The object of this book is to furnish the general practitioner in as simple and compact form as possible, the technique to be used in the treatment of various conditions by Mechanical Vibratory Stimulation.

    In writing this it has not been deemed necessary to include anatomy and physiology, with which all practitioners of medicine are familiar. All theory has been left out, and only a practical working basis given, so that any physician possessing a vibrator may take any individual case and in a moment's time be able to learn just how and where to apply vibration. The technique which is furnished here is based upon an experience of a number of years in which fully twenty-five thousand treatments have been given, covering many hundred individual cases of a widely varying lot of conditions. The technique which is described is one which has proven most efficacious in the writer's experience.
 It is sincerely hoped that this small manual will serve the purpose for which it is written and that it will enable the practitioner to broaden the field of usefulness of his vibrator.
 

ATTACHMENTS AND TREATMENT.

    Every vibrator should possess at least two attachments for spinal work, one to be used where the amount of sensitiveness present is not very great, and another in which a milder form of treatment can be given to those cases in which the spine is extremely sensitive. An  attachment for local use over the abdomen and over the limbs is necessary, and should be in the form of a brush, so as to give only superficial stimulation. In addition to these, there should be a special attachment for treating the eye, one for treating the throat, and another, for rectal or uterine vibration.

    The spinal treatment should always consist of as heavy vibration as the patient can stand and this should be increased at each treatment until they are able to bear quite a heavy treatment.

    For inhibition it is always best to use the attachment which will get deeply in the tissues and bring about the result very quickly. Inhibition can generally be obtained in from twenty-five seconds up to a minute and a half, depending on the length of stroke and the amount of pressure being used. With heavy vibration and heavy pressure, the result is obtained in from twenty-five to thirty seconds; if the pressure be decreased and the stroke be diminished, to a medium, then forty-five to fifty seconds are required; if the shortest stroke is used, and pressure be light, vibration should be kept up a minute to a minute and a half, rarely more.
 

STIMULATION AND INHIBITION.

    Vibratory Treatment should be divided into inhibition and stimulation, although some authors have three or more divisions of this subject. It seems that the point where stimulation merges into inhibition is so vague that no intermediate term need be used.
 Stimulation is that form of vibration which will increase the activity of a nerve cell or of the part to which it is applied, or increase the function of the organs which are controlled by the centre over which vibration is given. Inhibition is the opposite, and when treatment of this character is given, it serves to decrease the activity of the parts to which it is applied, or to the part controlled by the nerve centre to which it is given. Stimulation can be obtained in from five seconds to a minute and a half, increasing the length of time as the amount of pressure and length of stroke are decreased, or conversely decreasing time as pressure and stroke are increased. Inhibition requires from thirty-five to forty seconds up to two to three minutes, the shorter the stroke and the less pressure exerted, the more time is required. To secure either inhibition or stimulation quickly, it is best to use the ball attachment; where it is desired to continue the treatment for a longer time, then the softer attachment may be used.
 

ANEMIA.

    Give general spinal treatment with the brush, medium stroke and medium pressure, placing the attachment immediately over the spinous processes. Give this for a minute and a half to two minutes; then, with the ball attachment, thoroughly percuss the liver and spleen. Also use technique for raising the ribs. Then, with the ball and deep pressure, medium stroke, vibrate over the spleen anteriorly three-quarters of a minute to a minute and a half. If constipation exists use technique for correcting same.
 

ANGINA PECTORIS.

    Angina Pectoris may be benefited by vibration by use of inhibition over the centres which are found from the seventh cervical to the eighth dorsal inclusive. Very often examination of the thorax will show that one or more of the ribs are deflected from their normal position. Another common condition found is displacement of the clavicle at its sternal articulation. If any of these anatomical deviations be found, they must be corrected. This can usually be done in one or two treatments, although the displacements may recur until the muscles are toned up sufficiently to hold them in position, or, as is often the case, the deviation is due to muscular contracture which is pulling the bones from their normal position, then the muscles must be relaxed. In the treatment of this condition, vibration must also be given over the whole thorax, and an inhibitive treatment must be given the pneumogastric nerves. While giving the treatment over the thorax anteriorly, it is well to have the patients extend their arms over their head, and to have a pillow doubled up under their back so as to bring the thorax into as much prominence as possible. Treatment B Ball, cervical and dorsal regions, and at posterior angle of ribs.
 

