V V- . PARALYSIS •\ KN \-<5 ^s -1 ;;V >-' r-i-'v'v.'V.'.''■••• ■;•«' ' ^*'<-.;-'j:/-■'-■•• ■''■^ '-'r Scientific and Med. Books and all objects of Nat. Hist. P or Sale by A E. FOOTE, M. D.. 1223 Belmont Ave. Philadelphia, Penna. NLrl DD55flfit.5 1 Surgeon General's Office NLM005588651 PARALYSIS, AND OTHER AFFECTIONS OF THE NERVES: THEIR CURE BY VIBRATORY AND SPECIAL MOVEMENTS. By GEO. II. TAYLOR, M.D., AUTHOR OP "DISEASES OP WOMEN," "EXPOSITION OP THE SWEDISH MOVE- MENT CUBE," " ILLUSTEATED SKETCH OP THE MOVEMENT CUBE," ETC. •------♦ » » NEW YORK: Samuel R. Wells, Publisher, No. 389 BROADWAY. 1871. 1871 Entered, according to Act of Congress, in the year 1871, By GEO. H. TAYLOR, M.D., In the Office of the Librarian of Congress, jn Washington. John Kent, Stereotyper and Electrotyper, 13 Frankfort St., N. Y. CONTENTS. -------♦_»-♦------- PAGE Introductory........................................ 5 How Treatment becomes Remedial.................. 9 Office of Motion.................................... 12 Absence of Power of Motion—Paralysis............ 15 How Exterior Force affects Interior Bodily Organs 20 Vibratory Motion.................................... 28 Necessity for Apparatus............................ 28 Description of Apparatus........................... 29 Effects of Vibratory Motion on Bodily Temperature 34 Increase of Oxidation............................... 38 Elimination increased by Vibration................ 40 Removal of Congestion.............................. 44 Interchange of Fluids—Absorption................. 46 Revulsive Effect of Vibration...................... 50 Congestion the Primary Condition in Nervous Diseases.......................................... 56 Evolution of Force increased by Vibration........ 59 Exterior Force Auxiliary to its Interior Develop- ment.............................................. 61 Electricity a Product of Vibratory Motion........ 64 Confirmations of Principles derived from Nature. 67 Active and Semi-active Movements.................. 70 iy CONTENTS. PAGE Paralysis and Neuralgia due to a Variety of Dis- eased Conditions.................................. 72 Inflammations, Abscesses, Tumors..................... 74 Compression of Spinal Cord and Brain---......... 74 Degeneration op Central Nerve.................... 75 How Paralysis Occurs, and how Removed........... 77 Connection op Vibratory and other Movements with Restoration of Nervous Power............ 78 Application of Principles—Cerebral Congestion. .. 88 Sciatica.............................................. 87 Paralysis............................................ 90 Paraplegia, caused by Mental Work................ 96 General Paralysis...................................100 Hemephlegia.......................................... 103 Progressive Paralysis............................... 107 Facial Paralysis..................................... 118 Neuralgia............................................ 119 Supersensitiveness of Spine.......................... 126 Infantile Paralysis................................. 131 Removal of Deformities without Operations....... 36 Contracted Limbs — Improvement after Failure of Instruments...................................... 143 PARALYSIS, ETC. INTRODUCTORY. Though paralysis and other results of dis- eases of nerves, whether characterized by defi- ciency or by irregularity of power, are affections of common occurrence, yet their treatment by methods currently employed is far from satis- factory. The most astute medical minds have employed their talents in investigating the pathology of this class of diseases, and many interesting and curious facts have been devel- oped. But no remedial methods of acknowl- edged reliability have been brought into use to ameliorate the suffering of the neuralgic and nervous ; while to temporize with the paralytic generally fills the measure of the physician's expectation. Radical cures are comparatively infrequent and hardly expected. 6 PURPOSE OF THIS TREATISE. It therefore becomes a duty to investigate rational methods of remedial treatment for diseases so intractable, and which involve more than any other the noblest part of our nature. It also is very important that principles at once so perfectly intelligible to the common under- standing, and of rigorously demonstrated success in practice, should be extensively known, in order that their availability may be commensu- rate with their merits. The purpose of this treatise is : To show the uses and importance of motion in the living body, as contributing to its evolu- tion of power ; To explain the methods and rationale of the direct application of force, as in the form of vibratory motion for curative purposes ; To point out the uses and limitations of other exercises in diseases of the nervous sys- tem ; and To represent the success of the remedial method based on the direct use of force in cases of paralysis and other forms of disease of the nerves, that have been prolonged and proved intractable to other means. PATHOLOGY OF NERVOUS DISEASES. 7 PATHOLOGY OF NERVOUS DISEASES. Disease of the nerves differs from that of other portions of the body in certain particulars, rendering its investigation more difiicult, and remedial indications more obscure. The seat of such disease is generally understood to be in the nerve-centers of the brain and spinal cord, organs which are situated beneath and protected by bony coverings, and therefore removed from direct observation. The symp- toms of nervous affections are manifested in aberration of sensation and restriction of power at points often quite remote from the diseased centers. Our conclusions regarding the nature and extent of the disease are necessarily founded on rational considerations in connec- tion with light derived from experience. The case is quite different with affections of other portions of the body. We can see the changed color, and the increased size of the affected part; we know that the acute anguish actually pertains to the part to which it is referred, and to no other ; we can determine, by direct observation, the physical changes that 8 MEDICAL LITERATURE. are transpiring, and the curative indications are plain and direct, even though differently constituted minds may judge differently in regard to therapeutic measures. In making the following statements and con- clusions, I am not unmindful of the fullness of modern medical literature on the pathology of the nervous system, especially that portion relating to post-mortem appearances. These inquiries, however, are not valuable for ther- apeutic suggestions, since they can never be made until after the last act of the diseased process is concluded ; they exhibit the effects of morbid processes, but show nothing of the condition of the nerves while these processes are transpiring ; they disclose certain materials of disease which might have served equally as materials of health, but cast scarcely a glimmer of light upon the morbid action, and afford but the faintest intimation, if any, as to means appropriate to correct the diseased process and remove its effects. The physician is still guided by his own and by recorded experience in the selection of cura- tive means. But it is all-important that this HOW TREATMENT BECOMES REMEDIAL. 9 experience should be directed in accordance with the laws of normal action of the constitu- ents of the body, and not by what he guesses has taken place in developing diseased products, or may take place through the effect of drugs. He sees pathological action, and rightly infers pathological products ; — his direct object should be to introduce physiological action as the surest and only means of abating pathological processes. The purpose of this treatise is therefore lim- ited to the introduction of the reader (who, it is expected, is also an interested inquirer) to methods of cure at once practical and philo- sophical, avoiding the discussion of disputed and equivocal points of pathology. This topic will be referred to only so far as is necessary to gain an intelligible understanding of the cura- tive principles and means which may be brought to notice. HOW TREATMENT BECOMES REMEDIAL. Let us now briefly inquire into the way treatment is expected or designed to remedy nervous disease. Since all such disease is 1* 10 PURPOSE OF REMEDIES. manifested as altered, restricted, or excited action of portions of the nervous system, it follows that remedies must consist of means appropriate to increase, or repress and regulate action of nerve-centers which originate nervous power, whether the nervous function be that of sensation or motion. Ordinary remedies are not introduced into the system on account of any supposed adapt- edness to form an integral part of the vital instrument; if that were their purpose, they would constitute food, and not medicine. Their purpose is rather to influence by their presence nutritive changes in the nerve-centers, and thereby alter the quality and amount of vital action. They can only influence the motions of the incipient vital organs, or the disposal, that is direct the motions, of sub- stance which has yielded its vitality and become effete. In any case, whether we regard the effects of the drug as dynamic or chemical, or any other order of action, it is clear that the therapeutic effects are quite dependent on their control of the motions of the nutritive elements, while the drug itself passes on with other HOW TREATMENT BECOMES REMEDIAL. 11 rejected material, and soon finds exit from the system. The most generally accepted and modern views of the first principles of pathology of the nervous system may be stated as fol lows: Nervous diseases of all varieties depend on obstacles to healthful nutrition of the brain and spinal cord (cerebro-spinal axis). This defect may also include the central or organic nerves. Nutritive aberration may take either of the following preliminary forms; probably more than one of these conditions coexist. The nerve-centers may contain too much blood—hyperemia. They may contain too little blood—ansemia. The nutrition of the cerebro-spinal axis may suffer such change (preceded by hyperaemia) as to allow of morbid deposits or degeneration. The corresponding purposes of remedial treat- ment are therefore : To relieve nerve-centers of superfluous blood by removing it to other parts, which in this case are suffering from deficiency ; To convey to these centers the nutrition for 12 PROCESS OF CURE. which they have suffered, a result and reaction from the previous condition ; To perfect the transformation of non-vital nutrient matter to organized structure capable of evolving force which assumes the forms of sensorial and dynamic power ; To secure absorption of the abnormal mat- ters which may invade the power-evolving tis- sue, and retard or prevent its power-evolving function. The possession by these matters of a low form of organization, though a serious impediment, is not an effectual barrier to their removal. OFFICE OF MOTION. It will be observed that each and all of the purposes above indicated imply motion. Vi- tality is the manifestation of force or action by organized substance ; pathology and disease imply wrong action, and consequently defective motion of constituent parts of the organized structure ; while therapeutics consists in the correction and restoration of these motions to the normal standard, prescribed by the organ- ized structure itself. OFFICE OF MOTION. 13 In health, these various series of interior motions are maintained by the activities induced by the ordinary duties of life ; for the living being, as has been intimated, furnishes the arena for incessant atomic and molecular activ- ity of various kinds and orders. Change of place of fluids, of cells, of organized and semi- organized substance; gliding of membranes, fibers, and various other anatomical parts, are constantly going forward. These actions must have support. Doubtless there are influences at work to maintain these activities that we do not understand, but there are others which we do. Let volitional activity cease, and the sys- tem soon stagnates; it imperfectly vegetates, affording but a minimum of power available for the ends of existence. It is the activities of life, having their origin in the purposes of the will directed to securing real or fancied good, which maintain bodily health. The purposes of life are constantly varied, giving rise to varied interior actions, extending to all the innermost as well as remote parts of the system. These varieties of action are essential to the equipoise of the system, upon 14 COMMON SENSE. which health intimately depends. The great danger to health, which civilized life has to encounter, is lack of variety in these voluntary motions. Persons pursuing mental occupa- tions or monotonous employments are liable to engender comparatively too much motion in a restricted portion of the system, while other portions of equal, perhaps of greater import- ance to its physical welfare, are compelled to suffer from the need of motion. Unbalanced interior nutritive activity is the direct result; soon thereupon occur fixed morbid products; these are the evidences and effects of disease rather than disease itself. In our endeavors to overcome diseases origin- ating in imperfect action, were we to be guided by common sense and reason, rather than by precedent, we should scarcely be at a loss for means to accomplish this purpose. The very evident need is, to afford more vigorous nutri- tive action—that is, motion of the elements par- ticipating in vital acts from which are evolved the different forms of vital power. This should give rise to healthy products, whether these be muscular tissue, nerve substance, or the force ABSENCE OF POWER OF MOTION. 15 of which these are the instruments. It is, moreover, plain that if healthful vigor be ener- getically maintained in organized parts, not only will factitious and diseased, products be superseded by healthy, but those previously existing, which are the result of preceding im- perfect vital action, will be displaced. The feasibility of removing disease by mo- tion is but the corollary of the fact that health is thus maintained. A less degree of motion of elements than obtains in health, is prelimi- nary to, if it does not constitute, disease. It is only needful that the energy of motion which health gives be afforded to the chronic invalid. ABSENCE OF POWER OF MOTION—PARALYSIS. But in paralysis, and, indeed, in other forms of disease of nerves, the interior nutritive motions so indispensable to the generation of power are not maintained. The ability to sustain the conditions for making power is absent. This fact is the principal evidence, and in the beginning may be, and probably is, the essence of the disease of central nerves. The will either may not act, or its mandates do 16 ORDINARY PRACTICE. not reach the muscles whose action is desired. The purposes of the will in the organism falls short of their aim. The capacity for the evolu- tion of nerve-force by spontaneous action of nerve-centers is, as regards the function of some portion of the nervous system, partly or wholly suspended. The health of this function is not maintained, and can not easily or often be regained through power originating within. Ordinary medical practice, recognizing the facts stated, endeavors to overcome the inertia of nerve-centers and conductors by exciting through specific irritants the power-producing function — compelling the weakened and dis- abled centers to evolve more power. It is inclined to place a burden on the weakest part. The result is everywhere seen. Only in cases having excellent original capacity, where disease has made no, or but slight, progress, is the en- deavor successful. There is, in fact, much to fear from treatment dictated by this principle of stimulation and forcing, whatever may be its dis- tinctive methods. The compulsory and ineffect- ual endeavor of weak parts to act in response to extraordinary stimulation is liable to make ABSENCE OF POWER OF MOTION. 17 undue drafts upon the capacity to act, ending in exhaustion of the little remaining power instead of its re-enforcement. Cases previously cura- ble by direct and appropriate means are thus placed forever beyond the reach of remedies. Rare cases possessing an exceptional abund- ance of vitality may respond to efforts of this kind ; but these are few, and the large majority do not and can not thus respond. Treatment based upon the principles now presented pursues the opposite course. It hus- bands the weakened capacity ; it economizes the expenditure, so as to correspond with the generation of vital power; it refrains from tasking the disabled physiological elements previous to the reparative action ; it tries to preserve those delicate elements which consti- tute the source of power, from the destruc- tion that is imminent; it affords the motion required for nutrition and repair, but makes no demand on the will; it elicits the evolution of that power peculiar to each function, and re- serves that usually yielded by effort; while it supplies those conditions which are essential to its further development. 18 EFFECTS OF EXTERIOR MOTION. FORCE AND MOTION, MECHANICAL AND VITAL, The foregoing statements are merely those of physiology. They are so nearly self-evident as to receive a ready assent. But the special proposition 1 desire to elucidate is that motion, proceeding from an external source, is compe- tent to impart the degree and kind of motion requisite for the functions of physiology in the evolution of corporeal power ; that such motion becomes a direct auxiliary to normal internal processes. A little reflection will show the extreme probability of this proposition ; for the pro- cess referred to does not essentially differ from that which ordinarily obtains in the system. No new element is introduced to cause derange- ment. Furthermore, the force which the sys- tem in health is capable of evolving is referable to an ultimate exterior source, and does not absolutely originate within. The organism is an instrument, rather than a generator, of power. The nutritive and organizing processes are merely the means whereby force introduced with food, and involved in the constitution of force and motion, mechanical and vital. 19 food, is liberated. That is now manifested, in forms called vital, which before had some other mode of existence. But the nutritive and organizing processes can not proceed, and the force associated with food and air can never be so liberated in the absence of one essential condition. This condition is the motion both of minute masses and of separate atoms, which constitute interior physiological processes. This motion, which in health is abundantly supplied by the organism, is not necessarily confined to that source of supply. In default of that source, it may be contributed from exterior sources. The universe is replete with force ready and waiting to do human bidding and confer human benefits. Examples of the application of ordi- nary force or motion are seen in the marvels of mechanics. Heat is the essential condition of the existence of the arts of civilization as well as the comforts of life. Electricity in modern times has rivaled heat and motion in the inter- est with which it engages attention, while the wonders wrought by sunlight, as exhibited both in nature and in art, transcend all these 20 RELATED FORMS OF FORCE. ill vastness of effects. Science has proved that these, and perhaps others, are but different forms—correlations—of force rather than differ- ent forces, by causing their transformation and mutual replacement of each other. Of these, heat and electricity are in almost universal use as remedial agents. It therefore appears not only that the body is an agent for generating force within itself—the force which is mani- fested in the powers exhibited by vitality—but it may also be shown to be receptive of force derived from exterior sources, and that the application of force is capable of working changes, and, if properly employed, great benefits to its interior condition and health. HOW EXTERIOR FORCE AFFECTS INTERIOR BODILY ORGANS. The effects of actions communicated from without, all are familiar with, at least in some degree. For every one is aware of the peculiar- ly grateful sensations the invalid experiences when the surface of the body is gently rubbed by the hand of an attendant; in fact, this act is really not the least important duty of the nurse. exterior force affects INTERIOR ORGANS. 