CHRONIC DISEASES.
We have, in different parts of this work, referred to a large variety of ingeniously devised machinery and apparatus employed at the Invalids' Hotel and Surgical Institute, in the treatment of chronic diseases. Although we can, on paper, give but a meagre idea of the variety and adaptability of these valuable mechanical appliances, yet we will endeavor to illustrate and explain a few of our machines for the application of transmitted motion.
Fig. 1 represents a machine, called the Manipulator, which transmits motion through suitable attachments, which are adjustable by means of the ratchet G, so as to reach all parts of the body. It is equally available for applying motion to the head, feet, or any intermediate part of the body.
B, B are rubbing attachments, with two opposing elastic, adherent surfaces, between which an arm or a leg may be included. These have alternate reciprocating action from the rock-shaft H, and are made to approach each other, and press the included part at the will of the patient. This is sometimes called the double-rubber, and is made detachable if desired.
A is the lever, by which the two parts of the double-rubber are made to compress the arm or leg.
D is a single attachment for rubbing. It may be connected at either side of the machine, so as to present the rubbing surface in four different directions, as may be most convenient. It will act perpendicularly, horizontally, or diagonally, and from below or from above the part receiving the action, according to requirements. The shank of the rubber may have any special form to suit special cases.
C is the foot holder. It communicates to the leg the semi-rotary or oscillating motion of the rock-shaft. It may be attached to either end of the rock-shaft.
E is the hand holder, which, grasped by the hand, communicates motion to the arm, shoulder, and chest; or the hand may be inserted passively, when the effect of motion is more confined to the hand and fore-arm.
In the position shown in Fig. 2, by means of the single rubber attachment, the manipulator acts upon the upper portion of the trunk, neck, head, and arms; by means of the hand-holder, upon the arms; by means of the double-rubber, upon the arms, shoulders, and scalp.
When the acting part or head is lowered to its extreme limit, the machine occupies the least space. In this position, by means of the foot-holder it communicates oscillation to the legs; by means of the single-rubber, it acts upon the feet, ankles, and lower leg; by means of the double-rubber, it acts upon the legs, including the feet, the patient either sitting or lying.
In all of these applications of motion, energy travels from inanimate to animate matter; non-vital contributes to vital energy: and the various processes through which vital power is developed are promoted and carried forward in a degree till the point which constitutes health is attained.
The name, Manipulator, is very naturally applied to the instrument, the action of which resembles so much that of the living operator. It is, however, impossible for the unaided hand to impart the degree of rapidity necessary to secure the effects easily attained by this machine; and, practically, restoration is often secured in cases in which it is quite unattainable by any other remedial agent.
Motion, transmitted by the manipulator, exerts a curative effect in all chronic affections, and is not limited, as is sometimes supposed, to paralytic affections and deformities. In these latter affections it is a great assistance in effecting a cure; while, in chronic affections, whatever the local symptoms, it supplies the additional energy which is indispensable for recovery in all diseases of long standing.
Mode of Operation.—Fig. 4 represents the manipulator in operation. The machine is propelled by steam power at the Invalids' Hotel and Surgical Institute, but may be worked by hand, as here represented. One arm is inserted between the double-rubbing pads, which are raised to about the height of the shoulders, the patient being seated at the side of the machine; the other hand is placed on the lever, and as much pressure is applied as is perfectly agreeable, care being taken to diminish the pressure at any part which is unusually sensitive. All portions of the arm from the shoulder down are successively included in the rubbers, while a suitable degree of reciprocating or rubbing action is obtained by giving motion to the wheel.
To apply the same operation to the other arm, the patient may either turn in his seat or change his position to the opposite side of the machine.
If any portion of the extremity is affected with inflammation or swelling, it is necessary to apply the action described to the whole of the unaffected portion first; after this the affected part may be beneficially operated on, provided that the sensations are strictly heeded, and that it is so managed that only a comfortable feeling is produced.
In Fig. 5, the patient is so seated beside the machine that he can insert one thigh between the pads of the rubber, and also control the lever with the hand. It is sometimes more convenient to suspend a movable weight from the lever. While the machine is running, he can withdraw the leg gradually, as each portion receives its proper amount of action, till the whole, including the foot, becomes glowing with the effect. The boot or shoe affords no impediment to the effect, and should remain on.
Sometimes, especially in the beginning, or when the feet are habitually cold, it is better to apply the action only from the knees down.
