The Secrets of Specialists/Chapter 7

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Physicians, as a rule, never take very kindly to the manual methods of massage, which are outlined in the foregoing chapter. One possible reason may be that it involves too much labor, but when some mechanical genius invented the Vibrator a few years ago, it was immediately recognized by the medical profession, and received as hearty welcome from the physicians as the sulky plow did from the farmer: "It's the easy way."

One of the most important things to be considered in adopting Vibratory therapeutics in office practice is the selection of a vibrator. There are many types, with varying degrees of efficiency. Therefore, in selecting a vibrator the following point should be considered: The instrument should have sufficient motive power to deliver long, penetrating strokes, as well as medium and light ones, in order to receive the degree of stimulation or inhibition desired; it should also be capable of changing from a heavy to a light stroke, and vice versa, without any delay. It should have a well localized stroke and also a rotary and lateral stroke, for treating cavities.

A well constructed vibrator should never give any vibration to the operator's hand; by observing these points we really have a scientific instrument with which excellent results can be obtained.

Physicians have long recognized the value of stimulation, and for many years have depended upon electricity and Swedish massage for this purpose. We must give Dr. Still credit, however, for revolutionizing the older methods of massage and placing the subject purely upon a scientific basis, by complying with the anatomical structures of the body and physiological laws of nature. Vibratory massage is, ​ ​therefore, a means of conducting many osteopathic and Swedish massage treatments by a more convenient and less laborious method; the regional technique and vaso-motor areas are the same, and the only distinction is the manner of conducting the same influence by different means.

The most important field of operation of both osteopathy and vibratory massage is located between the transverse processes of the spinal vertebrae. At these points we find the main nerve trunks, conveying and imparting impressions to and from the brain, recognizing two great systems of nerve force in the body: the cerebro-spinal nervous system controlling sensations and motion, and the sympathetic nervous system, superintending the functions of the internal organs, which govern secretions, excretions, circulation, digestion, etc.

Many of the internal organs receive nerves from both systems; by referring to our anatomy we will find a double chain of ganglia of the sympathetic nerves on the anterior surface of the spinal column, extending from the base of the skull to the end of the coccyx. These ganglia have communicating branches, which connect with the cerebro-spinal nervous system, called rami communicanties. We, therefore, find ​that treating the nerve centers of the spinal column, as they emerge through the brain and spinal cord, has the power of conveying impulses to and from the periphery. These are called efferent and afferent nerves; the former convey impulses from the brain to the various peripheral organs; these nerves control muscular activity and conduct impulses to the glands and excite secretions. They also control the vasomotor impulses to the walls of the blood vessels, which regulate the caliber of the blood vessels and circulation of the blood, and also conduct impulses which will stimulate or inhibit the activity of any organ.

The afferent nerves carry the impulses from the peripheral organs to the brain; thus we find the special sense nerves of the eye, ear, nose, mouth and skin, which give rise in the brain to conscious sensations.

We also find special reflex nerves which conduct impulses to the nerve centers, to be reflected out through the efferent nerves to muscles, glands, blood vessels, etc.

In treating diseases by vibratory means we have three degrees of therapeutic application, depending upon the length of the stroke and the amount of pressure used.

Stimulation is produced by a short stroke and light pressure.

Sedation is produced by a medium stroke and pressure, used as a sedative to quiet excitability and promote sleep.

Inhibition is produced by a long stroke and heavy pressure. This is used to desensitize nerve centers, and will mitigate pain, slow the action of the heart, check peristaltis, stop hiccough, etc. Always bear in mind that all deep nerve trunks or centers, as a rule, require a long stroke and heavy pressure; while the superficial nerves require only the short strokes and more gentle pressure. In order to obtain the different degrees of strokes and pressure, the operator should see that the vibrator is supplied with a variety of vibratodes or appli​cators, which can easily be attached to the vibrator, for treating the different areas and cavities of the body. The accompanying cuts illustrate the modern portable vibrator, with all the applicators required for general use.

