-5 P 
 
 (76-
 
 of 
 steopatb^fl 
 
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 BY WILFRED L. tflGGS, D. O., 
 
 Dean and Professor of Physiology and Lecturer and Demon- 
 strator on Theory of Osteopathy in Still College of Osteopathy. 
 Member of the Examining and Operating Staff of the S. S. Still 
 Infirmary. Demonstrator in Clinics of Still College of Oste- 
 opathy. Member American Association for the Advancement 
 of Osteopathy. Formerly Professor of Science Idaho State 
 Normal, Etc. 
 
 Dee dBoinea, flowa 
 
 mew Science publisbing Co. 
 
 1000
 
 LOB 
 $ 
 
 Ifoo 
 
 KENYON PR4NTHMI * MM. CO. 
 
 DCS HOINB,K>WA.
 
 TO 
 
 Those who would find in the natural arrangement 
 of the various parts of the human body 
 
 the source of perfect order, harmony and health 
 this volume is respectfully dedicated by 
 
 THE AUTHOR 
 
 1900 
 
 COPYRIGHT APPLIED FOR BY 
 RIGGS AND HELM
 
 CONTENTS. 
 
 PAGE. 
 
 HEALTH AND DISEASE 15 
 
 PRINCIPLES OF OSTEOPATHY 41 
 
 SYMPATHETIC NERVOUS SYSTEM 61 
 
 VASO-MOTORS 85 
 
 OSTEOPATHIC CENTERS 95 
 
 THEORY OF THE TREATMENT OF THE SPINE . .107 
 
 REGIONS OF THE HEAD AND THORAX 119 
 
 REGIONS OF THE ABDOMEN AND PELVIS . . . .147 
 
 THE lyiMBs 164 
 
 GYNECOLOGY AND OBSTETRICS 179 
 
 CONSTIPATION, RHEUMATISM AND CATARRH . .193 
 
 How AND WHEN 207 
 
 INDBX GENERAL . . . 212 

 
 PREFACE. 
 
 IN THE preparation of this volume the author has 
 freely drawn from the rich store of anatomical 
 and physiological facts which are a part of general 
 science. For this he makes no attempt to give credit 
 save in a general way. 
 
 He has read the following works On anatomy : 
 Allen, Gray, Gerrish, Morris and Quain. On physi- 
 ology : The American Text Book, Dalton, Flint, 
 Foster, Stewart and I^andois & Stirling. On Osteop- 
 athy he has read with profit the works of the distin- 
 guished founder, Dr. A. T. Still, Dr. Chas. Hazzard, 
 Dr. C. P. McConnell, Dr. A. P. Davis and Dr. Henry. 
 Miscellaneous : Ranney's Applied Anatomy of the 
 Nervous System, Ranney's Diseases of the Nervous 
 System, Hilton's Rest and Pain, Holden's Landmarks, 
 Robinson's Abdominal Brain. On examination and 
 diagnosis : Page, Vierordt, Cor win, Hare, and Cohen 
 and Eshner. Osier's Practice of Medicine, Hughes'
 
 Practice of Medicine, American Text Books of Medi- 
 cine, Surgery, Obstetrics, Gynecology. On Massage 
 the author has read with pleasure and profit the works 
 of Taylor and Dowse. 
 
 To the many Osteopaths with whom he has been 
 associated the author would say, " I am a part of all 
 that I have met, ' ' and whatever of merit may be found 
 within this volume is, in a measure, due to those with 
 whom he has so fortunately come in contact. 
 
 The author is deeply indebted to Dr. J. W. Hofsess 
 and to Captain D wight H. Kelton, for many valuable 
 criticisms and corrections while the work was passing 
 through the press.
 
 INTRODUCTION. 
 
 /^\F MAKING many books there is no end " was 
 a truth three thousand years ago : it is 
 eminently true at the present time. There is nothing 
 which so interests the human race as does an advance 
 in the method of restoring to health a diseased body. 
 That the administration of drugs has been empirical 
 and that the knowledge of their effects has been 
 bought at a great price is well known, but tradition 
 still fetters the progress of the healing art. 
 
 Aught which differs from the fixed order of belief 
 as recognized by the profession, is condemned in 
 advance and must run the gauntlet of criticism and 
 opposition. To elucidate a method of healing which 
 is based upon known facts of science is certainly 
 a gratifying task. There is no fact of anatomy which 
 may not be of value to the osteopathic physician. He 
 uses all anatomical connections and relations. He 
 must be a bloodless surgeon, whose scalpel never 
 punctures the skin, nor sections the nerve, nor severs 
 the tendon. His knowledge of anatomy must be
 
 10 
 
 minute and profound, to the end that he may diagnose 
 diseased conditions though far removed from the 
 functional lesion. 
 
 ' ' Despise not the day of little things " is a text 
 which the osteopathic practitioner should embody into 
 his code of morals for daily repetition. The minute 
 nerve twig extending from spine to distant organ or 
 viscus, unimportant in size, is pregnant with sugges- 
 tions of the cause of the disturbed function. But, 
 while a knowledge of anatomy is essential to the 
 thoroughly equipped practitioner, he must likewise be 
 master of the known facts of physiology ; it is not 
 enough that the osteopathic physician be able to fore- 
 tell from the location of the lesion the viscus which is 
 affected ; he must be able to predicate the nature of 
 the disturbed function and its general result upon the 
 health of the patient. 
 
 There can be no pathological changes in a tissue 
 or organ which are not accompanied by disturb- 
 ances in the metabolism of the part, and metabolism is 
 wholly dependent upon the conditions of nutrition 
 and nerve supply. 
 
 Osteopathy is a protest against the growing practice 
 of taking drugs. It offers a more rational means and 
 bases its promises of cure upon the fact that in a 
 healthy organism in perfect repair there is no pain, no
 
 11 
 
 weakness, no disorder, and no disease. The laws of 
 nature are immutable. Water flows in sparkling 
 streams from mountain springs to the distant ocean in 
 obedience to these laws. The woody fibres of the 
 massive tree have been raised high in the air obedient 
 to these same forces. 
 
 The science of Osteopathy has magnified the impor- 
 tance of the spine as a guide in diagnosis, basing such 
 diagnosis upon the well-known physiological law of 
 transferred sensation, and the anatomical connection 
 between spine and viscus. From this fact comes our 
 accuracy in diagnosis, an accuracy which is based 
 upon mathematical calculation and cannot fail. The 
 variations which occur in the relations and struc- 
 ture of different parts of the organism sometimes 
 produce embarrassing results to the surgeon and fatal 
 ones to the patient. These variations are rarely suffi- 
 cient to embarrass the osteopath, though he must ever 
 be ready to correct errors in diagnosis due to varia- 
 tions in position of lesion, by examination of the 
 viscus affected. 
 
 Every method of examination known to the medical 
 world must be utilized to correct and to prove the 
 accuracy of the strictly osteopathic diagnosis. 
 
 The term lesion is used in osteopathy in a free 
 sense as a cause of disease, but it is not restricted in
 
 12 
 
 its meaning to osseous dislocations. That there are 
 spinal lesions associated with the great majority of 
 diseases is a fact to which every osteopathist can cer- 
 tify. In many cases these are the causes of the 
 diseased conditions ; in many others they are the 
 direct results, yet, as sequelae, serving to prolong the 
 disease. 
 
 The science of Osteopathy is progressive. It makes 
 a distinct advance in the art of healing. It demands 
 no external aid but recognizes in man the power to 
 successfully militate against the adverse conditions in 
 which he is placed. There is no hypnotic so con- 
 ducive to restful sleep as an equalized nerve force, no 
 stimulant so effective as a perfect circulation, no reac- 
 tion so natural as that rest which follows physiological 
 action. The blood is the life. The nerve controls the 
 condition and distribution of the blood. The science 
 rests upon the truth that pure blood and normal nerve 
 supply give health. The arrangement of the other 
 tissues of the body are for and to this end. 
 
 This science marks a new departure in three things 
 pertaining to diseased conditions, viz. : etiology, diag- 
 nosis and treatment. 
 
 There is no authority in etiology save anatomy and 
 physiology. The symptoms elicited and observed are 
 but the logical results of some interference with
 
 13 
 
 physiological function. Most of the facts upon which 
 Osteopathy rests are the common possession of the 
 medical world ; but the classification of these facts have 
 given shape and system to the science. The resistant 
 and recuperative powers of the body are being demon- 
 strated. Order, perfect order, in the human frame 
 results in a perfect performance of all the duties of 
 that organism. The curve of the muscle, the glow of 
 the skin, the gleam of the eye, all betoken a perfect 
 adaptability, an undisturbed motion of fluids, a condi- 
 tion called health. 
 
 The science of Osteopathy is an exact one. The 
 symptoms point the lesion ; the location and kind of 
 lesion suggest the treatment ; its correction results in 
 a restoration to health. 
 
 The osteopathic physician finds no force outside the 
 body which will maintain health or life. He trusts to 
 liberating and equalizing the forces of the organism 
 through the movements of the fluids. Motion is 
 essential that the matter of the body may manifest 
 itself ; and this manifestation is life. 
 
 External forces produce a powerful and continuous 
 effect upon the central nervous system. These influ- 
 ences reach the center through the various afferent 
 pathways, either consciously or unconsciously contrib- 
 uting to life. The function of the air, the sunlight,
 
 14 
 
 temperature, meteorological conditions ; these and 
 many other forces contribute to one general state of 
 health. It is upon this view that we seek to restore 
 health by changing the nature, quality and amount of 
 these forces. 
 
 Passive movement has certain curative value. 
 Motion may have been diminished ; this decrease of 
 motion may lead to a loss of afferent impulses from the 
 surrounding parts and thus to a diminution of physio- 
 logical processes. The science of Osteopathy is 
 entitled to separate, careful, special investigation, 
 whereby its facts and principles may be recognized at 
 their true therapeutic value. 
 
 This method has the broadest affiliations with gen- 
 eral science, resting upon all known truths of physi- 
 ology, and in harmony with each.
 
 CHAPTER I. 
 
 HEALTH AND DISEASE. 
 
 " TV/T ENS SANA IN CORPORE SANO" is an 
 
 i-T J. old L,atin aphorism of which Rousseau, andbody 
 the great French savant and philosopher, remarked 
 that it is a short but complete description of a per- 
 fect state in this world. These conditions assumed, 
 all other earthly conditions are attainable. All things 
 are possible to the fearless, perfect soul ; and fearless- 
 ness comes only as an attribute of a perfect mental and 
 physical condition. The body and mind are intro- 
 active. The mind rules the body, yet the body in 
 turn reacts most profoundly upon the mind. Bodily 
 health, perfect bodily condition, insures mental health. 
 Health is the end of ^dl therapeutics. It represents 
 the natural condition. It is not an end of life but a 
 means to perfect living. Health may be defined as 
 that condition of the organism which pertains when 
 every organ is perfectly adapted to perform the func- 
 tion for which it was designed. Nor is this condition
 
 Health is a 
 birthright. 
 
 The health of 
 the coming 
 ages. 
 
 16 
 
 of health unattainable in fact, it is or should be the 
 heritage of everyone a universal birthright. To 
 this end every child that is born has a right to demand 
 that it come of healthy parentage that weakness and 
 pallor and disease should not propagate their kind, 
 that health may be a universal possession of the domi- 
 nant races. When that time has come then will the 
 profession of physician become a thing of the past, 
 since the knowledge which he possesses as expert, or 
 professional attainments, will then have become general 
 knowledge a part of the common possessions of 
 mankind. Then children will remain unborn from 
 diseased parentage ; then those who are born will 
 develop to that growth and strength which is their 
 right, as does the twig grow into the tree or the young 
 of the untamed animals reach their maturity, un- 
 hampered by pain, untouched by disease. There will 
 come a race with nerves unracked by pain, which have 
 never yielded to the seductive effects of the deadly 
 anodynes. Then strength will be the glory of 
 man and woman, and weakness and sickness a 
 disgrace. That day will see men whose biceps meas- 
 ure will exceed that of the neck ; and wasp-waisted 
 women will be a tale that is told a tradition of the 
 barbarous past. This condition is typified in L,ong- 
 fellow's "Village Blacksmith"
 
 17 
 
 "The smith, a mighty man is he, 
 With large and sinewy hands, 
 And the muscles of his brawny arms 
 Are strong as iron bands." 
 
 To maintain this state and to restore it if lost, carelessness 
 
 causes disease. 
 
 has been the object of all systems of therapeutics. 
 Carelessness, a trait of the race, has caused man to 
 disregard prophylaxis and to trust more and more to 
 what are considered as curative agents. So long 
 as there is no noticeable deviation from the usual con- 
 dition of ease, comfort and strength, just so long will 
 the body receive no thought. Health is modest, 
 retiring. Subjectively it is unobtrusive and calls for 
 no thought. Objectively it is prominent and com- 
 mands attention. ' Tis the condition which excites 
 the admiration of all ; the envy of those who have 
 been so unfortunate as to lose it, for health is a jewel 
 unesteemed till lost, but once lost not all the wealth of 
 Golconda can replace it. Longfellow says, "Life 
 without health is a burden ; with health is a joy and 
 gladness." Empedocles delivered the people of 
 Selinus from a plague by draining a marsh and was 
 deified and a coin was struck in his honor. But 
 simple as may seem this condition, there is necessary 
 a great amount of care in order that the organism may 
 be maintained in proper working order. It may seem 
 strange to say that health is so difficult to maintain,
 
 18 
 
 but when we think of the manifold intricacies of the 
 structure of our bodies, the wonder rather seems that 
 we are able to maintain so nearly a perfect condition 
 of the body as exists in the majority of persons. There 
 
 Theintcrde- J J r 
 
 variomorgans. is such an interdependence between the various organs 
 each of which contributes to the welfare of the other 
 that the disarrangement of a single one will lead to the 
 disarrangement of the whole. There exists the vari- 
 ous systems, nervous, circulatory, respiratory, muscu- 
 lar, osseous, etc., so perfectly related that the one 
 cannot be at all disturbed in form or in function 
 without profoundly affecting each of the others. These 
 systems interact normally so as to produce the physio- 
 logical functions of all ; if a disturbance either prima- 
 rily or secondarily reaches the nervous system and 
 through it various other subordinate systems, soon 
 harmony, order and health have disappeared. 
 
 Diet must play an important part in the health of 
 
 Vitality main- 
 tained by diet, each community and each individual. The vitality, 
 
 the resistance of the body can be maintained only by 
 a dietary affording the proper amount of each of the 
 three great classes of alimentary principles, carbo- 
 hydrates, proteids and fats. But even here the per- 
 sonal desires and idiosyncrasies of the patient must 
 largely determine the particular form under which 
 each class shall be taken. To be productive of the
 
 19 
 
 highest good, the food should be palatable. Enjoy- 
 ment and appetite are the best digestives. 
 
 All hygienic knowledge should be rigorously applied 
 in the treatment of disease. Sunshine, pure air, venti- pm 
 lation, exercise and diet all are essential in prophy- 
 laxis and in the cure. In maintaining his own health 
 or in advising others to the same end, the osteopath 
 should never forget these minor details which are 
 known, and have been proven in many instances to be 
 life saving. " Prove all things ; hold fast that which 
 is good." Exercise, outdoor air, light, well venti- 
 lated living and sleeping rooms and one-third of each 
 twenty-four hours given to sleep will surely contribute 
 to health, mentality and virtue. 
 
 Disease is the reversed condition. It represents a Life compared 
 
 to a whirlpool. 
 
 change in the normal metabolic processes. Health is 
 maintained by a proper and perfect metabolism. Into 
 the ceaseless vortex certain substances are continually 
 entering, losing their identity and momentarily con- 
 tributing to the whirlpool, lending energy to draw in 
 other particles. By this intussusception, life is mani- 
 fested, certain low grade products of oxidation are 
 formed, energy is freed. This regular interchange from 
 the organic, through the living maelstrom to the lower 
 organic and to the inorganic, constitutes health. Within 
 certain limits the rate of change and the products may
 
 taboltem pro- 
 duce disease. 
 
 20 
 
 vary without seriously disturbing the functioning of 
 the organs, but should the rate of change be markedly 
 interrupted, then may biproducts be formed which 
 the depurative organs are not able to withdraw, sub- 
 oxides are formed and these acting as toxins interfere 
 with the harmony of the organism, producing disease. 
 Disease (from dis not ; and ease a state of rest) is 
 defined as that state or condition of the body which is 
 marked by an inharmonious action of one or more of 
 its organs, due either to abnormal conditions or 
 structural change. The causes of these conditions are 
 usually considered as exciting or the immediately con- 
 ditioning factor, and predisposing or that which tends 
 to the development of the condition. These two may 
 be further subdivided and may be so interrelated that a 
 strict differentiation is not always possible. They act 
 together in a majority f cases confusing etiology of 
 diseases and puzzling the diagnostician. True, in 
 many cases there is a causa cnusans, or the causing 
 cause, which is the essential predetermining factor. 
 This is in many cases so evident that the secondary 
 causes are apt to be overlooked. In addition to the 
 foregoing causes of disease there are the ordinary 
 causes, such as change in temperature, seasonal and 
 climatic variation, altitude, etc., to which all persons 
 are more or less exposed and against which the
 
 21 
 
 resisting power of the individual is ordinarily sufficient 
 protection . 
 
 Classifying causes of diseases as internal and 
 external, we have the following : 
 
 Causes acting from within : 
 
 1. Heredity Parents to off- 
 spring, transmitting either dis- 
 ease or a tendency to disease. 
 
 I. Predisposing 
 
 2. Individual peculiarities not 
 
 inherited connate and ac- 
 quired. 
 
 II. Mental and emotional causes. 
 
 III. Structural lesions secondary to or resulting 
 
 from any of the above. 
 
 IV. Abnormal blood supply. 
 V. Altered nerve influence. 
 
 Causes from without- 
 I. Physical or mechanical, producing structural 
 
 or relational lesions. 
 
 II. Chemical substances coming in contact with 
 the organism producing abnormal metab- 
 olism. 
 III. Micro-organisms. 
 
 Many times is disease produced by conditions . 
 
 * * Conditions 
 
 , . , ... , , . , . not always 
 
 which are known to be dangerous but which cannot controlled. 
 be avoided. Man constantly chooses occupations
 
 22 
 
 which are productive of disease or resides in a locality 
 known to be prejudicial to health. We feel that there 
 are other occupations in which health would be ours 
 in greater measure, but fitness, desire, etc., impel us 
 to an occupation in which we draw heavily and con- 
 tinually upon our vital capital. Health is a means 
 to an end, and in insuring it, by residence, occu- 
 pation, care of the body, etc., there is a limit to the 
 amount of premium that one can pay. Even life itself 
 may be too dearly bought and death with duty is to 
 be preferred to life with dishonor, cowardice and 
 shame. The question comes to all, what can I afford 
 to pay for health ? Bach must answer for himself. 
 The teacher in the schoolroom follows day after day 
 an occupation that she knows is taking her life and 
 strength. The shop girl hour after hour and month 
 after month works for a miserable pittance and stands 
 at her counter because she knows that every occupa- 
 tion in life is crowded and she holds with the tenacity 
 of hopelessness and fear to the only means of subsist- 
 ence which she possesses. 
 
 But to discuss the causes of disease. Of the 
 predisposing causes of disease, the most important are 
 those connected with some peculiarities of the bodily 
 structure which may be (i) inherited, or (2) congenital 
 but not inherited, or (3) acquired after birth.
 
 23 
 
 In the so-called hereditary diseases it is not the Germg not 
 
 usiiaJly trans- 
 disease itself nor its direct specific cause which is mttteatn 
 
 hereditary 
 
 transmitted from parent to child, but some peculiarity 
 of structure of tissue or organ which in the course of 
 development makes the person peculiarly susceptible 
 to disease or to causes which produce the disease. 
 These may be, either forces acting from without, or 
 else the peculiarity produces disorder itself either by 
 excess or defect of structure or function. Very few 
 diseases may be transmitted directly in utero, but of 
 this number are syphilis, small-pox and a few others. 
 The belief that the specific germ of tuberculosis and 
 scrofula is never transmitted but that inheritance gives a 
 peculiar susceptibility to the disease owing to weak- 
 ened resistance on the part of the protoplasm, is now 
 prevalent though not proven. 
 
 Heredity plays a part in immunity just as it does in immunity by 
 
 heredity. 
 
 liability to disease. This is seen not only in the 
 family but on a broad scale among races. Perhaps 
 this even may be due to their obedience to or neglect 
 of certain laws of health. But certain it is that the 
 negro of the southern states is almost immune against 
 cancer and in his African home is free from syphilis, 
 though in America is peculiarly subject to this disease. 
 He is peculiarly liable to tuberculosis and immune to 
 malaria.
 
 Lesions, 
 primary and 
 secondary, 
 causes of 
 disease. 
 
 24 
 
 The term lesion as used in this work includes 
 any deviation from the normal either in structure, 
 relation or function. It may be either a causa 
 causans, or it may act as an exciting cause of disease 
 either with predisposing causes or with other causes 
 from without. In other words, lesions, as the term is 
 used by osteopaths, may be either primary or secondary. 
 The division is self explanatory. The term primary 
 lesion is ordinarily restricted to conditions which pro- 
 duce disease ; hence, causative. The term secondary 
 lesion is applied to such as are the result of diseased 
 conditions. These lesions are sequelae of previous 
 diseases, yet may be causes of present pathological 
 conditions. The osteopath seeks for his lesions along 
 the spine and considers them either in the light of 
 causes of disease or of evidences of a diseased 
 conditions of the organ. 
 
 These lesions along the spine may vary in kind and 
 in degree. The effect is not infrequently dispropor- 
 tionate to the amount of the lesion, sometimes the 
 least detectable variation from the normal may produce 
 the most pronounced and widespread effects. On the 
 other hand the spine is sometimes so distorted that 
 one would expect a marked interruption to all the 
 processes of life, yet no such disturbance results.
 
 25 
 
 These spinal lesions may be of any of the following 
 types or more likely a combination of some two of 
 them : 
 
 1. Osseous. This maybe so pronounced as to be HOW osseous 
 
 lesions ^produce 
 
 a dislocation, or so slight as to be called a subluxatiou disease. 
 
 In either case there may be an interruption to the 
 free passage of nervous impulses which stream con- 
 tinually from viscus to center over the afferent nerve 
 fibres entering the cerebro-spinal system, or from 
 center to viscus over the efferent nerve fibres which 
 also pass through the spinal and cranial foramina. 
 These nerves serve as channels for all communication 
 between viscera and center ; these bind the parts 
 together into a harmonious whole ; these establish 
 equipoise and health. Every viscus, muscle and 
 tissue of the body is governed by impulses from the 
 centers passing through these foramina or through 
 corresponding openings in the base of the cranium. 
 Likewise through these go all those impulses which 
 reach the centers from the sensorium. Sensations of 
 ease, muscular sense, pressure, temperature, blood 
 pressure, vaso-motor condition, touch, all pass through 
 these channels. How rational that any change in 
 these co-aptiug surfaces should disturb the equilibrium 
 between the incoming and the outgoing impulses ; this 
 disturbance leads to a failure of some one or more
 
 26 
 
 of the viscera to function normally, disease being the 
 osseous teions, necessary result. Osseous lesions are usually primary 
 
 primary and 
 
 causes of disease and diseased conditions, though 
 muscular contractions in convulsions, in rheumatism, 
 and in other diseases may produce actual dislocation of 
 many of the strongest articulations of the body; so, 
 too, these and other causes may lead to slight subluxa- 
 tion of rib or vertebra which in turn may affect some 
 organ. This effect may be deferred or immediate. 
 This serves to explain many of the sequelae of diseases 
 which otherwise are inexplicable. 
 Muscular 2. Muscular. Aside from osseous lesions the 
 
 lesions effect 
 
 nerves reflexly. j ,. r ,. . ., 
 
 next most productive of disease is muscular. 
 This is usually a result of some abnormal condition, 
 some irritation to its motor nerve, resulting in its con- 
 traction, hyperaemia, and hyperesthesia. This condi- 
 tion acting reflexly may irritate the nerves to the 
 viscera, there affecting sensory and vaso-motor 
 conditions. Thus the muscular contraction, itself a 
 result, may serve as a cause for the continued disturbed 
 condition in acute diseases; its removal is followed 
 by an amelioration of the conditions. These muscular 
 lesions may result from strains, overwork, exposure to 
 cold, drafts, etc. 
 
 3. Ligamentous. The third kind may be classed 
 as lesions of connective tissue, or ligamentous. The
 
 27 
 
 muscular lesion always exists with the osseous at the increase of 
 
 connective 
 
 beginning. It may exist independent of it but in f* s e j$ r ~ 
 
 nutrition. 
 
 either case a continual contraction of a muscle means 
 a hyperaemia, venous stasis and retrograde metab- 
 olism, namely, an increase in the connective tissue 
 wrappings of the muscle, tightening and thickening 
 the ligaments and tendons and thus pressing upon the 
 channels for blood, lymph and nerve impulse. This 
 will explain why the osteopath attributes so many 
 diseased conditions to lesions ; not lesions in the nar- 
 row sense of dislocation, but in the sense of any 
 abnormality of structure. Their correction leads in 
 most cases to a cure ; in all cases the immediate result 
 
 is to palliate the condition. The correction of correction of 
 
 lesions 
 
 these lesions is the removal of the cause in many pro 
 diseased conditions. In bacterial diseases even 
 this treatment produces effects which tend to cure by 
 sending more and purer blood to the organ, increasing 
 the activity of assimilative and depurative tissues, 
 increasing the vitality and strength of the patient. 
 
 It seems to be an established belief, at best it is a 
 prevalent one, that in all things the medical man and 
 the osteopath must be on opposing sides of every 
 question ; and should the opposition by priority have 
 occupied the only tenable position it is necessary that 
 the osteopath should occupy any position, however
 
 No conflict 
 between 
 Osteopathy 
 and the 
 germ theory. 
 
 28 
 
 untenable, rather than stand in the same position as 
 his medical friends. This need not be. The belief in 
 the existence of lesions as a cause of disease has led to 
 a very conservative estimate among osteopaths as to the 
 functions of bacteria found in the body. The discrep- 
 ancy between the explanation of the causes of disease 
 from the view-point of the bacteriologist and that of 
 the osteopath is apparent only, for there is no neces- 
 sary conflict. The osteopath acknowledges that 
 inorganic and non-living poisons introduced into the 
 system may cause disease and death, and why not 
 acknowledge, too, that organisms whose rate of 
 increase is almost unbelievable and the virulence of 
 whose products is scarcely equaled by that of common 
 poisons may not produce like effects ? No one, for a 
 moment, claims that carbolic acid or some of the 
 compounds of lead may not be the real cause of 
 diseased conditions if introduced into the body, 
 though no one forgets that the resisting power of 
 some individuals is greater than that of others. 
 
 The history of the growth of the idea that micro- 
 organisms are the cause of many of the diseases that 
 flesh is heir to, is an interesting one. It entails the 
 idea of spontaneous generation. The discussions 
 which led to the positions occupied by scientists began 
 before the Christian era. All the ancients believed in
 
 29 
 
 spontaneous generation. Dead bodies decaying 
 became bees, hornets, flies, worms and beetles. 
 Animals were held to develop from moisture. Aris- 
 totle asserts that sometimes animals are found in 
 putrefying soil, in plants and in the fluids of other 
 animals. He announces that every substance which 
 has become moist and every moist body that has 
 become dry, produces living creatures, provided it is 
 fit to nourish them. Two thousand years later this 
 same belief prevailed, extending downward through 
 the middle ages, and incidentally contributing to the 
 science of bacteriology. 
 
 In 1668 Francesco Redi, expressed a belief, seem- 
 ingly the first to do so, that maggots formed in 
 decaying meats did not arise de novo, but were a 
 progeny of the flies which swarmed upon it. His 
 proof of his position is historic. Covering jars con- 
 taining the meat with paper, and later with gauze, he 
 showed that the flies deposited their eggs on the 
 covering, while the meat decayed as usual. 
 
 It was at this time that Leuwenhock (1675) per- 
 fected the compound microscope to such a degree as to 
 make it of some service. By the power of the lens 
 life was revealed which before had been but dimly 
 guessed at. The doctrine of spontaneous generation 
 again fought for recognition, while Plengig of Vienna
 
 30 
 
 for the first time, in 1762, announced a connection 
 between the organic life revealed by the microscope and 
 the origin of disease. This idea was for a long time 
 neglected, but other experiments were carried on which 
 led to the present position of scientists. The doctrine 
 of spontaneous generation was finally overturned by a 
 series of brilliant experiments, beginning with Spal- 
 lanzani. who subjected sealed flasks with infusorial 
 fluids to the temperature of boiling water and got no 
 evidence of life ; Schultze, who heated flasks and 
 passed air through sulphuric acid into them daily with 
 no evidence of life, made a vast step forward in 1836 ; 
 while Schwann proved that calcined air admitted to 
 putrescible liquids did not produce life. Pasteur 
 demonstrated that meat did not decay if kept free 
 from germs. 
 
 The crucial test for spontaneous generation 
 was made by John Tyndall. He arranged an air- 
 tight box with glass ends in such a manner that 
 test tubes introduced into the bottom could be filled 
 without communication from the outside. Waiting 
 until a ray of light passed through the box from end 
 to end made no illumination, indicating that all the 
 dust of the air had settled to the bottom or had 
 adhered to the sides which were oiled ; the test 
 tubes were then filled with such mixtures as had
 
 31 
 
 under ordinary circumstances been known to soon 
 become swarming with bacteria of putrefaction. The 
 mixtures were then heated to the boiling point and 
 allowed to stand for a few days, when they were 
 heated again. By this method of repeatedly raising 
 to a high temperature and allowing it to cool to a 
 temperature at which development of bacteria would 
 take place he hoped to thus overcome the condition 
 which he had conceived to be the cause of the failure 
 of other experiments of a similar nature. 
 
 His idea was that the spores have a greater resist- 
 ance to the action of heat than the fully developed 
 germs, and that they had withstood the tests of other 
 
 Life does not 
 
 investigators, but by successive heatings he hoped to 
 destroy them in their developing or in their matured 
 state. The plan proved successful and it was demon- 
 strated most conclusively that life does not originate 
 de novo. The tubes stood for months with no evidence 
 of life or decomposition. This experiment proved, 
 with others of a similar nature, that decomposition 
 does not take place except it be associated with the 
 action of certain microscopic organisms. 
 
 Tyndall's remarkable experiment finally overthrew 
 the doctrine of spontaneous generation. The neces- 
 sary data were now established for carrying out the
 
 32 
 
 crucial tests to which the germ theory was subjected 
 before it was accepted. 
 
 These tests put in common language were as fol- 
 lows : 
 
 The disease must be one that can be clearly iden- 
 tified. The specific germ must in all cases be capable 
 Kooh'stest. of being isolated. It must be present in the diseased 
 tissue or organ and not merely in the fluids associated 
 with the organ. It must be capable of being reared in 
 pure cultures and lastly when germs from these pure 
 cultures are introduced into the system of an otherwise 
 healthy animal, the introduction must be followed by 
 a disease having the same symptoms as the original 
 disease. The test made in numbers of cases has 
 established the germ theory as a scientific fact. It 
 places the germs as a cause of disease this far, that, 
 without the introduction of the germs the disease 
 would not have occurred. The osteopath regards the 
 germ as an exciting cause of disease. He considers 
 the resisting power of the body an important factor 
 in prophylaxis. This power depends upon the con- 
 dition of the blood ; and it is thus through the blood 
 that the osteopath seeks to militate against develop- 
 ment and effects of the pathogenic germs. The 
 
 Red blood as a osteopath practices asepsis and antisepsis. He con- 
 aermicide. 
 
 tends that the best germicide is good red blood, and
 
 33 
 
 acknowledges that drugging is theoretically the 
 method of killing the germ. The only difficulty 
 conies in finding a drug that will reach the bacterium. 
 Unfortunately, when drugs are administered, the 
 patient yields to the effect of the poison before the 
 germ is killed. 
 
 There is no longer any discussion among intelligent 
 men as to whether certain forms of germs are danger- 
 ous and destructive to life ; but how to prevent their 
 entrance and to combat their ravages when once 
 entered are the great questions for the physician. 
 
 A bacterium may be defined as a minute vegetable Definition of 
 
 bacteria. 
 
 cell. Its component substance is called myco-protein. 
 Its chemical nature has never been absolutely deter- 
 mined. For convenience of study those which produce 
 diseased conditions are divided into three classes. 
 
 First. The cocci, which are spherical in form, 
 either existing as single spores, micro-cocci ; or united 
 in pairs, diplo-cocci ; or arranged in chains, strepto- 
 cocci ; or in clusters or groups, when they are called 
 staphylo-cocci. 
 
