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Early Discoveries and Basic Principles
At the age of 93, I, Frederick Erdman, have written this autobiographical sketch to explain how I learned that there are opposite arterial tendencies in different people; and also that there may be these opposite circulatory conditions in different parts of the same person; and, most importantly, how I learned to restore the normal arterial tone.
Only by relaxing contracted arteries to normal and by contracting relaxed arteries to normal in every part of the body can anyone expect to restore the normal rate of blood flow, with the least effort of the heart. Achieving a normal rate of blood flow allows recovery from a great variety of disorders. This is discussed in detail in my book, The Control of the Circulation, first published in 1921 (second edition, 1956).
My journey of discovery began at the age of sixteen when I strained my back. For ten years afterward a variety of heat treatments, manipulations, and drugs was given to relieve my increasing backache. Each treatment made me immediately and progressively worse. At the beginning of these treatments I had been playing football and taking a great deal of other exercise, but I finally became so weak that I could neither sit nor stand for more than a few moments. Even if I placed my elbows on the arms of a chair and made the most desperate effort to sit up, I would gradually slump into the chair or to the floor.
Since my complaint was related to backache, I naturally went first to orthopedic surgeons. The first one said I had spinal curvature. The next specialist was a neurologist; he said my back was normal. Another surgeon said I had a curvature of the spine. Eventually I decided that the fluctuating behavior of my spine was due to my weakened condition.
For ten years I endured treatments that were injurious. For example, suspension by the neck was not successful and only added to my circulatory problem. Wearing spinal supports for fourteen years did no good and, in fact, relaxed my arteries more, as a result of the heat and pressure they caused.
In time I concluded that all "relaxing" treatments—heat, manual, or chemical—were injurious to me. Naturally, since all of these methods of treatment which made my condition worse were relaxing to the blood vessels, I concluded that my blood vessels had a lack of tone. I shall call them "relaxed." This, I felt, explained all my symptoms and experiences.
This was my first, most fundamental, and life-preserving decision. None of the men who gave me treatments knew or even suspected this fact.
All of My Experiences Explained
Since my blood vessels were relaxed, it should be obvious why all heat treatments made me worse immediately. (Even a warm water bottle on my stomach made me dizzy.) With this explanation of my circulatory handicap, it is not difficult to understand why spinal cautery might add to my troubles. It explains why all hot baths made me feel weak and why an electro-thermal bath with iodine painted on my stomach caused a "blackout."
The lack of tone in my blood vessels caused the heat of the sun, like any other warming treatment, to make me worse. Massage, osteopathy, and all other relaxing manipulations were prostrating. Because of my condition the pressure, heat, and pain caused by wearing metal and leather spinal supports for years only added to my symptoms.
A gentle warming of the sacral segments made my leg muscles very weak in two or three minutes. Rubbing the lumbar area produced diarrhea in a few minutes. Even a mere tickle along the whole length of the spine produced palpitation of the heart. Most of these tests were made many times, with the same results.
This is the explanation also of why the mental results of circulatory fluctuations to the brain were just as striking and uniform and, therefore, just as physiological as the other symptoms.
During many years I noticed that some or all of my symptoms were aggravated not only by heat treatments, but also even by a warm room.
The relaxation of my arteries explains why a teaspoonful of any tonic, or food preserved in alcohol (a vasodilator), made my knees shake in a few minutes. It would also explain why very small doses of relaxing sedative drugs were very prostrating. After taking one of these drugs, I was forced to lie on the ground from weakness, even at a time when I usually walked several miles a day and played football at a preparatory school.
Since I had this poor arterial tone, a "rest cure" of three months, which included daily massage, was the greatest mistake I ever made. Naturally, all relaxed arteries relaxed still more, and I could never have recovered from this condition if I had not learned how to contract the arteries. One specialist tried to solve my problem by advising me to "go west, rough it, but don't ride horseback or get tired!" Incidentally, after walking several thousand miles I learned that "taking more exercise" is not a panacea.
