Title Page
TITLE PAGE
The object of this book is to furnish the general practitioner in as simple and compact form as possible, the technique to be used in the treatment of various conditions by Mechanical Vibratory Stimulation. In writing this it has not been deemed necessary to include anatomy and physiology, with which all practitioners of medicine are familiar. All theory has been left out, and only a practical working basis given, so that any physician possessing a vibrator may take any individual case and in a moment's time be able to learn just how and where to apply vibration. The technique which is furnished here is based upon an experience of a number of years in which fully twenty-five thousand treatments have been given, covering many hundred individual cases of a widely varying lot of conditions. The technique which is described is one which has proven most efficacious in the writer's experience. It is sincerely hoped that this small manual will
serve the purpose for which it is written and that it will enable the practitioner
to broaden the field of usefulness of his vibrator.
Every vibrator should possess at least two attachments for spinal work, one to be used where the amount of sensitiveness present is not very great, and another in which a milder form of treatment can be given to those cases in which the spine is extremely sensitive. An attachment for local use over the abdomen and over the limbs is necessary, and should be in the form of a brush, so as to give only superficial stimulation. In addition to these, there should be a special attachment for treating the eye, one for treating the throat, and another, for rectal or uterine vibration. The spinal treatment should always consist of as heavy vibration as the patient can stand and this should be increased at each treatment until they are able to bear quite a heavy treatment. For inhibition it is always best to use the attachment which will get deeply in the tissues and bring about the result very quickly. Inhibition can generally be obtained in from twenty-five seconds up to a minute and a half, depending on the length of stroke and the amount of pressure being used. With heavy vibration and heavy pressure, the result is obtained in from twenty-five to thirty seconds; if the pressure be decreased and the stroke be diminished, to a medium, then forty-five to fifty seconds are required; if the shortest stroke is used, and pressure be light, vibration should be kept up a minute to a minute and a half, rarely more. Vibratory Treatment should be divided into inhibition and stimulation, although some authors have three or more divisions of this subject. It seems that the point where stimulation merges into inhibition is so vague that no intermediate term need be used. Stimulation is that form of vibration which will increase the activity of a nerve cell or of the part to which it is applied, or increase the function of the organs which are controlled by the centre over which vibration is given. Inhibition is the opposite, and when treatment of this character is given, it serves to decrease the activity of the parts to which it is applied, or to the part controlled by the nerve centre to which it is given. Stimulation can be obtained in from five seconds to a minute and a half, increasing the length of time as the amount of pressure and length of stroke are decreased, or conversely decreasing time as pressure and stroke are increased. Inhibition requires from thirty-five to forty seconds up to two to three minutes, the shorter the stroke and the less pressure exerted, the more time is required. To secure either inhibition or stimulation quickly, it is best to use the ball attachment; where it is desired to continue the treatment for a longer time, then the softer attachment may be used. ABNORMAL POSITION OF THE COCCYX. If the coccyx be displaced anteriorly or laterally, the muscles in the surrounding parts should be thoroughly relaxed, and then the attachment must be placed within the rectum and brought back against the coccyx and pressure exerted until the coccyx is forced back into its normal position. If the treatment causes a great deal of pain, the operator should not try to completely replace it in less than four or five treatments. After the bone has been put in place, the muscles attached to it should be gently stimulated, causing them to contract and hold the bone in its proper place. If the displacement be posterior, heavy vibration directly over the posterior surface of the coccyx should be used, being however, not to force it into position too quickly. The treatment of adenitis, no matter what the cause be, should consist of vibration over the glands themselves, and over the chains of lymphatics leading from and to them. If pain be present, then the spine should be examined for sensitive points, and these should be inhibited. It is always necessary, though, to stimulate the liver and spleen and to keep the bowels in good condition in order that absorbed products may be eliminated; otherwise febrile symptoms will appear. If the adenitis be of tubercular origin, a very mild spinal treatment should be used in addition to the local treatment for the purpose of stimulating the system as a whole. The results in adenitis are uniformly good, even in those cases in which fluctuation may be detected, Treatment of alopecia should be directed to improvement of the circulation in the scalp. This may be accomplished by vibration applied over the vaso motors which control the blood vessels which supply the part. The centres controlling this are found in the cervical and upper dorsal region. The treatment over the spine should be stimulative, while that over 'the cervical region anteriorly should be inhibitive. Local treatment should be given with the brush for fully five minutes. Treat cervical regions anteriorly and posteriorly. Ball, posteriorly, medium stroke, 15-20 seconds each point. Brush anteriorly 45-50 seconds. Amenorrhea, like all diseases of the menstrual function, is peculiarly susceptible to Mechanical Vibratory Stimulation, unless there be some obstruction, such as plugs, displacements, or other anatomical abnormalities that prevent the normal flow. Even in some cases in which displacement is the causative factor, good results are obtained by stimulation of the centres controlling the ligaments, in such a manner as to tone them up and cause them to bring the uterus back into its natural position. The cases of this condition which yield most readily are those in which abnormal conditions can be outlined along the spine, such as muscular contractions, and sensitiveness, and in the treatment, all of these things should be taken into consideration. Where contraction exists, the treatment should be such as to produce a relaxation of the muscles; where sensitiveness is obtained, the treatment should be carried to the point of inhibition, that is, until all sensitiveness disappears. Ordinarily, the treatment of amenorrhea should be given with the ball attachment, medium stroke and medium pressure, fifteen to twenty seconds at each point from about the eighth or ninth dorsal down to the upper border of the sacrum. Examination of these points will usually show muscular contraction and sensitiveness. However, if these do not exist, treatment should be applied just the same. Many cases of amenorrhea are due to anemia, and these should be given a general spinal treatment for the purpose of toning up the system as a whole. It is also well to thoroughly stimulate the spleen, as this will have a good effect on increasing the number of red corpuscles in the blood. In amenorrhea, as in other conditions, all symptoms must be taken into consideration, and if there be painful areas at any point an inhibitive treatment should be given; if constipation exists, treatment should be given for the relief of this. Where no apparent cause can be discerned, it is always well to look for abnormal positions of the pelvis and for displacements of the coccyx, as if either of these conditions exist, they will exert a very profound effect upon the sympathetic and spinal nervous systems and produce deleterious results. At times the non-appearance of the menstrual flow is due to inactivity of the ovaries, and this will require, in addition to stimulation over the ovarian centres, the application of vibration over the ovaries anteriorly; i.e., the patient should be placed upon her back and deep vibration be given in the iliac fossae. Give general spinal treatment with the brush, medium stroke and medium pressure, placing the attachment immediately over the spinous processes. Give this for a minute and a half to two minutes; then, with the ball attachment, thoroughly percuss the liver and spleen. Also use technique for raising the ribs. Then, with the ball and deep pressure, medium stroke, vibrate over the spleen anteriorly three-quarters of a minute to a minute and a half. If constipation exists use technique for correcting same. Angina Pectoris may be benefited by vibration by use of inhibition over the centres which are found from the seventh cervical to the eighth dorsal inclusive. Very often examination of the thorax will show that one or more of the ribs are deflected from their normal position. Another common condition found is displacement of the clavicle at its sternal articulation. If any of these anatomical deviations be found, they must be corrected. This can usually be done in one or two treatments, although the displacements may recur until the muscles are toned up sufficiently to hold them in position, or, as is often the case, the deviation is due to muscular contracture which is pulling the bones from their normal position, then the muscles must be relaxed. In the treatment of this condition, vibration must also be given over the whole thorax, and an inhibitive treatment must be given the pneumogastric nerves. While giving the treatment over the thorax anteriorly, it is well to have the patients extend their arms over their head, and to have a pillow doubled up under their back so as