 Second. The bacillus whose form is more or less rod 
 shaped. 
 
 Third. The spirilum having a cork-screw or spiral 
 form.
 
 34 
 
 Experiments have shown these to be present in pro- 
 fusion in most places, yet they do not occur in the 
 atmosphere over the ocean very far from land, at the 
 tops of mountains nor normally in the tissues of the 
 body. They follow the law of the universe in that 
 each produces its kind, although under certain condi- 
 tions it seems that their products may vary. 
 
 The term bacteria is used to include only vegetable 
 organisms. Micro-organisms may mean either vege- 
 table or animal organisms, though but few of the 
 protozoa are pathogenic. 
 
 Of the multitude of bacteria there are perhaps 
 less than twenty that are deleterious to the system 
 while there are numbers and numbers absolutely nec- 
 essary to life. 
 
 As to their size they are about 25 Q OO of an inch in 
 diameter. Their process of development is rapid as is 
 their rate of multiplication. Cohn calculated that 
 the weight of a single germ is 10,000,000,000 of a milli- 
 gram, yet under ideal conditions they multiply so 
 Rapidity of rapidly that in three days a single germ may have 
 
 development. 
 
 reached the astounding mass of 7,500 tons, its progeny 
 numbering 5,000,000,000,000. So marked is their 
 absence from the normal tissues of the body that their 
 presence there is always taken as a certain evidence of 
 disease. That under certain conditions they enter the
 
 35 
 
 tissues of the body and exist within them is not 
 denied by any one. 
 
 The marvelous rapidity of development prepares one 
 for the exceeding virulence of many diseases consequent 
 upon the activity of germs. Their products are 
 leucomanes, ptomains and toxalbumins which destroy 
 the integrity of the tissues, overthrow the harmonious 
 rule of the nervous centers and produce death as the 
 necessary result of such inharmony. Bacteria are 
 variously described according to conditions of growth, 
 as serobiotie, those growing in the presence of oxygen ; 
 and anserobiotics, those which do not grow in the pres- 
 ence of oxygen, while the term optional or facultative 
 aerobiotic is applied to those which may thrive under 
 either condition. It is worth more than passing notice 
 that the presence of sunlight is deadly to most forms 
 of germs, a fact of fundamental importance in sanita- 
 tion. 
 
 According to their products bacteria are divided into 
 several classes of which the pathogenic or disease 
 producing kind alone interest us in a work of this pathogenic 
 
 germs. 
 
 nature. These germs may be developed locally and 
 by their very presence block the channels of the fluids 
 to or from the part, or they may by their chemotactic 
 power effect the same result.
 
 36 
 
 Germs of suppuration are both toxic and chemotac- 
 tic and by the effects of their toxins upon the cells 
 with which they come in contact these in turn are 
 destroyed and may be rendered chemotactic. Septic 
 germs are those which multiply in the liquids and 
 are thus distributed to all parts of the body. 
 
 That germs cause small-pox, scarlet fever, measles 
 and other contagious and infectious diseases no sensible 
 person will for a moment deny. The proofs are on 
 every hand sufficient to satisfy the inquiring observer. 
 But not so with the exacting scientist. In order that 
 a disease can be attributed to a specific germ it must 
 comply in every particular with Koch's tests mentioned 
 above, postulates first demanded by Henle but impos- 
 sible with the methods in vogue in his day. 
 
 But the practical question comes to us, ' ' How does 
 the osteopath treat germ diseases ? ' ' Let me answer 
 by another. How does medicine treat such cases? 
 In diphtheria, in pneumonia and in pulmonary 
 tuberculosis it would seem that vapors or topical 
 
 No drug a 
 
 wrm fl diseases application would prevent the ravages of the germ, 
 but they are little used. In typhoid fever, in which dis- 
 ease the germ is demonstrated to be in the alimentary 
 tract, drugs should be able to reach and destroy all 
 such offending organisms, but even the advocates of 
 medicine do not advise the use of drugs in this disease.
 
 37 
 
 In no germ disease is there a safe and certain specific. 
 The object of all treatment is to increase the resisting 
 powers of the individual until there has been estab- 
 lished within the body the germicidal powers of certain 
 cells or germicidal serum, the product of these cells. 
 When this condition is secured then the germs cease 
 to multiply, the toxins are eliminated, the thermogenic 
 centers are no longer excited, metabolism is reduced 
 in rate, the thermolytic centers function properly, 
 the fever falls and the patient begins to recover. 
 Drugs now are given to stimulate the circulatory 
 and other vital organs. The disease is self lim- 
 ited. By the very product of the germ activity 
 its further development is limited. The osteopath in 
 his treatment seeks to reduce and control the fever, 
 thus preventing excessive metabolism. He allays osteopathy in 
 
 germ diseases. 
 
 nervousness and thus maintains equilibrium between 
 the nervous system and the subordinate tissues. But 
 above all he removes obstruction to the circulation in 
 the affected organ and sends to it the best blood in the 
 body. He increases oxidation and enriches the plasma 
 and nourishes the germicidal cells. He controls ther- 
 mogenesis and thermolysis. He also may, in a 
 crisis, stimulate a heart as no medicinal stimulant 
 can do. Foster, the great physiologist, says that 
 electrodes and induction coils are rough means and
 
 38 
 
 that we may more nearly approach the normal phases 
 of nerve action by mechanical stimulation, citing 
 as an instance the reflex inhibition of the heart 
 by vagal impulses, the result of irritating the abdomi- 
 nal splanchnics. 
 
 Thus in treatment of acute diseases, experience 
 has shown that by a knowledge of the physiolog- 
 ical functions of the various organs, and a knowledge 
 of the manipulations necessary to arouse the latent 
 powers of the body, the osteopath may very favor- 
 ably affect all diseases usually considered as being 
 of bacterial origin. That he accomplishes this is 
 shown by the records of his treatments in pneumonia, 
 typhoid fever, measles, diphtheria, etc. The treat- 
 ments result in establishing an immunity against 
 the further ravages of the germ. 
 
 This condition may be defined as the condition of 
 an animal by which it resists the entrance of the 
 disease producing germs or their growth and patho- 
 genesis. It is both racial and individual. There are 
 races which are immune to or susceptible to certain 
 diseases. The negro is practically immune to yellow 
 fever ; he is especially susceptible to tuberculosis. 
 The Jew is free from many diseases, but is especially 
 susceptible to diabetes.
 
 39 
 
 Man, then, has a condition of immunity, a condition 
 of the body which resists disease. Circumstances may 
 vary this power. 
 
 The virulent germ anthrax very few animals resist, 
 but some do ; nor can this resistance be explained on 
 structural difference. Immunity may be destroyed by 
 
 Susceptibility. 
 
 a changed condition of the blood. Thus, exhaustion 
 may make a person susceptible that would otherwise 
 have been immune. The membranes of the nose are 
 supposed, in health, to be germicidal. Susceptibility 
 may be defined as that condition which favors the 
 entrance, growth and development of pathogenic germs 
 within the tissues. 
 
 There are various modes for the entrance of the 
 germs of disease. 
 
 They may have an entrance through the skin or 
 mucous membrane ; 
 
 By the respiratory tract, through its mucous mem- 
 
 Modeof 
 
 brane, which is different from the ordinary mucous entrance of 
 
 germs. 
 
 membrane ; 
 
 Through the digestive tract ; 
 
 Through wounds ; 
 
 Through the placenta into the placental circulation. 
 
 From these sources they get into the blood stream. 
 They may also have a passive entrance, that is, they 
 may develop and grow outside and enter through the
 
 40 
 
 walls of the vessels. They may be carried directly 
 by the leucocytes or indirectly by way of the lymph 
 stream or lymphatics into the venous channels. 
 
 Prevention of germ disease can be best secured by 
 isolation. For those who must necessarily be exposed 
 to the action of the germs there is nothing which will 
 so protect against their entrance and action as perfect 
 bodily condition, good action of the heart, thorough 
 respiratory powers, good digestion and an observance 
 of the rules of hygiene. 
 
 Disinfection must always be thorough. It should 
 be the last action of the physician at the termination 
 of an infectious case to cause a thorough disinfection 
 of the room, furniture, bedding, etc., exposed to the 
 germs. Of his own person he cannot be too careful. 
 Antisepsis and asepsis are the safe-guards of every 
 person who has charge of the health of others in time 
 of sickness.
 
 CHAPTER II. 
 
 PRINCIPLES OF OSTEOPATHY. 
 
 IN AL/L, organic life the cell is histologically and 
 physiologically the unit. The conditions which 
 
 are essential to its growth and development vary. In 
 
 Cell essential to 
 the undifferentiated state, that is, before the histologi- development. 
 
 cal differentiation of the cells into the various tissues, 
 the only thing necessary to the development of the 
 cell is that the nourishment be continuous and the 
 temperature, of course, be such as to permit of the 
 normal actions of the cell. Instances of this kind are 
 seen in the unicellular animals, and in the leucocytes 
 and similar cells in man. In the more highly differ- 
 entiated tissues the activity of the cell is dependent on 
 another condition, that of nervous control. The nerves 
 as higher tissues, through their impulses, act as con- 
 trolling influences. The normal performances of cell 
 function are irritability, contraction, assimilation, 
 growth, reproduction and excretion. These functions 
 summed, modified and correlated constitute the
 
 42 
 
 phenomenon of life. Since health is a condition in 
 which every organ and part adequately performs its 
 function, then it must follow that the health of the 
 organ is dependent upon the healthy condition of the 
 cell, for the organs are composed of cells and their 
 products. The cell is really the important part of 
 every tissue and its health or disease depends upon the 
 blood and nerve supply. 
 
 First. This is a basic principle of Osteopathy, that 
 Health main- 
 
 and nerve. ( through the blood supply and the nerve supply to the 
 tissues, is the health of the body maintained. 
 
 Second. It is a law of physiology that any impair- 
 ment in the structure or function of an organ causes 
 
 Tenderness 
 
 evidence of a tenderness on pressure, and tenderness on pressure is 
 lesion. 
 
 the best evidence of a lesion of an organ, that is, a 
 lesion in the sense in which we have defined it any 
 abnormal condition. It is not always possible to reach 
 the organ directly, but it is possible in all cases to 
 reach the efferent or afferent nerve fibres of the organ. 
 These nerve fibres are sensitive to pressure just as are 
 the nerve fibrils in the organ itself. 
 
 Third. Tenderness along the course of the nerves 
 of any organ is an evidence of a lesion of the organ. 
 The lesion may be temporary or permanent. 
 
 Fourth. Pain is a warning of a pathological state 
 of an organ or a tissue and may be referred to the
 
 43 
 
 tissue or organ affected or to some other distribution 
 of the nerve through its branches. Hence, pain as the 
 sign of a lesion may refer to the organ affected or to 
 the peripheral distribution of the nerve. There will 
 be tenderness somewhere. Pain does not always warn 
 you where the lesion is. Every practitioner is familiar 
 with cases in which treatment has been directed to the 
 knee when the trouble is in the hip. If you follow 
 the pain back far enough you will find it is due to the 
 condition somewhere of the nonperformance of func- 
 tion of some organ, and nonperformance of function 
 is a lesion in the sense in which we defined it. 
 
 Fifth. Any irritation to an efferent nerve, either Effect of 
 
 muscular 
 
 central, peripheral or along its course disturbs the 7< 
 vaso-motor and motor equilibrium between organ and 
 nerve center and leads to a consequent contraction of 
 the muscles innervated by the corresponding segment 
 of the central nervous system. This contraction tends 
 to increase the severity of the symptoms and to prolong 
 the disturbed effect. This same result follows the 
 primary lesion of a viscus, irritating its afferent nerves. 
 Sixth. Any irritation to a nerve or interference 
 with the passage of the physiological nerve impulses 
 to an organ may produce a lesion of that organ. In 
 any case there will result a disturbed vaso-motor 
 equilibrium and an increased contraction and increased
 
 44 
 
 irritation to the muscles supplied by the nerves from 
 its segment. 
 
 Seventh. In like manner a continual irritation may 
 lead to an increase of connective tissue, shortening 
 and thickening the ligaments, interfering with circu- 
 lation, nerves and tendons and so prolonging the 
 disease and aggravating its symptoms. Thus, if the 
 muscles are contracted at the fourth, fifth and sixth 
 dorsal regions, it means there is a variation from 
 the usual amount of blood sent to that region and this 
 change in blood supply means an increase in growth 
 of connective tissue. This increase in growth of con- 
 nective tissue around the vertebrae will overcome the 
 freedom of their motion and lead to irritation of and 
 pressure upon the nerves passing from this region. 
 This irritation is referred to the stomach and cannot 
 be removed until you remove the cause. For this 
 reason we invariably treat the spine to relieve this 
 condition. Disease of the stomach may have caused a 
 congestion of these muscles and their increase in size 
 until they encroach upon the pathway of the nerve. 
 We must first overcome the contraction, whether it be 
 the cause or the product of the disease. Then we can 
 restore the normal condition of the nerves and nature 
 will do its work.
 
 45 
 
 Eighth. Any obstruction to the free passage of the obstruction 
 
 leads to 'disease. 
 efferent impulses to an organ may result in diminution 
 
 or a cessation of the normal mttabolism of the organ, 
 either trophic or secretory, or both, thus directly 
 leading to a diseased condition of the organ or 
 producing a nidus for bacterial activity, or resulting in 
 destructive metabolism and finally in all cases in 
 disease. 
 
 Ninth. The human body is a machine for the The, body a 
 
 machine. 
 
 transformation of energy. The amount and quality 
 of this energy formed in a large measure determines the 
 individuality of the person. The proper distribution 
 of this energy determines the health of the individual. 
 Any interference in the production, manifestation, 
 or distribution of energy will result in a changed 
 metabolism a condition called disease. This dis- 
 eased condition may remain indefinitely so long as the 
 condition which produced it remains, the disease then 
 being called chronic. Now any restoration to health 
 must be accomplished by changing the rate of manu- 
 facture, the quality or the equalization of the bodily 
 energy. This cannot be secured by adding foreign 
 substances to the mechanism, but by the simple process 
 of adjustment and correction. The friction removed, 
 the delicate structures replaced in their proper posi- 
 tions, the vital actions proceed uninterruptedly, ease
 
 46 
 
 succeeds disease, strength follows weakness, pain 
 disappears. There is no radical change from the 
 usual conditions which give health. The organism 
 demands nothing new. 
 
 Tenth. Oxidation is the process by which bodily 
 changes are produced bodily temperature maintained. 
 Motion increases oxidation and energy. Any influence 
 which decreases energy retards metabolism and forms 
 incomplete oxidation products. These suboxides are 
 disease producing. Therefore any manipulation 
 which tends to increase motion removes suboxides 
 and compels a restoration to health. Motion is 
 health. 
 
 Eleventh. The skin is largely a nervous organ. 
 
 Skin a nervous 
 
 organism. This in health receives the normal physiological 
 impulses which pour into the central nervous system, 
 there producing changes and arousing afferent impulses. 
 These afferent impulses maintain the tonic conditions of 
 glandular and other tissues of the body. Any increase 
 or decrease of these impulses may lead to a disturbance 
 of any of the outgoing impulses, either increasing or 
 diminishing them. Thus the skin may, by artificial 
 stimulation and a hyperaesthetic condition, depurate 
 the nerve centers, causing exhaustion. On the other 
 hand in conditions of anaemia and anaesthesia stimula- 
 tion of the sensory nerves in the skin may arouse
 
 47 
 
 afferent impulses to the proper physiological degree 
 which will restore the lost vigor and tone. 
 
 Twelfth. Passive muscular movement necessarily 
 entailed upon osteopathic treatment serves in many 
 cases to restore the equipoise between nerve centers 
 and the muscles by distributing the energy. This 
 means health. The condition in many cases of 
 disease is that of disturbed equipoise between muscle 
 and nerve centers. Passive muscular exercise serves 
 to divert the energy from the nerve centers to its 
 proper distribution, the muscles, thus re-establishing 
 the proper equipoise which is health producing. 
 
 Thirteenth. When several muscles are supplied by 
 branches of the same nerve their function is to act in 
 harmony and in unison ; this fact is of value in 
 diagnosis of lesion in case of loss of muscular power. 
 The reader is able to supply numerous examples of 
 such arrangement. 
 
 Fourteenth. "Superficial pains on both sides of the 
 
 body, which are symmetrical, imply an origin or 
 
 pain. 
 cause, the seat of which is central or bilateral ; while 
 
 unilateral pain implies a seat of origin which is one- 
 sided, and, as a rule, exists on the same side of the 
 body as the pain. ' ' Every pain has its distinct and 
 separate signification.
 
 48 
 
 Fifteenth. "The same trunks of nerves, whose 
 branches supply the groups of muscles moving a joint, 
 furnish also a distribution of nerves to the skin over 
 the insertions of the same muscles ; and the interior 
 of the joint moved by these muscles receives a nerve 
 supply from the same source." 
 
 Sixteenth. ' ' Every fascia of the body has a muscle 
 or muscles attached to it, and every fascia must be 
 considered as one of the points of insertion of the 
 muscles connected to it. ' ' 
 
 Seventeenth. Steady pressure upon the terminal 
 filaments of a nerve or upon the course of the nerve 
 will prevent the passage of impulses along the nerve, 
 thus inhibiting its action. Motion, sensation, reflexes, 
 vaso-motor effects are all alike affected ; hence 
 increased activity of any organ is reduced to the 
 normal by pressure on the nerves of the organ. The 
 inhibitory nerves are of course an exception to this 
 rule. Pressure upon these would produce no effect or 
 else increase the activity of the organ ; the effect 
 being dependent upon whether the nerves were in 
 action at the time. 
 
 Eighteenth. Activity of an organ may be aroused 
 by stimulating the functional nerves to the organ. 
 Marked variations in pressure upon any portion of a 
 nerve will stimulate the nerve. Thus the osteopath
 
 49 
 
 treats a nerve to arouse its activity by successive 
 variations in pressure rapidly applied. 
 
 Nineteenth. The points along the nerves where 
 stimulation will be most effective are (i) at the 
 periphery of the nerve, (2) at the emergence of the 
 nerve from the spinal canal. Inhibition is likewise 
 most easily accomplished at these points. 
 
 Twentieth. A stimulation of the vaso-constrictor 
 
 Vaso-motor 
 
 nerves of an organ will dimmish the amount of blood effect on 
 
 capillaries. 
 
 pressure in the capillaries ; their inhibition will pro- 
 duce the opposite result. The latter is the condition 
 in inflammation and oedema the former overcomes 
 these conditions. 
 
 Twenty-first. Head has found that ' ' When a painful 
 stimulus is applied to a part of low sensibility in close 
 central connection with a part of much greater sensibility, 
 the pain produced is felt in the part of higher sensibility 
 rather than in the part of lower sensibility to which the 
 stimulus was applied. ' ' 
 
 Tactile sensations sometime act in the same way 
 a transference called allochiria. This law of trans- 
 ference of effects of nervous stimulation may be 
 carried further and applied to motion, as in cases from 
 a reflex affecting the opposite member ; to vaso-motor 
 changes and to all forms of nerve impulses. Nor is 
 this all. Just as sensory, motor and vaso-motor
 
 50 
 
 impulses may be transferred, so, too, may inhibition 
 act reflexly. The skin and muscle of a spinal segment 
 are supplied by afferent nerves from the same central 
 origin, a region which also gives origin to efferent 
 nerves going to some one or more of the viscera. By 
 pressure on these sensory fibres we check the deluge 
 of impulses into the center and thereby decrease 
 the chemical changes within the center itself. It is 
 upon these chemical changes that the nature, quality 
 and quantity of the outgoing impulses depend. To 
 reduce these to the normal will serve to restore the 
 organ to harmonious relations. This is a fact of 
 fundamental importance in our treatment. Our 
 practice shows beyond possibility of error that inhibi- 
 tion of the periphery of one branch of a sensory nerve 
 will reduce the expression of pain in other branches 
 of the nerve. 
 
 Head's law is a statement of the fact upon which 
 we base many of our diagnoses by spinal examination. 
 The various deductions from it are applied in treat- 
 ment of nearly all pathological conditions. 
 
 Twenty-second. The only natural and rational 
 
 Cure depends 
 
 cause. method of treating such conditions is by removal of 
 
 the cause, and this result (except in cases demanding 
 surgical interference) is perfectly secured only by such 
 manipulation as will overcome all interference to the
 
 51 
 
 free passage of the efferent and afferent impulses 
 between organ and center ; and by stimulation or 
 inhibition counteract the present condition of innerva- 
 tion or irritation, thus allowing the inherent recupera- 
 tive power of the body to restore to normal structure 
 and function the deranged organ. 
 
 Osteopathy is a therapeutic science grounded upon 
 the known and verifiable laws of physiology just 
 enumerated. From those principles we deduct our 
 definition of the science. Osteopathy is a method of osteopathy 
 
 defined. 
 treating disease by manipulation, the purpose and result 
 
 of which is to restore the normal condition of nerve 
 control and blood supply to every organ of the body by 
 removing physical obstruction, or by stimulating or 
 inhibiting functional activity as the condition may 
 require. 
 
 By the term physical obstruction we mean any direct 
 interference to the nutritive or functional fluids or 
 forces of the organ, as pressure upon a vessel or nerve 
 by an abnormal condition of some denser tissue of 
 the body. This will cut off the nerve force and 
 affects the blood supply. Either of these may result 
 in producing an abnormal function of some organ 
 or organs and thus lead to a diseased condition. 
 
 Osteopathy achieves its chief results through the 
 nervous system . Nerve action may be influenced :
 
 52 
 
 First. Through the centers directly. We may effect 
 a certain nervous control of the abdominal organs by 
 pressing directly, as near as possible, over the solar 
 plexus. Pressure there may act to inhibit the 
 impulses sent out from that center which are pro- 
 ducing pain in the various abdominal organs. 
 
 Second. We may influence nerve action through the 
 fibres. We do this in various ways. We may affect 
 the fibres by removing any obstruction to the nerve 
 impulses along the fibre, or we may affect the fibre by 
 stimulation, not by removing the cover, but through 
 the medium of the covering structures, putting alter- 
 nate pressure upon it in such a way as to stimulate it. 
 
 Stimulation is a broad term and may be defined as 
 the act of producing or increasing functional activity. 
 The methods of accomplishing this are varied ; physi- 
 ological or natural, mechanical, thermal, electrical 
 and chemical. Of these the first or physiological is 
 the result of the interaction of the organs and the 
 reaction of the nervous system to the stimuli of the 
 environments. In conditions of health this kind is 
 sufficient ; in response to it the heart keeps up its 
 rhythmic throbbing, the glands act, the various 
 organs perform their functions. Each increased 
 strain, within limits, produces more activity. The 
 skeletal muscles are in a partial state of contraction
 
 53 
 
 called skeletal tone in response to a continual rain of 
 impulses through the organs of touch, temperature, 
 sight, smell, the muscular sense. While this is true 
 for the skeletal muscles it is eminently the case in 
 the condition known as arterial tone. Upon those 
 impulses from without depend the healthful state of the 
 circulatory system. These stimulations are continuous 
 and conducive to perfect action. The air stimulates 
 the skin, it reacts upon the wall of the alveoli, the 
 blood causes the centers of the organs to keep up 
 their constant outgoing impulses. The second and 
 most nearly natural in its effects is the mechanical, 
 the mode which the osteopath uses to the exclusion of 
 the others for the purpose of assisting nature. 
 
 Mechanical stimulation in its effects is similar to 
 physiological. There are two ways by which the 
 osteopath, through pressure, affects nerve fibres. One 
 is by variation in the degree of pressure, producing 
 stimulation. The other by continued steady pressure 
 cutting off the passage of impulses along the nerve, 
 thus producing inhibition, Experience shows that 
 steady pressure upon a nerve will produce no pain or 
 impulse, even though carried to the extent of crushing 
 the fibre of the nerve. We will now define inhibition 
 as an act which restrains or retards functional activity. 
 Inhibition of an organ may be produced by preventing
 
 54 
 
 inhibition. the passage of impulses to it, or it may be pro- 
 duced (as is the case of inhibitory fibres to the heart 
 which pass through the vagus nerve) , by impulses to 
 the organ whose effect is to restrain the action of the 
 organ. The osteopath must understand this double 
 meaning of the term for he frequently uses both 
 methods of producing inhibition. 
 
 This question now presents itself to us : In what 
 way may we repress or excite action? Nervous 
 tissue controls the other tissues. It is by nervous con- 
 nection that the organs of the body perform their 
 normal function. 
 
 Excitation of an organ may be perfectly and posi- 
 tively secured only by removal of obstructions to the 
 free passage of efferent and afferent nerve impulses to 
 the organ. It is clear that continued steady pressure 
 upon a nerve prevents the passage of impulses through 
 the nerve. This would produce a cessation of the 
 normal flow of these impulses to the organ, as is 
 illustrated by constant pressure on the nerves to the 
 
 Pressure may stomach. But it might have two effects. If it were 
 have two 
 
 perfectly constant the pressure would have the effect 
 of restricting the normal impulses from the cerebro- 
 spinal center, resulting in diminution of functional 
 activity. There would result enervation or loss of 
 tone of the organ, tone to which it is entitled. Vary-
 
 55 
 
 ing pressure will increase these impulses, thereby 
 increasing the tone and activity of the organ. 
 
 Tone is that healthy, normal state intermediate 
 between complete relaxation and contraction, pro- 
 duced by a summation of impulses from the external 
 world sent along the pathway of the nerve to the 
 central nervous system ; and there, by a reflex 
 mechanism sent out to the muscles which are con- 
 trolled by the same segment of the cord. Thus we 
 have arterial tone as a result of reflex mechanism in 
 continual action. It is a state of partial contraction 
 characteristic of muscles which enter into the struc- 
 ture of the blood vessels. By tone or tones of glands 
 or centers we mean their physiological state of activity. 
 
 These facts will serve to illustrate how obstruction 
 to nerve impulses may interfere with the normal func- 
 tion of the organ by lessening the activities, thus 
 serving as an inhibition. 
 
 Physical obstruction or interruption may interfere 
 with functional activity by increasing it. If steady 
 pressure in any way becomes a varying pressure, how- 
 ever slight, that would result in a constant irritation 
 to the nerves, producing impulses exciting the organ 
 to unusual activity and finally to a pathological condi- 
 tion. So, too, by interference with the nutrition of a 
 region the irritability of its nerves would be affected
 
 56 
 
 and a changed metabolism result. Again, we may 
 remove obstruction which serves as an inhibition, 
 resulting in a stimulation. Nerve activity is basic 
 to the activities of the other organs of the body. 
 
 Nerve action may be influenced by action upon the 
 Nerve activity 
 basic. centers themselves. A physiological or true center 
 
 means a group or collection of nerve cells connected 
 with some specific organ or function by means of 
 afferent and efferent fibres. 
 
 Osteopathic centers are entirely different. An oste- 
 
 OsteopatMc opathic center is a practical one. By the term we do 
 center defined. 
 
 not necessarily mean a local group of cells controlling 
 
 function, but a point at which we may most advantage- 
 ously reach the nerves or cells controlling the organ. 
 To illustrate : The center for coughing .is near the 
 third dorsal vertebra ; there is not at that point in the 
 spinal cord a group of cells whose function it is to 
 produce coughing. We mean that there are entering 
 that region afferent nerve fibres whose impulses have 
 been transmitted, resulting in a muscular contraction, 
 giving rise to a cough. By removing the irritation 
 thus preventing the impulses coming from that peri- 
 phery to the center, we have treated the center. 
 
 At the points of emergence of spinal nerves we are 
 able to obtain more satisfactory results than at any 
 other. Because we get certain results by treating cer-
 
 57 
 
 tain spinal nerves we cannot assert there is a true 
 physiological center at that level in the cord. Centers 
 may be anywhere so far as treatment is concerned 
 between emergence and peripheral ending of a nerve. 
 This will explain wh^ r we speak of centers osteopath- 
 ically which have no physiological existence. 
 
 We stimulate centers by treating their afferent and HOW treated. 
 efferent nerve fibres. Our effects are from stimulation 
 or inhibition along the pathway of the nerve. We 
 may further stimulate the action of the center by 
 stimulating the peripheral distribution of the sensory 
 nerve. We will go farther : We are able to treat 
 directly the muscular tissue and produce contraction, 
 or inhibition of muscular contraction. In this we 
 draw our conclusions from a limited number of cases. 
 In cases of perfect anaesthesia contracted muscles will, 
 under osteopathic treatment, relax as perfectly as 
 though the sensory nerve fibres were functioning. 
 Whether it is the result of direct stimulation of 
 the muscle is a question we cannot answer with 
 certainty, though the indications are to that effect. 
 In a case that came under my observation the 
 anaesthesia was so complete that even pressure 
 upon the deeper muscles produced no sensation. I 
 argue from that case that a muscular tissue will relax
 
 58 
 
 on treatment when not connected with the sensory 
 fibres as readily as when it is. 
 
 The point is this : It is not necessary in order to 
 produce an effect upon a muscle, particularly if that 
 effect be relaxation, to stimulate the endings of the 
 sensory nerves in the skin. The greater part of our 
 work of relaxation is accomplished on the more deeply 
 
 lying muscles. Painful stimulation of the sensory 
 Painful treat- 
 ment useless, nerve of the skm produces a defensive contraction of 
 
 the muscle underneath, therefore, the best results are 
 obtained with the minimum amount of pain. To this 
 end it is necessary to place the hands gently on the 
 integument above the muscle which you desire to 
 relax, care being taken to use the flat portion of the 
 fingers. Now by approximating the fingers of the two 
 hands you will produce a fold of skin between them. 
 Now strong pressure will produce practically no sensa- 
 tion of pain in the cutaneous nerves. If this pressure 
 be accompanied by a separation of the hands the effect 
 of relaxation will be produced on the contracted mus- 
 cles felt beneath. 
 
 I will here emphasize the caution just expressed, 
 that you, as far as possible, eliminate the use of the 
 ends of the fingers in treatment. Since it often happens 
 that your first treatments are directed towards over- 
 coming headaches and therefore administered near the
 
 59 
 
 base of the skull, congestion or chronic contraction 
 sometimes follow from the application of too much force 
 to a limited space beneath the ends of the fingers. 
 There are few regions, if any, which yield so readily to 
 osteopathic manipulation as the neck. There is no 
 part of the body more susceptible to injury if treatment 
 be incautiously applied. 
 
 We are able to inhibit contraction of a muscle by 
 osteopathic treatment applied directly to the muscle 
 itself. It is a physiological fact, that direct application 
 of stimulation to a muscle itself will produce contrac- 
 tion. From experience we say we can overcome a 
 contracted condition of a muscle, though the sensory 
 nerves are not in any way affecting it ; e. g. , in case 
 of perfect anaesthesia. 
 
 Dr. Schreiber sums up the effects of mechano- Effects of 
 
 mechano- 
 
 therapy as follows : 
 
 First, To cause an increased flow of blood to mus- 
 cles and soft parts, increasing thereby the circulation, 
 and removing accumulations of waste tissues whose 
 retention causes various disturbances of function. 
 
 To strengthen muscle fibres, and by setting up 
 molecular vibrations to induce changes, not only on 
 the muscle and nerve fibres, but perhaps even in the 
 nerve centers themselves.
 
 60 
 
 Second. To cause the resorption of exudations, 
 transudations, and infiltrations, in such organs as are 
 accessible. To effect the separation of adhesions in 
 tendon sheaths and in joints, without recourse to the 
 knife. To remove, by grinding away, intra-arthritic 
 vegetations. 
 
 Third. To increase by passive and active exercise 
 of all the muscles, the oxidizing powers of the blood, 
 in this way correcting disturbances in its composition 
 and stimulating all the vegetative processes. 
 
 Fourth. To relieve the congestion of such internal 
 organs as the brain, lungs, intestines, uterus, kidneys, 
 etc., by increasing the flow of blood to the muscles. 
 
 Fifth. To stimulate directly the sympathetic nerv- 
 ous system, thus increasing secretion and reflexly the 
 activity of unstriped muscle fibre, and so relieving 
 various functional derangements.
 
 CHAPTER III. 
 
 SYMPATHETIC NERVOUS SYSTEM. 
 