In view of the foregoing, it should be obvious to anyone that the large number of people in this country who have relaxed arteries and are receiving relaxing treatments (heat, massage, sedatives, etc.) have little chance of recovery. Whatever disease they may have will be steadily aggravated, as mine was for ten years, because I was receiving injurious treatment. Relaxed arteries will produce anything from migraine headaches to gangrene in the feet. Asylums are full of people with relaxed arteries who are still receiving sedatives and other relaxing drugs.
First Steps Toward Recovery
As stated previously, all of the methods of treatment which made my condition worse were relaxing to the blood vessels. Since they made me worse, I concluded that my blood vessels had a lack of tone. Next, I needed to determine how to improve my condition.
After ten years of the wrong treatments, I consulted the late J. P. Arnold, M.D., to whom I am indebted for encouraging me in my study of the utilization of the spinal reflexes to improve the circulation. He was using spinal treatment, but since all spinal stimuli (even the lightest possible pressure of the finger) produced undesirable reactions and aggravated my symptoms, I stopped the treatment. Dr. Arnold later advised me to buy a Rive Rocci sphygmomanometer and to continue experimenting on myself, which I did. For seven years I read standard medical textbooks, which he had recommended, and collected any information in regard to the circulation, if it seemed to be of any practical value.
Dr. Arnold had been Assistant Professor of Physiology at the University of Pennsylvania when he began to use physical instead of chemical methods of treatment. He took a very kind interest in my studies and observations. He gave me his list of the vasomotor centers which control the blood supply to each organ or other parts of the body. I could find no such list in any of the physiologies I consulted in those years.
As a result of stopping all treatment to relax muscle spasm, I experienced some improvement, but it was not until five years after Dr. Arnold's death that I learned the remedy for all my symptoms.
One day, after too much exposure to heat, I became ballooned up with intestinal gas and was on my back for a week in a hotel room. I did not dare call for any assistance after my many years of experience with harmful treatments. The resulting "week of prayer" and divine guidance received determined my recovery and that of several thousand people.
This turned out to be the greatest crisis of my life. I knew what had happened, but I did not know the remedy. Finally the bright (but belated) idea occurred to me to try the effect of some cold on my spine. I simply drew a cloth moistened with cold water down my spine. The improvement in my feelings, in my pulse, and upon the abdominal distention was quite immediate. This gave me very clear proof as to why all previous treatments had been injurious.
Two Opposite Therapies for Two Opposite Conditions
After more than sixty years since that time, I have learned that all people are included in one or the other of two opposite circulatory classes. It can sometimes be a matter of life-and-death importance to know which class one is in, because otherwise one may receive treatments which are injurious.
Determining the correct treatment was my second fundamental and far-reaching discovery. I now realized and could visualize what had happened to me in all the previous years. I found not only the reason but also the remedy for all the symptoms—not only for myself but also for many others. By contracting my arteries when they were relaxed, and by relaxing them if too much contracted, I maintained a large, strong pulse and did strenuous, continuous work for more than sixty years.
Instead of using cold water, I finally decided that a piece of cotton moistened with witch hazel or alcohol was the best method of applying the cold to the spine.
After using the cool spinal applications for some months, I suddenly noticed that the cool applications immediately made all the symptoms worse. There was one marked difference, however. For instead of my becoming faint and finding it difficult or impossible to stand or sit, my heart began pounding and aching. My heart was evidently overloaded. In addition, the intestines and stomach were very obviously contracted and retracted from the abdominal wall. Then I learned that it can be as undesirable to have too much as too little tension in the arteries and the alimentary tube.
To relieve the excess tension, I tried gentle heat and manipulation of the spinal muscles. I then observed that the alimentary tube relaxed and assumed its normal degree of distention, the gas moved, and the pulse and blood pressure improved. Since the blood pressure dropped during this period of excessive contraction, I learned that there were two kinds of low blood pressure which required opposite treatment to relieve all of the symptoms.
