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NERVE-VIBRATION AND EXCITATION. 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/nervevibrationexOOgran 
 
NERVE-VIBRATION AND 
 EXCITATION 
 
 AGENTS IN THE TREATMENT OF FUNCTIONAL 
 DISORDER AND ORGANIC DISEASE. 
 
 J. MORTIMER GRANVILLE, M.D. 
 
 LONDON: 
 J. & A. CHURCHILL, 
 
 NEW BURLINGTON STREET. 
 1883. 
 
/f/3 
 
TO THE READER. 
 
 The time has arrived when it seems incumbent upon 
 me to place before the profession in a succinct form 
 my views on the subject of nerve-vibration and excita- 
 tion as remedial agents, or processes, for the treatment 
 of functional disorder and organic disease. 
 
 I publish the statements submitted in the following 
 pages in the spirit of an investigator who feels bound 
 to report the progress he has made in an arduous and 
 difficult inquiry. It will be only fair to understand 
 that the inferences I have drawn from a large, though 
 perhaps insufficient, series of clinical observations, are 
 held and put forth tentatively. Further experience may 
 necessitate both corrections and recantations. Mean- 
 while, of the matters I have treated as facts in this 
 little treatise I am assured. It is only as to their 
 significance, and the relative value which should be 
 attached to them, there can be any question. 
 
 I ask nothing more than that courteous hearing which 
 is commonly accorded to the explorer who announces 
 the discovery of a new province, and such confidence as 
 may induce others to help in the investigation of what 
 seems likely to prove an important addition to the 
 number and range of our remedial resources. 
 
 J. Mortimer Granville. 
 
 16, Welbeck Street. 
 
CONTENTS. 
 
 TAGE 
 
 TO THE READER 6 
 
 INTRODUCTORY 9 
 
 THE PRINCIPLE 44 
 
 GENERAL OUTLINE OF THE TREATMENT AND DESCRIP- 
 TION OF THE APPARATUS 44 
 
 THE PRACTICE 6o 
 
 FOR THE RELIEF OF PAIN 6o 
 
 FOR THE CONTROL OF DISORDERLY MOVEMENTS . . 67 
 
 TO ELICIT ENERGY FROM TORPID CENTRES .... JO 
 
 TO ALLAY MORBID IRRITABILITY 72 
 
 TO RELIEVE CEREBRAL AND CEREBRO-SPINAL IRRI- 
 TATION AND DISTRESS 93 
 
 TO IMPROVE THE VASO-MOTOR STATE ...... I06 
 
 NEURASTHENIA 112 
 
 INDIGESTION, CONSTIPATION, TENSION-ALBUMINURIA, 
 
 ■ AND PSEUDO-DIABETES 1 17 
 
 CONCLUSION 125 
 
INTRODUCTORY. 
 
 I DO not affirm that nervous force is the product of 
 nerve-vibration ; but science certainly justifies the belief 
 that nerve action, or activity, consists in, or is accom- 
 panied by, vibrations of the essential elements of 
 nervous tissue in the body, or frame — so to say — 
 formed by the complementary parts of its structure. 
 
 Cells vibrate as bodies suspended in the intercellular 
 stroma of the grey matter, and fibres vibrate as deli- 
 cately poised rods or strung cords within the partite 
 cylinders formed by internal prolongations of the neuri- 
 lemma or nerve sheath. 
 
 When deposits take place, in the progress of disease, 
 in the interstices of a nervous cell bed, or between, 
 or upon, the layers or partition walls of a nerve sheath, 
 or when the connective tissue forming the framework 
 of a nervous structure proliferates, the vibration of cell 
 or fibre is mechanically prevented, and the discharge 
 or transmission of nervous force from a centre or along 
 a nerve becomes physically impracticable. 
 
 The pathological anatomist calls this solidification of 
 the stroma of the nervous organism sclerosis, and thinks 
 that in it he has found the efficient cause of loss of sensa- 
 
10 NERVE-VIBRATION AND EXCITATION. 
 
 tion or deprivation of power. He accepts the post hoc, 
 and interprets it as the propter hoc. In all humility, I 
 venture to doubt the accuracy of his judgment, and 
 to dispute the logical character of his reasoning. It is, I 
 think, by no means certain that sclerosis of the posterior 
 or anterior columns of the spinal cord is the cause of anaes- 
 thesia or of myo-paralysis respectively. If the student 
 of morbid appearances in the nervous system will take the 
 trouble to examine even a small area of sclerosed brain, 
 cord, or nerve tissue, carefully, particularly in the most 
 recent zones or tracts marking the progress of the disease, 
 he will almost certainly find some, often many, cells or 
 fibres which lie atrophied amid their surroundings, with 
 clear interspaces between their shrivelled walls, and the 
 adventitious matter producing the sclerosis. In short, 
 solidification, or sclerosis, is not less likely to be the 
 consequence or concomitant of atrophy of the essential 
 elements of nervous tissue than to be its cause. 
 
 The significance of this alternative reading of the 
 record left by disease in the post-mortem appearances 
 will be obvious, when we reflect that if cell and fibre are 
 the parts of nervous structure which first suffer in 
 the advances of paralytic disease, and the sclerosis is 
 contingent and secondary, it may well happen, if, indeed, 
 it be not probable, that by an energetic and wise applica- 
 tion of the law of development by exercise, the nutrition 
 of the nervous elements may be improved, and their 
 recovery effected by stimulation through function. If 
 the degenerating, but, perhaps, not yet irrecoverably 
 degenerated, cells or fibres are thrown into vibration they 
 may act, and, in obedience to the law which determines 
 
INTRODUCTORY. I I 
 
 that every particle of organic matter shall feed as it 
 works and in that proportion only, they may begin to take 
 in increased nourishment, and recover in virtue of the 
 vis mcdicatrix of the organism as they are healthily 
 stimulated by rhythmical motion. Moreover, by induc- 
 ing and maintaining vibratile movements in the nervous 
 elements proper, the encroachment of the solidifying 
 deposit or proliferating connective tissue may be arrested, 
 the mere mechanical motion of the nerve structure 
 tending to shake the elements loose from any recent and 
 as yet unconsolidated entanglement, and to promote the 
 absorption of adventitious material, in such manner as the 
 thickening around a joint, or those adhesive bands which 
 spring upwithin or between tendons and their sheaths, are 
 broken down and ultimately absorbed under the influence 
 of passive movements. Whatever else we may do to 
 promote the absorption of deposits, our first aim should 
 be to restore or preserve the free mobility of the vibratile 
 elements, and in no other way can this be so readily or 
 effectively accomplished as by mechanical vibration. 
 
 I do not think the mechanical vibration of nerve 
 tissue can be effected by electricity, or, at least, with the 
 constant current. That current simply uses the nerve 
 structure as a conductor, and passes along it without 
 throwing it into vibration. Electricity travels in the 
 line of least resistance, without relation to the particular 
 tissue which offers itself as a conductor, except so far 
 as regards its capacity for receiving and transmitting the 
 current. Electricity will pass along the track of a nerve, 
 taking the place of nervous energy, and itself produc- 
 ing the phenomena of muscular contraction instead of 
 
12 NERVE-VIBRATION AND EXCITATION. 
 
 eliciting nervous force from the nerve centres. So 
 far as the nutrition of tissues other than the nervous, 
 is concerned, the value of constant, or static, electricity 
 is beyond question. It is one of the most potent 
 therapeutic agents we possess, and when intelligently 
 and expertly applied, signally useful ; but I do not 
 think it improves the nutrition of the nerve or nerve 
 centres, unless it be indirectly. The interrupted current 
 acts differently. This has the power of throwing any 
 particle of matter, whether living or inorganic, into 
 mechanical vibration, and it is, therefore, quite possible 
 that it may throw nerve elements into vibration, but if 
 it does, there is added to this good the doubtful effect 
 of infusing the organism with a force which is foreign 
 to its economy, although it may closely resemble the 
 nervous force it substitutes. By introducing an electric 
 current into the body, we are taking the function of activity 
 out of the hands of Nature, and throwing the proper func- 
 tion of the nerve elements into abeyance ; whereas, by 
 simply calling out nervous force from the nerve centres, 
 by throwing them and their interconnecting fibres into 
 vibration, we are waiting on Nature, and helping her 
 to do her work with her own forces and in her own way. 
 All that is done by the nervous system in respect to the 
 stimulus of vibration is necessarily performed by nervous 
 force, elicited, reflexly, from the nerve centres. It can- 
 not be otherwise, because mere vibration has nothing to 
 communicate beyond its own " form of motion." 
 
 The facts underlying the principle of nerve-vibration 
 and excitation by mechanical movement may be set 
 out as follows : — 
 
INTRODUCTORY. I3< 
 
 i. When nervous tissue acts, its essential elements — 
 viz., cells and fibres — vibrate. It follows that by 
 throwing these elements into vibration by mechanical 
 movement, we establish a condition favourable to the 
 discharge of nervous force from the centres affected, and 
 at the same time stimulate the nerve centre, when 
 discharged, to develop new force to compensate the loss 
 of energy expended in exercise. 
 
 2. The vibration of nervous elements being a purely 
 mechanical process, it must be conformable to the laws 
 or conditions that govern the vibratile movement of other 
 bodies, whether organic or inorganic — for example, reed 
 instruments — and the vibration of cells and fibres should, 
 therefore, be amenable to the laws of concord and discord. 
 In short, what Newton discovered and taught in explica- 
 tion of the phenomena of light and sound, with the recog- 
 nized correlations of the diatonic and chromatic scales, 
 must be equally applicable to an as yet unrecognized 
 but doubtless existing scale of nerve-vibrations. And 
 such affinity must exist between the nature of the 
 faculty, and the working of the organic apparatus, of per- 
 ception, in regard to sound, colour, and other forms or 
 properties of the external, and other physical processes 
 whereby these forms or properties of matter are pro- 
 duced, that the nervous system and the external world 
 are not simply en rapport, but physically correlated. 
 It is, therefore, only reasonable to suppose that the 
 evolution of nervous force is governed by the same 
 laws that govern the evolution (or production) of light, 
 colour, sound, odour, and other qualities or properties of 
 matter which are in many instances demonstrably, and 
 
14 NERVE-VIBRATION AND EXCITATION. 
 
 in all others presumably, due to modes and formulae of 
 mechanical vibration. For example, light and sound 
 are effects of the specific vibration of particles or mole- 
 cules of matter, and they produce their characteristic 
 phenomena (so far as we are cognisant of their existence), 
 by vibrating the special apparatus of the eye and the ear 
 respectively — namely, the rod and cones of the retina 
 in the eye, and the loops or terminal expansion of the 
 auditory nerve in the internal ear. These several sets 
 of mechanical vibrations are propagated along the fibres 
 of the second and seventh nerves to their respective 
 centres, wherein, by the vibration of cells, in mechanical 
 relation with the communicating nerves, the function of 
 special perception is performed. 
 
 3. As a necessary result of this state of matters, it 
 must be possible to act on the nervous system by purely 
 mechanical agents and influences, with the effect of 
 interrupting, modifying, or altogether arresting organic 
 vibrations, whether in afferent sensory or efferent motor 
 nerves. These effects are capable of demonstration, 
 producing changes in the rate and rhythm of nerve 
 vibration precisely correspondent with those which would 
 be effected in the vibration of unorganized substances by 
 the operation of the same or similar agents working in 
 like processes. 
 
 The system or method of treatment which I am 
 anxious to bring under the very serious consideration of 
 the profession consists in the application of the laws of 
 physical, or mechanical, vibration as they affect ordinary 
 substances, to the interruption and change of morbid 
 states of the vibratile organism. The apparatus by 
 
INTRODUCTORY. 1 5 
 
 which the desired movements are produced is altogether 
 secondary in importance to the principle itself. I use 
 percussion ; others may use vibratory instruments which 
 do not percuss the tissue, but communicate their own 
 vibrations to the organism by simple continuity. This 
 I take to be the method adopted by M. Boudet de Paris, 
 who more than two years after my percuteurs were in 
 the hands of leading physiologists and therapeutists, 
 published a paper in Le Progres Medical, wherein he set 
 forth views and described a method differing in several 
 important particulars from my own, but practically 
 embodying the same idea. The Lancet, of Feb. 12, 
 1 88 1, just four years after my instruments were made in 
 London, contained the following summary of M. Boudet 
 de Paris' paper : — 
 
 " Treatment of Pain by Mechanical 
 Vibrations. 
 
 " For some years past Dr. Mortimer Granville has 
 been occupied with important researches upon the 
 possibility of combating neuralgia by mechanical means. 
 Proceeding largely upon theoretical considerations, he 
 came to the conclusion that a series of interrupted 
 mechanical shocks to a nerve would diminish its sensi- 
 bility, and for that purpose invented a small instrument 
 whereby a succession of rapid blows could be kept up 
 upon the skin. Many physicians in London and Paris 
 have seen and employed the apparatus, and spoken of it 
 with approval ; but Dr. Granville forbore to bring it 
 under general notice until it had been thoroughly tested. 
 He has paid the penalty of his patience, and the old 
 
1 6 NERVE-VIBRATION AND EXCITATION. 
 
 story is repeated of the publication of an idea by another 
 person by whom it was conceived long after the one 
 who first thought of it, but who did not proclaim it to 
 the world. In justice to himself, Dr. Granville should 
 forthwith point out how he arrived at the idea, and 
 state his experience of its practical enforcement. 
 Meanwhile it may be interesting to summarize the 
 statements of M. Boudet de Paris, who writes on 
 the subject in the current number of Le Pr ogres Medical. 
 After alluding to Dr. Brown-Sequard's observation that 
 chloroform applied over the skin of an animal produces 
 general anaesthesia by its irritant action on the peri- 
 pheral nerves, he points out that all irritants or re- 
 vulsives may be placed in one category — such as actual 
 cautery, hypodermic injections of water, application of 
 metals, magnets, tuning-forks, electricity, vesicatories, 
 sinapisms, compresses steeped in ether or chloroform, 
 a motley group, but each intended for the same end — 
 the relief of pain ; they all operate by irritating the 
 terminal twi^s of sensory nerves. Vulpian long ago 
 showed th$ - ;Ood effect of the local application of chlo- 
 roform ; i d Landouzy has recently pointed out the 
 remarkable influence in controlling the cough of phthisis 
 by hypodermic injections of water ; whilst the cautery, 
 acupuncture, and each of the forms of electricity are 
 commonly applied to relieve pain. The action of 
 metallic applications — metallo-therapy — of which we 
 have heard so much in the last few years, was best ex- 
 plained on the theory of vibrations by Vigouroux, who 
 proceeded to experiment upon the effect of sonorous 
 vibrations, which he thought might have a direct 
 
INTRODUCTORY. I "J 
 
 mechanical effect upon the sensory nerves. By the aid 
 of a large tuning fork and sounding-board he caused 
 hemianesthesia to disappear, and provoked contractions 
 in hysterical subjects at la Salpetriere, as rapidly as 
 with the magnet or electricity. The pains of an ataxic 
 were subdued when his legs were brought under the 
 influence of these sound-waves. M. Boudet de Paris 
 then thought this might be applied locally over a nerve 
 — the sonorous being changed to mechanical vibrations 
 by means of a small button attached to the resonater, 
 and applied over the nerve. He therefore contrived a 
 small apparatus consisting of an electrically mounted 
 tuning fork, the vibrations of which were transmitted 
 to a rod which could be easily applied over a nerve. 
 In a healthy man this mechanical excitation produced 
 rapid local analgesia, often anaesthesia, the maximum 
 effect being produced by application over a nerve which 
 could be compressed on a bony surface. When placed 
 against the skull its walls vibrate in harmony with the 
 tuning-fork, and a sensation of approaching vertigo, 
 frequently followed by a desire for sleep, is produced. 
 An attack of migraine can be cut short by the appli- 
 cation. Neuralgia — especially of the fifth, where the 
 nerves issue from bony canals — disappears after a few- 
 minutes' application of the instrument to the nerve at 
 such points, but in the case of deeper-seated nerves, 
 much protected by soft parts, it is more difficult to get 
 good results. The writer suggests this treatment for 
 the pains of ataxics and syphilitics ; he thinks there is 
 no limit to its applications, and suggests that perhaps 
 cranial vibrations may induce cerebral and thus general 
 
 B 
 
16 NERVE-VIBRATION AND EXCITATION. 
 
 anaesthesia. Its mechanical action is comprehensible, 
 when we see how simple friction of the skin may soothe 
 very acute pain. He does not regard the number of 
 vibrations as important. This, however, is we believe, 
 a point on which Dr. Mortimer Granville lays the 
 greatest stress.'' The publication of this paper by M. 
 Boudet de Paris, describing the method of M. Vigouroux, 
 forced my hand, so to say, and compelled me to place the 
 results of many years study of the subject prematurely 
 before the profession. My investigations grew out of a 
 search for means to relieve the intolerable pain of neu- 
 ralgia. It will be convenient to reproduce my own paper, 
 which appeared in The Lancet, February 19, 1 881, as 
 it is virtually a reply to M. Boudet de Paris : — 
 
 " The publication of certain results obtained in an 
 investigation which I have been pursuing for some 
 years past, having been to a large extent anticipated 
 hy a paper which appeared in Le Pr ogres Medical of 
 the 5th inst, from the pen of M. Boudet de Paris, 
 ancien interne des hopitaux de Paris, I have no 
 alternative but to bring my researches, together with 
 such facts, real or imaginary, as I have succeeded 
 in eliciting, under the notice of the profession here 
 and on the Continent, Indeed, I owe some expla- 
 nation to many friends in England and in Paris for 
 having so long delayed to report the progress of my 
 experiments. Nevertheless I break silence thus early 
 with the greatest reluctance, and only under the pres- 
 sure of circumstances. As regards the accident of 
 ' forestalling,' if I am not mistaken, M. Boudet de Paris 
 will have greater cause than I have to regret what I 
 
INTRODUCTO RV. 1 9 
 
 cannot but feel is the premature announcement of a 
 discovery. On August 5, 1878, Professor Brown- 
 Sequard wrote me as follows : — ' If it (the instru- 
 ment employed in these experiments) has the power 
 you state, you have certainly made a very important 
 discovery.' I could not but feel that there was a virtue 
 in that ' if to enforce reserve until other judgments 
 besides my own were fully satisfied. Such grave 
 responsibility attaches to any member of the profes- 
 sion who ventures to suggest a new, or seemingly new, 
 method of treatment, and who dares to hold out a hope 
 of remedy or relief for the miseries of mankind, that I, 
 for one, must confess to a great shrinking from the 
 hazard of rushing into print prematurely. This feeling 
 alone has induced me to keep silence during the last 
 three or four years, and I am convinced the same 
 motive has influenced the several physicians who have 
 kindly tried my method and employed my percuteur, 
 to wait until convinced of their validity and value before 
 giving to either the sanction of their authority. Among 
 the gentlemen to whom I have submitted my specula- 
 tions, and shown my instrument, I may mention Pro- 
 fessor Brown-Sequard, Professor Ball, and Dr. Oscar 
 Jennings of Paris, and Drs. Ringer and Gowers of 
 London. These names are in themselves sufficient to 
 guarantee that, if the results obtained by experiment had 
 been such as to establish my conclusions, they would 
 long since have been announced, and, unless I am greatly 
 mistaken, the results recorded by M. Boudet de Paris 
 cannot, in any therapeutical sense, be more trustworthy 
 than my own. I will now tell the story of my investiga- 
 
 B 2 
 
20 NERVE-VIBRATION AND EXCITATION. 
 
 tions, and thus mark the point reached in the search for 
 a new remedy. 
 
 "As far back as 1862-3, I was, in the course of 
 certain clinical studies of mental and sensory phe- 
 nomena, induced to believe that many forms of the 
 sensation we call ' pain' were in fact, unnecessary, and 
 might be interrupted by appropriate mental and physical 
 methods and appliances. My first observations were 
 made in connection with the paroxysmal, or recurrent, 
 pains accompanying the uterine contractions in the 
 natural process of parturition. On May 4, 1864, 
 Dr. Graily Hewitt was good enough to communi- 
 cate the results of my experiments and to show cer- 
 tain apparatus to the Obstetrical Society of London. 
 In a paper ' On the Application of Extreme Cold as 
 an Anodyne in the Pain attendant on Parturition,' a 
 short abstract of which will be found in The Lancet of 
 July 9, 1864, I contended that the sensations of pain 
 experienced by the parturient woman were not invari- 
 ably synchronous with what, for want of a better name, 
 we term the pains of labour ; and from this and other 
 premisses — for example, the circumstance that they 
 are commonly ' referred' to regions more or less remote 
 from the contracting uterus, or the dilating external 
 passages, in which the real seat of the pain might have 
 been supposed to be located — I deduced that the pain 
 attendant on labour is neuralgic in character. I had con- 
 structed small boxes or chambers of such sizes and shapes 
 as to admit of their being applied to the supposed seats of 
 the pain. These were filled with freezing mixture, and 
 the effect of sudden contact in some thirty cases was to 
 
INTRODUCTORY. 21 
 
 arrest the sensation of pain without in the least degree 
 lessening the force of the uterine contractions. The ex- 
 periment was of course simply interesting as bearing on 
 the nature of the pain, as this process was too trouble- 
 some to admit of its adoption in practice ; although 
 some of the persons on whom I had the opportunity of 
 trying my method experienced such striking relief that 
 on subsequent occasions I believe they asked that the 
 measure might be repeated. Having so far persuaded 
 myself that this form of pain was neuralgic, and that if 
 the nerve affected could be strongly impressed, so as to 
 change its state of irritation, the pain would cease, I 
 proceeded to try the effect of rapidly tapping the skin 
 over the fifth nerve in ordinary facial neuralgia with a 
 Bennett's percussion hammer, using the ivory plexi- 
 meter as a shield. The results obtained by this method 
 "were very remarkable. Still, I simply thought of 
 arresting the morbid action by shock. Later on — it is 
 only possible to sketch the outline of the inquiry — I 
 was led, by the light thrown on Newton's doctrine of 
 concords and discords, by Grove's generalization as to 
 the correlation of forces, and more recently by Professor 
 Tyndall's beautiful series of experiments with sensitive 
 flames and musical burners, to believe that the results 
 of the tapping were not, like the interruption with 
 shock produced by the sudden application of cold, due 
 to a mere arrest of the painful state of irritation into 
 which the nerve had been thrown, but were, in fact, 
 brought about by the extinguishment of a morbid — 
 that is, either inordinate or disorderly — set of vibrations 
 by the super-imposition of another, incompatible or dis- 
 
22 NERVE-VIBRATION AND EXCITATION. 
 
 cordant, set of vibrations mechanically produced. With 
 this notion I set to work to devise an instrument which 
 should give a known number of blows per second, and 
 thus admit of this new phase of the inquiry being- 
 pushed farther. Such an instrument was made for me 
 at the establishment of Mr. Streeter, of New Bond 
 Street, from a sketch and specification dated January 5, 
 1877. With the c percuteur' thus made, and others 
 by M. Collin, of Paris, results which I would charac- 
 terize as suggestive rather than conclusive have certainly 
 been obtained, They are, in brief, as follows : — 
 
 " The sensation produced by the application of the 
 instrument over a healthy nerve, so situated as to be 
 readily thrown into mechanical vibration, closely resem- 
 bles the effect of a weak dose of the interrupted current 
 of electricity, and if it be prolonged the vibration 
 extends its area, exciting first formication or tingling, 
 then a sensation of numbness, and finally some twitch- 
 ing of the superficial muscles. A nervous headache, 
 and even migraine, may be induced by the application 
 of the percuteur to the frontal ridges or the margins of 
 the orbit. By the intervention of a thin plate of metal, 
 or stiff paper, the vibration may be readily propa- 
 gated through a considerable region of the surface of 
 the body, and in time the deeper muscles will fre- 
 quently begin to act. I have, indeed, produced an 
 involuntary movement, not unlike tendon-reflex, by 
 applying the percuteur for some time over the tendon 
 of the rectus femoris above the patella. Still more 
 notable has been the fact that by laying a sheet of 
 paper over the abdomen, and moving the percuteur 
 
INTRODUCTORY. 23 
 
 slowly in large circles round the umbilicus, the in- 
 testines have seemed to be excited to vermicular move- 
 ment, and the bowels commenced to act. These 
 results have not been constant, but have occurred with 
 sufficient frequency to indicate that the experiments 
 already made are worthy to be repeated. 
 
