The Art of Massage J. H. Kellogg, M.D. 1895   MECHANICAL MASSAGE.  
 
    Inventive genius has devised a considerable number of appliances by means of which a more or less perfect imitation of the action of the hands in the application of massage may be obtained.  Zander, of Stockholm, and Taylor, of New York, as well as the writer, have invented machines for this purpose. For nearly thirty years the author has made use of various forms of apparatus designed to administer mechanical massage, or what is more commonly termed mechanical Swedish movements, with most excellent results in appropriate cases.
    Mechanical massage may be advantageously used as a substitute for a number of the procedures of manual massage. I have, however, found no device quite equal to the human hand, for the administration of kneading movements. Shaking and vibratory movements, on the other hand, may be applied more efficiently by apparatus than by hand in cases requiring vigorous and prolonged application, for the reason that much more vigorous, rapid, and uniform movements can be executed by machinery than by the hand, and the movement may be continued as long as necessary; whereas these movements are exceedingly trying to the masseur, and cannot be maintained, at best, for more than a few minutes continuously.
    Several other procedures may be given by mechanical appliances quite as well as by the hand, and with even greater efficiency. A brief description of some of the more important means and methods employed in mechanical massage, or Swedish movements, will not be out of place in a work which undertakes, as does this, to cover the whole ground of the subject from a practical standpoint. This chapter gives a brief description of the apparatus and modes of application which the author has had in use in the Battle Creek Sanitarium during the last fifteen to twenty years, and which have stood the test of practical use in some thousands of cases, not as an exclusive mode of treatment, but as an auxiliary means employed in connection with manual massage, exercise, hydrotherapy, electricity, and other rational methods.
    The meager knowledge which has heretofore existed in regard to the functions of the sympathetic nerve and its relations to the activities of the viscera, has rendered difficult an explanation of the remarkable therapeutic results which have been constantly witnessed from the employment of mechanical massage, especially in the treatment of hepatic and digestive disorders. Now that the functions of the great sympathetic nerve and of the abdominal ganglia and solar plexus are coining to be better understood, it is very clear that the application of strong vibratory or shaking movements to the abdomen may produce powerful physiological and therapeutic effects through the stimulation of the sympathetic. When it is recollected that the great abdominal brain controls the nutrition of the entire body through its influence upon the circulation and its universal control of glandular action, it must be clearly seen that therapeutic applications capable of affecting this portion of the nervous system cannot be made without marked results.
    The observations of the late Professor Charcot, of Paris, have called the attention of, the profession to the powerful physiological and therapeutic effects of vibration in the treatment of organic disease of the spine, one of the most intractable classes of maladies. The confidence in mechanical massage as a therapeutic measure inspired by the great prestige of this renowned Parisian physician, has encouraged the writer to give publicity to some of the observations which he has made
upon this subject during the last thirty years, and to describe some of the various means employed by him. Among the several devices made use of are a number which were invented by Zander and Taylor, who have, also been working in this line; but the majority of those which the author considers the most effective are the outgrowth of his own personal experience, and have been constructed after designs furnished by him. Several devices other than those described have been made and utilized, and have been found not without merit, but are not described here for lack of space.

    Mechanical Vibration. - One of the most useful of all the several forms of mechanical massage is mechanical vibration. The highest rate of movement which can be attained by the hand is ten to twelve to-and-fro movements per second , whereas, by the use of mechanical, electrical, or acoustic devices, effective vibratory movements may be produced at any rate desired between forty or fifty per second to ten times that number. Vibratory movements forcibly communicated to the body at the rate of sixty per second, have been shown to produce at first a distinct muscular contraction with each oscillation ; but if the vibration is long continued, the individual contractions become gradually less distinct, and after a time merge one into another, so that the contractions become continuous, or tetanic. From this fact it is apparent that mechanical vibration is capable of producing very decided physiological results as a mode of exercise; and that it exercises a powerful influence upon the circulation is a frequent observation. My patients constantly report that vibratory movements make them warm, and restore the balance of the circulation when disturbed by morbid reflex action, so that, while the feet are warmed, the head is cooled.
    Carefully conducted experiments which I have made, show that the temperature of a part subjected to mechanical vibration is actually increased, the amount of the increase depending upon the length of the application, and the degree of depression below the normal temperature at the start. Vibration is also one of the most efficient means with which the writer is acquainted for relieving the great variety of paraesthesias from which neurasthenic patients suffer, such as numbness, formication, tingling, etc.