In addition, I noticed that palpation of each half of the abdomen showed that the cool applications on one side of the spine would cause an immediate contraction and retraction of the bowel on the same side—often apparently as much as one or two inches—and that warming the spinal muscles on the same side of the spine caused the bowel to relax and return to the normal degree of distention. This became a routine test before and after all treatments, because the force and the rate of the pulse or the blood pressure changed in a few moments with every increase or decrease in arterial tension, or the retention of gas in any part of the gastrointestinal system.
Incidentally, I learned that whenever the pulse and blood pressure were depressed, either by excessive relaxation or contraction, it caused or revived the most intense ideas or feelings. I concluded from this that variations in the blood supply to the brain were responsible for all my abnormally intense ideas or feelings. I had read that the brain is more sensitive to variations in the rate of blood flow than is any other tissue of the body. Therefore, I concluded that my mental symptoms were just as physical and inevitable when the rate of blood flow to the brain was slowed as were the muscular contractions and all the other symptoms.
Identifying the Four Circulatory Classes
I have called the condition of relaxed arterial tone "Class 1." I eventually discovered a condition of partial relaxation, which I have labeled "Class 2." "Class 3" refers to the condition of high blood pressure, and "Class 4" represents normal arterial tension. The following account details the process of identifying the four classes.
Class 2 Discovered
After my initial discoveries, I observed that both the cool applications and the relaxing treatment made all of the symptoms worse. This seemed a hopeless problem, but by this time I had learned that any difficulty or problem was an opportunity to learn some additional law of physiology.
By applying the cool treatment to small areas of the spinal muscles, I found that it had a bad effect on the pulse, pressure, gastric tension, and mental feeling when it was applied to the spine from the first to the ninth dorsal segments, and also when applied to the sacral segments. The cool applications, however, had a good effect on the pulse, blood pressure, gastric tension, and mental feelings when applied to the spine over the tenth dorsal to the fifth lumbar segments. In other words, the blood vessels were relaxed only in that part of the body controlled by the "middle third" of the spine. Therefore, the cool spinal applications were needed only on this part of the spine. (See diagram)
Since relaxation of the arteries in this local area affects the whole of the abdomen and lower part of the body, there may result almost as much circulatory disturbance and aggravation of symptoms as when there is a general lack of arterial tone. Obviously, this combination, "Class 2," cannot be benefited by any general treatment or medication, because any treatment which is beneficial to two-thirds of the body is injurious to the other third, and vice versa. These areas are like two separate people and must be treated accordingly.
If a patient is in Class 2, the upper and lowest thirds should receive some relaxing treatment to reduce any excess tension before the cold is applied to the lumbar region. If the applications are put all up and down the spine first, any excess tension in the upper and lowest thirds might produce a misleading reaction.
Since the abdominal region is the largest vascular area, and since fluctuations here affect the blood supply to every part of the spinal cord and brain, it follows that until this area is properly controlled, attempts to control the local vasomotor mechanisms situated in the upper half of the thoracic regions, or in the sacral segments, may be futile. With the abdominal circulation disturbed, all local treatment of organs or tissues by specialists is, of course, proportionately futile.
Passing into Class 4—Normal Tension Class
Unless persistent and thorough relaxing treatment can be given at the time, the rate of blood flow may be poorer after one first passes into Class 4 from Class 1.
I learned later also, when treating many other people, that as one passes from the "relaxed" class into the normal tension class, the lowest lumbar segments are the last to pass into the tension class. The recovery of many people is dependent entirely upon the contraction of the blood vessels of the middle third only, and sometimes serious mental and nervous disorders (and even gangrene in the feet) were overcome by restoring the vasomotor tone in the area controlled by two or three lumbar segments only.
When one has learned a fundamental law and its application, as in the discovery of gravitation, it naturally enables one to explain many phenomena and also to learn other modifying laws. But I could never have learned anything on this subject if I had not made myself and each patient the standard or test of truth, or if I had been satisfied to call every unusual reaction an "allergy." A patient's nervous system always reacts to a stimulus just as it should. Each patient should be the criterion of the effect of a treatment, not the treatment itself or the doctor's expectations. Any other attitude is unscientific.
