Spondylotherapy : spinal concussion and the application of other methods to the spine in the treatment of disease

Front matter

By the Same Author

Clinical Diagnosis.

Third edition, revised and enlarged.

Preface

THE subject of spinal therapeutics has received less attention from the medical profession than it deserves. Even the laity know that cold applied to the back of the neck may arrest hemorrhage from the nose, and that heat applied to the small of the back may hasten menstruation. The profound and far-reaching physiologic truths which underlie these simple phenomena have either been ignored or only given inconsiderate attention.

Others, less scientific but more astute, have determined empirically that manipulation of the spine does sometimes cure conditions that have failed of cure in the hands of experienced physicians. So it has come to pass that schools of practice exploiting spinal manipulation as a cure-all have arisen. Neither the fury of tongue nor the truculence of pen can gainsay the confidence which these systems of practice have inspired in the community.

The author was led to a deeper study of spinal therapeutics in investigating various visceral reflexes which bear his name. As the years passed on, he ascertained that a number of pathologic conditions could be more easily and certainly controlled by spondylotherapeutic means, than by the conventional measures.

Some physicians may consider the remedial methods discussed in this book to be unduly and unworthily simple, on the principle that what is obvious can hardly compete with what is obscure in the treatment of disease. The most mystifying phenomena rest upon the least complex causes; and the simpler a thing is, the harder it is to understand.

Anybody, however, who investigates the study of spinal therapeutics in earnest, will discover that the simplicity is only apparent. The successful practice of spondylotherapy requires knowledge, observation and experience of the highest kind, and is comparable to the best effort in any other department of scientific medicine. Indeed, one of the author’s truest motives has been to lift this whole subject of spinal therapy out of the low state in which it blunders onward, hitting or missing as the case may be, and rescuing it from the lowly esteem which physicians as a class have thus felt for it. He has endeavored to put it in a place befitting its scientific importance, and to emphasize its great practical helpfulness in disease.

VII

Preface

Any method of cure that is more or less new is inclined to be viewed critically by the formalist and traditionalist, and so it should be. The writer knows better than any one else can the incompleteness and imperfections of his work. It is really a pioneer effort and he only asks that it be judged as such. Indeed, the author hopes to receive many suggestions and if need be, corrections, and to profit by them.

One word concerning the cases cited in illustration of the methods which the author has described in various parts of the book. These may seem more or less incredible, the outcome of enthusiasm, bias, of some defect of the power of scientific observation, or of judgment. Yet the cases cited are not the most remarkable that the author has encountered in his practice. Some of these cases have been deliberately suppressed with a feeling that many readers are hardly prepared to appreciate or to credit the results which may be achieved by an earnest study and practice of spondylotherapy. To eschew a remedy because we cannot gauge its material properties may be an act worthy of the scientist, but the aim of the physician is to cure disease. In the presence of a sick man, two questions are to be answered: “What is the matter with him, and what will do him good?” Neither the pragmatical doctrinaire who accepts nothing but what is demonstrated morphologically, nor the representative of an exclusive system of practice, with his introspective reasoning, can aid therapeutics. The former forgets that the crucial test for the action of remedial measures is in their clinical application and that many of our most potent drugs have been inherited from the therapeutic acumen of our medical ancestors. “The diseases of which we know the least pathology are the diseases which we treat successfully.” Cure, as conceived by the introspectionist, cannot merit the imprimatur of the scientist, and for this reason, the author has endeavored to justify his conclusions by demonstrable evidence.

ALBERT ABRAMS.

246 Powell Street,

San Francisco, Cal.,

January, 1910.

VIII

Chapter I. Historical

Page

Primitive Era of Spondylotherapeutics . . . i

The Griffin Brothers ..... 2

Swedish Gymnasts . . . . . 4

Osteopathy . . .... 4

Chiropractic . . . . . . .5

Chapter II. Anatomic, Topographic And Physiologic Data

Structure of the Spinal Cord . . . . 17

Roots and Distribution of the Spinal Nerves . . 18

Anatomic Landmarks . . . . . • I9

Sympathetic System ..... 24

Physiology of the Spinal Cord . . . . .26

Localization of the Functions in Different Segments of the Spinal

Chapter III. Symptomatology

Examination of the Back . . . . . 38

The Normal Spine ..... 38

Spondylography . . . . . .42

Examination of the Muscles of the Back ... 46

Stiff Back . . . . . . -5°

Muscular Hypotonia . . . . .52

LX

Contents

Pain and Tenderness of the Spine

Page

Dermatomes of Head .