21 It is often found that a great deal of energetic friction is of excellent service, and such advant- ages are insisted on by the medical adviser in a great variety of ailments, differing radically in their external manifestations or symptoms. Indeed, this very thing has been a common remedial recourse in all ages and among all nations. Suppose the attendant varies the operation and, instead of a rubbing motion, imparts very light, rapid strokes, directed perpendicu- larly upon some portion of the body. The force of the action is expended chiefly beneath the surface in this case, and another class of grateful sensations is evoked, especially if the part were previously suffering from pain. Effects similar to these might be multiplied, affecting various and differently related portions of the organism, according to the direction, degree, and rapidity of the impulse. It is evi- dent that this would afford, through the feel- ings, a vague clue to possible important bene- fits. A little consideration will show that the idea of therapeutic advantages through the channel 22 EFFECTS PRODUCED BY THE HAND. here indicated is not so far-fetched or illusory as might at first be supposed. We may at least comprehend some of the processes where- by such effects come. The motion and pressure of the hand may be regarded as expressing force in pounds and ounces. This force is the collected energy of organized substance from minutest parts. Its origin, so far as we can trace, is in the ultimate physiological and chemical activities of certain elements of the body. The anatomi- cal hand, being the medium or channel for the expression of the aggregate power of an infini- tude of distinct molecular elements and chemi- cal substances, is applied to oppose and over- come the resistance of external and wholly disconnected objects. The internal forces are transformed to external power. When, now, this force is applied to a solid body, it overcomes the inertia of the body en masse. The integral portions do not change their mutual relationship. But if the same force be applied to another living being, which is constituted of soft or movable parts, it is evident that the force thus EXTERIOR FORCE AFFECTS INTERIOR ORGANS. 23 employed overcomes, not the inertia of the whole, but that of its minutest and invisible parts ; is, in fact, distributed among these pri- mary elements and causes of animal power. But motion of the incipiently vital elements is necessary in order that they may fulfill their destiny; that the becoming muscle and nerve may really become those instruments of power ; that primary organization may occur. Each and every atom thus destined is by motion urged onward in its career to the consummation of its organic purpose. Without such motion, organizing elements could never be brought into due place, but must remain unendowed with vital privileges. Chemical changes, too, so necessary in the re- arrangement of molecules that they may con- form to the uses of vitality, and quite as important to affect their destruction and dis- missal from service, can never take place unless the materials concerned are moved into contact, and within the sphere of new chemical influ- ences. It hence appears that, when force exterior to the living body is expended upon such body, 24 UNIVERSAL PRINCIPLES. it is not lost, but is distributed among its minutest elements, where it becomes directly serviceable to vital needs. Though not trans- formed to vital force, it supplies the very con- ditions in which this force originates, and thus becomes a direct aid to its manifestations. This fact is especially apparent in cases where vital duties are illy performed, and where vital power is evidently defective, as is the case in most forms of chronic disease. The principles now brought into prominence are not of limited scope and application. They form a part of the domain of philosophy and universal science, and do not belong espe- cially to physiology and therapeutics. It may, therefore, serve to increase the reader's interest in the special application of these principles, to state them in more general and comprehen- sive terms. If a moving body come in contact with one at rest, its motion is arrested ; but the force by which it is projected is not obliterated ; it is not even diminished. A great variety of experi- ments has demonstrated that no portion of such force is lost; it is only caused to assume new EXTERIOR FORCE AFFECTS INTERIOR ORGANS. 25 forms. At the moment of impact the moving force is transformed to its equivalent of heat, electrical disturbance, in some cases light, and perhaps other forms of force. The arts supply abundant illustrations of this principle ; their pursuit consists in its practical application, wherein our wants are subserved. Scrutiny of various conditions under which these transform- ations appear, demonstrates the uniformity of this law of nature. It is apparent that if the body receiving the force were composed of particles destitute of cohesion, that is, fluid, the law would hold equally good, but the result would be distrib- uted among the separate atoms. The friction of the moving atoms of liquids, it was shown by Rumford, produced a large amount of heat, and both Meyer and Joule demonstrated the uniformity of the transformation of motion to heat, as well as their units of equivalence. If the particles of the fluid be of complex composition instead of being uniform, the diverse nature of the chemical elements is favorable to the transformation of such imping- ing force to its chemical equivalent. Chemical 2 26 CHEMICAL EFFECTS OF MOTION. action will be determined among these matters of diverse constitution, and new products will be formed. The kind of product will, of course, depend on the nature of the elements thus engaged. The energy of motion now results in new arrangements of elemental matter. The test tube of the chemist affords an infinite variety of illustrations of this prin- ciple. The human body evidently embodies all the conditions above presented, and is a constant illustration of the principle. In health and in disease it presents a broad arena for the combat of atoms, with varying results, depending on the extent of the control of outside influences. It is hence amenable in a wonderful degree to the wholesome control of pure force supplied from without. NECESSITY OF APPARATUS. Practically, it is quite impossible to carry forward experiments like the above to satisfac- tory results. The effects are produced in too limited a degree to be conspicuous. Besides, these effects are exactly in the direction of phys- necessity of apparatus. 27 iology, and are inevitably merged with the ordi- nary and unnoticed interior acts, as they should be. Pathological facts arrest our attention in proportion to their gravity; physiological facts are unnoticed in proportion to their perfection. No really curative plan, or reliance based on effects producible by the hand ol an opera- tor, has ever been established, because the power of the operator fails too soon. Indeed, more abundant power than the hand can af- ford was necessary to demonstrate a principle of action. Without further recourse, curative effects from this source must ever prove frag- mentary and unreliable. It hence became necessary to contrive appa- ratus dependent for its work upon a more pro- lific source of power than the hand of an opera- tor can supply ; and in the course of experi- ment it was fully proved that more power is usually required to maintain the interior molec- ular and chemical motions which sustain physi- ological actions, than is generated in the sys- tem of another person. This conclusion will not appear incredible when we reflect that many persons, including most invalids, evolve 28 WAVES OF MOTION. little or no surplus force for expenditure on exterior objects, it all being employed to maintain the even, sluggish, physiological pro- cesses. It becomes evident, not only that apparatus must be employed, but also that this apparatus must be capable of infinite degrees as well as various kinds of action. It should be prompt in obedience to the will of the operator as well as to the feelings of the patient. Force supplied to the living body must be in the form of Vibratory Motion. In this way waves of force are made to pervade the sys- tem, as light does a transparent body. Sup- plied in any other form it would affect the mass rather than the constituent elements of which the mass is composed. Were the mass moved, the relations of the component parts would remain undisturbed. This corresponds, also, with the methods of force in other potential and acting forms. Heat, light, and perhaps elec- tricity, affect bodies to which they are com- municated, by means of vibratory motion ; they thereby unfold energetic chemical aptitudes which result in new chemical relationships. description of apparatus. 29 DESCRIPTION OF APPARATUS. After much diligent inquiry regarding the principles now commended to attention, and experiment to determine their practical availa- bility, the ends sought in the application of vibratory operations for therapeutic purposes were fully realized. A series of machines has been constructed capable of applying vibratory motion, in agreeable forms, to every part of the body, and successfully carrying out these principles. These applications comprise seve- ral methods. The first method of applying vibratory motion is confined to the extremities. It con- sists in giving the limb, whether arm or leg, an oscillation—a rapid succession of short, quick turns or twists upon its axis,—the direction of the motion being at right angles to the longi- tudinal axis of the extremity. The motion is reciprocating or alternating in opposite direc- tions ; it may be continued uninterruptedly for several minutes, or till the desired effect is produced, which depends on the condition of the system. The patient may be either in a sit- 30 method of action. ting or reclining position, with one leg or arm extended for the action of the apparatus. This motion, or method of expending force, produces mechanical attrition between the ulti- mate anatomical elements of which the extrem- ity is composed ; it also produces alternate slight pressure and relaxation of these constitu- ent parts in rapid succession. In the second method of vibrating, the per- son subjected to the operation rests in a lying position upon the apparatus, wThich has the general appearance of a couch, and some se- lected point of the under portion of the body is subjected to the rapid but very light strokes of the instrument operating from beneath, the patient being situated so as to adjust the im- pinging force and to render it perfectly agree- able to his feelings. The immediate mechanical effect consists of a rapid series of vibratory waves, whose de- grees of intensity shade off in every direction from the impinging and radiating point. As the physiological and therapeutic effects will be revulsive, stimulant, etc., according to the de- gree of intensity of the motion, it is plain that description of apparatus. 31 the desired effect may be secured by adjusting the position according to the diagnosis or medi- cal ideas of the case as related to means em- ployed. Every portion of the body may be subjected to various kinds and degrees of action, and the particular effect desired can easily be secured. The third method of applying the action con- sists in the short, quick, reciprocating motion of an instrument applied to some selected portion of the body. Various effects are obtained through this action, according to the degree of pressure. If the pressure be slight* the action is expended chiefly on the surface of the body; if the pressure be in- creased, a similar action is produced among the deep-seated structures of the interior, and effects will be varied accordingly. When the contact of the impinging instru- ment is so slight as to allow it to glide upon the skin, this action is tolerably understood by the term rubbing. With more pressure, the skin is comparatively unaffected, while the frictional action is expended in deeper parts. In this operation, also, the apparatus is so 32 rate of motion. contrived that the degree of force and motion employed may be wholly governed by the person receiving the action. An analysis and comparison of these vibra- tory motions show their mechanical forms to be similar, and that the choice in their use will depend more on local convenience than the peculiar specific effects distinguishing them. The degree of rapidity with which these curative motions may be applied, generally ranges between one and two thousand vibra- tory acts per minute. Here, again, is opportu- nity to secure a variety of effects, such as experience may prove to be most desirable in different cases. The more rapid rate pro- duces effects somewhat allied to a diffusive stimulant, but more permanent and not fol- lowed by any sign of depression. The slower rates secure reactive effects of various grades quite as valuable in a therapeutic point of view. The specific effects, to be described, diminish with the rate of motion till this ceases to be vibratory and glides into that of kneading, giving it quite another character, whether judged of by the sensations or the DESCRIPTION OF APPARATUS. 33 control of nutritive functions. Very slow motions of this kind, if accompanied with due pressure, have still a therapeutic value, but of another class. The time during which any portion of the body may be subjected to the vibratory action will depend on the pathology of the case, and the therapeutic end desired. Especial refer- ence is had to the condition of the nervous system. In paralysis, these different forms of motion may be used almost without stint, if applied at the proper points and in pre- scribed order. In other forms of nervous affection vibration is, when well directed and not used in excess, a valuable as well as a powerful remedy. Everything depends on the purpose and design of the application, and the demeanor of the patient under its use. In short, the degree of success, in persons of great sensitiveness, depends on the tact of the opera- tor. Having thus explained what is meant by vibratory motion as applied to the different regions of the body, we are prepared to exam- ine how the physical, chemical, physiological, 2* 34 MOTION INCREASES TEMPERATURE. and vital operations of the organism are influ- enced by applications of this kind, and how the effects so produced are turned to therapeu- tic advantage. EFFECTS OF VIBRATORY MOTION ON BODILY TEMPERATURE. The most immediate and conspicuous of the effects of either of the forms of the vibratory process is an increase of the temperature of the part subjected to the action. No mat- ter how prolonged and obstinate the previ- ous feeling of cold in the extremities, a few minutes' employment of this agency invari- ably restores the normal temperature. The same is equally true of other regions of the body besides the extremities. The feeling of warmth thus induced gradually diffuses itself from the point to which the action is applied, over the whole body. A softening of the skin by increase of insensible perspiration is a con- stant result of the process, and an active per- spiration sometimes succeeds the access of heat. The temperature has not been observed to rise above the natural standard, except in EFFECTS OF VIBRATORY MOTION. 35 case of too prolonged application of the pro- cess, on several successive days. The vibratory processes have been demon- strated to be prompt and reliable as a means of permanently restoring the natural tempera- ture to any portion, or to the whole of the body, whenever it is deficient. Indeed, there has been found no condition of disease which effectually resists this heat-producing cause. It is consequently a means of depriving chronic disease of its most constant and troublesome characteristic. This increase of heat may doubtless be re- ferred to two sources. The friction of fluids, and of fluids and solids under agitation, has long been demonstrated to be a cause of heat. The source of heat is the motion which becomes by this means transformed to heat, and fur- nishes an illustration of the correlation of forces. But the chief source of heat in this case is probably the increased chemical action that is superinduced, particularly that occurring through the agency of oxygen. This form of action is hastened by yibratiqn, and the 36 HEAT PRODUCTION. elimination of heat is but an illustration of the nearly universal law, that heat is evolved when- ever complex chemical combinations, like those constituting the organism, are reduced to more simple forms. This heat actually appears interiorly, and differs from all other therapeutic applications of heat, which are made only to the surface. In one case the heat finds its way to the surface along with the normal products of waste, while in the other, it must be transferred inward from the surface, only through the cir- culation of the blood. The maintenance of the normal temperature has always been regarded of the utmost importance. The well have great facility for resupplying the waste of heat as fast as it occurs, while in the chronic invalid its waste is resupplied tardily and with difficulty. Hence, remedies which contribute to the heat of the body, if only transiently, have ever been in favor in the treatment of chronic invalids, even though they simply supply the element of heat without aiding its normal production. We may perhaps attain some idea of the uses of EFFECTS OF VIBRATORY MOTION. 37 temperature by reflecting that it appears to facilitate the development and perfection of elemental vital forms. This suggestion is supported by the well-known importance of heat for the germination of seeds, and for the development of eggs of oviparous animals. In both of these cases the development of vital activity is entirely dependent on the supply of heat. Physiology affords no dis- tinction between the elementary vital forms that are to serve in the animal structure as the instruments of its power and those that are destined for further development into separate and distinct organisms; and it is reasonable to suppose that in either case similar conditions are equally favorable to development. Vibratory motion not only immediately sup- plies heat to the body by the oxidation which it secures, and by the transformation of motion to heat through the friction and con- cussion of its elements, but experience has fully proved that this increased supply of heat directly becomes spontaneous and permanent. The natural production of heat is first imitated, 38 VALUE OF HEAT. and finally goes forward as in health. The vi- tal force-evolving elements of the nerve-centers are enabled to perform their functions more naturally and perfectly, and the indispens- able condition for the manifestation of nerve- power is restored. Heat has always been a favorite, perhaps because a ready, form for the application of force remedially, and its recent revival is due more to the devising of unique methods for its application by means of baths than to the dis- covery of new curative virtues. Applied to the extremities, it expands the capillaries, and is therefore revulsive in its effects. It aids the conveyance of effete saline compounds from the body through transpiration. Its effects, how- ever, whenever externally applied, are transient and superficial. INCREASE OF OXIDATION. The increase of heat produced by vibration is an evidence of the increased use by the sys- tem of oxygen. There are still other evidences quite as satisfactory, among which is : The products of oxidation passing from the INCREASE OF OXIDATION. 