 THE UNITY apparent in the structure of the 
 nervous system is evidenced in a physiolog- 
 ical unity, harmony and interdependence which proves 
 the truth of the statement that an isolated portion of 
 the nervous mechanism does not exist in a perfect 
 individual. Aside from the central nervous system 
 there is what is known as the sympathetic system. 
 This term includes the following distribution : To 
 the internal viscera ; to the glands outside as well 
 as within the hemal cavity ; to the vessels as vaso- 
 motors, and to the hairs as pilo-motors. Their com- 
 plete distribution is to the viscera, vessels and to 
 the plain muscle fibres generally. But this distribu- 
 tion to the plain muscular tissue is not confined 
 exclusively to the sympathetic system, the vagus hav- 
 ing extensive visceral distribution. In addition to 
 this, many fibres from spinal nerves have visceral con-
 
 62 
 
 nection, either passing through the sympathetic gan- 
 glia unchanged or not entering it. 
 
 The sympathetic system consists of a collection of 
 ganglia, nerve trunks and plexuses. The ganglia 
 contain cells, and fibres both gray and white, the 
 latter in all cases connected with cells within the 
 cerebro- spinal system. The plexus is essentially a 
 network of fibres, though it may also contain cells. 
 The gray fibres are truly sympathetic, having their 
 trophic connection with the cells in the sympathetic 
 system. 
 
 With these extensive ramifications it is necessary 
 that there be a varied and complicated mechanism ; 
 hence we find : 
 
 First. The two great gangliated cords extending 
 from the ganglion of Ribes above, connecting the 
 carotid plexuses via the anterior communicating 
 artery, downward to the coccyx where the two sacral 
 chains are united by a ganglion (the coccygeal, or 
 the ganglion impars), situated on the anterior sur- 
 face of the coccyx. 
 
 Second. The great prevertebral plexuses. 
 
 Third. The fibres and plexuses of distribution. 
 [There are also connected with the cranial nerves, 
 ganglia which in structure and connections agree with 
 the sympathetic and may be considered as a part of
 
 63 
 
 this system.] The first of these groups, the great 
 gangliated cord, consists of ganglia connected by 
 short cords, the ganglia being named cervical, dorsal, 
 lumbar, sacral, etc., approximately corresponding to 
 the vertebrae, except in the cervical region, where 
 the segmental arrangement has been modified by a 
 segregation of seven into three, called superior, mid- 
 dle and inferior cervical. 
 
 The foundation of the sympathetic system is consti- 
 
 White rami 
 
 tuted by small, white fibres from the cerebro-spinal 
 system through certain nerves into the cords and gan- 
 glia of the sympathetic. These constitute the white 
 rami communicantcs, which connects the cerebro-spinal 
 and sympathetic portions of the nervous systems. 
 
 They come, in man, from the first thoracic to the 
 second lumbar, inclusive, being both afferent and 
 efferent in function. In the sacral region the homo- 
 logues of the white rami pass directly to the preverte- 
 bral plexuses and are thence distributed to the pelvic 
 viscera as splanchnic divisions of the sacral nerves. 
 There are no white rami in the cervical region. The 
 visceral branches of the third nerve (to ciliary gan- 
 glion via short root), of the seventh, ninth, tenth and 
 eleventh, correspond in function to the white rami. 
 
 White rami enter the sympathetic either at the 
 lateral ganglia or at the cords connecting them, and
 
 64 
 
 may come from both roots of the spinal uerves. 
 Those of the posterior root are from the spinal gan- 
 glia and are afferent fibres. Those from the anterior 
 are efferent. These white fibres end in any of the 
 following ways : 
 
 First. loosing their sheaths in the lateral ganglia, 
 they end in dendritic brushes within the lateral ganglia. 
 
 Second. Some pass unchanged through the lateral 
 ganglia to the prevertebral plexuses (white rami effer- 
 entes), or they may continue as spinal fibres to their 
 distribution. 
 
 Third. The fibres of the white rami ending in the 
 lateral ganglia may branch before entering, giving off 
 one, two or three collaterals, thus connecting with 
 several ganglia. 
 
 Fourth. The fibre may not end in its correspond- 
 ing ganglion, but may pass to ganglia at either higher 
 or lower levels. 
 
 The functions of the white rami are varied. They 
 transmit all the impulses from the cerebro-spinal sys- 
 tem to the sympathetic ganglia and plexuses and vice 
 versa. This work is done by those which end within 
 these structures. These are : 
 
 First. Vaso-constrictors, from anterior roots, end- 
 ing in lateral ganglia.
 
 65 
 
 Second. Cardiac augmentors, ending in middle and 
 inferior cervical ganglia and in first thoracic. 
 
 Third. Viscero-motors from certain spinal nerves, 
 also the corresponding fibres from the ninth, tenth ajid 
 eleventh cranial nerves. 
 
 Fourth. Pilo-motor fibres, also motor nerves to 
 sphincter of iris through third nerve. 
 
 Fifth. Secretory fibres to the sweat glands and to 
 the glands of the various viscera. 
 
 Sixth. Viscero- inhibitory fibres also end in this 
 way, though in some cases they pass directly to the 
 viscera. 
 
 Seventh. Afferent fibres from viscera to cerebro- 
 spinal center. 
 
 In addition to these white fibres which transfer their 
 impulses to the sympathetic and are succeeded by gray 
 fibres, the vaso-dilator fibres pass unchanged to the 
 viscera, though some seem to end in the solar plexus. 
 
 Gray rami 
 
 Gray rami communicantes connect the lateral cord with 
 all the spinal nerves. They are ueuraxons of cells tion - 
 lying in the lateral ganglia, usually the one from 
 which they make their exit to the spinal nerve, though 
 rarely they pass upward or downward through the 
 cord to the succeeding ganglion. They unite with the 
 anterior primary division of the spinal nerves and 
 have any one of the following distributions :
 
 66 
 
 First. Peripherally to the distribution of the ante- 
 rior division of the spinal nerves, to their muscular 
 and cutaneous distribution. 
 
 Second. They may follow the anterior division 
 centrally to the main nerve trunk, whence they follow 
 the posterior primary division to its distribution. 
 
 Third. Centrally to the recurrent branch of the 
 spinal nerve and with it to the wrappings of the cord 
 and to the structure of the cord itself. 
 
 Fourth. Back through the wrappings of the pos- 
 terior root, to the dura of the cord. 
 
 The first and second vaso-constrictors are distributed 
 to the vessels of the skeletal muscles and of the skin, 
 secretory to the sweat glands, and pilo-motors to mus- 
 cles of the hairs. 
 
 The third and fourth are vaso-motor to the cord 
 mainly vaso-constrictors. 
 
 In addition to the rami communicantes there are true 
 sympathetic fibres, originating in the lateral ganglia, 
 which pass forward to the prevertebral plexuses. 
 With these are medullated fibres which have passed 
 through the lateral ganglia, together constituting the 
 rami cfferentes the gray, sympathetic; the white, 
 spinal. 
 
 The function of the sympathetic system may be 
 stated generally as follows : It presides over the move-
 
 67 
 ment of the plain muscle tissue, nutrition partially, Functions of 
 
 the sympa- 
 
 secretion usually, general sensibility of the viscera, thetlc - 
 thermotaxis and vaso-motor conditions. When dis- 
 turbed reflexly it affects one viscus from another and 
 may act almost independently of the cerebro-spinal 
 system under unusual conditions. 
 
 Specifically the functions of the sympathetic may be 
 classed as follows : 
 
 1. Independent, actions which continue when all 
 connection with the central nervous system has been 
 destroyed as in the (a) ganglia of the heart, () the 
 mesenteric plexuses, (c~) the plexuses of the uterus, 
 Fallopian tubes and ureters. 
 
 Even these are modified either in the direction of 
 stimulation or inhibition by impulses from the cerebro- 
 spinal system. 
 
 2. Dependent, 
 
 (a) Afferent impulses. 
 
 () Secretory action and trophic. 
 
 (V) Vaso-motor. 
 
 The superior cervical ganglion is situated on the superior 
 
 cervical gang- 
 
 rectus capitis anticus major muscle internal to the 
 tenth nerve and behind the internal carotid artery at 
 the level of the second and third vertebra. It is con- 
 nected with the first four spinal nerves, and with the 
 ninth, tenth and twelfth cranial nerves. This ganglion
 
 68 
 
 is almost an inch in length and a fourth as wide, and 
 is of great importance to the osteopath, as through it 
 he controls the vaso-motors to the head and face. It 
 is continuous above with the carotid and cavernous 
 plexuses and through this with the arteries and vessels 
 of the brain. Below it is connected with the middle 
 cervical ganglion which lies opposite the sixth or 
 seventh cervical vertebra, almost at the level of the 
 inferior thyroid artery. Above, this ganglion is con- 
 nected with the cavernous and carotid plexuses and 
 through these gives communication to the sixth nerve 
 within the cavernous sinus, and with the Gasserian 
 ganglion as the internal carotid artery passes through 
 the apex of the petrous portion of the temporal bone. 
 
 The cavernous plexus sends filaments into the third 
 and the fourth nerves, thus completing the control of the 
 blood supply to the eye and its motor apparatus. This 
 fact is of prime importance in eye trouble. Osteopathic 
 experience proves that trouble with the eye is asso- 
 ciated with a lesion in the upper cervical region, located 
 in the vast majority of cases, at the second and third 
 vertebrae. 
 
 The reasoning is plain. Here is the pathway of 
 those vaso-motor impulses to its nutrient vessels, and 
 their interruption means trouble with the nutrition and 
 action of the eye.
 
 69 
 
 It is followed upward from the superior cervical to 
 the cavernous plexus, and from it to the twig following 
 the arteria centralis retinse to the vessels of the inner 
 part of the globe of the eye. The same pathway 
 answers for those fibres which control the muscles of 
 the orbit, differing only in their final distribution. 
 
 This ganglion controls the lumen of the anterior 
 pial vessels and is of value in draining the cranial 
 cavity in frontal headache due to congestion and 
 venous stasis. 
 
 The large deep petrosal branch, the sympathetic Distribution 
 
 from Mechel's 
 
 root of the Vidian nerve, is from the carotid plexus and 
 through this channel it supplies sympathetic fibres to 
 Meckel's ganglion and through it to its distribution to 
 the orbit, the palate, the nose, the pharynx, the 
 antra, ethnioidal sinuses, tonsils, uvula, etc. 
 
 The cavernous plexus lies closely associated with 
 the carotid plexus in the cavernous sinus and 
 sends fibres to the third and fourth nerves, 
 and also to the ophthalmic division of the fifth 
 nerve and through it to the ciliary ganglion. 
 The importance of this ganglion in eye trouble, 
 epistaxis, oedema of glottis, pharyngitis, laryngitis, 
 sore throat, diphtheria, croup, etc., is readily seen. 
 By stimulating the ganglion the blood vessels of these 
 parts are constricted, capillary pressure is removed,
 
 70 
 
 resorption takes place, and normal secretion and action 
 is secured. Again this ganglion affords more direct 
 connection with the pharynx than through the spheno- 
 palatine ganglion, for it gives numerous fibres which 
 following the blood vessels, are distributed with the 
 ninth, tenth and eleventh nerves, forming the pharyn- 
 geal plexus. Aside from this the superior cervical 
 ganglion gives off a branch which is of much impor- 
 tance in contributing to the great cardiac plexus. 
 
 This ganglion controls the nutrition of the muscles 
 of the face, the action of the mucous and salivary 
 glands and even contributes to nourish the fifth nerve, 
 the great sensory nerve of the head and face. This 
 will make plain the value of this ganglion in diseases 
 affecting the nerves and musics of the face, the mucous 
 tract of the throat with its adenoid masses beneath. 
 This ganglion contains a large number of cells which 
 mark the beginnings of the fibres going to the distri- 
 butions above mentioned. 
 
 The middle cervical ganglion is situated anterior to 
 
 Middle cervical , r ., . ,, .1 i 
 
 the transverse process of the sixth or seventh cervical 
 vertebra. It lies near the inferior thyroid artery and 
 contributes fibres to it which control the lumen of its 
 branches in the thyroid gland. It is associated in 
 function with the superior cervical ganglion, transmit- 
 ting the fibres from below which end in the superior
 
 71 
 
 cervical ganglion. These fibres, as all the spinal fibres 
 in the cervical sympathic, come from the dorsal spinal 
 nerves; and, as white fibres, pass up to the ganglia in the 
 cervical region. Ending in this middle cervical gang- 
 lion are many cardiac augmeutor fibres which have 
 made their exit from the cerebro-spinal system at the 
 second, third and fourth thoracic nerves. Beginning 
 in this ganglion are the fibres which constitute the 
 middle cervical sympathetic cardiac fibres, and which 
 pass down into the thorax, helping to form the 
 cardiac plexus. This middle ganglion then has three 
 uses. In manipulation, steady pressure upon it will 
 dilate the vessels of the head and face, will retard 
 slightly the action of the heart, will dilate the vessels 
 in the thyroid glands. Pressure alternately applied 
 and removed will have the opposite effects. This 
 nerve connects with two cervical nerves, the fifth and 
 sixth, furnishing vaso-motor and perspiratory fibres 
 to them. 
 
 The inferior cervical ganglion is situated between 
 the sides of the seventh cervical vertebra and the first In f erior 
 
 cervical 
 
 rib and by its position is in connection above with the 
 middle and superior cervical ganglia and below with 
 the gangliated cord. Ofttimes it is a mass united to 
 the first thoracic and corresponds to the stellate gang- 
 lion in the lower animals either the first thoracic or
 
 72 
 
 a union of several of the thoracic. It is situated over 
 the first costo-central articulation between the vertebral 
 and the subclavian arteries external to the vertebral 
 and almost behind the inferior thyroid artery. It is 
 connected to the middle ganglion by a cord, passing 
 behind the subclavian artery. This cord is frequently 
 double, passing both behind and in front of the artery. 
 This anterior cord is called the ansa subclavian or 
 annulus of Vieussens. It sometimes extends from the 
 cord below the middle cervical ganglion to the lower 
 cervical or to the first thoracic. This annulus is much 
 more frequent on the left side than on the right and by 
 its contribution to the cardiac plexus exerts a powerful 
 influence over the action of the heart. The branches 
 of the inferior cervical ganglion are : i . To the two 
 lower cervical nerves it gives vaso-motor fibres. 2. The 
 inferior cardiac sympathetic to the cardiac plexus. 
 3. It supplies fibres to the vertebral artery extending 
 with it to the cranial cavity and controlling the blood 
 vessels of the posterior fossa of the skull. It also 
 sends fibres along the inferior thyroid artery into the 
 thyroid gland, affecting both its vessels and its action. 
 It controls the internal mammary artery and the comes 
 nervi phrenici artery from this vessel. This ganglion 
 is a strong point of attack in the treatment of the fol- 
 lowing organs and diseases: (i) the thyroid gland
 
 73 
 
 in goiter; (2) the circulation sending augmentor 
 impulses to the heart, if pressed upon sharply and 
 alternately; (3) it has an effect on the phrenic nerves 
 in many cases of asthma. 
 
 The cervical sympathetic receives no fibres from the 
 
 sympathetics. 
 
 cervical nerves but receives its spinal fibres from the 
 dorsal nerves. It contains : 
 
 (a) Vaso-constrictor for head from second, third 
 and fourth dorsal. 
 
 (b) Augmentor fibres to heart, chiefly from second, 
 third and fourth dorsal. 
 
 (c~) Secretory fibres to salivary glands, upper 
 dorsal. 
 
 (d) Pupilo dilator and motor fibres to the involun- 
 tary muscles of eye and orbit. 
 
 (tf) Afferent fibres whose stimulation causes activ- 
 ity of the vaso- motor center in the medulla. 
 
 The thoracic portion of the gangliated cord consists 
 of two cords lying on either side of the vertebrae, 
 within the hemal cavity and connecting above and tiwrac^ 18 ' 
 
 sympathetics. 
 
 below with the cervical and the lumbar respectively. 
 It consists of eleven, rarely twelve, ganglia with their 
 connections, corresponding approximately with the 
 costo-central articulations, though in the case of the 
 upper one or two and the lower there is a slight failure 
 to correspond to theSe positions. The branches of
 
 74 
 
 distribution from the upper four or five are given 
 chiefly to the corresponding vertebrae, their ligaments 
 and to the descending portion of the thoracic aorta. 
 From the second, third and fourth branches are sent 
 to the posterior pulmonary plexuses which gives inner- 
 vation to the vessels of the walls of the bronchial 
 tubes and of the bronchioles within the substance of 
 the lung itself. These fibres connect within these 
 plexuses with the fibres from the pneumogastric, 
 whence are furnished the motor impulses and sensory 
 fibres to the walls of the air passages, the sympathetics 
 affording the vaso-motor fibres. This distribution 
 explains why the ' ' centre ' ' for the lungs is said to 
 be in the upper dorsal region ; and also the philosophy 
 of our treatment for such conditions as bronchial 
 troubles, emphysema, pneumonia, tuberculosis of the 
 lung and kindred affections. This, then, is what the 
 osteopath calls the centre for the lungs located 
 at the second, third and fourth dorsal. From the 
 lower dorsal ganglia beginning at the fifth or sixth 
 are given fibres to form three large nerves, the 
 splanchnics, or the abdominal splanchnics of Gaskell, 
 which are of wide distribution to the abdominal 
 viscera, being transmitted in three separate and dis- 
 tinct trunks, the great, the small and the smallest 
 splanchnics. The great splanchnic takes origin from
 
 75 
 
 the fifth to the tenth dorsal ganglion inclusive, and 
 may be traced upward to the third or even the second 
 thoracic ganglion, and passing downward through 
 the crus is distributed to the setnilunar ganglion and 
 through it to the renal and suprarenal plexuses. 
 Some of the fibres of this nerve are truly sympathetic 
 fibres, while the majority are medullated fibres from 
 the spinal cord. The small splanchnic comes from 
 the ninth and tenth, or the tenth and eleventh and 
 follows in the pathway of the great splanchnic and is 
 distributed to the solar plexus and sometimes on the 
 plexus to the kidney the renal plexus. The small- 
 est splanchnic comes from the eleventh ganglion, or 
 from the region corresponding to the twelfth thoracic 
 vertebra and its distribution is to the kidney. The 
 term splanchnic should be used to include all nerves 
 whose distribution is to the various viscera, but the 
 more restricted use of the term has limited it to the 
 nerves mentioned and we shall follow the general use 
 of the term. 
 
 A summary of the functions of the thoracic sympa- 
 thetic is useful : 
 
 1. Augmentor fibres to cardiac plexus from 
 second, third and fourth. 
 
 2. Vaso-constrictors to the lungs, second, third 
 and fourth.
 
 76 
 
 3. Certain afferent fibres whose stimulation results 
 in cardie-inhibitory action in the medulla, sixth to 
 tenth. 
 
 4. The splanchnics contain vaso-constrictor fibres 
 to abdominal vessels and other plexuses of the 
 abdomen. 
 
 5. The secretion of the intestinal glands. 
 
 6. Secretory to sweat glands. 
 
 7. Vaso-constrictor for arms, upper sixth dorsal ; 
 for legs, lower dorsal and second lumbar. 
 
 8. Viscero-inhibitory fibres to stomach and intes- 
 tines. The motor fibres of the intestinal tract, except 
 the rectum, are from the vagus. 
 
 In the lumbar portion of the gangliated cord there 
 are usually four small oval ganglia closely situated 
 in front of the bodies of the lumbar vertebrae 
 along the inner margin of the psoas muscle. On the 
 right side the cord is under cover of the vena cava, on 
 the left it is beneath the aorta. The branches con- 
 necting the spinal nerves with the ganglia accompany 
 the lumbar arteries and are covered by the fibrous 
 bands from which the fasciculi of the psoas muscle 
 originate. 
 
 These ganglia, with their branches, connect with 
 the plexus around the aorta ; some fibres reach 
 the hypogastric plexus and through it the pelvic
 
 77 
 
 plexus, others going to the ligaments and vertebrae 
 within the lumbar region. Descending from the 
 thoracic cord to the lumbar we find fibres having 
 almost the same function as the thoracic sympathetic. 
 In the lumbar sympathetic we find viscero-inhib- 
 
 LumJjar 
 
 itors to the descending colon and rectum, vaso-con- 
 stricter to the pelvic viscera, to lower abdominal 
 vessels. These are from lower dorsal and first and 
 second lumbar. From this source come the vaso- 
 constrictors to legs ; vaso-constrictors to penis, first 
 and second lumbar to hypogastric plexus, thence via 
 pudic nerve as gray fibres. Motor fibres to bladder, 
 upper lumbar. Motor fibres to uterus, first and 
 second lumbar. Motor fibres to vas deferens (male), 
 round ligament (female), first and second lumbar. 
 
 The sacral sympathetic is diminished in size, consist- 
 ing of a variable number of ganglia, usually four, 
 joined below by a loop on which is the ganglion 
 impars (the coccygeal ganglion). This portion of the 
 sympathetic sends fibres to the pelvic plexus, others 
 to the plexus on the sacral artery, to the ligaments, 
 to the coccyx and to the coccygeal gland. There 
 are no fibres passing into the lateral ganglia from the 
 sacral nerves, these being supplied from the lumbar 
 cord above.
 
 78 
 
 The visceral branches of the sacral nerves are 
 equivalent to white rami. They pass at once to the 
 pelvic plexuses or to the pelvic viscera. 
 
 Because of this direct relation between the visceral 
 branches of the sacral nerves and the somatic divis- 
 ions, the pelvic viscera respond very readily to sacral 
 manipulations. In the sacral region we find : 
 
 1. Motor fibres to rectum. 
 
 2. Motor fibres to bladder. 
 
 3. Vaso-dilators to penis nervi erigentes. 
 
 4. Secretory fibres to prostate gland. 
 
 There are three prevertebral plexuses the cardiac, 
 solar and hypogastric, each of which has connections 
 with and subdivisions in minor plexuses which are to 
 be regarded as prolongations of the sympathetic along 
 the blood vessels. 
 
 The cardiac is a plexus deriving fibres directly from 
 
 the vagi and the cardiac branches of each of the three 
 
 Formation of cervical ganglia referred to above. It is divided into 
 
 cardiac plexus. 
 
 two portions ; superficial plexus just anterior to the 
 aortic arch, and deep cardiac plexus situated behind 
 the aorta anterior to the end of the trachea and 
 above the bifurcation of the pulmonary artery. 
 
 The superficial is derived from the superior cervical 
 branch of the sympathetic and from the lower cervical 
 cardiac branch of the pneumogastric on the left side.
 
 79 
 
 The deep cardiac plexus is formed by all the cardiac 
 branches from the cervical sympathetics, except the 
 superior cervical cardiac on the left side and the infe- 
 rior cardiac branch of the pueumogastric of the left 
 side. From this plexus fibres extend along the pul- 
 monary vessels to form the greater part of the anterior 
 pulmonary plexus, being assisted in this work by a 
 few fibres from the anterior pulmonary branches of 
 the tenth nerve. The posterior pulmonary branches 
 of the vagus unite with the fibres from the second, 
 third and fourth, sometimes also the first thoracic 
 ganglia, and forms the posterior pulmonary plexus 
 which is distributed to the substance of the lung, 
 including the muscles to the air tubes and the vaso- 
 motors to the various tissues of the organ. Here, too, 
 fibres are given off which form plexuses on the coro- 
 nary arteries of the heart. From this plexus we find 
 fibres going to the heart and to the lungs, the great 
 organs of circulation and respiration. The fibres are 
 from the vagus, and through the cervical ganglia form 
 the second, third, fourth, and, perhaps, first and fifth 
 thoracic ganglia. It is for this reason that such a 
 large part of osteopathic treatment is directed to these 
 two regions, the cervical and the upper dorsal. 
 
 The functions of the fibres in this plexus are : Aug- 
 mentor fibres to the heart, vaso-constrictors to the
 
 80 
 
 coronary arteries (through vagus), vaso-constrictors 
 to the pulmonary and bronchial blood vessels, sensory 
 fibres to the pleura and lungs, first to fifth dorsal ; 
 sensory fibres to heart and pericardium, second to 
 fifth dorsal. The sympathetic fibres may be reached 
 at the middle or inferior cervical ganglion at which 
 point steady pressure will retard the rate of heart- 
 beat, and dilate the pulmonary arterioles. The same 
 effect is produced by relaxing contracture in the 
 interscapular region. By this treatment the heart is 
 strengthened in two ways ; resistance in lung is re- 
 moved, and rate of beat is retarded. 
 
 Pain in pleura, pericardium, lungs or heart may be 
 assuaged by pressure applied in the interscapular 
 region first to sixth dorsal. 
 
 From the pneumogastric the cardiac plexus receives 
 fibres to the heart, depressor, inhibitory, vaso-con- 
 strictor, motor or constrictor fibres to the bronchioles, 
 sensory fibres to the mucous lining of the air tubes. 
 
 The solar plexus, which on account of its complex 
 connections and size, Byron Robinson calls the 
 " abdominal brain," lies on the aorta just back of the 
 stomach in the interval between the points of origin of 
 the phrenic and renal arteries, practically surrounding 
 the origin of the coeliac axis and the great mesenteric 
 artery. From this great ganglionic mass there are
 
 81 
 
 numerous branches given off accompanying the aorta 
 and its divisions to all the abdominal viscera, forming 
 secondary plexuses named after the arteries along 
 which they pass : cceliac, superior mesenteric, supra- 
 renal, renal, spermatic, aortic, etc. 
 
 This plexus is formed of fibres from the great 
 splanchnics, the lesser splanchnics and from the right 
 pneumogastric. The least splanchnic enters chiefly into 
 the formation of the renal plexus controlling the kid- 
 ney. These fibres are from the fifth to ninth or tenth 
 thoracic ganglia and are the vaso-motor fibres to the 
 stomach, intestines and glands of the abdomen, 
 viscero-inhibitory fibres to the stomach and intestines, 
 and secretory to the glands connected with alimentary 
 tract. In addition the splanchnics carry the impulses 
 of general sensibility and pain. The vagus contributes 
 to this plexus viscero-motor impulses which through 
 it reach the stomach and intestine as far down as the 
 sigmoid flexure ; sensory fibres from the mucous lin - 
 ing are carried by the vagus. The vagus is the motor 
 nerve to all portions of the stomach fundus and 
 pyloric portion including the sphincter pyloric. 
 
 The solar or epigastric plexus continues downward , 
 
 Subsidiary 
 
 as strands of fibres on either side of the aorta, cross formed from 
 
 solar. 
 
 the common iliac arteries and form a plexus lying in 
 front of the lowest lumbar vertebra. Into this plexus
 
 82 
 
 enter the fibres from the adjacent lumbar ganglia form- 
 ing the hypogastric plexus. From this are formed 
 chiefly the various plexuses which are distributed to 
 the pelvic organs. The pelvic plexuses lying by the 
 side of the rectum serve as relays from the hypogastric 
 and are increased by spinal branches from the third 
 and fourth sacral nerves, rarely by the second. 
 
 The fibres from this plexus differ in their distribu- 
 tion with the sex, but we should ever remember that 
 in the female we get the fibres through the lower lum- 
 bar and sacral region to the vagina, uterus, ovary and 
 tubes, and in man to the corresponding organs. 
 
 Again from this source fibres are distributed to the 
 bladder and rectum facts of peculiar interest to us 
 in the many cases of bladder trouble, constipation and 
 piles. The fibres to the vagina and to the bladder are 
 peculiarly rich in the continuation of the spinal 
 branches from the sacral nerves. 
 
 The functions of the hypogastric plexus briefly are 
 
 Function of . . . , . . , .. 
 
 hypogastnc these : vaso-constnctor to pelvic viscera from aortic 
 
 plexus. 
 
 plexus and from upper lumbar ganglia ; viscero- 
 inhibitor from lumbar to rectum ; viscero-motor. The 
 hypogastric plexus contributes vaso-constrictor and 
 viscero-inhibitor fibres. Through the hypogastric 
 plexus pass sensory impulses from the pelvic viscera.
 
 83 
 
 The sacral nerves furnish to the pelvic plexuses, 
 motor nerves to haetnorrhoidal plexuses of rectum, 
 motor nerves to the vesical plexus controlling the 
 walls of the bladder, sensory and motor fibres to 
 bladder pass from second and third sacral, some sen- 
 sory passing into hypogastric plexus and out to lumbar 
 ganglia. The lower portion of the ureter is supplied 
 by these nerves as well as the vas deferens and the 
 vesiculae seminalis. The prostatic plexus receives its 
 vaso-constrictor fibres from the first and second lumbar 
 via the white rami to lumbar ganglia, thence to pelvic 
 plexus. 
 
 The vaso-dilator fibres to this plexus from the second 
 and third sacral the nervi erigentes. These nerves, 
 the visceral or splanchnic branches of the sacral 
 nerves, do not pass into the sympathetic ganglia, but 
 pass to the plexuses and to the viscera direct. From 
 the prostatic plexus they pass to the erectile sub- 
 stance of the penis as the cavernous nerves, where 
 they mingle with sensory fibres from the pudic. 
 
 The vagina receives fibres from the second and third 
 sacral, both motor and vaso-dilator. Stimulation of 
 these serve as constrictors of the vagina, and produces 
 turgescence of the vulva. The uterus is supplied 
 almost exclusively by fibres from the hypogastric 
 plexus. From this source it receives vaso-constrictor
 
 84 
 
 and viscero-dilator fibres. Constrictor fibres to the 
 neck of the uterus pass to it from the first and second 
 sacral. Its sensory fibres are through the hypogastric 
 plexus and the lumbar nerves, chiefly the second and 
 third. 
 
 ACCOMPANYING DORSAL 
 
 ROOT TO DURA ^ DORSAl SPINAL 
 NERVE ROOT 
 
 =_ TO VEHT-EBft/t LIGAMENTS, 
 E?=^" SPINAL VESSELS 4 DURA 
 
 SOMATIC vASOMOTOR, 
 PILOMOTOR, SECRETORV 
 
 VISCERAL FIBRES 
 
 MEOufLATEO FIBRES PASSING THROUGH THE 
 
 GANGL>ON TO PREvERTEBRAL PLEXUSES 
 
 OR DIRECTLY TO VISCERA. 
 
 .{^SYMPATHETIC TRUNK 
 
 Wl 
 
 t d TFROM LOWER GANGLIA 
 
 FROM RAMU8 COMMUN. 
 TO VERTEBR/E AND 
 INTERCOSTAL AND 
 LUMBAR VESSELS. 
 
 TO LOWER GANGLIA 
 
 PLAN OF A LATERAL GANGLION OF THE SYMPATHETIC CORD 
 AND ITS CONNECTIONS. 
 
 Medullated fibres represented by continuous lines, non-medullated 
 fibres by interrupted lines. 
 
 (From Gerrish's Anatomy .)
 
 CHAPTER IV. 
 
 VASO-MOTORS. 
 
 IN A WORK explaining the laws of physiology 
 upon which the science of Osteopathy rests, the 
 vaso-motor nerves contributing as they do a powerful 
 influence to the circulation of the blood, are entitled 
 to a full consideration. These fibres are, in their 
 effect, of two kinds : vaso-constrietors or those whose 
 activity decreases the lumen of the blood vessels, and 
 vaso-dilators whose activity dilates the arterioles, 
 increasing their lumen. 
 
 This vaso-motor control is primarily a function of y^ V(180 _ 
 
 motor center. 
 
 the cerebro-spmal system and is associated with certain 
 cells situated in the medulla or bulb, a more or less 
 diffuse center lying on either side of the median line. 
 This bilateral center seems to be associated with the 
 antero-lateral nucleus of Clark and it may be that 
 these cells are the center for the vaso-motors. That 
 there is a center for vaso-dilator impulses in the
 
 86 
 
 medulla has never been proven, so we shall treat this 
 center as if wholly vaso-constrictor in function. It is 
 constantly in action producing tonic or hypertouic 
 effects. The dilators act locally and irregularly 
 producing hypotonic effects. In addition to the 
 general vaso-constrictor center there are subsidiary 
 centers located at varying levels of the spinal cord. 
 These are true vaso-motor reflex centers. Again 
 there are vaso-motor reflexes in the sympathetic 
 centers. These centers control the rhythmic activity 
 of many vessels of the body during health. 
 
 The vaso-dilators are not proven to have any general 
 
 . , _ 1t 
 
 center, but are supposed to come from centers or cells 
 located in different levels of the cerebro- spinal axis. 
 The dilators then are only local in their action, the 
 vaso-constrictors are both local and general. 
 
 The dilators make their exit from any portion of the 
 cerebro-spinal axis. The constrictors pass from but a 
 limited portion- of it that portion lying between the 
 second dorsal and the second lumbar inclusive. 
 
 All the vaso-dilators are medullated fibres until 
 their distribution to the vessels. They may pass 
 through the sympathetic ganglia, in which case they 
 continue through it as white rami efferentes. They 
 may, on the other hand, pass from the cord with the 
 anterior nerve root or their homologues in the brain
 
 87 
 
 and with it enter into the spinal nerves, following 
 chiefly the motor fibres to be distributed to the blood- 
 vessels of the muscle supplied by the nerve. 
 
