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VIBRATIONS. 45
iinued strong contraction of the muscles of the shoulder, arm,
and hand. When given thus, the manipulation becomes hard,
and the intensity, the acute sensibility that the operator should
have of the pressure he is applying, gets lost, while it is impos-
sible to continue the treatment for any length of time, even for a
few minutes. The effect over a weak heart is as bad as flexion
and extension at the wrist joint, if not worse. The patient will
constantly feel pain, because pressure cannot be avoided, and
may be he will faint.
I will give a few instances in which one can perceive the
difference between a movement produced by strong contraction
of the muscles of the arm,—which of course carries with it an
immovable wrist and hand, —and the way in which I have
described it :
—
1. Place the hand on the thigh. In the first kind of manipu-
lation a harder grip of the muscles is necessary, the muscular
mass moves as a whole, there are no vibrations just under the
place of application- of the hand, the range of the movement
produced is much smaller ; while in the second, the hand lies
loosely on the surface, the vibrations pass into and are felt in the
underlying muscles, and are widely propagated.
2. You may give vibrations to the anterior surface of the
thorax, and feel them in the other hand placed on the back of
the patient, while with the stiff arm and hand you feel nothing
at all.
3. Place a glass of water in the middle of a fairly large
table. Make the vibrations, and if the water moves as a
whole from side to side they are made wrongly, but if the
surface of the water quickens in the centre only they are made
correctly.
This may give an idea of how delicate the movements really
are, and how it is possible to use them in disorders where shak-
ings and the ordinary massage manipulations are entirely out of
question.
The vibrations have a much greater effect than the shakino-s
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