39 body are increased, as proved by the follow- ing: The skin becomes softer and moister, show- ing that more insensible perspiration is elimi- nated. The amount of urine is increased, often to the extent of fifty per cent., signifying that more water is produced by the oxidizing process. Urine previously of deep color becomes lighter and of natural color, indicating that the extractives are destroyed by reduction through oxygen. The amount of urea is increased, and that of uric acid is diminished, which effects are pro- duced by the same cause. The disappearance of rheumatism and scrof- ulous enlargements also affords evidence of in- creased energy of oxidation, reducing morbid material to the form in which it can be elim- inated. Further evidence in the same direction is afforded by the marked expansion of the chest, and the involuntary effort to perform deeper respiratory acts—evident attempts to respond to the increased demand for oxygen produced 40 PRODUCTS OF WASTE. by vibration. No exact experiments have demonstrated the amount of increase of car- bonic acid exhaled, but we are justified in presuming that this corresponds with the other effects noticed. ELIMINATION INCREASED BY VIBRATION. The effect of the increase of chemical action, secured by vibration, is expended chiefly on the retrogressive, wasting elements of the system —a consequence of the utmost importance in chronic illness. For it is at just this point in these cases that the failure which constitutes ill-health exists. According to Lehmann, the products of oxidation are always diminished in disease. This statement is corroborated by other investigators in physiological chemis- try. To the comprehension of all thoughtful observers, the furred tongue, the local conges- tions, the evidences of " biliousness," the dry- ness of the skin, coldness of surface and extremities, with a retinue of similar symptoms, are evidences of the presence of incompletely oxidized and therefore retained matters. Elim- ination is the immediate and inevitable conse- ELIMINATION INCREASED BY VIBRATION. 41 quence of carrying the oxidizing act forward. to completion, because the products of oxida- tion, secured by this means, become aeriform and fluid, and at once find exit through skin, lungs, and kidneys. The practical importance of this point it is impossible to exaggerate. Indeed, it is the indirect effect of all remedies, whatever be their aim, to restore the proper relation between supply and waste, by causing a more perfect use and disposal of food. Whatever else be the purpose of the body, it is, first, an oxidiz- ing apparatus. The other purposes of bodily existence are fulfilled in about the ratio of per- fection attained by this function. It follows that the kind of remedial assistance most needed is that which aids in perfecting this physiological process, because such assist- ance supplies at once the ordinary means of destroying morbific principles, and furnishes an antidote for their effects. The process of vibration is simply that of bringing these mobile elements of the system, which are seeking alliance, into contact. This secures the completion of those atomic changes 42 CHEMICAL ACTION. which it is the endeavor of physiology to se- cure. The test-tube in the hands of the chem- ist, which on agitation instantly indicates the expected reaction, illustrates the effect of mo- tion within the body in fulfilling the chemico- physiological tendencies of its constituent ele- ments. The oxygen held in solution by the blood becomes most potent and efficacious when brought into vigorous contact with oxidizable materials. The blood, on the other hand, can not attract this element from the air of respira- tion in greater proportion than it is yielded to the system. The effect of motion is to render active the latent chemical tendencies of atoms and molecules, and their attraction for oxygen throughout the system becomes energetic. In short, it is increased energy of chemico-vital affinities that needs to be vigorously asserted in order to meet the requirements of the chronic invalid. This view is in perfect harmony with ordinary medical practice. It only presents means more direct, and fulfills indications more completely. For all remedies do something either directly ELIMINATION INCREASED BY VIBRATION. 43 or indirectly toward the end here in view, or they fail to satisfy expectation. Practically, these views are fully justified by our experience of the effects of vibration. For as the products of waste rise to the normal standard, both in quality and amount, the countenance brightens, the appetite and strength return, and all those evidences of disease which constitute physical symptoms coincidently disappear. The effects now described as attainable through the application of vibratory action are desirable in all chronic disease, because they pertain to the quality of the blood, and the degree of perfection attained by the nutritive function. Many nervous symptoms are doubt- less attributable to the occurrence of some toxic element, interfering with the proper nutrition of the nerve-centers and conductors, which has its origin in an aberration of the retrogressive or denutritive processes. These symptoms find their natural and perfect remedy in the effects secured through the application of vibratory action. Another series of defects arises in chronic 44 NATURE OF CONGESTION. disease, which especially impedes the restora- tion of diseased nerves. This consists of the impediments to the transfer of matters which have already entered the vital arena from the digestive organs. These impediments appear in the forms of congestion of capillaries, defi- cient osmotic action, imperfect regional and imperfect general circulation of the blood. Each of these morbid conditions is specially related to the health of the nerves, and is par- ticularly amenable to the influence of vibra- tory operations. REMOVAL OF CONGESTION. In congestion, the minute vessels are dis- tended with blood, and the current is sluggish. The capillary walls do not contract effectively, so as to move forward their contents. Most diseases are characterized by congestion at some points. When this condition has long existed, the contained blood is deteriorated, and we are informed by pathologists that gelatinous corpuscles occur. These, together with the adherent blood-corpuscles, become attached to the capillary walls and to each other, caus- REMOVAL OF CONGESTION. 45 ing partial occlusion or stoppage in the vessels. The power of vibration to remove this con- dition of things can be easily understood. The mechanical impulse, instantly narrowing the walls of the dilated vessels, drives their con- tents forward. The same act also stimulates the vital contraction of these walls, adding this to the causes of motion acting upon the cur- rent. These causes conspire to force onward and remove the mechanical impediment in the minute vessels, and a fresh supply of blood from the heart is consequently admitted. The effect of vibration is to stimulate and nourish the capillary walls, and cause them to become permanently more contractile, and able to transmit duly their currents, instead of inju- riously retaining them. To produce these effects in a satisfactory manner requires something more than a hap- hazard and blundering way of applying the remedy. The mode of application, it has before been intimated, depends on the nature of the case, and a full knowledge of the pecu- liarities and powers of the remedy ; otherwise injury will be inflicted. It is necessary to say 46 CARE REQUIRED. here, that a full use of the revulsive means above described is an indispensable prelimi- nary in the production of these effects. The vibratory action should be gradually carried nearer the diseased point, sending at first the lighter waves of vibration into the diseased region, being always careful to be guided by the sensations of the patient. The physician may in this way have the satisfaction, as from time to time he examines his patient, of wit- nessing the removal of swelling (when this has been indolent) as well as pain and soreness from regions that have long suffered and proved intractable to the most approved and potent remedies before used. INTERCHANGE OF FLUIDS PRODUCED BY VIBRA TION—ABSORPTION. The motion of fluids caused by vibration is not confined to those contained by vessels. The effect is coextensive with the action, and includes interstitial as well as circulatory fluids. The agitating effect of vibration superin- duces an exchange of fluids. Those outside INTERCHANGE OF FLUIDS. 47 the vessels, in which the tissues in general are bathed, are transferred to the venous vessels through their membranous walls, while those contained by the nutritive or arterial vessels pass in the opposite direction. This is exactly the way in which these respective fluids natu- rally tend, by reason of their qualities, func- tions, and destinies. But these motions are aided and rendered perfect by mechanical as- sistance from an exterior source, —by vibra- tion. This effect, it will be noticed, is on the prin- ciple amplified in works on physical science under the designation of Osmosis. The con- ditions for this action consist in the differing fluids being separated by membranous walls. Motion being imparted to one of these fluids (that within the vessels in this case), the other is drawn through the membrane and joins that in the vessels. The physical conditions are amply fulfilled and the expected results attained in the case before us. The evidence of the action consists in the diminution of swelling, in disappearance of fat, and in cer- tain cases, at will of the operator, the sudden 48 EVIDENCES OF ABSORPTION. appearance of what are usually called "bil- ious '' symptoms. It hence appears that vibratory action be- comes a reliable and radical means of secur- ing interstitial absorption, and is of excellent remedial service in case of swollen parts. Practically, it is an effective means of reducing hypertrophies of organs whether internal or external, glandular swellings, and dropsical effusions whether areolar or in cavities. In the latter case the action of the skin, always increased by the motion described, often be- comes for a short time excessive, while the effusion in the mean time disappears. The diminution of scrofulous swellings and hypertrophies is probably produced by the joint result of two effects of vibration. First, the reducing effect of the additional oxygen caused to be attracted to and absorbed in the region; second, the absorption, through the agency of the same cause, of the liquefied materials into the general currents of the cir- culation, submitting them, in common with the rest, to purifying and eliminating causes inces- santly operative throughout the organism. INTERCHANGE OF FLUIDS. 49 These effects of vibration in scrofulous and other enlargements have often been practically demonstrated. The therapeutic influence of the effects of vibratory action in disease of the nerve-cen- ters is easily made intelligible. It matters not what pathological appearances may be re- vealed by post-mortem examinations ; it is the beginnings and early progress rather than the products of such disease with which we are called upon to deal. The beginnings of disease of nerve-centers must be allied to the initial stages of other forms of disease. There cer- tainly must be some dyscrasy of the blood capable of sustaining the disease before it can exist. There must also be perversion of local nutrition, here as elsewhere connected with the office of capillary nutrition, consisting in part, at least, of imperfect interchange of fluids. The wasting matters resulting from dis- integrating nerve-tissue are probably imper- fectly reduced, and consequently retained in some noxious form. These imperfectly elabor- ated matters are capable of either furnishing mechanical obstructions in the capillary circu- 3 50 CAPILLARY IMPEDIMENTS. lation of the cerebro-spinal centers ; or they may react as toxic agents, and hinder or per- vert the generation of power at this important seat of vitality. In either case vibratory action is wonderfully effective in removing the im- pediments to health which exist in capillaries. It will therefore exert a valuable, indeed in- dispensable, restorative power in diseases of the nerves. REVULSIVE EFFECT OF VIBRATION. The remedial method which consists in causing activity and even irritation in some tissue, or at some point, for the purpose of diminishing the evidences of disease in a dis- tant part, has always been emploj^d in medical practice. Surface irritants, such as blisters, plasters, ointments, vesicants, lini- ments, embracing a host of different articles, belong to this class. Cuppings, leechings, bleedings, issues, setons, and cauterizings belong to the same. The application of heat and cold to parts of the body, as well as the use of the Russian, Turkish, and other baths, are in part for the same purpose. Though REVULSIVE EFFECTS OF VIBRATION. 51 revulsive remedies may not always be em- ployed with good judgment, yet experience has fully shown the correctness of the principle which dictates their use. Doubtless the good effects of many internal remedies, as cathartics, stimulants, alteratives, etc., may be attributed to the same principle. Such is the obscurity of medicinal action, and such is our ignorance regarding the way medical effects are produced, that it is often impossible to determine whether, for instance, the cerebro-spinal substance is directly affected, or some other tissue is made by the action of the drug to call nutritive supply from the previously excited nerve-centers. There are proofs that the latter hypothesis is the correct one in many cases. Whether the one suppo- sition regarding the mode of operation of remedies, or the other be correct, it is quite certain that the disease is mitigated, not by making a physiological, but pathological im- pression. This impression may or it may not be transient. If we could fully know the causes of nervous maladies, we might often trace their origin to remedies whose immediate 52 KINDS OF REVULSION. consequence may be relief and seeming bene- fit, but whose ultimate effect on nerve-centers is disastrous. The facts in this case must be left to the further development of medical science. There are two kinds of revulsion. One con- sists in producing an afflux of blood to some region of the body, as the skin and extremities, whereby the quantity contained in a suffering part may be diminished. This is regional re- vulsion. The other kind relates to the physi- ological uses made of the materials the blood contains, whereby nutrition is changed from the support of one to that of another function. This is physiological revulsion. The mode of securing regional revulsion is readily understood. The vibratory applications are applied to a limited portion of the body; its nerves are aroused, and its nutritive activi- ties excited. This, more than any other cause, increases the measure of blood which flows to the designated region. The vessels become distended, their capacity increases, and the part gains color. The local increase is attended by a corre- REVULSIVE EFFECTS OF VIBRATION. 53 sponding diminution of blood in contiguous and even in remote regions of the body. This revulsive consequence of vibratory motion may be increased to any desired extent, simply by extending the area of the action and multiplying the applications. When new and vigorous ac- tion is assured in any chosen part, such part is made to assume new relations to the remainder of the body as regards the distribution of the nervous power, as well as that of the circula- tion—an instance of effect following closely on its cause. Nervous action is clearly dependent on blood supply, and increases or diminishes in any region or organ with the increase or diminu- tion of nutritive activity. This activity is com- pletely under the control of vibratory motion. The facility and thoroughness with which vibratory motion may be supplied, renders it a ready and reliable means for determining the real value of this therapeutic principle. It is found to be as valuable in mitigating and sub- duing affections of extended regions of the body as in controlling the lesser ailments of invalids. Thus, various disabilities relating to the head, chest, digestive organs, pelvis, etc., 54 CONGESTION REMOVED. find relief from the derivative use of vibratory action. But nowhere is the effect more satis- factory than in diseases of the cerebro-spinal axis, whether characterized by diminution of power or by neuralgic pain. Any portion of these centers of nervous power suffering from congestion will find direct relief in vibratory motion, if applied with a strictly revulsive design. This is probably because of the ex- citement produced in the skin and extremities, and the transfer of blood to them. The salutary effect is rendered permanent by cautious repe- titions of the operations at suitable intervals. There are no coincident pathological conditions superinduced to compromise the purity and permanency of the effect, as is the case when other revulsive means are employed. But the physiological revulsion produced by vibration is distinct from any effect produced by other means, inasmuch as it relates to bod- ily functions as well as regions. The principle forming the basis of this cura- tive process will be readily understood. Nor- mal action of the muscles is preceded and ac- companied by nerve action. REVULSIVE EFFECTS OF VIBRATION. 55 This nerve action may either have its origin in the will which communicates its incentive through the nerve to the muscle, or in the irritation produced by some cause affecting the sensory extremity of the nerve connected with the muscle. Now, the vibratory action, how- ever energetic it may be, takes place without the intervention of either of these causes. The nerve receives no incentive and does not act, and is entirely relieved of the necessity for acting. Hence, the nutritive effects which action always incites fall upon other than nerve-tissue; revulsive effect specially related to nerves is secured ; the pre-existing exces- sive activity of nerves is counterbalanced; their congestion is relieved; excited action of the cerebro-spinal centers is subdued. Indeed, it not unfrequently happens that persons of habitually excited nerves lapse into a quiet sleep while being subjected to the vibratory operations. These facts afford evidence that the most prominent cause of nervous disease, when this consists of congestion, is removed by vibratory movements. 56 VARIOUS CAUSES. CONGESTION, THE PRIMARY CONDITION IN NERVOUS DISEASES. It is well understood that a diversity of symptoms greatly differing in character may arise from the same cause in different individ- uals. There is much reason to believe that the first stages of diseases of the cerebro-spinal axis are characterized by the presence of too much blood in the nerve-centers. In the progress of the disease, the change of habits which is caused by enforced inactivity may, and prob- ably often does, produce subsequently an op- posite condition. This conclusion is sup- ported by the popular observation, that persons whose habits of life subject the nerves to undue activity and wear for a long period, incur a far greater liability to nervous disease than others; indeed, they are always verging on some form of such disease. Constitutional predisposition has also its place among influences conducing to such diseases ; but unequal use produces unequal nutrition, the essential and ultimate cause of this class of affections. Although the brain of man is but one-thir- CONGESTION. 