 The vaso-dilators are spinal nerves and lose their vao- 
 
 coiistrictors. 
 
 sheaths only on the vessels whose walls they effect. 
 
 The vaso-constrictors also begin as spinal nerves, 
 connected directly or medially with the cells in the 
 bulbar vaso-motor center, and they make their exit 
 from the spinal cord as medullated fibres through 
 the anterior roots of the spinal nerves from second 
 dorsal to second lumbar and run as white rami 
 communicantes to the ganglia of the lateral chain. 
 They never leave the chain as medullated fibres but 
 may pass either upward or downward in the chain 
 before losing their sheath in the ganglia. An example 
 of this is seen in the vaso-motors of the head, face, 
 etc. , which emerge from the spinal cord in the second , 
 third and fourth spinal nerves, and entering the 
 gangliated cord pass upward to the superior cervical 
 ganglion, in which they end. 
 
 From the lateral ganglia all the vaso-constrictor 
 impulses are carried over pale or sympathetic fibres. 
 These may follow in their distribution any of the 
 pathways of the gray rami communicates (Chap. Ill, 
 page 65) or they may pass directly to the viscera or
 
 88 
 
 indirectly as gray rami efferentes through the 
 prevertebral plexuses to the viscera. 
 
 The osteopath uses the vaso-motor nerves perhaps 
 more often than any other nerves of the body. Aside 
 from these there has never been any unequivocal proof 
 of the existence of trophic nerves and they are in 
 function closely associated with secretion. Their 
 disturbance interferes with the function of every gland 
 and tissue in the body. The effects of their activity 
 are twofold, local and general. The action of the 
 vaso-constrictors tends to increase the resistance to the 
 blood passing from the arteries into the capillaries and 
 into the veins. This effect will increase the work 
 thrown upon the heart. This effect will be propor- 
 tionate to the degree of constriction and the area 
 affected. Its maximum effect would be produced if 
 the whole arterial area were affected. Its minimum 
 effect is witnessed when a small area is affected. The 
 increased amount of work may be counter-balanced by 
 the action of a nerve which runs within the vagal 
 sheath the depressor nerve a nerve which conveys 
 sensory impulses from heart to vaso-motor center, 
 which impulses diminish arterial tone in other parts 
 of the organism, chiefly through the inhibition of the 
 vaso-constrictors of the abdominal splanchnics.
 
 89 
 Now the effect of vaso-dilatation is exactly the Effect of vaso- 
 
 dilatation. 
 
 opposite of constriction a diminution of blood 
 pressure everywhere. The general fall will be 
 proportional to the area dilated and the amount of the 
 dilatation. But in local dilatation the most marked 
 effect will be a flushing of the capillaries of the dilated 
 area. Just so in local constriction the most noticeable 
 effect will be the pallor of the constricted area. 
 
 These changes produce one effect upon the pressure 
 in the capillaries, another in the small arteries and 
 arterioles. To appreciate this it is necessary to 
 remember that the capillary walls consist of plates or 
 cells very sparsely wrapped with connective tissue but 
 containing no muscle fibres and therefore having no 
 vaso-motor control. These cells are capable of 
 expansion and of elastic recoil. 
 
 The change in the lumen of the capillary is a 
 passive one. When the firm and muscular walls of 
 the arterioles are contracted they receive the pressure 
 of the blood and resist its surging forward into the 
 capillaries. While the pressure against the walls of 
 the arterioles has remained unchanged the capillaries 
 have received much less blood and therefore are, by 
 the innate elasticity of the epithelioid plates much 
 reduced in lumen. During dilatation of the arterioles
 
 Constriction 
 decreases 
 capillary 
 pressure. 
 
 Facts per- 
 taining to 
 vaso-nwtors. 
 
 90 
 
 the lateral pressure of the blood must be resisted by 
 the capillaries, hence they are distended. 
 
 To put it briefly, constriction of the arterioles 
 decreases capillary pressure; dilatation of the arterioles 
 increases capillary pressure. 
 
 Now the vaso-constrictor center is in continual 
 action resulting in arterial tone. Any increase, either 
 general or local, is called hypertonic ; any decrease is 
 a hypotonic condition. Arterial tone is the result of 
 the condition of the blood which stimulates the vaso- 
 motor center and of the general relation between the 
 thermogenic and thermolytic centers and the summa- ' 
 tion of stimuli which stimulate the sensorium from 
 without. These conditions are further affected by the 
 action of the augmentor and the depressor fibres 
 regulating the strength, rapidity and rhythm of the 
 heart-beat. Any stimulation of a sensory nerve will 
 increase the action of the vase-motors. 
 
 There are a few well known facts upon which our 
 treatment is based : 
 
 First. The cervical sympathetics contain afferent 
 fibres which when stimulated excite the vaso-motor 
 center in the medulla. 
 
 Second. There is an inverse relation between the 
 vessels of the skin and the deeper parts on reflex 
 stimulation of the vaso-motor centers.
 
 91 
 
 Third. The vaso-constrictors are distributed chiefly 
 to the viscera and to the cutaneous vessels. The 
 vaso-dilators chiefly to the skeletal muscles and to 
 some other local structures and glands. 
 
 Fourth. Vaso-motor actions may be inhibited by 
 pressure. Cutting off the impulses which would 
 enter the center may allay the outgoing ones. 
 
 Fifth. Usually the rate of heart-beat and arterial 
 pressure vary inversely, a low peripheral resistance is 
 accompanied by a rapid pulse. 
 
 Sixth. In addition to the general bulbar center 
 there are subsidiary centers controlling the vaso-motor 
 condition of the various viscera. 
 
 Our theory of controlling the vaso-motor condition 
 of the body locally and generally is as follows : 
 
 First. By pressure upon the inferior cervical 
 ganglion we decrease the rate of the heart-beat ; this 
 decrease is followed by a reflex vaso-constriction. 
 
 Second. By varying the pressure put upon the 
 splanchnics the mesenteric vessels are constricted 
 and a reverse condition prevails in the cutaneous 
 capillaries. This is an important point in thermotaxis; 
 it serves to regulate the temperature by irradiation 
 and by evaporation of the product of the perspiratory 
 glands.
 
 Thermngenic 
 center. 
 
 Vaso-motor 
 centers for 
 organs. 
 
 92 
 
 Third. Steady pressure at the basi-occiput is 
 usually considered as holding the vaso-motors. What 
 is done is to reduce by mechanical pressure the blood- 
 flow to the brain, to quiet the irritated meningeal 
 nerves and to reduce the pressure in the arterial twigs 
 which nourish the vaso-motor center. This stimulates 
 the over-fatigued center to healthy action, increases 
 arterial tone, and reduces rate of heart - beat by 
 diminishing impulses from the augmentor center 
 situated near the vaso-motor center in the medulla. 
 
 Fourth. The thermogenic center is located in the 
 corpus striatum. Pressure on the vertebral artery 
 aided by downward pressure on the carotid sheath 
 will send less blood to this center, aid in its drainage 
 and thus reduce temperature. The splanchnics must 
 be stimulated at the same time to aid in thermolysis. 
 
 The following are the vaso-motor centers for the 
 various organs, members and viscera : 
 
 Head : The superior cervical ganglion. 
 
 Throat, tonsils, nose, etc., are reached at the same 
 point. 
 
 Dilators for tongue and mucous membrane : Fifth 
 and ninth cranial nerves. 
 
 Eye : Superior cervical ganglion through fifth 
 n erve.
 
 93 
 
 Brain, anterior and middle fossae : Superior cervical 
 ganglion. Posterior and middle fossae : Inferior 
 cervical ganglion. 
 
 Muscles of neck : The three cervical ganglia. 
 
 Thyroid gland : Middle and inferior cervical 
 ganglia. 
 
 PLAN OF AN UPPER DORSAL NERVE, SHOWING THE TYPICAL 
 
 MANNER OF BRANCHING OF THE ANTERIOR AND 
 
 POSTERIOR PRIMARY DIVISIONS OF A 
 
 SEGMENTAL NERVE. 
 
 (From Quain's Anatomy). 
 
 All of the above make their exit at the first to 
 fifth dorsal vertebra, hence any lesion in this or the 
 cervical region may affect any of these regions.
 
 94 
 
 Heart : The vagi. We obtain effects on nutrition of 
 heart at the middle and inferior cervical by inhibition. 
 
 I,ungs : From second to sixth dorsal. 
 
 Liver : The splanchnic area, sixth to tenth. 
 
 Intestines : Fifth dorsal to second lumbar, a 
 segmental supply in the order duodenum, jejunum, 
 ileum, colon. 
 
 Kidneys : Tenth to twelfth dorsal. 
 
 Spleen : Ninth and tenth dorsal. Vagus contracts 
 spleen through its action on muscular trabeculae. 
 
 Portal system : Fifth to tenth dorsal. 
 
 External generative organs, constrictors : First and 
 second lumbar to sympathetic and to hypogastric 
 plexus, thence through pelvic plexuses or through 
 pudicnerve. 
 
 Dilators : First and second sacral via nervi erigentes 
 to pelvic plexuses. 
 
 Internal generative organs (both sexes) : First and 
 second lumbar. 
 
 Arm, vaso-constrictors : Second and seventh dorsal. 
 Vaso-dilators chiefly in motor nerves of the muscles. 
 
 I/eg : Constrictors, sixth dorsal to second lumbar. 
 Dilators in sheaths of motor nerves. 
 
 Trunk : Constrictors, at corresponding segments. 
 Dilators, in motor nerves to muscles usually.
 
 CHAPTER V. 
 
 OSTEOPATHIC CENTERS. 
 
 work of the osteopath is in many cases 
 palliative always in acute cases and usually 
 as preparatory treatment in chronic conditions it is 
 necessary to reduce muscular contraction. This 
 muscular contraction is in many cases a reflex effect 
 of stimulation of branches of afferent nerves, other 
 branches of which are distributed to the muscles of the 
 spine. According to Head's law (Chap. II, page 49) 
 these contractions are the result of changed conditions 
 in the viscus. To remove these will restore the 
 normal circulation to the organ through vaso-motor 
 effects and tend to restore the organ to health. This 
 contraction is reduced by steady pressure applied to 
 the muscles of the back, usually the deeper layers. 
 The point at which this produces the most marked 
 effect is between the spines and the transverse 
 processes. The pressure should be directed upward,
 
 96 
 
 outward and forward. Quain gives the sensory nerve 
 supply to the various viscera as follows : 
 
 Heart : First, second and third dorsal. 
 
 Lungs : First, second, third, fourth and fifth dorsal. 
 
 Stomach : Sixth, seventh, eighth and ninth dorsal. 
 Cardiac end from sixth and seventh. Pyloric end from 
 ninth. 
 
 Intestines : (a) Down to upper part of rectum, ninth, 
 tenth, eleventh and twelfth dorsal, (b) Rectum, 
 second, third and fourth sacral. 
 
 Liver and Gall-bladder : Seventh, eighth, ninth 
 and tenth dorsal. 
 
 Kidney and Ureter : Tenth, eleventh and twelfth 
 dorsal. Upper part of ureter, tenth dorsal. At lower 
 end of ureter, first lumbar tends to appear. 
 
 Bladder : (a) Mucous membrane and neck of 
 bladder, second, third and fourth sacral ; () over 
 distention and ineffectual contraction, eleventh and 
 twelth dorsal and first lumbar. 
 
 Prostate : Tenth, eleventh, (twelfth) dorsal, first, 
 second and third, and fifth lumbar. 
 
 Bpididymis : Eleventh and twelfth dorsal, and first 
 lumbar. 
 
 Testis : Tenth dorsal. 
 
 Ovary : Tenth dorsal.
 
 97 
 
 Appendages, etc.: Eleventh and twelfth dorsal, 
 first lumbar. 
 
 Uterus : (a) In contraction, tenth, eleventh and 
 twelfth dorsal and first lumbar, (b) Os uteri ; (first) 
 second, third and fourth sacral (fifth lumbar very 
 rarely). 
 
 Osteopathy bases its claim to rank as a science of 
 healing upon the fact that there exists a definite and system. 
 fixed relation between an organ and the central nervous 
 system. This relation is secured through the 
 segmented arrangement of the spinal nerves or through 
 the sympathetic system, by means of rami communi- 
 cantes. The order of this inner vation is fairly constant, 
 though, as is the case with other portions of the body, 
 it may vary. This variation in no wise invalidates 
 the claim of osteopathy to rank as a science, but it does 
 emphasize the necessity of our searching for lesions 
 even in regions relatively remote from the center. 
 Specific treatment in the sense of work exclusively 
 upon a region said to be a center is rarely indicated. 
 Owing to the diffusion of pain and its attendant con- 
 ditions, it is necessary to remove any contracture which 
 may be associated with it. Again it sometimes occurs 
 that disease of an organ produces no effect on its usual 
 center, and in such an event it is necessary to carefully 
 examine other regions for the trouble. A case of con-
 
 98 
 
 gested ovary was recently related to me in which there 
 was no soreness in the usual center, eleventh dorsal, 
 nor would persistent treatment directed to this center 
 produce any effect, while a marked lesion was found 
 at the sacro-iliac synchondrosis and the removal by 
 treatment resulted in restoring the normal condition. 
 Know the location of the centers. Know also that 
 occasionally a lesion causing the trouble must be found 
 elsewhere. ' ' Touching the button " is a fascinating 
 method of treating, both in theory and in practice, but 
 the operator must be broad enough to expect it to be 
 difficult occasionally to locate the button. 
 
 Reminding you again that our use of the term cen- 
 ter is in the sense of a convenient and advantageous 
 place to reach fibres to or from a certain organ, we 
 shall point out some of the more prominent and 
 important centers : 
 
 The atlas is associated with disturbances to the vaso- 
 motors of the eye, ear, and with eczema and other 
 diseases of the face. 
 
 The axis and third cervical is a general vaso-motor 
 center, the superior cervical ganglion, center for side 
 of head, face, eye, nose, pharynx, tonsils and vessels of 
 the brain. 
 
 Third, fourth and fifth cervical, origin of phrenics, 
 center for hiccoughs.
 
 99 
 
 Fifth and sixth cervical, middle cervical ganglion ; 
 center for thyroid gland ; also augmentors to heart 
 through middle cervical ganglion. 
 
 The general function of the cervical region is that 
 of (i) vaso- constrictor effect through sympathetic 
 fibres passing into it from below through the second, 
 third, fourth and fifth dorsal, and vaso- dilator fibres in 
 the cervical spinal nerves, thus affecting all parts of the 
 body ; and (2) local vaso-motor effects on the neck, 
 head and face of the same side. That the upper 
 cervical region is sometimes said to be a center for the 
 kidney is based upon its influence over the general 
 vase-motors of the entire body. 
 
 Second, third, fourth, fifth and sixth dorsal are vaso- 
 constrictors to the pulmonary blood vessels. 
 
 Third to seventh dorsal, vaso-motors to arm via the 
 brachial plexus. 
 
 Seventh cervical and first dorsal, inferior cervical 
 ganglion, heart, thyroid gland, vertebral and basilar 
 arteries. 
 
 Annulus of Vieussens and second, third, fourth and 
 fifth dorsal, augmentory fibres to the heart. 
 
 The first three give regularity of rhythm. 
 
 Fourth and fifth control intermittency and regularity 
 of heart-beat.
 
 100 
 
 Fourth dorsal, sometimes third or fifth, stomach 
 center on right side usually. General effect as low as 
 the eighth. 
 
 Second and third dorsal center for ciliary muscle, 
 also muscle of eye. Center for vomiting. 
 
 Sixth to tenth dorsal, origin of the great splanchnic, 
 carrying viscero-inhibitory fibres and viscero-con- 
 strictor and secretory fibres to the stomach and small 
 intestine. 
 
 Eighth, ninth and tenth dorsal on right side, center 
 for the liver. This gives us the center for chills, as 
 the liver and spleen are implicated in malarial attacks. 
 
 Ninth and tenth dorsal on the left, center for the 
 spleen. In treatment of chills the general condition 
 must be controlled through cardiac and vaso-motor 
 centers, directing especial attention to the liver and 
 spleen. Also center for uterus via hypogastric plexus. 
 
 Eleventh and twelfth dorsal and upper lumbar, the 
 small intestine and kidney. 
 
 Eleventh and twelfth dorsal, center for ovary. 
 
 Second lumbar, center for parturition, micturition 
 and uterus. 
 
 Second, third and fourth lumbar, center for diarrhoea. 
 
 Fourth and fifth lumbar, hypogastric plexus, which 
 with fibres from the aortic plexus forms the pelvic 
 plexus distributing fibres to the pelvic organs.
 
 101 
 
 The anterior division of the sacral nerves are 
 splanchnic in function and are distributed to the 
 rectum, to the bladder, sphincter ani, vagina and 
 uterus. These seem to be chiefly viscero-motor in 
 function. 
 
 Second and third sacral, bladder. 
 
 Fourth sacral, vagina. 
 
 Fourth and fifth sacral, sphincter ani. 
 
 After a general view of the centers along the spine 
 
 Control of 
 
 it is necessary to form a resume of their location by circulatwn 
 mentioning the chief organs of the body and with 
 them the regions in which they may be affected 
 through their vaso-motor and viscero-motor, inhibitory 
 and secretory nerve supply. Generally speaking the 
 circulation is controlled through the great vaso-motor 
 centers, reached in the upper cervical region. It is 
 further controlled through the region from which the 
 augmentor fibres make their exit the second to the 
 fifth dorsal. It is also affected by treatment in the 
 splanchnic region controlling the vaso-motors to the 
 great capillary network of the mesenteries. 
 
 That the respiratory activity is closely affected by 
 the circulation is known to everyone, so a treatment 
 affecting the one in a measure modifies the other. So 
 far as is known there is no center for voluntary 
 motion other than the exit of the motor nerves along
 
 102 
 
 the spine. (The physiological center is in the 
 encephalon. ) 
 
 A spinal lesion may cause a paralysis of all the 
 motor apparatus below that lesion, or, if the lesion 
 affect a small area of the cord transversely, its effect 
 may be limited to a few muscles or to a few groups of 
 muscles in a region whose motor nerves pass through 
 the affected region. 
 
 Nutrition is likewise dependent upon respiration, 
 circulation and the condition of the stomach, 
 intestines, liver, etc., so a center for nutrition is 
 consequently not to be sought for in any one region. 
 
 The practical value of the foregoing facts is this : 
 If the symptoms indicate trouble or disturbance of a 
 certain organ, look carefully for lesions in the 
 corresponding spinal center. Should other symptoms 
 not permit of a differential diagnosis, as is often the 
 case, then the existence of a lesion at the center for 
 an organ will be an almost infallible evidence of 
 disease of that organ. 
 
 In case of a disturbance in any of the following 
 organs or members look for your spinal lesions as 
 follows : 
 
 Pharynx, larynx and tonsils: Second and third 
 cervical.
 
 103 
 
 Thyroid gland : Fifth and sixth cervical; general center for 
 
 thyroid gland 
 
 vaso-motor and cardiac center, seventh cervical and 
 first dorsal head of first rib ; clavicle. 
 
 Arm, motion, vaso-motor and nutrition : Brachial 
 plexus in fifth, sixth, seventh, eighth cervical and first 
 dorsal. Also vaso-motors in third to seventh dorsal. 
 
 Lungs and bronchi : Second to sixth or eighth 
 dorsal ; also vagus nerve. 
 
 Heart : Fibres from second to fifth dorsal, special 
 attention to fifth dorsal. Heart may also be reached 
 through middle and inferior cervical ganglion, and at 
 first rib, or annulus of Vieussens. 
 
 Stomach : Third to fifth dorsal specific on right 
 side, third to eighth generally ; also vagus. 
 
 Liver : Ninth and tenth dorsal, vaso-motor, vagus 
 motor. 
 
 Spleen : Eighth to eleventh dorsal, vaso-motor, 
 vagus motor. 
 
 Duodenum : Great splanchnic, sixth to tenth dorsal. 
 
 Jejunum and ileum : Lower dorsal and lumbar to 
 fourth and fibres from solar plexus. 
 
 Colon : Second to fifth lumbar. Also fibres from 
 solar plexus. 
 
 Rectum : Second to fifth lumbar via inferior 
 mesenteric plexus, inhibitory. Sacral, via hypo- 
 gastric plexus, motor ; also third and fourth dorsal.
 
 104 
 
 In the treatment of the abdominal viscera in addition 
 to the specific treatment it is always beneficial to give 
 direct treatment to the abdomen, paying particular 
 attention to the region of the solar plexus. This has 
 the effect of changing the blood by sheer compression, 
 thus relieving venosity and allaying increased peris- 
 talsis ; or in case of sluggishness of any organ it 
 stimulates the plexuses of Auerbach and Meissner , to 
 motion and secretion. It may also break up masses of 
 fecal matter lying within the abdominal canal. 
 
 Uterus : Second to fifth lumbar, ninth and tenth 
 dorsal. 
 
 Genitalia generally : Second to fifth lumbar. 
 
 Bladder : Second, third and fourth sacral. 
 
 Sphincter ani : Fifth sacral. 
 
 The knowledge of the location of these centers is of 
 incalculable advantage to the osteopath since it is 
 upon this knowledge that the accuracy of his treat- 
 ment depends, and since so much of the osteopaths' 
 success is dependent upon the accuracy of his 
 diagnosis this must be available knowledge. An 
 osseous lesion in the area which we have designated as 
 a center for a certain organ may lead to a diseased 
 condition of that organ ; while a lesion of an organ 
 may manifest itself in tenderness within its center
 
 105 
 
 along the spine. This tenderness may be found in the 
 following localities : 
 
 1. On the ends of the spinous processes, usually 
 indicating an anterior condition. 
 
 2. Above the spinous processes and about an inch 
 lateral at the articulation of the rib with the transverse 
 process of the vertebra, indicating a lateral movement 
 and often a tipping forward of the body of the 
 vertebra. 
 
 3. The soreness may be manifested at the angle of Location0 f 
 
 tenderness. 
 the rib, indicating a rotation of the rib upward or 
 
 downward on the axis connecting its two extremities. 
 
 4. Associated with any of these three conditions 
 may be found soreness in the muscles lying in that 
 region on either side of the spinous process. 
 
 To determine these conditions the patient should be 
 sitting. 
 
 Gentle pressure will determine any sensitiveness. 
 To examine the angles of the ribs in the interscapular 
 region the arm on the same side should be grasped at 
 the elbow and firmly passed across the chest. This 
 will tighten the muscles and expose the rib from the 
 covering of the scapula. In all these cases the 
 muscular contraction must be released ; to do this the 
 patient should be placed upon the table and a firm and 
 steady pressure applied to the muscles, the skin being
 
 106 
 
 lax, passing either upward or downward. This will 
 release the pressure and may be sufficient in acute 
 cases. In addition to this, an oscillation of the body 
 from side to side bending at the lesion will prove 
 helpful, as will rotation around the same point. 
 Springing the spine forward will produce a good 
 effect by releasing muscular and ligamentous con- 
 tractures.
 
 CHAPTER VI. 
 
 THEORY OF THE TREATMENT OF THE SPINE. 
 
 SINCE so large a part of our treatment is directed 
 toward the seat of the trouble via the spinal 
 nerves, it is necessary that we defend ourselves and 
 our science by rationally explaining the modus curandi 
 of osteopathic manipulations. It is necessary to recall 
 to mind the relation of the central nervous system to 
 the sympathetic through the rami communicantes, and 
 also the function of the sympathetic in distributing 
 secretory, nutritive, sensory viscero- motor and vaso- 
 motor impulses. Leaving out all disputed points we 
 take the primary facts upon which all physiologists 
 and anatomists are practically agreed, viz. : 
 
 (1) That from the entire length of the cerebro- 
 spinal center vaso-dilator fibres make their exit. 
 
 (2) That the vaso-constrictors are confined in their 
 exit to the region of the cord lying between the 
 second dorsal to the second lumbar inclusive.
 
 Non-aerated 
 blood an 
 stimulat to 
 peristalsis. 
 
 108 
 
 (3) That the viscero-motor go largely through the 
 vagus nerve to the stomach and intestines. 
 
 (4) That the sympathetics are the great vaso- 
 constrictor and viscero-inhibitors to the solar and 
 related plexuses. 
 
 (5) Sensory fibres from the viscera pass through 
 the sympathetics to the spinal nerves. 
 
 (6) Inhibition of nerve action may be procured 
 reflexly. Pressure on one branch of the nerve will 
 quiet pain in other branches. 
 
 (7) The motor, vaso-motor and secretory conditions 
 of a viscus are controlled by the condition of the 
 nerve center controlling that organ ; hence affecting 
 the sensory nerve affects the viscus. 
 
 It is necessary to remember that non-aerated blood 
 is the greatest stimulant to peristalsis ; pain and 
 cramping are often only an evidence of increased 
 peristalsis. 
 
 Any change in the blood supply to the stomach and 
 intestine has its direct effect upon the nutrition of the 
 body, influencing both digestion and absorption ; also 
 it has its effect on excretion through the kidneys. 
 Thus it is plain that the region that controls nutrition 
 and excretion is of vast importance in regulating the 
 general welfare of the organism.
 
 Dr. L. Hart's theory was as follows: "Through Dr. Hart's 
 
 theory. 
 
 stimulation of vase-motors distributed to the vessels 
 in the muscles along the spine we produce a constric- 
 tion of these peripheral vessels which thus increases 
 the pressure in the collateral branches of these arteries, 
 increasing the pressure of the blood in the vessels 
 within the cord itself. ' ' 
 
 This treatment is, according to Dr. Hart's theory, 
 directed toward regulating the blood supply to the 
 nerve cells within the spinal cord, and through over- 
 coming hypersemia or anaemia of the center restore 
 normal functioning to both nerve and organ with 
 which it is anatomically connected. 
 
 Another 
 
 Another theory which seems much more in accord theory. 
 with our immediate results obtained in acute cases or 
 in giving immediate relief to exacerbations of pain is 
 here given. 
 
 Our theory is this : First, we inhibit the passage of 
 afferent impulses by pressure on the posterior sensory 
 portions of spinal nerves. This reduces the impulses 
 sent in, quieting the pain by quieting the center. We 
 reduce muscular contractions which have irritated both 
 efferent and afferent fibres to the viscera. These con- 
 tractions have caused a venous stasis in the capillaries 
 of the muscles themselves irritating the posterior sen- 
 sory nerves which reflexly affect the viscera.
 
 110 
 
 We remove irritation from the vaso-constrictors 
 allowing normal blood supply to be re-established. We 
 stretch the connective tissue and take off pressure from 
 the nerve trunks. We equalize the nerve tension be- 
 tween center and periphery. 
 
 In order to appreciate this theory it is necessary 
 to grasp the philosophy of transferred or sympa- 
 thetic pains. This is a fact long known to the med- 
 ical profession though poorly utilized by them in 
 diagnosing disease. Investigations by Head prove 
 that in diseases of internal organs manifestations of 
 this condition will be made by tenderness in widely 
 removed parts, the diseased organ and the region 
 manifesting the tenderness having a fixed relationship. 
 Thus toothache may cause pain in the ear, heart 
 trouble may cause a localized pain between the 
 shoulders, kidney trouble manifests itself by pain in 
 the back. Careful investigation will reveal the fact 
 that the soreness is not in most instances associated 
 with the skin alone but that the tenderness is found 
 in the muscles beneath. Head explains the topo- 
 graphical association of tenderness with visceral 
 disorders by the assumption that the nerves supplying 
 the regions thus related have their origin within the 
 same segment of the spinal cord. The viscera are 
 regions of low sensibility while the skin and muscles
 
 Ill 
 
 are more freely supplied with sensory fibres and may 
 be called regions of high sensibility. The sensory 
 result of visceral irritation or lesion is summarized 
 thus : ' ' When painful stimulus is applied to a part of 
 low sensibility in close central connection with a part of 
 much greater sensibility, the pain produced is felt in 
 the part of higher sensibility rather than in the part of 
 low sensibility to which the stimulus was actually 
 applied." This law is proved both by experiment and 
 clinical practice. But clinical observation further 
 shows that the converse of that proposition is true. 
 Constant irritation or stimulation in a region of high 
 sensibility in close central connection with a viscus 
 will produce both functional and structural disturbance 
 in the viscus as well as sensitiveness in the region 
 stimulated. That such stimulation exists cannot be 
 doubted. Trauma ma}' produce slips or minor 
 dislocations. Anaemia allows a relaxation which will 
 favor such conditions. Cold, constant labor, over- 
 work, general excitement may produce muscular 
 contractions which often remain permanent. Thus 
 osseous, ligamentous or muscular pressure may serve 
 as a stimulus, which, having its first effect on a 
 region of high sensibility, will soon manifest itself in 
 some irregularity of the organ. Then the radical 
 treatment will be to remove the irritation by over-
 
 112 
 
 coming muscular contraction, or pressure upon the 
 nerve from whatever source. That a muscle devoid 
 of irritation may be made to contract is a simple 
 physiological fact easily proven. That steady pressure 
 accompanied by a stretching motion forcibly applied 
 to a contracted muscle will cause it to relax is also 
 proven in osteopathic practice daily. Again it is a 
 physiological axiom that prolonged stimulation of a 
 nerve causes it to fail to function ; hence, irritation of 
 a nerve, the result of contracture, ultimately causes 
 loss of tone to and function of the organ supplied by 
 that nerve, or, in other words, prolonged stimulation 
 serves to inhibit. 
 
 In conditions of anaemia of an organ, contraction 
 of muscles and tenderness of superficial nerves coming 
 from corresponding segments of the cord are always 
 found. 
 
 Now, our chief object, if the foregoing statements 
 are correct, is to relieve contracture, and whether the 
 condition be one of anaemia or hypersemia the removal 
 of this condition will allow a restoration of the normal 
 condition. This explains why one often obtains 
 the same result from a stimulating treatment as from 
 an inhibitory one. 
 
 The case is markedly different in the cervical region 
 where one may apply direct stimulation or inhibition
 
 113 
 
 to the sympathetics and to the vagus for the heart and Direct effect in 
 
 cervical and 
 viscera sacral regions. 
 
 It is also different in the sacral region, for there you 
 work on the posterior division of the sacral nerves 
 while the anterior division is splanchnic in function 
 and distribution, thus allowing a more direct effect 
 without any intervention of the sympathetics. 
 
 First. We correct osseous lesions which have 
 interfered with any of the classes of nerves to the 
 disturbed viscus. 
 
 Second, Immediate effects are produced by 
 reducing muscular contractures which have irritated 
 the somatic branches of motor, sensory, vaso-motor 
 and secretory nerves to the viscera. Irritation 
 removed, the nerves return to normal. 
 
 Third. Steady pressure on the posterior divisions 
 of the spinal nerves inhibits sensory, and vaso-motor 
 impulses to and from the center, thus retarding all 
 forms of activity. Rapid alteration of pressure 
 increases activity of the organ thus increasing 
 impulses to it. 
 
 Fourth. Steady pressure may restore visceral life 
 by removing muscular contracture which has served 
 as an inhibition.
 
 114 
 
 THE EXAMINATION OF THE SPINE. 
 That we may intelligently examine a spine we 
 should be thoroughly acquainted with the general 
 topography of the back. I shall after Holden give 
 you a brief outline of the landmarks of the back. It 
 must be remembered that the normal spine has four 
 curves, as follows: (i) The cervical, concave back- 
 ward, extending from the apex of the odontoid to the 
 second dorsal. (2) Beginning at the middle of the 
 second dorsal and extending to the twelfth, its 
 concavity forward is the dorsal curve. The most 
 
 The spinal 
 
 curves. prominent point is at the seventh and eighth dorsal. 
 
