the expiratory phase there is a suppression of the
motor impulse in the inspiratory center (Wegele)." Stimulation of the nasal
and ophthalmic branches of the trigemiuus, glossopharyngeal, and of the
olfactory stops respiration in expiration. [The Internal Secretions
and the Principles of Medicine, page 845]
Special reference has been made to these various
actions relative to stimuli, as such knowledge has a direct bearing on
the application of vibration and in explanation of some of the various
apparent phenomena that sometimes arise from treatment. The vaso-motors
(constrictors) of the blood vessels of the lungs come from the dorsal region
of the spinal cord (2nd to 7th dorsal) through the first thoracic ganglion
(Brown-Sequard, Fick and Badoud, Lichtheim), which is of prime importance
when spinal stimulation for such control may be necessary.
The following is a general review of the muscles
of respiration from Landois and Stirling's "Textbook of Human Physiology,
I. DURING ORDINARY INSPIRATION
(1) Diaphragm supplied by the phrenic nerve from
the 3rd, 4th, and 5th cervical and phrenic plexus of the sympathetic, which
can be reached near the right supra-renal capsule or the solar plexus.
The phrenic nerve "passes behind the sterno--clavicular joint." (2) "Mm.
Levatores costarum longi et breves (Rami-posteriores Nn. dorsalium). (3)
Mm. intercostales externi et intereartilaginei. (Nu. intercostales).
"According to their action, the auxiliary musclesof
forced inspiration, are those that elevate the ribs directly or indirectly,
or fix the lower jaw, so that muscles attached to the hyoid bone can act
"The hyoid bone is raised by the:
The sternum is raised by the:
The upper ribs are raised by:
The shoulder girdle is raised and drawn backwards by:
Serratus posticus superior.
The following muscles pull on the ribs and tend to approach
them to the raised shoulder girdle.
Levator anguli scapulae.
I. DURING ORDINARY EXPIRATION
The thoracic cavity is diminished by the weight of
the chest-wall, the elasticity of the lungs, costal cartilages, and abdominal
wall and abdominal contents.
Ordinary expiration, therefore, is non-muscular,
and the act is a purely passive one.
The abdominal contents are compressed and forced
against the diaphragm by:
The ribs are depressed by:
The data above and below are given in order that respiratory
activity may be more easily controlled through appropriate nerve or muscle
stimulation as indicated.
Serratus posticus inferior.
The innervation of the muscles of respiration appears
to Sajous [The Internal Secretions and the Principles of Medicine,
page 468] to be as follows:
"The nervous supply of the respiratory muscles is
"A. The divisions of the general motor system are
(1) the phrenic (the internal respiratory nerve of Bell), distributed to
the diaphragm; (2) the intercostals, distributed to the parietes of the
thorax and abdomen; and (3) the posterior thoracic (the external respiratory
nerve of Bell), distributed to the serrate magni.
"B. The divisions of the vagal system are (1) the
hypoglossal, distributed to the diaphragm (conjoined to the phrenic) and
to the intercostal and external respiratory muscles (instead of sympathetic);
(2) the inferior laryngeal distributed to the muscles of the larynx (except
the crico-thyroid) ; (3) the superior laryngeal, distributed to the crico-thyroid
The control by the two systems is as follows:
"The divisions of the general motor system maintain
tonic vascular contraction in, and nutrition of 9 the respiratory muscles,
while the divisions of the vagal system incite and govern their functional
and co-ordinative activity.
"The mechanical energy of the respiratory muscles
is the result, as in all muscular tissues, of a chemical action of the
oxidizing substance of the blood plasma upon the myosinogen of the musclecells.
Bradford and Dean [Sajous. The Internal Secretions
and the Principles of Medicine, page 481] found that PULMONARY PRESSURE
is raised, and aortic pressure lowered, that is, there is pulmonary vaso-constriction,
by stimulation of filaments which emerge from the cord from the 2nd to
the 6th dorsal nerve. These nerves have their origin from the lower
border of the spine of the 6th cervical to the lower border of the spine
of the 2nd thoracic or even just below the lower border of the spine of
the 5th thoracic vertebra, their exits being from between the 2nd and 3rd
dorsal vertebrae to where the 6th dorsal has its exit between the 6th and
7th dorsal vertebrae. "On a level with the 3rd, 4th and 5th dorsal
nerves maximum effects are obtained.
