TREATMENT BY MANIPULATION.
(This article may be taken as illustrating the Kellgren philosophy and treatment of disease.)
“In a previous issue we have endeavoured to give some idea of the nature and object of medical exercises, and we are now anxious to show the nature and object of treatment by manipulation for the cure of disease.
“In the first place, it must be remembered that all alternation in the normal condition of the body, that is to say, all forms of disease, cause the formation of morbid substances of some kind or another. The nature of these morbid products, together with the conditions which give rise to them, are too technically scientific to be dealt with in this article,-suffice it to say, that these products are, roughly speaking, either what is commonly known as matter and gas.
The formation of these naturally cause obstruction in the parts affected, to the detriment more or less of the whole system. It is equally obvious, therefore, that these obstructions must be got rid of before health can be restored.
” Where matter has formed, as in the case of wounds, abscesses, etc, it may be removed by working it to the surface and giving it an outlet there, and by dispersion.
” Most people can see the value of gently pushing matter towards the wound or boil, but many are apt to regard dispersion with disfavour. If matter formed, they say, it is far better to encourage it to tend towards the one centre, where it can discharge, than to spread the evil all over, the body by `backening’ it. It must be remembered, however, that matter is not a foreign body which has been somehow introduced into the system; on the contrary, it is a collection of legitimate products (in the first instance) which have become disorganized. As dirt has been defined as `matter out of place,’ so the morbid products of the body are legitimate constituents of the organism unlawfully congregated together. The white corpuscles of the blood, for instance, form bad matter, although they are healthy and necessary constituents of the blood when they move in a legitimate manner.
To disperse these, and to force them back to their proper spheres, is not to spread matter over the body, therefore, but to dissolve it into its original elements. Where morbid products have been formed for some time, however, processes of putrefaction ensue which render it impossible to disperse it, because the elements themselves become diseased, and it is then necessary to cause their discharge from the body. The task of deciding which method of treatment to apply is not so difficult as may be supposed, since Nature to a great extent decides the question herself. Where a wound or abscess is already formed, and shows itself plainly, it is probable the putrefaction has taken place, and, therefore, the great aim should be to promote its discharge; but if this stage has not been reached, it is sufficient simply to manipulate the place affected, thus causing movement in the obstructed tissues. If the elements of which the matter is composed are still healthy, the manipulation will loosen them from their position and drive them to their proper places; but if putrefaction has already begun, it will drive it to the surface, where it has the best chance of getting free.
It must be borne in mind that Nature is always trying to rid herself of unhealthy products, and manipulation, by encouraging movement in congested parts, assists the blood to throw off the poison which infects it, and drives it for refuge to the surface, which it will then try to burst through.
” In most diseases it is gas and not matter which forms the obstruction. This gas, which, like matter, is also a natural product of the body, increases too much in volume, and is altered in its nature by any deviation from the normal state of health, and forms a swelling, often imperceptible, in that part of the body where the disease has originated. This swelling can easily be detected by trained fingers, and is very sensitive to the touch. This power of detecting where a disease lies with the fingers is of the utmost value, because pain in often reflex, and gives no clue to the real seat of the malady. It also stands to sense that if a cure by manipulation is to be effected, the manipulator must be allowed to use his or her own discretion as to the places which are to be worked upon. It is nonsense for a patient to say, `work on my head for headache, or on my limb of rheumatism; there is no occasion to touch any other part of the body, as I am quiet well otherwise.’
A person’s digestion may seem sound, for instance, because the from indigestion from which they suffer shows itself indirectly by some reflex pain in the head or the limbs. To work at these only may give temporary relief, but no cure can reasonably be expected from such a partial method of treatment.
” The actual nature of manual treatment is either that of making frictions with the fingers or by vibrations. In no case are the fingers moved about over the skin, as in rubbing; the frictions and vibrations are made through the skin on nerves and vessels, etc., beneath. It is moreover, quite unnecessary to work upon the bare skin, a certain amount of loose clothing being no obstacle whatever to the efficacy of the work.”
I give the article entire, so that I may be quiet fair. That the kellgren treatment by manipulation is a close imitation of Nature is clear, and it must therefore command out respectful consideration, particularly when defended by such an able advocate as Dr. Floyer, whose writings in The Tocsin are a delight to read.
But I have thus far seen no published results, and have consequent nothing to judge it by as a practical system of curative medicine. A waiting these I suspend judgment.
What is matter?
By the would matter is here meant, not matter in a general scientific sense, but, say, the contents of an abscess.
In the foregoing article I have italicised the following :- “It must be remembered, however, that matter is not a foreign body which has been somehow introduced into the system; on the contrary, it is a collection of legitimate products (in the first instance) which have become disorganized. As dirt has been defined as `matter out of place,’ so the morbid products of the body are legitimate constituents of the organism unlawfully congregated together. The white corpuscles of the blood, for instance, form bad matter, although the are healthy and necessary constituents of the blood when they move in a legitimate manner. To disperse these, and to force them back to their proper spheres, is not to spread matter over the body, therefore, but to dissolve it into its original elements.”
Now, let us examine these statements.