 "With respect to the relief of neuralgic pain, the 
 operations of the instrument are certainly very remark- 
 able, but not, in my judgment or in that of other ob- 
 servers, such as to justify the assertion that it constitutes 
 an appliance for the relief of pain. In some instances 
 — pretty numerous — the pain of neuralgia in the 
 branches of the fifth has been quickly arrested by its 
 application, and has not soon returned, or, if it has done 
 so, has again unmistakably yielded. In other instances 
 the sensation has been aggravated by the augmented 
 state of vibration into which the nerve has been thrown 
 through the shaking of the adjacent tissues. And here 
 I must mention a point to which I attach the greatest 
 moment, and which, I think, will hereafter be found to 
 prove the key to the whole phenomena. A compara- 
 tively high number of vibrations per second seems to 
 relieve a dull aching, a ' massive ' or grinding pain, 
 while an acutely pitched .and quick pain is most 
 frequently arrested by a slower movement of the in- 
 strument. If I may step beyond the province of a 
 simple reporter of clinical phenomena for one moment, 
 I will take leave to say that I think these results go to 
 support my theory that it is by the introduction of 
 discord into the rhythm of the morbid vibrations of the 
 painful 'state' the change which brings relief is effected. 
 
24 NERVE-VIBRATION AND EXCITATION. 
 
 To apply the percuteur with a high rate of blows per 
 second will aggravate the morbid state when that is 
 itself a series of rapid vibrations, and in the same way 
 a low speed of percussion increases, instead of relieving, 
 the pains of a low pitched and slow ' boring ' or 
 'grinding' sensation. Acute or sharp pain is, I be- 
 lieve, like a high note in music, produced by rapid 
 vibrations, while a dull, heavy, or aching pain resembles 
 a low note or tone, and is caused by comparatively slow 
 vibrations. A slow rate of mechanical vibration will 
 therefore interrupt the rapid nerve-vibration of acute 
 pain, while quick mechanical vibration more readily 
 arrests the slower. The aim — if I am right in my con- 
 jecture — should be to set up a new set of vibrations 
 which shall interrupt or change the morbid set by intro- 
 ducing discord. Failure in the application of this 
 principle will, I believe, be found to explain the failure 
 to put an end to the pain ; and I have, accordingly, 
 set as much scientific value on my failures as on my 
 successes. 
 
 " My percuteurs are all defective in one particular : 
 although they consist of a simple train of cogged-wheels 
 worked by a spring and acting on a lever which car- 
 ries an ivory hammer, and are provided with an indi- 
 cator, which shows the speed, and a screw movement 
 to control it, they do not obey the will of the operator, 
 because the slightest pressure of his hand shortens the 
 arc in which the hammer works, and proportionally 
 accelerates the stroke. M. Collin has modified my 
 instrument, but he has not, so far as I am aware, entirely 
 remedied this defect. If M. Boudet de Paris can so 
 
INTRODUCTORY. 25 
 
 improve his instrument as to obtain control of its move- 
 ments and to propagate a known set of vibrations, he 
 may succeed better than I have done ; but I should be 
 glad to find that the result could be obtained without 
 the use of electricity, as it. is important to the scientific 
 interest of the instrument — and as yet it cannot, I am 
 convinced, be said to have a therapeutic value — to show 
 that the vibrations are purely mechanical, and propa- 
 gated through the tissues by a force acting externally. 
 It would be one thing to induce change of the organic 
 vibrations by internal force, and quite another to over- 
 power the internal movements by force operating from 
 without. The result may be the same, but the two 
 methods of reaching it are essentially different. 
 
 " That all nerve action is vibratile, and that the 
 neuralgic state consists essentially in an abnormal set or 
 series of vibrations into which the nerve has been thrown 
 — perhaps by a jet of cold air, or a mechanical or 
 chemical irritant — I have no doubt. That this state 
 may be changed by mechanical vibrations propagated 
 to the nerve-sheath and its contents through the 
 adjacent tissues I am convinced. I have not, however, 
 as yet, got one step further than persuading myself 
 that these are genuine propositions, and capable of 
 demonstration by experiment — to wit, the causation of 
 neuralgic pain, and the induction of the neuralgic state 
 generally, by mechanical vibrations, and the relief of 
 these conditions, when they exist, by the same method. 
 The essence of the process is disturbance and change of 
 the rhythm. When I began to study the effect of cold, I 
 thought the results obtained were reached by deadening 
 
2 6 NERVE-VIBRATION AND EXCITATION. 
 
 the nerve or 'lowering its sensibility,' as we say ; but I 
 soon found that the effect was proportioned to the 
 intensity of the shock produced by the sudden contact 
 with the cold substance, not the duration of the chilling 
 process. When cold gives relief by its continuance, 
 rather than instantly on its application, I think that is 
 because the morbid vibrations of the nerve cannot, for 
 some physical reason, be interrupted by shock ; possibly 
 the nerve is situated too deeply, or is covered by dense 
 tissues, or lies so loosely amid its surroundings as to be 
 practically insulated, and the morbid vibrations are not 
 arrested until the cold contracts the surrounding tissues, 
 and causes them to mechanically grip the terminal twigs 
 of the nerve which is vibrating painfully. In some 
 instances the percuteur is so powerful as to arrest 
 the morbid vibrations on one side and propagate a 
 painful set of vibrations through the centre to the other 
 side. This may strike the reader as a mere assertion, 
 but I am persuaded it will be found to be borne out by 
 experiment. If I am not greatly mistaken, the percu- 
 teur, or some more perfect mechanical vibrator, will do 
 all that ' metallo-therapy' has achieved in the same 
 class of cases. We do not sufficiently appreciate the 
 effect of subtle or subtilly applied forces acting on the 
 organism. When the so-called mesmerist induces a state 
 of hypnotism in his patient by simply blowing on the 
 face, or when by ' passes' he impresses the retina, he 
 acts physically on the terminal twigs of highly sensitive 
 — and generally educated — nerves, and induces a set 
 of actions which, though notable in themselves, are no 
 more mysterious in the manner of their production than 
 
INTRODUCTORY. 2 J 
 
 the involuntary strong muscular action excited by the 
 ' tickling' of a hair or a feather, or the crawling of an 
 insect. As a matter of fact, the surface is generally 
 more powerfully impressed by these minor applications 
 of mechanical force than by the greater. If you touch 
 an exposed sub-cuticular surface lightly you give ex- 
 treme pain ; if you grasp it somewhat firmly you cause 
 less suffering. This is quite as likely to be because, in 
 the first case, the terminal twigs of the sensitive nerves 
 are set vibrating, whereas in the latter vibration is pre- 
 prevented, as due to the local blood-change to which 
 these results are commonly attributed. While a 
 poultice is moist, and clings to the surface of a sore, it 
 soothes by holding the nerve-fibres still ; when it begins 
 to dry, and they are liberated, the poultice becomes an 
 irritant. The physical basis of the so-called hysterical 
 state, or the peculiarity of nervous organization which 
 predisposes to hysteria, is, I think, simply a class or 
 type of structure which renders the nervous elements 
 especially liable to vibrate in their sheaths, and thus ex- 
 poses them to the risk of falling readily into any rhythm 
 which the will, the physico-mental environment, or per- 
 haps even the proximity of similar structures vibrating 
 in other bodies characterized 'by the same physical 
 organization, may suggest. If musical burners, supplied 
 from different reservoirs of gas, will presently vibrate in 
 concord ; if strings or reeds vibrating at the same time, 
 though a short distance apart, will fall into harmony, 
 why is it unlikely that nervous organisms, possessing the 
 same qualities of physical structure, should exhibit a 
 corresponding affinity ? Science points clearly to 
 
28 NERVE- VIBRATION AND EXCITATION. 
 
 physical states, as the bases of nervous and mental 
 phenomena. The female organism is characterized not 
 inaccurately, though popularly, by the phrase - finely 
 strung nerves.' It is literally mobile, and it is chiefly 
 among females the phenomena of hysteria, and the 
 allied states, are observed. When the symptoms and 
 conditions so designated do occur in the male, the 
 individual organism is generally of a feminine character. 
 " In conclusion, I would venture to predict that it 
 will be found that nerve action, both normal and ab- 
 normal, consists of vibrations, and that other mechanical 
 vibrations set up and propagated by any mechanical 
 apparatus or appliance, acting from without and propa- 
 gated through the tissues, may be made to modify the 
 internal movements ; that normal vibrations consist of 
 movements of the constituent parts of a nerve within 
 its sheath, and that when these become inordinate or 
 disorderly they are propagated to the sheath itself, and 
 then become painful ; that under this last-mentioned 
 condition the wave of vibration is likely to be propa- 
 gated along the sheath of the nerve, and through it to 
 the sheaths of other nerves with which the first in order 
 of disturbance may be mechanically related, either by 
 direct contact or through intervening tissues ; that the 
 action of irritants applied to the skin is mechanical, 
 producing contraction of the tissues, and either first 
 gripping and then relaxing the terminal twigs of the 
 nerves, thus throwing them into mechanical vibration, 
 or so changing the constitution of the bed in which 
 these terminal twigs lie, as to oppose a mechanical 
 obstruction to their natural vibration, and thereby con- 
 
INTRODUCTORY. 29 
 
 vert it into a morbid rhythm. This, indeed, has been 
 demonstrated by Dr. Ringer, in his classic treatise on 
 Therapeutics, in connexion with the modus operandi of 
 blisters, etc. These may be set down as crude specula- 
 tions, but they are the results to which experiment and 
 commonplace reasoning point, and they are in harmony 
 with a view of the phenomena of nerve action and of pain 
 which the inquiry I am pursuing forces upon me, and 
 by which nearly all the wonders of the hysterical school 
 of medical philosophy may be explained. I cannot 
 claim to have discovered a ' cure' for neuralgia, or even 
 a certain method of treatment for its relief. The time 
 has not arrived when it may be possible to commend 
 this new method to the notice of the medical profession 
 as a known agency for the alleviation of suffering ; but 
 as the facts have been prematurely published, I think 
 the method should be tried." 
 
 It will be noted that whereas M. Boudet de Paris does 
 not, as The Lancet pointed out, attach any importance to 
 the rate or rhythm of the mechanical vibrations where- 
 with he strives to interrupt the morbid and painful vibra- 
 tions of the nerves on which he operates, I regard that 
 point as of crucial moment, and believe the issue of 
 success or failure will be mainly determined by the 
 musical relation which exists between the externally 
 induced motion and that which it is desired to control or 
 arrest. 
 
 As to the question of priority, this was happily 
 settled for me, at once, by the friendly promptitude of 
 Professor Brown-Sequard, Professor Ball, and Dr. Oscar 
 Jennings in Paris, and Dr. Sydney Ringer and others 
 
30 NERVE-VIBRATION AND EXCITATION. 
 
 in London, to whom my percuteurs were submitted 
 long before the experiments, upon which M. Boudet de 
 Paris founded his paper, were undertaken. As a 
 matter of fact, nerve-vibration by percussion, with 
 instruments furnished by myself, was tried at the 
 National Hospital in Queen Square, London, in 
 January and February, 1878. 
 
 The following is a note furnished to me by one 
 of the medical officers of the institution at that date : — 
 
 " A medical man complained of neuralgic pain in his 
 right internal cutaneous nerve, resulting, as he supposed, 
 from a blow by a cricket ball. The pain came on at 
 varying intervals, and during the intervals he could 
 produce it by squeezing the site of the blow. The 
 application of the instrument entirely stopped the pain 
 and, much to his surprise, for a few minutes after he was 
 unable to reproduce it. These experiments were repeated 
 twenty or thirty times with the same result.''' 
 
 The percuteur with which these experiments were per- 
 formed, Was made for me by Mr. Streeter, of New Bond 
 Street, from drawings dated Jan. 5, 1877. Later on, but 
 still long before the researches of M. Vigouroux and M. 
 Boudet de Paris, my percuteurs were on trial at the 
 Laennec Hospital, and the hospital of St. Anne, by the 
 courtesy of Professor Ball. Professor Brown- Sequard 
 affirmed my claim to priority before the Biological Society 
 of Paris ; Professor Ball did the same in U EncepJiale ; 
 and Dr. Oscar Jennings addressed the following letter to 
 Le Progres Medical, calling forth the annexed rejoinder 
 from M. Boudet de Paris : — 
 
INTRODUCTORY. 3 1 
 
 <l Traitement de la douleur par les vibrations 
 
 MECANIQUES. 
 
 " Nous avons recu, a. propos du travail de M. Boudet 
 de Paris que nous avons publie il y quelques jours (1) 
 la lettre suivante de M. le Dr. Jennings. 
 
 Monsieur le Redacteur, — Dans un article qui a paru 
 dans le dernier numero du Progres Medical, M. Boudet 
 de Paris s'occupe du traitement mecanique de la douleur. 
 
 Longtemps avant votre collaborateur, un medecin 
 anglais, M. le Dr. Mortimer-Granville, s'etait occupe de 
 la meme question. II a meme invente un instrument 
 special qu'il a nomme ' le percuteur.' Cet instrument 
 est destine a frapper des coups redoubles sur la partie 
 malade, avec une rapidite que Ton peut graduer a 
 volonte. II se vend chez Collin, le successeur de 
 Charriere. M. Granville a fait l'essai de son instru- 
 ment a Londres, il y a quatre ans, et des essais suivis 
 ont eu lieu Pannee derniere dans le service de M. 
 le Professeur Ball, a 1'hopital Laennec. Je possede de 
 nombreuses observations qui permettent d'apprecier la 
 valeur de ce traitement. Si elles n'ont pas ete 
 publiees jusqu^a present, c'est parce que Tutilite pratique 
 du percuteur ne me paraissait pas suffisamment demon- 
 tree. II calme incontestablement la douleur, mais pour 
 un temps limite. Cette observation s'appliquerait peut- 
 etre aux moyens employes par M. Boudet de Paris. 
 En tout cas, on ne peut se dispenser de reconnaitre les 
 droits de priorite de mon ami M. Mortimer-Granville, a 
 cet egard. 
 
 "Je viens vous prier, M. le Redacteur, d'inserer cette 
 
32 NERVE-VIBRATION AND EXCITATION. 
 
 lettre dans un prochafn numero, et d'agreer l'assurance 
 de ma parfaite consideration. 
 
 " Dr. Oscar Jennings." 
 
 Notre collaborates, auquel nous avons commu- 
 nique cette lettre, nous prie d'inserer la reponse 
 suivante. 
 
 " Mon cher Redacteur, — M. le Dr. Jennings reclame 
 la priorite, pour le traitement mecanique de la douleur, 
 an benefice du Dr. Mortimer-Granville. J'avoue ne 
 pas bien saisir le motif pour lequel M. Jennings a senti 
 la necessite de mettre ma personnalite en avant. 
 Dans l'article que vous avez bien voulu publier, j'ai 
 rapporte les experiences du Dr. Vigoureux sur les 
 mysteriques, decrit un moyen pratique de renouveler ces 
 experiences au point de vue therapeutique, et, enfin, 
 discute Faction physiologique de la methode. De la a 
 une invention il y a loin. Je ne pensais pas, en ecrivant 
 cet article, que Ton put me reprocher d'avoir pris quel- 
 que chose a quelqu'un. J'ai reconnu M. le Dr. Vigou- 
 roux comme le promoteur de l'ide'e d'employer le 
 diapason. Je crois le fait indeniable, et, jusqu'a preuve 
 du contraire, je resterai de cet avis. 
 
 u Les ' nombreuses observations inedites' que possede 
 M. Jennings seront sans doute d'un grand interet en 
 pareille occasion, mais il avouera que je ne pouvais pas 
 supposer leur existence. Je n'insiste pas plus long- 
 temps. Ni M. Mortimer-Granville, ni M. Jennings, 
 ni M. Vigouroux, ni moi n'avons invente les vibrations. 
 M. Vigouroux, puis moi, en avons park', M. Jennings 
 voudra bien reconnaitre que c'etait notre droit. 
 
INTRODUCTORY. 33 
 
 "Voila, mon cher confrere, ce que je crois devoir 
 repondre a la lettre, d'ailleurs fort courtoise, de M. 
 Jennings ; je regrette seulement qu'il soit a peu pres 
 impossible d'ecrire quelques lignes dans un journal 
 scientifique, sans voir immediatement surgir des 
 reclamations de priorite. 
 
 " Veuillez agreer, etc. 
 
 " Dr. M. Boudet de Paris." 
 
 There is no reason to suppose that either M. Vigou- 
 roux or M. Boudet de Paris have yet perceived the real 
 nature or vwdus operandi of the remedy they adopted, 
 or have recognized the value of " nerve vibration'''' in 
 reference to any of the uses to which I have applied 
 it besides the relief of pain. 
 
 I must crave the reader's indulgence for this digres- 
 sion. The question of priority in scientific work is, 
 of course, of wholly subordinate importance, but it is 
 a matter in which most investigators, who, like myself, 
 have been deterred, by the fear of deceiving themselves 
 and misleading others, from a hasty publication of 
 " results," have need to take a modest interest. 
 
 It was not until long after the appearance of my 
 last quoted paper that I was able to persuade myself 
 that I should be justified in recommending the employ- 
 ment of mechanical vibration in the treatment of 
 nerve states, other than those of which neuralgic pain 
 was the urgent symptom. 
 
 On the i ith of March of the present year, the fol- 
 lowing paper appeared in the British Medical Journal ; — 
 
 c 
 
34 nerve-vibration and excitation. 
 
 " Percussion as a Therapeutic Agent in 
 Nervous Diseases. 
 
 " With the cognizance of the leading physiologists 
 and neurologists in England and on the Continent, I 
 have for some years past been employing carefully 
 graduated and precisely applied percussion as a thera- 
 peutic agent in the treatment of nervous diseases and 
 disturbances, on a principle of which the following 
 statement, published by me in February, 1881, may be 
 taken as a brief exposition. [I omit passages from 
 The Lancet, sup. cit.] 
 
 " My method is, as will be seen from these extracts, 
 based upon the hypotheses: (1) that all nerve action, 
 whether normal or morbid, is vibratile ; and (2) that it 
 is possible to influence and control abnormal vibrations 
 — in the manner above described — by mechanical 
 vibrations propagated to the nervous structures, in 
 particular directions and at known rates of speed. It 
 is not my present purpose to discuss these hypotheses, 
 or the method in detail ; but I am anxious to re-state, 
 and now affirm, certain propositions, founded on expe- 
 rience, which, in previous intimations of the progress 
 and success of my experiments, I submitted tentatively. 
 They are these — 
 
 " 1. I have rarely failed, in a fairly large number of 
 cases, many of them of several years' standing, to 
 bring the cerebro-spinal and — sometimes directly at 
 others in secondary circuits — the sympathetic ganglia, 
 under control, by the application of my percuteur over, 
 or in mechanical relation through the adjacent tissues 
 with, those ganglia. 
 
INTRODUCTORY. 35 
 
 " 2. I have in no instance failed to produce activity 
 of the bowels, even in cases of previously obstinate con- 
 stipation ; and in many instances I have succeeded, 
 within a short period, in restoring the periodic evacua- 
 tion of their contents without recourse to drugs. This 
 success alone places the method on a footing of value 
 in daily practice. 
 
 "3. I can now, in result of my more recent experi- 
 ments, propagate the vibrations I produce along the 
 trunks and into the branches of most of the principal 
 nerves, from their centres of origin, or call them into 
 action, reflexly, through the afferent nerves connected 
 with those centres. In limited paralyses, and even in 
 circumscribed scleroses, this power is obviously of the 
 highest therapeutic importance. Of course the like 
 effect may be produced, and I admit, often more rapidly, 
 with the electric current ; but in the use of electricity 
 we are projecting an external force into the organism, 
 and one which always travels in the direction of least 
 resistance ; whereas the sole effect of vibration is to 
 excite the centres and call out their potential energy, 
 converting it into kinetic force. It can only act through 
 the nerves. 
 
 " 4. I can nearly always arouse torpid centres to 
 action, and thus pave the way for their restoration to 
 states of normal activity. Since it is physiologically 
 certain that nutrition depends on exercise, and every 
 part of the organism feeds in proportion as it works 
 healthily, it is a great thing to be able to act thus 
 directly on the nerve-centres which are the seats of 
 energy. 
 
 C 2 
 
o 
 
 6 NERVE-VIBRATION AND EXCITATION. 
 
 "5. I can subdue the exaggerated reflex irritability of 
 revolting subordinate centres, and replace them under 
 control of the higher centres, even in cases of lateral 
 sclerosis. 
 
 " Applying these facts — for such they undoubtedly 
 are — to the needs of special nervous states, the prac- 
 titioner will have no difficulty in perceiving that my 
 method has great and obvious uses. I am anxious not 
 to overstate the results I am obtaining, but they are 
 such as to show that the physiological process of me- 
 chanical vibration is likely to prove a potent agent in 
 the treatment of a wide range of maladies now most 
 intractable. It will afford me much pleasure to show 
 the process to any medical man who will call on me. 
 It is impossible at present to describe its details in 
 writing ; but I will gladly aid any one in its application. 
 My method has nothing in common with the '"'muscle- 
 beating'' and "shaking" recently introduced into this 
 country ; although my treatment was first tested in 
 Paris. It is a system which must be approved and 
 practised by the profession exclusively. Nothing do I 
 so much dread as its falling into unprofessional hands. 
 I have been engaged upon it since 1862, shortly after 
 which date some of the first results were communicated 
 to the Obstetrical Society- of London.'' 
 
 In June last I had a paper in The Lancet (10th) 
 giving the results of extended observations : — 
 
 "Nerve-Vibration as a Therapeutic Agext. 
 
 "Enlarged experience in nerve vibration as a means 
 or method of treating disease has confirmed my belief 
 
INTRODUCTORY. 37 
 
 in its value, and I have no longer any hesitation in 
 recommending its adoption by the profession. I do 
 this with a full sense of the responsibility which neces- 
 sarily attaches to the propounder of any strange doctrine 
 in medicine, such as that which the theory of nerve 
 vibration, undoubtedly, presupposes and implies ; and in 
 an especial sense to the introducer of a new therapeutic 
 agent. The responsibility of strongly urging a recourse 
 to nerve-vibration, I am now fully prepared to accept. 
 I commenced the investigation of nervous phenomena, 
 first in connection with the various forms and causes of 
 ' pain,' more than twenty' years ago, and this method, 
 which has been mentioned rather than recommended 
 by me on several oceasions during the last few years, is 
 the outcome of a long and careful series of experiments. 
 I have now employed it in a very considerable number 
 of cases, differing widely in their nature and character- 
 istics, and although I have had many failures — mainly, 
 as I believe, from errors in diagnosis and mismanage- 
 ment in the application of the treatment — the net result 
 has been such as to place beyond reasonable question 
 the fact that in precisely applied mechanical vibration 
 of nerves and nerve-centres, we have a means of elicit- 
 ing function and stimulating nutrition which surpasses 
 for directness and rapidity of action any other system 
 or method extant. If this should seem to be an over- 
 statement of the facts, it must be borne in mind that it 
 is made in a medical journal, and with the knowledge 
 that the profession will soon be able to verify or disprove 
 the accuracy of my exertions. 
 
 " I do not propose to publish my cases immediately, 
 
35 NERVE-VIBRATION AND EXCITATION. 
 
 because sufficient time has not yet elapsed since the 
 occurrence of what I conceive to have been ' cures' to 
 show that they merited that description. At the same 
 time, although as I have said, there are many obvious 
 failures in my record of cases treated in this manner, 
 the benefits which seem to have accrued from its adop- 
 tion are so marked that I do not feel justified in longer 
 delaying the step by which I place the means of form- 
 ing a judgment on my method in the hands of the 
 profession. Mr. Frederic Weiss, of the firm of Messrs. 
 Weiss and Sons, has greatly aided me in producing, 
 and will shortly be able to supply to members of the 
 profession — I hope exclusively — a very satisfactory per- 
 cuteur worked by electricity. I must acknowledge my 
 indebtedness to Dr. George W. Balfour, of Edinburgh, 
 for the recommendation to use electricity as a motive 
 power. My deeply regretted friend the late Mr. Donald 
 Napier advised me to employ this agent some five 
 years ago, but I was then reluctant to do so lest it 
 might be supposed that my process was in some way a 
 modification of the use of electricity. It should, therefore, 
 be understood that no current passes through the ham- 
 mer of my instrument. The patient is not in the 
 circuit. This force is, however, more convenient for 
 sustained use than that obtained from the clock-spring 
 in my mechanical percuteur. Messrs. Weiss and Sons 
 have also a clock-work apparatus which has been made 
 under my supervision, and which renders practicable 
 what the French instruments have not, with a few ex- 
 ceptions, hitherto enabled me to accomplish. I will 
 now briefly state the principles of the treatment, and 
 
INTRODUCTORY. 39 
 
 leave it in the hands of the profession to give it a 
 trial. 
 