Vertebral Pain ....

. 71

Vertebral Percussion

Vibrosuppression

Chapter IV. Summary Of Spinal Diseases And Symptoms

Backache ......

Chest Deformities ......

Coccygodynia ......

• 95

Faulty Attitudes ......

Litigation Backs .....

Lumbago .......

Neurotic Spine .....

. 103

Osteo-Arthritis ......

io5

Pott’s Disease of the Spine ....

. 108

Sacro-Iliac Disease ......

hi

Sacro-Iliac Relaxation .....

. hi

Spinal Curvatures ......

1 13

Scoliosis ......

Kyphosis and Lordosis ....

■ 115

Angular Curvature .....

. 117

Spondylitis .......

Spondylolisthesis .....

. 118

Traumatism of the Spine .....

Tumors of the Spine .....

. 121

Typhoid Spine ......

Vertebral Insufficiency .....

. 122

Diagnosis of Spinal Diseases ....

. 128

Deformity .......

Compression of the Spinal Cord

X

Contents

Page

Paraplegia

Tuberculosis

Syphilis

Gonorrhoea

. 141

Rheumatism

Spinal Meningitis .

chapter v. GENERAL SPONDYLOTHERAPY

Abdominal Supporters ...... 145

Acupuncture ...... 146

Counterirritation ...... 148

Electrotherapy . . . . . .151

Re-education of Co-ordinated Movements . . . 165

Spinal Hydro-Therapy ...... 166

Lumbar Puncture ...... 167

Psychrotherapy . . . . . .172

Thermotherapy . . . . . . 174

Vibratory Massage . . . . . 175

CHAPTER

VI.

PSEUDO- VISCERAL

DISEASES.

Neuralgia

. 182

Intercostal Neuralgia

.

Differential Diagnosis .

.

. 189

Pseudo-Appendicitis

.

Pseudo-Cerebral Disease

.

. 192

Pseudo-Angina Pectoris

.

Pseudo-Arrhythmia

-

- I9S

Pseud o-Esophagismus

-

XI

Conte n t s

Page

Pseudo-Nephrolithiasis ...... 197

Pseudo-Dyspepsia . . . . . .197

Pseudo-Cholelithiasis ...... 197

Pseudo-Mammary Neoplasms .... 198

Chapter VII. The Circulatory System

Cardiac Sufficiency . . . . .210

Differential Table of Asthma . . . . .212

Tests for Heart Sufficiency . . . . . 215

Angina Pectoris ...... 221

The Heart Reflex of Dilatation .... 221

Differential Table of True and False Angina . . .224

Functional Affections of the Heart .... 228

Inhibition of the Heart ..... 228

Physiology and Pathology of the Blood-Vessels . . 231

Blood-Pressure ....... 234

Vaso-Motor Factor in Blood-Pressure . . . 239

Sphygmomanometry ...... 244

Hypertension and Hypotension .... 246

The Aortic Reflexes ...... 254

Aneurysm of the Thoracic Aorta . . . .254

The Vaso-Motor Apparatus ..... 272

Chapter VIII. The Respiratory Apparatus

Physiology ....... 288

Postural Lung-Dullness . . . - .290

Lung Reflex of Dilatation ..... 294

Lung Reflex of Contraction ..... 298

XII

Conte n t s

Page

Pulmonary Atelectasis ..... 299

Spasmodic Bronchostenosis . . . . 311

Tuberculosis . . . . . - 3IS

Hemoptysis . . . . . 3 1 5

Chapter IX. The Digestive System

The Stomach ....... 316

The Stomach Reflexes . . . . .316

Percussion of the Stomach . . . . . 321

Treatment of Diseases of the Stomach . . . 324

The Intestine . . . . . . . 325

The Intestinal Reflexes . . . . .325

Diseases of the Intestines . . . . *326

Treatment of Constipation ..... 329

The Intestinal Neuroses ..... 330

Hepatic Toxemia ...... 334

Splanchnic Neurasthenia ..... 345

Chapter X. Miscellaneous Reflexes

The Spleen

Reflexes of the Spleen

Splenic Reflexes in Treatment .