The rubbing-pad (d) may be attached to either side of the machine, according to convenience or effect sought. The action derived from the right end of the rock-shaft is much less severe than that from the left, on account of the shape of the rubber appendage, and at the beginning should be used in preference. In Fig. 6, the patient sits on an ordinary stool, or, if feeble, in a chair, and presents any portion of the chest or abdomen to the action of the rubber. The instrument is raised or lowered to suit convenience, while the patient gently presses portions of the trunk successively upon the rubbing-pad. The degree of the effect is thus always under the absolute control of the one receiving the action. This operation, like the preceding, produces great heat, reddens the skin, relieves pain, and greatly stimulates the functions, not only of the skin, but of the organs contained in the cavities of the chest and the abdomen.
The same operation may be applied also to the legs while the patient is standing.
In Fig. 7, the back is presented to the action of the rubbing-pad. The action will, if desired, be made to reach from the neck to the hips, and even to the thighs. All sensitive portions of the back should at first be omitted, in order that they may be benefited by the counter-irritation or drawing away of the blood. This is easily produced by those familiar with the use of the machine. The rubbing of the back should be deferred till the close of each application, in order that the spinal centers may be relieved of hyperæmia, or excess of blood.
The machine, as represented by Fig. 8, is brought to the desired elevation, about as high as the shoulders, and the hand-holder is attached. One arm is extended horizontally, and the hand grasps the hand-holder, while rapid motion is given by turning the wheel. An alternate twisting motion is communicated to the arm, which causes corresponding pressure and relaxation of all the soft tissues of the limb, combined with slight rubbing or attrition. The action is increased by contracting the muscles, and also by grasping at greater distance from the center. Both hands may grasp at the same time, or the two sides may receive the motion in turn. The effect is similar to that of the rubbing before described, but it is less limited; by grasping firmly, it may extend to the whole chest.
The foot-holder is attached, as shown in Fig. 9, and brought by the means before described to a position to receive one foot at a comfortable elevation, the leg being extended, while the patient is seated in an ordinary chair in an easy position. The action is precisely like that above described as applied to the arm, and extends to the thigh and pelvis. If the knee is slightly flexed, the action is almost entirely confined to the lower leg. Each leg may be operated on in turn.
Mode of Applying Mechanical Movements to Very Feeble Invalids.—Experience demonstrates that no degree of feebleness excludes the beneficial use of these operations. Invalids too weak to stand, or able to help themselves in the least degree are often treated with perfect success. A judicious use of the Manipulator always increases nutrition and strength without any fatigue or exhaustion, however feeble the patient may be. It is only necessary to provide for these cases additional conveniences, so that the applications can be made in the recumbent position, and also that proper intervals of rest be allowed between successive operations. For this purpose couches are provided, each containing a certain portion of the Manipulator. These are operated by means of a short connecting-rod, joining the rock-shafts of the two pieces of mechanism, as shown in Fig. 10. The Vibrator has two small discs, or heads acting through an opening in the couch on which the invalid rests. These impinge with a rapid, direct stroke upon the portion of the body exposed to the action. The top of the couch is adjustable, and is quickly placed at the elevation which secures the proper force of the instrument, as shown in Fig 11. By simply turning and moving the body, the patient brings any part in contact with the vibrating discs. The cut represents the Vibrator, in which the force impinges at right angles with the surface of the body, sending waves of motion through its substance.
The rubbing which is shown in Figs. 4 and 5 may be applied to all parts of the body in a recumbent position. A couch is required of similar construction to the vibrating couch, but with a rubbing-pad instead of vibrating heads acting through the opening and operated by appropriate connections, as shown in Fig. 12. The top is adjustable, and the degree of effect desired is capable of easy regulation. The patient turns different portions of the body to the action of the rubber as required.
Kneading. Kneading is a process applied chiefly to the abdomen. The purpose of this operation is to increase nutrition, the muscular power and action of the abdominal walls, and the function of the organs which they contain. Three modes of applying this operation by the mechanical apparatus are in use, effected by the Direct, the Rotary, and the Revolving Kneader.
The Direct Kneader. This resembles in form and action the vibrating instrument shown in Fig. 11. The impinging heads, however, are made broader, the motion greater in extent, and the rate of motion less than one-tenth of that employed for the purpose of vibrating. This slowness of motion seems to increase the action of the muscles.
The Rotary Kneader. The action of the kneading heads in this form of apparatus, as shown in Fig. 13, is inward and upward alternately, and it is eminently well calculated to stimulate the action of the abdominal organs.
The Revolving Kneader. In the form of kneading apparatus, shown in Fig. 14, two thick rollers, which move freely on axes at the extremities of arms, projecting on either side of a shaft turned by a crank or belt, are made to act alternately upon each side of the abdomen.
In the methods of kneading above described, the degree of force acting on the body is governed by an arrangement for elevating or depressing the upholstered top of the couch upon which the patient rests, and through which the action is transmitted to the body.
If this form of apparatus is driven at a rate ten times more rapidly than is desired for kneading, the effect is vibratory, and it is, in fact, used for that purpose.