The pulmonary vaso-constrictors ascend the chain
up to the lst thoracic ganglion where they become detached, to reach t
he pulmonary plexuses."
"The following deductions" refer to the nervo-vovascular
mechanism of the lungs and the respiratory [Sajous. The Internal
Secretions and the Principles of Medicine, page 481]
"The nervo-vascular functional mechanism of the lungs
consists of two autonomous, though correlated, systems.
"A. The respiratory nervo-vascular system which is
"(a) The pulmonary lobules, in the walls of which
the blood is oxygenated.
"(b) The pulmonary artery and its subdivisions, which
bring venous blood, adrenal, secretion, and granules O to the capillaries
of the lobules.
"(c) The pulmonary venules and veins, which return
the arterialized blood to the heart.
"(d) The general motor nerves and plexuses (sympathetic)
which govern the functions of the foregoing structures and the vaso-constriction
of all vessels of the pneumo-respiratory system.
"B. The bronchial nervo-vascular system which is
"(a) The bronchial arteries, which, by their oxidizing
substance, sustain functional energy and metabolism in: (I) the interlobular
cellular, tissue and its lymphatic vessels and glands, the blood thus used
passing to the venae azygos by the bronchial veins, thence to the superior
vena cava; (III) the bronchi, the terminal ramifications of which only
reach to the exterior of the 1obules, but anastomose with the pulmonary
capillaries of the latter.
"(b) Vagal nerves and plexuses, which supply
sensation to the bronchial mucous membrane, incite and govern its secretion
and the vaso-constriction of all vessels of the bronchial system.
Vagus affects functions of bronchial tubes, etc., down to, but not including
the pulmonary lobule."
The following processes are of interest to the student
of physiological activities:
"1. The process through which functional energy is
supplied to the lobular structures (epithelium, basement membrane, and
vascular walls of the lobules) to compensate for the absence of oxygen
in the blood brought to them by the pulmonary artery is as follows: The
oxidizing substance in the blood of the bronchial terminal branches which
anastomose with the lobular capillaries, meets the granules contained in
the blood of the latter; oxidation of the granules ensuing, functional
energy is liberated, as it is elsewhere in the organism.
2. The functional oxidation process through which
the right heart is supplied with mechanical energy is repeated in the pulmonary
lobules, and there is some ground for the belief that the contractile effects
of the adrenal secretion on the myocardium are reproduced in the pulmonary
lobules, the abundant elastic fibres of the latter acting as contractile
3. The respiratory interchanges that occur in the
lobules represent the end-result of a complicated process for which the
reader is referred to Sajous' work..
By applying interrupted vibration with moderate or
fairly deep pressure with the, ball vibratode between the transverse processes
on each side of the spine from the 2nd cervical to the 12th dorsal and
over the solar plexus, the nutritional activity of all muscles in ordinary
inspiration and some of the muscles in forced inspiration is increased.
As before stated, the LUNG REFLEX OF CONTRACTION
is elicited by vibrating over the spinous processes of the 4th and 5th
cervical vertebrae or between their transverse processes, or directly over
When vibration is applied to the lungs directly,
if the patient is lying, the arms should be extended parallel to the sides
of the head, thus elevating the ribs and favoring chest expansion.
IN TREATING PULMONARY AFFECTIONS, a general vibratory
massage of the chest is indicated with special directions as to specific
indications. In the early stage Of PHTHISIS, the blood pressure is
usually high, in the later stages it is low. Concussion of 10th dorsal
spine is useful in early stage (Abrams).
With the patient lying and holding his arms slightly
outward and upward to straighten the pectorals without putting them on
a tension , apply very light centripetal friction with the disc vibratode,
going over each region about three times, from the insertion at the humerus
of the pectoral muscles and from the clavicle toward the upper part of
the sternum. Below the pectoral muscles work from the sternum toward
the axilla following the direction of the ribs and cartilages. Avoid
the breasts in women. Interrupted vibration with the rubber-covered
disc is used over the chest if there are painful spots, as are frequently
found in asthma, use deep interrupted vibration lightly at first,
gradually increasing the pressure until the pain lessens or disappears
when it is applied.
Movements may be used in connection with the vibratory
treatment for assisting inspiration or expiration. If it is desirable
to assist expiration, make pressure on the sides of the thorax or draw
the arms upward and outward.