 " In the treatment of neuralgia, I believe percussion 
 acts simply by interrupting a morbid series of vibra- 
 tions and substituting for it another series which is not 
 morbid. Its success is by no means certain ; but it 
 deserves a trial, and particularly in cases which would 
 otherwise be treated by nerve-stretching. When a nerve 
 is stretched, it is, for a time at least, prevented from 
 vibrating. When it is mechanically vibrated by per- 
 cussion, it is compelled to fall into a new rhythm by 
 the physical law of harmonies and discords, as explained 
 in my first paper on this subject in The Lancet, February 
 19, 1 88 1, p. 286. There are several modes of proce- 
 dure. The percuteur may be applied over the seat of 
 pain with varying force and speed until alleviation of 
 the trouble is produced ; or the percussion may be made 
 higher up in the trunk of the nerve, over the centre, or 
 at a more distant point in the periphery. If these 
 methods fail, an attempt may be made to act upon the 
 real or supposed seat of the pain indirectly through 
 some other set of nerves. If success should not attend 
 either of these modes of procedure, the irritation which 
 causes the pain will probably be found to be reflected 
 from some remote seat of disturbance, as in the case of 
 pains in the heels from piles ; and this seat of the excit- 
 ing cause may generally be discovered by the physi- 
 ological anatomist who will take the trouble to run over 
 and exhaust the series of probabilities. The plan I 
 suggest is, of course, far more exacting than the time- 
 honoured expedient of giving an anodyne ; but relieving 
 
40 NERVE-VIBRATION AND EXCITATION. 
 
 and curing pain are two totally different processes, and 
 it is only with the latter I have any concern. 
 
 " For the rousing of torpid nerve-centres and eliciting 
 function from the several organs of the body, I believe 
 nerve-vibration to be of the highest possible value. The 
 recognised topography of the centres may serve as a 
 rough guide for the application of the percuteur ; but as 
 it is essential that the particular nerve energising the 
 organ should be acted upon, and, as precisely as possible, 
 that only, the operator will need to tax his knowledge 
 of the nervous system in every case specifically. In a 
 large proportion of instances the organ will have to be 
 approached by a circuitous path, which can only be 
 discovered by experiment in the individual case under 
 treatment ; and the search for a way of reaching it must 
 be made with a practical knowledge of the whole of its 
 nervous connections. It should never be forgotten that 
 the therapeutic agent is mechanical nerve-vibration ; 
 and unless the nerve we want to stimulate is actually 
 thrown into vibration it will not be excited to action. 
 Every organ of the body, from the liver to the testicle, 
 may, in the absence of utterly disabling organic disease, 
 be made to perform its proper function by exciting the 
 nerve, which supplies it with energy, by mechanical vibra- 
 tion. In this way I have seen the liver unloaded, and 
 what seemed to be inveterate torpidity of the intestines, 
 remedied in a few successive vibrations. I have now 
 under treatment the case of a child who was six weeks 
 ago to all appearance an idiot ; but who has already 
 developed so much cerebral activity and growing 
 intelligence under the influence of specific centre and 
 
INTRODUCTORY. 4 1 
 
 nerve-vibration, that I entertain the strongest hope of 
 his ultimate awakening, and a fair approach to the 
 normal state. A surprising amount of success has 
 attended percussion in cases of obstinate, and what was 
 supposed to be irremediable, deafness. In a certain 
 class of cases the hearing seems to have been recovered 
 by arousing the auditory centre. In another class of 
 instances of benefit derived I believe this has been due 
 to the re-establishing of the mobility of the ossicular by 
 mechanical vibration at a very high speed, the tonicity 
 of the muscular fibres attached having been at the same 
 time restored. 
 
 " In neurasthenia, neurasthenia, and even commen- 
 cing sclerosis of the spinal cord with loss of tendon-reflex, 
 the most remarkable effects are produced by applying 
 the percuteur over the spinous processes of the appro- 
 priate vertebrae. I am afraid at present to publish 
 some of the results recently gained. In a few cases I 
 have wholly failed to do good, but in others — not a few 
 — the " locomotor ataxy" has been removed or sensibly 
 ameliorated, and the general improvement may be fairly 
 described as astonishing. It is often necessary in this 
 class of cases to combine proximate central percussion 
 with lighter percussion at the remote periphery, especially 
 when there is much trouble from lightning pains, or 
 that creeping paralysis which so often first shows itself 
 in the tibialis anticus. I believe Dr. Hughlings Jackson 
 has somewhere noted this clinical fact, but, at the 
 moment, I do not remember in what connection or 
 where. In cases of exaggerated reflex irritability — a 
 very common phenomenon,' which is too generally over- 
 
42 NERVE-VIBRATION AND EXCITATION. 
 
 looked or lightly regarded — I find the best plan of proce- 
 dure to be by percussion over the seat of the irritability 
 until that is removed, which generally happens after a 
 very few applications of the percuteur. In a majority of 
 my cases the subjugation of this irritable state has been 
 almost immediately followed by motor improvement. 
 
 " In ordinary paralyses, which depend upon or are 
 accompanied by deterioration of the muscles, I think 
 nerve-vibration by percussion is inferior in value to 
 electricity. In short, I do not think it has any appreci- 
 able effect except on the nerves themselves. It certainly 
 improves the nutrition of nervous tissue, and this in- 
 directly promotes the nutrition of muscles, but the 
 process is circuitous and slow. Faradaism is a prefer- 
 able remedy. Nerve vibration is not the rival of 
 electricity. The two agents act in totally different 
 manners. Vibration simply excites a nerve centre to 
 such activity as it may have strength or power to per- 
 form. It does not impart any new energy or introduce 
 any new force to the system. Electricity infuses an 
 extraneous force into the organism, but with this draw- 
 back, that it is impossible to ensure its acting only on 
 the nerve it is desired to stimulate, and solely in such 
 a way as to render any act of that nerve its own, and 
 therefore normal. Vibration cannot possibly act in any 
 other way than through the nerve or upon the centre, 
 and, in a strict sense, nervously. One curious effect of 
 percussion may be more interesting to the physiologist 
 than to the practitioner, but I will place it on record. 
 Playing over the centre from which the nerves supplying 
 a particular set of muscles arise is apt to produce a 
 
INTRODUCTORY. 43 
 
 feeling of fatigue or stiffness which may seem to be 
 located in the leg or arm, although the extremity itself 
 is not touched. This will help to explain how what is 
 called nightmare may produce cramp, and how the 
 activity of certain automatic centres in a wearying 
 dream of action may give rise to a sense of fatigue on 
 waking. 
 
 "These few hints will serve to point the practitioner 
 to a method of procedure in making trial of the remedy, 
 but all I know of the method is at the disposal of any 
 member of the profession who may desire to be more 
 fully or precisely informed. I will only say, in con- 
 clusion, that I am very hopeful that nerve vibration will 
 enable us to cure maladies which have hitherto been 
 beyond remedy ; and that in a certain class of cases — 
 namely, those which require the direct stimulation of 
 nerve-centres for their recovery — this agent will greatly 
 help, perhaps supersede, the use of drugs." 
 
 This, I fear, somewhat too egotistical summary of the 
 history of the investigations in which I have been 
 engaged, and of the communications which have from 
 time to time been made to the profession with a view 
 to bring the subject under its notice, clears the way for 
 a brief review of the principles of nerve vibration and 
 excitation in the treatment of functional and organic 
 disease, as I now understand and interpret the facts I 
 have been able to collate, and the system of physio- 
 logical treatment which they have suggested. 
 
44 
 
 THE PRINCIPLE. 
 
 GENERAL OUTLINE OF THE TREATMENT AND 
 DESCRIPTION OF THE APPARATUS. 
 
 It is necessary at the outset to distinguish between 
 vibration and excitation. The former does not always, 
 though it does generally, involve or induce the 
 latter ; and the latter, that is, excitation of a nerve, 
 may probably be effected by other means than vibration, 
 even when a vibratile body or instrument is employed 
 to excite the nerve, and although the nerve is un- 
 doubtedly thrown into a state of vibration as soon as 
 it becomes excited. The explanation of this seeming 
 paradox may be attempted as follows : — When the 
 practical physiologist — (the only interrogator of Nature, 
 whose results are wholly worthy and entirely trust- 
 worthy, I mean the vivisectionist) — draws his needle 
 with a light hand across the sheath of a nerve, 
 or presses the point of his instrument upon it steadily, 
 he excites the nerve or centre, which means that he 
 throws it into vibration. The reader who is familiar 
 with Dr. Sydney Ringer's beautiful exposition of the 
 action of blisters, in his classical work on Therapeutics, 
 will not need to be reminded that blisters, mustard 
 
THE PRINCIPLE. 45 
 
 poultices, and certain other remedies, which may be 
 classed as specific irritants, act in this way, namely, by 
 throwing nervous tissue — I mean nerve fibres and 
 cells — into particular formulae of vibration. Some pro- 
 duce large and slow waves, others small and quick 
 vibratile movements, with characteristic effects. A 
 knowledge of this fact lies at the root of the compre- 
 hension of the difference between vibration and excita- 
 tion. A nerve may, as I have said, be excited without 
 being directly vibrated by the excitor, which may not, 
 perhaps, be itself perceptibly vibrating, although the ex- 
 citement produced is vibratile. And the physical effect 
 of a vibrating instrument may be to excite by irritating, as 
 the needle point of the biological experimenter excites, 
 instead of inducing nerve action by directly propagating 
 its own vibration to the nervous tissue. 
 
 I say the recognition of this difference of method 
 in producing the desired result, namely, nerve action, 
 must be made at the outset, because it is essential 
 to a scientific use of the new remedy which I propose 
 for adoption that there should be no mistake as to 
 its modus operandi in each particular case or form 
 of administration. I have myself seen reason to 
 modify my first notion of the treatment in this respect. 
 When I commenced my experiments with the percuteur 
 I thought that, in every instance, the effect produced was 
 due to the propagation of the vibration set up in, or by, 
 the instrument to the nerve on which I was operating. I 
 now believe, that in some instances, the effect is rather 
 due to the excitation of the nerve by the first two or 
 three blows of the hammer. The practical inference I 
 
46 NERVE-VIBRATION AND EXCITATION. 
 
 have been led to draw from the recognition of this fact 
 — and I expect other investigators will be driven to the 
 same conclusion — is that it is desirable to use the per- 
 cuteur very delicately at first, particularly in cases of 
 neuralgia, and to touch the skin over the painfully 
 vibrating nerve sheaths lightly and quickly, rather than 
 to keep it playing on the part, as was at first my 
 practice. I mention this matter in this connection, 
 because, although it relates to the practice rather than 
 the principle of the treatment, it throws strong illus- 
 trative light on the distinction I am seeking to enforce 
 between vibration and excitation. 
 
 In starting from the physiological stand-point, as 
 regards nerve action, which I have incidentally taken 
 up in the introductory observations, it will be obvious that 
 the aim of the therapeutist who employs vibration must 
 be to throw the nerve into a new state of activity. This 
 is equally true, whether he be trying to rouse a torpid 
 centre or to change the rhythm of a morbid state. My 
 notion of morbid activity is this. I believe, as pre- 
 viously affirmed, that under normal conditions, when a 
 nerve cell or fibre becomes active, the one in receiving 
 impressions or discharging force, the other in trans- 
 mitting sensory impressions or reflex or direct motor im- 
 pulses, the essential elements of the nervous tissue vibrate 
 mechanically in their beds or cylinders. When either the 
 vibrations of cell or nerve are unrhythmical in them- 
 selves or discordant with the vibrations of other cells or 
 nerves, which they may either throw into disorder or 
 inhibit (perhaps this is the true explanation of the 
 " inhibitory " process), they propagate the commotion 
 
THE PRINCIPLE. 47 
 
 the disturbance has set up to their sheaths or envelopes, 
 and the activity becomes disorderly and painful. 
 
 I carry this hypothesis so far that my theory of a 
 cold, for example, as I have stated it, for the laity, 
 elsewhere, is as follows : — 
 
 " When the surface of the body or the air-passages are 
 chilled by a draught, or by being drenched with rain and 
 sitting in cold damp clothes, lying in damp sheets, and 
 the like, the mischievous impression is made, not on the 
 skin itself or on the lining membrane of the air-passages, 
 but upon the vast net-work of minute nerve-filaments 
 which lie beneath these membranes, and connect the 
 surfaces of the body — both external and internal — 
 with the nerve-centres, which are the sources and foci of 
 energy and power. These nerve-centres receive, through 
 the multitudinous branches of telegraph-like nerves, a 
 shock or staggering impression that for the moment 
 paralyses them ; and, so long as this paralysis or 
 stupefaction lasts, another part of the nervous system, 
 called the vaso-motor, or vessel-contracting centre, whose 
 peculiar function it is to regulate the calibre of the 
 blood-vessels, gets the upper hand, and these blood- 
 vessels are contracted so that they carry less blood than 
 usual, the smaller branches of the arterial system which 
 form a net-work immediately underneath the skin and 
 give it its bright pink colour are so reduced in ' bore' 
 or calibre — as an elastic or compressible tube may be 
 reduced — that the red blood does now flow through 
 them, and the surface looks pallid. Presently comes 
 the recovery from this state, or the ' reaction,' as it is 
 called, when the first effects of the shock have passed 
 
48 NE^VE- VIBRATION AND EXCITATION. 
 
 off and the centres revive. Now occurs the critical 
 moment. If the torpor has been great, and the re- 
 covery is slow or imperfect, as often happens in a 
 depressed or what is called 'delicate' state of the 
 organism, the vaso-motor centre, which of course shares 
 the general weakness, will give way before the reaction 
 is established ; and then the heart, pumping its blood 
 into yielding and unstrung vessels, dilates them, and local 
 congestions or accumulations of blood may take place ; 
 while the absence of proper resistance excites the heart 
 to tumultuous action, and the disturbances of fever and 
 inflammation occur. It is a question of balance in 
 power between two parts of the nervous system, the 
 general and the particular — the latter being, as I have 
 said, the centre which regulates the calibre of the blood- 
 vessels — and this practically resolves itself into a ques- 
 tion of time. If the reaction of the general nervous 
 system is quick, there is a rush of blood to the surface 
 vessels, and, due resistance being found, the heart 
 quickens its pump-like action, and the sweat-glands are 
 thrown into activity, so that perspiration ensues .If, on 
 the other hand, the vaso-motor centre has participated 
 in the shock, the blood propelled to the surface simply 
 dilates the vessels, and the skin remains dry ; there is 
 rapid action of the heart because there is an obstacle to 
 overcome, but the current of the blood moves slowly. 
 Coincident with these purely physical actions and reac- 
 tions, involving a departure from the healthy condition of 
 matter as regards the function of the nerve-centres and 
 the circulation of the blood, are disturbances of the 
 chemical processes of health and consequently alteration 
 
THE PRINCIPLE. 49 
 
 in the nutritive relation of the tissues of the body and 
 the blood ; but these changes are too complicated to be 
 discussed in this article, and it is not important to the 
 solution of the question before us that they should be 
 immediately considered. What then is ■ a cold ?' I 
 reply, it is a disturbance of the balance between the 
 several parts of the nervous system, brought about by 
 the shock of a sudden or prolonged exposure to the 
 depressing effects of chill ; but the same physico-vital 
 results may be produced in the organism by the opera- 
 tion of any agent which is capable of giving the nervous 
 system a similar shock and creating the same kind of 
 disturbance." 
 
 This may appear a digression, but its bearing on the 
 question under discussion will be apparent when I add 
 that, in my judgment, " Nature's provisions against ' a 
 cold,' in so far as that may be the effect of a chill, are 
 two — sneezing and shivering. A violent fit of sneezing 
 often saves a chilled body the consequences of a 
 depressing influence. The nerve centres are aroused, 
 the heart's action is stimulated, and the blood is 
 thrown to the surface by the convulsive and explosive 
 action. If sneezing fails, or sometimes in its absence if 
 the chill be great and deep, an intense and prolonged 
 fit of shivering may arouse the latent and, as it were > 
 suddenly-suppressed forces of the nervous system. It, 
 however, commonly happens that, when the chill is so 
 intense as to produce deep shivering, the mischief done 
 is too serious to admit of a prompt reaction. Thus it 
 comes to pass that the common saying is true : 
 sneezing shows that the cold will be slight, while 
 
 D 
 
50 NERVE-VIBRATION AND EXCITATION. 
 
 shivering, and particularly only a very brief but deep 
 shiver, portends a severe congestion or inflammation in 
 some organ. When organic blood and other poisons act 
 on the nerve-centres, shivering is a very bad sign, 
 as a rule. • In cases of threatened cold from chill, 
 sneezing, and occasionally shivering, produce perspira- 
 tion. When this occurs, and the sweating is profuse, 
 with a warm and reddened surface, the ' cold' is likely 
 to be prevented. It is not the perspiration that does 
 the good, but the outbreak of a hot sweat shows 
 that the arteries are offering healthy resistance to the 
 current of the blood ; and it is then probable that the 
 balance of force between the heart and the vessels will be 
 quickly re-established in such manner that the functions ot 
 the circulation may be duly performed and disturbances 
 which would otherwise end in disease may be prevented." 
 Dr. Hugh Campbell, who has for some time past been 
 employing nerve-vibration, has published the following 
 particulars in The British Medical Journal. They aptly 
 illustrate the view just taken ; and show its direct bear- 
 ing on the question under discussion. He writes : — 
 
 " In a case which I was recently treating by nerve- 
 vibration, the patient presented himself one day with all 
 the indications of a sharp attack of influenza — injected 
 conjunctivae, frontal headache, &c. Percussion over the 
 superior cervical ganglia, within a few minutes, unex- 
 pectedly removed both the objective and subjective 
 symptoms." 
 
 To return ; the aim of the vibration treatment is, I say, 
 to throw the nervous tissue into a new state or series of 
 vibrations. There are, therefore, two parts or stages of 
 
THE PRINCIPLE. 5 I 
 
 its action : first, that of change, either from quiescence to 
 motion,, or from one form of action to another; and second 
 the establishment of a new activity. The first part 
 relates to rousing, the second to continuing vibratile 
 activity of the nerve elements. It is in relation to the 
 action of the percuteur in " arousing" that the recogni- 
 tion of the difference which I have already pointed out, 
 between the two modes of its action, is chiefly important. 
 If a nerve or nerve centre is in itself healthy, though 
 dormant, it will suffice to awake it ; and percussion is 
 simply useful as a convenient and precise mode of 
 effecting this limited purpose. Any other would do 
 as well, if it could be as directly applied, and as 
 effectually restrained from setting up collateral vibrations 
 which may prove injurious or render the first feeble 
 efforts of the nerve or centre to act nugatory by inter- 
 ference. In my experience of the percussion, small 
 as it has yet been, I have known one or two touches 
 with the percuteur rouse a nerve, and call it into perma- 
 nent action. A curious instance of this occurred to 
 me recently. A patient under treatment by vibration 
 for dyspepsia dependent on inactivity of the fibres 
 of the muscular coat of the stomach, was, I found, 
 suffering from an injury to the spermatic cord, which 
 seemed to have produced paralysis of the cremaster. 
 The testicle of the affected side had dropped to such 
 an extent that a suspensory bandage required to be con- 
 tinually worn, and caused great inconvenience. I 
 applied the percuteur for a few moments over the in- 
 guinal branch of the genito- crural nerve, with the 
 effect of very quickly producing contraction of the 
 
 D 2 
 
52 NERVE-VIBRATION AND EXCITATION. 
 
 cremaster. After one or two applications, the patient 
 left off his bandage, and has never suffered from the 
 trouble since. In this instance, the action of the 
 percuteur had, obviously, only been of a rousing nature ; 
 and it simply had the effect of awakening a torpid nerve 
 from the prolonged slumber into which it had been thrown 
 by an injury. This will sufficiently explain what I 
 have called the first stage or form of the action of vibra- 
 tion. It is needless to recal to the recollection of the 
 reader how a blow on the head will sometimes rouse 
 the inert cells of the cerebrum, with the result of 
 converting a stupid brain into one of at least average 
 intellectual ability. 
 
 The first effect of nerve-vibration, therefore, is awak- 
 ening or interrupting ; the second is more like tuning 
 a violin string, or the wire of a pianoforte. Nerve- 
 stretching acts in one of two ways for a time. If 
 much force be used it disorganizes the nerve and pre- 
 vents any vibration taking place in its elements, with 
 the result, in successful cases, of giving it a new 
 starting-point when the integrity of the nerve-fibre is 
 restored in the process of natural repair. When less 
 force is used, the nerve is acted upon precisely as 
 screwing and stretching act on a violin string, altering 
 its physical capacity for vibration, and either reducing 
 or increasing the amplitude of the waves of movement 
 into which agitation will throw it. I doubt not that 
 nerves of different calibres have each their proper 
 physical capacities for vibration ; and the vibrations 
 of a nerve are, in perfect health, mathematically compo- 
 nent and complementary parts of the vibrations of the 
 
THE PRINCIPLE. 53 
 
 trunk from which it springs. When a nerve becomes 
 turgid from congestion, or is in any way swollen or 
 attenuated, this perfect relation is disturbed, and the 
 result is functional disorder, and probably pain. 
 
 The manner in which vibration acts in the second stage 
 or phase of its process is, I believe, explained by the law 
 of musical concords and discords or harmonies. We 
 interrupt by a discord, and control by substituting one 
 set of vibrations for another. In this way, by vibrating 
 a particular nerve daily, as nearly as possible at the 
 same hour and for the same length of time, with a per- 
 cuteur working at the same speed or number of vibrations 
 per second, we may educate the nerve-cells or fibres, so 
 to say, to a new rhythmical habit, and thus establish 
 new vibratile conditions. It is of the highest moment 
 to recognize this fact. We may not at first be able to 
 ascertain the precise rate or rhythm of normal nerve 
 vibrations — which I believe to bear a definite propor- 
 tional relation to the size of the nerve — this will come to 
 our knowledge later on ; but meanwhile we can change 
 the state and establish new conditions, and although the 
 feat is performed in the dark and clumsily, the result to 
 the patient is often singularly successful. We have 
 lifted him out of the painful or morbid state, although 
 what that was, and how his amended state differs from 
 the old one, we are not yet able to ascertain. 
 
 The reader will gather from this crude and con- 
 fessedly clumsy statement of my views how I believe 
 nerve-vibration acts. I adopt percussion as a mode 
 of throwing the nerve fibres and cells into vibration, 
 simply because it seems the readiest and the most 
 
54 NERVE-VIBRATION AND EXCITATION. 
 
 manageable ; but if it should be hereafter superseded by- 
 some better mode of effecting vibration, I shall be the 
 first to hail the improvement as a further development 
 of the method of treatment in which I am interested, 
 and which I beg the profession to study and test. In 
 practice it will be found that the number of blows given 
 by the percuteur must be varied, if we are to attain our 
 object. As a rule it is better to attack a large nerve, 
 or a dull, grinding pain, or a "numbness," with a 
 high rate of small vibrations ; and a small peripheral 
 nerve, or a very acute "fine," needle-like pain, with 
 comparatively slow and large vibrations. In the differ- 
 ence we are most likely to secure discord to inter- 
 rupt, or induce a change of state. If we could only 
 ascertain precisely the rate or character of the morbid 
 vibrations, we could, of course, by the law of musical 
 concords, at once apply the remedy in an appropriate 
 form. The point to remember, is that it is with the 
 nerve we have to deal, not with its surroundings ; but 
 these surroundings which lie between us and the nerve 
 on which we wish to operate require careful considera- 
 tion. It is useless vibrating over a nerve or centre 
 unless we can reach it. As a rule, the mere position of 
 a nerve or centre in topographical relation to the surface 
 of the body is not of the first importance ; sometimes it 
 is possible to act on a centre through the adjacent 
 bones. Often, for example, though not always, the 
 spinal cord may be vibrated by playing on the spinous 
 processes of the vertebrae. In this way I can occa- 
 sionally send an impulse along a particular nerve, but 
 the experiment is by no means uniformly successful. 
 
THE PRINCIPLE. 55 
 
 In the majority of instances it fails. As a rule it is 
 better to try to act on the centre, along the physio- 
 logical line of communication — namely, the afferent 
 nerve. In cases of " locomotor ataxy," and in some 
 other morbid states, reflex movements may be readily 
 called forth by operating upon the cutaneous nerves or 
 over large mixed nerves, such as the anterior tibial. 
 