 (3) The lumbar curve, from the middle of the twelfth 
 dorsal down to the angle between the fifth lumbar and 
 the base of the sacrum, its concavity being directed 
 backward. (4) From the base of the sacrum to the tip 
 of the coccyx, its concavity forward, is the pelvic curve. 
 Care must be taken to become thoroughly familiar 
 with the normal in order that any variation from this 
 type may be detected. There will be variations 
 within a limited range, even in health. The dorsal 
 and pelvic curves are primary and are due to the shape 
 of the vertebrae, while the cervical and lumbar are 
 secondary and compensatory and exist only after 
 birth, their existence being due to modifications in the 
 form of the intervertebral discs. There is one point
 
 115 
 
 in which the beginner is apt to be deceived, 
 particularly in the female. The lumbar curve 
 beginning at the sacro- vertebral articulation, drops 
 forward very abruptly and if this should be further 
 increased in appearance by well developed nates, the 
 operator may be deceived. The test must be made by 
 a careful examination for tenderness on pressure. 
 The spine should lie in a perpendicular plane while 
 the patient is sitting or standing erect, though there 
 is often a slight lateral curvature in the dorsal region, 
 the convexity of which is directed toward the hand 
 which is habitually used. This is doubtless caused by 
 the increased strength of the muscles of that side and 
 also the compensatory position taken by the head and 
 cervical region. Again the tips of the vertebral 
 spines should lie in a perpendicular plane, which may 
 be tested by bringing the hand briskly down over the 
 spines either directly over it or with two fingers, one 
 on each side of the prominences of the spines. By 
 this method one may detect any deviation from the 
 usual position, and if tenderness be present this may 
 serve as an evidence of a lesion, and reasoning from 
 cause to effect, the organ or organs affected may with 
 certainty be determined. But care must be used in 
 the matter of finding a lesion. The atlas has no 
 spine, only a mere tubercle and no surprise should be
 
 116 
 
 manifested at finding it "forward." The second 
 cervical is perhaps the most prominent feature in the 
 cervical region of a normal spine and its widely 
 bifurcating and massive spinous process may give the 
 beginner some uneasiness. The cervical spines are 
 bifid from the second to the sixth inclusive. The 
 vertebra prominens is close to the first dorsal, the 
 latter'very commonly being mistaken for it. 
 
 To examine, bare the spine, have the patient sit 
 erect. Note the curves whether they be normal, 
 indications. diminished or accentuated. A flat region in the upper 
 dorsal means lung and heart action impaired, and 
 weakened vitality. If the fifth to tenth dorsal are 
 anterior, or if the lumbar, dorsal and cervical are 
 almost in line there will be stomach and intestinal 
 disorders. Any marked deviation from the normal 
 curve in the lumbar region may result in constipation, 
 ovarian or uterine disorder, or it may cause derange- 
 ment of the function of the bladder. The sacral 
 vertebra are relative to each other always in place but 
 they may be slightly out of their true articulation 
 with either the auricular processes of the ilium or 
 with the lumbar vertebra above or the coccyx below. 
 In lesions of the lumbo-sacral and sacro-iliac articula- 
 tions you will find pelvic disturbances. The coccyx 
 may by dislocation cause constipation, haemorrhoids
 
 117 
 
 and piles. Detect any lateral curves that may be 
 present by careful inspection. Friction will bring into 
 view the spines and any marked separation or 
 deviation from the perpendicular, the patient sitting 
 erect, should call for careful palpation. 
 
 lyocate the second cervical by its prominence. The 
 first dorsal by the length of its spinous process. The 
 third dorsal by the level of the scapular spine. The 
 seventh dorsal by the angle of the scapula. The fourth 
 lumbar by the fact that a line from the iliac crests will 
 pass through its body. 
 
 The twelfth dorsal may be conveniently located by 
 having the patient fold his arms and lean forward thus 
 throwing into prominence the trapezii, whose converg- 
 ing external borders will indicate the twelfth spine or 
 better by the articulation with the last rib or by the 
 natural break between it and the first lumbar. After 
 being satisfied with inspection, a careful examination 
 with the hand will detect any irregularity that the 
 eye may overlook. The spines are the key to the 
 situation, but the tenderness in addition to abnormal 
 position must be found. 
 
 Each operator will have his preference for position 
 
 Positions for 
 
 of the patient. For a thorough examination many 
 positions may be necessary. The following order is 
 suggested, the back being exposed in all cases :
 
 118 
 
 First. Patient sits erect, operator standing behind. 
 
 Second. Patient leans forward, sitting squarely, 
 hands on knees. 
 
 Third. The patient is placed facing operator, first 
 on right and then on left side. The operator carefully 
 examines each spine and transverse process in 
 succession. During this examination the patient 
 must thoroughly relax. The operator uses arms and 
 legs of patient as levers for movement in examination. 
 
 Fourth. Patient on back, body straight so that 
 nose, chin and point between feet are in straight line, 
 arms at sides. The operator now stands at head and 
 examines both sides of vertebrae of neck. The spines 
 of cervical vertebras cannot be relied upon for diagnosis 
 so we examine transverse processes. Deviation from 
 a straight line either antero-posteriorly or laterally 
 indicates trouble at that point. An examination of its 
 spine will usually confirm this result. The atlas can 
 be examined only at its transverse process which 
 should be easily felt about half way between mastoid 
 process and the decending ramus of the inferior 
 maxilla. Tenderness is usually, if not always, 
 most pronounced on the side of the slip. The end of 
 the little finger may usually be passed between the 
 transverse process and the ramus of the jaw if in 
 normal position.
 
 CHAPTER VII. 
 
 REGIONS OF HEAD AND THORAX. 
 
 THE covering of the upper part of the head is 
 called the scalp. It consists of skin over an 
 aponeurosis of the occipito-frontalis muscle, which be- 
 comes muscular in front and behind. The chief bony 
 prominences are the occipital protuberance behind, 
 the mastoid process just behind and on a level with 
 the lobule of the ear, and the zygoma. 
 
 The arteries of the scalp are the supraorbital, mak- 
 
 Arteries and 
 
 ing its exit at the supraorbital ndtch; the temporal 
 from the external carotid passing up in front of the 
 ear, distributed to the anterior and middle part of the 
 scalp ; the posterior auricular to the posterior part of 
 the scalp passes posterior to the apex of the mastoid 
 process the occipital from the external carotid. 
 
 The nerves supplying sensory fibres to the scalp are 
 the supratrochlear, reached at the inner angle of the 
 orbit, the supraorbital reached above the supraorbital
 
 120 
 
 notch, the temporal branch of the tempo-malar half- 
 way between the eye and upper margin of ear, and the 
 auriculo-temporal best reached in front of tragus. 
 These are all branches of the fifth nerve. In addition 
 the small occipital and great occipital innervate the 
 posterior portion of the scalp. These are both from 
 the second cervical and may be reached at their exit. 
 
 These nerves are frequently affected in headaches. 
 Pressure at the points named will relieve this con- 
 dition. 
 
 The muscles of the face, excepting those of mastica- 
 tion, are supplied by the seventh nerve. This nerve 
 makes it exit from the stylo-mastoid foramen, anterior 
 to the mastoid process, and may be reached between 
 the mastoid process and the ramus of the jaw. 
 
 The sensory nerve of the face is the fifth, supplying 
 also the muscles of mastication. This nerve is affected 
 in neuralgia and is treated by steady pressure at the 
 following points : At the supraorbital notch and at 
 the infraorbital and mental foramina. A line passed 
 from the supraorbital notch to a point between the two 
 bicuspid teeth will pass through these points. Indi- 
 rectly it may be reached through its sensory distribu- 
 tion from Meckel's ganglion, lying in the spheno- 
 maxillary fossa.
 
 121 
 
 The arteries to the face are, the facial and branches 
 from the temporal. The facial may be felt as it crosses 
 the horizontal ramus of the lower jaw. 
 
 The mouth requires much attention in disease. The 
 points which the osteopath may reach within this are 
 the uvula, in the middle line posteriorly, the posterior 
 nerves to be reached and pressed upon in catarrh, the 
 tonsils latterly between the anterior and posterior pil- 
 lars of the fauces. 
 
 The pits into which open the Kustachian tubes may 
 be reached in the posterior and lateral portion of the 
 pharynx. The ninth nerve supplies the tonsils, part 
 of pharynx, Eustachian tube and tympanum with 
 sensory fibres. Treatment of this nerve is necessary 
 in catarrhal deafness. 
 
 The neck is one of the most important regions of 
 
 the body to the osteopath. Its drainage is accomp- 
 
 The neck. 
 
 lished largely through the external and the anterior 
 jugular veins, the former in line from the angle of the 
 jaw to the middle of the clavicle, the anterior lying in 
 front of the sterno-cleido-mastoid. The internal carotid 
 lies in the carotid sheath, extending from the mastoid 
 process to the inner end of the clavicle. The first two 
 mentioned are superficial and pulsate in case of tricus- 
 pid incompetency. In the neck, in front, lie the 
 trachea, the larynx, the hyoid bone, the latter felt just 
 on a level with the inferior maxilla.
 
 122 
 
 Beneath the sterno-clavicular joint lie the innom- 
 inate veins, the common carotid on the left and a divis- 
 ion of the innominate on the right. Rising into the 
 neck may be felt the subclavian artery. 
 
 The important muscles in the front of the neck are 
 the sterno-hyoid and sterno- thyroid. At the side is 
 the sterno-cleido-mastoid, while deeper lie the scaleni, 
 the rectus capitus anticus major and minor, and the 
 longus colli. Contracture of these muscles is often an 
 
 Contractun 
 
 interference to drainage of the organs in the head and 
 neck. The muscles in the posterior portion of the 
 neck, which the osteopath is called upon to relax, are 
 trapezius, levator anguli scapulae and the rhomboids. 
 More deeply lie the serratus superior and splenius. 
 Beneath these are the muscles which correspond to the 
 erector spinae and still more deeply are the complexus, 
 the rectus capitis posticus major and minor, and the 
 obliquii. Deep in the neck may be felt the transverse 
 processes and their corresponding spines. Superfici- 
 ally in the middle line behind, is the ligamentum 
 nuchae. This may be stretched by holding the trunk 
 and pushing the head and neck downward and for- 
 ward. 
 
 The vertebral artery may be compressed as it passes 
 over the atlas just beneath the base of the skull. 
 This is a point useful in treating headache.
 
 123 
 
 For examination the thorax is divided into four 
 regions, anterior, posterior and two lateral. 
 
 The anterior is surrounded by a line passing 
 through the upper ring of the trachea, horizontally to 
 the sterno-cleido-mastoid, thence to the inner end of 
 the outer fourth of the clavicle. From this point it 
 is bounded laterally by the anterior axillary line, 
 which, extending downward, passes through the point 
 
 Anterior 
 
 DIAGRAM SHOWING SUBDIVISIONS OF THE ANTERIOR 
 REGION OF THE THORAX. 
 
 (1) Supra-Clavicular. 
 
 (2) Clavicular. 
 
 (3) Infra-Clavicular. 
 
 (4) Mammary. 
 
 (5) Infra-Mammary. 
 
 (6) Supra-Sternal. 
 
 (7) Superior Sternal. 
 
 ( 8 ) Inferior Sternal. 
 
 ( 9 ) Area for Pulmonary sound. 
 
 (10) Area for Aortic sound. 
 
 (11) Area for Tricuspid sound. 
 
 Mitral sound is heard at point of cardiac impulse over apex of 
 heart.
 
 124 
 
 at which the pectorales muscles leave the chest, ending 
 at the lower margin of the twelfth rib. Inferior ly it 
 is bounded by the inferior margin of the twelfth ribs 
 and lower end of the sternum. This area is sub- 
 divided into a middle portion by the sternum and that 
 region lying within the sterno-cleido-mastoid muscles 
 above the sternum inferior to the line forming the 
 superior boundary of the anterior area. 
 
 That portion of the middle region lying above the 
 sternum is called the suprasternal region. It contains 
 the upper part of the oesophagus and the trachea. 
 Within this area also lies the vagi nerves, the common 
 carotid arteries and the jugular veins, three very 
 important structures. The phrenic nerves may be 
 reached in this region as they pass into the thorax 
 beneath the sterno-cleido-mastoid muscles. The 
 steruo-hyoid and sterno-thyroid muscles are within this 
 space and lie anterior to a most important structure, 
 the thyroid gland. This body lies on either side of 
 the trachea and is connected by a bridge of glandular 
 structure covering the second, third and fourth 
 tracheal rings. The lateral lobes of the gland lie 
 upon the inferior constrictor of the pharynx superiorly, 
 and lower lies upon and external to the trachea. 
 Posterior to it lie the carotid sheath and the inferior 
 thyroid artery and the recurrent laryngeal nerve.
 
 125 
 
 The lower portion of the gland lies beneath the omo- 
 hyoid, the steruo-hyoid and the sterno-thyroid 
 muscles. This gland is of interest to the osteopath in 
 
 Thyroid gland. 
 
 goiter. The muscles above mentioned are contracted 
 in case of enlargement of the gland. The veins 
 draining this structure are the superior and middle 
 thyroid veins emptying into the internal jugular, and 
 the inferior thyroid emptying into the innominate. 
 The arteries supplying it are the superior thyroid from 
 the external carotid, the inferior thyroid from the 
 thyroid axis of the subclavian artery and occasionally 
 a branch from the innominate or the aorta, the media 
 or thyroidea ima. Its nerves are from the middle and 
 inferior ganglia of the cervical sympathetic. On 
 account of the exceedingly rich vascular supply to 
 this organ and its peculiar relation to vaso-motor 
 disturbances, treatment should be toward regulating 
 the vaso-motor through the cervical region. There 
 may be physical obstruction to the drainage through 
 the muscular contractures. Or there may be com- 
 pression of the subclavian artery owing to a depressed 
 clavicle, or an elevated first rib. Careful examination 
 should always be made of the head of the first rib in 
 such a case, as tenderness there may indicate it is 
 turned.
 
 126 
 
 To the structures lying within this region let us add 
 the apex of the lung extending an inch above the 
 clavicle, lying deep behind the sterno-mastoid and 
 sterno- thyroid muscles. This portion of the lung is 
 peculiarly liable to tubercular infection and should be 
 carefully examined. The laryngeal nerves are also 
 reached in this region. 
 
 The superior sternal region is of comparatively 
 little importance from the osteopathic standpoint, save 
 in diagnosis. It is separated from the inferior sternal 
 region by a line drawn on a level with the upper 
 margin of the third rib. 
 
 The inferior sternal region corresponds to that por- 
 tion of the sternum lying below the line above men- 
 tioned. Covered as are these regions, they are diffi- 
 cult to reach, and it is through spinal treatment that 
 the osteopath secures his results. In the superior 
 sternal region the vena cava descendens, the pulmon- 
 ary artery and the bifurcation of the trachea are found, 
 while the lung tissue encroaches upon this area below 
 the level of the second costal cartilage. 
 
 In the inferior sternal region are found a portion of 
 the right auricle, the beginning of the aorta, and the 
 pulmonary artery. The right ventricle lies largely 
 within this space, while both lungs, the left and the 
 right, and the liver contribute to filling it. There
 
 127 
 
 may be malformations of the sternum as a result of 
 dress, occupation, or a rachitic condition in early child- 
 hood. Very little can be done to overcome this condi- 
 tion, though by pressure on the sternum and traction 
 on the lateral thoracic walls by means of the pectoral 
 muscles, the lateral diameter of the chest may be 
 incrsased. This treatment may be very effective if 
 administered in the early stages of the disease. 
 
 In the supraclavicular region is an important struc- 
 ture, the subclavian artery. Its pulsations can be seen 
 and felt near the outer border of the sterno-mastoid 
 muscle, about an inch above the clavicle. We may 
 desire to compress the artery in this position just as it 
 crosses over the first rib. It is here that we may 
 reach the annulus of Vieussens and the trunks of the 
 brachial plexus. To treat this region, it is usually 
 most convenient to stand behind the patient; while 
 the patient sits, with the head slightly inclined toward 
 the side treated. The arm is used as a lever to throw 
 the structures in different relations to each other, thus 
 insuring the effect of the manipulations. In this 
 region the relation of the first rib to the clavicle may 
 be detected. Normally the end of the finger or 
 thumb may be pushed between the two. In case the 
 clavicle is depressed it can be raised by passing the 
 thumb beneath the clavicle near its middle portion and
 
 128 
 
 using the arm as a lever throwing it upward, outwards 
 and forwards there will be felt pressure on the thumb, 
 thus elevating the sternal portion. The operator must 
 remember that the shoulder is easily dislocated and 
 must use due care that no injury is done. A depressed 
 clavicle may obstruct the subclavian vein. 
 infraciavicu- The structures lying beneath the clavicles and the 
 
 Zar region. 
 
 upper portion of the sternum are of great importance 
 to the osteopath, including the vessels of which we 
 have spoken, the internal mammary artery and the 
 phrenic and pneumogastric nerves. 
 
 The infraclavicular regions extend from the lower 
 margin of the clavicles to the inferior border of the 
 third rib and are almost wholly filled with lung tissue. 
 It is here that phthisis usually manifests itself, so that 
 the study of this region is important. There is a 
 marked difference in the position of the two bronchi: 
 the right, larger and more horizontal than the left, 
 enters the lung at the level of the second costal carti- 
 lage at its upper border ; the left passing beneath the 
 aortic arch, reaches the lung an inch lower, beneath 
 the third costal cartilage. This makes some slight 
 difference in the tympanitic note of these regions. At 
 the point of union of the second rib and cartilage the 
 aortic sound is best heard on the right side, while in 
 the corresponding position on the left side the pulmon-
 
 129 
 
 ary sound is heard. The right infraclavicular region 
 contains lung tissue, the vena cava descendens and the 
 right bronchus. The left side contains lung tissue, 
 the left bronchus and the pulmonary artery, the base 
 of the heart and a part of the ascending, transverse 
 and descending portions of the arch of the aorta. 
 This region often manifests tenderness on pressure in 
 case of diseased condition of the lung and should be 
 carefully examined. The costo-chondral articulations 
 very frequently in such cases show most marked 
 tenderness. 
 
 At the outer extremity of this region, extending Co8to . coraeoM 
 
 . , , membrane. 
 
 downward from the coracoid process to the upper mar- 
 gin of the pectoralis minor muscle is the costo-coracoid 
 membrane. It lies over the subclavian vessels and is 
 pierced by the cephalic vein, acromial thoracic artery 
 and vein, the superior thoracic artery and the anterior 
 thoracic nerves to the pectorales muscles. Its impor- 
 tance cannot be overestimated in cases of rheumatic 
 conditions of pectoral and deltoid muscles, also in 
 drainage to arm and shoulder. The mammary region, 
 extending from the infraclavicular to the inferior mar- 
 gin of the sixth rib, contains lung tissue, while the 
 heart lies within the mammary and inferior sternal and 
 infraclavicular regions. Its base lies almost exactly on 
 the level of the third rib. The apex lies at a point
 
 130 
 
 midway between the mammary and parasternal lines in 
 the fifth interspace, an inch and a half below and an 
 inch median to the nipple. It extends three-quarters 
 of an inch to the right of the sternum. The area of 
 superficial cardiac dullness is confined to the left mam- 
 mary region. The right side contains in the mammary 
 region the lung, the right auricle and ventricle ; the 
 left side, the left lung and the heart. 
 
 The infra-mammary region, lying below the inferior 
 margin of the sixth rib, contains the corresponding 
 lung, on deep inspection, and the corresponding lobe 
 of the liver. The right infra-mammary affords the 
 point beneath its inner boundary for directly stimulat- 
 ing the liver, one of the most potent methods of over- 
 coming torpidity of the liver and curing constipation. 
 To treat the liver at this point the patient should be 
 either on his back or on his left side, the knees and 
 thighs both gently flexed to loosen the wall of the 
 abdominal region ; then with the hand placed just 
 internal to the line of the cartilages the patient is told 
 to take a deep breath and then exhale. Synchronous 
 with the exhalation the operator presses forcibly 
 upward and outward. Under the dependent portion of 
 the liver, at a point just below the middle of the inner 
 border of this region, lies the bile cyst, its fundus 
 sometimes extending below the margin of the liver,
 
 131 
 
 under which circumstances it may be easily felt. 
 Pressure and stimulation here tends to empty the cyst 
 by increasing the peristalsis of the cyst, rather than 
 by forcible ejection. The fundus of the stomach lies 
 chiefly within the left infra-mammary region and 
 extends well up into the mammary area, while the 
 pyloric end stretches across and ends under the right, 
 thus placing a part of the duodenum and the hepatic 
 flexure of the colon beneath this area, the splenic flex- 
 ure of the colon entering the left. 
 
 The lateral areas, the right and left, extend from 
 the anterior axillary line in front to the anterior mar- Lateral areas. 
 gin of the axillary scapula posteriorly. Above it is 
 bounded by the axilla and below by the margin of 
 the false ribs. A line drawn from the level of th 
 superior border of the sixth rib to the inferior angle of 
 the scapula divides this region into an axillary region 
 above and the infraaxillary below. Within this 
 region, behind the pectoralis muscles, may be felt the 
 pulsations of the axillary artery, which here gives off 
 branches supplying the structures forming the lateral 
 wall, while the brachial plexus of nerves may be very 
 markedly affected in this region. The drainage of the 
 arm may be influenced by treating here the lym- 
 phatics of the axilla and the axillary vein. The 
 branches of the intercostal nerves in this region are
 
 132 
 
 particularly sensitive in case of any abnormality in 
 the position of the ribs, and on the left side they will 
 reflect any disturbance in function or structure of the 
 heart ; on either side, lungs and bronchi. The main 
 bronchi are placed deeply within this area. 
 
 The infraaxillary regions contain beneath their 
 surfaces lung tissue. In addition, the right one con- 
 tains the right lobe of the liver. The left also con- 
 tains the spleen and the fundus of the stomach. 
 
 The posterior region of the chest extends from the 
 first dorsal spine along the boundary of the supra- 
 spinous fossae to acromion process, thence along the 
 axillary margin of the scapula to the inferior angle, 
 thence perpendicularly downward to the lower border 
 of the twelfth rib, thence along the border of that rib 
 to the twelfth spine. The same direction on the other 
 side gives the completed boundary. A horizontal line 
 through the inferior angle of the scapula divides it into 
 a subscapular region below, further subdivided into a 
 right and left, while the superior portion is again sub- 
 divided into a suprascapular region, lying above the 
 scapular spine on either side corresponding to the 
 suprascapular fossae, a scapular region corresponding to 
 the infraspinous fossae, and a region lying between 
 these, the interspinous region. The suprascapular 
 regions cover the apices of the lungs, and contain
 
 133 
 
 DIAGRAM SHOWING DORSAL THORACIC REGION AND 
 ITS SUBDIVISIONS. 
 
 (1) Supra-Scapular. 
 
 (2) Scapular. 
 
 (3) Sub-Scapular. 
 
 (4) Inter Scapular. 
 
 supraspinati muscles covered by trapezii. The supra- 
 scapular nerve passes in through the suprascapular 
 notch and, passing downward under the acromion pro- 
 cess, is distributed to the infraspinatus muscle. We 
 here treat the deltoid muscle through its nerve, the 
 circumflex, which is distributed to the skin over the 
 shoulder joint, and to the teres minor and the deltoid. 
 This nerve, a branch from the posterior cord of the 
 brachial plexus, has its origin in fibres coming from
 
 134 
 
 the fifth, sixth, seventh and eighth cervical, inclusive. 
 Lying beneath this region is the substance of the lung. 
 
 The scapular area reaches to the eighth rib and 
 corresponds to the infraspinous fossa, though it 
 extends more lateral than it. It is filled in by the tra- 
 pezius and infraspinatus muscles, while the lower and 
 lateral portion is crossed by the latissimus dorsi and 
 teres major muscles. The relation of the latissimus 
 dorsi to the scapula is an important one, serving to 
 bind the scapula down at its inferior angle. Beneath 
 the scapula lies the subscapularis muscle. It is worthy 
 of note that the latissimus dorsi, the teres major and 
 the subscapularis having related functions are supplied 
 by the subscapular nerves, which, like the circumflex, 
 take origin from the cervical nerves, the fifth, sixth, 
 seventh and eighth. The deep contents of the scapu- 
 lar region are lung tissue. Its chief importance to 
 the osteopath consists in its relation to the shoulder, 
 and the further fact that the scapula offers a leverage 
 on his patient. 
 
 The infrascapular regions contain lung and kidney 
 on either side and on the right a large portion of the 
 right lobe of the liver ; on the left side, part of the 
 spleen and the splenic flexure of the colon. 
 
 The right subscapular area should be examined 
 most carefully, as in this region tenderness, either
 
 135 
 
 superficial or intercostal, may manifest itself. This is 
 the liver region, and tenderness over it or deeply 
 beneath it means some disturbance in liver structure 
 or function. At the spine are the centers for the liver, 
 the kidney, the spleen and the small intestine. In 
 fact, of so great importance is the spinal region of the 
 cervix, thorax, abdomen and pelvis, bounded laterally 
 by lines drawn through the tips of the transverse pro- 
 cesses of the vertebra in the cervical region, the 
 angles of the ribs in the dorsal, the transverse pro- 
 cesses in the lumbar and the lateral margins of the 
 sacrum and coccyx in the pelvic region, that this 
 should be designated the spinal region. 
 
 In the interscapular region on either side lie the 
 lung, bronchial glands, the main bronchus ; while the 
 left side contains in addition the aorta, oesophagus and 
 thoracic duct. Within this interscapular region are 
 the following centers : The lungs and bronchial 
 tubes, the stomach, the liver, the upper part of the 
 small intestine, and the augmentor fibres to the heart. 
 The muscles of the space are the trapezius, covering 
 the whole area, the latissimus dorsi which covers the 
 lower portion. Connecting the scapula with the spine 
 are the rhomboidei major and minor and the levator 
 anguli scapulse and more deeply lying are the splenius 
 capitis et colli and erector spinse. In case of trouble
 
 136 
 
 in any organ supplied by nerves from this region of the 
 cord there will be tenderness on pressure applied to 
 these muscles. This is the logical result of a con- 
 tracture of muscles, and before the normal and natural 
 impulses can pass along the efferent and afferent fibres 
 all such contractures must be eliminated. Thus we 
 work upon the muscles indicated. To do this most 
 advantageously use the arm as a lever and by pressure 
 on the muscles overcome their contraction. It is 
 through muscles largely that we secure our ends, and 
 by removing the inhibition or the irritation which re- 
 sults from their pressure upon the nerves the normal 
 conditions are restored. 
 Examination To examine the chest the patient should be stripped 
 
 of chest. 
 
 of clothing to the waist, except such as may be opened 
 in front and raised behind, a loose waist or dressing 
 sack. Avoid draughts and cold. The patient should 
 stand or sit with body erect and arms hanging evenly 
 at the side. Careful inspection, which is the first 
 method of examination following the verbal, will re- 
 veal the general shape and symmetry of the chest, 
 color, nutrition, size, the presence of tumors and 
 abdominal bulging, or flattening of the chest wall. 
 
 The front of the chest should be first examined ; for 
 this purpose Ftand in front of the patient. Perfect 
 symmetry is rare. Unusual development of the
 
 137 
 
 muscles, unusual development of a viscus, occu- 
 pation or spinal curvature are frequent causes 
 of asymmetry. But marked malformations are not 
 necessarily incompatible with healthy lungs and 
 heart. The apex beat of the heart may or may not 
 be seen. The undulatory movements of the chest 
 should be the same on both sides, any marked varia- 
 tions either in rhythm or depth from the normal would 
 suggest disease. Inspection should not reveal any 
 difference between the right and the left sides. There 
 maybe coloring of the skin, either natural or acquired; 
 if the latter it may be pigmentation, as in diseases of 
 the sympathetic nervous system, or in hepatic disturb- 
 ances. There may be unusual color due to vasculari- 
 zation, either a natural erythema, ruddy complexion, 
 or the opposite. On the other hand there may be evi- 
 dences of congestion, with eruptions as the result of 
 arterial distension. From venous stasis may come 
 ecchymosis and enlarged capillaries and superficial 
 veins. Aside from this there may be either cyanosis, 
 anaemia, pallor or general congestion. 
 
 Detect any local bulging due to tumors or abscesses 
 within the chest wall or to deformities of the bony 
 structure. There may be asymmetry due to pressure 
 from within, as hypertrophy of the heart, or the accu- 
 mulation of gases or fluids within the pericardium, or
 
 Enlargement. 
 
 Osteopothic 
 palpation. 
 
 138 
 
 hydro- or pneumo-pericardium. The lungs may exert 
 a pressure on the chest wall in tumors and swellings, 
 and in pleuritic accumulations of gas or fluids. Even 
 the thoracic form may be modified by the enlargement 
 of abdominal organs due to fibroid growth, or to the 
 accumulation of gases or fluids. 
 
 In the pigeon breast from rachitis there is marked 
 projection of the lower end of the sternum and a 
 straightening of the ribs with a lessening of the trans- 
 verse diameter. 
 
 The alar or flat chest is accompanied by a narrow 
 chest, acute costal angle, a flattening in the region of 
 the dorsal spinal curve, winglike projecting scapulae, 
 drooping shoulders, and neck set forward. These con- 
 ditions are accompanied by weakness of constitution, 
 and indicate imperfect expansion of the lungs, poor 
 heart action and inability to resist disease. Such a 
 patient is particularly liable to pulmonary tuberculosis. 
 
 The lateral areas should be examined for tumors, 
 pleuritic bulgings, etc. The posterior region should 
 be carefully inspected for abnormalities, curvatures, 
 straightening of spine, contractures of muscles, dis- 
 placements, etc. 
 
 The osteopath uses inspection just as the medical 
 practitioner, and reasons from cause to effect through 
 anatomical connections. When the osteopath palpates
 
 139 
 
 he uses the name and changes the deed both in method 
 and motive. Palpation to the old school meant the 
 'laying on of hands and trying to gain a knowledge of 
 the internal condition by the sonant vibrations from 
 the vocal chambers and from the transmitted move- 
 ment of the apex of the heart. The osteopath uses his 
 finger tips. With these he carefully explores the 
 region of the spine determining if the spinous pro- 
 cesses are prominent or retreating. He determines 
 any deviation from the perpendicular line. His fingers 
 tell him if the spines be separated, representing a point 
 of weakness or a break. His trained fingers carefully 
 examine the articulation of the tubercle of the rib 
 with the transverse process and note any congestion, 
 slip or thickening of the tissue here. 
 
 Tenderness in any of these locations is the sign of a 
 lesion, of the organs governed by that centre. This 
 requires a careful differential diagnosis. Should there 
 be a distinct anatomical disarrangement thea a correc- 
 tion of this condition will almost certainly remove the 
 disturbance. Should it be a transferred or sympa- 
 thetic tenderness, then the effect of treatment here 
 may be transient or permanent. Even in acute cases, 
 expect osseous lesion, there is always tenderness. 
 
 To examine the heart there must be first an ability Sounds of me 
 
 heart. 
 to distinguish the normal sounds and the locations
 
 140 
 
 at which they are best heard. This can be deter- 
 mined by means of the ear unaided, but the stetho- 
 scope or phonendoscope will aid in localizing and in 
 analyzing the sound. The points at which you would 
 apply the ear are as follows : 
 
 For the aortic sound at the union of the second rib 
 and its cartilage on the right side. For the pulmonary 
 sound the corresponding position on the left side. 
 The mitral is most advantageously heard at the point 
 of the cardiac impulse in the fifth interspace. This 
 sound is also heard in abnormal conditions between 
 the vertebral margin of the scapula and the spine at 
 the level of the fifth or sixth rib. This has the 
 advantage of being entirely removed from the other 
 heart sounds. It is important to remember that the 
 mitral valve is affected more frequently than any other 
 valve of the heart. Investigation of the tricuspid is 
 best conducted at a point just below the end of the 
 sternum in the soft wall, or else at the cartilages of 
 the false ribs on the right side. 
 
 The theory upon which the osteopath works in 
 treatment of cardiac troubles is this : 
 
 Theory of First. He affects the amount of work that the 
 
 cardiac 
 
 treatment. heart is doing through vaso-motors, increasing or 
 
 decreasing it at will through peripheral resistance.
 
 141 
 
 Second. Through augmentor fibres he increases or 
 decreases the intensity of the impulses and thus 
 directly affects the heart. 
 
 Third. Through the inhibitory effect of the vagus 
 he quiets an excited heart. 
 
 .Fourth. Through the general systemic effect of the 
 vaso-motors and the cardiac augmentors he contributes 
 to the general nutrition of the heart. 
 
 Fifth. The motor nerves to the papillary muscles 
 are from the upper dorsal, and by these any valvular 
 weakness of an atonic nature may be removed. 
 
 Sixth. The sensory fibres to the heart are from the 
 upper dorsal region. Removal of any irritation to 
 these will quiet any excited condition of the heart. 
 
 Treatment is directed to all these sources. Tender- 
 ness is usually marked at the angle of the fifth rib on 
 the left side, also at the chondral articulation of this 
 rib. Pressure at these two points at the same instant 
 will produce a sensation as of some sharp instrument 
 passing through the thorax. Examination of the ribs 
 will show them to be rotated downward, bringing the 
 inferior margin almost in contact with the superior 
 margin of the rib next below. This results in 
 tenderness of the intercostal nerves. The treatment 
 which the osteopath administers depends upon the 
 nature of the case. Any contracture of the
 
 142 
 
 rhomboids, or the more deeply lying splenius, 
 semispinalis, multifidus spinae, transversalis colli, etc., 
 must be removed, and in case of nervous affection this 
 treatment, together with building up the nutrition of 
 the body through the digestive organs, will prove 
 sufficient. By elevating the ribs the- capacity of the 
 chest is increased, thus removing the pressure upon 
 the pericardium. This frequently is done in cases 
 in which the patient complains of a feeling of smother- 
 ing and compression of the heart. 
 