It is obvious that if spinal stimuli can contract or dilate the blood vessels in any part of the body, and the gastrointestinal system as well as the spinal muscles, there open up therapeutic possibilities which never before have been approached.
Getting myself "tightened up" in the middle third of the spine was the next and final stage of moving into Class 4—normal tension. After some days of making the cool applications to the "middle third," the same symptoms recurred as when I had passed into Class 2 from Class 1. The heart showed signs of being overloaded, the intestines contracted and retracted too much in the middle third, and all symptoms became worse because the rate of blood flow was slowed. I therefore stopped the cool applications and gave relaxing treatment wherever I could find any area of excessive contraction of the stomach or intestines.
I learned later that if I relaxed the tension too much, I would drop back into Class 1 (entire relaxation) or into Class 2 (partial relaxation). As soon as the pulse reached the best condition, I stopped all treatment until some symptom developed.
After I passed from the relaxed class (Class 1) to the tension class (Class 4), there was a period of excessive tension of the gastrointestinal system. (During the years when my arteries had been relaxed, the nerves controlling the gastrointestinal system—the second system to recover—had become excessively irritable.) This, I found, always occurs when people have been in the relaxed class and move into the tension class.
After one passes into the tension class, the pylorus may contract too much and diminish the appetite, because food and gas and acid do not leave the stomach at the normal rate. Excess tension of the intestines may produce constipation. This is a point where care and experience are required to relax the pylorus and intestines to the normal point without relaxing the arteries and throwing one back into Class 1.
If the heart is strong and the cold applications are continued too long, the blood pressure will begin to go above normal. I have called this condition Class 3. Relaxing treatment brings high blood pressure down to the normal Class 4. It is better to have some excessive tension than to be in the relaxed class, but excessive tension is undesirable also. Relaxing treatment will overcome all such problems.
If people with relaxed arteries and low blood pressure come up to the 120 mm. of Hg. and those with high pressure come down to 120 mm. of Hg., then 120 mm. of Hg. must be normal. People may live for years with high or low pressures, but the rate of blood flow cannot be ideal or maximum or "normal" in the proper sense of the word unless the pulse is large and long (well sustained). This conclusion was the result of years of careful observation.
In summary, when one has a general lack of arterial tone, I have called this condition of the arteries Class 1. If only the arteries in the lumbar region have a lack or tone, I have called this condition Class 2.1 have called high blood pressure Class 3, and when the tension of the arteries and the gastrointestinal system is normal, I have called the condition Class 4.
Increased Irritability of the Nerves
Varying degrees of irritability of the nerves must be recognized in trying to relax tension. If the treatment irritates the nerves, it will increase tension and raise the blood pressure. This is often true in only one segment of the spinal nerves, but in giving treatment one must always keep below the threshold of irritation, and this is done by watching the pulse. If the pulse gets worse, the treatment has either been of the wrong kind or it has been too irritating. To help eliminate nervous irritation I have sometimes kept my hand as near the patient's back as possible, moving my hand up and down parallel to the spine vithout actually touching the back.
The problem of nervous irritation also exists in relaxing contractions or cramps in the gastrointestinal system. Gentle applications like warm compress will relax spasms when nothing else can. So also with muscular contractions.
Testing Both Sides of the Spine
To determine my classification and to produce the best pulse, I often applied the contracting stimulus to one side of the spine and the relaxing stimulus to the other and observed the opposite reactions in the two halves. The changes in the intestinal retractions or distensions were immediate and marked. At first I was misled, because when the intestinal contraction and retraction were the greatest, the abdomen felt most as soft to a light pressure of the fingers as when the intestine is relaxed.
Two Kinds of Low Blood Pressure
When my arteries were relaxed, my blood pressure fell below normal. If I applied more cold applications, or became too tired or cold after I had entered the normal tension class (Class 4), my heart became overloaded and my blood pressure fell below normal.
Both conditions are called "hypotension." The term is, therefore, ambiguous and dangerous, because the two conditions are exactly opposite in character and require opposite treatment.