 It will be understood that in no instance, and under no 
 circumstance, can the mere agitation of a purely efferent 
 or motor nerve produce muscular contraction. No 
 ~'force" is communicated by the hammer of the percuteur. 
 It simply vibrates the nerve elements, and any movement 
 produced must be due to the calling out of nerve force 
 from the centre. In short, the vibration must be pro- 
 jected along the afferent fibres to the centre, where 
 activity of the cells is excited, with the result of 
 provoking a discharge of nervous force — whatever 
 that may be — along the efferent nerve to the mus- 
 cle which contracts. It is scarcely possible to call 
 out force by this process of vibration in a healthy sub- 
 ject. Occasionally a very little action is produced in 
 individual cases, particularly when the percuteur is 
 applied over tendons at the precise point of their con- 
 nection with muscular fibres, but never, so far. as I can 
 detect, at any other point. When, however, there is either 
 torpidity or an excess of irritability, owing to the exist- 
 ence of some block in the motor line of communication, 
 vibration of the afferent nerve seems to incite the centre 
 to discharge its pent up force. I have utilized this effect 
 to obviate a tendency to spasm, by exhausting the motor 
 force of certain centres in the spinal cord, with the effect 
 
56 NERVE-VIBRATION AND EXCITATION. 
 
 of reducing that " irritability" which I believe to be the 
 main cause of the difficulty in walking in locomotor 
 ataxy, a difficulty wholly distinct from the loss of 
 sensation, which is due to affections of the posterior 
 columns of the cord. Perhaps the most curious and 
 suggestive results have, in my experience, been found 
 in cases of lateral sclerosis. When the limbs jerk and 
 fly off at tangents in trying to do anything, this is 
 clearly not because there is loss of sensation, since 
 it is equally apparent before and after the foot touches 
 the ground, or the hand comes into contact with any 
 object ! The motor force discharged by the action of the 
 cerebral centres upon the automatic centres is unable to 
 travel along the proper nerve, and goes off in the 
 direction of least resistance. We call this "inco-ordi- 
 nation," but that term only designates the phenomenon 
 without in any degree explaining its nature or dis- 
 covering its cause, which I believe to be that above 
 mentioned. When the irritability of the centre has been 
 exhausted reflexly by vibration of the nerves in connec- 
 tion with it, there is generally, for a time at least, marked 
 increase in the power, or possibility, of voluntary motion 
 and co-ordination. One interesting fact in relation to 
 the process of excitation by nerve- vibration may be men- 
 tioned here. All the movements excited by percussion 
 of the nerves in a limb have a tendency to be repeated. 
 I have frequently incited a centre to perform a particular 
 series of automatic movements as many as four or five 
 times in succession, with intervals of ten or fifteen 
 seconds, by a few minutes' vibration with the percuteur r 
 the movements being repeated while I sat by and 
 watched. Sometimes the observer notices the contrac- 
 
THE PRINCIPLE. 
 
 57 
 
 tion of the muscles before the patient is aware of what 
 his limbs are doing ; at others he will tell the operator 
 that they are "going to do something" before the 
 latter can detect any movement. I should here explain 
 that, with a view to eliminate possible sources of error 
 in the study of these phenomena, I have never yet 
 percussed a female patient, and have not founded any 
 of my conclusions on the treatment of hysterical males. 
 This is a matter of much moment in my judgment, 
 and I am, therefore, careful to place the fact on record. 
 I have avoided, and shall continue to avoid, the treat- 
 ment of women by percussion, simply because I do not 
 want to be hoodwinked, and help to mislead others, by 
 the vagaries of the hysterical state or the characteristic 
 phenomena of mimetic disease. 
 
 Enough has been said to indicate the outlines of the 
 principle ; I now turn to the apparatus. At first I used 
 
 Fig. i. 
 
 The Clockwork Peradeui-, showing the mode of using it. 
 
 D winding-up pivot. C, ivory button ; while this is pressed by the 
 finger, the hammer continues in action ; when the pressure is taken 
 off it stops. A. By pressing this button the length of stroke can be 
 increased, and the speed slightly reduced, while the force of the blow 
 is augmented. B, the pointed ivory hammer with which the percussion 
 is made. A flat-headed hammer, or brush, can be substituted for the 
 ivory point. 
 
 clockwork percuteurs, and some of the most notable 
 results I have gained in practice have been obtained with 
 these instruments ; but, except for the treatment of 
 
53 
 
 NERVE-VIBRATION AND EXCITATION. 
 
 neuralgia — and in bad cases of that intractable 
 malady — I do not recommend these instruments. The 
 
 Fig. 2. 
 
 
 
 The Percuteur worked by electro-magnetism, and the Bunseii's 
 Battery, as supplied by Messrs. Weiss & Sons. 
 
 (I am indebted to the late Mr. Donald Napier and Dr. 
 George W. Balfour, of Edinburgh, for the suggestion to use 
 electricity as a motive power for the percuteur.) 
 
 E, screws connecting battery wires with the percuteur. A, screws for 
 making connection. There are two ; either may be used. That neares 
 the hinge of the vibrator causes the hammer to beat at the highest 
 speed. B, screw for attaching the hammer, brushes, &c, to the in- 
 strument. C, brass cylinder through which the rod of the hammer passes. 
 D, vulcanite tube, which is attached with a screw, and regulates the 
 length of the stroke made by the hammer. F, button which, being 
 pressed or pushed with the finger, sets the percuteur going. 
 
 percuteur worked by electricity is, in every way, 
 superior to the clockwork instrument, except as regards 
 portability. In consulting-room practice, the electric 
 
THE PRINCIPLE. 
 
 59 
 
 instrument answers every purpose most efficiently. The 
 general practitioner will, however, need to provide him- 
 self with the clockwork percuteur for use at his patient's 
 house ; and, as I have said, although seemingly very 
 weak in its blow, and troublesome, because it requires 
 
 Fig. t,. 
 
 
 
 7, Flat-headed hammer ; 6, pointed hammer ; 5, light brush for relief 
 of superficial pain and to redden the surface ; 4, hard brush. This 
 brush grew out of a suggestion made by Dr. Hugh Campbell, and 
 is very effective ; 3, small disc ; 2, large disc for use in water ; 1, bent 
 hammer. G, connection screw, tipped with platinum ; D, D, vulcanite 
 tubes to protect hammers ; H, screw to attach hammer to percuteur ; 
 I, clamp to fix connecting screws. 
 
 to be frequently wound, it is by no means ineffectual. 
 The above diagrams will show the instruments and 
 their adjuncts. What little I have to say of their use 
 may be said most conveniently in the course of the 
 detailed observations I propose to make on nerve- 
 vibration in practice. 
 
6o 
 
 NERVE-VIBRATION AND EXCITATION 
 IN PRACTICE. 
 
 FOR THE RELIEF OF PAIN. 
 
 If I am right in my theory that pain occurs when 
 vibrations of the essential elements of nervous tissue 
 extend to the beds of cells and the sheaths of nerve fibres, 
 it is easy to understand how compression of a nerve, — 
 either by force applied directly to its trunk, as when the 
 ulnar nerve is squeezed as it passes behind the inner con- 
 dyle of the humerus, or by distension of the surrounding 
 tissues from congestion of the vessels, or by effusion — • 
 causes pain, and why the pain is proportioned to the con- 
 striction, short of extreme pressure, which must, of course, 
 altogether prevent vibration of the nerve affected. As the 
 nerve is compressed, its sheath is forced in upon the nerve 
 elements, and necessarily becomes irritated by their dis- 
 orderly vibrations. Without such an explanation as this 
 theory of pain affords, it has always seemed to me unac- 
 countable, that so little pressure — a very little at the most 
 — as can be caused by the congestion of a swollen 
 finger, should occasion so much agony as is experienced, 
 for example, in whitlow ; or that the throbbing of the 
 arteries, should be as acutely and painfully felt as we 
 
NERVE-VIBRATION AND EXCITATION IN PRACTICE. 6r 
 
 know to be the fact. In this way also one branch of a 
 nerve whose sheath is vibrating painfully, may com- 
 municate its vibration to another sheath which happens 
 to be in juxtaposition. In the treatment of pain by 
 vibration, it is necessary to determine, as precisely as 
 possible, the particular branch in which it is located, and 
 to act, in the first instance at least, upon that alone. The 
 treatment will fail if healthy or normally vibrating nerves 
 are mechanically vibrated with those which are in a 
 morbid state. It is, accordingly, important to localize 
 the seat of the disturbance in pain, and to apply the 
 percuteur as directly as may be, to the disorderly and 
 disturbing branch alone. 
 
 The rationale of the process of relief is to overpower 
 the tumultuous vibration of the nerve elements within 
 their sheath, by communicating an independent and 
 different vibratile motion to the nerve as a whole. 
 In the attempt to do this, the pain is for the 
 moment frequently increased ; but this exacerbation of 
 the distressed sensation, which is the contingent con- 
 sequence of an augmented tumult, rapidly subsides — 
 if it occurs, which is not always the case — as soon as 
 the elements are compelled to fall into the same rhyth- 
 mical vibration as that communicated to their sheath 
 by the regular beat of the percuteur; the discord between 
 the nerve elements and their sheath, which is the cause of 
 the pain, and the sensation subsiding together. If the 
 mechanical vibration, communicated to the nerve by 
 percussion, fail to overpower the morbid vibration of 
 the nerve elements, it is likely to aggravate the suffering. 
 When, therefore, the pain of neuralgia is not quickly 
 
62 NERVE-VIBRATION AND EXCITATION 
 
 relieved by vibration, it is wrong to continue it with the 
 same instrument working at the same speed. 
 
 The mechanical percuteurs (Fig. i, page 57) are 
 provided with a pressure movement (A, Fig. 1, page 57) 
 which lengthens the stroke of the hammer, and thus 
 diminishes its speed, while increasing its force at 
 pleasure, and the electrical percuteurs (Fig. 2, page 
 58) have two contact pins (A, Fig. 2, page 58) one 
 at the extremity, and the other half-way along the 
 length of the vibrator, which respectively give different 
 rates of vibration. If the pain does not pass away 
 almost immediately after a momentary increase, to 
 which I have previously alluded as being often produced 
 by the first agitation of the nerve sheath, in short, 
 within a few seconds of the application of the percuteur, 
 it is well to change the rate of the percussion. Another 
 point of moment is to withdraw the percuteur instantly 
 when the pain is relieved, and wait until it returns, 
 which it is almost sure to do in a few minutes. Then 
 touch it again. I find that the pain returns sometimes 
 with increased acuteness, if the percussion has been 
 rapid — as many as three or four times in as many 
 minutes — before it finally ceases. The application 
 should be precise and very light, and it ought to cease 
 the very moment the pain ceases. By continuing the 
 vibration too long — that is, after relief has been ob- 
 tained — a new vibration, equally disorderly and pain- 
 ful with that we are trying to relieve, may be set up by 
 the percussion. Great care and tact are necessary in 
 treating pain by nerve-vibration. The aim should 
 always be to gain the desired result with the least 
 
IN PRACTICE. 63 
 
 force of blow, and the shortest duration of percussion, 
 restricted within the smallest practicable area. By 
 mismanagement failure may be secured and the treat- 
 ment discredited. For some months after I commenced 
 my experiments, I was unsuccessful in the majority of 
 instances, and I began to doubt the value of the remedy ; 
 but, since arriving at the general rules for percussion 
 which I have now tried to make plain, I have seldom failed, 
 at least with the electrical percuteur. The mechanical 
 instrument is very uncertain in its effects, even in the 
 improved form in which it is now offered to the pro- 
 fession. The French instruments, which I tried to use 
 two years ago, must, I fear, looking to the very small 
 proportion of instances in which they prove efficient 
 for the purpose of relieving pain, be pronounced failures. 
 The relief of pain, though by no means the most 
 important, is undoubtedly one of the most urgent and 
 widely persistent claims which humanity makes on the 
 physician and his art, and it was in the search for an 
 efficient and rational mode of treating this grievous 
 symptom or concomitant of disease, I came to perceive 
 the nature of pain, and first made the attempt to allay 
 it as one would put an end to discord in the vibration 
 of a musical reed instrument. My interest in the 
 success of the method in this particular sphere of 
 its action is, therefore, exceedingly great, and I would 
 venture to ask and urge all who may try the treatment 
 to give the subject their special attention. I can only 
 repeat what I said in my first paper in The Lancet, 
 namely, that I attribute my failures to faults in the 
 method of applying the instrument. One of my 
 
*■■■■>■ 
 
 64 NERVE-VIBRATION AND EXCITATION 
 
 earliest and commonest blunders was to press too 
 heavily on the part affected. I now find that the 
 slightest touch with the point of the hammer is incom- 
 parably more successful. At first I vibrated the whole 
 of the surrounding tissues, and especially the adjacent 
 bones. For example, to relieve neuralgic pain in the 
 branches of the fifth, I percussed strongly either over 
 the superior margin of the orbit at or near the exit of 
 the supra-orbital branch, or upon the superior maxilla or 
 malar bone for the infra-orbital branch, or on the lower 
 jaw at or near the emergence of the mental branch 
 for pain in the inferior division of the fifth. I failed as 
 often as I succeeded. Now I try to hit on the exact 
 point to which the pain is referred, if it be superficial, or to 
 find some terminal twig in close anatomical relation with 
 the deep branch which is vibrating painfully, and with 
 the least possible pressure of the pointed hammer (No. 6, 
 Fig- 3, page 59) I percuss very rapidly, if the pain be of 
 a dull grinding character, or at a lower speed if the pain 
 be exceedingly sharp, and move the instrument slowly 
 over the skin until it touches the precise spot at which 
 the pain is located when, for the moment perhaps, it is 
 increased, but very quickly afterwards relieved. This I 
 take to be the principle of the treatment for the relief of 
 pain. If the pain cannot be localized, but seems to ex- 
 tend over a considerable area, the operator may use the 
 disc (No. 3, Fig. 3, page 59) very lightly, applying it to the 
 surface ; or in cases of extreme tenderness, for example, 
 if the pain be situated in an inflamed limb or joint, he 
 may immerse the foot in water, about the temperature of 
 the skin over the seat of the suffering, and vibrate 
 
IN PRACTICE. 
 
 65 
 
 through the water, holding the disc in the fluid, 
 and passing it round the painful part, about an inch 
 
 Fig. 4. 
 
 from its surface, without touching it. The sketch 
 will show the mode of using the disc in the manner 
 described. F IG e 
 
 In other cases, when the pain is either entirely 
 superficial, perhaps of a formicating, or tingling, or burn- 
 ing character, or when it seems to be deeply seated 
 
 E 
 
66 
 
 NERVE-VIBRATION AND EXCITATION. 
 
 below a dull and morbid skin — two apparently opposite 
 conditions — it is well to use one of the wire brushes 
 (Nos. 4, 5, Fig. 3, p. 59), as shown in Fig. 5 (p. 65), 
 passing it lightly over the surface ; or in some forms of 
 deep-seated pain, pressing it firmly on the skin. 
 
 The practitioner will discover the best plan of proceed- 
 ing very readily after a few experiments, and he will 
 recognize the difficulty of giving precise directions for 
 treatment. No two cases, though closely similar, are iden- 
 tical in their requirements, and the treatment must differ 
 
 Fig. 6. 
 
 with the state. For the relief of pain in many regions, 
 the bent rod hammer (No. 1, Fig. 3, p. 59), will be 
 found exceedingly useful, applied as above (Fig. 6). 
 It can be brought to bear on almost any nerve 
 which lies fairly near the surface. When the nerve 
 affected is wholly out of reach, relief is often obtained 
 by vibrating some afferent branch, which proceeds to 
 
IN PRACTICE. 67 
 
 the same, or an adjacent centre, or which passes near 
 the trunk of the affected nerve in some part of its 
 course. Cases of headache are generally best treated by- 
 percussion with the disc over the meatus of the ear, or 
 with the flat-headed hammer (No. 7, Fig. 3, p. 59) over 
 the superior cervical nerves and plexuses. Parietal head- 
 ache may often be relieved by percussion over the trans- 
 verse root of the zygoma ; and occipital by percussion 
 about an inch behind the posterior margin of the base 
 of the mastoid process, on the superior curved ridge of 
 the occipital bone, or the percuteur may be moved 
 slowly along the ridge two or three times. For this last 
 purpose it is well to use the pointed ivory hammer. 
 Hemicranial headache is best treated with the brush, 
 applied very lightly to the scalp, and moved from below 
 upwards and from before backwards, a few times in an 
 orderly manner. The patient should, in all cases of 
 percussion for pain, be told to speak the moment relief, 
 however slight it may be, is perceived, and the operator 
 should instantly suspend the percussion until the pain 
 returns, or if it has not quite subsided, increases. A 
 series of experiments with the percuteur used for the 
 purpose in the manner described, will give the prac- 
 titioner a better knowledge of its powers and defects 
 than could be conveyed by many pages of description. 
 
 For the Control of Disorderly Movements. 
 
 Choreic movements are generally due to an excess of 
 irritability in some centre, which renders it ever ready to 
 discharge its nervous force on the slightest excitation, 
 or even without the application of any provocation from 
 
 E 2 
 
68 NERVE-VIBRATION AND EXCITATION 
 
 without. Convulsive movements and twitches — tricks 
 as they are called — are generally worse when the nervous 
 system as a whole is excited, and particularly when the 
 higher centres — the organs of consciousness — are 
 specially active. There is what Dr. Hughlings Jackson 
 has significantly designated a barrel-organ arrangement, 
 which favours the repetition of combined or formulated 
 movements whenever the centres become surcharged as it 
 were, by the accumulation of nervous force. What has 
 been done once will be done again, because the first act 
 has left the molecules of the automatic centres as a train 
 ready to carry the explosive force a second time along 
 the same nerves, and so on until the barrel organ, when- 
 ever it acts at all, plays the same tune. Nerve vibration 
 by percussion is decidedly useful in these cases. The 
 method of applying it may be briefly described as 
 follows : — Strive to impress the centres by percussing 
 mixed or afferent nerves on that side or surface of the 
 limb which is opposite to the line or direction of the 
 choreic movement, or by percussing nerves through 
 which antagonistic muscles might — if the case were a 
 suitable one — be called into action refiexly. For example, 
 if the flexors and pronators of the arm contract convul- 
 sively, percuss the nerves most likelyto act refiexly on the 
 extensors and supinators. To do any real good the per- 
 cuteur must, in cases of this class, be played strongly with 
 considerable motive force — using, say, eight cells of the 
 Bunsen battery — and employing either the fiat-headed 
 hammer or the hard brush. If the latter be employed, it 
 must be held firmly but not pressed on the skin, the object 
 being to secure the heaviest practicable blow, which is 
 
IN PRACTICE. 69 
 
 best secured by holding it so that the points of the wires 
 rise clear of the skin each time the current is broken, in 
 order to take advantage of the full momentum of the im- 
 pact when the blow is struck. The percuteur may be 
 made to trace the principal nerves upwards, and the per- 
 cussion kept up for fully twenty minutes daily. If the 
 face is habitually contorted, percuss the nerves which 
 carry sensation from the skin covering the opposing 
 muscles. For example, if the zygomatic muscles 
 are in the habit of twitching with the orbicularis 
 palpebrarum, percuss a little above the eyebrow; and 
 around the mouth over the orbicularis, and the tri- 
 angularis, oris specially. In cases of general chorea, 
 percussion down the spine, while the patient sits 
 across a chair or on a stool, is serviceable. The 
 flat-headed hammer should be used with a good deal 
 of force, and the aim should be to vibrate the roots of 
 the spinal nerves, percussing as nearly as possible over 
 the interspaces of the transverse processes. The per- 
 cuteur should be passed down the back close on either 
 side of the spinous processes, resting a few moments at 
 each, and persisting wherever pain is produced by the 
 percussion, until it subsides. There is often considerable 
 irritability of the posterior branches of the nerves in 
 these cases, and not uncommonly neuralgic tenderness 
 over the vertebrae. These local symptoms are speedily 
 relieved by the vibration, and as the cure succeeds in 
 this particular, the choreic movements are at first less 
 strong, and then less frequent, until they gradually dis- 
 appear. The seventh cervical vertebrae should always 
 be vibrated for flying "twitches," and it is well in 
 
yo NERVE-VIBRATION AND EXCITATION 
 
 cases of this class to explore the whole length of the 
 spine, with a view to discover any local excitability or 
 " tenderness." I have not had any large experience 
 in these cases, but what I have seen of the effects of 
 nerve-vibration in chorea, gives me great hope of 
 its usefulness. If it should answer as well as I antici- 
 pate, it will prove a boon to the family practitioner, 
 who is often consulted for the remedy of "tricks" and 
 "grimaces" of the young. If these are neglected, or 
 not cured in youth, they often become confirmed and 
 very troublesome later on in life. 
 
 To Elicit Energy from Torpid Centres. 
 
 When the symptoms of disease, or the absence of 
 some function, point to the torpidity of a special nerve 
 centre, it is necessary to approach it by the physiolo- 
 gical rather than the anatomical route, although in a large 
 proportion of instances the two are identical/ The affe- 
 rent nerves offer the best, and often the only practicable 
 line of communication. For example, if there be failure, 
 or absence, of sexual power, the state may often be 
 remedied by percussing with the pointed percuteur over 
 the inguinal nerves and those of the perineum, rather 
 than by percussion with the fiat-headed hammer over 
 the second lumbar vertebrae, which would seem to be 
 the most likely mode of procedure — with a view to 
 vibrate the genito-urinary centre by strong percussion 
 through the spine. Cases of this defect or deficiency 
 differ greatly. I have frequently failed to do any good 
 by percussing the spine, but certainly failure is rare 
 when the centre is approached reflexly. I believe it is 
 
IN PRACTICE. 71 
 
 possible to act on any centre with the effect of sensibly 
 improving its nutrition by vibrating its afferent nerves. 
 The cerebral centres are best reached by percussing 
 with the disc applied over the ear, or with the flat- 
 headed hammer at the root of the zygomatic process of 
 the temporal bone, immediately in front of the auditory 
 meatus, also at the external angular process of the 
 frontal bone, and along the superior curved line of the 
 occipital bone. The centres of special sense are to be 
 approached through their terminal organs. The optic, 
 by very gentle vibration of the globe of the eye through 
 the closed lid, a florin being used as a shield, and the 
 flat-headed hammer being lightly applied; or the small 
 disc (No. 3, Fig. 3, p. 59), may be used if the eye be not 
 too sunken. The olfactory centres may be stimulated 
 by vibration of the vertical plate of the ethmoid bone with 
 the pointed hammer, applied exactly on the median line 
 at the root of the nose ; or with the bent arm hammer 
 passed into the nose and allowed to play gently upwards 
 and inwards on the cribriform plates. This operation, 
 needs, of course, to be performed very carefully with a 
 light hand, and considerable judgment. The gustatory 
 centres may be roused, and taste restored in many cases, 
 by percussing the mucous membrane of the tongue with 
 the bent arm hammer or the small disc, or the brush 
 held sideways so as to vibrate the papilla laterally 
 with the everted tips of its outer edge, the tongue 
 being protruded, and lying on the lower teeth. The 
 point to bear in mind is that even when it seems easy 
 to act directly on a centre, it is better to try to rouse 
 it through its afferent nerves. No immediate effect, 
 
72 NERVE-VIBRATION AND EXCITATION 
 
 is, of course, to be anticipated in cases of this class, but 
 by persevering percussion, most centres may be aroused, 
 their nutrition improved, and their energy of function 
 elicited. 
 
