An Old Highland Form of Massage, Popularly Practised for the Prevention of Consumption

D. T. Masson
1889 BMJ (Clinical Research Edition)  
April 20, 1889.] THE BRITISH MEDICAL JOURNAL. 881 palate and exposing the nasal fossm, the mucous membrane of the posterior nares was seen lined with a whitish wash-leather sort of membrane, elastic, stretching to a considerable degree, but then breaking off abruptly and with a clean edge. The epiglottis was covered completely on both surfaces with a dirty grey exudation, which descended and lined the whole of the interior of the larynx, filling up the ventricles and sacculi, but it ceased
more » ... but it ceased abruptly at the lower border of the cricoid cartilage. There was no exudation in the trachea or in the bronchial tubes, but a catarrhal secretion only. The cesophagus was quite normal in every respect. The stomach had a soft, semi-doughy feel, not unlike a portion of intestine that contains feeces of moderate consistence. On opening the stomach, it presented an irregular dark reddish-brown appearance with a slight olive-green tint. This was found to be the surface of a continuous membrane that lined the whole of the interior of the stomach, but was abruptly cut off at the cardiac and pyloric orifices. The membrane varied in thickness in different places; it averaged about one-twelfth of an inch; over the rugie it was one-eighth to one-sixth of an inch or more; in some of the sulci between the rugme it was less than one-sixteenth of an inch. The sites of the rugae were well seen, and marked by thick elevated longitudinal ridges of the false membrane. The membrane was adherent to the mucous surface of the stomach, but it was easy to separate it and peel it away. The under surface of the membrane was marked with depressions, elevations, etc., which corresponded to similar markings on the subjacent mucous membrane, and it was of a dark venous-red colour, without the green tinge of the free surface. The membrane was continuous, and might probably have been completely stripped off in one large piece. Except in thickness and colour, it differed but little in consistence, elasticity, and fracture from the exudation in the fauces and nares. On peeling off some of the exudation and exposing the mucous membrane, the latter was seen of a dark-red colour and glistening; it was entire, not abraded or ulcerated; it was soft, but without any mucus. On separating the rugLm, which was readily done by simply stretching the stomach, the spaces between were found of a much lighter colour, but studded with innumerable red points. The rugie themselves were very dark, with a black-currant-jelly-like colour, and studded with dark-red punctiform injections from a pin's point to a pin's head in size, round and circumscribed; some had coalesced, as it were, and formed dark-red spots as big as a split pea. The intestines showed no trace of disease. There was some pulmonary collapse, some emphysema, and some lobular pneumonia. The renal tubules and cells contained an excessive quantity of granular matter. The urine in the bladder was found to be loaded with albumen, and there was much renal epithelium and granular casts in it. The exudation from the stomach under the microscope presented an irregular, fibrillated, and reticulated appearance, not unlike simple coagulated lymph, and was rendered transparent by acetic acid. Intermingled were numerous red blood-discs and numbers of cells about the size and shape of white blood-corpuscles, granular, and in many distinct nuclei were seen on addition of acetic acid. Here and there was a columnar epithelial cell. A separate scraping from the free surface of the exudation showed numerous columnar epithelia, free nuclei and granules, and a few starch granules. No sporules or mycelia could be detected, and no sarcinme. The morbid specimens, together with the notes of the case, were given by me to Sir William Jenner, who was then lecturing on Medicine at University College, and they were shown by him to his class. He considered that the gastric exudation was a remarkable example of true diphtheritis of the stomach. The terms " croupous" and " diphtheritic" have been used with varying meanings. In the last edition, quite recently published, of Dr. Frederick Roberts's work on Medicine, he says: " Some pathologists regard diphtheritic as differing from croupous infiamma tion, in that a fibrinous exudation forms not only upon but also in the substance of and beneath the mucous membrane, which as a consequence is destroyed and converted into a slough, and an ulcerated surface is left on separation ;" and he says, "the reality of this distinction is very questionable." My case shows at least that in the stomach there is room for doubting this difference, for the exudation was undoubtedly diphtheritic, yet it presented the character of a croupous membrane, 6 inasmuch as it was deposited on the mucous surface in a manner in no way differing from so-called croupous deposits. , over the counties of Ross, Sutherland, and Caithness there was practised in my early days a form of chest massage for the prevention of consumption, which, like other popular remedies and manipulations, once laughed at as "old wives' cures," but now recognised and approved by the profession, might with advantage be received into the routine of regular therapeutics. The professed object of this manipulative treatment was to "open out the chest," and the modus operandi was as follows. The patient, stripped to the loins, was seated on a high stool, while the operator, usually a strong, healthy, muscular woman, stood behind. The patient was first made to raise his arms and join hands over the top of the head or behind the neck. The operator now advanced a hand on each side of the patient, from behind forwards, till both her hands met over the third and fourth segments of the sternum, whence, with firm, equable pressure, her palms, lubricated with sweet fresh butter, were swept downward and backward, following the line of the lower border of the chest. After two or three similar passes of the operator's palms over the same region, and with increasing pressure, her fingers were slightly curved downwards and inwards, so that in the sweep from sternum to spine the lower border of her palm, and especially the outer side of the little finger and tip of the fourth, were to some extent hooked under the lower border of the chest. Little by little this action was accentuated, till, in the backward sweep of the operator's palms, her fingers were pushed well under the lower border of the chest and the false ribs, pulling them steadily outwards. After this the backward sweep of her palms was carried step by step up the chest, sweep after sweep coming nearer the clavicle, where again the tips of the fingers, though in a modified way and to a greatly lessened extent, played the same part as they had been made to play at the lower border of the chest. And now came tlie critical part of the operation. In most persons, even while yet young, the xiphoid cartilage tends greatly to curve inwards into the abdomen. This my old Highland Medicine Woman held to be the " original sin," whence came almost all forms of chest infirmity, as well as not a few forms of serious stomach ailment. To the in-growing xiphoid, therefore, she now paid special attention. Very gently at first, but evermore with firmer and firmer touch, she concentrated her manipulations on this peccant appendage of the human breastbone. While her thumb made a succession of short steady passes, with considerable pressure, over what in young persons may be called the sterno-xiphoid articulation, her fingers watched their opportunity to get in under the free end of the xiphoid, so as to pull it outwards, and thus by continued and repeated manipulation to train it, as it were, into a more healthful direction. This manipulation was long continued and very searching; and the same manipulation, though not necessarily so carefully tentative or so prolonged, was agam very energetically practised along the whole lower border of the chest bit by bit, pulling outwards and upwards that whole plate of pliable semipalmated cartilage which there terminates the five lower true ribs, and forms the outer inferior boundary of the thorax. Bit by bit, from the xiphoid to near the spine, she thus dug her four powerful fingers under this cartilaginous lower border of my chest under the free ends of the false ribs, pulling them outwards with an energy that gave no little pain. This she called " opening the chest," and it certainly seemed as if she had effectually increased the breathing capacity of the lungs. On the prophylactic, and to some extent the remedial, value of this simple form of old Highland massage, I need here say nothing. One word more is alf that need be added. The nutritive treatment of incipient phthisis had a well-recognised place in our old popular Celtic therapeutics. Cod-liver oil was not then popularly known as a specific, but we had great faith in cream; in warm milk, fresh drawn from the healthy cow; living a healthy,
doi:10.1136/bmj.1.1477.881 fatcat:f7g6ohbeanddlcva7jibusk3wi