57 tieth the weight of the body, physiologists have shown that it receives from one-tenth to one-eighth of the blood sent from the heart to sustain the body. If the afflux be too much increased by use, or if it be not counterpoised by muscular action, the nerve-centers will be under perpetual pressure. If, now, the general health be from any cause impaired through the ordinary channels of derangement, it is clear that the deterioration must be more decided and grave at the point of greatest nutritive action, and disease of nerve-centers is the inevitable consequence. The remedial requirements of such conditions are perfectly obvious. The nutritive afflux to nerve-centers must be turned in the opposite direction. To increase the healthy action of the muscles and other physiological elements is to relieve the embarrassed nerves. This design there is no other proper way to fulfill. But the requirement is not met by ordinary exercise, because this implies effort. Such exercises commence in volition, which has its origin in cerebral-centers. In health, the co- equal use of nerve and muscle preserves their 3* 58 TRANSFER OF BLOOD. equipoise; but in disease of the nerves, there is inaptitude for any considerable degree of voluntary action. Besides, such exercise is damaging, because instead of restoring the equipoise, it increases the disparity of action, which already exists, between the twTo great channels of bodily power, the nerves and muscles. Exercise, to be beneficial in these cases, must be quite passive, and vibratory applications are the only methods yet devised whereby passive motion can be successfully applied for curative purposes. But there are also cases of nerve-disease in the progress of which the spinal cord becomes anaemic; it requires more blood to supply its nutritive wants. The vibratory operations are equally efficacious in transferring the circula- tion in the one direction as the other, and the need now indicated may be complied with readily. It is only necessary to reverse the or- der in which the applications are made. This change reverses the direction of the impulse afforded by the operation—sends the blood as easily to as from the spinal cord. In these cases, however, the essential need, FORCE INCREASED BY VIBRATION. 59 when thoroughly understood, will be found to be not so much an increased supply of blood in the cerebro-spinal centers, as increased facil- ity for initiating and perfecting those normal changes of matter whereby nervous power is generated. This principle has been sufficiently discussed in another section. EVOLUTION OF FORCE INCREASED BY VIBRATION. Physiologists agree that it is through chemical changes in the instruments of power that vital force is generated. In all disease, the chemical changes are imperfect and insufficient, as is proved, not only by the deficient force set free for the uses of the will, but also by the altered character of the waste passing from the body and deficient amount of normal products of waste. It has already been shown that exercises in general are designed by nature to maintain these changes and thereby to maintain health; and it has also been shown that vibratory motion is capable of supplying the same conditions, resulting in the evolution of the needed ner- vous power. These facts are equally appli- 60 SURPLUS FORCE. cable in maintaining and restoring the health of the nerves, the instruments of the will and sensation, as of the muscles, the instruments of dynamic power. But the power liberated in health, by the chemical changes, — " metamorphosis of tis- sue "—it is calculated, is in excess of that expended on objects outside the body. There is, hence, a residual force, which is appro- priated by the organizing elements, and em- ployed for constructive purposes. This sub- ject is fully elaborated in Dr. Carpenter's work entitled "Correlation of Vital and Physical Force." The bearing of this principle of physiology will be seen when it is understood that molecu- lar and chemical change is largely superin- duced by vibratory motion, and that force is in this way liberated without the usual ex- penditure. The exertion of the will, the usual cause of expenditure of nerve-power, is en- tirely suspended. This allows the constructive force generated in the manner above described, to be employed wholly for the reparation and benefit of the instruments of nerve-power. FORCE AUXILIARY TO DEVELOPMENT. 61 It thus appears to be a demonstrable fact, that vibratory motion aids the power, sustains and restores the health of the nerves, and is in strict accordance with theoretic considera- tions emanating from leading authorities. EXTERIOR FORCE AUXILIARY TO ITS INTERIOR DEVELOPMENT. That a large amount of force is required for the daily expenditures of the system is quite apparent, and the fact becomes the more obvi- ous when the amount generated is diminished by disease. But the system does not absolutely originate this force — it only eliminates that which is presented to it in the food and air it receives. The vegetable world organizes matter by combining it with force ; the two are subse- quently separated by the animal organism. The system is an instrumentality for giving form and direction to this elimination, and affords a predestined career to whatever it receives. The transpositions of material, which constitutes the basis of physiology, have the purpose of evolving from physical and chemical changes the actions and powers 62 MINUTE FACTORS OF POWER. of the living creature. To this end, the vital molecule influences contiguous matters, and subjugates them to the vital form ; but mobility is the inexorable condition. The suc- cession of atomic changes becomes in some way, at present unexplained, the bearer of vital power, and serves the purposes of the will. It follows that the amount and quality of power manifested by the organism are entirely dependent on the motions of these minute factors. The most useful remedies must consequently be those which act in the direction of the organic tendencies at every point in the career of matter in the system. Exterior force is a direct agency for this pur- pose, and can be legitimately and profitably employed. It will be observed that the supply of motion to the constituent elements of the body, if in suitable degree, introduces no new form of action. It only exalts to the desired point that which previously existed, rendering it more pronounced and effective. In other words, force, supplied from without, is, by physical, chemical, and physiological transformations, FORCE AUXILIARY TO DEVELOPMENT. 63 made to subserve and perfect vital uses. Every atom is assisted to consummate its tendencies. " We everywhere discover," says Claude Bernard, "a rigorous correlation between the intensity of physical and chemical phenomena, and the phenomena of life ; therefore we are able, by acting on the first, to modify the second, and regulate them at will." From this it will be noticed that the conse- quence of only a single impact of force upon the organism is distinctly traceable in inevitable, physical, chemical, and physiological effects in the inmost recesses of the body wherever vital power is evolved. That such a cause influences and controls the evolution of power, is a logical necessity. Though the energy expended among vital molecules by a single impact may be too inconsiderable, when trans- formed to physiological action, to be of much therapeutic value, yet, it must be remembered, that this act may be repeated without limit, and until the desired curative efficacy becomes con- spicuous. The form of the application admits of wide variations, adapting it to the needs of the system under varied circumstances, thus 64 ELECTRICAL DISTURBANCE. further complying with the needs of different invalids. ELECTRICITY, A PRODUCT OF VIBRATORY MOTION. The use of electricity, long employed as a curative force, has of late experienced a revi- val. That an agency so long known should not have achieved more rapid popularity, is evidence either that its curative virtues have not been fully brought out, or that it has often been indiscreetly applied. There are many facts which justify the latter inference, and show, also, that injurious effects are not only possible, but frequently actual. The employment of this agency attests readiness on the part of the scientific public to examine and test the merits of force for curative pur- poses. Progress is achieved even by experi- ments which do not as well as those which do result according to expectation. Vibratory motion most conclusively disturbs the static electricity of living bodies. This disturbance is probably attributable to the friction of the multitudes of particles, and to CONFIRMATIONS DERIVED FROM NATURE. 65 the transformation of the motor to electrical force. There does not arise an uncontrolled amount of this agency to compromise the vital welfare; nor does its presence cease directly on the discontinuance of the cause, as is the case with the galvanic stream. By exciting a rubber ruler by friction, and observing that electrical attraction lingers for a while after the exciting cause is withdrawn, one can be satisfied that the static is less evanescent than the galvanic form of the electrical force. Experiments are now in progress to determine the tension of the electrical force thus devel- oped, its degree of permanency, and its physi- ological effects, with the view of discovering what portion, if any, of the curative efficacy of vibration, may be attributable to electrical disturbance. CONFIRMATIONS OF THE FOREGOING PRINCIPLES DERIVED FROM NATURE. All motion returns to its starting-point and is in some manner reciprocal, having a divers- ity of rates of pulsation. The many millions per second of the vibrations of light, and the 66 TRANSFORMATION OF FORCE. motion of the planets in their eccentric orbits, are examples of the law. Mechanics change the rate but not the fact of reciprocity of motion. The many motions per minute of the piston of the locomotive are converted into and exactly measure the length of the journey both in time and space; the locomo- tive as well as the piston constantly returns to the same point. Nature is replete with examples both of the communication of vibratory motion from one object to another, and of the conversion of one form of vibration to other forms. The power of heat, light, and electricity to affect bodies within the sphere of their influence, and their mutual transformation into each other, need only to be referred to. Each of these forms of force, it is well known, may result from pure motion producing attrition of the particles of matter. In the animal body, everything is palpitating, reciprocal, vibratory, in different degrees. Its vitality is supported and manifested through modifications of such action. The air and food employed are alternately taken and given. CONFIRMATIONS DERIVED FROM NATURE. 67 The force which accompanies these supplies does not remain, but is immediately expended. The physiological acts of eating and assimila- ting, sleeping and waking, activity and rest, labor and recreation, are necessarily alter- nating. Now, note the dependence of vitality upon these reciprocating actions. Respiration is alternate motion, without which the oxygen required by the interior operations of the sys- tem could not be supplied. This reciprocating motion is transmitted to the stomach and lower digestive organs, and is an absolutely necessary condition of their health. The heart pulsates against the walls of the chest, and stimulates respiration. The arteries ramify and pulsate throughout the system, stimulating the nutritive actions they are designed to sup- port. But the system is so contrived as to insure in health an abundant supply from without, of reciprocating and vibratory motions. All the voluntary motions of the members of the body are necessarily reciprocating, and react generally upon its interior mass with vibratory 68 SPECIFIC EFFECTS OF MOTION. motion. In sitting and standing, the sustaining muscles work alternately, and so affect the interstitial and circulatory fluids. In walking, every foot-fall affords a wholesome vibratory motion extending throughout the system and reaching its minutest particle. Riding, whether in a carriage or on horseback, simply exalts this kind of action and its effects. Each ex- ercise increases the action of some portions of the body more than other portions. From each may therefore be derived a specific ther- apeutic value, according as it is desirable relatively to increase or diminish action in different regions of the body. Now, in all cases of chronic disease there are presented conditions to which these facts pertaining to motion correspond. There is deficiency of physiological motion, as well as of the conditions for its spontaneous supply. The property of motion to become converted into other forms of force whose presence is needed to perfect vital operations, is one of the utmost importance in therapeutics. Exterior aid can, through this property, be employed to perfect physiological endeavor, CONFIRMATIONS DERIVED FROM NATURE. 69 therefore to restore health. It need not be said that the application of vibratory motion to delicate and sensitive parts might prove inju- rious. The contrary assertion would deny the possession of curative power. The advantage of all power resides only in its discreet use. The value of a drug is closely connected with the fact that it becomes poisonous in some doses and under some circumstances. It is exactly so with force in vibratory as in other forms. Injurious effects only proclaim a wrong use of any agency, and the unfitness of the prescriber. The adaptation of remedies demands most thorough acquaintance with disease ; its special form and nature, its degree of progress, the constitution of the patient, the capacity of the system, and the relation of the parts to each other ; it also demands a thorough knowledge of the nature and powers of the remedy. Deficiency in any particular is sure to render treatment either useless or positively injurious ; the remedial use of motion is by no means an exception. 70 QUALITIES OF MOVEMENTS. ACTIVE AND SEMI-ACTIVE MOVEMENTS. Other movements than the vibratory are of indispensable service in most cases for the treat- ment of loss of muscular and nervous power. For while, as a general rule, it is of the utmost importance to husband the limited nerve-power by restricting its expenditure, yet it is some- times necessary to direct this power into the extremities. By vibration, the organic activi- ties are so aroused that more power seems to be generated; and it has been found that the volition can be put forth with greater ease and effect. Actions of this kind serve to extend the influence of the will to the extremities, and so to aid in regaining lost control over the mus- cles. The utmost caution is necessary in the use of voluntary exercises that they be not too vigor- ous, or too frequently repeated. Errors in this respect are often committed by persons who have failed to master the principles of the treatment by motion and force, and who there- fore can only imitate the methods I have devised. Understandmg that motion is the ACTIVE AND SEMI-ACTIVE MOVEMENTS. 71 form of the remedy employed, they proceed to make large and exhaustive demands on the will of their patients. They can only sadly fail in cases of real disease and of delicate constitutions, much to the detriment of correct practice. When the power of the nerve-centers is quickly exhausted, it is tolerably certain that this power is only slowly and with difficulty replenished, and that it is the replenishing rather than the exhausting process which demands assistance. Even slight indiscretions in the use of voluntary action will sometimes re-excite the morbid process which was the original disease. Why this effect may ensue is easily understood. For while, in health, the nerves and muscles act equally, they are supplied with nutrition to sustain their action in corresponding, that i-', equal ratio. But in disease the nerve-action is disproportionate to muscular action, causing also disproportionate distribution of blood-supply, and congestion of the nerve-centers is produced or continued as the case may be. It should be said, - however, that in practice there are circumstances which modify the 72 CONTROL OF EXPENDITURE. occurrence of results so grave. Among them are the coincident restriction of the power of the will, denying action to the nerve-centers, also the subsidence of the hypersemia of nerve-centers, and the substitution therefor of some of the morbid products disclosed by post-mortem examinations. The undesired effects of voluntary exercise in these cases of restricted power, may be avoided by using appropriate means to control expenditure. A certain way of exercising control is to move the affected extremity by the hands of assistants in such a way as to allow the invalid only a limited participation in the action. While this is safe and useful for the patient, it is too fatiguing to the assistant to be of very much account. PARALYSIS AND NEURALGIA DUE TO A VARIETY OF DISEASED CONDITIONS. The curative effect of vibratory and special movements in paralysis, neuralgia, and other affections of the nervous system, is manifestly due to the extraordinary control attained by these operations over all the primary actions, PARALYSIS AND NEURALGIA. 73 and especially the nutritive. Were this not the case, the remedy would be circumscribed in its curative effects to a very limited sphere, as is that of a drug. The different degrees and forms of paralysis and other nervous affections are in themselves only symptoms and effects; they are referable to a multitude of causes, but not to any uni- form and specific cause. Nerve-function consists of two branches— the evolution of nerve-power, and the conduc- tion of nerve-power. All causes, however diverse, which restrain or prevent the evolution of nerve-power ato its central source; and all causes which restrain or prevent the con- duction of nerve-power along its prescribed channels, whether the function be motor or sensory, will be attended by paralysis as the necessary consequence. So, also, all derangement in the manifestation of sensory power will be accompanied by sensations of an abnormal, and generally of a painful kind, and this constitutes neuralgia. It hence appears that paralysis and nervous affections in general have not that specific 4 74 PERIPHERAL PARALYSIS. character that is assignable to many forms of disease, and. that while the ultimate cause must lie in perverted nutrition, their interme- diate and direct causes are multiform. Among these, physicians are cognizant of the fol- lowing : Inflammations, abscesses, and tumors, aris- ing in the immediate proximity of a nerve-con- ductor, may afford such pressure upon it as to interrupt its function and destroy or modify its conducting power. The parts to which a nerve so affected leads will become paralyzed, or will suffer pain, according to the degree of pressure. There also are cases in which the conducting nerve does not readily resume its function even after the original obstruction is removed. This is peripheral paralysis. Compression of Spinal Cord or Brain, from Effused Fluid.—Serous or watery fluids may be too abundantly secreted by the arachnoid membrane which incloses the central nerves. The pressure thus produced will wholly or partly suspend the functions of these nerves. Loss of power—paralysis—and deranged sen- sations will be the consequence. DEGENERATION OF CENTRAL NERVES. 75 Degeneration of the Central Nerves by Soft- ening.— The power-evolving tissue looses its texture, becomes soft, and ceases to be of pro- per consistency or to be normally renewed, and nerve-force is consequently no longer generated. This form of degeneration is one of the conse- quences of imperfect nutrition. Paralysis is coextensive with this morbid change. Change of Structure.—The nerve tissue or substance is displaced at points by another formation—a hard whitish substance—called sclerosis. By this change the generation and conduction of nerve-power, both motor and sensory, are precluded. Embolus.—Coagula of blood sometimes ob- struct branches of the nutritive vessels of the central nerves and thus deprive the power-gen- erating tissue of its nutrition. These coagula doubtless begin as minute points and increase by accretion. Paralysis of the parts con- nected by nerves with the centers thus impover- ished is the consequence. The function of the brain may also be deranged by a somewhat allied affection consisting of an expansion of some vessel. 76 CAUSES OF PARALYSIS. Congestion.—In many cases of neuralgia, congestion of some portion of the nerve-centers or conductors undoubtedly exists. There is also abundant evidence that congestion is precedent to, and coexists with, those special morbid conditions of the nerve-centers from which paralysis results. Effectually to pre- vent and remove congestion is therefore equiv- alent to removing paralysis. Local Adventitious Matters.