ASTHMA.

    Varying results have been obtained by the use of vibration in this particular disease, all, depending upon the cause. As is well known, asthma may be caused from disease of the heart or kidney. These being organic in character, are not amenable to vibration, though if given at the time of a spasm, it may bring about temporary relief. Other cases of asthma yield better results, especially those which originate in some disorder of the nervous mechanism, and also those due to congestion of the various viscera. In asthma due to disease of the heart, treatment should be directed to the inhibition of the spinal centres lying in the area between the third and eighth dorsal. In those due to degenerative processes of the kidney, the treatment should be inhibitive, but should be given to the lower dorsal and the upper two or three lumbar. If the etiological factor be of nervous origin, the treatment should be inhibitive, and should be applied throughout the dorsal region. The patient should be turned upon his back, and an inhibitive treatment should be given to the pneumogastrics. Beneficial results are greatly hastened by thorough vibration of the thorax anteriorly. As is sometimes the case, asthma is due to a reflex condition from the nose; here the treatment should be inhibitive, but should be directed to the peripheral terminations of the nerves supplying the nose. This is best given with the small facial or eye attachment, used locally.

    Anatomical defects are often productive of asthmatic conditions; this is especially true of a depression of one or more ribs. Such conditions as this should be corrected by using the technique which is given in another part of the book under "Abnormalities of the Bony Structures Forming the Thorax." If the paroxysm be due to a congested condition of the liver, the liver centres should be inhibited; i.e., inhibition should be given to the centres lying between the fourth and eleventh dorsal, inclusive. In addition to this, the vibrator should be applied over the liver posteriorly, using a percussion stroke forty-five to fifty seconds. This usually suffices to reduce any congestion, and thus relieves the asthmatic attacks. Treatment B Ball, cervical region to ninth dorsal, medium stroke, 15-20 seconds each point. Brush over thorax anteriorly.
 

COLITIS.

    Colitis, where there is a catarrhal condition of the mucous membrane lining the intestinal tract, is, as a rule, readily relieved by vibratory treatment; the intestinal tract, with the exception of the rectum, being supplied by sympathetic nerves, may readily be affected by the use of vibration over the great sympathetic plexuses, which may be reached through the abdomen, or by means of the rami-communicantes, through the posterior primary divisions of the spinal nerves. The majority of the sympathetics in the intestines are derived from the splanchnic area, and as these lie in the dorsal region, they may be reached by using vibration over the posterior angles of the ribs, the vibration being transmitted through the bones to the sympathetics, which, in the dorsal region, lie on the heads of the ribs. Treatment either given locally over the abdomen or along the spine should be of a stimulative character; this will relieve the venous stasis and allow the free circulation of the blood in the vessels. For the relief of pain, the treatment should be given locally to the point of inhibition.
 

CONSTIPATION.

    It is safe to say that at least 95 percent of cases of this condition, whether they be chronic or acute, will be greatly benefited by vibratory stimulation, as there can be no doubt that mechanical or physical treatment is the ideal method to be used in conditions of this kind. Drugs and enemas are of no avail, as their use only serves to give temporary relief, and they have to be increased in frequency and amount each time they are given, while vibration gets at the seat of the cause, and by relieving or removing it, brings about the desired cure.

    The conditions which prevail more often in constipation than any others are atony or spasticity of the intestinal walls, and one or the other condition usually exists in constipation of any form. Atony may be due to lack of stimulation to the nerve supply of the intestines, due to an insufficient amount of food being taken into the system, or it may be due to overloading of the intestines, in which case a constant irritation to the nerve endings in the intestinal walls will, after a time, fail to arouse any response, and the intestines will become distended, and the peristaltic movements will be greatly diminished in frequency and force.

    A frequent cause of constipation is the failure on the part of the patient to respond to the impulses which the packing of the feces in the rectum brings about; this, as in cases of overloading of the intestines, results in atony of the rectum. When an atonic condition of the rectum exists, it is manifested by contracture or extreme sensitiveness at points overlying the foramina of the sacrum, due to the fact that the rectum, receiving its nerve supply from the sacral plexus of nerves, they are reflexly affected.