to bring the thorax into as much prominence as possible. Treatment – Ball, cervical and dorsal regions, and at posterior angle of ribs. Only the fibrous form of ankylosis is amenable to vibratory treatment, and many of these cases require a long course of treatment before any result is obtained. Heavy vibration should be given over the joint itself, and at the same time the operator should forcibly move the joint as much as possible. The centres controlling the blood supply to the affected part should be stimulated so as to increase the arterial flow and to relieve venous stasis. The circulation can also be directly benefited by using vibration over the blood vessels of the part, following their course and always working from the joint toward the trunk. The local treatment should be heavy over the joint itself, and light over the blood vessels. Treatment – Ball, spine, medium stroke, medium pressure, 15-20 seconds at each point. Brush locally. Look for displacements of the lumbar vertebrae, and for contractions of the erector spinae, or quadratus lumborum muscles. If a displaced vertebra is found, use the technique that is described in another chapter. Relax all contracted muscles by heavy vibration twenty-five to thirty seconds over each point. If none of these abnormalities are found, then vibrate heavily with medium stroke twenty-five to thirty seconds at each point from the ninth dorsal down to the sacrum. Use ball attachment with deep vibration a minute to a minute, and a half over the region of the appendix. Varying results have been obtained by the use of vibration in this particular disease, all, depending upon the cause. As is well known, asthma may be caused from disease of the heart or kidney. These being organic in character, are not amenable to vibration, though if given at the time of a spasm, it may bring about temporary relief. Other cases of asthma yield better results, especially those which originate in some disorder of the nervous mechanism, and also those due to congestion of the various viscera. In asthma due to disease of the heart, treatment should be directed to the inhibition of the spinal centres lying in the area between the third and eighth dorsal. In those due to degenerative processes of the kidney, the treatment should be inhibitive, but should be given to the lower dorsal and the upper two or three lumbar. If the etiological factor be of nervous origin, the treatment should be inhibitive, and should be applied throughout the dorsal region. The patient should be turned upon his back, and an inhibitive treatment should be given to the pneumogastrics. Beneficial results are greatly hastened by thorough vibration of the thorax anteriorly. As is sometimes the case, asthma is due to a reflex condition from the nose; here the treatment should be inhibitive, but should be directed to the peripheral terminations of the nerves supplying the nose. This is best given with the small facial or eye attachment, used locally. Anatomical defects are often productive of asthmatic conditions; this is especially true of a depression of one or more ribs. Such conditions as this should be corrected by using the technique which is given in another part of the book under "Abnormalities of the Bony Structures Forming the Thorax." If the paroxysm be due to a congested condition of the liver, the liver centres should be inhibited; i.e., inhibition should be given to the centres lying between the fourth and eleventh dorsal, inclusive. In addition to this, the vibrator should be applied over the liver posteriorly, using a percussion stroke forty-five to fifty seconds. This usually suffices to reduce any congestion, and thus relieves the asthmatic attacks. Treatment – Ball, cervical region to ninth dorsal, medium stroke, 15-20 seconds each point. Brush over thorax anteriorly. Vibration has proven efficient in a great many cases of Bell's Palsy, and should be given as follows: with the brush attachment, stroke less than medium, vibrate thoroughly over all facial muscles on the affected side; this should consume four to five minutes. The ball should then be used throughout the cervical region for the effect on the trophic centres. The stroke and the pressure should be medium, and the attachment should be left at each point twenty-five to thirty seconds. The sympathetics which lie in front of the transverse processes of the cervical vertebrae should be stimulated with the soft attachment; to do this requires three-quarters of a minute to a minute on either side. Practically the same treatment is necessary here as that which is described under tonsillitis, laryngitis, etc., with the addition of mild vibration over the thorax anteriorly. The vaso motors controlling the blood vessels to the head and face arise at about the second dorsal vertebra, and from this point they go anteriorly, and mingle with the inferior cervical ganglia; from thence they go as a single cord, through the middle and superior cervical ganglia, and, with the internal carotid artery, they enter the base of the skull, where they form the carotid and cavernous plexuses, and are closely associated with the ophthalmic branches of the cranial nerves. In their course, they send off a connecting branch which joins Jacobson's Nerve. This fact should always be taken into consideration in the treatment of any condition affecting the head or face. A routine treatment for catarrhal deafness, and one which will serve in most cases to bring about a cure, use the spinal attachment fifteen to twenty seconds at each point from the third dorsal up to the first cervical, going on either side of the spine; then, with the same attachment, same stroke, and same pressure, place the machine in such a manner as to get a percussion stroke. This should be used over the mastoid processes forty-five to fifty seconds each. The patient should then be placed on his back, and the cervical sympathetics stimulated twenty-five to thirty seconds; then, with the ear attachment go directly over the external meatus, vibrating here thirty to forty seconds. If the attachment is cup-shaped, the instrument should be raised and lowered so as to produce a suction effect, and thus cause an outward and inward motion of the drum. It has been recommended by some to use percussion over the point of the jaw, at the same time closing the ears by means of the fingers. This has been used successfully by Dr. Wilbur L. Wright, Washington, D. C. If a neurasthenic element is present in the condition, as one will often find, in addition to the above treatment, a general spinal stimulation should be given. The treatment generally serves to abate all noises, and after a time to increase the power of hearing, and one can safely say that improvement should follow in from 90 to 95 percent of all cases treated. Use ball attachment, heavy pressure with medium stroke forty to fifty seconds over each point from the first cervical to the fourth or fifth dorsal. Vibrate over the cervical region anteriorly a minute to a minute and a half on either side. With the ball attachment, medium stroke, from the first cervical to the fourth or fifth dorsal, going on either side of the spine and placing the attachment between the transverse, processes of the vertebrae, leaving it at each point twenty-five to thirty seconds. Then with the soft attachment vibrate forty to fifty seconds over the sympathetics in the cervical region. These can be reached anteriorly. It will be found that a large percentage of cases having choreic spasms will yield in comparatively few treatments to Mechanical Vibratory Stimulation. The treatment should be inhibitive, and should be directed to the centres controlling the area in which the spasms occur, as, for instance, if the facial muscles are those involved, the treatment should be directed throughout the cervical region and over the exit of all cranial nerves supplying the face; if the hands and arms are at fault, then the treatment should be given over the cervical and upper dorsal regions, and if the lower limbs are involved, vibration should be applied to the lower dorsal and lumbar regions. The operator should always bear in mind that any points which are extremely sensitive, or any areas in which muscular contraction lies should be given attention. Colitis, where there is a catarrhal condition of the mucous membrane lining the intestinal tract, is, as a rule, readily relieved by vibratory treatment; the intestinal tract, with the exception of the rectum, being supplied by sympathetic nerves, may readily be affected by the use of vibration over the great sympathetic plexuses, which may be reached through the abdomen, or by means of the rami-communicantes, through the posterior primary divisions of the spinal nerves. The majority of the sympathetics in the intestines are derived from the splanchnic area, and as these lie in the dorsal region, they may be reached by using vibration over the posterior angles of the ribs, the vibration being transmitted through the bones to the sympathetics, which, in the dorsal region, lie on the heads of the ribs. Treatment either given locally over the abdomen or along the spine should be of a stimulative character; this will relieve the venous stasis and allow the free circulation of the blood in the vessels. For the relief of pain, the treatment should be given locally to the point of inhibition. It is safe to say that at least 95 percent of cases of this condition, whether they be chronic or acute, will be greatly benefited by vibratory stimulation, as there can be no doubt that mechanical or physical treatment is the ideal method to be used in conditions of this kind. Drugs and enemas are of no avail, as their use only serves to give temporary relief, and they have to be increased in frequency and amount each time they are given, while vibration gets at the seat of the cause, and by relieving or removing it, brings about the desired cure. The conditions which prevail more often in constipation than any others are atony or spasticity of the intestinal walls, and one or the other condition