To help resist inspiration "Place one hand upon the
abdomen, causing the patient to lift it upward by the inspiratory movement,
making at the same time a degree of pressure variously adapted to the patient's
Stimulating the nose and larynx causes the bronchi
to contract reflexly (Landois and Stirling).
ASTHMA, SPASMODIC OR BRONCHIAL, is characterized
by cough, difficulty of expectoration, and dyspnoea, the expiration being
prolonged and wheezy. According to Osler, "All writers agree that
there is in a majority of cases of bronchial asthma a strong neurotic element,"
which has been the case with all cases under the writer's care. The
theories as to cause are (1) spasm of the bronchial muscles, (2) "swelling
of the bronchial, mucous membrane, fluctionary hyperemia (Traube), vaso-motor
turgesence (Weber), diffuse hyperemic swellings (Clark), (3) in special
form of inflammation of the smaller bronchioles," (4) "spasm of the diaphragm
or a reflex spasm of all the inspiratory muscles. "Asthma may be
cardiac, renal, vesical or sexual.
Salter and Bergson believe that bronchial asthma
due to "stimulation of the pulmonary plexus, causing spasmodic contraction
of the bronchial muscle. If this condition is really spasmodic in
its nature ( 7 of the vessels), it must be usually of a reflex character;
the afferent nerves may be those of the lung, skin, or genitals (in hysteria).
Perhaps however, it is due to a temporary paralysis of the pulmonary nerves
(afferent), which excite the respiratory center (excito-respiratory)."
Reflex asthma is due to "irritated surfaces of parts besides the lungs
exciting the, oversensitive vagal center."
Sajous' [The Internal Secretions and the Principles
of Medicine, page 1700] explanation in respect to asthma is worthy
of note. He believes bronchial asthma to be "a form of paroxysmal
dyspnoea due to the concurrence of two pathogenic factors: (1) hyperexcitability
of the general vagal center (2) the presence within or upon the bronchial
mucosa, of endogenous or exogenous irritants as products of hypocatabolism.
The mucosa requiring for the expulsion of these irritants, reflex impulses
derived from the general vagal center, the hyperexcitability of the latter
causes it to project unusually violent impulses, to all the elements of
the bronchi, including their muscles, and these in turn being inordinately
contracted, they reduce the calibre of the bronchi and thus provoke asthma."
He believes an attack to be due "to vagal stricto-dilation of the bronchial
arterioles" which means that the vasa vasorum of the arterioles that supply
muscles (as well as any other organ), are constricted and consequently
there is an arrest or diminished flow of blood to the blood vessels' walls,
and therefore less nourishment is furnished which in turn causes lowered
metabolism and heat in the blood vessels and consequently their spiral
muscular elements relax and dilatation follows. The calibre of the
bronchi is lessened "by (1) contraction of their muscles, (2) congestive
swelling of the bronchial mucous membrane." The lumen may become so small
that the air cannot escape from the alveoli in consequence of which the
thorax and diaphragm cannot contract and cyanosis occurs. If the
vasomotor center was stimulated, general vaso-conscriction would follow
with a resultant rise of pressure. Brodie aiad Dixon [Sajous. The
Internal Secretions and the Principles of Medicine, page 1702] confirmed
experimentally "that stimulation of the vagus causes a marked diminution
of the volume of air entering and leaving the corresponding lung, owing
to contraction of the bronchial muscles. Kingscote [Sajous. The
Internal Secretions and the Principles of Medicine, page 1702] states
moreover, that this procedure causes simultaneously spasmodic contraction
of the diaphragmatic muscle." According to "Lefevre, [Sajous. The Internal
Secretions and the Principles of Medicine, page 1703] Salter, Trousseau,
C. J. B. Williams, and many others, the spasmodic contraction of the bronchial
muscles by greatly narrowing the calibre of the bronchi, provokes the asthma."
Stricto-dilation of bronchial arterioles causes congestion of all the bronchial
elements and hyperemic swelling. Sajous also notes that researches
show the absence of venous trunks in the bronchial mucosa, so it is supplied
only with capillaries. In an attack these capillaries become hyperaemic.