 To Allay Morbid Irritability. 
 This is, in my judgment, one of the most interesting 
 — from a scientific point of view — of the many purposes 
 nerve-vibration can be employed to effect. The 
 operation may be studied to great advantage in the 
 treatment of locomotor ataxy. In the course of the 
 disease or diseases — for I believe there are several — 
 which have loss of " co-ordination" for one of their pro- 
 minent symptoms, it will soon be apparent to the careful 
 clinical observer that the essential morbid condition is a 
 block or undue resistance in the course of the motor 
 nerves. The notion that loss of sensation, is the primary 
 fault, may be dissipated by a simple familiar experiment. 
 Tell an ataxic patient to place his toe on a particular 
 spot of the carpet or into his shoe. Long before any 
 question of sensation arises, so far as contact with ex- 
 ternal objects — in this test, either the carpet or the shoe 
 — is concerned, the patient fails to make his muscles obey 
 his will. His foot is thrown out but does not go direct to 
 the mark, it is projected to one side of the object aimed 
 at, or is shot out, as though by explosive force, beyond 
 it ; or sometimes it cannot be extended at all. If any 
 one will take the trouble to study the muscular move- 
 ments of a spare subject trying to perform these acts, 
 he will, in many cases at least, be able to perceive, by 
 sight and feeling — placing his hand gently on the limb 
 
IN PRACTICE. 73 
 
 — that the opposing muscles, extensors and flexors, 
 adductors and abductors, internal and external rotators, 
 and the like, not only fail to act in co-ordination, but 
 are very differently affected by the nerve force projected 
 along the motor nerves of the limb. Only certain muscles 
 will be strongly energized, though the will is acting 
 powerfully, and the endeavour to touch the object be 
 maintained for a time. Some muscles will be spas- 
 modically contracted with a tonic result,having atendency 
 to run into cramp, while others are affected with an 
 irregular impulse, trembling, twitching, or being even 
 thrown into clonic convulsions. If these phenomena were 
 always present, or still more, if they always appeared 
 in the same muscles, it would be easy to explain the 
 condition on the hypothesis that certain motor branches 
 of the nerves supplying the limb were the seats of 
 mechanical block, and that the nerve force projected from 
 the lower centre at the bidding of the higher automatic 
 and still higher cerebral centres, finding resistance offered 
 on certain lines of nerves, passed off on other lines. The 
 condition is not, however, by any means constant. 
 At times an ataxic patient will walk well, at others 
 he can scarcely stand. One day he can perform almost 
 any desired movement, while on another he can scarcely 
 do anything in an orderly fashion. Nor is it possible 
 to connect the variations which take place in his power 
 of co-ordination with the mental or body state. At 
 least, I have failed to establish any such connection. 
 Sometimes I have thought a patient more orderly in 
 his movements when he was a little depressed ; at 
 others, when he was brightest. Treating many cases at 
 
74 NERVE-VIBRATION AND EXCITATION 
 
 the same time, I have observed a tendency on the part 
 of each and all of them — although not in communi- 
 cation, even in my waiting-rooms — to be at their worst 
 on the same day, and have naturally looked to the 
 weather, or the state of the atmosphere, as regards tem- 
 perature, moisture, and electrical conditions for an ex- 
 planation. I cannot say that I have succeeded in 
 discovering any connection. The only observation I 
 have been able to make is that there is evidently a 
 tendency to periodicity in the variations, not by direct 
 recurrence of the phenomenon at rhythmical periods, 
 but rather in short series of minor variations. Just as 
 the tide rises or falls by ascending or descending series 
 of waves, some ninth or tenth, or it may be fifth, 
 being the larger, so does an ataxic patient get better or 
 worse in the progress of his disease ; and it is not very 
 difficult, by keeping a careful record of any considerable 
 number of these cases seen, at very short intervals — 
 daily, if practicable — to determine whether the tide, 
 in even indolent cases, is rising or falling, so far 
 as the malady as a whole is concerned. Sometimes 
 patients, who suppose themselves to be mending, and who 
 are thought to be " doing well," are really losing ground, 
 and not slowly ; while every now and again it happens 
 that a patient who suffers very severely at certain periods, 
 and is greatly alarmed, while his medical attendant is 
 probably hopeless, is, in fact, making a tide-like pro- 
 gress towards health, with terribly long waves, which fall 
 back to return, not in a steady advance proportioned 
 to their recoil, but in a broken series of small advances. 
 The point I am anxious to bring out is this. If 
 
IN PRACTICE. 75 
 
 the real cause of ataxia were the sclerosis found after 
 death, the clinical history would be altogether different- 
 There would be a distinct stage of irritation during the 
 early days of the deposit, before it became sufficient in 
 quantity to create a block ; then there would be a 
 gradual and steady paralysis. The only variations 
 possible would depend on occasional congestions of 
 the cord or its meninges, and such variations of pressure 
 as can take place in the cerebro-spinal fluid. If there 
 were mechanical obstruction by deposit in a particular 
 part of the cord, or on the lines of certain nerve-trunks or 
 branches, it would not be here to-day and gone to-morrow ! 
 It is certainly not sclerosis of the posterior or the 
 antero-lateral columns of the cord which produces the 
 want of co-ordination. I have had under my observa- 
 tion more than one case of undoubted tabes spinalis 
 — not of my own diagnosis be it understood — in 
 which sensation has been perfectly restored, and yet 
 the motor power is now almost at it lowest ebb, so 
 far as the legs are concerned, in these cases. There 
 has not been a trace of patellar tendon-reflex for years, 
 but the cutaneous reflexes are strongly marked, and 
 when excited cause considerable muscular contractions. 
 What, then, is the explanation of the etiology of 
 tabes, which I have to submit ? Briefly this. I believe 
 the disease to be at the outset a disorderly vibration 
 of the nerve cells or fibres, and in the end an arrest of 
 vibration altogether. The first organic cause is, I think, 
 a nutritive change in the neurilemma ; and in the syphi- 
 litic type of the disease, I believe, the specific inflam- 
 matory action followed by deposit, extends along the 
 
76 NERVE- VIBRATION AND EXCITATION 
 
 course of the nerve sheaths, ascending to the centre 
 from the chancre. The nerves involved in the indu- 
 ration around a chancre are demonstrably shown to be 
 the seat of perverted cell growth. The researches of Cornil 
 support this view. He says : " The nerve fasciculi which 
 pass into the indurated tissue of a chancre, and which 
 are surrounded by a connective tissue infiltrated with 
 small round cells, are inflamed in their laminated sheaths, 
 the connective tissue which accompanies the vessels 
 between the nerve fibres in the interior of the fasciculi 
 being also inflamed. Thus, in the examination of a 
 chancre removed by Mauriac from Case V., I have been 
 able to study transverse and longitudinal sections of nerve 
 fasciculi. The laminated sheath was separated ; the 
 flat cells between the laminae were larger and more 
 swollen than normal, or were replaced by numerous 
 elongated, oval, and small cells. In another examina- 
 tion of a chancre, which had been treated by osmic 
 acid, immediately after its removal, the nerve fibres 
 were also normal. I should say, however, in these ex- 
 aminations, I have not searched for the ultimate ter- 
 minations of the nerves in the papillae. The inflamma- 
 tion, the separation of the sheath of the nerve fasciculi 
 by cells of a new formation in the tissue of the chancre, 
 is not accompanied with pain. This neuritis without 
 pain is a curious circumstance.'''" 
 
 Tabes may be originated by spinal irritation of any 
 kind, either mechanical, as in a fall, or by cold, as 
 in meningitis. However, the thickening of the envelope 
 
 * " Syphilis," by V. Cornil, Professor in the Faculty of Medicine of Paris. 
 Translated by Sims and White, Philadelphia. H. Kimpton, 18S2. 
 
IN PRACTICE. J7 
 
 of the nerve or cord is produced, it has the effect 
 of preventing orderly vibration of the adjacent nerve 
 elements, with the result of disturbing and impairing 
 the function of co-ordination. The motor impulse 
 comes down in all integrity from the higher centres; but 
 one of the hammers, so to say, strikes a wire which is 
 out of adjustment and vibrates irregularly, and the 
 musical chord produced is defective, because its com- 
 ponent notes are out of tune !. The disturbance set 
 up being always located in, or springing from, one 
 segment of the cord or one series of nerves, is likely 
 to be fairly constant in its effects, but there is 
 no more reason why these should not vary from 
 day to day and hour to hour, than that a piano, 
 which is out of tune, should not produce the strangest 
 vagaries of disorderly sound. In short, I believe the 
 cause of the malady to be a disturbance of that orderly 
 vibration which is essential to nerve action and function, 
 whether in the posterior, lateral, or anterior, columns of 
 the cord, or in the nerves that transmit impressions from 
 the periphery or carry down motor impulses from the 
 centres to the mu?cles. By-and-by, the consequence of 
 this perversion of function is to impair nutrition, and 
 the cells and fibres atrophy, the surrounding connective 
 tissue proliferates, and the disease becomes incurable. 
 Up to this point, however, it is remediable by excita- 
 tion to normal exercise, and consequent healthy nutri- 
 tion, and in the process of the cure by re-education 
 nerve-vibration is an accessory remedy ready to hand. 
 It controls the disorder, changes the state, and helps 
 to re-establish that mobility of the nervous elements 
 
78 NERVE-VIBRATION AND EXCITATION 
 
 which is essential to health. Moreover, it is itself a 
 powerful agent in the work of education by restoring 
 not merely vibration but rhythm. 
 
 Nerve-vibration is of value also as a means of giving 
 precision to diagnosis by enabling the physician to dis- 
 cover the locality of the disturbance. For example, he 
 passes the percuteur, with the pointed hammer, or the 
 hard brush, gently over the surface of the limb, com- 
 mencing at the toes and working upwards ; when the 
 nerves are healthy there is no disturbance, but the 
 moment the point of the percuteur touches the skin over 
 a morbid nerve a reflex action commences, and in a few 
 seconds, or longer — as the nerve centres may be more or 
 less out of tune — the muscles which can be reflexly con- 
 tracted from that particular spot are thrown into a state 
 of spasm. It will be easy to see how, with a fair 
 knowledge of the nervous system, the clinical investi- 
 gator may trace the disturbed branches to their trunks, 
 and finally up to the cord. The process is at once 
 intensely interesting in itself, and of highly practical 
 value to the patient, because when the particular tracts 
 which are affected have been clearly made out, the 
 vibration may be so applied as to act on these and 
 these alone. 
 
 This brings me by a somewhat discursive route back to 
 the practical question, how "to allay morbid irritability?" 
 Granted that I am right in my hypothesis of the sort of 
 disturbance which occurs in tabes spinalis and the 
 allied maladies, ranging from cataleptic hysteria to 
 tetanus, it follows that in so far as the irritability — 
 whether it manifest itself in jerkings, or clonic or tonic 
 
IN PRACTICE. 79 
 
 spasms — is the result of disorderly vibration, this may- 
 be reduced by overpowering the disorder with order. 
 The manner of operating is to apply the flat-headed 
 hammer, if we have to deal with a deeply-placed or 
 large nerve sheath, the pointed hammer if the nerve be 
 superficial or small, the hard brush if several nervous 
 filaments lying close together are affected, or the disk if 
 the area of superficial disturbance be very large ; and to 
 keep up the percussion until the jerking, twitching, or 
 spasm, reflexly excited by the vibration subsides. Either 
 of two courses maybe pursued: — I. The percussion, 
 which should always be as light as will suffice to pro- 
 duce the phenomenon, may cease the moment the 
 muscles are contracted, being recommenced when they 
 relax ; or (2) it may be maintained during the spasm. 
 There is a considerable drain of nerve force from the 
 centres when the latter course is pursued. The conditions 
 of expediency will vary with the cases under treatment; 
 but I am inclined to think it is generally well to stop 
 the percussion when the muscles are fully contracted. 
 They will then relax, and after an interval we may 
 repeat the vibration ; sometimes this repetition will 
 need to take place three or four times. 
 
 If the patient be in fairly good general health, the 
 treatment may be expedited by continuing the percus- 
 sion during the spasm, and directing him to resist the 
 effects of vibration. This is perfectly easy to do. The 
 spasm is purely reflex, and the moment a motor impulse 
 is sent through the automatic centre by or from the 
 cerebral centre, the spasm ceases. The educationary pro- 
 cess consists in this exercise, the effort being to subdue 
 
80 NERVE-VIBRATION AND EXCITATION 
 
 the insubordinate lower centre, and discipline it to obey 
 the higher centres. It is like drilling a stupid, or stub- 
 born recruit. Nor is the drill merely functional. By 
 the law of development through the environment — the 
 great law of Nature — function precedes organization, and 
 it is not only possible to improve the nutrition of a nerve 
 centre by exercising it, but actually to restore its cells and 
 fibres to health, just as you may promote the growth of 
 brain cells by education.* In this way it is that irrita- 
 bility may be allayed by nerve- vibration, the cause of 
 irritability — that is, disorderly vibration — being rectified 
 by the controlling, subduing, and disciplinary effect of 
 the mechanical vibration applied from without. If I am 
 right, the disorderly state we have to treat must be the 
 same, whether the cause of the disturbance is the irrita- 
 tion set up by a patch of deposit creeping along the sheath 
 of a nerve and gradually encroaching on the space neces- 
 sary for the oscillatory movements of the essential nerve 
 elements in vibration, or a disturbed and irregular 
 activity of the cells or fibres from any other cause — e.g., 
 the excessive mobility of the nerve elements in the 
 female organism, which renders hysteria, and in some 
 states cataleptic hysteria, a physiologically probable form 
 of nerve derangement. It is needless to adduce evidence 
 which will at once occur to the mind of every practitioner 
 in proof of the essential identity of the nerve-state — 
 without reference to its cause — in the several maladies 
 which are characterized by excessive irritability. It 
 follows that the principle of the treatment by vibration 
 
 * See a paper on "The Re-education of the Adult Brain," repro- 
 duced at p. 94. 
 
IN PRACTICE. 8 I 
 
 must be the same, however greatly the precise mode of 
 its application may need to vary in cases of different 
 class and type. 
 
 The following paper relates to an important adjunct 
 to nerve-vibration. The principle of the procedure is 
 applicable to the treatment of other disabilities besides 
 that for which I have here specially recommended 
 its adoption. The method suggested aims at the re- 
 generation of the nerve element by exercise on the 
 basis of the law of development through function. I 
 reproduce it from the Practitioner of November, 1881. 
 
 "A Note on One 'Symptom' of Locomotor 
 Ataxia. 
 
 "The hypothesis of dissolution as propounded by 
 Herbert Spencer and applied by Hughlings-Jackson to 
 the elucidation of morbid phenomena, receives pointed 
 illustration in the pathognomonic symptom, so-called,, 
 of locomotor ataxia. The patient cannot preserve his 
 equilibrium, but begins to reel, when his eyes are closed, 
 being unable to stand or walk without the assistance of 
 the sense of sight. Why is this ? I reply, because the 
 automatic function of balancing the body and maintaining 
 the erect posture, has been learnt — as all functions which 
 are performed by the co-ordination of muscular move- 
 ments must belearned before they can be relegated to the 
 domain of the sub-consciousness, and become automatic 
 — by sight; and the ataxic subject is reduced by 'dis- 
 solution' to the position of a child just learning to stand 
 and walk. He has lost the nervous bases of the organized 
 
 F 
 
82 NERVE-VIBRATION AND EXCITATION 
 
 movements which are essential to the performance of 
 these muscular acts automatically. The records are 
 either isolated from the current of energy ; or obliterated 
 so far as the active vitality of the cells or molecules 
 composing them is concerned, although the germinal 
 points of the latter are not, perhaps, destroyed, and 
 recovery is possible ; or those elements of the brain or 
 cord on which the lessons have been impressed are 
 atrophied, and the records are finally effaced. 
 
 " The infant fixes its gaze steadily on some object 
 when it first tries to stand, and it is by the aid of sight 
 it at length succeeds in steadying itself and in balancing 
 the weight its lower limbs have to carry and its vertebral 
 column has to hold upright. The process by which 
 the child learns first to stand and then to walk, is 
 identical with that by which the tight-rope-walker learns 
 to perform his feats of equipoise. In both cases the 
 gaze is centred on a fixed object, and the muscular 
 sense trained to control the movements of the body, so 
 that the direction of the line of sight may not be dis- 
 turbed. When the child has once acquired the power 
 of standing, the so-called 'muscular sense' is able to 
 balance the body without the aid of sight, and under 
 normal conditions it is as easy to stand or, so far as 
 muscular action is concerned, to walk with the eyes 
 closed as open. When, however, disease of a paralytic 
 type assails the organism, the most recently acquired 
 faculty is the first to be lost. This rule of denudation 
 from the surface downwards governs, as we know, the 
 demoralization of character in brain disease, and the 
 disorganization of function throughout the system. In 
 
IN PRACTICE. 83 
 
 the particular manifestation of disease called loco- 
 motor ataxia — an arbitrary name for an artificially- 
 defined combination of phenomena — the power of 
 balancing the body by the muscular sense is lost, and 
 the subject unconsciously falls back on the method of 
 performing the act of standing which he adopted when 
 first learning the process. It is only accidentally, 
 or when the physician applies the test, that the patient 
 becomes aware of his condition. In the case of a blind 
 man who is ataxic, the muscular sense has been so 
 highly developed to compensate for the loss of sight, 
 that it is not easily impaired even by paralytic disease, 
 and therefore, in the case of the blind, the distinctive 
 symptom of ataxia is often wanting, or seems to be so, 
 until an advanced stage of the disease. 
 
 " So far as I am aware, this explanation of the cha- 
 racteristic symptom of locomotor ataxia — which I sub- 
 mit is the true one — has not been given in any treatise 
 on the disease. It is important that it should be recog- 
 nized, because it affords corroborative evidence of the 
 hypothesis of dissolution undoing the work of evolu- 
 tion — that form of evolution which takes place in the 
 individual under educationary influences ; and because 
 it supplies a clue to the method of treatment most likely 
 to be effectual in delaying the progress, if not even 
 arresting the advance, of organic disease. No one who 
 believes, as I most firmly do, that all development is 
 evolutionary, in the Darwinian sense, and that what we 
 designate mind is the function of nervous matter, in 
 part located in the brain and in part in the spinal cord, 
 can refuse to admit that the brain — and if the brain, 
 
 F 2 
 
84 NERVE-VIBRATION AND EXCITATION 
 
 why not all the other nervous centres ? — may be organi- 
 cally developed or improved by training, through and 
 by the influence of function, just as muscular tissue 
 may be developed and its nutrition promoted by passive 
 or induced movement. In short, the nerve-centres which 
 are the seat of disease in locomotor ataxia, may, at 
 least in the early stages of disease, be stimulated to 
 normal activity and incited to restorative energy by 
 influences exerted through function, if only we take the 
 pains to study the modus operandi of function, and to 
 discover how it was originally evolved. 
 
 " The functional act of standing was developed first 
 by the aid of sight, and then by the aid of the muscular 
 sense. In locomotor ataxia the muscular sense is 
 abolished, and the subject left to stand and walk again 
 by sight, or, in other words, reduced to the position of 
 a child. Now, heterodox and unphysiological as it 
 may at the first mention be thought, I propose to 
 arrest the decay, or to renew the activity, of the mus- 
 cular sense, by re-educating the nerve-cells which are 
 sources of this particular form of energy. Of course, 
 when I use the term " muscular sense," I do not for 
 a moment suppose there is any sensation evolved in 
 muscular tissue. All I mean is, that the nerves of 
 sensation are tributary to the co-ordination of muscular" 
 acts in a way which seems to make the very muscles 
 themselves appear sensitive. It is a mere figure 
 of speech which may be taken to represent the 
 instant, consensual, almost reflex government of the, 
 muscular system, or trained series of muscles, in the 
 automatic performance of combined movements which 
 
IN PRACTICE. 85 
 
 have been learned and organized. What I suggest, 
 therefore, is really the stimulation of these nerve-cells 
 — whence springs the so-called " muscular sense" used 
 in standing and walking — by specifically directed ex- 
 citants. Every patient suffering from a malady which 
 in the most distant or indirect manner points to brain 
 or nerve disease should be tested, not only for the 
 power of standing firmly, but for ability to walk with a 
 slow and firm tread with the eyes closed. If there 
 be the slightest defect in this performance a distinct 
 exercise designed to train this faculty should be directed 
 and perseveringly carried out, with intent to increase 
 the activity and promote the nutrition of the centres 
 which are failing. 
 
 " The symptom to which I have alluded is only one 
 of a series indicating a particular malady, but it is one 
 that points directly to the organic lesion from which 
 the disease as a whole proceeds, or in which it mainly 
 consists. By treating the deep cause, through the 
 functional irritation, the disease may, I am convinced 
 by experiment, be delayed, or, as it seems, wholly 
 arrested. As it is, the disorganization proceeds until 
 the sufferer is reduced to the condition of a child, and 
 the power of standing automatically is lost before 
 the existence of the malady is recognized. Dr. 
 Buzzard has done great and lasting service to the 
 interests of early diagnosis in diseases of the cord by 
 popularizing Westphal's test for ' Tendon-Reflex.' There 
 may be little new in my suggestion, that every patient 
 should be tried for the power of balancing the body 
 and maintaining the upright position steadily without 
 
86 NERVE-VIBRATION AND EXCITATION 
 
 the aid of sight ; but there is at least novelty, if 
 nothing else, in the recommendation of a serious at- 
 tempt to stimulate the nervous centres to improved 
 nutrition by formal exercises. I make this recom- 
 mendation as the result of experiment, and with good 
 grounds, for confidence in the effect at which it aims. 
 In any case no harm can be done by trying the treat- 
 ment I suggest, and I am persuaded that if it be 
 honestly and perseveringly pursued in the early stages 
 of the disease, it will be found beneficial. 
 
 " The plan is simply this : the patient is to be directed 
 to stand with his eyes closed in his bath, after pouring a 
 small can of cold water down the spine (in some cases 
 which appeared to be sthenic I have directed the 
 application of a mustard-poultice over the full length 
 of the spine, for ten minutes or a quarter of an hour, 
 until redness was produced, every night, besides the 
 cold douche in the morning), and to persevere in the 
 attempt to do this steadily for, at first, a quarter of an 
 hour, and, as his state improves, for half an hour, every 
 morning. He is to be furnished with a chair or rail at 
 hand to which he can cling in case of need, but in- 
 structed to avoid using it except in actual danger of 
 falling. When he commences the daily exercise he 
 will probably for some two or three weeks make little 
 progress, but after this time he will begin to be able to 
 stand, and in less than three months, if my results are 
 trustworthy — not only will the symptom, which was 
 regarded as conclusively indicating the existence of an 
 incurable disease, be eliminated from the case, but other 
 symptoms will disappear with it, and the general state 
 
IN PRACTICE. 87 
 
 of the patient be sensibly improved. I will not say- 
 more as to the effect of this treatment ; but I will 
 venture to add that it ought to be tried. 
 
 " Before leaving the subject of locomotor ataxia, 
 although this brief note has for its topic one symptom 
 only, I should like to embrace the opportunity of saying 
 that marked benefit seems likely to attend the use of 
 mechanical vibrations propagated through the bony 
 column to the spine in the manner desribed by me in 
 a letter to The Lancet, October 15, 1881." 
 
 Since I wrote this last paragraph, greatly extended 
 experience has confirmed my good opinion of the effects 
 of nerve-vibration in these cases ; but I do not now, 
 as has been explained, attack the centres indirectly 
 through the spinal column, so much as directly — in the 
 physiological sense — through their afferent nerves. 
 
 On September 23 last, the following brief note ap- 
 peared in the British Medical Journal, on the Locomotor 
 Ataxy of Tabes Dorsalis, or as Sir William Gull has 
 more correctly named it, Tabes Spinalis. Every one must 
 admit the justice of the remark made by Sir William 
 when presiding at the discussion which took place on the 
 subject of this symptom or malady in the International 
 Medical Congress of 1881 : "Tabes Dorsalis certainly 
 it is not." 
 
 " A Note on the Treatment of Locomotor 
 Ataxy by Precise Nerve-Vibration. 
 
 " I do not think the evidence collected, up to this 
 point is sufficient to justify the assertion, that locomotor 
 ataxy can be certainly cured by nerve-vibration ; but 
 
88 NERVE-VIBRATION AND EXCITATION 
 
 the large measure of success I have recently obtained 
 in dealing with some very advanced cases of this truly 
 terrible disease, seems to render it incumbent upon me 
 to place the facts before the profession. The cases I 
 have had have all been clearly marked, with entire 
 absence of patellar tendon-reflex, and with the charac- 
 teristic impairment, in some instances amounting to 
 almost complete loss, of the power of co-ordination. 
 It is not my intention to report these cases at present, 
 as I am anxious to extend the area of observation, both 
 as regards the number of cases and their duration, 
 before committing myself to a final judgment. Mean- 
 while there are certain clinical facts which may be helpful 
 to others, and ought, therefore, to be communicated. 
 I will try to state them as tersely as possible. 
 
 " i. In every instance I find exaggerated reflex irrita- 
 bility on application of the percuteur to the periphery. 
 For example, when it is applied over the anterior tibial 
 (a mixed) nerve, the foot is drawn forcibly up, which 
 never happens in the case of a healthy subject. In some 
 instances the irritability is so great that the legs and 
 feet may be turned or drawn in any direction at pleasure, 
 by vibrating the appropriate afferent branches of the 
 nerves supplying them. No effect is produced by per- 
 cussing the muscles ; the effect follows only precise 
 vibration of the nerves. 
 