The same is true of the word "hypertension," or high blood pressure. Most people with high blood pressure have contracted arteries, but in a minority of people the rise in pressure is due to extra heart effort which is made to supplement the inadequate arterial tone. Therefore this kind of high pressure may develop even in people with relaxed arteries.
Discoveries Related to Cold Applications
Whenever I was making cold application to the skin, I noticed that if the whole skin was cold, the cold spinal applications did not produce the maximum improvement in the pulse. This was because when the blood vessels in the skin are contracted, the blood is forced into the interior of the body. Thus the applications which are intended to contract the blood vessels inside the body are opposed by the contraction of the skin vessels. For the same reason I found it was better not to have the cold applications too close together because it could cool down the whole exterior of the body.
I experimented with a great variety of cold stimuli. I tried metal spoons, bottles of water with different temperatures, and ice wrapped in a handkerchief and drawn down the back. I decided that the most generally effective method was to use a small piece of cotton dipped in witch hazel and drawn down the entire length of the spine or any part of it, as required.
I found it was important to wait from one to five minutes between the applications of cold, because the cold applications contract not only the arteries but also the stomach and intestines. As these latter contract, they retard the movement of the gas and temporarily disturb the pulse. Therefore, by waiting until the gas had moved along, I could expect the normal reaction to the cold stimulus.
However, if the weather was hot and the emergency great, the applications could be made every half-minute unless the cold effect was extending too far. If the relaxation of the arteries is extreme and the whole gastrointestinal system is filled up with gas, one must apply the cold applications exclusively to the left shoulder several times to reduce the excessive formation of gas. (See diagram)
Sometimes a patient is tested and found to be in Class 1, and a full- length cold application is made. This application may suddenly raise the resistance to the heart action so that the pulse becomes extremely weak. Therefore, for some people in Class 1 with weak pulses, it is better to make the first application to the upper third of the back only.
Though I continued in the tension class (Class 4) for many years, various conditions would cause me to relax and various symptoms would begin to come back until I applied the cool applications for one to several hours.
Hundreds of times I have had the thrilling experience of observing symptoms such as the pain of a migraine headache or even gangrene in the feet begin to subside and steadily recede after the first few applications of cold. When the applications were stopped the pain began to return, but when they were resumed all the pain subsided. This was often true even when the cool applications were required and made only on two or three lumbar segments. Although these applications could affect "only the circulation," they proved some fundamental but unrecognized laws in regard to the cause and cure of many disorders.
The Effect of Cold
In order to understand the process of "taking cold," I applied cold to the spine experimentally when I did not need it and watched the results. It first caused a cold in my nose. If I put on more applications of cold, they caused some disturbance in my gastrointestinal system. I continued the cold applications until I had a fever. When I went to bed, I spent much of the night reversing the effect of the cold by heat and treatment on the spinal muscles. This produced an active perspiration and corrected all the disturbances produced by the cold, and I was able to work the next day.
A number of times in my life, unavoidable exposure to cold was followed by similar experiences. Whenever the blood was driven from the skin, it went into the weakest part of the circulatory system. Even getting the feet or ankles too cold may cause or aggravate any local trouble.
Congestion of the spinal cord may follow when the circulation is most disturbed. The blood vessels of the spinal cord and brain are the best protected blood vessels and they have the greatest resistance to heat and cold.
This illustrates how any organ may become congested from cooling off the skin. These results could not be attributed to infection, because alcohol on the spine does not produce microbes. But whenever a congestion develops, it gives the opportunity for microbes to invade the body.
Everyone knows that weak babies must be kept in an incubator because the slightest drop in temperature might be fatal. I learned that even some adults with chronic disorders may be incredibly sensitive to cold. One lady whom I treated, whose husband was a doctor, had the most incredible sensitivity to cold. One drop of cold water on her face would start extreme pelvic contractions. Her husband had taken her to three clinics on different continents, but no one could stop the pain except by anesthetizing the patient. She was in Class 1, and the cold spinal applications controlled the spasms from the beginning, finally stopping them entirely. I learned to use cold applications with the same great caution as I used heat.