usually exists in constipation of any form. Atony may be due to lack of stimulation to the nerve supply of the intestines, due to an insufficient amount of food being taken into the system, or it may be due to overloading of the intestines, in which case a constant irritation to the nerve endings in the intestinal walls will, after a time, fail to arouse any response, and the intestines will become distended, and the peristaltic movements will be greatly diminished in frequency and force. A frequent cause of constipation is the failure on the part of the patient to respond to the impulses which the packing of the feces in the rectum brings about; this, as in cases of overloading of the intestines, results in atony of the rectum. When an atonic condition of the rectum exists, it is manifested by contracture or extreme sensitiveness at points overlying the foramina of the sacrum, due to the fact that the rectum, receiving its nerve supply from the sacral plexus of nerves, they are reflexly affected. The various secretory organs which furnish the fluids whose action is the digestion of food may be at fault, owing to the increase or decrease of any one of their constituents, thus changing their chemical make-up, or if the fluids themselves be small in quantity, digestion cannot take place, as there is too small any amount of fluid to affect the amount of food which is taken in. Taking the treatment of constipation up in order as the etiological factors are given we must, in addition to correcting all faulty habits, take into consideration the anatomical abnormalities which exist in atonic conditions of the intestines. Treatment is best applied through the splanchnic area, for reason that the intestines, with the exception of the rectum, are supplied by sympathetic nerves, and to reach these, we must depend upon the transmission of the vibratory impulse either through the posterior primary divisions of the spinal nerves by way of the rami-communicantes, or through the bony structures themselves, in the latter case using vibration over the posterior angles of the ribs, for reason that the sympathetics in the area which supply the intestines lie on the heads of the ribs themselves. Here stimulative vibration must be given, unless the operator is able to detect sensitive points; in this case, the treatment is given to the point of desensitization of all tender spots. In those cases where spasticity exists, the operator will, as a rule, find an intense amount of muscular contracture, and here it is his duty to relieve contractures by using vibration over each contracted muscle until it is thoroughly relaxed. Relaxation can be determined by the appearance of sensitiveness, and the vibration should be continued until this sensitiveness disappears. The operator will then know that he has succeeded in inhibiting the nerves over which he is working. Where the amount of liver secretion is very great, the spinal attachment should be used from about the second to the eleventh dorsal on the right side, leaving the attachment at each point thirty to forty seconds. If the amount of fluid be too small, then fifteen to twenty seconds at each point will suffice. Where the pancreatic fluid is in excess, inhibition should be given from the seventh to the eleventh dorsal inclusive, or, if the fluid be small in quantity, then stimulation of these points should be sought for. Constipation due to packing of feces in the rectum is best relieved by exceedingly heavy vibration given for a brief period of time over the lower lumbar and sacral regions, or, if as is often the case, the sphincters are contracted and the physician possesses a vibrator which is capable of divulging the sphincters, then this operation should be performed. All cases of atonic constipation are greatly, benefited by a mild stimulation of the pneumogastrics, and some few cases of atony are greatly relieved by work over the abdomen itself, the rule being to follow the course of the colon. The average man would think that the abdominal treatment was preferable in all cases, but experience has shown otherwise, for the reason that very few men will carry vibration to the point of stimulation only, and they usually think that the abdominal treatment should be of from fifteen to twenty minutes duration. They do not stop to consider that with the great plexuses of sympathetic nerves which are reached through the abdomen they will secure inhibition very quickly, and thus decrease the peristaltic action instead of increasing it, as they would like. If abdominal treatment is given at all, it must be very brief, never lasting over a minute to a minute and a quarter, and the treatment should be confined to the colon alone. Of course, in speaking of the brevity of abdominal treatment, we do not mean those cases in which the brush or soft attachment is used to secure the toning up of the abdominal muscles themselves, as in cases of this kind the treatment may be lengthened to two or three minutes, providing that heavy vibration is not given. In conjunction with vibratory treatment, it is always necessary, of course, to correct all faulty habits on the part of the patient, and in those in whom lack of exercise is the cause, then more exercise must be prescribed; in those in whom the diet is at fault, this must be corrected, or in the cases of those in whom the amount of fluids taken is deficient, the physician must impress upon the patient that a sufficient amount be used. Heavy vibration with short stroke twenty-five to thirty seconds at each point from the first cervical to the fourth or fifth dorsal. Use the soft attachment over the cervical region anteriorly thirty-five to forty seconds at each side. Use the facial attachment over the point of articulation of the nasal bones with the frontal – minute to a minute and a half, giving fairly deep pressure. Use light vibration either side of the nose. The spinal attachment must be used to the point of inhibition to the lower part of the spine, beginning at about the ninth dorsal, and going down over the sacrum. Heavy vibration must be applied in the perineum, and over the lower portion of the abdomen. The lymphatics in the inguinal and femoral regions must be stimulated, as should also the liver and spleen. About every other treatment the rectal attachment should be applied, passing it well up into the rectum, and bringing it forward so as to get as much vibration directly to the bladder as possible. These cases are also, as a rule, benefited by allowing the attachment to rest over the prostate gland for a half to three-quarters of a minute. It is sometimes well to use the brush over the lower part of the abdomen, using deep pressure and vibrating here for about a half to three-quarters of a minute. In the spinal treatment the attachment is left at each point fifteen to twenty seconds. The vibration in the perineum should not be continued longer than three-quarters of a minute to a minute. The stimulation over the lymphatics should be continued for a minute and a half to two minutes. In stimulating the liver and spleen the ball should be used with percussion stroke forty-five to fifty seconds over each. DEVIATIONS OF THE BONY STRUCTURES FORMING THE THORAX. Deviations to be looked for in the thorax consist of depression or elevation of one or more ribs, displacements at their spinal attachment in any direction, or at their junction with the cartileges. To detect the depression or elevation of a rib or displacement at its articulation, the operator should place his fingers in the intercostal spaces, comparing one side with the other, and comparing the spaces above and below. As a rule, where a rib is displaced, one can detect sensitiveness by using digital pressure at the point where the rib articulates with the vertebra. The technique for replacing a rib which is depressed is as follows: Use the brush attachment, placing it at the posterior angle of the rib, and using a short stroke and heavy pressure; while holding the instrument here, the operator should place his hand over the patient's shoulder down the anterior surface of the thorax. He should then lift up on the patient's body in such a manner as to spread the ribs apart, with the pressure at the posterior angle serving as a fulcrum and the patient's body as a lever. Pulling up in this way the muscles which are attached to the ribs will serve to pull the rib into its normal position. If the displacement of the rib be upward, then the same attachment and pressure should be used at the posterior angle, but the operator should place his fingers on the affected rib at some point distant from the spine and use downward pressure in such a manner as to force the rib down into its normal alignment. If a rib be displaced forward at its articulation with the spine, the brush should be placed at some point on the anterior wall of the thorax over the affected rib, using heavy pressure, at the same time the operator having his hand on the affected rib at a point about the mid-axillary line. Pressure should be downward and toward the sternum. This will pull the rib back into its proper position. If the displacement be backward at the articulation of the spine, heavy pressure directly over the rib will force it into position. Look for abnormalities in the ribs. If found, correct same. Otherwise use ball attachment, medium stroke, medium pressure, from the first dorsal to the fourth or fifth lumbar. Same attachment, same stroke and same pressure at the angle of the ribs fifteen to twenty seconds at each point. Thoroughly percuss the liver and spleen, using medium stroke and medium pressure. Then with short stroke and light to medium pressure vibrate forty to fifty seconds at the base of the skull. Vibration should also be given twenty-five to thirty seconds over the pneumogastric nerves. In acute cases of diarrhoea, especially that form in which the condition is due to increased peristaltic action, Mechanical Vibratory Stimulaton forms a very valuable method of treatment. Of course, if there be bacteria or any other agent