 " 2. This reflex irritability, or excitability, seems to 
 me the real hindrance to the walking ; the loss of sen- 
 sation, which is incident to the malady, being of com- 
 paratively secondary importance as regards the disability 
 for locomotion. It is almost invariably confined to the 
 
IN PRACTICE. 89 
 
 nerves supplying the extensors. I have not in any 
 instance met with more than a slight tendency to 
 cramp in the flexors, and that rarely. 
 
 " 3. By persisting in the vibration of the irritable 
 nerves, their excitability becomes exhausted ; and, in 
 proportion as this happens, they obey the mandate of 
 the will, and voluntary movements, in short, locomotive 
 acts, are possible. Not unfrequently some debility of 
 the nerve-power and depression of energy in the centres 
 follow immediately upon the exhaustion of their irrita- 
 bility ; so that for a few hours, or it may be days, the 
 patient complains of stiffness, and, although he may 
 have lost the jerky feeling in his limbs, he cannot move 
 them more readily. They are heavy and powerless. 
 This, however, quickly passes away, and the case is 
 found to have made decided progress. The walking is 
 easier and steadier, and control, generally, more direct 
 and precise. At this stage, not earlier, it may be ad- 
 vantageous to percuss over the spines of the vertebrae, 
 with the view of vibrating the nerve-centres. I do not 
 think it is easy, or in many cases possible, to excite the 
 centres except through their afferent nerves ; but after 
 the reflex irritability has been reduced, it then often 
 happens that vibrations, which could not at first be 
 propagated along the motor nerves, can be sent from 
 the centres by percussion immediately, or as nearly as 
 possible, over the latter. I believe it will be found that 
 the mechanical vibrations excited in a nerve by per- 
 cussion, invariably pass in the direction of its normal 
 activity — in the sensory branch, towards the centre ; 
 in the motor towards the periphery. There often seems 
 
90 NERVE-VIBRATION AND EXCITATION 
 
 to be a block, as it were, in the course of a nerve, 
 whether motor or sensory, and, while this lasts, the 
 impulse or impression is diverted, sometimes producing 
 very curious results under vibration by percussion. 
 When the block is broken down by mechanical vibra- 
 tion, the wave again passes in the normal direction. 
 Practically, I do not find much amiss with the sensory 
 nerves. The motor chiefly are at fault. 
 
 "4. I have collected almost, though perhaps not quite, 
 enough evidence to show that the syphilitic form of 
 locomotor ataxy, or that which undoubtedly follows 
 syphilitic disease, is not a localized, but a local affection. 
 It is a specific inflammatory extension from the penis 
 along the sheaths of the nerves to the proximate centre, 
 and thence by particular fibres to other parts of the 
 cord. The loss of sexual power which occurs, and which 
 is rapidly followed by the indications of deficient nutri- 
 tive action in the organs of generation, is the immediate 
 consequence of an interruption, more or less considerable, 
 in the nervous connections, consequent on the affection 
 of the nerve-sheaths. The impairment of control over 
 the bladder and sphincters, causing either diarrhoea or 
 constipation, is contingent on the local progress of the 
 disease, which may generally be traced by the anatomical 
 and physiological communications. It is very in- 
 structive to work out the details of a case of this class 
 clinically ; and no two cases, in my experience, have 
 been alike, although as a rule they have surface-features 
 of typical resemblance. For example, there is nearly 
 always something wrong with one of the ulnar nerves, not, 
 I believe, as an accident of disseminated sclerosis, but as 
 
IN PRACTICE. 91 
 
 a specific extension along particular fibres. I am con- 
 vinced that these cases of syphilitic ataxy ought to be 
 studied apart, and treated as distinct, from the mass of 
 ataxic disease. The two maladies have little, if any- 
 thing, in common beyond the name; and that is, as 
 regards both, I think, a misnomer. Moreover, the sen- 
 sory fault is by no means the primary one, as generally 
 supposed. 
 
 " 5. The sclerosis which occurs in the cord in the 
 syphilitic disease, I believe to be simply inflammatory 
 thickening of a specific character. I do not think we 
 need talk of 'gummata' or 'disseminated sclerosis.' The 
 malady consists in a direct extension of the local disease 
 along the sheaths of particular nervous tracts. Syphilis 
 is, of course, one of the blood- diseases ; but I doubt 
 whether syphilitic 'ataxy' falls into that category. The 
 interval which occurs between the healing of a chancre 
 and the appearance of ataxic symptoms may be great ; 
 but, if we inquire carefully into the history of cases, we 
 find that there have throughout been indications — 
 very slight it may be — of local nerve disturbance. 
 Nerve-vibration, unquestionably, does much for these 
 cases ; and among other effects which it produces, and 
 for which it is well to provide, is that, in the course of the 
 treatment, it every now and again revivifies the syphilitic 
 virus, and thus at once renders it possible, and necessary, 
 to treat the malady de novo, even in cases of very long 
 standing, where there has been no thought of active 
 syphilitic poison for years. Whether the mechanical 
 vibration of the nerves, with their thickened sheaths, 
 throws off particles of poisonous exudation which find 
 
92 NERVE-VIBRATION AND EXCITATION 
 
 their way into the current of the blood, as in the 
 breaking down of an old cicatrix which has entangled 
 the virus of rabies, I can only conjecture. 
 
 "It seems possible that the nerve-fibres, which have 
 been mechanically blocked by the exudative processes 
 of the specific disease may be, as it were, shaken loose 
 from their entanglement, and thus become again vibra- 
 tile. Perhaps it is in the course of this breaking up of 
 the 'block' debris are thrown into the circulation. 
 However the revival of the original specific disease 
 may be explained, it undoubtedly every now and again 
 occurs. 
 
 " I have thus just jotted down briefly, and in no formal 
 sequence, the leading facts which I desire to place on 
 record, and to which I think the attention of the pro- 
 fession ought to be directed. One word only, in con- 
 clusion : nerve vibration by percussion is undoubtedly a 
 most useful adjunct to the ordinary treatment of many 
 maladies, and of especial value in the diagnostic study 
 of disease. It will be monstrous if this method be 
 degraded to the level of a ' cure,' by placing percuteurs 
 in the hands of patients, and allowing them to use them 
 for themselves. Great harm will be done in some cases, 
 in others there will be disappointment, and nerve-vibra- 
 tion will be discredited. It is an agency for professional 
 use exclusively; and against its employment by laymen, 
 whether alone or under medical advice, I must most 
 earnestly protest." 
 
IN PRACTICE. 93 
 
 To Relieve Cerebral and Cerebrospinal 
 Irritation and Distress. 
 
 I use these terms, irritation or distress, to indicate 
 the commonest forms of brain and mind trouble, because 
 no others seem to me to express with equal precision 
 the states for which I believe vibration to be a good 
 remedy. Irritation conveys the idea of excitement 
 arising from debility, and distress indicates that labour- 
 ing and yet consciously ineffective state of the brain- 
 power which constitutes one of the most painful forms 
 of mental misery. 
 
 The general remarks offered under the last heading 
 apply, mutatis mutandis, to the subject now before 
 us. The treatment for irritability, whether cerebral, 
 cerebro-spinal — in the sense of seeming to pervade 
 the whole nervous axis — or spinal, such as that 
 I have previously discussed, must be essentially the 
 same. It consists of two parts, ( i ) healthy stimulation 
 and re-education through function ; and (2) rhythmical 
 vibration to subdue tumultuous and irregular vibration 
 of the nervous elements and thus restore order. I should 
 like in this place to cite a case which formed the sub- 
 ject of a short paper which appeared in Brain, Part VII. 
 October, 1879, on " Re-education of the Adult Brain." 
 It was suggested by a very interesting and important 
 case narrated by Professor Sharpey in the April number 
 of the same periodical, which recalled to memory one 
 that fell under my own observation many years before. 
 "In 1858 I was requested to see a daily governess 
 
94 NERVE-VIBRATION AND EXCITATION 
 
 and teacher of music, who had been suddenly attacked 
 with what was thought to be acute mania. I found a 
 spare, somewhat angular, eccentric looking young woman, 
 aged about 26, in a state of great excitement, hyste- 
 rical and choreic. Within a few hours — after a paroxysm 
 of considerable violence, during which she talked and 
 sang wildly, and was with difficulty restrained by those 
 around her — she fell into a state verging on suspended 
 animation, which lasted a week. The skin was cold, 
 and presented a dark mottled appearance ; the pulse 
 was scarcely perceptible at the wrist ; the breathing slow 
 and seldom deep ; there seemed to be complete loss of 
 consciousness, and scarcely any trace of sensibility. The 
 muscles were cataleptic, and the extremities dropped 
 slowly when raised. It was barely possible to feed the 
 patient by the mouth, by holding forward the larynx 
 and placing the fluid far back in the pharynx with 
 a spoon, when it seemed to flow down the oesophagus 
 as through a flaccid tube. This condition, which was 
 treated with the interrupted current from the occiput 
 and nape to the hypogastrium, and mustard-poultices 
 down the spine, subsided very gradually. Then came 
 the state I am chiefly interested to describe. There 
 had been an exciting cause for the attack in reli- 
 gious excitement, acting on a nervous system exhausted 
 by protracted toil as a teacher. 
 
 " When consciousness began to return, the latest sane 
 ideas formed previous to the illness, mingled curiously 
 with the new impressions received, as in the case of a 
 person awakening slowly from a dream. When propped 
 up with pillows in bed near the window, so that passers 
 
IN PRACTICE. 95 
 
 in the street could be seen, the patient described the 
 moving objects as 'trees walking;' and when asked 
 where she saw these things, she invariably replied 
 'in the other gospel.' In short, her mental state was 
 one in which the real and the ideal were not separable. 
 Her recollections on recovery, and for some time after- 
 wards, were indistinct, and, in regard to a large class 
 of common topics which must have formed the staple 
 material of her cerebration up to the period of the attack, 
 memory was blank. Special subjects of thought imme- 
 diately anterior to the malady seemed to have satu- 
 rated the mind so completely that the early impressions 
 received after recovery commenced were imbued with 
 them, while the cerebral record of penultimate brain 
 work, in the life before the morbid state, was, as it 
 were, obliterated. For example : although this young 
 woman had supported herself by daily duty as a 
 governess, she had no recollection of so simple a 
 matter as the use of a writing implement. When a pen 
 or pencil was placed in her hand, as it might be thrust 
 between the fingers of a child, the act of grasping it was 
 not excited, even reflexly: the touch or sight of the 
 instrument awoke no association of ideas. The most 
 perfect destruction of brain tissue could not have more 
 completely effaced the constructive effect of education 
 and habit on the cerebral elements. This state lasted 
 some weeks, and the " recollection" of what had been 
 " forgotten," to use conventional terms, was slow and 
 painful, needing, or, as I would now say, seeming to 
 require, a process of re-education as distinct as (though, 
 I judge, less prolonged than) that which proved neces- 
 
g6 NERVE-VIBRATION AND EXCITATION 
 
 sary in the case detailed by Professor Sharpey. In the' 
 end recovery was mentally and physically satisfactory. 
 
 " I cannot assume that anything in these two narra- 
 tives (Professor Sharpey's and my own) will strike the 
 practical psychologist as novel, or of even unfrequent 
 occurrence. The clinical aspect of such cases has been 
 sketched times without number. Nevertheless, they pre- 
 sent features of interest, as viewed from an etiological 
 stand-point, which may be worthy of more than a 
 passing notice. 
 
 "Either of three conditions may, I believe, be set 
 up by brain disturbance, or disease, causing ' loss of 
 memory': — I. Complete destruction of cerebral cells; 
 2. Withering or blighting, which amounts to obliteration 
 of the cells without destruction of their nuclei (I use 
 the term nucleus, here and throughout, in a non-physio- 
 logical sense, simply to designate the seat of life in a 
 cell, whatever that may be) ; 3. A suspension of function 
 without arrest of nutrition, as though a particular area 
 of the cerebral organism were simply thrown out of the 
 circuit of energy. 
 
 " In the first event there will be final effacement of the 
 records of ideation. So far as the cells destroyed are 
 concerned, they and their properties are lost for ever. 
 If the functions previously performed by these strata or 
 tracts reappear, it must be because some other part of 
 the brain has taken up the business vicariously — as I 
 believe is possible with nearly every function or mani- 
 festation of mental energy. In the second event, when 
 the cells are withered, but the nuclei remain, a new crop 
 of cells may spring from the parent organism, and after 
 
IN PRACTICE. 97 
 
 a lapse of time sufficient for development, the educa- 
 tionary record will reappear, the seed reproducing its 
 kind, plus the impress of training and ideation. It may- 
 be that there will need to be so much re-education as 
 to cultivate the new growth, and perhaps a re-impression 
 of purely objective ideas, but it may, and probably in 
 the majority of instances does, happen that the new 
 cells will be developed with all the characteristics of the 
 old. In the third event, recovery may occur instantly, 
 almost at any moment, if the obstacle to communication 
 be overcome or break down in convalescence, so that 
 the isolated, but scarcely injured, congeries of brain 
 cells may again be energized. I speak of brain cells 
 instead of ' nerve-molecules,' because, accepting the 
 vibration theory, it must be assumed that the vibrating 
 particles are cellular vital organisms. 
 
 "Supposing the states I have described to exist, I 
 venture to suggest that the development of a new crop 
 of cells from denuded germs or nuclei will account for 
 the facility with which re-education, in cases like that 
 described by Professor Sharpey, reproduces knowledge, 
 even at a period of life when it is not easy to learn, 
 What the new training and teaching does is not so 
 much to impart information as to foster the growth of 
 a new crop from the old seed, just as an after-crop may 
 be procured by breaking up an over-stocked soil and 
 applying the stimulus of manure. It is always possible 
 that in the first process of instruction more seed may 
 have been sown than germinated. Some good mental 
 seed doubtless falls on barren ground, and it is perhaps 
 due to the vitality and subsequent germination of this 
 
 G 
 
98 NERVE-VIBRATION AND EXCITATION 
 
 seed, ideas we do not seem to have cultivated deepen as 
 the years go on. 
 
 "Meanwhile I fancy it is as the progeny of old nuclei 
 the physical bases of a revived memory are restored 
 during general recovery in cases of the class before us. 
 It seldom happens that the re-educating process needs 
 to be very explicit or prolonged. Far less teaching than 
 was required to implant the knowledge in the first in- 
 stance will cause it to reappear. In cases where the cells 
 only are destroyed and their centres of vitality remain, 
 it may even happen that the mere re-establishment of 
 health will suffice to bring about complete mental re- 
 storation. When the new cells grow, the old memories 
 will be revived. This is what takes place in ordinary 
 cases, when, although no especial pains are taken to 
 re-educate, 'lost' knowledge returns. The complete- 
 ness of the recovery will probably depend on the vigour 
 of the first growth, and is doubtless governed by the 
 same law which determines permanence or tendency to 
 revert to an old type in the propagation of recently im- 
 pressed or acquired qualities of species or family. Ideas, 
 or an organic tendency to form particular conceptions, 
 are certainly transmitted from parent to child. The 
 cells first developed in a fcetal cerebrum are probably 
 imbued with the qualities and properties of the brains 
 of the mother and father, in different proportions. 
 The transmission of germs of mental character which 
 slumber through one generation and awaken with all 
 their ancestral energy in the next [Atavism of mind] is 
 a recognized fact. It will therefore probably happen 
 that the new crop does not at first present all the 
 features of that which was blighted by disease, but 
 
IN PRACTICE. 99 
 
 develops part of its characteristics later on. Thus 
 vigorous health at an advanced period of life will 
 sometimes produce a perfecting of the recovery com- 
 menced, but not consummated, years before. 
 
 "Cases of the first and third class are very likely to 
 be confounded in practice. Final destruction may be 
 assumed when, perhaps, a tract has been isolated without 
 being destroyed. In this way I venture to think hopeless 
 'dementia' is occasionally diagnosed, when what has 
 happened is the disconnection, or throwing out of the 
 circuit of cerebral energy, of a particular tract or stratum 
 of elements : and, unless watched, partial recovery, sus- 
 ceptible of treatment, may happen without being 
 observed and helped at the critical moment. 
 
 "Treatment for the first class of cases is valueless; 
 for the second, the cure must consist in the reproduc- 
 tion of brain cells, or rather, as I have suggested, the 
 development of a new crop from the denuded nuclei of 
 blighted cells. The so-called ' re-education' is only in a 
 limited, and scarcely physiological sense, educationary. 
 It is a repetition of the training, not so much to teach 
 as to stimulate the growth of new organic elements 
 from pre-existent germs imbued with formative forces 
 and characteristics which must themselves determine the 
 physico-mental result. If new cells are produced, they 
 will be found already educated — that is, endowed with 
 inherited characteristics which constitute the physical 
 bases of memory. The educated germ naturally pro- 
 duces an educated cell. Upon this hypothesis rests the 
 whole theory of heredity, species, and transmission. 
 - l In the third class of cases, recovery occurs as an 
 
 G 2 
 
IOO NERVE-VIBRATION AND EXCITATION 
 
 accident of treatment, except when in the presence of a 
 constitutional cachexia like syphilis, specific medication 
 may remove the grip of disease which, so to say, holds 
 the mental organism in fetters that its energy cannot 
 break. It will, I think, be often found that the seemingly 
 permanent losses of memory which occur after acute 
 disease are due to the isolation of special strata of 
 cerebral tissue by the stasis of syphilitic or gouty disease. 
 Mercury, iodide of potassium, or colchicum, may in this 
 way serve as ' memory-powder,' and work a cure, 
 
 " The two points I am chiefly anxious to place on 
 record, without any claim to novelty of suggestion are — 
 first, that what is called re-education is often simply the 
 fostering of a natural growth — never harmful unless 
 overdone, but of less value than may at first sight 
 be supposed ; second, that, in the absence of special 
 andications that what seems to be helpless dementia is 
 actually what it seems — i.e., a physical destruction of 
 brain-cells — it is always possible the patient may recover, 
 and therefore never justifiable to write a case off as in- 
 curable, and leave it to drift unnoticed and unhelped." 
 
 M. Ribot, in his interesting work on " Disorders of 
 Memory,'' has laid some stress on the explanation I 
 offered, in this little paper, of the physical, or, if any- 
 one please, let him say, the pathological cause of morbid 
 irritability, distress, and loss of memory. This case 
 occurred nearly five-and-twenty years ago, before the 
 method of treatment for which I am endeavouring to 
 obtain the consideration of the profession had suggested 
 itself, and even as late as 1879 I had not had such ex- 
 perience with nerve-vibration in cases of mind-troubles 
 as would justify the recommendation of its use. I have 
 
IN PRACTICE. 1 01 
 
 now the solid ground of fact to go upon, and without 
 affirming its sufficiency in all cases, to allay the morbid 
 irritability which constitutes mania, to supply the strength 
 of purpose and clearness of thought that lie at the base 
 of true intellectual vigour, or to rouse the consciousness 
 out of that lethargy which in too many cases of brain- 
 disorder merges in the apathy of dementia, paralysis, 
 and death, I may venture to say that there are few 
 instances in which the patient will not be benefited and 
 the power of other remedies and modes of treatment aug- 
 mented, by vibration precisely and judiciously applied. 
 The way vibration causes^, or helps, recovery in this 
 class of cases is, doubtless, by exciting the cerebral 
 centres to orderly exercise, and by energizing, and, as 
 it were, methodizing the activity of, the centres and 
 nervous apparatus of the organs of special sense. Pre- 
 cisely what can be done for the cord may be done for 
 the brain. The organs of the senses severally repre- 
 sent the distal extremities of afferent nerves, and to 
 these particularly the vibration should be applied. It 
 is not very difficult, though in some cases it calls for 
 special skill and adaptation on the part of the operator 
 to administer the remedy. For example, in appealing 
 to the optie centre through the eye, it is necessary to 
 apply the percuteur in such way that the retina may 
 be thrown into vibrations of greater force and ampli- 
 tude than those which agitate it in the performance 
 of its specific functions. Doubtless all light is vibratile, 
 and the reflection of light from the surfaces of external 
 objects, in the presence of the organ of vision in such 
 way that they are seen, acts on the rods and cones of 
 the retinal expansion of the optic nerve mechanically. 
 
102 NERVE -VIBRATION AND EXCITATION. 
 
 A sharp blow on the eyeball produces a sensation 01 
 seeing light ! The vibrations propagated to the retina 
 by a scene or picture of any kind are carried back to 
 the proper centre through and by the optic nerve. 
 Certain changes, of which we know no more definitely 
 than we know of the changes which take place in 
 the centres of the cord in the process of reflex-action, 
 are effected in the visual centre, and the centres which 
 are, so to say, the organs of the consciousness, become 
 cognisant of the impression formed or received. To 
 stimulate this — the visual or optic — centre, and relieve 
 its irritability, to give it tone, or to rouse it when inert — 
 not for its own sake only or chiefly, but for the sake of 
 the mental faculty of sight that stand behinds it, and of 
 which it is the representative and organ of relation — 
 and above all — perhaps in and by — these pro- 
 cesses, to improve its nutrition, I apply the disc with 
 exceeding lightness of hand to the closed eyelid, 
 and vibrate for a few seconds only at a time with the 
 highest practicable speed. To secure this effect the 
 battery with the percuteur must be in full working 
 power, and the screw which stands nearest to the hinge 
 or pivot of the vibrator (A, Fig. 2, page 5 8) must be 
 adjusted to come into play while the distant one is 
 withdrawn from electro-magnetic contact. The opera- 
 tion is one of extreme delicacy, but it is sufficiently 
 easy with ordinary care, and the effects gained should 
 be agreeable to the patient as well as beneficial to his 
 case. Optic neuritis does not contra-indicate the treat- 
 ment, but is in fact relieved by it. The arterioles 
 are made to contract, and the turgid capillaries relieved 
 of the blood-pressure, while their tone is restored. 
 
IN PRACTICE. 103 
 
 In cases of commencing atrophy nutrition may be 
 improved by gentle vibration, administered, as I have 
 said, for a few seconds only at a time with short in- 
 tervals of rest, the whole operation not being prolonged 
 beyond five minutes. This may be done daily with the 
 best results, both as regards the optic affection and the 
 brain as a whole in the relation of cerebral function to 
 sight — mental sight, dreams of sight, thoughts of sight, 
 and every part or phrase of the intellectuality in which 
 body or mind-vision are involved or concerned. So, 
 again, with the auditory centres, the disc applied over 
 the meatus will act first on the membrane of the tym- 
 panum mechanically and through the medium of the 
 apparatus of hearing in its entirety on the faculty and 
 sense of audition, both physical and mental. 
 
 It is not necessary to go further into details. 
 After a very few personal experiments with the 
 percuteur, the operator will see how with disc, hammer, 
 brush, or bent arm rod, he can communicate mechani- 
 cal vibrations to the nose, tongue, palate, and thus 
 act on any afferent nerve he pleases, and through the 
 natural line of communication upon the centre behind. 
 The point to be remembered is, that the influence ex- 
 erted is twofold ; first on the organ of sense, and then 
 on the cerebral centre which takes cognizance of the 
 effect, and performs the mental act of perception 
 within. It is not necessary to remind the physiological 
 physician, that whatever there may be behind matter, 
 it is only with the morbid organism the medical prac- 
 titioner has to deal, and for him mind is brain-function ; 
 and thoughts, and feelings, and ideas, and emotions, 
 and beliefs are simply forms of physical activity into 
 
104 NERVE -VIBRATION AND EXCITATION 
 
 which particular parts of the brain are thrown, to which 
 they are or may be excited, and which it is necessary 
 to excite for exercise and nutrition, and to bring under 
 control or order. I must leave the profession to 
 judge for itself how far vibration is likely to prove 
 useful in special affections of the eye, the ear, and other 
 organs of special sense. For myself I believe that certain 
 diseases of sight and some forms of deafness may be 
 benefited by its influence ; but although I have seen 
 good results in cases of this class, I am not specialist 
 enough to carry the application of nerve-vibration into- 
 many provinces of possible usefulness with the precision 
 required. ■ 
 
 Before leaving this great subject of brain and special 
 sensory nerve-vibration, I will take the opportunity 
 offered to bring under the notice of practitioners two 
 instruments which I find of great clinical value in test- 
 ing the daily state. The first is a differential spirit 
 thermometer, constructed* so as to admit of the ap- 
 plication of an air-ball to opposite parts of the head. 
 The scale is so arranged that ioo divisions represent one 
 degree Fahr. The diagram (Fig. 7) will make the use 
 of the instrument apparent at a glance. The second 
 I have called a strabismometer, because it measures in 
 fiftieths of an inch the rectification necessary to make 
 a pointer appear to lie accurately upon a double line, 
 first when looked at steadily with two eyes, and 
 afterwards with one eye and then with the other, the 
 head being kept in the same position during the few 
 moments occupied by the experiment. This also is a very 
 simple instrument, as will be seen by Fig. 8. 
 