—There doubtless occur various products of waste and of imper- fect nutrition which have never been isolated and named. The conditions for the existence of such products consist of deficient activity in the processes of oxidation and venous absorp- tion. The pressure of such matters upon, and their contact with, the power-generating nerve- substances must obstruct vital function and cause paralysis and neuralgia. Toxic Elements.—Nearly allied to the above is the spontaneous occurrence of blood-poisons. That the peculiar characteristics of many chronic diseases are due to this cause is ex- tremely probable; and there is no obvious (reason for making chronic nervous disease an DEGENERATION OF CENTRAL NERVES. 77 exception. That other forms of spontaneous blood-poisoning exist besides the universally recognized one of uraemia, is matter of legiti- mate inference. Those toxic principles which are conceded to be the bases of the acute erup- tive diseases, should have their analogues in the slowly developing or chronic affections. That the effects of these causes would be most con- spicuous in the nerve-centers is naturally infer- red from the sensitiveness of this portion of the organism. This suggestion accords with our experience in producing transient blood-pois- oning by certain drugs. In a deranged and morbid condition of the nutritive system there is a continuous supply of morbid products, capable of deranging the action of nerve-cen- ters in various ways, according to the composi- tion and quality of these unnamed products. HOW PARALYSIS OCCURS, AND HOW REMOVED. We are now enabled to understand the mode of origin of paralysis and other nervous affec- tions. Such affections are the consequences of certain proximate causes, a part of which are above enumerated; these, again, are the prod- 78 NATURE OF CURE. ucts of radical causes, related in some way to the development, sustenance, and destruction of the elemental vital form, which serves as the instrument of nervous power. It is plain that the real and radical remedy for nervous disease must reach both the proximate and the ultimate causes, or only imperfect relief is found. It is not enough that the extremity or other paralyzed part be stimulated to act by medi- cinal or even mechanical stimulants. Such action can be maintained only by power em- anating from a source back of the point where it is exhibited. Action is of no account unless it has its origin in the centers designed for its evolution. The power stimulating the muscles must be vital, and can arise from no other conditions than those which support vitality. THE CONNECTION OF VIBRATORY AND OTHER MOVEMENTS WITH THE RESTORATION OF NERVOUS POWER. The conditions for recovery consist in the removal of impediments to normal action, and the supply of power in the direction of physi- RESTORATION OF NERVOUS POWER. 79 ological activity. The physiological channels and mechanical methods through which these purposes are accomplished by motion have already been detailed. The application of these principles to special classes of paralytic and other nervous diseases is readily made. For example: In spontaneous blood-poisoning, and in case of adventitious substance in contact with nerve-tissue, the influence on the generation of nerve-power can only be annulled by the removal of the painful matters by oxidation. They occur only because of the incompleteness of the oxidizing function, and remedies afford no complete substitute. The oxidizing function is readily exalted simply by securing more energetic contact of oxidizable matters with this element. Such contact is rapidly and thoroughly secured by vibratory notion. This purpose is further assisted by cultivating the power of the respiratory organs through in- creased action of the muscles of the chest. That the effect sought is secured soon becomes evident upon the application of the appropriate movements. 80 REMOVAL OF CONGESTION. Congestion, whether of the head or spine, is removed by leading the blood away from the congested region, in connection with stimula- ting and strengthening the contractility of the weakened vessels. The revulsive effects of vibration and special movements are particu- larly efficacious in diverting and correcting the course of the circulation in the larger vessels ; while the direct effect of the same causes in refreshing the blood in the capillary vessels furnishes a new and important addition to therapeutic resources. The pressure of effused fluids upon the nerve-centers is removed only by promoting their absorption. By causing the blood to flow more freely in its vessels, the physical con- dition for transfer of fluids is supplied. Effu- sion can take place only when the circulating fluids are stagnant. Every physical impulse received from without by the capillaries urges their contents forward. This aids the removal of impediments in the circulation, and there- fore aids absorption. This impulse and action are fully supplied by vibratory motion. Even if the effused material be blood, the RESTORATION OF NERVOUS POWER. 81 chance for its complete removal by absorption is greatly increased by the vigor afforded that act through the influence of vibratory motion. In cases of degeneration and of hardening of sections of the central nerve-substance, the same agency induces effective restorative ac- tion. Remedial indications call for the correc- tion of the process whereby morbid change was produced in order to correct the effect. This remedy, however, will produce local as well as general effects. It has been repeatedly proved that scrofulous enlargements and glandular swellings disappear under the judicious use of vibratory and other movements; and it will be seen that cases of paralysis which are rationally referable to altered structure are restored under the influence of the same curative means. Coagula in vessels are possible only because the general conditions for the support of vital- ity fail. The motion which fructifies and sup- ports the vital endeavor at other points would be the most rational means of preventing the occurrence of this kind of mechanical impedi- ment in the circulation. Besides, the tendency 4* 82 REMOVAL OF IMPEDIMENTS. of vigorous motion would necessarily be to break up and reduce to its elements such mechanical impediments after they have formed, and thus serve as the most promising of all remedies for this cause of paralysis. Paralysis and neuralgia produced by chronic inflammation of contiguous tissues of course subside on the removal of the cause. The rationale of the cure of chronic inflammation has already been explained. The effect of the treatment by vibratory and special movements in nervous disease arising from this cause is more open to observations than in the other cases named, and is therefore more immediate- ly satisfactory to both physician and patient. APPLICATION OF THE FOREGOING THERAPEUTIC PRINCIPLES. Having examined the modes of action, the effects and curative power of vibratory and special movements, we are now prepared to in- quire into the results of their practical applica- tion in cases of nerve-disease. CEREBRAL CONGESTION. Fullness of the head, when habitual, is of itself a serious affection, and ordinarily diffi- cult to remove. When considered as the necessary preliminary of a series of diseased conditions which ultimate in paralysis, it be- comes a matter of the utmost significance. There can be no disagreement regarding the needs of cases belonging to this class. The first and most imperative one is the withdrawal of the surplus blood from the head, and its distribution to parts evidently suffering de- ficiency. Even if there be suspected disease of the arterial walls, which of course implies 84 CONTROL OF CIRCULATION. the worst consequences, the indications are not changed; nothing can be proposed of more promise than the removal of the undue arterial pressure, as the condition for the restoration of the integrity and contractile power of the arterial walls, upon which everything depends. Two things are required to secure the ends proposed: the kind and degree of action which shall cause the blood to flow freely to the extremities, and to become permanently em- ployed in supplying nutrition to the tissues ; and the kind and degree of action which fruc- tifies arterial nutrition, and strengthens these minute but all - important vessels. The re- markable influence attainable by vibratory and special movements over the circulation in the larger as well as in the minute vessels when freely brought into requisition is easily tested, and their power to afford renewed energy to defective parts may be implicitly relied on, as the following case will show: Mrs. B., aged forty-three, of full habit, with short neck, large head, and much color of face, bordering on purple, had been for several years engaged in business which required severe CEREBRAL CONGESTION. 85 tension of the calculating faculties. She be- came affected with cerebral symptoms of increasing severity. These consisted of a feel- ing of pressure in the head, accompanied with intolerable headache. These symptoms had irregular periods of aggravation, when she would be confined to her bed, dizzy at the least movement, eyes injected and intolerant of light, and voluntary power diminished and often temporarily lost. Her feet were always cold; no means had sufficed to maintain even a comfortable temperature. For more than a year she had been under the watchful and interested care of an eminent physician. But, unfortunately, medicine sup- plies no adequate, certainly no permanent, rem- edy for mal-distribution of the circulation. Ordinary revulsives and derivatives are limited to local and temporary effects, and the insidi- ous changes going forward in the cerebral structures proceed to their fatal termination, with scarcely any interruption from medical effects. Atheroma, thrombus, and effusion, affections leading to fatal consequences, must have their commencement in local defect in the 86 MOVEMENTS FOR CONGESTION. power of the vessels, and in sluggish local cir- culation. This local condition depends as much on the use other parts make of the cir- culation as the part specially suffering. The blood must be transferred to vital regions far beyond, in order that the threatened region may heal. In the present case, the frequent transient loss of power and consciousness con- stantly threatened to assume a fatal form. In this condition she came under my charge. Appropriate movements were applied to the extremities first, and to other portions of the body in due order. These operations from the first afforded her relief, and very soon she felt an assurance that the cause of her suffering was passing away. After four weeks, having had none of the former exacerbations, and be- ing quite free of all unpleasant symptoms, the treatment was suspended. A few weeks later, on the recurrence of a slight premonition of her old malady, she re- turned for a short period, and the result of treatment was complete success, since which she has remained well. It will, perhaps, be said that there was no SCIATICA. 87 lesion in this case to prevent recovery. To this it may be replied that similar cases are often hopeless from the beginning, that it can not be certainly known just what degree of change in the substance of an organ is required to consti- tute lesion. Besides, we are justified, from the proved efficacy of the means employed where the parts are open to observation, in the inference that reparation of serious injury may and often does transpire under the favorable circumstances presented. SCIATICA. This form of nervous disease, usually only ameliorated by medication, and by the exter- nal application of stimulants and irritants, is entirely amenable to the treatment by vibratory with other movements. It is probable that the two effects of revulsion are brought into use in these eases. The powerful agitation of the extremity calls blood into it, and simultane- ously diminishes the fullness of the capillaries of the lower segment of the spinal cord and of the plexus, in which the sciatic nerve originates, and from which it derives its power, thus re- 88 CURE OF NEURALGIA. storing the nerve-centers. At the same time the muscular action and nutrition of the affect- ed limb is increased by the same cause, which also inevitably restores the balance between the muscle and nerve ; congestion of the nerve and its pain are simultaneously removed. This statement of the principles of cure is fully corroborated by facts. An organ or ex- tremity suffering neuralgic pain diminishes in size. This indicates that the morbid and in- tense nerve-action, which constitutes pain, is supported at the expense of muscular nutri- tion. When the latter is restored by any ade- quate means, the muscular growth and action are restored, while the pain no longer continues. . The same principle of restoration is found equally effective in practice, when applied in case of neuralgia of the arms, or indeed any portion of the body. The following is an aver- age case illustrating the access, progress, and cure of sciatica. Mr. N., of this city, aged about forty-five, had suffered more than a year with sciatic pain of the left leg. He attributed its origin to har- assing business perplexities, being a merchant SCIATICA. 89 engaged at that time in an unsettled branch of trade. Though the pain was nearly constant, it fluctuated greatly in degree. The greatest suffering was at night. He was compelled to rise from his bed, rub his limb with his hands, and walk the room for relief, several times during the night. He had been treated by the usual methods, including electricity and rubbing applied by well-known physicians, but only temporary relief was attained. He placed himself under my care in the fall of 1869. The afflicted leg was shrunken in size, the flesh soft and flabby, exhibiting a very strong contrast with its fellow. The treat- ment, as usual, was adjusted with reference to increasing the muscular nutrition of the limb, while it should diminish the hypersemia of the lower segment of the spinal cord. The patient was required to do nothing, while energetic molecular activity was aroused in the extremi- ties, the unaffected as well as the affected one. Experience has shown that to secure the first described effect of revulsion, it is much better to produce excitement in both limbs than in one. At the same time the limbs were exten- 90 METHOD OF RESTORATION. sively stimulated by appropriate mechanical processes. In doing all this, care was taken not to engage the action of the will-power in the affected leg beyond a very moderate degree. The whole body was included in similar operations, both because the whole system labored under some defect, which precipitated upon a particular nerve caused the manifesta- tion of the disease, and also because in apply- ing treatment it is important to success that the circulatory, nervous, and nutritive activities should be thoroughly equalized. A single application of these processes caused decided amelioration of pain. This effect increased with each subsequent operation. After three weeks, the habit of wakefulness with which he had been so long afflicted was broken up, and he could rely upon good rest through the night. He continued the treatment two months, when the need for it disappeared altogether, being quite restored to health. PARALYSIS. All forms of paralysis afford the severest test of the efficacy of remedies. The reason of PARALYSIS. 91 the difficulty of conferring any benefit in these cases often arises from mistaken endeavors of the physician. He is inclined to dally with effects, the products of disease, instead of strengthening the vital power in every tissue, and perfecting the blood-making process, upon which all power so much depends. Even if the latter be the physician's purpose, he is generally not sufficiently cautious in choosing his remedies ; for, in case of paralysis, the nature of the affection is such as to require their prolonged use. If such remedies be employed as would prove injurious to the healthy, they must be much more so in case the vital power is insufficient to protect against their pathogenetic effects. However flattering their first effects may be, their prolonged em- ployment will serve but to weaken and destroy the little remaining chance for recovery. The continued use of medical stimulants to the spinal cord is, therefore, to be deprecated. Many physicians, though perhaps not fully agreeing with the statements above made, yet practically adopt the principle. This is proved by their having recourse to the remedial use of 92 DEFICIENT KNOWLEDGE. force in the form of electricity, thus acknowl- edging the insufficiency of ordinary remedies, and the probability of finding in some form or application of force the adequate aid for the vital endeavors. Even in the use of this agent the same practical error is not unfrequently committed. Paralytics often entertain sin- gular ideas as to the nature of their disease. They seem to regard disease and pain as some- thing synonymous. They declare themselves to be perfectly well, except some extremity which is useless ; and assume that that part only requires treatment. It is often difficult for them to understand that the grand purpose of the body is to yield power, and that all deficiency of this product indicates defect in the process, which is quite the same thing as ill health. Nearly all cases of paralysis are benefited by the treatment of vibratory and other movements. The following is a good illustration of the result attained in this dis- ease: Miss Y. was twenty-four years old when brought to me from a neighboring city. Her disease began five years before with typhoid PARALYSIS. 93 fever, accompanied with spinal meningitis, which lasted several weeks. She only par- tially recovered from the effects of this ill- ness ; for though she acquired the ability to walk, her power to do so diminished instead of increasing, and in less than a year she lost all control of her lower extremities. She suffered no pain, except occasionally in the loins, which was accompanied with a sensation of heat. Her disability was such that her only mode of locomotion was the wheel-chair often used by this class of invalids. Crutches were of no use to her ; she could stand only by being held in the upright position by as- sistants. Sensation was entirely absent from the knees to the feet; upward there was a gradual increase of sensibility to the loins, above which it was perfect; the control of the sphyncters was incomplete. The vibratory action was applied freely to the feet and legs first, afterward in succession to all other parts of the body. This operation was continued, with suitable intervals of rest, two or three hours daily. Little fatigue was experienced from these applications, but rather 94 PROGRESS OF CURE, a tendency to quietude and sleep. Increase of temperature of the extremities is always pro- duced ; in the present case it was sadly needed, though she was not sensible of the constant coldness of her feet and legs. Symp- toms of increase of power soon followed the restoration of natural heat. Occasionally, the sensation of heat in the loins was subdued by the application of the ice-bag for an hour over this particular region of the back. En- couraged by slow but constant improvement^ the treatment was kept up four months. At the end of this time she was able to walk about the house, assisted by a cane, and the presence of an attendant. In this condition she went to her home for the summer. In October she returned, having made some progress in the interval. Resuming the treatment as before, with such additions as her increased strength allowed, her progress was more rapid; she was soon able to make short excursions on the street, assisted by her cane and attendant. At the end of another four months the sensation and motion of her limbs had so far recovered as to afford to ordinary observers no intimation PARALYSIS. 