in the intestines, which, by constant irritation are exciting the intestines to excessive action, then these must be removed before relief can be obtained. Examination of the spine in diarrhoea will usually disclose an excessive amount of sensitiveness or muscular contracture in the lower part of the spine, especially through the lumbar region. The treatment by vibration consists of heavy pressure with a short stroke over all sensitive points or over all contracted muscles along the spine, and it is best to continue the vibration at each point forty-five to fifty seconds. In addition to this, the patient should be placed on his back, and, using the short stroke with deep pressure, thoroughly vibrate the plexuses of sympathetics which lie in the abdominal cavity. While holding the attachment over the abdominal points, the stroke should be gradually increased until it is at medium. If the above treatment does not cause a cessation of the symptoms then the operator must use the throat attachment with stroke a little less than medium, forty to fifty seconds over the pneumogastric nerves. If the digestive fluids be at fault, then stimulation or inhibition, as it may be required, should be used over the centres controlling the organ at fault, using stimulation where secretion is deficient, and inhibition where it is excessive. DISPLACEMENTS OF THE CLAVICLES. Displacements of the clavicles are detected by comparing the two sides, or comparing the clavicles with those of a normal individual. Displacements are usually anterior or posterior, although they may be up or down Where the displacement is posterior, the vibrator should be used with the brush attachment to relax all muscles around the articulation; then the operator should place his fingers on the under surface of the bone and lift up. This will pull the bone into its proper position. If the displacement be anterior, heavy vibration directly over the bone at its articulation will serve to correct the abnormality. These may be of the pelvis as a whole in which the muscles on one side of the body contract and pull the pelvis from its normal position, or there may be some slight displacement at the sacro-iliac synchondrosis. These are always detected by the apparent difference in the length of the limbs; to determine this the patient should lie on his back, lying as flat as possible. The operator should stand at the foot of the table and bring the patient's feet together, placing his thumbs on the internal malleoli. If any difference exists, it is easily discernible in this way, as when the patient's feet are brought together, the operator's thumbs will not be in contact, one will be higher or lower than the other. It may be that the abnormality is such that one limb is apparently longer than the other, and to determine whether one limb is too short or too long, digital pressure should be used in the inguinal region on either side. It will be found that there is extreme sensitiveness, or there is a marked thickening of Poupart's ligament on the affected side. To correct the condition of the pelvis the muscles in the lumbar region and the deep abdominal muscles should be thoroughly relaxed, as should also be the gluteal muscles. If, for example, the left limb be at fault, then the patient should be placed on his right side, keeping the right arm extended and flexing the left limb at the hip and at the knee. The operator should then grasp with one hand the anterior superior spine of the ilium on that side, and the tuberosity of the ischium with the other band. If the difference be an apparent shortening, then he will use pressure downward and backward with the hand on the anterior superior spine, and downward and forward with the hand on the tuberosity of the ischium. If the difference be an apparent lengthening, then the reverse should be used; the pressure should be upward and backward on the tuberosity of the ischium, and downward and forward on the anterior superior spine. If cases of this character are treated during the menstrual period, relief from pain can, as a rule, be obtained by use of inbibitory vibration over the spinal centres which are found from about the eleventh dorsal down to the upper border of the sacrum. It is often necessary to treat this condition daily during the period, as freedom from pain may not last longer than a few hours. Some cases of dysmenorrhea yield quickly and the results are permanent. This is especially true of those cases in which sensitive points can be detected along the spine. When sensitiveness is found, no matter in what portion of the spine, vibration must be given until the sensitiveness disappears. To be able to elicit tenderness in any case is always a favorable sign, and those cases treated a week or ten days before the beginning of the flow will usually have a period free from pain. In those cases in which no abnormalities can be detected along the spine, either in deviations of the bony structures or in sensitiveness over the posterior primary divisions of the spinal nerves, vibration will serve to give only temporary relief, and it is best to withhold treatment until the flow begins, or, at the most, give it only a day or two in advance. Careful examination should always be made to see if there is any displacement of the vertebra or the ribs, or if the pelvis is drawn from its natural position. The treatment in these cases should always be given with the spinal attachment, and if no sensitiveness is detected a medium stroke, medium pressure, and fifteen to twenty seconds at any one point is sufficient; if sensitiveness is obtained, then a shortened stroke should be used, and the attachment should be held forty to fifty seconds over each tender point. This condition, commonly known as progressive muscular atrophy, is due to some disturbance of the trophic centres in the upper portion of the spinal cord. Atrophy usually begins in the small muscles around the thumb and gradually extends up the forearm and arm until the pectoral muscles are involved. Prognosis in these cases must be doubtful, although some cases will be greatly benefitted. Treatment should be both local and spinal, giving the local treatment with the brush attachment and medium stroke, beginning at the hand and gradually working up to the shoulder. The patient should also be allowed to hold the vibrating part in his hand forty to fifty seconds. Spinal treatment must be stimulative and if the sensitiveness is not too great, the ball should be used, leaving it at each point fifteen to twenty seconds, having the stroke adjusted to medium, and the operator exerting medium pressure. The spinal treatment should be given throughout the cervical region, and down as low as the fourth or fifth dorsal. This same attachment should also be used at the posterior of the ribs on the affected side. While giving the treatment over the ribs, the operator should extend the patient's arm above his head so as to spread the ribs apart as much as possible. This condition is a most difficult one to treat by medicinal means, and the cases usually are of long standing and if any relief is obtained at all, it is usually only temporary. Vibration has proved very valuable as a method of treating this condition, and the results obtained have been of a permanent character. The form of eczema which is especially susceptible to vibration is that known as the senile variety, although many cases of different origin may be cured. Vibratory treatment should be directed in such a manner as to stimulate the circulation to all points involved, and should also be given over all lymphatic areas, and over the liver and spleen so as to promote absorption and elimination. It is, as a rule, not best to use the attachment directly over the part which is in a state of eruption, although treatment may be given the surrounding tissues. If constipation exists, this must be corrected. If of the acute variety, such as follows gonorrheal inflammatory conditions, a favorable prognosis can be made in all cases of enlarged prostate; if of the senile variety, one is not so safe in promising to bring about much reduction in the size of the gland, although he can promise a certain amount of relief. In the acute conditions the enlargement rapidly reduces, and all pain and discomfort are relieved; in the senile form, the first noticeable change is in softening of the gland, thus allowing the urethra to dilate and permit of a free passage of the urine without the use of a catheter. Vibration in either of the above forms must be both local and spinal. The spinal treatment should be given first, and should consist of stimulation from the eighth or ninth dorsal down to the end of the spine, for the purpose of starting up free circulation in the parts, and a percussion stroke must be used over the liver to equalize the circulation between the Portal System and the hemorrhoidal vessels. The next point is the local treatment, and this should be administered as follows: if the vibrator gives a percussion or rotary stroke, it does not matter in what position the patient is placed; if the stroke be lateral, then the patient must be placed on his side, and the vibrating arm placed in such a manner as to allow of a gliding stroke over the back of the prostate. The machine must always be put in motion and the attachment well lubricated before it is allowed to pass into the rectum. In passing the attachment within, the first direction of the instrument is anterior; i.e., almost directly towards the umbilicus, until it is well within the sphincter; then it should be turned backward and allowed to follow up the posterior wall of the rectum until it is well above the prostate. It should nowbe brought forward and downward until it rests on the gland, and should be left there three-quarters of a minute to a minute and a half. If there be any vesiculitis accompanying the prostatic trouble, and this is the rule in acute prostatic disease, the attachment must be pushed forward and to either side, so as to reach the vesicles and milk their contents into the