 * Negretti & Zambra. 
 
IN PRACTICE. 
 
 IO: 
 
 It affords a ready means of measuring converg- 
 ence and divergence, which I find to be a good indi- 
 cation of the strength or weakness of the muscles 
 
 Fig. 7. 
 
 CEPHALIC ^^s» \AW^S«SSK\P\- \ 
 
 "■.?:'.:' .' '.a.nJjBJE 
 
 of the eye. It is in fact a dynamometer applicable 
 to a set of muscles which are exceptionally free from 
 
 the misleading influences of consciousness and the 
 
 Fig. 8. 
 
 will. I am loth to leave a part of the subject, and a 
 class of maladies, in which I am particularly interested, 
 but I do not feel that the facts I have as yet been 
 
106 NERVE-VIBRATION AND EXCITATION 
 
 able to collect are sufficient to justify more than an 
 appeal to the profession to test nerve-vibration for the 
 remedying of mental and special-sensory disorders and 
 disturbances with especial hopefulness, caution, and care. 
 
 To Improve the Vaso-motor State. 
 
 I do not think we attach sufficient importance to the 
 vaso-motor state. Setting aside such degeneration of the 
 vascular coats as must cause the vessels to be perma- 
 nently rigid and contracted, or to be irremediably lax 
 and dilated in consequence of the final destruction of 
 muscular fibres — a very extreme but possible state of 
 matters — every variety of abnormal condition of the 
 arterioles, ranging from spasmodic contraction, almost 
 tetanic, as I believe, despite the notion about tonic 
 spasms occurring only in voluntary muscles, to utter loss 
 of contractability and very nearly complete loss also of 
 elasticity — may be caused by purely functional faults in 
 the innervation of the vessels from irritability or torpor of 
 the vaso-motor system of nerves. Vulpian, of Paris, is pro- 
 bably the only man who has approximately well studied 
 this subject. It is most painfully neglected in English 
 pathology — the pathology of existing disease — and is 
 scarcely ever intelligently applied in practice. There is 
 less to marvel at in the last-mentioned than in the 
 other phase, of this omission. Beyond giving a little 
 strychnia or nux vomica, or one or more of some half 
 a dozen so-called " tonics," we have no remedy at com- 
 mand which will go directly to the root of the evil and 
 act specifically on the vaso-motor system. If I am not 
 greatly mistaken, precise nerve-vibration is destined to 
 prove of signal value in this respect. In The Lancet of 
 June 10, 1882, I published a few notes of cases in- 
 
IN PRACTICE. 107 
 
 tended to illustrate the effect of this treatment on the 
 vaso-motor system. I will here reproduce them with 
 the remark that although I am as sceptical as any one 
 of my readers or critics can possibly be of the value of 
 the sphygmograph as a recording instrument — in fact, 
 I fear it is open to the heavy charge which lies at the 
 door of statistics, namely, that you can show or prove 
 anything with it — I do think in the instances submitted, 
 and in many others I could adduce, the changes indi- 
 cated by the pulse tracings have been borne out by the 
 improvement in the general state, setting aside the relief 
 afforded in respect to special symptoms. 
 
 "A. B., aged forty, consulted me for a highly nervous 
 condition, characterized by a strange mixture of agara- 
 phobia and claustrophobia, with occasional presence of 
 sugar in the urine. I will not anticipate the full report 
 which I may hereafter publish of this case, but simply 
 say that it may be set down as one of long standing 
 and serious neurasthenia. The pulse, taken Dec. 23, 
 1 881, was as below. 
 
 " The case was treated in the usual way with tonics, 
 &c, until Feb. 21, when the general symptoms being 
 in no sensible degree relieved, the patient came to 
 London, and I commenced nerve-vibration. At this 
 date (Feb. 21) I took the following tracing, which 
 
 certainly showed no improvement. The percus- 
 sion was administered daily until March 7, 
 
io8 
 
 NERVE- VIBRATION AND EXCITATION 
 
 when he left town relieved of all his troublesome 
 symptoms. The last tracing ( taken on March 6, 
 
 A.B.MARCH 6™ 
 
 shows a very nearly normal pulse. On April 3, when 
 this patient happened to be in London for a day, he 
 presented himself, improved in general health, and with- 
 out any return of his old symptoms, a pulse tracing 
 giving the following result : — 
 
 "C. D., aged thirty-seven, with lateral sclerosis, total 
 abolition of patellar tendon-reflex, and so much ataxy 
 as to render walking difficult, a lurching gait, and 
 general unsteadiness, gave the following pulse tracing on 
 April 4 before commencing treatment. On April 1 2 
 
 I took the next tracing-- The following was taken 
 
 G . D . APRIL 12"™ 
 
 on April 2 5 
 
 On May 5 the patient left me, walking steadily, 
 automatically, and in a straight line, his health being 
 improved, and the symptoms of his malady generally 
 
IX PRACTICE. 
 
 109 
 
 relieved or in abeyance. The pulse record was then as 
 below : — 
 
 " I will only give one additional instance of this vaso- 
 motor improvement. E. F. had suffered from neuras- 
 thenia for some seven or eight years, and had been 
 worse for eighteen months. He was intensely nervous, 
 shunned society, and started at the least sound. On 
 March 1 6, before commencing treatment by nerve- 
 vibration, his pulse tracing was as follows : — 
 
 " On March 21a tracing gave this result :- 
 
 E.F. MARCH 21 "J 
 
 " On April 3 this patient left me practically well, 
 with a pulse tracing which explained the improvement 
 thus : — 
 
 I then wrote, and I would now repeat : — 
 " I do not wish to lay greater stress on the clinical 
 value of the records taken by the sphygmograph in con- 
 sulting practice than may be justly due. For myself I 
 would not willingly dispense with the aid afforded by that 
 instrument in judging of the actual state of my patients. 
 
HO NERVE-VIBRATION AND EXCITATION 
 
 I am careful to apply it under, as nearly as possible, 
 the same conditions of pressure and adjustment on each 
 occasion, and I regard as important only the angle 
 formed by the up-stroke and the decline, together with 
 the relative proportional amplitude of the waves on the 
 descending line as compared with the height of the up- 
 stroke, whatever that may be. I think, however much 
 we may differ as to the significance of the tracings given 
 above, it will be conceded that the effect of the treat- 
 ment upon the vaso-motor centre must in each instance 
 have been marked. To this influence I attribute, in a 
 conspicuous degree, the change effected in the general 
 health as well as the amelioration of the particular 
 symptoms/' 
 
 The researches of MM. Dastre and Morat, to which 
 allusion was made in The Lancet of August 19 last, 
 show that vaso-motor activity may be excited from a 
 considerable distance in point of anatomical situation. 
 I have beyond question affected the vessels of the face, 
 and, inferentially, I judge also those of the brain, by 
 percussion over the anterior tibial nerve. It is, however, 
 easy, and therefore justly idle, to multiply mere asser- 
 tions. The profession will do wisely to make this phase 
 of the subject — namely, the effect of nerve-vibration on 
 the vaso-motor system — one of special observation. I 
 venture to think we are on the eve of important disco- 
 veries in relation to this matter, though it will probably be 
 necessary to develop nerve-vibration to a state of very 
 high efficiency before its full benefits can be obtained. 
 I will content myself by enumerating the effects which I 
 have been able to produce in the course of direct endea- 
 vours to influence the vaso-motor system by vibrating dis- 
 
IN PRACTICE. 1 I I 
 
 tant nerves, particularly those of the forearm and of the 
 lower leg and foot. It is curious — it may be an anomaly 
 in my experience — that I have not been able to produce 
 decided results by vibrating over the cervical region, or on 
 the face and head. The results gained and immediately 
 following percussion, in some instances lasting from 
 twelve to twenty-four hours, in others passing off more 
 rapidly, have been marked diminution of conjunctival 
 congestion and increased mobility of the pupils, a 
 healthier and clearer complexion, and better colour of 
 the skin generally, cessation of local perspirations, relief 
 of the feeling of chilliness, of formication, and of 
 tingling, in the skin, the remedy of certain forms 
 of sleeplessness — certain forms only, and I must admit 
 that I do not yet quite understand what these precisely 
 are — increase of mental power and clearness, conversely, 
 relief of mental depression, &c. Most, if not all, of 
 these effects, will be recognized as being direct results 
 of change in the condition of the blood-vessels. Among 
 the more permanent effects produced few have been so 
 marked as the rapid cure of acne, even in cases of long 
 standing; no new spots appearing after a few applications 
 of the percuteur, and the old ones dying rapidly away. 
 Meanwhile the tone and colour of the skin is, as I have 
 said, considerably improved. If I were not restrained by 
 anxiety to avoid overstating my case, I might adduce 
 other tokens of amendment in the general state, which 
 must, I am convinced, also be ascribed to influences 
 exerted on the vaso-motor system, such as the rapid 
 taking up of bile pigment from the skin, in cases which 
 have come under treatment jaundiced by old-standing 
 liver disease. I have not had any opportunity of testing 
 
112 NERVE-VIBRATION AND EXCITATION 
 
 the effect of the remedy in discolorations and affections 
 of the skin generally, but I am exceedingly anxious that 
 it should be thus tested, as I anticipate great results 
 from its use in this important specialty of practice. 
 
 The administration, to produce vaso-motor effects, 
 should, I think, be made with the hammer or hard brush, 
 and by preference to distant nerve vessels of some size, 
 rather than locally, though for skin troubles it may be 
 desirable, in addition to this special nerve-vibration, to 
 throw the whole network of subcutaneous nerves into 
 vibration by means of the large disc or the brush, passed 
 slowly over the region of the morbid sensation or ap- 
 pearance. For this purpose the force of the percussion 
 should be very small, the percuteur being held with a 
 light hand. When vibrating large branches of nerves, 
 particularly if somewhat deeply set, it may be necessary 
 to make firm pressure, but the protecting vulcanite tube, 
 through which the hammer passes (D, Fig. 2, p. 58) 
 should be carefully adjusted by screwing, so that the 
 hammer may have full play and strike the skin with its 
 
 entire force. 
 
 Neurasthenia. 
 
 I have no intention of dwelling upon the pathology 
 
 of this most distressing malady, though I should like 
 
 to contend that it is, in the outset at least, a purely 
 
 functional disorder, consisting in disturbance of the 
 
 rhythm of the vibration of the nerve elements, such as 
 
 that which is apt to be set up by slight concussion of the 
 
 spine in a railway accident. The agitation, consequent 
 
 upon the first disturbance, whatever it may be, grows 
 
 worse as time passes, and in the issue organic disease 
 
 may be induced. I think it is of the highest practical 
 
IN PRACTICE. I 13 
 
 moment to recognize the essential identity of neura- 
 sthenia with the group of affections commonly classed 
 together as traumatic — chiefly because they fall first 
 under the observation of the surgeon, . The " railway 
 spine" may be taken as an example of the multitude 
 of differing and yet mutually resembling affections 
 of which I speak. This malady, properly so called, is 
 not the result of accident or of any coarse lesion of the 
 cord, but is set up by the persistent causal injury of 
 frequent railway travelling. The cord is subject to 
 long continuing, or often repeated, vibrations, which are 
 propagated up the line of the axis of the cord. The 
 effect of these vibrations is, I believe, to "polarize" the 
 cord, and to give its fibres a tendency to longitudinal 
 vibration, or, in other words, to form a habit of vibrating 
 in a way that first enfeebles and then disorganizes the 
 nervous structure. The well-known symptoms of neu- 
 rasthenia spinalis are as nearly as possible those of 
 " railway spine" — with a difference — which difference 
 rather emphasizes the atonic features of the malady. All 
 affections of this class, whether proceeding from shock, 
 persistent vibration in one direction, or other debilitating 
 causes — for example, excessive excitement of the lower 
 segments of the cord in sexual abuse, and particu- 
 larly masturbation — are, I believe, essentially disorders 
 of a mechanical kind, and the degeneration which takes 
 place in the nervous structure is secondary. 
 
 I have had very remarkable cases of rapid recovery 
 under nerve-vibration after confirmed neurasthenia 
 extending over many years. The intense neuralgia, 
 which often, though not always, attends spinal neura- 
 
 H 
 
114 NERVE-VIBRATION AND EXCITATION 
 
 sthenia, is not unfrequently much relieved or even 
 wholly removed by one or two vibrations, and 
 the intense tenderness which is generally found at one 
 or two points in the range of the spinous processes, 
 Is quickly put to flight in one or other of the manners 
 described in the section " In the Relief of Pain." 
 
 I will only refer to the first of the three cases of 
 which I have given sphygmographic tracings at page 107 ; 
 and I mention another in which nerve-vibration, ad- 
 ministered daily for a fortnight, removed a neuralgia of 
 this class, involving entire disability for exercise during 
 several years. The periods which have elapsed since 
 the completion of these cases are now sufficiently long 
 to place beyond question the important point of perma- 
 nency in the cures, for such I may truly call them. I may 
 remark here, as I have elsewhere, that all my cases have 
 been those of men, and that I have done everything in 
 my power to prevent being deceived myself or mis- 
 leading others. 
 
 In the treatment of neurasthenia I generally percuss 
 the spinous processes with the fiat hammer, and apply 
 the percuteur also over the interspaces, about an inch on 
 each side of the spinous processes, so as to vibrate the 
 roots of the nerves. I have not yet had any case of 
 neurasthenia, uncomplicated with syphilitic or other 
 severe disease — and I have had many very severe cases 
 ■of long duration, which have exhausted other forms 
 of treatment, under the best diagnosticians and most 
 able therapeutists both here and on the Continent — 
 that has not yielded to steady vibration for a fort- 
 night. The full effects of the remedy have not in all 
 
IN PRACTICE. 115 
 
 cases shown themselves until after the treatment has 
 ceased, though there has always been some amendment 
 during the period of daily vibration, but afterwards the 
 gain has been rapid and the recovery evidenced by an 
 unmistakable return to health, without medicine or sup- 
 plementary treatment of any kind. I cannot speak too 
 strongly of the success of the treatment in cases of the 
 class I am now endeavouring to describe. Nerve- 
 vibration should undoubtedly be tried in all cases of 
 spinal weakness, with or without pain, and whatever 
 the " cause " of the malady be. In extremely 
 neuralgic cases it may be well to begin vibration with 
 the brush, then to use the disc, and after the pain 
 and tenderness have ceased, which will generally 
 happen in a few days, to complete the treatment by per- 
 cussion with the fiat hammer over the spinous processes 
 and the fiat or pointed hammer between them. For 
 the relief of spinal neuralgia, I can recommend the 
 remedy with perfect confidence and without reserve. 
 The theory of its action was embodied in a letter to 
 The Lancet, which I subjoin. It appeared October 19, 
 1881 :— 
 
 "A New Treatment for Certain Forms of 
 Neurasthenia Spinalis. 
 
 " Some months ago you were good enough to publish 
 a paper in which I introduced to the notice of the 
 profession in England the results obtained, so far as I 
 had then obtained any results, in the course of a long- 
 pending inquiry with respect to nerve-vibration, and 
 the treatment of pain in certain neuralgic states by 
 
 H2 
 
Il6 NERVE-VIBRATION AND EXCITATION 
 
 mechanical vibration. It may be remembered that I 
 announced the conclusions at which I had arrived quite 
 tentatively and under protest, in consequence of a claim 
 to the discovery made by M. Boudet de Paris, in one of 
 the French journals. I am not yet able to say that 
 pain is relieved by any mechanical vibration which I 
 have been able to apply, although the frequency of the 
 post hoc in a considerable number of cases leads me to 
 think it will hereafter prove to be pi'opter hoc. 
 
 " Meanwhile, I have lighted on a new, and seemingly 
 successful, mode of treating certain forms of neurasthenia 
 spinalis, and, at the risk of being charged with precipi- 
 tation, I feel bound to place the facts on record. They 
 are briefly these. Persons who travel much by railway 
 and suffer from what has been termed the ' railway 
 spine,' which is neurasthenic though neurosthenic, and 
 others who are affected with spinal debility, the result 
 of exhaustion from any of a variety of causes — ranging 
 from mechanical shock to sexual excess — and who may 
 be supposed to be the subjects of a loss of tone or 
 elasticity in the fibres of the spinal cord, are not only 
 relieved of their strangely diverse symptoms, but — as it 
 would seem — permanently benefited by the propagation 
 of lateral or transverse vibrations through the spinal 
 column by the application of my percuteur to the ridge 
 of the spinous processes. My method is to pass the 
 percuteur slowly up and down the spine for ten minutes, 
 or, if no disagreeable sensations are produced, a quarter 
 of an hour, daily, or every second day. I believe the 
 modus operandi of the treatment is to counteract the 
 tendency to a lax and flaccid condition of the cord by 
 
IN PRACTICE. 117 
 
 exciting it to vibrate in a direction at right angles to its 
 axis ; most of the vibrations which act injuriously on 
 the cord being propagated in the line of its axis. For 
 the present I will simply make this statement, but I 
 shall be glad to explain the matter more fully to any 
 one who may be interested." 
 
 The publication of this letter excited a good deal of 
 attention, and was the means of inducing many prac- 
 titioners of repute to bring cases under my notice in 
 consultation. A considerable proportion of these have 
 subsequently been treated by nerve-vibration, with, I 
 think I may say, generally good results. It is needless 
 to chronicle the fact that there have been failures, but 
 as the cases in which the treatment has been tried have 
 been almost uniformly of the greatest gravity and long 
 persistence, this is scarcely surprising. 
 
 Indigestion, Constipation, Tension-Albu- 
 minuria, and pseudo-dlabetes. 
 
 Probably no such strange group of maladies was ever 
 before made the subject of serious remark in a work 
 designed exclusively for medical readers. Nevertheless, 
 I venture to offer this grouping as a perfectly natural 
 and scientific classification. Each and all of the dis- 
 orders named are, in certain, at least, of their forms, 
 due to nervous irritation, or nervous weakness ; and it 
 is maladies springing from these causes that I propose 
 to treat by nerve- vibration. 
 
 First, there is a form of indigestion, and a very com- 
 mon one, too, which depends entirely on want of muscular 
 movement in the stomach and intestines. The muscular 
 
Il8 NERVE-VIBRATION AND EXCITATION 
 
 fibres of the stomach do not act as they are intended 
 to act, with a view to the turning over of the food in the 
 organ and its admixture with the gastric secre- 
 tion. Moreover, the absence of muscular movement 
 and the deficiency of nerve power, leave the glands of 
 the stomach without their natural mechanical stimulus to 
 action and without energy, so that the secretion is in- 
 sufficient in quantity, while its character is impaired. A 
 special symptom of this condition, in which the organ 
 more resembles a sac than a contractile organ, I have 
 not seen mentioned in any work on medicine ; albeit 
 sufferers from this most troublesome form of dyspepsia 
 commonly complain of it. They are unable to void 
 the flatus with which the stomach becomes distended 
 without making pressure on the epigastric region im- 
 mediately below the sternum. The food taken into the 
 stomach remains there until it undergoes much the same 
 change that the maternal milk undergoes in the 
 stomach of a weakly infant. It decomposes with the 
 heat before it is so acted upon, in the process of diges- 
 tion, as to be protected from the chemical and thermic 
 influences that tend to decompose it. The stomach re- 
 tains the food longer than is natural, and when at length 
 it is extruded, or rather gravitates, through the pylorus 
 into the duodenum and upper bowel, the time for intes- 
 tinal digestion is passed. The action of the bowels in 
 cases of this character is generally irregular, with a 
 tendency to what is called "diarrhoea," having this 
 characteristic, that the total amount passed is not large 
 though defalcation occurs frequently, and the stools are 
 patchy, consisting of portions of bilious fluid and 
 
IN PRACTICE. 119 
 
 imperfectly digested food. The matter voided tells the 
 physiological story of the disease in a manner, which 
 cannot be mistaken, if only the colour, consistency, and 
 weight of the faeces receive the attention they deserve. 
 The caput coli is nearly always distended in cases of 
 this class, and it is often the seat of neuralgic pain. 
 
 I have lately seen some very striking examples of this 
 muscular fault in digestion, and have found the effects 
 of treatment by nerve-vibration to be exceedingly rapid 
 and good. A very few days' percussion over the solar 
 plexus has, first, relieved the inability to void flatus by 
 the mouth, and then restored the natural action of the 
 stomach with the result of putting an end to the whole 
 trouble. The disturbance of, and pain in, the region of 
 the colon has lingered somewhat, but within two or 
 three weeks this too has yielded to treatment, and the 
 patient has been not only relieved of his troubles, but 
 found himself able to digest with entire comfort the very 
 articles of food and drink which he did not previously 
 dare to take. He has gained in weight. The stools have 
 become natural, and the depressing effecls of perpetual 
 "bad digestion" havewhollydisappeared. The flat-headed 
 hammer or the hard brush serve the purpose well for 
 the relief of this malady, and the result obtained is 
 almost uniformly good and quickly gained, although the 
 affection may have been the burden of life through long 
 years. It will seem that I overstate the facts ; but the 
 profession may readily put my assertions to the proof, 
 and if cases be accurately diagnosed, I have no mis- 
 giving as to results. 
 
 For the treatment of constipation, by nerve-vibration 
 
120 NERVE-VIBRATION AND EXCITATION 
 
 it is necessary to ascertain precisely where the fault 
 lies. What is the cause of the retention of the faeces ? 
 What part of the intestinal canal fails in respect to the 
 reflex by which the peristaltic movements are per- 
 formed? In some instances the small intestines do not, 
 so to say, feel the presence of the food debris above the 
 ilio cascal valve, with the effect of rendering the abdomen 
 distended and dull on percussion, or dull and tym- 
 panitic in patches. In other cases the ascending 
 colon is loaded, and a sense of weight, and often drag- 
 ging pain are experienced in the right iliac fossa. Occa- 
 sionally the transverse colon lies across the abdomen as 
 a solid mass extending from right to left. In another 
 variety of the affection the descending colon is loaded, 
 and the rectum becomes filled with an indurated mass 
 of faeces, the accumulation of many days. In a totally 
 different class of cases the "constipation" is not caused 
 by torpidity of the intestines, so much as by partial para- 
 lysis of the levator ani, and co-existing with this condi- 
 tion there is not unfrequently irritability of the sphincter, 
 so that, although the lower bowel is loaded, there is no 
 evacuation. The levator ani cannot draw up the anus. 
 The attempt to do this immediately produces a strong 
 contraction of the sphincter, so that only a thin 
 squeezed morsel of the faecal matter escapes. 
 
 Now, it is a curious and significant fact that vibration 
 with my percuteur has never once, in my experience, 
 produced peristaltic action ! I believe the force of the 
 blow is, under no circumstances, sufficient to accomplish 
 that result, and here, as elsewhere, no effect whatever 
 is produced by percussion over a muscle. If, however, 
 
IN PRACTICE. 121 
 
 the percuteur be applied with the flat-headed hammer 
 over the lower dorsal, lumbar, and sacral, spines, and 
 with the pointed ivory hammer, over the perineal nerves 
 — striking these branches firmly — it is generally pos- 
 sible, in the course of a few days, to render the nerves so 
 responsive, that the bowels act regularly, not be it ob- 
 served, immediately after the nerve-vibration, but at the 
 next habitual period. In only one instance have I known 
 defalcation to occur soon after the percussion, and this 
 was a case of locomotor ataxia. This effect followed 
 the first administration of the vibration, and was not 
 repeated, although the patient was under treatment 
 for a month. The bowels acted regularly, or nearly 
 so, every day, but not in any discernible relation to the 
 remedy, so far as the immediate effects of vibration are 
 concerned. I do not think it possible that so very 
 slight a motion as is communicated by the percuteur, 
 when most forcibly applied, can ever act on the bowels 
 directly. It is only by reducing the nervous irritability, 
 and heightening the response to the reflex generally, 
 habitual constipation may be remedied. Employed or 
 applied directly with the expectation of a speedy result, 
 percussion cannot do otherwise than fail. 
 