The selection of a vibratode for a given area, will depend upon the results you expect to obtain; the following is the general rule: A., represents the hard rubber ball applicator, which is used in treating intra-spineous spaces when stimulation or inhibition is desired. B., is a soft rubber applicator often referred to as the "brush"; this is used over sensitive areas, as the face, abdomen, etc., where sedation or inhibition is desired. C., is a soft rubber cup applicator; this is used over surfaces of the body for its sedative effect. D., is also used for the same purpose as C. E., is a soft rubber applicator for the eye and ear. F., is a soft rubber vaginal applicator. G., a hard rubber rectal applicator. H., hard rubber external rectal applicator. I., solid soft rubber ball, used same as "A" over sensitive areas. J., large disc for treating the surfaces: of the body. K., is a soft rubber attachment for giving an intermediate stroke with other applicators. L., soft rubber rectal or vaginal applicator. M., hard rubber prostatic applicator. O., is a soft rubber intestinal applicator. P., hard rubber cone rectal applicator. Q., hard rubber oval disc applicator. R., hard rubber half-ball applicator. S., soft rubber cup applicator. T., soft rubber disc applicator. U., soft rubber vacuum half-ball applicator. W., large two and one-half inch soft rubber cup applicator.

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The fundamental principles upon which vibratory massage is based, may be compared somewhat to electricity, although the current waves from electricity are more rapid in their stimulating effect upon metabolism.

Vibratory massage may be used at a slower and stronger rate without being as disagreeable to the patient. In many instances most pathological conditions are due to stasis, and ​by stimulating the nerves which control the circulation of the part, and by opening up the lymphatic drainage system, to carry away waste material, we have accomplished by vibratory massage what cannot be accomplished by any other means. As a rule, vibration is best applied as near a nerve Image missingPosition for treating the back. center as possible, and by treating the cerebro-spinal nerves as they emerge from the spinal column, better results will be obtained in less than half the time it would take if we treated the nerves farther out on their course. Nerve centers seem to have a certain amount of intelligence, enough at least, to adjust any abnormal condition within the reach of their jurisdiction. We therefore find that vibratory massage has its therapeutic effects in both a direct and indirect way; to illustrate: if we were to treat an inflamed joint, we would recognize that we have a condition of stasis to deal with, and to relieve the congestion or inflammation, our only means would be to treat the lypmhatics, that drainage may take place from the joint, and open the avenues of elimination; at the same time, our attention would be called to stimulating the nerve centers, which would produce new nourishment to the part. The joint proper may not be treated at all.

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Patients who are to be treated by vibratory massage should wear as little clothing as possible, over areas treated. If the patient is a lady she should remove her corset and other outer clothing down to the under vest. A light kimono may be worn, if desired, but the less clothing worn by either man or woman the better. In treating the spinal centers, the patient should be placed upon the table, face downward, and it is often a good plan to place a large pillow under the abdomen; this convexes the spinal column and allows better access to the spinal nerves.

The hard rubber applicator should be used in treating the spinal centers, and when the degree of the desired stroke is decided upon, the applicator should be pressed well in the sides of the inter-spinous openings of the transverse vertebras, on both sides of the spinal column.

Dr. Head was among the first to point out the vaso-motor centers and pain areas of the spinal column, which are illustrated in the accompanying diagram. Although this cut may have the appearance of a Chinese puzzle, it represents, and outlines the vaso-motor centers on the left side, and the visceral afferent floors of the spinal ganglia, or the pain areas, which call for treatment on the right side. To illustrate: If we wish to treat the stomach, the apex of the triangle points to the word "stomach," on both sides of the spinal column. The left side, the base of the triangle, is from the second dorsal to the ninth dorsal inclusive, which locates the vaso-motor centers. On the right side, the apex of the triangle points to the word "stomach," and the base of the triangle formed from the sixth to the ninth dorsal inclusive. This locates the points where pain or tenderness can be found by palpation, which requires either osteopathic or vibratory treatment. These areas are recognized by both the osteopathic and vibratory therapeutist; the only difference is in the method by which the treatment is applied. The osteopath utilizes his fingers, and the physician the vibrator; equal results can be obtained ​in many cases by either means. The osteopath has the advantage, however, as his instruments (his fingers) are always with him and he does not have to depend upon electric motive force.