Uterus Reflex

Dysmenorrhea .

The Bladder Reflex The Kidney Reflexes Nervous Symptoms Paralysis, Contractures, Ataxia

- 352 358

- 358 358

• 359 362 . 362

XIII

C o n t e n t s

Chapter XI. The Therapeutics And Diagnosis Of Pain

Segmental-Analgesia .....

Page - 366

Concussion-Analgesia ....

Segmental-Localization ....

• 367

The Trigeminus Nerve ....

Sinusoidal-Analgesia .....

Segmental-Psychrotherapy ....

Segmental-Analgesia of the Viscera

Segmental-Analgesia in Diagnosis .

Physiology of Spondylotherapeutic Methods

• 379

Spinal Nerve-Trunk Analgesia

Cortical Sinusoidalization ....

XIV

Illustrations

Figure. Page

1. Illustrating the Chiropractor’s Conception of Disease . 6

2. Plexor and Pleximeter for the Vertebral Reflexes . 9

3. Concussing the Spines with the Hands . . .10

4. Spinal Muscular Reflexes . . . . 13

5. Viscero-Motor Reflexes . . . . 14

6. Babinski Toe-Reflex ..... 16

7. Conducting Paths in the Spinal Cord . . .17

8. A Spinal Nerve ..... 18

9. Composition of a Peripheral Nerve-Trunk . 19

10. Relations of the Segments of the Spinal Cord . . 20

11. Posterior Aspect of the Thorax and Abdomen . .22

12. Sympathetic and Cerebro-Spinal Nervous System . 25

13. Mechanism of the Knee-Jerk . . . 2 7

14. Showing Spinal Segments for Motion and Sensibility .31

15. Segmental Skin Fields . . . . 35

16. Normal Vertebral Curves . . . . .40

17. Spondylograms ..... 42

18. Apparatus for Taking a Spondylogram . . - 43

19. Vertebral Areas of Muscular Spasm ... 49

20. Plan of the Cervical Plexus . . . 51

21. Diagrams of Transferred Pains ... 56

22. Illustrating Cutaneous Tenderness . . 58

23. Sensory Areas of the Skin (Anterior View) . . 61

24. Sensory Areas of the Skin (Posterior View) . .61

25. Sensory Areas of the Skin .... 63

26. Sensory Areas of the Skin . . . . 63

27. Painful Head-Areas Related to Visceral Disease . 65

28. Hyperalgesic Zones . . . . . 67

29. Hyperalgesic Zones ..... 68

30. Areas of Vertebral Tenderness . . . - 75

31. Areas of Vertebral Tenderness ... 78

32. The Vibrosuppressor . . . . .81

33. Effects of a Dilated Stomach on the Heart . . 85

34. Area of Lung-Dullness in Dislocation of the Heart . 86

35. Sites of Indurations ..... 90 xv

11 l u s t r a t i o n s

Figure. Page

36. Electric Massage-Apparatus .... 101

37. Curves in Kyphosis and Lordosis . . . 116

38. Relation of the Spinal Cord . . . .119

40. Areas for Counter-Irritation .... 148

41. Areas for Counter-Irritation .... 149

43. The Author’s Sinusoidal Apparatus . . .153

44. Kellogg’s Sinusoidal Apparatus . . . . 154

45. The Victor Sinusoidal Apparatus . . . 155

46. Interrupting Electrodes . . . . . 156

47. Electro-Motor Points of the Muscles of the Back . 157

48. Vertebral Areas for Eliciting Visceral Reflexes . .170

49. Cutaneous Areas for Influencing the Viscera . . 174

50. Pneumatic Hammer . . . . . 177

51. Electric Concussion-Hammer . . . .179

52. Diagram of a Thoracic Nerve .... 183

53. Cutaneous Nerves of the Thorax and Abdomen . 184

54. Illustrating the Heart Reflex .... 200

55. Illustrating the Heart Reflex .... 201

56. Sphygmogram After Inhaling Ammonia . . . 202

57. Illustrating the Heart Reflex .... 206

58. Illustrating the Heart Reflex .... 206

59. Sphygmogram After Straining at Stool . . 208

60. Illustrating the Heart Reflex in Myocarditis . .220

61. Illustrating the Heart Reflex in Myocarditis . . 220

62. Illustrating the Heart Reflex After Using Digitalis . 225

63. Position of Leg for Palpating the Tibial Artery . 226

64. Demonstrating the Amplitude of the Heart Reflex . 227

65. Position of Head to Inhibit the Heart . . . 228

66. Sphygmomanometer ..... 245

67. Rubber-Ring for Excluding Auto-Pulsations . . 246