 Relaxing the muscles of the neck and pressure upon 
 the middle and inferior cervical ganglia will reduce 
 the rapidity of the heart-beat. 
 
 Steady pressure on the solar plexus will quiet an 
 over-exciting heart. 
 
 In chronic heart trouble you will find costal or 
 verte bral lesions. Examine carefully the vertebra 
 from the second to the fifth dorsal. To treat, relax by 
 pressure the interscapular region, place patient on 
 right side and pull upward and forward, pressing 
 with right hand against angle of ribs. Another 
 movement is to place patient on face and put sudden 
 pressure on ribs at tubercle or transverse process. 
 Have patient, sitting, lock his hands behind occiput. 
 Standing at his back the operator passes his hands 
 under patients arms and clasps them across back of
 
 143 
 
 neck. Pulling downward on each side alternately 
 will aid in overcoming an anterior condition. 
 
 EXAMINATION OF THE LUNGS. 
 
 To understand the location of the lungs it is 
 necessary to be thoroughly conversant with the 
 landmarks of the chest and with the location of 
 certain lines. A perceptible ridge at the junction of 
 the manubrium with the gladiolus, marks the level of 
 the second cartilage. The nipple is between the 
 fourth and fifth ribs just external to their cartilages. 
 
 Thoracic 
 
 The lower border of the pectoralis major corresponds hne * f 
 with the fifth rib. The scapula covers the ribs from 
 the second to the seventh. The end of the sternum is 
 at the level of the tenth dorsal vertebra. The follow- 
 ing lines are useful : 
 
 The mesosternal, the middle line of the chest 
 anteriorly. 
 
 The sternal, following the margin of the sternum. 
 
 The niammillary, parallel to the mesosternal, 
 through the nipple. 
 
 The parasternal, midway between the mammillary 
 and sternal. 
 
 The anterior axillary, a perpendicular line dropped 
 from a point at which the pectoralis major leaves the 
 thorax, the arm extended.
 
 144 
 
 The posterior axillary, a vertical line at the point 
 where the latissimus dorsi leaves the chest, arm 
 extended. 
 
 The midaxillary line, midway between the anterior 
 and the posterior axillary. 
 
 The scapular line, vertical fronr the inferior angle of 
 the scapula. 
 
 The right lung extends about one and one-half 
 inches above the first rib into the suprascapular region . 
 It follows downward, reaching the mesosternal line at 
 the second costal cartilage, following it to the sixth, 
 thence it turns outward following the sixth rib to the 
 mammillary line. It is at the eighth rib in the mid- 
 axillary line and at the tenth rib in the scapular line. 
 This lung has three lobes formed by the two fissures, 
 long and short. The long fissure extends from above 
 and behind obliquely downward and forward. It 
 begins near the third dorsal vertebra and passes to the 
 midaxillary line at the fourth rib and cuts the mam- 
 millary line at the sixth. The short fissure begins 
 near the anterior border of the scapula at the level of 
 the third rib where it unites with the long, passes 
 downward, inward and forward to the junction of the 
 fourth costal cartilage with the sternum. Above this 
 lies the upper lobe of the lung.
 
 145 
 
 Between the third and the lower margin of the sixth 
 rib is the middle lobe. The lower lobe is posterior to 
 and below the long fissure. It reaches the thoracic 
 wall in the lateral and subscapular region, but is 
 absent in front. 
 
 The left lung extends one inch higher into the neck , 
 
 Left lung. 
 
 than the right. It leaves the mesosternal line at the 
 fourth costal cartilage, passes obliquely downward to 
 the sixth rib in the mammillary line and between the 
 eighth and ninth ribs at the midaxillary, and between 
 the tenth and eleventh ribs in the scapular line. It 
 has but one fissure which divides it into the upper and 
 lower lobes. 
 
 This fissure begins near the third vertebra, extends 
 downward, forward and outward to the midaxillary 
 line where it is at the level of the fourth rib. In the 
 mammillary line it cuts the lower margin of the lung 
 at the sixth rib. The upper lobe anteriorly occupies 
 all above the sixth rib ; laterally, above the fourth rib, 
 and posteriorly above the spine of the scapula. The 
 lower lobe is absent anteriorly and lies below the upper 
 lobe, posteriorly and laterally. 
 
 In examination and treatment of the lungs it is nec- 
 essary to keep their outlines in mind. Their space is 
 easily encroached upon by any abnormality in the 
 shape of the thoracic wall.
 
 146 
 
 The pleura and lungs are supplied with sensory 
 fibres from the spinal nerves coming from the first to 
 the seventh, though Quain limits it to the upper five. 
 The lungs are supplied by viscero-motor fibres from 
 the vagus and by vaso-motor fibres from the upper 
 dorsal, though some observers find these also to come 
 from the vagus. But in either case they make their 
 exit from the upper dorsal nerves. 
 Treatment of Our treatment for pulmonary or bronchial trouble is 
 
 lungs. 
 
 as follows : Contractures, in the upper spinal regions, 
 are reduced, the ribs are elevated by pressing against 
 their tubercles and pulling the arm upward and back- 
 ward. The patient lying on his back the hands are 
 drawn up over the head, the patient inhaling deeply, 
 then are pushed downward as he exhales. Another 
 treatment is to place the patient on a stool ; placing 
 your knee between his shoulders grasp the arms near 
 the elbows, pull upward and slightly backward, the 
 patient breathing .as before. 
 
 In bronchial troubles pay particular attention to the 
 anterior portion of the chest, placing two fingers be- 
 tween the ribs parallel to them, then turn and press 
 upward and outward at the same time. This relaxes 
 the intercostal muscles and removes irritation to the 
 sensory nerves.
 
 CHAPTER VIII. 
 
 ABDOMEN AND PELVIS. 
 
 A S THE divisions of the abdomen with their 
 *- * contents may be found in all works on 
 anatomy it will be omitted here. 
 
 The linea alba, or central abdominal line, extends 
 from the ensiform cartilage to the symphysis pubis. 
 
 The rectus muscle is crossed by three tendinous 
 intersections which divide it into three portions. 
 These sometimes cause mistakes in diagnosis, as a 
 spasmodic contraction of one of these, or a collection 
 of fluid within the sheath is taken for disease of the 
 abdominal organs. The lowest is at the level of the 
 umbilicus, the next at the level of the lower portion of 
 the tenth rib and the highest at the ensiform cartilage. 
 
 The umbilicus is the most prominent landmark of 
 the abdomen, lying in the middle line, nearer to the 
 pubes than to the ensiform. It is usually at the level 
 f the disc above the third lumbar vertebra.
 
 148 
 
 About one and one-half inches below the umbilicus 
 at the level of the highest part of the iliac crest is the 
 bifurcation of the aorta into the two common iliac. 
 Here is the hypogastric plexus. 
 
 The anterior superior . spine of the iliac is of great 
 importance to the osteopath since it is taken as a fixed 
 point in determining the length of the limb or nature 
 of pelvic or hip troubles. This point is of importance 
 in diagnosing femoral dislocations. The thumbs 
 placed on either spine and the fingers grasping the 
 trochanters will easily enable you to appreciate any 
 difference in the relation of the two sides. 
 
 The pubic spine is of importance in deciding the 
 nature of hernia ; the spine is on the outer side of an 
 inguinal hernia ; on the inner side of a femoral. 
 
 Lying one or one and one- quarter inches external to 
 the spine of the pubes on the line connecting it with 
 the trochanter major is the femoral ring which is the 
 upper end of the femoral canal. On account of the 
 relation of the internal saphenous vein and the 
 femoral artery and vein this canal is of much 
 importance. 
 
 Just above and slightly external to the spine of the 
 pubes is the external abdominal ring. The inguinal 
 canal, of which the external abdominal ring is the 
 inferior opening, extends obliquely downward and
 
 149 
 inward almost two inches fiom the internal abdominal Extema 
 
 abdominal 
 
 ring, about midway between the anterior superior rin ' 
 iliac spine and the syinphysis, more than half an inch 
 above Poupart's ligament. The external ring 
 transmits the round ligament in the female and the 
 spermatic cord in the male, two very important 
 structures in osteopathic practice. It is well to 
 emphasize a caution before given, that the operator be 
 careful to use the finger tips carefully to avoid injury 
 or irritation. 
 
 Lying chiefly within the hypochondrium, sheltered 
 by the ribs and cartilages is the liver the largest 
 gland in the body. It extends above the colon, 
 stomach and duodenum, from the right hypochon- 
 drium across the epigastric region into the left 
 hypochondrium, as far as the mammillary line. 
 
 The liver is from six to eight inches long, weighing The u wr , 
 not far from five pounds, varying with the individual, 
 and in the same individual at different times. Its 
 relation to the digestive and circulatory systems is a 
 peculiar one. It receives an abundant blood supply 
 and performs important changes on the partly assimi- 
 lated food stuffs. Its highest point is on the right 
 side, extending upward to within an inch of the 
 nipple, or on the right side at the mammillary line it 
 arises to the upper border of the fifth interspace.
 
 150 
 
 The liver on the right side is covered by the ribs 
 from the sixth to the eleventh inclusive. On the left 
 it lies beneath the cartilages of the sixth and seventh 
 ribs, its lower margin across the epigastrium lying 
 across the stomach corresponding to a line drawn 
 from the ejd of the ninth rib on the right to the 
 junction of the seventh on the left. At the point 
 where the liver crosses linea alba, half way from the 
 ensiform to the umbilicus, the edge is easily felt. 
 
 Constriction of the thorax and abdomen by stays 
 may result in displacement of the liver downward. 
 Here the liver lies in direct contact with the abdominal 
 wall. In precussion for liver dullness it must be 
 remembered that superiorly it is covered by lung, that 
 the phrenic sinus due to the arching upward of the 
 diaphragm is next, while the region of absolute liver 
 dullness is below the diaphragm. In the gastric fossa 
 sometimes loops of distended intestine lie anterior to 
 it, resulting in a tympanitic note. Its nutrient blood 
 is from the hepatic artery, a branch of the coeliac axis, 
 while its functional blood, much increased during 
 digestion, comes from the mesenteric veins, the gastric 
 and the splenic. 
 Functions of Its secretion is double, an internal contribution to 
 
 liver. 
 
 the blood, glycogen and urea ; an external, from the 
 gall cyst or directly from the liver into the digestive
 
 151 
 
 tract. Bile is a utilized waste product, as by its pres- 
 ence in the intestines it increases functional activity of 
 the tract and aids in absorption of fats. The urea 
 which it throws into the blood stream is an end prod- 
 uct of nitrogenous katabolism. Glycogen is a carbo- 
 hydrate which is essential as a force former ; the pig- 
 ments and acids of the bile when not thrown into the 
 sewage of the body act as harmful substances within 
 the blood, affecting the nerve centers, thus retarding 
 metabolism. Any impairment of the functions of the 
 liver will result in the retention within the blood of the 
 antecedent substances from which the urea is formed. 
 This substance, carbonate of ammonia, acts as a pow- 
 erful poison to the nervous system ; hence the nervous 
 disturbances that usually attend hepatic lesions. 
 
 Its nerve supply is from several sources ; the left 
 pneumogastric contributing fibres directly to the liver 
 from its distribution over the lesser curvature of the 
 stomach. The solar plexus through the cceliac plexus 
 sends fibres along the hepatic artery. These fibres are 
 from three sources, the right pneumogastric, the 
 splanchnics and the phrenics. The phrenics are dis- 
 tributed to the capsule and to the superior portion of 
 the liver. The splanchnics are the vaso-constrictors. 
 The vagi furnish vaso-dilator fibres and most likely
 
 152 
 
 secretory fibres, though the existence of the latter has 
 never been definitely proven. 
 
 Where treated. The center for the liver is rather a diffuse one, 
 though it is definitely located between the ninth and 
 tenth on the right side. The connection with this seg- 
 ment is to be found in the splanchnics. Again, the 
 liver may be reached through the solar plexus directly, 
 or along the course of the hepatic artery. This may 
 be reached one and one-half inches above the umbili- 
 cus and about the same distance to the right of the 
 middle line. Always examine the seventh to the tenth 
 ribs inclusive as they may by pressure cause trouble 
 with this organ. 
 
 The gall bladder is normally covered by liver sub- 
 stance lying inferior to the fossa vesicalic at the margin 
 of the quadrate lobe, the fundus alone extending from 
 beneath its glandular covering, emerging from its 
 chondral protection just at the level of the ninth car- 
 tilage. Under normal conditions the gall bladder can- 
 not be felt, though it may be if distended. It is just 
 external to the right rectus muscle. 
 
 Since all the blood passing through the coeliac axis 
 and some from the inferior mesenteric artery passes 
 through the portal system, it is clearly seen that the 
 liver is influenced by the condition of the circulation, 
 and also that any failure of the liver to function would
 
 153 
 
 result in leaving in the blood substances whose effects 
 are those of poisons. 
 
 Our treatment of the liver which has for its object 
 the restoration of function through its nerve and blood 
 supply is as follows : 
 
 First. Treatment to relieve any congestion or sub- 
 luxation in the liver area, the ninth and tenth dorsal. 
 
 Second. I^ocal effects through the solar plexus 
 or branches from it. 
 
 Third. A stimulation of the pneumogastric. 
 
 Fourth. By vibrating the thoracic walls over the 
 liver with the heel of the hand, thus physically caus- 
 ing a change in its circulation and supplying its cells 
 with pure blood. 
 
 For sluggishness of the liver resulting in torpidity 
 of bowel, the gall cyst is induced to empty its contents 
 into the duodenum by pressure on the fundus. To 
 accomplish this the hand is placed on the abdominal 
 wall at the ninth rib, just external to the rectus. The 
 legs are flexed upon the abdomen, the patient lying 
 either on the back or on the left side. The patient is 
 instructed to take a deep inspiration and then as the 
 breath is sent out the hand follows the retreating wall 
 and pressure is thus put on the fundus. This is not a 
 mechanical emptying but a stimulus applied directly 
 to the fundus, resulting in a peristalsis.
 
 154 
 
 Failure of the liver to function may cause icterus, 
 nervousness, skin eruptions, sleeplessness, drowsiness, 
 constipation, haemorrhoids, etc. 
 
 Spleen. The spleen is a much less important organ than the 
 
 liver, both in size and in function. It lies, as we said, 
 at the level of the tenth rib. Its upper margin is on a 
 level with the ninth dorsal spine, its lower with the 
 eleventh. It lies in the infraaxillary space, extending 
 from the anterior axillary line to the posterior. Cov- 
 ered with the chest wall, it cannot be felt, save in case 
 of enlargement. For examination the operator must 
 rely on percussion, save in enlargement. In all infec- 
 tious and malarial diseases the spleen is affected and 
 should have proper care. The general circulation 
 must be maintained. The ninth and tenth dorsal on 
 the left side will reach the spleen through the sym- 
 pathetic. The right vagus also contributes to this 
 organ. 
 
 stomach ^k e s ^ omac ^ 1 li es i fl the upper abdominal region ex- 
 
 tending from the left hypochondrium across the epi- 
 gastrium to the edge of the right hypochondrium. 
 This places about one-sixth to the right of the median 
 line, five-sixths to the left. The cardiac opening lies 
 just to the left of the middle line opposite the seventh 
 chondro-sternal articulation. The fundus extends up
 
 155 
 
 as high as the sixth interspace and emerges from the 
 hypochondrium at the end of the ninth rib. 
 
 In the median line in moderate distention the lower 
 edge of the stomach extends about an inch lower than 
 the liver, one and one-half inches above the umbilicus. 
 Arching upward and to the right the pylorus is situ- 
 ated beneath and behind the liver opposite the first 
 lumbar vertebra and back of the end of the eighth rib. 
 Under normal conditions the pylorus cannot be felt. 
 
 The fundus lies in the left hypochondrium and ex- 
 tends to the cupola of the diaphragm. Distention may 
 seriously encroach upon the thoracic space, leading to 
 palpitation and irregularity of heart action, and short- 
 ness of breath. This must be examined in functional 
 disturbances of the heart. 
 
 The stomach is covered anteriorly by the diaphragm 
 and the thoracic wall formed by portions of the sixth, 
 seventh, eighth and ninth ribs, the left and quadrate 
 lobes of the liver and the abdominal wall. It lies an- 
 terior to the abdominal aorta and vena cava and the 
 coeliac axis. It is in relation with the left kidney, the 
 spleen and its vessels, the pancreas, the colon and part 
 of the duodenum. Back of the stomach lies the solar 
 plexus which, to the osteopath, is its most important 
 relation.
 
 156 
 
 Blood and The stomach has a liberal blood supply ; from the 
 
 nerve supply. 
 
 cceliac axis, the gastric; from the hepatic, the pyloric; 
 
 from the gastro-duodenalis, branch of the hepatic, the 
 gastro-epiploica dextra ; from the splenic, the vasa 
 brevia and the gastro-epiploica sinistra. Thus the en- 
 tire blood supply is from the co2liac axis through its 
 subdivisions and their branches. 
 
 With the blood vessels the stomach receives inner- 
 vation from the solar plexus, fibres coming from the 
 splanchnic and from the right pneumogastric. In ad- 
 dition the stomach receives fibres directly from both 
 the right and left vagi. These fibres from the vagi 
 enter into the structure of the walls of the stomach 
 and are supposed to end within the fibres of the 
 muscles. Experiments upon animals show the vagi to 
 be the nerves of motion to the stomach, stimulation of 
 its peripheral portion after section resulting in in- 
 creased movement. But the fact of section of both 
 vagi does not mean a cessation of motion, for the 
 stomach will manifest normal movements after all ner- 
 vous connections have been severed. It may be that 
 the stomach has the power of originating motion, a 
 property derived perhaps from the plexuses of Auer- 
 bach within the walls. The solar plexus contributes 
 chiefly vaso-constrictors from the splanchnics, though 
 vaso-dilators also are found. The splanchnics entering
 
 157 
 
 into the cceliac plexus also carry secretory, inhibitory, 
 and sensory fibres. These splanchnic fibres are from 
 the fourth to the eighth dorsal in orgin, though we 
 get our surest effect at the fourth to sixth dorsal verte- 
 bra, more accurately between the fourth and fifth. 
 
 The duodenum begins at the level of the first lum- 
 bar vertebra on the right side, lying beneath the carti- 
 lages of the false ribs at the level of the sixth inter- 
 space. It curves upward, backward and to the right. 
 It is in close relation with the liver and gall cyst 
 superiorly. Above and posterior to it run the hepatic 
 artery, portal vein and bile duct. It now descends 
 over the vena cava ascendens and the right kidney to 
 the level of the fourth lumbar vertebra. It here 
 ascends obliquely upward across the third and fourth 
 lumbar vertebrae, crossing the vena cava and aorta to 
 its ascending portion lying beside the aorta and the 
 fourth, third and second lumbar vertebrae. The head 
 of the pancreas lies within the concavity of the arch, 
 while the body lies above the transverse and ascending 
 portions. The terminal portion of the duodenum lies 
 behind the stomach to the left of the superior mesen- 
 teric vessels, and just at the inner side of the left 
 kidney. This now marks the beginning of the second 
 portion of the small intestine, the jejunum, which 
 continues for the next two-fifths of the length of the
 
 158 
 
 small intestine, the remaining portion being called the 
 ileum. 
 
 The small intestine as a whole lies within the 
 middle zone of the abdomen, the mesogastric, practi- 
 tically filling the umbilical region, lying anterior to 
 the ascending colon in the right lumbar and bearing 
 the same relation in the left lumbar to the descending. 
 The small intestine will or will not lie in the pubic 
 region according as the bladder is empty or distended. 
 Location and The mesentery, to which so much of the blood of 
 
 Treatment of 
 
 the mesenteric artery is sent, lies almost exclusively in 
 the umbilical region. Gentle movement and pressure 
 here will quiet pain in the small intestine. 
 
 In the right iliac region lies the caecum and the 
 point of union of the caecum and the ileum. Begin- 
 ning at this point is the large intestine, the ascending 
 portion passing up through the right lumbar to the 
 inferior surface of the liver, thence across the abdo- 
 men on a line separating the umbilical and epigastric 
 regions, as the transverse colon. It lies above the 
 umbilicus in this region and in front of the duodenum 
 next to the anterior abdominal wall. The descending 
 colon extends from the splenic flexure in the 
 left hypochondrium downward for eight inches to 
 the iliac crest, at which point begins the sigmoid or 
 omega loop.
 
 159 
 
 The kidneys lie on either side of the vertebral 
 column, anterior to the transverse processes, extending 
 from the upper margin of the twelfth dorsal vertebra 
 to the upper part of the third lumbar. Covered later- 
 ally by the twelfth rib and by the quadratus lurn- 
 borum and psoas muscles, palpation will reveal but 
 little as to their condition. Tenderness, muscular con- 
 traction, vertebral and costal dislocations are the 
 leading symptoms to the osteopath. Urinary exam- 
 ination must also be made. 
 
 Above the kidney on the left side is the spleen, on 
 the right the liver. The nerves to the kidney come 
 through the solar plexus and chiefly from the least 
 splanchnic nerve. Some fibres are derived from the 
 aortic plexus. Vaso-constrictor and sensory fibres 
 to the kidney are from the eleventh dorsal to the 
 first lumbar inclusive. 
 
 To treat the kidneys the patient is placed on side, Treatmentof 
 facing operator, the knees and thighs are flexed and 
 strong pressure is applied to the lower dorsal and 
 upper lumbar regions, the spine being strongly moved 
 backward and forward at the same time. 
 
 Another treatment is strong and steady pressure at 
 this point, the patient lying on his face. 
 
 Again, the patient lies on his back with legs drawn 
 up. The operator puts hands beneath him, palms
 
 160 
 
 upward. Now, with the patient lying on finger tips, 
 the operator repeatedly raises him, relaxing the 
 muscles, at the same time rotating the legs and moving 
 them from side to side. 
 
 The massive bony basin which lies beneath the 
 abdomen has for its structure four bones compactly 
 put together, the sacrum, the ilium, the ischium and 
 the pubes. This constitutes the pelvis. 
 
 The plane passing through the upper margin of 
 the symphysis, linea ilio-pectinea and the sacral promi- 
 nence divides this basin into two portions ; the part 
 above, the false pelvis, and the part below, the true 
 pelvis. The false pelvis is in position and function a 
 portion of the abdominal cavity, serving to hold the 
 weight of the intestines from the pelvic organs. The 
 anterior boundary is between the widely separated iliac 
 spines closed by abdominal parieties. 
 
 This region, which is really a portion of the hypo- 
 gastrium, is bounded laterally by the ossa ilii and 
 contains part of the intestine ; the bladder in 
 distention, and the uterus in pregnancy, extend up 
 into this region. 
 
 Opening through the abdominal or pelvic wall, 
 just above and to the outer side of the crest of the os 
 pubis, is a hiatus in the external oblique muscle called 
 the external abdominal ring. This opening lies above
 
 161 
 
 and internal to Poupart's ligament at its insertion into 
 the pubic spine, extending about an inch upward and 
 outward from a point between the spine and sym- 
 physis. This opening transmits the spermatic cord or 
 the round ligament, according to sex. 
 
 The points of importance to the osteopath are 
 these : An inch lateral to the lumbo-sacral articula- 
 tion just above, and median to the posterior superior 
 spine is the posterior sacro-iliac ligament. The 
 lumbo-sacral articulation is itself one of the 
 weak portions of the spine. Here, in case of slip, strain 
 or dislocation, will be found marked tenderness. One 
 and one-half inches below and three-fourths of an inch 
 lateral to this point is the lower and posterior portion 
 of auricular articulation, below the posterior superior 
 spine. Tenderness here is indicative of a slip of the 
 ilium upon the sacrum. An inch below this is the 
 great sacro-sciatic notch, lying under the posterior 
 inferior spine of the ilium. About two inches below 
 the inferior iliac spine is the ischiatic spine, which 
 with the lesser sciatic ligament attached to it converts 
 the greater sciatic notch into a foramen and separates 
 it from the lesser notch below. 
 
 The pyriforinis muscle passes through the greater 
 
 muscle. 
 
 notch and attaches to the great trochanter. This is a 
 very important structure. Above this muscle pass
 
 162 
 
 out the gluteal artery and vein and the superior glu- 
 teal nerve ; through this notch, below the muscle, pass 
 the two sciatic nerves, the sciatic vessels, the internal 
 pudic vessels and the pudic nerve. The pudic nerve 
 passes over the spine and re-enters the pelvis through 
 the lesser notch. This nerve is distributed to the 
 penis or clitoris, to the rectum and to the perinaeuin. 
 
 The pyriformis, the gemelli, the obturator and 
 the quadratus femoris muscles may all be relaxed by 
 internal rotation of the thigh, accompanied by pressure. 
 This will be useful in rheumatism of the muscles of the 
 hip, in sciatica and in vaso-motor or circulatory dis- 
 turbances in the limb. 
 
 The ischiatic tuberosity is to the side of the anal 
 opening and can be plainly felt. Half way between 
 this point and the trochanter major the great sciatic 
 nerve may be compressed. 
 
 The coccyx can always be felt just above the anus. 
 It is important that it be in correct position as it is 
 frequently the cause of constipation, coccygodynia, etc. 
 It can be best examined per rectum. 
 
 The anterior bony prominence is the pubic spine 
 nearly an inch lateral to the symphysis. It should 
 not be sensitive to pressure, but if there be a slip of the 
 ilium on the sacrum there will be marked tenderness
 
 163 
 
 at symphysis. Also one side Will be elevated or 
 depressed as the case may be. 
 
 The ischio-rectal fossa lies between the anus and the 
 tuberosity of the ischium. In this the osteopath reaches 
 the levator ani, sphincter ani, the coccygeus muscles, 
 fascia covering important structures, the walls of the 
 rectum, the posterior wall of the vagina, the pudic 
 nerve and vessels and their branches. 
 
 The ischio-rectal fossa is also treated by insertion 
 of the finger into the rectum. Here, too, may be 
 treated the prostate gland and the membranous 
 urethra. The lower and upper sphincters may be 
 reached and dilated and a stimulation applied to the 
 rectal wall. Treatment per rectum should not be 
 given more often than once per week, except in rare 
 cases. Rectal examination will reveal much as to the 
 position of the uterus. Vaginal examination will 
 detect the urethra along its anterior wall, the rami of 
 the pubes and ischia. The ovary cannot be felt either 
 per vagina or through the pubic region unless pro- 
 lapsed or enlarged. They lie two inches on either 
 side of the middle line of the body and about the same 
 distance above the pubic crest.
 
 CHAPTER IX. 
 
 THE LIMBS. 
 
 f~ I^VHE shoulder is to the osteopath an important 
 -* articulation. The arm is used in many of the 
 movements which the operator administers. Owing 
 to the multiform uses of the arm and hand, the shoulder 
 is called into actions varied and constant, so that 
 strains and dislocations are of frequent occurrence, 
 while the massive musculature is prone to deposit the 
 product of destructive metabolism within the tissues 
 which go to perfect its motion. From strains, colds 
 and rheumatism, the shoulder suffers more often than 
 any other joint. 
 
 The clavicle extends in an almost horizontal position 
 from the manubrium sterni to the acromion process 
 where usually the acromio-clavicular joint forms an 
 almost even plane, but there may be a noticeable 
 enlargement of the acrornial end of the clavicle or an 
 increase of the fibro-cartilage in the joint. This
 
 165 
 
 prominence is often mistaken for a dislocation or for a 
 clavicular fracture. On the other hand a dislocation 
 is often mistaken for this projection. When in doubt 
 compare carefully with other shoulder. The three 
 chief landmarks are, (r) the union of the scapular 
 spine with the acromion process, a fixed point from 
 which to measure the relative lengths of the arms ; (2) 
 the coracoid process about two inches anterior to this, 
 and (3) the greater and lesser tuberosities of the 
 humerus. 
 
 The greater tuberosity faces in the direction of the 
 external condyle ; the lesser in the normal position 
 of the arm lying somewhat in front and toward the 
 median line of the body. The bicipital grove may be 
 felt on deep pressure lying between the tuberosities, 
 extending downward marking the direction of the 
 biceps muscle. The head of the humerus can be felt 
 above the axillary space. If low in the axillary 
 space, or below and in front of the coracoid process, or 
 behind on the back of the scapula below the acromion, 
 it is dislocated. Great care must be used in diagnos- 
 ing a dislocation as sometimes a fracture may be 
 overlooked. Crepitation, freedom of movement and 
 holding the head of the humerus while the arm is 
 moved will aid in differentiating between these con- 
 ditions.
 
 166 
 
 The clavicle is attached to both the sternum and the 
 cartilage of the first rib by ligaments which allow of 
 motion, though limited, in all directions, and is the cen- 
 ter of all movements of the shoulder. It passes high 
 above and internal and posterior to the coracoid process, 
 to which it is bound by the coraco-clavicular ligament. 
 The clavicle is firmly bound to the acromion, yet in 
 such a way as to permit either bone to move on the 
 other, the clavicle gliding, the scapula rotating on the 
 clavicle. This articulation sometimes becomes the 
 seat of acute pains which manifest themselves in eleva- 
 tion of the shoulder. This joint is supplied by the 
 suprascapular nerve. The nerves to the shoulder 
 joint are the suprascapular and the circumflex, from 
 the brachial plexus. 
 
 The muscles which connect the arm with the trunk, 
 with which the osteopath is most especially concerned, 
 are the following : The pectorales major and minor 
 and the subclavius which are useful in ordinary 
 movements of the arm and shoulder, yet their use is 
 much magnified by the osteopathic practitioner. 
 These three muscles all attach to the ribs, the 
 subclavius to the first, the pectoralis minor to the 
 third, fourth and fifth, while the major embraces the 
 clavicle, sternum and cartilages of the ribs to the 
 seventh, thus giving the ideal leverage on the ribs for
 
 167 
 
 drawing them up and expanding the chest. In case 
 any of the first six or seven ribs are deflected these 
 muscles are used in replacing them, by drawing the 
 arm upward, outward and backward, pressing at the 
 same time on the angle of the ribs. The nerves of 
 the pectoral muscles pass inward, the external crossing 
 the axillary artery, the internal lying between it and 
 the vein and both passing across the pectoralis minor ; 
 the external piercing the costo-coracoid membrane, 
 thence between the muscles and thus lying by its 
 branches both below and above the pectoralis minor. 
 
 The blood supply to the pectoral region is from the 
 superior thoracic, thoracic branch of the acromial 
 thoracic and the long thoracic together with the 
 subscapular. These are all branches from the axillary 
 artery and may be reached in the axillary space 
 beneath the pectoralis muscle. 
 
 The costo-coracoid membrane covers the space Costo . coracoid 
 between the clavicle above, the pectoralis minor below, 
 the coracoid process externally and the first rib 
 internally ; these points being its attachments. The 
 anterior thoracic nerves may both be reached here as 
 may the acromial thoracic, the superior thoracic 
 vessels and the cephalic vein. The last is useful in 
 drainage of the arm.
 
 168 
 
 The deltoid muscle raises the arm at right angles 
 laterally to the trunk and together with the teres 
 minor receives the circumflex nerve. The teres minor 
 can be reached in the posterior scapular region, 
 extending from the scapula to the lowest facet of 
 the humerus. This muscle rotates the humerus out- 
 ward and with the major and the supraspinatus pro- 
 tects the joint from anterior dislocation. 
 
 The circumflex nerve which supplies the deltoid and 
 
 The deltoid 
 
 the teres minor is distributed to the joint and to the 
 skin covering it. It crosses the quadrilateral space 
 formed by the long head of the triceps internally, the 
 neck of the humerus externally, the teres minor above 
 and the major below. Here it may be reached either 
 anteriorly or posteriorly. The branches are upper and 
 lower, the lower may be reached at the posterior 
 margin of the deltoid, the upper at the anterior. This 
 nerve is frequently involved in case of trouble at the 
 shoulder. 
 
 The two spinati muscles which insert into the upper 
 and middle facets of the humeral head, act with the 
 deltoid and the teres minor. The supraspinatus in 
 elevating the arm, the infraspinatus in rotating the 
 humerus outward. The suprascapular nerve coming 
 from the fifth and sixth cervical supply those muscles, 
 while it also distributes branches to the shoulder and
 
 169 
 
 to the claviculo-acromial articulation. This nerve 
 enters the supraspinatus fossa at the suprascapular 
 notch and crossing the fossa passes beneath the 
 acromial end of the spine to the infraspinatus muscle. 
 It may be reached either at its origin or as it crosses 
 the fossa beneath the trapezius and the supraspinatus 
 muscles. 
 