    The Vibrating Chair. - Figs. 115 and 116 represent a vibrating chair which I devised in 1883, and have since had in constant use at the Battle Creek Sanitarium. The usual rate of vibration which I employ is sixty per second. A person needs to experience but a single application to become convinced of the powerful physiological effects which may be produced by mechanical vibration. When seated in the chair, strong vibratory movements are experienced, in which the whole body takes part. The greatest amount of force is applied to the lower portion of the trunk. The vibratory impulses communicated are felt powerfully in the lower bowel, and have a decided stimulating effect upon the rectum.
    By placing the hands upon the arms of the chair, and inclining the. trunk either forward or backward, the impulses may be transmitted more or less forcibly, as desired, from the lower to the upper portions of the spinal column. The application should continue from three to ten minutes, to secure decided physiological effects.
 
    Vibrating Platform. - In standing erect upon the moving platform on which the chair rests, the muscles of the legs are brought into powerful action. Not only the muscles of the lower leg, but the muscles of the thigh, are thrown into tetanic contraction by the strong vibratory movements transmitted through the legs (Fig. 116). The application usually lasts about five minutes. A separate platform may also be used.

    The Vibrating Bar. - Fig. 117 is a very imperfect representation of an apparatus I had constructed several years ago, in which a suitable mechanism drives a pair of horizontal bars at a high rate of speed. In using the vibrating bar, the hands are first placed upon it with the fingers spread and held rigid, but with the wrists flexible. This throws the hands into violent vibration without communicating the vibratory impulses to any other portion of the body. The bar is then seized by the hands, which grasp it tightly while the arm is partly flexed at the elbow, the shoulder joint being relaxed. Then, straightening the arms and holding them rigid, the muscles of the shoulders being fixed and the bar held firmly, the vibratory movements may be communicated to the upper spine and head with very great vigor, producing a powerfully stimulating effect upon the upper spine.
    The vibratory impulses may also be communicated to the stomach, liver, loins, sacrum, rectum, and other parts by bringing these portions of the body into direct contact with the bar.
    Powerful endwise vibratory movements are given to the legs by placing the patient in a chair facing the apparatus, with the feet against the uprights which support the end of the bar opposite the driving mechanism. The vibratory movements obtained from this apparatus are applied to each part from half a minute to one minute.

    Vibration of the Arms and Legs. - The legs are vibrated in three ways: (1) By means of an endwise movement; (2) by means of a lateral movement; (3) by means of a rotary movement. The effects of these three modes of vibration are similar, yet in some respects different. The time of application is usually from three to five minutes.
    Endwise vibration is by far the most vigorous of the three modes. It is administered by means of a horizontal vibrating bar against the end of which the feet are placed, supported in suitable rests (Fig. 118).
    Lateral vibration is administered by means of the same apparatus, the feet being placed against the side of. the bar instead of the end (Fig. 118).
    Rotary vibration is produced by means of a rotating bar, against the end of which the feet are supported (Fig. 119).
    The leg is held straight, not flexed as in the cut. The same apparatus is used for the arms.

    Nerve-percuter, or Vibrator. - This instrument, which I have recently had constructed and to which reference has previously been made, consists of a metallic chamber in which a mass of soft iron is made to play to and fro with considerable force by means of an alternating electrical current passing through a coil of wire which constitutes a part of the chamber. The blows struck by the oscillating mass of iron are communicated to the portion of the body under treatment by a brass rod terminating in a knob. By means of this simple device, very vigorous vibratory movements may be applied to the head, to a nerve trunk, or to any part of the body to which it is desirable to make vibratory applications, (Fig. 121).