urethra. After the local treatment, if there be any sensation of bearing down or other discomfort about the anus or rectum, vibration must be given in the perineum. This should be of a mild character, and should be kept up a half to three-quarters of a minute. It will usually be found that this will suffice to relieve all discomfort. Before undertaking to treat cases of this condition, a thorough physical examination should be made to see if there be any anatomical cause, and if any are found, they must be corrected. If examination fails to reveal an adhering prepuce, or any other anatomical defect, then a favorable prognosis can be made, and no other treatment than Mechanical Vibratory Stimulation is needed. These cases usually show a great amount of muscular contraction in the lower part of the spine, and treatment should be directed to the relaxation of the muscular structures, and to the inhibition of the spinal centres which are found from about the ninth dorsal down to the fifth lumbar. Inhibition is secured here by first relaxing the muscles, using the vibrator, and leaving it over each interspace between the transverse processes thirty to forty seconds. Treatment should be given daily until the desired result is brought about. Epilepsy, is, as a rule, a very unfavorable condition to treat, as no matter what remedy be used, the patient will for a time be improved, only to, after a time, again become as bad as, ever. Vibration will produce permanent results only in those cases in which anatomical, defects are responsible for the condition. These anatomical defects are usually found in the, cervical region, and consist of deviations of the cervical vertebra to one side or the other. These can be replaced by using vibration to relax the muscles and then placing the attachment at the transverse process on the opposite side to which the spine is deviated. Pressure should be exerted here, and at the same time, the operator, with his thumb on the spinous process, should try to force the vertebra back to its normal position. It may require ten to fifteen treatments before this can be accomplished. If no displacement of the vertebra is discernible, then all sensitive points must be treated, and if they are not to be found, then a general spinal stimulation is required. Spasmodic contractions of the muscles of the face should be treated locally, giving especial attention to the nerves which supply the muscles, always treating them until inhibition is secured. A thorough examination must also be made of the spine to detect any sensitive points. These are usually obtained in the cervical region on the opposite side to which the spasms occur. Treatment here should be given with the ball until the sensitive points are inhibited. Cases of this character are best treated every day for two to three weeks, and then treatments may be decreased to one or two treatments per week until a cure is effected. It rarely takes more than six or eight weeks to get a complete cure. This condition is best treated by local application of vibration to the point of inhibition over the nerves as they emerge from the bony structures. If, for instance, the supra-orbital nerve be at fault, then an inhibitive treatment must be given over the supraorbital notch; if the infraorbital is affected, then over the malor bone; and if the facial nerve is the one involved, it may be reached by directing the treatment over the parotid gland. A cure may be hastened by correcting the blood supply to the face and bead, and this may be done by use of vibration over the cervical region, both anteriorly and posteriorly, always vibrating until all sensitive points are inhibited, or, if they be not present, then using it to increase or decrease the amount of blood to the head and face by giving an inhibitive or stimulative treatment, as may be required. For this condition treatment should be applied from the eighth dorsal to the second or third lumbar, using the spinal attachment with medium stroke and medium to heavy pressure twenty-five to thirty seconds, going over the area two or three times. The patient should then be given a gentle treatment with the brush the entire length of the spine a minute to minute and a half. Following this, vibration should be applied over the abdomen, getting deeply down into the tissues with the ball attachment, thus causing the ligaments to resume their normal tone and pull the kidney back into its proper position. Heavy vibration from the third to the ninth dorsal on the left side; also at the posterior angles of the ribs on the left side. Vibrate at each point twenty-five to thirty seconds. Then use ball, with deep vibration, medium stroke, over the stomach anteriorly. In order to relieve conditions of this kind, it is necessary that the vibrations reach the sympathetic nerves and that the degree of treatment should be a stimulative one. It is rare to find a case of distension of the stomach in which one cannot outline distinct sensitive points in the dorsal region, extending from about the third or fourth down to the tenth or eleventh. This sensitiveness is more marked on the left side, and usually is apparent even out to the angle of the ribs and along the border of the scapula. The treatment is best given with the ball attachment, varying the stroke and pressure in accordance with the amount of sensitiveness present, gradually increasing stroke and pressure until a medium stroke and quite a degree of pressure can be used. While vibrating over the ribs themselves, the operator should place his hand in the patient's axilla on the side which is being treated, and exert pressure upward so as to spread the ribs apart. This same thing can be accomplished by extending the patient's arm above his head, grasping it firmly and using extension. About every third treatment application should be made over the abdomen going directly over the area in which the stomach lies. This whole treatment should not consume more than two and a half to three minutes. If there be any marked sensitiveness present, a general spinal treatment with the brush attachment may be given in addition. Give a stimulative treatment from about the eighth or ninth dorsal down the rest of the spine, using the ball attachment with medium stroke; then, with the brush attachment, stimulate the lymphatic glands in the inguinal and femoral regions, and use vibration directly over the penis a half to three-quarters of a minute. At every treatment it is always necessary to thoroughly stimulate the liver and spleen; this is best done by use of the ball with a percussion stroke over these organs posteriorly forty-five to fifty seconds each. This will promote the elimination of the waste products. In the treatment along the spine the attachment should be left at each point about fifteen to twenty seconds. The local treatment with the brush over the glands may be continued from a minute and a half to two minutes. Both the simple and the exophthalmic varieties of goitre form conditions which are favorably affected by Mechanical Treatment. The results to be obtained in simple goitre are very pleasing and usually manifest themselves at once, and rarely will the first treatment fail to cause a noticeable reduction in the size of the gland. Sometimes this may amount to as much as a quarter of an inch or more. In the exophthalmic variety, the treatment is followed by a rapid abatement of the extreme nervous symptoms, and a marked decrease in the number of heart beats. The insomnia can be relieved and the patient made to feel very comfortable. Ordinarily, both forms of goitre require both local and spinal treatment, although occasionally one will meet with cases of the simple form in which local treatment alone is necessary. In fact, some of these cases the spinal treatment will retard rather than hasten the result. Local treatment should be given with one of the soft attachments, and should be stimulative, using mild vibration and keeping it directly over the gland. The spinal treatment should he given throughout the cervical region and down to the third or fourth dorsal, using medium vibration twenty-five to thirty seconds at each point. In the case of the exophthalmic form, the spinal treatment should be given the whole length of the spine, and in addition, vibration must be given over the thorax anteriorly and posteriorly. In both forms it is necessary to stimulate the chains of lymphatics in the cervical and axillary regions. Always look for displacements of the sternum and for deviations of the vertebra. If there be any rise in temperature following any of the treatments, the liver and spleen should be stimulated. All efforts here should be directed to the breaking up of deposits in the joints, and to their absorption and elimination; this, of course, between attacks of pain. During painful periods the treatment should he such as would produce inhibition of the nerves supplying the painful area. To break up the deposits, local treatment is essential, and should be applied over the parts themselves, at the same time using forcible flexion and extension of the joints. The brush should be used along the course of the veins draining the part, and over the lymphatics in the neighborhood, and at all points along the limb. Absorption and elimination may also be promoted by stimulation of the spinal centres, and by direct stimulation of the liver and spleen. Treatment must also be directed to the intestines, and to the centres governing the kidneys. Where no cause can be found, a general spinal treatment should be given, and vibration should also be used at the posterior angle of the ribs. Occasionally a cure may be hastened by use of the brush over the head locally, going directly over the painful areas. If the headache can be attributed to an anemic condition, then an inhibitive treatment should be given through the cervical region, which will inhibit the vaso constrictors and thus allow the vessels to dilate and increase the amount of blood to the brain. If hyperemia exists, then the treatment should be stimulative, i.e., such