 The subscapularis muscle passes from the ventral 
 surface of the scapula and serves as a guard against 
 anterior dislocation of the humerus by inserting into 
 the lesser tuberosity. Its nerve supply is in common 
 with the teres major and the latissimus dorsi, derived 
 from the subscapular nerves. These nerves come 
 from the fifth to the eight cervical and may be reached 
 at their origin or at the posterior border of the axilla. 
 
 By means of the arm and shoulder the osteopath 
 obtains leverage upon the entire vertebral column. Levera ^ e - 
 Through the latissimus dorsi on the lower dorsal and 
 lumbar, through the teres and subscapularies by the 
 rhomboids he puts stress upon the upper dorsal. The 
 levator anguli scapula connects the shoulder with the 
 cervical region. 
 
 The rhomboids are innervated from the fourth and 
 fifth, or from the trunk of the fifth just before the 
 cord is formed ; the levator anguli scapulae gets the 
 third cervical.
 
 170 
 
 The important muscles of the shoulder joint are the 
 biceps, coraco-brachialis and triceps. The inner mar- 
 gin of the coraco-brachialis lying almost parallel with 
 the axillary artery. The long head of the biceps lies 
 in the bicipital groove, is attached to the supra-glenoid 
 tubercle and is thus closely related to the joint, being 
 easily involved in troubles of the shoulder. Its loca- 
 tion may be determined by the two tuberosities be- 
 tween which it lies. The median nerve and the 
 brachial artery lie along the inner margin of the coraco- 
 brachialis and the biceps, the median lying first exter- 
 nal and then crossing the artery in its middle course. 
 The ulnar nerve lies about an inch internal to the 
 median, almost parallel to it, leaving it at the elbow ; 
 the median at first passing beneath the bicipital fascia 
 to the middle of the forearm. The basilic vein lies 
 between the artery and the ulnar nerve, a fact to be 
 remembered as this vein is useful in drainage. 
 
 The elbow is the seat of much trouble, lack of mo- 
 tion, displacement, etc. The outer and inner condyles 
 are easily located, while the olecranon process of the 
 ulna comes on a level with those two points when the 
 arm is extended. Place the thumb on one condyle, 
 the middle finger on the other and the index finger on 
 the olecranon. Ulnar dislocation would destroy these 
 relations. The olecranon is nearer the inner than' the
 
 171 
 
 outer condyle. Between the olecranon and the inner 
 condyle is a depression which conveys the ulnar nerve 
 the funny bone of the laity. External to the olec- 
 ranon is a well marked depression lying just below 
 the external condyle. This is one of the most im- 
 portant landmarks, since deep within it, external to 
 the supinator longus and the extensor carpi radialis 
 may be felt the head of the radius moving in pronation 
 and supiuation. This is a guide in determining dislo- 
 cation of the radius. The lymphatics of the elbow 
 usually are the first to manifest excitation if poisons 
 are absorbed through wounds of the hand, a small 
 gland just above the internal condyle usually first 
 showing this condition. The musculo-spiral nerve 
 winds around the arm and becomes anterior above the 
 external condyle. 
 
 The simplicity of structure of the arm makes this a 
 very easily studied articulation. The biceps, the 
 brachialis anticus and the supinator longus are the 
 chief muscles of flexion of the forearm. The triceps 
 is the chief extensor, the anconeus which may be con- 
 sidered as a portion of the triceps, assisting. The two 
 supinators are innervated by or from the musculo- 
 spiral, the pronators by the musculo-cutaneous. 
 
 The usual dislocation at the elbow is one or both 
 bones backward or else both forward ; the former when
 
 172 
 
 the forearm is extended, the latter when flexed. lat- 
 eral displacement is rare. The usual method of reduc- 
 ing such dislocation is by a direct pull, the knee may 
 be placed at the bend of the elbow, and straightening 
 the arm, at the same time exercising great force so as 
 to overcome the dislocation. 
 
 The wrist is frequently the seat of synovitis arising 
 from rheumatic troubles or from pyaemia. Distention 
 of the synovial sack causes fullness over the back of 
 the wrist. The styloid processes are the guides to the 
 wrist, that of the radius extending downward farther 
 than the ulna. There is a bony furrow on the back 
 part of the radius which transmits the tendon of the 
 extensor longus pollicis muscle. This is the place of 
 examination in case of Colles fracture of the radius. 
 In case of radial fracture the styloid process of the 
 radius will be on a level with or above the styloid of 
 the ulna. The scaphoid tubercle may be distinguished 
 just below the radius, the articulation of these bones 
 lying between these points. The trapezium lies just 
 below and articulates with the metacarpal of the 
 thumb. The pisiform bone may be felt just below the 
 ulnar styloid, the unciform lying within. The tendons 
 of the wrist are important. The extensors may be 
 traced, using each alternately, the three extensors of 
 the thumb lying on the outer side of the wrist. The
 
 173 
 
 flexor carpi radialis tendon is a guide to the radial 
 artery. 
 
 The hip is related to many important structures 
 which bear upon the physiology of the limb. You will 
 recall some points referred to in the preceding chapter, 
 namely, the symphysis pubes and the spine of the 
 pubes which lies external to the symphysis on the 
 same level as the upper part of the trochanter major 
 About one and one-half inches external to this is the Sapnenous 
 
 , . , . , r , Opening. 
 
 saphenous opening, a point at which a femoral 
 
 hernia first makes its appearance. The point is just 
 below Poupart's ligament. Its chief importance to the 
 osteopath lies in its relation to the drainage of the leg 
 The femoral ring is half an inch higher than the 
 saphenous opening. Find the pulsation of the iliac 
 artery, pass toward the median line one-half inch 
 from the iliac vein and next is the femoral opening or 
 ring. The anterior superior spine of the ilium is an- 
 other point of interest as being the fixed point of meas- 
 urement in case of suspected dislocation. 
 
 The trochanter major is a prominence which cannot 
 be missed. It is covered by the skin and by the fascia 
 of the gluteus maximus. The head of the femuris 
 about three-fourths of an inch above the level of the 
 pubic spine, in all positions looking in the direction of 
 the inner condyle. Great care is necessary in diag-
 
 174 
 
 nosis of femoral dislocations. The osteopath must 
 bear in mind the fact that even partial or complete dis- 
 location may be the result of tubercular processes. 
 Motion in such cases is a positive injury, though treat- 
 ment may be effective if directed toward the blood and 
 nerve supply. In dislocation the ilio-femoral liga- 
 ment, the most resistant portion of the capsular, 
 determines largely the position of the hip. 
 Test for To detect dislocation the patient should be lying 
 
 dislocated hip. 
 
 straight, face upward ; place the thumbs on the 
 anterior superior spines of the ilia. A comparison of 
 the two sides is usually the surest way of determining 
 relative positions of the parts. Nelaton's line is use- 
 ful. It is a line from the anterior superior spine to 
 the tuberosity ischii. On this line lies the center of 
 the acetabulum and at the same level as the trochanter 
 major. The femur may be dislocated in any direction; 
 backward, either above the dorsum ilii, or below the 
 obturator internus muscle into the sacro-sciatic notch, 
 or it may be anterior on the pubes or inferior into the 
 obturator or thyroid foramen. 
 
 The chief muscles which serve as landmarks around 
 the hip are the glutei, the sartorius and the adductor 
 longus. Raising the leg will throw the sartorius and 
 adductor longus into relief, thus outlining Scarpa's 
 triangle.
 
 175 
 
 Between the ischiatic tuberosity and the greater 
 trochanter may be reached the sciatic nerve, lying 
 close to the femur. It may be followed down the 
 thigh, where it divides into popliteal branches above 
 the popliteal space. This nerve supplies the hamstring 
 muscles, the adductor magnus and some branches to 
 the hip joint, while some fibres from both its popliteal 
 branches are distributed to the knee. 
 
 The obturator nerve may be reached just below the Obturator 
 
 nerve. 
 
 pyriformis internal to the sciatic. This nerve supplies 
 the acetabulutn and also the teres ligament and in 
 common with the sciatic and the anterior crural nerve 
 is distributed to the knee on its inner side. It is one 
 of the three nerves affected when trouble at the hip is 
 indicated by pain at the knee. The adductors and 
 gracilis are innervated by this nerve. 
 
 The femoral artery which supplies the thigh and leg 
 may be followed to the knee by a line drawn from the 
 middle of Poupart's ligament to the adductor tubercle 
 on the inner condyle. 
 
 The patella can be felt on the anterior of any knee, 
 its tendon lying in a vertical plane. This tendon, a 
 continuation of the extensor tendons of the leg, lies in 
 the line continued through the tubercle of the tibia, 
 drawn from the middle point of the ankle. The 
 sy no vial sac lies beneath the patellar ligament one-
 
 176 
 
 half its length, while it rises above the patella two 
 inches, slightly higher beneath the vastus internus 
 than the vastus externus. 
 
 The condyles of the femur and the tubercle of the 
 tibia to which the ligaraentum patella is attached are 
 prominent points. The head of the fibula lies at the 
 level of the insertion of the patellar ligament, on the 
 outer side, the tubercle of the tibia on the inner side. 
 
 The ligamentous structures of the knee are compli- 
 cated and liable to injury. The external are the only 
 ones which are palpable and their positions should be 
 remembered. 
 
 The patella has been mentioned. The posterior 
 extends across the floor of the popliteal space. The 
 internal reaches from the tuberosity on the inner con- 
 dyle of the femur to that of the tibia, being crossed 
 by the inner hamstrings ; the short external extends 
 behind the external from the condyle to the styloid 
 process of the fibula. Beneath the external lateral 
 ligaments pass the external articulate vessels and 
 nerves. 
 
 The nerves are from the external and internal popli- 
 teal branches of the sciatic, from the anterior crural 
 and the obturator. 
 
 Its vascular supply is abundant and may be utilized 
 in case of effusion around the joint. The tendons of
 
 177 
 
 muscle around the joint are : The quadratus femoris, 
 anteriorly ; internally and posteriorly, sartorius, 
 gracilis, semi-membranosus and semi-tendinosus which 
 are inserted into the inner aspect of the tibia. 
 
 The biceps tendon is related to the external lateral 
 ligament and is attached to both tibia and fibula, the 
 ilio-tibial band passing anterior to it to be inserted 
 into the head of the tibia. The popliteal space offers 
 the point for effecting both superficial and deep drain- 
 age of knee and leg through the popliteal and short 
 saphenous veins. Locking of the knee in extension is 
 due oftentimes to shortening of these cords, sometimes 
 due to misplacement of the semilunar fibro-cartilages 
 of the knee. 
 
 The two prominent landmarks of the ankle are the Landmarks of 
 
 the anhle. 
 two malleoli, the inner longer and lower than the 
 
 outer. Back of the inner malleolus may be reached 
 the posterior tibial nerve, a continuation of the 
 internal popliteal, the posterior tibial artery and the 
 short saphenous vein. 
 
 The anterior tibial artery and nerve lie between the 
 tibia and the fibula anteriorly, passing beneath the 
 annular ligament between the tendons of the flexor 
 proprius hallucis internally and the flexor longus 
 digitorum.
 
 178 
 
 The tendons around the ankle are : The ten do- 
 achillis prominent behind ; external to this the two 
 peroneii, while internal to it behind the inner malleolus 
 we find tendons of the tibialis posticus, flexor longus 
 digitorum and the flexor longus hallucis. On the 
 front of the ankle are the four tendons which extend 
 to the foot and the toes. The sciatic nerve innervates 
 all the muscles of the leg and the foot through its 
 branches or sub-branches. 
 
 The popliteal artery divides into the anterior and 
 the posterior tibial an inch and a half below the 
 popliteal space, the anterior passing between the bones 
 anteriorly and the posterior continuing down the 
 middle line of the leg. 
 
 In rheumatic affections of the knee or the ankle or 
 in strains of these articulations the nerves must be 
 carefully treated. The drainage must be watched in 
 all cases in which effusion is a condition. This is 
 secured by manipulation of the muscles, by pressure 
 over the deep nerves, and by tracing the superficial 
 veins, giving particular attention to the saphenous 
 opening.
 
 CHAPTER X. 
 
 GYN ECOLOGY AND OBSTETRICS. 
 
 OUR race is entitled to a healthier motherhood. 
 In eliminating drugs and substituting a rational 
 method of treatment, Osteopathy has contributed much 
 to this end. In pelvic, even more prominently than in 
 other diseases, is the rationale of osteopathic treatment 
 brought into view. 
 
 Take off the pressure. Remove the stasis. Replace 
 and strengthen the organs. Nature will restore health 
 and vitality if she have the opportunity. No matter 
 what condition the disease of the pelvic organs may 
 have assumed, there is too much blood there, for con- 
 tinued over-stimulation of the vaso-constrictors would 
 soon result in a weakness of both nerves and vascular 
 walls and a consequent engorgement. Always too 
 much blood, hyperaemia. This results in a stasis, 
 but still too much blood. Moving blood is health. 
 Stasis reduces the nutritive properties of the blood, 
 creases its percentage of waste products, deteriorates
 
 180 
 
 the vascular walls and produces transudation and 
 oedema. 
 
 This increase of local fluid is an irritant to the nerve 
 endings and the organs are excited to a condition of 
 pain. This condition now results in a morbid metab- 
 olism, either constructive as growths, enlargements, 
 and tumors ; or to breaking down of tissue through 
 retrograde metabolism, as in ulcerations. 
 
 In almost all cases of pelvic disturbances leucorrhcea 
 is a preceding condition, an unmistakable sign of 
 hypersemia, venous stasis, and decreased vitality of 
 vascular walls. This fluid should be returned by 
 nature's conduits, the veins, designed to carry back 
 the products of oxidation in the tissues. If there be 
 pressure on the venous channels anywhere between 
 pelvis and heart then will this exudation be present. 
 But this pressure to the veins is not the only factor 
 which may disturb the vitality of the pelvic organs. 
 Closely related as they are with the sympathetic ner- 
 vous system and with the cerebro-spinal both directly 
 and indirectly, the pelvic organs are the servants of the 
 nervous system. Any change in their positions may 
 irritate an afferent nerve and reflexly interfere with 
 their nutrition and function. 
 
 But this is not all. Any change that may occur 
 along the pathway of these nerves will produce the
 
 181 
 
 same effect. The pelvic organs are innervated by the Innervati0 n 
 
 of the pelvic 
 nerves making their exit from the lumbar and from organs. 
 
 the sacral portions of the spinal canal, and from the 
 hypogastric plexus lying over the body of the fifth 
 lumbar vertebra. 
 
 The nerves to the ovary come from the uterus along 
 the Fallopian tubes while another pathway is from the 
 ovarian plexus, derived from the aortic plexus, thus 
 related to the lower portion of the solar plexus. The 
 hypogastric plexus also receives fibres from the 
 lower dorsal thus connecting these organs with the 
 lower dorsal and upper lumbar spinal segments. 
 
 The arterial supply to the pelvic viscera is from the 
 aorta via the ovarian and from the internal iliac via 
 the uterine, drainage being effected into corresponding 
 veins. 
 
 In position the uterus extends from fundus a little 
 below the brim of the pelvis, slightly to the right of 
 the middle line to the upper portion of the vagina into 
 which the cervix projects, meeting it normally at a 
 right angle or greater. The condition of the bladder 
 and rectum will affect the position of this organ. 
 
 The Fallopian tubes extend from the highest point 
 of the uterus laterally, lying below the level of the sacral 
 promontory, enwrapped in the broad ligament. They 
 are from three to five inches in length lying over and
 
 182 
 
 around the ovaries. The latter bodies are about one 
 and one-half inches long, one inch broad and one-half 
 inch thick, and lie in the broad ligament. They lie 
 just within the true pelvis at the side of the uterus and 
 cannot normally be palpated through the abdominal 
 wall. Their blood supply is derived from the ovarian 
 artery, their nerves from the hypogastric plexus. 
 Examination. Examination of the pelvic organs can be made in 
 many cases and cures be affected without a vaginal ex- 
 amination. This is often true in cases of young girls. 
 The examination should first be directed to the spine 
 in the following regions : the ninth to eleventh dorsal, 
 the first to third lumbar, the lumbo-sacral articulation, 
 the sacro-iliac synchondroses and the second and third 
 sacral nerves. 
 
 In addition, the fifth lumbar is almost invariably 
 affected, either primarily disturbing the hypogastric 
 plexus or reflexly from it. 
 
 For a local examination the patient should be on her 
 back, the legs flexed. The body of the patient should 
 be covered. For examination the hand should be 
 carefully cleaned and rendered aseptic, and slightly 
 coated with some non-irritating substance. Should it 
 become necessary to examine a virgin the greatest care 
 must be taken to avoid rupturing the hymen. Often 
 an imperforate hymen may be the cause of trouble.
 
 183 
 
 The left hand should be used to depress the uterus 
 through the anterior abdominal wall. Carefully notice 
 the position of the uterus. In ordinary cases the in- 
 dex finger should, without force, reach the uterus as it 
 extends into the vagina. Should it be too close to the 
 vaginal entrance there is prolapse. The direction of 
 the os and cervix will determine whether the uterus is 
 tipped anteriorly, posteriorly or laterally ; called ante- 
 version, retro- version and latero- version. 
 
 Should the fundus be bent upon the cervix the cor- 
 responding flexion prevails. An examination with 
 speculum and sound is often necessary. 
 
 Should any of these conditions be present it is an 
 indication of the presence of too much blood of an in- 
 ferior quality. Pain and irritation have called too much 
 blood to the parts ; stasis has caused its quality to 
 deteriorate. Local applications are useless. Pessa- 
 ries and supports are in no sense correctives. The 
 
 Treatment. 
 
 treatment consists in correcting the disturbances in 
 some of the following locations : The muscles, liga- 
 ments and vertebrae in the lower dorsal and lumbar 
 regions should be made normal. An inpacted sigmoid 
 and rectum may cause trouble to the uterus itself or to 
 the hypogastric plexus. Overcome constipation and 
 in many cases the cure is effected. Remove the pres- 
 sure of the abdominal viscera, prevent lacing, cause
 
 184 
 
 patient to stand and sit with spine straight, thorax for- 
 ward and abdomen drawn backward. Control of the 
 lower portion of the abdominal parieties so as to exert 
 a constant lifting force on the abdominal contents will 
 prevent many diseases and overcome the incipient 
 stages of all. 
 
 The pudic nerve should be stimulated as it passes 
 over the spine of the ischium. This nerve supplies 
 most of the perineal muscles. By maintaining their 
 tonic condition the vaginal walls are suported, thus 
 keeping the uterus in place. Relaxation of the perin- 
 eum tends toward prolapsus. 
 
 Good effects are secured by drawing upward the pelvic 
 portion of the abdominal wall. This is done while the 
 patient is lying on her back, the legs flexed; or by draw- 
 ing the viscera forward, the patient occupying the 
 genu-pectoral position. Ordinary cases of displace- 
 ments may be cured by the preceding movements. A 
 very efficient treatment for misplacement is to insert 
 two fingers into the vagina, the patient in the genu- 
 pectoral position, the abdominal viscera pushed for- 
 ward, then spread the fingers so as to admit air to the 
 vagina. The pressure of the atmosphere will usually 
 replace the uterus. The patient should remain quiet 
 for some time after the treatment. Stimulation of the
 
 185 
 
 
 
 round ligament is useful should there be retro-flexion 
 or retro-version. 
 
 Coccygodinea should be treated by removing any 
 irritation to the coccygeal nerve ; and by quieting the 
 coccygeal gland. A dislocated coccyx may give much 
 trouble of this nature. 
 
 Metritis is treated through the lumbar nerves and 
 the hypogastric plexus. The pudic nerve is always to 
 be treated in cases involving the vaginal walls. 
 
 Ovaritis is often relieved at the lower dorsal or first 
 lumbar through correction of osseous dislocation. 
 Dysmenorrhcea can be relieved and cured by correc- 
 tion of these lumbar and lower dorsal vertebra, and 
 the sacro-iliac synchondrosis, together with the cor- 
 rection of any uterine displacement. Amenorrhoea is 
 relieved by building up the respiratory, circulatory 
 and alimentary systems ; by spreading the lumbar 
 vertebrae with a "figure of eight " motion ; and in 
 addition by striking your left hand, laid across the 
 patient's sacrum, sharply with your right closed fist. 
 This is a powerful stimulant. 
 
 The foetus is formed as the result of the union of Development 
 
 of embryo. 
 
 matured male and female reproductive cells, either 
 within the uterus or the Fallopian tubes. Segmenta- 
 tion rapidly takes place, forming the blastoderm. A 
 triple layered arrangement of cells prevails for two
 
 186 
 
 weeks, at which time the stage of the ovum is suc- 
 ceeded by the stage of the embryo, lasting until the 
 fifth week. The remaining weeks of pregnancy are 
 called the foetal stage. The formation of the neural 
 folds and the notochord begins at the end of the 
 second week. Up to this time the ovum has absorbed 
 its nourishment from the lymph of the uterine mucous 
 membrane. Now the development of the membrane 
 begins. First the amnion, the innermost layer, is 
 formed from the ectoderm and from the mesodermal 
 layer of the embryo. Outside of the true amnion the 
 false amnion is formed by the reduplicature and fusion 
 of the laminae of the true amnion. The allantois 
 develops from the hind gut and serves to connect the 
 foetus with the placenta. 
 
 By its development the allantoic tissue unites with 
 the outer or false amnion, serving to form the embry- 
 onal portion of the placenta, uniting with the uterine 
 or maternal portion which is developed from tissue of 
 the mucous membrane of the uterus. There is thus a 
 
 Origin of 
 
 double origin for the placenta. The sac of the allan- 
 tois with its amniotic wrapping is the forerunner of 
 the umbilical cord which connects the foetus and the 
 mother through the placenta. The placenta receives 
 blood from the uterine arteries of the mother which 
 have been increasing from earliest pregnancy. It is
 
 187 
 
 drained back to the maternal circulation by the uterine 
 veins. The umbilical veins, later veins, begin in the 
 foetal portion of the placenta and absorb through their 
 capillary walls the pure blood brought thither by the 
 uterine arteries ; the blood thus passes to the foetus, 
 entering its venous circulation, the portal vein and the 
 inferior vena cava. The placenta receives impure 
 blood from the hypogastric arteries, constituent parts 
 of the umbilical cord. 
 
 Thus the nourishment for and the excrement from 
 the foetus must be carried through the maternal 
 vessels. 
 
 The foetus during the first three months is largely 
 head, assuming the human form during the ninth to 
 the eleventh week. At five months the heart, liver 
 and head are alike very much developed, while move- 
 ments are now felt. The vernix caseosa is formed by 
 the sixth month and is completed by the eighth. 
 
 It is safe to assume that a woman apparently well 
 formed will come safely through childbirth, so it is not 
 necessary to examine the pelvis unless there is a 
 deformity or a rachitic history. But there are certain 
 precautions which every woman should take during 
 pregnancy. Diet, of fruits and cereals, outdoor exer- 
 cise and baths are conducive to an easy delivery and a 
 perfect child.
 
 188 
 
 When called the physician should carry with him a 
 cool head and willing hands. In addition he should 
 have a case containing tablets of mercury bichloride, 
 shears, surgeons' cotton, a roll of clean muslin, a 
 sponge and a spool of silk thread. 
 Essential Uncleanliness and untidiness in a case of this kind 
 
 Preparations. 
 
 is a crime. The expectant mother should first be given 
 a sitz bath carefully cleansing the perinseum. Then 
 the hand of the operator after a thorough scrubbing 
 with soap and water should be held in a bichloride 
 solution, i to i ,000, for a few minutes and then an 
 examination of the patient should be made. The 
 hand should be thoroughly cleansed and rendered 
 aseptic previous to each examination. This must 
 never be disregarded. 
 
 The bed should be prepared by placing either oil- 
 cloth, rubber or a layer of newspapers beneath the 
 sheet. The perinseum and vagina should be thor- 
 oughly relaxed. Pressure upon and manipulations of 
 the perineal body will produce a very satisfactory 
 result. The dilatation of the os may be very much 
 hastened by passing the finger, thoroughly aseptic, 
 around the edge of the os, also by pressure on clitoris 
 and on round ligaments. This will lessen pain. 
 To reduce the pain press on either side of the spine in 
 the lumbar region, fourth and fifth, and in the eighth
 
 189 
 to tenth dorsal ; this does not retard the progress Manipulations 
 
 that aid in 
 
 of the case. Should the pains and the expulsive 
 movements of the uterus become tardy, stimulation in 
 the lumbar region may be very effective. Relaxation 
 of the round ligaments as they pass over the pubic 
 crest will allow the uterus to protrude further into the 
 canal of the vagina. Steady pressure at the sym- 
 physis pubis will also aid in relaxation of the parts and 
 reduction of pain. 
 
 Should the child be large and the labor difficult it is 
 well to guard the periuseum by holding the hand 
 against the perineal body, thus guiding the infant 
 through the vaginal opening. Push the tissues from 
 the symphsis toward the perineal body. 
 
 As soon as the head is born examine to see if the 
 cord be around the neck. If so, loosen and follow it 
 with the fingers, one on either side, within the vagina 
 to protect it from occlusion. In foot presentation the 
 body should be wrapped in cloth or cotton to pro- 
 tect from the air until the head is born. The cool air 
 against the skin may stimulate the respiratory center, 
 causing the child to breathe. 
 
 As soon as the child is born, open its mouth, cleanse 
 the mucous passages until it has given a good cry, 
 then keep it covered and wait until the pulsations have 
 ceased in the unbilical cord. Now draw the cord
 
 190 
 
 between the thumb and finger toward the unbilicus 
 and tie with a clean thread about two and one-half 
 inches from the infant's navel, tie again an inch 
 further out and snip the cord between these points. 
 If the placenta has not yet been delivered, gentle 
 traction on the cord may produce it. The mother can 
 usually assist by an expulsive movement, as cough- 
 ing or blowing into the closed hand. There is 
 no need to hurry in this matter, an hour may some- 
 times elapse before the placenta is passed. In case it 
 is not easily secured pressure on the abdominal wall 
 above the pelvis may secure it. Place the palms flat 
 
 HOW to obtain upon the walls and press forcibly downward. Do not 
 
 the placenta. 
 
 insert the hand into the uterus unless necessary. If 
 the hand is inserted, be sure that it is aseptic. Pass 
 the fingers between the placenta and the uterine wall, 
 the air entering will often release it. If this is not 
 sufficient, gently force it from the wall of the uterus. 
 After the delivery, if there has been no laceration 
 and no cause to suspect infection, the external genitals 
 should be carefully cleansed, the vulva protected by a 
 cloth fastened as the napkins are usually fastened. 
 Between the napkin and the vulva should be a pad of 
 surgeon's cotton. Should there be post-partum hem- 
 orrhage it can be checked by stroking sharply, with 
 cold hand, the mons veneris.
 
 191 
 
 The uterus must be reduced to contract the vessels Antiseptic 
 
 injections 
 
 and close the sinuses. This is done by gently work- 
 ing the fundus through the abdominal wall. This 
 will reduce the intensity and the number of the after- 
 pains and shorten the lying-in period and prevent 
 hemorrhage. 
 
 The mother should, after being made scrupulously 
 clean, be left to sleep. Rest is the great restorer. The 
 nurse should be instructed to carefully cleanse the ex- 
 ternal genitals with soap and water, following with a 
 solution of bichloride of mercury, i to 2,000. Should 
 it be deemed necessary to use an injection a perfectly 
 sterile pipe must be used, having been dipped in boil- 
 ing water, both tube and pipe having been left in a 
 bichloride solution of i to 1,000 for ten minutes. The 
 injection may be i to 4000 bichloride or creolin i to 100 
 
 (i%). 
 
 The nurse should be given explicit directions as to core of the 
 
 breasts. 
 
 the care of the patient, The breasts should be watched 
 carefully. A scanty secretion of milk may be in- 
 creased by a separation of the upper five or six ribs, 
 lifting scapula, and freeing the subclavian and axillary 
 arteries. This affects the internal mammary branches 
 which supply the mammary gland. It also stimu- 
 lates the intercostal nerves in this region. We spread 
 the ribs increasing the blood supply through the
 
 192 
 
 perforating arteries, and giving a perfect drainage 
 through the veins. The internal mammary artery may 
 be reached at its origin from the subclavian, producing 
 effect through the plexus derived from the subclavian 
 and from the inferior cervical ganglion. L,et me repeat 
 that the introduction of the hand into the uterus to 
 take the placenta is the most dangerous part of child- 
 birth. It should be done only as a last resort.
 
 CHAPTER XL 
 
 CONSTIPATION, RHEUMATISM AND CATARRH. 
 
 /^VCCUPATION, diet, the drug habit, irregularity 
 ^^ in the time of defecation, morbid secretions of 
 liver and pancreas, osseous lesions and general neurotic 
 conditions, are causes of constipation, while this may 
 in turn be the cause of anaemia, neuritis, menstrual 
 disorders, poor circulation, piles, haemorrhoids, etc. 
 The normal time for evacuation is once per day though 
 it may vary from this, twice a day being perfectly 
 natural with some and once every second day being 
 in many cases normal. 
 
 The condition is massing of fecal material in the 
 lower bowel, usually the descending colon and the sig- 
 moid. A preceding atony of the colon, particularly the 
 musculature of the sigmoid, is frequently an obstinate 
 cause. That constipation so frequently follows peri- 
 tonitis and fevers is a suggestion of a very common 
 cause, viz. : inflammation with its consequent engorge- 
 ment and stasis.
 
 194 
 
 The presence of fecal matter within the intestine 
 should lead to a normal peristalsis, when the nerves 
 are no longer stimulated by such a condition, or when 
 the muscles fail to respond to such stimulation, then 
 costiveness results. If normal peristalsis occurs above 
 while there is sluggishness in the lower portion of the 
 tract, then impaction must occur. This impaction 
 may occur at the hepatic or splenic flexures, or in the 
 left inguinal region, extending down into the sigmoid 
 and the rectum. In case of such impaction the 
 masses must be broken up and removed before the 
 treatment directed toward restoring tonus to the mus- 
 culature and health to the mucosa can be effective. 
 
 The blood supply is from the superior and inferior 
 mesenteric arteries to the colon and sigmoid, while the 
 rectum receives its supply from the inferior mesenteric, 
 the internal pudic, the sacra media, the sciatic, and, 
 in the female, the vaginal. 
 
 The innervation of the lower bowel is from the 
 vagus, lumbar and sacral, the vagus supply- 
 ing the alimentary tract as far as the sigmoid 
 while the lumbar and sacral are inhibitor and aug- 
 mentor respectively to the remainder. The lumbar 
 are, in addition, vaso-constrictors through their rami 
 communicantes, while their secretory fibres must con- 
 trol the flow of the intestinal juices. The sacral
 
 195 
 
 nerves distributed directly to the pelvic organs are the 
 vaso- dilator and also viscero-motor to the large intes- 
 tine. The lower portion of the rectum receives fibres 
 from the inferior hsemorrhoidal, a branch of the pudic. 
 
 In treatment of this condition the patient must yield 
 strict obedience to directions. Few things are better 
 than outdoor exercise. 
 
 The normal number of nerve impulses should be 
 sent along the nerves of the abdominal muscles, the 
 muscles of the thigh and the hip in order that the 
 proper amount of impulses reach the lower portion of 
 the intestinal tract, which is innervated by nerves 
 originating in the corresponding segments of the 
 cerebro-spinal axis. Physiological nerve impulses 
 passing along the lumbar and sacral nerve trunks, 
 both afferent and efferent, cannot but favorably affect 
 the splanchnic fibres from the same nerves distributed 
 to the viscera within the abdominal and pelvic cavities. 
 Any form of physical exercise involving the use of 
 the muscles of the abdomen and thigh will thus be 
 beneficial to this particular condition. 
 
 See that your patient uses water freely ; few people 
 drink enough. The lower bowel is the great dessi- 
 
 Watenf 
 
 cator ; but, should the fecal mass contain but little value ' 
 fluid this will all be taken, and a dry and hard resist- 
 ant mass will remain to irritate the intestinal mucosa
 
 196 
 
 until finally it fails to respond to such irritation. 
 Then sets in an atonic condition of the bowel, due to 
 its over-distention by the continual crowding down 
 from above the material left from each meal. Three 
 pints of water per day is necessary, and more than 
 this amount if much is taken from the system by per- 
 spiration. This water is a stimulus to the circulation 
 and to the liver, and an incalculable benefit to the 
 kidneys. 
 