95 of any defects except that her steps Were slow and measured. In the course of the succeed- ing year she returned again, and received treatment three months. At the end of this time there was nothing wanting in sensation, motion, or health. She Was soon married, and has continued well, not only able to engage in the ordinary occupations, exercises, and enjoyments of life, but thinks nothing of walking two miles upon the street at one time. In fact, she is able to walk farther and endure more, with less fatigue and no disagreeable consequences, than the average of ladies who consider themselves well. This lady's case affords an excellent test of the value of other medical resources for para- lytics, compared with force, as vibratory motion. For five years she was undergoing different kinds of medical treatment. During the first portion of this period she did not stray beyond the ordinary range of the physician's resources; afterwards she resorted to such special means as electricity, then Turkish baths, etc. These different methods gave her some encouragement, but none had made a real im- 96 PERSEVERANCE REWARDED. pression on her disease; and she remained as helpless as before, and came to me with no hope of a radical and permanent cure. The favorable result attained in her case, and attainable in multitudes of similar cases, is plainly due to the greater relevancy and ampli- tude of the curative means. Neither unaided nature, nor the usual resources, could secure so thorough and constant revulsion from the spinal cord ; none could impart to the nutritive forces, which form the basis of all power, the requisite nutritive energy. These indications are, however, liberally met by the judicious application of movements. It is important to remark for the encourage- ment of paralytic invalids, that less perseve- rance would have attained less, perhaps no reward. If she had become discouraged at the end of two or three or four months, as many afflicted in this way are inclined to be, the result would have been entirely negative. PARAPLEGIA, AFTER EXCESSIVE MENTAL WORK It is probable that in sudden attacks of paralysis, a precedent condition conducive to PARAPLEGIA, AFTER MENTAL WORK. 97 it, existed. The nutritive vessels of the brain or spinal cord are in such condition of disease as to render a full attack inevitable. The cir- cumstance to which the attack is referred is the occasion for developing, rather than initiat- ing, the disease. Sooner or later an attack would be inevitable, unless those habits of life which insidiously but certainly undermine the general and local health are radically changed. There are always causes for disease of the nerves, traceable far back of the symptoms, and it is to these causes that the physician's as well as patient's attention is most earnestly invited. An instance now in mind is that of Mr. M., aged sixty, who was, at the time of his attack, a clerk of a State legislative body. His duties in this position were and had been extremely arduous, even requiring his attention so much at night as seriously to interfere with his time for sleeping. After some months of this excessive strain on his mental and bodily powers, he was suddenly struck down speechless and nearly motionless wTith a paralytic attack affecting the whole body, but the lower extremities in 5 98 CASE OF PARAPLEGIA. greater degree, which remained for several weeks quite useless. He improved very slowly, and at the end of about a year his general health was apparently good, the arms were only weak, and by the aid of a cane he could walk about after being lifted by an assistant from his chair. The flexors of the feet, how- ever, had but feeble contractile power, and sensation in the lower portion of his legs was nearly absent; his countenance was dull and appearance dejected. In this condition he came to me, having required in his journey hither the aid of two men to effect his transfer to and from the different conveyances. The treatment was exclusively by vibratory and special movements, and was rapidly bene- ficial. Sensation returned to his legs, and his control over them increased daily. Vivacity returned to his countenance, and his whole appearance improved. In three weeks he could easily rise unaided from his chair; in five weeks there was full return of power and feeling to his legs, but the flexors of his feet still acted tardily, causing the toes slightly to droop, but not enough to be conspicuous in PARAPLEGIA, AFTER MENTAL WORK. 99 his gait. He was fond of surprising those who had known his helplessness, by exhibitions of his agility. Circumstances at this time com- pelled him to return home, being now able to engage in business pursuits. We can never be so sure of the exact nature of the spinal affection from which paralysis proceeds, before the patient has received treat- ment as afterward. There appeared nothing in the history of this case, or in its symptoms, to indicate that it would not, under ordinary circumstances, pursue the same course of gradual diminution of power that is ordinarily witnessed in similar cases. The rapid improve- ment which immediately followed the applica- tion of means adapted to remove local conges- tion and to produce absorption, proves that the obstructions to the manifestation of ner- vous power did not consist of deposits of a low form of organization, or of a material degree of degeneration of the spinal centers. More time is requisite to effect the changes pre- liminary to recovery after morbid deposits or actual degeneration has occurred. We do know, however, from daily experi- 100 PROGRESSIVE NATURE OF DISEASE. ence, that pathological states form a progress- ive series—one gliding into another for which it is the preliminary, with unerring certainty. An easily removable congestion becomes duly transformed to fixed products, perhaps of low organization, most difficult to liquefy and remove. We may infer the nature and extent of such transformation from the greater or less facility with which the case yields to appro- priate treatment. If the treatment has been inappropriate,—that is, does not most power- fully antagonize congestion, and produce the other effects desired, — our judgment is not aided by the result. GENERAL PARALYSIS. Even elderly persons afflicted with paralysis are amenable to treatment, and the lives of such may be rendered not merely comfortable, but useful for a prolonged period. Mrs. E'., aged sixty-two, came to me for medical care and treatment four months after a stroke of paraly- sis, affecting the whole system in nearly equal degree. At this time she was unable either to turn in bed, rise from a seat, articulate dis- GENERAL PARALYSIS. 101 tinctly, use her hands to feed herself, or her feet to walk. Every change of position re- quired assistance. At times there was great difficulty of swallowing, with spasm of the throat and diaphragm. Her symptoms were scarcely better than immediately after the attack. Added to this were other long-standing difficulties. One lateral half of her body was defective in size and power, the result of infant- ile paralysis, and had, through life, been the seat of much neuralgic pain. The bodily weakness, or perhaps the consciousness of restricted power, reacted on the mind ; she was subject to frequent fits of involuntary sob- bing and great depression of spirits, and was quite as hopeless of recovery as were her friends. The caprices of fortune had borne heavily upon her, and as a necessary recourse she had devoted herself to intellectual and literary labor with more energy and tenacity than could be healthfully borne, which was regarded as the probable cause of the precipi- tation of her attack. After four or five weeks of careful applica- 102 SERIOUS SYMPTOMS REMOVED. tion of the varied forms of this treatment, acting upon the extremities and afterwards other parts of the body, she began to show the desired evidences of improvement. Her voice returned, and she could use her hands to feed and wait upon herself. At the end of three months she had acquired natural and com- plete, though not vigorous, control of every muscle of her body. Her mind became clear, her hands resumed their cunning, she could feed and wait upon herself; she cut, prepar- ed, and made her apparel ; her feet obeyed her wishes, and not only bore her large, heavy body over level surface, but up long flights of stairs without assistance. It was in- convenient for her to pursue longer the regu- lar applications of the treatment, but at irreg- ular intervals she resorted to my rooms for this purpose, coming from her home ; thus she for a while continued the improvement so well begun. After two or three months more her strength was so far restored as to enable her to engage in usual female avocations, and to resume to some extent the exercise of her pen. Her age is against her ever regaining the HEMIPLEGIA. 103 full vigor of middle life even had circumstances allowed her to continue the treatment which she greatly desired. But at this date, nearly four years since she came to me, she still enjoys comfortable health, having lost nothing that she acquired while under treatment. In this case it is probable that the process of restoration was simply that of absorption; or at least that absorption of effused fluids was the foremost of the processes of curative action. Vibratory motion is a most powerful agency for causing capillary action and the return of interstitial fluids to the circulation. To cause this action is, in such a case, to re- move the surplus fluids in the sub-arachnoid spaces and the consequent pressure, from the brain and spinal cord. The well-proved oxidizing effect of vibration, and its aid in sustaining and reproducing the wasting organic instruments of power, are also to be kept in mind in accounting for the restoration of these cases. HEMIPLEGIA. Paralysis of one side is regarded as pro- 104 ADVANTAGES OF TREATMENT. ceeding from disease or injury of the spinal nerve at one side above the parts where defect- ive power is manifested. Paralysis of this form may be progressive, or it may occur sud- denly. On account of the concealed position of the seat of the affection in the cerebro-spinal axis, the exact nature of the morbid change can not be precisely known during the patient's life. While this fact may render a prognosis impossible, it does not in the least absolve the physician from his duty to the invalid with paralytic disease. The treatment by force through the instru- mentality of motion affords peculiar advantages. While in no degree hazardous, differing in this respect from many spinal remedies, this remedy acts only in the direction of health. It almost without exception produces beneficial effects, even in those cases which are not destined to complete recovery. The following case illustrates the beneficial effects of the use of vibratory and other motions in a case of hemiplegia, referable to an affection within the cranium. Mr. S. was a gentleman well known in pub- HEMIPLEGIA. 105 lie life, of an extremely active, sanguine, irre- pressible temperament, with fine intellectual and superior oratorical powers, and at the time he applied to me for medical counsel was aged fifty-nine. He had been the subject of great extremes of excitement in the arena of politics as well as business, a thoroughly "used- up" man, whose general appearance indicated twenty more years than he had seen ; in short, one of that class of cases for whom the physician expects least benefit from his remedies. The accession of his disease was sudden, and affected the whole of the right side. Percus- sion revealed a dull tenderness near the base of the head, at the left side. He could walk a few rods with great difficulty, by giving the affected leg a lateral swing, having no control of the flexors of the foot, and those of the leg being nearly in the same condition. He was unable to raise his right arm, and it swung uselessly at his side. He could not move his hand or fingers, except, perhaps, in the slight- est degree; they were numb and rigid, and could not be straightened ; they were much 5* 106 SUFFICIENCY OF MOTION. swollen, from debility of the vessels. The mental evidences of the affection were promi- nent. He had often an uncontrollable dispo- sition to weep, great fear of being left alone, great depression of spirits, all of which were sources of intense misery. His judgment, however, was correct, and his interest in affairs as active as ever. He came under my care about ten months after his attack. All treatment was suspended but that derived from various forms of motion. Special pains was taken to reawaken powers of motion and sensation in the affected arm and hand. This patient was satisfied with a small amount of treatment, which is contrary to the usual desires of this class of invalids, but it was daily and regularly applied, according to the variations in his nervous condition. In three weeks he could for the first time use his knife and cut his food, and also began to employ the affected hand to open doors, etc. In six weeks he went home greatly improved in body and mind. During several succeeding months he came for a few weeks' treatment at different times, as suited his convenience and LOCOMOTOR ATAXY. 107 fancy. He became able to walk long distances in the streets, though not without a degree of awkwardness in his control of the right foot. He acquired control of all the muscles of his right arm, though not the wonted celerity of motion. He had not, since his attack, been able to write his name; now, he wrote letters covering several sheets of paper, in a beautiful round, clear hand. This result certainly ex- ceeded all expectation founded on ordinary experience. LOCOMOTOR ATAXY—PROGRESSIVE PARALYSIS. This form of paralysis is characterized by deficiency or absence of control of the motions of the lower extremities. It is accompanied by loss of sensation, while the strength of the muscles remains. The motions are irregular, the invalid staggers in walking. These pecu- liar symptoms arise from degeneration of the posterior columns or portion of the spinal cord, while the anterior portion is less affected. The affection comes on very slowly, and progresses till all power is lost. The control exercised over nutrition by 108 REMARKABLE SYMPTOMS. vibratory motion affords a new prospect for recovery, in this confessedly intractable class of cases. Not only is the degeneration of the cord arrested, but the renewed vivacity of all the nutritive operations results in restoration of power, and probably also in the reproduc- tion of power-giving tissue. Mr. N. had been for years engaged in exten- sive manufacturing as well as mercantile busi- ness involving many cares and much anxiety, but from all of these he was now laid aside. When he came to me he had been a great sufferer for three years. The symptoms of his disease had. developed very gradually, but with decided and uninterrupted increase from the beginning. On examination I found com- plete absence of sensation in his feet and legs. A pin passed its whole length into his leg, in different places, elicited no sensation whatever. He did not feel the touch of his feet on the ground. He had full muscular power in the legs, but was obliged to maintain his balance in walking by placing his feet wider apart, and constantly looking at them. Notwithstanding the numbness, he suffered LOCOMOTOR ATAXY. 109 much torture from morbid sensations. The chafing of his pants was annoying, while the casual brushing of ladies' skirts against his legs in walking often gave great suffering. In addition, and in seeming inconsistency with numbness, he had occasional attacks of sting- ing, burning pains, generally confined to a very small area. He compared this sensation to that which might be caused by the impinging of a jet of steam against the leg. This form of pain frequently shifted its location. Common sensi- bility remained entirely absent during these paroxysms of excited and morbid sensation. He was quite disqualified for business, re- ceiving meanwhile the advice and care of the most esteemed in the medical profession. His adviser for several months before consulting me was Dr. Brown-Sequard; nothing, however, had served in the least to arrest the progress of his disease, or even to mitigate his peculiar suffering. The medical reader will doubtless form an hypothesis from the narration of symp- toms given, that there was progressive degen- eration of the posterior columns of the cord, and that this diseased condition was attended 110 DIFFICULTIES ENCOUNTERED. by, and probably produced, a congested con- dition, perhaps sub-inflammation at various points of the anterior columns. Considerable difficulty was experienced in adjusting the treatment to the seemingly mixed and contradictory symptoms. Should the blood in the spinal cord be increased or diminished ? and in what portions of it are these different effects required ? were questions which could not be satisfactorily answered. Even if they could be, it is impossible to treat differently nervous elements in immediate contiguity as are the anterior and posterior columns of the spinal cord. No benefit ap- peared at first to be derived from the treatment; the absence of feeling, the difficulty of locomo- tion, and the attacks of acute suffering con- tinued, but as he did not grow worse—his previous constant experience—he persevered. I had demonstrated in a sufficient number of instances to be satisfied of the certainty of the power of vibratory motions to remove conges- tion, and to invigorate the nutritive tone of any part for whose benefit these motions were used ; and the treatment of the case was accordingly LOCOMOTOR ATAXY. Ill continued. In eight or nine weeks the tac- tile sense — sensation — began to appear, and the paroxysms of pain to diminish in severity and frequency. At the end of four months, though not restored, he felt able to take some active part in his business, consequently sus- pended treatment and went to his home. The sensations were now normal, except a little remaining numbness in his feet, and the parox- ysms of pain were infrequent and comparatively slight. The next winter he returned, having lost nothing in power or health during the eight months he had been absent; on the contrary, he had continued in some respects to im- prove, notwithstanding he habitually devoted several hours each day to active business. He could now walk with a firmer step, and the act demanded less of his attention. I found him decidedly more amenable to treat- ment. He remained with me three months more. At the end of this time the sensations and motions of his feet and legs had become perfectly natural, and the strength as full and vigorous as ever. He has for the last two 112 PROGRESSIVE RECOVERY. years filled his place at the head of a large business, where he has heavy responsibilities, but not a symptom of his old illness has re- turned. This case also confirms the supposition, that the curative process goes forward in the seat of the disease for a considerable time before the fact is manifested in the sensations and strength of the patient. The nature of these intermediate processes of restoration is a mat- ter of rational inference based on what we know of the means employed and the condition precedent to their use. In the spinal cord there must be diseased substance and prob- ably dead adventitious matters, consequently material foreign to the composition of vital, power-evolving tissue. To oxidize and remove these is the primary object. The acting vital elements of the spinal cord need to be rein- forced with fresh power. Nothing can do this so well as to aid the nutritive endeavors. That the atomic and molecular motions which are induced by vibratory movements are capable of effectually securing these ends, is apparent from the wholesome changes they work in LOCOMOTOR ATAXY. 