Even my gas attacks came from cold. I would realize that nothing I had eaten could cause so much disturbance; and I could always look back and recall when part or all of my skin was cooled down sufficiently to drive the blood inside and dilate the blood vessels of the stomach and frequently also those of the intestines, causing a simultaneous diarrhea. Whatever the cause, I have always been able to control the excessive gas formation and colonic disturbances during a treatment. I learned, therefore, how to do the same for other people.
If I added to the load on the heart by giving contracting treatment when it was not needed, the heart would, like any other pump, slow down the number of beats per minute. If the load was increased still more, the heart would go into higher gear and beat faster, instead of slower, than normal. In other words, a slow pulse is intermediate between normal and high. If one knows his normal number of heart beats, all variations from this number are indications of the amount of unnecessary work thrown on the heart.
Fatigue, mental or physical, and cold were the usual causes of most disturbances of the circulation. Sometimes indigestion was the cause, but more often the indigestion was a result of cold.
The effect of cold even on a small area is illustrated by the following experience. I was riding in a parlor car and taking a nap when some stranger opened a window which caused a draft to hit me on one side of my face. A few hours later the side of my face hit by the draft was covered with pimples, and one developed into a boil. This shows how secondary an infection may be.
Most people realize that the circulation in the skin is related to one's complexion and is usually a sign of health. This is very evident when people pass into Class 4, the normal class. If the skin is dry or cold, it means that blood is flowing to some other area more than it should. The circulatory balance is disturbed.
Whenever cold contracts the blood vessels of the skin sufficiently, it drives the blood to the nose and produces congestion and mucus. If the blood is driven to the stomach, it produces mucus, acid, and gas. If it is driven to the bowels, it produces mucus and water.
The nose is supplied by the most superficial layer of the circulatory system. Because the blood vessels of the body are all connected, if one area of the blood vessels contracts, another must dilate. The nose is often chronically congested. If so, whenever cold air strikes any part of the skin, nasal congestion is immediately increased, and more mucus is secreted in a few seconds. I have observed this thousands of times, and since I could reduce the congestion in a few moments by treating the controlling area in the spinal muscles, I could observe these changes readily.
I learned that working in a comfortably warm office but with cold floors may have a disastrous effect on the health by causing contraction of the blood vessels in the lower part of the body and forcing the blood up into the head, thereby aggravating any nervous or physical symptom.
I learned by repeated experiences that a draft striking any part of the body, even if only on a limited area, may produce a spasm of all of the blood vessels in the skin and produce a cold in the head. This happened a number of times when I sat close to a cold outside wall of the church where I felt a cold current of air only on top of my head. I supposed that the effect of a draft on a limited area like the top of my head could be easily controlled when I got home, but I learned that the contraction of the external blood vessels required general and thorough treatment to control the disturbance.
I observed that many stimuli had opposite effects on different people, and also on myself, depending on whether my arteries were in a relaxed or tension state or class. For example, if I took a cool bath when in the tension class, it produced excessive dizziness immediately. When I was partly or entirely in the relaxed arterial state, a cool bath produced a "good reaction"; that is, my skin became pink or even very red.
Restoring Normal Circulation
I learned that every symptom I had for fifty years was controlled, stopped, or relieved (cured, if you do not object to the use of this word) by restoring the normal circulation. If anything was done to disturb the circulation, it made the symptom worse.
For the sake of those who are interested only in "techniques" but not in the physiology involved in all treatments, I might mention a few rather humorous "first aid" substitutes I used.
Many people with relaxed arteries have gotten immediate relief from faintness and other symptoms and could resume their work by leaning up against a cold wall. All felt the need of cool air and wore lighter clothes than most other people. They instinctively avoided all heat treatments even when prescribed.
One man who had serious gas attacks had consulted specialists, yet still had no relief. He called me one night on account of an attack. Since I knew he needed cold applications, I looked around and saw a pistol lying in a drawer. I drew this down his spine and the patient received quick relief.
I was called to see two ladies in the same house, both with prolonged headaches. One was in the relaxed class, and a small cold electric iron drawn down the back relieved her. The other lady was in the tension class. By warming the same iron and relaxing the excess tension, her headache was relieved. No one could understand this experience unless he knew the significance of the opposite circulatory classes.