68. Relation of Heart and Aorta to the Chest- Wall . 254

69. Aortic Reflex of Contraction in Aneurysm . . 255

70. Aortic Reflexes in Aneurysm (Posterior View) . 255

71. Aortic Reflexes ...... 260

72. Aortic Reflexes of the Abdominal Aorta . . 263

XVI

11 lustrations

Figure. Page

73. Reflex of the Abdominal Aorta . . . . 265

74. Path of a Vasoconstrictor Nerve . . .273

75. Photograph of Exophthalmic Goitre . . . 282

76. Photograph of Exophthalmic Goitre . . . 283

77. Types of Breathing ..... 289

78. Diagram of the Respiratory Center . . . 290

79. Atelectatic Zones ...... 300

80. Atelectatic Zones ..... 300

81. Illustrating the Bronchial Tubes in Asthma . . 308

82. Arrangement of Bottles for Promoting Lung-Contraction 314

83. Nerves of the Stomach . . . . . 31:7

84. Illustrating Traube’s Space . . . .318

85. Effects of Ether-Inhalation on the Stomach . -. 319

86. Percussion of Stomach by the Vago-Visceral Reflex . 322

87. Liver Reflex of Contraction .... 332

88. Liver Reflex of Dilatation .... 333

89. Cardio-Splanchnic Phenomenon .... 346

90. Splenic Reflexes . . . . - 353

91. Kidney Reflexes ...... 360

92. Skin-Areas Related to Spinal Segments . . 368

93. Skin-Areas Related to Spinal-Segments . . . 368

94. Peripheral Distribution of Sensory Nerves . . 372

95. Peripheral Distribution of Sensory Nerves . - 373

96. Location of the Gasserian Ganglion . . .374

97. Localization of the Motor Area .... 384

XVII

Chapter I. Historical

PRIMITIVE ERA OF SPONDYLOTHERAPEUTICS THE GRIFFIN BROTHERS

— SWEDISH GYMNASTS OSTEOPATHY CHIROPRACTIC — DANA

QUINCKE — HEAD — THE VERTEBRAL REFLEXES.

TN the primitive era of hydrotherapy, the application to the spinal region of the hot-water bag and ice-bag was a conventional procedure dictated by empiricism with little physiologic knowledge concerning the action of water on the spinal centers. Even at the present day, our therapeutic armament embraces various physical methods which are indiscriminately employed with neither rhyme nor reason. Thus therapeutics is discredited and any good results achieved from treatment are attributed to suggestion. We dare not wholly ignore the physical methods of treatment even though there is no physiologic reason to justify their employment, although it should be the constant effort of the physician to rationalize his methods. We are not justified in discrediting clinical observations because they have not been confirmed in the laboratories. Gowers observes, “The diseases of which we know the least pathology are the diseases which we treat successfully.”

We should be prepared to welcome new truths, even though, as Goethe observed, they threaten to overturn beliefs which we have entertained for years and have handed down to others.

One must not forget, however, the unconscious tendency of specialists to exaggerate the importance of some special method of treatment

In the presence of abdominal pain, the surgeon who uses his head as well as his knife thinks of appendicitis, but when he uses his knife to the exclusion of his head, he thinks of nothing else. There is the gynecologist whose conception of disease is limited to the uterus and adnexa, and there is the oculist with mental astigmatism, who reflects his subjectivity in the examination of his patients.

We all know the tendency to patronize special organs, diseases or remedies, and the poet Crabbe, in verse, thus immortalizes this tendency:

“One to the gout contracts all human pain,

He views it raging in the frantic brain;

Finds it in fevers, all his efforts mar,

And sees it lurking in the cold catarrh.

Bilious by some, by others nervous seen,

Rage the fantastic demons of the spleen;

And every symptom of the strange disease,

With every system of the sage agrees.”

