1910 Journal of the American Medical Association (JAMA)  
a fair proportion of the usual clinical successes, the training in simple, iminvolved living has been of the utmost value to the patients. SIGNIFICANCE OK THE PBINCirLE I cannot refrain from directing your attention for a moment to the possible significance of this industrial principle as applied to a Held reaching far beyond the confines of the functional nervous diseases. So many people ¡ire suffering in mind and body because of the attempt to accomplish too much, or from idleness which is
more » ... dleness which is not necessary, that a therapeutic readjustment would mean preventive and curative medicine on a large and important scale. Nor is achievement along these lines impracticable. Last year, in a stimulating and sugges¬ tive article, Dr. Jacoby of New York reviewed the work "of two large charitable institutions in Germany1' where appropriate work is part of the treatment of nervously I.roken down patients. Here and there in our own country are men awake to the possibilities of handi¬ capped labor, both from the humanitarian and clinical point of view, and because of the really important clin¬ ical results to be secured. In tbe sanatoria, where such a thing has been quite unknown until within'the past two or three years, productive industry is rapidly find¬ ing a place. A dual and most hopeful consideration is this, that the work of Ihe invalid and the handicapped may mercifully be kept within the limitations of the individual capacity and may still be so carefully de¬ signed and so well direeted thai it equals or exceeds in value much of the accepted product of those who ave sound and well. sage is in the domain of nervous diseases, because the problem here is generally one of nutrition and restoration of muscular function. Every specialist in these diseases should, in my opinion, have a practical training in these branches of mechanotherapy, because otherwise he cannot intelligently direct such treatment, and a considerable portion of it should be performed with his own hands. I shll not here discuss the technic further than to call attention to a few points and procedures. Nearly all patients with nervous disease suffer from digestive troubles, constipation and poor nutrition, and in abdominal massage which should be performed by the physician, or an experienced masseur or masseuse in exceptional instances, we have, to my mind, the most valuable single remedial agent for these conditions. ABDOMINAL AND GENERA MASSAGE Abdominal massage should be performed through a single covering; for instance, the undershirt, and should consist of kneading of the colon in circles by Ihe palmar tips of one hand, with the tips of the other making the requisite pressure on the middle knuckles, this to be followed by deep stroking along the course of the colon from the ileocecal valve to the sigmoicl; then by a vibra¬ tion of the entire abdomen with the flat band applied over the navel region. Lifting of the transverse colon and stomach with vibration in Glenard's syndrome, which I might say in passing is far more common and of far less significance than is usually supposed, is at times of assistance. All other manipulations I believe to be superflous. With daily treatments until the bowels reacquire the habit of moving once in the twenty-four hours, I advise the patient to strengthen the psoas and iliacus and the external abdominal muscles by the ex¬ ercise of rising from the supine position on the floor to the sitting, without bending the knees. Whenever general massage is indicated it should be preceded, in my opinion, by passive movements of each i i nib, because the circulation is thereby so much en¬ hanced that it practically doubles Ihe value of the treat¬ ment. The vibrator invented by Liedbeck, of Stockholm, and so much exploited in this country the past few years, has physiologically the same effect as electricity in ex¬ citing muscular contraction and thereby stimulating the circulation and metabolism, and will fail in specific remedial action just as does electricity, if blind faith instead of an exact knowledge of its physiologic effects guide its use. As a sedative to nerve irritability and pain it surpasses the electric current, but it is not nearly so powerful a stimulant to muscles and nerves and there¬ by to nutrition and function, but it is generally more pleasant to have applied. The extravagant claims for massage by lay operators and ignorant practitioners, together with the confusing and repelling elaboration of teehnie by authors on this subject, have resulted in the avoidance of a study and use of this really valuable therapeutic aid. Many man¬ ipulations require practice, but really the art is very simple and requires mainly anatomic and physiologic knowledge. The principles which guide us in prescribing exercise or massage practically resolve themselves into a consid¬ eration of physiological action, ruder gymnastics and massage we include also all exercise. »
doi:10.1001/jama.1910.04330040033011 fatcat:k3vxpfqpdfaulbj67dlepfhwcu