    Vibration of the Trunk. - In Fig. 120 is shown a method of applying vigorous vibratory movements to the trunk. The apparatus consists of a mechanism by means of which a strong horizontal bar is made to oscillate at the rate of 1200 to 1500 per minute. By means of suitable padded rests placed upon the bar, vibratory movements may be communicated to the back, the abdomen, or to either side, as may be desired. The special purpose of this apparatus is to communicate mechanical motion to the liver, stomach, bowels, and other abdominal viscera. It is a vigorous means of stimulating peristaltic activity, and of quickening the circulation in the large viscera of the abdomen. This apparatus the writer has had in use at the Battle Creek Sanitarium for twenty years, and has found it an exceedingly effective device. It is not simply a means of amusing the patient, but is capable of producing powerful physiological and therapeutic effects. The time of application to each part is usually from three to five minutes.

    Mechanical Kneading. - By means of suitable apparatus, mechanical kneading may be applied in a very efficient manner to the bowels, the arms, the legs, and even to the whole trunk.
    Mechanical kneading of the abdomen is one, of the most useful of the several forms of kneading; it may perhaps with justice be said to be the most useful of all. It is best administered by means of the apparatus shown in the cut (Fig. 122). The writer had this apparatus specially constructed for the purpose some twelve years ago, and has had it in constant use since. The, apparatus consists of a table with a large aperture near the center of its top. In this opening plays a series of six vertically-placed bars, each surmounted by a suitable pad. Each bar is separately actuated by a cam, or eccentric, so that it has its own independent motion. These six eccentrics are so arranged as to give a wave-like form to the combined movement of the six kneading pads. Simultaneously with the vertical movement of this kneading device, the table top, with the patient which it bears, is made to move back and forth, thus changing the relation of the pads to the abdominal surface, and causing them to knead the entire abdomen. The two sets of movements are so timed that the wave-like kneading movement is made to follow very closely the course of the colon, thus bringing this part of the intestine especially under control. Zander has a similar machine.
    I have found this apparatus of very great service in the treatment of constipation. It is not, of course, a panacea for this disease, which arises from many different causes; but it is a most efficient auxiliary to other measures, and riot a few cases have been observed in which the patient traced the greater part, of the, benefit received from a systematic course of treatment to this apparatus alone.
    Mechanical kneading of the abdomen is useful not only in constipation, but also in cases of dilatation of the stomach in which there is, as a result of the dilatation, a considerable degree of motor insufficiency, in consequence of which the stomach does not empty itself with normal promptness. This treatment is of value in all cases of slow digestion so-called, and should be used within an hour or two after each meal. The kneading is usually continued from five to fifteen minutes.
    Mechanical kneading of the arms is executed by means of the apparatus shown in Fig. 123. When the pressure is made sufficient to prevent the rubbers from slipping over the surface, the movement is that of rolling, a form of deep kneading; with lighter pressure, it is that of friction. This is a valuable mode of utilizing mechanical massage. The time of application is from three to five minutes.
    The legs may receive mechanical massage by means of a similar apparatus, shown in Fig. 124. This is an excellent means of aiding the circulation in cases in which the legs and feet are habitually cold. The application should be continued from five to eight minutes, or until the extremities are thoroughly warmed.
    Mechanical kneading of various parts may also be employed, as shown in Fig. 123. The apparatus utilized is similar to that used for rotary vibration of the feet. A suitable pad is secured at the end of a bar, which is made to rotate while it rests against any portion of the trunk to which it can be conveniently applied. It is especially useful in making applications to the back, stomach, bowels, shoulders, and the region of the liver. In cases of gall-stones, it is a most excellent means of jostling imbedded calculi down into the bile duct, thereby hastening the emptying of the gall-bladder. It also facilitates the discharge of the fluid contents of the gall-bladder, and is thus a valuable aid to digestion. It will be apparent from these observations that this particular form of apparatus is a very efficient form of vibration, as well as a thorough kneading procedure. The time of application should be from one to three minutes to each part.

    Trunk Rolling. - The apparatus represented in use in Fig. 125 consists of a pair of pulleys moving in alternation and in opposite directions, a fraction of a revolution in each direction. To each pulley is attached one end of a broad strap, which is passed around the trunk in such a manner that, as the strap is pulled first in one direction and then in the opposite, the tissues are acted upon very much as in certain forms of palm. kneading. When applied about the waist, it is a very excellent means of administering a rolling movement to the muscles of the trunk, and a shaking movement to the viscera; when applied across the shoulders, the effect is that of deep kneading. This is a favorite apparatus with patients who are under treatment by mechanical massage. It was devised by the author about ten years ago. This application is so vigorous that it is not usually continued longer than from two to four minutes.