    The various secretory organs which furnish the fluids whose action is the digestion of food may be at fault, owing to the increase or decrease of any one of their constituents, thus changing their chemical make-up, or if the fluids themselves be small in quantity, digestion cannot take place, as there is too small any amount of fluid to affect the amount of food which is taken in.

    Taking the treatment of constipation up in order as the etiological factors are given we must, in addition to correcting all faulty habits, take into consideration the anatomical abnormalities which exist in atonic conditions of the intestines. Treatment is best applied through the splanchnic area, for reason that the intestines, with the exception of the rectum, are supplied by sympathetic nerves, and to reach these, we must depend upon the transmission of the vibratory impulse either through the posterior primary divisions of the spinal nerves by way of the rami-communicantes, or through the bony structures themselves, in the latter case using vibration over the posterior angles of the ribs, for reason that the sympathetics in the area which supply the intestines lie on the heads of the ribs themselves. Here stimulative vibration must be given, unless the operator is able to detect sensitive points; in this case, the treatment is given to the point of desensitization of all tender spots.

    In those cases where spasticity exists, the operator will, as a rule, find an intense amount of muscular contracture, and here it is his duty to relieve contractures by using vibration over each contracted muscle until it is thoroughly relaxed. Relaxation can be determined by the appearance of sensitiveness, and the vibration should be continued until this sensitiveness disappears. The operator will then know that he has succeeded in inhibiting the nerves over which he is working.
 
    Where the amount of liver secretion is very great, the spinal attachment should be used from about the second to the eleventh dorsal on the right side, leaving the attachment at each point thirty to forty seconds. If the amount of fluid be too small, then fifteen to twenty seconds at each point will suffice.

    Where the pancreatic fluid is in excess, inhibition should be given from the seventh to the eleventh dorsal inclusive, or, if the fluid be small in quantity, then stimulation of these points should be sought for.

    Constipation due to packing of feces in the rectum is best relieved by exceedingly heavy vibration given for a brief period of time over the lower lumbar and sacral regions, or, if as is often the case, the sphincters are contracted and the physician possesses a vibrator which is capable of divulging the sphincters, then this operation should be performed.

    All cases of atonic constipation are greatly, benefited by a mild stimulation of the pneumogastrics, and some few cases of atony are greatly relieved by work over the abdomen itself, the rule being to follow the course of the colon. The average man would think that the abdominal treatment was preferable in all cases, but experience has shown otherwise, for the reason that very few men will carry vibration to the point of stimulation only, and they usually think that the abdominal treatment should be of from fifteen to twenty minutes duration. They do not stop to consider that with the great plexuses of sympathetic nerves which are reached through the abdomen they will secure inhibition very quickly, and thus decrease the peristaltic action instead of increasing it, as they would like. If abdominal treatment is given at all, it must be very brief, never lasting over a minute to a minute and a quarter, and the treatment should be confined to the colon alone. Of course, in speaking of the brevity of abdominal treatment, we do not mean those cases in which the brush or soft attachment is used to secure the toning up of the abdominal muscles themselves, as in cases of this kind the treatment may be lengthened to two or three minutes, providing that heavy vibration is not given.

    In conjunction with vibratory treatment, it is always necessary, of course, to correct all faulty habits on the part of the patient, and in those in whom lack of exercise is the cause, then more exercise must be prescribed; in those in whom the diet is at fault, this must be corrected, or in the cases of those in whom the amount of fluids taken is deficient, the physician must impress upon the patient that a sufficient amount be used.
 

DIABETES MELITUS.

    Look for abnormalities in the ribs. If found, correct same. Otherwise use ball attachment, medium stroke, medium pressure, from the first dorsal to the fourth or fifth lumbar. Same attachment, same stroke and same pressure at the angle of the ribs fifteen to twenty seconds at each point. Thoroughly percuss the liver and spleen, using medium stroke and medium pressure. Then with short stroke and light to medium pressure vibrate forty to fifty seconds at the base of the skull. Vibration should also be given twenty-five to thirty seconds over the pneumogastric nerves.
 