We may grant that matter is made up of the white blood corpuscles which have wandered out of the circulation, but why have they wandered out? Why did they not stay at home and live happily together in the blood? The reason is that they have become charged with a function, their mission has become a new one, and they wander out of the blood that is within the vessels in order to carry away a given poison, or virus, or other hurtful thing; they are poisoned, and hurry out of the circulation en masse, and hasten to a common rendezvous at the surface, to be cast out as matter. These blood corpuscles are no longer mere blood corpuscles, but poisoned members of their community, and they hasten out of the body to save it, they offer themselves a sacrifice on the altar of the organism. They are not unlawfully congregated together; they are not runaway sinners unlawfully congregated together-run wind, as it were, in a herd. Not at all; on the contrary, they are so law-abiding that they sacrifice themselves to duty, and they are in numbers proportionate to the quantity of poison that has to be got rid of: the more the poison the greater the number of corpuscles.
It follows, therefore, that to force these poison-carrying, out- wandered blood corpuscles back whence they came (if it were possible) must be bad practice indeed : and to do so would be backening the matter and spreading the poison, of which they are the dying or dead carriers, all over the body.
Dr. Floyer says.- ” The morbid products of the body are legitimate constituents of the organism unlawfully congregated together.” This is impossible; what he should say were a morbid product of the body is no longer a constituent of the organism at all. On the contrary, the erstwhile blood corpuscles having become morbid, are cast out or wander out, and so cease to be constituents. The act of congregating together is merely their collective mode of exit from the economy.
The putrefactive process is a secondary affair. If the morbid products are dispersed, and sent back before the process of putrefaction sets in, then they carry back merely the poison they had brought out; while if they are sent back subsequent to putrefaction, then they many carry back with not only the poison they were carrying away, but also products of the putrefaction.
I am, therefore, with those who regard dispersion with disfavour, particularly if the boil constituents are poison carries, as I believe they usually are, and that notwithstanding the fact that the boil-constituents were previously body- constituents.
Finally, it seems to me that Kellgrenism is itself contradictory, for while it is contended for it aids Nature to expel the peccant matter or gas, it is also maintained that it aids Nature by dispersing what Nature has gathered together. Both can only be tenable if it be held that the disorder consequent upon the obstructions to the circulation are synonymous with the disorders themselves.
It seems to me that if it be good to help Nature to bring the matter to the periphery and let it out, it cannot be good to disperse what Nature unaided had already brought together in a boil for ejectment. That is in general principle. Of course, if it can be shown that the disorder is primarily stagnation, and nothing else-sky capillary stagnation, and nothing else-say capillary stasis-then dispersion (early enough) and cure would be identical terms.
THE LOCALIST’S POSITION CONTRADICTORY.
The localistic surgeons, who claim that operation is a cure of fistula, tell us that the pre-fistular abscess must be opened to let the matter out, while the fistula must be operated upon to make it close! So, according to this, the essence of the disease in the case of the abscess lies in the fact that Nature cannot, unaided, get rid of the matter; while in the fistula, where she does get freely rid of the matter, the essence of the disease lies in the fact that Nature if helping herself.
The Kellgrenists seem to consider that stasis is the real factor in boils; for me, the stasis is merely a concomitant-just the first necessary stage in effecting an organic lesion of the peripheral continuity to gain an outlet for inimical stuff, be this stuff leucomaine, ptomaine, cadaverine, urea, or even bacilli or microbes.
Abscess is not a disease sui generis; it is a patho- biological process, and we have, in each case of abscess, to consider this patho-biological process by itself, i.e., Nature’s method of turning out an unwelcome guest at a peripheral lesion of her own making. It the guest be one simple innocuous thing or substance, then as soon as that is detruded the matter is ended- the abscess heals.
If the surgeon lances, in such a case, this aid to Nature would under circumstances be rational and sensible. If the stasis itself be the whole affair, then Kellgrenism would be right to disperse, for then an outlet would not be needed, since there would be nothing to let out. In this stasis-abscess, gentle pressive coaxing aid would be the most rational, the “free incision” merely a wood-hacker’s mode of doing the same thing, i.e., getting rid of the stagnation.
But the pre-fistular abscess differs widely from the two kinds of abscess just mentioned. It is not a stasis-abscess, for its stasis is a means to an end, the means being to mortify a bit of tissue to form an outlet; and the end being the detrusion of not a simple innocuous thing or substance, but some organismic morbid product that is being daily and hourly produced, and therefore needs daily and hourly discharge, in fact a constantly open issue, which a fistula in my opinion often is. If I am correct in this view, it must follow that a fistula should not be made to heal up by any and every local means, but the fistula- patient should be cured by internal constitutional treatment.
I find myself quiet unable to believe that causing the fistula to heal up is in any sense a real cure; on the contrary, I believe this proceeding to be bad practice, and very harmful in its consequences for the future health and well-being of the patients. Neither am I able to conceive how any kind of treatment by manipulation could possibly alter the state of one’s constitution : a syphilitic, a strumous, a sycotic, a psoric individual would, so far as I can see, be just as syphilitic, as strumous, as sycotic, as psoric after being manipulated as before.