113 other forms of disease. The favorable results, easily demonstrated, prove that the means employed are far more powerful, and better adapted to the end desired, than ordinary remedies, since such remedies are of only temporary service, or entirely useless. Other conditions being equal, recent cases of paralytic disease are far more tractable than those which have existed for several years. The latter class need not, however, despair of help. The following case proves that the im- pediments to the manifestation of nerve-power may be removed after they have apparently become fixed. This case is that of a Southern gentleman, forty-eight years of age. Until five years ago he had enjoyed excellent health, and then his illness came upon him without a pre- monitory symptom. On awaking in the morn- ing, he found himself unable to move any of his limbs ; his head was the only part of the body that would obey his will. The sphincters were utterly powerless, and so remained for a long time. He, however, improved slowly, and in six months had regained the use of his arms, and was able to stand upon his feet, if sup- 114 EFFORTS FOR RECOVERY. ported. His efforts were thereafter directed to full recovery. To this end he availed himself of the counsel of the ablest physicians, and submitted to the usual variety of medical treatment. During his illness he resided for a period at each of the several Virginia Springs, the Arkansas Hot Springs, the Kentucky, and St. Catherine's, Canada. He had also availed himself of the skill of the eminent leaders of medical practice in nervous diseases in this city. During the last year he had relinquished all treatment and hopes of further improvement. At this time a former patient, a well-known gentleman, observing his helplessness, urged him to try once again. So faithless was he, however, that he could be persuaded to come for an examination only by being accompanied by his philanthropic acquaintance. His symp- toms were those of an ataxic invalid. It was impossible for him to walk straight or erect, He would make excessive strides, and his legs would be thrown out in a very irregular and even ludicrous manner at either side. His thighs were a good deal emaciated, and he had little power to retain urine. His feet were so LOCOMOTOR ATAXY. 115 numb that it was possible to inflict serious in- jury without his knowledge. At the end of one month after beginning treatment his main symptoms appeared unchanged; but in two weeks more he had made great improvement. He could now walk perfectly erect, scarcely any singularity could be detected in his gait, and sensation had in good degree returned to his feet. His control of urine had also much improved, and there was every prospect of continued improvement and ultimate re- covery. Paralysis is sometimes helped by vibratory and special movements in a very short time, when still from some cause full restoration is not attained. The power of the treatment and the harmfulness of impatience are well illus- trated in the case of Mr. E., aged forty-eight— a gentleman of remarkable energy and business capacity. His was a case of progressive paral- ysis, beginning at the lower extremities with numbness and loss of motion. He resorted to medical treatment at once and continually, but nothing checked the progress of his disease, and at the end of eighteen months he had not 116 PROGRESS OF RECOVERY. the power to rise from his chair, or even stand when lifted to his feet. The numbness had extended to his waist, and he could neither control the lower bowel or evacuate the blad- der. His urine was ammoniacal and contained much mucus. In this condition he came under my charge, not having relieved his bladder during his jour- ney of twenty-four hours. The treatment was prescribed, and applied with great care, and he improved from the first. In three or four weeks the power over the bladder was com- pletely restored, the urine was of normal qual- ity, and he was able not only to stand, but to walk with the aid of a cane and one attend- ant. In eight weeks his control of his legs had so increased that he made frequent, but unad- vised, walks about the house with the aid only of his cane. Having gained confidence in this increased power and control over his extremi- ties, he now walked the distance of thirty feet without cane, attendant, or any assistance whatever. This effort was contrary to advice, and proved injurious ; his mind became unduly excited ; he grew impatient at what he regarded LOCOMOTOR ATAXY. 117 the slowness of his recovery, and consequently concluded that the virtues of the treatment had become exhausted. In this frame of mind and critical physical condition he went from my care and resorted to electricity. I however did not lose sight of this interesting case. He lost health and power directly, so that he returned to his home in less than six weeks after leaving me, in a much worse condition than he came. This case affords also confirmation of a prin- ciple of therapeutics previously expressed, that it is fatal to success to make undue attempts to exercise. The results of his efforts were not transmitted to the muscles of his extremi- ties, but reacted upon the cerebro-spinal centers and promoted the congestion of those sensitive parts from which all nerve influence emanates. The consequences must be disastrous, and often irremediably so. The desired changes in the diseased nerve-centers can only be attained by affording preponderating activity to the muscles. This can only be done "by withhold- ing the exercise of the will, while the other tissues receive energetic exercise. 118 RESTRICTED PARALYSIS. FACIAL PARALYSIS. In a few cases, paralysis arises from some affection in the course of the nerve, the centers remaining sound. In these cases the nerve becomes diseased by contact with diseased structure through which it traverses. Health is more speedily and certainly restored in such cases than when the affection has a deeper seat. The case of Capt. S., of one of the ocean steamers, is in point. In this instance, an injury inflicted on the head, which confined him to his house and room for several months, resulted in paralysis of the facial nerve. There was complete loss both of action and feeling in the left side of the face. The mouth and cheek were consequently drawn to one side, and the left eye was drawn wide open, even in sleeping. He had no power to close the eye, not even to wink. The constant exposure of the membrane produced conjunctivitis, with incessant and profuse lachrymation. His appearance was of course unsightly. He came to me imme- diately on leaving his long confinement. The application of the treatment was extremely NEURALGIA AND HYPERESTHESIA. 119 agreeable to him, and his lost powers were rapidly developed. In one month sensation fully returned to the affected side of his face, he could control his eyelid, and was perfectly restored. In this case no improvement had taken place in these several months, notwithstanding the care and skill that had been bestowed on a widely known and valuable man. It is pos- sible that time would have wrought favorable changes, but no indications of it had appeared. Reparation of the nerve was doubtless attribu- table to absorption, always produced by the treatment. The rapidity of restoration attests the vigor and appropriateness of the remedy. NEURALGIA AND HYPERESTHESIA. The subject of pain* though old as life itself, has not been enough studied from rational data. It has been regarded and treated as useless, and having no compensa- ting quality. The sensation, rather than its * For a more complete account of pain and its relations to health, the reader is referred to my work entitled Diseases of WOMEK, THEIR CAUSES, PREVENTION, AND RADICAL CURE. 120 FUNCTION OF PAIN. cause, is the dreaded thing, and consequently, in the more anxious than intelligent endeavors to be relieved, the effect instead of its cause receives medical attention. Accordingly, when experiment develops med- icaments whose employment mitigates or an- nuls pain,—or, rather, the consciousness of it, —such medicaments are forthwith regarded as an unqualified boon, and are adopted without further inquiry. It is not to be inferred from this that I condemn all use of remedies of this class ; and that a temporary annihilation of the consciousness, so far as relates to pain under easily conceived and frequently occur- ring circumstances, may not be best. What is to be deprecated is the abuse of vitality arising from their frequent, especially their habitual, use ; and also the influence of such remedies to discourage adequate investigation into the nature and relations of pain. Pain undoubtedly is a mode of expressing vital power. In case of disease its absence indicates inaction of the instruments which should express it, but not, necessarily, an abatement of the morbid process. This view is NEURALGIA AND HYPERESTHESIA. 121 supported by the fact that sedative medica- ments diminish the waste of the system, con- sequently, the organic changes whereby nerve- power is evolved ; and also by the return of the pain as soon as the system is relieved of the presence of the drug. The prevention and the reduction of pain by medicaments consists, therefore, in the transient and local repression of nutritive action. The cure for pain is a different thing from its suppression. The one corrects the process whereby pain is evolved, generally by causing a more appropriate use by the system of nutri- tion ; the other conceals the results of misuse of nutrition, while the disordered relations continue. There is, I am justified by facts in stating, a radical remedy for chronic pain and excited sensibility—a cure that courts every test of efficacy. It consists in exciting activity in other tissues bearing a relation to the nerve- centers from which pain proceeds. Empirical practice, even when employed in a very crude manner, and to an inadequate extent, as when relief is found from rubbing near painful parts, confirms the correctness of the statement. But 6 122 QUALITY OF BLOOD. when processes are applied in a systematic and intelligent manner, the results leave nothing further to be desired. There are probably several reasons for these effects, among which may be stated the follow- ing : The two kinds of revulsion previously de- scribed are made distinctly and thoroughly available. The blood, bearing nutritive sup- plies, is energetically transferred to the skin and extremities, and, therefore, from the con- gested nerve-centers. The demand of the muscles and other tissues for nutritive support is made by this action paramount to that of the nerves—thus revers- ing the previously existing relation. The oxidizing effect which is the inevitable and direct consequence of vibration, works a change in the quality of the blood, destroys the toxic principles which may have arisen therein, and thus enables it more perfectly to supply nerve-support. The following is a good illustration of the radical effect of vibratory and other movements in extreme and prolonged neuralgia and hyperesthesia of one leg. The NEURALGIA AND HYPERESTHESIA. 123 case was that of an unmarried lady, sixty- three years of age when she placed herself under my care. She was of a strong constitu- tion originally, and possesses a vigorous, active intellect which she continued at times to task, but had early broken down in health of nerve by extreme labor in teaching and devotion to educational enterprises. She had neuralgic pain of the limb, accompanied constantly by extreme morbid sensibility — tenderness and soreness — so acute at times as not only to render the touch of another person exceeding- ly disagreeable but this sensation would be prolonged for many hours. This sensibility prevailed throughout the whole leg, but was greatest along the sciatic nerve and its ramifi- cations, and extended to the foot. She always required the aid of two crutches for locomotion, and was unable to mount stairs even with their aid. The soreness was aggravated if the foot was allowed to rest on the floor while sitting. The whole limb was much shrunken, soft, and flabby, and considerably smaller than the other. A notable characteristic in this case was 124 INORDINATE MENTAL ACTION. that these disagreeable symptoms were always aggravated by mental activity. Even five minutes' close attention to any subject would cause an increase of pain and soreness. To participate in conversation of unusual interest would arouse these symptoms to greater inten- sity, soon compelling her to desist. For more than twenty years this condition had been per- petuated without any important variations. This affection wras not thus prolonged through lack of medical attention. After having con- formed to the advice of different physicians of eminence in general practice without advantage, she had freely availed herself of all sorts of special remedial treatment that happened to be presented to her. She had been an inmate and patient at nearly every health establish- ment in the States, but all were equally inef- fectual in even mitigating her symptoms. Indeed, the intolerable sensitiveness of the limb was rather aggravated than otherwise by these frequent applications of nerve-exciting remedies. Having in several instances demon- strated the peculiar efficacy of vibratory and other movements in reducing nervous excite- NEURALGIA AND HYPERESTHESIA. 125 ment. I saw in this case an opportunity for putting the principle to the severest test. The treatment was so applied as to secure its revul- sive effects, both as respects regions and func- tions. At first, and for some time, the affected limb was left untouched, while the various forms of vibratory action were applied to the unaffected limb, as well as to the whole body. In a few weeks we were gratified to find a diminution of the painful tenderness, and she began to tolerate the application of the treat- ment to the suffering extremity. She continued the treatment through the winter, at the end of which time her crutches ceased to be of further service, except on occasions of fatigue, when some degree of the old sensitiveness and sore- ness was apt to return. After an interval of several months the treatment was resumed. The weak limb acquired hardness, strength, and size till it finally became equal in every respect to the other. She has not used or needed her crutches for six years. She walks upon the street wherever she chooses ; mounts stairs with perfect ease ; does a great amount of intellectual labor; writes and publishes 126 EVIDENCE OF CONGESTION. books; works from five in the morning until night habitually ; travels about the country from Maine to Florida ; is out in all kinds of weather ; sometimes overworks, takes cold, and is temporarily ill, but never feels any return of her old suffering or weakness, and is now, at seventy, more energetic and healthy than since her early womanhood. This case shows con- clusively that complete restoration can be secured in spite of age and long-standing illness. SUPERSENSITIVENESS OF SPINE. Excess of sensibility is generally accom- panied by excess of blood in the part from which it proceeds, and in proportion as such part is relieved of excess of blood, sensibility diminishes. In exterior parts we have ocular demonstrations of both the excess and diminu- tion. In interior parts we have the evidence of the same conditions in the relieved sensibility which invariably follows the use of processes that draw the blood from the interior parts. Hence, morbid sensibility finds relief in those measures which operate to withdraw surplus SUPERSENSITIVENESS OF SPINE. 127 blood from the spinal centers. This view is substantially supported by all medical practice, and is carried out by the use of counter-irri- tants to the spine, and by remedies wdiich pro- duce the effect of diminishing the caliber of the spinal capillaries. It must be said, however, that sufficient dis- tinction is not made between the transient and the permanent benefits which may accrue from the use of remedies. Furthermore, the very important fact is too often ignored, that the remote effect of a remedy is frequently quite the reverse of the immediate effect. These statements are sustained by the ex- perience of invalids affected with too great manifestation of sensory power. For, in the case last narrated, in which supersensitiveness was added to pain, there was neither lack of means or time employed to secure the de- sired result. But the effects proved to be simply a series of temporary mitigations, without permanently affecting those interior conditions on which the symptoms depended. Remedies which affect sensory nerve-centers produce perturbations of the sensory power, 128 CASE OF SENSITIVENESS. without essentially diminishing the aggregate of morbid action. To indefinitely continue this kind of experience is to render more and more impressible the nerve thus acted upon, and render restoration either spontane- ously or by any means quite impossible. The following case illustrates these principles : Miss S., aged forty, when I was called to see her, had been for several months confined to her bed in consequence of the gradual increase of a spinal affection which commenced a dozen years before. Her principal symptoms were those of exquisite sensibility of the back, mostly in its upper portion, extending at times to the head, accompanied with periods of special aggravation and severe hysterical attacks, in which the extremities and whole system would become convulsed and rigid. Her invalid history hardly deviated from the ordinary course of this class of cases. She had been for years uselessly treated for uterine affection, mistaking the subsidiary for the primary element of disease. Counter-irritation to the spine, as the scarred appearance of her back amply testified, had been freely employed SUPERSENSITIVENESS OF SPINE. 129 without once attempting to obviate the need of counter-irritation. The relevancy of sedative and narcotic drugs had been fully tested, and she was now in the constant use of various opiate preparations. The supposition that the use of the so-called sedative remedies suffices to diminish the aggre- gate of pain in chronic disease, is a very per- nicious error. The effect assigned is only the primary; the secondary and opposite effect is overlooked. The reaction from temporary annihilation of pain, or rather from the oblivi- ousness to its existence, is severe ; the sensa- tions are greater, are less endurable, and call loudly for repetition of the drug. These state- ments are proved by reference to cases that have for a long period been in the habitual use of narcotics. The feelings become greatly ex- aggerated and the system so far subverted that it has but little power for any other pur- pose than to respond to sensorial impressions. This was the condition in which I found Miss S. Her sufferings were excessive, and the very means habitually employed to mitigate them had the effect of making her more sensitive, 6* 130 PROGRESS OF RECOVERY. of actually increasing her suffering, and of rendering her more and more hopeless. As, however, she appeared to have a good constitu- tion, I considered her case hopeful, and she was accordingly brought to my Institute in the fall of 1867. The first thing to be done was to break from the use of opium, and, indeed, from all sedative and nerve remedies. This is always a serious matter, but becomes comparatively easy with the aid of movements. The stimulus these operations afford the nerves appears to act somewhat in substitution for the drug, and the system glides nearly unperceived from its mor- bid exaltation into a state approaching health. This, however, did not occur without one or two hysterical spasms. She continued to gain in strength through all the variations of feeling. In two months she was entirely emancipated from the need of quieting remedies, and the sensitiveness of the spine was permanently relieved. She continued the treatment a month or two longer, at the end of which time she returned to her home perfectly well. At this writing she remains in good health. INFANTILE PARALYSIS. 