THE GRIFFIN BROTHERS.

In 1834 William and Daniel Griffin, physicians, respectively, of Edinburgh and London, published a work in which 148 cases were analyzed showing the relation of certain symptoms to definite spinal regions. These symptoms were associated with spinal tenderness in fixed regions. They concluded that the tenderness in question was either primary in the spinal cord or secondary to visceral or other diseases. The Griffin Brothers queried as follows: “We should like to learn why pressure on a particular vertebra increases, or excites, the disease about which we are consulted, why it at one time excites headache or croup or sickness of the stomach.” “Why, in some instances, any of these complaints may be called up at will by touching a corresponding point

The Griffin Brothers of the spinal chain?” The following table by the Griffin Brothers1 demonstrates the tender areas of the spine:

CASES.

Twenty-eight cases of cervical tenderness, 8 men; 8 married, 12 unmarried.

Forty-six cases of cervical and dorsal tenderness, 7, 15

married, 24 unmarried.

Twenty-three cases of dorsal tenderness, 4, o - - 6 married, 16 unmarried.

Fifteen cases of dorsal and lumbar; 1 man; 11 married, 3 unmarried.

Thirteen cases of lumbar tenderness.

Twenty-three cases, all of the spine, 4, o —4 married, 15 unmarried.

Five cases; no tenderness of the spine.

PROMINENT SYMPTOMS.

Fleadache, nausea or vomiting, face-ache, fits of insensibility, affections of the upper extremities.

In 2 cases only, pain of stomach; In 5, nausea and vomiting.

In addition to the foregoing symptoms, pain of stomach and sides, pyrosis, palpitation, oppression. In 34 cases, pain of stomach. In 10 cases, nausea or vomiting.

Pain in stomach and sides, cough, oppression, fits of syncope, hiccough, eructations. In one case only, nausea and vomiting. In almost all, pain of stomach.

Pain in abdomen, loins, hips, lower extremities, dysury, ischury in addition to the symptoms attendant on tenderness of the dorsal. In 1 case only, nausea.

Pains in lower part of abdomen, dysury, ischury, pains in testes or lower extremities, or disposition to paralysis. In 1 case only, spasms of stomach and retching.

Combines the symptoms of all the foregoing cases.

Cases resembling the foregoing.

At this period (1834) Swedish gymnasts, notably Ling, observed among cardiopaths, tenderness over the 4th or 5th dorsal nerves when this region was subjected to friction. The Swedish school recognizes definite areas of spinal tenderness identified with the various organs. Thus, in affections of the stomach, tenderness is observed in the region of the 6th, 7th and 8th dorsal nerves on the left side, and manipulation of the region in question often evokes eructations of gas.

In 1841 Marshall Hall published his memorable work which established the importance of the spinal reflex.

OSTEOPATHY.

In 1874 osteopathy was founded. It was based on the theory that health signifies a natural flow of blood and that the bones may be employed as levers to relieve pressure on nerves, veins and arteries. The pressure is assumed to be caused by dislocated bones, and, when the osteopath refers to a “lesion,” he intimates malposition of a bone.

The theory of the osteopath may be at variance with our accepted views of etiology, yet the latter, by his manipulations, unconsciously evokes reflexes which are cogent factors in favorably influencing disease.

The osteopath indignantly resents any comparison of his system to massage. The following statement occurs in a representative work on this system by G. D. Hulett2: “Masseurs are aware of the fact and the possible significance of tender points in the tissues along the spine over the area from which the nerves are given off to the organs which are in a diseased condition; evidently, however, they have considered these tender points as always secondary to the diseased viscus.” “The essential distinction between osteopathy and all other systems of healing,” continues the same

C h i r o p r a c t i c writer, “based on manipulation, clusters around the etiology of disease.” In other words, in disease of an organ, the masseur acts directly upon the organ; but the osteopath taking into consideration what he regards as a fact “The ability of nature to functionate properly, treats the central force.”

According to the foregoing, the osteopath regards disease from a central and not from a peripheral standpoint.

CHIROPRACTIC.

This system was founded in 1885. The theory sustaining this system presumes that, in consequence of displaced vertebrae, the intervertebral foramina are occluded through which the spinal nerves pass (Fig. 1).