as will contract the vessels and decrease the amount of blood to the brain. If constipation is the cause, then use technique which is given under heading of "Constipation." If congested liver be the etiological factor, then use percussion over the liver posteriorly forty-five to fifty seconds, and use the ball attachment with medium stroke and medium pressure fifteen seconds at each point from the second to the tenth dorsal, inclusive. Alleviation of all painful symptoms usually results from vibratory treatment, although the variety of hemorrhoids which are more susceptible to treatment is the internal form. Where one has internal tumors which are protruding through the sphincters, relief is immediate. This is accomplished by use of the rectal attachment directly against the tumors, even though they be bleeding, held at each point a minute to a minute and a half, or until the tumors retract into the rectum. Each treatment usually suffices to hold them within twenty-four to forty-eight hours, and after nine to twelve applications, a permanent result is usually obtained. Before giving the local treatment the spine must be thoroughly stimulated from about the eighth dorsal down to the coccyx. Percussion must also be used over the liver to equalize the circulation between the Portal and Hemorrhoidal vessels. Where treatment is given at a time when protrusion does not exist, the attachment must not be passed within the sphincters, but must be used around the anus only, for the purpose of stimulating the muscular structures to contract and hold the tumors within. External hemorrhoids yield slowly, and the best treatment is local, using the rectal attachment directly over the tumors themselves. If after a rectal treatment any sensation of bearing down is felt, then the operator must relieve this by use of the ball attachment in the perineum, being sure to get the attachment on the inner side of the tuber Ball attachment, medium stroke, medium pressure the entire length of the spine, twenty-five to thirty seconds at each point. Percuss over the liver and spleen with medium stroke, medium pressure, forty-five to fifty seconds each. If constipation is present, correct same. If any abnormalities in the bony structures are found, use technique described. Use brush attachment, medium stroke and medium pressure over all enlarged glands. Give a general spinal treatment, and vibrate thoroughly over the liver and spleen posteriorly, and stimulate all lymphatics. Look for displacements of the ribs as the causative factor and if found, correct them. If there be spasmodic contractions of the ducts, then use inhibition over the spinal centres, and, if possible, directly over the part itself. As a rule, in these cases one will usually find constipation, and if this is found, it must, of course, be corrected by using the technique which is given in another part of this work. In the general spinal treatment, unless there be an extreme amount of sensitiveness, the ball should be used, leaving it at each point between the transverse processes ten to fifteen seconds. If the spine be very sensitive, then the brush should be used over the whole length of the spine two or three times; in these cases the whole spinal treatment should not last longer than a minute and a half to two minutes. If there is spasmodic contraction of the ducts, inhibition should be secured by using the ball, with medium to heavy stroke over the spinal centres, leaving it at each point forty-five to fifty seconds. This is a condition which every practitioner is called upon to treat, and one for which he has very little in his armamentarium to offer as a relief. Vibratory treatment has been very successfully used in relieving the condition, and the results are usually quickly obtained. This is especially true of those cases which are purely functional in character. The treatment should be of a stimulative form, and should be given to the lower part of the spine, beginning at about the eighth dorsal, and going down to the coccyx. Vibration should also be applied in the perineum, and about every third or fourth treatment the prostate should be massaged. Occasionally benefit may be obtained by stimulation of the pelvic plexuses of the sympathetic nerves. These may be reached by treating over the abdomen, using deep pressure and the ball attachment. In all cases of this kind the operator must examine the cervical region, where he will usually find the muscles very puffy, soft and flabby. Where this is found very heavy vibration should be given, going not only over the points on either side of the vertebra, but over all parts of the muscles themselves. The treatment should be a general spinal with the ball attachment, medium stroke and medium pressure, leaving the attachment at each point between the transverse processes of the vertebra twenty to thirty seconds; then, with the brush, a minute to a minute and a half over the limbs that are involved. If the lower extremities are affected, the ball should be used over the epiphyseal lines at the lower end of the femur and the upper end of the tibia to promote cell growth and thus prevent shortening. The local treatment over the limbs is not of as much importance as the spinal treatment. Cases of this character require a long course of treatment, and the results to be obtained are prevention of shortening to a certain extent, building up of the atrophied muscles, and bringing the limb up to normal temperature. This should be treated in the same manner as Colitis Mucous. Use the ball attachment, medium stroke and medium pressure twenty to thirty seconds at all points from the ninth dorsal down. Also over all sensitive points that arc found. About once every four or five treatments a mild stimulative treatment should be given directly in the vagina. This should not occupy more than a minute to a minute and a half. In some cases it may be necessary to use the ball over the abdomen directly over the uterus. Where the ball is used over the abdomen, as deep pressure should be given as the patient can stand. In some cases it will be found that the attachment cannot be used in the vagina; when this is so, the treatment will have to be directed to the rectum, passing the attachment well within, and holding it against the anterior wall so as to transmit as much of the vibration to the uterus as possible . The brush should be used over the lymphatics in the inguinal and femoral regions a minute and a half to two minutes. For the pains in the lower part of the spine the brush should be used directly over the sacrum, using heavy pressure three-quarters of a minute to a minute. The stroke should be at medium. A great deal may be promised the patient suffering this condition, in relieving pains, giving control of the bladder and rectum, improving the gait, and in some cases restoring the reflexes and giving a return of sexual power. The treatment consists of heavy vibration at the sciatic notches twenty-five to thirty seconds each, and then the entire length of the spine twenty to twenty-five seconds at each point. No treatment is required over the limbs. As this condition is caused by a degeneration of the cells in the posterior columns of the cord, the operator cannot say just how much improvement will result from the treatment, as it will depend entirely upon the amount of cell matter which is left in these columns that is not destroyed, but is in an inactive state. This condition usually requires one to three applications of vibration, which should be given with as long a stroke and as heavy pressure as the patient can bear over the lumbar muscles and through the lower dorsal and lumbar regions of the spine. Relief is usually experienced at the first treatment, and after three or four is generally permanent. Cases which do not yield to one or two treatments should be examined to see if the pelvis is in an abnormal position; if so, this should be corrected. In some cases of lumbago the amount of sensitiveness would be so great as to prohibit the use of the ball; if such be the case, the brush should be used beginning with short stroke and gradually increasing it as the patient can stand it. As a rule, after a half to two minutes of this, the patient will be able to stand the use of the ball; if so, the treatment should be begun with short stroke, gradually increasing it, as with the brush, and increasing pressure also. The rectal attachment should be used to massage the prostate, and should be passed within the sphincter, first directing the attachment in a line toward the umbilicus, and after it passes through the sphincters, turning it toward the posterior wall of the rectum, following this course until it is well above the gland; then bringing it downward and forward until it rests upon the prostate. Here it should be left a minute to a minute and a half, constantly using pressure upon the gland itself. Examination of the penis at this time will usually disclose an emission of fluid, showing that the contents of the gland have been stripped and forced into the urethra. Here, as in all cases of rectal treatment, if there be any sensation of bearing down, the ball should be used in the perineum, and on the inner side of the tuber ischii. In melancholia all the viscera are in a more or less inactive state, and require a heavy stimulative treatment. As it is a well-known fact that the majority of these cases present a very sensitive spine, the operator must use great care in beginning the treatment, although it is often found that cases which are very sensitive to a digital pressure will be able to stand quite a heavy treatment with the vibrator. If this is impossible, then, of course, the treatment must be very mild at first, beginning with the brush attachment and short stroke, gradually increasing the amount of pressure until they can stand a heavy treatment; then beginning with the ball and short stroke, gradually increase the severity until they are able to stand a treatment using medium stroke and medium to heavy pressure. In these cases it is always well