In treating the spinal nerve centers, the seventh cervical vertebra, known as vertebra prominens, is always used as a "landmark" to count from. When locating special areas, the left hand can trace the vertebra while the right hand can apply the vibration. In treating the different areas and organs of the body, the following table is the generally accepted technique:

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​Head and Neck.—For pain in these locations, vibration should be applied from the third cervical to the fifth dorsal, inclusive.

Arms.—Vibrate from the third to the seventh dorsal inclusive.

Heart.—Vibrate from the third cervical to the fifth dorsal, inclusive, and tender spots may be located at the first, second and third dorsal.

Lungs.—Vibrate from the third to the seventh dorsal; tenderness may be located from the first to the fifth dorsal, inclusive.

Stomach.—Vibrate from the second to the ninth dorsal; tenderness from the sixth to the ninth dorsal.

Spleen.—Vibrate from the third dorsal to the first lumbar, inclusive, especially the fifth, sixth, seventh, eighth and ninth dorsal on the left side sensitiveness will be detected on the left side from the fifth to the ninth dorsal vertebra.

Liver.—Vibrate from the third to the eleventh dorsal, especially from the fifth to the ninth on the right side. Tenderness will be found from the seventh to the tenth on the right side.

Pancreas.—Vibrate from the fifth dorsal to the first lumbar, inclusive.

Kidney and Ureters.—Vibrate from the fourth dorsal to the fourth lumbar. Tenderness will be located from the tenth dorsal to the first lumbar, inclusive.

​Bladder.—Vibrate from the eleventh dorsal to the fourth sacral, inclusive, and look for tenderness over this area.

Prostate.—Vibrate from the first lumbar to the fifth sacral; look for tenderness from the tenth dorsal to the third sacral.

Uterus and Vagina.—Vibrate the lumbar nerves and also look for pain or tenderness at this region.

External Genitals.—Vibrate from the twelfth dorsal to the fourth sacral; tenderness over the same region.

Intestines.—Vibrate from the sixth dorsal to the first lumbar, inclusive; tenderness from the ninth to the twelfth dorsal.

Colon and Rectum.—Vibrate the sacral nerves and look for tenderness at the second, third and fourth vertebra.

Anus.—Vibrate from the twelfth dorsal to the fourth sacral; tenderness over same area.

Legs.—Vibrate from the eleventh dorsal to the third lumbar, inclusive.

Skin of the Body.—Vibrate from the first dorsal to the fourth lumbar, inclusive.

Testis Epidymis and Ovary.—Vibrate from the eighth dorsal to the fourth sacral; tenderness will be found from the tenth dorsal to the first lumbar.

In maintaining the normal functions of the body, in which health may be considered the standard, we have four principal factors, which are of the greatest importance; the nerve and blood supply, absorption and elimination. These organs and functions are especially favorably influenced by vibratory massage, often requiring treatment in both a direct and indirect way; that is, we can control these functions in what may be considered an indirect or reflex way, through the nerve centers of the spinal column, and can assist elimination by vibrating directly over the part. To illustrate: the most obstinate cases of constipation can be relieved by either of three methods, or better still, the three combined. First, by stimulating the nerve centers in the spinal column, from the sixth dorsal to the twelfth, inclusive, and the third, fourth and ​fifth lumbar, and the first, second and third sacral. It is always a good plan, however, to vibrate from the fifth dorsal down to the coccyx, on both sides of the spinal column, pressing the ball applicator firmly in at the side of the spinous processes. Great care should be exercised not to vibrate too long, or to make too heavy pressure; the percussion stroke is used from eight to ten seconds. An important thing to remember is that too long and heavy stroking will inhibit and produce constipation, while the short strokes repeated frequently over the same areas, during the treatment period, will produce stimulation, which is the result desired.

The patient is now changed from the abdominal to the dorsal position, with his knees drawn up, to relax the abdominal muscles; this is the preferable position in abdominal and thoracic treatments. Direct stimulation may now be applied over the liver, to increase the activity of that organ; the brush or flat applicator is preferable, with a lateral or rotary stroke.