131 INFANTILE PARALYSIS. The grave and permanent consequences growing out of paralysis occurring in in- fancy and childhood, invests it with extraordi- nary interest. The physical capacities for life depend on what seems the accident of a mo- ment, and the intelligence with which the accident is met. This affection usually occurs, without warn- ing, during the progress of some of the tempo- rary illnesses to which children are liable. Neither the causes of the disease, nor the actual condition of the spinal centers involved, are clearly understood. That hereditary influ- ences have much to do with its occurrence is inferable from the fact that it sometimes appears at birth. That it is removable and its consequences obviated, if treated by such means as are calculated to remove spinal con- gestion, I have had opportunity for demon- strating. Timely and correct treatment is often followed by complete recovery. But the great mass of instances of infantile paralysis are practically neglected in the early 132 CONSEQUENCES OF NEGLECT. stage ; the consequences are serious and per- manent. The peripheral nerves remain paral- yzed, although the centers may recover so far as is possible in the absence of the stimulus derived from sensation. The child grows, but the paralyzed parts, not being stimulated by influences extending to them from the will and being deprived of action, are but feebly nour- ished, and fall far behind in development. Extremities thus affected are therefore deficient in growth, withered in appearance, cold to the touch, and greatly wanting in sensation and power. Another serious complication sooner or later follows, the extent depending on the degree of the paralysis. A portion of the nerve-fibers supplied to the limb retain a degree of natural power. The muscles to which these healthy nerves are distributed are consequently not impaired, they continue to grow and to increase in contractile power. But the action of these muscles is not properly antagonized in conse- quence of the paralysis of the opposing mus- cles. This unequal action of these two sets of muscles draws the limb out of place, usually INFANTILE PARALYSIS. 133 deforming the ankle or wrist, and sometimes other joints. The deformity increases in proportion to the disparity in the nutrition of the well and the paralyzed parts. Examinations of the tissue of unused muscles have in some cases de- monstrated that it becomes degenerated, the muscular material being displaced by fat, and the possibility of muscular contraction under any stimulus is therefore out of the question. The means usually employed for the relief of these cases have been galvanism and braces. Galvanism has proved of service only in the milder cases, and satisfactory in but few. Braces are not used so much for the disease as to mitigate its inconveniences. Their employ- ment is an intimation that nothing better or more radical can be done. Such a conclusion is, however, without warrant. While appli- ances may, in some instances, be better than nothing, they are far from being the only or the best aids to develop the lacking power and substance of the limb. I have shown the power of vibratory and special movements— 134 POWER OF MOVEMENTS. To excite nutritive activity in feeble parts, even though paralyzed ; To conduct the blood to enfeebled regions ; To restore temperature to any region where it is deficient; To arouse sensation ; To produce absorption of deposited matters whether they be adventitious material in the spinal cord, or fatty matter in the muscles ; To relieve congestion of the spine ; To increase the growth and action of muscles ; To harmonize the relations between the action of muscle and nerve. All these effects are imperatively demanded to their fullest extent in infantile paralysis ; and the patient recovers only in proportion as they are produced. Much time is necessarily required to gain a complete demonstration of these effects. It happens, however, that my experience covers sufficient time to afford the needed evidences ; I therefore select the follow- ing example : Jane B. became paralyzed in the right leg when three years of age. When between six and seven years old she came to me for treat- INFANTILE PARALYSIS. 135 ment. The affected limb was at this time three inches shorter than the other, the disparity in growth having been occasioned by the paral- ysis. The limb was cold and shrunken; the ankle had insufficient power to support the body, and was liable to turn whenever her weight rested upon it. She could not walk, but hobbled about in a painful manner. The shortening of the leg had caused at the lumbar region a permanent curvature of the spine. She was a bright, active child, and entered with much interest into the treatment which was continued with satisfactory evidences of progress about five months. At this time, nutrition having become permanently directed toward the affected limb, she was able to stand upon the foot without the ankle yielding to her weight. The curvature of the spine was en- tirely corrected, and she now went home, but continued for many months to receive some of the exercises that had been applied to her while under my care. This was ten years ago. I have occasionally seen this patient during her growth into the womanhood she has now attain- ed. The difference between the size and strength 136 SURGERY INSUFFICIENT. of the legs has continued to diminish, till now her style of walking and appearance give no evidence of her former defect, and many of her present acquaintances and friends are quite unaware that she was ever deformed, either in spine or limb. REMOVAL OF DEFORMITIES WITHOUT OPERA- TIONS—INSUFFICIENCY OF SURGERY. In many cases of paralysis non-paralyzed parts do not act healthfully, but are in a state of either frequent or constant spasm. It is probable that the central disease, which sus- pends the action of certain nerve-elements, extends its influence to contiguous nerve- centers, and that the inferior degree of disease produced in this manner causes the abnormal and uncontrollable form of action which is denominated spasm. Thus, we have utter relaxation of a portion of the muscles of an extremity, and uncontrolled and excessive action of another portion. When this condi- tion occurs in infancy, or, indeed, during the period of active growth, the constant drawing of the member to one side causes those fixed REMOVAL OF DEFORMITIES. 137 deformities and flexions which never recover spontaneously, and which it is the purpose of orthopaedic surgery to relieve. The method usually adopted to redress these deformities consists of tenotomy, or severing the tendon of the contracted muscles, combined with extension of the limb by means of appa- ratus. Sometimes stretching the contracted parts by continuous application of force is employed alone. The advantages supposed to arise from cut- ting the tendon may be stated as follows : The opposite sides of the deformed limb are made alike in action. The contracted muscles have no longer power to act upon the extremity, and it can be fully straightened. The interspace between the separated ends of the cut tendon is soon filled in with tendon ; the muscle thus lengthened is restored to ser- vice, and ceases to cause deformity. An instrument adapted to maintain the limb in place enables the child to use it, and thus increase its development and power. The weight of the instrument, added to that of the limb, is supposed to increase the exer- 138 SUPPOSED ADVANTAGES OF TENOTOMY. cise of its muscles, and thus further to aid the development of the wasted extremity. This method of treating deformed limbs has doubtless been of good service in some of the above-mentioned particulars, and is justifiable in the absence of knowledge of superior meth- ods for remedying these defects. The results expected of treatment when it is confined to the means described, are, however, seldom fully realized ; and whatever result is attained re- quires a very long time. The difficulties in the way of success may be summarized as follows : The operation of severing tendons does nothing either toward removing the cause of muscular contraction, or the contraction itself. It only releases the limb from its effect. Even the contraction is itself but an effect; the impulse to contract is derived from central nerve-irritation, which is not abated by discon- necting the tendon from the point to which it is attached. The operation is only palliative, and in no sense a radical or curative measure. Hence the recoveries which follow these opera- tions do not proceed from this, but from other causes. REMOVAL OF DEFORMITIES. 139 By severing tendons, the antagonizing muscles are rendered alike, not by increasing the power of the weak, but by annihilating that of the strong muscles. The aggregate power dispersed to the extremity is therefore not increased, but diminished by cutting off that which was represented in the contracted muscles ; the control of the will over the ex- tremity remains as imperfect as ever, and its nutritive supply as feeble. The deformity often returns after the res- toration of the continuity of the severed tendon in consequence of the continued action of the original cause. Only when the cause of con- traction has spontaneously abated can the in- strumental process become helpful. After the adjustment of instruments, the weight of the extremity, together with that of the instrument, is often borne by muscles situ- ated higher up, and not by those of the affected parts—not by the muscles which ought to per- form that office. These latter are the muscles which every endeavor should be made to stim- ulate, but the means in question have little influence to do this, and far from as much as is 140 ACTION OF WRONG MUSCLES. desirable and attainable. The child provided with supports walks as with a wooden limb. The effect of this mode of locomotion is to em- ploy in the parts which really act, the nerve- power and the nutritive support which should flow to the extremities. The consequence is to maintain an unequal nutrition in the parts already suffering from that cause. It is evident that when the means for cor- recting this class of deformities is confined to the orthopaedic methods, the attention of the physician is concentrated on effects, while the causes producing them are neglected; that nothing adequate or radical is attempted to restore power to paralyzed parts, or to abate the irritability and spasm of the contracted parts ; that the disparity between the extremi- ties must continue ; and that the necessity for artificial support must exist for an indefinite period. The only compensation to these draw- backs and difficulties is that of enabling the child to stand upon its feet. It hence appears that the views of the nature and needs of this class of deformities which are adopted by orthopaedists, are partial and inad- REMOVAL OF DEFORMITIES. 141 equate to supply the treatment required by these cases ; and that the mechanical devices which it furnishes are useful only hi a limited number of cases. The resources of orthopaedists will remain in- complete till they adopt adequate means for re- lieving spasm ; for restoring health and power to diseased nerve-centers ; for restoring normal action to nerve-conductors; for increasing the nutrition and power of the muscles to which the nerves are distributed, and which from long inaction have lost not only their function, but normal substance. This want is supplied, and without surgical operation or processes, as is shown in the following case. Master G., aged twelve years, suffered an attack of paralysis affecting the right leg, when six years of age. On examination, the leg was found of nearly equal length with the other, but weak, flabby, and cold. Sensation was so dull that he did not suffer from the constant low temperature of the limb. The muscles were illy developed, and of feeble contractile power, and there was but little action below the knee. He, however, had managed to hob- 142 DEFORMED TOE. ble about, with a very awkward limp, without support. The great toe of the affected limb was permanently bent under, in consequence of severe contraction of its muscles, and could be straightened only by using positive force. This deformity greatly increased his difficulty in walking. He was treated by vibratory and special movements applied to the weak side and leg, particular reference being had to the affected toe, and also to the chest which had become contracted in consequence of the bowed and unseemly position his defective limb obliged him to assume in walking. In six weeks his paralyzed limb maintained its temperature equal to that of its fellow, and very good sensation had returned. At the end of three months the deformed toe had become straight- ened, and no longer troubled him in walking or in wearing his shoe, though the control of the extensors was still weak. Whenever he gave attention to his gait, it was not defective, the habit of limping was not, however, entirely overcome. There is every probability that by continuing even moderate attention to the prin- CONTRACTED LIMB. 143 ciples inculcated by the treatment, the defective limb will become as large and perfect as the other before the young man attains his growth. This case is selected for record here, not only because it is a good illustration of the adequacy of this treatment to restore power and to cor- rect deformities, but because of the obvious futility of any attempt to accomplish these ob- jects in his case by the orthopaedic method. It is interesting to note in these cases that difference in power of the two limbs diminishes much more rapidly than difference in size. The unaffected limb which for years has done nearly all the work of standing and even of walking becomes exaggerated in size. When the action and the habit of use of the two limbs are re- versed by the treatment, the difference of power is changed with the difference of nutritive sup- port, till these become finally equalized; but restoration of size falls behind that of power. CONTRACTED LIMBS — IMPROVEMENT AFTER FAILURE OF TENOTOMY AND INSTRUMENTS. The principle that the restoration of power and the removal of spasm entirely depend on 144 IRRITABLE SPINE. the restoring of health to the nerve-centers from which these symptoms proceed, does not admit of question. And since deformities occur as another consequence of these same causes, it follows that the same treatment is required in the one case as in the other. It is also legitimately inferable that forcible exten- sion is not only inappropriate, but that it may prove a source of additional irritation to the already diseased nerve-centers, and that the deformity may be increased and perpetuated rather than ameliorated by such treatment. These results actually occur, as will be seen in the following cases : A young lady in a neighboring city had been afflicted with a nervous disease from the age of fifteen. Her spine was highly irritable ; the least touch would at times cause intense spasm of the whole body. One leg had become per- manently contracted, the foot being drawn up nearly as high as the knee, and was crossed over the other leg. The contraction of the leg had destroyed all power of locomotion, and she had remained in this helpless condition for nine years. In addition to the usual resources of CONTRACTED LIMB. 145 medicine, she had during this period employed those of orthopaedic surgery. The contracted tendons had been severed, and an apparatus capable of maintaining extension and flexibil- ity of the limb had been fitted to her. This treatment was of no service, she was still unable to walk, and tlie leg soon returned to its pre- vious contracted condition in spite of all efforts to maintain extension. It was three years after this experience that I first saw her. I found in addition to contraction and spasm that she was afflicted with chorea, the jerkings of which were easily excited and of great intensity. The inference was direct that the cerebro-spinal affection caused and maintained the deformity ; that special attention to the deformity was futile while the cause remained ; and that there could be no permanent help without restoring health to the nerves. On account of the exquisite sensitiveness of this invalid, and consequent tendency of all impressions to produce reflex action, the treat- ment was very slow and cautious. In six months the deformed limb was completely straightened, she became able to walk, and 7 146 CONFIRMED CONTRACTION. has since retained this power, a period of seven years, except when prostrated by acute disease. The following case has been reported in the medical journals, and regarded as beyond the resources of medical and surgical treatment. The extreme severity of the contractions, their prolonged existence, the continued action of the cause, the extent to which the muscular system is implicated, the potential nature both of the medical and surgical treatment which have been employed for relief, and the negative results flowing therefrom, combine to render it a case of peculiar interest, and also to dem- onstrate the extraordinary control vibratory and special movements exert in diseases of the nerves. The case referred to is that of a gen- tleman who, ten years since, was stricken with paralysis accompanied by convulsions followed by extreme contractions. Two years ago he was brought to New York for medical treat- ment, and secured advice from eminent pro- fessors. The right arm was the only limb that was of the least service to him. The left arm and even the fingers were so contracted that he EXTREME CONTRACTION. 147 had very little control of their motions, the elbow and most of the finger-joints being quite fixed. The right leg and foot had slight sensation, the left was quite devoid of all sensation. The legs were crossed and so strongly flexed at both the knee and thigh joints, that the calves of the legs pressed upon the thighs and one knee was nearly in contact with the abdomen ; the legs being crossed prevented the other knee from coming up as far. He was absolutely consti- pated, his urine was ammoniacal and he had very little control over its passage. He received electrical treatment, in all the various wrays dictated by modern use of that agent. He is also reported as having taken 180 grains of iodide of potassium daily, besides bichloride of mercury and other medicines. He was submitted to surgical operations; his tendons severed, and forcible stretchings ap- plied till the contracted skin under his knees separated three inches. This, as might be ex- pected, threw him into a fever, from which it was with great difficulty he recovered. He was then brought to me. He bore large scars 148 EXTREME SPASMODIC ACTION. of bed sores just healed. These sores occurred during the sickness produced by the surgical operations. There had been great loss of the muscular substance of the thighs where the sores occurred. His legs and thighs were still flexed, and legs crossed in the manner above described — the remedies had aggravated the deformity, because, instead of soothing and restoring, they increased the irritability of the spine. In this state I began his treatment without the least expectation of relieving the deformi- ties of his limbs, but with some faint hope of diminishing his terrible neuralgic condition and thus rendering life more tolerable. His supersensitiveness and especially the excitability of his reflex power precluded any but the mildest treatment, but even this made him more comfortable, and lessened the tend- ency in his limbs to spasmodic action. In the spring, after six months' treatment, he went to the country and spent the most comfortable season since he became paralyzed. He re- turned late in the fall, resumed the treatment, and continued it five months longer. The result EXTREME CONTRACTION. 149 has been that he has acquired tolerable use of his nearly useless arm ; all but one of the contracted fingers are restored; the legs no longer cross each other or are pressed upon the abdomen; sensation has returned to his feet; he has acquired the power of moving them as well as his legs to a limited extent. He now sits in his chair, and in sitting appears like a well person. His improvement has been slow, but beyond all expectation of his friends, and indeed any one who knew his medical history. I am not prepared to reverse the medical sentence which has long been passed upon him ; he is still a sick man, but I am glad to present his case again to the public, to disprove the tacit as well as the often direct allegation that orthopaedic surgery furnishes the best aid for the restoration of deformed limbs, and that the use of drugs supplies the most reliable and direct means for restoring health to the cere- bro-spinal axis. ,:■ J* jJl.fi ■Am ■ ~ . V** ™ NLfl 00S5flflbS 1 3M mm w^S^J^j Ml wa :#b "s^t-TO NLM005588651