More attention was paid to the opposite circulatory classes 2,000 years ago than in recent years. In the year One, whole schools of "medicine" were based on the therapeutic use of heat or cold or both. Since then, in recent millennia, there has been a generous and indiscriminate use of vasodilators on or in all four circulatory classes. As a result, no one could tell whether a patient died from a failure of the circulatory system or from the medication. If the arteries in only three segments of the lumbar area are relaxed, vasodilators are just as deadly.
During sixty years I classified thousands of people. I did this almost continuously. I learned that there are innumerable people suffering from nervous or mental disorders, or even threatened with amputation of the feet because of gangrene, who simply had a lack of arterial tone in the abdominal and other blood vessels of the body. This was proved by the recovery of such people when the arterial tone was restored by treatment. The rate of blood flow, therefore, is the most important consideration in the treatment of every kind of disorder.
In the Reader's Digest of January, 1961, a writer quotes from various doctors to the effect that at least for people with headaches, there are two opposite circulatory causes. The arteries may be contracted, forcing the blood into the head, or the arteries may be relaxed and need some drug or other treatment to contract them and to restore the normal circulation to the head.
This was the first sign of such intelligence I noticed since the years when I was trying to save myself from complete circulatory collapse.
Procedure for Determining Class
First, take the blood pressure and the number and quality of the pulse, noting the hardness or distention or retraction of the stomach and the colon. Next, take a piece of absorbent cotton about the diameter of an ordinary lead pencil and twist it to a point, or better still, wrap the cotton around an applicator, because a warm hand has relaxed some people. Then moisten the cotton in alcohol, or preferably witch hazel. Squeeze out all but a little moisture. Using a gentle pressure, draw this over the skin about one-half inch to the left and then to the right of the spine, on the "upper third" of the back. Keep the rest of the body quite warm under a blanket or blankets, but not to the point of perspiration. This application, if repeated two or three times, will increase or decrease the amount of gas in the stomach and also the tension of the stomach. If the effect is good, the cold should be applied to the whole spine. If too light a touch is made with the cotton, so that a tickle is produced, it will cause too extensive a vasoconstriction in the skin.
The applications should be repeated at one to five minute intervals until there is a definite change in the blood pressure or pulse, or until the amount of gas in the stomach is definitely greater or less. If the cold applications reduce the amount of gas in the stomach, make the pulse better, and also perhaps bring the blood pressure toward 120 mm. of Hg., conclude that the patient is in Class 1. The arteries are relaxed all through the body, and the cold is needed. If, however, the cold applications increase the amount of gas in the stomach and the stomach feels harder upon palpation, and if the pulse becomes weaker (more compressible) and the blood pressure moves away from 120 mm. of Hg., then the cold applications are not needed on either the upper or lowest thirds. To test the middle third, the effects of the cold applications must then be reversed by a little warming or gentle manipulation of the spinal muscles in the upper and lowest thirds. Often a few seconds of manipulation is enough.
The "middle third" should next be tested. If several cold applications have a favorable effect here, the patient is in Class 2 and requires the cold applications in the "middle third" only. The applications should be made until they begin to have the same bad effect as they had on the "upper third." Often one cool spinal application will make the pulse poor and cause the blood pressure to drop 20 to 40 mm. of Hg. Sometimes the pressure will rise. This bad effect on the whole "middle third" should be reversed briefly by a few seconds of gentle manipulation of the muscles of the upper half of this middle third. Then some applications of cold should be made to the third and fourth lumbar segments (lower half of the middle third) only. Occasionally people have a lack of tone in the arteries controlled from these spinal segments only, and applying the cold here has restored many extreme conditions to normal. If these applications to this restricted area also have a bad effect, conclude that the patient is in Class 4 and should be given a general relaxing treatment. If the applications have a good effect, this shows that the arteries are relaxed, and contracting treatment should be continued until the patient passes into Class 4, which is the class of normal tension.
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