In this way the nerves are pinched and chiropractors assume that such pinching is responsible for 95 per cent of all diseases. Chiropractic concerns itself with an “adjustment” of the subluxations, thus removing pressure on the nerves.

What the chiropractor calls “nerve-tracing,” consists of following a sensitive nerve from its vertebral exit to and from the affected organs. The chiropractor differentiates his method from osteopathy by the following asseverations :

1. The hands are used in a different manner and the movements are dissimilar;

2. The etiology of disease is unlike that accepted by osteopathy;

3. Chiropractors “adjust” for more diseases than osteopaths and the results are immediate.

It is known that pain may be felt at a point distant from the actual site of a lesion. Such pains are know as transferred pains. Thus the pains sometimes felt in the l

A B

Fig. i. — Illustrating the chiropractor’s conception of disease. A, the vertebrae are in the normal position with the spinal window open (SWO); B, showing that with an open spinal window the nerve is not compressed. The dotted lines show the correct alignment of the spinous processes; C, the spinal window is closed (SWC) owing to displaced vertebrae and in consequence the nerve at its exit is pinched (D). (After Palmer.)

mammary gland in uterine disease and in the knee in hip-joint disease are transferred or referred pains.

The well-known illustrations of Dana (page 56) represent the location of transferred pains.

In 1890 Quincke studied the sites of sympathetic sensations (page 57).

Still later, in 1893, Henry Head, of London, demonstrated that in visceral disease, pain and disturbed sensation may be referred to definite cutaneous areas (vide page 58).

THE VERTEBRAL REFLEXES.

In medical literature the author has referred repeatedly to certain visceral reflexes elicited by cutaneous irritation, viz., the lung reflexes of dilatation3 and contraction4, the heart reflex 5, liver reflex 6, stomach and intestinal reflexes1, and the aortic reflexes 8.

The reflexes in question are endowed with more than mere physiologic interest. They yield unequivocal demonstration of the fact that the sensory peripheral nerve terminations receive impressions which are conducted, communicated or reflected by aid of the nervous system.

Such impressions react on the viscera and the manifestations of the reaction may be utilized in a diagnostic and therapeutic direction.

The evidence heretofore adduced in explanation of the results achieved by electric, hydriatic, mechanic and balneary treatment of disease was naught else than a mere array of words conceived only in conjecture.

The cutaneous visceral reflexes referred to, suggest the rationale of the different peripheral methods of treatment.

Visceral reflexes may be evoked not only by cutaneous irritation but likewise by concussion and the application of the sinusoidal current to the spinous processes of the vertebrae.

Reflexes elicited from the spinous processes have been specified by the author as vertebral reflexes.9

The manipulation of definite vertebrae corresponds with the elicitation of specific reflexes, but, if the spinous processes are promiscuously manipulated, counter-reflexes are evoked which nullify the reflexes sought. As we proceed with our subject, we will determine that vertebral manipulation is influential for weal or woe in the treatment of disease and it will be the endeavor of the author, to endow spondvlotherapeutics with some scientific accuracy and thus substitute order for chaos.

To excite the vertebral reflexes for therapeutic purposes, concussion by means of an apparatus (page 176) or the sinusoidal current (page 151) is employed. Fordiagnostic purposes, either the sinusoidal current or simple concussion after the manner to be described is used. When the current is employed, the moistened, indifferent pad (usually large) is placed over the sacral region, whereas an interrupting electrode (Fig. 46), which permits one to close and open the circuit, is placed over definite spinal processes.

For simple concussion the author employs a piece of soft rubber or linoleum about 6 inches long, ij inches wide, and about a j of an inch in thickness as a pleximeter for receiving the stroke and a plexor with a large piece of thick rubber for delivering the blow (Fig. 2).

The plexor used by the author is similar to that employed by French clinicians for obtaining the knee-jerk and is known as the plexor of Dejerine.

In the absence of the latter, a mallet or even an ordinary tack -hammer will suffice.

One may also strike the spinous processes with the

Fig. 2. — Plexor and pleximeter employed for eliciting the vertebral reflexes.

knuckles or better still, the fingers may be used as a pleximeter and the clenched fist as a plexor. In the latter instance, the palmar surfaces of the fingers are applied to the spinous processes to be concussed, and, with the clenched fist, the dorsal surfaces of the fingers are struck a series of short and vigorous blows (Fig. 3).