to spread the ribs and to use percussion over the liver and spleen. Where constipation exists, this should be corrected by use of the technique which is given in another part of this work. Women who are passing through the period when menstruation is gradually ceasing, are usually affected with a large variety of extreme nervous conditions. These are irritability, insomnia, vague pains all over the body, bearing down sensations, etc. These cases require a general treatment, the severity of which will depend upon the amount of sensitiveness present, although the treatment should always be very brief, owing to the ease with which these patients are exhausted. Mental disease of any form should be given a general spinal treatment, using as heavy vibration as the patient can stand, giving it two and a half to three minutes. Treatment should be given every other day. Between menstrual periods a general spinal treatment should be given with the brush attachment, using medium stroke and medium pressure, being careful not to give over two or three minutes to the whole treatment. During a period of menstruation, the ball should be used with medium stroke and light to medium pressure twenty to thirty seconds over all sensitive points and throughout the lower dorsal, the lumbar and the sacral regions. Always look for abnormalities of the bony structures, especially malposition of the coccyx. This is best treated with the ball attachment and stroke a little less than medium, with light to medium pressure, throughout the cervical region; then, with the brush, thoroughly vibrate over all parts of the scalp. Treatment may be given daily, and if necessary, more than once during the twenty-four hours. The operator should always look for abnormalities in the cervical region and for displacements of the clavicles. These are often found, and when corrected give instant relief from the severe pain. In many cases a very light treatment over the eyes will have a good effect. If the cases do not yield to this treatment, a general spinal treatment should be given in addition, using the brush attachment directly over the spinous processes, going over the spine four or five times, consuming about two and one-half to three minutes. The treatment through the cervical region with the ball attachment should be given about fifteen to twenty seconds at each point. The vibration over the scalp should be kept up for four to five minutes. Use the ball attachment, medium stroke, the entire length of the spine, vibrating at each point twenty-five to thirty seconds, using medium to heavy pressure. The brush should then be used over all painful areas until inhibition is secured. The brush should also be used in a general spinal treatment, going over the spine four or five times, placing the attachment directly over the spinous processes. Constipation is usually present, and this should be corrected; it is very often necessary to give rectal treatment in order to do this. A light stimulative treatment should be given over all muscles which are beginning to atrophy, or which are in a state of atrophy. The brush should also be used along the course of all painful nerve trunks. With the brush attachment, vibrate over the muscles involved, two to three minutes. Then with the ball, medium stroke, medium pressure, twenty-five to thirty seconds over all points in which the motor and sensory nerves and trophic centres are found. This condition usually yields in from one to three or four treatments. The treatment should consist in relaxation of the muscles and inhibition of the nerve supplying the painful area. In the treatment along the spine the ball attachment should be used with as heavy pressure as the patient can bear twenty-five to thirty seconds at each point, using a medium stroke. Care should be used to see that the attachment is placed directly between the transverse processes as to get immediately over the posterior primary divisions of the spinal nerves supplying the painful area. If the patient can stand it, the ball should be used directly over the muscles involved, keeping up vibration until inhibition is secured. In beginning the treatment over the muscles, it may be necessary to use light pressure at first, but this should be gradually increased as the pain lessens. It is rarely necessary to give anything more than a local treatment in cases of myalgia, and as a rule one or two treatments will suffice to produce permanent relief. The treatment should be given with the ball attachment, medium stroke and medium pressure, and the attachment should be left over the muscles until all pain is relieved. Those cases which do not yield rapidly should be examined for displacements of the bony structures, and if none are found, then inhibition should be used over the nerves supplying the part at the point where they emerge from the spinal column. This condition should be treated practically the same as melancholia, special attention must be paid to the cervical region. Inhibition should be used over the point of emergence of all spinal nerves supplying the painful area. If it be the lower limbs that are involved, then an inhibitive treatment should be directed to the sciatic notch; if the brachial nerves are the ones which are affected, then treatment should be given along the course of the nerves down the arm; then the patient should be made to grasp the attachment tightly and hold it for a minute to a minute and a half while it is in motion. All sensitive points along the spine should be inhibited, and all muscles should be relaxed. The ball attachment is preferable in the treatment of cases of this kind unless there be an undue amount of sensitiveness to pressure; then the brush should be used. Use very heavy vibration with the short stroke from the first to the third cervical, if the ball is used, going on either side of the spine, and if the brush be used, then directly over the spinous processes. Begin with the ball attachment and medium stroke and thoroughly vibrate over the obese parts; then gradually increase the pressure and length of stroke, until the patient can stand a very heavy treatment. In the beginning treatment should not last over three minutes; the time should be gradually increased until the patient can stand twenty to twenty-five-minute seances. The operator should carefully avoid treatment over the spine, but should give special attention to the liver and spleen, and to the lymphatics, stimulating them so that all the waste products can be quickly eliminated. See Catarrhal Deafness. Inhibition should be secured over the spinal centres which are found from the eighth dorsal down to the second lumbar; also use of inhibition directly over the ovary itself with the ball attachment. This can be reached by giving deep abdominal treatment. Displacements of the coccyx and abnormal position of the pelvis must be looked for, as either one of them is sufficient to produce neuralgic conditions of the ovary. All abnormalities in the bony structures must be corrected, all muscles be relaxed, and inhibition of the nerves supplying the part be secured. To secure inhibition, the ball should be used with medium stroke and medium to heavy pressure directly over the point where the nerves supplying the part emerge from the spinal column. Treatment in these cases may be given three or more times a day, if necessary, but should one do this, the treatment must be directed to the nerves supplying the part only, and not to the whole spine, as a general spinal treatment given so frequently would exhaust the patient. Some cases will only have temporary relief from the spinal treatments, and here it may be necessary to use the treatment locally; if so, the brush should be used with as heavy pressure as the patient can stand, directly over the part, leaving it there until inhibition of the peripheral terminations of the nerves is secured. Local treatment is always necessary in neuralgia of the facial, supraorbital or infraorbital nerves. In paralysis of any character, a general spinal treatment is required. Use the ball attachment, medium stroke and medium to heavy pressure, leaving it at each point twenty-five to thirty seconds. In addition to the spinal treatment, the brush should be used over the affected parts, beginning at the distal portion and working toward the trunk. For the purpose of increasing absorption and elimination, the liver and spleen should be stimulated; all lymphatics should be given thorough treatment with the brush, being careful not to use enough pressure to injure these delicate structures. Treatment in these cases may be given daily, and the patient should be instructed to exercise the parts as much as possible between treatments. In obscure cases of paralysis one will often find a deviation of some of the vertebrae, and if these are found, they must be corrected. If there be loss of control of the rectum, an occasional application of vibration just around the anus for half to three-quarters of a minute will prove effective. In paralysis agitans the spine must be left alone, and the treatment should be of a general character, going over the limbs, over the trunk posteriorly and anteriorly, and over the cervical sympathetics. It should be as heavy and severe as the patient can possibly stand, and should be given for five to ten minutes, or even longer. The patient should then take the attachment in either hand for a minute each. The results in this condition will be only temporary relief of all aggravating symptoms, and no cure can be secured. While using the ball over the heavy muscles of the back, it is well for the operator to use his free hand to lift up the tissues and then force the ball into them as deeply as possible. This will have a very decided effect on these structures, causing them to become soft and pliable, and when this is accomplished, the patient will be able to move more freely and rapidly. Rarely can a complete restoration of function be secured in cases of paralysis due to hemorrhage, although the muscles may be brought up by stimulation over