An attack is relieved by depleting them. They "can be depleted as
soon as the excess of blood supplied to them is reduced." Sajous
believes that "a hypersensitiveness of the vagal center in the posterior
pituitary body is a predisposing cause of asthma. Poisons act on
the bronchial sensory end-organs of the vagus." These cause afferent
impulses which are transmitted to the vagal center. Normally
they would cause "periodical contractions of the bronchi, but being hypersensitive
the center projects violent stimuli to the bronchial muscles and mucosa,"
which causes broncho-stenosis, which in turn causes the asthma. Since
broncho-stenosis is due principally to contraction of the bronchial muscles
and congestive swelling of the bronchial mucous membrane, and the swelling
is due to stricto-dilation of the arterioles the first indication is to
contract the arterioles and lessen the quantity of blood sent to them.
Constriction of the arterioles is by means of the sympathetic fibres.
Landois [Text-Book of Human Physiology, page
719] says "the cervical sympathetic cord contains centripetal fibres that
stimulate the vaso-motor center in the medulla oblongata." It is
possible that the sympathetics are reached by vibration over the 4th and
5th cervical spines which gives temporary or permanent relief.
Pressor fibres [Landois. Text-Book of Human Physiology,
page 764] are represented by fibres of centripetal nerves, "irritation
of which influences the vaso-motor center. They increase blood pressure.
Aubert and Roever discovered pressor fibres in the cervical sympathetic."
THE TREATMENT indicated is to first control the paroxysm
as by a drug stimulating the sympathetic center as belladonna which raises
blood pressure and gives better oxygenation. [Sajous. The Internal Secretions
and the Principles of Medicine, page 1214] This can be accomplished
by mechanical vibratory treatment so applied as to increase the vascular
tension. The second indication for treatment is the removal of the
The causes are local disorders or foci of irritation
arising from the toxins or endotoxins of diseases following successively
or from the constant irritation of toxic products resulting from the effects
of hypocatabolism on the central neurons. Measures should be employed
to care for and remove the causes as they present themselves. In
the latter cases there is an excess of waste products requiring elimination.
Metabolism must, therefore, be promoted by means which will awaken tissue
activity, such as the application of general or local mechanical vibration
or the high potential electrical currents, radiant light and heat, or by
stimulating the adrenal center which may, according to Sajous, cause an
increase of auto-antitoxin in the blood. Diet is of the utmost importance.
A diet largely of milk is to be preferred.
The induction of the LUNG REFLEX OF CONTRACTION (Abrams)
is effected by a five or ten-minute seance of interrupted vibration with
the ball vibratode applied between the 4th and 5th cervical vertebrae.
The patient may sit erect or lie face down during the treatment.
This will relieve the rales in a remarkable manner. If conditions
call for a longer vibration, it may be applied for an additional five minutes.
If the rales have not then fully disappeared, an interrupted vibration
over the region between the clavicle and breast and over the sternum with
the disc vibratode may be applied, a half stroke and moderate speed being
used. The parts are vibrated interruptedly two or three times.
Abrams advises forcible concussion over. any area of the lungs (by means
of a plexor and pleximeter) as a method of inducing the lung reflex of
contraction. When not entirely relieved, an administration of the
static wave current with a small metal electrode (1 by 3 inches) covering
the intervertebral space between the 4th and 5th cervical vertebrae for
fifteen minutes is often followed with good results. Blowing exercises
are also practiced to advantage.
Another method is as follows: The patient first removes
all clothing about the waist and chest except the undervest. Then
use the ball vibratode with medium stroke for the cervical region if necessary,
otherwise with full stroke and regulated pressure with a moderate rate
of speed. Apply deep interrupted spinal vibration on each side alternately
between the transverse processes from the lst cervical vertebra to the
waist line noting the painful sites. This application should be made
to each interspace from above downward, two or three times. When
sensitive spots are found, as they will be in most cases to the right of
the 6th cervical vertebra, and often in the interscapular region, apply
interrupted vibration for six or seven times, i.e., interruptedly each
time increasing the pressure, according to the effect produced. Apply
the vibratode lightly at first, gradually increasing the pressure with
each application as the pain diminishes. The disc vibratode is afterwards
used for applying interrupted vibration to the tense muscles of the back,
then the patient is allowed to rest for a short time, after which he should
lie upon his back with a pillow beneath the thorax to elevate the chest,
and the arms should be extended upward along the sides of his head.
Then apply vibratory friction to the neck with the rubber-covered disc
vibratode, employing a short stroke.