The use of a pleximeter and plexor is decidedly more effective than the latter method which is only employed in an emergency. Here the strip of linoleum or rubber is applied to the spinous process or processes to be concussed, and, with the hammer, a series of sharp and vigorous blows are allowed to fall upon the pleximeter.

Fig. 3. — Showing the method of concussing the spinous processes with the hands for eliciting the vertebral reflexes.

Naturally, the blows jar the patient somewhat, but beyond this no inconvenience is suffered.

The vertebral reflexes, when the stimulant is concussion, are probably due to transmitted mechanic stimulation of the roots of the spinal nerves, insomuch as many physiologists contend that the spinal cord does not react to direct stimuli. In some instances concussion is more effective than the sinusoidal current in eliciting certain vertebral reflexes, whereas, in other instances, the current supersedes concussion. The relative value of these methods, however, will be studied in detail in succeeding chapters. There is yet another method for eliciting the vertebral reflexes by means of pressure at the vertebral exits of definite spinal nerves (page 169).

Reference to Fig. 4 shows the spinal muscular reflexes thus far elicited by the author, whereas, Fig. 5 represents the viscero-motor reflexes of spinal origin. The latter, with the exception of the aortic reflexes, probably act on the musculature of the organs independently of the vaso-motor system.

Unstriped or involuntary muscular fibers are present in practically all the organs of the body. Even the liver is not exempt. Here the muscular fibers contained in the fibrous coat of the organ enter the organ at the transverse fissure.

The viscera, even in health, vary in size, and this alternate enlargement and diminution in bulk is due in part to variations in the supply of blood and in part to the contractility of the visceral musculature.

If I am permitted to digress for a moment to give expression to my prejudiced conception of many morbid manifestations, I witness muscular tissue in a state of incoordination , uncontrolled by will and subordinated to the vagaries of undisciplined reflex centers, the muscular orgy presents the tableau of muscles gone mad. Practically everywhere throughout the organism where muscle is found, fibers coexist which dilate or contract. When neither function predominates there are no morbid manifestations; in other words, a normal function is a question of muscular equilibrium. The moment one set of fibers gains the ascendancy over its antagonist the symptomatic picture is made up of spasm or paralysis {vide Asthma, page 303).

SPINAL MUSCULAR REFLEXES.

These reflexes are best elicited by means of a powerful sinusoidal current after the manner already described (page 11). Concussion by means of the plexor and pleximeter will also excite some of them. It will be observed that the reflexes in question are bilateral, in contradistinction to the conventional cutaneo-peripheral reflexes, which are unilateral.

For the convenience of their clinical elicitation they have been studied with relation to definite vertebral spinous processes.

It must be observed, however, that the areas in question may vary in different patients, but, as here cited, the areas are approximately correct. Like all reflexes, the degree of stimulation necessary for their excitation varies with the individual, but, as a rule, powerful currents are necessary. Practically every muscle, or group of muscles, may be brought to contraction, but, insomuch as this work is designed for a utilitarian rather than an academic purpose, only a few muscular reflexes thus far elicited by the author will be cited.

1. Sterno-cleido -mastoid reflex. — This is best observed when the head is flexed and when the interrupting electrode is fixed over the spinous process of the 7th cervical vertebra. Concussion of the latter will also evoke the reflex. This bilateral reflex is most pronounced at the sterno-clavicular attachment of the muscles.

2. Biceps, triceps, and wrist-jerk. — Elicited by concussion of the spinous processes of the 5th and 6th cervical vertebras or by application of the current to the same processes. Here the processes are concussed in succession or the electrode used is large enough to embrace both spinous processes. The upper extremities must be placed in a state of flexion, with muscles absolutely relaxed and the elbows resting in either hand of an assistant. The elbows may also rest on a table in the flexed position and relaxed.

3. Palmar reflex. — This consists of a contraction of two or more fingers when the interrupting electrode is applied over the spinous process of the 6th cervical vertebra.

4. Pectoral reflex. — The patient lies on his side with arms elevated to bring the pectoral muscles into slight prominence, after which the dorsal spinous processes (3d to the 6th) are either concussed or sinusoidalized.

5. Scapular reflex. — Concussion or sinusoidalization of the 5th cervical spinous process.