    Mechanical Percussion. - There are two forms of percussion which may be administered mechanically, viz.: (1) Slapping; (2) Beating.
    Slapping is administered mechanically by means of a vertical revolving bar, to which is attached a broad strap about sixteen inches in length (Fig. 126). The strap is fastened to the bar at its middle, the two ends being free; and thus two blows are struck at each revolution. Different degrees of force are secured by modifications of the speed with which the bar is made to revolve, the thickness of the strap, and the position of the patient in relation to the bar and the strap. The time of application, is from one to three minutes.
    Mechanical slapping is a most effective measure for stimulating the surface circulation. In this respect it is not excelled by any procedure which can be administered by the hand. It is most usefully applied to the shoulders and back, the legs and thighs, and the soles of the feet.
    Mechanical beating (Fig. 127) is an efficient mode of percussion, though less valuable in comparison with beating administered by the hand than is mechanical percussion in comparison with manual percussion. It is most effectively applied to the spine and chest, and over the abdomen. The apparatus shown was devised simultaneously by the writer and by Zander, of Stockholm. The usual time of application is from two to four minutes.

    Mechanical Friction. - Friction may be applied to the soles of the feet by a revolving ribbed cylinder (Fig. 128), which was first used by Zander. The writer has added a number of features which have proved serviceable. One of these is the employment of an apron to cover the ribs of the revolving cylinder, thus preventing the wearing upon the patient's stockings or slippers ; another improvement is the insulation of the chair in which the patient sits, which I was led to make by noticing that sparks could often be drawn from different parts of the patient's body while receiving treatment from the apparatus. It is not an uncommon thing to see the hair of a patient sitting in the insulated seat, erected by the electric charge generated by the friction of the machine. It is possible that a certain portion of the static electricity may be generated by the driving belt. This phenomenon is of course chiefly confined to the colder months, when the atmosphere is dry.
    The apparatus is a very valuable one, as it performs its work efficiently, and does something which cannot be so well accomplished in any other way. It is a favorite machine with our patients. The application is a very agreeable one, and may be continued almost ad libitum without injury. The usual time is from five to ten minutes.

    Tilting-table. - In Fig. 129 is represented a tilting-table, which the writer devised nearly twelve years ago, and has had in use since. The patient lies upon his back while one end of the table top is lifted by means of a large cam operating beneath it The patient lies with his head at the stationary, end of the table.
    The purpose of this apparatus is to secure what I have termed "vasomotor gymnastics." When the hand is raised above the head, a strong contraction of its blood vessels occurs, the effect being rendered visible to the eye by blanching of the skin. At the same time that the blood vessels of the arm are thus made to contract by a vasomotor reflex, the vessels of the corresponding portion of the brain also contract. By a repetition of the movement, real gymnastics of the muscular walls of the
vessels may be executed, and thus relaxed vessels be contracted and strengthened, and local congestion relieved, if so situated as to come within the sphere of the reflex action set up by the change in the position of the arm.
    This same principle applies with equal force to the lower extremities, which have a relation to the organs of the pelvis similar to that which the arms sustain to the brain. Leg raising, with the patient lying in a horizontal position, is one of the recognized and most valuable movements in the medical gymnastics of the Swedes. There is, however, a certain disadvantage in this mode of exciting vascular contraction. It is impossible to raise a limb by voluntary effort without a certain degree of strain, which involves holding the breath, and producing, as a result, an increase of pelvic and portal congestion, so that the exercise must to some degree defeat its own purpose. In this exercise, also, but one leg is raised at once. When the lower part of the body is elevated mechanically, there is no exertion on the part of the patient, consequently no strain, and both limbs are elevated at the same time; thus the maximum effect is obtained.
    This apparatus is of great service in all forms of pelvic congestion, in ovarian disease, uterine catarrh, displacements of the pelvic viscera, and in rectal disease of various forms. After spending a few minutes upon the tilting-table, rising and falling with its oscillations at the rate of about eight times a minute, patients suffering from the maladies named and others similar, almost invariably express themselves as experiencing a marked sense of relief. The effects of this mode of passive exercise of the blood vessels are so agreeable that patients are inclined to continue the application as long as they are allowed to do so. As a rule, ten to fifteen minutes is sufficient to secure decided physiological effects.