 It is beginning to be recognized, but cannot yet be 
 said to be commonly known, that albumen may and 
 does appear in perfectly healthy urine, under conditions 
 which either raise the tension of the blood in the vessels 
 of the kidney to a very high point, or render the blood 
 surcharged with albuminous material, as for example, 
 when a patient lives almost exclusively on eggs. It 
 is of course well-known that the urine often contains 
 
122 NERVE-VIBRATION AND EXCITATION 
 
 albumen during pregnancy, because the blood is then 
 loaded with nutrient materials. It is, doubtless, similarly- 
 loaded immediately before each catamenial period, and, 
 therefore, tension-albuminuria is physiologically likely 
 to occur without any serious departure from the state of 
 health at frequently recurring periods in the life of 
 woman. The urine also contains albumen occasionally, 
 soon after a heavy meal, or during particularly energetic 
 muscular exertion, when the hard worker is also a vora- 
 cious feeder and well supplied with albuminous food. 
 Mere debility of the vessels of the kidney may allow 
 the albumen to pass into the urine under these condi- 
 tions. The systemic appetite seems to be over stimulated, 
 so that more albumen is assimilated than the tissues 
 require, and the surplusage is quickly thrown back 
 into the current of the circulation, or passed off by the 
 kidneys. Great and needless alarm is often caused by 
 the discovery of albumen in the urine of young men 
 who lead active lives, and particularly in that of brain- 
 workers, who being overdone with intellectual labour 
 resort to the unphysiological artifice of trying to work 
 their bodies to relieve their minds, as though mind were 
 something else than brain function, and the cerebrum 
 was not an integral part of the organism as a whole. 
 I have named this phenomenon tension-albiiniinuria y 
 because it certainly needs to be known by some dis- 
 tinctive term if it is ever to be known at all ; and 
 looking to the misery inflicted on families by too hasty 
 diagnoses and desperate prognoses which are not 
 justified by the state or verified by the subsequent 
 history of the case, it is time that an effort were made 
 
IN PRACTICE. 123 
 
 to secure the recognition of a " symptom" which does 
 not necessarily indicate disease. 
 
 By pseudo-diabetes, I mean the presence of sugar in the 
 urine with polyuria, or an increase in the quantity of urine 
 passed on special occasions, with debility and wasting. 
 The sugar is only found now and again, while the 
 debility, which may be slight, or a serious feature of the 
 ease, is constant. The sugar appears when there is 
 much irritation of the brain, and particularly when the 
 et nervousness" is so great as to take the form of mental 
 derangement, and render it difficult for the sufferer to mix 
 in societyor even to sit in a room with his intimate friends. 
 Toothache, or facial neuralgia, may accompany the 
 malady, or there may be preternatural acuteness of 
 hearing. I have seen several cases of this description 
 recently, and in all it has been possible to trace the 
 appearance of the sugar to special irritation of one of 
 the nerves having a deep origin beneath the floor of the 
 fourth ventricle. The " diabetes/' falsely so called, is 
 merely an incident in the course of another malady, 
 which is generally neurosthenic in its type, and neura- 
 sthenic in its essential nature. 
 
 The treatment for tension-albuminuria and pseudo- 
 diabetes, so far as nerve-vibration is concerned, is that 
 which I have described for the various forms of neura- 
 sthenia, namely, percussion of the spinal column. The 
 case of A. B., mentioned at page 107, may be cited as a 
 good specimen of the class in which sugar is occasionally 
 found in the urine. It is not by any means an un- 
 common thing to find sugar and albumen alternatively 
 in the urine of ataxic or neurasthenic patients, more 
 
124 NERVE-VIBRATION AND EXCITATION. 
 
 particularly, when great efforts are being made to struggle 
 against the disease, and the sufferer, while undergoing 
 much mental anxiety and taking a great deal of exercise, 
 consumes a large quantity of stimulating food, under the 
 impression that by a specially nourishing and full diet 
 he may recover his failing strength. I think it is a 
 condition of the appearance of the phenomenon that 
 there should be an inordinate demand made bythe organ- 
 ism, and more food assimilated than is required to replace 
 the tissues consumed by use. We all recognize the 
 existence of an organic appetite, distinct from the appe- 
 tite or craving for food which proceeds from the stimu- 
 lation of the nerves of taste or the unsatisfied longings 
 of an empty stomach. This inner appetite is often more 
 exigeant than the " appetite" properly so called. In 
 the cases I am trying to indicate, I believe the inner, 
 deeper, or organic appeal is itself exaggerated so that the 
 tissues take up — or try to take up — more food than they 
 require, and (if I may say so) dissimilation commences 
 before assimilation is complete. Nerve-vibration seems 
 to act in a very satisfactory way in these cases. It 
 needs to be spinal in the main ; but this general 
 treatment should be supplemented by precise vibration 
 of any of the nerves of special sense which may be 
 found irritable, or of which the patient complains. 
 
125 
 
 CONCLUSION. 
 
 I HAVE now briefly, and, I fear, very inadequately re- 
 viewed the leading points of the case I have to lay 
 before the profession in support of my plea for 
 nerve-vibration, at first, of course, in cases in which 
 other remedies and methods of treatment have 
 already been tried and failed. It is a severe but 
 fitting ordeal through which any new therapeutic 
 agent must pass, that it should be put to the test of 
 being employed for the relief or cure of disorders 
 which have been found to resist all the received modes 
 of treatment. It is in such cases only, that I have 
 yet myself employed nerve-vibration, and I shall be 
 well content if others judge of its value by evidence 
 collected on the same line of investigation. It would 
 not be justifiable to omit or postpone recourse to such 
 tried remedies as we already possess, but after all these 
 are found to be useless, I venture to urge that the 
 method I suggest should be accorded a trial. 
 
 In making choice of the several classes of cases in 
 respect to which I now find myself in a position to recom- 
 mend the use of nerve-vibration, I have been influenced 
 solely by my experience of that remedy. I do not, because 
 I cannot, strongly urge recourse to the method in a 
 considerable number of troublous affections in the treat- 
 
126 NERVE-VIBRATION AND EXCITATION. 
 
 ment of which I have not yet had any large experience 
 of its use. Among these may be mentioned hysteria 
 and the mimetic diseases, and disorders of the sexual 
 organs, particularly impotence and the affection known, 
 erroneously I believe, as spermatorrhoea. I have had 
 cases of the two last-mentioned diseases, some of 
 which have been and are, greatly benefited, one or two 
 apparently cured, but a much larger number of obser- 
 vations than I have yet been able to make, would be 
 necessary to justify any practitioner in holding out a 
 hope that he had actually discovered a new remedy. 
 That the mimetic diseases may be successfully 
 treated by nerve-vibration, I have little doubt ; 
 but I am not sure that any results gained in this 
 department of therapy can be wholly trustworthy. 
 In another group of affections in which I am much 
 interested, I am hopeful that nerve-vibration may prove 
 a valuable aid to other treatment, if not sufficiently 
 good to stand alone, namely, the epileptic. The influ- 
 ence which precise nerve percussion undoubtedly exerts 
 on the vaso-motor system certainly leads me to hope 
 that the daily vibration of the anterior tibial nerve, or the 
 corresponding nerve in the forearm will have a marked 
 effect on the " fits." If this be not successful, I should 
 vibrate the whole of the principal peripheral nerves with 
 the brush or the disk, either applied directly to the skin 
 or through water. I doubt whether it would be worth 
 while to vibrate the solar plexus alone, but I should 
 most certainly apply the fiat-headed hammer or the hard 
 brush over the epigastric region, alternately with the per- 
 cussion over the anterior tibial nerve. In idiocy, even of 
 
CONCLUSION. 127 
 
 the micro-cephalic type, I have already seen unmistak- 
 able proof of the efficacy of nerve-vibration as a means 
 of rousing the dormant centres, and while effecting that 
 immediate purpose, at the same time extending its 
 influence to the improved nutrition of the body. 
 
 I have not seen any bad effects from nerve-vibration, 
 and it is difficult to believe that, as it will be employed 
 by medical practitioners, percussion with the very 
 small and light instrument I use can possibly be 
 harmful. The worst that is likely to happen is that, 
 like most other methods of " cure," the new method 
 may fail. There is one measure of treatment which I 
 think nerve vibration should be allowed to precede, I 
 refer to nerve-stretching. I do not think it is justifi- 
 able to undertake so formidable an operation as firmly 
 stretching a nerve until so simple a remedy as nerve- 
 vibration has been fairly and fully tried ! The aim of 
 the two specialties of treatment is unquestionably the 
 same — namely, to change the character and rhythm 
 of vibrations, which are either themselves painful, or 
 induce the sensation of pain by the influence they 
 exert on the vibration of other nerves. Nerve-stretch- 
 ing seeks to attain this object by the heroic expedient 
 of stretching the nerve until its essential elements must be, 
 for the time at least, thrown out of gear and mechanically 
 disorganized. Nerve-vibration, on the other hand, 
 makes the natural, and, it must be admitted, eminently 
 rational endeavour to restore the discordant activity to 
 order by the process whereby musical discords are 
 silenced and concord is established. It may be urged 
 that we stretch a violin or harp string to change the 
 
128 NERVE- VIBRATION AND EXCITATION. 
 
 amplitude of its vibrations, and thus alter its tone, but the 
 string of a musical instrument is not a living organ, and 
 I think it will be conceded that we ought to try a per- 
 fectly harmless method of obtaining our object before 
 we resort to one which, under the best circumstances, is 
 formidable, and can never be justified until other means 
 for the radical cure of the malady have been tried and 
 proved of no avail. 
 
 I now leave this system of nerve-vibration in the hands 
 of the medical profession, to be tried and either adopted 
 or rejected, as it may prove deserving of either fate. 
 For myself, I am fully persuaded that, whether or not 
 my mode of applying the remedy is the best that 
 can be devised, the underlying principle is sound, and 
 the natural law I have sought to utilize is applicable to 
 the relief of pain and the remedy of disease, and ought 
 to be so employed. 
 
 THE END. 
 
 PRINTED BY BALLANTYNE, HANSON AND CO 
 LONDON AND EDINBURGH — 
 
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INDEX. 
 
 Acton's Reproductive Organs, 14 
 
 Flower's Diagrams of the Nerves, 4 
 
 Adams (W.) on Clubfoot. 11 
 
 Foster's Clinical Medicine, 8 
 
 Contraction of the Fingers, 11 
 
 Fox's (C. B.) Examinations of Water, Air, and Food, 4 
 
 
 Fox's (G. H.) Photographs of Cutaneous Syphilis, 14 
 
 Allan on Fever Nursing, 7 
 
 
 Allingham on Diseases of the Rectum, 13 
 
 Fox's (T.) Atlas of Skin Diseases, 13 
 
 Anatomical Remembrancer, 4 
 
 Frey's Histology and Histo-Chemistry, 4 
 
 Anderson (McC.) on Eczema, 13 
 
 Fulton's Text-Book of Physiology, 4 
 
 Aveling on the Chamberlens and the Midwifery Forceps, 6 
 
 Galabin's Diseases of Women, 6 
 
 Influence of Posture on Women, 6 
 
 Gamgee's Fractures of the Limbs, n 
 
 Balfour's Diseases of the Heart and Aorta, g 
 
 Treatment of Wounds, 1 1 
 
 Balkwill's Mechanical Dentistry, 13 
 
 Gant's Diseases of the Bladder, 14 
 
 Bantock on Rupture of the Female Perineum, 6 
 
 Gaskoin on Psoriasis or Lepra, 13 
 
 Barclay's Medical Diagnosis, 8 
 
 Gay on Haemorrhoidal Disorder, 13 
 
 Barnes on Obstetric Operations, 5 
 
 Gill on Indigestion, 10 
 
 
 Glenn's Laws affecting Medical Men, 14 
 Godlee's Atlas of Human Anatomy, 3 
 
 Beale's Microscope in Medicine, 8 
 
 Sli~ht \ilmcnt^ 8 
 
 Gowers' Diseases of the Spinal Cord, 9 
 
 
 Bellamy's Surgical Anatomy, 3 
 
 Epilepsy, 9 
 
 Bennet (J.H.) on the Mediterranean, 10 
 
 Medical Ophthalmoscopy, 9 
 
 on Pulmonary Consumption, 10 
 
 Pseudo-Hypertrophic Muscular Paralysis, 9 
 
 
 Habershon's Diseases of the Abdomen, 9 
 Stomach, 9 
 
 Bentley and Trimen's Medicinal Plants, 7 
 
 Bentley's Manual of Botany, 7 
 
 — ■ Pneumogastric Nerve, 9 
 
 Bigg (H. H.) on Orthopraxy, n 
 
 Hamilton's Nervous Diseases, 9 
 
 Bigg (R. H.) on the Orthopragms of Spine, 11 
 
 Hardwicke's Medical Education, 14 
 
 Binz's Elements of Therapeutics, 7 
 
 Harley on Diseases of the Liver, 9 
 
 Black on the Urinary Organs, 14 
 
 Harris on Lithotomy, 14 
 
 Bose's Rational Therapeutics, 7 
 
 Harrison's Surgical Disorders of the Urinary Organs, 14 
 
 Recognisant Medicine, 7 
 
 
 
 Braune's Topographical Anatomy, 3 
 
 Heath's Injuries and Diseases of thejaws, 10 
 
 Brodhurst's Anchylosis, 11 
 
 Minor Surgery and Bandaging, 10 
 
 Orthopaedic Surgery, n 
 
 Operative Surgery, 10 
 
 Bryant's Practice of Surgery, 11 
 
 Practical Anatomy, 3 
 
 Bucknill and Tuke's Psychological Medicine, 5 
 
 Surgical Diagnosis, 10 
 
 Bulkley on Eczema, 13 
 
 Hemming on the Laryngoscope, 12 
 
 on Diseases of the Skin, 13 
 
 Higgens' Ophthalmic Out-patient Practice, 11 
 
 Burdett's Cottage Hospitals, 5 
 
 Hillis' Leprosy in British Guiana, 13 
 
 
 Hogg's Indian Notes, 7 
 
 
 Burnett on the Ear, 12 
 
 Holden's Dissections, 3 
 
 Burton's Midwifery for Midwives, 5 
 
 Human Osteology, 3 
 
 Butlin's Sarcoma and Carcinoma, 13 
 
 Landmarks, 3 
 
 Buzzard's Diseases of the Nervous System, 9 
 
 Holmes' (G.) Guide to Use of Laryngoscope, 12 
 
 Carpenter's Human Physiology, 4 
 
 Vocal Physiology and Hygiene, 12 
 
 Carter (H. V.) on Spirillum Fever, 8 
 
 Hood on Gout, Rheumatism, &c. , 9 
 
 Carter (W.) on Renal and Urinary Diseases, 14 
 
 Hooper's Physicians' Vade-Mecum, 8 
 
 Cayley's Typhoid Fever, 9 
 
 Horton's Tropical Diseases, 7 
 
 Charteris' Practice of Medicine, 8 
 
 Hutchinson's Clinical Surgery, n 
 
 Clark's Outlines of Surgery, 10 
 
 Rare Diseases of the Skin, 13 
 
 Clay's (C.) Obstetric Surgery, 6 
 
 Huth's Marriage of Near Kin, 4 
 
 Cobbold on Parasites, 14 
 
 Ireland's Idiocy and Imbecility, 5 
 
 Coles' Dental Mechanics, 13 
 
 Irvine's Relapse of Typhoid Fever, 9 
 
 Deformities of the Mouth, 13 
 
 James on Sore Throat, 12 
 
 Cormack's Clinical Studies, 8 
 
 Jones' (C. H.) Functional Nervous Disorders, 9 
 
 Coulson on Stone in the Bladder, 14 
 
 Jones (C. H.) and Sieveking's Pathological Anatomy, 
 
 
 Jones' (H. McN.) Aural Surgery, 12 
 
 on oypiuus, 14 
 
 
 Atlas of Diseases of Membrana Tympani, 12 
 
 on -diseases 01 me xjiaoaer, 14 
 
 Courty's Diseases of the Uterus, Ovaries, &c, 5 
 
 Jones' (T. W.) Ophthalmic Medicine and Surgery, n 
 
 Cripps' Cancer of the Rectum, 14 
 
 Jordan's Surgical Enquiries, 11 
 
 Curling's Diseases of the Testis, 13 
 
 Lancereaux's Atlas of Pathological Anatomy 4 
 
 Diguenet s Manual of Ophthalmoscopy, 12 
 
 Lane's Lectures on Syphilis, 14 
 
 Dalby's Diseases and Injuries of the Ear, 12 
 
 Lee (H.) on Syphilis, 14 
 
 Dalton's Human Physiology, 4 
 
 Leared on Imperfect Digestion, 10 
 
 Day on Diseases of Children, 6 
 
 Lewis (Bevan) on the Human Brain, 4 
 
 on Headaches, 10 
 
 Liebreich's Atlas of Ophthalmoscopy, 11 
 
 De Chaumont's Sanitary Assurance, 4 
 
 Liveing's Megrim, Sick Headache, &c.,io 
 
 Dobell's Lectures on Winter Cough, 8 
 
 Lucas's Indian Hygiene, 8 
 
 Lo~~ of Weight ^~c ° 
 
 Macdonald's (A.) Chronic Disease of the Heart, 6 
 
 
 Mont Dore Cure, 8 
 
 Macdonald's (J. D.) Examination of Water, 4 
 
 Domville's Manual for Nurses, 7 
 
 Macewen's Osteotomy: Knock-knee, Bow-leg, &c, 11 
 
 Druitt's Surgeon's Vade-Mecum, n 
 
 Mackenzie on Diphtheria, 12 
 
 Duncan on the Female Perineum, 5 
 
 
 on j-jiseases 01 tne xnroatana ^>ose, 12 
 
 
 Maclise's Dislocations and Fractures, n 
 
 on uiseases 01 *v omen, j 
 
 Dunglison's Medical Dictionary, 14 
 
 Surgical Anatomy, 3 
 
 Ellis's Manual for Mothers, 6 
 
 MacMunn's Spectroscope in Medicine, 8 
 
 
 Macnab's Medical Account Books, 14 
 
 01 tne .uiseases 01 L-nnuren, 
 
 Emmet's Gynaecology, 5 
 
 Macnamara's Diseases of Bones and Joints, n 
 
 Eulenburg and Guttmann's System of Nerves, 9 
 
 the Eye, 12 
 
 Fayrer's Climate and Fevers of India, 7 
 
 Madden's Principal Health-Resorts, 10 
 
 Observations in India, 7 
 
 Marsden's Certain Forms of Cancer, 13 
 
 
 Martin's Military and State Medicine, 5 
 
 .Lropicai uysentery ana iyiarrnoea, 7 
 
 Fenwick's Chronic Atrophy of the Stomach, 8 
 
 Mason on Hare-Lip and Cleft Palate, 12 
 
 
 
 
 on ourgery 01 tne race, 12 
 
 Outlines of Medical Treatment, 8 
 
 Mayne's Medical Vocabulary, 14 
 
 Fergusson's Practical Surgery, 10 
 
 — — — Notes on Poisons, 7 
 
 Flint on Phthisis, 8 
 
 
 .Lnerapeutical Kememorancer, 7 
 
 on Clinical Medicine, 8 
 
 Mitchell (R.) on Cancer Life, 13 
 
 ] 
 
 \C0utiu1ied 071 tlie nexf /•ape. 
 
I ndex — continued 
 
 Mitchell's (S. Weir) Nervous System in Women, 6 
 Moore's family Medicine for India, 7 
 
 Health Resorts for Tropical Invalids, 7 
 
 Morris' (H.) Anatomy of the Joints, 3 
 Nettleship's Diseases of the Eye, 12 
 Nunn's Cancer of the Breast, 13 
 Ogston's Medical Jurisprudence, 4 
 Osborn on Diseases of the Testis, 13 
 
 on Hydrocele, 13 
 
 Parkes' Practic?.! Hygiene, 5 
 Pavy on Diabetes, 10 
 
 on Food and Dietetics, 10 
 
 Peacock's Diseases of the Heart, 9 
 
 Pharmacopoeia of the London Hospital, 7 
 
 Phillips' Materia Medica and Therapeutics, 7 
 
 Pirrie's Principles and Practice of Surgery, 11 
 
 Pollock on Rheumatism, 9 
 
 Pridham on Asthma, 8 
 
 Purcell on Cancer, 13 
 
 Radford's Csesarean Section, 5 
 
 Ralfe's Morbid Conditions of the Urine, 14 
 
 Ramsbotham's Obstetrics, 6 
 
 Reynolds' (J. J.) Diseases of Women, 6 
 
 Notes on Midwifery, 6 
 
 Reynolds' (J. R.) Clinical Electricity, 10 
 Roberts' (C.) Manual of Anthropometry, 5 
 Roberts' (D. Lloyd) Practice of Midwifery, 5 
 Ross's Diseases of the Nervous System, 9 
 Roth on Dress : Its Sanitary Aspect, 5 
 Roussel's Transfusion of Blood, 8 
 Routh's Infant Feeding, 6 
 Royle and Harley's Materia Medica, 7 
 Sanderson's Physiological Handbook, 4 
 Sansom's Diseases of the Heart, 9 
 
 Antiseptic System, 9 
 
 Savage on the Female Pelvic Organs, 6 
 Sayre's Orthopaedic Surgery, 11 
 Schroeder's Manual of Midwifery, 6 
 Sewill's Dental Anatomy, 12 
 Sheppard on Madness, 5 
 Sibson's Medical Anatomy, 3 
 Sieveking's Life Assurance, 14 
 Smith's (E.) Wasting Diseases of Children, 6 
 
 ■ ■ — ■ — Clinical Studies, 6 
 
 Smith's (Henry) Surgery of the Rectum, 14 
 Smith's (Heywood) Dysmenorrhea, 6 
 
 ■ Gynaecology, 6 
 
 Smith (Priestley) en Glaucoma, 12 
 
 Southam's Regional Surgery, 10 
 
 Sparks on the Riviera, 10 
 
 Squire's Companion to the Pharmacopoeia, 7 
 
 Squire's Pharmacopoeias of London Hospitals. 7 
 Stille and Maisch's National Dispensatory, 7 
 Stocken's Dental Materia Medica and Therapeutics, 12 
 Sullivan's Tropical Diseases, 7 
 Swain's Surgical Emergencies, 10 
 Swayne's Obstetric Aphorisms, 6 
 Taft's Operative Dentistry, 12 
 Taylor's Medical Jurisprudence, 4 
 
 Poisons in relation to Medical Jurisprudence, 4 
 
 Teale's Dangers to Health. 5 
 Thomas on Ear and Throat Diseases, 12 
 Thompson's (SirH.) Calculous Disease, 13 
 
 Diseases of the Urinary Organs, 13 
 
 ■ Diseases of the Prostate, 13 
 
 Lithotomy and Lithotrity, 13 
 
 Thompson's (Dr. H.) Clinical Lectures, 8 
 Thorowgood on Asthma, 8 
 
 on Materia Medica and Therapeutics, 7 
 
 Thudichum's Pathology of the Urine, 14 
 Tibbits' Medical and Surgical Electricity, 10 
 
 Map of Motor Points, 10 
 
 Tidy and Woodman's Forensic Medicine, 4 
 Tilt's Change of Life, 6 
 
 Uterine Therapeutics, 6 
 
 Tomes' (C. S.) Dental Anatomy, 12 
 
 (J. & C. S.) Dental Surgery, 12 
 
 Van Buren on the Genito-Urinary Organs, 14 
 "Veitch's Handbook for Nurses, 6 
 Virchow's Post-mortem Examinations, 4 
 Wagstaffe's Human Osteology, 3 
 Walker's Ophthalmology, 12 
 Waring's Indian Bazaar Medicines, 7 
 
 Practical Therapeutics, 7 
 
 Warner's Guide to Medical Case-Taking, 3 
 Waters' (A. T. H.) Diseases of the Chest, 8 
 Waters (J. H.) on Fits, 9 
 
 Wells (Spencer) on Ovarian and Uterine Tumours, 6 
 West and Duncan's Diseases of Women, 5 
 Whistler's Syphilis of the Larynx, 12 
 Whitehead's (J. L.) Climate of the Undercliff, 10 
 Whittaker's Primer on the Urine, 14 
 •Wilks and Moxon's Pathological Anatomy, 4 
 Wilson's (Sir E.) Anatomists' Vade-Mecum, 3 
 
 Lectures on Dermatology, 13 
 
 Wilson's (G.) Handbook of Hygiene, 5 
 
 Healthy Life and Dwellings, 5 
 
 Wilson's (W. S.) Ocean as a Health-Resort, 10 
 
 Wise's Davos Platz, 10 
 
 Wolfe's Diseases and Injuries of the Eye, 11 
 
 Yeo's Contagiousness of Pulmonary Consumption, 8 
 
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