the trophic centres in the spinal cord, and by local vibration over the muscles themselves. Treatment can usually be depended upon to build the muscles up to a certain extent and to improve movements. Perverted sensation in the different portions of the body may be treated by giving a stimulative application of vibration both over the motor and sensory nerves, and over the centres controlling the nutrition to the part. The majority of these cases will get well quickly, especially if there be no neurasthenic element present. As a rule constipation is present in all cases of paresthesia, and this, of course, should be corrected. In parestbesia of the hands one will often find displacements of the ribs or of the upper dorsal or cervical vertebrae. In paresthesia of the feet one will very frequently find displacements of the pelvis. These abnormalities must be corrected before a cure can be expected. In the spinal treatment the ball should be used with medium stroke and medium to heavy pressure, leaving it at each point fifteen to twenty seconds. Local treatment is rarely necessary, although it may be given, using the brush and medium stroke a minute and a half to two minutes. Ball attachment, medium stroke and medium to heavy pressure throughout the dorsal region and over the thorax anteriorly; then the ribs must be raised, as described in another part of this book. This condition, as well as all cases of paralysis following acute infectious diseases, can be greatly improved, if not entirely cured, by use of Mechanical Vibratory Stimulation. The treatment should be directed the entire length of the spine, using the ball attachment, medium stroke and medium to heavy pressure fifteen to twenty seconds at each point; then going over the muscles themselves with the brush. All lymphatic glands, and the liver and spleen must be stimulated to promote the elimination of all poisonous products. If the voice be affected a stimulative treatment should be given through the cervical region both anteriorly and posteriorly, using the soft attachment anteriorly on either side of the pharynx forty to fifty seconds each. If there be atrophy of the muscles on one side of the spine, especially so in the cervical region, the operator will in all probability be able to find displacements of the vertebrae. These should be corrected first by using a stimulative treatment to the atrophied muscles so as to build them up, and then by using the technique which is described under abnormalities. Treatment should be given over the spinal centres supplying the part, and over the trophic: centres which control the nutrition using the ball attachment, then with the brush give two to three minutes' treatment over the seat of the fracture itself, then thoroughly stimulate all lymphatics which drain the area, and follow up the course of the veins in the part. Patients convalescing from operations should be given a mild spinal treatment the entire length, using the brush and never giving over a minute and a half to two minutes for the entire treatment. If pain be present then, of course, inhibition of the nerves supplying the painful area must be secured. See technique for treating enlarged prostate. Use ball attachment, medium stroke, heavy pressure, forty to fifty seconds at each point from the first cervical down to the second or third lumbar. Use medium stroke ball attachment, medium pressure, percussing over the liver and spleen posteriorly forty-five to fifty seconds. Thoroughly stimulate the chains of lymphatics with the soft brush attachment. If constipation exists, use technique described for same. Heavy vibration forty to fifty seconds over each point from the eighth dorsal down to the third or fourth lumbar. Relax all contracted muscles and treat all sensitive points. Percuss over the liver and spleen forty-five to fifty seconds. Use deep vibration a minute to a minute and a half over the abdomen in the area in which the kidneys lie. An inhibitive treatment must be given the spinal centres and also the spinal nerves which supply the part. During an attack of pain inhibition of the peripheral terminations of the nerves supplying the painful area must be secured. This is done by use of the brush, medium stroke and as heavy pressure as the patient can bear. Special attention must be given the excretory organs and the lymphatic system to promote elimination of retained products of metabolism. Treatment should be given daily, and in some cases of extreme pain, may be given even oftener. In some cases displacements of the pelvis or of the bony structures forming the thorax may be found, and it is always well to look for these. Pain in the sciatic nerve or any of its branches may be relieved by use of inhibition over the nerve at some point in its course. This is best given at the sciatic notch, where, after relaxation of the muscles one has the nerve upon a bony background. Here it will only require forty-five to fifty seconds to produce complete relaxation of the muscles and inhibition of the nerve itself. In some cases in which the pain extends down the leg or into the foot, vibration must be given over the calf. The secret of all success in the treatment of this condition is the thorough relaxation of the muscles, and the inhibition of the nerve. In cases of long standing it is rare to find one in which there is not some displacement of the pelvis from its normal position, and in such cases as this, complete relief will not be obtained until the pelvis is replaced. The technique for replacing the pelvis is given in another chapter. Use mild vibration the entire length of the spine, increasing the severity of the treatment as the sensitiveness disappears, never giving over a minute and a half to two minutes' treatment, as these patients are easily weakened. Inhibition should be applied through the cervical region over the origin of the phrenic nerves, and the same treatment should be given over the pillars of the diaphragm, and over its attachment to the thorax. The patient should be placed on his back with the knees drawn up, and heavy vibration should be applied well up under the ribs, so as to get in as close contact with the diaphragm as possible; twenty-five to thirty seconds over each of the pneumogastrics is also useful, and in many cases will cause immediate cessation of the spasms. Examine the back and note on which side of the spine the muscles are contracted. Over these use a very heavy vibration two to three minutes. On the opposite side use the brush attachment with mild or stimulative vibration one to one and one-half minutes. The brush should also be used directly against the spinous processes on the side toward which the convexity of the curve is directed, using pressure in such a manner as to try to force the bones back into their normal alignment. The physician using vibration should depend almost altogether on spinal treatment to obtain results, although in some painful conditions it may be necessary to use vibration locally to obtain the desired effect. Local vibration should be given in cedema, ankylosis, and other local conditions of this character, though, even in these, it is always best to give spinal treatment in addition. In spinal treatment the ball should always be used where possible. If there be extreme sensitiveness, then the brush must be used. However, it is always well to try to use the ball, making the stroke short and the pressure very light at the beginning of the treatment. Ball attachment, medium stroke, and medium to heavy pressure twenty-five to thirty seconds over all points from the eighth dorsal to the third or fourth lumbar; use same attachment, same stroke and same pressure over the region of the kidneys posteriorly a minute to a minute and a half. Relax all contracted muscles and treat all sensitive points. Look for deviations in the pelvis, and if found, correct same. Use the brush over the chains of lymphatic glands. Use heavy vibration with medium stroke forty-five to fifty seconds over the muscles involved. Also use same attachment, same stroke, same pressure, and same length of time along the spine over the points where the nerves which supply the part emerge. TONSILLITIS, LARYNGITIS, AND PHARYNGITIS. Use the ball attachment, medium stroke, and light to medium pressure twenty to thirty seconds at all points in the cervical region. It is usually well to extend this treatment down to the third or fourth dorsal. A percussion stroke should be used over the liver and spleen posteriorly a minute to a minute and a quarter each. The throat attachment should then be used through the cervical region anteriorly a minute to a minute and a half on either side, getting well under the inferior maxillary. Special attention must be given the lymphatics in the cervical and axillary regions and if constipation exists, this must be corrected. Heavy vibration directly over the muscles involved; also throughout the cervical region and down as low as the fourth or fifth dorsal, using the ball attachment. Examine carefully for displacement of any of the vertebra. In the treatment over the muscles the ball attachment must be used with a medium stroke, and should be kept up four to five minutes or until the muscles begin to soften and relax. In the majority of cases of torticollis one will find a minute contracture of the muscles lying along the spine, that is, contractures of only portions of the muscles, small bundles of fibres. These are usually found directly over the nerves as they emerge from the spinal column, and their presence is causing an irritation of the nerve supply of the muscles which are causing the torticollis. Relaxation of these will, as a rule, relieve the condition. In varicose conditions a general spinal treatment should be given with the ball attachment, placing it between the transverse processes of the vertebrae, leaving it at each point fifteen to twenty seconds. The brush should then be used lightly over the varicosities. The lymphatics in the surrounding parts should be stimulated. See chapter on Occupation Neurosis. |