DIARRHOEA.

    In acute cases of diarrhoea, especially that form in which the condition is due to increased peristaltic action, Mechanical Vibratory Stimulaton forms a very valuable method of treatment. Of course, if there be bacteria or any other agent in the intestines, which, by constant irritation are exciting the intestines to excessive action, then these must be removed before relief can be obtained. Examination of the spine in diarrhoea will usually disclose an excessive amount of sensitiveness or muscular contracture in the lower part of the spine, especially through the lumbar region.

    The treatment by vibration consists of heavy pressure with a short stroke over all sensitive points or over all contracted muscles along the spine, and it is best to continue the vibration at each point forty-five to fifty seconds. In addition to this, the patient should be placed on his back, and, using the short stroke with deep pressure, thoroughly vibrate the plexuses of sympathetics which lie in the abdominal cavity.

    While holding the attachment over the abdominal points, the stroke should be gradually increased until it is at medium. If the above treatment does not cause a cessation of the symptoms then the operator must use the throat attachment with stroke a little less than medium, forty to fifty seconds over the pneumogastric nerves.

    If the digestive fluids be at fault, then stimulation or inhibition, as it may be required, should be used over the centres controlling the organ at fault, using stimulation where secretion is deficient, and inhibition where it is excessive.
 

ENLARGED PROSTATE.

    If of the acute variety, such as follows gonorrheal inflammatory conditions, a favorable prognosis can be made in all cases of enlarged prostate; if of the senile variety, one is not so safe in promising to bring about much reduction in the size of the gland, although he can promise a certain amount of relief. In the acute conditions the enlargement rapidly reduces, and all pain and discomfort are relieved; in the senile form, the first noticeable change is in softening of the gland, thus allowing the urethra to dilate and permit of a free passage of the urine without the use of a catheter.

    Vibration in either of the above forms must be both local and spinal. The spinal treatment should be given first, and should consist of stimulation from the eighth or ninth dorsal down to the end of the spine, for the purpose of starting up free circulation in the parts, and a percussion stroke must be used over the liver to equalize the circulation between the Portal System and the hemorrhoidal vessels. The next point is the local treatment, and this should be administered as follows: if the vibrator gives a percussion or rotary stroke, it does not matter in what position the patient is placed; if the stroke be lateral, then the patient must be placed on his side, and the vibrating arm placed in such a manner as to allow of a gliding stroke over the back of the prostate. The machine must always be put in motion and the attachment well lubricated before it is allowed to pass into the rectum. In passing the attachment within, the first direction of the instrument is anterior; i.e., almost directly towards the umbilicus, until it is well within the sphincter; then it should be turned backward and allowed to follow up the posterior wall of the rectum until it is well above the prostate. It should nowbe brought forward and downward until it rests on the gland, and should be left there three-quarters of a minute to a minute and a half.

    If there be any vesiculitis accompanying the prostatic trouble, and this is the rule in acute prostatic disease, the attachment must be pushed forward and to either side, so as to reach the vesicles and milk their contents into the urethra. After the local treatment, if there be any sensation of bearing down or other discomfort about the anus or rectum, vibration must be given in the perineum. This should be of a mild character, and should be kept up a half to three-quarters of a minute. It will usually be found that this will suffice to relieve all discomfort.
 

HEADACHES.

    Where no cause can be found, a general spinal treatment should be given, and vibration should also be used at the posterior angle of the ribs. Occasionally a cure may be hastened by use of the brush over the head locally, going directly over the painful areas. If the headache can be attributed to an anemic condition, then an inhibitive treatment should be given through the cervical region, which will inhibit the vaso constrictors and thus allow the vessels to dilate and increase the amount of blood to the brain. If hyperemia exists, then the treatment should be stimulative, i.e., such as will contract the vessels and decrease the amount of blood to the brain. If constipation is the cause, then use technique which is given under heading of "Constipation." If congested liver be the etiological factor, then use percussion over the liver posteriorly forty-five to fifty seconds, and use the ball attachment with medium stroke and medium pressure fifteen seconds at each point from the second to the tenth dorsal, inclusive.
 