    Pelvis Tilting. - Nearly all forms of pelvic disease give indications for the use of the tilting-table above described. In displacement of the womb or ovaries, however, as well as of the stomach, liver, kidneys, bowels, and other abdominal organs, it is important to combine with the vasomotor gymnastics described, the employment of position as an aid to restoration of the displaced viscera. This is accomplished by adding to the tilting-table above described a device by means of which the pelvis is lifted free from the table while the patient lies upon the face, thus causing the abdominal wall to sag downward (Fig. 130). As the table is tilted, the patient is lifted into such a position as to cause gravity to make an upward (in relation to the normal position) pull upon the viscera of the trunk. The device consists simply of an attachment placed in the center of the table, which is made to rise more rapidly than the table itself, thus lifting the pelvis before the rest of the body, and holding it in this relation until the table returns to a state of rest. The effect of this apparatus is increased, if, while the patient is elevated, the attendant applies percussion or beating to the sacral region.
    The use of this apparatus alone is not sufficient to restore displaced organs to position, but it aids greatly in relieving congestion, and is certainly a help toward a cure of visceral prolapse. The application should be made daily, or twice daily, and continued from eight to ten minutes each time.

    Trunk-exercising Apparatus. - Figs. 131 and 132, represent forms of apparatus which are of substantial service in exercising the muscles of the trunk. Although the results obtained are different, the principle of both machines is the same, and is based upon the fact that the body involuntarily seeks to maintain its equilibrium.
    Active-passive Rotation of the Hips.  - Fig. 131 is an apparatus so constructed as to cause a seat to revolve in such a manner that its plane shall continually change, thus inducing the patient, when seated upon the apparatus, to contract the muscles of the trunk in maintaining his equilibrium, the body being steadied by the hands. There is thus secured a complete and perfect rotation of the hips. This is a most excellent form of, exercise for persons with weak trunk muscles, which is the condition of most women who come under the care of the gynecologist, as well as of a large share of the cases of nervous dyspepsia in both men and women. This apparatus has the advantage over other forms of gymnastic apparatus in that it brings the muscles. into action automatically, as in walking, and thus secures a more complete and natural movement of the muscles of the trunk. The first applications with this apparatus should be brief, - not more than one or two minutes, - as the muscles of the trunk are brought into such vigorous action that they are likely to be overtaxed, especially in feeble persons. The apparatus may be used either with or without power attachment, but is usually employed without.
    Trunk Flexion. - In the apparatus shown in Fig. 132 the movement is a tilting of the seat from side to side. It is used in two positions: (1) With the patient sitting parallel with the line of movement; (2) with the patient sitting at right angles to the line of movement. In the first position, the patient is induced to make alternate flexion of the trunk forward and backward; in the second position, the patient flexes the trunk from side to side.
    The use of this apparatus is indicated in the same class of cases as the preceding. Its action is less powerful, and consequently it is especially adapted to feeble patients at the beginning of a course of treatment, and as an introduction to the more vigorous movements. The action of this apparatus being less energetic than the preceding, the applications may be somewhat longer - two or three minutes at first, and longer after the patient becomes accustomed to them.

    Mechanical Respiration. - In Fig. 133 is shown an apparatus by means of which artificial respiration may be mechanically administered. In its use the patient is seated upon a stool, the arms being placed over movable rests, which fall in the axillae. The back is supported by a padded rest placed between the shoulders. When the machine is set in motion, the shoulders are lifted upward and backward in such a way as to expand the chest in an efficient manner, producing a strong inspiratory movement quite independent of any effort on the part of the patient. The effect is to correct the condition known as flat, or hollow, chest, and to give flexibility to the chest walls when they have become rigid in consequence of insufficient use. This apparatus is in part modeled after a similar arrangement by Zander, but several improvements have been added; among others, is a device by means of which the arms, as well as the shoulders, are raised, thus increasing the vigor of the inspiratory movement.