After a few minutes' rest, apply interrupted vibration
with the disc vibratode from the insertion at the humerus of the pectoral
muscles toward the sternum, and below the pectorals vibrate from the sternum
to the axilla. If there are any particularly sensitive spots, apply
interrupted vibration very lightly at first, gradually increasing the pressure
at each impulse until the pain is lessened or disappears. Also apply
interrupted vibration with the rubber-covered disc vibratode over the solar
plexus to affect the phrenic nerve and thus affect the action of the diaphragm.
In addition the writer sometimes applies interrupted vibration over the
region of soreness, which may form a girdle around the waist line in men,
or be in the abdominal region in women, probably due to their manner of
breathing and mode of dress. Treatments should be given daily at
first, and later the intervals may be lengthened as the condition improves.
If possible, give the treatments early in the day for the comfort of the
patient. Sometimes forced breathing exercises are useful while the
patient lies in, a prone position, the head and chest being below the level
of the pelvis, to assist in getting rid of the secretion. If the
patient's general condition is poor, the static wave current may be administered
with advantage, employing a spinal electrode.
Theoretically the induction of THE REFLEX LUNG CONTRACTION
is indicated in CHRONIC BRONCHITIS where "bronchial dilatations are not
uncommon and emphysema is a constant accompaniment, in BRONCHIECTASIS when
not congenital or an anomaly, in later stages Of PHTHISIS, and in all conditions
where there is overexpansion.
IN ACUTE BRONCHITIS, CHRONIC BRONCHITIS AND PHTHISIS
PULMONUM, Cyriax [Elements of Kellgren's Manual Treatment, page
164] has always found an interscapular tenderness which he believes is
due to the posterior pulmonary plexus being "largely formed of sympathetic
fibres from the second to and including the fourth thoracic sympathetic
ganglia." He also often noted tenderness in the nerves supplying the intercostal
spaces that lie over any affected area.
EMPHYSEMA, the most marked form of which is hypertrophic
emphysema is "characterized by enlargement of the lungs due to distension
of the air cells and atrophy of their walls, and clinically by imperfect
aeration of the blood and more or less marked dyspnoea." The treatment
should aim [Sajous. The Internal Secretions and the Principles of Medicine,
page 1859] to "increase the blood supplied to what normal alveoli remain,
by causing dilation of the arterioles or by increasing their propulsive
activity, and simultaneously the power of the blood to absorb oxygen."
Hence stimulate [Abrams. Spondylotherapy, page 303] the sympathetic
and the adrenal systems. Induce a rise of blood pressure. The
treatment is practically the same as for asthma, but the prognosis is not
THE LUNG REFLEX OF DILATATION is elicited (Abrams)
by concussing from the 3rd to the 8th dorsal vertebral or by vibrating
between the transverse processes of the 3rd and 4th, 4th and 5th, 5th and
6th, 6th and 7th, 7th and 8th dorsal vertebrae [Abrams. Spondylotherapy,
page 303], when the same effect has been produced by the writer.
The effect is recognized by hyper-resonance and the "extension of the pulmonary
percussion note and obliteration of the cardiac and splenic areas of dulness."
[Abrams. Spondylotherapy, page 295]
Theoretically the lung reflex of dilatation
may be employed in PULMONARY ATELECTASIS when the lessened expansion is
not due to causes of obstruction or compression which are not removable
as tonsillar enlargement, adenoids, growths, kypho-scoliosis.
Absorption is assisted by stimulating the lymphatics
communicating with the axillary glands. To accomplish this apply
vibratory friction centripetally.
"Poliakow reports most excellent results in the treatment
of cases of PLEURISY WITH EXUDATION," by the employment of thoracic massage.
The manipulations were made in the direction of the lymphatics of the affected
region. The treatment was begun with light stroking, and soon brisk, deep
massage was employed, and this was followed by percussion all consuming from
ten to twenty minutes daily. Vibratory friction may be supplemented by
interrupted vibration. Vibration applied to produce the vibratory effect
of "hacking" is useful in UNRESOLVED PNEUMONIA, CHRONIC PLEURISY, and where
there is an effusion of a serous character. According to Graham, Dr. Emil
Schliegel accelerated absorption in some cases of pleuritic effusion by
manual massage "in the form of percussion, employing only the ulnar border of
the hand, striking at a rate of two blows a second, or six hundred in five minutes,
which made a sitting and two of these were given daily." Properly applied vibration
will accomplish the same results and with greater facility. The number
of percussions per second given by Schliegel will suggest to the operator the
importance of employing a definite control of speed.