 The osteopathic treatment for constipation is based 
 upon the anatomy and physiology of the bowel and 
 its contributory glands. The liver, by its contribution 
 of bile, is one of the most important organs in the 
 work of the bowel. Its bile is beyond doubt the 
 normal stimulus to peristalsis. Thorough change of 
 blood within the substance will overcome the stasis of 
 blood and reduce the resistance "afronte," thus 
 facilitating the drainage from the entire alimentary 
 canal from stomach to rectum. This reduction of 
 stasis will of itself overcome plethora of venous blood 
 within the mesentery, meso-colon, meso-sigmoid and 
 meso-rectum. 
 
 Venosity of blood is itself a cause of excessive peri- 
 stalsis, should the venosity be introduced suddenly, 
 but when it comes gradually as the result of a 
 decreasing activity of the liver then it leads to atony
 
 197 
 
 of the walls, sluggishness, impaction and the various 
 attendant conditions of constipation. Hence to relieve 
 
 Treatment. 
 
 constipation, stimulate the liver to activity by treating 
 directly over the walls of the abdomen and thorax 
 beneath which it lies. A stimulation along the line 
 of the hepatic artery, pressure against the gall cyst, the 
 patient making the greatest expiratory effort with the 
 thighs flexed upon the abdomen, will be effective. Sep- 
 aration of the ribs by the aid of the serratus magnus 
 and latissimus dorsi, and correction of any osseous 
 lesion that may exist near the ninth or tenth dorsal 
 will restore the liver to normal function. 
 
 In addition to this treatment of the liver the bowel 
 must have especial attention. The major portion of 
 the large intestine and all of the small intestine receive 
 their secretory, trophic, vaso-motor, motor and inhib- 
 itory nerves via the solar plexus. Through their end- 
 ings these fibres may be reached at any part of the 
 abdominal parieties anteriorly or in the splanchnic 
 region of the spine. 
 
 The colon, sigmoid and rectum must first be 
 cleansed from any impacted feces. The colon should 
 be carefully kneaded. By such action the end fibres 
 of the pneumogastric nerve may be stimulated, thus 
 increasing peristalsis. The secretory fibres in the
 
 198 
 
 plexus of Meissner are also stimulated, thus tending 
 to restore the normal condition. 
 
 The lumbar region will usually show lesions in con- 
 stipation. These may be osseous, and if such will be 
 corrected, each case demanding its own treatment. In 
 case of muscular contracture which has cut off the 
 nerve force to the part, then such contracture must be 
 reduced. This will usually be found to be in the 
 region of the quadratus lumborum. This muscle may 
 be stretched by a bias stretch, placing one hand on the 
 iliac crest, the other on the lower ribs at or near their 
 angles, the patient lying on his side with face toward 
 the operator. Drawing the ribs toward him and the 
 ilium from him, and then reversing the movement the 
 operator is enabled to accomplish a thorough reduction 
 of this muscle. The psoas muscles lying in contact 
 with the ascending and descending colon and also 
 containing, as it were, the origin of the lumbar plexus, 
 is an important factor in osteopathic manipulation for 
 constipation. It is attached to the lumbar and to the 
 last dorsal vertebrae, and is inserted into the lesser 
 trochanter. Flexion, rotation and circumduction of 
 the thigh will affect this muscle which will in turn in- 
 fluence the lumbar plexus. Good results are obtained 
 by placing patient on face and strongly raising 
 the legs.
 
 199 
 
 The sacral nerves are the motor nerves to the 
 descending colon, the sigmoid and the rectum, and 
 their stimulation will increase the movement of that 
 portion of the canal. 
 
 There is often soreness in this region, showing 
 
 ' nerve. 
 
 need of stimulation to these nerves. The pudic 
 nerve which sends its inferior hsemorrhoidal branch to 
 the rectum may be reached at the ischio-rectal fossa. 
 This nerve should not be overlooked in constipation as 
 it often has an important effect on this condition when 
 due to rectal enervation. 
 
 The sphincters should also be carefully examined as 
 it may be that they are so contracted as to prevent the 
 passage of the feces. The finger well covered with 
 vaseline is a good dilator. After the insertion of one, 
 two should be inserted and then forceful separation 
 serves to overcome the contraction of the sphincter. 
 The finger should carefully examine the rectal walls 
 for prolapsus, growths or haemorrhoids. 
 
 The coccyx should be examined, as it is often 
 thrown forward, acting as a physical impediment. It 
 can be replaced by passing the finger above and in 
 front of it and drawing downward, thus extending it 
 upon the sacrum. The ganglion impar, situated on 
 the anterior surface of the coccyx, is easily reached 
 per rectum and its stimulation serves to increase the
 
 200 
 
 activity of the sympathetic nerves regulating the cir- 
 culation and the alimentary systems. 
 
 The sigmoid is often more or less prolapsed in case 
 of constipation. This can be raised by traction in the 
 iliac region through the abdominal wall, the patient 
 lying on side, the operator standing behind, the legs 
 being slightly flexed in order to loosen the abdominal 
 wall. Should the vertebrae be posterior the patient 
 may lie on side and the operator first exaggerate the 
 condition by curving the lumbar spine, then pressing 
 upon the prominent spines while returning the spine 
 to the normal condition. The patient may lie face 
 downward, after thorough and complete relaxation, 
 and the operator put sudden pressure upon the spines. 
 This is very effective, though care must be used to 
 avoid violence. 
 
 The patient seated on a stool is in a position of 
 advantage. Sometimes it is helpful to have the 
 patient lie obliquely across the table and then put an 
 auger twist upon his legs. In addition to these treat- 
 ments the quadratus lumborum must be relaxed and 
 the thighs flexed and rotated outward so as to call 
 into activity the psoas muscle. Separation of the 
 knees against the muscular resistance of the patient is 
 of value.
 
 201 
 RHEUMATISM. 
 
 The term rheumatism does not carry with it any symptoms. 
 definite idea of either cause or symptoms. Manifest- 
 ing itself by pain, with or without swelling, it inter- 
 feres with the use of the muscles, enlarges the bones 
 at their articular portions, and by stasis of blood 
 stiffens the ligaments, tendons and connective tissue 
 until from proliferations and shortening of the fibres 
 motion is more or less completely lost. This may 
 affect one articulation or may involve the entire body. 
 The presence of lactic acid or its isomeric form in the 
 blood in this disease has led to the belief that it is one 
 of the primary causes of the disease. Though often 
 present it does not follow that lactic acid is a cause of 
 the disease, but would rather suggest it as a result. 
 The fact that the disease may confine itself to one or 
 to a few articulations would indicate that there are 
 other factors involved. Our system of therapy 
 teaches that every organ or member will function 
 properly if its structure be perfect and the natural 
 nerve impulses be unchanged. 
 
 That a single tissue or organ may be the seat 
 of rheumatic affection points unmistakably to a weak- 
 ened power of resistance on the part of that tissue or 
 organ, or else to what is the same thing, deficiency in 
 nourishment or to a failure in impulses reaching it
 
 202 
 
 from the nervous system. That there are disturbing 
 elements in the blood cannot be doubted. That they 
 are the result of failure of the assimilative tissues, 
 increased by a disturbance of the harmony existing 
 between katabolism and excretion, seems certain. 
 This, then, will attribute the trouble to the liver on 
 one hand and to the kidneys on the other. The respir- 
 atory power may be at fault, leading to retarded 
 oxidation and to the formation of suboxides. The 
 change in the functioning of the liver interferes with 
 the character of the blood, thus involving the heart 
 and interfering with the circulation. 
 
 Our treatment is directed to the nervous system to 
 re-establish the proper control of the disturbed organs. 
 
 In all cases the diet must be carefully selected ; 
 cereals, little meat and a reduction of the carbo- 
 hydrates will aid in overcoming the acidity of the 
 blood and in resting a disturbed digestive tract. 
 
 As an adjunct to other treatment the patient should 
 be required to drink freely of hot water. This serves 
 to flush the sewers of the body, thoroughly cleansing 
 the capillaries and washing the detritus from the tub- 
 ules of the kidneys. 
 
 In case of muscular rheumatism affecting one 
 muscle or a group of muscles, look for a lesion at 
 the exit of the nerve which supplies that region.
 
 203 
 
 Pressure upon the nerve, either at its emergence or 
 along its course may be the cause of the condition. 
 This frequently disappears after a single treatment. 
 Remove the cause and torticollis, lumbago and similar 
 forms disappear. 
 
 The mono-articular type, whether chronic or acute, 
 is in most cases a result of a local injury. Correction 
 of this lesion will be followed by cure. 
 
 In cases affecting the lower limbs the three points 
 to be noticed most carefully are the tissues around the 
 exit of the sciatic nerve, the saphenous opening and 
 the lumbar spine. In case the upper limb is affected 
 the points to be most carefully scrutinized are the 
 cervical vertebrae from the fifth to the eighth, the 
 interscapular area and from the second to the sixth 
 dorsal and the brachial plexus. 
 
 In all cases the spine must be corrected, stretched 
 and relaxed. All lesions in the region of the liver, 
 seventh to tenth dorsal, must be corrected. These 
 may be lesions of bone or of muscle. 
 
 The kidney region, eleventh dorsal to first lumbar, 
 must have the same care in order that the excretion 
 may be thoroughly accomplished The entire splanch- 
 nic area must be stimulated to activity. The various 
 nerves affected must be freed from pressure their entire 
 length so as to overcome stasis in their blood supply.
 
 204 
 
 In case the hands and feet are affected treatment 
 must be given each articulation to maintain and secure 
 mobility. While the nerves are hypersensitive, caus- 
 ing a chronic shortening of the flexor muscles, it is of 
 value to thoroughly knead the muscles to secure their 
 relaxation. Stretching the muscles will prevent such 
 contracture or will correct it if present. In case of 
 oedema the effusion can be removed by pressure and 
 movement directed toward the venous flow. Acute 
 attacks should be treated two or three times each day. 
 Hot baths are valuable adjuncts to the treatments, 
 though care must be used to avoid taking cold. 
 
 CATARRH. 
 
 In considering the various forms which this disease 
 may assume it is well to consider the primary changes 
 in the mucous membrane with which it is associated. 
 There is always an initial dilatation of the blood ves- 
 sels due to an inhibition of the local vaso-constrictor 
 action. This results in an increase of capillary pres- 
 sure, venous stasis, transudation of lymph, oedema and 
 discharge. This discharge at first is thin and watery 
 but soon changes to greater consistency. 
 
 It may be acute (coryza), chronic (rhinitis), seasonal 
 (hay fever). This catarrhal condition may affect the 
 mucous tract anywhere. Our treatment for it is as
 
 205 
 
 follows : Secure a thorough drainage of the catarrhal 
 tract by removing any stoppage to the veins from the 
 part. Begin this by thorough relaxation of the fol- 
 lowing muscles of the neck : the platysma, sterno- 
 cleido-mastoid and the more deeply lying infrahyoid 
 group, the scaleni, the recti capiti and the longus colli. 
 This treatment should flow be followed by a thorough 
 relaxation of the muscles in the upper dorsal region 
 including the muscles connecting trunk, neck and 
 occiput. 
 
 A thorough stimulation of the superior cervical Treatment of 
 
 catarrh. 
 
 ganglion will reduce the venous stasis while a stimu- 
 lation of the cardiac center in the upper dorsal region 
 will result in sending blood from the mesenteric reser- 
 voir of capillaries to the cutaneous surfaces, relieving 
 the mucous congestion, equalizing the general pressure 
 and at the same time furnishing the congested mem- 
 brane with a fresh supply of pure blood. 
 
 The nutritive fibres to the muscles of the face are 
 transmitted by the seventh nerve. This may be 
 treated by relaxing the tissues around its exit as it 
 traverses the space between the stylo-mastoid foramen 
 and the ramus of the inferior maxilla. 
 
 The sensory and trophic distribution to skin of 
 the face and mucous membrane of catarrhal tract 
 is through the fifth, ninth and tenth nerves. These
 
 206 
 
 nerves are treated as follows : Pressure on the 
 fifth nerve at its points of emergence on the face will 
 quiet the sensory nerves and bring blood to the sur- 
 face. Downward pressure over the carotid sheath will 
 reach the tenth nerve and at the same time assist in 
 drainage. The ninth nerve is reached as it leaves the 
 jugular foramen, also on the tonsils internally, in case 
 it affects the Eustachian tube or the middle ear. 
 
 The first, second and third cervical are often at fault 
 in this trouble.
 
 CHAPTER XII. 
 
 HOW AND WHERE. 
 ( A few practical bints for emergencies. ) 
 
 IN case of eye trouble, inflammation, pain, tc., not 
 due to the presence of a foreign body, treat the fifth 
 nerve at its terminal portions around the orbit ; the 
 superior cervical ganglion, which through the carotid 
 and cavernous plexuses is distributed to the eye and to 
 the parts surrounding it ; the first and second cervical 
 vertebra ; the upper dorsal, the latter being the exit of 
 the fibres going to the eye. Pressure on eye for 
 muscles of orbit and for ciliary ganglion on fifth nerve. 
 Ear : The ninth nerve for the ramus tympanicus ; 
 the auricular branch of the tenth ; the auriculo-tem- 
 poral from the inferior maxillary of fifth ; the small 
 occipital and the great occipital ; the ninth for deaf- 
 ness and ringing in the ear; the cervical and the auric- 
 ulo-temporal for earache. Relax the opening of the
 
 208 
 
 Eustachian tube in pharynx ; the second cervical 
 vertebra is often a disturbing factor. 
 
 Thyroid Gland : Over gland itself, following veins, 
 at middle and inferior cervical ganglia, raise the clav- 
 icle ; correct first rib. Fifth and sixth cervical ver- 
 tebra. 
 
 Bronchial Tubes : The upper three ribs ; relax the 
 intercostal muscles ; relax the muscles in the corre- 
 sponding spinal segment ; raise the ribs. 
 
 Lungs : Treatment much the same as for bronchial 
 tubes, extending lower to ninth. 
 
 Heart : Quiet it by steady pressure at annulus of 
 Vieussens. Raise fifth rib ; separate ribs on left side ; 
 hold vaso-motors; correct lesion in upper dorsal region; 
 inhibit solar plexus to equalize circulation. 
 
 Larynx : Tenth nerve ; superior cervical ganglion . 
 
 Tonsils : Treat by stimulating superior cervical 
 ganglion ; by working over their mucous covering ; 
 by treatment at exit of ninth and tenth nerves. 
 
 Headache : Work downward over carotid sheath to 
 aid in drainage ; to check blood supply bend back head, 
 pressing tightly against vertebral artery ; steady pres- 
 sure on great, small and suboccipital nerves at basi- 
 occiput ; steady pressure on filaments of fifth nerve ; 
 look for uterine or ovarian trouble ; stomach fre-
 
 209 
 
 quently at fault ; press on solar plexus. In anaemic 
 headache stimulate heart action. 
 
 Liver : Relax at ninth and tenth; vibrate the liver; 
 treat over solar plexus ; reach gall cyst under ninth 
 costal cartilages on right side ; knead liver. 
 
 Stomach : Pressure at third and fourth dorsal on 
 right side ; osseous lesions, third to fifth ; quiet vom- 
 iting, pressure at angle of third to fifth ribs on right ; 
 elevate the ribs. 
 
 Small intestine : Reach mesentery through meso- 
 gastric zone ; solar plexus back of stomach ; in middle 
 and lower dorsal. 
 
 Large intestine : Flux and diarrhoea ; patient on 
 face ; strong pressure on each side of spines in lumbar 
 region ; lift legs while pressing, springing spine for- 
 ward. 
 
 Knuresis : Look for trouble in middle lumbar ; 
 sometimes lower ; examine clitoris in female, glans in 
 male for irritation ; examine urine for cystitis ; correct 
 spinal lesion ; examine for phimosis, vulvitis, worms. 
 
 Croup : Loosen the tissues of the neck, giving 
 especial attention to the deep muscles ; work on supe- 
 rior cervical ganglion ; follow veins and lymphatics 
 for drainage. Stimulate in dorsal region. 
 
 Sciatica : Lesion is usually in lower lumbar ; often 
 a contraction of pyriformis causes it ; stretch this and
 
 210 
 
 other external rotators by turning thigh inward, press- 
 ing on structures closing the greater sacro-sciatic 
 notch ; follow nerve to knee, relaxing the structures ; 
 flex leg on thigh and thigh on pelvis, then with thigh 
 flexed extend the leg. This will effectually stretch 
 the sciatic nerve. 
 
 Toothache : Press on branches of the fifth nerve, 
 either at infraorbital or just below malar bone, over 
 spheno -palatine ganglion beneath the zygoma, and 
 near the articulation of inferior maxillary. 
 
 Fainting : I^eave head low ; stimulate heart to 
 action through the inferior and middle cervical gan- 
 glion. In case of prolonged unconsciousness the 
 fingers inserted into the rectum, briskly stimulating 
 the ganglion impar, will usually be effective. Stim- 
 ulate the suboccipital region. 
 
 Anterior upper dorsal : Cross patient's arms in 
 front, stand behind. Pull on wrists and push outward 
 and forward on scapulae. An assistant is necessary 
 for this work. 
 
 Epistaxis : To stop bleeding stimulate superior cer- 
 vical ganglion. Press on nose at inner canthus of eye. 
 
 Rigors : Strong stimulation in dorsal region. Stim- 
 ulation of inferior cervical ganglion. Strongly stimu- 
 late liver. Stimulate solar plexus. Increase respira- 
 tory activity. I^oosen contractures in cervical region.
 
 211 
 
 Epileptic convulsions : Hold strongly on suboccip- 
 ital region, pressing head backward. Relax the 
 muscles in upper dorsal. 
 
 Cramps and clonic spasms in women attributable to 
 uterine irritation : Inhibition in lumbar region and the 
 round ligaments ; sometimes replace uterus. 
 
 Hiccoughs : Inhibition of the phrenic over the 
 third, fourth and fifth cervical. If severe, treat 
 splanchnic area. 
 
 Tormina : Inhibit lumbar nerves and solax plexus. 
 
 Tenesmus : Inhibit over sacrum. 
 
 Depressed rib : Use arm as lever and while pulling 
 upward and backward with one hand, press strongly 
 at angle of ribs with other, maintaining the pressure 
 until the arm is returned to a position of rest. 
 
 Patient may lie on side or back, or may sit for this 
 treatment. The knee may be placed against the 
 vertebra, operator then using both hands. 
 
 First or second rib elevated : Place thumb of one 
 hand on head of rib. Draw hand in opposite direction 
 so as to tighten scaleni muscles, then pressing down- 
 ward on rib rotate the hand and draw back toward 
 affected rib. This will slip rib into position. 
 
 Eleventh and twelfth rib elevated : Stretch quadra- 
 tus lumborum and push downward on angle of 
 depressed rib.
 
 GENERAL INDEX. 
 
 ABDOMEN 147 
 
 ALLOCHIRIA 49 
 
 AMENORRHCEA. 185 
 
 ANKLE 177 
 
 Tendons of 178 
 
 Drainage of 178 
 
 ANTISEPSIS 32 
 
 AORTA, bifurcation of 148 
 
 ARM, vaso-motors of 94, 103 
 
 Vaso-constrictors of 76 
 
 A lever 127 
 
 ARTERIES, coronary 80 
 
 Carotid 122 
 
 Internal mammary 192 
 
 Subclavian 122 
 
 Anterior tibial 177 
 
 Posterior tibial 177 
 
 Femoral 175 
 
 Of intestine 194 
 
 ARTICULATION, lumbo-sacral 161 
 
 Claviculo-acromial 169 
 
 ASEPSIS 32 
 
 A safe guard 40 
 
 Method of securing 191 
 
 ATLAS 98, 115 
 
 AUGMENTORS, cardiac 65, 73, 99 
 
 Axis 98-116 
 
 B 
 
 BACILLUS 33 
 
 BACTERIA, Classified 33 
 
 Defined 33 
 
 Where found 34 
 
 Size of 34 
 
 Developement of 34 
 
 Products of 35 
 
 BLADDER, sensory nerves to. . .96, 104 
 
 BLASTODERM 185 
 
 BLOOD, a germicide 32 
 
 BRAIN, vaso-motors for 93 
 
 BREASTS, care of 191 
 
 Treatment of 191 
 
 BRONCHIAL TUBES 208 
 
 Treatment of 146, 208 
 
 CECUM 158 
 
 CANAL, inguinal 148 
 
 CATARRH 204 
 
 Symptoms of 205-206 
 
 Lesions for 206 
 
 CAUSES OF DISEASE 21 
 
 CELL, a unit 41 
 
 Function of 41 
 
 Conditions of development , 41
 
 214 
 
 CENTER, defined 56 
 
 Osteopathic 56 
 
 For coughing 56 
 
 Eye, ear, face 98 
 
 For hiccoughs 98, 211 
 
 Lungs, arm, heart 99, 103 
 
 Stomach 100, 103 
 
 Liver 100, 103 
 
 Spleen 100, 103 
 
 Chills zoo 
 
 Uterus, ovary 100 
 
 Diarrhoea 100 
 
 Biadder 101 
 
 For vagina 101 
 
 For spinchter ani 101, 104 
 
 For pharynx 102 
 
 For duodenum 103 
 
 Vaso-motor 85 
 
 Osteopathic 98 to 104 
 
 Thermogenic 92 
 
 How treated 57 
 
 CHEST, examination of 136 
 
 Asymmetry of 137 
 
 Enlargement of 138 
 
 Lines of 143 
 
 CLAVICLE 164, 166 
 
 Depressed 128 
 
 Cocci 33 
 
 COCCYX 162 
 
 In constipation 199 
 
 COCCYGODYNIA 185 
 
 CONTRACTION 59 
 
 CONTRACTURE 112 
 
 COLLATERALS 64 
 
 CONSTIPATION, causes of. 193 
 
 Treatment of 196 
 
 Lesions for 198 
 
 CONVULSIONS 211 
 
 CORD, umbilical 189 
 
 Umbilical, cutting of 190 
 
 CRAMPS 211 
 
 CROUP, treatment of 209 
 
 CURVES, spinal 114 
 
 DIARRHOEA 100, 209 
 
 DIET 18 
 
 DISEASE, defined 19 
 
 Causes of 20 
 
 Transmission of 23 
 
 DISINFECTION 40 
 
 DISLOCATION, femoral 148 
 
 DUODENUM 157 
 
 DYSMENORRHCEA 185 
 
 E 
 
 EAR, treatment of 207 
 
 Nerves of 207 
 
 ELBOW, landmarks of 170 
 
 Dislocation of. 171 
 
 ENURESIS 209 
 
 EPISTAXIS 210 
 
 EUSTACHIAN TUBE 121 
 
 EXAMINATION, position for.. 117, 118 
 
 Vaginal 182, 183 
 
 EYE, lesions for 68 
 
 Treatment of 207 
 
 FAINTING 210 
 
 FALLOPIAN TUBES 181, 182, 185 
 
 FASCIA 48 
 
 FEMORAL RING 148-173 
 
 FEMUR, head of 173 
 
 Condyles of 176 
 
 FLUX 209 
 
 FCETUS, development of 185, 186 
 
 G 
 
 GALL BLADDER 152 
 
 Treatment of . 153 
 
 GANGLION, Meckel's 120
 
 215 
 
 Impar 62 
 
 Superior cervical 67 
 
 Middle cervical 70 
 
 Middle cervical, function of. .70, 71 
 
 Middle cervical, fibres from 71 
 
 Inferior cervical 71 
 
 Superior cervical 87 
 
 GENITALIA 94, 104 
 
 GERMS 32 
 
 Pathogenic 35 
 
 How enter tissue 39 
 
 Diseases 36 
 
 Diseases, how treated 37 
 
 GLAND, thyroid 93, 99, 103, 125 
 
 Thyroid, vessels of 125 
 
 Thyroid, nerves of 125 
 
 Thyroid, treatment of 125 
 
 GYNECOLOGY 179 
 
 HART, DR., theory of 109 
 
 HEALTH 15 
 
 How maintained 42 
 
 HEAD'S law 49, in 
 
 Diagnosis by 50 
 
 HEART 94, 96 
 
 Treatment of 80, 140, 141, 208 
 
 Position of. 129 
 
 Boundaries of 139 
 
 Trouble, lesions for 142 
 
 Centers for 96, 103 
 
 HEADACHE 208 
 
 HEREDITY 23 
 
 HICCOUGHS 98, 211 
 
 HILTON'S law 48 
 
 HIP 173 
 
 Dislocation of 174 
 
 HYOID bone 121 
 
 HYPER^MIA 26, 179 
 
 HYPER^ESTHESIA. , .26 
 
 IMMUNITY, by heredity 23 
 
 Defined 38 
 
 Examples of 38 
 
 IMPULSES, nervous 25 
 
 IMPACTION 194 
 
 IMPAR, ganglion of 199 
 
 INHIBITION, effect of 50 
 
 Defined 53 
 
 By reflex 108 
 
 INSPECTION 137 
 
 INTESTINE 94, 103, 209 
 
 K 
 
 KIDNEY 94,99,159 
 
 Sensory nerve to 96 
 
 Treatment of 159 
 
 KNEE 175 
 
 Ligaments of 176 
 
 Structures around 176-177 
 
 LARYNX 121, 208 
 
 LEG 94 
 
 LESIONS, structural 21 
 
 Defined 24 
 
 Kind of 24 
 
 Effect of 24 
 
 Osseous 25, 26 
 
 Muscular 26, 43 
 
 Correction of 27 
 
 LEUCOMAIN 35 
 
 LEUCORRHCEA 180 
 
 LIGAMENT, Poupart's 149, 173 
 
 LlGAMENTUM NUCH^E 112 
 
 LINEA ALBA 147 
 
 LINE, Nelaton's 174 
 
 LIVER 94, 96, 103, 209 
 
 Treatment of 130, 149, 153 
 
 Displacement of 150 
 
 Percussion 150
 
 216 
 
 Function of 150 
 
 Nerves of 151 
 
 Center for 152 
 
 LUNGS, examination of 143 
 
 Location of 144 
 
 Nerves of 146 
 
 Sensory center 96, 146 
 
 Treatment of 146, 208 
 
 M 
 
 MALLEOLI 177 
 
 MKCKEL'S GANGLION 69 
 
 MECHANO-THERAPY 59 
 
 MEISSNER, plexus of 198 
 
 MESENTERY 158 
 
 MEMBRANE, costo-coracoid 129 
 
 METRITIS 185 
 
 METABOLISM 45 
 
 MICRO-ORGANISMS 21, 34 
 
 MISPLACEMENT, correction of ... 184 
 
 MOUTH 121 
 
 MUSCLES OF NECK 122 
 
 Of shoulder 170 
 
 Pyriformis 161 
 
 Deltoid 168 
 
 N 
 
 NECK 121 
 
 Muscles of 122 
 
 NERVES 25 
 
 NKRVE ACTION, how influenced. . 52 
 
 Activity, basic 56 
 
 Depressor 88 
 
 Seventh 120 
 
 Fifth 120 
 
 Circumflex 168 
 
 Superscapular 168 
 
 Pudic 184, 185, 199 
 
 Sciatic 175, 203 
 
 To rhomboid 169 
 
 Median 170 
 
 Ulnar 170 
 
 Obturator 175 
 
 NERVI ERIGENTES 78, 83 
 
 NERVES, sacral 83, 113, 199 
 
 Of vagina 83 
 
 Of uterus 83 
 
 To bladder 96, 104 
 
 Laryngeal 126 
 
 Of intestine 194 
 
 To pelvic organs 181 
 
 NOTCH, sacro-sciatic 161 
 
 NUTRITION 102 
 
 
 
 OBSTETRICS 179 
 
 OBSTRUCTION 45 
 
 OLECRANON 171 
 
 Os, dilatation of 188 
 
 OSTEOPATHY DEFINED 51 
 
 OSTEOPATHY A SCIENCE 97 
 
 OVARITIS . . 185 
 
 OVARY, center for 100 
 
 Sensory nerve to 96 
 
 OXIDATION 46 
 
 PAIN, a warning 42 
 
 Sign of a lesion 43~47 
 
 Superficial 47 
 
 PALPATION 139 
 
 PARTURITION 188 
 
 PATELLA 175 
 
 PELVIS 160 
 
 PERICARDIUM 80 
 
 PILO-MOTOR NERVES 65 
 
 PLACENTA 186-190 
 
 PLEURA 80 
 
 PLEXUS, cavernous 68, 69 
 
 Cardiac 78, 79 
 
 Hypogastric 82 
 
 Prevertebral .62
 
 217 
 
 Pelvic 82 
 
 Prostatic 83 
 
 Solar 80, 155 
 
 PRESSURE 48, 91 
 
 PREGNANCY 187 
 
 PROPHYLAXIS 19 
 
 PROSTATE, nerves to 96 
 
 PTOMAIN 35 
 
 B 
 
 RADIUS, head of 171 
 
 RAMI COMMUNICANTES 63 
 
 Illustration of 84 
 
 RAMI EFFKRBNTES 66, 88 
 
 RECTUM, center for 103 
 
 REGION, suprascapular 132 
 
 Suprasternal 124 
 
 Superior sternal 126 
 
 Inferior sternal 126 
 
 Supraclavicular 127 
 
 Infraclavicular 128 
 
 Inframammary 130 
 
 REGIONS, lateral 131 
 
 Axillary 131 
 
 Infraaxillary 132 
 
 Posterior 132 
 
 Subscapular 132, 134 
 
 Infrascapular 134 
 
 Interscapular 135 
 
 RESORPTION 60 
 
 RHEUMATISM 201 to 203 
 
 RIBES, ganglion of 62 
 
 RIBS, setting 211 
 
 RIGORS 210 
 
 RING, external abdominal 148, 160 
 
 SAPHENOUS OPENING 173, 203 
 
 SCALP 119 
 
 SCIATICA . . 209 
 
 SHOULDER 128, 164 
 
 Landmarks of 165 
 
 SPACE, popliteal 177 
 
 SPINE, pubic 148, 162 
 
 Anterior superior iliac 148 
 
 Lesions of n6 
 
 SPINE, examination of. 114 
 
 Landmarks of. 117 
 
 Ischiatic 161 
 
 Posterior inferior 161 
 
 Of ilium 173 
 
 Leverage on 169 
 
 SPINAL TREATMENT 107 
 
 SPINOUS PROCESSES 105 
 
 SPLANCHNICS 74, 75, 81 
 
 SPLEEN 94, 154 
 
 STIMULATION . . .38, 48, 49, 52, 58, 112 
 STOMACH, sensory nerves to 
 
 96, 154, 155 
 
 Center 100, 103 
 
 Treatment 209 
 
 Location of 131 
 
 SUBOXIDES 20 
 
 SUSCEPTIBILITY 39 
 
 SYMPATHETIC SYSTEM 61-85 
 
 Cervical 73, 99 
 
 Lumbar 77 
 
 Sacral 77 
 
 Sacral, visceral branches of 78 
 
 Thoracic 73, 74, 75 
 
 SYMPHYSIS, pubic . .163 
 
 TENESMUS 211 
 
 TESTIS 96 
 
 THORAX 123 
 
 THYROID gland 208 
 
 TISSUES 41 
 
 TONE 53, 55 
 
 TOX- ALBUMIN 35 
 
 TONSILS 208 
 
 TOOTHACHE. . . . .no
 
 218 
 
 TORMINA 211 
 
 TRACHEA 121 
 
 TREATMENT for pelvic trouble. 183-184 
 
 TRIANGLE, Scarpa 174 
 
 TROCHAKTER MAJOR 173 
 
 TRUNK 94 
 
 TUBKROSITV ISCHII 162 
 
 u 
 
 UMBILICUS 144 
 
 URETER, nerves to 83 
 
 Sensory nerves to 96 
 
 UTERUS, nerves of 83 
 
 Sensory nerves to 97 
 
 Position of. 181 
 
 Contraction of 191 
 
 Center for 100, 104 
 
 V 
 
 VAGINA, nerves of 83 
 
 VAGUS NERVE 81, 156 
 
 VAS DEFERKNS 83 
 
 VASO CONSTRICTORS 
 
 49, 64, 87, 90, 91, 107 
 
 Constrictors for head 73 
 
 Motors 85, 88, 91, 92 
 
 Motors center 85, 91, 92 
 
 Motors center for head, throat, 
 
 tonsils, nose, tongue, eye 92 
 
 VASO-DILATORS 86, 107 
 
 VEINS, innominate 122 
 
 Short saphenous 177 
 
 Jugular 121 
 
 VERTEBRA, anterior 210 
 
 VIEUSSENS, annulus 72, 99 
 
 VlSCERO-MOTOR 65,108 
 
 w 
 
 WATER 195-196 
 
 WRIST 172 
 
 Landmarks of. 172 
 
 Tendons of 172
 
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 Theory of osteopathy 
 
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 Theory of osteopathy 
 
 1900 
 
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