HEMORRHOIDS.

    Alleviation of all painful symptoms usually results from vibratory treatment, although the variety of hemorrhoids which are more susceptible to treatment is the internal form. Where one has internal tumors which are protruding through the sphincters, relief is immediate. This is accomplished by use of the rectal attachment directly against the tumors, even though they be bleeding, held at each point a minute to a minute and a half, or until the tumors retract into the rectum. Each treatment usually suffices to hold them within twenty-four to forty-eight hours, and after nine to twelve applications, a permanent result is usually obtained. Before giving the local treatment the spine must be thoroughly stimulated from about the eighth dorsal down to the coccyx. Percussion must also be used over the liver to equalize the circulation between the Portal and Hemorrhoidal vessels.

    Where treatment is given at a time when protrusion does not exist, the attachment must not be passed within the sphincters, but must be used around the anus only, for the purpose of stimulating the muscular structures to contract and hold the tumors within.

    External hemorrhoids yield slowly, and the best treatment is local, using the rectal attachment directly over the tumors themselves.

    If after a rectal treatment any sensation of bearing down is felt, then the operator must relieve this by use of the ball attachment in the perineum, being sure to get the attachment on the inner side of the tuber
 

LUMBAGO.

    This condition usually requires one to three applications of vibration, which should be given with as long a stroke and as heavy pressure as the patient can bear over the lumbar muscles and through the lower dorsal and lumbar regions of the spine. Relief is usually experienced at the first treatment, and after three or four is generally permanent. Cases which do not yield to one or two treatments should be examined to see if the pelvis is in an abnormal position; if so, this should be corrected.

    In some cases of lumbago the amount of sensitiveness would be so great as to prohibit the use of the ball; if such be the case, the brush should be used beginning with short stroke and gradually increasing it as the patient can stand it. As a rule, after a half to two minutes of this, the patient will be able to stand the use of the ball; if so, the treatment should be begun with short stroke, gradually increasing it, as with the brush, and increasing pressure also.
 

PAIN

    All abnormalities in the bony structures must be corrected, all muscles be relaxed, and inhibition of the nerves supplying the part be secured.

    To secure inhibition, the ball should be used with medium stroke and medium to heavy pressure directly over the point where the nerves supplying the part emerge from the spinal column. Treatment in these cases may be given three or more times a day, if necessary, but should one do this, the treatment must be directed to the nerves supplying the part only, and not to the whole spine, as a general spinal treatment given so frequently would exhaust the patient. Some cases will only have temporary relief from the spinal treatments, and here it may be necessary to use the treatment locally; if so, the brush should be used with as heavy pressure as the patient can stand, directly over the part, leaving it there until inhibition of the peripheral terminations of the nerves is secured. Local treatment is always necessary in neuralgia of the facial, supraorbital or infraorbital nerves.
 

RHEUMATISM.

    An inhibitive treatment must be given the spinal centres and also the spinal nerves which supply the part. During an attack of pain inhibition of the peripheral terminations of the nerves supplying the painful area must be secured. This is done by use of the brush, medium stroke and as heavy pressure as the patient can bear. Special attention must be given the excretory organs and the lymphatic system to promote elimination of retained products of metabolism.

    Treatment should be given daily, and in some cases of extreme pain, may be given even oftener. In some cases displacements of the pelvis or of the bony structures forming the thorax may be found, and it is always well to look for these.
 

SCIATICA.

    Pain in the sciatic nerve or any of its branches may be relieved by use of inhibition over the nerve at some point in its course. This is best given at the sciatic notch, where, after relaxation of the muscles one has the nerve upon a bony background. Here it will only require forty-five to fifty seconds to produce complete relaxation of the muscles and inhibition of the nerve itself.

    In some cases in which the pain extends down the leg or into the foot, vibration must be given over the calf. The secret of all success in the treatment of this condition is the thorough relaxation of the muscles, and the inhibition of the nerve. In cases of long standing it is rare to find one in which there is not some displacement of the pelvis from its normal position, and in such cases as this, complete relief will not be obtained until the pelvis is replaced. The technique for replacing the pelvis is given in another chapter.