The colon is the next organ or occupy our attention, starting at the cecum, and following the course of the ascending transverse and descending bowel, dwelling only a few seconds at each point, and continuing the course of the vibrator in a spiral or rotary movement, (see illustration). This course should be followed several times during each treatment, which is more effectual than one treatment applied at length. The patient should now be placed in the Sim's position, for direct vibration to rectum and lower bowel. For this purpose the vibratodes G. and O. may be used and the medium rotary or lateral stroke is to be employed (the percussion stroke is absolutely of no value) by making firm pressure against the anus for thirty or sixty or more seconds. At the termination of the treatment the patient will usually experience a desire to evacuate the bowels, which, of course, he should be allowed to do. The value of vibratory massage may be summarized as follows:

The Blood, which in all instances may be considered the first, and to the injured, a very important element, as it is through this vital fluid that all processes of healing take place, ​and by controlling and equalizing circulation, we generally maintain health. Wherever obstruction of circulation is observed, we find congestion, inflammation or perhaps abscesses. Obstruction to the veinous circulation is the most frequently met with, and nearly always present in many forms of heart, lung, liver and kidney diseases; as an adjunct to other therapeutic measures vibratory massage is indispensable.

The Lymphatics perhaps hold the second place of the important organs to which vibratory therapeutics are successfully applied. These glands are divided into two sets, the superficial and deep-seated; the former lie just beneath the skin, in the loose connective tissue, and are found in the neck, axillae, front of elbows, groin, popliteal space, etc., the latter follows the course of the large blood vessels and are found on both curvatures of the stomach, in the mesentery, liver, spleen, kidneys, uterus, bladder, etc. These glands are often referred to as the scavengers of our body.

When disease attacks any special area of the body these glands become at once involved, often obstructing their functions. It is plain to see the importance of vibratory stimulation, as an adjunct therapeutic measure to open up this drainage outlet, and unload the system of toxic material, through the eliminative process. A very important thing to remember is that all vibratory movements pertaining to the circulatory system should be made towards the center; that is, the blood vessels should be vibrated towards the heart and the lymphatics should be vibrated in the direction of the lymph flow. The vibratode simply acts like a pump, by forcing the blood and lymph onward in their natural course, which not only relieves the system of toxic influences, but stimulates the organs to new life and activity.

The Nerves.—Having previously discussed the technique of vibratory massage upon the spinal nerve centers, we find it often necessary to apply direct vibration to nerve trunks, in many pathological conditions. The pneumogastric nerve emerges from the cranium at the jugular formum and passes down the neck in the sheath of the carotid artery and is best ​ ​reached along the inner border of the sterno-eleido-mastoid muscle (see illustration). It should be borne in mind that prolonged stimulation of this nerve slows the action of the heart, even to the stage of fainting, and such treatment should not last over ten or twenty seconds. The sciatic nerve can be reached along its course on the posterior thigh, and also back of the great trochanter (see vaso-motor centers). The solarplexus is best reached and influenced by vibrating upwards and downwards about two and one-half inches, on both sides of the umbilicus; commence just below the umbilicus and vibrate upward to the rib line, and downward from this point. Headache and neuralgia are nearly always relieved by prolonged vibrating directly over the painful area: frontal headache is best relieved by vibrating over the super orbital notches.

We have already described the method of vibrating the colon. The small intestines may be stimulated to activity by commencing at the umbilicus, and following a circular course to the cecum. It is well to follow this course, previous to vibrating the colon, for stomach disorders and inactivity of the bowels.

Vibrating the Chest.—In vibrating the chest the patient should be placed upon his back, and his hands clasped back of his head. The brush applicator is preferable, for these movements commence from the inferior maxillary, and stroke downward to the clavical; the inter-costal spaces of the sixth upper ribs should be treated towards the sternum and the spaces below. (The short arrows on the accompanying cut will illustrate the course to pursue.) The sternum itself can be stroked either up or down.